A single-arm feasibility study of community-delivered Baduanjin (Qigong practice of the eight Brocades) training for frail older adults

Xiao Liu, Jean Wei Ting Seah, Benedict Wei Jun Pang, Mary Ann Tsao, Falong Gu, Wai Chong Ng, Junie Ying Ru Tay, Tze Pin Ng, Shiou Liang Wee, Xiao Liu, Jean Wei Ting Seah, Benedict Wei Jun Pang, Mary Ann Tsao, Falong Gu, Wai Chong Ng, Junie Ying Ru Tay, Tze Pin Ng, Shiou Liang Wee

Abstract

Background: Frailty is a common geriatric syndrome, characterized by reduced physiologic reserve and increased vulnerability to stressors, due to cumulative decline in multiple physiological systems. We studied the feasibility of a community-delivered Baduanjin (BDJ) training program among pre-frail/frail community-dwelling older people. We examined (1) safety (adverse events) and physical and psychological effects; and (2) feasibility of recruitment, retention, adherence; recruitment efforts, and any program challenges, so as to inform future studies.

Methods: Our study was a single arm pre-post study in a community setting. Sixteen-week group BDJ training (2×/week in the first 4 weeks and 3×/week thereafter) was co-designed and implemented by community-based providers in Singapore. Recruitment, attendance, and adverse events were recorded throughout the training. A participants' survey was also administered after the training program. Effects of the intervention on physical and functional outcomes (hand grip strength, knee extension strength, Time Up and Go (TUG), Physiological Profile Assessment (PPA), 30-s Sit-to-Stand test, 6-m fast gait speed test), frailty outcomes (frailty score and status), and other outcomes (Maastricht Questionnaire (MQ), Fall Efficacy Scale (FES), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), and EQ-5D-5L) were examined before and after the program.

Results: Of 31 older adults screened to be frail, 15 met inclusion criteria and 3 refused participation, resulting in 12 older adults (9 women) enrolled into the program. During the program, one participant was hospitalized (unrelated to BDJ training) and the other 11 (aged 77 ± 6 years; 2 frail, 9 prefrail at baseline) completed the program with average overall attendance of 89%. Most (89%) of the 44 training sessions had attendance > 80%. The program received positive feedback with no training-related adverse events. Participants either reversed (n = 2) or maintained (n = 9) their frailty statuses. There post-training outcomes in hand grip strength, knee extension strength, TUG, MQ, FES, MoCA, GDS, and EQ-5D-5L index score appeared to be better. The reduction of frailty and PPA fall risk scores was of moderate-to-large effect size.

Conclusions: Community-delivered BDJ training program was safe and feasible for prefrail/frail older adults with the potential to improve physical and cognitive function, reduce fall risk, improve psychological well-being, and reverse frailty status.

Keywords: Baduanjin; Community; Exercise program; Pilot study; Prefrail/frail.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Baduanjin exercise
Fig. 2
Fig. 2
Adherence rate for each session of the program
Fig. 3
Fig. 3
Attendance rate for each participant
Fig. 4
Fig. 4
Responses from feedback survey (n = 11)

References

    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Med Sci. 2001;56(3):M146–MM57.
    1. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–1492.
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–762.
    1. Sloane PD, Cesari M. Research on frailty: continued progress, continued challenges. J Am Med Dir Assoc. 2018;19(4):279–281.
    1. Cesari M, Prince M, Thiyagarajan JA, De Carvalho IA, Bernabei R, Chan P, et al. Frailty: an emerging public health priority. J Am Med Dir Assoc. 2016;17(3):188–192.
    1. Lang P-O, Michel J-P, Zekry D. Frailty syndrome: a transitional state in a dynamic process. Gerontology. 2009;55(5):539–549.
    1. Morley JE, Vellas B, Van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–397.
    1. Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, et al. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI Database System Rev Implement Rep. 2018;16(1):140–232.
    1. Jadczak AD, Luscombe-Marsh N, Taylor P, Barnard R, Makwana N, Visvanathan R. The EXPRESS study: exercise and protein effectiveness supplementation study supporting autonomy in community dwelling frail older people-study protocol for a randomized controlled pilot and feasibility study. Pilot and feasibility studies. 2018;4(1):8.
    1. GCV G, JMR B, do Socorro Simões M, Lin SM, LAP V, Varise EM, et al. Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit Plus™ for frail elderly: study protocol for a feasibility trial. Pilot and feasibility studies. 2017;3(1):41.
    1. Liu X, Ng DH-M, Seah JW-T, Munro YL, Wee S-L. Update on interventions to prevent or reduce frailty in community-dwelling older adults: a scoping review and community translation. Current Geriatrics Reports. 2019:1–15.
    1. Puts MTE, Toubasi S, Andrew MK, Ashe MC, Ploeg J, Atkinson E, et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age Ageing. 2017;46(3):383–392.
    1. Yamada M, Arai H, Sonoda T, Aoyama T. Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. J Am Med Dir Assoc. 2012;13(6):507–511.
    1. Zheng G, Chen B, Fang Q, Yi H, Lin Q, Chen L, et al. Primary prevention for risk factors of ischemic stroke with Baduanjin exercise intervention in the community elder population: study protocol for a randomized controlled trial. Trials. 2014;15(1):113.
    1. Zou L, Wang C. Traditional Chinese Baduanjin Qigong for older adults: a mini-review. nursing. 2017;49(3):265–273.
    1. Zou L, SasaKi JE, Wang H, Xiao Z, Fang Q, Zhang M. A systematic review and meta-analysis of Baduanjin Qigong for health benefits: randomized controlled trials. Evid Based Complement Alternat Med. 2017;2017.
    1. Guo Y, Shi H, Yu D, Qiu P. Health benefits of traditional Chinese sports and physical activity for older adults: a systematic review of evidence. J Sport Health Sci. 2016;5(3):270–280.
    1. Xiao CM, Zhuang YC. Effect of health Baduanjin Qigong for mild to moderate Parkinson’s disease. Geriatr Gerontol Int. 2016;16(8):911–919.
    1. Yun Liu X, Gao J, Xiang Yin B, Yu Yang X, Xi Bai D. Efficacy of Ba Duan Jin in improving balance: a study in Chinese community-dwelling older adults. J Gerontol Nurs. 2016;42(5):38–46.
    1. Li M, Fang Q, Li J, Zheng X, Tao J, Yan X, et al. The effect of Chinese traditional exercise-Baduanjin on physical and psychological well-being of college students: a randomized controlled trial. PLoS One. 2015;10(7):e0130544-e.
    1. Chan JS, Li A, Ng S-M, Ho RT, Xu A, Yao T-J, et al. Adiponectin potentially contributes to the antidepressive effects of Baduanjin Qigong exercise in women with chronic fatigue syndrome-like illness. Cell Transplant. 2017;26(3):493–501.
    1. Zhang H, Zhu M, Song Y, Kong M. Baduanjin exercise improved premenstrual syndrome symptoms in Macau women. J Tradit Chin Med. 2014;34(4):460–464.
    1. Hu GX, Gu KP. Effects of Qigong eight section brocade exercise on quality of life of the elderly. Medicine and Society. 2014;27(5):74–76.
    1. Yu W. The influence of “Health Qigong Ba Duan Jin” training on the psychological health of college students [J]. Journal of Beijing Sport University. 2011;12.
    1. Liu X, Gao J, Zhang Q. Influence of Ba Duan Jin exercise on quality of life of elderly in community. Journal of Nursing Care. 2014;12(7):577–579.
    1. Xiu MN. Study on influence of Baduanjin exercise on cancer chemotherapy patients with cancer-related fatigue. Chinese General Practice Nursing. 2015;13(30):3012–3014.
    1. Tabak RG, Sinclair KA, Baumann AA, Racette SB, Sebert Kuhlmann A, Johnson-Jennings MD, et al. A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med. 2015;5(4):401–414.
    1. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–608.
    1. Logan SL, Gottlieb BH, Maitland SB, Meegan D, Spriet LL. The Physical Activity Scale for the Elderly (PASE) questionnaire; does it predict physical health? Int J Environ Res Public Health. 2013;10(9):3967–3986.
    1. Umetani K, Singer DH, McCraty R, Atkinson M. Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol. 1998;31(3):593–601.
    1. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: six-minute walk test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82(2):128–137.
    1. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10(1):1.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148.
    1. Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003;83(3):237–252.
    1. Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol Ser A Biol Med Sci. 2002;57(8):M539–MM43.
    1. Ware JE Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996:220–33.
    1. Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P. Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. J Clin Epidemiol. 2004;57(3):252–258.
    1. Meesters C, Appels A. An interview to measure vital exhaustion. II. Reliability and validity of the interview and correlations of vital exhaustion with personality characteristics. Psychol Health. 1996;11(4):573–581.
    1. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I) Age Ageing. 2005;34(6):614–619.
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727–1736.
    1. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37–49.
    1. Buckinx F, Rolland Y, Reginster J-Y, Ricour C, Petermans J, Bruyère O. Burden of frailty in the elderly population: perspectives for a public health challenge. Archives of Public Health. 2015;73(1):19.
    1. Woo J. Challenges of population ageing: putting frailty as a cornerstone of health and social care systems. Springer; 2018.
    1. Picorelli AMA, Pereira LSM, Pereira DS, Felício D, Sherrington C. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Phys. 2014;60(3):151–156.
    1. Zheng G, Fang Q, Chen B, Yi H, Lin Q, Chen L. Qualitative evaluation of baduanjin (Traditional Chinese Qigong) on health promotion among an elderly community population at risk for ischemic stroke. Evid Based Complement Alternat Med. 2015;2015.
    1. McKay HA, Sims-Gould J, Nettlefold L, Hoy CL, Bauman AE. Implementing and evaluating an older adult physical activity model at scale: framework for action. Translational Journal of the American College of Sports Medicine. 2017;2(2):10–19.
    1. Leal J, Gray A, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, et al. Impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int. 2016;27(2):549–558.
    1. England PH. Falls: applying All Our Health [updated 24 July 2019. Available from: .
    1. Zou L, Pan Z, Yeung A, Talwar S, Wang C, Liu Y, et al. A review study on the beneficial effects of Baduanjin. J Altern Complement Med. 2018;24(4):324–335.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit