A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome

Rainbow T H Ho, Jessie S M Chan, Chong-Wen Wang, Benson W M Lau, Kwok Fai So, Li Ping Yuen, Jonathan S T Sham, Cecilia L W Chan, Rainbow T H Ho, Jessie S M Chan, Chong-Wen Wang, Benson W M Lau, Kwok Fai So, Li Ping Yuen, Jonathan S T Sham, Cecilia L W Chan

Abstract

Background: Chronic fatigue is common in the general population. Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms.

Purpose: This study aimed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome.

Methods: Sixty-four participants were randomly assigned to either an intervention group or a wait list control group. Outcome measures included fatigue symptoms, physical functioning, mental functioning, and telomerase activity.

Results: Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls. Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units (p < 0.05). The change was statistically significant when compared to the control group (p < 0.05).

Conclusion: Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome.

Figures

Fig. 1
Fig. 1
Flow chart of the selection of participants in the study

References

    1. Fukuda K, Straus SE, Hickie I, International Chronic Fatigue Syndrome Study Group et al. The chronic fatigue syndrome: A comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953–959.
    1. Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: Clinical working case definition, diagnostic and treatment protocols. J Chronic Fatigue Syndr. 2003;11:7–36. doi: 10.1300/J092v11n01_02.
    1. Wong WS, Fielding R. Prevalence of chronic fatigue among Chinese adults in Hong Kong: A population-based study. J Affect Disord. 2010;127:248–256. doi: 10.1016/j.jad.2010.04.029.
    1. Kim CH, Shin HC, Won CW. Prevalence of chronic fatigue and chronic fatigue syndrome in Korea: Community-based primary care study. J Korean Med Sci. 2005;20:529–534. doi: 10.3346/jkms.2005.20.4.529.
    1. Evengard B, Jacks A, Pedersen NL, Sullivan PF. The epidemiology of chronic fatigue in the Swedish Twin Registry. Psychol Med. 2005;35:1317–1326. doi: 10.1017/S0033291705005052.
    1. Dinos S, Khoshaba B, Ashby D, et al. A systematic review of chronic fatigue, its syndromes and ethnicity: Prevalence, severity, co-morbidity and coping. Int J Epidemiol. 2009;38:1554–1570. doi: 10.1093/ije/dyp147.
    1. Nacul LC, Lacerda EM, Pheby D, et al. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: A repeated cross-sectional study in primary care. BMC Med. 2011;9:91. doi: 10.1186/1741-7015-9-91.
    1. Cho HJ, Menezes PR, Hotopf M, Bhugra D, Wessely S. Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: Prevalence and recognition. Br J Psychiatry. 2009;194:117–122. doi: 10.1192/bjp.bp.108.051813.
    1. Afari N, Buchwald D. Chronic fatigue syndrome: A review. Am J Psychiatry. 2003;160:221–236. doi: 10.1176/appi.ajp.160.2.221.
    1. Lee S, Yu H, Wing Y, et al. Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong. Am J Psychiatry. 2000;157:380–384. doi: 10.1176/appi.ajp.157.3.380.
    1. Harvey SB, Wessely S. Chronic fatigue syndrome: Identifying zebras amongst the horses. BMC Med. 2009;7:58. doi: 10.1186/1741-7015-7-58.
    1. Vercoulen JH, Swanink CM, Galama JM, et al. The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model. J Psychosom Res. 1998;45:507–517. doi: 10.1016/S0022-3999(98)00023-3.
    1. Maes M, Twisk FN. Chronic fatigue syndrome: Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways. BMC Med. 2010;8:35. doi: 10.1186/1741-7015-8-35.
    1. Nater UM, Maloney E, Heim C, Reeves WC. Cumulative life stress in chronic fatigue syndrome. Psychiatry Res. 2011;189(2):318–320. doi: 10.1016/j.psychres.2011.07.015.
    1. Van Houdenhove B, Luyten P, Egle UT. Stress as a key concept in chronic widespread pain and fatigue disorders. J Musculoskelet Pain. 2009;17:390–399. doi: 10.3109/10582450903284745.
    1. Cleare AJ, Wessely SC. Chronic fatigue syndrome: A stress disorder? Br J Hosp Med. 1996;55:571–574.
    1. Masuda A, Munemoto T, Yamanaka T, Takei M, Tei C. Psychosocial characteristics and immunological functions in patients with postinfectious chronic fatigue syndrome and noninfectious chronic fatigue syndrome. J Behav Med. 2002;25:477–485. doi: 10.1023/A:1020423124675.
    1. Nater UM, Lin J-MS, Maloney EM, et al. Psychiatric comorbidity in persons with chronic fatigue syndrome identified from the Georgia population. Psychosom Med. 2009;71:557–565. doi: 10.1097/PSY.0b013e31819ea179.
    1. Faulkner S, Smith A. A longitudinal study of the relationship between psychological distress and recurrence of upper respiratory tract infections in chronic fatigue syndrome. Br J Health Psychol. 2008;13:177–186. doi: 10.1348/135910706X171469.
    1. Heim C, Wagner D, Maloney E, et al. Early adverse experience and risk for chronic fatigue syndrome: Results from a population-based study. Arch Gen Psychiatry. 2006;63:1258–1266. doi: 10.1001/archpsyc.63.11.1258.
    1. Huibers MJH, Beurskens AJHM, Van Schayck CP, et al. Efficacy of cognitive-behavioural therapy by general practitioners for unexplained fatigue among employees: Randomised controlled trial. Br J Psychiatry. 2004;184:240–246. doi: 10.1192/bjp.184.3.240.
    1. Chen R, Moriya J, Yamakawa J, Takahashi T, Kanda T. Traditional Chinese medicine for chronic fatigue syndrome. Evid Based Complement Alternat Med. 2010;7:3–10. doi: 10.1093/ecam/nen017.
    1. Afari N, Eisenberg DM, Herrell R, et al. Use of alternative treatments by chronic fatigue syndrome discordant twins. Integr Med. 2000;2:97–103. doi: 10.1016/S1096-2190(99)00017-7.
    1. Porter NS, Jason LA, Boulton A, Bothne N, Coleman B. Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. J Altern Complement Med. 2010;16:235–249. doi: 10.1089/acm.2008.0376.
    1. Adams D, Wu T, Yang X, Tai S, Vohra S. Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome. Cochrane Database Syst Rev. 2009;4:CD006348.
    1. Rendant D, Pach D, Ludtke R, et al. Qigong versus exercise versus no therapy for patients with chronic neck pain: A randomized controlled trial. Spine (Phila Pa 1976) 2011;36:419–427. doi: 10.1097/BRS.0b013e3181d51fca.
    1. Lansinger B, Larsson E, Persson LC, Carlsson JY. Qigong and exercise therapy in patients with long-term neck pain: A prospective randomized trial. Spine (Phila Pa 1976) 2007;32:2415–2422. doi: 10.1097/BRS.0b013e3181573b4b.
    1. Lee HJ, Park HJ, Chae Y, et al. Tai chi qigong for the quality of life of patients with knee osteoarthritis: A pilot, randomized, waiting list controlled trial. Clin Rehabil. 2009;23:504–511. doi: 10.1177/0269215508101746.
    1. Haak T, Scott B. The effect of qigong on fibromyalgia (FMS): A controlled randomized study. Disabil Rehabil. 2008;30:625–633. doi: 10.1080/09638280701400540.
    1. Ng BH, Tsang HW, Jones AY, So CT, Mok TY. Functional and psychosocial effects of health qigong in patients with COPD: A randomized controlled trial. J Altern Complement Med. 2011;17:243–251. doi: 10.1089/acm.2010.0215.
    1. Oh B, Butow P, Mullan B, et al. Impact of medical qigong on quality of life, fatigue, mood and inflammation in cancer patients: A randomized controlled trial. Ann Oncol. 2010;21:608–614. doi: 10.1093/annonc/mdp479.
    1. Craske NJM, Turner W, Zammit-Maempe J, Lee MS. Qigong ameliorates symptoms of chronic fatigue: A pilot uncontrolled study. Evid Based Complement Alternat Med. 2009;6:265–270. doi: 10.1093/ecam/nem088.
    1. Dybwad MH, Frøslie KF, Stanghelle JK. Work capacity, fatigue and health related quality of life in patients with myalgic encephalopathy or chronic fatigue syndrome, before and after qigong therapy, a randomized controlled study. Nesoddtangen, Norway: Sunnaas Rehabilitation Hospital; 2007.
    1. Blackburn EH. Structure and function of telomeres. Nature. 1991;350:569–573. doi: 10.1038/350569a0.
    1. Houben JM, Moonen HJ, van Schooten FJ, Hageman GJ. Telomere length assessment: Biomarker of chronic oxidative stress? Free Radic Biol Med. 2008;44:235–246. doi: 10.1016/j.freeradbiomed.2007.10.001.
    1. Epel ES. Telomeres in a life-span perspective: A new “psychobiomarker”? Curr Dir Psychol Sci. 2009;18:6–10. doi: 10.1111/j.1467-8721.2009.01596.x.
    1. Campbell K. Telomere length and mortality. Lancet. 2003;361:1224. doi: 10.1016/S0140-6736(03)12930-3.
    1. Willeit P, Willeit J, Mayr A, et al. Telomere length and risk of incident cancer and cancer mortality. JAMA. 2010;304:69–75. doi: 10.1001/jama.2010.897.
    1. Cawthon RM, Smith KR, O'Brien E, Sivatchenko A, Kerber RA. Association between telomere length in blood and mortality in people aged 60 years or older. Lancet. 2003;361:393–395. doi: 10.1016/S0140-6736(03)12384-7.
    1. Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: A pilot study. Lancet Oncol. 2008;9:1048–1057. doi: 10.1016/S1470-2045(08)70234-1.
    1. Epel ES, Blackburn EH, Lin J, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A. 2004;101:17312–17315. doi: 10.1073/pnas.0407162101.
    1. Simon NM, Smoller JW, McNamara KL, et al. Telomere shortening and mood disorders: Preliminary support for a chronic stress model of accelerated aging. Biol Psychiatry. 2006;60:432–435. doi: 10.1016/j.biopsych.2006.02.004.
    1. Kiecolt-Glaser JK, Glaser R. Psychological stress, telomeres, and telomerase. Brain Behav Immun. 2010;24:529–530. doi: 10.1016/j.bbi.2010.02.002.
    1. Jacobs TL, Epel ES, Lin J, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011;36:664–681. doi: 10.1016/j.psyneuen.2010.09.010.
    1. Lavretsky H, Epel ES, Siddarth P, et al. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: Effects on mental health, cognition, and telomerase activity. Int J Geriatr Psychiatry. 2012 Mar 11. [Epub ahead of print].
    1. Werner C, Hanhoun M, Widmann T, et al. Effects of physical exercise on myocardial telomere-regulating proteins, survival pathways, and apoptosis. J Am Coll Cardiol. 2008;52:470–482. doi: 10.1016/j.jacc.2008.04.034.
    1. Wolf SA, Melnik A, Kempermann G. Physical exercise increases adult neurogenesis and telomerase activity, and improves behavioral deficits in a mouse model of schizophrenia. Brain Behav Immun. 2011;25:971–980. doi: 10.1016/j.bbi.2010.10.014.
    1. Deale A, Chalder T, Marks I, Wessely S. Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial. Am J Psychiatry. 1997;154:408–414.
    1. Sharpe M, Hawton K, Simkin S, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: A randomized controlled trial. BMJ. 1996;312:22–26. doi: 10.1136/bmj.312.7022.22.
    1. Chalder T, Berelowitz G, Pawlikowska T, et al. Development of a fatigue scale. J Psychosom Res. 1993;37:147–153. doi: 10.1016/0022-3999(93)90081-P.
    1. Wong WS, Fielding R. Construct validity of the Chinese version of the Chalder Fatigue Scale in a Chinese community sample. J Psychosom Res. 2010;68:89–93. doi: 10.1016/j.jpsychores.2009.05.008.
    1. Ware J, 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;34:220–233. doi: 10.1097/00005650-199603000-00003.
    1. Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14:539–547. doi: 10.1007/s11136-004-0704-3.
    1. Unnebrink K, Windeler J. Intention-to-treat: Methods for dealing with missing values in clinical trials of progressively deteriorating diseases. Stat Med. 2001;20:3931–3946. doi: 10.1002/sim.1149.
    1. Wearden A, Appleby L. Cognitive performance and complaints of cognitive impairment in chronic fatigue syndrome (CFS) Psychol Med. 1997;27:81–90. doi: 10.1017/S0033291796004035.
    1. Wolkowitz OM, Mellon SH, Epel ES, et al. Resting leukocyte telomerase activity is elevated in major depression and predicts treatment response. Mol Psychiatry. 2012;17:164–172. doi: 10.1038/mp.2010.133.
    1. Epel ES, Lin J, Dhabhar FS, et al. Dynamics of telomerase activity in response to acute psychological stress. Brain Behav Immun. 2010;24:531–539. doi: 10.1016/j.bbi.2009.11.018.
    1. Saretzki G. Telomerase, mitochondria and oxidative stress. Exp Gerontol. 2009;44:485–492. doi: 10.1016/j.exger.2009.05.004.
    1. Binz N, Shalaby T, Rivera P, Shin-ya K, Grotzer MA. Telomerase inhibition, telomere shortening, cell growth suppression and induction of apoptosis by telomestatin in childhood neuroblastoma cells. Eur J Cancer. 2005;41:2873–2881. doi: 10.1016/j.ejca.2005.08.025.
    1. Kennedy G, Spence VA, McLaren M, et al. Oxidative stress levels are raised in chronic fatigue syndrome and are associated with clinical symptoms. Free Radic Biol Med. 2005;39:584–589. doi: 10.1016/j.freeradbiomed.2005.04.020.
    1. Van Houdenhove B, Van Den Eede F, Luyten P. Does hypothalamic–pituitary–adrenal axis hypofunction in chronic fatigue syndrome reflect a 'crash' in the stress system? Med Hypotheses. 2009;72:701–705. doi: 10.1016/j.mehy.2008.11.044.
    1. Ludlow AT, Zimmerman JOB, Witkowski S, et al. Relationship between physical activity level, telomere length, and telomerase activity. Med Sci Sports Exerc. 2008;40:1764. doi: 10.1249/MSS.0b013e31817c92aa.

Source: PubMed

3
Abonnere