Medical Qigong for Mobility and Balance Self-Confidence in Older Adults

James E Stahl, Shoshana S Belisle, Wenyan Zhao, James E Stahl, Shoshana S Belisle, Wenyan Zhao

Abstract

Background/Objectives: Physical inactivity, sedentary lifestyle, and impaired neuromuscular function increases fall risk and fractures in our aging population. Mind-body modalities, improve strength, balance and coordination, mitigating these risks. This study examined whether a manualized Medical Qigong protocol measurably improves balance, gait, and health self-confidence among older adults. Design: Randomized prospective cohort pre-post study with wait time control. Setting: Two martial arts centers in Massachusetts and Arizona. Participants: Ninety-five adults age ≥ 50 (mean age 68.6 y.o., range 51-96) were randomly assigned to an immediate start group (N = 53) or 4-week delayed start group (N = 43). Intervention: A 10 form qigong protocol taught over 12 weekly classes. Measurments: Primary outcome measures were the Community Balance and Mobility Scale (CBMS) and Activities-Specific Balance Confidence (ABC) Scale. Data was collected at baseline, 1-month and 4-months. Results: Both groups at both sites demonstrated improved balance and gait (CBMS + 11.9 points, p < 0.001). This effect was strongest in patients in their 60 s (CBMS +12.9 p < 0.01) and 70 s (CBMS + 14.3, p < 0.001), was equal across genders and socioeconomic status. Balance self-confidence did not significantly change (ABC + 0.9, p = 0.48), though several elements within ABC trended toward improvement [e.g., walk up/down ramp (p = 0.07), bend over/pick up (p = 0.09)]. Falls in the past year was inversely correlated with balance self-confidence (p = 0.01). Conclusion: A 12-week manualized Medical Qigong protocol significantly improved balance and gait and modestly improved balance self-confidence among older adults. Medical Qigong may be a useful clinical intervention for older adults at heightened risk for falls and related injuries. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04430751.

Keywords: balance; falls; health confidence; mind-body medicine; qigong; stability.

Copyright © 2020 Stahl, Belisle and Zhao.

Figures

Figure 1
Figure 1
Change in subjects balance confidence from pre-intervention to post-intervention.
Figure 2
Figure 2
Flow chart of subject recruitment, participation and retention.
Figure 3
Figure 3
The Medical Qigong Intervention.
Figure 4
Figure 4
Change in subjects physical balance competence from pre-intervention to post-intervention.

References

    1. Gallagher S. Body Schema and Intentionality. Cambridge, MA: MIT Press; (1995).
    1. Bergen G, Stevens M, Burns E. Falls and fall injuries among adults aged ≥ 65 years- United states, 2014. MMWR Morb Mortal Wkly Rep. (2016) 65:993–8. 10.15585/mmwr.mm6537a2
    1. Alexander B, Rivara F, Wolf M. The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health. (1992) 82:1020–3. 10.2105/AJPH.82.7.1020
    1. Sterling D, O'Connor J, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma Acute Care Surg. (2001) 50:116–9. 10.1097/00005373-200101000-00021
    1. Burns E, Kakara R. Deaths from falls among persons aged ≥ 65 years—United states, 2007–2016 Morb Mortal Wkly Rep. (2018) 67:509–14. 10.15585/mmwr.mm6718a1
    1. Florence C, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. (2018) 66:693–8. 10.1111/jgs.15304
    1. An Aging Nation: Projected Number of Children and Older Adults United States Census Bureau. (2018). Available online at: (accessed January 7, 2019).
    1. Ambrose A, Paul G, Hausdorff J. Risk factors for falls among older adults: A review of the literature. Maturitas. (2013) 75:51–61. 10.1016/j.maturitas.2013.02.009
    1. Gillespie L, Robertson M, Gillespie W, Sherrington C, Gates S, Clemson L, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. (2010) 3:CD007146 10.1002/14651858.CD007146.pub2
    1. Stevens J, Burns E. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. Atlanta, GA: Centers for Disease Control and Prevention National Center for Injury Prevention and Control; (2015).
    1. Sherrington C, Whitney J, Lord S, Herbert R, Cumming R, Close J. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. (2008) 56:2234–43. 10.1111/j.1532-5415.2008.02014.x
    1. Sherrington C, Michaleff Z, Fairhall N, Paul S, Tiedemann A, Whitney J, et al. . Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. (2017) 51:1750–8. 10.1136/bjsports-2016-096547
    1. National Council on Aging 6 Steps to Prevent a Fall [infographic]. National Council on Aging 2017. (2017). Available online at: (accessed January 5, 2019).
    1. Giangregorio L, Papaioannou A, Macintyre N, Ashe M, Heinonen A, Shipp K, et al. Too fit to fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int. (2014) 25:821–35. 10.1007/s00198-013-2523-2
    1. Hackney M, Wolf S. Impact of tai chi chu'an practice on balance and mobility in older adults: an integrative review of 20 years of research. J Geriatric Phys Ther. (2014) 37:127–35. 10.1519/JPT.0b013e3182abe784
    1. Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, et al. . Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. (2011) CD000333. 10.1002/14651858.CD000333.pub2
    1. Main Differences Between Tai Chi Qigong. QiGong Institute (2019). Available online at: . (accessed August 19, 2019).
    1. Lauche R, Wayne P, Dobos G, Cramer H. Prevalence, patterns, and predictors of T'ai chi and qigong use in the united states: results of a nationally representative survey. J Altern Complement Med. (2016) 22:336–42. 10.1089/acm.2015.0356
    1. Wayne P, Hausdorff J, Lough M, Gow B, Lipsitz L, Novak V, et al. . Tai chi training may reduce dual task gait variability, a potential mediator of fall risk, in healthy older adults: cross-sectional and randomized trial studies. Front Hum Neurosci. (2015) 9:332. 10.3389/fnhum.2015.00332
    1. Chan K, Qin L, Lau M, Woo J, Au S, Choy W, et al. . A randomized, prospective study of the effects of tai chi chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil. (2004) 85:717–22. 10.1016/j.apmr.2003.08.091
    1. Chen H, Yeh M, Lee F. The effects of baduanjin qigong in the prevention of bone loss for middle-aged women. Am J Chin Med. (2006) 34:741–7. 10.1142/S0192415X06004259
    1. Fong S, Choi A, Luk W, Yam T, Leung J, Chung J. Bone mineral density, balance performance, balance self-efficacy, and falls in breast cancer survivors with and without qigong training: an observational study. Integrative Cancer Therapies. (2018) 17:124–30. 10.1177/1534735416686687
    1. Zou L, Sasaki J, Wang H, Xiao Z, Fang Q, Zhang M. A systematic review and meta-analysis Baduanjin Qigong for health benefits: randomized controlled trials. Evid Based Complement Altern Med. (2017) 2017:4548706. 10.1155/2017/4548706
    1. Howe J, Inness L. (2015). Available online at: (accessed Jan 28, 2019).
    1. Balasubramanian C. The community balance and mobility scale alleviates the ceiling effects observed in the currently used gait and balance assessments for the community-dwelling older adults. J Geriatr Phys Ther. (2015) 38:78–89. 10.1519/JPT.0000000000000024
    1. Powell L, Myers A. The activities-specific balance confidence (ABC) scale. J Gerontol Ser A. (1995) 50:M28–34. 10.1093/gerona/50A.1.M28
    1. Talley K, Wyman J, Gross C. Psychometric properties of the activities-specific balance confidence scale and the survey of activities and fear of falling in older women. J Am Geriatr Soc. (2008) 56:328–33. 10.1111/j.1532-5415.2007.01550.x
    1. Young W, Williams A. How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations. Gait Posture. (2015) 41:7–12. 10.1016/j.gaitpost.2014.09.006
    1. Chow Y, Dorcas A, Siu A. The effects of qigong on reducing stress and anxiety and enhancing body-mind well-being. Mindfulness. (2012) 3:51–9. 10.1007/s12671-011-0080-3
    1. Hwang E, Chung S, Cho J, Song M, Kim S, Kim J. Effects of a brief Qigong-based stress reduction program (BQSRP) in a distressed Korean population: a randomized trial. BMC Complement Altern Med. (2013) 13:113. 10.1186/1472-6882-13-113
    1. Wang C, Bannuru R, Ramel J, Kupelnick B, Scott T, Schmid C. BMC Complement Altern Med. (2010) 10:23 10.1186/1472-6882-10-23
    1. Chong C, Tsunaka M, Tsang H, Chan E, Cheung W. Effects of yoga on stress management in healthy adults: a systematic review. Altern Ther Health Med. (2011) 17:32–8.
    1. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. Altern Complement Med. (2009) 15:593–600. 10.1089/acm.2008.0495
    1. Johansson M, Hassmén P. Acute psychological responses to qigong exercise of varying durations. Am J Chin Med. (2008) 36:449–58. 10.1142/S0192415X08005898
    1. Sharp P, Sutton B, Paul E, Sherepa N, Hillman C, Cohen N, et al. . Mindfulness training induces structural connectome changes in insula networks. Sci Rep. (2018) 8:7929. 10.1038/s41598-018-26268-w
    1. Chang P, Knobf M, Funk M, Oh B. Feasibility and acceptability of qigong exercise in community-dwelling older adults in the united states. J Altern Complement Med. (2018) 24:48–54. 10.1089/acm.2017.0096

Source: PubMed

Подписаться