Traditional Chinese exercises for pulmonary rehabilitation: evidence from a systematic review.

BACKGROUND: Qigong (QG) and tai chi (TC), alternative forms of exercise based on traditional Chinese medicine, are reported to be beneficial to patients with chronic obstructive pulmonary disease (COPD). This systematic review analyzed the evidence and made recommendations for clinical applications and future research. METHODS: Key words "qigong," "tai chi," "COPD," and "randomized controlled trial" or corresponding terms in Chinese were searched using MEDLINE, EMBASE, and 3 Chinese databases. Randomized controlled trials (RCTs) on QG and/or TC for patients with COPD were included. The quality of each RCT was appraised using the Physiotherapy Evidence Database (PEDro) scale. Outcome variables that were reported by greater than one-third of the RCTs were pooled for analysis. RESULTS: A total of 37 RCTs were identified, with 12 matching the inclusion criteria. The average PEDro score was 5.25, indicating that limitations were noted in the methodology. Only forced expiratory volume in the first second of expiration/forced vital capacity ratio and the 6-Minute Walk Test (6MWT) distance were common outcome measures in greater than one-third of the RCTs. The weighted mean differences and the 95% CI estimation for mean gains in forced expiratory volume in the first second of expiration/forced vital capacity ratio and mean gains in 6MWT distance between QG/TC and conventional exercise groups were 0.62 (95% CI, 0.30-0.93) and 12.18 (95% CI, 10.32-14.05) m, respectively. The corresponding values between QG/TC and no exercise groups were 2.90 (95% CI, 2.37-3.43) and 37.77 (95% CI, 35.42-40.12) m, respectively. CONCLUSIONS: This systematic review supports the therapeutic value of QG/TC in patients with COPD and highlights areas for future research.

Functional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trial.

CONTEXT: The initial gain from a Pulmonary Rehabilitation Program (PRP) among patients with chronic obstructive pulmonary disease (COPD) begins to fade away 6 months after the completion of a rehabilitation program. One possible reason may be due to the poor compliance of the patients to the existing forms of home exercise program (e.g., walking, weight training activities, etc.). OBJECTIVES: This study tested the efficacy of health qigong (HQG), a traditional Chinese exercise, as an adjunct home exercise program in optimizing the gains obtained from PRP until 6 months after discharge. DESIGN: This was a randomized controlled trial (RCT) on a mind-body exercise intervention. PARTICIPANTS: Eighty (80) patients with COPD receiving conventional PRP pulmonary rehabilitation program were randomized to the HQG intervention group (n = 40) and control group (n = 40). OUTCOME MEASURES: Assessments were undertaken by blinded assessors at baseline, discharge from training, and follow-up (FU) at 3 and 6 months. Primary outcomes involved functional capacity scales and secondary outcomes involved quality-of-life scales. RESULTS: Intention-to-treat analysis identified trends of improvement in all outcome measures in the HQG group, whereas lesser improvement and trends of deteriorations were identified in the control group. Ancillary analysis using a per-protocol method, however, identified significantly better improvements in functional capacity measures among the HQG at the 6-month FU. CONCLUSIONS: This RCT provided some evidence to support the positive effect of HQG as an adjunct home exercise for rehabilitation among people with COPD and to support further related research.

Psychophysiological outcomes of health qigong for chronic conditions: a systematic review.

We aimed to unravel the clinical benefits and the plausible underlying psychophysiological mechanism based on available randomized controlled trials (RCTs). Meta-analysis of 26 RCTs shortlisted from electronic databases from 1997 to 2006 shows that qigong had some effects on increasing the numbers of white blood cells and lymphocytes, stroke volume, peak early transmitral filling velocity, peak late transmitral filling velocity, forced vital capacity, and forced expiratory volume, and, conversely, lowering of total cholesterol, systolic blood pressure, diastolic blood pressure, and depressive mood scores. Explanatory pathways may pertain to stress reduction via nervous, endocrine, and immune systems. Limitations on methodology are discussed and directions for further studies are suggested. Because of its safety, minimal cost, and clinical benefit, health qigong can be advocated as an adjunctive exercise therapy for older people with chronic conditions.

Factors predicting rehabilitation outcomes of elderly patients with hip fracture.

OBJECTIVE: To identify predictors of rehabilitation outcomes for the development of a case-mix system to rehabilitate patients suffering from hip fractures. DESIGN: Prospective cohort study. SETTING: Two hospitals in Hong Kong. PATIENTS: A cohort of hip fracture patients in 2005 (n=303) with a mean age of 82 years was studied. Rehabilitation outcomes were defined as: mortality, length of stay, placement, ambulation status, activity of daily living at the time of discharge and at 6-month follow-up. A comparison between groups and multivariate analysis was conducted to validate the best predictors. MAIN OUTCOME MEASURES: Potential predictors and rehabilitation outcomes. RESULTS: Two predictors, the Abbreviated Mental Test score of lower than 6 (odds ratio=0.19, P<0.05) and the Functional Independence Measures score of lower than 75 (odds ratio=38.0, P<0.05), at the time of admission to the rehabilitation setting were found to be related to outcomes. Our findings provided further support for a case-mix system based on these two factors, as they could correctly assign patients into three groups with different baseline characteristics and outcomes. A review of the possible limitations of the existing service with respect to each case-mix group was also conducted. CONCLUSION: A case-mix system utilising the cognition and activity of daily living function is recommended. Revisions of respective care plans are advocated with more realistic outcome expectations and specific actions for the respective case-mix groups. An evaluation study on the usefulness of this case-mix classification could then follow.