Synopsis: The Impact of Qi Gong & Tai Chi On Wellness

WIL Publication | By Global Health Intern Shreya Pandrala

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Introduction

Qi Gong involves gentle, rhythmic movements, breathing techniques and meditations for sustaining health and overall well-being. Qi Gong was developed by Taoist sages in ancient China over 4,000 years ago. Since that time, it has been an important part of Traditional Chinese Medicine, offering potential benefits for physical, emotional, and spiritual wellbeing. Tai Chi, which is better known in the West, began much later in the 1700s as a branch or tributary of Qi Gong. Today in the West, traditional Eastern practices such as mindfulness meditation, yoga and Qi Gong have become quite popular as part of the wellness movement and adapted to offer both in-person and online sessions.

Qi Gong draws on the idea of balancing and harnessing ‘life force’ energy or “qi” within and around oneself. A goal is to offer alternative healing modalities to conventional Western medicine, improve one’s health, and attain inner balance. This may be achieved in numerous ways, such as through breathwork, stretching or engaging in certain poses. By doing so, Qi Gong may reduce stress, improve energy and a positive frame of mind - all leading to an enhanced quality of life. Qi Gong practices are generally suitable and may be adapted for people of all ages, mental health status, genders, those with or without disabilities, and various levels of cognitive functioning. The aim of this synopsis is to summarize the growing evidence from Western science regarding the benefits and limitations of Qi Gong including Tai Chi practices.

Methods

The databases used were Google Scholar and PubMed, which provided peer-reviewed journal articles (ranging from 2010-2024) on Qi Gong and Tai Chi, with a specific focus on literature published within the last 5 years (mostly in the United States or China but other regions as well). There are a total of 30 journal articles being assessed in this literature review, consisting of 20 systematic reviews and 10 empirical studies featuring randomised controlled trials. All articles were either written in English or translated into English from Standard Chinese, and both qualitative and quantitative studies were selected. The systematic reviews and empirical studies were chosen based on their relevance to the effect of Qi Gong on wellness and how they categorized Qi Gong as an intervention for mental health or public health-related initiatives. The studies were organized for syntheses based on the historical context of Eastern medicine, psychological benefits, physiological benefits, and efficacy of the practices. Empirical studies or systematic reviews examining the relationship between Qi Gong and diseases or physiological disorders were excluded from this review. All the articles that met the criteria for inclusion were considered the most relevant to the research question, which addressed the value and caution of using Qi Gong and Tai Chi for fostering mental, emotional, and spiritual wellness.

Key Findings

Research Evidence

Twenty systematic reviews were examined. Primarily, the populations of most interest to researchers have been people with mental illnesses or disorders, senior citizens, and women. Amongst those with mental illnesses, research shows that most empirical trials have resulted in lessened symptoms for anxiety, depression and insomnia. Interestingly, the results do not vary much whether adolescent, middle-aged, or elderly populations are studied, with mental health improving in all three demographics across various studies, countries, and study design. Most individuals taught Qi Gong or Tai Chi practices gained improvements to their mental health through such programs. Furthermore, studies on elderly show that there are physiological benefits to Qi Gong and Tai Chi such as better balance, coordination, and lower risk of falling. As people age, their balance and motor function tend to deteriorate but Qi Gong and Tai Chi can improve balance in elderly, especially the following types of practices; BaDuan Jin and Yi Jin Jing. Not only do they diminish the amount of falls the average elderly person may experience in their lifetime, but they also minimize the overall number of falls in high-risk individuals and those with more severe balance issues.

Qi Gong can also help women with perimenopausal, postmenopausal or intimate partner violence experiences. Menopause usually affects the menstruation cycle of those above 45-55 years of age and can present in numerous ways such as through hot or cold flashes, weight fluctuations, mood swings, dry skin, and sleep disturbance. Yet, women who have undergone Qi Gong or Tai Chi intervention programs have reported significant positive effects on their sleeping habits, including sleep duration, latency, and efficiency. Furthermore, sleep disturbances and the inability to go to sleep can be exacerbated in women suffering or recovering from intimate partner violence. But, through Qi Gong and Tai Chi training sessions, hundreds of women have shown significant improvements in their quality of sleep, in comparison to control groups. These improvements on sleep quality are partially attributed to the decrease in anxiety and depression symptoms that are comorbid with insomnia in domestic violence victims. As the rates of depression and anxiety decreased through the introduction of Qi Gong and Tai Chi in the women's lives, so did sleep disturbance. Therefore, Qi Gong and Tai Chi (Baduanjin, in particular), can be recommended for those with poor mental health, elderly who are at risk of falling, and women who experience sleep disturbances due to menopause or intimate partner violence.

While many studies have been conducted in research labs or healthcare settings, there is also a fair amount of research with elderly in nursing homes and long term care facilities. Chair-based practices are often used in nursing homes, as they prevent the risk of injury from standing while doing Qi Gong or Tai Chi. Since many nursing home residents are disabled or have mobility issues in some way, Qi Gong and similar exercises can be modified for disabled elderly to reap its benefits. The studies conclude that chair-based exercises such as yoga, Qi Gong and Tai Chi are usually safe and feasible for senior citizens, increasing their physical and cognitive capabilities, as well as enhancing their health.

As for studies conducted in primary and secondary schools, Qi Gong or Tai Chi practices were usually performed during Phys-ed (physical education) class with pre-teens or teenagers. The study outcomes assessed were attention, anxiety, stress, and student wellbeing. As the ability to concentrate is a critical skill for students to perform well academically, it became the objective of many researchers to allow children to glean the same benefits. By evaluating students through attention tests before and after practice sessions, researchers were able to ascertain the different ways in which Qi Gong and Tai Chi influence the cognitive and intellectual development of young people. Other studies suggest that Qi Gong and Tai Chi can ease the symptoms of depression and anxiety that adolescents experience, even causing a reduction in their cortisol levels. Since students may face many hardships at school between schoolwork, interpersonal relationships, and managing extracurriculars, they are susceptible to mental health issues such as anxiety.,So performing Qi Gong practices in a daily school context may provide them the mental relief and relaxation they require. The findings of multiple systematic reviews demonstrate that Qi Gong and Tai Chi are an excellent way to introduce self-care methods and therapeutic interventions to young children. By integrating it into their Phys-ed. classes and daily school life, it may reduce their anxiety and also contribute to their psychological well-being.

While in-person Qi Gong and Tai Chi sessions may facilitate more engagement, there are an increasing amount of Qi Gong classes being taught entirely online. For example, due to the COVID-19 pandemic many Qi Gong and Tai Chi instructors moved their classes into virtual spaces and have continued to digitally deliver their practices. But, more studies are needed on the impacts of Qi Gong being moved from physical to online spaces. It is imperative that the accessibility and impacts of digital platforms be determined. While it may offer a strong alternative to in-person classes and promotes social distancing, online programs may have drawbacks, such as creating more difficulties for those who want to engage in Qi Gong but lack computer literacy. For instance, a large part of the elderly population, especially in China, participate and benefit from Qi Gong. Inadequate digital access and literacy could threaten the implementation of Qi Gong unless access is addressed. Even if the people have high-speed, high-quality internet connections, access to electronic devices, and are relatively safe when engaging in Qi Gong exercises, they may feel less motivated to participate in online sessions because of the lack of personal interaction. The willingness to engage amongst participants may increase by creating more convenient methods of delivery that do not require a great deal of digital literacy, providing technological support and sharing encouraging words; along with other methods that will lead to more social interaction and involvement in online-based Qi Gong. In this way, online Qi Gong can be optimized for the user’s convenience, foster community, allow sessions to be recorded, provide enrichment to seniors, offer larger class sizes, and create opportunities for disabled people who may find online forms of Qi Gong more accessible.

Limitations of Current Research

Many research studies to date have limitations due to weak scientific methodology such as a lack of placebo controls. Sufficient controls in most studies are not present, with some studies choosing to not include a control or reference group at all. Additionally, many trials use the subjects’ survey answers as the primary data. Although self-report can provide important data, the research could be corroborated and strengthened by including behavioral and physical measures such as cortisol levels in hair or in saliva. These measures could provide indicators about whether stress levels in the subjects have decreased after Qi Gong sessions.Other recommendations for future research include:

• Using larger sample sizes, which would increase statistical power for detecting significant results, and more fully represent the population they are studying.

• Conducting double-blind controlled studies, where neither the researchers nor the participants understand what treatment or intervention the subjects are receiving to limit any biases.

• Controlling for confounding variables that could occur such as personal expectations about the effects of Qi Gong or external factors such as social stressors.

Five Examples of Systematic Reviews

1. Abbott, R., & Lavretsky, H. (2013). Tai Chi and Qigong for the treatment and prevention of mental disorders. The Psychiatric Clinics of North America, 36(1), 109–119. https://doi.org/10.1016/j.psc.2013.01.011

Chi and Qigong may be effective in reducing depressive symptoms, stress, anxiety, and mood disturbances. The article also goes onto explain the clinical applications of Tai Chi and Qi Gong, the health-related quality of life, their influence on psychosocial wellbeing, stress management, mood, anxiety, depression, sleep disturbance, substance abuse, cognitive functioning, and overall, its relevance as a complementary approach to Western medicine. Though there are sections of the article in which medical treatments are discussed, such as Tai Chi/Qi Gong’s impact on symptom alleviation in Parkinson’s disease, traumatic brain injuries (TBI), etc., I will be excluding those from the literature review and will simply focus on the sections related to Tai Chi/Qi Gong as mental health interventions only.

2. Chen, W., Li, M., Li, H., Lin, Y., & Feng, Z. (2023). Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomised controlled trials. Frontiers in public health, 11, 1236050. https://doi.org/10.3389/fpubh.2023.1236050

This study aims to investigate the beneficial effects of Tai Chi (only) on fall prevention and balance improvement in older adults. They conducted a systematic review and meta-analysis of 24 randomised controlled trials related to Tai Chi, falls, and balance ability, searching for articles up until December 31, 2022. The results showed that Tai Chi can effectively reduce the risk of falls in older adults, decrease the number of falls altogether, and improve balancing abilities. In addition, the effect of Yang-style Tai Chi was found to be better/more effective than that of Sun-style Tai Chi. This systematic review provides valuable insight into how Tai Chi can be used as a fall prevention intervention in older adults.

3. Gonçalves M, Matos LC, Duarte L, Machado J, Greten HJ, Franconi G. Problems of scientific methodology related to placebo control in Qigong studies: A systematic review. J Bodyw Mov Ther. 2020 Oct;24(4):261-270. doi: 10.1016/j.jbmt.2020.06.035. Epub 2020 Jul 11. PMID: 33218521.

Three databases were assessed in January 2018 to retrieve articles on this topic and the literature found was examined for the effects of Qigong as compared to a control intervention. A total of 20 studies were included in this systematic review and the authors concluded that no criteria for placebo controls had been published in any peer-reviewed journal articles on Qi Gong so far. Then, they suggested that placebo controls should be developed using assessments such as heart rate variability, thermography, and electrophysiological measurements, psychometric tests and other quantitative evaluations to rule out logistical and statistical errors, ineffectual study designs, and inconclusive results in studies published on Qi Gong. The article here is useful for critiquing problems within psychological research, especially in relation to Qi Gong; as there seems to be a lack of adequate controls for Qigong research, compromising the reliability of evidence.

4. Junsheng L. Teo, Stephen R. Bird, Xiaoqiu Wang, Zhen Zheng. Using telehealth to deliver Qi Gong and Tai Chi programs: A mixed-methods systematic review on feasibility, acceptability and participant engagement factors. Archives of Gerontology and Geriatrics. Volume 117 (2024). 105203. ISSN 0167-4943. https://doi.org/10.1016/j.archger.2023.105203.

One of the most unique articles I’ve found so far addresses the feasibility, acceptability, and participant engagement variables of delivering Qi Gong and Tai Chi through telehealth (zoom/phone/skype, etc.). One of the main problems in ensuring all participants had an enjoyable time partaking in the exercises was poor digital/computer literacy (even in providers). However, there were no notable issues pertaining to access to an internet connection, participant safety, program costs, or connectivity. As the Wellness Impact Lab’s Interbeing Wellness Series is conducted over Zoom, and many senior-aged participants join, I thought this article would be insightful in helping us comprehend the benefits and challenges of performing telehealth. The participants in the study reportedly were satisfied with their online programs, but the concerns on how to ensure all participants have proper digital literacy, are able to form acceptance (i.e they might feel embarrassed to be on camera), actively engage, and how telehealth compares to in-person Tai Chi/Qi Gong sessions are all problems that are worth addressing in the literature review using this article.

5. Kraft, J., Waibl, P.J. & Meissner, K. Stress reduction through taiji: a systematic review and meta-analysis. BMC Complement Med Ther 24, 210 (2024). https://doi.org/10.1186/s12906-024-04493-3

This review investigates the potential of taiji (Tai Chi) as a viable strategy for alleviating stress. Factors considered were perceived stress, biological stress markers, anxiety, depression, and quality of life (QoL). Eleven trials with a total of 1323 patients comparing taiji to no intervention met the inclusion criteria. Secondary outcomes/assessments post-Tai Chi highlighted improvements in anxiety and physical quality of life, while depression, mental quality of life, and biological stress markers remained unchanged. Still, the results underscore taiji's potential in mitigating perceived stress, as evidenced by lessening depressive symptoms, lowered anxiety levels, and increased physical quality of life. This evidence can be taken into consideration when assessing how to create mental health programs that are beneficial to patients, hence, it provides value to this literature review.

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