Fact Sheet on Qigong: A Review of An Important New Resource
Fifteen-minute read. The National Center for Complementary and Integrative Health (NCCIH) published the New Fact Sheet on Qigong February 2022, and it is available on the NCCIH website.
I was delighted to see this new Qigong Fact Sheet publication, because it is a valuable resource for educating the general public as well as health care professionals about Qigong. As a health care practice, Qigong is a mind-body exercise that could readily be integrated into the ordinary life of the individual and also into professional health care settings. The publication of the Qigong Fact Sheet both honors the roots of Qigong as an ancient practice originating in China and acknowledges scientific evidence that Qigong is a safe and effective as a health care practice. The Qigong Fact Sheet also importantly educates the public about Qigong as a practice that is related to Tai Chi but also distinct as an approach to movement-based contemplative practice.
How Qigong and Tai Chi are Related
The NCCIH has a Tai Chi Fact Sheet that is clearly related to the Qigong Fact Sheet, and the decision to tease the two apart better reflects the relationship between the two. Both exercises are mind-body practice characterized by tending to the body, the mind, and the breath simultaneously. On this level, Tai Chi and Qigong are the same. However: Qigong is the umbrella term, where the words Qi and Gong mean “energy” and “work” respectively. Thus, Tai Chi is a form of Qigong, where Qigong has many forms that are not specifically Tai Chi. Tai Chi happens to be the most popular form of Qigong, and the scientific research reflects this as there is quantitatively more scientific research that pertains solely to Tai Chi compared to Qigong to date. However, using the framework of contemplative movement-based mind-body practice for health promotion when regarding the two exercises gives a way to understand the evidence and a way to use Qigong and Tai Chi as applications for creating health. The systematic review of studies of Qigong and Tai chi as beneficial therapeutic interventions specifies “performing Tai Chi as Qigong” as the lens by which to consider the two practices side by side in order to see their common benefits. The expectation is that movements are performed slowly and smoothly with emphasis on breathing, posture, and mental focus.
Qigong Forms are Researched as Health Practice
In practice, there are various Qigong forms that have been studied as distinct Qigong practices, also known as Qigong forms, which got passed down over the generations. For example, the Ba Duan Jin Qigong form, which is also known as the Eight Brocades is said to have originated during the Song Dynasty in China, and thus would be over one thousand years old. Given its history and popularity, Ba Duan Jin has been widely studied by health researchers in China and Harvard Medical School in the United States is also taking interest in studying this form as a health intervention. The Qigong Fact Sheet cites in its list of primary references four systematic reviews and meta-analyses that specifically address the use of Ba Duan Jin for used in the treatment of various health conditions, which are chronic obstructive pulmonary disease, knee osteoarthritis, cognitive decline, and musculoskeletal pain and sleep quality.
It is a matter of cultural sensitivity to acknowledge the difference between Qigong and Tai Chi; because, in the actual practice of either one, there are differences in schools, lineages and even the nature of competitions. Thus, for clarity about the names of practices, either Tai Chi or Qigong, that members of the public may encounter when they seek to join classes, Qigong is appropriately scientifically investigated independent of Tai Chi. However, the underlying relationship between the two is important to keep in mind when considering Qigong and Tai Chi research outcomes. Regarding Tai Chi and Qigong to be in the same category of meditative movement exercise characterized by gentle movement coordinated with breath and mental focus means we understand that they share a related scientific evidence base.
That Qigong is a movement-based exercise and beneficial to health is a perspective that is consistent with the way Qigong is regarded by the Chinese government, which also very much considers Qigong a health practice, almost like a sport, and promotes “Health Qigong” that includes specific and well-known Qigong forms (such as the Ba Duan Jin Qigong form) and other practices as Chinese "Health Qigong" (Chinese Health Qigong 2022) with chapters all over the world.
Indeed, for decades now, mind-body practices have been researched by scientists who investigate the biological mechanisms and dissemination of health interventions, and it is important that the associated research outcomes be shared with the public. With health care under scrutiny and needing to evolve as the world responds to the pandemic and anticipates future outbreaks, now the role of mind-body practice in basic health care and preventing disease is a viable topic whose time has come.
The existence of the Qigong Fact Sheet addresses the fact that ordinary citizens are encountering Qigong practices in the marketplace of alternative and complementary health practices and may have questions or concerns about the practice of Qigong. The Qigong Fact Sheet helps people recognize that the safety and health benefits of these practices have been verified through scientific study. The research outcomes can inform the health conversation between individuals who are consumers and providers of health care.
Information on Qigong for Health Care Providers
The references cited in the Qigong Fact Sheet understandably do not point to pilot and feasibility studies or directions of future research. However, anyone interested in pursuing the details and directions of future academic study of Qigong can navigate to the section of the Qigong Fact Sheet with the heading, “For Health Care Providers” to visit PubMed directly and survey the randomized control trials on Qigong.
While the NCCIH Qigong Fact Sheet answers basic questions about Qigong, it also omits some aspects of the practice that may help the public understand the practice of Qigong and thus take it up as a health practice. The important description of Qigong as neuromotor exercise that can improve balance, coordination and posture and keep motor skills sharp is omitted for some reason. The American College of Sports Medicine (ACSM) exercise position statement recommends doing separate neuromotor exercise in addition to everyday activities and functional movement of living. Qigong and Tai Chi are noted as multifaceted and multicomponent activities examples of neuromotor exercise in the ACSM position statement. The ACSM position statement mentions that: “Neuromotor exercise training is beneficial as a part of a comprehensive exercise program for older persons, especially to improve balance, agility, muscle strength, and reduce the risk of falls.” (Garber, et al, 2011) In this regard, Qigong and Tai Chi as neuromotor exercises can help maintain or improve function.
Can Qigong Benefit People with Chronic Pain?
The Qigong Fact Sheet can be useful for the health care professional who regularly educates others about beneficial health practices that make a difference in managing health conditions and situations of many kinds. The Qigong Fact Sheet Features specific references to scientific Qigong studies, systematic reviews of studies and meta-analyses and notes the areas of scientific research on Qigong where there is conflicting evidence about the role of Qigong in caring for a condition. For example, there is conflicting evidence that Qigong reduces pain. Given the complex nature of pain and pain research, the many types of pain, the various models of pain care, and the varieties in individual pain experience, it makes sense that there is more work to be done in the study of the role of Qigong in managing and reducing pain. Since I have been leading Qigong and Tai Chi classes for people in chronic pain situations, I follow the subject of pain management and Qigong research closely, and reducing pain is only one part of the chronic pain puzzle, given the many ways a person can feel pain and the many ways pain can affect a person’s life. I have observed that even pain medications and analgesics have varying effects on people who struggle with pain. So, what people find effective and use for relief can vary, and it appears that mind-body practice for pain is very effective under the right conditions for some people. I have also observed the times Qigong and Tai Chi made a difference and became the core of the personal (at-home) pain care for some patients and students who returned to work after taking part in functional restoration programs of the pain centers where I teach. There have also been cases where Qigong practice was not readily adopted as a practice for pain care for some patients and students. So, clearly, there is more work to be done in researching pain mechanisms and in researching the biological mechanisms involved in the health effects associated with Qigong practice and pain. In the meantime, it is helpful to understand that in complex pain situations, many things are beneficial, and mind-body practice is potentially beneficial in managing pain situations in many cases. For pain, the Qigong Fact Sheet shows that Qigong is potentially safe and beneficial, but outcomes are influenced by many factors, including the kind of pain presented (for example, back pain versus neck pain or neuropathic pain versus musculoskeletal pain).
From my experience in teaching Qigong and Tai Chi for chronic pain patients undergoing the functional restoration program in two San Francisco Bay Area pain centers, Qigong helps people manage other aspects of pain situations or health challenges. For example, regular Qigong practice trains your body to recognize the body’s signals of stress (for example, tightness in muscles or a shortness of breath as stress levels increase). Once you recognize the signals, you then can use that information to make a choice that addresses the situation and steers it towards relief before the situation becomes more stressful or painful. At the pain centers, this is the skill of directing attention in a nonjudgmental and calm way that helps a patient wisely pace their activities in the moment and have a sense of not being hindered by pain. It takes practice, but patients who master such attention skills can then experience effective pacing of activities that can then lead to enjoying a higher quality of life as a result.
The future direction of research on Qigong as a health intervention that works on many levels and engages the whole person is promising. Recent pilot studies, not included in the Qigong Fact Sheet, show that while Qigong may not directly reduce pain, it can be helpful in addressing other aspects of the pain experience. For example, a pilot study that showed pain catastrophizing (the self-report that scores the intrusive thought patterns associated with pain conditions) was reduced in patients suffering from pain post-surgery for breast cancer who practiced Qigong exercises for 12 weeks (Osypiuk, et al, 2020) speaks to the fact that Qigong works on physical and psychological levels and can be beneficial for people in pain situations.
Qigong Provides A Way to Stay Physically Active
In terms of how well Qigong might be accepted and taken up by patients who are at risk for reducing activity levels post cancer treatment, recently published pilot studies on Qigong and cancer show that Qigong and Tai Chi can be “novel and culturally sensitive” physical activity for Latina breast cancer survivors who are at risk for weight gain post cancer surgery (Soletero, et al, 2022). Again, such pilot studies show that Qigong works on many levels, psychological, social, and physical levels, each of which contribute uniquely to a person’s overall health. Indeed, at the chronic pain centers where I teach Qigong and Tai Chi classes for the patients, Qigong aligns well with the biopsychosocial model of health care used in the pain centers where the intent is to take care of the health of the whole person in treating their chronic pain condition. Qigong is a valuable mind-body practice that can be presented sensitively and respectfully and thus shows promise in terms of being adopted by people of varying levels of abilities and cultural backgrounds.
The Covid-19 and Qigong scientific reviews referenced in the Qigong Fact Sheet speak to the evidence for using complementary health interventions based on Traditional Chinese Medicine in the treatment of Covid-19 as effective auxiliary treatment that can help manage symptoms and reduce disease progression. Thus, the conversation about Covid-19 and Qigong is about educating people about staying well, building immunity and managing health with Qigong versus using complementary health interventions on their own as a cure for Covid-19. In the active creation of health, a person can use Qigong as a meaningful health strategy.
The unprecedented global challenges of the Covid-19 pandemic have amounted to tragedy of loss and division. Coupled with worldly and local unrest in cities, there are many signs that change is urgently needed. Historically, the resilience of humanity is what gets built up during the challenging times such as these. The distress signals a need for change, and the momentary disorder and distress amount to a chance to reform and do things differently. This is certainly true on a personal level as ordinary citizens rethink personal health and work choices. On the level of the governance of nations and economies, innovations can take root when great numbers have been affected, and improvements are hard won and at great cost as in the case in the number of deaths and the suffering brought on by the Covid-19 pandemic. The need to rethink health care access and practice is present not just for individuals but for entire communities, cities and nations. The opportunity to expand the notion of health and wellbeing is before us, and Qigong, Tai Chi, Yoga, and mind-body practice as a whole can be part of a health care innovation that gives ordinary people access to simple ways to take care of themselves and meet the health challenges of the moment.
References
Chinese Health Qigong main informational membership page. 2022. https://www.ihqfo.org/en/index.php?p=news_list&lanmu=10
Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and Science in Sports and Exercise. 2011 Jul;43(7):1334-1359. DOI: 10.1249/mss.0b013e318213fefb. PMID: 21694556.
Osypiuk K, Ligibel J, Giobbie-Hurder A, Vergara-Diaz G, Bonato P, Quinn R, Ng W, Wayne PM. Qigong Mind-Body Exercise as a Biopsychosocial Therapy for Persistent Post-Surgical Pain in Breast Cancer: A Pilot Study. Integr Cancer Ther. 2020 Jan-Dec;19:1534735419893766. doi: 10.1177/1534735419893766. PMID: 32009481; PMCID: PMC7050958.
Qigong: What You Need To Know, National Center for Complementary and integrative Health. https://www.nccih.nih.gov/health/qigong-what-you-need-to-know?
Rogers, T. An Introduction to Qigong Health Care. Qigong Institute eBook 2022.
Soltero EG, Larkey LK, Kim WS, Rosales Chavez JB, Lee RE. Latin dance and Qigong/Tai Chi effects on physical activity and body composition in breast cancer survivors: A pilot study. Complement Ther Clin Pract. 2022 Feb 15;47:101554. doi: 10.1016/j.ctcp.2022.101554. Epub ahead of print. PMID: 35257993.
Tai Chi: What You Need To Know, National Center for Complementary and integrative Health. https://www.nccih.nih.gov/health/tai-chi-what-you-need-to-know