Introduction Exercise and relaxation decrease Randomised Controlled - - PDF document

Randomised Controlled Trial of Qigong in Hypertension

BMY Cheung, JLF Lo, DY Fong, MY Chan, SHT Wong, CP Lau, KSL Lam, V Wong, JPE Karlberg

Introduction

Exercise and relaxation decrease

blood pressure

Exercise decreases blood pressure

Kokkinos et al. NEJM 1995.

Relaxation techniques help to lower blood pressure

Randomised controlled trial of yoga and bio- feedback in management of hypertension

• 34 hypertensive patients randomised

either to yoga or general relaxation (control) for 6 weeks

• Blood-pressure fell from 168/100 to

141/84 mm. Hg in the treated group and from 169/101 to 160/96 mm Hg in the control group.

• The control group was then trained in

yoga relaxation, and their blood- pressure fell to that of the other group (now used as controls).

Patel C, North WR. Lancet 1975; 2(7925): 93-5.

Breathing-control lowers blood pressure

• Using a new technology BIM (Breathe with

Interactive Music), hypertensive patients were guided towards slow and regular breathing.

• 33 patients were randomised to either BIM or

control treatment (listening to Walkman)

• Treatment for 10 min daily for 8 weeks
• BP change was -7.5/-4.0 mm Hg in the active

treatment group, vs -2.9/-1.5 mm Hg in the control group (P = 0.001 for systolic BP).

• Home-measured data showed similar changes
• BP response in 56% of the BIM group but only

14% in the control group (P = 0.02).

• Breathing exercise for 10 min daily using BIM

reduces BP

Grossman et al. J Hum Hypertens 2001

An estimated 60 million people in

China practise it daily.

It is also popular among overseas

Chinese and is gaining popularity in the West.

Many claims have been made about

qigong, that it may enhance function

• f the central nervous,

cardiovascular, renal, immune and reproductive systems.5-7

It is also thought to be helpful in

patients with malignancies in improving their mood and even prolonging survival.

Guolin qigong

introduced more than 50 years ago

by Madam Guo, a long-term cancer survivor

characterised by a slow walking

exercise accompanied by arm movements and twisting of the waist

chosen because it is non-religious,

non-political and widely practised Effect of qigong training on stress hormone levels in man

• Qigong increased the level of beta-endorphin
• ACTH decreased

Ryu et al. Am J Chin Med 1996

In view of the popularity of qigong

and the many claims of benefit, it is necessary to investigate its health effects in a randomised controlled trial

Method

Eighty-eight patients were

randomised to qigong or conventional exercise for 16 weeks

In addition to clinical and laboratory

assessments, quality of life instruments SF-36, Beck Anxiety and Depression Inventory were also completed by the patients

Qigong

Goulin qigong was taught by an expert

instructor

Initially, 2-hour training classes twice a

week for 1 month

Thereafter, monthly classes for 3 months Total time in class was 22 hours Subjects were asked to practise qigong for

60 minutes in the morning and 15 minutes in the evening every day for the duration

• f the study

Conventional exercise

Taught by a physiotherapist Schedule and size of the classes were the

same in both groups

The work load of the stretching, walking

and pressure relieving exercises were 2.0, 1.7 and 2.1 METS in qigong and 1.8, 2.0, 2.1 METS in conventional exercise respectively

The equivalence in exercise intensity was

verified by measuring oxygen consumption

Subjects performed 60 min of exercise in

the morning and 15 min in the evening every day

The study was designed, monitored

and analysed in the Clinical Trials Centre of the University of Hong Kong

An independent data and safety

monitoring committee was established for the study

Results

Randomised (n=91) Allocated to qigong (n=47) All received qigong Allocated to exercise (n=44) 41 received exercise Did not complete (n=10) Analysed (n=47) Did not complete (n=5) Analysed (n=41)

In the qigong and exercise groups,

24 (51 %) and 16 (39 %) subjects, respectively, attended all 8 sessions,

43 (91%) and 34 (83%) subjects,

respectively, attended at least 6 out

• f 8 sessions

Week 4 8 12 16

• No. of subjects

Qigong 47 45 41 39 37 Exercise 44 41 40 39 39 Systolic blood pressure (mmHg) Qigong 146.3±1.1 142.3±1.7 142.0±2.1 139.0±1.9 135.5±1.6b Exercise 140.9±1.7a 138.8±1.9 138.0±2.0 135.0±7.8 129.7±1.8b Diastolic blood pressure (mmHg) Qigong 93.0±0.6 91.5±1.0 87.0±1.1 87.5±1.2 87.1±1.3b Exercise 93.1±0.5 90.8±1.0 90.2±1.1 89.0±1.1 86.0±1.1b Heart rate (bpm) Qigong 74.7±1.1 75.7±1.2 74.2±1.1 74.6±1.1 71.7±1.0b Exercise 73.6±0.9 71.7±1.0 71.5±1.3 72.5±1.0 70.1±1.0b 24 hour ambulatory systolic blood pressure (mmHg) Qigong 133.9±2.3

• 134.6±2.4

Exercise 130.6±2.4

• 127.3±2.6

24 hour ambulatory diastolic blood pressure (mmHg) Qigong 86.5±1.5

• 86.2±1.6

Exercise 86.9±1.5

• 84.1±1.6c

24 hour ambulatory heart rate (bpm) Qigong 74.9±1.3

• 73.9±1.3

Exercise 72.5±1.3

• 72.4±1.3

Qigong baseline (n=47) final Exercise baseline (n=41) final

Weight (kg)

65.6±2.0 62.8±1.8 62.2±1.7 61.0±1.9

Body mass index (kg/m2)

25.2±0.5 24.4±0.5 24.1±0.6 23.8±0.6

Body fat (%)

30.4±1.1 29.9±1.2 29.9±1.2 29.3±1.3

Waist circumference (cm)

88.3±1.5 86.0±1.4 83.1±1.6a 81.8±1.8

Waist hip ratio

0.91±0.01 0.91±0.01 0.87±0.01b 0.86±0.01 Qigong baseline (n=22) final Exercise baseline (n=8) final

Left ventricular mass index 222.9.2±15.7 248.8±20.6 208.1±20.7 197.9±27.0 Ejection fraction 77.6±1.8 77.3±3.8 71.3±3.8 73.6±3.3

• 10
• 5

5 10 15 PF RP BP GH VT SF RE MH SF-36 domains Change in score between baseline and final visit

Exercise Qigong

At week 4, the scores for

performance of qigong were lower than those of conventional exercise, both in self-assessment (42.6±20.2%

• vs. 65.7±19.7%, p<0.001) and in

the assessment by the instructor (43.6±20.9% vs. 91.9±16.1%, p<0.001), suggesting that qigong was harder to master than conventional exercise

Results

Blood pressure decreased in both

groups by the same degree

Results

Heart rate, weight, BMI, waist

circumference, total cholesterol, renin and 24 hour urinary albumin excretion significantly decreased in both groups after 16 weeks

General health, bodily pain, social

functioning and depression also improved in both groups

Results

No significant differences between

qigong and conventional exercise were found

One female in the qigong group

developed vestibular neuronitis

Conclusions

Both Guolin qigong and conventional

exercise lower the blood pressure in patients with mild essential hypertension

Benefits beside lowering blood pressure

Both groups achieved a small degree

• f weight reduction, associated with

a decrease in waist circumference, a reduction in urinary protein excretion and improvement in health status

The exercise intensity is low

compared to brisk walking (2 vs. 5 METs), making it suitable for the majority of the elderly

Conclusions

Qigong is an alternative to

conventional exercise in the non- drug treatment of hypertension for those who prefer it

Support from the Li Ka Shing Foundation is gratefully acknowledged. Qigong was taught by Ms SK Chan .

Qigong training

two 2-hour training classes of

qigong/exercise per week for four weeks.

Thereafter, the classes were monthly altogether 22 hours of instruction 1st session - explanations and pressure

relieving exercises

2nd – 4th sessions - walking exercises and

pressure relieving exercises

5th – 7th session, stretching exercises

added

8th session - revision

Qigong practice

60 minutes in the morning 15 minutes in the evening every day walking exercises for 40 minutes eight sets of stretching exercises three sets of pressure relieving

exercises in the morning and three sets of pressure relieving exercises in the evening