Introduction Exercise and relaxation decrease Randomised Controlled - PDF document

Introduction � Exercise and relaxation decrease Randomised Controlled Trial of blood pressure Qigong in Hypertension BMY Cheung, JLF Lo, DY Fong, MY Chan, SHT Wong, CP Lau, KSL Lam, V Wong, JPE Karlberg Relaxation techniques help to Exercise decreases blood pressure lower blood pressure Kokkinos et al. NEJM 1995. Randomised controlled trial of yoga and bio- Breathing-control lowers blood pressure feedback in management of hypertension Using a new technology BIM (Breathe with � 34 hypertensive patients randomised Interactive Music), hypertensive patients were � guided towards slow and regular breathing. either to yoga or general relaxation 33 patients were randomised to either BIM or (control) for 6 weeks � control treatment (listening to Walkman) Blood-pressure fell from 168/100 to � Treatment for 10 min daily for 8 weeks � 141/84 mm. Hg in the treated group and BP change was -7.5/-4.0 mm Hg in the active from 169/101 to 160/96 mm Hg in the � treatment group, vs -2.9/-1.5 mm Hg in the control group. control group (P = 0.001 for systolic BP). The control group was then trained in Home-measured data showed similar changes � � yoga relaxation, and their blood- BP response in 56% of the BIM group but only � pressure fell to that of the other group 14% in the control group (P = 0.02). (now used as controls). Breathing exercise for 10 min daily using BIM � reduces BP Patel C, North WR. Lancet 1975; 2(7925): 93-5. Grossman et al. J Hum Hypertens 2001

� Many claims have been made about � An estimated 60 million people in qigong, that it may enhance function China practise it daily. of the central nervous, � It is also popular among overseas cardiovascular, renal, immune and Chinese and is gaining popularity in reproductive systems.5-7 the West. � It is also thought to be helpful in patients with malignancies in improving their mood and even prolonging survival. Effect of qigong training on stress hormone Guolin qigong levels in man � introduced more than 50 years ago Qigong increased the level of beta-endorphin � ACTH decreased by Madam Guo, a long-term cancer � survivor � characterised by a slow walking exercise accompanied by arm Ryu et al. Am J Chin Med 1996 movements and twisting of the waist � chosen because it is non-religious, non-political and widely practised Method � In view of the popularity of qigong � Eighty-eight patients were and the many claims of benefit, it is randomised to qigong or necessary to investigate its health conventional exercise for 16 weeks effects in a randomised controlled � In addition to clinical and laboratory trial assessments, quality of life instruments SF-36, Beck Anxiety and Depression Inventory were also completed by the patients

Qigong Conventional exercise � Taught by a physiotherapist � Goulin qigong was taught by an expert instructor � Schedule and size of the classes were the same in both groups � Initially, 2-hour training classes twice a � The work load of the stretching, walking week for 1 month and pressure relieving exercises were 2.0, � Thereafter, monthly classes for 3 months 1.7 and 2.1 METS in qigong and 1.8, 2.0, � Total time in class was 22 hours 2.1 METS in conventional exercise respectively � Subjects were asked to practise qigong for � The equivalence in exercise intensity was 60 minutes in the morning and 15 minutes verified by measuring oxygen in the evening every day for the duration consumption of the study � 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 Results Centre of the University of Hong Kong � An independent data and safety monitoring committee was established for the study Randomised � In the qigong and exercise groups, (n=91) 24 (51 %) and 16 (39 %) subjects, Allocated to qigong Allocated to exercise respectively, attended all 8 sessions, (n=47) (n=44) � 43 (91%) and 34 (83%) subjects, All received qigong 41 received exercise respectively, attended at least 6 out Did not complete (n=10) Did not complete (n=5) of 8 sessions Analysed (n=47) Analysed (n=41)

Week 0 4 8 12 16 No. of subjects Qigong 47 45 41 39 37 Exercise 44 41 40 39 39 Qigong (n=47) Exercise (n=41) Systolic blood pressure (mmHg) Qigong 146.3 ± 1.1 142.3 ± 1.7 142.0 ± 2.1 139.0 ± 1.9 135.5 ± 1.6 b baseline final baseline final Exercise 140.9 ± 1.7 a 138.8 ± 1.9 138.0 ± 2.0 135.0 ± 7.8 129.7 ± 1.8 b Diastolic blood pressure (mmHg) Weight (kg) 65.6 ± 2.0 62.8 ± 1.8 62.2 ± 1.7 61.0 ± 1.9 87.1 ± 1.3 b Qigong 93.0 ± 0.6 91.5 ± 1.0 87.0 ± 1.1 87.5 ± 1.2 Exercise 93.1 ± 0.5 90.8 ± 1.0 90.2 ± 1.1 89.0 ± 1.1 86.0 ± 1.1 b Body mass index (kg/m 2 ) 25.2 ± 0.5 24.4 ± 0.5 24.1 ± 0.6 23.8 ± 0.6 Heart rate (bpm) 71.7 ± 1.0 b Qigong 74.7 ± 1.1 75.7 ± 1.2 74.2 ± 1.1 74.6 ± 1.1 Body fat (%) 30.4 ± 1.1 29.9 ± 1.2 29.9 ± 1.2 29.3 ± 1.3 Exercise 73.6 ± 0.9 71.7 ± 1.0 71.5 ± 1.3 72.5 ± 1.0 70.1 ± 1.0 b 24 hour ambulatory systolic blood 83.1 ± 1.6 a Waist circumference (cm) 88.3 ± 1.5 86.0 ± 1.4 81.8 ± 1.8 pressure (mmHg) Qigong 133.9 ± 2.3 - - - 134.6 ± 2.4 Waist hip ratio 0.91 ± 0.01 0.91 ± 0.01 0.87 ± 0.01 b 0.86 ± 0.01 Exercise 130.6 ± 2.4 - - - 127.3 ± 2.6 24 hour ambulatory diastolic blood pressure (mmHg) 86.5 ± 1.5 86.2 ± 1.6 Qigong - - - Exercise 86.9 ± 1.5 - - - 84.1 ± 1.6 c 24 hour ambulatory heart rate (bpm) 74.9 ± 1.3 73.9 ± 1.3 Qigong - - - Exercise 72.5 ± 1.3 - - - 72.4 ± 1.3 15 Change in score between baseline 10 Qigong (n=22) Exercise (n=8) and final visit Exercise 5 baseline final baseline final Left ventricular mass index 222.9.2 ± 15.7 248.8 ± 20.6 208.1 ± 20.7 197.9 ± 27.0 0 Qigong Ejection fraction 77.6 ± 1.8 77.3 ± 3.8 71.3 ± 3.8 73.6 ± 3.3 -5 -10 PF RP BP GH VT SF RE MH SF-36 domains Results � At week 4, the scores for � Blood pressure decreased in both performance of qigong were lower groups by the same degree 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 Results � Heart rate, weight, BMI, waist � No significant differences between circumference, total cholesterol, qigong and conventional exercise renin and 24 hour urinary albumin were found excretion significantly decreased in � One female in the qigong group both groups after 16 weeks developed vestibular neuronitis � General health, bodily pain, social functioning and depression also improved in both groups Benefits beside lowering blood Conclusions pressure � Both groups achieved a small degree � Both Guolin qigong and conventional of weight reduction, associated with exercise lower the blood pressure in a decrease in waist circumference, a patients with mild essential reduction in urinary protein excretion hypertension 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 Qigong practice � two 2-hour training classes of � 60 minutes in the morning qigong/exercise per week for four weeks. � 15 minutes in the evening � Thereafter, the classes were monthly � every day � altogether 22 hours of instruction � 1st session - explanations and pressure � walking exercises for 40 minutes relieving exercises � eight sets of stretching exercises � 2 nd – 4th sessions - walking exercises and � three sets of pressure relieving pressure relieving exercises � 5 th – 7th session, stretching exercises exercises in the morning and three added sets of pressure relieving exercises in � 8th session - revision the evening