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Health Qigong: its application and evidenceHealth Qigong: its application and evidencein Cardiac Rehabilitation

Athina POON OTI United Christian Hospital

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pHK

Content

Health Qigong and Cardiac rehabilitation programprogram

Clinical study and clinical application:Health Qigong (HQG) Badunjin (BDJ)Health Qigong (HQG) Liu Zi Jue (LZJ)

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Background

Heart disease including Acute Myocardial Infraction (AMI) and Congestive Heart ( ) gFailure (CHF).

Have become a worldwide health and economic burden with high mortality rate and re-hospitalization rate.

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Heart disease as 2nd leading cause of death in HK.

BackgroundThe annual incidence of heart disease had reached up to 14 /1000 and 20 /1000 in men and womenmen and women.

16,000 heart failure admissions & accounting for 1.4 % admission to HA hospitals (Hospital Authority statistics,2006).

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Around 25 to 50% of hospitalized patients will be readmitted within 6 months after discharge. (Hospital Authority statistics,1997).

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BackgroundThe activity level of people with heart disease was limited by :disease was limited by :

chest pain,fatigue, dyspnoea, edema,emotion, like depression.

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emotion, like depression.

Background

Effective treatment for heart disease was not only prolonging life symptom controlnot only prolonging life, symptom control.

A clinical priority for treating patients with heart disease :

promoting the QOL, d d i i

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reduce re-admission control cardiovascular risk factors

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Cardiac Rehabilitation Program (CRP)

WHO definition:The sum of activities required to influence favorably the underlying cause of the disease, as well as to ensure the patients the best possible physical, mental and social conditions so that they may be by their own efforts, preserve or resume when lost, as normal a l ibl i th it

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place as possible in the community.

Cardiac Rehabilitation Program (CRP)

The CRP program should concerned the full spectrum of QOL which included both full spectrum of QOL, which included both physical skill training and educational programs, cater to psychosocial aspect.

(Denollet et al,1995)

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Health Qigong (HQG)Qigong was formed by 2 characters.

“Qi” means ‘breathing of vital energy’“G ‘ h kill f k ‘ l i i“Gong” means ‘the skills of work’, ‘cultivation’and ‘achievement’.

Composed of 2 characteristics: slow body movements as an aerobic exercise and a controlled synchronized slow breathing.

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Qigong was to cultivate vital energy to maintain ones health and get rid of illness.

Health Qigong (HQG)

Many literatures and systematic reviews have positive evidence supporting the have positive evidence supporting the clinical benefits of health qigong on :

lowering of total cholesterol, lowering of systolic blood pressure, lowering of diastolic blood pressure

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lowering of diastolic blood pressure, lowering of depressive mood scores

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Health Qigong (HQG)Qigong enhanced healthy lifestyle, functional ability and improve QOL (Tse,1995)

Qigong has effects on cardio-pulmonary dimensions (Lim et al, 1993)

Rhythmic movements of qigong reduce stress, build stamina, increase vitality, and enhance the immune system. (The National Qigong Association, USA)

Qigong and psychological effects (Allen Dorcas 1996)

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Qigong and psychological effects (Allen Dorcas,1996)

Qigong on blood pressure and hypertension ( Christine R K, 2001)

HQG v.s. Cardiac Rehabilitation

Aim to investigate the effectiveness of HQG in heart disease people on :HQG in heart disease people on :

physiological performance psychological aspects

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Our experience

Year Journey

2000 Tried HQG practice in CRPII

2005 HQG (BDJ) study in AMI patients

2006 12 weeks HQG(BDJ) program for AMI patients led by lay leaders

2007 HQG (LZJ) study in CHF patients

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Q ( ) y p

2009 Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program

Our experience –Tried HQG practice in CRPII

HQG practice had been tried at the United Christian Hospital (UCH) cardiac Christian Hospital (UCH) cardiac rehabilitation program phase II (CRP II) for patient with AMI since 2000.

14Practiced Qigong at Day Rehabilitation Center

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CRPII

Patient types: Myocardial InfarctPost CABG, PCI…post onset 4 -6 /12

Age range: Average ~ 63 years old

Chinese 99%

METS level: Exercise capacity >3METS

Frequency/duration: 10 sessions (1 hr/ session)

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Program : Psycho-education (30 mins)

+ Health Qigong Practice (30 mins)

Vital Sign Screening

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Health Qigong Background

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Live Demonstration

Warm Up ex.

& Practice

17Vital Sign Re-check


Exclusion criteriaExclusion criteriaProblems with musculoskeletalNeurological deficitPsychiatric illness with medical complication e.g. unstable angina, uncontrollable BP etc

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Eff i ?Effectiveness?

Study………….

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Our experience –HQG (Ba Duan Jin - BDJ) study in AMI patients

An Evaluation of Qigong in improving the QOL in Cardiac Patients.

Hui et al. The Journal of Alternative and Complementary Medicine 2005

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Our experience –HQG (BDJ) study in AMI patients

BDJ incorporates physical physical movements & postures with breathing techniques & meditation to

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cleanse & restore Qi. Eight different movement steps

Ba Duan Jin


Outcome Measures

Physiological measures:Blood Pressure (BP)

systolic blood pressure (SBP) diastolic blood pressure (DBP)

Heart Rate (HR)

Psychosocial measures:An iet le el (STAI)

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Anxiety level (STAI)Quality of Life (SF36)

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N= 28 Pre-TreatmentMean (SD)

Post-TreatmentMean (SD)

P-value

SBP 130.89 20.78 123.93 21.33 .013*

DBP 66.86 12.80 67.14 11.75 .901

HR 67.21 12.95 64.57 12.88 .115

STAITraitAnxiety

41.39 10.4842.29 7.87

32.57 10.2935.43 9.22

.000*

.000*

SF36 Mental healthSocial Functioning

63.71 29.0966 52 36 33

78.00 25.8486 16 21 87

.003*

.001*

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Social FunctioningVitalityRole disruption (physical problems)Role disruption (emotional problems)

General HealthBody PainPhysical Function

66.52 36.3356.43 24.7541.07 46.2651.19 46.6945.46 16.9577.39 21.8082.32 13.57

86.16 21.8770.00 23.5768.75 40.6180.95 37.8757.50 20.5276.71 19.0388.93 12.86

.001

.006*

.005*

.003*

.001*.888

.000*

Clinical

HQG (BDJ) study in AMI patients

Clinical Application

Regular practice

applied HQG (BDJ) in CRPII for AMI

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in CRPII for AMI patient

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3 month follow up by telephone

Variables Post-CRP II Post CRP II 3-month

p value

PCS 47.75 ±7.35 51.23 ± 5.87 0.142

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MCS 52.011 ±1.21 56.82 ± 4.13 0.039*

According to patient self report, patients fail to complied, they either said :


“ I am too busy with my household chores, I had no time to perform it”

“ I am rather lazy”

“ I am rather tired and sleep all day!”

“ It is difficult to learn, usually I forgot all the steps after going b k h ”

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back home.”

“My family members keep tissing me about my posture, I had no confidence in performing it at home!”

“ I need to work at daytime, I am exhausted after work!!”

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Compliance …..

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Home Program Enhancement to enhance home practice HQG compliance :


VCDWritten Instruction Self Reported Daily Sheet

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Duration of qigong practice at HomeSignificant increase in duration of home qigong practice

d


per day

g qi

gong

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14

12

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Recorded day

10987654321

Mea

n tim

e fo

r per

form

ing

10

8

6

N=47

P=0.001 (repeated measures of ANOVA)

Home Program Clinical gEnhancement

to enhance home practice HQG compliance


Regular practice –

Applied HQG (BDJ) Home Program

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compliance

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L ff S i bili ?Long term effect , Sustainability….?

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By observation peer effect influenced

Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders

By observation, peer effect influenced compliance and motivation, leader in group helps reinforcing peer effect

Supported by the social cognitive theory (Bandura, 1986), using of group as an agent of change was based on group dynamics literature. King (1994) noted that it is important is to find ways

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King (1994) noted that it is important is to find ways to promote these social forces when using the group approach to deliver physical activity training and promote commitment to what participants learn.

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Using self recorded sheet provides a personalized plan and facilitate self


personalized plan and facilitate self regulatory responsibility for enhancing exercise adoption and maintenance

According to social cognitive theory, the aspect of perceived efficacy that is most relevant is not whether one can execute the

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efficacy that is most relevant is not whether one can execute the physical skills, which are readily mastered, but the self-regulatory efficacy to mobilize oneself to exercise regularly in the face of a variety of personal, social, and situational impediments. (Bandura, 1986)

Occupational Therapy DepartmentMedical & Geriatric Department, Cardiac

Division


Health Resource Center United Chrsitain Hospital

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Aim of Study12 week health qigong (Badunjin)


12-week health qigong (Badunjin) program on cardiac patients Evaluate

physiological psychosocial effect

The maintenance effect of the program was also evaluated at post discharge

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was also evaluated at post-discharge 12-week from the program.

Hypothesisa 12 weeks’ health qigong program involves


a 12 weeks’ health qigong program, involves both regular group and daily home practice, will significantly improve

physiologicalpsychosocial functionsinitial significant improvements will be sustained over 6 months, and

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The outcome of intervention group will significantly differ from the control group, with better physiological and psychosocial aspects.

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Our experience –12 weeks HQG(BDJ) program for AMI patients led by lay leaders

Subjects: Selection criteria:

completed CRPII (80% of attendance)learnt basic skills of health qigongwilling to participate in the study

Exclusion criteria

Onset of :uncontrolled angina, arrhythmia dyspnea attackadditional medical admission during CRPIII

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Lay Leaders: the graduated CRPII patients6-session train-the-trainer course

Program frequency health qigong class 1/ week ≧ 4 times home practice/week.

ResultN=57


2030

N=57

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Exp. group

Control group

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Exp. gp. Control

gp.

male

femake

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25

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Exp. group Control group

Control group

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Homogeneity between groups

Total (n= 57 ) Exp (n= 31 ) Control (n=26) P value


Total (n= 57 ) Exp. (n= 31 ) Control (n=26) P-value

n % n % n % Chi-square

Gender

Male 39 68.4 19 61.3 20 76.9 0.164*

Female 18 31.6 12 38.7 6 23.1

Regular ex. habit

Yes 52 91.2 30 96.8 22 84.6 0.126*

N 2 8 8 1 3 2 4 15 4

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No 2 8.8 1 3.2 4 15.4

n Mean n Mean n Mean Ind. T Test

Age

57 62.1 31 63.2 26 60.7 0.405*


N=31 Attendance(total 12 sessions)

1 – 12 week Home practice

12 – 24 week Home practice

Mean 9.3 7.9 times/wk 6.5 times/wk

SD 3.0 3.4 3.2

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1

1.5

2

2.5

3

Exp. gp

control gp

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0

0.5

1

Re-admit Mortality

Heart Rate change during Class

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ate


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1 2 3 4 5 6 7 8 9 10 11 12 Session

Hea

rt R

a

Pre-HR

Post-HR

SBP change during class

145

150

DBP change during class

79808182

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115

120

125

130

135

140

1 2 3 4 5 6 7 8 9 10 11 12

Session

SB

P

Pre-SBP

Post-SBP 717273747576777879

1 2 3 4 5 6 7 8 9 10 11 12

Session

DB

P

Pre-DBP

Post-DBP

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Heart rate change in diff. time interval

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HR

Experimental

Control

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Pre Wk 12 Wk 24

Time

HR Pre Wk 12 Wk 24

Experimental 64.2 62.84 60.8

Control 61.1 62.77 65.0

SBP change in diff. time interval

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122

124

126

128

130

132

134

SB

P

Experimental

Control

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122

Pre Wk 12 Wk 24

Time

SBP Pre Wk 12 Wk 24


Control 130.2 126.4 133.4

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DBP change in diff. time interval

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P Wk 12 Wk 24

DB

P

Experimental

Control

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Pre Wk 12 Wk 24

Time

DBP Pre Wk 12 Wk 24


Control 74.8 72.8 76.3

Experimental Gp(n=31)

Control Gp (n=26)

p

mean mean


ea eaHR Baseline 64.2 61.1

12 weeks 62.8 62.8 24 weeks 60.8 65.0

0.001*

SBP Baseline 130.1 129.8

12 weeks 128.7 126.4 24 weeks 130.6 133.4

0.529

DBP Baseline 77.0 74.8

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12 weeks 74.4 72.8 24 weeks 74.8 76.3

0.284

* Significantly difference by Repeated ANOVA (2x3)

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C-SF36 resultsgeneral improvement in all 8 domains of


general improvement in all 8 domains of psychosocial functioning , especially in vitality (p=0.009) in the experimental group

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Feedbacks from lay leaders & patientsFeedbacks from lay leaders & patientsPositive feedback from participants


more active in daily life with enhanced confidence enhanced self-efficacy in coping with their cardiac problems and dealing with their daily lives

Other factors like the cultural relevant Traditional Chinese Medical components of health qigong,

f t i th l l d

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sense of empowerment as in the lay leaders, changes in lifestyle, peer group sharing, learning and support were also identified which had contributed to the positive outcome of the program.

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12 weeks HQG(BDJ) program for AMI patients led by lay leaders


2 sessions of Health Qigong group lead byby lay leaders group lead by lay leader weekly for post CRPII patient

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Apply other HQG in other patient group…..

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Our experience - HQG (Liu Zi Jue- LZJ) study in CHF patients

E l ti f th ff t f H lth Evaluation of the effect of Health Qigong in people with heart failure

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Our experience - HQG (LZJ) study in CHF patients

regulated & controlled the controlled the rise & fall of Qi inside the bodySlow and gentle breathing and movementsuitable for

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suitable for elderly 6 main steps, together with the starting and closing steps

Liu Zi Jue

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Design of study:an experimental and prospective study.


an experimental and prospective study. Convenient sampling of the outpatientswhom were referred to UCH for heart failure rehabilitation programme.

Outcome :Heart rate blood pressure and QOL

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Heart rate, blood pressure and QOL,The Chronic Heart Failure Questionnaire (Chinese version) and SF 36


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Conclusion:


there was a lowering effect of heart rate and diastolic blood pressure but not systolic blood pressure after practicing Health Qigong

ff t i i i QOL

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an effect in improving QOL

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HQG (LZJ) study in CHF patients


Routine practice

Apply HQG (LZJ) f C

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in HFPII for CHF patient

Patient satisfaction towards Health Qigong………

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to assess the health status and patients’satisfaction of the patient self help and lay

Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program

satisfaction of the patient self-help and lay leader led health qigong program.

by patient satisfactory survey consisted of 10 questions

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N31


NGender 74.2 % male 25.8 % female

Age 66.0 (mean) 6.9(SD)

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Practi ced H QG d urat io n

6months1year1to 2 years> 2yearsothers

Q1

Pies show counts

3 .2 3 %3 .2 3 %

2 9 .0 3 %

5 8 .0 6 %

6 .4 5 %

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Practiced HQG(Badunjin) duration N Percent

Valid 6 months 1 3.2

1 year 1 3.2

1 to 2 years 9 29.0

> 2 years 18 58.1

Others (3 years) 2 6.5

Total 31 100.0

Home practiced HQG frequency/ week:


Practi ced H QG durat ion

>5ti mes/ week3to 5 ti mes/ week<2ti mes/ weekNA

Q3

Pies show counts

2 5 .8 1 %

9 .6 8 %

1 6 .1 3 %

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Home practiced HQG frequency/ week N Percent

Valid > 5 times/ week 8 25.8

3 to 5 times / week 15 48.4

<2 times / week 3 9.7

NA 5 16.1

Total 31 100.0

4 8 .3 9 %

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Home practiced HQG duration (minutes)/ practice


Practi ced H QG d urat io n

> 40mi nutes15to 40 minutes< 15mi nutesNA

Q4

Pies show counts

2 2 .5 8 %

1 2 .9 0 %

9 .6 8 %

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Home practiced HQG duration (minutes)/ practice N Percent

Valid > 40 minutes 7 22.6

15 to 40 minutes 17 54.8

< 15 minutes 4 12.9

NA 3 9.7

Total 31 100.0

5 4 .8 4 %


100% patients expressed they will continue to practice HQG.Over 96.8% patients were not admitted in the past 1 year (due to cardiac related problem) after practiced HQG.

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Q93 .2 3 %

Practi ced H QG du rat ion

yesno

Pies show counts

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9 6 .7 7 %

N %

Able to relax after practiced HQG 31 93.5

Able to build up healthy life style (active life style, relax) 31 93.5

Patients’ feeling of self-efficacy in sustaining active d h lth lif t l tt ft ti HQG


and healthy lifestyle pattern after practice HQG

•improved physique •improved breathing•less pain of L/L•improved cardio-pulmonary fitness•improved health

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•improved health•less illness

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Q109 6 8 %

Practi ced H QG du rat ion


mutual encouragemutual supportrol e model

Q10

Pies show count s

5 8 .0 6 %

3 2 .2 6 %

9 .6 8 %

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Satisfaction N Percent

Overall satisfy lay leader led health qigong program 31 100

Will recommend others to join lay leader led health qigong program 31 100

Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program


Apply HQG in Cardiac Rehab.

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Program

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Keys of Qigong practice in cardiac patient:

MotivationInterestInterestComplianceMutual /peer supportAV aids support

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Keys of Qigong practice in cardiac patient:Characteristics to enhance adherence Health Qigong

Affordable, no extra equipment

Simple to learn

Gradable according to conditions and level

No time pressure; pace set by self

Challenging enough to motivate practice

Social reinforcement, e.g. discussion in mass media di i lf h l

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discussion, self-help group

No environmental, weather & financial constraints(e.g. limited space requirement, no extra expenditure on using extra equipments)

High perceived therapeutic value

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Keys of Qigong practice in cardiac patient:

Therapist’s role Observe and regular the paceObserve and regular the paceFacilitate proper practicePractice breathing , relaxed posture, relaxed mindScreen any contraindication, knee pain…

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Conclusion

A culturally relevant, safe, minimal cost, and proven clinical benefit, health qigong can be considered as

a cost-effective intervention to facilitate cardiovascular risk factors control, active lifestyle engagement, self-efficacy enhancement in sustaining active,

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y ghealthy lifestyle pattern ,long-term community reintegration ,with possible reduction in the avoidable re-admissions due to coronary heart disease.

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Thank You

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3s34 athina iotc 24.2.2012 [相容模式]hkiot.org/2012otc/docs/pdf/3s3.4_ms athina poon.pdf ·...

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