Acute Physiological and Psychological Effects of Qigong Exercise in Older Practitioners
Acute Physiological and Psychological Effects of Qigong Exercise in Older Practitioners
Chun-Yi Lin 0 1 2
Tze-Taur Wei 3
Chen-Chen Wang 1
Wan-Chen Chen 2
Yu-Min Wang 2
Song-Yen Tsai 4
0 School of Medicine, College of Medicine, Fu Jen Catholic University , No. 510, Zhongzheng Rd., Xinzhuang District, New Taipei City , Taiwan
1 Research Assistant Center, Show Chwan Memorial Hospital , No. 542, Sec. 1, Chung-Shan Rd., Changhua , Taiwan
2 Department of Nuclear Medicine, Show Chwan Memorial Hospital , No. 542, Sec. 1, Chung-Shan Rd., Changhua , Taiwan
3 Society of Chinese Bioenergy Medical Qigong , No. 130-1, Nanyuan St., North District, Tainan City , Taiwan
4 Naturopathic Medicine Research Center, Changhua Christian Hospital , No. 135 Nanhsiao Street, Changhua City , Taiwan
Qigong is a gentle exercise that promotes health and well-being. This study evaluated the acute physiological and psychological effects of one session of qigong exercise in older practitioners. A total of 45 participants (mean age, 65.14 years) were recruited. Meridian electrical conductance, State-Trait Anxiety Inventory (STAI), heart rate variability (HRV), and Short Form 36 (SF-36) were evaluated and compared before and after one session of qigong exercise. The results revealed that the electrical conductance of all meridians, except spleen and bladder meridians, increased significantly ( < 0.05). Compared with baseline values, upper to lower body ratio and sympathetic/vagal index were significantly improved and closer to 1 ( = 0.011 and = 0.007, resp.). STAI-S and STAI-T scores decreased significantly ( < 0.001 and = 0.001, resp.). The RR interval of HRV decreased significantly ( = 0.035), a significant positive correlation was observed between k idney meridian electrical conductance and SF-36 physical scores ( = 0.74, = 0.018), and a positive correlation was observed between pericardium meridian electrical conductance and SF-36 mental scores ( = 0.50, = 0.06). In conclusion, one session of qigong exercise increased meridian electrical conductance, reduced anxiety, and improved body and autonomic nervous system balance. These findings provide scientific evidence for acute physiological and psychological effects of qigong exercise in older practitioners.
Qigong, an ancient Chinese healing practice that was
originally a martial art, has been developed and used to improve
physical fitness and strength in China for 7000 years [
]. The word ?qigong? involves two theories: ?qi,? the vital
energy of the body and ?gong,? the training or cultivation
of qi . Concentration, relaxation, meditation, breathing
regulation, and body posture and movements are the basic
components of qigong [
]. In contrast to conventional
exercise, qigong aims to achieve a harmonious flow of qi in
the body and cultivate a spirit of systematic training exercise
to improve physical fitness and overall well-being through the
coordination of rhythmic movements, regulated breathing,
and meditation . There are essentially two types of qigong:
internal and external. Internal qigong or qigong exercise is
self-directed and involves the use of movements, meditation,
and controlled breathing patterns, whereas external qigong
is typically performed by experienced practitioners who use
their hands to direct qi onto patients for healing or treatment
]. Typically, qigong can be classified into dynamic and
static qigong. Dynamic qigong involves the coordination of
movements and meditation, whereas static qigong focuses on
mental concentration and body relaxation without physical
Meridians are associated with the underdifferentiated,
interconnected cellular networks that regulate growth and
physiology. The meridian theory explains the distribution
and nonspecific activation of organizing centers, acupuncture
points, and the high electrical conductance of the meridians
]. In the human body, meridian theory deals with
physical regulation and pathological changes [
condition of the meridian system can be measured by its
electrical characteristics which have been studied since the
1950s. Acupuncture points have been widely accepted as
areas of low electrical impedance and high conductance [
]. Skin conductance response is typically measured by
applying a small direct current signal through two electrodes
placed on the skin [
]. Nakatani identified 12 channels
of high electrical conductance on the left and right sides
of the body (24 in total) and developed the Ryodoraku
theory according to the philosophy of traditional Chinese
medicine (TCM) . Skin electrical conductance varies with
the activity of a subject?s autonomic nervous system and has
been used to investigate mood changes and the mechanisms
of the autonomic nervous system [
]. The properties of
meridians reflect the conditions of certain organs when their
mutual relations and changes with microelectrical current are
analyzed and compared . The electrical information
mapping transforms associated with various medical syndromes,
signs, symptoms, and diseases were reported in a previous
The meridian electrical conductance investigates the
meridian energy. Meridian energy analysis devices can reflex
the conditions of certain organs through analysis of the
symmetrical Yuan points. Changes with microelectrical currents
represent the physiological phenomena of the relevant
]. T he electrical conductivity has been reported to
monitor the effects of qigong workshop in the previous study
. Heart rate variability (HRV) is used as a sensitive index
of autonomic nerve activity. The analysis of HRV provides
quantitative information on autonomic control mechanisms
]. It has been reported that five minutes of Tai Chi
Qigong was found to improve HRV in nasopharyngeal cancer
]. The State-Trait Anxiety Inventory (STAI) is
a psychological inventory based on a 4-point Likert scale.
It consists of forty questions on a self-report basis. These
questionnaires are a highly reliable measure of stress and
]. Qigong exercise significantly relieved anxiety
and reduced stress among healthy people were reported in the
previous study [
]. The SF-36 health survey is a self-report
survey commonly used as a generic health questionnaire for
adults which covers eight health domains, namely, physical
functioning, physical role functioning, bodily pain, general
health perceptions, vitality, social role functioning, emotional
role functioning, and mental health [
]. SF-36 scores have
been used to evaluate the effects of qigong exercise in breast
cancer survivors [
]. The conceptual framework of this study
was shown in Figure 1 guiding this study.
Long-term practice of qigong exercise may help in
maintaining satisfactory health and preventing and treating illness.
Qigong exercise has been reported to influence depression,
stress, anxiety symptoms, chronic pain, immunity, infection,
and quality of life [
]. However, evidence-based
research on the acute physiological and psychological effects
of qigong exercise in older practitioners is yet to be reported.
This study therefore evaluated the acute physiological and
psychological effects of one session of qigong exercise in older
2. Methods and Measures
2.1. Study Design. This research involved a prospective,
preand postcomparison study. After obtaining informed consent
from the participants, meridian electrical conductance
measurements, questionnaires, and baseline heart rate variability
(HRV) measurements were obtained before and after one
session of qigong exercise.
Chinese Bioenergy Qigong is a popular and well known
exercise in Taiwan and Hong Kong. It is easy to learn with
low cost. There is no limitation in time or place to
practice. Hundred thousand people practice Chinese Bioenergy
Qigong in Taiwan. It not only active body adjustment but
also harmonizes mind adjustment. It is easy for general
population to practice every day. Chinese Bioenergy Qigong
is a 1-hour session of qigong exercise conducted and
popularized by Dr. Li Cheng Chung, which includes warm-up
movements, breathing regulation, gentle movements, body
stretching, meditation, and relaxation. Thus Chinese
Bioenergy Qigong was chosen to be the intervention program in
this study. Additional details can be obtained from the
Acute is referring to a condition of rapid onset and is
of generally brief duration. In this study, the physiological
and psychological conditions before and after qigong exercise
were evaluated within 30 minutes, so the physiological and
psychological ef fects of Qigong exercise were conceptually
defined as acute effects.
2.2. Participants. One of the authors in this study, TT
Wei, is the senior coach of Chinese Bioenergy Qigong. He
announced the information about the study and searched
for participants. Optimal qigong practicing environment to
conduct the study was taken into consideration. It takes about
two months to learn to practice Chinese Bioenergy Qigong.
The low frequency of practicing may forget how to practice
As far back as 1875, in Britain, the Friendly Societies Act
enacted the definition of old age as ?any age after 50? [
The age of 50 years was defined as the working definition
of ?older? or ?old? in World Health Organization (WHO)
minimum data set (MDS) project meeting on aging in 2001 in
order to take into account the real situation of older persons
in developing countries [
]. Furthermore, participants aged
50 to 70 years were regarded as elders in the previous study
From September 23, 2016, to November 5, 2016, elders
aged 50 to 90 years from two communities (Tou-Liou and
Tan-Mu) in Taiwan without severe medical conditions and
practicing Chinese Bioenergy Qigong 5 days a week for at
least 3 months were eligible to be recruited in this study
the effects of
(1) Meridian electrical
phenomena of the
(2) Heart rate variability
(HRV): index of
(3) Short Form 36
(SF36): physical scores
represent the physical
(1) State-Trait Anxiety
(2) Short Form 36
(SF36): mental scores
represent the mental
One session of
Acute effects measurement
(1) Values of
activity on HRV
(3) Physical scores
of Short Form 36
(1) Scores of
(2) Mental scores of
Short Form 36
in order to make sure the participants can practice qigong
correctly and smoothly. Subjects who were unable to read
and sign the consent form, had been diagnosed with a major
illness (such as acute myocardial infarction, stroke, late-stage
cancer, paralysis, and major organ transplantation), were
pregnant, or had been diagnosed with a mental disorder (such
as anxiety and depression) were excluded.
The study was approved by the Institutional Review
Board of Shown Chwan Memorial Hospital, Taiwan (number
1040408). Informed consent was provided by all participants.
2.3. Measurements. In order to avoid interoperator
variability, the machines were operated by the same skilled operator
in this study [
]. The skin electrical conductance was
operated by CY Lin, and heart rate variability was operated
by CC Wang for all participants. The meridian electrical
conductance and heart rate variability data were measured
before and after qigong exercise within 30 minutes.
2.3.1. Meridian Electrical Conductance. The participants were
rested on a chair for 10 minutes before measurements were
recorded. All measurements were obtained on a sunny
morning in fall to maintain temperature and moisture
consistency. It has been reported that the degree of skin moisture
would influence Meridian Energy Analysis Device (MEAD)
]. To avoid sweat after qigong influence
MEAD measurement, all participants were required to dry
the body with a dry towel especially wrists and ankle.
The electrical conductance of 24 acupuncture points in the
wrists and ankles of the 12 left and 12 right meridians was
measured using a device (MEAD, 6th generation, Medpex
Enterprises, Taiwan). The meridians were as follows: lung
(L, H1), pericardium (P, H2), heart (H, H3), small intestine
(SI, H4), triple energizer (TE, H5), large intestine (LI, H6),
spleen (SP, F1), liver (LIV, F2), kidney (K, F3), urinary
bladder (B, F4), gallbladder (G, F5), and stomach (S, F6). The
conductivity at the acupuncture point is directly proportional
to the amperage of the DC current that flows through the
skin when 12 V with an output current of 0?200 uA is applied
to the points individually. Higher values indicate higher
conductance between the reference electrode, which is 35 mm
in diameter and clipped on the left palm, and the acupuncture
point, which is measured using a 10 mm diameter cotton with
saturated saline solution. The average electrical conductance
of 24 meridians in each subject was calculated. The index of
sympathetic/vagal balance was defined as the highest average
limb electroconductivity value on the dorsal or ventral side,
which was divided by the lowest value during MEAD analysis.
The yin meridians were lung, pericardium, heart, liver, spleen,
and kidney, while yang meridians were small intestine, triple
energizer, large intestine, urinary bladder gallbladder, and
stomach. The upper meridians indicate those on hands and
the lower meridians indicate those on feet. There are 12
meridians each on the left and right sides of the body. The
upper to lower body ratio is calculated as the sum of the upper
meridians divided by the sum of the lower meridians. The
yin to yang ratio is def ined as the sum of the yin meridians
divided by the sum of the yang meridians. The left to right
ratio means the sum of the left meridian divided by the sum
of the right meridians [
16, 20, 21
2.3.2. Heart Rate Variability. Five-minute
electrocardiography data were recorded immediately after the MEAD
measurements. Polar heart-rate monitors (Polar Vantage
NV, Polar Electro Oy, Finland) were used to continuously
collect heart rate data in the form of RR intervals from all
participants before and after one session of qigong exercise.
After data collection, HRV parameters were calculated using
Kubios HRV (version 2.1; Biosignal Analysis and Medical
Imaging Group, University of Eastern Finland, Finland) [
The participants? spectral HRV data were expressed in terms
of RR intervals, lower frequency (LF), high frequency (HF),
normalized LF, and normalized HF.
2.3.3. Questionnaire. Two instruments were adopted in this
study. The first was the Short Form 36 (SF-36) health survey
and the second was the State-Trait Anxiety Inventory (STAI).
Both were self-report questionnaires.
Short Form 36 Health Survey. The SF-36 health survey is a
self-report survey commonly used as a generic health
questionnaire for adults. It covers eight health domains, namely,
physical functioning, physical role functioning, bodily pain,
general health perceptions, vitality, social role functioning,
emotional role functioning, and mental health [
questionnaire includes 36 main questions, which contain
several subset questions. These questions are related to the
various domains deliberately nested into the instrument
to ensure that participants carefully read and assess each
question before responding.
State-Trait Anxiety Inventory. The STAI contains two subsets,
which collect subjective data from participants on their state
and trait anxiety in the form of two questionnaires of 20
questions each. These questionnaires are a highly reliable measure
of stress and anxiety. State anxiety (STAI-S) is designed to
assess individuals? reaction to stress and their emotional state
at a particular time, whereas trait anxiety (STAI-T) is related
to individuals? personality traits and their stress perceptions.
The questions require the participants to rank their current
and general feelings toward certain statements among four
options of increasing frequency ranging from ?almost never?
to ?almost always.? Higher STAI scores suggest higher anxiety
28, 44, 45
2.4. Statistical Analysis. The demographic data were
expressed as means and standard deviations. The continuous
data before and after one session of qigong exercise were
compared using the paired -test. The correlations between
the variables were evaluated using the Pearson correlation
test. STATA 11 was used for statistical analysis; < 0.05 was
considered statistically significant.
3.1. Comparisons of Electrical Conductance of Meridians before
and after Qigong Practice. A total of 45 participants (13
men and 32 women; mean age, 65.14 ? 9.38 years) were
recruited in this study. All participants were Asian who live
in Taiwan. More than half of the participants were married
(75.56%). T he mean value of education years was 10.62 ?
4.46 years. The mean values of heart rate before and after
qigong exercise were 73.24 ? 11.77 and 73.20 ? 11.03 bpm
( > 0.05). The electrical conductance of all meridians,
except the spleen and bladder meridians ( > 0.05), increased
significantly ( < 0.05) after one session of qigong exercise.
The mean values of the electrical conductance of 12 meridians
were significantly higher than the baseline values (Table 1).
Compared with the baseline values, the upper to lower
body ratio and sympathetic/vagal index were significantly
improved and close to 1 ( = 0.011 and = 0.007, resp.).
However, no significant differences were observed in the yin
to yang or left to right body balance ( = 0.57 and = 0.26,
resp.; Table 2).
3.2. Comparisons of STAI and SF-36 before and after Qigong
Exercise. The STAI-S and STAI-T scores and the RR intervals
of HRV decreased significantly ( < 0.001, = 0.001, and
= 0.035, resp.). However, HF, LF, normalized HF, and
normalized LF did not differ significantly ( = 0.39, =
0.84, = 0.28, and = 0.43, resp.; Table 3). A signif icant
positive correlation was observed between kidney meridian
electrical conductance and SF-36 physical scores ( = 0.74,
= 0.018; Figure 2(a)). Furthermore, nonsignificant
positive correlations were observed between kidney meridian
electrical conductance and SF-36 total scores ( = 0.30,
= 0.06; Figure 2(b)). A positive relationship was observed
between pericardium meridian electrical conductance and
SF-36 mental scores ( = 0.50, = 0.06) (Figure 3(a)). By
contrast, a negative correlation was observed between
pericardium meridian electrical conductance and STAI-S scores
( = ?0.57, = 0.092; Figure 3(b)).
Qigong is a comprehensive mind-body practice and a
lowcost exercise that has been practiced in China for 7000 years.
Qigong can be performed anywhere at any time. Studies
investigating the sustained benefits of regular qigong practice
have revealed that it prevents bone loss, reduces oxidative
stress, and increases antioxidant enzymes in middle-aged
women and improves quality of life and sleep quality in
elderly people [
]. Moreover, qigong has been
reported to effectively improve balance and strength and
promote physical flexibility in healthy adults [
describes the meridian system as an essential pathway system
and conduit for qi [
]. The core theory of the meridian
system plays a crucial role in various therapies, including
acupuncture, acupressure, moxibustion, tai chi, and qigong.
Major acupuncture points are located on the skin along the 12
main meridian pathways. It is believed that qi is guided and
transferred through a connection from the somatic meridian
to the internal organs as an integrated system [
The application of Meridian Energy Analysis Device
(MEAD) is of high clinical interest not only in the objective
assessment of traditional Chinese medicine but also in
predicting the meridian flow of the corresponding organ.
However, some technical factors can influence skin electrical
impedance, including the size of electrode, the amount of
pressure it place on the skin, the accuracy of the acupoint
?Significant differences between before and after a qigong exercise.
location, environment, and degree of skin moisture [
]. In order to control of the quality of study, the
MEAD machine performed automatic digital calibration
systems every time before taking measurement to help the
operator to exactly control the confounding factors. To avoid
interoperator variability, the MEAD machine was operated
by the same skilled operator, CY Lin, for all participants. T he
environment and degree of skin moisture tried to be in the
same condition as possible as we can. The MEAD usually
indicates constant values in the human body in the absence of
external stimulation, visceral abnormalities, of diseases. It has
been reported by Nakatani that the reproducibility is 93.2% to
support the use of MEAD [
The acute physiological and psychological effects of
qigong exercise on individual meridians are yet to be
reported. After one session of qigong exercise, the electrical
conductance of all meridians, except the spleen and
bladder meridians, increased significantly in the current study.
Our findings are consistent with previous studies, which
have revealed that qigong exercise promotes qi and blood
circulation to increase physical energy and health [
According to TCM, the spleen is responsible for the
transformation and transportation of different substances that are
the foundation of after-birth existence. Spleen functions are
essential in maintaining the digestive power of the body and
transforming food into qi and blood [
]. The spleen in
STAI: state-trait anxiety inventory; SF-36: short form 36; HRV: heart rate variability; HF: high frequency; LF: lower frequency; HF Ln: normalized high
frequency; LF Ln: normalized lower frequency. ?Significant differences between before and after a qigong exercise.
SF-36 physical score
TCM is similar to the gastrointestinal system in conventional
medicine. Age-related selective decline in gut functions, such
as changes in taste, esophageal sphincter motility, gastric
emptying, and neurons of gut transit-related mesenteric
plexus, may result in malnutrition [
]. Furthermore, aging
has been associated with defects in structural and functional
mucosal defense, diminished ability to generate protective
immunity, and increased incidence of inflammation and
oxidative stress; therefore, gastrointestinal disorders occur
more frequently in elderly population [
]. In this study,
two possible reasons why the spleen meridian electrical
conductance did not change significantly are functional
deficiencies in the spleen and the long-term effects of
agerelated gastrointestinal tract states in older adults. In TCM,
the bladder meridian is the longest and largest detox pathway.
It is often associated with disease symptoms caused by
external harmful effects, including cold, wind, fire, dampness,
dryness, and summer heat. Because the bladder meridian is
considered the most exterior meridian, it is the first to be
invaded during external attacks [
]; this means that rapidly
modulating its electrical conductance during qigong exercise
may be difficult.
We observed a significant positive correlation between
kidney meridian electrical conductance and SF-36 physical
scores in this study. In TCM, the kidney is considered the
foundation for good health and vitality. The kidney is the
powerhouse of the body which stores essence (jing) and
is the support system for all aspects of organic life. The
SF-36 mental score
stored essence comprises congenital and acquired essence
and supply reserve energy to any organ. Kidney essence is
the material basis for numerous functional activities and is
responsible for human growth and development and human
]. The kidney also absorbs qi [
]. Based on
the present findings, we hypothesized that many potential
advantages of qigong exercise, such as the enhancement of
physical fitness and strength, can be attributed to elevated
kidney meridian electrical conductance.
Qigong can affect psychological state, influence the
neuroendocrine system, and exert effects on immune cells [
]. T his mind-body training has been reported to improve
immune functions by stimulating the homeostasis of the
sympathetic and parasympathetic nerve systems through
hypothalamic action [
]. Several studies have
investigated the effects of qigong exercise on sleep, distress,
anxiety, and depression [
29, 69, 70
]. In this study, participants
were more comfortable, relaxed, and vigorous after one
session of qigong exercise. The present findings showed a
negative correlation between pericardium meridian electrical
conductance and STAI-S scores and a positive correlation
between pericardium meridian electrical conductance and
SF-36 mental scores. The higher the SF-36 mental scores
indicates the healthier the mental status, while the higher
the STAI -S scores means the higher the anxiety status.
Thus a positive correlation between pericardium meridian
electrical conductance and SF-36 mental scores is consistent
with a negative correlation between pericardium electrical
conductance and STAI -S scores, although nonsignificant. In
TCM, the pericardium is the heart?s protective sack which
is known as a fire-energy organ which protects the heart.
Not only does pericardium provide the heart with physical
protection, its energy also protects the heart from damage
and disruption by excessive emotional energies generated by
the other organs including anger from the liver, fear from the
kidneys, and grief from the lungs. The pericardium meridian
is associated with heart and blood functions. Emotionally,
pericardium energy is related to the loving feelings. Because
the heart is the seat of spiritual or mental activities, the
pericardium meridian is associated with mania and mental
]. Based on the results of the present study, we
hypothesized that decreased anxiety and improved mental
status due to qigong exercise can be attributed to increased
pericardium meridian electrical conductance.
Balanced meridians indicate that an individual is healthy
]. In our study, one session of qigong exercise improved
energy balance between the upper and lower halves of the
body. Moreover, the sympathetic/vagal index was
significantly improved and closer to 1, indicating an improvement
in the autonomic nervous system balance. However, a similar
finding was not observed for HRV. Wu et al. reported that
skin electrical conductance is a useful tool for detecting
subtle noncardiovascular physical responses that may be
more sensitive than HRV in analyzing autonomic responses
. The present findings are consistent with the results of
The present study had some limitations. First, this is a
one-group, pre- and postcomparison study. This study lacked
control group of sham intervention to evaluate the placebo
effect in this study. Second, the participants were older
practitioners; therefore, future studies are suggested to elucidate
the effects of qigong exercise across different age groups.
Third, blood pressure data were not evaluated and thus the
influence of blood pressure on the results was unknown.
Fourth, substantial time has to be invested for learning and
practicing these mind-body techniques. Fifth, to generalize
these findings, further studies using larger sample sizes
and/or different kinds of qigong are required. The present
findings might be generalized only to older populations who
are more health conscious with practicing specific type of
qigong exercise, such as Chinese Bioenergy Qigong.
One session of qigong exercise increased meridian electrical
conductance, reduced anxiety, and improved balance in both
the autonomic nervous system and the body overall. In
conclusion, these findings provide scientific evidence for
the acute physiological and psychological effects of qigong
exercise in older practitioners. According to the results of
this study, Chinese Bioenergy Qigong may be considered
as one of the complementary therapies accompanied with
conventional medicine to treat the patients with autonomic
dysfunction or anxiety. More researches in the future are
encouraged to investigate into the possible effects of Chinese
Bioenergy Qigong on improving various pathological
functions in different population.
STAI: State-Trait Anxiety Inventory
HRV: Heart rate variability
SF-36: Short Form 36
LF: Lower frequency
HF: High frequency
STAI-S: State anxiety
STAI-T: Trait anxiety.
The study was approved by the Clinical Research Ethics
Committee of Show Chwan Memorial Hospital, Taiwan (no.
Informed consent was provided by all participants.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Chun-Yi Lin undertook the literature searches and the data
analyses and was mainly responsible for drafts and revisions
of the manuscript. Tze-Taur Wei, Chen-Chen Wang,
WanChen Chen, and Yu-Min Wang participated in the literature
searches and contributed to data collection of the study.
Song-Yen Tsai contributed to revisions and the final draft
of the manuscript. All authors read and approved the final
T his study was supported by the Show Chwan Memorial
Hospital, Changhua, Taiwan (RA15014).
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