Qigong for movement disorders: A systematic review

Parkinson’s disease (PD) or other types of movement disorders occur worldwide in all ethnic groups and socioeconomic classes. Because of the chronic and debilitating symptoms of PD or other types of movement disorders patients often use complementary medicine. One such treatment option is qigong. Qigong is a form of traditional Asian medicine, which incorporates exercise for posture, coordination of different breathing patterns, movement, and meditation. It has been reported that qigong has beneficial effects in improving psychological health, reducing high blood pressure and pain, and modulating neurohormone and immune systems. It, therefore, seems pertinent to evaluate the effectiveness of qigong for movement disorders. The objective of this systematic review is to summarize and critically assess the evidence of qigong for treating movement disorders. Databases systematically searched from their respective inceptions through to March 2008 were: Medline, AMED, British Nursing Index, CINAHL, EMBASE, PsycInfo, Scopus, The Cochrane Library 2008 (Issue 1), 6 Korean Medical Databases (Korean Studies Information, DBPIA, Korea Institute of Science and Technology Information, Research Information Center for Health Database, KoreanMed, and National Assembly Library), 4 Chinese Medical Databases (China Academic Journal, Century Journal Project, China Doctor/ Master Dissertation Full Text DB, and China Proceedings Conference Full Text DB), the Qigong and Energy Medicine Database (Version 7.4, Qigong Institute, Melon Park, CA), and Electronic Japan Science and Technology Information Aggregator. The search phrase used was ‘‘qigong AND (corticobasal degeneration OR dyskinesias (paroxysmal) OR dystonia OR essential tremor OR hereditary spastic paraplegia OR Huntington’s disease OR multiple system atrophy OR myoclonus OR Parkinson’s disease OR progressive supranuclear palsy OR restless legs syndrome OR Rett syndrome OR spasticity OR Sydenham’s Chorea OR tardive dyskinesia OR Tourette’s syndrome OR Wilson disease). ’’ The references in all located articles were manually searched for further relevant articles. All prospective clinical studies related to the effects of qigong on movement disorders were included. No language restrictions were imposed. Dissertations and abstracts were included. Hard copies of all articles were obtained and read in full. A modified Jadad score was used whereby a point was given for blinding if the outcome assessor was blinded. One hundred and forty-seven articles were located (Supplement Table 1 shows the reason for exclusion), of which four were included (see Fig. 1). Of the four included studies (Table 1), one randomized clinical trial (RCT) failed to show qigong to be superior to aerobic exercise in terms of the Unified PD Rating Scale (UPDRS), depression and PD Questionnaires-39 (PDQ-39). Another RCT found no effects of qigong on locomotor ability when compared with tai chi. This study was published only as a proceeding, and hence it had not been formally peer reviewed (it also lacked essential details). Furthermore, these two RCT compared qigong to aerobic exercise or tai chi without demonstrating the effectiveness of the treatment. Whether the findings of no difference compared with aerobic exercise or tai chi reflects equivalence of effect or ineffectiveness is as yet unclear. The third RCT reported effects of qigong adjunct to usual care on the UPDRS III but failed to do on the PDQ when compared with usual care control. However, an add-on treatment provides little information about any specific effects. The remaining study was a nonrandomized clinical trial, which showed superior effects of qigong on severity of PD compared with no treatment. This type of study