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1. Background

The regular practice of Qigong exercise is known to boost the immune system and mediate the inflammatory response [ 24 , 34 ], two factors linked to cancer prognosis. Further, there is preliminary evidence that Qigong practice can influence the repair of telemeres [ 35 ]. Telemeres are chromosome ends, a specialized structure involved in the replication and stability of DNA molecules. Telemere damage has been associated with a poor prognosis for cancer survival [ 36 ]. This collective body of emerging evidence provides a rationale for future, objective, more rigorously controlled evaluations of the benefits of Qigong exercise practice with regards to cancer prevention and management.


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  • The Tradition?

Foundational to modern scientific study validation, there are more than a thousand years of empirical evidence within the practice of Chinese medicine. There may be as many styles and forms of Qigong exercise as there are Qigong masters.

These include many form variations of mind-body exercises and meditations. Descriptions of Qigong exercises that form the basis for many of the modified modern Qigong forms can be found in a English translation of Qigong exercises compiled by a committee of Chinese Qigong experts including Master Gu Daifeng, Dr.

Cao Xizhen, Dr. Wang Ziping, and Master Guo Lin [ 43 ]. A variety of derivative Qigong forms have been employed as research protocols and found to be effective in supportive cancer care [ 21 ]. Guolin Qigong, a form made popular in China as specific for cancer care, is recognized by its stylized walk accentuated by a coordinated arm swing, resultant trunk rotation, and breath regulation. This walking exercise is complemented with basic, intermediate and advanced forms performed as gentle exercise.

Acupressure point stimulation is self-applied as body tapping or drumming or through external Qigong. The comprehensive practice of Guolin Qigong also includes social support and education in nutrition and stress management [ 44 ]. The first level of practice is physical. At its base level, practitioners learn to master a series of postural corrective exercises as well as techniques for self-massage.

Benefits of physical practice include brain activation associated with new learning, balance, strength, neuromotor coordination, postural correctives and visceral stimulation.

Tai Chi and Qi Gong [All 5 Chapters]

On the second level, breathing is integrated within movement patterns or static postures inducing mental calm and a relaxation effect. Again, practice at this level does not provide the full benefit of traditional Qigong practice. It does provide the additional benefit of dynamic progressive relaxation. At the third level, meditative intent Yi cultivates energy. Yi dao, Qi dao. Mindful meditation involves clearing the mind of all distractions letting go and allowing or directing the accumulation, circulation, and storage of energy from our environment into and through our body electric. The following proposes an expanded explanation for mechanisms of action at each progressive level of dynamic exercise practice: physical, physical plus breath regulation to induce relaxation, and mindful or meditative Qigong.

The physical component of dynamic Qigong exercise patterns can be deconstructed as multi-dimensional. On a biomechanical level, many of the exercises serve as postural correctives increasing flexibility and restoring muscular and soft tissue structural balance as well as providing a gentle, regenerative, mechanical stimulation of articular surfaces. General benefits of exercise including benefits to cardiovascular and immune function are also realized.

Most basic Qigong exercises and simplified Tai chi forms can be adapted to activity tolerance for performance in standing, sitting, or lying postures. Dynamic movement patterns of traditional Qigong combine biomechanical effects and self-massage.

Tai chi poses for balance

Self-massage has the potential to stimulate acupuncture points along meridians, open energy gates, and provide visceral massage. Self-massage may be applied directly as gentle circular massage, as body drumming or tapping, and as acupressure e. High frequency, low amplitude vibrations transmitted to vital organs through sustained vocalizations, known as healing sounds [ 46 ], can also be considered a form of self-massage. Other massage techniques include auric massage where the hand strokes the energy field lying adjacent to the limits of the physical body, very much like self-applied Reiki or Therapeutic Touch.

It is widely accepted that stress threatens health. Training in relaxation is commonly used as a stress management strategy. Breath regulation during Qigong exercise induces a calming relaxation response.

Tai chi poses for balance

The relaxation response stimulates the parasympathetic nervous system [ 14 ]. Activation of the vagus nerve slows and deepens respiration, increasing oxygen levels and dilating arteries, thereby lowering cardiovascular resistance and subsequently lowering blood pressure. Additional beneficial effects include improved blood flow to the brain, altering of brain waves associated with a sense of well-being, boosting the immune system, and regulation of blood sugar levels. Meditation is an integral and root component of traditional Qigong exercise practice [ 47 ].

It is known to have a wide range of health benefits [ 48 ]. Qigong experts use a variety of modes of meditation to advance practice and cultivate Qi.

Cultivate Boundless Energy With An Ancient Standing Meditation Called Zhan Zhuang

Qigong instructors traditionally emphasize mindful exercise, encouraging the development of an inner awareness during exercise. Mindfulness is a term often associated with Qigong exercise. Through mindfulness, one develops a heightened sense of inner awareness. One is instructed to focus on breathing and all sensations associated with the exercise being performed, be it quiet posturing or active movement.

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Mindfulness allows one to stay in the moment and to avoid distractions of thought or external stimuli. In addition to stress management and inducing the relaxation effect, mindful meditation has been proven to change brain structure. In an eight-week study of novice practitioners, mindful meditation, learned as part of a stress reduction program, was associated with changes in the gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking [ 49 ]. Two other modes of meditation commonly used in Qigong practice include a emphasis on emptying the mind fully to allow the Qi to flow naturally; and b direction to focus on inward visualization or intentionally directing the flow of the Qi.

Each strategy has utility and Qigong instructors often employ multiple strategies to serve the intended purposes see Table 1 for comparative examples of modes of meditation instruction. Examples of Qigong mediation modes: empty mind vs. Initially, meditative Qigong may best be learned and practiced in static postures: lying, sitting, or standing.

In addition to instruction in mindful dynamic exercise, Qigong practice often includes quiet meditation which may be practiced while lying, sitting or standing. It is only when free, flowing exercise movements are automatic, after many repetitions of practice, that they can be performed in a meditative state.

With the complex movement patterns of traditional Tai chi, this may take many years of practice, if ever achieved. Employing simplified movements and forms, characteristic of Qigong and modified Tai chi, makes the goal of reaching a meditative state during dynamic exercise more attainable.

The Answers Are Within You

Because achieving a meditative state is conceivably more important to the individual with cancer than mastering complex movement patterns and forms, Qigong or modified easy-to-learn Tai chi with a limited number of dynamic postures is considered most appropriate for use with this clinical population. Sometimes what is old is new. While ancient in origin, the practice of acupuncture was only introduced to the West in the s.

Today, it is well known. Similarly, Qigong is ancient, but can be considered as innovative within Western health care. The adoption of health care innovation follows a familiar pattern: empirical interest, the establishment of efficacy, theory validation, service demand and delivery logistics. Given the strength of evidence of effect and advancement on theory validation, we are rapidly moving into service demand and delivery logistics. There are an estimated 15 million cancer survivors in the United States alone [ 59 ], and another estimated 15 million newly-diagnosed cases annually worldwide [ 60 ].

This incidence and prevalence combined with the belief that advances in cancer treatment will increase survivorship, such that many will experience cancer as a chronic illness, establishes the potential of a high service need. The challenges to meeting the adoption of Qigong as a therapeutic intervention within Western integrative oncology are many.

Among these challenges are limited awareness of the benefits of Qigong exercise among the public and health care communities, as well as limited programming availability, lack of consensus on programming structure, and a need to build work force capacity. Public and professional awareness can be raised through education via professional presentation to peers and to the public through media presentations such as the YouTube postings by Dr.

Yang that include an informative video series featuring participants of the program at the Memorial Sloan Kettering Cancer Center [ 61 ]. Dedicated programming for Qigong in cancer care availability to meet a potential future demand is lacking. Chen, University of Maryland, School of Medicine, offers a seven-day, self-healing retreat utilizing a Qigong system designed specifically for managing cancer [ 62 ]. The retreat includes instruction in meditative exercise as well as stress management strategies related to changing how one thinks, perceives, and responds to life experiences.

Wellspring Niagara, an independently funded cancer support service organization affiliated with regional centers across Canada, is an example of community-based program [ 63 ]. It has been offering free Qigong group classes to clients served for over 15 years. However, these resources are the exception rather than the rule. Given that limited availability of qualified Qigong instructors challenges the capacity to meet an expanding service need, the question then arises: how do we plan to meet this need?

There is no single, universally recognized Qigong accrediting body to assure Qigong instructor competence. The National Qigong Association NQA does independently certify Qigong instructors who meet a standard of a minimum of h of qualified instruction. The NQA numbers approximately members from six countries. This is a small number considering the potential need. Free-standing instructor training programs do exist for many Qigong styles. These training courses can be as short as a weekend introduction to a specific form to more comprehensive study over two to three years that generally includes energy medicine theory and therapeutics.

One suggestion as a mechanism to expand the Qigong work force is to consider cross-training exercise and rehabilitation health care professionals. For example, schools of Physical Therapy might enlist Qigong experts to add instruction in Qigong as a therapeutic exercise to entry-level and continuing professional education curricula.

Beyond the actual number of instructors is a question of competence. Existing, entry-level Qigong training may be sufficient for serving healthy or generally healthy aging populations, but training may need to be augmented to meet the specific needs of the clinical population of individuals with cancer. Concurrent with future research of populations addressing prevention and long-term clinical studies assessing cancer-related survival benefit, applied research to establish consensus guidelines for Qigong in cancer care programming structure would serve society.

Such guidelines could assist to assure future programming quality and to guide Qigong instructor training to meet the anticipated future service need in supportive cancer care. While many research questions remain unanswered, there is sufficient evidence supporting the belief that Qigong exercise has a complementary role in supportive cancer care. There are established benefits validating the potential of Qigong practice to improve cancer-related QOL with no known serious side effects.

Qigong practice has been linked to prevention and improved cancer-related mortality rates. Challenges to wide-spread Qigong in cancer care programming adoption include a lack of awareness and general knowledge among the public, health care providers and programming administrators regarding the effectiveness of Qigong in cancer care; b limited availability of existing programming to meet potential need; and c limitations in work force capacity to meet the anticipated expanding demand for dedicated programming.

It is with a true sense of humility that the author honors the many Qigong masters and scholars, past and present, who have advanced the art of Qigong. Gratitude is also offered to the researchers who have chosen to dedicate their professional work to expanding our knowledge of Qigong. National Center for Biotechnology Information , U. Journal List Medicines Basel v.