Qigong (Chi Gong or Chi Kung) is an art of moving qi/chi (vital life energy) through the body, releasing energy blocks, and eliminating causes of illness and imbalance. Hundreds of forms of qigong exercises designed for specific or general health enhancement purposes have been created and practiced [51
]. According to traditional Chinese medicine, good health is the result of free-flowing, well-balanced qi, while sickness or pain, such as arthritis, is the result of a blockage of the qi flow or unbalanced qi in the body [42
Qigong can be divided into internal and external types. Internal qigong refers to individual practices and exercises to achieve optimal dynamic mind-body integration through improved qi circulation such as TC qigong, Baduanjin qigong, and meditation. External qigong involves interaction between a patient and a qigong healer who uses hand movement, acupressure on specific points, focused attention, and/or projection or emission of qi toward the patient's body to improve the flow of qi by breaking qi blockages or removing sick qi, to restore balance of the system, to relieve pain, and/or to cure disease [53
External qigong therapy (EQT) and internal qigong practice may palliate symptoms of arthritis by relaxing diseased tissues and enhancing blood flow to the area [42
]. Increased blood flow leads to more efficient delivery of oxygen, nutrients, pain-killing substances and drugs, as well as more efficient removal of mediators of pain and metabolic waste products that contribute to pain [57
]. There is considerable variability in the EQTs of different schools and practitioners. Some studies in China reported improvement of severe arthritis symptoms by EQTs [42
Three RCT studies evaluating the impact of qigong on management of OA have been reported (). Chen et al. [42
] reported that OA subjects in the EQT group, after receiving 5 to 6 sessions of EQT treatment in 3 weeks by two different healers, demonstrated a greater pain reduction and improvement in functionality (as assessed by WOMAC) than those in the placebo-sham group. It was further found that the beneficial effects of EQT on pain reduction and functionality improvement were sustained 3 months after the intervention, but only in subjects treated by one of the 2 healers (healer 2). Subjects treated by this healer also tended to walk faster than the placebo-sham group, but similar result was not observed in those subjects treated by the other healer (healer 1). There was no difference in range of motion, anxiety or depression scale between the EQT group and the sham-control group, regardless of healers. Subjects treated by healer 2 tended to demonstrate lower negative mood level but not in those treated by healer 1. Apparently, the results of the two qigong healers were not consistent, and outcomes of healer 2 seemed to be more beneficial than healer 1, making the results difficult to interpret. This suggests that the effectiveness of EQT may be provider dependent and underscores the difficulty of EQT research as different qigong healer (master) may possess different level of healing qi power that may result in different outcomes in patients. Even the qi power of the same healer may vary depending on his/her own physical condition at the time of treatment. The basic unresolved issue is quantification of the power of qi that is delivered by the healer and actually received by the patient through physical measurements. Before this issue is resolved, EQT clinical studies will continue to be limited by unquantified intervention.
Effects of Qigong exercise on management of osteoarthritis reported in randomized controlled trials.
In internal qigong, Baduanjin qigong
(translated as the “eight section of brocades”, as it contains 8 fine, delicate, and smooth exercise movements) can be learned easily and is less physically and cognitively demanding than TC [43
was defined as a low-level aerobic exercise that can improve the limbs' range of motion, strength, and general health [43
], while it also contains much stretching and controlled breathing aimed to improve circulation of qi. In a pilot feasibility study by An et al. [43
], subjects with OA reported reduced knee pain and stiffness, and improved physical function in the Baduanjin
group compared to the control group (). In addition, subjects in the Baduanjin
group demonstrated statistically significant improvement in aerobic capacity (assessed by 6-minute walking test) as well as quadriceps strength (assessed by isokinetic strength of the knee extensors) [43
]. However, there was no difference in SF-36 between the Baduanjin
group and the control group ().
TC qigong, another form of internal qigong, is a combination of TC movement with qigong training including incorporating intention into movement and enhancing awareness of breathing [44
]. Basically, TC qigong can be considered as TC focusing on qi and without martial applications. The TC qigong implemented in [44
] consisted of a sequence of 18 movements, performed six times in a fluid and continuous manner, combined with deep abdominal breathing. It was claimed that TC qigong is an easy and safe qigong for patients, because it is simpler and more repetitive than TC, and it is especially suitable for patients with joint problems, as the motion does not impose undue pressure on the pivot joint, such as the waist, knee, and ankles during training [44
]. TC qigong improved physical function (measured by 6-min walking test) and quality of life (measured by SF-36) compared to the waiting list control [44