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The Effects of Qigong on Reducing Stress and Anxiety and Enhancing Body–
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Mindfulness (2012) 3:51–59
DOI 10.1007/s12671-011-0080-3
ORIGINAL PAPER
The Effects of Qigong on Reducing Stress and Anxiety
and Enhancing Body–Mind Well-being
Yvonne W. Y. Chow & Allen Dorcas & Andrew M. H. Siu
Published online: 11 October 2011
# Springer Science+Business Media, LLC 2011
Abstract Stress-related comorbid illnesses such as de-
pression, anxiety disorders, hypertension, and heart
disease are responsible for considerable disability world-
wide. Using a combination of psychological and
physiological approaches, the intent of this study was
to investigate whether practicing qigong helps to reduce
stress and anxiety, thus enhancing body–mind well-
being. A randomized controlled clinical trial was
conducted. Thirty-four healthy middle-aged adults par-
ticipated in an 8-week qigong program. Their outcomes
were compared with 31 matched subjects in the wait list
control group. The outcome measures included measures
of mood states (Depression Anxiety Stress Scales–21
(DASS-21)), quality of life (ChQOL), and physiological
measures of stress (salivary cortisol level and blood
pressure). GLM was used to analyze the data of the two
groups collected in the 1st, 4th, 8th, and 12th weeks. In
week 8, the treatment group had significant reduction in
cortisol level and blood pressure when compared with
the control group. In week 12, the qigong group had
significant positive changes in the DASS-21 scales, the
ChQOL scales, cortisol level, and blood pressure when
compared with the control group. In general, the qigong
group enjoyed better quality of life, had more positive
affect, lower cortisol levels and blood pressure than the
Y. W. Y. Chow (*) : A. Dorcas
Department of Applied Social Sciences,
The Hong Kong Polytechnic University,
Hung Hom, Hong Kong
e-mail: yvonne2d@yahoo.com
A. M. H. Siu
Department of Rehabilitation Sciences,
The Hong Kong Polytechnic University,
Hung Hom, Hong Kong
control group. The present findings support that qigong
has a positive effect on reducing stress and anxiety and
enhancing body–mind well-being. In this study, we
restructured a traditional qigong exercise into a systematic
workout structure and demonstrated its positive impact on
mood regulation as illustrated by both psychological and
physiological measures.
Keywords Anxiety . Mindful . Qigong . Stress . Well-being
Introduction
While an optimal level of stress can raise performance,
excessive stress could lead to a whole sequence of
consequences as anxiety, depression, anxiety disorders,
impaired immune system function, and other chronic
diseases such as hypertension, heart disease, and cancer
(Pandya 1988; Stahl and Hauger 1994). It is estimated that
two thirds of visits to the doctors are for stress-related
illnesses and that stress contributes to 50% of all illness in
the USA (U.S. Department of Health and Human Services
2001). About 65 million who suffered from stress problems
spent more than US $370 million a year on stress-related
medications and treatments (Segail 2007). Anxiety and
depression are two common stress-related psychological
illnesses seen in the general medical setting (Olfson et al.
2000; Ormel et al. 1994). In the UK, work-related stress,
depression, and anxiety affected more than 400,000 people
in 2007/2008, with a loss of 13.5 million working days
(Health & Safety Executive 2009). A local investigation
revealed that 23.7% and 40% of Hong Kong people
demonstrated high levels of depression and anxiety,
respectively. These figures were even higher than those of
the USA (U.S. Census Bureau 2005).
52
Insensitivity to symptoms, somatization of illness, and
concerns about social stigma often discourage persons with
emotional disorders from seeking early intervention. Al-
though more than 45% of the respondents experienced high
stress levels and 12% even had suicidal thoughts, only 16%
would seek professional help (The Hong Kong Research
Association 2009). Moreover, drug therapy often requires
good drug compliance and constant monitoring by physi-
cians to enhance its effectiveness. However, side effects,
reduced quality of life, lack of improvement in symptoms,
and concerns about dependency often make sufferers of
anxiety and depression take less than the prescribed dosage
or cease medication prematurely (Croog et al. 1986;
Haslam et al. 2003).
WHO (2001) defined health as “a state of complete
physical, mental and social well-being and not merely the
absence of disease or infirmity” (p. 1). This biopsy-
chosocial model of health emphasizes that physical, social,
and psychological components are intertwining systems and
contribute to body–mind well-being in a synergistic manner
(Engel 1980). Such a concept of wellness bears a
remarkable resemblance to the holistic perspective
employed by alternative therapy. Although there is growing
evidence that demonstrates the positive value of physical
exercise on body–mind well-being (Scully et al. 1998),
public awareness and research attention given to mindful
exercise is much less than aerobic exercises (Fang and
Schinke 2007). Moreover, high-intensity exercise might
discourage the elderly population (Lan et al. 2004), or those
who dislike running and sweating from doing exercise
regularly (Berger and Owen 1988). Therefore, people who
prefer less vigorous activities might be left out in studies of
aerobic exercise. Moreover, stigmatization, somatization,
delayed intervention, and poor drug compliance further
increase the preference of mindful exercises as nonpharma-
cologic, home-based, and easy to use body–mind strategies
to promote wellness, stabilize mood disturbance at an early
stage or to be used as a complementary therapy to
mainstream treatments (Fang and Schinke 2007; Lee et al.
2004b). More research efforts are needed to provide
evidence of the effectiveness of mindful exercise in
reducing stress, improving mood, and body–mind well-
being in a holistic manner.
Mindful exercise is a kind of exercise which focuses on
self-awareness and intrapersonal body–mind alignment,
accompanied by low-to-moderate muscular exercise and
nonjudgmental meditation (Forge 2005). It originated from
two ancient oriental exercises: qigong and yoga. Qigong is
an old Chinese exercise for yang sheng (longevity) and bao
jian (health maintenance) with a history of several thousand
years. The three main doctrines of qigong are tiao xin (mind
regulation), tiao shen (body regulation), and tiao xi (breath
regulation). A balanced state of internal qi (vital energy)
Mindfulness (2012) 3:51–59
flow is necessary for optimal physical and emotional health
as well as vitality. It shares the health concept (i.e.,
harmony of yin and yang) and meridians theory of
Traditional Chinese Medicine (TCM). The Chinese pop-
ulations often have great interest in qigong, and it is widely
recognized as a self-help exercise for health, vitality, and
longevity. Nowadays, about 60 million people practice it
daily in China (Cheung et al. 2005). In modern fitness
programs, a proper fitness workout always include progres-
sive warm-up (e.g., stretching) to satisfy individual condi-
tioning levels, the core practices (from low intensity to high
intensity), and a cool down (e.g., calming, restoration)
period. Proper warm-up and cool down periods are
fundamental for a healthy and safe fitness regimen.
However, in ancient Chinese culture, the concept of body-
building exercise is not as systematic as in modern days and
often does not include these stages. Most traditional qigong
styles are rather short, simple, and do not have such a
stepwise progressive structure. Furthermore, the old-
fashioned image of qigong might appear to be less
attractive, less trendy, and not meeting the needs for
modern beauty and body fitness (Tan and Tian 2008).
Qigong has different styles, and the therapeutic effects
might vary. Recent studies have focused on styles like
baduanjin (Griffith et al. 2008; Tsang et al. 2006) and
guolin (Cheung et al. 2005; Jones 2001), but few have
focused on chan mi gong. Chan mi gong is one of the major
qigong styles of the Buddhist tradition and was considered
among the ten most popular forms from the 1980s to the
1990s (Immigration and Refugee Board of Canada 2008). It
stresses the rolling of the spine, where the rhythmic wavy
movements that ripple throughout the body are unique in
the field. Though research efforts have demonstrated its
benefits on promoting physiological health, none measured
stress and mental health (Du et al. 1992; Hong et al. 1990;
Qu and Xu 1992; Wang et al. 1990; Zhang et al. 1990).
These studies were done almost 20 years ago in mainland
China. Therefore, the effects of chan mi gong on the
regulation of mood, in particular stress, anxiety, and quality
of life, to the best of our knowledge, have never been
investigated before. Previous qigong studies have docu-
mented that qigong is effective in reducing stress (He et al.
1999; Lee et al. 2003b; Lee et al. 2000), treating anxiety
and depression (Pavek 1988; Shan et al. 1989), reducing
adrenocorticotropic hormone, cortisol, and aldosterone
levels (Lee et al. 2004a), reducing norepinephrine and
epinephrine (Lee et al. 2003b); improving mood (Lee et al.
2001), and enhancing the immune system (Lee et al.
2003a). Qigong distinguishes itself from other therapies in
terms of its roots in TCM concepts and its emphasis on qi
(vital energy) and yi (intention power), which are regarded
as an effective intervention to manage mood states and
enhance body–mind well-being (Lehrer et al. 2007).
Mindfulness (2012) 3:51–59
Nevertheless, there are some limitations in available
qigong studies. Qigong suggests the holistic view of well-
being lies in the dynamic mind–body–environment interac-
tion rather than specific physiological characteristics.
However, a majority of qigong studies focused on either
physiological health (e.g., blood pressure) or psychological
health conditions (e.g., 36-item Short Form Health Survey
(SF-36)), but not both. They might not be able to provide a
holistic picture of body–mind well-being. Moreover, most
studies recruited patients as subjects, and the results may
not always be applicable to the healthy population (Cheung
et al. 2005; Hui et al. 2006; Tsang et al. 2006). Cortisol
level is a significant indicator of stress level. Few qigong
studies measured plasma cortisol levels (Jones 2001; Lee et
al. 2004a; Lee et al. 2003b); however, the use of needles in
blood sample collection might stimulate stress or anxiety in
the subjects. To the best of our knowledge, we are the first
(i.e., 2009) in qigong studies to use saliva as a means (less
invasive than blood sampling) to detect the cortisol levels.
In addition, follow-up measurement was not commonly
included in previous studies to detect the ongoing effect
after a period of qigong training. Moreover, qualitative
interviews have seldom been conducted to gain a subjective
experience of qigong. Therefore, the subjective experience
of qi has not yet been thoroughly demonstrated. Cohen
(1997) also claimed that de qi (reach the qi) is important in
healing and treatment. Qi, the essence of qigong, a
significant piece of the puzzle, seems missing in the studies
about qigong. In addition, the significance of de qi, gender,
and practice hours are rarely documented in the available
literature.
This study aims to investigate whether practicing qigong
helps to reduce stress and anxiety and thus enhance body–
mind well-being by employing both physiological (e.g.,
cortisol) and psychological (e.g., Depression Anxiety Stress
Scales–21 (DASS-21)) indicators. More specifically, we
aim at evaluating the psychological and physiological
effects by restructuring a traditional school of qigong into
a standardized set of qigong exercises. Qigong is expected
to enhance body–mind well-being and would demonstrate
its effects on outcome variables like blood pressure, heart
rate, cortisol level, stress level, anxiety level, and quality of
life. The secondary aim of this study is, by using interviews
and our newly designed questionnaires, to gain more
information about the individual experience of practicing
qigong and the feeling of qi which is rarely discussed in
previous qigong studies. The results of this study could be
an important addition to the existing literature on the
effectiveness of qigong, which underscores the promotion
of qigong as a self-help early intervention for well-being
from a holistic perspective. This study hypothesized that
after 8 weeks of qigong practice, when compared with the
baseline values, the psychological and physiological well-
53
being of the intervention subjects who practiced qigong
would be better than that of the wait list control group.
Method
Based on a repeated measures design, this study was a
randomized clinical trial of qigong intervention on reducing
stress and anxiety and improving body–mind well-being. In
order to ensure an equal number of female and male
subjects in each group, the 68 eligible subjects were
stratified based on their age and gender and then randomly
allocated into two groups with each having 34 subjects.
General linear model was used for analysis of differences
between intervention and control groups, while accounting
for the changes in outcomes over four repeated measures:
pretest (week 1), midway (week 4), posttest (week 8), and
follow-up (week 12; Figure 1). Per-protocol analysis was
used in which only those subjects (i.e., N=65) who
completed the entire intervention program are counted
towards the final results. Post hoc contrast (Bonferroni)
was used to compare measurements taken at different time
points to identify where the significant changes occurred
substantially over the 12 weeks. Eta squared (η2) was used
to estimate the effect size. In order to increase the
generalizability to the general population, we recruited
healthy adults as our subjects. Among the subjects of the
qigong group, we also did a secondary analysis based on
four pairs of comparisons: (a) between those who could feel
qi and those who could not, (b) between those who
practiced more (home practice hours) and those who
practiced less, (c) between men and women, and (d)
between older subjects and younger subjects.
Subjects
The subjects for this study were recruited by posters,
leaflets, and emails in April 2009. Over four weeks, 132
individuals (89 women, 43 men) showed interest in the
qigong program. Volunteer participants were scheduled for
a meeting with the investigator a week prior to the start of
the qigong class to explain the study and collect their
written consents. Subjects were recruited to participate in
the study if they met the following inclusion criteria: (1)
age 18 years or older, (2) nonsmoker; (3) physically healthy
(e.g., not taking medication for chronic disease), (4)
physically suitable for doing medium-intensity exercise as
assessed by the Physical Activity Readiness Questionnaire
(Thomas et al. 1992), and demonstrated at least a mild
degree of mood disturbance as defined by the range of
scores according to the DASS manual in one or more
domain of DASS (i.e., stress, anxiety, or depression) in the
preliminary screening test. The exclusion criteria were: (1)
54 Mindfulness (2012) 3:51–59

Assessed for eligibility (n = 132) reliability and significant correlations with BDI-II and
(89 women/43 men)
BAI (Brown et al. 1997; Lovibond and Lovibond 1995).
It is suggested that the concept of well-being is closely
Not meeting inclusion criteria
(n = 62) (42 women/20 men) related to the concept of the quality of life (Zikmund,
2003). The Chinese Quality of Life instrument (ChQOL)
Refused to participate (n = 2)
(2 women/0 men) (Leung et al. 2005) is a self-reported five-point scale
questionnaire developed based on the TCM knowledge of
Random allocation into either qigong or control group
matched with age and gender (n = 68) (45 women/23 men) health. It consists of 50 items in three domains (i.e.,
physical, spiritual/vitality, and emotional) which were
treated as the operational definitions indicating the psycho-
Qigong exercise class (n = 34) Waitlist control group (n = 34) logical well-being of our subjects. The psychometric
(22 women/12 men) (23 women/11 men) properties of the ChQOL are good, and it has a good
correlation with the WHOQOL-100 and the SF-36 (Zhao et
al. 2007, 2006).
Assessed in week 1 (n = 34) Assessed in week 1 (n = 34)
(22 women/12 men) (23women/11 men)
Physiological Changes Salivary cortisol concentrations
Drop out (n = 2)
correspond closely to serum cortisol for the determina-
2 women tion of physiologic stress (Riad-Fahmy et al. 1982). The
correlation between saliva and serum was highly signifi-
cant, r=0.89, p<.0001 (Salimetric 2003). Salivary cortisol
Re-assessed in week 4 (n = 34) Re-assessed in week 4 (n = 32)
(22women/12 men) (21women/11 men) was assayed using ELISA kit (Cortisol Correlate-EIA kit,
Assay Designs Inc., USA). The salivary cortisol levels,
blood pressure (systolic and diastolic), and heart rates
Drop out (n = 1)
1 woman were regarded as operational indicators of physiological
well-being.
Re-assessed in week 8 (n = 34) Re-assessed in week 8 (n = 31)
(22 women/12 men) (20 women/11 men) Qualitative Evaluation Qualitative information such as
subjective experience of qi was collected by logbooks and
interviews. The de qi sensations (e.g., tingling, dull ache,
Re-assessed in week 12 (follow-up), Re-assessed in week 12 (follow-up) etc.) induced by needling in acupuncture are mainly at or
short interviews (n = 31) (20 women/11 men)
(n = 34) (22 women/12 men) around the acupuncture points. However, in qigong, the
sensations of qi (e.g., warm, itchy, light, numb, etc.) are not
limited to specific acupoints. The feelings of de qi (reach
Individual in-depth interview the qi) can feel like swollen hands, electric flow (like pins
(n = 2) (1 woman/1 man)
or needles) inside the body, ants crawling on the body, and
soreness (Cheung 2009). We used these feelings as a
Fig. 1 Flowchart of the subjects’ flow
reference to collect information about the qi feelings of the
participants. As per our knowledge, so far, there are no
have used psychiatric drugs during the last 6 months, accredited tools to measure the qi feeling. Therefore, we
(2) pregnant, (3) have chronic illness and need regular designed a chart to collect the subjective qualitative
medication (e.g, heart problem), (4) have learned any experience of qi. The chart also included some Chinese
kind of mindful exercise (e.g., yoga, qigong) and have terms about the psychological feelings of qi, such as inner
been practicing it regularly throughout the last year, and peacefulness (心情恬靜), emptiness (虛空), and unity of
(5) regularly participate in other kinds of sports (e.g., heaven, and man (天人合一) (Ning 1990).
swimming).

Measures Treatment Program

Psychological Well-being The three subscales (i.e., depres-
sion, anxiety, and stress) of the DASS-21 (the simplified
version of DASS-42) were regarded as the operational
definitions which reflected the mood states of the subjects
in our study. The subscales had acceptable test–retest
We restructured the elementary syllabus of chan mi gong
and integrated it with proper warm-up and cool-down
elements into a more modern stepwise structure. The
therapeutic values and safety of our newly designed qigong
protocol were evaluated by a seven-member expert panel
Mindfulness (2012) 3:51–59
including two qigong masters, a TCM practitioner, a
psychiatrist, a rehabilitation specialist, an occupational
therapist, and a psychologist. Each of them has solid
experience in qigong, other kinds of mindful exercise or
physical exercise for body–mind well-being in his/her own
profession. The intervention (qigong) group learnt and
practiced the qigong protocol once every week under the
supervision of the instructor for 8 weeks and continued
with 4 weeks of home practice. Each session lasted around
90 min. A make-up qigong course was given to the wait list
control group after waiting for 12 weeks.
Procedures
Since cortisol level rises to a peak after awakening in the
morning and decreases over the next few hours, data
collection was done in the morning. The subjects were
required to rest for 15–20 min before blood pressure and
heart rate were taken. Then, they were given standardized
questionnaires (e.g., ChQOL) to complete. After that,
salivary samples were collected. The first lot (week 1) of
data was treated as baseline for further comparisons with
the second (week 4) and third lots (week 8) of data. Four
weeks after the 8-week training had finished (i.e., week 12),
in addition to the usual measurements, subjects were also
requested to report their experience about the feeling of qi,
whether they could de qi and their subjective health
changes after practicing the qigong protocol. This was
done with open-ended questions in a self-report question-
naire. Moreover, two subjects were invited for in-depth
individual interviews.
Results
Sixty-eight subjects (45 women, 23 men) with a mean age
of 44.2 (SD=11.03) years (ranged from 21 to 64) met the
selection criteria and participated in our study. After the
subjects were matched based on their age and gender, the
34 matched pairs were randomly allocated to the treatment
and control groups. In the qigong group, there were 22
women and 12 men with a mean age of 43.79 (SD=10.37)
years. Twenty-three women and 11 men with a mean age of
44.66 (SD=11.86) years were assigned to the wait list
control group. Three women in the control group dropped
out in the middle of the program.
Psychological Well-being
There was no significant difference in the baselines of
psychological measures at the beginning. In week 8, the
qigong subjects generally enjoyed better mood states and
quality of life than the waiting subjects as shown by the
55
mean scores over time. A significant time×group interac-
tion effect was found (F[3,187]=3.54, p=.016), but the
main effects were not significant. In week 12, there was a
significant group difference in overall psychological well-
being (F[1,63]=4.26, p=.043, η2 =.063) and mood states (F
[1,63]=6.38, p=.014, η2 =.092). The two groups also
differed substantially in all subscales of quality of life (F
[1,63]=6.04, p=.017, η2 =.088). Over the four repeated
measures (Table 1), the qigong group experienced signifi-
cant decreases in stress and anxiety levels when compared
with the control group, as reflected by significant main
effects on DASS stress subscale (DASS-S) (F[1,63]=5.77,
p=.019) and DASS anxiety subscale (DASS-A) (F[1,63]=
4.72, p=.034). The qigong group also demonstrated better
quality of life than the control group as indicated by
significant main effects on ChQOL spiritual/vitality domain
(ChQOL-S) (F[1,63]=4.23, p=.044), ChQOL emotional
domain (ChQOL-E) (F[1,63]=6.49, p=.013), and ChQOL
overall scale (ChQOL-OA) (F[1,63]=6.04, p=.017). The
differences in the DASS depression subscale (DASS-D)
and ChQOL physical domain (ChQOL-P) between the two
groups did not reach significant level though they were
very close.
Physiological Measures
The t tests results showed that the two groups were only
significantly different on pretest scores of salivary cortisol
level (t[63]=2.82, p=.007) but not for the other physiolog-
ical measures at the beginning. As shown in Table 1, the
significant main effects indicated that the qigong group had
significantly lower systolic (F[1,63]=4.08, p=.048) and
diastolic blood pressure (F[1,63]=4.37, p=.041) than the
wait list control group after 8 weeks of qigong intervention.
The significant main effect (F[1,62]=5.73, p=.020) further
indicated that the qigong group had lower cortisol levels
than the control group. In week 12, with increased
significant levels and effect sizes, the qigong group
experienced lower systolic blood pressure (F[1,63]=6.59,
p=.013), diastolic blood pressure (F[1,63]=4.49, p=.038),
and lower cortisol levels (F[1,62]=15.91, p<.001) than the
control group. However, the group differences on heart rate
were not significant in both week 8 and week 12.
Post Hoc Contrasts
The results of post hoc comparisons indicated that
significant improvements of qigong group subjects mainly
started in midway (week 4), although a decrease in stress
level (DASS-S), as well as improvements in ChQOL-P and
ChQOL-OA appeared earlier (i.e., between week 1 and
week 4). Those who practiced more (daily practice time,
more than 25.63 min) experienced lower heart rates (F
 56

Table 1 Comparison of treatment effects between qigong group and wait list control group over repeated assessments

Outcome Qigong groupa Wait list control groupb Between group comparisons
measures
M (SD) M (SD) Week 1 to week 8 Week 1 to week 12

Week 1 Week 4 Week 8 Week 12 Week 1 Week 4 Week 8 Week 12 F p η2 F p η2

DASS-S 16.65 (3.87) 13.41 (5.15) 11.76 (4.11) 9.18 (4.95) 17.03 (4.09) 15.13 (6.69) 15.35 (5.57) 13.94 (5.92) 3.12 .082 – 5.77* .019 .084
DASS-A 8.24 (6.53) 6.88 (4.88) 4.71 (3.65) 4.18 (3.24) 9.10 (6.87) 8.32 (6.79) 8.26 (6.63) 9.29 (7.02) 2.19 .144 – 4.72* .034 .070
DASS-D 6.29 (5.33) 5.12 (6.23) 2.94 (3.69) 2.47 (3.38) 6.97 (5.93) 6.19 (6.27) 6.45 (6.36) 6.65 (6.40) 1.88 .175 – 3.91 .053 .058
ChQOL-P 57.59 (13.42) 61.70 (11.61) 65.09 (9.77) 66.91 (10.26) 58.15 (12.39) 57.31 (14.09) 56.22 (17.15) 55.74 (16.76) 1.93 .169 – 3.83 .053 .058
ChQOL-S 58.63 (16.00) 63.59 (14.28) 65.60 (14.37) 69.55 (14.97) 57.11 (14.78) 57.15 (14.64) 57.16 (18.36) 55.94 (21.31) 2.45 .122 – 4.23* .044 .063
ChQOL-E 63.17 (15.69) 67.84 (13.18) 71.97 (10.29) 75.38 (10.67) 60.93 (12.76) 60.66 (16.78) 62.65 (16.12) 61.46 (17.98) 3.71 .059 – 6.49** .013 .093
ChQOL-OA 59.79 (12.68) 63.38 (10.89) 67.55 (9.12) 70.62 (9.88) 58.73 (11.41) 58.38 (13.41) 58.68 (15.90) 57.71 (17.65) 3.44 .068 – 6.04* .017 .088
Cortisolc 3,270.25 (1,000.19) 3,200.47 (868.07) 2,656.01 (898.28) 2,088.80 (879.90) 2,571.06 (1,000.29) 2,739.34 (1,323.52) 2,636.05 (1,163.26) 2,699.51 (1,122.84) 5.73* .020 .085 15.91** <.001 .204
Sys BP 108.28 (11.04) 106.54 (11.42) 105.28 (9.84) 101.75 (10.21) 112.13 (9.99) 111.39 (11.51) 111.08 (10.39) 111.00 (11.35) 4.08* .048 .061 6.59* .013 .095
Dia BP 73.06 (9.01) 69.69 (8.62) 70.79 (7.86) 69.79 (7.97) 76.56 (7.81) 73.95 (7.15) 73.81 (5.74) 73.06 (7.04) 4.37* .041 .065 4.49* .038 .067
Heart rate 68.21 (7.34) 71.96 (7.12) 71.67 (6.75) 69.87 (5.94) 67.65 (7.17) 68.27 (10.38) 68.35 (7.92) 72.13 (7.81) 2.05 .158 – 0.61 .441 –

DASS-S Depression Anxiety Stress Scales-stress subscale, DASS-A Depression Anxiety Stress Scales–anxiety subscale, DASS-D Depression Anxiety Stress Scales–depression subscale, ChQOL-P
Chinese Quality of Life–physical domain, ChQOL-S Chinese Quality of Life–spiritual/vitality domain, ChQOL-E Chinese Quality of Life–emotional domain, ChQOL-OA Chinese Quality of Life–
overall scale, Cortisol salivary cortisol, Sys BP systolic blood pressure, Dia BP diastolic blood pressure, – effect sizes (η2 ) of nonsignificant F values were omitted
a
n=34
b
n=31
c
Week 1 (pretest) was used as covariate to equate the baselines
* p<0.05; ** p<0.01
Mindfulness (2012) 3:51–59
Mindfulness (2012) 3:51–59
[1,32]=5.20, p=.029, η2 =.140) than the less practice
subjects (daily practice time, 25.63 min or less). The
female subjects appeared to benefit more from qigong
training than the males in terms of systolic (F[1,31]=6.04
p=.020, η2 =.163) and diastolic blood pressure (F[1,31]=
5.72 p=.023, η2 =.152). No significant difference was
found between older (above 44.5 years old) and younger
(44.5 years old or less) qigong subjects.
Qualitative Interviews
The findings from the interviews indicated that after qigong
training, a majority (about 97%) of the qigong trainees
found that they experienced emotional relief, and a more
relaxed mind with reduced stress (over 90%), anxiety (over
80%), and depressive mood (about 80%). Physically, most
of them (about 88%) generally agreed that they were more
energetic and less tired after our 8-week qigong training.
Regarding the feelings of qi, the most commonly
reported bodily feelings included warmth, heat, numbness,
swelling, and qi flow inside the body. The feelings were
more obvious in the dantian, abdomen, center of palms,
face, and some said the whole body. The mental sentiments
reported by the subjects included inner peacefulness, inner
happiness, and feeling of xing fu (felicity). A secondary
data analysis showed that those who de qi had lower stress
levels (F [1,16]=7.33, p=.016, η2 =.314) and heart rate
(F [1,16]=5.60, p=.031, η2 =.259) than their counter parts
after 8 weeks of qigong training.
Discussion
The significant changes in physiological outcome measures
replicated the results of those similar clinical trials. The
qigong group reported a lower mean cortisol level (Lee et
al. 2004a) and more reduction in blood pressure (Hui et al.
2006; Lee et al. 2004b) than the control group. Our findings
supported earlier claims that chan mi gong has positive
effects on blood pressure regulation (Zhang et al. 1990).
According to amine and endorphin theories, the en-
hancement of parasympathetic tone and the reduction of
sympathetic activity are manifested by the decrease of
blood pressure, levels of stress hormones (e.g., noradrena-
line, cortisol, etc.), anxiety, and stress levels after short-term
practice of qigong (Jones 2001; Lee et al. 2004a; Lee et al.
2003b). The significant lower blood pressure, cortisol
levels, stress, and anxiety symptoms of our qigong subjects
when compared with the waiting subjects provided some
empirical support for the parasympathetic regulation after
qigong intervention. “Body regulation” requires the partic-
ipant to practice specific qigong movements which help the
regulation of blood circulation and physical functions
57
(Zeng 2004). Our qigong protocol involves a lot of tapping,
stretching, massaging, twisting, and pressuring of the spine,
internal organs, and muscle groups. These actions may
possibly enhance body flexibility and physical health. In
fact, evidence has shown that the unique spinal twisting and
swinging movements in chan mi gong are related to
improvement of blood circulation (Du et al. 1992).
For the psychological effects, results also showed that
the qigong subjects outperformed the waiting subjects in
most psychological outcome measures after 12 weeks of
qigong practice. The results here are in accordance with
other studies which used relatively healthy volunteers and
found that qigong intervention helps increase positive
moods and reduce anxiety and depressiveness (Hu and
Liu 2008; Johansson and Hassmén 2008). The qigong
group here also experienced less stress and a better quality
of life (vitality domain) than the wait list group. Our
findings replicated the results of another longitudinal study
which also employed a group of healthy people as a wait
list control group and matched the two groups before
comparisons (Griffith et al. 2008).
Cognitive behavioral theory suggests that visual imagery
helps athletes to regulate emotions, keep focusing under
pressure, and increase pain tolerance which are essential for
optimal performance. Qigong also requires the person to
clear wandering thoughts and focus on here-and-now visual
imagery (e.g., qi circulation). Moreover, as suggested by
distraction theory, the cognitive-based activity could tem-
porarily distract the subjects from daily stress and worries.
To facilitate achieving the state of ru jing (tranquility) in
“mind regulation,” qigong practitioners commonly use
positive autosuggestions (e.g., relax) which were also
employed in our qigong program. Positive self-
suggestions probably give support and speed up the healing
process. Studies have also shown that practicing qigong
regularly brings improvement in psychological well-being,
relaxation, physical ability, as well as relieving psychoso-
matic and stress-related disorders (Hui et al. 2006; Lee et al.
2000;Yong and Lee 2005). Our findings from the inter-
views indicated that improvements in qi xi (energy and
vitality), moods, flexibility of muscles and joints were
commonly reported by the qigong subjects. Some subjects
further mentioned that there was some relief in their own
specific physical illness (e.g., back pain).
Though we were able to recruit healthy adults as
subjects, a small sample size and a larger number of female
subjects compared to the male subjects could limit the
generalizability of the present findings. Furthermore,
although the qigong protocol was assessed by an expert
panel who believed its therapeutic value, we did not have
an objective assessment tool to measure how far the
subjects could master the exercise. Like other mindful
exercises (e.g., yoga) and some sports (e.g., Karate), the
58
performance of the athlete is commonly assessed by the
experience of the master or coach. It is not common to use
observational instruments to evaluate learning. The effects of
qigong might be discounted if some subjects could not follow
the protocol. Moreover, when interpreting the effectiveness of
the qigong protocol, the possibility of placebo effect (e.g.,
positive expectations of the subjects towards the intervention)
should be noted. Future designs can employ a sham qigong
protocol for comparison, though it is rather difficult to
formulate, for monitoring the placebo effect. Our question-
naire about qi feelings is still in its very preliminary format,
and the information collected was not analyzed by sophis-
ticated statistical calculations. Therefore, the results about de
qi and its significance are subject to further verifications. If
more resources are available, we suggest future studies to
include EEG measurements to detect the brain activities of
de qi state and supplement with a more systematic and
representative tool to capture the invisible qi.
To conclude, the present significant findings imply that
qigong, an original mindful exercise, can meet the increasing
demand of self-help modality for early intervention on
reducing stress and anxiety and achieving body–mind well-
being for the general population. However, a small sample
size, preliminary qi-feeling assessment, etc., might limit the
generalizability of this study. All the same, these do not
discount the uniqueness of this study to reveal the benefits of
qigong, by both psychological and physiological indicators
taken at four measurement times. This study is also unique in
its restructuring of an old-fashioned qigong exercise with a
modern face, in providing new evidence of the psychological
benefits of chan mi gong, in introducing salivary cortisol
measurement in the field, and in investigating the
mysterious qi feelings. Further sophisticated researches
with double-blinded designs and larger samples are
warranted to determine the therapeutic value of qigong
in enhancing mood states and body–mind well-being.
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