Evaluation of a Tai Chi Qigong Program in Promoting Physiological and Psychosocial Health Statuses in Chronic Obstructive Pulmonary Disease Clients.

摘要

Background: Incidences of chronic obstructive pulmonary disease (COPD), currently the fourth leading cause of death, continue to increase worldwide. People with COPD may experience a decline in their physical ability, which in turn influences their quality of life. In addition, these physical and psychosocial limitations can increase their need for support from family and friends. Existing medications are mainly used to decrease symptoms, rather than to modify lung functions and improve psychosocial functions. Ideally, clients need to develop skills in disease management in order to improve their health and functional status. COPD clients need to be physically active to reduce the impact of the lung damage, as well as to maintain fitness and reduce disability. Tai chi Qigong (TCQ), a traditional Chinese health-promoting exercise, is believed to be beneficial to the respiratory system. During practice, Tai chi displays a better training effect because of its higher intensity, whereas Qigong enhances breathing efficiency. This study attempts to evaluate the effectiveness of a TCQ program in improving physiological and psychosocial functions in COPD clients.;Method: In this single-blind, randomized controlled trial, 206 COPD clients were recruited from five general outpatient clinics. Subjects were randomly assigned into one of the three groups: TCQ, exercise, or control. Subjects in the TCQ group received a TCQ program consisting of two 60-minute sessions each week for three months. Subjects in the exercise group were taught to practice breathing techniques in combination with walking as an exercise. Subjects in the control group received their usual care. All subjects continued their prescribed medical treatment. Data collections were performed at baseline, six weeks, three months, and six months. The primary outcomes were measured by spirometry, six-minute walk test (6MWT), St. George's respiratory questionnaire (SGRQ), and multidimensional scale of perceived social support (MSPSS) questionnaire. Repeated-measures analyses of covariance were used to examine the differences of outcome measures within groups and between the independent samples.;Results: No significant difference was found in demographic data except in gender (p =.021) as fewer females were in the TCQ group. Confounding effect of gender was controlled as covariate for data analysis. Improvements were seen in lung functions, forced vital capacity (F (5.56, 561.10) = 6.334, P < .001), and forced expiratory volume in one second (F (4.72, 476.61) = 6.356, P < .001) in the TCQ group. No significant changes in lung functions were found in the exercise group, whereas deterioration was observed in the control group. Improvement was also noted in the 6MWT (F (5.25, 530.19) = 7.871, P < .001) of the TCQ group. No significant differences in 6MWT were found in either the exercise group or the control group. For the health-related quality of life assessed by SGRQ, findings revealed significant group and time interactions, with TCQ group showing greater improvement (F (6, 400) = 3.510, P = .002) across the six-month study period compared to the exercise and control groups. For MSPSS, significant improvement in perceived social support from friends was observed in the TCQ group ( F (4.68, 472.47) = 2.338, P = .045). No significant changes were found in the other two groups.;Conclusion: TCQ improved lung function, activity tolerance, and health-related quality of life, as well as perceived social support from friends in COPD clients. This should be included as part of the chronic care model for COPD management.