Featured ArticleEffects of tai chi and Qigong on cognition in neurological disorders: A systematic review and meta-analysis
Author links open overlay panelYuxin Wang MD a 1, Qi Zhang MD b 1, Fei Li MD c, Qi Li MD a, Yi Jin MD dShow more
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Abstract
Objectives
To explore whether tai chi and Qigong can improve cognitive function in patients with neurological disorders.
Methods
The PubMed, Embase, Cochrane Central Register of Controlled Trials, SinoMed Database, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal Database (VIP) databases were searched from inception to December 24, 2021. The methodological quality of the included studies was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions criteria.
Results
This study included 2,754 participants from 40 randomized controlled trials (RCT)s with low to high methodological quality. Analysis of active and non-active comparisons showed significant effects for tai chi/Qigong (P<0.05) on global cognitive function, executive function, memory, visuospatial ability, and cognitive processing speed.
Conclusions
Tai chi and Qigong were effective interventions to improve cognition in patients with Parkinson's disease, stroke, mild cognitive impairment, dementia, and traumatic brain injury; however, no RCTs were performed for other neurological disorders.
Introduction
Neurological disorders affect the brain, behaviors, and cognition; these conditions usually influence the ability to move, learn, and speak, and also present psychological symptoms,1,2 mainly related to deficits in neuromuscular and neurocognitive functions. These deficits lead to complicated problems such as decreased moving capacity, reduced quality of life, restricted ability to learn, memory problems, speech problems, cognitive impairment, and negative emotions, which pose severe challenges to individuals and public health.3 Among the symptoms and progression of various neurological disorders, cognitive impairment is an important symptom, based on its prevalence and incidence.4, 5, 6, 7, 8, 9 These deficits can cause functional decline and limited daily activities.10,11 Moreover, comorbid cognitive impairment and other neurological disorders (e.g., stroke, Parkinson's disease [PD]) are common phenomena that limit patient prognosis and reduce their quality of life, cause depression and anxiety, and even lead to stroke recurrence.9,12,13 Therefore, effective interventions for cognitive impairments are critical. Due to the adverse effects of pharmacological treatment and the lack of expert consensus regarding medication for cognitive impairment,14 an increasing number of non-pharmacological interventions are used to protect against cognitive deficits.
Traditional Chinese exercise (TCE) is an ancient, special, and low-intensity aerobic exercise with the common functions of working out and medical treatment.15 The most popular forms of TCEs are tai chi and Qigong.16 Tai chi focuses on mind-body practice, including slow movements combining hardness and softness, strength training, reaction training, deep breathing, and mediation, whereas Qigong is an exercise based on the theories of traditional Chinese medicine (TCM), including static and dynamic training performance, which focuses on coordinating physical training, breathing exercises and mental states.17,18 Qigong also involves diverse styles such as Baduanjin and Wuqinxi. Tai chi originated from martial arts, whereas Qigong was a health movement. Thus, Qigong more strongly emphasizes internal energy flow compared to tai chi.16 However, tai chi and Qigong share features due to their common roots and are regarded as similar interventions popular for the enhancement of physical and psychological health of older people.19, 20, 21 These exercises are also associated with functional connectivity and nerve growth factor in cognitive improvement.22,23 Tai chi and Qigong are currently used to improve cognitive function in patients with neurological disorders, which may be beneficial in improving the autonomy and quality of life of these patients.
Although some systematic reviews and meta-analyses have indicated the beneficial roles of tai chi and Qigong in patients with stroke, mild cognitive impairment (MCI), PD, and other neurological disorders,19,24,25 whether these exercises are more beneficial than other exercise interventions in improving cognitive function in patients with neurological disorders is unclear. Because few reviews have quantified the effects of tai chi or Qigong on cognition in the population, there is a lack of solid evidence of the benefits of these exercises in improving cognitive performance. A meta-analysis by Song et al. focused on the effects of tai chi or Qigong on depression and quality of life in PD, which reported controversial effects of these interventions on cognition in older adults with PD.19 A review suggested that tai chi had beneficial effects on non-motor symptoms but did not quantify its effects on cognition in stroke.26 A review by Zou et al. reported that mind-body exercises could enhance cognitive abilities but it did not stratify the results based on the type of interventions.27 Cognitive impairment is common among neurological disorders. Therefore, various trials must be synthesized to evaluate the effects of tai chi and Qigong on cognition in individuals with neurological disorders. To our knowledge, no systematic reviews or meta-analyses have evaluated the efficacy of tai chi and Qigong for neurological disorders such as traumatic brain injury (TBI), dementia, or stroke. Therefore, this systematic review and meta-analysis aimed to quantify the effects of tai chi and Qigong on cognitive function in individuals with neurological disorders.
The aims of this review were to identify 1) the effects of tai chi or Qigong on cognitive function in adults with neurological disorders and 2) to provide a reference for cognitive function in patients with comorbid neurological disorders.
Section snippets
Search strategy
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we searched for randomized controlled trials (RCTs) from inception to December 24, 2021, in the PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), SinoMed Database, China National Knowledge Infrastructure (CNKI), Wanfang and China Science and Technology Journal Database (VIP) databases.28 A combination of Medical Subject Headings (MeSH) and text terms (in
Study selection
Fig. 1 shows the process of literature search and study selection. A total of 6,261 records were searched from seven databases and four records from other sources. Three trials were retrieved by screening the reference lists of the included studies and related articles. After removing 1,050 duplicates, 5,126 articles were excluded after screening the titles and abstracts. Subsequently, 85 articles were retrieved, 74 full-text articles were evaluated, and 40 studies were included.
Study characteristics
Table 1 shows
Discussion
To our knowledge, this innovative systematic review of 40 RCTs is the first to evaluate the effects of tai chi or Qigong on cognition in patients with neurological disorders. Our results indicated that tai chi and Qigong can improve global cognitive function in patients with neurological disorders (MCI, dementia, stroke, TBI, and PD). The results also showed the positive effects of tai chi or Qigong on specific cognitive domains, such as executive function, memory, visuospatial ability, and
Conclusion
Tai chi and Qigong can be considered promising interventions for improving global cognitive function, executive function, memory, visuospatial ability, and cognitive processing speed in patients with neurological disorders (PD, stroke, MCI, dementia, and TBI). However, a larger sample size and stronger high-quality trials are required to draw more reliable conclusions regarding the efficacy of tai chi/Qigong on cognition in people with other neurological disorders and make recommendations for
Funding
This review did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Acknowledgment
None
References (86)D.P. Kennedy et al.
The social brain in psychiatric and neurological disorders
Trends Cogn Sci
(2012)
A. Moreno et al.
A systematic review of the use of virtual reality and its effects on cognition in individuals with neurocognitive disorders
Alzheimers Dement (N Y)
(2019)
J. Rodakowski et al.
Non-pharmacological interventions for adults with mild cognitive impairment and early stage dementia: An updated scoping review
Mol Aspects Med
(2015)
L. Ge et al.
Effects of traditional Chinese exercises on the rehabilitation of limb function among stroke patients: A systematic review and meta-analysis
Complement Ther Clin Pract
(2017)
X. Liu et al.
A systematic review and meta-analysis of the effects of Qigong and Tai Chi for depressive symptoms
Complement Ther Med
(2015)
F. Feng et al.
Qigong for the Prevention, Treatment, and Rehabilitation of COVID-19 Infection in Older Adults
Am J Geriatr Psychiatry
(2020)
S.H.W. Chan et al.
The beneficial effects of Qigong on elderly depression
Int Rev Neurobiol
(2019)
R. Song et al.
The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: a systematic review and meta-analysis
Parkinsonism Relat Disord
(2017)
L. Zou et al.
The Beneficial Effects of Mind-Body Exercises for People With Mild Cognitive Impairment: a Systematic Review With Meta-analysis
Arch Phys Med Rehabil
(2019)
S. Moon et al.
Can Qigong improve non-motor symptoms in people with Parkinson's disease - a pilot randomized controlled trial?
ComplementTherapClinPract
(2020)View more references
Cited by (2)
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2023, Biological Research for Nursing
Are tai chi and qigong effective in the treatment of TBI? A systematic review protocol
2023, Frontiers in Aging Neuroscience
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Acknowledgment
None
References (86)D.P. Kennedy et al.
The social brain in psychiatric and neurological disorders
Trends Cogn Sci
(2012)
A. Moreno et al.
A systematic review of the use of virtual reality and its effects on cognition in individuals with neurocognitive disorders
Alzheimers Dement (N Y)
(2019)
J. Rodakowski et al.
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Mol Aspects Med
(2015)
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Effects of traditional Chinese exercises on the rehabilitation of limb function among stroke patients: A systematic review and meta-analysis
Complement Ther Clin Pract
(2017)
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Complement Ther Med
(2015)
F. Feng et al.
Qigong for the Prevention, Treatment, and Rehabilitation of COVID-19 Infection in Older Adults
Am J Geriatr Psychiatry
(2020)
S.H.W. Chan et al.
The beneficial effects of Qigong on elderly depression
Int Rev Neurobiol
(2019)
R. Song et al.
The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: a systematic review and meta-analysis
Parkinsonism Relat Disord
(2017)
L. Zou et al.
The Beneficial Effects of Mind-Body Exercises for People With Mild Cognitive Impairment: a Systematic Review With Meta-analysis
Arch Phys Med Rehabil
(2019)
S. Moon et al.
Can Qigong improve non-motor symptoms in people with Parkinson's disease - a pilot randomized controlled trial?
ComplementTherapClinPract
(2020)View more references
Cited by (2)
Effects of Tai Chi on Lung Function, Exercise Capacity and Psychosocial Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials
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The authors contributed equally to this work and should be considered co-first authors.View full text
© 2022 Elsevier Inc. All rights reserved.
