bs_bs_banner Geriatr Gerontol Int 2016; 16: 911 919 ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH Effect of health Baduanjin Qigong for mild to moderate Parkinson s disease Chun-Mei Xiao 1 and Yong-Chang Zhuang 2 1 Department of Health Promotion and Physical Education, Beijing Institute of Graphic Communication, and 2 Department of Wushu, Beijing Sport University, Beijing, China Aim: The present study investigated the effectiveness of Baduanjin Qigong on symptoms related to gait, functional mobility and sleep in Parkinson disease (PD) patients. Methods: A total of 100 patients (age 67.53 ± 8.56 years, range 55 80 years) with mild to moderate PD were randomly assigned to two groups. Participants in the Baduanjin Qigong group (BQG) received a Baduanjin Qigong program, consisting of four 45-min sessions each week and daily walking 30 min for 6 months. Participants in the control group were carried out daily walking for 30 min. Pre- and post-intervention testing was carried out to assess sleep quality, fatigue, functional mobility and gait performance in these participants. Results: After the 6-month Baduanjin Qigong intervention, the BQG showed sleep quality improvements in the Unified Parkinson s Disease Rating Scale score (P = 0.049), Parkinson s Disease Sleep Scale-2 (PDSS-2) total score (P = 0.039), Motor Symptoms at Night (PDSS-2) score (P = 0.039), PD Symptoms at Night (PDSS-2) score (P = 0.029), Disturbed Sleep (PDSS-2) score (P = 0.037). The BQG showing functional mobility capacity greater improvements in the Berg Balance Scale (P = 0.041) and 6-minute walk test (P = 0.042), and greater decrease in the Timed Up & Go (s; P = 0.046). The BQG showing gait function increased in the gait speed (m/s; P = 0.011). However, this was not the case for the control group, which remained at the same level as pretest performance. Conclusions: BQG improved the gait performance, functional mobility and sleep quality in older adults with PD at the 6-month follow up. It is as an alternative home exercise program for older adults in rehabilitation for PD. Geriatr Gerontol Int 2016; 16: 911 919. Keywords: Baduanjin Qigong, functional mobility, gait, Parkinson s disease, sleep, the elder. Introduction Parkinson s disease (PD) is a neurodegenerative disorder of the basal ganglia that affects approximately 1.5% of adults over the age of 65 years. 1 The disease is expressed through a variety of motor and non-motor symptoms. It is generally associated with four primary features of motor impairment. These include tremor, bradykinesia (slowness of movement), rigidity and postural instability. 2 The cardinal motor features of PD combine to create a characteristic gait pattern. This includes reduced arm swing, reduced trunk rotations, Accepted for publication 7 June 2015. Correspondence: Associate professor, Master of Education Lecturer Yong-Chang Zhuang Master of education, Department of Wushu Beijing Sport University, Beijing 100084, China, Email: tiyibu@sina.com. stooped posture, reduced range of motion in the lower extremities, slow gait speed, reduced step size and low ground clearance. 3 Falls are especially dangerous to PD patients because their increased gait and balance difficulties clearly limit functional mobility. Non-motor features of the disease are quite variable, but symptoms commonly experienced include cognitive impairment, depression, apathy, impaired speech, olfactory dysfunction and sleeping disorders. 2 Sleeping disorders impact a large portion of patients, with approximately half suffering from insomnia. 1 Fatigue occurs in up to twothirds of patients, and could also contribute to worsening of motor symptoms. 2 Successful management of these issues is a major focus in the treatment of PD. This holds true for patients with PD, and there is evidence that different forms of exercise and physiotherapy can be effective in some aspects of disease management. 4 Because of the chronic and debilitating 2015 Japan Geriatrics Society doi: 10.1111/ggi.12571 911
C-M Xiao and Y-C Zhuang symptoms of PD, patients often use complementary therapies. 5 It is estimated that one-third of adults in the USA use some form of alternative therapy. This proportion is higher in PD, where approximately 40% of patients use some form of alternative therapy for treatment of PD symptoms. 4 These therapies can include aerobic exercise, strength training, Tai Chi, Qigong, yoga, acupuncture and dance among others. In the regimen of Traditional Chinese Medicine, qigong has long been regarded as a form of mind body intervention, which simultaneously exercises the mind and the body for treating various chronic diseases and promoting a healthy life. 6 As a traditional Chinese health and fitness Qigong exercise routine, Baduanjin[ ] dates back to the Song Dynasty (960 1279). Baduanjin is part of the New Health Qigong Exercise Series compiled and published by the Chinese Health Qigong Association. 7 As a safe aerobic exercise, it features a movement intensity and format in line with the theories of kinetics and physiology. The practice of Baduanjin Qigong consists of the eight excellent movements: Holding the hands high with palms up to regulate the internal organs, posing as an archer shooting both left- and right-handed, holding one arm aloft to regulate the functions of the spleen and stomach, looking backwards to prevent sickness and strain, twisting the head and lower body to relieve stress, moving the hands down the back and legs and touching feet to strengthen the kidneys, thrusting the fists and making the eyes glare to enhance strength, and raising and lowering the heels to cure various diseases. 8 Here, we can see that the Baduanjin Qigong (BQ) exercises had already been formed into a complete healthenhancing routine. The majority of studies regarding balance reported significant improvements as a result of Baduanjin Qigong movement interventions. Comparisons of alternative forms of exercise, including slow run, walking, and stretching programs, showed significant improvements in balance assessments and fall frequency in the Baduanjin groups. 9 This was evident in elderly, sedentary, arthritic, type 2 diabetes and frail populations. 10 In addition to these observed changes, those participating in Baduanjin movements reported significant improvement in fall self-efficacy and reduced fear of falling. 9 Baduanjin appeared to have a significant impact on psychological aspects of quality of life. Interventions led to significant improvements in anxiety, depression and stress including the perceived ability to deal with stressful or novel experiences. 11,12 While 20 people who actively participating in these exercise therapies, showed a significant improvement in quality of sleep. 13 The available data for changes in gait quality in PD populations as a result of meditative movement are limited. The present study aimed to explore the impact of implementing health Qigong Baduanjin as a complementary therapy for patients with PD. Specifically, parameters relating to gait performance, functional mobility, sleep quality and fatigue were investigated in depth. It was hypothesized that after completion of a 6-month intervention, patients would show improvements in gait performance as measured by 3-D gait analysis, and the Berg Balance Scale (BBS), 6-minute walk test (6MW) and Timed Up & Go (TUG) as functional mobility capacity measured, and sleep and fatigue as measured by questionnaires specific to these parameters in PD. Materials and methods This randomized clinical trial provides evidence that 6-month Health qigong Baduanjin exercise was effective in improving health of patients with Parkinson. A total of 100 patients (age 67.53 ± 8.56 years, 55 80 years) with mild to moderate PD were recruited from the Parkinson s Disease and Movement Disorder Center in Beijing. The present study was carried out according to the ethical standards for human experimentation. Participants gave written informed consent to take part in the study, as approved by the ethics review committee of the Beijing Sport University. The participants fulfilling the following criteria were recruited: (i) diagnosis of idiopathic PD; (ii) men and women between the ages of 55 80 years; (iii) Hoehn and Yahr (H&Y) stage I III; 14 (iv) ability to walk unassisted for the required gait tasks; (v) on a stable dose of antiparkinsonism medication for at least 2 weeks before beginning the study; (vi) no prior history of practicing qigong; and (vii) able to follow simple commands and having no uncontrolled chronic diseases. Exclusion criteria included: (i) score of less than 23 on the Mini-Mental State Examination (MMSE); 15 (ii) a history of other neurological, cardiovascular or orthopedic diseases affecting postural stability; (iii) treatment using deep brain stimulation; and (iv) on off motor fluctuation and dyskinesia above grade 3 on the Unified Parkinson s Disease Rating Scale (UPDRS). 16 The participants were randomized into two groups, 50 participants in the Baduanjin Qigong group (BQG) and 50 participants of the control group (CG) to serve as a referent. Design of the experiment This was a randomized controlled trial with singleblinded outcome assessors. The outcomes assessment was administered by blinded assessors, who did not know which treatment arm each participant was assigned to, at three time-points: on admission to the study before randomization, at the time of discharge from the PD rehabilitation program and at 6-month follow up (FU). 912 2015 Japan Geriatrics Society
Health qigong Baduanjin for PD patients Intervention protocols BQG. For the BQG, each patient received four 45-min training sessions on Baduanjin Qigong as led by a trained therapist, together with a home learning package in the format of audiovisual material. The specific form of health qigong chosen in this study was Baduanjin (Fig. 1). 8 It consists of eight distinct movement routines, and each movement routine is repeated six times. Participants were required to coordinate their breathing with the prescribed movements. The whole protocol usually takes 12 15 min to complete at the usual pace. Exercise intensity. Each patient can make the appropriate adjustments to the difficulty of movement when implemented in accordance with the physical condition of each person. Baduanjin Qigong and Tai Chi belongs to a low-intensity physical activity, the mean of the induced maximum heart rates ranges from 43% to 49% of predicted maximum heart rates. 17 Exercise 6-month treatment group. In order to maximize the potential benefits of the training, the minimal dosage of the training protocol that the experts advised was to practice at least once per day and for at least four times in a week up until the 6-month FU. In addition, they were advised to keep daily walking for not less than 30 min up until the 6-month FU, each patient was issued a printed dairy time log. CG. For the CG, each patient was advised to keep daily walking for not less than 30 min up until the 6-month FU, and record using the time log. All participants continued their prescribed medical treatments. Arrangements were made for participants in the BQG and CG to join community activities, such as Putonghua or writing classes, to ensure that all groups consistently attended weekly gatherings. Outcome measures Testing procedure. All testing was carried out after the participants had withdrawn from their antiparkinsonism medication for a minimum of 12 h. This results in a practically defined off state that allows for the assessment of the severity of the underlying unmedicated condition. 18 Participants were assessed the week before initiation of Baduanjin Qigong training and the week after the 6-month training. Participants were tested on medications and at the same time of day for pre- and post-measures. Clinical assessments. Clinical assessments were used to assess the level of disease impairment as well as sleep quality and fatigue. The UPDRS was carried out by an experienced and qualified member of the neurology team to assess the level of impairment as a result of PD. 16 Sleep quality was assessed using the revised Parkinson s Disease Sleep Scale (PDSS-2). This 15-item questionnaire surveys sleep issues related to Motor Symptoms at Night, PD Symptoms at Night and Disturbed Sleep. 19 Fatigue was assessed with the 16-item Parkinson Fatigue Scale (PFS-16). 20 The MMSE was used to assess overall cognitive impairment. 15 Balance was evaluated using the BBS. 21 Mobility was assessed with the TUG. 22 For the TUG, participants carried out five trials of each task, and the results from the five trials were averaged. The 6MW test is commonly used to assess the exercise capacity and the functional status of older adults and patients with severe Figure 1 The Health Baduanjin Qigong. Adaptations for patients with Parkinson s disease. (1) Requires that the postures and approaches fit the requirements and regulations. The physical condition of the practitioners, especially aged and infirm practitioners, should be taken in to account when gauging the intensity of the routines. (2) Breathing method. Natural breathing is recommended for beginners. Deep breathing can be adopted after mastering the basic points, when coordination between movements and breathing is required. (3) Movements should be carried out at a range within one s comfort zone, but a little sense of stretching is required. (4) Allows pauses for rest. (5) Allows choices of routines that the patients feel competent to practice at the start, and gradually upgrade to the full set according to individual progress. Reproduced with permission from the Chinese Health Qigong Association. 2015 Japan Geriatrics Society 913
C-M Xiao and Y-C Zhuang cardiopulmonary diseases. 23 At the beginning of the walk, patients are instructed to walk along the walkway covering as much distance as possible during 6 min. Gait testing was carried out using a six-camera Vicon 512 motion capture system (Vicon Peak, Lake Forest, CA, USA). Three-dimensional trajectory data and video recordings were collected for the gait trails. For the straight task, stride time, stride length, double support time and gait velocity were measured. Additionally, gait variability was assessed using the coefficient of variation (CV; CV = [SD / mean] 100) of stride time and stride length. Participants also completed a Freezing of Gait questionnaire, a six-item self-report questionnaire where each item is answered on a 0 4 scale for a maximum possible score of 24. 13 Higher scores indicate the perception of more freezing. Statistical analysis Data analyses were carried out using the Statistical Package for the Social Sciences (SPSS) version 16.0 (SPSS, Chicago, IL, USA). Student s t-test and Fisher s exact test were used to compare the baseline characteristics of the two groups. To test for differences in group and time interaction, repeated measures ANOVA, followed by post-hoc t-test analysis at FU time-point, were used. To test for group differences in mean change from baseline at the 6-month FU, t-test was used. Results were reported as significant at 0.05, except in post-hoc analysis, where the a values were adjusted accordingly. To preserve the value of randomization, an intentionto-treat analysis was applied in calculating the missing values at other time-points. In the case of withdrawals, data were carried forward. Results A total of 100 patients were approached. Of these, nine, who met the inclusion criteria, agreed to participate and continued with the random allocation (Fig. 2). A response rate of 96% was thus obtained. The total numbers of dropout and loss to FU did not differ significantly between the two groups (i.e. 6.25% for the BQG and 8.33% for the CG). Both the BQG and the CG participants carried out daily walking exercise for not less than 30 min during the 6-month of FU. For the BQG, just 45 patients followed through the Baduanjin qigong practice of not less than one time a day and four times a week by themselves up to the 6-month FU, according to the prescribed protocol. The remaining three withdrew from practice shortly after discharge from the PD rehabilitation program. The main reasons for attrition were disinterest to continue, hospital admissions, and increased motor and non-motor symptoms. There were no significant differences between the BQG and the control group (CG) at baseline on all measures, including age, UPDRS, H&Y, time with PD, fall history, freezing status, MMSE, BBS, TUG (s), 6MW (m), FOG (out of 24), gait speed (m/s), stride length (m), stride time (s), double support (% CG), CV stride length, CV stride time, PDSS-2 total, Motor Symptoms at Night, PD Symptoms at Night, Disturbed Sleep and PFS-16 total (Table 1). Outcome measurements Clinical assessments The findings showed significant group time interactions, with the BQG showing a significant decrease in impairment measured by the UPDRS-III score (P = 0.038), PDSS-2 total score (P = 0.045), Motor Symptoms at Night (PDSS-2) score (P = 0.049), PD Symptoms at Night (PDSS-2) score (P = 0.037) and Disturbed Sleep (PDSS-2) score (P = 0.045), across the 6-month study period when compared with the BQG and CG (see Table 2). After 6 months of Health Qigong Baduanjin exercise, older adults with PD significantly decreased in the UPDRS-III score (P = 0.049), PDSS-2 total score (P = 0.039), Motor Symptoms at Night (PDSS-2) score (P = 0.039), PD Symptoms at Night (PDSS-2) score (P = 0.029) and Disturbed Sleep (PDSS-2) score (P = 0.037). However, this was not the case for the CG, which remained at the same level as pretest performance (Table 2). Functional mobility capacity The findings showed significant group time interactions, with the BQG showing greater improvements in the BBS (P = 0.037) and 6MW (P = 0.045), and greater decrease in the TUG (P = 0.028), across the 6-month study period when compared with the BQG and CG (see Table 2). After 6 months of Health Qigong Baduanjin exercise, older adults with PD significantly increased in the BBS (P = 0.041) and 6MW (P = 0.042), and significantly decreased in the TUG (P = 0.046). However, this was not the case for the CG, which remained at the same level as pretest performance (Table 2). Gait performance The findings showed significant group time interactions, with the BQG showing a significant increase in the gait speed (P = 0.021) across the 6-month study period when compared with the BQG and CG (see Table 2). After 6 months of Health Qigong Baduanjin exercise, older adults with PD significantly increased in gait speed 914 2015 Japan Geriatrics Society
Health qigong Baduanjin for PD patients Assessed for eligibility (n= 100) Excluded (n= 4) Enrollment Refuse to participate, n= 2 Practice QiGong, n= 2 Randomized (n=96) Allocated to Baduanjin Allocated to Conventional Qigong (n= 48) Training (n=48) Allocation Received allocated intervention (n= 47) Received allocated intervention (n=46) Did not received allocated Did not received allocated intervention (n=1) intervention (n= 2) Unidentified, n=1 Hospital admission, n= 1/Die Unidentified, n= 1 Fol low-up Lost to follow-up (n=2) Hospital admission, n= 1 Unidentified reasons, n= 1 Discontinued Intervention (n= 0) Lost to follow-up (n= 2) Hospital admission, n= 1 Discontinued Intervention (n= 1) Complaint poor health Figure 2 Consort flow diagram. Analysis Analyzed (n=45) Analyzed (n=44) (P = 0.011). However, this was not the case for the CG, which remained at the same level as pretest performance (Table 2). Discussion This was an exploratory study designed to determine the efficacy of implementing Baduanjin Qigong as a complementary therapy in mild to moderate PD with the goal of improving sleep quality, fatigue and motor performance in patients. Analysis of measured outcome variables showed that this specific therapy might be significantly beneficial in improving sleep quality and gait performance, and functional mobility. The results support the hypothesis that Baduanjin qigong exercise serves as an alternative home program to produce better improvement in the functional capacity and quality of life in clients with PD at the 6-month FU than the control program, under the condition that the BQG participants complied with the protocol. A major benefit linked to studies involving meditative movement has been the observed improvement in sleep, including overall sleep quality and excessive daytime sleepiness. 30 The current study shows some evidence to further support these findings. In the present study, after 6 months of Health Qigong Baduanjin exercise, overall sleep quality showed a significant improvement, dropping from 29.01 to 15.29 (P = 0.039). Evaluation of the subscales showed a significant decrease in motor symptoms at night (P = 0.039) and in disturbed sleep (P = 0.037) (Table 2). Baduanjin qigong exercise is a process that combines bodily movements with the regulation of the psychological state and the breathing process. It improves the respiratory system, limb strength and flexibility of the joints, and fortifies the nerves, as well as enhancing sleep quality. The result is consistent with LI et al., who reported the potential benefits of Baduanjin qigong as a treatment of insomnia patients with type 2 diabetes. 24 2015 Japan Geriatrics Society 915
C-M Xiao and Y-C Zhuang Table 1 Comparison of baseline characteristics of all randomized cases Control group (n = 48) Baduanjin Qigong group (n = 48) P Age 66.52 (2.13) 68.17 (2.27) 0.989 a Male 70.83% 68.75% 0.715 b Time with PD (years) 6.15 (2.63) 5.45 (3.61) 0.641 a UPDRS Motor Subscale III 26.9 (2.05) 27.4 (2.51) 0.975 a H&Y 2.1 (0.23) 2.2 (0.21) 0.643 a MMSE 27.9 (1.49) 28.08 (1.87) 0.964 a Fallers/non-fallers 71.43 84.62 0.664 b Freezers/non-freezers 65.52 77.78 0.658 b BBS 48.2 (2.02) 47.8 (1.67) 0.998 a TUG (s) 12.1 (1.69) 12.4 (1.77) 0.899 a 6MW (m) 367.4 (27.62) 363.2 (24.47) 0.983 a FOG (out of 24) 7.6 (1.28) 8.1 (1.43) 0.644 a Gait speed (m/s) 0.89 (0.21) 0.87 (0.19) 0.752 a Stride length (m) 1.08 (0.19) 1.09 (0.07) 0.857 a Stride time (s) 1.241 (0.14) 1.238 (0.11) 0.547 a Double support (% GC) 28.49 (6.57) 28.61 (7.10) 0.738 a CV stride length 5.13 (1.39) 5.11 (1.19) 0.829 a CV stride time 4.53 (1.98) 4.54 (2.13) 0.843 a PDSS-2 total 28.89 (10.64) 29.01 (13.42) 0.741 a Motor Symptoms at Night 9.24 (4.74) 9.41 (5.67) 0.845 a (PDSS-2) PD Symptoms at Night 7.31 (5.84) 7.23 (6.14) 0.798 a (PDSS-2) Disturbed Sleep (PDSS-2) 12.72 (4.53) 12.69 (5.41) 0.877 a PFS-16 total 47.44 (15.33) 48.12 (17.24) 0.824 a Numbers in parentheses designate standard error. a Independent sample t-test; b Fisher s exact test. 6MWD, 6-min walk distance; BBS, Berg Balance Scale; BQD, Baduanjin Qigong group; CV stride length, the coefficient of variation (CV = [SD / mean] 100) for stride length; CV stride time, the coefficient of variation (CV = [SD / mean] 100) for stride time; FOG, freezing of gait; CG, the control group; H&Y, Hoehn and Yahr; MMSE, Mini-Mental State Examination; PDSS-2, Revised Parkinson s Disease Sleep Scale; PFS-16, Parkinson s Fatigue Scale; TUG, Timed Up & Go; UPDRS-III, Unified Parkinson s Disease Rating Scale, part III. Changes noted on the UPDRS, BBS, 6MW and TUG could have functional significance. A conservative five-point, or 20%, change on the UPDRS was the clinically relevant cut-off for those in stages I III who had received 6 months of pharmacological treatment. 25 Therefore, the changes we observed approach clinical meaningfulness, with the Baduanjin qigong group reaching the aforementioned clinical cut-off of 3.3 points, significantly decreasing in impairment measured by the UPDRS-III score (P = 0.049). On the BBS, a five-point change is the minimal detectable change for clinical significance in those with parkinsonism, which was matched by our interventions statistically significant 2.5-point increase on the BBS. 26 An 82-m change is the minimal detectable change of the 6MW for those with PD, an estimate that might be high given an extremely large standard deviation. 26 Also, effect sizes of 0.5 0.6 can be considered a clinically substantial change, which correspond to an increase of just 50 m for the 6MW in older adults with moderate motor impairment. 27 Baduanjin qigong increased the 6MW by just 9.4 m for older adults with PD. Furthermore, a 9.4-m improvement in the 6MW is considered a small functionally meaningful change, while statistically significant (P = 0.042). This improvement in 6MW performance could reflect improved balance. On the BBS, the Baduanjin intervention group improved by 5.23%; and on the TUG, the Baduanjin intervention group decreased by 9.68%, across the 6-month Baduanjin Qigong exercise. The result is consistent with Liu et al., who reported that Baduanjin qigong as a treatment of improves balance and reduces the risk of falls in older adults. 9 916 2015 Japan Geriatrics Society
Health qigong Baduanjin for PD patients Table 2 Comparison of mean changes from baseline at 6-month follow up Outcome measure Intervention group Time Intervention time Baseline 6-M FU interaction P-value Mean (SE) Mean (SE) UPDRS-III BQG (n = 45) 27.4 (2.51) 24.3 (3.4)* # 0.049 Control (n = 44) 26.9 (2.05) 28.4 (2.7) 0.079 P value: BQG vs control 0.975 0.038 BBS BQG (n = 45) 47.8 (1.67) 50.3 (0.85)* # 0.041 Control (n = 44) 48.2 (2.02) 47.0 (2.15) 0.957 P-value: BQG vs control 0.998 0.037 TUG (s) BQG (n = 45) 12.4 (1.77) 11.2 (1.7)* # 0.046 Control (n = 44) 12.1 (1.69) 13.1 (3.1) 0.552 P-value: BQG vs control 0.899 0.028 6MWD (m) BQG (n = 45) 363.2 (24.47) 372.6 (19.7)* # 0.042 Control (n = 44) 367.4 (27.62) 365.9 (23.5) 0.689 P-value: BQG vs control 0.983 0.045 FOG (out of 24) BQG (n = 45) 8.1 (1.43) 7.35 (1.43) 0.554 Control (n = 44) 7.6 (1.28) 7.78 (1.51) 0.716 P-value: BQG vs control 0.644 0.597 Gait speed (m/s) BQG (n = 45) 0.87 (0.19) 0.98 (0.23)* # 0.011 Control (n = 44) 0.89 (0.21) 0.90 (0.32) 0.840 P-value: BQG vs control 0.752 0.021 Stride length (m) BQG (n = 45) 1.09 (0.067) 1.10 (0.065) 0.498 Control (n = 44) 1.08 (0.063) 1.08 (0.064) 0.851 P-value: BQG vs control 0.857 0.407 Stride time (s) BQG (n = 45) 1.238 (0.061) 1.218 (0.059) 0.417 Control (n = 44) 1.241 (0.062) 1.237 (0.06) 0.524 P-value: BQG vs control 0.547 0.406 Double support (% GC) BQG (n = 45) 28.61 (7.10) 26.89 (5.68) 0.097 Control (n = 44) 28.49 (6.57) 28.01 (8.23) 0.367 P-value: BQG vs control 0.738 0.085 CV stride length BQG (n = 45) 6.147 (1.19) 5.91 (1.48) 0.821 Control (n = 44) 5.83 (1.39) 5.92 (1.21) 0.656 P-value: BQG vs control 0.829 1.509 CV stride time BQG (n = 45) 4.927 (2.13) 4.844 (1.12) 0.581 Control (n = 44) 4.995 (1.98) 4.85 (1.82) 0.418 P-value: BQG vs control 0.843 0.852 PDSS-2 total BQG (n = 45) 29.01 (13.42) 15.29 (11.18)* # 0.039 Control (n = 44) 28.89 (10.64) 26.76 (9.45) 0.153 P0-value: BQG vs control 0.741 0.045 Motor Symptoms at Night (PDSS-2) BQG (n = 45) 9.41 (5.67) 3.82 (1.96)* # 0.039 Control (n = 44) 9.24 (4.74) 8.49 (4.28) 0.766 P-value: BQG vs control 0.845 0.049 PD Symptoms at Night (PDSS-2) BQG (n = 45) 7.23 (4.14) 3.95 (2.86)* # 0.029 Control (n = 44) 7.31 (5.84) 7.05 (3.23) 0.261 P-value: BQG vs control 0.798 0.037 Disturbed Sleep (PDSS-2) BQG (n = 45) 12.69 (5.41) 8.93 (3.76)* # 0.037 Control (n = 44) 12.72 (4.53) 12.37 (4.18) 0.193 P-value: BQG vs control 0.877 0.045 PFS-16 total BQG (n = 45) 48.12 (7.24) 47.81 (6.72) 0.842 Control (n = 44) 47.44 (5.33) 46.36 (5.82) 0.652 P-value: BQG vs control 0.824 0.526 Numbers in parentheses represent the standard error. *P < 0.05 compared with baseline. **P < 0.01 compared with baseline. # P < 0.05 BQG compared with control after 6 months. ## P < 0.01 Baduanjin Qigong group (BQG) compared with control after 6 months. 6-M FU, 6-month follow up; 6MWD, 6-min walk distance; BBS, Berg Balance Scale; BQD, Baduanjin Qigong group; CV stride length, the coefficient of variation (CV = [SD / mean] 100) for stride length; CV stride time, the coefficient of variation (CV = [SD / mean] 100) for stride time; FOG, freezing of gait; CG, the control group; H&Y, Hoehn and Yahr; MMSE, Mini-Mental State Examination; PDSS-2, Revised Parkinson s Disease Sleep Scale; PFS-16, Parkinson s Fatigue Scale; TUG, Timed Up & Go; UPDRS-III, Unified Parkinson s Disease Rating Scale, part III. 2015 Japan Geriatrics Society 917
C-M Xiao and Y-C Zhuang The specific gait parameters evaluated in the present study were selected because of their strong representation of the changes that occur in PD gait compared with healthy populations, as shown in a number of previous studies. Reduced gait velocity is often considered the primary characteristic of gait in PD, and is typically improved by levodopa. A previous study found patients not taking levodopa medication walked at a speed of 0.902 m/s compared with 0.935 m/s while taking medication, a 3.65% increase. 28 In the current study, postintervention velocity increased from 0.87 m/s to 0.98 m/s, a change of 12.64%. This improvement shows a greater magnitude of change than shown in the study on levodopa. In comparison with other studies of meditative movement, a study of Tai Chi in PD, showed a 14% increase in baseline gait speed as measured by the 50-ft walk test. 29 These findings suggest that there appears to be a benefit in gait velocity from the Baduanjin Qigong intervention in PD. The results of the present study recommend that Baduanjin qigong exercise, as an alternative home exercise program, shows improvement in sleep quality, as well as a number of improvements in gait speed and functional mobility, and quality of life than the conventional management in older adults with PD at the 6-month FU. These results suggest that the specific form of the Baduanjin Qigong exercise that was implemented might provide potential benefits to people with PD. Acknowledgments The authors gratefully acknowledge all of the participants who volunteered their time. Disclosure statement No potential conflicts of interest were disclosed. References 1 Postuma RB, Montplaisir J. 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