Introduction

Qigong is an ancient Chinese health practice with a history spanning thousands of years. It integrates slow, mindful movements, regulated breathing, and meditative awareness to promote the circulation of vital energy, known as “Qi” [1]. Qigong is regarded as both a preventive and a complementary approach to healthcare which enhances physical, mental, and emotional well-being.

Several styles of Qigong exist, each differing in its emphasis on therapeutic, spiritual, or philosophical aspects [1]. Despite these variations, common benefits have been reported including improved muscle strength, flexibility, posture, balance, and motor coordination [2]. Regular practice is also associated with better qi circulation, reduced stress and anxiety, and increased vitality [3,4]. Studies have reported that Qigong may strengthen the immune system, and support better sleep quality and alleviate insomnia [5–8]. In terms of broader health impacts, Qigong has shown potential benefits for cardiovascular [9], respiratory [10] gastrointestinal function [11], improved blood pressure regulation [12], and enhanced overall health [13]. These wide-ranging effects have made Qigong increasingly popular, and adaptations for individuals of different ages and fitness levels have made Qigong accessible [1].

Whilst evidence supporting the efficacy of Qigong continues to amount, thorough evaluations of its implementation in online formats have become increasingly important (particularly as the demand for virtual learning and telehealth services grow).

This study reports the effects of an online Qigong course on participants’ physical, psychological, social, and environmental dimensions of health following three months of regular practice. Additional goals included assessing changes in pain, anxiety, sleep quality, and overall participant satisfaction with the online course.

Materials and Methods

1. Study design

A prospective, longitudinal, exploratory study was conducted to evaluate the impact of a 12-session (24-hour) online Qigong course on the quality of life amongst participants. Baseline data were collected before the first class and after the final class via an online questionnaire. The research protocol was approved by the Ethics Committee of the State University of Campinas (CAAE no.: 77023624.4.0000.5418), and all participants provided informed consent electronically before entering the study.

2. Participants and recruitment

A total of 21 adults aged 18 to 60 years, who were able to read and write, and had at least eight years of formal education, voluntarily enrolled in the course. The course did not exclude any participants based on health status or previous Qigong experience. Recruitment targeted individuals interested in Chinese energy practices or health promotion. Those who attended at least eight of the 12 classes were invited to complete the final online questionnaire.

3. Intervention: Online Qigong course

The course, titled “Qigong for Health Maintenance and Longevity,” consisted of a two-hour session per week over 12 weeks (totaling 24 hours tuition). The classes, taught via Zoom, covered both theoretical and practical components of Qigong including:

3.1. Foundational principles

3.1.1. Energetic anatomy (meridians, Yin-Yang concepts, and the three Dantiens).

3.1.2. Approaches to cleansing and harmonizing the body and environment.

3.2. Physical and energetic exercises

3.2.1. Movements targeting the lungs, kidneys, liver, heart, and spleen.

3.2.2. Techniques to purge toxic energies, tonify organs, and store qi.

3.3. Meditative practices

3.3.1. Breathing methods for relaxation and stress reduction.

3.3.2. Focused attention exercises promoting mental clarity and longevity.

Course materials were shared with participants, and synchronous virtual classes allowed real-time instruction and posture corrections. Students were encouraged to keep their cameras on during practice sessions. The content of the course was primarily derived from translations of a Qigong textbook published in 2014 [1].

4. Data collection instruments

Quality of life was assessed using the World Health Organization Quality of Life Brief Version (WHOQOL-bref) questionnaire [14,15]. This instrument has 26 questions including two global items on overall quality of life and health, plus 24 aspects grouped into four domains of physical, psychological, social relations, and environment. Data were collected at baseline (before the first class) and immediately after the final session (12^th class).

Three supplementary questions were added at baseline and at completion of the Qigong course, each asking participants to rate their intensity of pain, anxiety, and sleep quality, on a numeric scale from 0 to 10 (10 being the worst case scenario). The final section captured participant satisfaction with the course and allowed open-ended comments.

5. Statistical analysis

Descriptive statistics were used to summarize participant characteristics and measure baselines. Pre- and post-course comparisons of WHOQOL-bref domain scores were conducted using the Wilcoxon signed-rank test. Data were analyzed using SPSS Version 21.0. Statistical significance was set at p < 0.05 for all analyses.

Results

All 21 participants completed their initial and final questionnaires. The majority were women (n = 16), and the mean age of the study population was 56.14 years (range 36–71). Over half of the participants had no prior Qigong experience (57.1%). At baseline, 76.2% of the participants reported experiencing bodily pain (e.g., neck, back, knee, joint pain), of which, 47.6% rated their pain severity ≥ 6 (0–10 scale with 10 being the worst imaginable pain).

After three months of online Qigong practice, participants’ overall quality of life score increased by 10.86%, from a mean of 68.44 at baseline to 75.87 post-intervention (p < 0.0001, Figure 1). Improvements were significant in all four WHOQOL-bref domains (Physical domain: 11.49% increase (70.78 to 78.91; p = 0.003); Psychological domain: 9.36% increase (69.13 to 75.40; p = 0.004); Social Relations: 8.72% increase (70.45 to 76.59; p = 0.046); and Environment: 12.76% increase (65.08 to 76.36; p = 0.001). These findings suggested broad benefits of Qigong practice across participants’ physical, mental, and social well-being, as well as a facilitating more positive perception of their living environment. In an itemized breakdown of the WHOQOL-bref components, some of the largest gains were observed in energy levels (+ 12.45%), ability to carry out daily activities (+ 10.60%), quality of sleep and rest (+ 10.23%), self-esteem (+ 9.41%), and body image (+ 11.31%). Transportation satisfaction also showed notable improvement (Supplementary Table 1).

Self-reported ratings on pain, anxiety, and sleep quality showed marked progress when comparing baseline scores and completion scores at three months, but were statistically insignificant (Supplementary Table 2). More than half of the participants moved from moderate or high levels of pain towards the lower end of the scale, and a decrease in the amount of anxiety was observed for most participants. Improvement in sleep quality following completion of the course was 54.7% (ranging between 70% and 100%) relative to their baseline status.

Course adherence was high. There were 90.5% of participants who consistently maintained motivation throughout the 12 sessions, and 95.2% stated that they would recommend the course to others. Open-ended feedback included remarks about significant benefit gained during the course including physical, and mental benefits, more energy, increased focus, and the desire to continue learning Qigong, and sharing it with others. Comments reflected an overall appreciation for integrative health concepts, particularly those grounded in Traditional Chinese Medicine.

Discussion

This 3-month, online Qigong intervention yielded significant improvements in participants’ overall quality of life (+ 10.86%), with notable gains in energy levels, daily functioning, self-esteem, and sleep quality. These results align with existing literature on body-mind practices which are often integrated into the broader framework of Traditional Chinese Medicine which emphasizes preventive care, self-regulation, and holistic well-being [16,17].

In Brazil, the National Policy for Integrative and Complementary Practices in the Unified Health System supports modalities like acupuncture and body-based practices including Qigong [18]. Similar trends in use are observed worldwide. The World Health Organization has reported that more than 100 million Europeans regularly use Traditional and Complementary Medicines [19]. It has been reported that these approaches offer complementary benefits to conventional health systems, whereby integrative medicine could potentially reduce the need for more costly interventions [20].

The findings of this study also reflect previous research linking Qigong practice to reductions in stress, anxiety, and insomnia [3,5,8]. For instance, in a review on sleep quality Ko et al [5] concluded that Qigong could significantly improve sleep quality in adults, although it was noted that there was potential influence of nonspecific effects in some studies reviewed. In a study by Huang et al [8] it was reported that Qigong enhanced sleep and health-related quality of life amongst adult drug users. Although the participants in this current study did not represent that specific clinical population, they demonstrated similar improvements in physical well-being, mental clarity, and sleep quality.

In addition, evidence from psychoneuroimmunology research indicated that Qigong-related therapies can enhance immune function [21]. Systematic reviews and randomized controlled trials further corroborate the benefits in blood pressure regulation, overall well-being, and stress management [22–24]. Whilst this current study lacked a control group it was a prospective, longitudinal, exploratory design and the results add to the growing body of literature on the advantages of Qigong.

The participants’ opinions in this current study reinforced what was previously observed in a systematic review of body practices as integrative medicine [25]. This review assessed the contribution of these practices to the process of reframing the ways of conceiving and dealing with health and illness [24]. Body practice therapy is concerned with people understanding the body as a whole to feel better in their daily lives, and through changes in perception, an individual can face adversities related to the health-disease process with more awareness, greater acceptance, and less suffering [24]. In another study, integrative body practices were promoted as healthcare based on the vitality-energy paradigm (with breathing techniques, relaxation, mental attitude, and mobility), and it was suggested that people should be encouraged to discover their limits and potential of the body [26].

In a study by Contadore et al [27], on the use and policy of use of integrative medicine, it was revealed that there was non-linearity in the number of articles over time. This was reportedly related to the low number of researchers dedicated to the topic, and the lack of specialized centers for conducting research on integrative practices. In addition, scientific validation of integrative medicine practice, and bias in the design of studies does not promote the extensive potential of complementary integrative practices in primary healthcare. More research, with established methodology to reduce bias, is needed.

An interesting observation in this current study was the relative difference in improvement between domains: while participants reported significant enhancement in social relationships (8.72%), it was the smallest gain. This may be partly due to the online, individual nature of participation (each person practiced in their own space) which could limit some aspects afforded to in-person practice and the social bonding this may offer. Conversely, participants’ perception of environment improved the most (12.76%), possibly indicating heightened awareness and satisfaction in one’s immediate surroundings, a factor practice of Qigong often emphasizes through mindful and energetic practices.

Finally, the strong course attendance, positive feedback, and willingness to recommend the program suggested that online Qigong may be feasible and appealing for adults seeking alternative or complementary integrative approaches to health promotion.

Conclusion

Regular online Qigong practice (≥ 8 sessions) over three months was associated with significant improvements in physical, psychological, social, and environmental domains of quality of life. Participants also reported notable reductions in pain, anxiety, and sleep difficulties. High adherence and positive feedback highlighted the viability of virtual instruction for integrative body practices. Although this study did not include a control group, and targeted participants with an interested in Chinese energy practices, the observations underscore the potential of Qigong as a supportive modality for holistic well-being. Future research with a multicenter, randomized controlled design with a larger sample size and is warranted to validate these findings.

Supplementary Materials

Article information

Author Contributions

Conceptualization: MLRS. Methodology: MLRS, MILM. Formal investigation: MLRS, MILM, and EJ. Data analysis: MILM. Writing original draft: MLRS. Writing - review and editing: MLRS, MILM, and EJ.

Conflicts of Interest

The authors have no conflicts of interest to declar.

Funding

None.

Ethical Statement

This study was conducted in compliance with the ethical standards set forth in the Declaration of Helsinki. The research protocol was approved by the Ethics Committee of the State University of Campinas (CAAE no.: 77023624.4.0000.5418). Prior to participation, all individuals received detailed information about the study’s objectives, procedures, potential risks, and benefits. Informed consent was obtained electronically from each participant before they were enrolled in the study.

Data Availability

Figure 1

Quality of life values and dimensions, at the beginning (initial) and at end (final) of the online qigong course.

References

• [1] Johnson JA. The secret teachings of Chinese energetic medicine. International Institute of Medical Qigong Publishing House; 2014. 680 p
• [2] Yang H, Li B, Feng L, Zhang Z, Liu X. Effects of health qigong exercise on upper extremity muscle activity, balance function, and quality of life in stroke patients. Front Neurosci 2023;17:1208554. ArticlePubMedPMC
• [3] Zhang P, Li Z, Yang Q, Zhou J, Ma X. Effects of Taijiquan and Qigong exercises on depression and anxiety levels in patients with substance use disorders: a systematic review and meta-analysis. Sports Med Health Sci 2022;4(2):85−94.ArticlePubMedPMC
• [4] Van Dam K. Individual stress prevention through Qigong. Int J Environ Res Public Health 2020;17(19):7342. ArticlePubMedPMC
• [5] Ko L-H, Hsieh Y-J, Wang M-Y, Hou W-H, Tsai PS. Effects of health qigong on sleep quality: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2022;71:102876. ArticlePubMed
• [6] Kuo C-C, Wang C-C, Chang W-L, Liao T-C, Chen P-E, Tung TH. Clinical effects of Baduanjin Qigong exercise on cancer patients: A systematic review and meta-analysis on randomized controlled trials. Evid Based Complement Alternat Med 2021;2021:6651238. ArticlePubMedPMCPDF
• [7] Oh B, Bae K, Lamoury G, Eade T, Boyle F, Corless B, et al. The effects of tai chi and qigong on immune responses: A systematic review and meta-analysis. Medicines (Basel) 2020;7(7):39. ArticlePubMedPMC
• [8] Huang X, Wang X, Shao Y, Lin A, Zhang Z, Qi H, et al. Effects of health qigong exercise on sleep and life quality in patients with drug abuse. Hong Kong J Occup Ther 2023;36(1):13−9.ArticlePubMedPMCPDF
• [9] Tao S, Li Z. Effects of qigong exercise on cardiovascular risk factors in patients with metabolic syndrome: a systematic review and meta-analysis. Front Physiol 2023;14:1092480. ArticlePubMedPMC
• [10] Xu S, Zhang D, He Q, Ma C, Ye S, Ge L, et al. Efficacy of Liuzijue Qigong in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Complement Ther Med 2022;65:102809. ArticlePubMed
• [11] Yang L-H, Duan P-B, Hou Q-M, Wang XQ. Qigong exercise for patients with gastrointestinal cancer undergoing chemotherapy and at high risk for depression: a randomized clinical trial. J Altern Complement Med 2021;27(9):750−9.ArticlePubMed
• [12] Dong X, Shi Z, Ding M, Yi X. The Effects of Qigong for hypertension: a meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2021;2021:5622631. ArticlePubMedPMCPDF
• [13] Li X, Si H, Chen Y, Li S, Yin N, Wang Z. Effects of fitness qigong and tai chi on middle-aged and elderly patients with type 2 diabetes mellitus. PLoS One 2020;15(12):e0243989. ArticlePubMedPMC
• [14] Fleck M, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica 2000;34(2):178−83. [in Portuguese]PubMed
• [15] Fleck M, Leal O, Louzada S, Xavier M, Chachamovich E, Vieira G, et al. Development of the Portuguese version of the WHO quality of life assessment instrument (WHOQOL-100). Braz J Psychiatry 1999;21(1):19−28. [in Portuguese]ArticlePubMed
• [16] Barros NFd, Siegel P, Simoni Cd. National Policy of Integrative and Complementary Practices in SUS: Steps Toward Pluralism in Health. SciELO Public Health 2007. [in Portuguese] https://bvsms.saude.gov.br/bvs/publicacoes/pnpic_access_expansion_initiative.pdf?utm_source=chatgpt.comArticle
• [17] Sousa IMCd, Bodstein RCdA, Tesser CD, Santos FdAdS, Hortale VA. Integrative and complementary health practices: the supply and production of care in the Unified National Health System and in selected municipalities in Brazil. Cad Saúde Pública 2012;28(11):2143−54.Article
• [18] Cabral MEGdS. Users of bodily practices: quality of life and reasons for seeking integrative and complementary practices. 2015. [in Portuguese]
• [19] Salud OMdl. WHO traditional medicine strategy: 2014–2023. OMS, Ginebra, 2013. [in Portuguese] https://www.who.int/publications/i/item/9789241506096
• [20] Camargo TCdA, Telles SdCC, Souza CTVd. The (re) invention of daily life in aging by corporate and integrative practices: possible choices, responsibilization and self-care. Cad Bras Ter Ocup 2018;26(2):367−80.Article
• [21] Lee MS, Huh HJ, Hong SS, Jang HS, Ryu H, Lee HS, et al. Psychoneuroimmunological effects of Qi-therapy: preliminary study on the changes of level of anxiety, mood, cortisol and melatonin and cellular function of neutrophil and natural killer cells. Stress and Health 2001;17(1):17−24.Article
• [22] Dong X, Bergren S. Qigong among older adults: a global review. Clin Res Trial 2016;2(1):120−44.Article
• [23] Chan JS, Ho RT, Chung K-f, Wang C-w, Yao T-j, Ng S-m, et al. Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness. Evid Based Complement Alternat Med 2014;2014:106048. ArticlePubMedPMCPDF
• [24] Jahnke R, Larkey L, Rogers C, Etnier J, Lin F. A comprehensive review of health benefits of qigong and tai chi. AmJ Health Promot 2010;24(6):e1−25.Article
• [25] de Cesaro Antunes P, Lagranha DM, de Sousa MF, Silva AM, Fraga AB. Systematic review on bodily practices conducted within the perspective of integrative and complementary health practices. Motrivivência 2018;30(55):227−47. [in Portuguese]Article
• [26] Antunes PdC, Fraga AB. Integrative bodily practices: concept proposal for the field of Traditional and Complementary Medicine. Cien Saude Colet 2021;26(9):4217−32. [in Portuguese]ArticlePubMed
• [27] Contatore OA, deBarros NF, Durval MR, daCunha Barrio PCC, Coutinho BD, Santos JA, et al. The use, care and policy of complementary and integrative practices in primary health care. Cien Saude Colet 2015;20(10):3263−73. [in Portuguese]PubMed

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References

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