Effectiveness of Liu-zi-jue exercise on coronavirus disease 2019 in the patients: a randomized controlled trial

doi:10.19852/j.cnki.jtcm.2022.06.009

Abstract

Abstract:

OBJECTIVE: The aim of this study was to examine the effect of Liu-zi-jue exercise on the respiratory symptoms, quality of life, and mental health of patients with mild coronavirus disease 2019 (COVID-19).

METHODS: A single-center randomized controlled trial was conducted with 104 patients with mild COVID-19. The patients were randomly assigned to the Liu-zi-jue plus conventional therapy group and conventional therapy group. The outcome measures included Modified Borg Dyspnea Scale (MBDS) score, Patient Health Questionnaire-9 (PHQ-9) score, Fatigue Scale-14 (FS-14), respiratory symptoms, and vital signs. Data were collected on the first and sixth days of hospitalization and on the discharge day.

RESULTS: Repeated-measures ANOVA revealed that the whole scales all showed a downward trend in the two groups (all P < 0.05). The results of single-group effect suggested that the whole scale score in the intervention group was significantly lower than that in the control group at the sixth day of hospitalization. Compared with the control group, only the MBDS, expectoration, and FS-14 scores showed significantly lower scores at the discharge day (P < 0.001, P = 0.011, P = 0.002). Comparison within the group showed that all the variables were significantly different at the three time points with a decreasing trend (P < 0.05), except for the PHQ-9 and expectoration scores (P = 0.331, 0.052). All patients' vital signs remained within a stable normal range throughout the hospital stay.

CONCLUSION: The results suggested that Liu-zi-jue exercise as a complementary and alternative therapy showed beneficial effects on improving the symptoms (shortness of breath, fatigue, and cough), quality of life, and mental health of patients with mild COVID-19.

Key words: COVID-19, Liu-zi-jue exercise, respiratory symptom, physical and mental health, randomized controlled trial.

ZHU Qingguang, ZHANG Shuaipan, LI Jingxian, SUN Wuquan, CHENG Wei, ZHAN Chao, CHENG Yanbin, FANG Lei, FANG Min. Effectiveness of Liu-zi-jue exercise on coronavirus disease 2019 in the patients: a randomized controlled trial[J]. Journal of Traditional Chinese Medicine, 2022, 42(6): 997-10053.

Figures/Tables 4

Figure 1 Flow diagram of participant recruitment

Figure 2 Illustration of the six Liu-zi-jue movements

Table 1 Demographic characteristic of patients in the two groups ($\bar{x} \pm s$)

Variables	Control group (n = 37)	Intervention group (n = 37)	P value
Variables	Male/Female	Male/Female	P value
Sex (n)	M: 14, F: 19	M: 19, F: 18	0.242^a
Number of patients with history of illness	9	10	0.790^a
History of circulatory system disease	5	6	0.744^a
History of respiratory diseases	2	1	0.556^a
Age (years)	44.81±14.6	42.35±10	0.401
BMI (kg/m²⁾	21.91±3	21.95±2.22	0.948
T (°C)	36.89±0.55	36.94±0.5	0.676
P (beats/min)	82.81±10.11	81.24±9.32	0.49
R (breaths/min)	20.65±1.78	20.51±1.63	0.734
SBP (mm Hg)	121.73±10.11	121.35±10.38	0.874
DBP (mm Hg)	73.08±11.91	74.03±12.53	0.74
SaO₂(%)	95.95±2.34	96.16±2.4	0.696

Figure 3 Diagram of ANOVA for clinical scales A-C: the intervention group was compared with the control group in the median score of Modified Borg Dyspnea Scale (MBDS) score, the Patient Health Questionnaire-9 (PHQ-9) score and Fatigue Scale-14 (FS-14) at the three time points. D-H: the intervention group was compared with the control group in the median score of respiratory symptoms, including cough, expectoration, dyspnea, chest tightness, and fatigue.

References 44

[1]	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England) 2020; 395: 497-506. DOI URL
[2]	Morens DM, Daszak P, Taubenberger JK. Escaping Pandora’s Box — another novel coronavirus. New Engl J Med 2020; 382: 1293-95
[3]	Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. New Engl J Med 2020; 382: 1177-79. DOI URL
[4]	World Health Organization home page. (2020-5-27), Assessed 2020-10-27, cited 2020-10-13 13:12:00, Available from URL: https://covid19.who.int/.
[5]	Gates B. Responding to Covid-19 — a once-in-a-century pandemic? New Engl J Med 2020; 382: 1677-79. DOI URL
[6]	Hoehl S, Rabenau H, Berger A, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. New Engl J Med 2020; 382: 1278-80. DOI URL
[7]	Xiang Y, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry 2020; 7: 228-9. DOI URL
[8]	Weng H, Yang F, Zhang L, et al. Joint predictive value of cTnI and NT-proBNP on mortality in patients with coronavirus disease 2019: A retrospective research in Wuhan, China. J Transl Intern Med 2021; 9: 177-84. DOI URL
[9]	Jin H, Yang S, Yang F, et al. Elevated resting heart rates are a risk factor for mortality among patients with coronavirus disease 2019 in Wuhan, China. J Transl Intern Med 2021; 9: 285-93. DOI URL
[10]	Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. New Engl J Med 2020; 382: e53. DOI URL
[11]	Jin Y, Cai L, Cheng Z, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Medical Research 2020; 7: 4. DOI URL
[12]	Minodier L, Charrel RN, Ceccaldi P, et al. Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J 2015; 12: 215. DOI PMID
[13]	National Health Commission of the People’s Republic of China home page. (2020-5-4) (Assessed on 2020-5-22), cited 2020-05-19 21:49:00, Available from URL: Http://www.nhc.gov.cn.
[14]	Chen S, Yang J, Yang W, Wang C, Bärnighausen T. COVID-19 control in China during mass population movements at New Year. The Lancet 2020; 395: 764-6. DOI URL
[15]	Divo M, Pinto-Plata V. Role of exercise in testing and in therapy of COPD. Med Clin N Am 2012; 96: 753-66. DOI URL
[16]	Wu WB, Liu XD, Li PJ, Li N, Wang ZW. Effect of Liuzijue Exercise Combined with Elastic Band Resistance Exercise on Patients with COPD: A Randomized Controlled Trial. Evid Based Complement Alternat Med: eCAM 2018; 2018: 2361962.
[17]	Tong H, Liu Y, Zhu Y, Zhang B, Hu J. The therapeutic effects of qigong in patients with chronic obstructive pulmonary disease in the stable stage: a meta-analysis. Bmc Complem Altern M 2019; 19: 239. DOI PMID
[18]	Yeh GY, Wang C, Wayne PM, Phillips R. Tai chi exercise for patients with cardiovascular conditions and risk factors: a systematic review. J Cardiopulm Rehabil Prev 2009; 29: 152-160. DOI URL
[19]	National Health Commission of the People’s Republic of China home page (opens in new tab)Accessed 2020-5-3, cited 2020-03-10 17: 31: 001-3, Available from URL: http://www.nhc.gov.cn.
[20]	Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New Engl J Med 2020. 382:1860.
[21]	Hongli L, Gaiyan L, Gongliang L, Ying Z. Liuzijue Qigong vs traditional breathing training for patients with post-stroke dysarthria complicated with abnormal respiratory control: study protocol of a single center randomized controlled trial. Trials 2018; 19: 335 DOI PMID
[22]	Galloza J, Castillo B, Micheo W. Benefits of Exercise in the Older Population. Phys Med Reh Clin N 2017; 28: 659-69.
[23]	Ijiri N, Kanazawa H, Yoshikawa T, Hirata K. Application of a new parameter in the 6-minute walk test for manifold analysis of exercise capacity in patients with COPD. Int J Chronic Obstr 2014; 9: 1235-40. DOI PMID
[24]	Urtasun M, Daray FM, Teti GL, et al. Validation and calibration of the patient health questionnaire (PHQ-9) in Argentina. BMC Psychiatry 2019; 19: 291. DOI PMID
[25]	Jing M, Lin W, Wang Q, et al. Reliability and Construct Validity of Two Versions of Chalder Fatigue Scale among the General Population in Mainland China. Int J Env Res Pub He 2016; 13: 147. DOI URL
[26]	Chalder T, Berelowitz G, Pawlikowska T, et al. Development of a fatigue scale. J Psychosom Res 1993; 37: 147-53. PMID
[27]	Mok WQ, Wang W, Liaw SY. Vital signs monitoring to detect patient deterioration: An integrative literature review. Int J Nurs Pract 2015; 21 Suppl 2: 91-8. DOI URL
[28]	Li P, Liu J, Lu Y, Liu X, Wang Z, Wu W. Effects of long-term home-based Liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease. Clin Interv Aging 2018; 13: 1391-9. DOI PMID
[29]	Chan JSM, Ho RTH, Chung K, 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: eCAM 2014; 2014: 106048.
[30]	Jahnke R, Larkey L, Rogers C, Etnier J, Lin F. A comprehensive review of health benefits of qigong and tai chi. Am J Health Promot: AJHP 2010; 24: e1-25.
[31]	Yeh GY, Wood MJ, Lorell BH, et al. Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. Am J Med 2004; 117: 541-8. DOI PMID
[32]	Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2020; 8: 247-55.
[33]	Zhu W. Should, and how can, exercise be done during a coronavirus outbreak? An interview with Dr. Jeffrey A. Woods. J Sport Health Sci 2020; 9: 105-7.
[34]	Chan AW, Yu DS, Choi KC. Effects of tai chi qigong on psychosocial well-being among hidden elderly, using elderly neighborhood volunteer approach: a pilot randomized controlled trial. Clin Interv Aging 2017; 12: 85-96. DOI PMID
[35]	Wang C, Chan CLW, Ho RTH, Tsang HWH, Chan CHY, Ng S. The effect of qigong on depressive and anxiety symptoms: a systematic review and meta-analysis of randomized controlled trials. Evidence-based complementary and alternative medicine: eCAM 2013; 2013: 716094.
[36]	Guo L, Kong Z, Zhang Y. Qigong-based therapy for treating adults with major depressive disorder: a Meta-analysis of randomized controlled trials. Int J Env Res Pub He 2019; 16: 826. DOI URL
[37]	Wang CY, Pan RY, Wan XY, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Disease (COVID-19) epidemic among the general population in China. Int J Env Res Pub He 2020; 17: 1-25. DOI URL
[38]	Hall RC, Chapman MJ. The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics. Gen Hosp Psychiat 2008; 30: 446-52. DOI URL
[39]	Van Bortel T, A B, F W, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. B World Health Organ 2016 ; 94(3): 210-214.
[40]	X C, J C, R L, et al. Dao Yin (a.k.a. Qigong): origin, development, potential mechanisms, and clinical applications. Evid Based Complement Alternat Med: eCAM 2019; 2019: 3705120.
[41]	Jones BM. Changes in cytokine production in healthy subjects practicing Guolin Qigong : a pilot study. BMC Complement Altern Med 2001; 1: 8. DOI URL
[42]	Wang CW, Ng SM, Ho RTH, Ziea ETC, Wong VCW, Chan CLW. The effect of qigong exercise on immunity and infections: a systematic review of controlled trials. Am J Chin Med 2012; 40: 1143-56 DOI URL
[43]	Woods JA, Keylock KT, Lowder T, et al. Cardiovascular exercise training extends influenza vaccine seroprotection in sedentary older adults: the immune function intervention trial. J Am Geriatr Soc 2009; 57: 2183-91. DOI PMID
[44]	Yang Y, Verkuilen J, Rosengren KS, et al. Effects of a Taiji and Qigong intervention on the antibody response to influenza vaccine in older adults. Am J Chin Med 2007; 35: 597-607. DOI URL

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