Problems of scientific methodology related to placebo control in Qigong studies: A systematic review

INTRODUCTION

Qigong is widespread in the West and used for preventive care, stress-induced conditions, emotional and vegetative symptoms like migraine and hypertension, as well as for better coordination in the elderly and quality of life enhancement in severe disease such as cancer. Adequate controls for Qigong research are lacking, compromising the level of efficacy evidence. Adequate Qigong placebo control exercises should match clear and standardized criteria.

METHODS

Three computerized databases were assessed in January 2018 (Scopus, Web of Science and MEDLINE on PubMed) using the following keywords or their combinations: (Qigong OR Qi Gong OR Gong Qi OR Chi Kung OR Kung Chi OR Kiko OR Ki Gong OR Ki Kong) AND placebo. In addition, all reference lists were scanned for further relevant articles. Literature was examined for the effects of Qigong as compared to a control intervention.

RESULTS

110 articles were found, 78 of which were excluded after examining the title and abstract, and 16 because they were duplicates. Four more articles were found by searching in the bibliographies of published papers. A total of 20 studies were included in this systematic review. We found that, to the best of our knowledge, no criteria for placebo controls have been published in peer-reviewed journals so far.

CONCLUSION

Placebo controls should be developed by the usage of vegetative functional assessments such as heart rate variability, thermography, and electrophysiological measurements, thus excluding major vegetative effects of the exercise, as well as by the usage of psychometric tests and other quantitative evaluations.

Qigong Exercises for the Management of Type 2 Diabetes Mellitus

Background: The purpose of this article is to clarify and define medical qigong and to identify an appropriate study design and methodology for a large-scale study looking at the effects of qigong in patients with type 2 diabetes mellitus (T2DM), specifically subject enrollment criteria, selection of the control group and study duration. Methods: A comprehensive literature review of English databases was used to locate articles from 1980-May 2017 involving qigong and T2DM. Control groups, subject criteria and the results of major diabetic markers were reviewed and compared within each study. Definitions of qigong and its differentiation from physical exercise were also considered. Results: After a thorough review, it was found that qigong shows positive effects on T2DM; however, there were inconsistencies in control groups, research subjects and diabetic markers analyzed. It was also discovered that there is a large variation in styles and definitions of qigong. Conclusions: Qigong exercise has shown promising results in clinical experience and in randomized, controlled pilot studies for affecting aspects of T2DM including blood glucose, triglycerides, total cholesterol, weight, BMI and insulin resistance. Due to the inconsistencies in study design and methods and the lack of large-scale studies, further well-designed randomized control trials (RCT) are needed to evaluate the 'vital energy' or qi aspect of internal medical qigong in people who have been diagnosed with T2DM.

Acupuncture Alters Expression of Insulin Signaling Related Molecules and Improves Insulin Resistance in OLETF Rats

To determine effect of acupuncture on insulin resistance in Otsuka Long-Evans Tokushima Fatty (OLETF) rats and to evaluate expression of insulin signaling components. Rats were divided into three groups: Sprague-Dawley (SD) rats, OLETF rats, and acupuncture+OLETF rats. Acupuncture was subcutaneously applied to Neiguan (PC6), Zusanli (ST36), and Sanyinjiao (SP6); in contrast, acupuncture to Shenshu (BL23) was administered perpendicularly. For Neiguan (PC6) and Zusanli (ST36), needles were connected to an electroacupuncture (EA) apparatus. Fasting blood glucose (FPG) was measured by glucose oxidase method. Plasma fasting insulin (FINS) and serum C peptide (C-P) were determined by ELISA. Protein and mRNA expressions of insulin signaling molecules were determined by Western blot and real-time RT-PCR, respectively. OLETF rats exhibit increased levels of FPG, FINS, C-P, and homeostasis model assessment-estimated insulin resistance (HOMA-IR), which were effectively decreased by acupuncture treatment. mRNA expressions of several insulin signaling related molecules IRS1, IRS2, Akt2, aPKCζ, and GLUT4 were decreased in OLETF rats compared to SD controls. Expression of these molecules was restored back to normal levels upon acupuncture administration. PI3K-p85α was increased in OLETF rats; this increase was also reversed by acupuncture treatment. Acupuncture improves insulin resistance in OLETF rats, possibly via regulating expression of key insulin signaling related molecules.

A systematic review of the effectiveness of qigong exercise in cardiac rehabilitation

The objective of this study was to assess evidence for the efficacy and effectiveness of Chinese qigong exercise in rehabilitative programs among cardiac patients. Thirteen databases were searched through to November 2010, and all controlled clinical trials on Chinese qigong exercise among patients with chronic heart diseases were included. For each included study, data was extracted and validity was assessed. Study quality was evaluated and summarized using both the Jadad Scale and the criteria for levels of evidence. Seven randomized controlled trials (RCTs) and one non-randomized controlled clinical trial (CCT) published between 1988 and 2007 met the inclusion criteria. In total, these studies covered 540 patients with various chronic heart diseases including atrial fibrillation, coronary artery disease, myocardial infarct, valve replacement, and ischemic heart disease. Outcome measures emerged in these studies included subjective outcomes such as symptoms and quality of life; and objective outcomes such as blood pressure, ECG findings, and exercise capacity, physical activity, balance, co-ordination, heart rate, and oxygen uptake. Overall, these studies suggest that Chinese qigong exercise seems to be an optimal option for patients with chronic heart diseases who were unable to engage in other forms of physical activity; however, its efficacy and effectiveness in cardiac rehabilitation programs should be further tested.

Scientific publications from mainland China, Taiwan, and Hong Kong in integrative and complementary medicine journals: a ten-year literature survey

Practitioners and researchers from China, the largest user of complementary and alternative medicine (CAM), have been publishing an increasing number of scientific articles in world-famous CAM journals in recent years. However, the status of CAM research in the three major regions of China, the Mainland, Taiwan and Hong Kong has, until now, not been reported. In this study, we compared articles from these three regions published in international CAM journals from 2000 to 2009 using PubMed database and the Journal Citation Reports. The study results showed that the number of published articles from Mainland China increased significantly from 2000 to 2009, particularly since 2005. Meanwhile, the number of published articles from Taiwan also increased, whereas those from Hong Kong remained steady. Clinical trials and randomized controlled trials from Chinese authors both took a small percentage of the total. The impact factors of the journals in which these articles were published suggested similar academic levels whereas the average number of citation of articles from the Mainland was less than those from the other two regions. Journal of Ethnopharmacology, American Journal of Chinese Medicine, Journal of Alternative and Complementary Medicine and Evidence-based Complementary and Alternative Medicine were the most popular journals for Chinese authors.

Qi-gong mind-body therapy and diabetes control. A randomized controlled trial

BACKGROUND

Previous studies have shown that qi-gong, a form of mind-body movement therapy, may be beneficial for people with type 2 diabetes; however, no controlled studies have been conducted to examine the predictors and mediators of qi-gong effects on indicators of diabetes control. This study examined the effects of qi-gong on diabetes control and identified the predictors and mediators of these effects.

DESIGN

RCT.

SETTING/PARTICIPANTS

The study included forty-one participants (16 men and 25 women; aged 41-71 years) with elevated blood glucose levels.

INTERVENTIONS

Participants were randomized to qi-gong intervention or a usual medical care control group. Physical and hematologic measures were assessed at baseline and after 12 weeks.

MAIN OUTCOME MEASURES

The outcomes were indicators of diabetes control (HbA1c, insulin resistance, fasting blood glucose and insulin, and 2-hour blood glucose and insulin) and potential mediators of these (body weight, waist circumference, and leg strength). Data were collected in 2006 and analyzed in 2007 to 2009.

RESULTS

Linear regression analyses showed significant between-group differences in favor of the intervention group in weight (p<0.01); waist circumference (p<0.01); leg strength (p<0.01); HbA1c (p<0.05); insulin resistance (p<0.01); and fasting blood insulin (p<0.01) at 12 weeks. Logistic regression analyses showed that the qi-gong intervention was a significant predictor of reduced weight (odds for decreasing by -2 kg=11.14, p<0.01); waist circumference (by -5 cm=22.50, p<0.01); insulin resistance (by -0.2 unit=3.75, p<0.05); and improved leg strength (odds for increasing by 4 stands in 30 seconds=7.00, p<0.01). The effect of the qi-gong intervention on improved insulin resistance was mediated by reduced weight.

CONCLUSIONS

The qi-gong intervention was associated with improvements in weight, waist circumference, leg strength, and insulin resistance. The mediation analyses highlight the importance of weight reduction in the control of diabetes. TRIAL REGISTRATION #: Australian New Zealand Clinical Trials Registry: ACTRN12607000528459.

Electroacupuncture at the Zusanli (ST-36) Acupoint Induces a Hypoglycemic Effect by Stimulating the Cholinergic Nerve in a Rat Model of Streptozotocine-Induced Insulin-Dependent Diabetes Mellitus

Animal studies have shown that electroacupuncture (EA) at Zusanli (ST-36) and Zhongwan (CV-12) acupoints reduces plasma glucose concentrations in rats with type II diabetes. However, whether EA reduces plasma glucose levels in type I diabetes is still unknown. In this study, we explore the various non-insulin-dependent pathways involved in EA-induced lowering of plasma glucose. Streptozotocin (STZ) (60 mg kg⁻¹, i.v.) was administered via the femoral vein to induce insulin-dependent diabetes in non-adrenalectomized and in adrenalectomomized rats. EA (15 Hz) was applied for 30 min to bilateral ST-36 acupoints after administration of Atropine (0.1 mg kg⁻¹ i.p.), Eserine (0.01 mg kg⁻¹ i.p.), or Hemicholinium-3 (5 μg kg⁻¹ i.p.) in non-adrenalectomized rats. Rats administered acetylcholine (0.01 mg kg⁻¹ i.v.) did not undergo EA. Adrenalectomized rats underwent EA at bilateral ST-36 acupoints without further treatment. Blood samples were drawn from all rats before and after EA to measure changes in plasma glucose levels. Expression of insulin signaling proteins (IRS1, AKT2) in atropine-exposed rats before and after EA was measured by western blot. Atropine and hemicholinium-3 completely blocked the plasma glucose lowering effects of EA, whereas eserine led to a significant hypoglycemic response. In addition, plasma glucose levels after administration of acetylcholine were significantly lower than the fasting glucose levels. In STZ-adrenalectomized rats, EA did not induce a hypoglycemic response. EA stimulated the expression of IRS1 and AKT2 and atropine treatment blocked the EA-induced expression of those insulin signaling proteins. Taken together, EA at the ST-36 acupoint reduces plasma glucose concentrations by stimulating the cholinergic nerves.