The effects of Baduanjin exercise on fatigue and quality of life in patients with heart failure: A randomized controlled trial

Baduanjin for ischemic heart failure with mildly reduced/preserved ejection fraction (BEAR Trial): A randomized controlled trial

AIM

While Baduanjin, a traditional Chinese mind-body exercise, has shown potential health benefits, its efficacy in improving outcomes for heart failure patients with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) has not been well documented. We aimed to investigate the adjunctive impact of Baduanjin on exercise capacity and quality of life for HFmrEF/HFpEF.

METHODS

Patients with HFmrEF/HFpEF were enrolled in this multicenter randomized clinical trial. All participants were randomized to conventional cardiac rehabilitation with or without an additional 12-week Baduanjin exercise. The primary endpoint was the distance covered in a 6-min walk test (6MWD), while key secondary outcomes included quality of life measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and cardiopulmonary function including anaerobic threshold (VO2 AT).

RESULTS

A total of 120 patients were enrolled, and 109 completed all session and tests. The mean age of the 120 patients was 60.5 years (SD, 9.21 years), and 23 (19.2%) were women. The Baduanjin group exhibited a 6.14% improvement in 6MWD compared to a 1.32% improvement in the control group (median improvement, 25.0 vs. 5.0 m; p < 0.001) at 12th week. The VO2 AT increased by 25.87% in the Baduanjin group versus 3.94% in the control group (p < 0.001). Quality of life also significantly improved in the Baduanjin group as indicated by MLHFQ score changes (-16.8% vs. -3.99%; p < 0.001).

CONCLUSIONS

Adding Baduanjin to exercise-based cardiac rehabilitation for patients with ischemic HFmrEF or HFpEF are generally safe and could provide significant improvements in exercise capacity and quality of life.

Impact of Different Exercise Modalities on Physical Function and Quality of Life in Patients with Heart Failure

Heart failure, a chronic condition, often manifests with reduced physical function and an overall decline in quality of life. It is considered critical that patients with heart failure recover as soon as possible; exercise training, which includes aerobic exercise, resistance exercise, inspiratory muscle training, traditional mind-body exercise, and combined training, facilitates this. The research progress on the impact of various exercise modalities on the physical function and quality of life of patients with heart failure is systematically reviewed in this article. The objective is to augment the understanding of healthcare personnel regarding the status of implementation and outcomes associated with varied exercise modalities. This endeavor seeks to provide a point of reference for the development of exercise rehabilitation programs tailored to individuals contending with heart failure.

Exercise-based cardiac rehabilitation for adults with heart failure

BACKGROUND

People with heart failure experience substantial disease burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous 2018 Cochrane review reported that exercise-based cardiac rehabilitation (ExCR) compared to no exercise control shows improvement in HRQoL and hospital admission amongst people with heart failure, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane review include the following: (1) most trials were undertaken in patients with heart failure with reduced (< 45%) ejection fraction (HFrEF), and women, older people, and those with heart failure with preserved (≥ 45%) ejection fraction (HFpEF) were under-represented; and (2) most trials were undertaken in a hospital or centre-based setting.

OBJECTIVES

To assess the effects of ExCR on mortality, hospital admission, and health-related quality of life of adults with heart failure.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science without language restriction on 13 December 2021. We also checked the bibliographies of included studies, identified relevant systematic reviews, and two clinical trials registers.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared ExCR interventions (either exercise only or exercise as part of a comprehensive cardiac rehabilitation) with a follow-up of six months or longer versus a no-exercise control (e.g. usual medical care). The study population comprised adults (≥ 18 years) with heart failure - either HFrEF or HFpEF.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were all-cause mortality, mortality due to heart failure, all-cause hospital admissions, heart failure-related hospital admissions, and HRQoL. Secondary outcomes were costs and cost-effectiveness. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We included 60 trials (8728 participants) with a median of six months' follow-up. For this latest update, we identified 16 new trials (2945 new participants), in addition to the previously identified 44 trials (5783 existing participants). Although the existing evidence base predominantly includes patients with HFrEF, with New York Heart Association (NYHA) classes II and III receiving centre-based ExCR programmes, a growing body of trials includes patients with HFpEF with ExCR undertaken in a home-based setting. All included trials employed a usual care comparator with a formal no-exercise intervention as well as a wide range of active comparators, such as education, psychological intervention, or medical management. The overall risk of bias in the included trials was low or unclear, and we mostly downgraded the certainty of evidence of outcomes upon GRADE assessment. There was no evidence of a difference in the short term (up to 12 months' follow-up) in the pooled risk of all-cause mortality when comparing ExCR versus usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.71 to 1.21; absolute effects 5.0% versus 5.8%; 34 trials, 36 comparisons, 3941 participants; low-certainty evidence). Only a few trials reported information on whether participants died due to heart failure. Participation in ExCR versus usual care likely reduced the risk of all-cause hospital admissions (RR 0.69, 95% CI 0.56 to 0.86; absolute effects 15.9% versus 23.8%; 23 trials, 24 comparisons, 2283 participants; moderate-certainty evidence) and heart failure-related hospital admissions (RR 0.82, 95% CI 0.49 to 1.35; absolute effects 5.6% versus 6.4%; 10 trials; 10 comparisons, 911 participants; moderate-certainty evidence) in the short term. Participation in ExCR likely improved short-term HRQoL as measured by the Minnesota Living with Heart Failure (MLWHF) questionnaire (lower scores indicate better HRQoL and a difference of 5 points or more indicates clinical importance; mean difference (MD) -7.39 points, 95% CI -10.30 to -4.77; 21 trials, 22 comparisons, 2699 participants; moderate-certainty evidence). When pooling HRQoL data measured by any questionnaire/scale, we found that ExCR may improve HRQoL in the short term, but the evidence is very uncertain (33 trials, 37 comparisons, 4769 participants; standardised mean difference (SMD) -0.52, 95% CI -0.70 to -0.34; very-low certainty evidence). ExCR effects appeared to be consistent across different models of ExCR delivery: centre- versus home-based, exercise dose, exercise only versus comprehensive programmes, and aerobic training alone versus aerobic plus resistance programmes.

AUTHORS' CONCLUSIONS

This updated Cochrane review provides additional randomised evidence (16 trials) to support the conclusions of the previous 2018 version of the review. Compared to no exercise control, whilst there was no evidence of a difference in all-cause mortality in people with heart failure, ExCR participation likely reduces the risk of all-cause hospital admissions and heart failure-related hospital admissions, and may result in important improvements in HRQoL. Importantly, this updated review provides additional evidence supporting the use of alternative modes of ExCR delivery, including home-based and digitally-supported programmes. Future ExCR trials need to focus on the recruitment of traditionally less represented heart failure patient groups including older patients, women, and those with HFpEF.

The Effect of Benson's Relaxation Technique on Fatigue and Quality of Life of Patients Diagnosed With Heart Failure

Patients with heart failure (HF) reported poor quality of life (QOL) due to different reasons among which fatigue is the most important. Improving QOL is a crucial objective for patients with HF and their primary health care providers. Managing fatigue with medication is not enough. Benson's relaxation technique (BRT) is a complementary therapy used to manage fatigue among different populations with limited studies checking its effect among patients diagnosed with HF. The purpose of this quasi-experimental study was to check the effect of BRT on fatigue and QOL among 140 (68 intervention and 72 control) patients diagnosed with HF. Intervention group performed BRT for 20 minutes twice a day for 2 months. Control group received regular care from their health care providers. At baseline, there were no differences between intervention and control groups regarding fatigue, physical component summary, and mental component summary. At follow-up, intervention group had higher scores in physical and mental component summaries than control group (45.48 ± 10.52 vs 37.97 ± 14.78) and (46.22 ± 8.39 vs 41.01 ± 10.36), respectively. Also, intervention group had lower levels of fatigue than control group (2.54 ± 0.87 vs 6.33 ± 0.61). In conclusion, the use of BRT as a complementary therapy for patients with HF might decrease fatigue level and improve QOL.

Effects of a PRECEDE-PROCEED Model-Based Intervention on Fatigue in Patients With Coronary Heart Disease: A Randomized Controlled Trial

OBJECTIVE

This research aimed to determine how a 12-week PRECEDE-PROCEED model-based intervention affected fatigue in patients with coronary heart disease.

METHODS

This cluster randomized controlled trial recruited participants diagnosed with coronary heart disease at 2 community health centers in China. Participants in the control group (n = 36) received routine health education, whereas those in the intervention group (n = 38) were given a 12-week PRECEDE-PROCEED model-based intervention and routine health education. The intervention consisted of 6 training sessions on coronary heart disease, fatigue, fatigue management, self-management skills and social support. A primary outcome (fatigue) and 4 secondary outcomes (knowledge of fatigue, self-management, quality of life and body mass index) were assessed using the Fatigue Scale-14, Fatigue Cognitive Questionnaire for Patients with Coronary Heart Disease, Coronary Artery Disease Self-Management Scale, Chinese Cardiovascular Questionnaire of Quality of Life, and electronic weighing scale, respectively. Data were collected 3 times over 12 weeks.

RESULTS

Compared with the control group, the intervention group showed a statistically significant improvement in the level of fatigue (8.72 vs 7.06, P < .001), knowledge of fatigue (P < .001), self-management skills (P < .001), and quality of life (P < .001). However, there was no significant difference in body mass index between the 2 groups (P = .504).

CONCLUSIONS

The findings suggest that a well-designed intervention based on the PRECEDE-PROCEED model could alleviate fatigue symptoms and increase knowledge of fatigue, self-management skills and quality of life in patients with coronary heart disease.

Effects of Mind-Body Qigong Exercise on Overall Health, Fatigue/Sleep, and Cognition in Older Chinese Immigrants in the US: An Intervention Study with Control

Background

Culturally relevant exercises may help improve health and address disparities faced by older immigrants due to language and cultural barriers. Few studies have focused on such exercise interventions among older Chinese immigrants at US daycare centers.

Methods

We conducted a 10-week nonrandomized controlled trial in older Chinese immigrants in Philadelphia, US. The intervention group practiced Chinese Qigong (Baduanjin) 5 days a week guided by trained research assistants and video instructions. The control group maintained their usual daily activities. We collected self-report assessments on overall health, sleep, and fatigue and implemented two computerized cognitive tests measuring psychomotor vigilance task (PVT) and memory twice, preintervention and postintervention. Repeated measures general linear model (GLM) and paired samples t-tests were used for data analyses.

Results

Eighty-eight older adults (Qigong, n = 53; control, n = 35) with an average age of 78.13 (SD = 5.05) were included. Groups showed no significant differences at baseline evaluation. After the 10-week exercise, the intervention group showed significant improvements in overall health (p=0.032), fatigue (p < 0.001), and cognitive functions including memory (p=0.01), response speed (p=0.002), and response time (p=0.012) on the PVT, as well as marginally significant benefits in sleep (p=0.058). Between-group comparisons identified significant group-by-time interactions in health (p=0.024), sleep (p=0.004), fatigue (p=0.004), and memory (p=0.004).

Conclusion

We revealed significant positive effects of Qigong in older Chinese immigrants across multiple health domains. Findings highlight the potential of a culturally relevant exercise in addressing health disparities.

The effect of using a sports application on the quality of sleep in patients with heart failure: a randomized clinical trial study

BACKGROUND

Patients with heart failure often suffer from sleep disorders. Due to the side effects of medications used to treat this disorder, non-pharmacological methods may be used to improve these patients' sleep quality. This study aimed to determine the effect of a sports application on sleep quality in patients with heart failure.

METHODS

In this single-blinded randomized clinical trial, 60 patients aged 30-70 referred to Shafa Hospital in Kerman were randomly assigned to control (n = 30) and intervention (n = 30) groups based on convenience sampling. The intervention group used the sports application for eight consecutive weeks. Data was collected using a demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI). An independent t-test and a Mann-Whitney U test were used for comparisons between groups and paired t-tests and Wilcoxon tests were used for comparisons within groups.

RESULTS

The data analysis revealed a significant difference in sleep quality scores between the two groups after the intervention, meaning that the intervention group had better sleep quality than the control group (P < 0.05).

CONCLUSIONS

As a result of the study, it was found that the sport application improved the quality of sleep in patients with heart failure. Our recommendation is for healthcare providers to use this sports application to present educational content related to physical activity and improve the sleep quality of patients.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT. 2019123045475N1." Registered 16 December 2019.

Baduanjin Mind-Body Exercise for Cancer-Related Fatigue: Protocol for a Remotely Delivered Randomized Wait-List Controlled Feasibility Study

BACKGROUND

People living with a cancer diagnosis often experience cancer-related fatigue (CRF). Between 9% and 45% of people report CRF as moderate to severe, negatively impacting their quality-of-life (QOL). The evidence-base for managing CRF recommends exercise-related therapies over pharmaceutical interventions. One such exercise-like therapy is Baduanjin mind-body exercise (MBE), which has additional benefits. A remotely delivered program may further benefit people with CRF. The primary objective of this pilot will test study feasibility of a remotely delivered Baduanjin MBE exercise program for people living with CRF.

METHODS

This is a randomized wait-list controlled pilot study and will take place in Sydney, Australia. Subject to informed consent, 40 adults with moderate CRF levels and receiving or previously received adjuvant chemotherapy, will undertake a home-based 8-week Baduanjin MBE program supported by online resources and instructors. The primary feasibility outcomes are recruitment, enrollment, retention, and adherence rates; and safety as measured by tolerance and adverse-event frequency. Clinical outcomes (eg, changes in CRF, QOL, and participant perceptions) are assessed at pre-intervention, week 1, week 4, week 8, and post-intervention. Analyses follows the Intent-to-Treat (all participants as per randomization) and per-protocol (participants adhering to the protocol). Missing data will be imputed from previous data entries and regression models may be tested to predict missing outcomes.

DISCUSSION

To our knowledge, this is the first study evaluating the feasibility and effects of Baduanjin MBE on CRF using a remote delivery method. These feasibility data will inform a fully powered future trial investigating evidence of effect on CRF and QOL.Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR 12623000177651).Ringgold ID: 651498 Chinese Medicine Centre.

Physical activity improves health-related quality of life, 6MWT, and VO2 peak before and during COVID-19 in patients with heart failure: A meta-analysis

OBJECTIVE

To compare the effects of physical activity on improving health-related quality of life (HRQOL), six minutes walking test (6MWT), and oxygen consumption (VO2) peak before and during Coronavirus disease (COVID-19) in patients with heart failure.

METHODS

Following PRISMA guidelines, we searched for relevant articles from five databases, including Embase, MEDLINE, CINAHL, PEDro, Cochrane, and additional resources. Study quality was assessed using Joanna Briggs Institution (JBI). RevMan 5.3 software was used to perform the meta-analysis.

RESULT

Fifteen randomized controlled trial studies met the criteria. Analysis of the subgroup before COVID-19 showed that PA had a significant effect on HRQOL, as measured by MLHFQ (SDM: -0.27, 95% CI: -0.47 to -0.07, n=590), KCCQ (SDM: 2.10, 95% CI: 0.74 to 3.46, n=53), 6MWT (SMD: 1.63, 95% CI: 0.80 to 2.46, n=284), and VO2 peak (SMD: 0.97, 95% CI: 0.00 to 1.93, n=106). Analysis of the subgroup during COVID-19 showed that PA resulted in a significant effect on HRQOL, MLHFQ (SDM: -0.62, 95% CI: -1.32 to 0.09, n=221), KCCQ (SDM: 0.33, 95% CI: 0.15 to 0.50, n=486), 6MWT (SMD: 0.47, 95% CI: 0.22 to 0.73, n=493), and VO2 peak (SMD: 0.35, 95% CI: 0.10 to 0.60, n=325).

CONCLUSION

The PA could increase HRQOL, 6MWT, and VO2 peak before and during COVID-19, and therefore should be considered as part of daily activities for patients with HF.

Quantitative Evidence of the effect of Baduanjin exercise on quality of life and cardiac function in adults with chronic heart failure

BACKGROUND

This study aimed to assess the effects of Baduanjin exercise on the quality of life (QoL), cardiac function, and maximal oxygen consumption (VO2max) in patients with chronic heart failure (CHF).

METHODS

A systematic search of relevant literature published from inception until February 2023 was performed in the Scopus, PubMed, MEDLINE, CINAHL, Cochrane Library, SPORTDiscus, and China National Knowledge Infrastructure databases. We included randomized controlled trials (RCTs) that examined the effects of Baduanjin exercise on QoL (Minnesota Living with Heart Failure Questionnaire [MLHFQ]), cardiac function (N-terminal B-type natriuretic peptide [NT-Pro BNP] and left ventricular ejection fraction [LVEF]), and VO2max in patients with CHF.

RESULTS

Fifteen studies (1180 participants) were included in this analysis. The synthesized results suggested that Baduanjin exercise contributed to significant improvements in the MLHFQ scores (standard mean difference [SMD] = 1.10, 95% confidence interval [CI]: 0.81 to 1.39, p < 0.001), NT-Pro BNP levels (SMD = 0.62, 95% CI: 0.31 to 0.93, p < 0.01), LVEF (SMD = 0.53, 95% CI: 0.18 to 0.88, p < 0.01), and VO2max (SMD = 0.92, 95% CI: 0.24 to 1.60, p < 0.001) compared with the results of the control groups. Subgroup analyses revealed that engaging in Baduanjin exercise 5-7 times per week was more effective in improving the MLHFQ score compared with 3-4 times per week (p = 0.04).

CONCLUSION

Evidence from the meta-analysis support the beneficial effects of Baduanjin exercise on the QoL, cardiac function, and VO2max in patients with CHFin China. For optimal QoL improvements, it is recommended to engage in Baduanjin exercise 5-7 times per week for 30-60 min, over a duration of at least 8 weeks. In terms of NT-Pro BNP, Baduanjin exercise sessions of 30-60 min, 2-7 times per week, for a minimum of 8 weeks are recommended.

Effect of Baduanjin exercise on primary osteoporosis: study protocol for randomized controlled trial

BACKGROUND

Lack of exercise is often a major cause of chronic disease. Osteoporosis (OP) is a chronic disease with multifactorial co-morbidity. Baduanjin (BDJ) exercise may be a powerful tool for modifying risk factors. The aim is to provide more evidence about the effectiveness of BDJ exercise in improving pain and balance ability in patients with OP.

METHODS

In the prospective randomized controlled trial, 160 participants will be recruited and randomized to the treatment group (BDJ exercise combined with Calcium carbonate and D3) or the control group (Calcium carbonate and D3) at 1:1 ratio. Participants in the treatment group will receive 24-week BDJ exercise for 30-60 min, 3 times a week, along with Calcium carbonate and D3 at each day, while participants in the control group will receive Calcium carbonate and D3 only. All outcome indicators will be measured at baseline, after the 6th month of treatment and 6th month after the end of treatment. The primary outcomes include pain and balance ability, as measured by the visual analogue scale (VAS) and Berg balance scale (BBS). The secondary outcomes will primarily include bone mineral density (BMD), laboratory tests (including P1NP, β-CTX, MSTN, FDF-23, NPY), the timed "up and go" (TUG) test, the morse fall scale (MFS), the five-times sit-to-stand test (FTSST).

DISCUSSION

The study will hopefully confirm that BDJ exercise, as a non-drug intervention, should be recommended for patients with OP to prevent bone loss, falls and fractures.

TRIAL REGISTRATION

International standard randomized controlled trial number (ISRCTN) registry: ISRCTN76945140 registered on 07/06/2022.

Efficacy of Baduanjin for treatment of fatigue: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Numerous studies have suggested that Baduanjin, a traditional Chinese exercise, can alleviate fatigue symptoms in patients with various illnesses. The aim of this review was to evaluate the efficacy of Baduanjin in reducing fatigue symptoms.

METHODS

A comprehensive literature search was conducted using several databases, including PubMed, Web of Science, Embase, Medline, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang, from inception to June 2023. Relevant studies reporting on the effects of Baduanjin on fatigue symptoms were included. A random-effects meta-analysis model with standardized mean differences was used to estimate the treatment effects. Moderator analyses were conducted using continuous variables and meta-regression. This review was registered in the International Prospective Register of Systematic Reviews (identifier CRD42023411532). Grading of recommendations, assessment, development and evaluations framework was used to assess the certainty of evidence.

RESULTS

Ten randomized controlled trials with patients diagnosed with 9 different diseases were included in the meta-analysis. The Baduanjin intervention groups showed significant improvements in total fatigue intensity (standard mean difference = -0.49, 95% confidence interval = -0.69 to -0.30, P = .000; I2 = 56%, P = .009). The statistically significant differences in the subgroup analyses, including intervention durations, age of participants, fatigue types, and practice location, remained unchanged. Meta-regression showed that practice place might have significant effect on the results. The certainty of the evidence was moderate for participants 55-year younger or in hospital training. However, fatigue, different groups, participants 55-year or older, training at home, and different fatigue types had lower evidence certainty.

CONCLUSION

Baduanjin can effectively alleviate fatigue symptoms with relatively flexible requirements. However, studies investigating the same disease types and including non-Chinese populations are scarce. Therefore, further studies with long-term interventions, larger sample sizes, and well-designed methodologies are warranted.

Effect of Traditional Chinese Exercises on Patients with Chronic Heart Failure (TCE-HF): A Systematic Review and Meta-Analysis

Exercise-based cardiac rehabilitation is safe and effective for chronic heart failure (CHF) patients. The present study aimed to investigate the effects of traditional Chinese exercise (TCE) on patients with CHF and the impact of exercise types and duration. Evaluation of randomized controlled trials (RCTs) of TCE in patients with CHF published since 1997 from PubMed, Embase, Web of Science, the Cochrane Library, Chongqing VIP, Wanfang Databases, and the China National Knowledge was performed. A total of 41 RCTs, including 3209 patients with CHF, were included. It showed that TCE significantly increased 6-min walk distance (6MWD) [mean difference (MD) = 72.82 m, p < 0.001] and left ventricular ejection fraction (MD = 5.09%, p < 0.001), whereas reduced B-type natriuretic peptide (BNP) (MD = −56.80 pg/mL, p < 0.001), N-terminal pro-BNP (MD = −174.94 pg/mL, p < 0.05), and Minnesota Living with Heart Failure Questionnaire scores (MD = −11.31, p < 0.001). However, no significant difference was found in the effects of TCE on peak oxygen consumption. The increase in TCE weekly duration and program duration significantly improved 6MWD (MD = 71.91 m, p < 0.001; MD = 74.11 m, p < 0.001). The combination of TCE and conventional aerobic exercise significantly improved 6MWD (MD = 19.86 m, p < 0.005). TCE improves exercise capacity, cardiac function, and quality of life in patients with CHF, which might be an optimal and available pattern of exercise-based cardiac rehabilitation.

Effects of Baduanjin exercise on quality-of-life and exercise capacity in patients with heart failure: A systematic review and meta-analysis

PURPOSE

Exercise training is an efficient non-pharmacological intervention for patients with heart failure (HF). This study aimed to objectively evaluate the effects of Baduanjin exercise on the quality of life (QOL) and exercise capacity in patients with HF.

METHODS

PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data were searched from the date of their inception until 30 September 2022. All randomised controlled trials (RCTs) evaluating the effects of Baduanjin exercise on QOL and exercise capacity in patients with HF were selected. The primary outcomes were QOL, assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and exercise capacity, evaluated using the 6-min walking test (6-MWT). A meta-analysis was performed by comparing the MLHFQ domain scores. Review Manager 5.3 and Stata 14.0, were used for the data analysis.

RESULTS

Baduanjin exercise showed a favourable improvement of the overall QOL (mean difference = -8.25; 95% confidence interval: -13.62 to -2.89; P = 0.003) and exercise capacity (mean difference = 118.49; 95% confidence interval: 52.57 to 184.41; P = 0.0004). Meta-analyses of the MLHFQ domain score indicated that Baduanjin exercise significantly improved the patients' physical (mean difference = -2.83; 95% confidence interval: -3.76, -1.90; P < 0.00001), emotional (mean difference = -2.52; 95% confidence interval: -3.67 to -1.37; P < 0.0001), and general QOL (mean difference = -2.61; 95% confidence interval: -5.17 to -0.06; P = 0.05), based on the decrease in the MLHFQ domain score. Marked statistical heterogeneity (I2> 70%) was observed for all the QOL and exercise capacity outcomes.

CONCLUSIONS

Baduanjin exercise is a safe, feasible, and acceptable intervention that can improve the QOL and exercise capacity in patients with HF. However, more RCTs with rigorous research designs are needed to assist in the rehabilitation of such patients.

Effects of traditional Chinese eight brocade exercise with same frequency and different durations on the quality of life, 6-min walk and brain natriuretic peptide in patients with chronic heart failure

BACKGROUND

Traditional Chinese eight brocade exercise (TCEBE) with same cycle and frequency and different durations has an effect on patients with chronic heart failure (CHF). However, relevant reports on the topic are lacking.

OBJECTIVE

This study aims to explore the differences of rehabilitation effect by conducting TCEBE with the same cycle and frequency and different single exercise time for patients with CHF.

METHODS

A total of 103 patients with CHF were randomly divided into long-time group (LTG), short-time group (STG) and control group (CG). The subjects in the three groups were given corresponding routine treatment. In addition, under the guidance of professional TCEBE coaches and nurses, TCEBE was conducted for 12 weeks (3 times/week) for LTG (60 min/time) and STG (30 min/time). Minnesota living with heart failure questionnaire (MLHFQ) was used, and 6-min walk (6MWK) and brain nautical peptide (BNP) were tested.

RESULTS

1) At 12 weeks, the comparison between groups obtained the following results: For the LTG, MLHFQ was less than that of the CG (P < 0.01), 6MWT was greater than that of the CG (P < 0.05), and 6MWT was greater than that of the STG (P < 0.05); for the STG, MLHFQ was less than that of the CG (P < 0.05); no significant difference in BNP was found among the three groups; 2) At 12 weeks and 0 weeks, the comparison obtained the following results: For the LTG, MLHFQ decreased by 37.7 %, and 6MWT increased by 46.7 % (P < 0.01); for the STG, MLHFQ decreased by 31.7 %, and 6MWT increased by 31.5 % (P < 0.01); for the CG, MLHFQ decreased by 14.6 %, and 6MWT increased by 19.7 % (P < 0.05); no significant change in BNP was found in each group.

CONCLUSION

TCEBE of two kinds of duration improves the quality of life and 6MWT of patients with CHF but has no positive effect on BNP. Compared with 30-min/time, 60-min/time further improves 6MWT in patients with CHF but has no additional benefit on quality of life.

Traditional Baduanjin exercise through the eyes of patients with chronic heart failure: A qualitative content analysis study

Objective

Baduanjin (eight silken movements) is a traditional Chinese exercise that can be used as cardiac rehabilitation therapy for patients with chronic heart failure (CHF) especially when other forms of rehabilitation are scarce or unaffordable. This study explores the experiences of Chinese patients with CHF who undertook Baduanjin exercise at home as part of a pilot trial in Guangzhou, China.

Methods

We conducted seven qualitative interviews with participants who had participated in the intervention arm of a pilot randomized controlled trial (RCT) (n = 8). For data collection, we used a semi-structured interview guide with both open-ended, and follow-up questions. We audio recorded the interviews, transcribed them verbatim, and then analyzed them with content analysis.

Results

Participants' experiences of doing Baduanjin were classified into three categories: (1) improving practice (2) factors facilitating good exercise adherence, and (3) feeling good. Participants reported that the exercises were easy but that the correct Baduanjin execution and coordination between the mind, movements, and breathing were only achievable through practice. In addition, the training benefits which they perceived were the predominant motivation for patients to keep practicing. Finally, trust in Baduanjin, personal attitudes toward health, flexibility in practice times, as well as social support helped the participants to achieve good adherence to home-based training.

Conclusion

This study's findings indicate that Baduanjin could be a cardiac rehabilitation exercise modality for patients with CHF in China, especially in a home-based setting.

Effects of traditional Chinese exercises on the rehabilitation of patients with chronic heart failure: A meta-analysis

Background

With the development of rehabilitation medicine, exercise therapy has gradually become one of the methods to prevent and treat cardiovascular diseases. It is widely used in clinic because it can further reduce the mortality rate, improve clinical symptoms, restore the activity ability of the body, improve the quality of life of patients and reduce the hospitalization rate. Traditional Chinese exercises have developed rapidly in recent years, which mainly include Baduanjin, Tai Ji, etc. However, meta-analyses of all types of exercises are not well characterized.

Objectives

To evaluate the effect of traditional Chinese exercises (TCEs) on the rehabilitation of patients with chronic heart failure (CHF) using a meta-analysis.

Methods

A systematic search of randomized controlled trials (RCTs) on TCEs for patients with CHF in 13 databases (PubMed, China National Knowledge Infrastructure, etc.). Meta-analysis was performed using Review Manager software (version 5.3) after two investigators independently screened the studies, assessed the quality of the studies, and extracted the data.

Results

Meta-analysis of 21 randomized controlled trials which involved 1,665 patients with chronic heart failure showed that practicing TCEs was effective in improving patients' physiological outcomes such as VO₂max [MD = 2.14, 95% CI (1.02, 3.26), P < 0.001], AT [MD = 1.61, 95% CI (1.06, 2.16), P < 0.001], and left ventricular ejection fraction [MD = 2.60, 95% CI (1.17, 4.02), P < 0.001]. Non-physiological outcomes benefited from the application of TCEs: 6-min walking distance [MD = 38.55, 95% CI (36.67, 40.42), P < 0.001], quality of life [MD = 5.52, 95% CI (3.17, 7.88), P < 0.001], and single-item TCM symptom scores in CHF patients: tiredness and fatigue [MD = 0.78, 95% CI (0.03, 1.53), P = 0.04], shortness of breath [MD = 0.44,95% CI (0.26, 0.62), P < 0.0001], facial puffiness and limb swelling [MD = 0.44,95% CI (0.12, 0.76), P = 0.007], palpitations [MD = 0.68,95% CI (0.14, 1.21), P = 0.01] were improved.

Conclusions

TCEs improved several recovery indicators, heart failure-related clinical symptoms, quality of life, and physiological indicators in patients with CHF. It is worthwhile to expand the participants for practical application in clinical practice, but the existing evidence is insufficient and the heterogeneity of outcome is large. Therefore, more high-quality clinical trials are needed to support these results.

Systematic review registration

PROSPERO, identifier [CRD42022383246].

Effects of Baduanjin exercise in nasopharyngeal carcinoma patients after chemoradiotherapy: a randomized controlled trial

OBJECTIVE

To evaluate the effects of traditional Chinese Baduanjin Qigong exercises on the physical and psychological recovery of patients with nasopharyngeal carcinoma after chemoradiotherapy.

METHODS

Eighty-eight nasopharyngeal carcinoma patients who had completed chemoradiotherapy were randomly divided into the Baduanjin intervention group (n = 44) and the control group (n = 44). Patients in the intervention group practised Baduanjin exercise for 12 weeks, with the frequency of 40 min a day and 5 days a week after discharge from the hospital. Participants in the control group received usual care. Outcome indicators included quality of life (QOL), complications, cancer-related fatigue (CRF), sleep quality, anxiety, and depression. The intention-to-treat and per-protocol populations were compared using univariate analysis of variance. Partial eta squared was used as a measure of the effect size.

RESULTS

A total of 75 patients completed the study. In the intention-to-treat analysis, after 12 weeks of exercise intervention, there were significant increases in the global FACT-H&N (95% CI = 2.09 to 11.47, η_p² = 0.088), social/family well-being (95% CI = 0.13 to 2.26, η_p² = 0.055), emotional well-being (95% CI = 0.34 to 2.44, η_p² = 0.074), and head and neck cancer subscale scores (95% CI = 0.17 to 3.86, η_p² = 0.052) in the Baduanjin group compared with the control group at the 12th week. In the per-protocol analysis, there were significant increases in the global FACT-H&N (95% CI = 4.11 to 11.75, η_p² = 0.190), physical well-being (95% CI: 0.50 to 3.04, η_p² = 0.096), social/family well-being (95% CI: 0.32 to 2.15, η_p² = 0.090), emotional well-being (95% CI: 0.60 to 2.53, η_p² = 0.125), functional well-being (95% CI: 0.25 to 2.49, η_p² = 0.075), and head and neck cancer subscale (95% CI: 1.08 to 4.08, η_p² = 0.139) scores in the Baduanjin group compared with the control group at the 12th week.

CONCLUSION

The findings in this study indicate that Baduanjin exercise is an effective and appropriate intervention for improving quality of life and is worthy of recommendation and implementation by oncology nurses in the rehabilitation process of patients with nasopharyngeal carcinoma.

Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis

Background

This review aimed to compare the relative effectiveness of different exercise-based cardiac rehabilitation (ExCR) delivery modes (centre-based, home-based, hybrid and technology-enabled ExCR) on key heart failure (HF) outcomes: exercise capacity, health-related quality of life (HRQoL), HF-related hospitalisation and HF-related mortality.

Methods and results

Randomised controlled trials (RCTs) published through 20 June 2021 were identified from six databases, and reference lists of included studies. Risk of bias and certainty of evidence were evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Bayesian network meta-analysis was performed using R. Continuous and binary outcomes are reported as mean differences (MD) and ORs, respectively, with 95% credible intervals (95% CrI). One-hundred and thirty-nine RCTs (n=18 670) were included in the analysis. Network meta-analysis demonstrated improvements in VO₂peak following centre-based (MD (95% CrI)=3.10 (2.56 to 3.65) mL/kg/min), home-based (MD=2.69 (1.67 to 3.70) mL/kg/min) and technology-enabled ExCR (MD=1.76 (0.27 to 3.26) mL/kg/min). Similarly, 6 min walk distance was improved following hybrid (MD=84.78 (31.64 to 138.32) m), centre-based (MD=50.35 (30.15 to 70.56) m) and home-based ExCR (MD=36.77 (12.47 to 61.29) m). Incremental shuttle walk distance did not improve following any ExCR delivery modes. Minnesota living with HF questionnaire improved after centre-based (MD=−10.38 (−14.15 to –6.46)) and home-based ExCR (MD=−8.80 (−13.62 to –4.07)). Kansas City Cardiomyopathy Questionnaire was improved following home-based ExCR (MD=20.61 (4.61 to 36.47)), and Short Form Survey 36 mental component after centre-based ExCR (MD=3.64 (0.30 to 6.14)). HF-related hospitalisation and mortality risks reduced only after centre-based ExCR (OR=0.41 (0.17 to 0.76) and OR=0.42 (0.16 to 0.90), respectively). Mean age of study participants was only associated with changes in VO₂peak.

Conclusion

ExCR programmes have broader benefits for people with HF and since different delivery modes were comparably effective for improving exercise capacity and HRQoL, the selection of delivery modes should be tailored to individuals’ preferences.

The Effects of Exercise-Based Interventions on Fluid Overload Symptoms in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Patients with heart failure are subjected to a substantial burden related to fluid overload symptoms. Exercise can help the lymphatic system function more effectively to prevent fluid build-up in tissues and interstitium, thus potentially mitigating the symptoms due to fluid overload. The objective of this systematic review was to examine the effects of exercise-based interventions on fluid overload symptoms among patients with heart failure. MEDLINE, Embase, Cochrane Library, and CINAHL databases were systematically searched for relevant studies published from inception to August 2021. We included randomized controlled trials that compared exercise-based interventions of different modalities and usual medical care for adult patients with heart failure and reported the effects of interventions on any symptoms related to fluid overload. A random-effects meta-analysis was used to estimate the effectiveness, and a subgroup analysis and univariate meta-regression analysis were used to explore heterogeneity. Seventeen studies covering 1086 participants were included. We found robust evidence indicating the positive effect of exercises in dyspnea relief (SMD = −0.48; 95%CI [−0.76, −0.19]; p = 0.001); the intervention length also influenced the treatment effect (β = 0.033; 95%CI [0.003, 0.063]; p = 0.04). Initial evidence from existing limited research showed that exercise-based intervention had positive effect to alleviate edema, yet more studies are needed to verify the effect. In contrast, the exercise-based interventions did not improve fatigue compared with usual care (SMD = −0.27; 95%CI [−0.61, 0.06]; p = 0.11). Findings regarding the effects of exercises on bodily pain, gastro-intestinal symptoms, and peripheral circulatory symptoms were inconclusive due to limited available studies. In conclusion, exercise-based interventions can be considered as an effective nonpharmacological therapy for patients with heart failure to promote lymph flow and manage fluid overload symptoms. Exercise-based interventions seem to have very limited effect on fatigue. More research should investigate the mechanism of fatigue related to heart failure. Future studies with high methodological quality and comprehensive assessment of symptoms and objective measure of fluid overload are warranted.

Qingjin Yiqi granules for post-COVID-19 condition: A randomized clinical trial

OBJECTIVE

To evaluate the effectiveness and safety of Qingjin Yiqi granules (QJYQ) on post-COVID-19 condition (PCC).

METHOD

Patients who met the inclusion criteria were randomly assigned to two groups, the QJYQ group received QJYQ combined with standard rehabilitation treatments (SRTs) and the control group only received SRTs. The treatment course was 14 days. The primary outcomes were modified Medical Research Council (mMRC) scale and Borg scale, while the secondary outcomes included symptoms score and 6-minute walking distance (6MWD). The safety outcome was the incidence of adverse events.

RESULTS

A total of 388 patients with PCC were enrolled and randomly assigned to the QJYQ group (n = 194) and the control group (n = 194). Compared to the controls, the mMRC scale was improved in the QJYQ group, which was better than that of the control group [β (95%CI): -0.626 (-1.101, -0.151), p = 0.010]. A significant improvement in Borg scale was also observed in the QJYQ group compared to the control group [β (95%CI): -0.395(-0.744, -0.046), p = 0.026]. There was no statistically significant difference in symptoms score and 6MWD between the two groups (p = 0.293, p = 0.724). No treatment-related adverse events were observed in either group.

CONCLUSIONS

QJYQ can bring benefits to patients with PCC, mainly in the improvement of breathlessness and fatigue.

Impact of Qigong exercises on the severity of the menopausal symptoms and health-related quality of life: a randomized controlled trial

ABSTRACTThe aim of the present study was to analyze the effects of a Qigong exercise program on the severity of the menopausal symptoms and health-related quality of life (HRQoL) of community-dwelling postmenopausal women. This was done by means of a randomized clinical trial with a sample of 125 women who were assigned to either a control (n = 62) or an experimental group (n = 63). The severity of their menopause-related symptoms and HRQoL were assessed through the Menopause Rating Scale (MRS) and the 36-item Short-Form Health Survey (SF-36) respectively, before and after the intervention period. The main findings of our study reveal significant improvement in the severity of menopausal symptoms at the somatic, psychological, and urogenital levels, as well as in the total score of the MRS. Additionally, participants assigned to the Qigong group experienced improvement in the general health, physical functioning, role-physical, bodily pain, vitality, and mental health domains of the 36-item Short-Form Health Survey, as well as in its physical component and mental component summaries. We can therefore conclude that, among Spanish postmenopausal women, a twelve-week Qigong exercise program has beneficial effects on the severity of menopausal symptoms and HRQoL.Trial registration: ClinicalTrials.gov identifier: NCT03989453..

Effectiveness of Baduanjin Exercise on Quality of Life and Psychological Health in Postoperative Patients With Breast Cancer: A Systematic Review and Meta-analysis

Background:

Baduanjin exercise is a traditional Chinese Qigong exercise. This study aimed to investigate the effects of Baduanjin exercise on the quality of life and psychological status of postoperative patients with breast cancer.

Methods:

A systematic review and meta-analysis were conducted. Eight databases were searched from inception to December 15, 2021, restricting the language to English and Chinese. RevMan5.3 software was employed for data analysis. This study was registered in PROSPERO, number CRD 42020222132.

Results:

A total of 7 randomized controlled trials (RCTs) with 450 postoperative breast cancer patients with or without Baduanjin exercise were collected. Compared with the group without Baduanjin, those who practiced Baduanjin showed significant improvement in quality of life (WMD = 5.70, 95% CI 3.11-8.29, P < .0001). Subgroup analysis showed significant improvement in physical (WMD = 1.83, 95% CI 1.13-2.53, P < .00001) and functional well-being (WMD = 1.58, 95% CI 0.77-2.39, P = .0001), which were measured by the functional assessment of cancer therapy-breast (FACT-B). Subgroup analysis also showed that role-physical (WMD = 11.49, 95% CI 8.86-14.13, P < .00001) and vitality (WMD = 8.58, 95% CI 5.60-11.56, P < .00001) were significantly increased, as measured by a 36-item Short Form survey (SF-36). In terms of psychological health, Baduanjin exercise reduced patients’ anxiety (WMD = −8.02, 95% CI −9.27 to −6.78, P < .00001) and depression (WMD = −4.45, 95% CI −5.62 to −3.28, P < .00001).

Conclusions:

Baduanjin is an effective exercise, which can significantly improve the quality of life and psychological health of breast cancer patients after operation.

Baduanjin Exercise for Adults Aged 65 Years and Older: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

This study performed a systematic review and meta-analysis to evaluate the health effects of Baduanjin exercise on adults aged 65 years and older. Chinese and English databases were electronically searched using search terms related to the PICO model from inception through June 2021. The study quality assessment and meta-analysis were conducted using the PEDro scale and RevMan 5.4 software. Eleven included Chinese studies, published between 2015 and 2021, recruited participants from the mainland of China. The aggregated results showed significant benefits of Baduanjin on physical function, walking ability, balance, and anxiety. A long-term Baduanjin intervention could also improve quality of life and reduce falls and pain. Baduanjin appears to have the potential to improve the health of older adults, but conclusions are limited due to the lack of rigorous and robust studies within and outside of mainland China. Larger, well-designed RCTs are needed to confirm these findings.

Effects of Baduanjin Exercise on Physical Function and Health-Related Quality of Life in Peritoneal Dialysis Patients: A Randomized Trial

Background and Aims: Exercise is an efficient non-pharmacological intervention for chronic kidney disease. The study aims to evaluate the effects of Baduanjin exercise on physical function and health-related quality of life (HRQOL) in peritoneal dialysis (PD) patients. Methods: Seventy PD patients were randomly assigned to either the Baduanjin exercise group or the control group. Fifty-seven patients completed the study (exercise group, 25; control group, 32). The exercise group received the Baduanjin exercise program for 12 weeks. The control group received usual care. Three well-established performance-based tests determined physical function: five times sit-to-stand test (FTSST), timed up and go test (TUGT), and handgrip strength (HGS). HRQOL was assessed by the Kidney Disease Quality of Life-Short Form. Results: At baseline, no differences in physical function and HRQOL were observed between the Baduanjin exercise and the control group. At follow-up, the Baduanjin exercise group showed a marginally significant improvement in FTSST (P = 0.008) and TUGT (P = 0.040) over the 12 weeks compared to the control group. HRQOL in the Baduanjin exercise group was significantly higher than that of the control group. Conclusions: A 12-week Baduanjin exercise program may improve physical function and HRQOL in PD patients. Longer follow-up is needed to determine if these findings will translate into clinical application.

Effects of Cardiac Rehabilitation Training in Patients with Heart Failure Based on Traditional Chinese Exercise: A Systematic Review and Meta-Analysis

Methods

PubMed, Embase, Cochrane Library, and three Chinese databases, namely, China National Knowledge Network, Wanfang, and China Biomedical Network, were searched from the time of their inceptions through August, 2021. We retrieved the studies on the application of TCE-based cardiac rehabilitation in patients with HF. Based on the standard evaluation methods of Cochrane Reviewer's Handbook 5.1.0, two authors independently assessed the risk of bias and evaluated the methodological quality of the studies included. The RevMan 5.3 software was used for further meta-analysis. Additionally, the GRADEpro GDT web version was used to assess the quality of the evidence in these studies.

Results

Nine randomized controlled trials involving 721 patients were included in this analysis. The meta-analysis revealed that the TCE (experimental group) effectively improved the patient's motor function and endurance compared to walking or other activities (control group) (mean difference, MD = 68.23, 95% CI [54.55, 81.91]; P < 0.00001). From each subgroup analysis, the exercising ability of the experimental group was higher than that of the control group. The quality of life's score in the experimental group was lower than that of the control group (MD = −9.51, 95%CI [−17.84, −1.18]; P=0.03). The plasma B-type natriuretic peptide content in the experimental group was lower than that in the control group (MD = −59.77, 95%CI [−82.85, −36.7]; P < 0.00001). The number of hospitalizations (MD = −0.83, 95%CI [−0.98, −0.68]; P < 0.00001) and hospital costs in the experimental group (MD = −1.6, 95%CI [−1.89, −1.31]; P < 0.00001) were lower than those in the control group. However, no significant differences were observed in the left ventricular ejection fraction and maximal oxygen consumption between the two groups (MD = 1.38, 95%CI [−3.08, 5.84] and P=0.54; MD = −0.04, 95%CI [−1.62, 1.54] and P=0.96, respectively). From the current analysis, TCE can be considered a relatively safe exercise method. According to the GRADE evaluation results on the evidence level, the studies included were of moderate quality, low quality, or very low quality.

Conclusions

Our systematic review showed that TCE had potential benefits in improving patients' cardiac function, motor function, and quality of life. Therefore, TCE might be an effective adjuvant therapy in patients with HF. However, given the inclusion of the low-quality elucidations, further rigorous studies are urgently needed to confirm these results.

Feasibility and Preliminary Effects of the BESMILE-HF Program on Chronic Heart Failure Patients: A Pilot Randomized Controlled Trial

Aims: The Baduanjin Eight-Silken-Movements wIth Self-Efficacy building for Heart Failure (BESMILE-HF) program is a contextually adapted cardiac rehabilitation program. It uses a traditional Chinese exercise, Baduanjin, to solve the unmet demand of exercise-based cardiac rehabilitation programs due to their scarcity and unaffordability in China. This pilot study assesses BESMILE-HF's feasibility and preliminary effects.

Methods: Eighteen patients with chronic heart failure were included: 8 in a BESMILE-HF group (age: 67 ± 5 years, EF: 40.4 ± 13.6%) and 10 in a control group (age: 70 ± 13 years, EF: 42.9 ± 12.5%). Both received the usual medications, with the intervention group receiving additionally the BESMILE-HF program for 6 weeks. Feasibility was explored by participants' involvement in the intended intervention. Clinical outcome assessments were conducted at baseline and post-intervention, while adverse events were captured throughout the study period.

Results: The BESMILE-HF program was well-received by patients, and adherence to the intervention was good. The intervention group completed all required home exercises and total home-practice time was correlated with baseline self-efficacy (r = 0.831, p = 0.011). Moreover, after 6 weeks, self-efficacy increased in the BESMILE-HF group (p = 0.028) and the change was higher than in the control [mean difference (MD): 3.2; 95% confidence interval (CI) 0.6–5.9, p = 0.004]. For the exercise capacity, the control group demonstrated a significant decline in peak oxygen consumption (p =0.018) whereas, the BESMILE-HF group maintained their exercise capacity (p = 0.063). Although the between-group difference was not statistically significance, there was clear clinical improvement in the BESMILE-HF group (1.5 mL/kg/min, 95% CI, −0.3 to 3.2 vs. minimal clinically important difference of 1 mL/kg/min). Throughout the study period, no adverse events related to the intervention were captured.

Conclusions: BESMILE-HF is feasible for patients with chronic heart failure in Chinese settings. A larger sample size and a longer follow-up period is needed to confirm its benefit on clinical outcomes.

Clinical Trial Registration:ClinicalTrials.gov: NCT03180320.

Understanding the Benefits of Standing and Sitting Baduanjin Based on Cardiopulmonary Exercise Testing: An Observational Study

Objectives: Although Baduanjin (a traditional Chinese physical activity) has been reported to promote general health, the optimal exercise intensity and kinematic characteristics of this intervention remain poorly understood. This investigation aimed to quantify and compare the exercise intensities of traditional standing Baduanjin (TB) and sitting Baduanjin (SB) using cardiopulmonary exercise testing, to further clarify the sources of the previously observed benefits of this modality. Study design: Observational study. Interventions: Healthy individuals were recruited to perform TB, SB, and cycling (in order) until they reached their ventilatory threshold. Intensity-relevant parameters based on type of exercise and specific time points (exercise start and the end of the 2nd, 4th, 6th, and 8th set of motion) were compared between TB and SB with ventilatory threshold as control. Results: Forty individuals (18 male and 22 female) completed the trial. Significant differences in peak oxygen uptake, metabolic equivalent of task, and Borg scale existed among the three exercise types, indicating a decreasing overall exercise intensity in the order of ventilatory threshold, TB, and SB. All parameters except the respiratory exchange ratio fluctuated significantly across the time points. Conclusions: Both TB and SB resulted in a significantly lower exercise intensity when compared with the ventilatory threshold established through cycling exercise. The benefits of Baduanjin might be explained partly by its appropriate exercise intensity and intermittent intensity pattern. Baduanjin might be a potential alternative to existing schemes for exercise rehabilitation.

Traditional Chinese exercise potential role as prevention and adjuvant therapy in patients with COVID-19

The epidemic situation of COVID-19 is a great public health emergency worldwide characterized by fastest spreading, widest infection range and the mostly difficult to prevent and control in recent years. According to medical experience, traditional Chinese exercises (TCE) have been applied for COVID-19 prevention, adjuvant treatment or rehabilitation, and achieved some curative effects. They can enhance the body immunity, improve the function of organs, especially cardiopulmonary function, promote physical and mental rehabilitation by adjusting the body, regulating the breath, regulating the mind. This paper aims to investigate the potential value of TCE for health preservation in the prevention and adjuvant treatment for COVID-19 according to an overview of application and analysis of existing evidence. On this basis, this review proposed the TCE plan by visiting clinical and practice experts, so as to provide some references for the prevention and treatment of COVID-19 with TCE in the world.

Effects of Baduanjin on patients with chronic nonspecific low back pain: A randomized controlled trial

BACKGROUND

Chronic low back pain (CLBP) is 1 of the common clinical diseases, and many treatment methods can only improve the symptoms of pain in the short term. Traditional Chinese sports - Baduanjin has been proven to have a positive effect on chronic low back pain. However, the quality of the research is low, the sample size is small, and safety observations are lacking. We describe the protocol of a randomized controlled trial to study the efficacy and safety of Baduanjin chronic low back pain.

METHODS

This randomized, controlled, evaluator-blind, two-arm, parallel clinical trial will include 90 outpatients with chronic low back pain recruited from the First Hospital of Nanping City, Fujian Province. The patients were randomly assigned to the intervention group (Baduanjin exercise training) and the control group (not receiving any special exercise training) at a ratio of 1:1. Patients in the intervention group will receive Baduanjin exercise training 3 times a week for 24 weeks. The 2 groups received a 4- week follow-up observation at 24 weeks. The main result from the intervention before intervention to 24 weeks later, and the follow-up of 4 changes the visual analog scale score at weeks, and by independent t are tested groups. It will also review the Pain-related disability index, The Quebec Back Pain Disability Scale, Health-related quality of life, Roland Morris (Roland Morris) Disability Questionnaire, Overall Perceived Effect (OPE) and safety Compare. Cost data for cost-benefit and cost-benefit analysis will be collected.

DISCUSSION

This will be the first study to compare the effectiveness and safety of Baduanjin for patients with chronic low back pain. The results may help healthcare professionals make clinical decisions and may reduce the cost of treatment for this disease.

TRIAL REGISTRATION

ChiCTR2000033908.

The Safety of Baduanjin Exercise: A Systematic Review

OBJECTIVES

Baduanjin exercise is a form of Qigong exercise therapy that has become increasingly popular worldwide. The aims of the current systematic review were to summarize reported adverse events potentially associated with Baduanjin exercise based on currently available literature and to evaluate the quality of the methods used to monitor adverse events in the trials assessed.

METHODS

The English databases PubMed, Cochrane library, and EMbase were searched from inception to October 2020 using the keywords "Baduanjin" or "eight session brocade." Only studies that included Baduanjin exercise therapy were included.

RESULTS

Forty-seven trials with a total of 3877 participants were included in this systematic review. Twenty-two studies reported protocols for monitoring adverse events, and two studies reported the occurrence of adverse events during training. The adverse events reported included palpitation, giddiness, knee pain, backache, fatigue, nervousness, dizziness, shoulder pain, chest tightness, shortness of breath, and muscle ache.

CONCLUSIONS

Only two studies reported adverse events that were potentially caused by Baduanjin exercise. Adverse events related to Baduanjin exercise in patients with chronic fatigue syndrome may include muscle ache, palpitation, giddiness, knee pain, backache, fatigue, nervousness, dizziness, shoulder pain, chest tightness, and shortness of breath. Further studies conducted in accordance with the Consolidated Standards of Reporting Trials statement guideline incorporating monitoring of adverse events are recommended. Additional clinical trials in which Baduanjin exercise is used as a main intervention are needed, and further meta-analysis may be required to assess its safety and reach more informed conclusions in this regard in the future.

Tai Chi and Qigong Practices for Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Several randomized controlled trials (RCTs) have assessed the role of Tai Chi and Qigong Practices (TQPs) in managing chronic heart failure (CHF). They have included broad variations in comparators, sample sizes, and results. This study evaluates existing RCTs for evidence of TQPs rehabilitation effects for CHF.

METHODS

Both English and Chinese databases were searched from their inception to October 23, 2019. RCTs were included if they compared the addition of TQPs into routine managements (RMs) to RMs alone or compared TQPs to general exercise, with RMs as a consistent cointervention in both groups. Data were screened and extracted independently using predesigned forms. RCT quality was assessed with the Cochrane tool. The primary outcomes were peak oxygen consumption (VO2peak), 6-minute walking distance (6MWD), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Mean differences (MDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with an I 2 statistic.

RESULTS

A total of 33 RCTs with 2,465 patients were included in the systematic review. Compared to the RMs alone, TQPs plus RMs improved VO2peak (MD: 1.24 mL/kg/min, 95% CI, 0.91 to 1.57; I 2 = 0%), 6MWD (MD: 59.63 meters, 95% CI, 43.35 to 75.90 I 2 = 88%), and MLHFQ (MD: -8.63 scores; 95% CI, -10.60 to -6.67; I 2 = 94%). Compared to general exercise, superior improvements were found in the TQP group; they were significant in MLHFQ (MD: -9.18 scores; 95% CI, -17.95 to -0.41; I 2 = 86%), but not in VO2peak or 6MWD. Evidence was also found of TQPs' safety and high adherence.

CONCLUSIONS

Considering that there are low costs, multiple physical benefits, and no equipment required, TQPs are a promising rehabilitation therapy, as an adjunct to routine pharmacotherapies or as an alternative to conventional exercises, especially in home-based settings.

Intensity level and cardiorespiratory responses to Baduanjin exercise in patients with chronic heart failure

AIMS

Baduanjin (eight silken movements), a traditional Chinese exercise, is an alternative to the most common cardiac rehabilitation programmes due to their scarcity and unaffordability in China. The aim of this study was to measure the intensity and energy expenditure during Baduanjin and to determine the relative oxygen consumption (VO2 ) and heart rate (HR) responses of Baduanjin compared with maximal capacity in patients with chronic heart failure.

METHODS AND RESULTS

Twenty participants (age: 65 ± 10 years, male: n = 17) with New York Heart Association II-III volunteered for this study. Participants were examined during two separate sessions, with 1-2 weeks between sessions. During session one, a symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer for measurement of maximal exercise capacity. Additionally, participants were taught Baduanjin exercise from a professional coach and were required to do it at home until the second session when their technique was confirmed by the coach. During session two, participants performed one 9 min round of Baduanjin with continuous measurement of VO2 and HR. Measurements obtained during the Baduanjin were compared with data obtained during cardiopulmonary exercise testing. While performing Baduanjin, the mean VO2 and HR were 7.1 ± 1.2 mL/kg/min and 86.1 ± 15.2 b.p.m., respectively. Compared with the cardiopulmonary exercise test, the VO2 was 44% of their VO2max and 67% of their HRmax , categorizing Baduanjin as a moderate-intensity exercise. The average energy expenditure during Baduanjin was 23.3 ± 4.4 kcal. Additionally, the VO2 and HR responses during Baduanjin both exhibited a bimodal pattern.

CONCLUSIONS

The results suggest that Baduanjin is a moderate-intensity aerobic exercise that could be an effective and safe exercise modality for home-based cardiac rehabilitation.

Effectiveness and safety of Baduanjin exercise (BDJE) on heart failure with preserved left ventricular ejection fraction (HFpEF): A protocol for systematic review and meta-analysis

BACKGROUND

Nearly half of the heart failure (HF) patients have been classified as HF with preserved left ventricular ejection fraction (HFpEF) and the prevalence has been increasing over time. The subject of this study is to assess the clinical effectiveness and safety of Baduanjin exercise (BDJE), as a kind of traditional Chinese exercises, for HFpEF patients.

METHODS

A systematic literature search for articles up to September 2020 will be performed in following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM), Chinese Biomedical Literature Service System (SinoMed) and Wanfang Database. Inclusion criteria are randomized controlled trials of BDJE applied on HFpEF patients. The primary outcome measures will be exercise capacity (cardiopulmonary exercise test or 6-minute walking test) and quality of life. The secondary outcomes will be as the following: blood pressure, heart rate, echocardiography, endothelial function, arterial stiffness and hypersensitive C-reactive protein and N-Terminal pro-B-type natriuretic peptide. The safety outcome measures will be adverse events, liver and kidney function. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Stata 12.0 will be used for meta-regression and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of evidence.

CONCLUSION

The study will give an explicit evidence to evaluate the effectiveness and safety of BDJE for HFpEF patients.

ETHICS AND DISSEMINATION

This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42020200324.

Beneficial Effects of Baduanjin Exercise on Left Ventricular Remodelling in Patients after Acute Myocardial Infarction: an Exploratory Clinical Trial and Proteomic Analysis

BACKGROUND

The beneficial effects of physical exercise on cardiac remodelling improvement after myocardial infarction have already been suggested. However, the results of previous clinical trials have not been consistent. Moreover, the putative molecular mechanisms leading to the clinically observed effects of physical exercise still remain elusive.

AIM

We aimed to evaluate whether the well-defined and strictly controlled traditional Chinese Qigong Baduanjin exercise (BE) would attenuate the adverse left ventricular (LV) remodelling in patients with ST-elevation myocardial infarction (STEMI).

METHODS

A total of 110 clinically stable STEMI patients, following successful revascularization of their infarcted coronary arteries, were randomized and enrolled in two groups: 56 were subjected to a 12-week BE-based cardiac rehabilitation programme (BE group), and the remaining 54 were exposed to the usual physical exercise (control group) for the same time period. The primary outcome was the change from baseline to 6 months in the echocardiographic LV end-diastolic volume index (ΔLVEDVi). Proteomic analysis was also performed to uncover associated mechanisms.

RESULTS

Compared with the control group, the BE group showed significantly lower ΔLVEDVi (-5.1 ± 1.1 vs. 0.3 ± 1.2 mL/m², P < 0.01). Proteomic analysis revealed BE-induced variations in the expression of 80 proteins linked to regulation the of metabolic process, immune process, and extracellular matrix reorganization. Furthermore, correlation analyses between the validated serum proteomes and primary endpoint demonstrated a positive association between ΔLVEDVi and MMP-9 expression, but a negative correlation between ΔLVEDVi and CXCL1 expression.

CONCLUSION

This is the first study indicating that BE in STEMI patients can alleviate adverse LV remodelling associated with beneficial energy metabolism adaptation, inflammation curbing, and extracellular matrix organization adjustment.

Effect of Baduanjin Sequential Therapy on the Quality of Life and Cardiac Function in Patients with AMI After PCI: A Randomized Controlled Trial

Purpose

The purpose of this study was to examine the effects of Baduanjin sequential therapy (BST) on the quality of life and cardiac function in patients with AMI after PCI.

Subjects

96 patients with AMI after PCI were randomly assigned as subjects to two groups: BST group who received 24 weeks of BST training and control group who received no training.

Methods

The methods used in this study included the changes in SF-36 subscales, the measures of left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), the body mass index (BMI), and the abdominal circumference.

Results

Of the 96 participants, 82 total patients completed the entire study. At 12 weeks, role physical and health transition of SF-36 were significantly different between the two groups, with a difference of 26.12 (95% CI, 11.59 to 40.64) in role physical and a difference of 15.94 (95% CI, 5.60 to 26.28) in health transition (p < 0.05). However, there were statistically significant differences in all aspects of SF-36 between the two groups at 24 weeks (p < 0.05). The BST also lowered abdominal circumference and BMI as compared with the control group. In the 24-week follow-up, a significant difference was found in the decline of the LVEF in the control group (p=0.020), while there was a nonsignificant difference in the BST group (p=0.552). Compared with the control group, the BST group reduced 50 pg/ml on the NT-pro-BNP at 24 weeks (p=0.013). The effects of BST exercise were maintained at 24 weeks after the intervention. No serious adverse events were observed.

Conclusions

The BST appears to improve the quality of life in patients with AMI after PCI, with additional benefits of lowered abdominal circumference and BMI and improved level of cardiac function. This trial is registered with NCT02693795.

Baduanjin exercise for chronic obstructive pulmonary disease: an updated systematic review and meta-analysis

OBJECTIVE

To objectively evaluate the effectiveness of Baduanjin exercise on cardiopulmonary function and quality of life in chronic obstructive pulmonary disease patients.

DATA SOURCES

Articles published in PubMed, EMBASE, China National Knowledge Infrastructure Database, the Cochrane Library, Wanfang Database, and China Biological Medicine Database from inception to March 2020.

REVIEW METHOD

Articles on randomized controlled trials about Baduanjin exercise for the treatment of chronic obstructive pulmonary disease were identified. Cochrane handbook was applied to assess the quality of included trials. Stata (version 14.0) and Review Manager (version 5.3) were employed for data analysis. Mean difference with 95% confidence intervals were calculated for pulmonary function, 6-minute walking distance, and the quality of life.

RESULTS

Thirty-one randomized controlled trials including 3045 patients were included. The result of meta-analysis indicated that comparing with any other type of treatment alone, Baduanjin exercise combined other type of treatment revealed well efficacy in improving exercise capability on 6-minute walking distance (mean difference = 43.83, 95% confidence interval (29.47, 58.20), P < 0.00001), forced expiratory volume in 1 second (mean difference = 0.23, 95% confidence interval (0.15, 0.31), P < 0.00001), forced volume vital capacity (mean difference = 0.19, 95% confidence interval (0.08, 0.30), P = 0.0007), the ratio of forced expiratory volume in the first second to forced vital capacity (mean difference = 3.85, 95% confidence interval (2.19, 5.51), P < 0.00001), and the quality of life in chronic obstructive pulmonary disease patients regarding the St. George respiratory questionnaire (mean difference = -7.71, 95% confidence interval (-10.54, -4.89), P < 0.00001) and chronic obstructive pulmonary disease assessment test (mean difference = -2.56, 95% confidence interval (-4.13, -1.00), P = 0.001).

CONCLUSIONS

Baduanjin exercise could improve exercise capacity, pulmonary function, and quality of life for patients with chronic obstructive pulmonary disease.

Relationship Between Praying and Self-Care in Elderly with Heart Failure: A Cross-Sectional Study in West of Iran

Given the prevalence of Heart Failure (HF), the current study was conducted, aiming to determine the relationship between praying and self-care in the patients with HF in Iran in 2018. The type of the study is descriptive-analytical, which has been conducted in patient group of more than 65, suffering HF. The population of study has consisted of HF patients, referring to Shahid Mostafa Khomeini Hospital of Ilam province. Therefore, the patients, referring to this hospital for medical treatments, were included in this study. The study data were analyzed using software SPSS16. The findings showed there was a significant relationship between the severity of prayer and the demographic variables, such as gender (p < 0.004), education (p < 0.03), and duration of the disease (p < 0.001). The findings also showed that there was a relationship between self-care and gender (p < 0.001), education (p < 0.004), and duration of disease (p < 0.001). Also, the findings showed that there is a relationship between self-care and prayer (r = 727), so that increasing the amount of prayer will increase self-care. The mean (SD) of total prayer is 167.33 (10.49) and total self-care is 35.86 (10.60). With the increase in the rate of praying, their self-care increased. Based upon this, religious interventions are recommended to be held for this group of patients, focusing on praying.

Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory.

AIM

To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients.

METHODS

This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO₂ peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data.

RESULTS

A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO₂ peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO₂ peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.

CONCLUSION

This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.

The effect of Baduanjin exercise on health-related physical fitness of college students: study protocol for a randomized controlled trial

BACKGROUND

Low health-related physical fitness in college students is a risk factor for future development of cardiovascular diseases at later stages in life, but appropriate exercise is one of the main determinant factors of health-related physical fitness. Previous studies have showed that Baduanjin exercise is beneficial in improving sleep quality, mental health, body flexibility, and body physique. However, the evidence is unclear whether Baduanjin exercise can be recommended as an effective exercise to promote health-related physical fitness of college students.

METHODS/DESIGN

One hundred twenty college students will be recruited and randomly allocated to either the Baduanjin exercise or the control group at a ratio of 1:1. The students in the Baduanjin exercise group will receive a 12-week supervised Baduanjin exercise training intervention with a frequency of 1 h each day and 4 days per week, while those in the control group will not receive any specific exercise intervention and will be informed to maintain their original lifestyle for 12 weeks. The primary outcome of health-related physical fitness involving measurements of body flexibility, muscular strength, cardiopulmonary fitness, and body endurance will be measured at baseline and after the 12-week intervention period. Mixed linear models will be used to analyze the effect of the Baduanjin exercise intervention on the health-related physical fitness of college students.

DISCUSSION

This is the first trial to evaluate the effects of Baduanjin exercise on health-related physical fitness in college students. If the results are as expected, they will provide evidence of Baduanjin exercise in promoting health-related physical fitness in young adults.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-IOR-17013011 . Registered on 17 November 2017.

Symptoms, Hope, Self-Management Behaviors, and Quality of Life Among Chinese Preoperative Patient With Symptomatic Valvular Heart Diseases

Introduction: More than 42 million people are estimated to suffer from valvular heart disease (VHD) worldwide with a prevalence of 5.3% to 7.7% in the Chinese adult population. The purpose of this study was to examine the associations between symptoms, hope, self-management behaviors, and quality of life (QOL) for preoperative patients with symptomatic VHD in a rural area of China. Method: This was a descriptive comparative study that took place in Nanning, China, between January 2015 and March 2016. The sample was 128 preoperative patients with symptomatic VHD. Data were collected using the Symptom Distress Questionnaire, Herth Hope Index, Self-Management Scale, and Minnesota Living with Heart Failure Questionnaire. Results: Data from 122 patients were included in the final analysis. Mean scores of hope, self-management, and QOL were 36.71, 55.27, and 55.56. Worse total scores of symptom severity (r = 0.57 to 0.69, p < .001) and self-management behaviors (r = -0.22 to -0.25, p < .05) were associated with poorer QOL. Fatigue, loss of appetite, and self-management behaviors explained 49.90% variance of QOL (p < .001). Discussion: Fatigue, loss of appetite, and self-management influenced QOL of patients with symptomatic VHD. Interventions aimed at strengthening self-management and relieving symptoms should be tailored for patients with symptomatic VHD base on their traditional animist belief and food culture in rural areas of China such as the Zhuang Autonomous Region.

The health effects of Baduanjin exercise (a type of Qigong exercise) in breast cancer survivors: A randomized, controlled, single-blinded trial

PURPOSE

This study aimed to evaluate the effectiveness of Baduanjin exercise, which is a traditional Chinese Qigong exercise, in breast cancer survivors to assess its efficacy for physical and psychological rehabilitation.

METHODS

The study was a single-blinded randomized controlled trial. Eighty-six subjects were randomly assigned to the intervention (n = 46) or control (n = 40) groups. The intervention group received Baduanjin exercise 3 days/week at hospital and another 4 days/week at home for 6 months, whereas the control group were requested to maintain their original physical activity. Outcomes included body mass index (BMI), heart rate variability, lung capacity, arm circumference, shoulder range of motion, step test index, anxiety, depression, and quality of life (QOL).

RESULTS

After 6 months of intervention, heart rate variability and shoulder range of motion were significantly improved in the Baduanjin group compared to the control group (P < 0.05). There were also significant improvements in depression, QOL, and four QOL dimension scores (physical well-being, social well-being, functional well-being, and breast cancer subscale) (P < 0.05). However, there were no differences in the BMI, lung capacity, arm circumference, step test index, anxiety, and the emotional well-being QOL dimension scores.

CONCLUSION

Our findings indicate that Baduanjin is an effective intervention for improving physical and psychological health outcomes among breast cancer survivors, which is worth recommending and implementing by oncology nurses for breast cancer survivors during their long rehabilitation journeys.

Seated-Baduanjin as an adjuvant rehabilitation treatment for dysfunctional ventilatory weaning response: A case report

RATIONALE

Seated-Baduanjin as adjuvant rehabilitation treatment in a patient with Dysfunctional ventilatory weaning response(DVWR) is extremely rare, and we report a case of a patient's rehabilitation exercise who suffered from DVWR.

PATIENT CONCERNS

A 62-year-old patient was admitted for dyspnea for more than a month after surgery.

DIAGNOSES

On arrival, the patient was conscious but anxious, and he had difficulty breathing. When attempting to disconnect the ventilator, the patient's autonomous respiration > 25 times /min, and the heart rate > 120 times /min. He had to rely on the ventilator to survive. According to the characteristics of the patient, we considered the patient with DVWR.

INTERVENTIONS

We provided the same essential treatment as the last hospital and performed the Seated-Baduanjin for the patient which was a new form of bed exercise, 2 times a day, 30 minutes each time.

OUTCOMES

The patient showed a gradual improvement in breathing and muscle strength.

LESSONS

In this case report, the Seated-Baduanjin showed a remarkable therapeutic effect on a patient and might be an adjuvant treatment for DVWR.