Mind-body practice of qigong can improve cancer-related fatigue

A study led by Brown University researchers found that a low-impact, meditative movement program involving qigong was as effective as more standard exercise programs in improving cancer-related fatigue.

PROVIDENCE, R.I. [Brown University] — Fatigue is a common, debilitating and often long-term side effect of cancer as well as its treatment. Researchers at Brown University’s Carney Institute for Brain Science found that people with cancer-related fatigue who practiced qigong, a mind-body movement practice, showed clinically significant improvements in fatigue over the course of a 10-week study. And qigong was as effective at reducing fatigue as a more energy-intensive exercise and nutrition program, the researchers found.

The new study, led by Brown’s Stephanie R. Jones, an associate professor of neuroscience, who built on work by the late Assistant Professor of Family Medicine Catherine Kerr, analyzed the effects of a regular qigong practice on cancer-related fatigue and compared the results to fatigue treatments involving exercise.

As many as 45% of cancer survivors report moderate to severe fatigue even years after stopping treatment. The researchers note that this fatigue can be more burdensome and disruptive to daily life than ongoing pain, nausea and depression. While studies show that exercise can help improve fatigue, there is not yet enough evidence to recommend a particular type of exercise or regimen. In addition, a moderate-to-vigorous exercise program may feel too intense or overwhelming for some patients with fatigue.

“Our study is important because it is the first randomized clinical trial to directly compare qigong practice to the best standards of care for fatigue — namely, exercise,” Jones said. “It would have been hard to predict that people who perform gentle non-aerobic intentional movements would show the same level of improvement as those who go through moderate strength training and aerobic exercise. It is exciting that our findings establish that this is indeed the case.”

The study included 24 female participants who had completed cancer treatment (including surgery, radiation and/or chemotherapy) at least eight weeks prior to the research, all of whom reported cancer-related fatigue and agreed to participate in 10 weeks of classes.

Half of the group was assigned to take classes in qigong, a Chinese mind-body practice that involves sequences of gentle, rhythmic and repetitive movements as well as meditation. The other half participated in a class focused on healthy living that incorporated both physical exercise (Pilates-like core movements as well as resistance training and aerobic exercise) and general health and nutrition education. All classes were held twice a week, for about two hours per session, at the Miriam Hospital in Providence, Rhode Island. For both groups, researchers analyzed changes in participants’ fatigue, emotional health and stress before and after the intervention.

The findings, published in the journal Integrative Cancer Therapies, showed that both interventions significantly improved cancer-related fatigue. The improvement levels were more than double the established "minimal clinically important difference," which is the minimal change in score considered relevant by patients and physicians. The results from the qigong group were comparable to those from the exercise and nutrition group. The participants in the qigong group also reported significant improvements in mood, emotion regulation and stress, while those who had completed the exercise and nutrition program reported significant improvements in sleep and fatigue levels.

Mind-body approaches, which include qigong as well as yoga, mindfulness and tai-chi, are receiving increasing attention for their potential to affect physical, emotional and cognitive health — all of which may be helpful for those with cancer-related fatigue, Jones said. Importantly, the researchers noted that a gentle, low-intensity practice like qigong may offer some of the same physical benefits of exercise without requiring the same level of physical effort, which can be difficult for someone who has recently been through an experience like cancer.

Jones and her team are now studying how qigong might affect a person’s perception of fatigue.

“We are currently also examining changes in electrophysiological measures of brain and muscle activity that occur with practice in each group,” Jones said. “We’re testing the hypothesis that the treatment efficacy is related to modulation of brain-muscle communication that may be distinct in each group due to the different techniques.”

Jones noted that this study of 24 women was relatively small, and that future research could study the effects of mind-body interventions for cancer-related fatigue with larger and more diverse study populations.

This work underpinning this study was initiated by Catherine Kerr, who before her death in 2016 directed translational neuroscience at the Contemplative Studies Initiative at Brown University. Diagnosed with multiple myeloma in 1995, Kerr benefited from qigong practice and sought a better understanding of why — that interest led to the current study, which was supported by funding from the Berkman-Landis Family Fund.

“We hope that this study, which was conceived by our colleague, the late Dr. Catherine Kerr, in her cancer journey, sets a foundation for further scientific inquiry on the healing trajectories promoted by qigong,” Jones said.

Study author Chloe Zimmerman is an M.D./Ph.D. candidate in neuroscience at Brown who started working on this research under Kerr’s mentorship.

“I think we still have a lot to learn about which mind-body practices are best for which patient,” Zimmerman said. “Being a part of this clinical trial with qigong has shown me how much healing potential there is from practices that have been historically dismissed by the biomedical clinical and research communities. I think we have a responsibility to keep investigating how they may exert their healing effects in rigorously designed studies.”

Brown researchers who contributed to this study include Research Assistant Dylan Daniels, Assistant Research Professor Simona Temereanca, and undergraduate students Cooper Penner and Tariq Cannonier.