The Qigong of Prolong Life With Nine Turn Method Relieve Fatigue, Sleep, Anxiety and Depression in Patients With CFS:, 2022, Xie et al

[Andy]

Full title: The Qigong of Prolong Life With Nine Turn Method Relieve Fatigue, Sleep, Anxiety and Depression in Patients With Chronic Fatigue Syndrome: A Randomized Controlled Clinical Study

Background: Chronic fatigue syndrome (CFS) is a complex disease of unknown etiology and mechanism. The purpose of this study was to investigate the effect of Prolong Life with Nine Turn Method (PLWNT) Qigong exercise on CFS focusing on fatigue, sleep quality, depression, and anxiety.

Methods: A total of 90 participants diagnosed with CFS were randomly assigned into two parallel groups: PLWNT and cognitive behavioral therapy (CBT). The participants in the PLWNT or CBT group participated in qigong exercise or cognitive behavior education program, respectively, once a week in-person and were supervised online during the remaining 6 days at home, over 12 consecutive weeks. The primary outcome was fatigue (Multi-dimensional Fatigue Inventory 20 [MFI-20]), and secondary outcomes were sleep quality (Pittsburgh Sleep Quality Index [PSQI]), anxiety, depression (Hospital Anxiety and Depression Scale [HADS]), and changes in the Neuropeptide Y (NPY) of peripheral blood.

Results: The within-group comparisons of the PLWNT and CBT groups revealed significant improvement in both groups in MFI-20, PSQI, and HADS scores (P < 0.05). No significant difference were found between the PLWNT and CBT groups, even though the effective rate of the PLWNT group was 62.22%, which is slightly than 50.00% of the CBT group. The fatigue scores in the PLWNT group were positively correlated with sleep degree (r = 0.315) and anxiety degree (r = 0.333), only anxiety degree (r = 0.332) was found to be positively correlated with fatigue in the CBT group. The analysis of peripheral blood showed that NPY decreased after PLWNT intervention but increased significantly in the CBT.

Conclusion: The PLWNT qigong exercise has potential to be an effective rehabilitation method for CFS symptoms including fatigue, sleep disturbance, anxiety, and depression. Future studies should expand study sample size for in-depth investigation to determine the optimal frequency and intensity of PLWNT qigong intervention in CFS patients. The study was registered in the ClinicalTrials.govdatabase on April 12, 2018, with registration number NCT03496961.

Open access, https://www.frontiersin.org/articles/10.3389/fmed.2022.828414/full

 

[Hutan]

Several researchers have proposed that graded exercise therapy and CBT might be effective treatments for CFS to improve fatigue and poor mental health, including depression, anxiety, and schizophrenia (13, 15). However, evidence of persistent and sustained significant outcomes in CFS patients is not sufficient (16).

Th recognition that GET and CBT might not be effective treatments is good, although I'm not sure where the schizophrenia fits in.

The clinical manual published by the International Association for Chronic Fatigue Syndrome recommends traditional Chinese medicine (TCM) treatments as a complementary alternative therapy, including acupuncture and massage (17).

That's Friedberg F. ME/CFS: Primer for clinical practitioners. (2014). Available online at: www.iacfsme.org. (accessed July 2014). That primer should be withdrawn, it is full of a lot of unevidenced statements.

Acupuncture, Tuina and Qigong can all regulate Qi, and it has been clinically proven to be effective in the treatment of CFS (6, 22, 23).

I'd be surprised.

I've got to say, so far the research protocol is very good. The allocation of participants to the treatments was randomised by an independent statistician. The participants all had to come in for a session once a week, and then had to practice at home. They had to post videos of them doing their home practice each day. The treatment involves abdominal massage - they even had pressure-sensing gloves so the they could get the right amount of pressure.

Before we did the exercises, we gave the patient a 3-day training in the amount of abdominal stimulation, During the period, we let patients wear manual stimulation data gloves, the average amount of abdominal stimulation for the first eight rubbings was 0.5 ± 0.1 kg, and monitor the strength of the manual in real time in the LABVIEW2017 software, so that patients can feel the amount of stimulation.

 

[Hutan]

Qualified CBT therapists [e.g., those with a diploma in CBT or other professionally accredited qualifications involving CBT as a major part of training (e.g., a clinical or counseling psychologist degree)] were invited to conduct CBT by giving lectures or psychological consultations on the prevention and treatment of CFS for 1 h each week. On the remaining 6 days of the week, all participants were required to listen to lectures on WeChat for 30 min every day.

That's pretty intensive CBT.

Primary outcome - MFI-20 - fatigue
Secondary outcomes -

• Overall efficacy evaluation - probably as good as any subjective measure - 4 levels - basically complete cure, nearly a cure, a significant improvement, and minimal or no change, also incorporating the MFI-20 changes.
• PSQI - sleep quality
• HADS - anxiety and depression - these researchers don't seem to have realised that HADS doesn't work in ME/CFS
• Peripheral blood markers - although the title is in the plural, the only one mentioned is NPY, they claim it is an objective biomarker of sleep, anxiety and depression in CFS. I don't think it's as clear cut as that.

Any adverse events were reported and evaluated by a medical committee. If they judged that it was an adverse event, the cost of treatment and financial compensation would be paid to the claimant. Yes, the participants were paying to be involved in this study. (There were 6 adverse events, only two were felt to be related to the qigong, none to the CBT.)

They report only one dropout (CBT group), from a shoulder fracture.

RESULTS

The results showed that the total effective rate of the PLWNT group was 62.22%, in which zero cases were cured, seven cases had markedly effective results, 21 cases had effective results, and 17 cases had ineffective results.
The total effective rate of the CBT group was 50%, in which zero cases were cured, zero cases had markedly effective results, 22 cases had effective results, and 22 cases had ineffective results.

Qigong wins! (as was expected by the researchers). No cures by either treatment, but CBT couldn't even produce a single markedly effective result. To be fair, the daily CBT lectures were probably pretty boring, and I'd be annoyed if I had paid for them.

But, in terms of the primary outcome (MFI-20) and the PSQI and HADS, there was no significant difference between the two treatments. These are subjective outcomes, measured straight after the treatment, so don't really mean anything.

I don't know what to make of the NPY. It didn't really change in the Qigong group (126 to 124), but it went up in the CBT group (142 to 201). There's no unit given anywhere in this qigong/cbt study, so that makes it hard to compare the results with other studies.

I've talked about NPY in this study
Plasma Neuropeptide Y: a biomarker for symptom severity in chronic fatigue syndrome, 2010, Fletcher et al which didn't really find differences in NPY levels in CFS compared to controls and GWI, although they claimed it was higher in the CFS group. The qigong authors quote that study as showing that levels are higher in CFS, but I don't think the study shows that at all.

NPY is involved in lots of things so it's too simplistic to suggest it means anything specifically about anxiety levels. Some references say that repeated stress and a bad diet increases NPY levels, while others suggest that higher levels are associated with a resilience to stress.


CONCLUSION: Subjective outcomes in an unblinded trial, measured only at the end of treatment - that trial set up could prove anything worked, and so it did. It seems that stomach massage works just as well, if not better than CBT. It's not really clear what the only objective measure, NPY was measuring.

 

[rvallee]

I want to take this place to congratulate all the "medical professionals", and I use the term very loosely here, pushing the biopsychosocial ideology and the company they will bring in the future. This is it, and it will not be getting any prettier moving forward.

They made standards so low that even nonsense like this reads exactly like their work, because it pretty much is the same thing. It's a standard formula where the content is completely irrelevant. There is zero real difference between this and LP, CBT, GET, acupuncture, swearing at angels, homeopathic hot-dog water and literally any nonsense you can think of. How about a literal "thoughts and prayers for CFS"? Literally the exact same, because the difference between one pseudoscience and another is: who gives a damn?

 

[Hutan]

They made standards so low that even nonsense like this reads exactly like their work, because it pretty much is the same thing.

Indeed.

But, if you believe ME/CFS is psychosomatic, then I guess it doesn't matter all that much what the treatment is. You go through the motions of treating the patient and, provided the treatment is convincing enough, the patient reports feeling better, and so, the job is done.

One thing I note that was missed from the reporting was the results of the diaries that the participants were supposed to fill out every day about how they feel about the treatment. I would like to see those. It's hard to imagine the participants feeling thrilled to dial in for their daily CBT 30 mins after weeks of that. It would be interesting to know how many of the participants moved to the option of 'reviewing the CBT powerpoint slides in their own time' rather than listening to the CBT therapist, and how many in the qigong arm continue to practice qigong at home now.

 

[ME/CFS Skeptic]

Quote from the article:

"Prolong Life with Nine Turn Method (PLWNT) is a type of qigong practice that uses external energy to strengthen the limbs and internal energy to reconcile the viscera. This practice sims to smooth the circulating qi and blood that was introduced by a centenarian named Kai Fang in the Qing Dynasty [...] It may trigger the contraction of the intestinal and rectal muscles (25), which can train the function of the intestines."
​

I wonder what CBT-proponents think of these studies.

 

[Hutan]

I wonder what CBT-proponents think of these studies.

That they need to start learning how to be qigong masters, because the practice produces outcomes that are as good as CBT and it sounds more fun, with its pressure sensing glove and all?

 

[perchance dreamer]

I've recently started practicing qigong at home and am noticing more flexibility and range of motion in my knees, hips, and neck. It hasn't relieved any other symptoms, but that's okay. I value it as a pleasant physical exercise that doesn't make my joints hurt.