A single-arm feasibility study of community-delivered Baduanjin (Qigong practice of the eight Brocades) training for frail older adults

Abstract

Background: Frailty is a common geriatric syndrome, characterized by reduced physiologic reserve and increased vulnerability to stressors, due to cumulative decline in multiple physiological systems. We studied the feasibility of a community-delivered Baduanjin (BDJ) training program among pre-frail/frail community-dwelling older people. We examined 1) safety (adverse events), physical and psychological effects; and 2) feasibility of recruitment, retention, adherence; recruitment efforts and any program challenges, so as to inform future studies.Methods: Our study was a single arm pre-post study in a community setting. Sixteen week group BDJ training (2x/week in the first 4 weeks, and 3x/week thereafter) co-designed and implemented by community-based providers in Singapore. Recruitment, attendance and adverse events were recorded throughout the training. A participants’ survey was also administered after the training program. Effects of the intervention on physical and functional outcomes (hand grip strength, knee extension strength, Time Up and Go (TUG), Physiological Profile Assessment (PPA), 30-second Sit-to-Stand test, 6-meter fast gait speed test), frailty outcomes (frailty score and status), and other outcomes (Maastricht Questionnaire (MQ), Fall Efficacy Scale (FES), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), and EQ-5D-5L) were examined before and after the program.Results: Of 31 older adults screened to be frail, 15 met inclusion criteria and 3 refused participation, resulting in 12 older adults (9 women) enrolled into the program. During the program, one participant was hospitalized (unrelated to BDJ training) and the other 11 (aged 77±6 years; 2 frail, 9 prefrail at baseline) completed the program with average overall attendance of 89%. Most (89%) of the 44 training sessions had attendance >80%. The program received positive feedback with no training-related adverse events. Participants either reversed (n=2) or maintained (n=9) their frailty statuses. There post-training outcomes in hand grip strength, knee extension strength, TUG , MQ , FES , MoCA , GDS and EQ-5D-5L index score appeared to be better. The reduction of frailty and PPA fall risk scores were of moderate-to-large effect size. Conclusions: Community-delivered BDJ training program was safe and feasible for prefrail/frail older adults with the potential to improve physical and cognitive function, reduce fall risk, improve psychological well-being, and reverse frailty status.

The Safety of Baduanjin Exercise: A Systematic Review

“…Most of the studies were conducted in China, including ten in Fujian [ 20 – 29 ], six in Beijing [ 19 , 30 – 34 ], five in Taiwan [ 35 – 39 ], five in Guangdong [ 7 , 40 – 43 ], four in Hong Kong [ 6 , 44 – 46 ], three in Shanghai [ 18 , 47 , 48 ], two in each of Hebei [ 49 , 50 ], Jiangsu [ 51 , 52 ], Sichuan [ 53 , 54 ], and Hubei [ 17 , 55 ], and one in each of Tianjin [ 4 ], Shanxi [ 56 ], Jiangxi [ 57 ], and Macau [ 58 ]. One study was conducted in Singapore [ 59 ], and one study was conducted in the USA [ 60 ].…”

“…Eleven trials included healthy participants only [ 17 , 20 , 22 , 30 , 33 , 36 , 37 , 39 , 49 , 55 , 60 ], and the remaining 36 included participants with a variety of physical and mental health conditions [ 4 , 6 , 7 , 18 , 19 , 21 , 23 – 29 , 31 , 32 , 34 , 35 , 38 , 40 – 48 , 50 – 54 , 56 – 59 ].…”

“…The Baduanjin exercise regimes used in the studies varied in content, frequency, duration, and intensity. The majority of studies used standing Baduanjin exercises as an intervention [ 4 , 6 , 17 – 39 , 41 – 59 ], two studies used a mixed model including standing and sitting Baduanjin exercises [ 40 , 60 ], and one study used sitting Baduanjin exercises only [ 7 ]. The duration of Baduanjin exercise ranged from 12 minutes to 120 minutes.…”

“…Of the 47 studies assessed, 22 reported protocols used to monitor AEs [ 4 , 6 , 17 , 20 , 21 , 26 , 27 , 29 , 32 , 35 , 37 , 38 , 40 , 41 , 43 , 44 , 46 – 48 , 52 , 55 , 59 ], but only 2 reported the actual occurrence of AEs during the trial [ 44 , 52 ]. Of these two studies, one reported muscle ache only [ 52 ] and the other reported muscle ache, palpitation, giddiness, knee pain, backache, fatigue, nervousness, dizziness, shoulder pain, chest tightness, and shortness of breath [ 44 ] ( Table 2 ).…”

Baduanjin exercise for balance function in community-dwelling older adults with cognitive frailty: a randomized controlled trial protocol

“…Studies indicate that Baduanjin has positive physiological and psychological effects for older adults with/without chronic disease, for example, improving cognitive function for older adults with or without cognitive impairment [ 20 ], alleviating cancer-related fatigue in cancer patients [ 21 ], and alleviating musculoskeletal pain in older people with chronic low back pain [ 22 ]. A recent preliminary study assessing the feasibility and efficacy of Baduanjin for prefrail/frail community-based older adults found that Baduanjin training was safe and feasible for prefrail/frail older adults with the potential to improve physical and cognitive function, reduce fall risk, improve psychological well-being, and reverse frailty status [ 23 ]. Two other studies also showed that 8-12 weeks of Baduanjin training was effective in improving balance, leg strength and mobility and was a safe and sustainable form of home-based exercise for people with chronic stroke or community-dwelling older adults [ 24 , 25 ].…”