Liuzijue Qigong and Chronic Lung Disease
What a Meta-Analysis of 14 Trials Reveals
In a 2020 study published in BMC Complementary Medicine and Therapies, Xiao and colleagues examined whether Liuzijue exercise could improve symptoms and physical function in patients with stable chronic obstructive pulmonary disease (COPD). The researchers conducted a systematic review and meta-analysis of randomized controlled trials to evaluate whether this traditional breathing and movement practice affects dyspnea, lung function, exercise endurance, and quality of life.
COPD is a progressive respiratory illness characterized by persistent airflow limitation and chronic breathing difficulty. Because the disease gradually reduces a person’s ability to move and perform daily tasks, rehabilitation programs often focus on breathing training and moderate exercise. The purpose of the study was to determine whether Liuzijue, a traditional Chinese breathing exercise, produces measurable improvements in these clinical outcomes.
COPD is one of the most common chronic lung diseases worldwide. It is characterized by narrowing of the airways and damage to the lung’s air sacs, which together reduce airflow and make breathing more difficult. As the disease progresses, patients often experience persistent shortness of breath, fatigue, and declining exercise tolerance.
Pulmonary rehabilitation programs attempt to slow this decline through structured exercise and breathing training. These programs aim to improve respiratory muscle function, increase exercise capacity, and reduce the sensation of breathlessness during daily activity.
Traditional Chinese exercise systems have occasionally been incorporated into rehabilitation programs because they combine slow movement with regulated breathing. Liuzijue is one of these practices. The exercise uses six vocalized breathing sounds combined with gentle body movements and abdominal breathing. The breathing pattern involves long exhalations and controlled airflow, which resembles respiratory techniques commonly used in clinical breathing therapy.
What the Researchers Did
The authors searched six scientific databases including PubMed, EMBASE, Web of Science, and major Chinese medical databases to identify randomized controlled trials investigating Liuzijue exercise in patients with stable COPD. Only studies that compared Liuzijue with standard medical care were included in the analysis.
Fourteen randomized trials met the inclusion criteria. Together these studies included 920 participants diagnosed with COPD. The control groups received routine medical treatment and general health guidance, while the intervention groups practiced Liuzijue exercises.
Training programs differed somewhat across studies, but several patterns were consistent. Participants typically practiced Liuzijue several times per week, and training sessions lasted roughly thirty minutes. The overall training periods ranged from three months to one year.
Researchers evaluated several common measures used in pulmonary rehabilitation research. These included dyspnea scales that measure perceived breathlessness, lung function measurements obtained through spirometry, walking endurance tests, and standardized questionnaires assessing quality of life. The six-minute walking test was frequently used to evaluate functional endurance, while lung function was assessed through measurements such as forced expiratory volume in one second and related spirometry indicators.
What Changed
When the data from the fourteen trials were combined, several consistent trends appeared. Patients practicing Liuzijue reported reduced breathlessness compared with those receiving standard care. Exercise endurance also improved. Participants in the Liuzijue groups were able to walk farther during the six-minute walking test, indicating improved physical capacity.
Lung function measurements also shifted modestly in a positive direction. Several spirometry indicators improved in patients practicing the exercise. Quality-of-life questionnaires also showed improvement, suggesting that patients experienced fewer respiratory limitations in daily activities.
Although the magnitude of change varied between studies, the overall pattern across the trials indicated improvements across multiple outcomes related to respiratory health.
The Numbers
Across the fourteen randomized trials included in the analysis, a total of 920 patients with stable COPD were studied. When the results were pooled together, several measurable changes appeared. Breathlessness scores improved by about 0.73 points on the Modified Medical Research Council dyspnea scale, a clinical scale used to rate how difficult breathing feels during daily activity. Walking endurance increased by roughly 17.8 meters on the six-minute walking test, a standard rehabilitation measure that evaluates how far a patient can walk in six minutes as an indicator of functional capacity.
Lung function measurements also improved. Forced expiratory volume in one second (FEV1), which measures how much air a person can forcefully exhale in the first second of breathing out, increased by about 0.23 liters. The percentage of predicted FEV1, a value that compares a patient’s lung capacity to expected values for their age and body size, improved by about 7.6%. The ratio between FEV1 and forced vital capacity (FEV1/FVC), a common indicator used to diagnose airway obstruction, increased by roughly 6.8%. Quality of life scores shifted as well. The St. George’s Respiratory Questionnaire decreased by nearly 9.9 points, indicating fewer respiratory limitations in daily life, and COPD Assessment Test scores decreased by about 2.3 points. These numbers reflect modest but consistent improvements across breathing symptoms, lung mechanics, and physical endurance in patients practicing Liuzijue.
Mechanism and Interpretation
The mechanisms discussed in the paper largely relate to breathing mechanics and respiratory muscle activity.
Liuzijue combines controlled abdominal breathing with prolonged exhalation. During the exercise, participants inhale slowly and then exhale while producing one of six vocalized sounds. Each sound requires different movements of the lips, tongue, and throat. These movements create controlled airflow during exhalation.
Prolonged exhalation can reduce airway collapse and slow the breathing rate. In patients with COPD, this type of breathing pattern can improve ventilation efficiency by reducing air trapping within the lungs. The authors also note that the vocalization involved in the six sounds may engage respiratory muscles during exhalation.
The movement component of Liuzijue also contributes to the exercise. The practice includes gentle stretching, upper limb movement, trunk rotation, and expansion of the chest. These movements can activate accessory respiratory muscles and increase thoracic mobility. Increased respiratory muscle engagement and improved chest movement may contribute to improved breathing efficiency during daily activities.
System-Level Framing
The outcomes measured in COPD rehabilitation research often influence one another.
Breathlessness, lung function, exercise endurance, and quality of life are interconnected variables. Improvements in breathing efficiency can reduce the sensation of dyspnea during activity. Reduced breathlessness may allow patients to move more comfortably and remain physically active. Increased activity can then support muscular conditioning and cardiovascular function.
In the trials included in this meta-analysis, improvements appeared across several of these domains simultaneously. Lung function measures improved modestly, walking endurance increased, and quality-of-life scores moved in a favorable direction. This clustering of outcomes suggests that the intervention affected multiple aspects of respiratory and physical function rather than producing an isolated change in a single measurement.
Limitations
The authors noted several limitations in the available evidence.
Many of the included trials had relatively small sample sizes and limited methodological reporting. In exercise studies, it is difficult to blind participants or instructors to the intervention, which can introduce expectation effects. Some studies also lacked detailed descriptions of their randomization procedures or allocation concealment.
Variation between study protocols was another limitation. Training duration ranged from three months to one year, and the exact exercise programs differed somewhat across studies. Because of these variations, it is difficult to determine the exact training dose required for consistent results.
For these reasons, the authors conclude that additional high-quality randomized trials are necessary to confirm the findings.
Final Perspective
This meta-analysis examined fourteen randomized trials involving patients with stable COPD. Across these studies, Liuzijue practice was associated with improvements in breathlessness, exercise endurance, lung function measurements, and quality of life.
The intervention combines controlled breathing, vocalized exhalation, and gentle movement. These elements overlap with established principles used in pulmonary rehabilitation, including respiratory muscle training and prolonged exhalation breathing techniques.
From a rehabilitation perspective, Liuzijue can be understood as a structured breathing and movement practice that influences respiratory mechanics and functional endurance. The results of the analysis indicate that regular practice may produce measurable changes across several physiological and functional domains that are relevant to COPD management.
Reference
Xiao, L., Duan, H., Li, P., Wu, W., Shan, C., & Liu, X. (2020). A systematic review and meta-analysis of Liuzijue in stable patients with chronic obstructive pulmonary disease. BMC Complementary Medicine and Therapies, 20, 308.
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