Peer Reviewed Research: Effects of 3-Month Qigong Exercise on Heart Rate Variability and Respiration in Anxious College Students.
The study by Sun et al. (2024) set out to examine how a structured Qigong program impacts heart rate variability (HRV) and respiration in a group of anxious college students. HRV—an indicator of the balance between sympathetic and parasympathetic activity—is increasingly recognized as a key physiological measure linked to emotional regulation, stress resilience, and cardiovascular health. Low HRV is associated with anxiety and other psychopathological states, while interventions that improve vagal tone and HRV may reduce anxiety symptoms.
The research specifically combined two forms of Qigong: Yijinjing, which focuses on postural adjustment and coordinated breathing to improve physical health and prevent disease, and Liuzijue, which emphasizes controlled breathing with vocalization to support organ function and emotional balance. This combination was chosen to maximize both physical conditioning and breathing regulation.
Study Design and Methods Relevant to HRV
Participants and Intervention:
The study recruited sedentary college students (18–25 years) with significant anxiety, defined as a Hamilton Anxiety Rating Scale (HAM-A) score above 14. Thirty-seven students met the inclusion criteria and were randomized into either the intervention group (n=18) or the control group (n=19). The intervention group performed Qigong five times per week for 12 weeks, with each 60-minute session including warm-up, main exercise, and cool down.
HRV Measurement Protocol:
HRV was measured both before and after the intervention using standard electrocardiographic recording with R-wave detection. Time-domain measures included:
SDNN (standard deviation of NN intervals), indicating total HRV.
PNN50 (percentage of successive NN intervals differing by more than 50 ms), reflecting parasympathetic activity.
Frequency-domain measures included:
Normalized Low Frequency (nLF; 0.04–0.15 Hz) – often interpreted as reflecting both sympathetic and parasympathetic modulation, but with a dominant sympathetic component.
Normalized High Frequency (nHF; 0.15–0.4 Hz) – associated with parasympathetic activity, particularly respiratory sinus arrhythmia.
LF/HF ratio – indicating sympathovagal balance.
Key Results Related to HRV
Time-Domain Findings:
The most notable change was a significant increase in SDNN in the intervention group after the Qigong program (p < 0.05). This suggests that the overall variability in heart rate improved, reflecting enhanced adaptability of the autonomic nervous system. The between-group comparison of SDNN changes was also significant (p = 0.039), confirming that this improvement was attributable to the Qigong intervention rather than chance or external factors.
PNN50, another parasympathetic marker, did not show statistically significant change. This may indicate that the primary effect of Qigong in this cohort was on overall HRV modulation rather than isolated increases in parasympathetic activity detectable via this measure.
Frequency-Domain Findings:
In frequency-domain analysis, normalized low-frequency power (nLF) significantly decreased in the intervention group after the program (p < 0.05). This shift suggests a relative reduction in sympathetic modulation, potentially favoring parasympathetic dominance.
No significant within- or between-group changes were observed for normalized high frequency (nHF) or the LF/HF ratio, although trends in the data indicated movement toward more balanced autonomic control.
Mechanisms Proposed in the Study
The authors offered several physiological explanations for these HRV changes:
Autonomic Nervous System Rebalancing:
The slow, rhythmic movement patterns in Yijinjing, coupled with the controlled breathing and vocalization of Liuzijue, appear to modulate the autonomic nervous system, shifting the balance toward parasympathetic dominance. This shift improves HRV by enhancing vagal input to the sinoatrial node of the heart.Breathing Regulation and HRV Enhancement:
The study emphasized the role of respiratory modulation in HRV improvement. Slow, deep, and abdominal breathing—as practiced in Liuzijue—has been shown in other research to synchronize respiratory and cardiac rhythms, enhancing respiratory sinus arrhythmia and increasing vagal tone. Equal inhalation and exhalation ratios can stabilize the balance between sympathetic and parasympathetic activity.Mind–Body Integration:
Qigong’s meditative component may contribute to reduced sympathetic arousal and increased parasympathetic activity. Mental focus during movement, combined with breath awareness, likely reduces hypothalamic–pituitary–adrenal (HPA) axis activation, leading to decreased physiological arousal and improved HRV.Potential Central Nervous System Effects:
The authors referenced prior research showing that Qigong can increase alpha wave activity on EEG. Such neurophysiological changes may underpin improvements in autonomic regulation by fostering a relaxed yet alert mental state conducive to vagal dominance.
Respiratory Findings and Their Link to HRV
While HRV was the main autonomic measure, the respiratory data in the study help explain why HRV improvements occurred:
The intervention group demonstrated increased abdominal breathing depth and increased abdominal breathing frequency after the Qigong program (both p < 0.05).
Thoracic breathing changes were less pronounced, supporting the idea that the training shifted participants toward deeper, diaphragmatic breathing.
This abdominal breathing pattern likely facilitated the HRV improvements by promoting greater respiratory sinus arrhythmia—a key parasympathetic-driven mechanism.
The authors cited prior research showing that even short bouts of controlled breathing can improve psychophysiological coherence, and suggested that the sustained 12-week intervention amplified these benefits.
Interpretation and Implications
The study’s findings fit into a growing body of evidence showing that Qigong, Tai Chi, and other mind–body practices can improve autonomic regulation. The specific combination of Yijinjing and Liuzijue appears particularly well-suited for individuals with anxiety because:
It is low-impact and accessible to sedentary individuals.
It emphasizes slow, controlled breathing that directly supports vagal activation.
It integrates mental focus and meditative awareness, which can reduce sympathetic drive.
The increase in SDNN and decrease in nLF observed in the intervention group are consistent with the hypothesis that Qigong enhances autonomic flexibility and reduces sympathetic overactivation—two key goals in the management of anxiety disorders.
Clinical Relevance for Anxiety Management
Low HRV is both a marker and potential contributor to anxiety. Enhancing HRV through lifestyle and behavioral interventions has been proposed as a non-pharmacological adjunct for anxiety management. Qigong may offer several advantages in this context:
No pharmacological side effects.
Holistic benefits beyond HRV improvement, including better sleep and reduced physical pain (both reported in this study).
Potential for long-term adherence due to the gentle and meditative nature of the practice.
This study reinforces the idea that HRV should be considered not just as a research outcome, but also as a therapeutic target in anxiety management strategies.
Limitations Relevant to HRV Interpretation
While the HRV results are promising, several limitations must be considered:
The sample size was modest (n=37 completing participants), which may limit generalizability.
The intervention duration was 12 weeks; it is unclear whether benefits would persist long-term without continued practice.
Frequency-domain results were less robust than time-domain findings, suggesting that further research should examine whether specific Qigong breathing patterns can more strongly influence high-frequency power and LF/HF ratios.
The control group did not engage in any form of structured breathing or exercise, so future studies might compare Qigong to other breathing-focused interventions to isolate unique benefits.
Conclusion
Sun et al. (2024) provide compelling evidence that a structured, 12-week program of Yijinjing and Liuzijue Qigong can significantly improve HRV in anxious college students. The key findings—increased SDNN and decreased nLF—indicate enhanced autonomic flexibility and reduced sympathetic predominance. These changes were likely mediated by the intervention’s emphasis on deep abdominal breathing, slow movement, and meditative focus.
From a mechanistic standpoint, the program appears to work through:
Direct modulation of the autonomic nervous system via slow, rhythmic movement.
Enhancement of vagal activity through controlled breathing patterns.
Psychological relaxation and reduced HPA axis activation from the meditative components.
For clinicians and researchers, these results highlight the value of integrating Qigong into anxiety management programs, especially for younger, sedentary populations. For the broader field of psychophysiology, the study adds to the growing evidence that mind–body practices can produce measurable, beneficial changes in autonomic regulation.
Reference
Sun, J., Zhuo, J., Chu, H., Wang, J., Chen, T., Li, B., Lu, T., Zheng, H., Xu, Y., Dong, J., & Cicchella, A. (2024). Effects of 3-month Qigong exercise on heart rate variability and respiration in anxious college students. Scandinavian Journal of Medicine & Science in Sports, 34(1), e14521.
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