Peer-Reviewed Research: Qigong Exercise and Its Efficacy in Cognitive Impairment in Schizophrenia
The randomized controlled study titled "Shen-based Qigong Exercise improves cognitive impairment in stable schizophrenia patients in rehabilitation wards: a randomized controlled study" by Shen et al. (2024) investigates the potential cognitive benefits of a Shen-Based Qigong Exercise (SBQE) intervention for stable schizophrenia patients. This review evaluates the study's rationale, methodology, findings, and broader implications while discussing its strengths and limitations.
Background and Rationale
Schizophrenia is a chronic mental disorder associated with significant cognitive deficits and negative symptoms that reduce quality of life and functional capacity. Traditional Chinese Medicine (TCM), specifically Qigong, has a history of application in managing mental health conditions, including schizophrenia. The study hypothesizes that SBQE, derived from TCM principles of “body-spirit syncretism” (xin shen he yi), could address cognitive impairments by integrating physical movements, breath control, and meditation.
The authors cite previous evidence suggesting that mind-body exercises like Tai Chi and Baduanjin improve cognitive and physical health in schizophrenia, providing a foundation for the study. However, they highlight gaps in assessing cognitive outcomes and the need for targeted Qigong interventions tailored to cognitive rehabilitation.
Methodology
The study adopts a 12-week randomized, single-blind controlled trial design. Forty participants, all diagnosed with stable schizophrenia and meeting stringent inclusion criteria, were randomized into two groups: one receiving routine rehabilitation plus SBQE, and the other receiving routine rehabilitation alone. Cognitive performance and negative symptoms were assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Scale for the Assessment of Negative Symptoms (SANS), respectively.
The SBQE intervention involved movements selected from established Qigong styles (Liuzijue, Baduanjin, Wuqinxi, and Yijinjing), organized into eight actions. Each session included warm-up, active exercise, and cool-down phases, supervised and conducted with standardized intensity. Routine rehabilitation included conventional activities like painting and gardening.
The primary outcomes were changes in cognitive function, as measured by RBANS, and negative symptoms, measured by SANS. Statistical analyses included mixed-effects regression for repeated measures, ensuring robustness despite the small sample size.
Findings
The SBQE group demonstrated a significant improvement in cognitive performance, with an 11.6-point increase in RBANS scores compared to the control group at week 12 (p = 0.04). This suggests that SBQE positively influences domains like memory and attention. However, changes in SANS scores, though favoring the SBQE group, did not achieve statistical significance, highlighting the complex interplay between negative symptoms and cognitive recovery.
The authors suggest potential mechanisms for SBQE’s cognitive benefits, including enhanced brain plasticity, improved functional connectivity, and modulation of attention networks. These findings align with prior research on mind-body exercises, supporting their neurophysiological benefits.
Strengths
Innovative Intervention Design: By tailoring Qigong movements to address specific cognitive deficits in schizophrenia, the study introduces a novel therapeutic modality rooted in TCM principles.
Rigorous Methodology: Randomization, blinding of assessors, and robust statistical analyses enhance the study’s credibility.
Clinical Relevance: The focus on stable schizophrenia patients in rehabilitation wards aligns with real-world clinical needs, potentially broadening the application of SBQE as a supplementary therapy.
Limitations
Small Sample Size: With only 40 participants, the study lacks the statistical power to detect subtle effects, particularly in secondary outcomes like SANS scores.
Short Duration: The 12-week intervention does not provide insights into the long-term sustainability of cognitive improvements.
Lack of Comparative Groups: Including a group practicing other Qigong styles or aerobic exercises would clarify SBQE’s unique efficacy.
Limited Cognitive Measures: While RBANS is a validated tool, it does not assess executive functions or working memory, critical domains in schizophrenia.
Absence of Follow-Up: Post-intervention assessments could elucidate whether SBQE effects persist over time or require ongoing practice.
Broader Implications
The findings contribute to the growing body of evidence supporting mind-body interventions for cognitive rehabilitation in psychiatric populations. SBQE’s focus on integrating physical and mental practices reflects a holistic approach that aligns with contemporary trends in complementary medicine. Furthermore, the study bridges Eastern and Western paradigms, offering a culturally inclusive perspective on mental health care.
However, to establish SBQE as a standardized treatment, further research with larger, diverse cohorts and more comprehensive cognitive assessments is essential. Exploring mechanisms through neuroimaging or biomarkers could substantiate its physiological impact.
Conclusion
Shen et al.’s study provides preliminary evidence that SBQE enhances cognitive function in stable schizophrenia patients. While the results are promising, the study’s limitations necessitate cautious interpretation. Future trials should address these gaps to validate SBQE as a robust adjunct to conventional schizophrenia treatment.
APA Citation
Shen, H., Lian, A., Wu, Y., Zhou, J., Liu, Y., Zhu, L., Zhang, Y., Yi, Z., Liu, X., & Fan, Q. (2024). Shen-based Qigong exercise improves cognitive impairment in stable schizophrenia patients in rehabilitation wards: A randomized controlled study. BMC Psychiatry, 24(796)
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