Qigong as a Therapeutic Modality for Anxiety and Depression in Older Adults: Mechanisms from a Systematic Review and Meta-Analysis
The rise in mental health challenges among aging populations underscores the urgent need for safe, effective, and accessible non-pharmacological treatments. The systematic review and meta-analysis by Dong et al. (2025) offers compelling evidence that Traditional Chinese Exercises (TCEs), especially Qigong, significantly reduce symptoms of anxiety and depression in older adults. The study synthesizes findings from 31 randomized controlled trials involving 2,501 participants, exploring the efficacy of Tai Chi and Qigong through subgroup analysis of exercise frequency, duration, and intensity. While Tai Chi and Qigong share overlapping features, this review emphasizes the distinct mechanisms and therapeutic impact of Qigong in the management of anxiety and depression.
Mind-Body Integration as Core Mechanism
Qigong, a classical practice combining breath regulation, meditative awareness, and intentional movement, is rooted in the philosophy of harmonizing the internal environment (qi) with the outer world. Dong et al. highlight that Qigong exerts its psychological benefits through both physiological and psychological pathways. Unlike high-intensity physical training, Qigong engages the parasympathetic nervous system, activating a “rest-and-digest” response via deep abdominal breathing, rhythmic motion, and mindful focus.
This parasympathetic activation serves as a physiological countermeasure to chronic stress, known to elevate cortisol and disrupt homeostasis. By emphasizing slow, rhythmic breathing and meditative awareness, Qigong downregulates the hypothalamic-pituitary-adrenal (HPA) axis, resulting in decreased secretion of stress hormones such as cortisol, epinephrine, and norepinephrine. This hormonal modulation is critical in attenuating the physiological arousal associated with anxiety and the dysphoric mood in depression.
Emotional Regulation and Neurochemical Balance
The meta-analysis notes that Qigong’s benefits are particularly pronounced in improving emotional regulation. This is achieved through two primary mechanisms: enhancement of neuroplasticity and modulation of neurochemical pathways. Specifically, consistent Qigong practice increases levels of serotonin and dopamine—neurotransmitters associated with mood stabilization, pleasure, and motivation—while reducing pro-inflammatory cytokines that contribute to the neuroinflammatory model of depression.
Moreover, the repetitive, meditative movements of Qigong encourage focused attention and present-moment awareness, reducing default mode network (DMN) overactivity. In depression and anxiety, the DMN is often hyperactive, leading to persistent rumination and self-referential thought patterns. Qigong interrupts these patterns by engaging motor, sensory, and attentional systems in a unified, calming activity.
Qigong and Autonomic Regulation
One of the most robust mechanisms identified in the paper is Qigong’s influence on autonomic balance. Studies included in the meta-analysis reveal that Qigong improves heart rate variability (HRV), a marker of autonomic flexibility and resilience. Higher HRV is correlated with improved emotional regulation and reduced symptoms of anxiety and depression. The review confirms that Qigong interventions of 40–60 minutes, 3 to 5 times weekly, significantly enhance HRV in older adults, suggesting increased vagal tone and greater parasympathetic dominance.
This autonomic shift is especially relevant in anxiety, where sympathetic overactivation is common. Qigong mitigates this by fostering a parasympathetic state through coordinated breathwork, gentle motion, and sensory grounding. The resulting neurophysiological changes include reduced muscle tension, lower heart rate, and decreased respiratory rate, all of which are clinical targets in anxiety reduction protocols.
Depression: Enhancing Engagement and Self-Efficacy
While anxiety is characterized by hyperarousal, depression often involves hypoarousal, withdrawal, and a lack of motivation. Qigong addresses these through structured, achievable engagement in physical activity. For older adults facing mobility issues or motivational deficits, Qigong offers a low-barrier entry point into movement-based therapy. The repetitive patterns and gentle sequences allow participants to build mastery, enhancing self-efficacy—a well-documented psychological buffer against depression.
Dong et al. report that depression outcomes improved most significantly in trials where Qigong was practiced 5–7 times per week over at least 24 weeks, with sessions lasting 40–60 minutes. This high-frequency protocol suggests that the cumulative effect of regular practice is essential in driving long-term neurochemical and emotional change. The improvement in physical function and balance also indirectly supports emotional well-being by increasing independence and reducing fear of falls or injury—factors frequently associated with depression in geriatric populations.
Optimal Intervention Parameters for Qigong
The study provides a nuanced look at intervention parameters. The subgroup analyses show that anxiety symptoms responded best to Qigong practiced 3–4 times per week for 12–16 weeks. Depression, however, required more sustained engagement—5 to 7 sessions per week over a 24-week minimum. Both conditions showed maximal benefit when session durations ranged from 40 to 60 minutes.
This divergence points to the need for personalized protocols. Anxiety, which responds more quickly to autonomic modulation and stress hormone reduction, may not require the same frequency and duration of practice as depression, which benefits from long-term neuroplastic changes and behavioral activation.
Cognitive and Sensory Integration
Qigong’s therapeutic potential also lies in its unique integration of body awareness and cognitive focus. The meta-analysis points out that, unlike pharmacological or talk therapy interventions, Qigong enhances interoceptive awareness—the brain’s perception of internal body states. This sensory engagement is crucial for emotional clarity and self-regulation. As practitioners become more attuned to their breath, muscle tension, and posture, they develop increased agency over their emotional and physiological states.
Additionally, the meditative quality of Qigong reduces reactivity to negative emotions. By cultivating an observational stance toward bodily sensations and mental states, practitioners become less identified with their distress, facilitating a cognitive shift known as “decentering,” commonly found in mindfulness-based cognitive therapies.
Implications for Public Health and Aging Populations
From a public health perspective, Qigong offers a scalable, low-cost, and culturally adaptable intervention for mental health in older adults. As the authors emphasize, older adults are often under-treated due to barriers in accessing conventional psychotherapy or due to contraindications for pharmacological treatments. Qigong circumvents these limitations by being accessible in group or individual settings, requiring no equipment, and showing minimal risk of adverse effects.
Given its proven efficacy, particularly in depression where high frequency and consistency are key, Qigong could serve as a front-line or adjunctive therapy in mental health care for aging populations. Its holistic nature—engaging body, breath, and mind—also aligns with geriatric care models that emphasize integrated physical and psychological well-being.
Summary of Key Mechanisms
The review identifies several converging pathways through which Qigong alleviates anxiety and depression:
Neurohormonal Regulation: Decreases in cortisol and sympathetic activity; increases in serotonin and dopamine.
Autonomic Nervous System Modulation: Improved HRV, increased vagal tone, and reduced physiological arousal.
Neuroplasticity: Enhanced emotional regulation and cognitive flexibility through repetitive mindful movement.
Behavioral Activation: Improved motivation, self-efficacy, and engagement in daily life.
Mindfulness and Decentering: Development of meta-cognitive awareness and reduced reactivity to negative thoughts.
Conclusion
Qigong emerges from this systematic review as a robust, evidence-based modality for managing anxiety and depression in older adults. Its physiological mechanisms—rooted in parasympathetic activation and neurochemical modulation—are complemented by its psychological benefits, including increased mindfulness, emotional resilience, and behavioral engagement. As Dong et al. conclude, clinical practitioners should tailor Qigong programs to patient needs, aiming for 40–60 minute sessions, 3–7 times weekly, sustained over several months. With its blend of movement, breath, and awareness, Qigong stands as a bridge between traditional wisdom and modern evidence-based mental health care.
APA Reference
Dong, Y., Pang, D., Xiang, J., Chao, G., & Kuang, X. (2025). Exploring the benefits of traditional Chinese exercises (Tai Chi and Qigong) on the anxiety and depression of older adults: A systematic review and meta-analysis. Medicine, 104(12), e41908
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