Qigong for multiple sclerosis

 • Primary: Assess feasibility of a pragmatic trial of community qigong classes • Secondary: Explore preliminary effects of qigong on balance, gait, and quality of life

• This study allowed for an assessment of qigong for people with MS in a ‘real world’ 

setting

• Some feasibility outcomes were not met, suggesting the need to modify current 

design to better meet participants’ needs and increase retention

• Exploratory analyses suggest trends in improvement of mental health and fatigue 

that may warrant further investigation with a modified qigong intervention

• Varied levels of classes, including simpler or more meditative forms of qigong to meet 

specific needs of participants

• Refined inclusion criteria to capture potential effects of physical function

Qigong for Multiple Sclerosis: A Pragmatic, Randomized Feasibility Study

1National University of Natural Medicine, Helfgott Research Institute, Portland, OR

2Oregon Health & Science University, Department of Neurology, Portland, OR

Lita Buttolph, PhD1

; Joshua Corn, ND1

; Douglas Hanes, PhD1

; Angela Senders, ND, MCR1,2

Feasibility Outcomes

• Recruitment achieved in 8 months

• 60% retention of Qigong group, 100% controls

• 50% retention of wait list controls in Qigong

• Mean adherence 70% of classes, 3 of 7 

days/week home practice

• Qigong group able to fully participate with minor modifications to some movements Secondary Outcomes • No differences between qigong group & controls • Pre/post-qigong found improvement in global mental health (p=0.04), and trend 

toward improved fatigue (p=0.06) 

Perceived Benefits and Challenges

• 100% of participants who completed the qigong intervention reported 

perceived benefits including improved energy, mood, flexibility, sleep and 

mobility. • 30% reported some discomfort with qigong

Retention 

Recruitment 

Adherence 

Participation 

1. Amano S, Nocera JR, Vallabhajosula S, et al. The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson’s disease. Parkinsonism Relat Disord. 2013;19(11):955-960. doi:10.1016/j.parkreldis.2013.06.007. 2. Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. 2012;366(6):511-519. doi:10.1056/NEJMoa1107911. 3. Ni X, Liu S, Lu F, Shi X, Guo X. Efficacy and safety of tai chi for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(6):e99377. doi:10.1371/journal.pone.0099377. 4. Schmitz-Hübsch T, Pyfer D, Kielwein K, Fimmers R, Klockgether T, Wüllner U. Qigong exercise for the symptoms of Parkinson’s disease: a randomized, controlled pilot study. Mov Disord. 2006;21(4):543-548. doi:10.1002/mds.20705. 5. Chan JSM, Ho RTH, Wang C-W, Yuen LP, Sham JST, Chan CLW. Effects of qigong exercise on fatigue, anxiety, and depressive symptoms of patients with chronic fatigue syndrome-like illness: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:485341. doi:10.1155/2013/485341. 6. Ho RTH, Chan JSM, Wang C-W, et al. A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome. Ann Behav Med. 2012;44(2):160-170. doi:10.1007/s12160-012-9381-6. 7. Oh B, Butow P, Mullan B, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol. 2010;21(3):608-614. doi:10.1093/annonc/mdp479.

Study Design

• Randomized-controlled feasibility trial of qigong (n=10) vs wait list control (n=10) • Outcomes assessed at baseline, 12 & 24 weeks

Feasibility Criteria for Success

• Recruitment of participants within 8 months

• 80% retention of study participants

• Adherence to qigong classes (70%) and home practice (2 days/week) • Ability to participate in qigong movements (Y/N)

Secondary Outcome Measures

• Timed 25-Ft Walk, Timed Up and Go, Four Square Step tests

• MS Impact Scale, MS Walking Scale, Modified Fatigue Impact Scale

• PROMIS: Quality of life, fatigue, anxiety and depression

Statistical Analyses

• Independent t-tests comparing between-group change from baseline to 12 wks

• Paired t-tests for exploratory within-group qigong

Inclusion Criteria

• >18 years old and self-reported MS 

diagnosis

• Able to walk 50 feet w/o assistive device

• Stable for > 3 mos on DMTs for MS or balance medications Exclusion Criteria

• Regular qigong, tai chi or yoga practice 

>1/mo w/in past 6 mos

• Relapse w/in 30 days prior to first 

study visit 

Control (n=10) Qigong (n=10)

Age (years, SD) 46 (10.6) 42(8.9) Female 80% 70%

College degree or higher 80% 70%

Type of MS

Relapsing Remitting 90% 90%

Secondary Progressive 10%

Unknown 10%

Use of Disease Modifying Therapy 60% 50%

Moderate Exercise > 1 times/week 100% 90%

Table 1: Descriptive statistics

Control (n=10) Qigong (n=6) Baseline (BL) Follow-up (FU) Change

(FU-BL) t P-value

T25FW

Control 5.45 (1.45) 5.16 (1.10) -0.03 -2.56 0.02 Qigong 5.23 (0.97) 5.72 (1.16) 0.49

TUG

Control 8.36 (1.81) 7.66 (1.13) -0.29 -1.80 0.112 Qigong 7.72 (1.93) 8.13 (2.34) 0.41

FSSTControl 10.14 (2.58) 9.22 (1.53) -0.52 0.13 0.90 Qigong 10.22 (1.73) 9.62 (1.56) -0.59 MFISControl 45.0 (23.57) 41.5 (26.15) -3.5 1.15 0.27 Qigong 60.83 (18.00) 48.33 (18.07) -12.5 MSIS29 Control 42.69 (15.60) 42.21 (15.99) -0.48 -0.81 0.43 Qigong 44.02 (10.00) 47.36 (13.58) 3.33 MSWS12 Control 36.17 (14.61) 38.17 (18.14) 2.0 -0.51 0.62 Qigong 49.44 (19.99) 54.16 (25.47) 4.7 PROMIS Global health (mental) Control 43.48 (6.65) 45.49 (7.16) 2.01 -0.86 0.41 Qigong 43.60 (8.93) 47.87 (10.11) 4.27 Global health (physical) Control 45.85 (7.26) 46.76 (8.19) 0.91 0.22 0.83 Qigong 41.55 (7.45) 41.93 (3.19) 0.38 Anxiety Control 59.01 (8.31) 57.29 (5.91) 1.72 -0.49 0.63 Qigong 57.27(3.76) 57.03 (8.02) 0.23 Depression Control 54.42 (9.02) 52.93 (7.14) 1.49 -0.10 0.92 Qigong 54.58 (5.72) 53.32 (5.58) 1.27

Fatigue Control 54.66 (10.48) 58.15 (10.47) 3.49 1.61 0.13 Qigong 59.85 (6.49) 59.22 (5.39) -0.63 Physical fxn Control 44.98 (6.94) 44.44 (5.10) -0.54 1.26 0.23 Qigong 43.95 (6.59) 41.38 (7.75) -2.56

n=10 Pre-Qigong mean (sd) Post-Qigong mean (sd) Mean Difference (95%CI) T P-value

T25FW 4.97 (0.85) 5.28 (1.06) -0.31 (-0.58 to -0.04) -2.61 0.03

TUG 7.42 (1.54) 7.54 (1.98) -0.12 (-0.72 to 0.52) -0.42 0.69

FSST 9.38 (1.71) 8.95 (1.54) 0.42 (-0.04 to 0.89) 2.07 0.07 MFIS 53.50 (21.86) 40.50 (18.02) 13.00 (-0.51 to 26.51) 2.18 0.06 MSIS29 43.10 (12.58) 40.90 (13.37) 2.21 (-8.48 to 12.89) 0.48 0.65 MSWS12 43.67 (17.70) 43.33 (23.77) 0.33 (-8.76 to 9.43) 0.08 0.94 PROMIS Global health (mental) 46.22 (8.77) 49.14 (8.84) -2.92 (-5.67 to -0.17) -2.40 0.04 Global health (physical) 43.72 (6.92) 45.96 (6.10) -2.24 (-6.26 to 1.79) -1.26 0.24 Anxiety 58.14 (5.18) 57.07 (6.25) 1.07 (-3.91 to 6.05) 0.49 0.64 Depression 53.54 (7.43) 50.62 (6.34) 2.92 (-0.99 to 6.83) 1.69 0.13

Fatigue 59.72 (6.93) 55.16 (7.88) 4.56 (-1.01 to 10.13) 1.85 0.10 Physical fxn 43.96 (5.56) 44.23 (7.52) -0.27 (-4.09 to 3.55) -0.16 0.88

Table 2. Between-group change in 

secondary outcome measures comparing 

qigong vs control using independent t-tests

Table 3. Exploratory analysis of within-group 

change for all qigong participants (qigong + 

wait list control) using paired t-tests. 

• Qigong is a traditional 

Chinese mind-body exercise, similar to Tai Chi • Tai Chi and Qigong have 

been shown to improve 

balance, fatigue, and quality 

of life for many chronic conditions.1–7 Perceived Benefits Challenges

“Learned more about qi, flows and meridians and how to help myself using them. Gave me time to practice meditation and benefit from others in the class and their energy.” “Some bending and stretching poses were strenuous and mildly uncomfortable.” “I felt like I slept better and moved more.” “Back pain possibly from over exercising.”

“I felt more centered emotionally and I felt energized.” “About the 4th week my legs started to get worse. Extreme spasticity.”

“Increased functionality and control of one of my legs, majority of the help was just from the stretching.”

“Some back and leg nerve pain until I modified two of the exercises.”

“My negative inner voices have been lessened, I'm noticeably less depressed and less dragged down by mental issues. Physically, I'm able to stand, walk, run, carry things, in fact, do all physical activities better and longer without trouble or needing help.” “The one…class I attended was physically and emotionally uncomfortable - I didn't feel like the instructor gave enough explanation of modification of poses, the room was hot, and I was uncomfortable with many others in class without MS and who were more advanced in qigong.”

This study was part of a Master’s thesis in Integrative Medicine Research at the National University of Natural Medicine. I am grateful to the OHSU MS Neurology staff for their comments in the early design of the study. I am also grateful to Carol Choutka of the Portland Chapter of the National MS Society for allowing me to host a table at their annual meeting. Many thanks to the qigong instructors who volunteered their time and allowed participants to attend their classes for free. Finally, I am grateful to the study participants for their time, dedication and participation in this study. Contact information: Lita Buttolph, lita.buttolph@icloud.com, (503) 358-0739

Table 4. Selected quotes from participants who reported benefits and challenges of community qigong classes.• Primary: Assess feasibility of a pragmatic trial of community qigong classes • Secondary: Explore preliminary effects of qigong on balance, gait, and quality of life

• This study allowed for an assessment of qigong for people with MS in a ‘real world’

setting

• Some feasibility outcomes were not met, suggesting the need to modify current

design to better meet participants’ needs and increase retention

• Exploratory analyses suggest trends in improvement of mental health and fatigue

that may warrant further investigation with a modified qigong intervention

• Varied levels of classes, including simpler or more meditative forms of qigong to meet

specific needs of participants

• Refined inclusion criteria to capture potential effects of physical function

Qigong for Multiple Sclerosis: A Pragmatic, Randomized Feasibility Study

1National University of Natural Medicine, Helfgott Research Institute, Portland, OR

2Oregon Health & Science University, Department of Neurology, Portland, OR

Lita Buttolph, PhD1

; Joshua Corn, ND1

; Douglas Hanes, PhD1

; Angela Senders, ND, MCR1,2

Feasibility Outcomes

• Recruitment achieved in 8 months

• 60% retention of Qigong group, 100% controls

• 50% retention of wait list controls in Qigong

• Mean adherence 70% of classes, 3 of 7

days/week home practice

• Qigong group able to fully participate with minor modifications to some movements Secondary Outcomes • No differences between qigong group & controls • Pre/post-qigong found improvement in global mental health (p=0.04), and trend

toward improved fatigue (p=0.06)

Perceived Benefits and Challenges

• 100% of participants who completed the qigong intervention reported

perceived benefits including improved energy, mood, flexibility, sleep and

mobility. • 30% reported some discomfort with qigong

Retention

Recruitment

Adherence

Participation

1. Amano S, Nocera JR, Vallabhajosula S, et al. The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson’s disease. Parkinsonism Relat Disord. 2013;19(11):955-960. doi:10.1016/j.parkreldis.2013.06.007. 2. Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. 2012;366(6):511-519. doi:10.1056/NEJMoa1107911. 3. Ni X, Liu S, Lu F, Shi X, Guo X. Efficacy and safety of tai chi for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(6):e99377. doi:10.1371/journal.pone.0099377. 4. Schmitz-Hübsch T, Pyfer D, Kielwein K, Fimmers R, Klockgether T, Wüllner U. Qigong exercise for the symptoms of Parkinson’s disease: a randomized, controlled pilot study. Mov Disord. 2006;21(4):543-548. doi:10.1002/mds.20705. 5. Chan JSM, Ho RTH, Wang C-W, Yuen LP, Sham JST, Chan CLW. Effects of qigong exercise on fatigue, anxiety, and depressive symptoms of patients with chronic fatigue syndrome-like illness: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:485341. doi:10.1155/2013/485341. 6. Ho RTH, Chan JSM, Wang C-W, et al. A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome. Ann Behav Med. 2012;44(2):160-170. doi:10.1007/s12160-012-9381-6. 7. Oh B, Butow P, Mullan B, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol. 2010;21(3):608-614. doi:10.1093/annonc/mdp479.

Study Design

• Randomized-controlled feasibility trial of qigong (n=10) vs wait list control (n=10) • Outcomes assessed at baseline, 12 & 24 weeks

Feasibility Criteria for Success

• Recruitment of participants within 8 months

• 80% retention of study participants

• Adherence to qigong classes (70%) and home practice (2 days/week) • Ability to participate in qigong movements (Y/N)

Secondary Outcome Measures

• Timed 25-Ft Walk, Timed Up and Go, Four Square Step tests

• MS Impact Scale, MS Walking Scale, Modified Fatigue Impact Scale

• PROMIS: Quality of life, fatigue, anxiety and depression

Statistical Analyses

• Independent t-tests comparing between-group change from baseline to 12 wks

• Paired t-tests for exploratory within-group qigong

Inclusion Criteria

• >18 years old and self-reported MS

diagnosis

• Able to walk 50 feet w/o assistive device

• Stable for > 3 mos on DMTs for MS or balance medications Exclusion Criteria

• Regular qigong, tai chi or yoga practice

>1/mo w/in past 6 mos

• Relapse w/in 30 days prior to first

study visit

Control (n=10) Qigong (n=10)

Age (years, SD) 46 (10.6) 42(8.9) Female 80% 70%

College degree or higher 80% 70%

Type of MS

Relapsing Remitting 90% 90%

Secondary Progressive 10%

Unknown 10%

Use of Disease Modifying Therapy 60% 50%

Moderate Exercise > 1 times/week 100% 90%

Table 1: Descriptive statistics

Control (n=10) Qigong (n=6) Baseline (BL) Follow-up (FU) Change

(FU-BL) t P-value

T25FW

Control 5.45 (1.45) 5.16 (1.10) -0.03 -2.56 0.02 Qigong 5.23 (0.97) 5.72 (1.16) 0.49

TUG

Control 8.36 (1.81) 7.66 (1.13) -0.29 -1.80 0.112 Qigong 7.72 (1.93) 8.13 (2.34) 0.41

FSSTControl 10.14 (2.58) 9.22 (1.53) -0.52 0.13 0.90 Qigong 10.22 (1.73) 9.62 (1.56) -0.59 MFISControl 45.0 (23.57) 41.5 (26.15) -3.5 1.15 0.27 Qigong 60.83 (18.00) 48.33 (18.07) -12.5 MSIS29 Control 42.69 (15.60) 42.21 (15.99) -0.48 -0.81 0.43 Qigong 44.02 (10.00) 47.36 (13.58) 3.33 MSWS12 Control 36.17 (14.61) 38.17 (18.14) 2.0 -0.51 0.62 Qigong 49.44 (19.99) 54.16 (25.47) 4.7 PROMIS Global health (mental) Control 43.48 (6.65) 45.49 (7.16) 2.01 -0.86 0.41 Qigong 43.60 (8.93) 47.87 (10.11) 4.27 Global health (physical) Control 45.85 (7.26) 46.76 (8.19) 0.91 0.22 0.83 Qigong 41.55 (7.45) 41.93 (3.19) 0.38 Anxiety Control 59.01 (8.31) 57.29 (5.91) 1.72 -0.49 0.63 Qigong 57.27(3.76) 57.03 (8.02) 0.23 Depression Control 54.42 (9.02) 52.93 (7.14) 1.49 -0.10 0.92 Qigong 54.58 (5.72) 53.32 (5.58) 1.27

Fatigue Control 54.66 (10.48) 58.15 (10.47) 3.49 1.61 0.13 Qigong 59.85 (6.49) 59.22 (5.39) -0.63 Physical fxn Control 44.98 (6.94) 44.44 (5.10) -0.54 1.26 0.23 Qigong 43.95 (6.59) 41.38 (7.75) -2.56

n=10 Pre-Qigong mean (sd) Post-Qigong mean (sd) Mean Difference (95%CI) T P-value

T25FW 4.97 (0.85) 5.28 (1.06) -0.31 (-0.58 to -0.04) -2.61 0.03

TUG 7.42 (1.54) 7.54 (1.98) -0.12 (-0.72 to 0.52) -0.42 0.69

FSST 9.38 (1.71) 8.95 (1.54) 0.42 (-0.04 to 0.89) 2.07 0.07 MFIS 53.50 (21.86) 40.50 (18.02) 13.00 (-0.51 to 26.51) 2.18 0.06 MSIS29 43.10 (12.58) 40.90 (13.37) 2.21 (-8.48 to 12.89) 0.48 0.65 MSWS12 43.67 (17.70) 43.33 (23.77) 0.33 (-8.76 to 9.43) 0.08 0.94 PROMIS Global health (mental) 46.22 (8.77) 49.14 (8.84) -2.92 (-5.67 to -0.17) -2.40 0.04 Global health (physical) 43.72 (6.92) 45.96 (6.10) -2.24 (-6.26 to 1.79) -1.26 0.24 Anxiety 58.14 (5.18) 57.07 (6.25) 1.07 (-3.91 to 6.05) 0.49 0.64 Depression 53.54 (7.43) 50.62 (6.34) 2.92 (-0.99 to 6.83) 1.69 0.13

Fatigue 59.72 (6.93) 55.16 (7.88) 4.56 (-1.01 to 10.13) 1.85 0.10 Physical fxn 43.96 (5.56) 44.23 (7.52) -0.27 (-4.09 to 3.55) -0.16 0.88

Table 2. Between-group change in

secondary outcome measures comparing

qigong vs control using independent t-tests

Table 3. Exploratory analysis of within-group

change for all qigong participants (qigong +

wait list control) using paired t-tests.

• Qigong is a traditional

Chinese mind-body exercise, similar to Tai Chi • Tai Chi and Qigong have

been shown to improve

balance, fatigue, and quality

of life for many chronic conditions.1–7 Perceived Benefits Challenges

“Learned more about qi, flows and meridians and how to help myself using them. Gave me time to practice meditation and benefit from others in the class and their energy.” “Some bending and stretching poses were strenuous and mildly uncomfortable.” “I felt like I slept better and moved more.” “Back pain possibly from over exercising.”

“I felt more centered emotionally and I felt energized.” “About the 4th week my legs started to get worse. Extreme spasticity.”

“Increased functionality and control of one of my legs, majority of the help was just from the stretching.”

“Some back and leg nerve pain until I modified two of the exercises.”

“My negative inner voices have been lessened, I'm noticeably less depressed and less dragged down by mental issues. Physically, I'm able to stand, walk, run, carry things, in fact, do all physical activities better and longer without trouble or needing help.” “The one…class I attended was physically and emotionally uncomfortable - I didn't feel like the instructor gave enough explanation of modification of poses, the room was hot, and I was uncomfortable with many others in class without MS and who were more advanced in qigong.”

This study was part of a Master’s thesis in Integrative Medicine Research at the National University of Natural Medicine. I am grateful to the OHSU MS Neurology staff for their comments in the early design of the study. I am also grateful to Carol Choutka of the Portland Chapter of the National MS Society for allowing me to host a table at their annual meeting. Many thanks to the qigong instructors who volunteered their time and allowed participants to attend their classes for free. Finally, I am grateful to the study participants for their time, dedication and participation in this study. Contact information: Lita Buttolph, lita.buttolph@icloud.com, (503) 358-0739

Table 4. Selected quotes from participants who reported benefits and challenges of community qigong classes.