Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Study Registration
2.2. Search Strategy
2.3. Inclusion Criteria and Study Selection
2.4. Quality Assessment for Each Eligible Study
2.5. Data Extraction and Data Synthesis
3. Results
3.1. Literature Search
3.2. Study Characteristics
3.3. Methodological Quality
3.4. Effects of Baduanjin on Anxiety and Depression
3.4.1. Baduanjin Intervention Versus Control Group on Anxiety and Depression
3.4.2. Moderator Analysis
4. Discussion
5. Conclusion
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Author [Reference] | Location (Language) | ISZ (AR) | Study Participants | Intervention Protocol | Exercise Intensity | Outcome Measured | Adverse Event; Follow-Up | ||
---|---|---|---|---|---|---|---|---|---|
Training Duration and Dosage (Qualification of Instructor) | Total Hour | No. of Session | |||||||
Randomized controlled trials | |||||||||
Chan et al. (2014) [27] | Hong Kong, China (English) | 150 (13.3%) | CFS-like illness with mild anxiety and depression (a mean age of 39) | BJ: 16 90-min sessions for 9 weeks (a Qigong master) (daily 30-min home practice); CG: Waitlist | 24 | 16 | NR | Anxiety and depression (HADS) | No; 3-month |
Suo, Yu et al. (2016) [28] | Nanjin, China (Chinese) | 60 (0%) | Perimenopasual women with depression (aged 44–56) | BJ: 7 × 60 min/wk for 12 weeks (trained nurse) + mental therapy (2 × 30 min/wk for 12 weeks) + usual drug therapy; CG: mental therapy (2 × 30 min/wk for 3 weeks) + usual drug therapy | 84 | 84 | NR | Depression (HAMD) | No/ 6-month |
Li et al. (2014) [29] | Hengyan, China (Chinese) | 45 (11.1%) | College students with depression (aged 20–23) | BJ: 5 × 60 min /wk for 40 weeks (an Qigong instructor); CG: Usual physical education classes (training volume was NR) | 200 | 200 | NR | Depression (SDS) | NR; No |
Yang et al. (2017) [30] | Zhengzhou, China (Chinese) | 110 (4.5%) | Type 2 DM patients with depression (aged 32–70) | BJ: 7× 60 min/wk for 12 weeks (an Qigong instructor) + usual care; CG: 2 × 30 min/wk for 3 weeks (educational program) + usual care | 84 | 84 | NR | Depression (HAMD) | NR No |
Cao et al. (2016) [31] | Nangjin, China (Chinese) | 103(0.97%) | COPD patients with anxiety and depression (a mean age of 70.49) | BJ: 4 × 30 min/wk for 24 weeks (trained instructors) + usual care; CG: 4 × 30 min/wk for 24 weeks (self-selected pace walking) + usual care | 48 | 96 | NR | Anxiety (SAS) Depression (SDS) | NR; 12-week |
Li et al. (2017) [32] | ShanXi, China (Chinese) | 68(10.3%) | Patients with breast cancer (a mean age of 45.45) | BJ: 5 sessions (session length was NR; trained nurse)/wk for 12 weeks + usual care CG: Usual care | NA | 60 | NR | Anxiety (SAS) Depression (SDS) | NR; No |
Ma et al. (2010) [33] | Tangshan, China (Chinese) | 100 (0%) | Perimenopasual women with depression (aged 45–55) | BJ: 7 × 45 min/wk for 12 weeks (instructor qualification was NR); CG: Unaltered lifestyle | 63 | 84 | AHR:100 bpm | Depression (CESD) | NR; No |
Lin (2017) [34] | FuZhou, China Chinese | 94(0%) | Older adults with mild cognitive impairment (aged 61–79) | BJ: 6 sessions (session length was NR; instructor qualification was NR)/wk for 24 weeks + usual care; CG: Usual care | NA | 144 | NR | Depression (GDS) | NR; No |
Sun (2015) [35] | Jilin, China (Chinese) | 65 (0%) | Type 2 DM patients (a mean age of 46.1) | BJ: 5 × 60 min/wk for 24 weeks (trained instructor) CG: Unaltered lifestyle | 120 | 120 | ARH:100 bpm | Anxiety (SAS) Depression (SDS) | NR; No |
Guan et al. (2012) [36] | Hefei, China (Chinese) | 80(1.25%) | Type 2 DM patients (aged 45–70) | BJ: 7 × 60 min/wk for 16 weeks + usual care CG: Usual care | 112 | 112 | NR | Anxiety (SAS) Depression (SDS) | NR; No |
Li, Wang et al. (2017) [37] | Shanxi, China (Chinese) | 70(4.3%) | Patients with Non-small cell lung cancer (a mean age of 56). | BJ: at least 3 × 30 min/wk for 12 weeks (trained nurse) + usual care CG: Usual care | 18 | 36 | NR | Anxiety (SAS) Depression (SDS) | NR; No |
Ma et al. (2011) [38] | Tangshan, China (Chinese) | 145 (0%) | Perimenopausal women with depression (aged 45–55) | BJ: 54 × 45 min/wk for 12 weeks (trained instructor) CG1: 5 × 45/wk for 12 weeks (self-selected pace walking); CG2: Unaltered lifestyle | 45 | 60 | THR: 100 bpm | Depression (CESD) | No; No |
Zhang & Luo (2016) [39] | Chengdu, China (Chinese) | 93(0%) | Perimenopausal women with depression and anxiety (aged 45–55) | BJ: 7 × 45 min/wk for 12 weeks (community doctor) + educational program (twice per week); CG: Twice per week (educational program) | 63 | 84 | NR | Anxiety (SAS) Depression (SDS) | No; No |
Zhang, Gao et al. (2016) [40] | Bejing, China (Chinese) | 60(0%) | Patients with glaucoma (aged 40–60) | BJ: 7 × 30 min/wk for 12 weeks (hospital doctor) + usual care CG: Usual care | 42 | 84 | NR | Anxiety (SAS) Depression (SDS) | No; No |
Liu, Huo et al. (2012) [41] | Beijing, Ching (Chinese) | 88(21.6%) | Type 2 DM patients with depression (a mean age of 64.2) | BJ: 3 × 40 min/wk for 12 weeks (trained instructor) +educational program (a total of 6 30 min educational sessions); CG: Educational program (a total of 6 30 min sessions). | 24 | 36 | NR | Depression (SDS) | No; No |
Zhou (2014) [42] | Beijing, China (Chinese) | 25 (0%) | Type 2 DM patients with depression (aged 51–80) | BJ: 7 × 60 min/wk for 12 weeks (NR) +usual care CG: Usual care | 84 | 84 | NR | Depression (SDS) | No; No |
Wang et al. (2016) [43] | Fuzhou, China (Chinese) | 50 (0%) | Patients with coronary heart disease (aged 60–70) | BJ: (Training volume was NR) for 12 weeks (NR) + usual drug therapy + educational program CG: Usual drug therapy + educational program | NA | NA | NR | Anxiety (SAS) Depression (SDS) | NR; No |
Zhang, Lin et al. (2017) [44] | Liaochen, China (Chinese) | 124 (0%) | Patients with depression (a mean age of 42.8). | BJ: 7 × 60 min/wk for 6 weeks (trained instructor) +usual drug therapy CG: Usual drug therapy | 42 | 42 | NR | Depression (HAMD) | NR;no |
Wu, Chen et al. (2016) [45] | Changsha, China (Chinese) | 60 (0%) | Patients with coronary heart disease (aged 49–79) | BJ: 5 × 60 min/wk for 12 weeks (NR) + usual care CG: Usual care | 60 | 60 | NR | Anxiety (SAS) Depression (SDS) | NR; No |
Ji et al. (2012) [46] | Wuxi, China (Chinese) | 62(0%) | DM patients (aged 36–81) | BJ: 7 × 45 min/wk for 8 weeks (physical therapist) + usual care + education program CG: Usual care + educational program | 42 | 56 | NR | Anxiety (SAS) Depression (SDS) | NR; No |
Wu, Xue et al. (2017) [47] | Beijing, China (Chinese) | 120(0%) | Older adults with anxiety and balance impaired (aged 65–80). | BJ: 2 sessions (session length was NR) per day for 30 days (hospital doctor) CG: Unaltered lifestyle | NA | 60 | NR | Anxiety (SAS) | NR; no |
Han et al. (2017) [48] | TaiYuan, China (Chinese) | 64(6.25%) | Patients with breast cancer and depression (a mean age of 46.23). | BJ: 5 × 20 min/wk for 12 weeks (five trained nurses) + usual care CG: Usual care | 20 | 60 | NR | Anxiety (SAS) | NR; No |
Liu, Chen et al. (2014) [49] | Changsha, China (Chinese) | 40(0%) | Type 2 DM with anxiety (a mean of 57). | BJ: 5 × 30 min/wk for 24 weeks (NR) + usual care + drug therapy CG: Usual care + drug therapy | 60 | 120 | NR | Anxiety (SAS) | NR; No |
Zhang, Zhang et al. (2016) [50] | Beijing, China (Chinese) | 64(3.1%) | Patients with generalized anxiety disorder (aged 22–65). | BJ: 2 × 60 min/wk for 12 weeks (NR) (daily 30 min home practice) + usual care + drug therapy CG: Usual care + drug therapy | 24 | 24 | NR | Anxiety (SAS and HARS) | NR; No |
Huang et al. (2015) [51] | Zhuhai, China (Chinese) | 100(12%) | Heroin addicts with anxiety (aged 18–50) | BJ: 7 × 30 min/wk for 20 weeks (NR) + mental therapy + drug therapy; CG: Mental therapy + drug therapy | 70 | 140 | NR | Anxiety (SAS) | NR; No |
Yin et al. (2016) [52] | Zhuhai, China (Chinese) | 88(0%) | DM patients with mental illness (a mean age of 55.47) | BJ:2 x 60 min/wk for 24 weeks (trained nurse) (daily 60min home practice) +usual care +mental therapy CG: Usual care + mental therapy | 48 | 48 | NR | Anxiety (SAS) Depression (SDS) | NR; No |
2. Non-randomized controlled studies | |||||||||
Non-randomized controlled trial | |||||||||
Guan, Liu et al. (2016) [53] | Fuzhou, China (Chinese) | 60 (0%) | Inpatients with depression (a mean age of 41.4) | BJ: 7 × 30 min/wk for 6 weeks (trained nurse) + usual care + drug therapy; CG1: The choreographed aerobic exercise (dosage was not reported) + usual care + drug therapy CG2: Usual care + drug therapy | 21 | 42 | NR | Depression (HAMD) | NR; No |
Author [Reference] | Study Location | ISZ (AT) | Health Status | Duration and Dosage | Exercise Intensity | QOI | Outcome Measured | Conclusion | p | AE/FU |
---|---|---|---|---|---|---|---|---|---|---|
Wu, Li (2014) [54] | Beijing, China (Chinese) | 68 (8.8%) | Patients with coronary heart disease and depression, with a mean age of 53. | BJ: 3 × 30 min/wk, 2 weeks | NR | Trained instructor | Depression (SDS and HAMD) | SDS: 68(11.34) vs. 67.63(11.46) HAMD: 33.23(6.9) vs. 32.60(7.13) Effectively reduced depression | 0.02 0.004 | NR/No |
Zhou, Chen et al. (2011) [55] | Tangshan, China (Chinese) | 30 (0%) | Perimenopausal women with depression, with a mean age of 48.05. | BJ: Daily morning practice (training volume was not specifically reported), 6 months | NR | Trained instructor | Depression (CESD) | CESD: 25.67(5.82) vs. 19.03(4.93) Effectively reduced depression | <0.01 | NR/No |
Author [Reference] | Item 1 | Item 2 | Item 3 | Item 4 | Item 5 | Item 6 | Item 7 | Item 8 | Item 9 | Score |
---|---|---|---|---|---|---|---|---|---|---|
Randomized controlled trials or non-randomized controlled studies | ||||||||||
Chan, Li et al. (2014) [27] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 9/9 |
Suo, Yu et al. (2016) [28] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Li, Tan et al. (2014) [29] | Yes | Yes | Yes | Yes | Yes | Yes | No | No | Yes | 7/9 |
Yang, Huang et al. (2017) [30] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Cao, Guo et al. (2016) [31] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Li et al. (2017) [32] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Ma, Dou et al. (2010) [33] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 8/9 |
Lin (2017) [34] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Sun (2015) [35] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Guan, Wang et al. (2012) [36] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Li, Wang et al. (2017) [37] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Ma, Dou et al. (2011) [38] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 8/9 |
Zhang & Luo (2016) [39] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Zhang, Gao et al. (2016) [40] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Liu, Huo et al. (2012) [41] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Zhou (2014) [42] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Wang, Guan et al. (2016) [43] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Zhang, Lin et al. (2017) [44] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Wu, Chen et al. (2016) [45] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Ji, Wang et al. (2012) [46] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Wu, Xue et al. (2017) [47] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 8/9 |
Han, Wang et al. (2017) [48] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Liu, Chen et al. (2014) [49] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Zhang, Zhang et al. (2016) [50] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Huang, Wu et al. (2015) [51] | Yes | Yes | No | Yes | Yes | Yes | No | No | Yes | 6/9 |
Yin, Zhao et al. (2016) [52] | Yes | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 7/9 |
Guan, Liu et al. (2016) [53] | No | Yes | No | Yes | Yes | Yes | Yes | No | Yes | 6/9 |
Wu, Li (2014) [54] | No | No | Yes | Yes | Yes | No | No | No | Yes | 4/9 |
Zhou, Chen et al. (2011) [55] | No | No | Yes | Yes | Yes | No | No | No | Yes | 4/9 |
Categorical Moderator | Outcome | Level | No. of Studies | Hedge’s g | 95% CI | I2, % | Test for Between-Group Homogeneity | ||
---|---|---|---|---|---|---|---|---|---|
Q-Value | df(Q) | p-Value | |||||||
Intervention duration | Anxiety | <16 weeks | 9 | −0.99 | −1.23 to −0.75 | 45.87% | 0.55 | 1 | 0.46 |
≥16 weeks | 5 | −1.13 | −1.39 to −0.86 | 38.64% | |||||
Training frequency | Anxiety | <5 sessions/week | 5 | −0.93 | −1.21 to −0.65 | 44.89% | 1.51 | 1 | 0.22 |
≥5 sessions/week | 10 | −1.20 | −1.52 to −0.87 | 74.31% | |||||
Session length | Anxiety | Less than 1 h | 8 | −1.15 | −1.47 to −0.83 | 67.61% | 0.09 | 1 | 0.76 |
1 h or longer | 5 | −1.22 | −1.54 to −0.90 | 47% | |||||
Control type | Anxiety | Active | 7 | −0.98 | −1.15 to −0.80 | 0% | 0.113 | 1 | 0.736 |
passive | 8 | −1.04 | −1.39 to −0.70 | 73.19% | |||||
Study quality | Anxiety | Low risk | 8 | −1 | −1.33 to −0.67 | 72.68% | 0.00 | 1 | 0.96 |
High risk | 7 | −0.99 | −1.17 to −0.81 | 0% | |||||
Continuous Moderator | Level | No. of Studies | 95% Confidence Interval | Q-Value | df | p | |||
Total hour | Anxiety | 13 | −0.0053 | −0.009 to −0.0014 | 6.9 | 1 | 0.008 | ||
Number of total sessions | Anxiety | 14 | −0.0009 | −0.005 to 0.003 | 0.2 | 1 | 0.66 |
Categorical Moderator | Outcome | Level | No. of Studies | Hedge’s g | 95% CI | I2, % | Test for between-Group Homogeneity | ||
---|---|---|---|---|---|---|---|---|---|
Q-Value | df(Q) | p-Value | |||||||
Intervention duration | Depression | <16 weeks | 12 | −1.08 | −1.39 to −0.77 | 78.3% | 0.03 | 1 | 0.87 |
≥6 weeks | 5 | −1.04 | −1.4 to −0.68 | 64.98% | |||||
Training frequency | Depression | <5 sessions/week | 5 | −0.84 | −1.20 to −0.48 | 2.822 | 2.8 | 1 | 0.09 |
≥5 sessions/week | 11 | −1.22 | −1.50 to −0.95 | ||||||
Session length | Depression | Less than 1 h | 8 | −1.14 | −1.54 to −0.74 | 82.75% | 0.7 | 1 | 0.4 |
1 h or longer | 6 | −0.94 | −1.19 to −0.68 | 37.51% | |||||
Control type | Depression | Active | 8 | −0.84 | −1.02 to −0.66 | 16% | 3.74 | 1 | 0.053 |
passive | 9 | −1.27 | −1.65 to −0.89 | 82.16% | |||||
Study quality | Depression | Low risk | 12 | −1.11 | −1.41 to −0.82 | 76.8% | 0.44 | 1 | 0.51 |
High risk | 5 | −0.95 | −1.34 to −0.57 | 68.97% | |||||
Continuous Moderator | Level | No. of Studies | 95% Confidence Interval | Q-Value | df | p | |||
Total hour | Depression | 14 | −0.0018 | −0.0051 to 0.0015 | 1.088 | 1 | 0.297 | ||
Number of total sessions | Depression | 16 | −0.0023 | −0.006 to −0.0004 | 4.85 | 1 | 0.028 |
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Zou, L.; Yeung, A.; Quan, X.; Hui, S.S.-C.; Hu, X.; Chan, J.S.M.; Wang, C.; Boyden, S.D.; Sun, L.; Wang, H. Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2018, 15, 321. https://doi.org/10.3390/ijerph15020321
Zou L, Yeung A, Quan X, Hui SS-C, Hu X, Chan JSM, Wang C, Boyden SD, Sun L, Wang H. Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2018; 15(2):321. https://doi.org/10.3390/ijerph15020321
Chicago/Turabian StyleZou, Liye, Albert Yeung, Xinfeng Quan, Stanley Sai-Chuen Hui, Xiaoyue Hu, Jessie S. M. Chan, Chaoyi Wang, Sean David Boyden, Li Sun, and Huiru Wang. 2018. "Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 15, no. 2: 321. https://doi.org/10.3390/ijerph15020321