Journal of Gerontological Nursing

Feature Article 

Effect of Low-Intensity, Kinect™-Based Kaimai-Style Qigong Exercise in Older Adults With Type 2 Diabetes

Hong Cai, MD; Guichen Li, MD; Shengqian Jiang, MD; Huiru Yin, PhD; Peng Liu, PhD; Li Chen, PhD

Abstract

The aim of the current study was to investigate the effect of low-intensity, Kinect™-based Kaimai-style Qigong exercise among older adults with type 2 diabetes mellitus (T2DM). A non-randomized controlled trial was conducted in a community center in Changchun, China, from July to September 2017. Participants (N = 55) were assigned to the Qigong group or control group. Participants in the Qigong group received 30-minute Kinect-based Kaimai-style Qigong sessions three times per week for 12 weeks. Participants in the control group were waitlisted. Body mass index (BMI), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and lipid level, as well as Mini-Mental State Examination and Berg Balance Scale scores, were measured at baseline and postintervention. The Qigong group showed decreases in weight (p = 0.002), BMI (p = 0.004), HbA1c (p = 0.001), and FBG (p = 0.018) after the intervention. The Qigong group also showed improvements in cognitive (p ≤ 0.001) and balance (p ≤ 0.001) function. The Kinect-based Kaimai-style Qigong intervention was effective in reducing HbA1c and improving balance and cognitive function in older adults with T2DM. [Journal of Gerontological Nursing, 45(2), 42–52.]

Abstract

The aim of the current study was to investigate the effect of low-intensity, Kinect™-based Kaimai-style Qigong exercise among older adults with type 2 diabetes mellitus (T2DM). A non-randomized controlled trial was conducted in a community center in Changchun, China, from July to September 2017. Participants (N = 55) were assigned to the Qigong group or control group. Participants in the Qigong group received 30-minute Kinect-based Kaimai-style Qigong sessions three times per week for 12 weeks. Participants in the control group were waitlisted. Body mass index (BMI), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and lipid level, as well as Mini-Mental State Examination and Berg Balance Scale scores, were measured at baseline and postintervention. The Qigong group showed decreases in weight (p = 0.002), BMI (p = 0.004), HbA1c (p = 0.001), and FBG (p = 0.018) after the intervention. The Qigong group also showed improvements in cognitive (p ≤ 0.001) and balance (p ≤ 0.001) function. The Kinect-based Kaimai-style Qigong intervention was effective in reducing HbA1c and improving balance and cognitive function in older adults with T2DM. [Journal of Gerontological Nursing, 45(2), 42–52.]

Type 2 diabetes mellitus (T2DM) is a metabolic disorder mainly caused by insulin resistance and progressive beta cell impairment. China has the highest number of individuals with diabetes, reaching 114.4 million in 2017 (International Diabetes Federation [IDF], 2017). It is estimated that one in three older adults develop T2DM due to aging (Dhaliwal & Rosen, 2016). Moreover, China has the highest number of older adults with T2DM, with a total of 67.7 million individuals in 2017 (IDF, 2017).

A sedentary lifestyle is considered an independent predictor of T2DM (Wilmot et al., 2012). In addition, poor glycemic control may lead to deleterious consequences for many target organs (e.g., eyes, kidneys, heart), thereby increasing medical care costs and decreasing quality of life of individuals with T2DM (Mansikkamaki et al., 2016). T2DM has been linked to increased risk of cognitive impairment, including prodromal and Alzheimer's disease as well vascular dementia (Biessels, Deary, & Ryan, 2008; Cukierman, Gerstein, & Williamson, 2005; Luchsinger, 2010), with the relative increased risk for Alzheimer's disease estimated at 73% (Gudala, Bansal, Schifano, & Bhansali, 2013). Older adults with T2DM experience 1.25 falls every year, and 41% of these individuals will fall more than two times per year (Allet et al., 2008). Falling may reduce physical activity and decrease quality of life of older adults with T2DM. In addition, a study reported that fear of falling may increase risk of falls (Hill, Moore, Dorevitch, & Day, 2008). Therefore, older adults with T2DM should be regarded as needing fall prevention care (Freiberger, Häberle, Spirduso, & Zijlstra, 2012).

Exercise, the aim of which is to improve or maintain physical fitness, is a subset of physical activity that is planned, structured, and repetitive (Caspersen, Powell, & Christenson, 1985). Exercise therapy is a key preventive strategy for diabetes, with many studies showing that exercise can enhance peripheral tissue insulin sensitivity (Roberts, Little, & Thyfault, 2013) and liver (Gonzalez, Fuchs, Betts, & van Loon, 2016) and muscle glycogen breakdown (Jensen & Richter, 2012). In addition, exercise has been shown to reduce blood sugar, with effects sustained for more than 12 hours (Hayashino et al., 2014; Oliveira, Simoes, Carvalho, & Ribeiro, 2012; Sanz, Gautier, & Hanaire, 2010).

Older adults with T2DM generally have poor exercise adherence rates, and inappropriate exercise intensity will aggravate their condition. Tai chi combines strength and balance and is recognized as the most suitable exercise for older adults (Adler & Roberts, 2006). Tai chi is slow and soft and combines various continuous movements. Through practicing tai chi, all parts of the body can be slowly and steadily exercised with muscle relaxation (Fetherston & Wei, 2011; Lan, Lai, Chen, & Wong, 2000; Yan & Downing, 1998). Kaimai-style Qigong is one type of tai chi designed for individuals with diabetes and obesity (Liu, Miller, Burton, Chang, & Brown, 2013). Liu et al. (2013) provided three 1.5-hour supervised and group-based training sessions per week of a Kaimai-style Qigong intervention for individuals with elevated blood glucose who did not have diabetes or were not taking diabetes medication. Findings showed that the Kaimai-style Qigong program improved participants' health-related quality of life. However, their study did not examine the effect of Kaimai-style Qigong among older adults with T2DM.

Physical training may be emphasized as part of prevention programs developed for individuals with diabetes to minimize risk of neurodegenerative disease onset (Bertram, Brixius, & Brinkmann, 2016), because exercise may maintain brain activity (Brown, Peiffer, & Martins, 2013). Meta-analyses have found that exercise may improve cognitive function in individuals with Alzheimer's disease (Groot et al., 2016), mild cognitive impairment (Zheng, Xia, Zhou, Tao, & Chen, 2016), and chronic disease (Cai, Li, Hua, Liu, & Chen, 2017). A randomized controlled trial with 28 adults meeting 2-hour tolerance test criteria for glucose intolerance examined the effect of exercise on cognitive function. Results showed that 6 months of aerobic exercise suggested cognitive enhancement in older adults with glucose intolerance (Baker et al., 2010). However, the effect of exercise on cognitive function in older adults with T2DM has not been examined.

Microsoft® Kinect™ is a computer game controlled through body movement. Kinect tracks the position of the limbs and body without the need for handheld controllers or force platforms. Kinect has become more advanced in recent years and is widely used in somatosensory equipment, such as health care auxiliary skill training, physiotherapy, physical and labor evaluation, and intelligent nursing (Galna et al., 2014; Stone, Skubic, Rantz, Abbott, & Miller, 2015). Moreover, a meta-analytical review of the effects of exergaming compared to the effect of alternative exercise training and passive control on standing balance and functional mobility in healthy community-dwelling older adults found that exergaming might serve as an attractive complementary training approach for this population (Donath, Rössler, & Faude, 2016). Therefore, the purpose of the current study was to investigate the effect of Kinect-based Kaimai-style Qigong among older adults with T2DM.

Method

Study Design

A non-randomized controlled trial was conducted in a community center in Changchun, Jilin Province, China, from July to September 2017. Participants were grouped by community to ensure the intervention and control group did not communicate. One community comprised the Qigong (12-week intervention) group and the other comprised the control (waitlisted) group. Ethical approval was obtained from the Ethics Committee of Sino-Japanese Friendship Hospital, Jilin University.

Participants

Study inclusion criteria were age >60 years and a diagnosis of T2DM for ⩽10 years. Participants were excluded if they engaged in moderate or strenuous exercise 6 months before the start of the intervention; practiced Kaimai-style Qigong as part of their exercise routine; participated in regular physical activity at the time of recruitment (defined as ⩾150 minutes per week); were unable to walk independently; had a serious diabetes complication that limited physical activity participation; or had serious myocardial ischemia or hypertension.

Recruitment Procedure

Potential participants were recruited via hospital media, community posters, and a community web-site. Interested individuals received a call from a member of the research team who explained the study purpose and procedures. Eligible participants signed the informed consent form and were allocated at a ratio of 1:1 to the Qigong intervention group or waitlisted control group.

Sample Size

The main indicator of the study was glycated hemoglobin (HbA1c), and a decrease in HbA1c of 0.8 was the primary outcome of the study. The intervention was expected to have a significant effect on HbA1c. Based on the sample calculation formula, 25 participants (N = 50, (1-β) = 0.8, α = 0.05) were enrolled in each group. The effect size was based on Yeh et al.'s (2007) study. The effect of the intervention on HbA1c was examined with a single design criterion (mean difference score = 0.8, SD = 1.2). According to the sample formula, this study assumed that 10% of patients would be lost to follow up and 27 participants per group would be involved.

Intervention Procedure

Kinect-Based Kaimai-Style Qigong. The Kinect-based Kaimai-style Qigong program was created by the School of Nursing and School of Mechanical Science and Aerospace Engineering of Jilin University. Kinect version 1.0 was used. The Kinect-based Kaimai-style Qigong training platform includes three modules: (a) learning, (b) evaluation, and (c) interactive. The learning module included trajectory training, tracking training, and proficiency evaluation. Trajectory training designed Kaimai-style Qigong as a fixed route and participants exercised according to the digital display and learned the basic posture of Kaimai-style Qigong. Tracking training provided video guidance and action tips for participants to complete the specified action according to their completion rate of proficiency scoring. The evaluation module introduced the concept of standard vector and recorded the standard posture of the space vector through the corresponding action and standard vector. The evaluation module, through the effective combination of Kinect and Unity™ 3D technology, provides a remote interactive training platform (i.e., a virtual environment of Kaimai-style Qigong interactive training), records the space vector of standard posture, and determines whether the movement angle meets the standard by comparing the participant's movement with the standard vector, so as to reduce the movement error and achieve the rating effect.

Participants exercised three times per week, 30 minutes per session for 12 weeks. Each session included 20 minutes of Kinect-based Kaimai-style Qigong exercise, 5 minutes of warm-up, and 5 minutes of stretching after the exercise. Participants were asked to maintain their usual diet and daily activities for the duration of the intervention. Participants worked out in front of the monitor. One research assistant explained how to play the game, provided a demonstration, and helped participants practice and perform the Kinect-based Kaimai-style Qigong (Table 1). Each participant was given a recording after completing the session. Participants in the intervention group received a monthly telephone call from the research assistant reminding them to fill out the sports record and informing them about the importance of adherence to exercise.

Typical Movements of Kaimai-Style Qigong

Table 1:

Typical Movements of Kaimai-Style Qigong

Waitlisted Control Group. Participants in this group were advised to maintain their original lifestyle. The control group did not receive any exercise intervention. Participants received a monthly telephone call from the research assistant. During this telephone call, the research assistant asked general questions about participants' health. Calls aimed to provide a control for the potential effects because of the attention that was given to the Qigong group. After all assessments were completed, participants in the control group were offered the Qigong intervention.

Outcome Measures

All measurements were conducted pre- and postintervention. The same researchers performed the pre- and postintervention test measurements for both groups.

Sociodemographic and Clinical Information. Patient age, sex, duration of diabetes, educational level, presence of comorbidities, diabetes treatment, sleeping time, accumulated sitting time, and physical labor intensity were obtained at the first interview. Body mass index (BMI) was also calculated (body weight [kg]/height [m]2).

Fasting Blood Glucose, HbA1c, and Lipid Levels. Fasting blood samples were obtained from all participants in the morning between 8:00 and 10:00 a.m. The samples were centrifuged, aliquoted, and immediately frozen at −80°C for analysis of fasting blood glucose (FBG), HbA1c, and lipid levels.

Glucose control was evaluated by FBG and HbA1c. FBG reflects current glucose level. HbA1c, which is glycosylated by the hemoglobin molecule, was used to assess overall metabolic control over 8 to 12 weeks. Analysis of FBG and HbA1c was performed with chromatography.

Lipids included total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) and were calculated using the Fried Ewald equation.

Cognitive Function. The Mini-Mental State Examination (MMSE) was used to measure participants' cognitive function (Dick et al., 1984). The scale comprises 30 items, with each item scored as 1 (correct) or 0 (wrong/unknown). Total score range is 0 to 30; scores between 27 and 30 indicate normal cognitive function, and scores <27 indicate cognitive impairment.

Balance. The Berg Balance Scale was used to measure participants' balance function (Wee, Bagg, & Palepu, 1999). This scale has a total of 14 items, with each item scored on a Likert scale from 0 to 4. Higher scores indicate better balance function.

Adverse Events. The total number and type of adverse events during the intervention were recorded, and the reasons for these events were analyzed.

Data Analysis

All outcomes were checked for normality after data collection. If results met normal distribution, they were expressed as mean and standard deviation. If results met two-class or other count data, chi-square test was used. At baseline, the differences in the continuous variables between groups were analyzed using t test. After the intervention, the effect of the intervention outcome was examined using t test. Correlation analysis was used to analyze the correlation among various outcomes. All statistical analyses were performed using SPSS version 20, with p < 0.05 established as the level of significance.

Results

A total of 55 older adults with T2DM with an average age of 63.96 years were enrolled in the study. The Qigong group comprised 27 participants, and the control group comprised 28 participants. Five participants in the control group withdrew from the study (Figure 1). There were no significant differences in the general demographic data, including gender, age, height, weight, BMI, duration of disease, educational level, presence of comorbidities, diabetes treatment, sleeping time, accumulated sitting time, and physical labor intensity, between the Qigong and control groups (p > 0.05) (Table 2). In addition, no significant differences were noted in FBG, HbA1c, and lipid levels, as well as MMSE and Berg Balance Scale scores between the Qigong and control groups (p > 0.05).

Flow chart of study participant recruitment.

Figure 1.

Flow chart of study participant recruitment.

Baseline Demographic Characteristics

Table 2:

Baseline Demographic Characteristics

In the Qigong group, no significant differences were observed for total cholesterol, LDL-C, and triglycerides (p > 0.05) at the end of the intervention; however, HbA1c, weight, BMI, and FBG were significantly decreased (p < 0.05). HDL-C level was significantly increased in the Qigong group at the end of the intervention (p < 0.05), as were MMSE and Berg Balance Scale scores (p < 0.05). No significant differences were observed in BMI, HbA1c, FBG, total cholesterol, HDL-C, and triglycerides or MMSE and Berg Balance Scale scores (p > 0.05) in the control group at the end of the intervention. LDL-C level was significantly increased in the control group (p < 0.05). No significant differences were observed in total cholesterol, LDL-C, HDL-C, and triglycerides (p > 0.05) between the Qigong and control groups. There was a significant increase in MMSE and Berg Balance Scale scores at the end of the intervention in the Qigong group (p < 0.05) (Table 3). No significant adverse events were recorded during the training sessions.

Intervention Outcomes

Table 3:

Intervention Outcomes

After the intervention, the differences between pre- and postintervention values of the indicators were tested for normality. The results showed that the data were normally distributed. Spearman's correlation analysis was used to analyze: (a) the relationship between MMSE score and weight, BMI, HbA1c, FBG, cholesterol, triglycerides, HDL-C, and LDL-C; and (b) the relationship between Berg Balance Scale score and weight, BMI, HbA1c, FBG, cholesterol, triglycerides, HDL-C, and LDL-C. The results showed that there was a: (a) significant negative correlation between HbA1c and BMI and MMSE score; (b) negative correlation between cholesterol and Berg Balance Scale score; and (c) significant negative correlation between LDL-C and Berg Balance Scale score (Table 4).

Spearman Rank Correlation Analysis

Table 4:

Spearman Rank Correlation Analysis

Discussion

The current study evaluated the effect of a Kinect-based Kaimai-style Qigong intervention in older adults with T2DM. No significant differences were observed for total cholesterol, LDL-C, HDL-C, and triglycerides between the Qigong and control groups; however, HbA1c, BMI, and FBG were significantly decreased in the Qigong group compared to the control group at the end of the intervention. In addition, MMSE and Berg Balance Scale scores had significantly increased in the Qigong group compared to the control group at the end of the intervention.

The current study found that low-intensity exercise has a significant effect on older adults with T2DM. A previous study about the effect of low-intensity aerobic exercise in obese patients with T2DM found that 30 minutes of low-intensity bicycle exercise significantly enhanced the lower level of insulin-induced glucose uptake shortly after exercise and that this exercise might be useful for the treatment of post-prandial hyperglycemia (da Silva et al., 2014). A meta-analysis and systematic review of the effect of exercise on cognitive function in patients with chronic disease found positive random effects of low-intensity exercise intervention on cognitive function (Cai et al., 2017). These results were similar to the results of the current study.

Another explanation for the current results may be that the Kinect-based Kaimai-style Qigong system provided high-quality exercise. First, the exercise instruction required participants to understand the movement of their own body and perform standard actions of Kaimai-style Qigong. Second, participants received training according to the digital display in the learning module. In addition, the evaluation module recorded participants' standard posture. Lastly, the action angle was determined by comparing the corresponding action of the participant with the standard vector, making it easy for users to conform their body movements. Sato, Kuroki, Saiki, and Nagatomi (2015) developed an exergame that used Kinect. Their randomized controlled trial evaluated the effect of using this exergame on muscle strength and balance in healthy older adults. The exergame using Kinect made it possible to acquire data such as participants' knee and hip bending angles and height and duration of exercise, which were reflected in the game content. After the intervention, results showed improvement in motor functions, lower limb muscle strength, walking, and balance in the group that received the exergame using Kinect (Sato et al., 2015). Although the current study did not obtain knee and hip bending angles, the application of standard vectors may improve the accuracy of participants' postures.

Five participants in the control group dropped out of the current study; however, no participants dropped out of the Qigong group. Adding Kinect to the intervention may improve adherence in three ways. First, it might be that Kinect provided interesting exercise that led to enhanced adherence of the intervention. Kinect represents an advanced form of human–computer interaction that allows users to interact naturally when immersed in computer games. Second, Kinect may strengthen the effect of interventions due to this interaction (Weiner, Trangenstein, McNew, & Gordon, 2016). Third, Kinect was entertaining and interesting to participants; thus, participants were more willing to take part in the Kinect-based exercise intervention (Dockx et al., 2017). No adverse events occurred during the intervention. Possible reasons include: (a) the Kinect-based Kaimai-style Qigong is a virtual reality system, which may prevent older adults with T2DM from experiencing adverse events; (b) users can make adjustments to the system according to their own needs so that the amount of exercise is within their tolerance level; and (c) Kaimai-style Qigong is a low-intensity exercise.

Significant improvement in cognitive function was observed in the Qigong group relative to the control group after the 12-week intervention. Diabetes complications are related to high HbA1c (Stratton et al., 2000). Tai chi has been shown to reduce hyperglycemia, insulin resistance, and HbA1c (Ahn & Song, 2012; Liu et al., 2013). A reduction in HbA1c may prevent the incidence of vascular complications. In addition, physical activity may positively affect cognitive function in patients by enhancing brain vitality (Groot et al., 2016). Evidence from rats showed that regular exercise directly enhances cerebral angiogenesis by increasing the growth of new capillaries in the brain motor cortex (Swain et al., 2003). This growth of new capillaries leads to total capillary volume increase (Wang et al., 2015). Two meta-analyses found that aerobic exercise improved cognitive function (Cai et al., 2017; Zheng et al., 2016). Kaimai-style Qigong, one type of aerobic exercise, may accelerate the body's blood flow and open meridians (Liu et al., 2013). Thus, these results are similar to the results of the current study.

Gul et al. (2014) reported a correlation between high HbA1c and cognitive decline in older adults with T2DM. In the current study, a decrease in HbA1c in older adults with T2DM was found to be correlated with the improvement of cognitive function; however, a decrease in FBG was not correlated with improved cognitive function in these participants. The sample size may not be large enough, thereby causing a lack of correlation between FBG and cognitive function in the study population. HbA1c level was based on 120 days of FBG; thus, regular examination of FBG may be effective in controlling a healthy HbA1c level in older adults with T2DM. Moreover, self-examination of FBG and regular examination of HbA1c may motivate older adults with T2DM to participate in physical activity, thus giving patients the confidence to control their blood glucose levels through physical activity. High BMI was found to be one risk factor for cognitive decline in older adults with T2DM (Hassing, Dahl, Pedersen, & Johansson, 2010). In the current study, the 12-week Kinect-based Kaimai-style Qigong intervention was found to reduce participants' weight and BMI and was associated with an increase in cognitive function.

Significant improvement was noted in balance in the Qigong group compared to the control group after the 12-week intervention. Tai chi has been recommended as one type of training targeted at balance improvement by the American College of Sports Medicine (Thompson, Arena, Riebe, & Pescatello, 2013). The principle movements of Kaimai-style Qigong increase the difficulty of maintaining balance by moving the center of gravity (Guo, Qiu, & Liu, 2014; Lan, Chen, Lai, & Wong, 2013). Kaimai-style Qigong with movements such as weight shifting between the left leg and right leg has the potential to improve balance and decrease the possibility of falls in older adults with T2DM (Liu et al., 2011). In addition, Kaimai-style Qigong combines movement, breathing, and mind training. This mind–body movement therapy may increase blood flow and blood oxygen levels (Liu et al., 2011).

In the current study, decreases in HbA1c and FBG were not correlated with the improvement of balance function in older adults with T2DM. The decrease in BMI was also not correlated with an increase in participants' balance function. Obesity may be one reason for decreased balance function (Balducci et al., 2006). Although decreases in weight were found in the current study, there was no correlation with increase in balance function.

Kaimai-style Qigong was designed for individuals with diabetes. In addition to the current study, three other studies reported the effects of Kaimai-style Qigong exercise for patients with elevated FBG or diabetes (Liu et al., 2013), centrally obese adults with depression symptoms (Liu et al., 2015), and patients with diabetes (Liu, Miller, Burton, Chang, & Brown, 2011). The results showed that Kaimai-style Qigong exercise improved patients' quality of life (Liu et al., 2013); reduced depression, anxiety, and stress (Liu et al., 2015); and was beneficial to blood glucose control (Liu et al., 2011). Therefore, Kaimai-style Qigong exercise was effective for patients with diabetes or similar conditions; however, its effect on other chronic illnesses requires further research.

Limitations

The current study has some limitations. First, the study did not include follow up; thus, continuation of the intervention effect was not observed. Therefore, a longitudinal study is needed to determine the long-term effects of Kaimai-style Qigong for older adults with T2DM. Second, there was no traditional exercise control group; therefore, a comparison between Kinect-based Kaimai-style Qigong and traditional Kaimai-style Qigong was not examined.

Implications

Kaimai-style Qigong is a gentle and slow exercise that is safe and effective for older adults with T2DM. The current intervention provided effective and professional practice with limited health care resources. By using Kinect, additional individuals were not needed to supervise participants' movements. Therefore, participants in the intervention group should be encouraged to continue using the Kinect-based Kaimai-style Qigong exercise, as it showed significant reductions in HbA1c, weight, BMI, and FBG and improved balance and cognitive function. Nurses should educate older adults with T2DM about Kaimai-style Qigong to improve their balance and cognitive function and to prevent diabetes complications.

Conclusion

Implementation of the Kinect-based Kaimai-style Qigong intervention was found to be safe and effective in older adults with T2DM. The 12-week intervention was effective in reducing participants' HbA1c, weight, BMI, and FBG, and improving balance and cognitive function. Furthermore, Kinect-based Kaimai-style Qigong may help prevent progression of T2DM and its complications.

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Typical Movements of Kaimai-Style Qigong

FormMovement
1As you inhale, swing your arms forward up to shoulder level, palms down. As you exhale, press your hands slowly down to your sides, palms down, and bend your legs. As you inhale, look forward and swing your arms out from the sides of your body, up to shoulder level, palms down, and bend and extend your legs. As you exhale, press your hands slowly down to your sides, palms down, and bend your legs.
2As you move your body slightly to the left, form a ball with the palms of the hands in front of the body, with the right hand on top and the left hand on the bottom. At the same time, bend both legs, move the center of gravity to the right leg while keeping the left heel on the ground; your hands do not move. Shift the center of gravity to the left foot by pushing your right heel into the ground and lunging left. At the same time, the left arm is extended at chest level, with the palm facing away from you. Place your right hand on the right shoulder, palm down, and look at the left hand.
3Follow your body to the left by placing your right foot next to the left foot and putting your weight on the left leg. At the same time, put your hands out in front of your body at chest level, slightly wider than your shoulders, palms down, and look forward. Move the center of gravity to the right leg, then lift the left foot and place it down next to the right foot. Your feet should be shoulder width apart, with both legs bent and the center of gravity distributed evenly between legs. At the same time, look forward with the arms bent, elbows loose, and palms down. Bring your hands down slowly, extend the legs, and look forward.

Baseline Demographic Characteristics

CharacteristicQigong Group (n = 27)Control Group (n = 28)t Test/χ2p Value
Mean (SD) (Range)
Age (years)64.54 (4.1) (60 to 75)64.51 (3.1) (60 to 72)0.1310.896
Height (cm)165 (8.17) (153 to 178)166.15 (7.54) (152 to 177)0.5410.591
Weight (kg)66.33 (9.62) (45.8 to 92)69.41 (8.13) (51.5 to 82)1.2880.203
Body mass index (kg/m2)24.25 (2.52) (18.3 to 29)24.81 (1.76) (21.5 to 27.3)0.9620.375
Duration of diabetes (years)4.93 (2.29) (1 to 10)5.54 (3.25) (1 to 10)0.8020.426
n (%)
Sex (male/female)13 (48.2)/14 (51.9)11 (39.3)/17 (60.7)0.4390.591
Educational level0.6540.884
  Primary school9 (33.3)11 (39.3)
  Junior high school6 (22.2)5 (17.9)
  High school10 (37)11 (39.3)
  University and above2 (7.4)1 (3.6)
Comorbidities0.5060.973
  Hypertension24 (88.9)22 (78.6)
  Hyperlipidemia16 (59.3)16 (57.1)
  Fatty liver6 (22.2)8 (28.6)
  Stroke3 (11.1)4 (14.3)
  Coronary heart disease1 (3.7)1 (3.6)
Diabetes treatment0.3910.822
  Insulin16 (59.3)17 (60.7)
  Oral hypoglycemic agents14 (51.9)17 (60.7)
  Diet therapy3 (11.1)2 (7.1)
Sleeping time0.0020.648
  <3 to <6 hours3 (11.1)3 (10.7)
  6 to <9 hours24 (88.9)25 (89.3)
Accumulated sitting time4.3730.112
  ≤3 to <6 hours19 (70.4)25 (89.3)
  6 to <9 hours6 (22.2)1 (3.6)
  ≥9 hours2 (7.4)2 (7.1)
Physical labor intensity1.1590.292
  Light24 (88.9)27 (96.4)
  Moderate3 (11.1)1 (3.6)

Intervention Outcomes

VariableQigong Group (n = 27)Control Group (n = 28)Comparison Between Groups
Pre (Mean [SD])Post (Mean [SD])t Test95% CIp ValuePre (Mean [SD])Post (Mean [SD])t Test95% CIp Valuet Test95% CIp Value
Weight (kg)66.30 (9.56)65.21 (9.23)4.07[0.53, 1.62]<0.001*68.20 (7.40)68.34 (7.56)−0.58[−0.66, 0.37]0.5703.32[0.48, 1.96]0.002*
BMI (kg/m2)24.25 (2.52)23.86 (2.33)3.71[0.17, 0.61]0.001*24.81 (1.76)24.86 (1.78)−0.48[−0.25, 0.16]0.6343.01[0.15, 0.73]0.004*
HbA1c8.90 (1.97)7.93 (1.59)4.75[0.55, 1.39]<0.001*8.06 (1.17)8.03 (1.37)0.19[−0.26, 0.32]0.8543.68[0.43, 1.46]0.001*
FBG9.51 (3.51)8.50 (2.85)3.03[0.32, 1.69]<0.001*7.89 (1.31)7.91 (1.52)−1.07[−0.51, 0.46]0.9162.46[0.19, 1.87]0.018*
Total cholesterol5.09 (1.13)4.97 (0.88)1.09[−1.00, 0.33]0.2835.22 (1.13)5.26 (1.20)−0.78[−0.15, 0.07]0.4451.26[−0.09, 0.41]0.213
Triglycerides2.10 (1.24)1.80 (1.03)1.70[−0.06, 0.66]0.1021.71 (1.33)1.58 (0.90)0.79[−0.21, 0.47]0.4400.69[−0.32, 0.66]0.496
HDL-C1.24 (0.28)1.30 (0.26)−2.91[−0.10, −0.01]0.005*1.29 (0.34)1.25 (0.32)0.95[−0.04, 0.13]0.352−2.21[−0.19, −0.01]0.320
LDL-C2.82 (0.97)2.88 (0.87)−0.86[−0.17, −0.07]0.3972.89 (0.96)3.08 (1.02)−3.68[−0.30, −0.08]0.001*1.72[−0.02, 0.30]0.92
MMSE score26.85 (1.41)28.85 (1.05)−8.05[−2.56, −1.52]<0.001*27.09 (1.00)26.91 (1.16)1.28[−1.07, 0.46]0.213−7.32[−2.82, −1.60]<0.001*
BBS score45.44 (4.02)49.11 (3.85)−5.43[−5.05, −2.28]<0.001*44.17 (2.44)43.70 (2.20)0.87[−0.67, 1.62]0.395−5.56[−5.65, −2.65]<0.001*

Spearman Rank Correlation Analysis

VariableMMSEBerg Balance Scale
BMI (kg/m2)−0.280*−0.172
HbA1c−0.348*−0.341
FBG−0.157−0.230
Total cholesterol−0.215−0.016
Triglycerides−0.1940.337
HDL-C0.1190.023
LDL-C−0.045−0.363**
Authors

Dr. Cai is Master's Student, Dr. Li is Lecturer, Dr. Yin is Lecturer, and Dr. Chen is Professor, School of Nursing, and Dr. Jiang is Master's Student, and Dr. Liu is Associate Professor, School of Mechanical Science and Aerospace Engineering, Jilin University, Jilin, China.

The authors have disclosed no potential conflicts of interest, financial or otherwise. Work on this manuscript was supported by the Youth Program of Health and Family Planning Commission of Jilin Province (2015Q022). Dr. Cai and Dr. Li contributed equally to this work and should be considered equal first authors.

Address correspondence to Li Chen, PhD, Professor, School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, Jilin 130021, China; e-mail: chen_care@126.com.

Received: August 12, 2018
Accepted: November 26, 2018

10.3928/00989134-20190111-05

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