Effectiveness of meditative movement on COPD: a systematic review and meta-analysis

Figures & data

Table 1 Characteristics of included studies

Author, year	Country	Comparison arms	Sample size, N	Protocol	Mean age in years (SD/range)	FEV1 predicted (%)	Duration	Outcomes
Chan et al,^Citation36 2013	Hong Kong, China	G1: TCQ G2: Exercise G3: Control	G1: 70 G2: 69 G3: 67	G1: 60 minutes/session 2 sessions/week 3 months G2: 60 minutes/day 3 months	G1: 71.7 (8.2) G2: 73.6 (7.5) G3: 73.6 (7.4)	G1: 50.1 (21.8) G2: 56.4 (25.6) G3: 55.1 (23.3)	6 months	1. 6MWD 2. FEV1, FVC 3. Borg 4. SaO2%
Chan et al,^Citation37 2013	Hong Kong, China	G1: TCQ G2: Exercise G3: Control	G1: 70 G2: 69 G3: 67	G1: 60 minutes/session 2 sessions/week 3 months G2: 60 minutes/day 3 months	G1: 71.7 (8.2) G2: 73.6 (7.5) G3: 73.6 (7.4)	G1: 50.1 (21.8) G2: 56.4 (25.6) G3: 55.1 (23.3)	6 months	SGQR
Zhang et al,^Citation38 2016	Jiangsu, China	G1: QYJJ G2: Exercise G3: Control	G1: 42 G2: 43 G3: 45	G1: 60 minutes/day 7 sessions/week 6 months G2: 60 minutes/day 6 months	G1: 64.77 (11.07) G2: 63.34 (7.86) G3: 62.35 (9.27)	G1: 59.12 (4.13) G2: 57.39 (5.37) G3: 58.11 (4.37)	6 months	1. 6MWD 2. FEV1, FEV1%, FEV1/FVC 3. CAT
Xiao and Zhuang,^Citation39 2015	Beijing, China	G1: LQG G2: Exercise	G1: 63 G2: 63	G1: 45 minutes/session 4 sessions/week 30 minutes walking/day 6 months G2: 30 minutes/day 6 months	G1: 72.2 (1.7) G2: 70.9 (1.4)	G1: 41.5 (4.5) G2: 40.7 (4.0)	6 months	1. 6MWD 2. CRQ, SF-36
Ng et al,^Citation40 2011	Hong Kong, China	G1: QG G2: Exercise	G1: 40 G2: 40	G1: 45 minutes/session 4 sessions/week 6 months G2: 30 minutes/day 6 months	G1: 71.75 (1.05) G2: 73.12 (1.33)	G1: 37.13 (2.22) G2: 36.75 (2.11)	6 months	1. 6MWD 2. CRQ, SF-36
Yeh et al,^Citation41 2010	USA	G1: TC G2: Control	G1: 5 G2: 5	G1: 60 minutes/session 2 sessions/week 3 months	G1: 65 (6) G2: 66 (6)	G1: 53 (7) G2: 47 (7)	3 months	1. 6MWD 2. FEV1/FVC 3. CRQ
Leung et al,^Citation42 2013	Australia	G1: TC G2: Control	G1: 22 G2: 20	G1: 60 minutes/day 7 days/week 3 months	73 (8)	59 (16)	3 months	1. CRQ
Niu et al,^Citation43 2014	Changsha, China	G1: TC G2: Control	G1: 20 G2: 20	G1: 50 minutes/session 1 days/session 7 sessions/week 6 months	G1: 59.7 (2.76) G2: 61.3 (2.89)	G1: 41.9 (5.50) G2: 43.7 (5.16)	6 months	1. 6MWD 2. FEV1, FEV1 % 3. PaO2, PaCO2
Ng et al,^Citation44 2014	Hong Kong, China	G1: TC G2: Control	G1: 94 G2: 98	G1: 60 minutes/session 7 sessions/week 6 weeks	G1: 74.16 (6.46) G2: 74.13 (6.81)	G1: 56.4 (23.81) G2: 63.1 (22.12)	6 months	1. 6MWD 2. FVC, FEV1, FEV1 % 3. SGRQ 4. SaO2
Ranjita et al,^Citation45 2016	India	G1: Yoga G2: Control	G1: 36 G2: 36	G1: 90 minutes/session 6 sessions/week 3 months	G1: 53.69 (5.66) G2: 54.41 (5.40)	NA	3 months	1. 6MWD 2. Brog 3. SpO2%
Gupta et al,^Citation46 2014	India	G1: Yoga G2: Control	G1: 25 G2: 25	G1: 30 minutes/session 2 sessions/week 3 months	G1: 52.5 (3.9) G2: 52 (4.1)	G1: 51.1 (8.7) G2: 49.6 (8.6)	3 months	1. 6MWD 2. FEV1 % 3. CAT
Donesky-Cuenco et al,^Citation47 2009	USA	G1: Yoga G2: Control	G1: 14 G2: 15	G1: 60 minutes/session 2 sessions/week 3 months	G1: 72.2 (6.5) G2: 67.7 (11.5)	G1: 51.2 (10.5) G2: 44.4 (19.0)	3 months	1. 6MWD 2. FEV1/FVC, FEV1 % 3. CRQ, SF-36
Soni et al,^Citation48 2012	India	G1: Yoga G2: Control	G1: 30 G2: 30	G1: 45 minutes/day 2 months	45 (7.65)	NA	2 months	1. TLCO
Tandon,^Citation49 1978	Australia	G1: Yoga G2: Control	G1: 12 G2: 12	G1: 60 minutes/session 1–4 weeks: 3 sessions/week 5–8 weeks: 2 sessions/week 9 weeks–9 months: 2 sessions/week 9 months	G1: 59 (3.06) G2: 58 (3.06)	NA	9 months	1. FEV1, FVC 2. PaO2, PaCO2
Kulpati et al,^Citation51 1982	India	G1: Yoga G2: Control	G1: 25 G2: 50	G1: 30 minutes/session 2 sessions/week 3 months	G1: 50.6 (12.23) G2: 48.65 (9.17)	NA	3 months	1. FEV1, FVC, FEV1/FVC 2. PaO2, PaCO2
Katiyar and Bihari,^Citation50 2006	India	G1: Yoga G2: Control		G1: 30 minutes/session 6 sessions/week 3 months	G1: 53.3 (2.9) G2: 51.1 (3)	G1: 48 (2.4) G2: 48 (2)	3 months	1. FEV1, FVC 2. SGRQ

Abbreviations: 6MWD, 6-minute walking distance; CAT, exercise of the COPD Assessment Test; CRQ, Chronic Respiratory Disease Questionnaire; FEV₁, forced expiratory volume in 1 s; FEV₁% predicted, FEV₁ percent predicted normal values; FVC, forced vital capacity; FEV₁/FVC, the ratio of FEV₁ to FVC; G, Group; LQG, Liuzijue qigong; NA, not available; PaCO₂, partial pressure of carbon dioxide; PaO₂, partial pressure of oxygen; QG, Qigong; QYJJ, Qigong Yi Jinjing; SF-36, 36-Item Short Form Health Survey; SGRQ, St George Respiratory Questionnaire; TC, Tai chi; TCQ, Tai chi Qigong; Borg, Borg scale of dyspnea and fatigue levels; TLCO, transfer factor of lung for carbon monoxide.

Figure 1 Flow of study selection.

Table 2 Assessment of included studies for risk of bias

Author, year	Adequate sequence generation	Allocation concealment	Blinding of participants and personnel	Blinding of outcome assessment	Incomplete outcome data	Selective reporting	Other bias	Study design
Chan et al,^Citation36,Citation37 2013	Low	Unclear	Unclear	Low	Low	Low	Unclear	RCT (single-blind)
Zhang et al,^Citation38 2016	Unclear	Unclear	Low	Unclear	Unclear	Low	Unclear	RCT (single-blind)
Xiao and Zhuang,^Citation39 2015	Unclear	Unclear	Low	Low	Low	Low	Unclear	RCT (single-blind)
Ng et al,^Citation40 2011	Low	Low	Low	Low	Low	Low	Unclear	RCT (single-blind)
Yeh et al,^Citation41 2010	Low	Low	Low	Low	Low	Low	Unclear	RCT (single-blind)
Leung et al,^Citation42 2013	Low	Low	Low	Low	Low	Low	Unclear	RCT (single-blind)
Niu et al,^Citation43 2014	Low	Unclear	Unclear	Low	Low	Low	Unclear	RCT (single-blind)
Ng et al,^Citation44 2014	Low	Low	Low	Low	Low	Low	Unclear	RCT (single-blind)
Ranjita et al,^Citation45 2016	Unclear	Unclear	Low	Low	Low	Low	Unclear	RCT (single-blind)
Gupta et al,^Citation46 2014	Unclear	Unclear	Low	Low	Unclear	Low	Unclear	RCT
Donesky-Cuenco et al,^Citation47 2009	Unclear	Unclear	Low	Low	Unclear	Low	Unclear	RCT
Soni et al,^Citation48 2012	Unclear	Unclear	Unclear	Unclear	Low	Low	Unclear	RCT
Tandon,^Citation49 1978	Unclear	Unclear	Unclear	Unclear	Low	Low	Unclear	RCT
Kulpati et al,^Citation51 1982	Unclear	Unclear	Unclear	Unclear	Unclear	Low	Unclear	RCT
Katiyar and Bihari,^Citation50 2006	Low	Unclear	Unclear	Low	Low	Low	Unclear	RCT

Abbreviation: RCT, randomized controlled trial.

Figure 2 Risk of bias summary.

Figure 3 (A) Forest plot of comparison: meditative movement versus nonexercise, outcome: 6-minute walk test. (B) Forest plot of comparison: meditative movement versus walking exercise, outcome: 6-minute walk test.

Figure 4 (A) Forest plot of comparison: meditative movement versus nonexercise, outcome: forced expiratory volume in 1 s. (B) Forest plot of comparison: meditative movement versus walking exercise, outcome: forced expiratory volume in 1 s.

Figure 5 Forest plot of comparison: meditative movement versus nonexercise, outcome: FEV₁ percent predicted normal values.

Abbreviation: FEV₁, forced expiratory volume in 1 s.

Figure 6 Forest plot of comparison: meditative movement versus nonexercise, outcome: CRQ, 3-month.

Abbreviation: CRQ, Chronic Respiratory Disease Questionnaire.

Figure 7 Forest plot of comparison: meditative movement versus walking exercise, outcome: CRQ, 6-month.

Abbreviation: CRQ, Chronic Respiratory Disease Questionnaire.

ChanAWLeeALeeDTThe sustaining effects of Tai chi Qigong on physiological health for COPD patients: a randomized controlled trialComplement Ther Med201321658559424280465

 PubMed Web of Science ®Google Scholar

ChanAWLeeALeeDTSitJWChairSYEvaluation of the sustaining effects of Tai Chi Qigong in the sixth month in promoting psychosocial health in COPD patients: a single-blind, randomized controlled trialSci World J20132013425082

 Web of Science ®Google Scholar

ZhangMXvGLuoCMengDJiYQigong Yi Jinjing promotes pulmonary function, physical activity, quality of life and emotion regulation self-efficacy in patients with chronic obstructive pulmonary disease: a Pilot StudyJ Altern Complement Med2016221081081727487437

 PubMed Web of Science ®Google Scholar

XiaoCMZhuangYCEfficacy of Liuzijue Qigong in individuals with chronic obstructive pulmonary disease in remissionJ Am Geriatr Soc20156371420142526131612

 PubMed Web of Science ®Google Scholar

NgBHTsangHWJonesAYSoCTMokTYFunctional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trialJ Altern Complement Med201117324325121417809

 PubMed Web of Science ®Google Scholar

YehGYRobertsDHWaynePMDavisRBQuiltyMTPhillipsRSTai chi exercise for patients with chronic obstructive pulmonary disease: a pilot studyRespir Care201055111475148220979675

 PubMed Web of Science ®Google Scholar

LeungRWMcKeoughZJPetersMJAlisonJAShort-form Sun-style t’ai chi as an exercise training modality in people with COPDEur Respir J20134151051105722878879

 PubMed Web of Science ®Google Scholar

NiuRHeRLuoBLHuCThe effect of tai chi on chronic obstructive pulmonary disease: a pilot randomised study of lung function, exercise capacity and diaphragm strengthHeart Lung Circ201423434735224210727

 PubMed Web of Science ®Google Scholar

NgLChiangLKTangREffectiveness of incorporating Tai Chi in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD) in primary care – a pilot randomized controlled trialEur J Integr Med201463248258

 Web of Science ®Google Scholar

RanjitaRHankeyANagendraHRMohantySYoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: a randomized controlled trialJ Ayurveda Integr Med20167315816627545747

 PubMedGoogle Scholar

GuptaAGuptaRSoodSArkhamMPranayam for treatment of chronic obstructive pulmonary disease: results from a randomized, controlled trialIntegr Med (Encinitas)2014131263126770079

 PubMedGoogle Scholar

Donesky-CuencoDNguyenHQPaulSCarrieri-KohlmanVYoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot studyJ Altern Complement Med200915322523419249998

 PubMed Web of Science ®Google Scholar

SoniRMunishKSinghKSinghSStudy of the effect of yoga training on diffusion capacity in chronic obstructive pulmonary disease patients: a controlled trialInt J Yoga20125212312722869996

 PubMedGoogle Scholar

TandonMKAdjunct treatment with yoga in chronic severe airways obstructionThorax1978334514517694807

 PubMed Web of Science ®Google Scholar

KulpatiDDKamathRKChauhanMRThe influence of physical conditioning by yogasanas and breathing exercises in patients of chronic obstruction pulmonary diseaseJ Assoc Physicians India1982308658687184909

 PubMedGoogle Scholar

KatiyarSKBihariSRole of pranayama in rehabilitation of COPD patients – a randomized controlled studyIndian J Allergy Asthma Immunol200620298104

 Google Scholar