THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 13, Number 4, 2007, pp. 427433

Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2006.6052

A Qualitative Review of the Role of Qigong in the

Management of Diabetes

LIU XIN, M.Ed., YVETTE D. MILLER, Ph.D., and WENDY J. BROWN, Ph.D.

ABSTRACT

Objective: To review the evidence relating to the effectiveness of qigong in the management of diabetes.
Methods: We performed a systematic literature review of qigong intervention studies published in English
or Chinese since 1980, retrieved from English-language databases and Chinese journals. Qigong intervention
studies conducted with adults with diabetes, which reported both preintervention and postintervention measures
of fasting blood glucose and/or hemoglobin A1c (HbA1c) were included. Sample characteristics, intervention
frequency/duration, and metabolic outcomes were reviewed.
Results: Sixty-nine intervention studies were located. Of these, only 11 met the criteria for inclusion. There
were consistent and statistically significant positive associations between participation in qigong and fasting
and 2-hour oral glucose tolerance test results, blood glucose, and triglycerides and total cholesterol. Effects on
insulin and HbA1c were inconsistent. There was no evidence of any effect of qigong on weight. Most of the
studies were of short duration, involved small samples, and did not include a control group.
Conclusions: Although qigong has beneficial effects on some of the metabolic risk factors for type 2 dia-
betes, methodologic limitations make it difficult to draw firm conclusions about the benefits reported. Ran-
domized controlled trials are required to confirm the potential beneficial effects of qigong on the management
of type 2 diabetes.

INTRODUCTION can be practiced alone as a home-based activity, or in groups,

with the potential added benefits of social support.

A s its potential for improving general health has become

more widely recognized, the practice of qigong has be-
come more popular in Western countries. This traditional Chi-
nese exercise, which is often practiced as a component of tai
chi, is widely recognized in China as a medical exercise in
its own right, having been practiced for thousands of years as
a part of Traditional Chinese Medicine (TCM). Qigong is a
type of moving meditation, characterized by a unique com-
bination of mental and physical training, combining slow,
deep, diaphragmatic breathing and relaxation with spiral and
circular movements of skeletal muscles, transference of
weight, and adoption of specific postures, which are linked
to the yin and yang theory of TCM. Qigong can be conducted
in static (sitting, lying, or standing) or dynamic (moving) flow, which, according to theories of TCM, underpin the
styles, and is generally easier to master than tai chi. Qigong
In recent years, there has been increased research inter-
est in the potential of qigong for the prevention and treat-
ment of several health problems, including cancer and
asthma.13 Recent reports of the increasing prevalence of
type 2 diabetes in both Eastern and Western countries4,5
have also now directed more specific research attention to
the effects of qigong on diabetes management.616 Accord-
ing to Chinese medicine, the benefits of qigong for diabetes
control are achieved through enhancing glucose uptake by
skeletal muscles and by improving the action of the beta
cells in the pancreas. The specific patterns of movement and
breathing in qigong involve coordination of many muscle
groups, as well as free circulation of energy and blood
therapeutic effects of qigong.

School of Human Movement Studies, The University of Queensland, St. Lucia, Queensland, Australia.

427
428
Qigong may also affect diabetes control through its stress-
reducing properties. In 2003, Lee et al. demonstrated re-
ductions in norepinephrine, epinephrine, cortisol, and self-
reported stress following 10 weeks of qigong training, and
these improvements were significantly different from those
in controls without training.17 Stress can have stimulatory
effects on insulin antagonists such as cortisol, adrenaline,
glucagon, and growth hormone, which may affect glucose
control adversely, and lack of improvement or deterioration
in glycemic control has been associated with the experience
of personal stressors.18
There appear to be several possible mechanisms for the
potential of qigong to influence glycemic control positively
among people with diabetes. Because little evidence about
the effectiveness of qigong for diabetes management is read-
ily available in the western scientific literature, the aim of
this paper is to provide a qualitative review of contempo-
rary evidence about the effectiveness of qigong as an inter-
vention strategy for the management of diabetes.
METHODS
A systematic literature search was conducted to identify
evidence relating to the effectiveness of qigong interven-
tions in the treatment of type 2 diabetes. PubMed and MED-
LINE electronic databases were utilized with the search
terms physical activity, exercise, diabetes, adult onset dia-
betes, type 2 diabetes, impaired fasting glucose, impaired
glucose tolerance (IGT), metabolic syndrome, qigong, qi
gong, chikung, chi kung. The search strategy also included
a hand search of all volumes of the Chinese Journal of Sports
Medicine, Chinese Journal of Diabetes, Chinese Journal of
Integrated Western and Eastern Medicine, Chinese Journal of
Rehabilitation Medicine, Journal of Chinese Qigong, and the
content of international websites related to alternative medical
approaches to diabetes prevention and management (e.g.,
www.alternativehealing.org/diabetes_qigong_therapy.htm).
We included both English- and Chinese-language papers
published since 1980 that reported on qigong intervention
trials on diabetes. Single-session trials, case studies, studies
that did not objectively measure diabetes-related outcomes
or did not report the magnitude of changes in those out-
comes, and studies on animals were excluded. For inclusion
in this review, studies were also required to report objective
measures of fasting blood glucose and/or HbA1c before and
after qigong. When units of outcome measures were reported
in mg/dL, these were converted to mmol/L using an estab-
lished conversion formula.19
RESULTS
A total of 69 intervention studies published in English or
Chinese since 1980 were located, but 58 of these did not
XIN ET AL.
meet the inclusion criteria for this review and were excluded.
Reasons for exclusion were that 1 trial was a single-session
trial, 18 were case studies, 23 did not measure diabetes-re-
lated outcomes objectively or did not report the magnitude
of changes in those outcomes, 13 did not report pre- and
post-qigong measures of fasting blood glucose and/or HbA1c
and 3 were conducted with rats. Eleven studies met the in-
clusion criteria for this review, and all but one16 were con-
ducted in China. A summary of each of these studies is pro-
vided in Table 1. Effects are reported with the specificity
provided by the authors. Details about the magnitude of
changes in outcome variables, the composition of the sam-
ples, and the frequency and duration of qigong participation
sessions were not consistently reported.
Only one of the 11 studies included a control group.16
Most of the studies were conducted with samples of adults
with diabetes who were recruited from hospitals6,7,9,10,14 or
clinics8,11; 5 studies included only participants with type 2
diabetes810,12,16; 2 studies also included a small number of
participants (2 in each) with type 1 diabetes6,7; and 4 stud-
ies did not provide this information.11,1315 The reported du-
ration of the interventions ranged from 10 days13 to at least
3 years,15 although most were conducted for 3 weeks to 3
months. Three studies involved the dynamic (moving) style
of qigong,7,9,12 4 studies used a combination of the dynamic
and static styles,11,1315 1 study used only the static style,8
and 3 studies did not provide this information.6,10,16 Group
qigong training was conducted at least once per week in
most trials, usually with recommended daily home training.
At least some participants in most trials took medication for
diabetes during the intervention period, but there was no di-
etary intervention in any of the trials reviewed here.
All 10 studies that reported changes in fasting blood glu-
cose with qigong615 demonstrated decreases that ranged from
0.08 mmol/L10 to 5.65 mmol/L,6 and the majority of these were
statistically significant changes. The preintervention levels of
fasting blood glucose were lower in the 2 studies that did not
demonstrate statistically significant changes in this measure8,10
than in those studies that did find such changes. Blood glucose
was measured 2 hours after a glucose load in 2 trials, which
reported decreases of 5.05 mmol/L after 3 months7 and 1.9
mmol/L after 1 month (p  0.05),10 respectively.
Changes in fasting insulin were measured in 4 of the tri-
als,7,9,12,14 with inconsistent effects. One study reported a de-
crease of 9.65 u/mL after 20 days (p  0.05),9 while an-
other study (with quite intensive training for more than an
hour and a half daily) reported an increase in fasting insulin
of 5.58 u/mL after 21 days.14 Only 1 of the trials reported
changes in insulin at 2 hours after a glucose load, and found
a nonsignificant increase of 8.5 u/mL after 23 months.7
Two trials assessed changes in HbA1c. One of these re-
ported almost no change, but assessed HbA1c after only 20
days,9 making assessment of HbA1c inappropriate. The other
trial demonstrated a statistically significant decrease of 0.8%
in HbA1c after 4 months of training, as compared with a de-
 TABLE 1. SUMMARY OF QIGONG INTERVENTION STUDIES FOR DIABETES MANAGEMENT

Outcomes (preintervention  postintervention)

BW (kg)
FBG BG2h FIN IN2h HbA11c TG TCH or Change in
Source Participants Intervention (mmol/L) (mmol/L) (u/mL) (u/mL) (%) (mmol/L) (mmol/L) BMI medication

Du et al., 13 convalencent Qigong 16.10 15% Reduced

19856 hospital 26 days  85% Stopped
(China) inpatients, 10.45
9M, 4F
T1DM: 2
T2DM: 11
Mean age: 52
Shen et al., 20 hospital, Hexiangzhuang 10.92  4.3 21.08  9.26 14.9  7.8 37.2  22.2 2.78  1.93 6.12  1.63 NS No change
19877 inpatients, qigong      
(China) 11M, 9F (dynamic style) 6.88  2.48 16.03  6.64 14.5  5.5 45.7  32.5 1.45  0.64 4.68  1.03
T1DM: 2, Twice daily,
T2DM: 18 7 times/week p  0.01 NS NS NS p  0.05 p  0.01
Mean age: for 23 months
52.7  7.3
Tu et al., 14 clinic Qigong (static 8.59  3.77 1.60  0.56 5.52  1.26 62.46  7.95 NR
19878 outpatients, style) 1550    
(China) 11M, 3F minutes 7.24  1.45 1.33  0.6 5.07  0.71 62.12  7.69
T2DM (progressive)
Age range: 3 times/week NS p  0.05 NS NS
4966 for 3 months

Wu et al., 10 hospital, Zikong Qigong 9.66  3.66 23.8  13.74 1.148  0.23 3.69  7.45 6.21  1.44 68.15  10.09 No change
19889 inpatients, (dynamic style)      
(China) 73M, 3F 30 minutes/session, 8.44  3.70 16.4  13.13 1.1  0.15 1.74  1.69 6.05  0.89 69.06  10.82
T2DM twice daily, p  0.05 (10 days) (10 days) (10 days) (10 days) (10 days)
Mean age: 7 days/week (10 days)     
52.7 for 20 days  14.15  5.17 1.24  0.20 1.62  1.33 5.97  1.02 67.85  9.17
9.07  3.72 p  0.05 (20 days) (20 days) (20 days) (20 days)
(20 days) (20 days) NS
Wu et al., 24 hospital Zhenfa Qigong 7.11 12.93 NR
199110 inpatients  1 month  
China 4 clinic 7.03 11.03
outpatients, NS p  0.05
14M, 14F
T2DM (Continued)
 TABLE 1. SUMMARY OF QIGONG INTERVENTION STUDIES FOR DIABETES MANAGEMENT (CONTD)

Outcomes (preintervention  postintervention)

BW (kg)
FBG BG2h FIN IN2h HbA11c TG TCH or Change in
Source Participants Intervention (mmol/L) (mmol/L) (u/mL) (u/mL) (%) (mmol/L) (mmol/L) BMI medication

Huaxia, 120 attendees at Zhineng 12.65  1.08 10.8% stopped

199411 rehabilitation qigong (static)  88.5% reduced
(China) clinic/qigong style plus 11.17  2.31 or no change
training center, dynamic style) p  0.01
48M, 72F 24 days
Age range:
1475
Jing Recruitment HuiChun 10.19  3.29 16.60  6.01 2.80  1.01 6.75  1.32 68.55  10.24 No change
et al., source: NR Qigong     
199412 N  31 (dynamic style) 6.93  1.98 12.6  14.85 1.34  0.71 5.51  1.16 69.02  9.84
(China) 22M, 9F 10 days of daily p  0.001 NS p  0.001 p  0.001 NS
T2DM group training,
Mean age: then 1 group
62.85 session/week
and
recommended
daily home
training for
12 mths
Zhang 34 attendees at ZangMi Qigong 12.06  3.79 NR
et al., qigong (static style 
199413 training class plus dynamic 8.55  3.59
(China) style) p  0.01
10 days of
training
Zhang 16 hospital Qigong (static 7.627  2.306 17.69  23.27 64% reduced
199614 patients style plus  36% NR
(China) 6M, 10F (dynamic style) 5.138  0.986
Mean age: 59.3 95 min/day, p  0.01
twice daily,
for 21 days
Zhang Recruitment ZangMi 11.51  3.33 NR
et al., source: NR Qigong (static 
199915 N  14 style plus 8.21  1.40
(China) 4M, 10F dynamic style) (3 years;
Mean age: 56 12 h/day, p  0.05)
7 days/week 
for 34 years. 8.55  2.43
Majority of (4 years;
participants did p  0.05)
group exercise
Tsujiuchi, Recruitment Qigong Months 14: NS No change
et al., source: NR 2 h/week of intervention in BMI
200216 group training 8.13  1.73
(Japan) Intervention and 
group: recommended 7.33  1.09
N  16 (T2DM) daily home Control:
Mean age: training. 8.29  1.63
65.3  7.7 Control group 
Control group: underwent 8.17  1.30
N  10 intervention Months 58:
Mean age: after 4 months Control:
59.1  9.0 8.17  1.30

7.23  0.90
p  0.005

M, male; F, female; FBG, fasting blood glucose; BG2h, blood glucose at 2 hours after glucose load; FIN, fasting insulin; IN2h, insulin at 2 hours post load; HbA1c, hemoglobin A1c; TG, triglycerides; TCH,
total cholesterol; BW, body weight; BMI, bodymass index; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus; NS, no significant change; NR, not reported.
Note:  denotes compared with.
432
crease of only 0.12% in the control group. This finding was
substantiated by a decrease of 0.94% in HbA1c in the wait-
list control group when the latter followed the same train-
ing protocol for the following 4-month period.16
There were consistent decreases in total cholesterol across
the 4 trials that measured it,79,12 and two of these decreases
were statistically significant. Consistent improvements in
triglycerides were also reported in the 4 studies that included
this variable, and in 3 of the 4 studies the reported im-
provements were statistically significant (p  0.05).7,8,12
There were no significant changes in bodymass index
(BMI) or body weight in the 5 trials that reported these vari-
ables.79,12,16 Relief of symptoms6,14 and reduced doses of
medication6,11,14 (see Table 1) were reported in some trials,
and 1 trial demonstrated significant improvements in some
psychological measures such as anxiety (p  0.05) and
mood (p  0.05).16
Although changes in diet and physical activity (other than
that associated with the intervention) may explain the ob-
served changes in many of the outcomes assessed, 5 stud-
ies8,10,11,1315 did not report on changes in diet, and 10615
did not report on changes in other physical activities. Five
studies reported that there was no change in diet during the
testing period,6,7,9,12,16 and 1 reported that there was no
change in physical activity outside the intervention pro-
gram.16
DISCUSSION
Ours is the first study to systematically review the evi-
dence relating to qigong and diabetes management using pa-
pers from both the English- and Chinese-language literature.
On the basis of the studies reviewed here, it is clear that suf-
ficient evidence exists to suggest that qigong may positively
affect some indicators of diabetes control. However, most
of the published evidence in this field is from studies with
serious design flaws, such as the lack of a control group,
small sample size, and no reporting of potentially con-
founding variables.
The most consistent positive effects of qigong were
demonstrated for blood-glucose measures (both fasting and
2-hour postglucose-load values), and the data suggest that
the magnitude of the changes in fasting blood glucose
(0.085.65 mmol/L)615 after qigong training can be of sim-
ilar magnitude to that reported after metformin therapy
(3.33.9mmol/L).20 Similarly, the changes in HbA1c re-
ported after qigong training (0.8%0.94%)16 were close to
those reported in metformin trials (1%2%).20,21
The main problem with interpretation of the data in the stud-
ies reviewed here is that only one of the studies included a
control group. Other limitations relate to the relatively short
duration of most of the trials and the inconsistent or poorly
described frequency and intensity of participation in qigong.
In addition, concurrent pharmacologic intervention among
XIN ET AL.
study participants was variable or not reported, making it im-
possible to ascertain the effects of medication and changes in
medication on reported outcomes. Only one study reported
commencing the intervention of qigong after pharmacologic
stabilization of blood-glucose levels,9 making it difficult to es-
timate the isolated effect of qigong on blood glucose after ad-
justment for the effects of medication. There is therefore a
clear need for more well-designed studies to assess the effect
of qigong on diabetes management, and to evaluate the im-
pact of qigong interventions among patients with prediabetes.
Qigong has particular characteristics that are likely to be
important for diabetes control and prevention. For example,
qigong involves the activation of large muscle groups, which
is likely to enhance glucose disposal, and it has a strong fo-
cus on relaxation and controlled breathing, which may have
important effects in terms of stress reduction. The combi-
nation of both muscle movement and stress-reduction prop-
erties points to the potential of qigong for diabetes preven-
tion and management, particularly in light of strong evidence
of associations between diabetes and both physical activ-
ity2225 and stress.26 This low-intensity, low-impact activity
may be particularly useful for managing diabetes among
older adults or those with overweight or obesity, since these
people may find more conventional forms of Western exer-
cise more challenging, and may be fearful of injury and other
adverse health consequences of more vigorous exercise.27
Qigong may also offer an alternative form of exercise for
older people who prefer not to exercise in gymnasiums and
who are therefore unlikely to participate in the kind of re-
sistance-training programs that have previously shown
promise in the management of type 2 diabetes.28
Although the results reported here suggest that qigong
training may have a positive effect on diabetes control, more
rigorous studies are required to ascertain its effectiveness in
the management of diabetes and its potential for preventing
onset of the disease. Such studies should be designed to in-
clude control groups and ensure the representativeness of
study-group samples by recruiting participants from com-
munity-based sources. Future studies should also attempt to
control or at least assess medication effects and attempt to
report the isolated effects of qigong training on indicators
of diabetes management after controlling for other concur-
rent treatment effects. Given the lack of rigorous evidence
for the effectiveness of qigong training on diabetes man-
agement, the full range of relevant indicators of diabetes
management should be assessed, and blood should be taken
after a sufficient interval since the last previous training pe-
riod so as to remove the acute effects of training on mea-
sures of blood glucose and insulin. Furthermore, the qual-
ity of reporting of studies of the effect of qigong on diabetes
management in the published literature requires improve-
ment, including more explicit description of the type of train-
ing used (static versus dynamic, duration, frequency, pre-
dominant movements, etc.), to allow replication and
comparability of effects between studies.
QIGONG AND DIABETES MANAGEMENT
CONCLUSIONS
If the efficacy of qigong in the prevention and/or man-
agement of diabetes can be more clearly demonstrated, as-
sessment of the potential for more widespread implementa-
tion of qigong programs in Western countries, and the
acceptability of these programs, will have to be considered.
However, the findings presented here provide grounds for
cautious optimism in considering the potential role of qigong
for diabetes management.
ACKNOWLEDGMENTS
Wen Jing accessed and forwarded articles published in
China that could not be retrieved in Australia. Lin Zhong-
peng provided resources to expand our search of the Chi-
nese literature. Liu Xin is supported by a University of
Queensland scholarship, and Dr. Miller is supported by a
Capacity Building Grant from the National Health and Med-
ical Research Council of Australia.
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Address reprint requests to:
Liu Xin, M.Ed.
School of Human Movement Studies
The University of Queensland
St Lucia, QLD 4072
Australia
E-mail: liuxin@hms.uq.edu.au