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Health Qigong: its application and evidenceHealth Qigong: its application and evidencein Cardiac Rehabilitation
Athina POON OTI United Christian Hospital
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pHK
Content
Health Qigong and Cardiac rehabilitation programprogram
Clinical study and clinical application:Health Qigong (HQG) Badunjin (BDJ)Health Qigong (HQG) Liu Zi Jue (LZJ)
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Background
Heart disease including Acute Myocardial Infraction (AMI) and Congestive Heart ( ) gFailure (CHF).
Have become a worldwide health and economic burden with high mortality rate and re-hospitalization rate.
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Heart disease as 2nd leading cause of death in HK.
BackgroundThe annual incidence of heart disease had reached up to 14 /1000 and 20 /1000 in men and womenmen and women.
16,000 heart failure admissions & accounting for 1.4 % admission to HA hospitals (Hospital Authority statistics,2006).
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Around 25 to 50% of hospitalized patients will be readmitted within 6 months after discharge. (Hospital Authority statistics,1997).
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BackgroundThe activity level of people with heart disease was limited by :disease was limited by :
chest pain,fatigue, dyspnoea, edema,emotion, like depression.
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emotion, like depression.
Background
Effective treatment for heart disease was not only prolonging life symptom controlnot only prolonging life, symptom control.
A clinical priority for treating patients with heart disease :
promoting the QOL, d d i i
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reduce re-admission control cardiovascular risk factors
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Cardiac Rehabilitation Program (CRP)
WHO definition:The sum of activities required to influence favorably the underlying cause of the disease, as well as to ensure the patients the best possible physical, mental and social conditions so that they may be by their own efforts, preserve or resume when lost, as normal a l ibl i th it
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place as possible in the community.
Cardiac Rehabilitation Program (CRP)
The CRP program should concerned the full spectrum of QOL which included both full spectrum of QOL, which included both physical skill training and educational programs, cater to psychosocial aspect.
(Denollet et al,1995)
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Health Qigong (HQG)Qigong was formed by 2 characters.
“Qi” means ‘breathing of vital energy’“G ‘ h kill f k ‘ l i i“Gong” means ‘the skills of work’, ‘cultivation’and ‘achievement’.
Composed of 2 characteristics: slow body movements as an aerobic exercise and a controlled synchronized slow breathing.
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Qigong was to cultivate vital energy to maintain ones health and get rid of illness.
Health Qigong (HQG)
Many literatures and systematic reviews have positive evidence supporting the have positive evidence supporting the clinical benefits of health qigong on :
lowering of total cholesterol, lowering of systolic blood pressure, lowering of diastolic blood pressure
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lowering of diastolic blood pressure, lowering of depressive mood scores
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Health Qigong (HQG)Qigong enhanced healthy lifestyle, functional ability and improve QOL (Tse,1995)
Qigong has effects on cardio-pulmonary dimensions (Lim et al, 1993)
Rhythmic movements of qigong reduce stress, build stamina, increase vitality, and enhance the immune system. (The National Qigong Association, USA)
Qigong and psychological effects (Allen Dorcas 1996)
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Qigong and psychological effects (Allen Dorcas,1996)
Qigong on blood pressure and hypertension ( Christine R K, 2001)
HQG v.s. Cardiac Rehabilitation
Aim to investigate the effectiveness of HQG in heart disease people on :HQG in heart disease people on :
physiological performance psychological aspects
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Our experience
Year Journey
2000 Tried HQG practice in CRPII
2005 HQG (BDJ) study in AMI patients
2006 12 weeks HQG(BDJ) program for AMI patients led by lay leaders
2007 HQG (LZJ) study in CHF patients
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Q ( ) y p
2009 Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
Our experience –Tried HQG practice in CRPII
HQG practice had been tried at the United Christian Hospital (UCH) cardiac Christian Hospital (UCH) cardiac rehabilitation program phase II (CRP II) for patient with AMI since 2000.
14Practiced Qigong at Day Rehabilitation Center
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Our experience –Tried HQG practice in CRPII
CRPII
Patient types: Myocardial InfarctPost CABG, PCI…post onset 4 -6 /12
Age range: Average ~ 63 years old
Chinese 99%
METS level: Exercise capacity >3METS
Frequency/duration: 10 sessions (1 hr/ session)
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Program : Psycho-education (30 mins)
+ Health Qigong Practice (30 mins)
Vital Sign Screening
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Health Qigong Background
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Live Demonstration
Warm Up ex.
& Practice
17Vital Sign Re-check
Our experience –Tried HQG practice in CRPII
Exclusion criteriaExclusion criteriaProblems with musculoskeletalNeurological deficitPsychiatric illness with medical complication e.g. unstable angina, uncontrollable BP etc
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Eff i ?Effectiveness?
Study………….
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Our experience –HQG (Ba Duan Jin - BDJ) study in AMI patients
An Evaluation of Qigong in improving the QOL in Cardiac Patients.
Hui et al. The Journal of Alternative and Complementary Medicine 2005
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11
Our experience –HQG (BDJ) study in AMI patients
BDJ incorporates physical physical movements & postures with breathing techniques & meditation to
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cleanse & restore Qi. Eight different movement steps
Ba Duan Jin
Our experience –HQG (BDJ) study in AMI patients
Outcome Measures
Physiological measures:Blood Pressure (BP)
systolic blood pressure (SBP) diastolic blood pressure (DBP)
Heart Rate (HR)
Psychosocial measures:An iet le el (STAI)
22
Anxiety level (STAI)Quality of Life (SF36)
12
Our experience –HQG (BDJ) study in AMI patients
N= 28 Pre-TreatmentMean (SD)
Post-TreatmentMean (SD)
P-value
SBP 130.89 20.78 123.93 21.33 .013*
DBP 66.86 12.80 67.14 11.75 .901
HR 67.21 12.95 64.57 12.88 .115
STAITraitAnxiety
41.39 10.4842.29 7.87
32.57 10.2935.43 9.22
.000*
.000*
SF36 Mental healthSocial Functioning
63.71 29.0966 52 36 33
78.00 25.8486 16 21 87
.003*
.001*
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Social FunctioningVitalityRole disruption (physical problems)Role disruption (emotional problems)
General HealthBody PainPhysical Function
66.52 36.3356.43 24.7541.07 46.2651.19 46.6945.46 16.9577.39 21.8082.32 13.57
86.16 21.8770.00 23.5768.75 40.6180.95 37.8757.50 20.5276.71 19.0388.93 12.86
.001
.006*
.005*
.003*
.001*.888
.000*
Clinical
HQG (BDJ) study in AMI patients
Clinical Application
Regular practice
applied HQG (BDJ) in CRPII for AMI
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in CRPII for AMI patient
13
Our experience –HQG (BDJ) study in AMI patients
3 month follow up by telephone
Variables Post-CRP II Post CRP II 3-month
p value
PCS 47.75 ±7.35 51.23 ± 5.87 0.142
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MCS 52.011 ±1.21 56.82 ± 4.13 0.039*
According to patient self report, patients fail to complied, they either said :
Our experience –HQG (BDJ) study in AMI patients
“ I am too busy with my household chores, I had no time to perform it”
“ I am rather lazy”
“ I am rather tired and sleep all day!”
“ It is difficult to learn, usually I forgot all the steps after going b k h ”
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back home.”
“My family members keep tissing me about my posture, I had no confidence in performing it at home!”
“ I need to work at daytime, I am exhausted after work!!”
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Compliance …..
27
Home Program Enhancement to enhance home practice HQG compliance :
Our experience –HQG (BDJ) study in AMI patients
VCDWritten Instruction Self Reported Daily Sheet
28
15
Duration of qigong practice at HomeSignificant increase in duration of home qigong practice
d
Our experience –HQG (BDJ) study in AMI patients
per day
g qi
gong
16
14
12
29
Recorded day
10987654321
Mea
n tim
e fo
r per
form
ing
10
8
6
N=47
P=0.001 (repeated measures of ANOVA)
Home Program Clinical gEnhancement
to enhance home practice HQG compliance
Clinical Application
Regular practice –
Applied HQG (BDJ) Home Program
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compliance
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L ff S i bili ?Long term effect , Sustainability….?
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By observation peer effect influenced
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
By observation, peer effect influenced compliance and motivation, leader in group helps reinforcing peer effect
Supported by the social cognitive theory (Bandura, 1986), using of group as an agent of change was based on group dynamics literature. King (1994) noted that it is important is to find ways
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King (1994) noted that it is important is to find ways to promote these social forces when using the group approach to deliver physical activity training and promote commitment to what participants learn.
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Using self recorded sheet provides a personalized plan and facilitate self
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
personalized plan and facilitate self regulatory responsibility for enhancing exercise adoption and maintenance
According to social cognitive theory, the aspect of perceived efficacy that is most relevant is not whether one can execute the
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efficacy that is most relevant is not whether one can execute the physical skills, which are readily mastered, but the self-regulatory efficacy to mobilize oneself to exercise regularly in the face of a variety of personal, social, and situational impediments. (Bandura, 1986)
Occupational Therapy DepartmentMedical & Geriatric Department, Cardiac
Division
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
Health Resource Center United Chrsitain Hospital
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Aim of Study12 week health qigong (Badunjin)
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
12-week health qigong (Badunjin) program on cardiac patients Evaluate
physiological psychosocial effect
The maintenance effect of the program was also evaluated at post discharge
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was also evaluated at post-discharge 12-week from the program.
Hypothesisa 12 weeks’ health qigong program involves
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
a 12 weeks’ health qigong program, involves both regular group and daily home practice, will significantly improve
physiologicalpsychosocial functionsinitial significant improvements will be sustained over 6 months, and
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The outcome of intervention group will significantly differ from the control group, with better physiological and psychosocial aspects.
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Our experience –12 weeks HQG(BDJ) program for AMI patients led by lay leaders
Subjects: Selection criteria:
completed CRPII (80% of attendance)learnt basic skills of health qigongwilling to participate in the study
Exclusion criteria
Onset of :uncontrolled angina, arrhythmia dyspnea attackadditional medical admission during CRPIII
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Lay Leaders: the graduated CRPII patients6-session train-the-trainer course
Program frequency health qigong class 1/ week ≧ 4 times home practice/week.
ResultN=57
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
2030
N=57
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30
31
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Exp. group
Control group
01020
Exp. gp. Control
gp.
male
femake
38
23
24
25
26
Exp. group Control group
Control group
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Homogeneity between groups
Total (n= 57 ) Exp (n= 31 ) Control (n=26) P value
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
Total (n= 57 ) Exp. (n= 31 ) Control (n=26) P-value
n % n % n % Chi-square
Gender
Male 39 68.4 19 61.3 20 76.9 0.164*
Female 18 31.6 12 38.7 6 23.1
Regular ex. habit
Yes 52 91.2 30 96.8 22 84.6 0.126*
N 2 8 8 1 3 2 4 15 4
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No 2 8.8 1 3.2 4 15.4
n Mean n Mean n Mean Ind. T Test
Age
57 62.1 31 63.2 26 60.7 0.405*
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
N=31 Attendance(total 12 sessions)
1 – 12 week Home practice
12 – 24 week Home practice
Mean 9.3 7.9 times/wk 6.5 times/wk
SD 3.0 3.4 3.2
40
21
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
1
1.5
2
2.5
3
Exp. gp
control gp
41
0
0.5
1
Re-admit Mortality
Heart Rate change during Class
64
66
68
70
ate
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
56
58
60
62
64
1 2 3 4 5 6 7 8 9 10 11 12 Session
Hea
rt R
a
Pre-HR
Post-HR
SBP change during class
145
150
DBP change during class
79808182
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115
120
125
130
135
140
1 2 3 4 5 6 7 8 9 10 11 12
Session
SB
P
Pre-SBP
Post-SBP 717273747576777879
1 2 3 4 5 6 7 8 9 10 11 12
Session
DB
P
Pre-DBP
Post-DBP
22
Heart rate change in diff. time interval
66
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
58
59
60
61
62
63
64
65
66
HR
Experimental
Control
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Pre Wk 12 Wk 24
Time
HR Pre Wk 12 Wk 24
Experimental 64.2 62.84 60.8
Control 61.1 62.77 65.0
SBP change in diff. time interval
134
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
122
124
126
128
130
132
134
SB
P
Experimental
Control
44
122
Pre Wk 12 Wk 24
Time
SBP Pre Wk 12 Wk 24
Experimental 130.1 128.7 130.6
Control 130.2 126.4 133.4
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DBP change in diff. time interval
78
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
70
71
72
73
74
75
76
77
78
P Wk 12 Wk 24
DB
P
Experimental
Control
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Pre Wk 12 Wk 24
Time
DBP Pre Wk 12 Wk 24
Experimental 77.0 74.4 74.8
Control 74.8 72.8 76.3
Experimental Gp(n=31)
Control Gp (n=26)
p
mean mean
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
ea eaHR Baseline 64.2 61.1
12 weeks 62.8 62.8 24 weeks 60.8 65.0
0.001*
SBP Baseline 130.1 129.8
12 weeks 128.7 126.4 24 weeks 130.6 133.4
0.529
DBP Baseline 77.0 74.8
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12 weeks 74.4 72.8 24 weeks 74.8 76.3
0.284
* Significantly difference by Repeated ANOVA (2x3)
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C-SF36 resultsgeneral improvement in all 8 domains of
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
general improvement in all 8 domains of psychosocial functioning , especially in vitality (p=0.009) in the experimental group
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Feedbacks from lay leaders & patientsFeedbacks from lay leaders & patientsPositive feedback from participants
Our experience -12 weeks HQG(BDJ) program for AMI patients led by lay leaders
more active in daily life with enhanced confidence enhanced self-efficacy in coping with their cardiac problems and dealing with their daily lives
Other factors like the cultural relevant Traditional Chinese Medical components of health qigong,
f t i th l l d
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sense of empowerment as in the lay leaders, changes in lifestyle, peer group sharing, learning and support were also identified which had contributed to the positive outcome of the program.
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12 weeks HQG(BDJ) program for AMI patients led by lay leaders
Clinical Application
2 sessions of Health Qigong group lead byby lay leaders group lead by lay leader weekly for post CRPII patient
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Apply other HQG in other patient group…..
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26
Our experience - HQG (Liu Zi Jue- LZJ) study in CHF patients
E l ti f th ff t f H lth Evaluation of the effect of Health Qigong in people with heart failure
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Our experience - HQG (LZJ) study in CHF patients
regulated & controlled the controlled the rise & fall of Qi inside the bodySlow and gentle breathing and movementsuitable for
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suitable for elderly 6 main steps, together with the starting and closing steps
Liu Zi Jue
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Design of study:an experimental and prospective study.
Our experience - HQG (LZJ) study in CHF patients
an experimental and prospective study. Convenient sampling of the outpatientswhom were referred to UCH for heart failure rehabilitation programme.
Outcome :Heart rate blood pressure and QOL
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Heart rate, blood pressure and QOL,The Chronic Heart Failure Questionnaire (Chinese version) and SF 36
Our experience - HQG (LZJ) study in CHF patients
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Our experience - HQG (LZJ) study in CHF patients
55
Our experience - HQG (LZJ) study in CHF patients
56
29
Our experience - HQG (LZJ) study in CHF patients
57
Our experience - HQG (LZJ) study in CHF patients
58
30
Our experience - HQG (LZJ) study in CHF patients
59
Conclusion:
Our experience - HQG (LZJ) study in CHF patients
there was a lowering effect of heart rate and diastolic blood pressure but not systolic blood pressure after practicing Health Qigong
ff t i i i QOL
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an effect in improving QOL
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HQG (LZJ) study in CHF patients
Clinical Application
Routine practice
Apply HQG (LZJ) f C
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in HFPII for CHF patient
Patient satisfaction towards Health Qigong………
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to assess the health status and patients’satisfaction of the patient self help and lay
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
satisfaction of the patient self-help and lay leader led health qigong program.
by patient satisfactory survey consisted of 10 questions
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N31
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
NGender 74.2 % male 25.8 % female
Age 66.0 (mean) 6.9(SD)
64
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Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
Practi ced H QG d urat io n
6months1year1to 2 years> 2yearsothers
Q1
Pies show counts
3 .2 3 %3 .2 3 %
2 9 .0 3 %
5 8 .0 6 %
6 .4 5 %
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Practiced HQG(Badunjin) duration N Percent
Valid 6 months 1 3.2
1 year 1 3.2
1 to 2 years 9 29.0
> 2 years 18 58.1
Others (3 years) 2 6.5
Total 31 100.0
Home practiced HQG frequency/ week:
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
Practi ced H QG durat ion
>5ti mes/ week3to 5 ti mes/ week<2ti mes/ weekNA
Q3
Pies show counts
2 5 .8 1 %
9 .6 8 %
1 6 .1 3 %
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Home practiced HQG frequency/ week N Percent
Valid > 5 times/ week 8 25.8
3 to 5 times / week 15 48.4
<2 times / week 3 9.7
NA 5 16.1
Total 31 100.0
4 8 .3 9 %
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Home practiced HQG duration (minutes)/ practice
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
Practi ced H QG d urat io n
> 40mi nutes15to 40 minutes< 15mi nutesNA
Q4
Pies show counts
2 2 .5 8 %
1 2 .9 0 %
9 .6 8 %
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Home practiced HQG duration (minutes)/ practice N Percent
Valid > 40 minutes 7 22.6
15 to 40 minutes 17 54.8
< 15 minutes 4 12.9
NA 3 9.7
Total 31 100.0
5 4 .8 4 %
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
100% patients expressed they will continue to practice HQG.Over 96.8% patients were not admitted in the past 1 year (due to cardiac related problem) after practiced HQG.
68
35
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
Q93 .2 3 %
Practi ced H QG du rat ion
yesno
Pies show counts
69
9 6 .7 7 %
N %
Able to relax after practiced HQG 31 93.5
Able to build up healthy life style (active life style, relax) 31 93.5
Patients’ feeling of self-efficacy in sustaining active d h lth lif t l tt ft ti HQG
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
and healthy lifestyle pattern after practice HQG
•improved physique •improved breathing•less pain of L/L•improved cardio-pulmonary fitness•improved health
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•improved health•less illness
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Q109 6 8 %
Practi ced H QG du rat ion
Our experience –Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
mutual encouragemutual supportrol e model
Q10
Pies show count s
5 8 .0 6 %
3 2 .2 6 %
9 .6 8 %
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Satisfaction N Percent
Overall satisfy lay leader led health qigong program 31 100
Will recommend others to join lay leader led health qigong program 31 100
Health survey of the cardiac patient self help & lay leader led HQG (BDJ) program
Clinical Application
Apply HQG in Cardiac Rehab.
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Program
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Keys of Qigong practice in cardiac patient:
MotivationInterestInterestComplianceMutual /peer supportAV aids support
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Keys of Qigong practice in cardiac patient:Characteristics to enhance adherence Health Qigong
Affordable, no extra equipment
Simple to learn
Gradable according to conditions and level
No time pressure; pace set by self
Challenging enough to motivate practice
Social reinforcement, e.g. discussion in mass media di i lf h l
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discussion, self-help group
No environmental, weather & financial constraints(e.g. limited space requirement, no extra expenditure on using extra equipments)
High perceived therapeutic value
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Keys of Qigong practice in cardiac patient:
Therapist’s role Observe and regular the paceObserve and regular the paceFacilitate proper practicePractice breathing , relaxed posture, relaxed mindScreen any contraindication, knee pain…
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Conclusion
A culturally relevant, safe, minimal cost, and proven clinical benefit, health qigong can be considered as
a cost-effective intervention to facilitate cardiovascular risk factors control, active lifestyle engagement, self-efficacy enhancement in sustaining active,
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y ghealthy lifestyle pattern ,long-term community reintegration ,with possible reduction in the avoidable re-admissions due to coronary heart disease.