A number of systematic reviews conducted in recent years have concluded that exercise represents a safe and effective intervention that can help to control symptoms and enhance cardiorespiratory fitness in cancer patients that are either undergoing or have recently completed adjuvant therapy.[19–26] Qigong is a traditional form of exercise that has been practiced in China for over 3,000 years, and that has been shown to offer a number of benefits to the health of its practitioners. To date, however, there has been relatively limited research aimed at exploring the value of GLQG training in NSCLC patients.
Survivors of NSCLC often experience poorer impaired cardiorespiratory function, decreased QOL, and greater anxiety and depression relative to the general population. This study was therefore designed to evaluate the impact of GLQG training and climate on the cardiorespiratory fitness, dyspnea symptoms, QOL, anxiety/depression, and AGR and NLR variables in patients with histologically confirmed inoperable NSCLC. These patients were separated into four groups and underwent either GLQG training or basic stretching exercises in either Hainan or Heilongjiang Province. The results of this study suggested that both GLGQ and a favorable climate were associated with beneficial physical and psychological outcomes among NSCLC patients.
Previous studies have demonstrated a direct correlation between increased cardiorespiratory endurance and decreased mortality among cancer patients. In the present study, we found that while there were no significant differences between the control and intervention groups in Heilongjiang Province with respect to patient VO2MAX, FEV1/FVC (%), or dyspnea, there were intervention-related upward trends for all of these variables. These patients may have experienced more robust improvements had they been subjected to a longer intervention period or to more robust medical supervision during cardiorespiratory endurance training. In the Hainan cohort, we found that patients in the intervention group exhibited marked improvements in FEV1% pred, FVC % pred, and depression scores relative to controls (P < 0.05). In the Hainan cohort, patients in the intervention group exhibited significantly improved cardiorespiratory fitness (VO2MAX, FEV1/FVC (%), FEV1% pred, FVC % pred), dyspnea, and depression relative to controls (P < 0.05). In addition, the intervention group in Hainan Province exhibited significant improvements in cardiorespiratory fitness (VO2MAX, FEV1/FVC (%), FEV1% pred, FVC % pred), dyspnea, and physical and emotional well-being relative to intervention group patients in Heilongjiang Province (P < 0.05). Together, these results thus suggest that GLQG and/or a more favorable climate are associated with improvements in cardiorespiratory capacity and dyspnea symptoms in NSCLC patients, with the combination of these two interventions being most efficacious.
Previous work by Milne et al.[27, 28] revealed that a combination of aerobic exercise and resistance training for 8 weeks was associated with improved cardiovascular fitness, while Sprod et al.[29] found that only cancer patients that had exercised for a minimum of 6 months exhibited significant improvements in pulmonary functionality (FVC, FEV1). We found that a 4-month period of GLQG exercise was associated with significantly improved cardiovascular endurance.[30] This may be attributable to the fact that Qigong is gentler than are resistance training/aerobic exercise, incorporating mindfulness activities and gentle aerobic exercise to achieve positive outcomes over the long-term. Previous research, however, has not evaluated the impact of GLQG on the cardiopulmonary fitness of NSCLC patients Given the fact that it is a form of gentle exercise, it may offer some of the same beneficial effects as other exercise training through comparable mechanisms associated with increased endothelial nitric oxide synthase and myocardial heat shock protein levels that can reduce chemotherapy-driven myocardial lipid peroxidation. GLQG is primarily focused on breathing exercises, however, emphasizing the importance of breathing fresh air in an oxygen-rich environment. Air pollution is known to adversely impact human health, and as such a more favorable climate will inevitably benefit GLQG practitioners. In addition, work by Qin et al. found that aerobic exercise was associated with a reduction in the adverse pulmonary effects of PM2.5 in Wistar rats, underscoring the beneficial cardiorespiratory effects of such exercise.[31] Qigong practices are also thought to alter blood viscosity and vascular elasticity, thus improving microvascular circulation in practitioners.[32]
Previous research has shown that lung cancer patients practicing GLQG exhibit improvements in microcirculation. In the present study, we also observed significant trends towards improvements in the QOL of intervention group patients. Qigong intervention activities help to promote relaxation and improved regulation of emotions and other central nervous system functions. GLQG, in particular, enables its practitioners to better achieve inner peace through regulated breathing activities, potentially relieving emotional burdens and improving mental and immunological functionality. In traditional Chinese practice, Qigong is considered to be an optimal approach to achieving a healthy body and mind through the cultivation of qi (vital energy) and yi (consciousness or intention). Through the strengthening and balancing of these factors, Qigong practitioners can potentially slow disease progression or mitigate its adverse effects. In line with our results, Chen et al. also determined that GLQG was able to improve QOL among cancer patients.[13]
ALB and GLB are two key indicators of systemic inflammation and anti-tumor responses.[33] These indicators are commonly evaluated based on the combined AGR value, which has been studied in a range of cancer types including hepatocellular carcinoma, lung cancers, and nasopharyngeal carcinoma.[34, 35] Neutrophils and lymphocytes are key regulators of systemic immunity, and a higher NLR value is associated with a poorer prognosis among cancer patients.[29, 36, 37] Herein, we found that there were significant differences between groups with respect to mean AGR and NLR values when comparing intervention and control groups (P < 0.05). As systemic inflammation is a key driver of cancer progression, we hypothesize that GLGQ and a more favorable climate may improve cancer patient prognosis via suppressing systemic inflammation.
There are a number of limitations to the present pilot study. For one, we had a limited sample size. In addition, participants were neither randomized nor blinded to their interventions. Future large-scale randomized studies with a longer intervention period will therefore be needed to better validate the findings of the present study. Despite these limitations, the positive results of our study suggest that GLQG and a favorable climate may facilitate significant improvements in physical and psychological well-being among NSCLC patients As this non-pharmacological intervention strategy is relatively inexpensive and is not associated with significant side effects, it may represent an ideal intervention strategy for cancer patients.