Baduanjin Exercise for Frailty Management in Frail or Prefrail Older Adults: A Systematic Review and Meta-Analysis
Abstract
Introduction: This systematic review and meta-analysis evaluated the effects of Baduanjin, a traditional Chinese mind-body exercise, on frailty and multidimensional health outcomes in older adults.
Methods: Following PRISMA guidelines, we systematically searched multiple databases for RCTs on Baduanjin in frail adults aged ?60 years. Data were pooled using fixed- or random-effects models to calculate MDs or SMDs with 95% CIs. Heterogeneity was quantified by the I² statistic, with random-effects models applied if I² > 50%. Publication bias was assessed by funnel plots and Egger’s test, with the trim-and-fill method used for adjustment when indicated.
Results: Fifteen RCTs (n = 1,044) were included. Baduanjin significantly reduced frailty severity (SMD = -1.12; 95% CI: -1.59 to -0.65) and improved physical function outcomes, including grip strength (MD = 2.39 kg, 95% CI: 2.17 to 2.62, P < 0.001), 6-minute walking distance (MD = 33.72 m; 95% CI: 12.47 to 54.97), and short-distance walk time, although the pooled effect (MD = -0.31 s; 95% CI: -0.57 to -0.06) was moderated by test distance with significant heterogeneity. Mental health improvements encompassed reduced anxiety/depression (SMD = -0.73; 95% CI: -1.11 to -0.35) and enhanced sleep quality (MD = -2.48; 95% CI: -3.21 to -1.76). Cognitive function (MMSE: MD = 2.81; 95% CI: 0.11 to 5.51) showed a statistically significant improvement, though with wide confidence intervals. Quality of life (SF-12/SF-36: SMD = 0.75; 95% CI: 0.48 to 1.02) also improved significantly.
Conclusion: Despite methodological limitations in the included trials, pooled evidence suggests that Baduanjin may confer clinical benefits for managing frailty in older adults. Given its simplicity, safety, and adaptability, Baduanjin should be considered for integration into standard geriatric care and community health programs.
References
Kim DH, Rockwood K. Frailty in older adults. New England Journal of Medicine. 2024;391(6):538-48. https://doi.org/10.1056/NEJMra2301292
Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. The Lancet. 2019;394(10206):1365-75. https://doi.org/10.1016/S0140-6736(19)31786-6
Bai G, Szwajda A, Wang Y, Li X, Bower H, Karlsson IK, et al. Frailty trajectories in three longitudinal studies of aging: Is the level or the rate of change more predictive of mortality? Age and Ageing. 2021;50(6):2174-82. https://doi.org/10.1093/ageing/afab106
Yang Z-C, Lin H, Jiang G-H, Chu Y-H, Gao J-H, Tong Z-J, et al. Frailty is a risk factor for falls in the older adults: a systematic review and meta-analysis. The journal of nutrition, health & aging. 2023;27(6):487-95. https://doi.org/10.1007/s12603-023-1935-8
Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to prevent and manage frailty and fragility fractures. Current osteoporosis reports. 2023;21(2):205-15. https://doi.org/10.1007/s11914-023-00777-8
TL R, MA G, LS M. Frailty and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis of Cross-Sectional Studies - PubMed. Neuropsychology review. 2022;32(2). https://doi.org/10.1007/s11065021-09497-1
Tang KF, Teh P-L, Lee SWH. Cognitive Frailty and Functional Disability Among Community-Dwelling Older Adults: A Systematic Review. Innovation in Aging. 2023;7(2). https://doi.org/10.1093/geroni/igad005
Santamaría-Ulloa C, Lehning AJ, Cortés-Ortiz MV, Méndez-Chacón E. Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States. BMC public health. 2023;23(1):1960. https://doi.org/10.1186/s12889-023-16900-4
Xu L, Lan X, Lou Y, Engström M. Associations between frailty, sociodemographic characteristics and quality?of?life among community?dwelling older adults: A cross?sectional study. Nursing Open. 2023;10(4):2392-405. https://doi.org/10.1002/nop2.149
Bhattarai U, Bashyal B, Shrestha A, Koirala B, Sharma SK. Frailty and chronic diseases: A bi?directional relationship. Aging Medicine. 2024;7(4):510-5. https://doi.org/10.1002/agm2.12349
Randles MA, O’Mahony D, Gallagher PF. Frailty and potentially inappropriate prescribing in older people with polypharmacy: a bi-directional relationship? Drugs & aging. 2022;39(8):597-606. https://doi.org/10.1007/s40266-022-00952-z
Deng M-G, Liu F, Liang Y, Wang K, Nie J-Q, Liu J. Association between frailty and depression: A bidirectional Mendelian randomization study. Science advances. 2023;9(38):eadi3902. https://doi.org/10.1126/sciadv.adi3902
Kojima G, Taniguchi Y, Aoyama R, Tanabe M. Associations between loneliness and physical frailty in community-dwelling older adults: A systematic review and meta-analysis. Ageing research reviews. 2022;81:101705. https://doi.org/10.1016/j.arr.2022.101705
Carvalhas-Almeida C, Cavadas C, Álvaro AR. The impact of insomnia on frailty and the hallmarks of aging. Aging Clinical and Experimental Research. 2023;35(2):253-69. https://doi.org/10.1007/s40520-022-02310-w
Kolle AT, Lewis KB, Lalonde M, Backman C. Reversing frailty in older adults: a scoping review. BMC geriatrics. 2023;23(1):751. https://doi.org/10.1186/s12877-023-04309-y
Zhou J, Yu Y, Cao B, Li X, Wu M, Wen T, et al. Characteristic of clinical studies on Baduanjin during 2000–2019: a comprehensive review. Evidence?Based Complementary and Alternative Medicine. 2020;2020(1):4783915. https://doi.org/10.1155/2020/4783915
Guo L, Liu Z, Yuan W. The effect of Baduanjin on the balancing ability of older adults: a systematic review and meta-analysis. Frontiers in medicine. 2022;9:995577. https://doi.org/10.3389/fmed.2022.995577
Cheng M, Wang Y, Wang S, Cao W, Wang X. Network meta-analysis of the efficacy of four traditional Chinese physical exercise therapies on the prevention of falls in the elderly. Frontiers in public health. 2023;10:1096599. https://doi.org/10.3389/fpubh.2022.1096599
Tan TY, Cao BY, Liang WM, Lou S, Han Z, Ji YX, et al. The superiority trial of Baduanjin training on patients chronic low back pain: a study protocol for a randomized controlled trial. BMC Complementary Medicine and Therapies. 2024;24:1. https://doi.org/10.1186/s12906-024-04649-1
Chen J, Zhang M, Wang Y, Zhang Z, Gao S, Zhang Y. The effect of Ba Duan Jin exercise intervention on cardiovascular disease: a meta-analysis of randomized controlled trials. Frontiers in Public Health. 2024;12:1425843. https://doi.org/10.3389/fpubh.2024.1425843
Shuai Z, Xiao Q, Ling Y, Zhang Y, Zhang Y. Efficacy of traditional Chinese exercise (Baduanjin) on patients with stable COPD: A systematic review and meta-analysis. Complementary Therapies in Medicine. 2023;75:102953. https://doi.org/10.1016/j.ctim.2023.102953
Luo X, Zhao M, Zhang Y, Zhang Y. Effects of baduanjin exercise on blood glucose, depression and anxiety among patients with type II diabetes and emotional disorders: A meta-analysis. Complementary Therapies in Clinical Practice. 2023;50:101702. https://doi.org/10.1016/j.ctcp.2022.101702
Guo M, Cai M, Wang H, Hu Z, Feng H, Xie C. Effects of Baduanjin Exercise on Glucose and Lipid Metabolism in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Current Research in Medical Sciences. 2023;2(1):98-123. https://doi.org/10.56397/CRMS.2023.03.15
Zhang Y, Shilko T. Relationship between Qigong Baduanjin and depression in Chinese elderly. ?????????? ???????? ????? ?????? ???????????? ?????????. 2021;6(2):114-7. https://doi.org/10.47475/2500-0365 2021-16218
Lu Y, Li J, Jiang J, Chen C-Y, Zhao X-T. The effect of Baduanjin on depression: a systematic review. Chinese Preventive Medicine. 2021;10.16506/j.1009-6639.2021.06.007:434–44. https://doi.org/10.16506/j.10096639.2021.06.007
Wang X, Wu J, Ye M, Wang L, Zheng G. Effect of Baduanjin exercise on the cognitive function of middle-aged and older adults: a systematic review and meta-analysis. Complementary therapies in medicine. 2021;59:102727. https://doi.org/10.1016/j.ctim.2021.102727
Xie C, Xie F, Ma J, Yue H, You Y, Yao F. Effect of Baduanjin Qigong on Sleep Quality and Hyperarousal State in Adults With Chronic Insomnia: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 2023;12(1):e53501. https://doi.org/10.2196/53501
Liang Q, Yang L, Wen Z, Liang X, Wang H, Zhang H, et al. The effect of Baduanjin on the insomnia of older adults: A systematic review and meta-analysis. Geriatric Nursing. 2024;60:241-8. https://doi.org/10.1016/j.gerinurse.2024.09.002
Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. The Lancet. 2019;394(10206):1376-86. https://doi.org/10.1016/S01406736(19)31785-4
Sun X, Liu W, Gao Y, Qin L, Feng H, Tan H, et al. Comparative effectiveness of non-pharmacological interventions for frailty: a systematic review and network meta-analysis. Age and Ageing. 2023;52(2):afad004. https://doi.org/10.1093/ageing/afad004
Pérez-Zepeda MU, Martínez-Velilla N, Kehler DS, Izquierdo M, Rockwood K, Theou O. The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial. Age and ageing. 2022;51(2):afac028. https://doi.org/10.1093/ageing/afac028
Tou NX, Goh SF, Harding S, Tsao MA, Ng TP, Wee S-L. Effectiveness of community-based Baduanjin exercise intervention for older adults with varying frailty status: a randomized controlled trial. European Review of Aging and Physical Activity. 2024;21(1):28. https://doi.org/10.1186/s11556-024-00363-6
Fang J, Zhang L, Wu F, Ye J, Cai S, Lian X. The safety of Baduanjin exercise: a systematic review. Evidence?Based Complementary and Alternative Medicine. 2021;2021(1):8867098. https://doi.org/10.1155/2021/8867098
Lin H, Wan M, Ye Y, Zheng G. Effects of Baduanjin exercise on the physical function of middle-aged and elderly people: a systematic review and meta-analysis of randomized controlled trials. BMC complementary medicine and therapies. 2023;23(1):38. https://doi.org/10.1186/s12906-023-03866-4
Jones C, Qi M, Xie Z, Moyle W, Weeks B, Li P. Baduanjin exercise for adults aged 65 years and older: a systematic review and meta-analysis of randomized controlled studies. Journal of Applied Gerontology. 2022;41(4):1244-56. https://doi.org/10.1177/07334648211059324
Li L, Li W, Fan T. Baduanjin Exercise Improves Cognitive Function in Older Adults With Mild Cognitive Impairment: A Systematic Review and Meta-analysis. The Journal of Nervous and Mental Disease. 2024;212(9):500-6. https://doi.org/10.1097/NMD.0000000000001796
Higgins Jpt T, Chandler J, Cumpston M, Li T, Page M, Welch V, editors. Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022)2022.
Chen YZ, Li YT, Wang W, Zhong RX, Ji GZ. Effect Analysis of Sitting Baduanjin combined with Zusanli Acupressure on Elderly Patients with Asthenia in Community. Progress in Modern Biomedicine. 2023;23(11). https://doi.org/10.13241/j.cnki.pmb.2023.11.013
Wang ZP, Du CF. The Impact of LEARNS Education Model Combined with Baduanjin Intervention on Elderly Hypertensive Patients with Frailty. Clinical Research. 2024;32(08):167-9.
Liu FF, Gao HM, Cui YX. Combined Therapy of Wuxing Music (Five-Element Music Therapy) and Baduanjin for Fatigue and Frailty in Hemodialysis Patients [Title translated by author]. Journal of Qilu Nursing. 2022;28(23):149-51. https://doi.org/10.3969/j.issn.1006-7256.2022.23.048
Zheng L, Fan W, Zou L, Chen F, Rao Y, Fang X. Effect of Baduanjin in elderly hypertensive patients with frailty. Journal of Nursing Science. 2021;36(24):90-3+7. https://doi.org/10.3870/j.issn.10014152.2021.24.090
Hu K, Guan G, Yu H, Wang H, Li Y, Tan C, et al. To explore the influence of Baduanjin method based on the theory of “Producing Yang by moving” on frailty,depression and inflammatory mediators during chemotherapy in elderly patients with malignant tumors. Academic Journal of Guangzhou Medical University. 2024;52(01):35-9. https://doi.org/10.3969/j.issn.2095-9664.2024.01.07
Zhang B. Syndrome Elements of Frailty in Traditional Chinese Medicine and Baduanjin Intervention for Rural Elderly in Bashang Region: A Clinical Study [Title translated by author]: Beijing University of Chinese Medicine; 2023
Yan Y, Cai Y. Zusanli Acupressure Combined with Baduanjin for Coronary Heart Disease with Frailty in the Elderly: Efficacy Evaluation[Title translated by author]. Tibetan Medicine. 2024;45(04):142-4.
Pang Y, Lin H, Qi LJ, Huang SP, Peng ZL, Tang ML, et al. Clinical Efficacy of Qiangxin Decoction Combined with Baduanjin in Treatment of Elderly Patients with Chronic Heart Failure and Weakness. Chinese Journal of Experimental Traditional Medical Formulae. 2023;29(4):104-9. https://doi.org/10.13422/j.cnki.syfjx.20230497
Fang SL, Yao TQ, Fang CX, Sun AP. The Impact of Baduanjin on the Quality of Life and Exercise Tolerance in Elderly Patients with Heart Failure and Frailty [Title translated by author]. Chinese Journal of Rehabilitation Medicine. 2022;37(1):108-11. https://doi.org/10.3969/j.issn.1001-1242.2022.01.021
Gao ZP. Rehabilitation Effect of Baduanjin on Frailty Status and Lower Extremity Motor Function on Pre-frail Elderly People: North China University of Science and Technology; 2020
Hou XL. Research of the Application of Baduanjin in Institutionalized Elderly Frailty: Chendu university of Chinese medicine; 2018
Cheung DST, Chau PH, Lam T-C, Ng AYM, Kwok TWH, Takemura N, et al. A pilot randomized controlled trial using Baduanjin qigong to reverse frailty status among post-treatment older cancer survivors. Journal of Geriatric Oncology. 2022;13(5):682-90. https://doi.org/10.1016/j.jgo.2022.02.014
Ni RP, Lin XL, Luo YY, Liu Z, Tan J. Impact of Sitting Baduanjin Exercise on Cancer-Related Fatigue and Frailty of Elderly Patients with Primary Liver Cancer Surgery. Clinical Medicine ? Engineering. 2023;30(06):845-6. https://doi.org/10.3969/j.issn.1674-4659.2023.06.0845
Guo P. Application of Chair-Based Baduanjin Training in Frail Elderly Residents of Senior Care Facilities: An Intervention Study [Title translated by author]: Hunan university of Chinese medicine; 2023
Park M, Song R, Ju K, Shin JC, Seo J, Fan X, et al. Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: systematic review, meta-analysis, and meta-regression of randomized clinical trials. BMC geriatrics. 2023;23(1):352. https://doi.org/10.1186/s12877-023-04070-2
Huang C-Y, Mayer PK, Wu M-Y, Liu D-H, Wu P-C, Yen H-R. The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials. Ageing research reviews. 2022;82:101747. https://doi.org/10.1016/j.arr.2022.101747
Lee SY, Nyunt MSZ, Gao Q, Gwee X, Chua DQL, Yap KB, et al. Association of Tai Chi exercise with physical and neurocognitive functions, frailty, quality of life and mortality in older adults: Singapore Longitudinal Ageing Study. Age and Ageing. 2022;51(4):afac086. https://doi.org/10.1093/ageing/afac086
Tao J, Chen X, Egorova N, Liu J, Xue X, Wang Q, et al. Tai Chi Chuan and Baduanjin practice modulates functional connectivity of the cognitive control network in older adults. Scientific reports. 2017;7(1):41581. https://doi.org/10.1038/srep41581
Zou H, Lin X, Duan T, Zheng J, Xiao H. Simple Sitting Baduanjin mind-body exercise: randomized controlled trial protocol for advanced cancer patients with the fatigue-sleep disturbance symptom cluster. BMC Complementary Medicine and Therapies. 2024;24(1):348. https://doi.org/10.1186/s12906-024-04652-6
Huang X, Wang X, Shao Y, Lin A, Zhang Z, Qi H, et al. Effects of health qigong exercise on sleep and life quality in patients with drug abuse. Hong Kong Journal of Occupational Therapy. 2023;36(1):13-9. https://doi.org/10.1177/15691861231156002
Khaleghi M, Ahmadi F. Effect of different exercises on sleep quality in elderly women: a systematic review. Comparative Exercise Physiology. 2024;1(aop):1-12. https://doi.org/10.1163/17552559-00001049
Yao L, Sun G, Wang J, Hai Y. Effects of Baduanjin imagery and exercise on cognitive function in the elderly: A functional near-infrared spectroscopy study. Frontiers in Public Health. 2022;10:968642. https://doi.org/10.3389/fpubh.2022.968642
Yu L, Liu F, Nie P, Shen C, Chen J, Yao L. Systematic review and meta-analysis of randomized controlled trials assessing the impact of Baduanjin exercise on cognition and memory in patients with mild cognitive impairment. Clinical Rehabilitation. 2021;35(4):492-505. https://doi.org/10.1177/0269215520969661
Ma C, Zhou W, Jia Y, Tang Q. Effects of home-based Baduanjin combined with elastic band exercise in patients with chronic heart failure. European journal of cardiovascular nursing. 2022;21(6):587-96. https://doi.org/10.1093/eurjcn/zvab128
Zhang H, Yin L, Peng Y, Zhang G, Chen Q, Liang J, et al. Effect of five-elements music therapy combined with Baduanjin qigong on patients with mild COVID-19. Hong Kong Journal of Occupational Therapy. 2023;36(1):31-8. https://doi.org/10.1177/15691861231167536
Jing L, Jin Y, Zhang X, Wang F, Song Y, Xing F. The effect of Baduanjin qigong combined with CBT on physical fitness and psychological health of elderly housebound. Medicine. 2018;97(51):e13654. https://doi.org/10.1097/MD.0000000000013654
Li N, Ou J, He H, He J, Zhang L, Peng Z, et al. Exploration of a machine learning approach for diagnosing sarcopenia among Chinese community-dwelling older adults using sEMG-based data. Journal of NeuroEngineering and Rehabilitation. 2024;21(1):69. https://doi.org/10.1186/s12984-024-01369-y
Jiang R, Noble S, Sui J, Yoo K, Rosenblatt M, Horien C, et al. Associations of physical frailty with health outcomes and brain structure in 483 033 middle-aged and older adults: a population-based study from the UK Biobank. The Lancet Digital Health. 2023;5(6):e350-e9. https://doi.org/10.1016/S2589-7500(23)00043-2
Lee YH, Lin CH, Wu WR, Chiu HY, Huang HC. Virtual reality exercise programs ameliorate frailty and fall risks in older adults: A meta?analysis. Journal of the American Geriatrics Society. 2023;71(9):2946-55. https://doi.org/10.1111/jgs.18398
Talebisiavashani F, Mohammadi-Sartang M. The effect of mindfulness-based interventions on mental health and cognitive function in older adults: A systematic review and meta-analysis. Journal of Aging and Health. 2024;10.1177/08982643241263882:08982643241263882. https://doi.org/10.1177/08982643241263882
Bao X, Qiu Q-x, Shao Y-J, Quiben M, Liu H. Effect of sitting Ba-Duan-Jin exercises on balance and quality of life among older adults: a preliminary study. Rehabilitation Nursing Journal. 2020;45(5):271-8.
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