Effects of Taijiquan and Qigong exercises on depression and anxiety levels in patients with substance use disorders: A systematic review and meta-analysis

Abstract

Previous studies have shown that Taijiquan and Qigong exercise can effectively reduce depression and anxiety in healthy and clinical populations. At present, only a few reviews have elaborated on the premise of different types of interventions, and there is still a lack of studies that systematically summarize the clinical evidence of patients with substance use disorders. The purpose of this meta-analysis was to assess the impact of the Taijiquan and Qigong exercise on the mood of individuals with substance use disorders (SUD); Articles were searched in Pubmed, Embase, Cochrane Library, Web of Science, and CNKI from their inception to the May 24, 2021. All randomized controlled trials (RCT) using Taijiquan and Qigong intervention were included. With the Review Manager software to determine the effect (standardized mean difference, SMD), subgroup analysis was conducted to intervention type, exercise time, and exercise duration. Nine studies totaling 823 participants were included in the study. Overall results indicated that Taijiquan and Qigong exercise had significant benefits in reducing depression (SMD = −0.35, 95% CI: −0.53 to −0.18, Z = 4.00, p < 0.01) and anxiety (SMD = −0.31, 95% CI: −0.50 to −0.11, Z = 3.06, p < 0.01) symptoms in SUD. When depression and anxiety were examined separately, subgroup analysis demonstrated that Taijiquan intervention (SMD = −0.45, 95% CI: −0.71 to −0.19, Z = 3.39, p < 0.01) and Qigong intervention (SMD = −0.28, 95% CI −0.51 to −0.04, Z = 2.33, p = 0.02),30-60 min exercise time (SMD = −0.41, 95% CI: −0.61 to −0.20, Z = 3.82, p < 0.01) and duration of 9-12 weeks (SMD = −0.57, 95% CI: −1.10 to −0.04, Z = 2.10, p = 0.04) more than 12 weeks (SMD = −0.28, 95% CI: −0.50 to −0.07, Z = 2.59, p = 0.01) could effectively alleviate the symptoms of depression. Meanwhile, Qigong intervention (SMD = −0.31, 95% CI: −0.52 to −0.10, Z = 2.85, p < 0.01), 30-60 min exercise time (SMD = −0.29, 95% CI: −0.53 to −0.04, Z = 2.28, p = 0.02), more than 60 min exercise time (SMD = −0.54, 95% CI: −1.06 to −0.02, Z = 2.05, p = 0.04), and duration of less than 9 weeks (SMD = −0.35, 95% CI: −0.68 to −0.02, Z = 2.07, p = 0.04) had positive effects on alleviating anxiety symptoms with SUD. Taijiquan and Qigong exercise could reduce levels of anxiety and depression in those with SUD. Considering the small number of included studies, more reliable RCTs are needed on this topic.

Keywords

Depression / Anxiety / Substance abuse disorder / Exercise / Taijiquan / Qigong

References

[[1]] UNODC. World Drug Report -Executive Summary—Conclusions and Policy Implications,1, United Nations Office on Drugs and Crime (UNODC), New York ( 2018)

[[2]] UNODC. World Drug Report -Executive Summary—Conclusions and Policy Implications,1, United Nations Office on Drugs and Crime (UNODC), New York ( 2019)

[[3]] Y. Zhang, C. Lu, J. Zhang, et al.. Gender differences in abusers of amphetamine-type stimulants and ketamine in southwestern China. Addict Behav, 38 (1) ( 2013), pp. 1424-1430, DOI: 10.1016/j.addbeh.2012.06.024

[[4]] M.D. Anglin, C. Burke, B. Perrochet, E. Stamper, S. Dawud-Noursi. History of the methamphetamine problem. J Psychoactive Drugs, 32 (2) ( 2000), pp. 137-141, DOI: 10.1080/02791072.2000.10400221

[[5]] B.D. Homer, T.M. Solomon, R.W. Moeller, A. Mascia, L. DeRaleau, P.N. Halkitis. Methamphetamine abuse and impairment of social functioning: a review of the underlying neurophysiological causes and behavioral implications. Psychol Bull, 134 (2) ( 2008), pp. 301-310, DOI: 10.1037/0033-2909.134.2.301

[[6]] N.C. Beadell, E.M. Thompson, J.B. Delashaw, J.S. Cetas. The deleterious effects of methamphetamine use on initial presentation and clinical outcomes in aneurysmal subarachnoid hemorrhage. J Neurosurg, 117 (4) ( 2012), pp. 781-786, DOI: 10.3171/2012.7.JNS12396

[[7]] J.B. Cohen, A. Dickow, K. Horner, et al.. Abuse and violence history of men and women in treatment for methamphetamine dependence. Am J Addict, 12 (5) ( 2003), pp. 377-385

[[8]] N. Pocuca, J.W. Young, D.A. MacQueen, et al.. Sustained attention and vigilance deficits associated with HIV and a history of methamphetamine dependence. Drug Alcohol Depend, 215 ( 2020), p. 108245, DOI: 10.1016/j.drugalcdep.2020.108245

[[9]] E. Krupitsky, E. Zvartau, G. Woody. Use of naltrexone to treat opioid addiction in a country in which methadone and buprenorphine are not available. Curr Psychiatry Rep, 12 (5) ( 2010), pp. 448-453, DOI: 10.1007/s11920-010-0135-5

[[10]] Q. Deng, Q. Tang, R.S. Schottenfeld, W. Hao, M.C. Chawarski. Drug use in rural China: a preliminary investigation in Hunan Province. Addiction, 107 (3) ( 2012), pp. 610-613, DOI: 10.1111/j.1360-0443.2011.03648.x

[[11]] H. Joseph, S. Stancliff, J. Langrod. Methadone maintenance treatment (MMT): a review of historical and clinical issues. Mt Sinai J Med, 67 (5-6) ( 2000), pp. 347-364

[[12]] A.S. Huhn, E.C. Strain, D.A. Tompkins, K.E. Dunn.A hidden aspect of the U.S. opioid crisis: Rise in first-time treatment admissions for older adults with opioid use disorder. Drug Alcohol Depend, 193 ( 2018), pp. 142-147, DOI: 10.1016/j.drugalcdep.2018.10.002

[[13]] S. Nielsen, P. Dietze, N. Lee, A. Dunlop, D. Taylor. Concurrent buprenorphine and benzodiazepines use and self-reported opioid toxicity in opioid substitution treatment. Addiction, 102 (4) ( 2007), pp. 616-622, DOI: 10.1111/j.1360-0443.2006.01731.x

[[14]] R.A. Rawson.Current research on the epidemiology, medical and psychiatric effects, and treatment of methamphetamine use. J Food Drug Anal, 21 (4) ( 2013), pp. S77-S81, DOI: 10.1016/j. jfda.2013.09.039

[[15]] F.B. Schuch, D. Vancampfort, J. Firth, et al.. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatr, 175 (7) ( 2018), pp. 631-648, DOI: 10.1176/appi.ajp.2018.17111194

[[16]] S.B. Harvey, S. Øverland, S.L. Hatch, S. Wessely, A. Mykletun, M. Hotopf. Exercise and the Prevention of Depression: Results of the HUNT Cohort Study. Am J Psychiatr, 175 (1) ( 2018), pp. 28-36, DOI: 10.1176/appi.ajp.2017.16111223

[[17]] J. Vieira, M. Porcu, P. Rocha. The regular physical exercises practice as complementary therapy to the treatment of depressed women. Jornal Brasileiro De Psiquiatria [in Portuguese], 56 (1) ( 2007), pp. 23-28, DOI: 10.1590/S0047-20852007000100007

[[18]] C.P. McDowell, R.K. Dishman, D. Vancampfort, et al.. Physical activity and generalized anxiety disorder: results from The Irish Longitudinal Study on Ageing (TILDA). Int J Epidemiol, 47 (5) ( 2018), pp. 1443-1453, DOI: 10.1093/ije/dyy141

[[19]] C.A. LeardMann, M.L. Kelton, B. Smith, et al.. Prospectively assessed posttraumatic stress disorder and associated physical activity. Public Health Rep, 126 (3) ( 2011), pp. 371-383, DOI: 10.1177/003335491112600311

[[20]] J. Torales, M. Almirón, I. Gonzalez, et al.. Physical exercise as an adjuvant treatment of mental disorders. A narrative review. Anales de la Facultad de Ciencias Médicas (Asunción) [in Spanish], 51 (3) ( 2018), pp. 27-32, DOI: 10.18004/anales/2018.051(03)27-032

[[21]] H.H. Bassøe. Anorexia/bulimia nervosa: the development of anorexia nervosa and of mental symptoms. Treatment and the outcome of the disease. Acta Psychiatr Scand Suppl, 361 ( 1990), pp. 7-13, DOI: 10.1111/j.1600-0447.1990.tb11076.x

[[22]] E. Zschucke, A. Heinz, A. Ströhle.Exercise and physical activity in the therapy of substance use disorders. Sci World J, 2012 ( 2012), p. 901741, DOI: 10.1100/2012/901741

[[23]] M. Hallgren, D. Vancampfort, E.S. Giesen, A. Lundin, B. Stubbs. Exercise as treatment for alcohol use disorders: systematic review and meta-analysis. Br J Sports Med, 51 (14) ( 2017), pp. 1058-1064, DOI: 10.1136/bjsports-2016-096814

[[24]] B.C. Bock, B.H. Marcus, T.K. King, B. Borrelli, M.R. Roberts. Exercise effects on withdrawal and mood among women attempting smoking cessation. Addict Behav, 24 (3) ( 1999), pp. 399-410, DOI: 10.1016/s0306-4603(98)00088-4

[[25]] D. Scully, J. Kremer, M.M. Meade, R. Graham, K. Dudgeon. Physical exercise and psychological well being: a critical review. Br J Sports Med, 32 (2) ( 1998), pp. 111-120, DOI: 10.1136/bjsm.32.2.111

[[26]] M.H. Ussher, A.H. Taylor, R. West,A. McEwen. Does exercise aid smoking cessation? A systematic review. Addiction, 95 (2) ( 2000), pp. 199-208, DOI: 10.1046/j.1360-0443.2000.9521996.x

[[27]] X. LG. Chinese Medical Qigong. Heilongjiang Science and Technology Publisher, Harbin ( 1990)

[[28]] D. Zhu, D. Xu, G. Dai, F. Wang, X. Xu, D. Zhou. Beneficial effects of Tai Chi for amphetamine-type stimulant dependence: a pilot study. Am J Drug Alcohol Abuse, 42 (4) ( 2016), pp. 469-478, DOI: 10.3109/00952990.2016.1153646

[[29]] D. Wang, Y. Wang, Y. Wang, R. Li, C. Zhou. Impact of physical exercise on substance use disorders: a meta-analysis. PLoS One, 9 (10) ( 2014), Article e110728, DOI: 10.1371/journal.pone.0110728

[[30]] C.W. Wang, C.H. Chan, R.T. Ho, J.S. Chan, S.M. Ng, C.L. Chan.Managing stress and anxiety through qigong exercise in healthy adults: a systematic review and meta-analysis of randomized controlled trials. BMC Complement Altern Med, 14 ( 2014), p. 8, DOI: 10.1186/1472-6882-14-8

[[31]] A. Giles, Y. Nasstasia, A. Baker, et al.. Exercise as Treatment for Youth With Major Depression: The Healthy Body Healthy Mind Feasibility Study. J Psychiatr Pract, 26 (6) ( 2020), pp. 444-460, DOI: 10.1097/PRA.0000000000000516

[[32]] N.L. McCain, D.P. Gray, R.K. Elswick, et al.. A randomized clinical trial of alternative stress management interventions in persons with HIV infection. J Consult Clin Psychol, 76 (3) ( 2008), pp. 431-441, DOI: 10.1037/0022-006X.76.3.431

[[33]] Y. Zeng, T. Luo, H. Xie, M. Huang, A.S. Cheng. Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med, 22 (1) ( 2014), pp. 173-186, DOI: 10.1016/j.ctim.2013.11.010

[[34]] G.Y. Yeh, D.H. Roberts, P.M. Wayne, R.B. Davids, M.T. Quilty, R.S. Phillips. Tai Chi Exercise for Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study. Respir care, 55 (11) ( 2010), pp. 1475-1482

[[35]] J.J. Wu, Y.X. Zhang, W.S. Du, et al.. Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients: A meta-analysis. Medicine (Baltimore), 98 (22) ( 2019), Article e15776, DOI: 10.1097/MD.0000000000015776

[[36]] J.P.T. Higgins, S. Green (Eds.), Cochrane Handbook for Systematic Reviews of Interventions, The Cochrane Collaboration ( 2011). [updated March 2011]. Version 5.1.0

[[37]] M. Li, K. Chen, Z. Mo. Use of qigong therapy in the detoxification of heroin addicts. Altern Ther Health Med, 8 (1) ( 2002), pp. 50-59

[[38]] D.X. Li, X.Y. Zhuang, Y.P. Zhang, et al.. Effects of Tai Chi on the protracted abstinence syndrome: a time trial analysis. Am J Chin Med, 41 (1) ( 2013), pp. 43-57, DOI: 10.1142/S0192415X13500043

[[39]] D. Zhu, G. Dai, D. Xu, et al.. Long-Term Effects of Tai Chi Intervention on Sleep and Mental Health of Female Individuals With Dependence on Amphetamine-Type Stimulants. Front Psychol, 9 ( 2018), p. 1476, DOI: 10.3389/fpsyg.2018.01476

[[40]] C.U. Oh, N.C. Kim. Effects of T'ai Chi on Serotonin, Nicotine Dependency, Depression, and Anger in Hospitalized Alcohol-Dependent Patients. J Altern Complement Med, 22 (12) ( 2016), pp. 957-963, DOI: 10.1089/acm.2016.0246

[[41]] J. Geng, D. Zhu, D. Xu. Rehabilitation effect of Taiji rehabilitation exercise on compulsory isolation of female drug abusers. Chin J Sports Med [in Chinese], 35 (11) ( 2016), pp. 1048-1051, DOI: 10.16038/j.1000-6710.2016.11.011

[[42]] X. Huang, S. Wu, H. Xu. Clinical observation of modified Ba Duan Jin combined with methadone in improving anxiety symptoms of heroin addicts. Shenzhen J Integrated Tradit Chin West Med. [in Chinese], 25 (13) ( 2015), pp. 98-99, DOI: 10.16458/j.cnki.1007-0893.2015.13.052

[[43]] Z. Zhang, D. Zhu.Effect of Taijiquan exercise on rehabilitation of male amphetamine-type addicts. Evid Based Complement Alternat Med, 2020 ( 2020), p. 8886562, DOI: 10.1155/2020/8886562

[[44]] D. Smelson, K.W. Chen, D. Ziedonis, et al.. A pilot study of Qigong for reducing cocaine craving early in recovery. J Altern Complement Med, 19 (2) ( 2013), pp. 97-101, DOI: 10.1089/acm.2012.0052

[[45]] G. Fu, S. Huang, C. Tang, Y. Liu, Y. Gao, et al.. Effect of Wuqinxi on emotion in patients abstaining from drug. J Anhui Univ Chin Med. [in Chinese], 35 (05) ( 2016), pp. 26-29, DOI: 10.3969/j.issn.2095-7246.2016.05.008

[[46]] F. Liu, J. Cui, X. Liu, K.W. Chen, X. Chen, R. Li.The effect of tai chi and Qigong exercise on depression and anxiety of individuals with substance use disorders: a systematic review and meta-analysis. BMC Complement Med Ther, 20 (1) ( 2020), p. 161, DOI: 10.1186/s12906-020-02967-8

[[47]] M.M. Belcheva, M.T. Ho, E.G. Ignatova, et al.. Buprenorphine differentially alters opioid receptor adaptation in rat brain regions. J Pharmacol Exp Ther, 277 (3) ( 1996), pp. 1322-1327

[[48]] J.E. Swain, S.S. Ho. Opioids and maternal brain-behavior adaptation. Neuropsychopharmacology, 46 (1) ( 2021), pp. 265-266, DOI: 10.1038/s41386-020-00858-7

[[49]] J.A. Martin, A. Campbell, T. Killip, et al.. QT interval screening in methadone maintenance treatment: report of a SAMHSA expert panel [published correction appears in J Addict Dis. J Addict Dis, 31 (1) (2012 Jan), p. 91. Haigney, Mark C P [added]]. J Addict Dis. 2011; 30(4):283-306.. DOI: 10.1080/10550887.2011.610710

[[50]] A.I. Leshner. Addiction is a brain disease, and it matters. Science, 278 (5335) ( 1997), pp. 45-47, DOI: 10.1126/science.278.5335.45

[[51]] Y.P. Liu, M.Z. Yuan, C. H, et al.. Effect of 12-week taichi on catecholamines and angiotensin-II in young people. Journal of Fujian Normal University (Natural Science Edition) [in Chinese], 31 (5) ( 2015), pp. 115-119

[[52]] Y. Shaham, S. Erb, J. Stewart. Stress-induced relapse to heroin and cocaine seeking in rats: a review. Brain Res Brain Res Rev, 33 (1) ( 2000), pp. 13-33, DOI: 10.1016/s0165-0173(00)00024-2

[[53]] M. Sairanen, O'Leary OF, J.E. Knuuttila, E. Castrén. Chronic antidepressant treatment selectively increases expression of plasticity-related proteins in the hippocampus and medial prefrontal cortex of the rat. Neuroscience, 144 (1) ( 2007), pp. 368-374, DOI: 10.1016/j.neuroscience.2006.08.069

[[54]] S. Lapmanee, J. Charoenphandhu, J. Teerapornpuntakit, N. Krishnamra,N. Charoenphandhu. Agomelatine, venlafaxine, and running exercise effectively prevent anxiety- and depression-like behaviors and memory impairment in restraint stressed rats. PLoS One, 12 (11) ( 2017), p. e0187671, DOI: 10.1371/journal.pone.0187671

[[55]] C.P. Müller, J.R. Homberg. The role of serotonin in drug use and addiction. Behav Brain Res, 277 ( 2015), pp. 146-192, DOI: 10.1016/j.bbr.2014.04.007

[[56]] G. Fink. Encyclopedia of stress. Academic Press ( 2000)

[[57]] L. Zou, J. Han, C. Li, et al.. Effects of Tai Chi on lower limb proprioception in adults aged over 55: A systematic review and meta-analysis. Arch Phys Med Rehabil, 100 (6) ( 2019), pp. 1102-1113, DOI: 10.1016/j.apmr.2018.07.425

[[58]] J. Pa, W. Goodson, A. Bloch, A.C. King, K. Yaffe, D.E. Barnes. Effect of exercise and cognitive activity on self-reported sleep quality in community-dwelling older adults with cognitive complaints: a randomized controlled trial. J Am Geriatr Soc, 62 (12) ( 2014), pp. 2319-2326, DOI: 10.1111/jgs.13158

[[59]] T.H. Kim, J. Pascual-Leone, J. Johnson,H. Tamim. The mental-attention Tai Chi effect with older adults. BMC Psychol, 4 (1) ( 2016), p. 29, DOI: 10.1186/s40359-016-0137-0

[[60]] C. Wang, J.P. Collet, J. Lau. The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review. Arch Intern Med, 164 (5) ( 2004), pp. 493-501, DOI: 10.1001/archinte.164.5.493

[[61]] L.D. Gillespie, M.C. Robertson, W.J. Gillespie, et al.. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 2 ( 2009), p. CD007146, DOI: 10.1002/14651858.CD007146.pub2

[[62]] C.E. Garber, B. Blissmer, M.R. Deschenes, et al.. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 43 (7) ( 2011), pp. 1334-1359, DOI: 10.1249/MSS.0b013e318213fefb

[[63]] F. Wang, J.K. Man, E.K. Lee, et al.. The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis. Evid Based Complement Alternat Med, 2013 ( 2013), p. 152738, DOI: 10.1155/2013/152738

[[64]] K.T. Breslin, M.R. Reed, S.B. Malone. An holistic approach to substance abuse treatment. J Psychoactive Drugs, 35 (2) ( 2003), pp. 247-251, DOI: 10.1080/02791072.2003.10400006

This research was funded by Sichuan Social Science Fund, grant number SC21ZW003.