Does Liuzijue Qigong Affect Anxiety In Patients With Chronic Obstructive Pulmonary Disease, Even During The Covid-19 Outbreak? A Randomized, Controlled Trial

Background: Anxiety is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), but no well-recognized method can provide effective relief. Liuzijue Qigong (LQG) is a traditional Chinese fitness method, based on breath pronunciation. This study aimed to examine the efficacy of LQG to relieve anxiety in COPD patients and to explore the factors that influence anxiety, including whether LQG is effective during the coronavirus disease 2019 (COVID-19) outbreak. Methods: We conducted an open-label, randomized, controlled, clinical trial. A total of 60 patients with stable COPD were randomly assigned to two groups. Both groups were given routine medical treatment, and the patients in the pulmonary rehabilitation (PR) group were given an extra intervention in the form of LQG, performed for 30 minutes each day for 12 weeks. Data collection was performed at baseline and 12 weeks (during the COVID-19 epidemic). The primary outcomes were the self-rating anxiety scale (SAS) scores, and the secondary outcomes were relevant information during the epidemic and analyses of the related factors that influenced SAS scores during the COVID-19 outbreak. Results: Compared with baseline, patients in both groups demonstrated varying degrees of improvements in their SAS scores (all P < 0.01). An analysis of covariance, adjusted for baseline scores, indicated that the SAS scores improved more dramatically in the PR group than in the control group (F = 9.539, P = 0.004). During the outbreak, the SAS scores for sleep disorder were higher than all other factors, reaching 1.38 +/- 0.67, and the scores for "I can breathe in and out easily" for the PR group were lower than the scores for the control group (Z = -2.108, P = 0.035). Significant differences were identified between the two groups for the categories "How much has the outbreak affected your life", "Do you practice LQG during the epidemic" and "Do you practice other exercises during the epidemic" (all P < 0.05). Compared with current reports, LQG had a relatively high adherence rate (80.95%). A multiple linear regression analysis revealed multiple predictors for SAS scores during the outbreak: group (b = -3.907, t = -3.824, P < 0.001), COPD assessment test score (b = 0.309, t = 2.876, P = 0.006), SAS score at baseline (b = 0.189, t = 3.074, P = 0.004), and living in a village (b = 4.886, t = 2.085, P = 0.043). Conclusion: LQG could effectively reduce the risks of anxiety among COPD patients, even during the COVID-19 outbreak. For those COPD patients with high COPD assessment test and high baseline SAS scores or who live in villages, we should reinforce the management and intervention of psychological factors during the epidemic.