When the late Brown University researcher Catherine Kerr had cancer, she benefited from an ancient Chinese practice known as qigong and began looking into its impact on others.
Now, her colleagues are building on Kerr's work, studying how practicing qigong affects a person's perception of fatigue in a small group of 24 female cancer patients just out of treatment.
They found that qigong was as effective at reducing fatigue as an energy-intensive exercise and nutrition program. It might also be easier for someone tired after weeks or months of treatment to begin.
Stephanie Jones, an associate professor of neuroscience who led the study for Brown University's Cancer Institute for Brain Science, called the results remarkable.
"Fatigue in cancer survivors is extremely debilitating, which Cathy knew well because she lived it and she had undergone a number of types of treatment. And exercise can be really challenging," Jones explained.
"Physical exercise we know is good for fatigue, but it can be really difficult when you're tired," Jones noted. "This is a very gentle, slow movement, meditation-based practice that is showing clinically relevant improvement."
Fatigue is a common experience for cancer survivors, 45% of whom experience it at a moderate to severe level, according to the study. It can be an even bigger burden than pain, nausea and depression, the authors said.
Exercise can help.
This is the first randomized clinical trial -- albeit quite small -- to compare qigong directly to standard exercise.
Qigong uses slow, deliberate exercises in combination with deep breathing and sometimes meditation. When tai chi is performed for health, it can be considered a form of qigong, according to the U.S. National Center for Complementary and Integrated Health.
All of the patients finished their surgery, radiation and/or chemotherapy at least eight weeks before joining the trial and agreed to participate in 10 weeks of classes.
In the exercise group, participants did an hour of power walking and Pilates, then an hour of health education. Meanwhile, the qigong group spent the equivalent time on that gentle activity plus education.
"It wasn't the same metabolic exertion. People's heart rates weren't elevated or anything like that," said study author Chloe Zimmerman, an MD/PhD candidate in neuroscience at Brown. "That's also an interesting component is the very different physical intensity demands."
Zimmerman noted that Kerr was interested in qigong specifically because it stemmed from the Chinese traditions looking at vital energy, the concept of energy cultivation and how that might subjectively lead to a greater sense of vitality and recovery.
"I think one of the big goals of this study is how do you get people to really thrive post-treatment? And can that happen with a much gentler mind-body practice?" Zimmerman said.
Mind-body practices, which would also include yoga, mindfulness and tai chi, are getting more attention for their potential benefits to physical, emotional and brain health, the researchers noted.
Although both groups experienced improvement in fatigue, the qigong group also had more improvements in mood and stress levels. Exit interviews indicated that some of the individuals in each group may have done better still in the opposite group.
"I think all of these practices have things to offer and being more nuanced in how you assess who might benefit most from what is a really important next step for the studies," Zimmerman said.
Jones said the team is looking at changes in electrophysiological measures of brain and muscle activity, testing the hypothesis that as a treatment the effectiveness is related to changing brain-muscle communication that may be distinct in each of the two groups.
The study was published recently in the journal Integrative Cancer Therapies. Future studies should be larger and more diverse, Jones noted.
Several hospitals are now offering qigong programs, the authors noted, and people may also be able to access them online.
Memorial Sloan Kettering Cancer Center in New York City offers qigong as part of its integrative medicine home program, said Dr. Jun Mao, chief of Integrative Medicine Services at Sloan Kettering.
"We don't fully understand the mechanism of qigong, but qigong often involves gentle physical activities [moving arms, legs or torsos, meditation and breathing exercises]," Mao said. "The combination of these activities helps cultivate more mind-body connections."
Mao also noted that qigong may feel like an easier way to be active than traditional forms of exercise. Some of the movements can even be done while in bed, decreasing barriers for cancer patients who have a lot of functional limitations.
"There is some evidence to suggest other mind-body exercises such as yoga or tai chi can also help with cancer-related fatigue," Mao said.
"Some of the meditation practices, along with deep breathing, can increase vagal tone which helps bring on more relaxation to a person," Mao said, referring to the vagus nerve. "Often, we may not think relaxation helps fatigue; however, when our body is very tense, we tend to feel more tired."
Kerr directed translational neuroscience at the Contemplative Studies Initiative at Brown University. She was diagnosed with multiple myeloma in 1995 and died in 2016.