Lian Gong as a Health Promotion Strategy in Primary Care: A Systematic Review

Abstract

The objective of this study is to analyze the studies that evaluated the performance of Lian Gong in 18 therapies as a health promotion strategy for individuals of different age groups, followed in the Primary Health Care (PHC) services of the Sistema Único de Saúde (SUS). This is a systematic review study, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model, from the Lilacs, MedLine, SciElo, PubMed, Virtual Health Library, and Capes Periodicals Portal databases, using the descriptors: PHC, Health Promotion, Complementary therapies, Chinese Traditional Medicine, Lian Gong, Qigong, PHC, and Health Promotion. Following the inclusion and exclusion criteria, 25 articles published between 2006 and 2023 in the national and international literature were analyzed. The best evaluated attributes with the practice of Lian Gong in primary care include the improvement of symptoms of pain and depression, while the worst performances found were related to changes in the individuals’ immune systems. Most of the services evaluated were Brazilian and Chinese, applied in Basic Health Units and Family Health Strategies. The services evaluated showed a need to strengthen the components of the structure and process to facilitate the population's access to integrative and complementary practices and obtain better performance of PHC in health promotion.

Introduction

Lian Gong in 18 Therapies (LG18T), or simply Lian Gong, is a body practice associated with Traditional Chinese Medicine (TCM), but it is also based on modern medicine. The set of exercises proposed by this practice combines martial arts movements and oriental therapeutic arts movements, with the aim of preventing and treating pain throughout the body and chronic diseases (Netto & Camargos, 2022).

In Brazil, the practice was first introduced in 1986 and again in 2006, through Ordinance No. 971, of May 3, 2006, the Unified Health System (Sistema Único de Saúde—SUS) incorporated it into the National Policy of Integrative and Complementary Practices (PNPIC) as a TCM body practice (Brazil. Ordinance GM/MS No. 971, of May 3, 2006). The PNPIC consists of a set of regulations and guidelines that aim to incorporate and implement integrative and complementary practices (PICS) within the scope of the SUS and is based on the perspective of disease prevention, health promotion and recovery with an emphasis on continued, humanized and comprehensive health care (Brazil. Ordinance GM No. 849, of March 27, 2017; Brazil. Ordinance GM no. 702, of March 21, 2018). In 2017 and 2018, the PNPIC was expanded to 29 practices with the publication of Ordinances No. 849/2017 and No. 702/2018.

In this context, LG18T achieved greater visibility and became more accessible, especially to people who regularly attend Primary Health Care (PHC) services, since PICS contribute to the expansion of care approaches and allow new therapeutic possibilities for users, favoring greater comprehensiveness and resolution of health care (Brazil. Ordinance GM/MS No. 971, of May 3, 2006).

The World Health Organization (WHO) defines health as a state of physical, mental, and social well-being and not just the absence of disease. Therefore, it is understood that for an individual to be healthy, he or she must value comprehensive care and not just focus on the physical aspect. Thus, health promotion strategies frequently used in primary care make it possible to improve the health condition of individuals or populations in some way. These initiatives are essential as they bring practices to the population that also have an effect on the individual's emotional spectrum, as is the case with LG18T. The practices are slow, work on breathing techniques and exercise concentration, so that, by the end of the exercise, the practitioner will have worked not only the physical structure, but also the mental component (Brazil. Ordinance GM/MS No. 971, of May 3, 2006; Brazil. Ordinance GM No. 849, of March 27, 2017).

In the meantime, LG18T can be a great tool to promote health, quality of life, and general well-being, encompassing care that integrates body and mind. The individuals always are considered as a whole, and even receiving social support is one of the expected results during the practices, which are usually applied in groups (Andrade et al., 2012).

Based on this premise, the [Extension Program] linked to the[Institution] has proposed, since 2019, to study and promote Lian Gong practices in 18 therapies inside and outside the campus, expanding the population's access to the practice of LG18T, in the municipality of Divinópolis, in Minas Gerais, Brazil (LAPPIS, 2022).

The proposal to implement [Extension Program] at the [Institution] and in the municipality of Divinópolis is in line with the teaching, research, and extension activities provided for in the work plans of the professors involved in the Program, with the Political Pedagogical Projects of the Undergraduate Courses in the areas of Health at [Institution]. In addition, it beings in line with the recommendations of the Ministry of Education and Culture (MEC) regarding the inseparability and integration of teaching-research-extension and with the global agenda for sustainable development, by presenting a model that articulates teaching, research and extension in actions that aim at the construction of transformative knowledge and practices, based on the integration between different areas of knowledge. It also aligns with the demands and social causes expressed in the 17 sustainable development goals (SDGs) of the UN 2030 Agenda for Sustainable Development, with an emphasis on actions that aim to ensure a healthy life and promote well-being for all, at all ages (SDG 3)—Good Health and Well-being) and actions aimed at ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all (SDG 4—Quality Education) (LAPPIS, 2022; United Nations, 2015).

Based on the practices and studies at this topic, and considering the contact with the community and the awareness of the Brazilian and local reality, about the inclusion and access of the population to PICS in the SUS, the following question arose: How does Lian Gong perform as a health promotion strategy for individuals of different age groups followed up in PHC services? Based on this question and the scarcity of evidence on the topic, this review study's proposed, which aims to analyze the studies that evaluated the performance of Lian Gong in 18 therapies as a health promotion strategy for individuals followed up in PHC services.

This study is justified because, despite being ancient, TCM practices are still recent in Brazil and other countries besides China and, therefore, lack scientific evidence to support its recommendation in different cultures. Therefore, the proposal to develop a review study has an exploratory character and aims to analyze what the literature has to offer about this topic. In addition to evaluating the impacts of Lian Gong on health, it is important to investigate the use of PICS in the daily routine of primary care services of the SUS as a way to complement conventional treatments and improve the quality of life of users.

Holistic nursing seeks to integrate approaches that consider the individual as a whole, including physical, emotional, and social aspects, promoting a more humanized and effective form of care. In this context, Lian Gong emerges as a promising strategy for promoting well-being. The theoretical framework guiding this study aligns with the principles of holistic nursing, emphasizing the integration of physical, emotional, and spiritual dimensions in patient care. Jean Watson's Theory of Human Caring provides a foundational perspective, advocating for a transpersonal approach that fosters meaningful connections between caregivers and patients while acknowledging the role of integrative practices in health promotion (Watson, 2008).

Lian Gong serves as a practical embodiment of these holistic principles. The practice integrates gentle physical movements (Netto & Camargos, 2022) designed to alleviate pain and improve functional capacity with conscious breathing and focused attention, directly addressing the inseparable connection between body and mind that Watson advocates for. Furthermore, as it is often conducted in group settings, it fosters a sense of community and social support, which aligns with Watson’s (2008) emphasis on creating a healing environment and fostering transpersonal relationships. By simultaneously targeting physical ailments, promoting mental tranquility, and strengthening social bonds, Lian Gong operationalizes the core tenets of Watson's Theory of Human Caring, offering a tangible method to promote health from a whole-person perspective rather than merely treating symptoms.

In addition to its foundation in Traditional Chinese Medicine, Lian Gong incorporates concepts from modern medicine, offering benefits such as pain relief, stress reduction, and improved quality of life—essential aspects for a nursing model that prioritizes the balance between mind and body. Therefore, this manuscript contributes to broadening the understanding of Lian Gong's role in holistic nursing, reinforcing its scientific and practical relevance for patient-centered care (Watson, 2008).

Method

This systematic literature review (Apostle, 2017; Conforto et al., 2011) aims to group and synthesize the results of studies that address the effects of Lian Gong, a Traditional Chinese body practice, as a health-promoting strategy for individuals of different age groups followed in the primary care network of the SUS. The study followed the guidelines outlined by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) (Moher et al., 2015) checklist and the research protocol were registered in the PROSPERO database (ID CRD42023463130) (Page et al., 2021).

The question proposed for this study was: What is the performance of Lian Gong as a health promotion strategy for individuals of different age groups monitored in SUS Primary Health Care services?

Considering the fundamental elements of a research question, the acronym PICO (Population, Interest, and Context) was used to construct the research question for the bibliographic search for evidence to assist in categorizing the articles. The process was carried out in the design of P (Population), formed by users of PHC services of different age groups who actively perform Lian Gong practices. The primary intervention adopted (phenomenon of Interest) was the practices of Lian Gong in PHC, and the setting chosen for the study (Context) was the PHC services of the SUS (Apostle, 2017; Lopes & Fracolli, 2008). The main outcome are the changes in the quality of life and physical, social, and mental well-being of LG18T practitioners in primary care, after performing these practices among the population studied.

The sources of information for data collection were based on research into articles available in the electronic databases Lilacs, MedLine, SciElo, PubMed, national databases of the Virtual Health Library Portal (BVS), and Capes Periodicals Portal, which are databases compatible with the object of the study because of the greater concentration of documents aligned with the health area. The search strategy for this study took into account an advanced search in the databases recognized in the academic environment as the best bases for health research in the national and global scenario. For the research, the following descriptors (DeCS/MeSH) were considered in the searches by subject: “Complementary therapies,” “Integrative Medicine,” “Chinese Traditional Medicine,” “Lian Gong,” “Qigong,” “Primary Health Care,” and “Health Promotion” and its correlates in Portuguese and Spanish. Thus, considering the PICO strategy, the Boolean descriptors OR and AND were applied in the advanced searches of the research sites used, resulting in a search strategy structured as follows: “Lian Gong” OR “Qigong” OR “Complementary therapies” OR “Integrative Medicine” OR “Chinese Traditional Medicine” AND “Primary Health Care” AND “Health Promotion.” Tests were carried out with ballers to search for more articles and avoid biases and sample loss.

The scope of this systematic review is specifically delimited to the application and effects of mind-body practices within primary care settings. This focus was adopted due to the fundamental role of primary care as the principal gateway for the implementation and dissemination of integrative and complementary practices within public health systems. The objective of this delimitation is to synthesize evidence that is most relevant to practitioners and policymakers working at the foundational level of community health. Consequently, studies conducted exclusively in specialized care settings, such as oncology, cardiology, or tertiary pain management clinics, were not included in this review.

The selection of articles was based on reading the abstracts of the selected publications with the aim of refining the sample through inclusion and exclusion criteria. Based on the eligibility criteria, the sample selection, reading, and analysis were carried out by two independent researchers to identify those potentially eligible for the study. The selected or excluded studies underwent double analysis, avoiding selection and analysis bias. Since there was no divergence between the two researchers in the selection or exclusion of data, there was no need for a third evaluator with expertise in the case to endorse the articles that entered the review.

Inclusion and exclusion criteria were established to select the relevant studies used in this research. The sample included original scientific articles available electronically and free of charge, indexed in the databases of choice and published from the implementation of the PNPIC in the SUS (2006) until 2023, in Portuguese, English, and Spanish, and fitting the proposed theme that evaluated Liang Gong as a strategy to promote the health of PHC users.

Duplicate articles that were not published in the cited languages, as well as unpublished manuscripts, preprints, conference abstracts, opinion or reflection articles, study registration data, study reports, e-books, monographs, dissertations, course completion papers, controlled study protocols, government reports, book chapters, paid articles, those that do not fit the proposed theme (Lian Gong and/or Qigong as their focus) or that were published before 2006 and those without an abstract in online search platforms were excluded based on a manual search for primary studies and a cursory reading of the title, abstract, and keywords.

We also excluded from the research the articles that did not have PHC as their place of action, the full text was not freely available, and there were repeated articles.

Information regarding the title of the article, year, journal in which it was published, country in which the study was developed, keywords, authors, type of study, methods used, level of health service assessed (primary, secondary, or tertiary care), and results found was extracted from the selected articles.

The articles were grouped in a spreadsheet, divided according to the items extracted from the sample, to compose the text. The articles selected for analysis in this review were organized according to the descriptions presented previously.

The analysis consisted of reading the complete study, the strategy chosen for presenting the results of individual studies through the preparation of synoptic tables and then, the synthesis of the data was done through descriptive statistical analysis and simple frequency calculations, with comparisons of data from studies with methodological equivalence (Lopes & Fracolli, 2008).

The ATLAS.ti software was used to organize the data and analyze the data of interest (Atlas.ti Scientific Software Development GmbH, 2022), and the Mendeley program served as a support tool in formatting the study (Mendeley Reference Manager, 2022). The GRADE method was used to classify the levels of evidence of the publications (Brazil. Ministry of Health, 2014).

As this is a review study, there are no risks in carrying out the study, and its benefits include analyzing how Lian Gong helps PHC users to promote their health, favoring its safe indication by SUS professionals.

Ethical Considerations

Since this study is a systematic literature review, it does not involve direct research with human participants and therefore does not require procedures for informed consent, confidentiality, or anonymity. However, ethical considerations remain crucial in ensuring transparency and integrity in the research process. This review adhered to rigorous methodological standards, including a comprehensive and unbiased selection of studies, accurate data extraction, and proper citation of sources to maintain academic integrity. Additionally, all included studies were evaluated based on their ethical compliance, ensuring that the findings presented align with established ethical research guidelines. The review process followed principles of research ethics to avoid misrepresentation, bias, or misuse of analyzed data, reinforcing the commitment to scientific rigor and responsible scholarship.

Results

The search conducted in the databases, based on the abstracts, selected 680 articles, from which, after classification based on the inclusion criteria to achieve the proposed objective, resulted in the selection of 49 works, which were fully read. After reading the pre-selected texts in full, it was still necessary to exclude another 24 works because they did not fully meet the inclusion criteria, namely: they did not have Lian Gong and/or Qigong as their focus (n = 5), did not have PHC as their place of action (n = 14), the full text was not freely available (n = 3) and there were repeated articles (n = 2). Thus, 25 studies remained to compose the systematic literature review, as shown in Figure 1.

Figure 1.

Flowchart of the study selection process to compose the systematic review, 2024.

From the sample, it can be observed that all studies indexed in the BVS, MedLine, and PubMed databases were excluded from the sample because they did not meet the criteria. Of the 15 studies found in the BVS and of the 11 found in MedLine, no article was selected. Of the 166 found in PubMed, only one was selected, but after reading the full text, it was excluded. Of the databases whose studies filled up the sample, three studies are indexed in Lilacs, two were selected and are included in the final sample, one of which was excluded from the analysis of the abstracts. Of the 15 studies found in SciElo, 10 were selected, and after reading the full text, three were excluded; and of the 470 studies from the Capes Periodicals Portal, 36 were selected, and after reading the full text, 20 were excluded.

All scientific articles selected in the sample were read in full to compose the review, whose characteristics extracted from the reviewed studies will be shown in above.

Of the total eligible sample (n = 25), the methodological representation is composed of systematic review meta-analysis (32%), randomized clinical trial (32%), comparative cross-sectional study and qualitative observational study (8% each), in addition to comparative analysis study, observational cross-sectional study, observational case study, evaluative research with a qualitative approach and comparative study (4% each) (Table 1).

Table 1.

Characterization of Articles Included in the Systematic Literature Review, 2025.

Characteristic	Description
Author (year)	Nunes and Santos (2009)
Title	Functional Assessment of Older Adults in Three Physical Activity Programs: Walking, Water Aerobics, and Lian Gong
Country	Portugal
Study design	Comparative analysis
Level of evidence (grade)	Moderate quality
Sample/age	Older adults (mean age: 68.8 ± 6.3 years)
Objective	To conduct a comparative analysis among Walking, Water Aerobics, and Lian Gong programs to identify possible differences in the functional capacity of their practitioners.
Main findings	The Walking group outperformed the Water Aerobics and Lian Gong groups in tests of lower limb strength and aerobic capacity. All evaluated programs demonstrated equivalent performance in terms of motor capacity. Walking and water aerobics groups showed superior performance in developing motor skills, suggesting these activities may be complementary.
Keywords	Functional capacity, elderly, and physical activity
—	—
Author (year)	Ho et al. (2011)
Title	Effect of Qigong on Quality of Life: A Cross-Sectional Population-Based Comparison Study in Taiwan
Country	Taiwan
Study design	Comparative cross-sectional study
Level of evidence (grade)	Low quality
Sample/age	Waitankung (WTK) practitioners and the general population (mean age: 54.7 ± 14.8 years)
Objective	To compare the health-related quality of life between people who practice Waitankung (WTK) and the general population in Taiwan.
Main findings	The prevalence of chronic diseases (e.g., diabetes, heart disease, and hypertension) was significantly lower in the WTK group. The WTK group scored higher on eight of the 10 SF-36 components compared to sedentary individuals. The group achieved better scores on general health, vitality, and the physical component summary.
Keywords	General health, Qigong, quality of life, Waitankung
—	—
Author (year)	Ho et al. (2012)
Title	A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons With Chronic Fatigue or Chronic Fatigue Syndrome
Country	China
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Persons with chronic fatigue or chronic fatigue syndrome (mean age: 51 years, range: 21–69)
Objective	To evaluate the effect of a 4-month Qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome.
Main findings	Fatigue symptoms and mental functioning significantly improved in the Qigong group compared to controls. Telomerase activity increased significantly in the Qigong group (p < .05). Qigong exercise can be used as an alternative therapy for chronic fatigue.
Keywords	Qigong, exercise, chronic fatigue, telomerase, randomized controlled clinical trial
—	—
Author (year)	Chan et al. (2013)
Title	Evaluation of the Sustaining Effects of Tai Chi Qigong in the Sixth Month in Promoting Psychosocial Health in COPD Patients: A Single-Blind, Randomized Controlled Trial
Country	China
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Patients with COPD (mean age: 72.3 ± 7.8 years)
Objective	To systematically evaluate and quantify the effects of Qigong (TCQ) on improving psychosocial health in patients with COPD.
Main findings	The Qigong group showed significant improvements in quality of life (SGRQ) and perceived social support. Qigong demonstrated sustained effects on psychosocial health after 6 months. The practice was considered a useful and appropriate exercise for patients with COPD.
Keywords	Exercise, chronic obstructive pulmonary disease, Qigong, quality of life, social support
—	—
Author (year)	Kim et al. (2015)
Title	Qigong Program on Insomnia and Stress in Cancer Patients: A Case Series Report
Country	South Korea
Study design	Observational case study
Level of evidence (grade)	High quality
Sample/age	Cancer patients (ages: 52, 58, 67, and 71)
Objective	To obtain preliminary data on the impact of Qigong on sleep, stress, anxiety, and quality of life in cancer patients.
Main findings	Pittsburgh Sleep Quality Index and Stress Scale scores were reduced following the Qigong program. Three out of four subjects showed improvement in quality of life (QoL). A future randomized clinical trial is necessary to determine long-term effects.
Keywords	Pittsburgh Sleep Quality Index, Qigong, cancer, case series, insomnia, stress
—	—
Author (Year)	Randow et al. (2017)
Title	Lian Gong in 18 Therapies as a health promotion strategy
Country	Brazil
Study design	Observational cross-sectional study
Level of evidence (grade)	Moderate quality
Sample/age	Practitioners of Lian Gong in 18 Therapies (majority over 60 years old)
Objective	To identify the main benefits achieved by practitioners of Lian Gong in 18 Therapies as a primary care health promotion strategy.
Main findings	The majority of practitioners were retired women over 60 with hypertension and diabetes. Prolonged practice (>7 months, 2x/week) was associated with greater pain reduction. This led to fewer primary care visits and discontinuation of analgesics/antidepressants in almost 50% of practitioners.
Keywords	Health promotion, Traditional Chinese Medicine, complementary therapies, Primary Health Care
—	—
Author (year)	Galvanese et al. (2017)
Title	Contributions and Challenges of Mind-Body and Meditative Practices for Health Promotion in the Public Primary Care Network of the Municipality of São Paulo, Brazil
Country	Brazil
Study design	Qualitative observational study
Level of evidence (grade)	Low quality
Sample/age	Practitioners of mind-body practices (predominantly older adults)
Objective	To analyze the contributions and challenges of mind-body and meditative practices for health promotion in the public primary care network.
Main findings	Practitioners reported improvements in posture, breathing, community ties, and relationship with life. The practices promote self-awareness, responsibility, and autonomy in self-care. Contributions to health promotion depend on action, critical reflection, and policy formulation.
Keywords	Health Knowledge, Attitudes, Practice, Complementary Therapies, Meditation
—	—
Author (year)	Wayne et al. (2017)
Title	Tai Chi and Qigong for Cancer-Related Symptoms and Quality of Life: A Systematic Review and Meta-Analysis
Country	United States
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Cancer survivors (mean age in studies was generally above 50 years)
Objective	To summarize and critically evaluate the effects of Tai Chi and Qigong (TCQ) mind-body exercises on symptoms and quality of life in cancer survivors.
Main findings	TCQ was associated with significant improvements in fatigue, sleep difficulties, and depression. There was a trend towards pain reduction and an overall improvement in quality of life.
Keywords	Cancer, Fatigue, Meta-analysis, Qigong, Quality of life, Tai Chi
—	—
Author (year)	Song et al. (2017)
Title	The Impact of Tai Chi and Qigong Mind-Body Exercises on Motor and Non-Motor Function and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis
Country	China
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Patients with Parkinson's disease (mean age in studies: 60–70 years)
Objective	To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) in patients with Parkinson's disease (PD).
Main findings	TCQ was associated with significant improvements in motor function, balance, performance time, and reduced risk of falls. It also reduced depressive symptoms and improved overall quality of life.
Keywords	Meta-analysis, motor activity, Parkinson's disease, Quality of life, Tai Chi
—	—
Author (year)	Bobbo et al. (2018)
Title	Health, pain, and activities of daily living among older adult Lian Gong practitioners and sedentary individuals
Country	Brazil
Study design	Comparative cross-sectional study
Level of evidence (grade)	Moderate quality
Sample/age	Older adults (60 years or older)
Objective	To evaluate the presence of chronic pain in older adults, comparing Lian Gong practitioners and sedentary individuals.
Main findings	The Lian Gong group showed significant results for health, empowerment, and well-being. Among active individuals, lower medication consumption and a more positive perception of health were observed. A lower limitation of movement in daily activities was also noted.
Keywords	Exercise, chronic pain, complementary therapies, Primary Health Care
—	—
Author (year)	Santos et al. (2018)
Title	Integrative and Complementary Practices: Advances and Challenges for Health Promotion in Older Adults
Country	Brazil
Study design	Evaluative research with a qualitative approach
Level of evidence (grade)	Low quality
Sample/age	Instructors of Lian Gong/Tai Chi Pai Lin (mean age: 59 years)
Objective	To identify advances and challenges in the National Policy on Integrative and Complementary Practices (PNPIC) for health promotion in older adults.
Main findings	Integrative practices improve the health of older adults and have the support of health managers. Challenges include increasing participation, course availability, qualification, and overcoming a lack of dissemination and infrastructure.
Keywords	Complementary Therapies, Health Policy, Health Promotion, Elderly
—	—
Author (year)	Manfroi et al. (2019)
Title	Pain: The Impulse in the Search for Health by Means of Integrative and Complementary Practices
Country	Brazil
Study design	Qualitative observational study
Level of evidence (grade)	Low quality
Sample/age	Members of a pain management group (most participants were over 50 years old)
Objective	To investigate the relationships between the playful component and the process of rehabilitation, treatment, and health promotion in a pain management group.
Main findings	The Pain Group was considered an important initiative for improving the lives of those involved. It recognizes the potential of humanizing and playful actions in therapeutic initiatives, addressing physical, psychological, and social aspects of pain.
Keywords	Group, Lian Gong/Qi Gong, pain, recreational
—	—
Author (year)	Wu et al. (2019)
Title	Effect of Qigong on Self-Rating Depression and Anxiety Scale Scores of COPD Patients
Country	China
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Patients with COPD (age range in studies: 65–72 years)
Objective	To explore the clinical efficacy and safety of Qigong in reducing depression (SDS) and anxiety (SAS) scores in patients with COPD.
Main findings	Qigong can effectively reduce depression (SDS) and anxiety (SAS) scores in patients with COPD. It also has supportive effects in improving pulmonary function, 6-minute walk test (6MWT) distance, and SGRQ scores.
Keywords	COPD, meta-analysis, Qigong, RCT, SAS, SDS
—	—
Author (year)	Guo et al. (2019)
Title	Qigong-Based Therapy for Treating Adults with Major Depressive Disorder: A Meta-Analysis of Randomized Controlled Trials
Country	China
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Adults with MDD (Mean age in studies was generally between 40 and 60 years)
Objective	To systematically evaluate and quantify the effects of Qigong (TCQ) in patients with major depressive disorder (MDD).
Main findings	Compared to active and passive control groups, the TCQ group showed a significant reduction in depression. The TCQ group also showed significant improvement in treatment response and remission rates compared to the waitlist control group.
Keywords	Mind-body exercise, Qigong, Tai Chi, mental disorder, emotional dysfunction
—	—
Author (year)	Pölönen et al. (2019)
Title	Effect of Meditative Movement on Affect and Flow in Qigong Practitioners
Country	Finland
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Qigong practitioners (mean age: 55.6 ± 12.2 years)
Objective	To evaluate and quantify the effects of Qigong (TCQ) on practitioners during exercise.
Main findings	Qigong produced positive effects on affect, with practitioners reporting a shift towards positive emotions. Participants’ descriptions after the practice included words like “rest,” “relaxation,” “happiness,” “balance,” and “clarity.”
Keywords	Exercise, meditative movement, flow experience, affect, Qigong
—	—
Author (year)	Phansuea et al. (2020)
Title	Qigong Programme Among Community-Dwelling Older Adults at Risk of Depression: A Randomized Controlled Study
Country	Thailand
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Community-dwelling older adults (mean age: 70.3 ± 6.0 years)
Objective	To evaluate the effects of the Qigong program on older adults with mild to moderate depression.
Main findings	The Qigong group showed an average decrease of 10.39 points in depression scores from baseline to 12 weeks. The control group recorded a decrease of only 0.52 points. The Qigong program appears to confer greater improvements than the usual prayer and singing program.
Keywords	Qigong, older adults, depression, community-dwelling, randomized controlled trial, mind-body exercise
—	—
Author (year)	Jin et al. (2020)
Title	Effect of 1 Year of Qigong Exercise on Cognitive Function Among Older Chinese Adults at Risk of Cognitive Decline: A Cluster Randomized Controlled Trial
Country	China
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Older adults at risk of cognitive decline (65 years or older)
Objective	To compare the effectiveness of a personalized Qigong exercise with a stretching exercise in maintaining cognitive abilities.
Main findings	The Qigong group showed significantly higher scores on the global cognitive function test (MoCA) compared to the stretching group. Improvements were seen in memory, visuospatial/constructive ability, and language. The Qigong group had a significantly lower risk of cognitive decline progression after 1 year.
Keywords	Qigong, exercise, cognitive function, cognitive decline, aging, elderly
—	—
Author (year)	Oh et al. (2020)
Title	The Effects of Tai Chi and Qigong on Immune Responses: A Systematic Review and Meta-Analysis
Country	Australia
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Wide age range, from young adults to older adults
Objective	To evaluate and quantify the effects of Qigong (TCQ) on immune responses.
Main findings	Qigong had a significant and positive effect on increasing immune cell levels compared to control conditions. It did not have a significant effect on reducing inflammation levels as measured by C-reactive protein (CRP).
Keywords	Tai Chi, qigong, immune system, immunity, inflammation
—	—
Author (year)	Ye et al. (2020)
Title	The Effects of Baduanjin Qigong on Postural Stability, Proprioception, and Symptoms of Patients With Knee Osteoarthritis: A Randomized Controlled Trial
Country	China
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Patients with knee osteoarthritis (mean age: 63.8 ± 7.1 years)
Objective	To investigate the effects of Baduanjin Qigong on patients with knee osteoarthritis.
Main findings	The Baduanjin Qigong group showed significant improvements in knee joint proprioception. Postural stability in the anteroposterior direction with eyes closed also improved significantly compared to the control group.
Keywords	Baduanjin, Qigong, exercise, osteoarthritis, postural stability, proprioception
—	—
Author (Year)	Lopes et al. (2021)
Title	Lian Gong as a Therapeutic Treatment Option in Primary Care for Patients With Dizziness: A Randomized Controlled Trial
Country	Brazil
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Primary care patients with dizziness (mean age: 63 years)
Objective	To evaluate the effectiveness of Lian Gong (LG) as a vestibular rehabilitation (VR) strategy to reduce the impact of dizziness.
Main findings	The LG group had a significant reduction in the impact of dizziness across all three domains of the dizziness handicap inventory (DHI). The traditional VR group had a reduction only in the emotional impact domain. There were no significant differences in the control group.
Keywords	Dizziness, primary health care, complementary therapies, speech therapy, clinical screening
—	—
Author (year)	Carcelén-Fraile et al. (2021)
Title	Qigong for Muscle Strength and Static Postural Control in Middle-Aged and Older Postmenopausal Women: A Randomized Controlled Trial
Country	Spain
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Middle-aged and older postmenopausal women (mean age: 58.7 ± 4.9 years)
Objective	To determine the effects of a Qigong exercise program on muscle strength and postural control in middle-aged and older postmenopausal women.
Main findings	The experimental group showed improvement in muscle strength and postural control. There was an improvement in the mean velocity of displacement of the center of pressure (CoP) with both eyes open and closed. Improvements in CoP sway area and oscillations were observed only with eyes open.
Keywords	Qigong, middle age, muscle strength, postmenopause, postural control
—	—
Author (year)	Park et al. (2022)
Title	Effects of Tai Chi and Qigong on the Mobility of Stroke Survivors: A Systematic Review and Meta-Analysis of Randomized Trials
Country	South Korea
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Stroke survivors (mean age in studies ranged from 55 to 72 years)
Objective	To identify Tai Chi and Qigong as an effective alternative intervention among stroke survivors.
Main findings	TCQ effectively improved mobility, specifically in walking ability, dynamic balance, and activities of daily living (ADL). The effects were significant in both short-term and long-term programs. TCQ could be effectively applied to stroke survivors to promote functional recovery.
Keywords	Activities of daily living, humans; Qigong, randomized clinical trials, stroke
—	—
Author (year)	Fraile et al. (2022)
Title	Qigong for mental health and sleep quality in postmenopausal women: A randomized controlled trial
Country	Spain
Study design	Randomized clinical trial
Level of evidence (grade)	High quality
Sample/age	Postmenopausal women (age range: 45–65 years)
Objective	To analyze the effectiveness of a Qigong exercise program on sleep quality, anxiety, and depression in Spanish postmenopausal women.
Main findings	The Qigong program resulted in a significant improvement in the participants' sleep quality. These women also showed reduced levels of anxiety and depression, improving their overall well-being.
Keywords	Anxiety, depression, postmenopausal women, Qigong, sleep quality
—	—
Author (year)	Manzaneque et al. (2023)
Title	Immunomodulatory Effects in Healthy Individuals Following a 4-Week Taoist Qigong Intervention: A Comparative Study
Country	Spain
Study design	Comparative study
Level of evidence (grade)	Moderate quality
Sample/age	Healthy individuals (mean age: 49.6 ± 11.8 years)
Objective	To evaluate the effects of Taoist Qigong (TCQ) on the immunological parameters of healthy individuals.
Main findings	Taoist Qigong induced a distinct immunomodulatory profile, characterized by reduced counts of various white blood cell parameters. It also led to increased percentages of certain agranulocytes. The findings highlight the need for more research on the immunological effects of this practice.
Keywords	Immunomodulation, Mind-Body Therapies, Qigong
—	—
Author (year)	Tao et al. (2023)
Title	Effects of Qigong Exercise on Cardiovascular Risk Factors in Patients With Metabolic Syndrome: A Systematic Review and Meta-Analysis
Country	China
Study design	Systematic review and meta-analysis
Level of evidence (grade)	High quality
Sample/age	Patients with metabolic syndrome (mean age in studies was approx. 55 years)
Objective	To systematically evaluate and quantify the effects of Qigong (TCQ) in patients with metabolic syndrome.
Main findings	Qigong had significant effects on several cardiovascular risk factors, including a reduction in waist circumference and systolic blood pressure. Triglyceride levels were also reduced. Regarding LDL cholesterol levels, Qigong showed minimal effects.
Keywords	Meta-analysis, metabolic syndrome, qigong exercise, randomized controlled trials, systematic review

Regarding the year of publication, most articles were published in the last 5 years (56%). Considering the GRADE method, the publications present high (64%), low (20%), and moderate (16%) levels of evidence (Brazil. Ministry of Health, 2014).

Most of the studies were published in China (32%), between 2012 and 2023, in the journals Frontiers in medicine (8%), Frontiers in Physiology (12%), as well as Annals of behavioral medicine, The Scientific World Journal, Parkinsonism & Related Disorders, Medicine (Baltimore) and Environmental Research and Public Health (4% each), available on the Capes Portal database (64%), addressing the effects of Lian Gong on people with different health conditions, such as chronic fatigue, COPD, Parkinson's disease, major depressive disorder, metabolic syndrome and osteoarthritis in the knee.

In the Brazilian literature (24%), the studies were published between 2017 and 2021, in the journals International Archives of Otorhinolaryngology, Brazilian Journal of Pain, Revista Mineira de Enfermagem, Ciência & Saúde Coletiva, Cadernos de Saúde Pública and Revista Brasileira de Promoção da Saúde (with 4% each). Most of the national studies are available in the Capes Portal database (64%) and address the benefits of the practice and its relationship with health promotion in primary care.

Analyzing the descriptors, it is observed that Qigong (60%), Exercise (28%), Complementary Therapies (20%), Quality of life (16%), in addition to Elderly and PHC (12% each) were the most used. The descriptor Tai Chi appears in 13% of the results, since it was a technique used together with Qigong in the selected articles.

Most article titles directly mentioned Qigong (72%), followed by Lian Gong (16%), and the remainder only emphasized the term body, meditative, or complementary practices (12%).

A detailed analysis of the participant demographics reveals a significant concentration of research on specific age cohorts. The data indicate that 92% (23 out of 25) of the reviewed studies focused on middle-aged and older adult populations, with the mean age of participants consistently exceeding 50 years. Furthermore, a substantial portion of this research, 56% (14 out of 25) of the studies, specifically targeted participants aged 60 and older. This demographic focus is consistent with the prevalent application of these mind-body practices for managing age-related health conditions and promoting well-being in later life.

Regarding the health level, all articles address the practice of LG18T in a primary care setting, albeit in a way that complements actions originating from secondary or tertiary care services.

All articles reported positive results after Lian Gong or Qigong practices by interest groups. Most reported improvement in symptoms of pain, depression, fatigue, insomnia, motor function, and overall improvement in quality of life (64%). Others reported positive results in relation to chronic cardiovascular diseases (8%), immune system (8%), cognitive function (4%), dizziness (4%), post-menopause (4%), functional recovery of stroke survivors (4%), and osteoarthritis (4%).

Discussion

The results of this study were qualitatively analyzed, leading to the construction of a Map Tree that visually organizes the main findings (Figure 2). The analysis reveals a broad overview of the effects of Lian Gong in Primary Care, ranging from impacts on physical and motor conditioning to benefits for mental health and psychosocial aspects, in addition to highlighting the challenges in its implementation. To further analyze the most prominent points, the following discussion will focus on three central axes: the role of Lian Gong as a tool for non-pharmacological pain treatment; its impacts on physical conditioning and muscle strengthening; and finally, the improvement in interpersonal relationships and the mental health of practitioners.

Lian Gong/Qigong as a tool for non-pharmacological pain treatment. Pain is a subjective and variable experience, the effects of which are modulated by multiple factors (Lopes et al., 2024). It is a consensus that living with chronic pain has a negative impact on quality of life, since it is related to individual expectations and frustrations despite the ability to perform activities of daily living and work. Thus, the lack of health education on pain management in everyday life causes the majority of the population to view health care only through curative means, in which drugs end up being the only viable way to meet their needs (Vieira et al., 2022).

Figure 2.

Thematic map of the main findings on Lian Gong as a health promotion strategy in Primary Care.

Unlike the chronic use of pain relief medications, which can lead to adverse events such as nausea, dizziness and drug tolerance, in addition to possible drug dependence (Moens et al., 2024), the practice of regular physical activity, such as Lian Gong, in addition to other approaches, such as psychotherapy, help to reduce the perception of pain and overcome deficiencies related to chronic pain in individuals (Bäckryd et al., 2024; Leźnicka et al., 2024).

At this point, the research results are convincing in linking the continued practice of Lian Gong as a non-pharmacological resource for relieving muscle and osteoarticular pain. Studies show that the breathing and relaxation techniques used in the practice of Lian Gong reduce psychosomatic symptoms, while the dynamic and symmetrical movements promote greater control of joint flexion and extension, reducing pain (Lopes et al., 2021; Ye et al., 2020).

Corroborating what is described in the literature, physical activities provide positive relief in the daily lives of individuals, ultimately offering a kind of reward, both physical and mental, to practitioners, generating a determination to continue with physical activity for a longer period of time (De Andrade et al., 2023). In addition, body movement helps to improve cognitive functioning, as well as providing greater physical disposition to the practitioner (Corrêa & Dias, 2023).

Impacts on physical conditioning and muscle strengthening. The literature review makes it clear that the practice of Lian Gong improves physical conditioning and muscle strengthening, since the movements performed promote energy consumption and fat burning (Tao & Li, 2023), helping to reduce cardiovascular risk factors and improving the mobility and stability of practitioners (Park et al., 2022).

Therefore, encouraging the practice of physical and bodily activities, such as Lian Gong, is part of public policies associated with a context of combating chronic non-communicable diseases (Vieira & Carvalho, 2024), given that improving flexibility and balance helps prevent falls and bone fractures, in addition to promoting the maintenance of muscle mass (Palma et al., 2014).

However, access to physical activity is unequal in Brazil, linked to the socioeconomic context of individuals (Carvalho et al., 2024). Thus, considering the practices offered by the SUS, Lian Gong can act as a facilitator of access to physical activity and, therefore, proves to be an important tool for improving quality of life, accessible to the entire population.

On the other hand, excessive physical activity can lead to fatigue not only of the muscle group, but also of the central nervous system (Zhang, 2023). In this sense, for safe physical exercise, it is necessary to perform preparatory and final activities, such as aerobic exercises and exercises using one's own hands or with adequate weightlifting. Finally, considering the practice of physical activities in the elderly, it is essential that this group receives constant guidance to avoid the development of injuries (Sang, 2023). To this end, it is recommended to perform stretching exercises before practicing physical activity, followed by relaxation exercises after finishing.

Improvement in interpersonal relationships and the way of dealing with everyday life events, directly impacting people's mental health. Studies show that the collective practice of Lian Gong promotes social relationships, since the feeling of belonging to a group of regular practitioners of physical or mental activity brings comfort and security, as well as ongoing motivation to maintain the practice as a healthy lifestyle habit, as highlighted by studies conducted in Brazil and in various parts of the world (Carcelén-Fraile et al., 2022; Galvanese et al., 2017; Jin et al., 2020; Phansuea et al., 2020). Other authors emphasize in their studies that involvement in physical, mental, and sports activities in general makes individuals feel like they belong to a social group, favoring the development of bonds and friendships within and outside the context of the activity (Baptista & Brandão, 2022; Corrêa & Dias, 2023).

In general, public leisure spaces are places where social relationships occur and, for this reason, many individuals, especially the elderly, seek out city gyms, health units, or other social spaces in order to avoid social isolation (Nascimento & Gomes, 2024). Considering that the elderly population has greater difficulty in social integration due to ageism (Fuente et al., 2023), social groups created to encourage physical and mental activity constitute an important socialization strategy for this group, encouraging the recovery of autonomy and self-care (Experiences of elderly people living alone, 2020).

In this sense, we can consider the impacts of the COVID-19 pandemic and restrictions on social interaction, changing the dynamics of the population, especially the routine of the elderly, reducing their socialization and contact with family and friends, and the repercussions on the mental health of this group (Fuente et al., 2023).

Furthermore, stress management is essential for dealing with everyday life events. Studies show that techniques such as mindfulness and progressive muscle relaxation have proven effective in reducing anxiety and improving quality of life, since the person acts as their own controller, developing skills to accept, without judgment, unpleasant physiological and psychological responses. In addition to focusing on the present moment, these practices promote a state of calm and mental clarity, allowing a more balanced response to challenges, which can be explained by the reduction in the frequency of negative thoughts observed in the practices, resulting from the non-judgment implicit in the procedure (Guimarães et al., 2021). These resources prove to be important strategies in reducing symptoms of anxiety and depression.

Some studies, however, highlight that, although practices such as Qigong and Tai Chi can have beneficial effects on the immune system, there are attributes that perform worse. In particular, they indicate that, despite the increase in the number of cells of the innate and adaptive immune system, there was no significant reduction in the levels of inflammation, measured by biomarkers such as C-reactive protein and cytokines (Oh et al., 2020), and that, although there was a distinct immunological modulation, some parameters of white blood cells showed a decrease, which can be interpreted as a less robust immune response (Manzaneque et al., 2023). These results suggest that, despite the general benefits, there are limitations to the effectiveness of these practices in reducing systemic inflammation and maintaining a balanced immune response.

Despite the benefits discussed, it is crucial to consider the challenges of implementing PICS in Primary Care, a theme that also emerged prominently from the data analysis (Figure 2). Implementing PICS in PHC settings faces significant challenges due to a lack of adequate training. Many health care professionals lack specific education or ongoing training in PICS, which limits their ability to effectively integrate these practices into daily care. Furthermore, PHC facilities often lack the infrastructure to accommodate the specific needs of PICS, such as adequate spaces for group activities or materials needed for certain therapies (Galvanese et al., 2017). Furthermore, the lack of standardized protocols and robust scientific evidence on the effectiveness of some practices contributes to hesitation in adopting these approaches (Santos et al., 2018). Consequently, PICS integration in PHC settings is often fragmented and inconsistent, undermining the potential of these practices to promote patient health and well-being.

Final Considerations

The research was focused on works that contained LG18T or Qigong as a theme, associating it with health promotion and PHC. This decision was made to analyze national and international scientific production on the subject in the main health databases. The inclusion of Lian Gong in holistic nursing practice and healthcare research presents significant implications for advancing knowledge and improving patient-centered care. The analysis of the literature shows that among the attributes best evaluated for Lian Gong practitioners, the improvement of symptoms of pain and depression stands out, while the worst performances found were related to changes in the individuals’ immune systems.

Lian Gong stands out as a non-pharmacological method of pain treatment, offering a holistic approach that goes beyond physical relief. It's regular practice not only contributes to muscle strengthening, but also promotes a significant improvement in interpersonal relationships and how individuals deal with everyday challenges, positively impacting the mental health of practitioners.

It is worth noting that most of the services involved in the studies were Brazilian and Chinese, applied in Basic Health Units and in the Family Health Strategy, showing that the services evaluated need to strengthen the components of the structure and process to facilitate the population's access to PICS and obtain better performance of PHC in health promotion. Lian Gong's accessibility is one of its greatest assets, requiring few resources and presenting minimal negative impacts.

To integrate Lian Gong into PHC, it is necessary to overcome some obstacles, since the services evaluated showed a need to strengthen the components of the structure, in addition to the lack of training for health professionals. Furthermore, the incipient recognition of these practices contributes to inadequate implementation, making it important to have greater dissemination of their scientific recognition, facilitating access by the population.

A limitation of the present review is its exclusive focus on primary care settings. While this approach was intentionally chosen to synthesize evidence most relevant to community and public health systems, it necessarily omits a significant and growing body of research from specialized care arenas. For example, promising findings on the application of these practices in fields such as oncology and cardiac rehabilitation were not included. Therefore, the conclusions of this review should be interpreted within the context of primary care, as they do not represent the full spectrum of evidence for these mind-body practices across all healthcare settings. Future reviews dedicated to these specialized contexts are warranted.

The benefits of practicing Lian Gong, on the other hand, are vast and well-documented, especially among the elderly population. However, there is a gap in the literature regarding the applicability of Lian Gong among the younger population. Future research should explore how this practice can benefit different age groups, considering the specific needs of each group.

In short, Lian Gong presents itself as a valuable therapeutic practice, with the potential to improve the physical and mental health of individuals, being a beneficial addition to comprehensive care strategies in public health.

Footnotes

ORCID iDs

Isabela de Macedo Del Rey

Giovana Bandeira Dugnani

Luciana Netto

Author Contribution(s)

IMDR participated in the conception, elaboration of the project, collection, analysis, and interpretation of data, writing of the article, and final approval of the version to be published. GBD participated in the elaboration of the project, collection, analysis, and interpretation of data, writing of the article, and final approval of the version to be published. LN participated in the conception, elaboration of the project, collection, analysis, and interpretation of data, writing, and relevant critical review of the intellectual content of the article, and final approval of the version to be published. The authors are responsible for all aspects of the work in ensuring the accuracy and integrity of any part of the work.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was carried out with the support of the Institutional Scientific Initiation Scholarship Program – Scientific and Technological Development National Council.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Isabela de Macedo Del Rey is a Medical Student at the Federal University of São João del-Rei (UFSJ). Her research interests include public health and integrative and complementary practices, with experience in scientific initiation projects.

Giovana Bandeira Dugnani is a Medical Student at the Federal University of São João del-Rei (UFSJ). Her area of research focuses on public health and integrative health strategies.

Luciana Netto is an Associate Professor at the Federal University of São João del-Rei (UFSJ). She holds a PhD in Nursing from the Federal University of Minas Gerais (UFMG) and her research focuses on women's health, integrative and complementary practices, and health education.

References

2020. Experiences of elderly people living alone: Arrangements, choices and challenges. Revista Brasileira de Medicina do Esporte, 23(5), e200088.

Andrade

Leão

Silva

Melo

Guimarães

Paulo

(2012). Experience of the insertion of Lian Gong in the Family Health Strategy of Samambaia–Federal District. Revista, 22(4), 9–18. https://bvsms.saude.gov.br/bvs/periodicos/revista_ESCS_v23_n1_a01_experiencia_insercao_lian.pdf

Apostle

(2017). Evidence synthesis in the context of science translation. Coimbra School of Nursing (ESEnfC).

Atlas.ti Scientific Software Development GmbH . (2022). ATLAS.ti 22 Windows. https://atlasti.com/

Bäckryd

Ghafouri

Gerdle

Dragioti

(2024). Rehabilitation interventions for neuropathic pain: A systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine, 56, jrm13963. https://doi.org/10.2340/jrm.v56.40188

Baptista

Brandão

(2022). The construction of sociability in CrossFit: Collectively individualized bodies. Movimento, 28, e28021. https://doi.org/10.22456/1982-8918.122225

Bobbo

V. C.

Trevisan

D. D.

Amaral

M. C.

Silva

E. M.

(2018). Health, pain and activities of daily living among elderly Lian Gong practitioners and sedentary individuals. Ciência & Saúde Coletiva, 23(4), 1151–1158. https://doi.org/10.1590/1413-81232018234.17682016

Brazil. Ministry of Health . (2014). Methodological Guidelines - GRADE System–manual for grading the quality of evidence and strength of recommendations for decision-making in health. Brasília–DF.

Brazil. Ordinance GM/MS No. 971, of May 3 . (2006). Approves the National Policy for Integrative and Complementary Practices (PNPIC) in the Unified Health System. Brasília: Ministry of Health, 2006.

10.

Brazil. Ordinance GM no. 702, of March 21 . (2018). Amends Consolidation Ordinance no. 2/GM/MS, of September 28, 2017, to include new practices in the National Policy of Integrative and Complementary Practices in the SUS–PNPIC. Brasília: Ministry of Health, 2018.

11.

Brazil. Ordinance GM No. 849, of March 27 . (2017). Includes art therapy, ayurveda, biodance, circular dance, meditation, music therapy, naturopathy, osteopathy, chiropractic, reflexology, reiki, shantala, integrative community therapy and yoga to the PNPIC in the SUS. Brasília: Ministry of Health, 2017.

12.

Carcelén-Fraile

M. C.

Aibar-Almazán

Martínez-Amat

Brandão-Loureiro

Jiménez-García

J. D.

Castellote-Caballero

, et al. (2021). Qigong for muscle strength and static postural control in middle-aged and older postmenopausal women: A randomized controlled trial. Frontiers in Medicine, 8, 794178. https://doi.org/10.3389/fmed.2021.784320

13.

Carcelén-Fraile

M. C.

Aibar-Almazán

Martínez-Amat

Jiménez-García

J. D.

Brandão-Loureiro

García-Garro

P. A.

Fábrega-Cuadros

Rivas-Campo

Hita-Contreras

(2022). Qigong for mental health and sleep quality in postmenopausal women: A randomized controlled trial. Medicine (Baltimore), 101(39), e30897. https://doi.org/10.1097/MD.0000000000030897

14.

Carvalho

F. F. B.

Vieira

L. A.

Malhão

T. A.

Loch

M. R.

(2024). Analysis of the implementation of the Federal Incentive for Physical Activity in Primary Care: equity in focus. SciELO Preprints.

15.

Chan

A. W.

Lee

D. T.

Sit

J. W.

Chair

S. Y.

(2013). Evaluation of the sustaining effects of tai chi qigong in the sixth month in promoting psychosocial health in COPD patients: A single-blind, randomized controlled trial. The Scientific World Journal, 2013(1), 904019. https://doi.org/10.1155/2013/425082

16.

Conforto

E. C.

Amaral

D. C.

Silva

S. L.

(2011). Script for systematic literature review: application in product development and project management. Abstracts.

17.

Corrêa

M. A.

Dias

A. C. G.

(2023). “Elps Not to Go Crazy”: Qualitative study on the practice of sports in academic integration. Estudos e Pesquisas em Psicologia, 23(2), 494–515. https://doi.org/10.12957/epp.2023.77699

18.

De Andrade

A. J. L.

Coutinho

A. Q. O.

Ribeiro

D. B.

Brandão

G. O.

Faiete

L. B. P.

Moraes

M. J. G. T.

, et al. (2023). Motivations for practicing physical activity during undergraduate psychology students. Journal of Physics Education, 34, e3451. https://doi.org/10.4025/JPHYSEDUC.V34I1.3458

19.

Fuente

M. B.

Hernández-Salas

Pineda-Caniulaf

Rodríguez-Azócar

Carrasco-Madariaga

(2023). Repercussions of the confinement due to the COVID-19 pandemic on autonomy and social participation of people over 75 years old: An occupational perspective. Cadernos Brasileiros de Terapia Ocupacional, 31, e3345. https://doi.org/10.1590/2526-8910.ctoAO252132943

20.

Galvanese

A. T. C.

Barros

N. F.

d'Oliveira

A. F. P. L.

(2017). Contributions and challenges of body and meditative practices to health promotion in the public primary care network of the city of São Paulo, Brazil. Cadernos De Saude Publica, 33(12), e00032117. https://doi.org/10.1590/0102-311X00122016

21.

Guimarães

Galli

Nunes

(2021). Effects of meditation on the treatment of stress and anxiety. Psychology (Savannah, GA), 22(2), 1–10. https://doi.org/10.15309/21psd220223

22.

Guo

Kong

Zhang

(2019). Qigong-based therapy for treating adults with major depressive disorder: A meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health, 16(5), 826. https://doi.org/10.3390/ijerph16050826

23.

R. T. H.

Chan

J. S. M.

Wang

C. W.

Lau

B. W. M.

K. F.

Yuen

L. P.

Sham

J. S. T.

Chan

C. L. W.

(2012). A randomized controlled trial of Qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome. Annals of Behavioral Medicine, 44(2), 160–170. https://doi.org/10.1007/s12160-012-9381-6

24.

T. J.

Christiani

D. C.

T. C.

Jang

T. R.

Lieng

C. H.

Yeh

Y. C.

Lin

S.-Z.

Lin

J.-G.

Lai

J.-S.

Lan

T.-Y.

(2011). Effect of Qigong on quality of life: A cross-sectional population-based comparison study in Taiwan. BMC Public Health, 11(1), 546. https://doi.org/10.1186/1471-2458-11-546

25.

Jin

Wang

Zhang

Zhou

Gao

Wang

(2020). Effect of 1 year of qigong exercise on cognitive function among older Chinese adults at risk of cognitive decline: A cluster randomized controlled trial. Frontiers in Psychology, 11, 584489. https://doi.org/10.3389/fpsyg.2020.546834

26.

Kim

Lee

Kwon

Park

Seo

Kim

(2015). Qigong program on insomnia and stress in cancer patients: A case series report. SAGE Open Medical Case Reports, 3, 2050313X1456660. https://doi.org/10.1177/2050313x14556408

27.

LAPPIS . (2022). [Internet]. [place unknown]. https://ufsj.edu.br/lappis/index.php

28.

Leźnicka

Gasiorowska

Pawlak

Jażdżewska

Maciejewska-Skrendo

Lubkowska

Szumilewicz

(2024). How can the pain sensitivity to be affected by maximal progressive exercise test during pregnancy? PLoS One, 19(8), e0308372. https://doi.org/10.1371/journal.pone.0300058

29.

Lopes

A. L.

Fracolli

(2008). Systematic literature review and qualitative metasynthesis: Considerations on its application in nursing research. Texto & Contexto - Enfermagem, 17(4), 771–778. https://doi.org/10.1590/S0104-07072008000400020

30.

Lopes

A. L.

Lemos

S. M.

Figueiredo

P. H.

Gonçalves

D. U.

Santos

J. N.

(2021). Lian Gong as a therapeutic treatment option in primary care for patients with dizziness: A randomized controlled trial. International Archives of Otorhinolaryngology, 25(3), e458–e465. https://doi.org/10.1055/s-0040-1718956

31.

Lopes

Veiga

Fagundes

(2024). The effectiveness of the application of green clay in padelists with chronic muscle pain. Brazilian Journal of Pain, 7, e20230058. https://doi.org/10.5935/2595-0118.20240039-en

32.

Manfroi

M. N.

Correia

P. M.

Franzoni

W. C.

Moraes

L. B.

Stein

Marinho

(2019). Pain: The impulse in the search for health by means of integrative and complementary practices. Brazilian Journal of Pain, 2(4), 357–362. https://doi.org/10.5935/2595-0118.20190058

33.

Manzaneque

J. M.

Vera

F. M.

Rodríguez-Peña

F. M.

Alonso

Blanca

M. J.

(2023). Immunomodulatory effects in healthy individuals following a 4-week Taoist qigong intervention: A comparative study. Medical Science Monitor, 29, e941199. https://doi.org/10.12659/MSM.940450

34.

Mendeley Reference Manager . (2022). New York: Elsevier Inc.

35.

Moens

Crunelle

Putman

Wuyts

Bultinck

Van Puyenbroeck

Goudman

(2024). Pain medication tapering for patients with Persistent Spinal Pain Syndrome Type II, treated with Spinal Cord Stimulation: A RCT-study protocol of the PIANISSIMO study. PLoS One, 19(8), e0308891. https://doi.org/10.1371/journal.pone.0302842

36.

Moher

Shamseer

Clarke

Ghersi

Liberati

Petticrew

Shekelle

Stewart

L. A.

(2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1. https://doi.org/10.1186/2046-4053-4-1

37.

Nascimento

Gomes

(2024). Social groups for the elderly and sociabilities. Licere, 27(1), 21–44. https://doi.org/10.35699/2447-6218.2024.52140

38.

Netto

Camargos

G. O.

(2022). Lian Gong and Traditional Chinese Medicine. https://drive.google.com/file/d/1t8EVtYahTGH0hWIk9DWhI8Q23OHmzcDH/view

39.

Nunes

Santos

(2009). Functional assessment of elderly individuals in three physical activity programs: Walking, water aerobics and Lian Gong. Portuguese Journal of Sport Sciences, 9(2–3), 150–159. https://doi.org/10.5628/rpcd.09.02-03.150

40.

Nunes

Santos

(2009). Functional assessment of elderly individuals in three physical activity programs: Walking, water aerobics and Lian Gong. Port J Sport Sci, 9(2–3), 150–159. https://doi.org/10.1590/S1414-32832009000100013

41.

Bae

Lamoury

Eade

Boyle

Corless

Clarke

Yeung

Rosenthal

Schapira

Back

(2020). The effects of tai chi and qigong on immune responses: A systematic review and meta-analysis. Medicines (Basel), 7(7), 39. https://doi.org/10.3390/medicines7070039

42.

Page

M. J.

Moher

Bossuyt

P. M.

Boutron

Hoffmann

T. C.

Mulrow

C. D.

Shamseer

Tetzlaff

J. M.

Akl

E. A.

Brennan

S. E.

Chou

Glanville

Grimshaw

J. M.

Hróbjartsson

Lalu

M. M.

Loder

E. W.

Mayo-Wilson

McDonald

, … McKenzie

J. E.

(2021). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ, 372(n160), https://doi.org/10.1136/bmj.n160

43.

Palma

A. G.

Arce

M. Z.

Droguett

Martín

F. G. S.

Contreras

J. O.

Toncoso

, et al. (2014). Yoga as complementary therapy for older adults. Notas Enferm, 25(43), 62–67. https://doi.org/10.59843/2618-3692.v25.n43.45455

44.

Park

Song

Seo

Fan

Ryu

Y. L.

Jang

(2022). Effects of Tai Chi and Qigong on the mobility of stroke survivors: A systematic review and meta-analysis of randomized trials. PLoS One, 17(11), e0277541. https://doi.org/10.1371/journal.pone.0277541

45.

Phansuea

Tangwongchai

Rattananupong

Lohsoonthorn

Lertmaharit

(2020). Qigong program among community-dwelling older adults at risk of depression: A randomized controlled study. Cogent Medicine, 7(1), 1711655. https://doi.org/10.1080/2331205X.2020.1711655

46.

Pölönen

Lappi

Tervaniemi

(2019). Effect of meditative movement on affect and flow in Qigong practitioners. Frontiers in Psychology, 10, 2375. https://doi.org/10.3389/fpsyg.2019.02375

47.

Randow

Mendes

N. C.

Silva

L. T. H.

Abreu

M. N. S.

Campos

K. F. C.

Guerra

V. A.

(2017). Lian Gong in 18 therapies as a health promotion strategy. Revista Brasileira em Prooção da Saúde, 30(4), 1–10. https://doi.org/10.5020/18061230.2017.6365

48.

Sang

(2023). Common sports injuries and health services in the elderly. Revista Brasileira de Medicina do Esporte, 29, e2022_0569. https://doi.org/10.1590/1517-8692202329012022_0471

49.

Santos

M. S.

Amarello

M. M.

Vigeta

S. M. G.

Horta

A. L. M.

Tanaka

L. H.

Souza

K. M. J.

(2018). Integrative and complementary practices: Advances and challenges for the health promotion of the elderly. Reme, 22, e-1149. https://doi.org/10.5935/1415-2762.20180048

50.

Song

Grabowska

Park

Osypiuk

Vergara-Diaz

G. P.

Bonato

Hausdorff

J. M.

Fox

Sudarsky

L. R.

Macklin

Wayne

P. M.

(2017). The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism & Related Disorders, 41(Special Issue), 3–13. https://doi.org/10.1016/j.parkreldis.2017.05.019

51.

Tao

(2023). Effects of qigong exercise on cardiovascular risk factors in patients with metabolic syndrome: A systematic review and meta-analysis. Frontiers in Physiology, 14, 1143808. https://doi.org/10.3389/fphys.2023.1092480

52.

United Nations . (2015). Transforming our world: the 2030 agenda for sustainable development. Resolution A/RES/70/1. New York: UN.

53.

Vieira

A. S. M.

Vidal

D. G.

Sousa

H. F. P.

Dinis

M. A. P.

Sá

K. N.

(2022). Health education for individuals with chronic pain: A clinical trial. Brazilian Journal of Pain, 5(1), 39–46. https://doi.org/10.5935/2595-0118.20220013

54.

Vieira

L. A.

Carvalho

F. F. B.

(2024). Planning in the SUS: The agenda of body practices and physical activities from 2004 to 2023. Saúde em Debate, 48(141), e8865. https://doi.org/10.1590/2358-289820241418865p

55.

Watson

(2008). Nursing: The philosophy and science of caring. University Press of Colorado.

56.

Wayne

P. M.

Lee

M. S.

Novakowski

Osypiuk

Ligibel

Carlson

L. E.

Song

(2017). Tai Chi and Qigong for cancer-related symptoms and quality of life: A systematic review and meta-analysis. Journal of Cancer Survivorship, 12(2), 256–267. https://doi.org/10.1007/s11764-017-0665-5

57.

J. J.

Zhang

Y. X.

W. S.

Jiang

L. D.

Jin

R. F.

H. Y.

, et al. (2019). Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients. Medicine (Baltimore), 98(22), e15866. https://doi.org/10.1097/MD.0000000000015866

58.

Simpson

M. W.

Liu

Lin

Zhong

Cai

, et al. (2020). The effects of Baduanjin Qigong on postural stability, proprioception, and symptoms of patients with knee osteoarthritis: A randomized controlled trial. Frontiers in Medicine, 6, 326. https://doi.org/10.3389/fmed.2019.00307

59.

Zhang

(2023). Analysis and interventions of common sports injuries in college basketball players. Revista Brasileira de Medicina do Esporte, 29(Special Issue), e2023_0182. https://doi.org/10.1590/1517-8692202329012022_0187