Mindfulness-Based Finger Exercise for Health and Well-Being: Theory, Evidence, and Implications

Abstract

Background

Finger exercise is a mind-body practice rooted in Traditional Chinese Medicine (TCM), grounded in meridian and acupoint theory. It consists of coordinated finger and hand movements, massage, and pressure techniques that stimulate the flow of Qi and improve circulation, strengthen hand–brain connectivity, and cultivate mindfulness. Finger exercise is intended to promote physical health, enhance cognitive function, and support mental well-being.

Objective

To introduce the concept of finger exercise, synthesize emerging evidence on its effects on general, physical, cognitive, and mental well-being, and explore potential mechanisms and implications for research and practice. A preliminary framework was developed based on initial evidence.

Methods

We conducted a literature search of randominzed controlled trials across three English and two Chinese databases using search terms such as “finger exercise” combined with keywords related to health, cognition, depression, anxiety, and sleep. A total of 12 studies published in English or Chinese (with English abstracts) were included in this review.

Results

The reviewed studies reported varied intervention protocols incorporating TCM principles, brain-hand coordination, pressure techniques, and mindfulness-based strategies. Preliminary evidence suggests that finger exercise may improve general functioning (eg, ADL/IADL), physical indicators (eg, fatigue, sleep), cognitive performance, and mental health (eg, depression, anxiety). Potential mechanisms include enhanced Qi flow, neuroplasticity, neurotransmitter modulation, reduced inflammation, and improved mindfulness.

Conclusion

Mindfulness-based finger exercise shows promise as a low-cost, safe, and easily implemented non-pharmacological intervention that can be done standing or seated and is also suitable for individuals with disabilities or mobility limitations. It has a potential to be integrated into community centers, nursing homes, hospitals, and rehabilitation programs. Further research should confirm its benefits and clarify mechanisms.

Finger exercise, or finger practice, is a Traditional Chinese Medicine (TCM)-based mind-body practice rooted in Qi (气) flow and the meridian system.^1-3 Finger exercise involves targeted rubbing, pressing, and tapping with all ten fingers and both hands, while emphasizing mindfulness to achieve balance. In TCM theory, fingers and hands are gateways to systemic health, as many meridians terminate or pass through the fingers, allowing stimulation of specific acupoints to regulate internal organ function. This integration of movement and mindfulness has the potential to promote both mental well-being ⁴ and cognitive functions. ⁵

The origins of finger exercise can be traced to ancient Chinese treatises on health, such as the Huangdi Neijing (黄帝内经, the Inner Canon of the Yellow Emperor). ⁶ In this foundational work of TCM dated over 2000 years ago, it was noted that “The twelve meridians inwardly connect to the internal organs, and outwardly connect to the limbs and joints,” underscoring the connections among hands, meridians, and overall health. Additionally, hand movements are essential components of various traditional Qigong, including Wuqinxi (五禽戏, Five Animal Frolics) ⁷ and Baduanjin (八段锦, Eight Pieces of Brocade). ⁸ These exercises are grounded in the principles of balancing Qi and fostering harmony within the body.

Finger exercise typically involves stimulating acupoints on the fingers and hands, which are believed to regulate organ function, calm the mind, and enhance cognitive clarity. For example, Hegu (合谷, LI4) is traditionally used to relieve tension and improve Qi circulation, ⁹ while Laogong (劳宫, PC8) is associated with calming the mind and reducing anxiety. ¹⁰ These points illustrate how finger movements may influence physical, emotional, and cognitive states by activating key meridian pathways. These effects, long described in TCM, are also supported by biophysiological research evidence.

In this integrative/narrative review, we aim to introduce mindfulness-based finger exercise, synthesize existing evidence on its health effects, explore potential mechanisms, and outline research and practical implications. Key components of this framework are reflected in Figure 1, and will be detailed in the following sections.

Figure 1.

Conceptual Framework of Mindfulness-Based Finger Exercise for Health and Well-Being With Proposed Mechanisms.

Notes. Figure 1 links three sections: finger exercise components, mechanisms, and health outcomes. The far-left section shows four core components of finger exercise. The middle section presents two independent yet connected mechanism categories: (1) Qi flow, meridian regulation, and mindfulness (TCM-based), and (2) Biophysiological mechanisms (biomedical pathways). Notably, mindfulness appears both as a component of finger exercise (when embedded in practice) and as a mechanism (enhancing attention, bodily awareness, and emotional regulation) for health benefits. Together, these mechanisms are proposed to contribute to general, physical, cognitive, and mental health benefits

Introduction to Finger Exercise

Finger exercise is a simple, low-risk mind-body practice rooted in TCM. This section introduces its theoretical foundation, core components, and the overview of the conceptual framework of finger exercise on health outcomes and associated mechanisms.

TCM Basis of Finger Exercise

Finger exercise is grounded in TCM theories of meridians, acupoints, and reflex zones, which connect to internal organs and physiological systems. ¹¹ By stimulating specific regions on hands and fingers, individuals could gradually restore the balance of Qi (energy) and promote holistic health. ¹² Notably, of the twelve principal meridians, six end on the hands (see Figure 2), ¹³ linking to the lungs, heart, and intestines. Stimulating these pathways is believed to balance Yin-Yang (阴阳, the dynamic balance between opposing forces), and improve health. As an example, fMRI studies suggest Hegu (合谷, LI4) modulates brain networks for pain and cognition, ¹⁴ while Laogong (劳宫, PC8) appears to influence autonomic and emotional regulation. ¹⁰ Figure 2 illustrates key meridians and acupoints on hands relevant to practice.

Figure 2.

Key Meridians and Acupoints on Hands and Fingers. LU: Taiyin Lung Channel of Hand (手太阴肺经). PC: Jueyin Pericardium Channel of Hand (手厥阴心包经). HT: Shaoyin Heart Channel of Hand (手少阴心经). SI: Taiyang Small Intestine Channel of Hand (手太阳小肠经). TH: Shaoyang Sanjiao Channel of Hand (手少阳三焦经). LI: Yangming Large Intestine Channel of Hand (手阳明大肠经). These Acupoints – such as Hegu (合谷, LI4), Laogong (劳宫, PC8), Neiguan (内关, PC6), Shenmen (神门, HT7), and Shaochong (少冲, HT9) – are Commonly Used in Finger Exercise and are Believed to Regulate Qi Flow, Support Organ Function, and Promote Physical and Mental Well-Being Based on TCM Theory. Figure Extracted and Adapted from Online Website: The Exact Location of the Meridians on Hands and Fingers (Dr Peizhi Ye)

Overview of the Conceptual Framework of Mindfulness-Based Finger Exercise on Health Outcomes and Associated Mechanisms

Currently, there is no developed theoretical framework or standardized set of movements of finger exercise (unlike Wuqinxi or Baduanjin), although it has been practiced for centuries and has gained renewed attention in recent years as a low-impact, accessible mind-body practice. While the current evidence is limited, we here propose a preliminary framework (Figure 1) upon an integrative synthesis of TCM principles and emerging biomedical evidence. Figure 1 conceptualizes finger exercise as a multi-component intervention, with health effects hypothesized to occur through both TCM-based processes and biophysiological mechanisms.

The left section of Figure 1 highlights four interrelated components of finger exercise: (1) acupoint stimulation, (2) hand-brain coordination movements, (3) stretching and relaxation techniques, and (4) mindfulness and focused attention. Acupoint stimulation techniques include acupressure, massage, or gentle rhythmic tapping of key hand/finger points,^15,16 to regulate Qi flow and promote systemic balance. Hand-brain coordination movements use patterned finger moves to engage both hemispheres of the brain and support cognitive function,^17,18 to enhance attention, memory, and executive function. Stretching and relaxation movements reduce muscular tension, promote finger and hand dexterity and flexibility, support musculoskeletal and mental relaxation. ¹⁹ Mindfulness and focused attention support present-moment awareness of movements and sensations, thus helping with attentional control, emotional stability, and stress regulation. ²⁰ Notably, mindfulness functions both as a component of finger exercise and also a mechanism for enhancing attention, bodily awareness, and emotional regulation.

The central section of the framework depicts two interconnected categories of mechanisms. The first, Qi flow, meridian regulation, and mindfulness, reflects TCM-based theories, and the second, biophysiological mechanisms, includes pathways supported by biomedical evidence. Together, these mechanisms are hypothesized to contribute to the right section of the framework, which is the general, physical, cognitive, and mental health outcomes. Subsequent sections of this paper will elaborate on mechanisms and health outcomes, along with the empirical evidence.

Finger Exercise and Health Outcomes

Although finger exercise has long been incorporated in health practices, ³² scientific investigation into its health effects is relatively recent, with most empirical studies emerging over the past two decades. Current research has primarily focused on adults and older adults, with the majority of studies conducted in China and published in Chinese-language journals. ³³ While a few studies have reported limited or inconclusive findings, most studies suggest finger exercise may serve as a promising non-pharmacological intervention to improve sleep, ²⁵ chronic pain, ²⁶ depression, ²⁸ cognitive function,^3,21,22 and overall health.^{22,23,25,27,28,30} The following sections review the current evidence of finger exercise’s health effects, organized by four domains: general, physical, cognitive, and mental health. Brief explanations of underlying mechanisms are also discussed.

To identify empirical intervetion studies on finger exercise and health outcomes, a search was conducted across five databases (PubMed, Cochrane Library, PsycINFO, Wanfang, and CNKI) from inception to February 2024. Eligible studies were randomized controlled trials involving middle-aged or older adults and reporting outcomes in at least one prespecified health domain (general, physical, cognitive, or mental health). Characteristics of included studies are summarized in Table 1. Full details of the search strategy, inclusion/exclusion criteria, and quality assessment procedures (also in Supplemental Table) are provided in the Supplementary Material.

Table 1.

Summary of included studies detailing sample characteristics, intervention features, and outcome measures

Reference	Participants	Sample size (I/C)	Age (mean(SD))	Intervention	Control	Daily interval, frequency	Duration	Instruments/health domains
Chen, 2016 21	MCI patients	65 (32/33)	68.49 ± 5.27	Finger exercise	Health education	60 min, 2 days/week	3 months	MMSE: Cognition
								FAQ: General health
Xue, 2019 22	MCI patients	69 (35/34)	71.40 ± 8.69; 72.97 ± 7.36	Finger exercise	Health education	10 min, 3 times/day	6 months	MoCA, MMSE, MES: Cognition
								FS-14: Fatigue
								EQ-5D, ADL, FAQ: General health
Qu et al, 2012 23	Mild AD patients	60 (30/30)	55∼90	Finger exercise	Free uninstructed finger exercise	45 min/day	6 months	ADL: General health
Wang, 2016 24	AD patients	45 (21/24)	73.57 ± 9.77; 73.46 ± 8.83	Finger exercise and Donepezil	Donepezil	≥20 min/day, ≥3 days/week	12 months	MMSE, MoCA: Cognition
								ADL: General health
Zhang & Lin, 2022 25	AD patients	60 (20/20/20)	/	Five elements music finger exercise with personalized care	Personalized care; Regular care	10 min, 2 times/day	6 months	MMSE: Cognition
								ADL: General health
								PSQI: Sleep
								24-HAMD: Mental health
Zhang, 2023 26	Elderly patients with gouty arthritis	62 (31/31)	69.75 ± 2.46; 69.34 ± 2.77	Finger exercise	Regular care	2 times/day	4 weeks	VAS: Pain
						At least 10 days/week		SF-36: Physical health, pain, energy/Fatigue, mental health, general health
								ADL: General health
Zhang et al, 2017 27	AD patients	200 (50/50; 50/50)	79.64 ± 6.08; 75.79 ± 6.84; 78.21 ± 6.24; 77.43 ± 6.56	Finger exercise; Combined	Control; Buyang Huanwu tang	∼75 min, 2 times/day	3 months	HDS, ADAS-cog: Cognition
								ADL: General health
Zhang et al, 2016 28	Mild senile dementia patients	120 (60/60)	70.4 (65∼82); 69.3 (65∼83)	Finger exercise and Donepezil	Donepezil	≥15 min/day	6 months	MMSE, MoCA: Cognition
								ADL: General health
Liu et al, 2016 29	Senile dementia patients	36 (18/18)	80.72 ± 7.291; 79.72 ± 9.430	Passive finger exercise	Regular care	25 min/day	3 months	MMSE: Cognition
								ADL: General health
								NPI: Mental health
Li et al, 2021 30	CIS patients	200 (100/100)	63.3 ± 5.7; 64.2 ± 5.0	Finger exercise	Routine care	∼60 min, 2 times/day	3 months	MoCA, MMSE, NIHSS, VCI: Cognition
								ADL: General health
Wang et al, 2022 3	MCI patients	232 (117/115)	67.97 ± 6.32; 67.95 ± 6.80	Finger exercise	Control	30 min, 2 times/day	1 month	MMSE: Cognition
*Liao et al, 2025 31	Community older adults	284 (142/142)	67.8 ± 5.7	Finger exercise	Control	20 min, 2 times/day	2 months	PHQ-9: Mental health
								WHOQOL-BREF: General health

Notes. I, intervention; C, control; SD, standard deviation; MCI, mild cognitive impairment; AD, Alzheimer’s Disease; CIS, cerebral ischemic stroke; SF-36, the short form (36) health survey; MMSE, mini-mental state examination; MoCA, montreal cognitive assessment; ADL, activity of daily living; NPI, neuropsychiatric inventory; FAQ, functional activities questionnaire; VAS, visual analogue Scale; MES, memory and executive screening; EQ-5D, european quality of 5 dimensions; FS-14, fatigue scale-14; PSQI, pittsburgh sleep quality index; 24-HAMD, hamilton depression rating scale; HDS, hasegawa dementia scale; ADAS-cog, Alzheimer Disease assessment scale-cognitive section; NIHSS, neurologic functional defect; VCI, incidence of mild vascular cognitive impairment; PHQ-9, patient health questionnaire; WHOQOL-BREF, world health organization quality-of-life scale. Weekly intervention frequency being 7 days/week if not specified. *All studies were searched until February 2024, except the Liao et al, 2025 study.

General Health Outcomes and Daily Function

Many studies examining finger exercise have included measures of overall well-being, focusing on participants’ abilities to perform daily functional tasks, such as bathing, dressing, feeding, transferring, and toileting. A recent systematic review and meta-analysis ³³ reported finger exercise interventions may lead to improvements in activities of daily living (ADL) in older adults with mild cognitive impairment (MCI) or Alzheimer’s disease (AD). This meta-analysis synthesized data from eight studies involving 770 participants,^22-25,27-30 of which six studies demonstrated significant improvements in ADL^{22,23,25,27,28,30} while two did not observe statistically significant results.^24,29 Several studies also evaluated instrumental activities of daily living (IADLs), such as food preparation, housekeeping, laundry, shopping, managing medications and finances, and using transportation. For instance, Xue et al. ²² found that the finger exercise intervention group showed a 4.79% improvement in ADL score, a 19.52%, improvement in functional activities such as gaming, social visits, and memory tasks, and a 17.79% improvement in quality of life scores. Similarly, Chen et al. ²¹ observed enhanced performance in functional activities after the finger exercise intervention. Qu et al. ²³ also found improvements in both ADL and IADL scores post-intervention. Although Liu et al. ²⁹ did not observe significant changes in overall ADL scores, they did report improvements in specific domains such as urinary control. Importantly, while the majority of evidence comes from cognitively impaired populations, one study also noted ADL improvements among older adults with arthritis. ²⁶ Finally, in a most recent study where community older adults participated in 20-min, twice daily finger exercise intervention for two months, the quality of life scores of the intervention group were significantly improved. ³¹ Importantly, they also found the number of falls significantly reduced, and balance and gait enhanced. A summary of findings related to general health outcomes, including ADL and IADL measures, is provided in Table 2.

Table 2.

Summary of Findings on General Health

Reference	Instrument	Key Findings
Chen, 2016 21	FAQ	Participants in the experimental group showed significant improvements in functional activity compared to the control group post-intervention (t = 2.974, P = .004)
Xue, 2019 22	ADL	Significant group-by-time interaction were observed in abilities to perform daily activities and functional activities. For all three instruments, there were significant differences between groups post-intervention, with the intervention group showed 4.79%, 19.52%, and 17.79% improvements in ADL, FAQ, and EQ-5D, respectively
	FAQ
	EQ-5D
Qu et al, 2012 23	ADL	The intervention group showed significant improvements compared to the control group post-intervention (P < 0.05)
Wang, 2016 24	ADL	No significant differences exist across two groups
Zhang & Lin, 2022 25	ADL	There were no differences between the two groups at baseline and after 1-month intervention. After 3-month and 6-month’s intervention, the finger exercise group showed significantly improved independence in performing daily activities
Zhang, 2023 26	SF-36	With similar baseline level, the intervention group showed significantly better general health and abilities to perform daily activities compared to the control group post-intervention
	ADL
Zhang et al, 2017 27	ADL	Finger exercise intervention groups showed significantly improved daily activity abilities compared to baseline and to corresponding control groups after intervention
Zhang et al, 2016 28	ADL	The intervention group exhibited significantly improved ability in performing daily activities compared to the baseline level and the control group after 6 months’ finger exercise intervention
Liu et al, 2016 29	ADL	The total score in self-care ability were significantly improved post-intervention in the intervention group, whereas the control group experienced significant decreases
Li et al, 2021 30	ADL	Self-care ability significantly improved in the intervention group compared to baseline and that of the control group post-intervention
Liao et al, 2025 31	WHOQOL-BREF	Quality of life significantly improved in the intervention group in all domains as compared to the control group, except for environmental health. Number of falls was reduced, and balance and gait were improved.

Several factors may contribute to the different effects of finger exercise on ADL, with age emerging as a potential moderator. Some evidence suggests the effectiveness of finger exercise may decline with advancing age.^29,30 This trend aligns with broader findings in cognitive training literature, where older adults were sometimes shown to benefit less from interventions compared to younger individuals. ³⁴ However, some other studies reported older adults may still achieve meaningful gains. ³⁵ In the context of finger exercise, the reduced benefits with increasing age could be attributed to declines in physical functioning and cognitive plasticity, ³⁶ making it more challenging to perform intricate finger movements with high precision.

Potential Mechanisms

The improvement in ADL and IADL could be attributed to several potential mechanisms. For example, acupoint stimulation is believed to regulate internal organ systems. Stimulating acupoints such as Laogong (劳宫, PC8) and Hegu (合谷, LI4) may enhance Qi flow, promote systemic balance, and improve physiological functions relevant to daily activities such as continence and digestion.^37,38

Another important mechanism is the enhancement of motor skills and hand function. The combination of repeated finger movements, hand-eye coordination tasks, and massaging/stretching techniques has been associated with improvements in joint flexibility, coordination, and functional mobility. These movements stimulate neural pathways and brain regions associated with motor control, ³⁹ executive function, and coordination, promoting inter-hemispheric connectivity and overall neural function. ⁴⁰ This, in turn, could support better ADL performance. As an example, massaging the thumb during the finger exercise has been proposed to stimulate brain areas responsible for continence control, which is a key component of ADL. ⁴¹

Overall, these mechanisms may contribute to improvements in physical function, energy balance, and overall well-being, highlighting the potential role of finger exercise in enhancing ADL and IADL performance. ¹

Physical Health Outcomes

While some previous studies have demonstrated that finger exercise improves hand-specific functions like grip strength and post-surgical recovery, this review focuses more on its broader physical health effects, particularly related to fatigue, sleep, and joint pain. Fatigue has been one of the more frequently reported outcomes in finger exercise research. In a 6-month RCT, ²² older adults with MCI who engaged in a structured 5-min finger exercise were found to experience significant reductions in self-reported fatigue. The intervention involved 14 movements, including palm massage, finger grasping, finger math calculation, acupoint stimulation on Hegu (合谷, LI4), Houxi (后溪, SI3), Shenmen (神门, HT7), Daling (大陵, PC7), and Taiyuan (太渊, LU9), and relaxation/hand-shaking movements. Similarly, Zhang ²⁶ reported reductions in fatigue in a 4-week study among older adults with gouty arthritis, using a protocol that included massage, tapping, wrist relaxation, and acupoint activation. Sleep quality also appears to benefit in some cases from finger exercise. Zhang & Lin ²⁵ studied the effect of five elements music finger exercise on hospitalized AD patients in various health domains. Participants reported improved sleep quality and fewer disturbances 3- and 6-month post-intervention, although no effects were seen at 1 month, suggesting benefits for sleep may require longer durations. Joint pain and general physical functioning were also examined in Zhang’s study, ²⁶ which found reductions in joint discomfort and improvements in general physical functioning after the short 4-week intervention. Although the intervention duration was short, the protocol was comprehensive, and the result suggests that even brief engagement in finger exercise may be beneficial in managing physical symptoms. However, the study did not investigate long-term effects, and additional research is needed to evaluate the health benefits over time.

Despite the promising findings, the literature remains inconsistent. While some studies report significant improvements in physical health, others have found only marginally significant effects. ²² Additionally, some improvements in sleep disturbances were not observed shortly after the intervention began but only emerged after a longer period of time. ²⁵ This indicates the effects of finger exercise on sleep outcomes may require a longer duration to manifest, as compared to more immediate outcomes like joint pain. Overall, despite growing attention to non-pharmacological approaches for improving sleep and fatigue, relatively few studies have examined the effects of finger exercise in this area. Further research is needed to clarify long-term physical health benefits of finger exercise, and identify optimal intervention protocols. Table 3 summarizes key findings on physical health outcomes associated with finger exercise.

Table 3.

Summary of Findings on Physical Health

Reference	Domain	Instrument	Key Findings
Xue, 2019 22	Fatigue	FS-14	A marginal significant group x time interaction was identified. The intervention group showed significant reduced fatigue level across intervention, while the control group exhibited no significant difference
Zhang & Lin, 2022 25	Sleep	PSQI	There were no differences between the two groups at baseline and after 1-month intervention. After 3-month and 6-month’s intervention, the finger exercise group showed significantly less sleep disturbances
Zhang, 2023 26	Pain	VAS	With similar baseline level, the intervention group showed significantly lower joint pain compared to the control group post-intervention
Zhang, 2023 26	General	SF-36	With similar baseline level, the intervention group showed significantly better physical functioning and physical role functioning compared to the control group post-intervention

Potential Mechanisms

Finger exercise movements, particularly those involving meridian-based techniques and acupoint stimulation, are hypothesized to improve physical health through several mechanisms. First, the stimulation of acupoints such as Hegu (合谷, LI4), Daling (大陵, PC7), and Shaochong (少冲, HT9) is believed to enhance blood circulation and flow to the hands, upper limbs, and upper body,^42,43 reducing muscular stiffness, and support recovery in aging populations. These acupoints are frequently incorporated into finger exercise protocols. ²²

Additionally, finger exercise may alleviate fatigue by modulating immune responses, leading to reduced levels of inflammation markers such as C-reactive protein (CRP) and improved physical functioning. For instance, a study found that inflammatory factors including IL-6 and hs-CRP were reduced after acupoint stimulation of Hegu (合谷, LI4) and Neiguan (内关, PC6), ⁴⁴ suggesting a systemic anti-inflammatory effect.

Furthermore, acupressure on Hegu (合谷, LI4) and Shenmen (神门, HT7) was found to improve sleep quality and reduce insomnia symptoms, as well as alleviate fatigue,^45,46 potentially through modulation of inflammatory pathways and activation of the parasympathetic nervous system.

Collectively, these findings suggest potential pathways (circulatory, anti-inflammatory, and neuroregulatory) through which finger exercise might contribute to improved physical health outcomes such as fatigue, pain, and sleep disturbance.

Cognitive Health Outcomes

Although investigations on the health outcomes of finger exercise are overall limited, cognitive health has been the most extensively studied, with emerging but mixed evidence suggesting its potential benefits, particularly among individuals with MCI or early-stage AD. ³³ Most studies have used validated tools such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE).^47,48 Evidence in MCI populations has been generally more consistent than AD patients. Among older adults with MCI in China,^3,21,22 significant improvements in MoCA or MMSE scores were consistently reported after 1-6 months of finger exercise intervention, which included hand/finger massage, stretching, finger math, and stimulation of acupoints such as Neiguan (内关, PC6), Waiguan (外关, SJ5), Hegu (合谷, LI4), Houxi (后溪, SI3), and Laogong (劳宫, PC8).

However, findings in AD populations, especially those at moderate to severe stages, have been more mixed, ³³ and disease severity appears to play a regulatory role that warrants further discussion. Zhang et al. ²⁸ studied mild-stage AD patients practicing a 4-section finger exercise involving grasping, ordered movements, and object manipulation for 6 months, reporting significant cognitive improvements. In another study, MMSE cognition score was also significantly improved in the finger exercise group both 3 months and 6 months post-intervention. ²⁵ Similarly, a study ²⁷ with 200 AD patients compared groups receiving basic care, TCM treatment, or finger exercise with acupoint stimulation, and reported significantly better cognitive performance measured by the Hasegawa Dementia Scale (HDS) and Alzheimer Disease Assessment Scale-Cognitive Section (ADAS-cog) in groups involving finger exercise. However, not all studies in AD populations found strong and positive effects. Liu et al. ²⁹ studied mostly moderate-stage (77.8%) AD patients using an 8-section passive finger exercise routine over 3 months. While some MMSE subscale improvements (recall, language) were observed, total MMSE differences were only marginally significant. Furthermore, Wang, ²⁴ who included both mild and moderate AD patients, found no significant between-group cognitive differences after a 12-month intervention. These findings suggest that finger exercise may be less effective in more advanced stages of AD, where neurodegeneration may limit neuroplasticity; instead, it may be more helpful for individuals with milder levels of cognitive decline. Table 4 summarizes the findings on cognition associated with finger exercise.

Table 4.

Summary of Findings on Cognitive Health

Reference	Instrument	Key Findings
Chen, 2016 21	MMSE	Scores of MMSE, attention and calculation, and delayed recall in experimental group are significantly increased comparing to control group before and after intervention (P < .05)
Xue, 2019 22	MoCA	There were significant group X time interactions in MoCA, MMSE, and MES, with the intervention group showing better cognitive function compared to the control group at 3 months and 6 months post-intervention
	MMSE
	MES
Wang, 2016 24	MoCA	No significant differences exist across two groups
	MMSE
Zhang & Lin, 2022 25	MMSE	There were no differences between the two groups at baseline and after 1-month intervention. After 3-month and 6-month’s intervention, the finger exercise group showed significantly better cognitive performance
Zhang et al, 2017 27	HDS	Finger exercise intervention groups showed significantly improved cognitive performance compared to baseline and to corresponding control groups after intervention
	ADAS-cog
Zhang et al, 2016 28	MMSE	The intervention group exhibited significantly improved cognitive performance compared to the baseline level and the control group after 6 months’ finger exercise intervention
	MoCA
Liu et al, 2016 29	MMSE	After intervention, the scores of intervention group were higher than control group in the ability of recall and language, which had significant difference in two groups (P < .05)
Li et al, 2021 30	MoCA, MMSE, NIHSS, VCI	The scores of all instruments were improved in the intervention group compared to baseline and that of the control group post-intervention
Wang et al, 2022 3	MMSE	The cognitive function as indicated by MMSE score were improved significantly in the intervention group compared to the control group

Several factors may contribute to the mixed findings. First, the duration of the intervention could play a key role. In studies where significant cognitive improvements were not observed, the exercise duration may have been too short, thus insufficient to yield significant benefits. ²⁴ Supporting this, a meta-regression analysis identified total exercise hours as a significant moderator, indicating better outcomes at longer exercise hours. ³³ Second, the severity of cognitive impairment appears to moderate the effects; interventions tend to show more consistent benefits in MCI or mild dementia compared to moderate or severe AD. This stage-specific pattern is consistent with previous findings showing that patients with amnestic MCI benefit more from interventions than those with mild AD,^49,50 and studies in AD populations generally have more frequently reported mixed or limited efficacy. ⁵¹ Third, the specific intervention protocols could influence outcomes. Protocols focusing solely on motor coordination and muscle stretching may be less effective than those also incorporating acupoint stimulation. Further research is needed to assess the effectiveness of different finger exercise components. Finally, intervention fidelity may have varied across studies. For instance, without direct supervision, participants may have performed movements incorrectly, reducing effectiveness. Despite these mixed findings, the current evidence provides preliminary support for the efficacy of finger exercise in improving cognitive function, particularly in MCI or mild dementia populations.^28,51 These findings highlight the importance of implementing early-stage interventions to slow cognitive decline.

Potential Mechanisms

Several mechanisms have been suggested to explain how finger exercise enhances cognitive function. First, repetitive and coordinated finger movements may enhance neural activity in areas involved in executive function, attention, and memory. ⁵² Neuroimaging studies have shown that finger exercise can stimulate neuroplasticity and strengthen functional connectivity between sensorimotor regions and cognitive networks.^3,30,53

Second, finger exercise often incorporates focused attention and mindful engagement, requiring individuals to maintain concentration on finger sequences and sensations. This mindfulness component may improve attentional control and working memory. ⁵⁴ Similar to practices like Tai Chi, ⁵⁵ the attentional focus in finger exercise is thought to help improve cognitive health in aging populations.

Third, finger exercise may increase the production of brain-derived neurotrophic factor (BDNF), which promotes synaptic plasticity and supports cognitive performance such as learning and memory, ⁵⁶ as evidenced by a recent RCT study reporting increased BDNF levels following a finger exercise intervention. ³¹ Additionally, finger exercise may have anti-inflammatory effects that help mitigate neuroinflammation, a key contributor to cognitive decline. ⁵⁷ These effects contribute to a better environment for neuronal function and cognitive processes.

Finally, from a TCM perspective, finger exercise activates acupoints linked to brain regions involved in cognition. For example, stimulation of Daling (大陵, PC7) and Neiguan (内关, PC6) increased connectivity of nodes located in brain areas associated with memory and language,^53,58 and Hegu (合谷, LI4) modulated resting-state brain networks in AD. ⁵⁹ Animal studies further support cognitive benefits of finger and hand acupuncture.^56,60

Taken together, these findings suggest that finger exercise may enhance cognition through multiple pathways involving neuroplasticity, BDNF release, inflammation reduction, and acupoint-specific brain modulation, though further studies are needed to strengthen the evidence.

Mental Health Outcomes

Although research on the mental health effects of finger exercise remains limited, several studies have reported potentially promising findings, particularly in reducing symptoms of depression, anxiety, and broader neuropsychiatric disturbances. Depressive symptoms have been a focus in a few studies. Zhang et al. ²⁸ assessed depression in AD patients using the Hamilton Depression Rating Scale (24-HAMD). After 3 and 6 months, the intervention group showed significantly lower depression scores. Supporting these findings, Zhang ²⁶ demonstrated that participants who received a finger exercise intervention exhibited significant improvements in mental well-being and mental role functioning. This improvement could be attributed to the dual benefits of physical activity and cognitive stimulation offered by finger exercise, which may help enhance mood, increase self-efficacy, and foster a greater sense of control over one’s mental health. Neuropsychiatric symptoms have also shown improvement. In a 3-month finger exercise intervention, ²⁹ significant reductions were observed in total Neuropsychiatric Inventory (NPI) scores as well as subscales for anxiety, disinhibition, and abnormal behavior in AD patients. Notably, in a recent study among 284 community older adults, the depressive symptoms were significantly reduced in the finger exercise intervention group. ³¹ However, replication across diverse populations and study designs remains limited. Table 5 summarizes the findings on mental health outcomes associated with finger exercise.

Table 5.

Summary of Findings on Mental Health

Reference	Instrument	Key Findings
Zhang et al, 2016 28	24-HAMD	There were no differences between the two groups at baseline and after 1-month intervention. After 3-month and 6-month’s intervention, the finger exercise group showed significantly less depression compared with the control group
Zhang, 2023 26	SF-36	With similar baseline level, the intervention group showed significantly better mental functioning and mental role functioning compared to the control group post-intervention
Liu et al, 2016 29	NPI	After intervention, the behavioral and psychological symptoms, including anxiety, disinhibition and abnormal behavior were significantly different (P < .05) across groups
Liao et al, 2025 31	PHQ-9	Depressive symptoms significantly improved in the finger exercise intervention group as compared to the control group

Like other health outcomes, intervention duration appears to be a key factor influencing mental health. Studies with shorter durations (eg, 1 month) tend to show less pronounced effects on mental health, whereas longer interventions (3-6 months) appear to generate more consistent improvements. ²⁸ This underscores the importance of considering intervention length in designing interventions targeting mental health.

Potential Mechanisms

Several pathways may explain how finger exercise could potentially support mental health. Drawing from acupuncture research, ⁶¹ one key mechanism involves neurotransmitter modulation. Finger exercise may stimulate the release of endorphins and neuropeptide Y (NPY), which help reduce pain, elevate mood, and relieve stress. ⁶²

Inflammation reduction is another potential pathway. Stimulating acupoints such as Hegu (合谷, LI4) has been shown to regulate the kynurenine pathway, reduce inflammation and glutamate release, and improve depression-like behaviors. ⁶³

From a TCM perspective, finger exercise may promote emotional stability by supporting liver function, which in TCM is linked to mood regulation. Acupoints like Hegu (合谷, LI4) and Shenmen (神门, HT7) are believed to facilitate Qi flow in liver-associated meridians. Supporting this link, studies have shown that individuals with liver disease are more likely to develop depressive symptoms. ⁶⁴ However, this theoretical connection remains speculative and requires more empirical validation.

Finger exercise may also reduce sympathoadrenal system activity by promoting parasympathetic activation through mindful movement and acupoint stimulation, leading to lower stress hormone levels, thereby alleviating symptoms of anxiety. ⁶⁵

Finally, mindfulness and attentional focus may further enhance mental health. Many finger exercise protocols require sustained attention to movement and sensation, fostering a mindfulness-like state associated with improved emotional regulation and reduced anxiety. ⁶⁶ These effects parallel those observed in broader mindfulness-based practices. ⁶⁷ Specific acupoints on hands and arms, such as Jianshi (间使, PC5) and Shenmen (神门, HT7), have also been linked to improved attention, ⁶⁸ and mindfulness may enhance self-regulation by increasing awareness of emotional and bodily signals. ⁶⁹

Collectively, these mechanisms suggest that finger exercise can enhance mental health through a combination of neurobiological, physiological, and psychological processes, and further rigorous studies are needed to confirm the pathways involved and assess the generalizability of findings.

Summary of Potential Mechanisms

Although the mechanisms of finger exercise are not fully established, evidence suggests shared pathways supporting physical, cognitive, and emotional benefits. These reflect an integration of Traditional Chinese Medicine (TCM), neurobiology, and psychological self-regulation, activated through acupoint stimulation, hand-brain coordination, and mindful stretching/relaxation movement.

Finger exercise may promote health through numerous TCM-related processes. First, improved Qi flow and meridian regulation are considered foundational. Acupoint stimulation is thought to restore Qi circulation, balance Yin-Yang, and support organ health, thereby promoting blood flow, organ function, and systemic balance. ⁴²

Second, mindfulness and focused attention further support emotional and cognitive regulation. Many protocols emphasize focused attention on movement and sensation, fostering a mindfulness-like state that enhances emotional awareness and stability, which may further alleviate symptoms of anxiety and depression.

Finger exercise may also exert its effects through biophysiological pathways. First, inflammation and immune modulation may play a role. Stimulating points like Hegu (合谷, LI4) and Shenmen (神门, HT7) may reduce inflammation, as shown by decreased CRP and IL-6 levels, ⁴⁴ supporting fatigue and chronic pain management. While these effects are supported by acupressure studies, and some studies have explored acupoints on other regions of the body that reduce inflammation,^70,71 more research is needed to confirm these outcomes specifically through finger and hand acupoints.

Second, neural activation and plasticity represent another key pathway. Finger exercise may enhance connectivity between motor and cognitive brain regions, partly through increased production of BDNF and other neurotrophic factors.^3,30,53 Evidence in this area is relatively strong; however, results are mixed among those with advanced cognitive decline. ³³ The discrepancies may be attributed to the severity of cognitive impairment, exercise duration, and the specific components of finger exercise used.

Third, autonomic regulation and stress reduction are also implicated. Gentle, rhythmic ten finger movements may stimulate the parasympathetic nervous system, reduce cortisol levels, ⁷² and ease anxiety and depressive symptoms.^61,65 While the evidence is promising, it remains limited, and further studies are needed to better understand these effects.

These interconnected mechanisms are summarized in Figure 1. Importantly, although Qi flow and meridian regulation originate from TCM theory, a growing number of studies suggest that acupoint stimulation may influence modern physiological pathways. For example, it may activate peripheral nerves that modulate BDNF ⁷³ and reduce inflammatory cytokines, ⁷⁴ which are linked to cognitive and emotional regulation. These parallels remain preliminary, and more research is needed to clarify how TCM-related and biomedical mechanisms intersect. By regulating Qi, inflammation, neural connectivity, stress, and mindfulness, finger exercise functions as a holistic, multi-system intervention. Further research using standardized protocols, biomarkers, and imaging techniques is needed to clarify these pathways and optimize implementation.

Implications

Research Implications: Gaps and Future Directions

This paper provides the first integrative/narrative review of mindfulness-based finger exercise theory, evidence, and implications for health and well-being. While findings indicate potential benefits across physical, cognitive, and mental health domains, several gaps remain. First, most existing studies were conducted in Chinese populations and published in Chinese-language journals, which limits generalizability. Future RCTs should include more diverse populations and examine a wider range of outcomes, including sleep quality, fatigue, and pain, where evidence remains preliminary.

Another gap lies in the lack of standardized protocols of mindfulness-based finger exercise. Unlike established practices such as Baduanjin or Wuqinxi, finger exercise has no unified set of movements, and existing protocols vary in duration, frequency, acupoint selection, and incorporation of cognitive or mindfulness elements. These inconsistencies may contribute to inconclusive findings, for example among individuals with Alzheimer’s Disease. Further research is needed to refine and standardize protocols, identify essential components, and develop evidence-based guidelines, including comparative evaluations with other non-pharmacological interventions such as Tai Chi.

Methodological quality is also a concern, as many studies showed relatively high risks of bias and lacking details on randomization, allocation concealment, and blinding. Control conditions were often limited to health education or usual care, increasing performance bias. Future studies should adopt rigorous designs with well-defined protocols to minimize bias and strengthen the reliability of findings.

Evidence on mechanisms is similarly limited. Much current understanding derives from acupuncture studies, since little direct evidence exits on finger movement or acupressure. Future research should use finger exercise interventions to explore underlying mechanisms, connecting TCM-based principles with biophysiological pathways such as inflammation, neuroplasticity, and autonomic regulation. Studies incorporating neurobiological and physiological measures, such as biomarkers (eg, cortisol, BDNF) and brain imaging (eg, fMRI), are particularly needed to clarify pathways.

Finally, all existing interventions were delivered in person. Digital platforms, including AI-based motion sensors and mobile apps, could improve adherence, scalability, and remote tracking and data collection, thus enhancing both feasibility and fidelity. Collectively, these directions can build stronger evidence for the integration of finger exercise into health promotion and clinical practice.

Regarding the limitations of this review, the literature search was restricted to English- and Chinese-language databases, which may have excluded studies published in other Asian languages. Future reviews should capture a broader body of medical literature published on finger exercise. Additionally, due to the limited available evidence on finger exercise, the present study adopts an integrative/narrative review approach. Future reviews should employ systematic methods (including meta-analyses) to quantitatively synthesize findings when more robust evidence becomes available.

Practical Implications

Mindfulness-based finger exercise/practice offers a potentially practical, low-cost, non-pharmacological approach that can be easily integrated into various healthcare and community settings. In hospitals and rehabilitation centers, it may serve as a complementary tool to support recovery and symptom management, especially for individuals with disabilities, limited mobility, and cognitive challenges. In nursing homes and community centers, staff can implement group programs in collaboration with health professionals, residents, and families. Our recent feasibility study with 116 ethnically diverse older adults in Philadelphia ⁷⁵ showed that finger exercise was safe, easy to learn, and feasible even for those with mobility limitations.

Importantly, given that the review found intervention effects to be more pronounced in milder stages of cognitive decline, finger exercise may hold particular value as an early preventive strategy. Implementing such interventions before substantial neurodegeneration occurs may maximize potential benefits and help slow functional decline.

At home, finger exercise can be part of daily self-care routines. It is safe, requires no equipment, can be practiced seated, and empowers older adults to manage their health, promote independence, and improve quality of life.

Overall, finger exercise holds potential as a simple and scalable intervention, though further evidence is needed to confirm its effectiveness and generalizability across populations.

Conclusion

Mindfulness-based finger exercise is a simple, safe and non-pharmacological approach grounded in Traditional Chinese Medicine (TCM) principles that can be practiced standing or seated. It aligns with whole-person health and integrative medicine by integrating physical movement, acupoint stimulation, and mindful attention. Emerging evidence suggests potential benefits for physical function, cognitive performance, and emotional well-being, especially in older adults and individuals with chronic conditions, disabilities or limited mobility.

However, current evidence is limited by methodological constraints, including small sample sizes, short intervention durations, heterogeneous protocols, and a predominance of studies conducted in Chinese populations. Further research is needed to clarify underlying mechanisms, evaluate long-term outcomes, and test finger exercise’s applicability across diverse populations. As interest in integrative and preventive health grows, mindfulness-based finger exercise offers a promising, low-cost strategy that warrants greater scientific and clinical attention.

ORCID iD

Jianghong Liu https://orcid.org/0000-0002-8405-6153