Skip to main content
Scientific Reports logoLink to Scientific Reports
. 2019 Feb 4;9:1240. doi: 10.1038/s41598-018-37544-0

Baduanjin exercise intervention for community adults at risk of ischamic stroke: A randomized controlled trial

Guohua Zheng 1,2, Bai Chen 2, Qianying Fang 2, Qiu Lin 3, Jing Tao 4, Lidian Chen 5,
PMCID: PMC6362011  PMID: 30718622

Abstract

The aim of current study was to assess the effects of Baduanjin exercise on cerebrovascular function, cardiac structure and cardiac function, static pulmonary function, traditional risk factors of CVD and the related psychological outcomes in older community adults at risk for ischaemic stroke. A randomized controlled trial was conducted in three community between November 2013 and October 2015. Older community-dwelling adults (N = 170) were randomly allocated into either a Baduanjin training (5 × 60 min/weekly) or control group who kept their unaltered lifestyle during a 12-week intervention period. Primary (cerebral haemodynamic parameters) and secondary outcomes (cardiac structure, cardiac function, static pulmonary function, traditional risk factors and the related psychological outcomes) were measured at baseline, after a 12-week intervention period and after an additional 12-week follow-up period. After the 12-week intervention period and additional 12-week follow-up period, the Baduanjin exercise group displayed significant changes in most cerebral haemodynamic parameters compared to the control group: lower systolic blood pressure, diastolic blood pressure, plasma total cholesterol levels, waist circumference, hip circumference and waist/hip ratio; and improved mood, self-confidence, self-esteem, quality of life and sleep quality. A supervised 12-week Baduanjin exercise intervention was effective and safe in modulating cerebral haemodynamics, reducing blood pressure and improving anthropometric parameters and related psychological outcomes in older community adults at risk for ischaemic stroke.

Introduction

Ischaemic stroke remains the leading cause of long-term disability in adults worldwide1. Although age-standardized mortality of stroke have decreased around the world in the past twenty years, the absolute number of people suffering from stroke is increasing, and its impact is likely to dramatically increase in the future because of the ageing population and health transitions observed in developing countries2,3. Currently, no country in the world has exhibited a substantial reduction in stroke burden in terms of the absolute number of people affected by and/or dying from stroke. This implies that it is important to make efforts to prevent stroke, particularly the establishment of effective primary prevention strategies for older community adults.

Studies have demonstrated that stroke and most other cardiovascular diseases can be prevented4. The most effective means available for stroke prevention involve the control of modifiable risk factors5,6. According to the INTERSTROKE study, ten risk factors, including vascular risk factors, unhealthy diet and physical inactivity, account for 90% of the population-attributable risk of stroke, and most of them are modifiable risk factors7,8. It is well known that more than 50% of strokes could be prevented through the control of modifiable risk factors9. Even so, their preventive mechanisms remain unclear, which may limit the efficacy of primary prevention.

In terms of aetiology, the direct cause of ischaemic stroke is associated with intracranial atherosclerotic stenosis and the disruption of atherosclerotic plaques with subsequent thromboembolism10. The downstream cerebral haemodynamic changes and the cerebrovascular reserve may play an important role11. For example, the narrowing cerebral vasculature resulting from cerebral intracranial atherosclerosis can cause a reduction in cerebral perfusion pressure (CPP), and the subsequent autoregulation of the vasculature will maximally dilate the cerebral arterioles to maintain cerebral blood flow (CBF). However, with the further reduction in CPP and the maximally dilated arterioles, CBF will also decrease and potentially increase the risk of stroke12. Therefore, cerebral haemodynamic impairment is considered an important pathophysiological mechanism involved in ischaemic stroke. CBF depends on arterial blood pressure, cerebrovascular resistance, and the distribution of cardiac output. CBP is rigorously regulated by a set of mechanisms that include cerebral autoregulation, neurovascular coupling and cerebrovascular carbon dioxide and oxygen reactivity to safeguard the balance of cerebral metabolic demand and supply13,14. Studies have suggested that an increase in cerebrovascular resistance and a decrease in CPP could cause a reduction in cerebral blood flow15, whereas a slight alteration in cardiac output could also lead to changes in CBF despite blood pressure remaining stable or within the autoregulatory range16. Generally, traditional risk factors of ischaemic stroke, such as ageing, hypertension, diabetes, and lipid disorders, are associated with these conditions. For example, diabetes is associated with an increased risk of cerebral autoregulation dysfunction, whereas poorly controlled hypertension is related to a decline in CBF17,18. Normal ageing is linked to marked structural and functional alterations in the cerebrovascular system19. Recent studies have indicated that an estimated 30% of older community adults over 65 years old suffer from intracranial atherosclerotic stenosis (ICAS), as determined by magnetic resonance angiography20, and that more than 90% of individuals with ICAS have at least one vascular risk factor of cardiovascular disease (CVD)21. Therefore, controlling traditional cardiovascular risk factors and their appropriate treatment are vital to establishing primary preventive strategies of stroke by improving the direct aetiology of ischaemic stroke.

Current evidence clearly shows that exercise or physical activity is an effective intervention for preventing ischaemic stroke or other cardiovascular diseases. Therefore, the American Heart Association (AHA) and American College of Cardiology (ACC) recommend that adults should participate in at least 3 sessions of aerobic physical activity of moderate or vigorous intensity lasting an average of 40 minutes each week22,23. However, fewer than 50% of adults, particularly adults over the age of 60, achieve this recommendation despite the broad recognition of its benefits24. As one of the traditional Chinese Qigong exercises, Baduanjin exercise consists of eight separate, delicate and smooth movements; it is a low-moderate intensity mind-body exercise that has been practised in China for hundreds of years25. Current studies have suggested that Baduanjin training appears to have substantive benefits for older adults and is an appropriate exercise for older community people26,27. Many significant improvements have been reported in balance, strength and flexibility as well as in sleep quality and psychological and mental health2830. Recently, an increasing number of studies have demonstrated the benefits of regular Baduanjin practise in reducing blood pressure, insulin resistance and blood glucose levels as well as in controlling traditional CVD risk factors3133. However, the effects of Baduanjin exercise on the aetiology of ischaemic stroke, such as cerebral haemodynamics in older community people, have not been studied yet. The aim of this study was to conduct a randomized controlled trial to examine the effects of Baduanjin exercise on cerebrovascular functions, cardiac structure and function, static pulmonary function, physical fitness, traditional risk factors of CVD, quality of life and sleep quality in older community adults at risk for ischaemic stroke.

Methods

Design and Setting

This study was a two-armed, randomized, assessor-blinded, parallel controlled trial with computer-generated randomization and the concealed allocation. It was conducted between November 2013 and October 2015 in three community centres (Wufeng, Fengdanbailu, and Chuntian) in Fuzhou, China. The participants were randomly allocated to either a Baduanjin training group or usual physical activity group at a 1:1 ratio. Ethics approval was obtained from a local ethics committee in the Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine (No. 2013-021-02). This study was performed in accordance with the Declaration of Helsinki. The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-13003588). The design of this study was described in further detail in the published study protocol34.

Participants

The participants were at a high risk of ischaemic stroke according to the “2012 annual screening and intervention project workbook for population with high risk of stroke”35. To be eligible, participants had to be aged 50 to 75 years and not have regularly exercised for at least one year (regular exercise was defined as one exercise that is practised for 30 minutes or longer each time at least three times per week for more than 3 months). Participants were excluded if they suffered from severe cerebrovascular diseases, musculoskeletal system diseases or other sport contraindications or if they had a history of stroke or a communication disorder.

The trial was advertised by posters or leaflets or by establishing a free clinic at the community centres. The community adults who were interested in this trial were assessed by two trained research assistants in the lounge room based on the eligibility criteria, and they were informed regarding the overall design of this study. If the subjects were eligible and agreed to participate, their baseline measurements were acquired after signing the written informed consent.

Practiced the Baduanjin exercise and practiced Baduanjin form

Participants in the Baduanjin training group gathered in their community centres and practised the Baduanjin exercise that originated from the “Health Qigong Baduanjin Standard” established by the State Sports General Administration in 200336. Two certified instructors instructed and supervised their training. The training programme was comprised of 60 minutes per session with five sessions per week for 12 weeks. Each session consisted of 45 minutes of Baduanjin form, a 10-minute warm-up and a 5-minute cool-down. Two research assistants managed the training spot and recorded the participants’ attendance. The participants in the control group were informed to maintain their usual physical activity during the 12-week intervention period.

Following the 12-week intervention period, participants of both the Baduanjin training and control groups entered an additional 12-week unsupervised follow-up period in which no additional exercise intervention was administered to any participant.

In addition, all participants were asked to keep a daily diary of physical activity level during the 12-week intervention period and the additional 12-week follow-up period. The physical activity level was assessed by using self-reported form, in which the duration and intensity of physical activity for each individual in a whole day was classified into three sections including the duration of low-intensity activity (e.g. walking, drop around, walk the dog), the duration of moderate-intensity activity (e.g. brisk walking, square dances, housework), and duration of high-intensity activity (jogging, play ball, swimming).

Measures

The primary and secondary outcomes were assessed at baseline (−2 to −1 week), the end of the intervention (13 weeks) and the end of the additional 12-week follow-up period (25 weeks). All measurements were performed by the professional operators who did not know the allocation group at the Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital.

The primary outcomes of this trial were cerebrovascular function, consisting of cerebral haemodynamics and cerebrovascular elasticity. Cerebral haemodynamics was expressed by the maximum blood flow velocity (BFVmax), minimum blood flow velocity (BFVmin) and mean blood flow velocity (BFVmean) parameters, whereas cerebrovascular elasticity was expressed using the vascular pulsatility index (PI, calculated using following formula: (peak systolic velocity - end-diastolic velocity)/mean flow velocity)) and the vascular resistance index (RI, calculated by following formula: (peak systolic velocity – end-diastolic velocity)/end-diastolic velocity)). Those variables were measured in nine main cerebral arteries, including the bilateral vertebral artery (VA), bilateral middle cerebral artery (MCA), bilateral anterior cerebral artery (ACA), bilateral posterior cerebral artery (PCA) and basilar artery (BA), using a colour Doppler ultrasound imaging device (Philips, product type: IU22).

The secondary outcomes were cardiac structure and cardiac function, static pulmonary function, traditional risk factors of CVD and psychological outcomes. Cardiac structure and cardiac function were measured using the colour Doppler ultrasound imaging device (product type: SIEMENS Acuson X300). Static lung function was measured using cardiopulmonary function instruments (JAEGER, Germany, product type: OXYCON PRO PC). Traditional risk factors of CVD include blood pressure, heart rate, plasma indicators and anthropometric measurements. The blood pressure was measured manually by the professional staff at the hospital. The plasma indicators of CVD include blood lipid and fasting blood glucose, which were measured quantitatively using an automatic analyser according to the specifications of the fasting period using kit (Rongshen, Shanghai) and enzymatic method (NSA-400, Shenyang). The anthropometric measurements include body mass index (BMI, calculated by weight (kg)/height (m2)), waist circumference, hip circumference and waist-to-hip ratio (waist circumference (cm)/hip circumference (cm)), which were measured using a body scale for BMI and a metric ruler for waist circumference and hip circumference. The related psychological outcomes, including mood, self-confidence and self-esteem, quality of life and sleep quality, were assessed using the Brief Profile of Mood States (BPOMS), the Rosenberg Self-Esteem Scale, the Chinese version of the Social Functioning 36 (SF-36) scale and the Pittsburgh Sleep Quality Index (PSQI), respectively.

Sample Size and Statistical Analysis

A priori sample size calculation was based on an anticipated 10% improvement in cerebral haemodynamic parameters among participants undergoing the 12-week Baduanjin training compared to those in the control group. 85 participants per group was determined a priori based on a 1:1 treatment allocation, considering the target effect size detected, a significance level of 0.05 (type I error), an analysis power of 90% (type II error of 0.10), and a maximum loss to follow-up of 15%34.

All statistical analyses were conducted by a blinded statistician using the IBM SPSS 21.0 (IBM Inc., Chicago, IL, USA) statistical software package. A two-sided p value of less than 0.05 was considered significantly different. Baseline characteristics between the two groups were analysed using the t test or the Mann-Whitney test for continuous variables and Pearson’s χ2 test for categorical variables. Using the linear mixed models based on the intention-to-treat (ITT) principle, a multiple analysis assessed the changes in cerebrovascular function, cardiopulmonary function, plasma traditional risk indicators of CVD, anthropometric measurements, quality of life, happiness, mood and sleep quality from baseline to the endpoint of the intervention or from baseline to the endpoint of follow-up between the Baduanjin group and the control group. The main between-group effect (2 levels: Baduanjin vs control) and interaction effect for group and time point (3 levels: baseline, 12 weeks and 24 weeks) were treated as fixed effects with time and a repeated fixed effect, whereas the participants were random variables. The baseline data and comparison group were used as the reference variable. A fully unstructured variance-covariance matrix was assumed for the error terms. Missing data were imputed using the multiple imputation method based on the Fully Conditional Specification (FCS) algorithm.

Results

Participant Characteristics at Baseline

Figure 1 outlines the flow of participants during the trial. Recruitment started on 1 November 2013 and was completed on 28 February 2014. A total of 2,263 older community adults were assessed for eligibility, and 2,093 individuals were excluded because of conflicts with the eligibility criteria or because they were unwilling to participate. In total, 170 eligible participants were randomized into either the Baduanjin training group or the usual physical activity control group with an equal allocation rate. The baseline characteristics were similar between groups (Table 1).

Figure 1.

Figure 1

Participants flow through the study reported in a CONSORT diagram.

Table 1.

Baseline demographic characteristics of participants between Baduanjin group and control group.

Variables Control group (n = 85) Baduanjin group(n = 85)
Age, years (mean ± SD) 59.75 ± 6.34 60.53 ± 6.29
Gender (n, %)
Male 31 (36.5) 30 (35.3)
Female 54 (63.5) 55 (64.7)
Overweight * (n, %)
Yes 56 (65.9) 50 (58.8)
No 29 (34.1) 35 (41.2)
Smoking (n, %)
Yes 15 (17.6) 8 (9.4)
No 70 (82.4) 77 (90.6)
Diabetes (n, %)
Yes 17 (20) 17 (20)
No 68 (80) 68 (80)
Hypertension * (n, %)
Yes 43 (50.6) 46 (54.1)
No 42 (49.4) 39 (45.9)
Dyslipidemia * (n, %)
Yes 67 (78.8) 62 (72.9)
No 18 (21.2) 23 (27.1)
Fibrillation atrial(n, %)
Yes 1 (1.2) 4 (4.7)
No 84 (98.8) 81 (95.3)
Family history of stroke (n, %)
Yes 32 (37.6) 30 (35.3)
No 53 (62.4) 55 (64.7)
Transient ischemic attack(n, %)
Yes 18 (21.2) 18 (21.2)
No 67 (78.8) 67 (78.8)

*Definition: Overweight (BMI ≥ 25); hypertension (blood pressure ≥ 140/90 mmHg); dyslipidemia (TC ≥ 6.22 mmol/L, or TG ≥ 2.26 mmol/L, or LDL-C ≥ 4.14 mmol/L, or HDL-C ≤ 1.04 mmol/L).

Compliance

Of the 170 participants who completed the baseline assessment, 168 (98.8%) performed the post-intervention evaluation, and 148 (87.1%) completed the 12-week follow-up. The dropout rate was significantly higher in the control group than in the Baduanjin training group according to Pearson’s Chi-square test (χ2 = 5.221, P = 0.04), but no significant difference was found in the baseline characteristics except for fibrillation atrial in between the subjects who dropped out in the study and the subjects who completed the whole study.

Daily Physical Activity During Study Period

Table 2 presents the daily physical activity between Baduanjin training group and control group during study period. The average duration of low intensity activity was not significantly different between the two groups during the study period. The average duration of moderate intensity activity in the Baduanjin exercise group was higher than that for the control group. No high intensity physical activity was reported during the study period.

Table 2.

Comparison of the daily physical activities between groups during study period (hour, mean ± standard deviation).

Study period Intensity Control group Baduanjin group T(Z) P value
n M ± SD n M ± SD
Intervention period low intensity 84 3.62 ± 1.69 84 3.61 ± 1.50 0.048 0.962
Moderate intensity 4.65 ± 1.88 5.81 ± 1.86 −4.064 <0.001
High intensity 0 0 / /
Follow-up period low intensity 69 3.54 ± 1.49 79 3.50 ± 1.70 0.168 0.867
Moderate intensity 4.75 ± 1.81 5.54 ± 1.92 −2.754 0.007
High intensity 0 0 / /

M: mean; SD: standard deviation.

Cerebrovascular Haemodynamic Parameters

Table 3 presents the changes in haemodynamic parameters, including the maximum, minimum and mean blood flow velocities (BFVmax, BFVmin and BFVmean) and the PI and RI in the cerebral basilar arteries (BAs), bilateral vertebral arteries (LVA and RVA), bilateral anterior, and middle and posterior arteries (LAA, RAA, LMA, RMA, LPA and RPA) at baseline, at 12 weeks post-intervention and after an additional 12 weeks of follow-up. There was no significant difference in any parameters between the groups at baseline. Linear mixed models with repeated measures showed a significant interaction effect of group (intervention) by time in the PI and RI parameters for all the measured cerebrovascular arteries; in BFVmax for BA, RVA and LAA; and in BFVmin and BFVmean for the BA, LVA and RVA. A significant main effect of group in RI for BA; in BFVmax for LVA, and in BFVmean for RMA was observed. These results indicated a significant improvement in those cerebrovascular haemodynamic parameters in the Baduanjin exercise group compared with the control group. After the 12-week intervention, a significant difference between the groups was found in almost all parameters except for the RI in the BA and RMA, BFVmean in the RVA; BFVmax in the RMA; and BFVmax, BFVmix and BFVmin in the LAA, LMA and RPA. A significant difference between the groups was also determined in all the measured parameters except BFVmax in the RPA, BA and LVA; BAFmean and BAFmin in the RAA; and five haemodynamic parameters (BFVmax, BFVmin, BFVmean, PI and RI) in the LPA after the additional 12-week follow-up period. Furthermore, the differences showed that those parameters were significantly lower in the Baduanjin intervention group than in the control group (Table 3).

Table 3.

Mean haemodynamic parameters of five cerebrovascular arteries at all time points.

Variables Time points Control Baduanjin Mean difference between comparison group (95% CI) P value Mixed linear model
N Mean ± SE N Mean ± SE P-value (between-groups) P-value (Time × Group)
Basilar artery (BA)
BFVmax, cm/s Baseline 85 69.17 ± 3.01 85 67.67 ± 1.58 1.49 (−4.69–7.67) 0.660
12-weeks 85 67.96 ± 3.07 85 60.50 ± 1.39 7.46 (0.79–14.13) 0.028
24-weeks 85 64.95 ± 2.69 85 59.27 ± 1.47 5.69 (−0.36–11.73) 0.065 0.111 0.003
BFVmin, cm/s Baseline 85 63.42 ± 2.76 85 62.33 ± 1.50 1.19 (−4.99–7.38) 0.704
12-weeks 85 63.28 ± 3.01 85 55.84 ± 1.33 7.44 (0.95–13.93) 0.025
24-weeks 85 61.26 ± 2.50 85 55.03 ± 1.41 6.23 (0.56–11.90) 0.031 0.088 0.001
BFVmean, cm/s Baseline 85 66.38 ± 2.86 85 65.05 ± 1.53 1.34 (−5.08–7.75) 0.681
12-weeks 85 65.80 ± 3.04 85 58.11 ± 1.35 7.69 (1.12–14.27) 0.022
24-weeks 85 63.42 ± 2.54 85 57.14 ± 1.47 6.29 (0.50–12.07) 0.033 0.086 0.001
PI Baseline 85 1.11 ± 0.22 85 1.14 ± 0.22 −0.04 (−0.10–0.03) 0.265
12-weeks 85 1.17 ± 0.03 85 1.08 ± 0.02 0.08 (0.02–0.15) 0.01
24-weeks 85 1.14 ± 0.04 85 1.04 ± 0.02 0.10 (0.017–0.188) 0.019 0.060 <0.001
RI Baseline 85 0.63 ± 0.01 85 0.64 ± 0.01 −0.01 (−0.03–0.01) 0.291
12-weeks 85 0.65 ± 0.01 85 0.63 ± 0.01 0.03 (0.01–0.04) 0.12
24-weeks 85 0.64 ± 0.01 85 0.61 ± 0.01 0.037 (0.01–0.06) 0.01 0.045 <0.001
Left vertebral artery (LVA)
BFVmax, cm/s Baseline 85 64.70 ± 4.47 85 60.47 ± 1.74 4.23 (−5.23–13.70) 0.379
12-weeks 85 61.31 ± 2.24 85 54.79 ± 1.41 6.51 (1.29–11.74) 0.015
24-weeks 85 59.19 ± 1.95 85 54.59 ± 1.51 4.60 (−0.27–9.46) 0.064 0.036 0.563
BFVmin, cm/s Baseline 85 55.60 ± 1.77 85 55.46 ± 1.68 0.14 (−4.68–4.96) 0.955
12-weeks 85 56.13 ± 2.18 85 50.45 ± 1.36 5.68 (0.61–10.75) 0.028
24-weeks 85 54.83 ± 1.66 85 50.12 ± 1.41 4.71 (0.42–9.00) 0.032 0.102 0.007
BFVmean, cm/s Baseline 85 58.02 ± 1.82 85 57.92 ± 1.70 0.10 (−4.82–5.02) 0.968
12-weeks 85 58.96 ± 2.21 85 52.84 ± 1.40 6.11 (0.96–11.28) 0.02
24-weeks 85 57.44 ± 1.69 85 52.42 ± 1.45 5.02 (0.62–9.42) 0.026 0.089 0.003
PI Baseline 85 1.10 ± 0.024 85 1.16 ± 0.022 −0.06 (−0.12–0.07) 0.079
12-weeks 85 1.16 ± 0.02 85 1.09 ± 0.02 0.073 (0.014–0.132) 0.016
24-weeks 85 1.15 ± 0.02 85 1.05 ± 0.02 0.10 (0.04–0.16) 0.001 0.095 <0.001
RI Baseline 85 0.63 ± 0.008 85 0.65 ± 0.007 −0.02 (−0.04–0.02) 0.069
12-weeks 85 0.65 ± 0.007 85 0.63 ± 0.007 0.025 (0.005–0.043) 0.013
24-weeks 85 0.65 ± 0.008 85 0.61 ± 0.007 0.034 (0.013–0.055) 0.001 0.087 <0.001
Right vertebral artery (RVA)
BFVmax, cm/s Baseline 85 60.92 ± 1.89 85 59.89 ± 1.69 1.03 (−3.98–6.03) 0.686
12-weeks 85 60.43 ± 2.16 85 55.25 ± 1.34 5.18 (0.10–10.27) 0.046
24-weeks 85 60.34 ± 1.78 85 54.13 ± 1.46 6.21 (1.66–10.76) 0.008 0.056 0.037
BFVmin, cm/s Baseline 85 55.31 ± 1.76 85 54.70 ± 1.67 0.61 (−4.18–5.40) 0.802
12-weeks 85 55.25 ± 2.11 85 50.32 ± 1.34 4.93 (0.01–9.86) 0.05
24-weeks 85 55.49 ± 1.70 85 49.79 ± 1.43 5.70 (1.31–10.08) 0.011 0.074 0.027
BFVmean, cm/s Baseline 85 58.11 ± 1.83 85 57.35 ± 1.69 0.76 (−4.16–5.68) 0.761
12-weeks 85 57.81 ± 2.13 85 53.13 ± 1.37 4.68 (−0.32–9.67) 0.066
24-weeks 85 57.83 ± 1.76 85 52.04 ± 1.46 5.78 (1.27–10.30) 0.012 0.083 0.039
PI Baseline 85 1.10 ± 0.023 85 1.18 ± 0.02 −0.08 (−0.14–0.02) 0.015
12-weeks 85 1.20 ± 0.023 85 1.10 ± 0.02 0.11 (0.05–0.17) 0.001
24-weeks 85 1.15 ± 0.03 85 1.01 ± 0.02 0.14 (0.06–0.21) 0.001 0.021 <0.001
RI Baseline 85 0.63 ± 0.008 85 0.65 ± 0.007 −0.02(−0.04–0.01) 0.016
12-weeks 85 0.66 ± 0.007 85 0.63 ± 0.006 0.03 (0.013–0.053) 0.001
24-weeks 85 0.64 ± 0.009 85 0.60 ± 0.007 0.04 (0.02–0.07) <0.001 0.022 <0.001
Left anterior artery (LAA)
BFVmax, cm/s Baseline 69 85.74 ± 2.84 69 89.58 ± 2.56 −3.84 (−11.40–3.72) 0.317
12-weeks 69 87.01 ± 2.31 69 81.80 ± 2.07 5.21 (−0.92–11.34) 0.095
24-weeks 69 85.55 ± 2.03 69 79.88 ± 1.71 5.67 (0.42–10.93) 0.035 0.319 0.048
BFVmin, cm/s Baseline 69 79.58 ± 2.80 69 82.49 ± 2.55 −2.91 (−10.40–4.58) 0.443
12-weeks 69 81.45 ± 2.21 69 75.98 ± 1.97 5.47 (−0.39–11.33) 0.067
24-weeks 69 78.68 ± 1.79 69 73.80 ± 1.67 4.88 (0.04–9.72) 0.048 0.286 0.073
BFVmean, cm/s Baseline 69 82.64 ± 2.80 69 86.10 ± 2.49 −3.46 (−10.87–3.94) 0.357
12-weeks 69 84.07 ± 2.23 69 78.82 ± 1.99 5.24 (−0.66–11.15) 0.067
24-weeks 69 82.54 ± 1.90 69 76.79 ± 1.71 5.76 (0.70–10.81) 0.026 0.275 0.052
PI Baseline 69 1.03 ± 0.025 69 1.06 ± 0.019 −0.03 (−0.09–0.03) 0.363
12-weeks 69 1.09 ± 0.022 69 1.00 ± 0.018 0.09 (0.036–0.148) 0.001
24-weeks 69 1.06 ± 0.029 69 0.91 ± 0.021 0.15 (0.077–0.219) <0.001 0.005 <0.001
RI Baseline 69 0.61 ± 0.009 69 0.62 ± 0.006 −0.01 (−0.03–0.01) 0.371
12-weeks 69 0.63 ± 0.007 69 0.60 ± 0.006 0.03 (0.012–0.049) 0.001
24-weeks 69 0.62 ± 0.01 69 0.56 ± 0.008 0.05 (0.026–0.079) <0.001 0.005 <0.001
Right anterior artery (RAA)
BFVmax, cm/s Baseline 58 88.88 ± 3.19 64 87.55 ± 2.52 1.33 (−6.64–9.31) 0.741
12-weeks 58 91.93 ± 2.54 64 83.59 ± 2.10 8.35 (1.86–14.83) 0.012
24-weeks 58 87.51 ± 1.90 64 83.14 ± 1.66 4.37 (−0.60–9.34) 0.085 0.069 0.135
BFVmin, cm/s Baseline 58 83.19 ± 3.14 64 81.44 ± 2.50 1.75 (−6.12–9.62) 0.660
12-weeks 58 86.19 ± 2.47 64 78.29 ± 2.09 7.91 (1.54–14.27) 0.015
24-weeks 58 81.92 ± 1.89 64 77.45 ± 1.68 4.46 (−0.52–9.44) 0.079 0.065 0.190
BFVmean, cm/s Baseline 58 85.78 ± 3.16 64 84.80 ± 2.51 0.98 (−6.94–8.90) 0.807
12-weeks 58 88.91 ± 2.46 64 80.95 ± 2.11 7.96 (1.57–14.35) 0.015
24-weeks 58 84.88 ± 1.94 64 80.34 ± 1.67 4.54 (−0.50–9.58) 0.077 0.078 0.144
PI Baseline 58 1.06 ± 0.028 64 1.06 ± 0.020 −0.001 (−0.07–0.06) 0.979
12-weeks 58 1.11 ± 0.026 64 1.01 ± 0.019 0.10 (0.04–0.167) 0.002
24-weeks 58 1.00 ± 0.029 64 0.91 ± 0.018 0.09 (0.03–0.161) 0.005 0.01 0.009
RI Baseline 58 0.61 ± 0.009 64 0.62 ± 0.007 −0.01 (−0.03–0.019) 0.712
12-weeks 58 0.64 ± 0.009 64 0.60 ± 0.007 0.035 (0.012–0.06) 0.003
24-weeks 58 0.60 ± 0.01 64 0.56 ± 0.007 0.04 (0.01–0.06) 0.006 0.018 0.004
Left middle artery (LMA)
BFVmax, cm/s Baseline 68 99.18 ± 3.82 72 97.07 ± 3.18 2.11 (−7.69–11.90) 0.671
12-weeks 68 98.15 ± 3.13 72 92.27 ± 2.83 5.89 (−2.43–14.21) 0.164
24-weeks 68 96.79 ± 2.95 72 89.28 ± 2.42 7.51 (0.01–15.02) 0.05 0.159 0.503
BFVmin, cm/s Baseline 68 93.07 ± 3.72 72 89.39 ± 3.00 3.69 (−5.72–13.09) 0.440
12-weeks 68 91.68 ± 2.99 72 86.05 ± 2.79 5.63 (−2.45–13.71) 0.170
24-weeks 68 90.66 ± 2.77 72 82.91 ± 2.28 7.75 (0.69–14.82) 0.032 0.109 0.660
BFVmean, cm/s Baseline 68 95.69 ± 3.71 72 93.10 ± 3.02 2.59 (−6.81–11.99) 0.586
12-weeks 68 95.51 ± 3.08 72 89.30 ± 2.81 6.21 (−2.02–14.44) 0.138
24-weeks 68 94.06 ± 2.87 72 86.33 ± 2.37 7.74 (0.41–15.06) 0.039 0.125 0.498
PI Baseline 68 0.96 ± 0.026 72 0.99 ± 0.019 −0.03 (−0.09–0.03) 0.347
12-weeks 68 1.04 ± 0.023 72 0.96 ± 0.016 0.084 (0.029–0.139) 0.003
24-weeks 68 0.98 ± 0.027 72 0.88 ± 0.017 0.095 (0.033–0.157) 0.003 0.047 <0.001
RI Baseline 68 0.58 ± 0.009 72 0.59 ± 0.007 −0.017 (−0.04–0.006) 0.146
12-weeks 68 0.61 ± 0.008 72 0.58 ± 0.006 0.029 (0.01–0.047) 0.003
24-weeks 68 0.59 ± 0.009 72 0.55 ± 0.007 0.033 (0.01–0.056) 0.005 0.088 <0.001
Right middle artery (RMA)
BFVmax, cm/s Baseline 85 95.51 ± 2.36 85 92.37 ± 2.25 3.14 (−3.29–9.57) 0.337
12-weeks 85 97.11 ± 2.17 85 90.58 ± 1.91 6.53 (0.82–12.24) 0.025
24-weeks 85 94.20 ± 1.81 85 86.21 ± 1.63 7.99 (3.18–12.81) 0.001 0.012 0.249
BFVmin, cm/s Baseline 85 88.75 ± 2.34 85 85.80 ± 2.22 2.95 (−3.42–9.32) 0.361
12-weeks 85 88.98 ± 2.04 85 84.25 ± 1.91 4.73 (−0.78–10.25) 0.092
24-weeks 85 86.34 ± 1.80 85 79.64 ± 1.58 6.71 (1.99–11.43) 0.006 0.022 0.446
BFVmean, cm/s Baseline 85 91.91 ± 2.35 85 88.80 ± 2.23 3.11 (−3.29–9.51) 0.339
12-weeks 85 93.98 ± 2.11 85 87.10 ± 1.92 6.88 (1.25–12.51) 0.017
24-weeks 85 90.35 ± 1.80 85 83.74 ± 1.62 6.61 (1.83–11.40) 0.007 0.017 0.360
PI Baseline 85 0.94 ± 0.022 85 1.00 ± 0.021 −0.06 (−0.113–0.005) 0.071
12-weeks 85 1.03 ± 0.023 85 0.96 ± 0.019 0.06 (0.004–0.122) 0.038
24-weeks 85 0.94 ± 0.021 85 0.87 ± 0.021 0.07 (0.013–0.129) 0.017 0.057 <0.001
RI Baseline 85 0.57 ± 0.009 85 0.59 ± 0.009 −0.02 (−0.045–0.004) 0.100
12-weeks 85 0.60 ± 0.01 85 0.58 ± 0.008 0.017 (−0.01–0.04) 0.182
24-weeks 85 0.58 ± 0.009 85 0.55 ± 0.009 0.027 (0.002–0.051) 0.032 0.066 <0.001
Left posterior artery (LPA)
BFVmax, cm/s Baseline 68 53.66 ± 1.34 67 54.61 ± 1.37 −0.95 (−4.75–2.85) 0.621
12-weeks 68 54.36 ± 1.29 67 50.71 ± 1.19 3.65 (0.16–7.14) 0.041
24-weeks 68 54.32 ± 1.12 67 51.50 ± 1.30 2.82 (−0.57–6.22) 0.103 0.133 0.140
BFVmin, cm/s Baseline 68 48.71 ± 1.31 67 49.15 ± 1.38 −0.44 (−4.21–3.32) 0.816
12-weeks 68 49.63 ± 1.25 67 46.02 ± 1.08 3.61 (0.34–6.88) 0.031
24-weeks 68 49.38 ± 0.97 67 46.51 ± 1.21 2.87 (−0.19–5.94) 0.066 0.088 0.182
BFVmean, cm/s Baseline 68 51.24 ± 1.32 67 51.97 ± 1.38 −0.74 (−4.51–3.04) 0.701
12-weeks 68 51.94 ± 1.25 67 48.59 ± 1.17 3.35 (−0.05–6.74) 0.053
24-weeks 68 52.02 ± 1.01 67 49.12 ± 1.17 2.90 (−0.15–5.95) 0.062 0.122 0.177
PI Baseline 68 1.03 ± 0.023 67 1.06 ± 0.022 −0.03 (−0.09–0.032) 0.329
12-weeks 68 1.13 ± 0.022 67 1.03 ± 0.019 0.092 (0.034–0.151) 0.002
24-weeks 68 1.02 ± 0.029 67 0.95 ± 0.022 0.07 (−0.001–0.141) 0.055 0.074 0.003
RI Baseline 68 0.61 ± 0.008 67 0.62 ± 0.007 −0.01 (−0.03–0.01) 0.360
12-weeks 68 0.64 ± 0.007 67 0.61 ± 0.007 0.03 (0.011–0.050) 0.003
24-weeks 68 0.60 ± 0.01 67 0.58 ± 0.008 0.023 (−0.002–0.048) 0.071 0.08 0.006
Right posterior artery (RPA)
BFVmax, cm/s Baseline 56 49.55 ± 1.57 64 51.55 ± 1.59 −1.99 (−6.44–2.45) 0.376
12-weeks 56 51.71 ± 1.28 64 49.90 ± 1.36 1.80 (−1.91–5.52) 0.339
24-weeks 56 53.16 ± 1.29 64 50.51 ± 1.16 2.66 (−0.78–6.09) 0.128 0.547 0.200
BFVmin, cm/s Baseline 56 45.04 ± 1.53 64 46.39 ± 1.53 −1.36 (−5.67–2.96) 0.535
12-weeks 56 46.92 ± 1.20 64 44.85 ± 1.31 2.07 (−1.48–5.62) 0.251
24-weeks 56 48.75 ± 1.29 64 45.32 ± 1.06 3.43 (0.16–6.71) 0.04 0.298 0.179
BFVmean, cm/s Baseline 56 47.23 ± 1.55 64 49.28 ± 1.57 −2.05 (−6.44–2.24) 0.357
12-weeks 56 49.66 ± 1.28 64 47.46 ± 1.30 2.20 (−1.44–5.83) 0.233
24-weeks 56 50.90 ± 1.25 64 47.88 ± 1.08 3.03 (−0.23–6.28) 0.068 0.429 0.134
PI Baseline 56 1.04 ± 0.025 64 1.09 ± 0.023 −0.05 (−0.117–0.015) 0.128
12-weeks 56 1.12 ± 0.024 64 1.01 ± 0.020 0.11 (0.05–0.174) <0.001
24-weeks 56 1.02 ± 0.028 64 0.87 ± 0.023 0.14 (0.07–0.21) <0.001 0.005 <0.001
RI Baseline 56 0.61 ± 0.008 64 0.63 ± 0.008 −0.02 (−0.04–0.003) 0.09
12-weeks 56 0.64 ± 0.008 64 0.60 ± 0.007 0.04 (0.018–0.058) <0.001
24-weeks 56 0.60 ± 0.01 64 0.55 ± 0.009 0.05 (0.028–0.08) <0.001 0.004 <0.001

Abbreviations: BFV, blood flow velocity; PI, pulsatility index; RI, resistance index.

Cardiac Structure, Cardiac Function and Static Pulmonary Function

We found no significant differences in all parameters of cardiac structure and function and static pulmonary function, including left atrial diameter, right ventricular diameter, left ventricular ejection fraction, minute ventilation volume, vital capacity and maximal voluntary ventilation, between the Baduanjin exercise group and the control group, whereas a significant interaction of group by time was also not identified by the mixed linear model analysis (Table 4).

Table 4.

Mean cardiopulmonary function outcomes at all time points (Mean ± SE).

Variables Time points Control Baduanjin Mean difference (95% CI) P value Mixed linear model
P-value (between-groups) P-value (Time × Group)
n Mean ± SE n Mean ± SE
MVV (L/min) Baseline 85 11.64 ± 0.59 85 11.45 ± 0.53 0.18 (−1.39~1.76) 0.820
12-weeks 85 12.55 ± 0.68 85 12.62 ± 0.68 −0.06 (−1.96~1.83) 0.948
24-weeks 85 11.05 ± 1.04 85 12.20 ± 0.60 −1.16 (−3.53~1.21) 0.337 0.611 0.637
VC (L) Baseline 85 2.90 ± 0.08 85 2.93 ± 0.11 −0.03 (−0.31~0.23) 0.770
12-weeks 85 3.03 ± 0.07 85 3.09 ± 0.07 −0.06 (−0.26~0.14) 0.546
24-weeks 85 3.14 ± 0.09 85 3.15 ± 0.08 −0.01 (−0.24~0.23) 0.955 0.735 0.813
VVmax (L/min) Baseline 85 84.44 ± 2.77 85 86.35 ± 3.14 −1.91 (−10.18~6.37) 0.650
12-weeks 85 85.87 ± 2.35 85 89.03 ± 2.83 −3.16 (−10.43~4.11) 0.167
24-weeks 85 94.14 ± 2.29 85 100.62 ± 2.33 −6.48 (−12.93~−0.03) 0.049 0.203 0.605
TV (L) Baseline 85 0.59 ± 0.02 85 0.61 ± 0.03 −0.02 (−0.08~0.04) 0.522
12-weeks 85 0.75 ± 0.04 85 0.75 ± 0.03 −0.006 (−0.11~0.09) 0.907
24-weeks 85 0.68 ± 0.03 85 0.64 ± 0.03 0.04 (−0.05~0.13) 0.372 0.894 0.461
FEV1 (L) Baseline 85 2.38 ± 0.06 85 2.46 ± 0.06 −0.08 (−0.24~0.080 0.306
12-weeks 85 2.39 ± 0.05 85 2.50 ± 0.06 −0.11 (−0.25~0.04) 0.154
24-weeks 85 2.47 ± 0.05 85 2.48 ± 0.05 −0.01 (−0.16~0.14) 0.888 0.355 0.098
IC (L) Baseline 85 2.32 ± 0.07 85 2.26 ± 0.09 0.05 (−0.18~0.28) 0.659
12-weeks 85 2.45 ± 0.07 85 2.50 ± 0.05 −0.05 (−0.21~0.12) 0.596
24-weeks 85 2.46 ± 0.08 85 2.41 ± 0.07 0.05 (−0.17~0.26) 0.651 0.823 0.512
FEV1/FVC (%) Baseline 85 89.01 ± 0.96 85 89.67 ± 2.01 −0.67 (−5.08~3.74) 0.764
12-weeks 85 82.67 ± 0.73 85 84.27 ± 0.67 −1.60 (−3.57~0.37) 0.111
24-weeks 85 83.71 ± 1.15 85 84.06 ± 0.88 −0.35 (−3.20~2.49) 0.808 0.437 0.703
AD (mm) Baseline 85 2.83 ± 0.03 85 2.80 ± 0.30 0.03 (−0.07~0.12) 0.570
12-weeks 85 2.90 ± 0.04 85 2.92 ± 0.04 −0.02 (−0.14~0.08) 0.658
24-weeks 85 2.89 ± 0.04 85 2.86 ± 0.03 0.03 (−0.07~0.13) 0.561 0.792 0.534
LAD (cm) Baseline 85 3.18 ± 0.04 85 3.22 ± 0.04 −0.04 (−0.16~0.08) 0.487
12-weeks 85 3.22 ± 0.04 85 3.29 ± 0.04 −0.07 (−0.18~0.04) 0.210
24-weeks 85 3.11 ± 0.04 85 3.11 ± 0.05 −0.005 (−0.14~0.13) 0.940 0.414 0.642
IVST (cm) Baseline 85 1.02 ± 0.01 85 1.01 ± 0.01 0.01 (−0.02~0.05) 0.360
12-weeks 85 0.98 ± 0.01 85 0.98 ± 0.01 0.00 (−0.03~0.03) 0.955
24-weeks 85 0.98 ± 0.01 85 0.97 ± 0.01 0.01 (−0.02~0.04) 0.539 0.480 0.739
LVPWT Baseline 85 0.94 ± 0.01 85 0.95 ± 0.01 −0.01 (−0.03~0.02) 0.666
12-weeks 85 0.94 ± 0.01 85 0.93 ± 0.01 0.01 (−0.01~0.04) 0.236
24-weeks 85 0.93 ± 0.01 85 0.92 ± 0.01 0.01 (−0.03~0.03) 0.825 0.638 0.422
RVD (cm) Baseline 85 3.00 ± 0.03 85 2.97 ± 0.03 0.03 (−0.07~0.13) 0.541
12-weeks 85 2.90 ± 0.03 85 2.99 ± 0.03 −0.09 (−0.20~0.01) 0.068
24-weeks 85 2.86 ± 0.03 85 2.82 ± 0.03 0.04 (−0.07~0.14) 0.482 0.756 0.09
MPAD Baseline 85 2.05 ± 0.02 85 2.04 ± 0.02 0.01 (−0.06~0.08) 0.812
12-weeks 85 2.08 ± 0.02 85 2.09 ± 0.02 −0.01 (−0.06~0.05) 0.815
24-weeks 85 2.07 ± 0.02 85 2.10 ± 0.02 −0.03 (−0.09~0.04) 0.454 0.706 0.795
LVEF (%) Baseline 85 61.92 ± 0.41 85 62.29 ± 0.47 −0.37 (0.63~1.61) 0.548
12-weeks 85 63.16 ± 0.39 85 63.47 ± 0.43 −0.36 (0.58~−1.51) 0.540
24-weeks 85 61.65 ± 0.34 85 62.37 ± 0.32 −0.98 (−1.94~−0.02) 0.046 0.125 0.617

Abbreviations: MVV: Minute ventilation volume; VC: Vital capacity; VVmax: Maximal voluntary ventilation; TV: Tidal volume; FEV1: Forced expiratory volume in one second; IC: Inspiratory capacity; FVC: Forced vital capacity; AD: Aortic diameters; LAD: left atrial diameter; IVST: Interventricular septal thickness; LVPWT: left ventricular posterior wall thickness; RVD: right ventricular diameter; MPAD: main pulmonary artery diameter; LVEF: Left ventricular ejection fraction.

Traditional Risk Factors of Cerebrovascular Diseases

A significant main effect of group and interaction effect of group by time in the plasma risk factors including the total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), fasting blood glucose (FBG) and homocysteine (Hcy) was not observed (Table 5).

Table 5.

The traditional risk factors of cardiovascular diseases at all time points.

Variables Time points Control Baduanjin Mean difference (95% CI) P value Mixed linear model
n Mean ± SE n Mean ± SE P-value (between-groups) P-value (Time × Group)
TC (mmol/L) Baseline 85 1.57 ± 0.09 85 1.48 ± 0.08 0.09 (−1.56~0.32) 0.489
12-weeks 85 1.53 ± 0.09 85 1.32 ± 0.06 0.21 (0.01~0.42) 0.05
24-weeks 85 2.03 ± 0.13 85 1.75 ± 0.09 0.28 (−0.04~0.59) 0.09 0.088 0.315
TG (mmol/L) Baseline 85 5.67 ± 0.14 85 5.32 ± 0.10 0.35 (0.01~0.69) 0.042
12-weeks 85 5.22 ± 0.12 85 5.00 ± 0.10 0.22 (−0.09~0.53) 0.162
24-weeks 85 5.57 ± 0.12 85 5.37 ± 0.11 0.20 (−0.13~0.53) 0.241 0.084 0.451
LDL-C (mmol/L) Baseline 85 1.32 ± 0.03 85 1.33 ± 0.03 −0.01 (−0.10~0.08) 0.759
12-weeks 85 1.34 ± 0.04 85 1.34 ± 0.03 0.00 (−0.09~0.09) 0.986
24-weeks 85 1.41 ± 0.04 85 1.39 ± 0.03 0.02 (−0.08~0.11) 0.688 0.970 0.667
HDL-C (mmol/L) Baseline 85 3.78 ± 0.13 85 3.43 ± 0.09 0.35 (0.03~0.65) 0.03
12-weeks 85 3.57 ± 0.11 85 3.37 ± 0.10 0.20 (−0.09~0.49) 0.174
24-weeks 85 2.70 ± 0.10 85 2.63 ± 0.09 0.07 (−0.19~0.32) 0.614 0.113 0.091
FGB (mmol/L) Baseline 85 5.88 ± 0.21 85 5.75 ± 0.10 0.13 (−0.33~0.59) 0.584
12-weeks 85 5.71 ± 0.14 85 5.55 ± 0.08 0.16 (−0.16~0.48) 0.328
24-weeks 85 5.86 ± 0.19 85 5.71 ± 0.11 0.15 (−0.28~0.58) 0.487 0.445 0.960
Hcy (mmol/L) Baseline 85 11.44 ± 0.64 85 12.14 ± 0.66 −0.70 (−2.52~1.12) 0.448
12-weeks 85 13.17 ± 0.67 85 13.07 ± 0.62 0.10 (−1.69~1.89) 0.912
24-weeks 85 13.21 ± 0.80 85 13.27 ± 0.62 −0.06 (−2.05~1.94) 0.958 0.804 0.240
BMI (kg/m2) Baseline 85 25.25 ± 0.34 85 24.61 ± 0.35 0.64 (−0.31~1.59) 0.188
12-weeks 85 24.96 ± 0.34 85 24.20 ± 0.35 0.76 (−0.21~1.73) 0.124
24-weeks 85 24.87 ± 0.33 85 24.28 ± 0.36 0.58 (−0.38~1.55) 0.235 0.174 0.221
WC (cm) Baseline 85 87.95 ± 0.97 85 86.93 ± 1.02 1.02 (−1.76~3.81) 0.469
12-weeks 85 87.85 ± 1.00 85 84.03 ± 0.92 3.82 (1.13~6.51) 0.006
24-weeks 85 88.67 ± 0.96 85 84.64 ± 0.98 4.02 (1.32~6.73) 0.004 0.03 <0.001
HC (cm) Baseline 85 96.65 ± 0.71 85 96.09 ± 0.79 0.55 (−1.53~2.64) 0.602
12-weeks 85 96.50 ± 0.65 85 94.76 ± 0.70 1.74 (−0.15~3.62) 0.071
24-weeks 85 96.52 ± 0.64 85 94.63 ± 0.71 1.89 (0.00~3.79) 0.05 0.151 0.006
Waist/hip ratio (%) Baseline 85 0.91 ± 0.006 85 0.90 ± 0.007 0.01 (−0.01~0.03) 0.385
12-weeks 85 0.91 ± 0.007 85 0.89 ± 0.006 0.02 (0.01~0.04) 0.012
24-weeks 85 0.92 ± 0.006 85 0.89 ± 0.006 0.03 (0.01~0.04) 0.007 0.034 0.033
SBP (mmHg) Baseline 85 134.3 ± 2.04 85 135.9 ± 2.01 −1.68 (−7.33~3.97) 0.557
12-weeks 85 133.5 ± 1.92 85 122.2 ± 1.39 11.27 (6.59~15.96) <0.001
24-weeks 85 136.0 ± 2.18 85 125.7 ± 1.68 10.37 (4.93~15.81) <0.001 0.004 <0.001
DBP (mmHg) Baseline 85 79.27 ± 1.20 85 79.62 ± 1.19 −0.35 (−3.69~2.99) 0.835
12-weeks 85 78.35 ± 1.18 85 75.26 ± 0.91 3.05 (0.08~6.02) 0.044
24-weeks 85 80.20 ± 1.19 85 76.57 ± 0.95 2.93 (−0.23~6.08) 0.069 0.113 0.023
HR (times/min) Baseline 85 77.9 ± 1.0 85 78.1 ± 1.0 −0.17 (−2.97~2.64) 0.908
12-weeks 85 76.1 ± 1.0 85 73.6 ± 0.8 2.70 (0.15~5.25) 0.038
24-weeks 85 73.2 ± 0.9 85 71.9 ± 0.9 1.64 (−1.12~4.41) 0.242 0.269 0.069

Abbreviations: TC, Total cholesterol; TG, Triglyceride; LDL-C, Low density lipoprotein; HDL-C, High density lipoprotein; FGB, Fasting blood glucose; Hcy, Homocysteine; BMI, Body mass index; WC, Waist circumference; HC, Hip circumference; SBP, Systolic blood pressure; DBP, Diastolic blood pressure; HR, Heart rate.

Among the four measured anthropometric measurements, including body mass index (BMI), waist circumference (WC), hip circumference (HC) and waist/hip ratio, the mixed linear model showed a significant interaction of group by time and main effect of group on WC, HC and the waist/hip ratio; three (WC, HC and the waist/hip ratio) were significantly lower in the Baduanjin training group than in the control group at post-intervention or after the additional 12-week follow-up (Table 5).

For the systolic blood pressure (SBP) and diastolic blood pressure (DBP), the analysis of mixed linear model method showed obviously significant interaction effect of group by time (P < 0.001 and P = 0.023, respectively). The SBP and DBP values were significantly lower in the Baduanjin training group than in the control group at post-intervention (P < 0.001 for SBP and P = 0.044 for DBP), and this effect in SBP was maintained after the additional 12-week follow-up (P < 0.001). No significant main effect of group and interaction effect of group by time in heart rate was observed. These results are listed in Table 5.

The Related Psychological outcomes

The measured psychological outcomes include mood, self-confidence, self-esteem, quality of life and sleep quality. A significant interaction effect of group by time and the main effect of group in all of those measured psychological outcomes were observed based on the mixed linear model analysis. In addition, we also found that all those outcomes in the Baduanjin training group were significantly superior to those in the controls at both post-intervention or after the additional 12-week follow-up (Table 6).

Table 6.

The related psychological outcomes at all time points.

Variables Time points Control Baduanjin Mean difference (95% CI) P value Mixed linear model
n Mean ± SE n Mean ± SE P-value (between-groups) P-value (Time × Group)
Mood (POMS) Baseline 85 100.2 ± 1.61 85 103.2 ± 1.70 −2.98 (−7.61~1.66) 0.206
12-weeks 85 105.8 ± 1.63 85 92.61 ± 1.10 13.22 (9.35~17.10) <0.001
24-weeks 85 104.3 ± 1.32 85 92.82 ± 1.14 11.45 (8.01~14.88) <0.001 <0.001 <0.001
Self-confidence Baseline 85 28.48 ± 0.32 85 27.92 ± 0.26 0.57 (−0.25~1.38) 0.173
12-weeks 85 27.69 ± 0.31 85 29.22 ± 0.25 −1.53(−2.31~−0.75) <0.001
24-weeks 85 27.63 ± 0.27 85 28.76 ± 0.22 −1.13 (−1.81~−0.45) 0.001 0.037 <0.001
Self-esteem Baseline 85 28.38 ± 0.26 85 28.08 ± 0.27 0.30 (−0.44~1.03) 0.430
12-weeks 85 27.79 ± 0.25 85 29.45 ± 0.24 −1.66 (−2.34~−0.98) <0.001
24-weeks 85 27.66 ± 0.24 85 29.16 ± 0.23 −1.51 (−2.15~−0.86) <0.001 0.002 <0.001
Quality of life (SF-36)
SF-36 (Physical health) Baseline 85 67.63 ± 1.73 85 64.18 ± 1.76 3.45 (−1.43~8.33) 0.165
12-weeks 85 59.52 ± 1.92 85 78.63 ± 1.26 −19.1 (−23.6~−14.7) <0.001
24-weeks 85 59.26 ± 1.89 85 79.13 ± 1.21 −19.9 (−24.3~−15.4) <0.001 <0.001 <0.001
SF-36 (Mind health) Baseline 85 75.77 ± 1.55 85 72.46 ± 1.84 3.31 (−1.44~8.06) 0.171
12-weeks 85 71.11 ± 1.73 85 82.78 ± 1.16 −11.7 (−15.8~−7.55) <0.001
24-weeks 85 70.41 ± 1.66 85 84.17 ± 1.07 −13.8 (−17.7~−9.87) <0.001 <0.001 <0.001
Sleep quality (Pitsburgh sleep quality index, PSQI)
PSQI Baseline 85 7.68 ± 0.37 85 7.81 ± 0.38 −0.13 (−1.17~0.91) 0.806
12-weeks 85 7.99 ± 0.36 85 5.50 ± 0.25 2.49 (1.63~3.35) <0.001
24-weeks 85 8.50 ± 0.38 85 5.85 ± 0.27 2.65 (1.74~3.57) <0.001 <0.001 <0.001

Adverse Events

No adverse events were reported during the exercise training or follow-up period.

Discussion

Main Findings

Compared with the control group, the 12-week Baduanjin training group showed a significant reduction in most of the cerebral haemodynamic parameters, particularly PI and RI, in nine measured cerebral arteries. Furthermore, most of those significant effects were sustained in the additional 12-week follow-up. We also found an obvious reduction in SBP, DBP, heart rate and anthropometric measurements, including WC, HC and the waist/hip ratio, and an obvious improvement in the related psychological or mental outcomes, including mood, self-confidence, self-esteem, sleep quality and quality of life, in the Baduanjin training group after the 12-week intervention or the additional 12-week follow-up.

Cerebrovascular Haemodynamic Changes

Generally, normal ageing will cause marked structural and functional alterations in the cardiovascular and cerebrovascular systems, which may be linked to reductions in global CBF37. However, regular aerobic exercise can increase long-term CBF. The mechanisms are related to that aerobic exercise can enhance systemic arterial endothelial function, reduce large elastic artery stiffness and risk of arterial atherosclerosis in middle-aged and older adults38,39. The findings in this study show that the blood velocity of most measured cerebral arteries in the Badjanjin training group were significantly lower than in the control group. Those results seem to indicate that CBF is lower in the intervention group than in the control group, which conflicts with previous studies that showed that regular aerobic exercise was associated with elevated CBF in adults40,41. However, the resting CBF changes are tightly coupled to neuronal activity via adjustments in vascular resistance15, and they are easily influenced by physiological or psychological factors42. In our study, we also observed that the PI and RI of almost all measured arteries were significantly lower in the Baduanjin training group than in the control group. Furthermore, the observed psychological or mental variables including mood, self-confidence, self-esteem, sleep quality and quality of life were better in the Baduanjin training group than in the control group and may be a reasonable explanation for the findings in this study. In addition, low-intensity aerobic exercise may not directly affect the cerebrovascular blood velocity or cause CBF changes, and an increase in exercise intensity up to nearly 60% of the maximal oxygen uptake can result in elevations in CBF43. Ainslie PN, et al. reported that regular aerobic-endurance exercise (vigorous road running or cycling races more than 4 times per week) is associated with higher blood flow velocity in the MCA40. This study used rigorously screened healthy humans to avoid the known effects of prevalent age-related diseases on CBF. Another cross-sectional study also reported that over 150 minutes of moderate- to vigorous-intensity aerobic activity per week sustained during the adult lifespan can maintain aerobic fitness throughout the lifespan and improve cerebral haemodynamics later in life44. Baduanjin is a traditional Chinese Qigong exercise with a low exercise intensity. It consists of eight separate, delicate and smooth movements. Practising Baduanjin requires body-mind coordination by combining body posture, movement and breathing with meditation45. Therefore, we speculated that 12 weeks of regular Baduanjin training might improve cerebrovascular compliance by reducing the resistance of cerebral arteries due to relaxed body-mind training, thus resulting in a decrease in cerebral blood velocity.

Cardiopulmonary Structure and Function

Cardiorespiratory capacity is typically associated with cerebrovascular diseases, and low cardiorespiratory capacity is an independent risk factor of ischaemic stroke46. Regular physical activity, particularly aerobic exercise, can substantially improve cardiorespiratory capacity, not only among healthy older adults but also among patients with chronic diseases, by improving cardiac structure, cardiac function and lung function4749. However, no significant differences were found in the outcomes of cardiopulmonary structure and function between groups in the present study. A possible explanation is that the 12-week Baduanjin exercise intervention period may not have been sufficiently long to identify significant differences in those parameters among older community-dwelling adults at risk for ischaemic stroke.

Blood Pressure, Heart Rate, Plasma Risk Factors and Anthropometric measurements

We observed significantly lower SBP after the 12-week Baduanjin training intervention and the additional 12-week follow-up. We also observed lower DBP and heart rate after 12 weeks of the Baduanjin intervention in community elderly adults at a high risk of ischaemic stroke in the Baduanjin training group compared to the control group. DBP and heart rate did not differ between the groups after the additional 12-week follow-up. High blood pressure in elderly adults is associated with an increased risk of ischaemic stroke and thus must be controlled. Li et al.50 did not observe effects on blood pressure in healthy adults with normal pressure after 16 weeks of Baduanjin training in their RCT, but a recent systematic review of 8 RCTs reported the beneficial effect of Baduanjin training combined with antihypertensive drugs versus antihypertensive drug use alone among patients with hypertension32. In our study, 54.1% of the participants (46/85) in the Baduanjin exercise group had hypertension, and 50.6% (43/85) of the patients in the control group had hypertension. Therefore, our findings indicate the efficacy of Baduanjin training as a management method for hypertension.

Plasma risk factors of ischaemic stroke include TC, TG, LDL, HDL, FBG and Hcy and were measured in our study, but no significant differences were found between groups except for the TC level, which was lower in the Baduanjin exercise group than in the control group at post-intervention. These findings were in line with those from the Li et al. study on healthy adults48 but in conflict with our previous systematic review regarding healthy adults or patients with hyperlipidaemia33. Additional studies are necessary to ascertain whether Baduanjin training can modulate blood lipids in adults with a high risk of ischaemic stroke.

Anthropometric measurements, including WC, HC and ratio of the waist/HCs, but not BMI, were significantly decreased in the Baduanjin training group compared to the control group. Li et al. found that a 16-week Baduanjin training intervention significantly decreased BMI and skinfold thickness at the abdomen in healthy adults in their RCT, whereas no significant differences were observed between groups for waist and hip parameters50.

The Psychological or Mental Effect

To our knowledge, several previous studies have evaluated the effect of the Baduanjin training intervention on psychological outcomes among healthy adults or patients and have reported the positive beneficial results30,31. Chen et al. also observed that the 12-week Baduanjin training intervention could significantly improve sleep quality among community-dwelling older adults aged 60 years or older29. The findings in the present study are in accordance with the results of those previous studies.

Strengths and Limitations of the Study

This is the first RCT to provide empirical evidence regarding the effectiveness of traditional Chinese Qigong-Baduanjin exercise on cerebral haemodynamic parameters; cardiopulmonary structure and function; traditional risk factors of CVD; and the related psychological outcomes of ischaemic stroke among older community adults at risk of ischaemic stroke. Our sample is representative of the population at risk for ischaemic stroke because all of them were recruited from the older population in the general community. A standardized and supervised Baduanjin exercise training programme makes it easy to reproduce. Furthermore, we had thorough recordings of exercise adherence and physical activity levels in the two groups. Second, no specific exercise intervention was used in the control group, which means that the between-group differences were due to the Baduanjin exercise training.

The main limitation of our study was that nine cerebral arteries with forty-five haemodynamic parameters (five parameters per artery) were selected as the primary outcomes, which may thereby increase the risk of detecting differences between groups by chance and making type I errors. Furthermore, we indirectly assessed CBF and cerebral vascular function using the cerebral haemodynamic parameters. Although it is well established that the blood flow velocity of some cerebral arteries may be considered a reliable indicator of cerebral perfusion at rest51, the positive changes in those haemodynamic parameters may not directly lead to improvements in CBF and cerebral vascular function. Second, a double-blinded study design was not possible due to the difficulty in administration and operation. Therefore, participants in the Baduanjin training group might have had higher expectations of the intervention effect. This awareness of intervention assignment might have introduced some bias into the results. Third, the 12-week follow-up assessment may not have been long enough to observe long-term effects, such as clinical events related to ischaemic stroke. Additional long-term randomized controlled trials should be conducted to determine whether and to what extent improvements in CBF and cerebral vascular function after Baduanjin training affect disease activity and the clinical events of ischaemic stroke in older community adults. Finally, Due to the difference of percentage of fibrillation atrial between the dropped out participants and the participants finished the study, it may cause to some extent confounding effect to the main results.

Conclusion

This study demonstrated that Baduanjin significantly contributed to modulating cerebral haemodynamic parameters, reducing blood pressure and improving anthropometric parameters, mood, sleep quality and quality of life. Baduanjin exercise may be a useful and feasible strategy to reduce the risk of ischaemic stroke in older community populations.

Acknowledgements

We thank the participants and staff at the communities and hospitals for their work in this project, including the Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital and the Health Check Center of the Second People’s Hospital of Fujian Province. This study was supported by the Programme for Fostering Middle-Aged and Young Key Talent at Fujian Provincial Health and Family Planning Commission (2014-ZQN-ZD-27) and the Collaboration Innovation Center for Rehabilitation Technology (X2012002-Xietong).

Author Contributions

C.L.D. and Z.G.H. conceived and designed the study protocol. Z.G.H. wrote the manuscript. T.J. was in charge of coordination and direct implementation. C.B. and F.Q.Y. managed the training location and the follow-up. L.Q. instructed the participants in Baduanjin training. All authors contributed to drafting the manuscript and have read and approved the final manuscript.

Availability of Data and Materials

The datasets used and/or analysed during the current study are available from the corresponding author upon request.

Competing Interests

The authors declare no competing interests.

Footnotes

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  • 1.Writing group members et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–e215. doi: 10.1161/CIRCULATIONAHA.109.192667. [DOI] [PubMed] [Google Scholar]
  • 2.Roth GA, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015;372:1333–41. doi: 10.1056/NEJMoa1406656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Feigin VL, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990–2013: the GBD 2013 Study. Neuroepidemiology. 2015;45:161–176. doi: 10.1159/000441085. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Lackland DT, et al. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke. 2014;45:315–53. doi: 10.1161/01.str.0000437068.30550.cf. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Allen CL, Bayraktutan U. Risk factors for ischaemic stroke. Int J Stroke. 2008;3:105–116. doi: 10.1111/j.1747-4949.2008.00187.x. [DOI] [PubMed] [Google Scholar]
  • 6.The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25:457–507. doi: 10.1159/000131083. [DOI] [PubMed] [Google Scholar]
  • 7.O’Donnell MJ, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–23. doi: 10.1016/S0140-6736(10)60834-3. [DOI] [PubMed] [Google Scholar]
  • 8.Hankey GJ. INTERSTROKE Study and the EPITHET Trial. Stroke: fresh insights into causes, prevention, and treatment. Lancet Neurol. 2011;10:2–3. doi: 10.1016/S1474-4422(10)70279-9. [DOI] [PubMed] [Google Scholar]
  • 9.Di LS, Koch G, Diomedi M, Stanzione P, Sallustio F. Stroke prevention: managing modifiable risk factors. Stroke Res Treat. 2012;2012:391538. doi: 10.1155/2012/391538. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Zafar A, Al-Khamis FA, Al-Bakr AI, Alsulaiman AA, Msmar AH. Risk factors and subtypes of acute ischemic stroke. A study at King Fahd Hospital of the University. Neurosciences (Riyadh). 2016;21:246–51. doi: 10.17712/nsj.2016.3.20150731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Gupta A, et al. Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion: a systematic review and meta-analysis. Stroke. 2012;43:2884–91. doi: 10.1161/STROKEAHA.112.663716. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Bramlett HM, Dietrich WD. Pathophysiology of cerebral ischemia and brain trauma: similarities and differences. J Cereb Blood Flow Metab. 2004;24:133–50. doi: 10.1097/01.WCB.0000111614.19196.04. [DOI] [PubMed] [Google Scholar]
  • 13.Bor-Seng-Shu E, et al. Cerebral hemodynamics: concepts of clinical importance. Arq Neuropsiquiatr. 2012;70:352–6. doi: 10.1590/S0004-282X2012000500009. [DOI] [PubMed] [Google Scholar]
  • 14.Meng L, et al. Cardiac output and cerebral blood flow: the integrated regulation of brain perfusion in adult humans. Anesthesiology. 2015;123:1198–208. doi: 10.1097/ALN.0000000000000872. [DOI] [PubMed] [Google Scholar]
  • 15.Grüne F, Kazmaier S, Stolker RJ, Visser GH, Weyland A. Carbon dioxide induced changes in cerebral blood flow and flow velocity: role of cerebrovascular resistance and effective cerebral perfusion pressure. J Cereb Blood Flow Metab. 2015;35:1470–7. doi: 10.1038/jcbfm.2015.63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2:161–92. [PubMed] [Google Scholar]
  • 17.Kim YS, et al. Dynamic cerebral autoregulatory capacity is affected early in Type 2 diabetes. Clin Sci (Lond). 2008;115:255–62. doi: 10.1042/CS20070458. [DOI] [PubMed] [Google Scholar]
  • 18.Muller M, et al. Hypertension and longitudinal changes in cerebral blood flow: the SMART-MR study. Ann Neurol. 2012;71:825–33. doi: 10.1002/ana.23554. [DOI] [PubMed] [Google Scholar]
  • 19.Yu, H., Huang, G.P., Yang, Z., Liang, F. & Ludwig, B. The Influence of Normal and Early Vascular Aging on Hemodynamic Characteristics in Cardio- and Cerebrovascular Systems. J Biomech Eng. 138, 10.1115/1.4033179 (2016). [DOI] [PubMed]
  • 20.Suri MF, et al. Prevalence of Intracranial Atherosclerotic Stenosis Using High-Resolution Magnetic Resonance Angiography in the General Population: The Atherosclerosis Risk in Communities Study. Stroke. 2016;47:1187–93. doi: 10.1161/STROKEAHA.115.011292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Zhang S, et al. Prevalence and risk factors of asymptomatic intracranial arterial stenosis in a community-based population of Chinese adults. Eur J Neurol. 2013;20:1479–85. doi: 10.1111/j.1468-1331.2012.03856.x. [DOI] [PubMed] [Google Scholar]
  • 22.Haskell WL, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1081–93. doi: 10.1161/CIRCULATIONAHA.107.185649. [DOI] [PubMed] [Google Scholar]
  • 23.Eckel RH, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S76–99. doi: 10.1161/01.cir.0000437740.48606.d1. [DOI] [PubMed] [Google Scholar]
  • 24.Kernan WN, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–236. doi: 10.1161/STR.0000000000000024. [DOI] [PubMed] [Google Scholar]
  • 25.Koh TC. Baduanjin—an ancient Chinese exercise. Am J Chin Med. 1982;10:14–21. doi: 10.1142/S0192415X8200004X. [DOI] [PubMed] [Google Scholar]
  • 26.Zou, L., Wang, C., Chen, X. & Wang, H. Baduanjin Exercise for Stroke Rehabilitation: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health. 15, 600 (2018). [DOI] [PMC free article] [PubMed]
  • 27.Zou L, et al. Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2018;15:321. doi: 10.3390/ijerph15020321. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Zeng YG, Zhou XQ, Wang AL, Yang B, Wang ST. Research on the impacts of fitness Qigong Baduanjin on figure and physical function among the middle-aged and aged people. J Beijing Sport Univ. 2005;9:1207–1209. [Google Scholar]
  • 29.Chen MC, Liu HE, Huang HY, Chiou AF. The effect of a simple traditional exercise programme (Baduanjin exercise) on sleep quality of older adults: a randomized controlled trial. Int J Nurs Stud. 2012;49:265–273. doi: 10.1016/j.ijnurstu.2011.09.009. [DOI] [PubMed] [Google Scholar]
  • 30.Cheng FK. Effects of Baduanjin on mental health: a comprehensive review. J Bodyw Mov Ther. 2015;19:138–149. doi: 10.1016/j.jbmt.2014.11.001. [DOI] [PubMed] [Google Scholar]
  • 31.Wu YM, Lin KL, Chen RF. Research the intervention with Baduanjin exercise and healthy education to the 175 plasma glucose of diabetes mellitus subhealthy state. Chin Primary Health Care. 2008;22:80–82. [Google Scholar]
  • 32.Xiong X, Wang P, Li S, Zhang Y, Li X. Effect of Baduanjin exercise for hypertension: a systematic review and meta-analysis of randomized controlled trials. Maturitas. 2015;80:370–8. doi: 10.1016/j.maturitas.2015.01.002. [DOI] [PubMed] [Google Scholar]
  • 33.Mei L, Chen Q, Ge L, Zheng G, Chen J. Systematic review of chinese traditional exercise baduanjin modulating the blood lipid metabolism. Evid Based Complement Alternat Med. 2012;2012:282131. doi: 10.1155/2012/282131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Zheng, G. et al. Primary prevention for risk factors of ischemic stroke with Baduanjin exercise intervention in the community elder population: study protocol for a randomized controlled trial. Trials. 15, 113, doi: 10.1186 (2014). [DOI] [PMC free article] [PubMed]
  • 35.Wang, L. D. Screening of subjects at high risk for stroke [M]. Beijing: Screening and Prevention Program of Stroke Organized by Ministry of Public Health Press. 2–4 (2012).
  • 36. Health Qigong Management Center of General Administration of Sport of China: Health Qigong-Baduanjin. Beijing: People’s Sports Publishing House of China (2003).
  • 37.Niehaus L, Lehmann R, Röricht S, Meyer BU. Age-related reduction in visually evoked cerebral blood flow responses. Neurobiol Aging. 2001;22:35–8. doi: 10.1016/S0197-4580(00)00212-8. [DOI] [PubMed] [Google Scholar]
  • 38.Ainslie PN, et al. Elevation ctivity prevents age-related impai with aerobic fitness throughout healthy human ageing. J Physiol. 2008;586:4005–4010. doi: 10.1113/jphysiol.2008.158279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Taddei S, et al. Physical activity prevents age-related impairment in nitric oxide availability in elderly athletes. Circulation. 2000;101:2896–901. doi: 10.1161/01.CIR.101.25.2896. [DOI] [PubMed] [Google Scholar]
  • 40.Ainslie PN, et al. Elevation in cerebral blood flow velocity with aerobic fitness throughout healthy human ageing. J Physiol. 2008;586:4005–10. doi: 10.1113/jphysiol.2008.158279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Wang Y, Li M, Dong F, Zhang J, Zhang F. Physical exercise-induced protection on ischemic cardiovascular and cerebrovascular diseases. Int J Clin Exp Med. 2015;8:19859–66. [PMC free article] [PubMed] [Google Scholar]
  • 42.Nagata K, et al. Cerebral circulation in aging. Ageing research review. 2016;30:49–60. doi: 10.1016/j.arr.2016.06.001. [DOI] [PubMed] [Google Scholar]
  • 43.Querido JS, Sheel AW. Regulation of cerebral blood flow during exercise. Sports Med. 2007;37:765–782. doi: 10.2165/00007256-200737090-00002. [DOI] [PubMed] [Google Scholar]
  • 44.Bailey DM, et al. Elevated aerobic fitness sustained throughout the adult lifespan is associated with improved cerebral hemodynamics. Stroke. 2013;44:3235–8. doi: 10.1161/STROKEAHA.113.002589. [DOI] [PubMed] [Google Scholar]
  • 45.Zheng G, et al. The effect of Baduanjin exercise for physical and psychological wellbeing of college students: study protocol for a randomized controlled trial. Trials. 2013;14:422. doi: 10.1186/1745-6215-14-422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Kodama S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301:2024–35. doi: 10.1001/jama.2009.681. [DOI] [PubMed] [Google Scholar]
  • 47.Mahdiabadi J, Gaeini AA, Kazemi T, Mahdiabadi MA. The effect of aerobic continuous and interval training on left ventricular structure and function in male non-athletes. Biol Sport. 2013;30:207–11. doi: 10.5604/20831862.1059302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Spruit MA, et al. COPD and exercise: does it make a difference? Breathe (Sheff). 2016;12:e38–49. doi: 10.1183/20734735.003916. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Platt C, Houstis N, Rosenzweig A. Using exercise to measure and modify cardiac function. Cell Metab. 2015;21:227–36. doi: 10.1016/j.cmet.2015.01.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Li R, et al. The effect of baduanjin on promoting the physical fitness and health of adults. Evid Based Complement Alternat Med. 2014;2014:784059. doi: 10.1155/2014/784059. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Serrador JM, Picot PA, Rutt BK, Shoemaker JK, Bondar RL. MRI measures of middle cerebral artery diameter in conscious humans during simulated orthostasis. Stroke. 2000;31:1672–1678. doi: 10.1161/01.STR.31.7.1672. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets used and/or analysed during the current study are available from the corresponding author upon request.


Articles from Scientific Reports are provided here courtesy of Nature Publishing Group

RESOURCES