Effect of Baduanjin on pulmonary rehabilitation outcomes in patients with moderate chronic obstructive pulmonary disease: a multi-center randomized controlled trial

Effect of Baduanjin on pulmonary rehabilitation outcomes in patients with moderate chronic obstructive pulmonary disease: a multi-center randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Baduanjin on pulmonary rehabilitation outcomes in patients with moderate chronic obstructive pulmonary disease: a multi-center randomized controlled trial Xuan Chen, Cuiping Fu, Xiongbiao Wang, Meng Sun, Jindong Shi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2847660/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Effect of Baduanjin, as a traditional Chinese mindful movement, on patients with moderate chronic obstructive pulmonary disease (COPD), was still unknown. The aim of our study was to evaluate its efficiency on pulmonary function and exercise capacity in moderate COPD patients. Method: A multi-center randomized controlled trial about moderate COPD patients were collected from ten hospitals in Shanghai. Tri-Ball® Respiratory training was used as the control PR intervention in this trail to evaluate the efficiency of Baduanjin. After signing informed consent, all participants recruited were followed a two-week run-in period. Participants were randomly assigned into four groups, namely Baduanjin alone, Tri-Ball® Respiratory training alone, Baduanjin combined with respiratory training, and the control group. Each group lasted for 12 weeks. The outcome assessments were conducted at four time points, namely at the 4 th week and 8 th week during the intervention, at the end of 12-week pulmonary rehabilitation program, and at the end of the 24-week follow up. Result: A total of 240 participants were recruited in this prospective randomized controlled trail. After exclusion, 217 moderate COPD patients were analyzed in this study. After 12 weeks, Baduanjin traing showed improvement in pulmonary function (percent of FEV1 predicted, FEV1 pred%) and dyspnea (modified British medical research council questionnaire, mMRC scale), exercise capacity (six-minute walk distance, 6MWD), and therapeutic efficiency (COPD assessment test, CAT) in moderate COPD patients. Banduanjin presented better PR results than the control. Besides, combining Baduanjin with additional inspiratory muscle training presented better PR result than banduanjin or inrespiratory muscle exercise alone. The positive effect on parameter of pulmonary function, exercise capacity and therapeutic efficiency were perceived by subjects and continued to maintain after 24-week follow up. Conclusion: The results of this trial indicated that traditional Baduanjin exercise could prevent COPD lung function deterioration, and provide a simple, and daily pulmonary rehabilitation measure for the patients with moderate COPD. Trial Registration: The study protocol has been registered with the Clinical Trial Registry (NCT03892629). Chronic obstructive pulmonary disease Baduanjin pulmonary rehabilitation inspiratory muscle training Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Chronic obstructive pulmonary disease (COPD) is characterized by partially reversible airflow obstruction. In addition to the progressive deterioration of lung function, COPD is associated with a decrease in exercise tolerance, physical activity, muscle force, occupational performance, mental status, and activities of daily living and an increase in medical costs. The estimated prevalence of COPD in a representative sample of adults aged 40 years or older in China in 2014-2015 was 13.6%, indicating that COPD has become a major public health problem [1]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend using pulmonary rehabilitation (PR) for the non-pharmacological treatment of COPD. Baduanjin (also known as Eight-Section Brocades) is a regarded as traditional Chinese Qigong in China for more than 1000 years and has also been used in PR for COPD. Qigong is a mind-body exercise form that uses meditation, breathing, and movement to increase energy and enable the body to heal itself. The exercise and healing techniques used were developed in ancient China and Tibet. It is practiced for a variety of reasons and has countless health-related benefits. Since the establishment of the Chinese Health Qigong Association in 2004, Baduanjin has used in health improvement and rehabilitation and is being increasingly prescribed by health practitioners in China and abroad [2]. Baduanjin consists of eight different postures, and users are required to control breathing and perform movements to promote the flow of internal energy (“qi”) in the body. Taking these breathing and body movements together, Baduanjin is recognized as a mindful movement in tender intensity [3]. Baduanjin reduces muscle wasting [4] and disturbed breathing patterns, improving exercise capacity [5]. Thus, COPD patients, especially those with moderate stable stage, may benefit from Baduanjin. As an healthy Qigong, Baduanjin is suitable for COPD patients to practice at home, and increase metabolic equivalent (MET) [6] and aerobic capacity [7]. In addition, Baduanjin prevents pulmonary function impairment in mild COPD patients [8]. However, high-quality evidence of the effectiveness of Baduanjin in reducing or preventing lung function deterioration in COPD patients is limited. Moreover, the use of Baduanjin for PR in patients with moderate COPD has not been determined. Inspiratory muscle training (IMT) improves lung function in COPD patients [9]. The American Thoracic Society and European Respiratory Society stated that IMT could be integrated into systemic training programs for COPD patients [10]. However, whether Baduanjin alone, IMT alone or combined with IMT will be better for PR in COPD is unknown. This multi-center, prospective, single-blind randomized controlled trial assessed the effect of Baduanjin , IMT, and Baduanjin combined with IMT on pulmonary capacity in patients with moderate COPD. Methods Study design Outcomes were evaluated by researchers blinded to treatment allocation. The study was performed from January 1, 2021, to December 30, 2021, and recruited patients from 10 hospitals in Shanghai (Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai Pulmonary Hospital, Shanghai Putuo District Central Hospital, Shanghai Tong Ren Hospital, Shanghai Songjiang District Fangta Hospital, Shanghai Wusong Central Hospital, and Shanghai Pudong Hospital. All participants gave written informed consent. Institutional ethical approval was sought from Zhongshan Hospital before the study began (No. B2018-216R). The study protocol was registered in the clinical trial register as NCT03892629 (27/03/2019). Participants and setting Institutional ethical approval was sought from Zhongshan Hospital before the study began (No. B2018-216R). The inclusion criteria were: (1) age 40-80 years, (2) patients with COPD confirmed by medical records and airflow limitation in accordance with GOLD criteria [11] (forced expiratory volume in first second to forced vital capacity (FEV1/FVC) was less than 70%), measured after postbronchodilator, (3) COPD patients with GOLD stage 2 or 3 (percentage of forced expiratory volume in first second (FEV1%) ≥30% and < 80% of predicted range), (4) participants signed the informed consent, (5) patients who did not enroll in other PR programs within 6 months before the beginning of the study, (6) absence of other disabling diseases, including stroke, heart disease, and Parkinson’s disease, (7) patients who were clinically stable, with no emergency department visits or hospital admissions due to pulmonary diseases within 4 weeks before the beginning of the study, (8) Written informed consent was obtained from participants. The exclusion criteria were patients with: (1) severe COPD, (2) restricted movements caused by other diseases, (3) acute COPD exacerbations, (3) contraindications to exercise training, (4) other severe acute or chronic organic diseases or mental disorders. Sample size and power calculation The 6-min walk distance (6MWD) test was used as a reference for sample size calculation in COPD patients [12]. The sample size was based on a minimum difference of 12 m in the 6MWD results between the control group (CG) and the Baduanjin group (BG). With a power of 80%, alpha of 5% (two-sided), and a drop-out rate of 10%, the minimum sample size per group was 60. Thus, 240 participants were recruited. Participants were randomly assigned to four different groups using random numbers generated by SPSS software, and randomization was performed by a researcher blinded to group allocation. Random number table will be placed in sealed opaque envelopes to blind the group allocation until the end of the trial. Intervention protocols Participants were randomly assigned to four groups at 1:1:1:1 ratio. A minimum of 12 supervised sessions are recommended in PR programs [13]. Thus, we adopted a 12-week PR program. The BG and breathing training group (BTG) performed training 5 days per week, twice a day for 12 weeks, with 30-min sessions. Each participant in the BG received 30-min training sessions on Baduanjin for 5 days per week. Sessions in the first week were performed by a trained therapist, followed by home-based training with audiovisual material. The BTG was trained by professional therapists using a Tri-Ball ® incentive spirometer for breathing exercises. The combined training group (CTG) underwent Baduanjin and Tri-Ball-based breathing training following the protocols described above. The BG, BTG, and CTG received home-based training for 11 weeks, performing the exercises presented in the videos, with 30 min of Baduanjin exercises and 30 min of breathing training, 5 days per week, twice per day for 12 weeks. The CG did not undergo PR or exercise training. All participants gave written informed consent and completed a 2-week run-in period. The participants were prescribed budesonide/formoterol (160/4.5 mg) in a single inhaler twice daily until the end of the study. In addition, all participants in the intervention groups recorded their activities in a log book, including the date, time of day, and exercise duration. Outcome measurements Data were collected at five time points: at the beginning of the intervention (after the 2-week run-in period), at weeks 4 and 8 of the PR program, at the end of the 12-week program, and at 24-week follow-up. The primary outcome was exercise capacity (6MWD). The secondary outcomes were pulmonary function indicators, including forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), percentage of predicted FEV1 (FEV1 pred%), dyspnea (modified British Medical Research Council [mMRC] scale), COPD assessment test (CAT) scores, St. George’s respiratory questionnaire (SGRQ) scores [14], and TCM syndrome scores. Outcomes were assessed according to the American Thoracic Society (ATS) guidelines [15-16]. The quantified and classified TCM syndrome scores were measured according to guidelines and consensus on COPD [17, 18]. CAT, mMRC, and TCM scores, body temperature, blood pressure, respiratory rate, and heart rate were measured at each time point. The study flowchart is shown in Figure 1. Statistical analysis Data are presented as means ± standard deviations for normally distributed continuous variables and numbers and percentages for categorical variables. The significance of differences between means of normally distributed continuous variables was assessed using unpaired Student’s t -test. Non-normally distributed data were analyzed by Wilcoxon rank-sum test or Fisher’s exact test. Statistical analyses were performed using R software. A two-tailed P <0.05 was considered statistically significant. Results Characteristics of the study population The demographic and baseline characteristics of the study population by group allocation are summarized in Table 1. Among 240 participants, 23 (9.58%) were lost to follow-up because of noncompliance with exercise regimens (three cases), worsening of subjective symptoms (eight cases), interruption of treatment (five cases), and missing data in logbooks (seven cases). A total of 217 participants (171 men [78.80%] and 46 women [21.20%]) were included in the analysis, 55 in the BG, 54 in the BTG, 55 in the CTG, and 53 in the CG. The mean age was 63 (46–86) years. Outcomes Results of parameters above were showed at each time point. 6MWD, as the primary outcome, was improved in groups BG group and BT group ( P <0.05), and remarkably improved in combination training group compared to the control group( P <0.01, figure 2). The parameter of FEV1% was increased in single PR intervention groups (BG group and BT group)( P <0.05), and markedly increased in CT group ( P <0.01, figure 3). The CAT score in BG group or BT group or CT were lower than the control group ( P <0.05 figure 4). TCM symptom score in BG group or BT or CT group were lower than the control group ( P <0.05, figure 5). No obvious decrease was shown in CT group in CAT score and TCM symptom score compared to the BG or BT group ( figure 4 and figure 5). Data of CAT, mMRC, TCM score and basic vital signs at the 4th week was shown in table 2. Data of the 8th week were shown in table 3. Assessment of outcome after 12-week PR training was shown in table 4. Table 5 showed the data of intervention after 24-week follow up. No statistic difference was shown in terms of mMRC score ( P >0.05, figure 6). No statistic difference between groups was noticed in SGRQ score and some basic vital signs(Temperature(℃), Systolic pressure, Diastolic pressure, Respiratory rate, Heart rate (bp)) at each point (table 2-5). Discussion Our study showed that Baduanjin, as a mindful movement intervention, improved FEV1% and 6MWD in COPD patients. Combining Baduanjin with additional inspiratory muscle training exerted better PR result than Banduanjin or inrespiratory muscle training alone. The improvement in pulmonary function and exercise capacity persisted after 24-week follow up. No improvement in CAT and TCM syndrome scores was noticed at 4-week and 8-week of PR. Body temperature, blood pressure, heart rate, and respiratory rate were stable in the intervention groups, demonstrating the safety of this PR study. The 12-week Baduanjin training increased 6MWD. Motor impairment in the lower limbs may lead to a progressive decline in activities of daily living. Baduanjin exercises involve postural adjustments, breathing regulation, and mental relaxation. Five of the eight sections of Baduanjin emphasized the lower extremity training with squat position holding, body weight shifting and mindful breathing. Studies revealed that skeletal muscle fatigue limited exercise capacity in a remarkable proportion of COPD patients[19, 20]. A possible mechanism by which Baduanjin improves exercise capacity in COPD patients is strengthening skeletal muscles, especially in the lower limbs. In our study, Baduanjin improved FEV1% in participants after 12-week Baduanjin intervention. Similar trends of improvement in FEV1% was also observed in another Retrospective Randomized Controlled Trial[21] involving Baduanjin exercise. Meta-analysis[22] included 14 RCTs showed that Baduanjin was effective in improving FEV 1% (Hedge’s g = 0.38, CI 0.21 to 0.56, p < 0.001,I2 = 54.74% ) as compared to usual care. Slow, intentional, and mindful breathing is a key element of Baduanjin.COPD patients benefit from slow and deep breathing, which improves autonomic function [23]. Respiratory muscle weakness contributes to breathlessness and exercise impairment in COPD [24]. Furthermore, Baduanjin coordinated diaphragmatic breathing with muscle stretching, relaxation and postural alignment. Thus, Baduanjin was helpful in strengthening the diaphragmatic muscle and improving breathing pattern in COPD patients. In our study, we found that Baduanjin improve FEV1% after 12-week training. Baduanjin could be effective in improving pulmoanry function in COPD patients. Baduanjin is usually practiced with soft body stretching and focuses on self-awareness and relaxation. Baduanjin, as an aerobic exercise, could improve the quality of life[25]. Our results showed that participants recieved Baduanjin training had lower CAT, SGRQ, and TCM syndrome scores, demonstrating its potential benefit as PR intervention for COPD patients. Baduanjin improved pulmonary function and exercise capacity to a greater extent than breathing training alone, demonstrated by better FEVI% and 6MWD in the BG. However, improvement in FEVI% and 6MWD were more prominant in the CTG than in the other three groups. Baduanjin combined with IMT improves PR outcomes in COPD patients. There were no significant differences in mMRC scores among the four groups after the 12-week intervention and at 24-week follow-up. However, the improvement in pulmonary function was higher in the BG and CTG. Breathlessness is defined as mMRC of ≥2 [26]. The percentage of participants in the CTG with mMRC of <2 was higher at 24-week follow-up than at the beginning of the intervention. In our cohort, the improvement in pulmonary function and physical capacity was maintained after 24-week follow up. Rehabilitation outcomes depend on self-management and intervention adherence. Compared with other traditional Chinese exercises such as Tai Chi, Baduanjin consists of eight movements that are less physically and cognitively demanding and are easier to learn and follow, improving compliance. The TRI-BALL ® spirometer consists of three transparent chambers, each with a plastic ball. The balls are gradually raised in the chambers during inhalation, allowing patients to intuitively see the increase in inspiratory volume through the raise of balls. This positive feedback of inhalation performance could be a specific adherence strategy in pulmonary rehabilitation. This study has limitations. First, the effect of Baduanjin exercise on skeletal muscle function was not compared with other resistance exercise interventions, including weight lifting and elastic band exercises. Second, as an exercise intervention, the patients were not blinded to treatment interventions, potentially leading to bias. Third, the study was performed in one city, and the results are not representative of other regions of China. Therefore, additional studies with larger sample sizes are necessary to increase awareness of the effectiveness of Baduanjin in pulmonary rehabilitation [27]. Conclusion The results of this trial indicated that traditional Baduanjin exercise could prevent COPD lung function deterioration, and provide a simple, and daily pulmonary rehabilitation measure for the patients with moderate COPD. Abbreviations COPD: chronic obstructive pulmonary disease; GOLD: Global Initiative for Chronic Obstructive Lung Disease; PR: pulmonary rehabilitation;MET: metabolic equivalent; IMT:Inspiratory muscle training; BG: Baduanjin group; BT: breath training; CT: combination training; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George's respiratory questionnaire; T.C.M.: Traditional Chinese Medicine. Declarations Ethics approval and consent to participate: All participants was given written informed consent. Informed consent was obtained from all subjects and/or their legal guardian(s) before recruitment. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the research ethics committee of Zhongshan Hospital before the study began (No. B2018-216R). The study protocol was registered in the clinical trial register as NCT03892629. Informed consent was obtained from all subjects and/or their legal guardian(s) Consent for publication: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Availability of data and materials: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request by healthcare providers, investigators, and researchers to address specific scientific or clinical objectives. The corresponding author is committed to reviewing requests from researchers for access to clinical trial protocols, de-identified patient-level clinical trial data, and study-level clinical trial data. Competing interests The authors declare that they have no competing interests. Funding: This work was funded by the National Natural Science Foundation of China (82100109), National Key Research and Development Program of China (2018YFC1313600), Shanghai Science and Technology Commission（20DZ2272200）, and Shanghai Key Clinical Specialty Construction Project (No. shslczdzk05101), National Science Foundation of Jiangsu Province (BK20180198) . Authors' contributions (1) Conception and design: Shanqun Li and Wei Zhang (2)Administrative support：Xiongbiao Wang (3) Provision of study materials or patients: Xuan Chen, Cuiping Fu and Xiongbiao Wang. (4) Collection and assembly of data: Xuan Chen, Cuiping Fu and Meng Sun (5) Data analysis and interpretation: Xuan Chen, Cuiping Fu and Jindong Shi (6) Manuscript writing: All authors. (7) Final approval of manuscript: All authors. Acknowledgment Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request by healthcare providers, investigators, and researchers to address specific scientific or clinical objectives. The corresponding author is committed to reviewing requests from researchers for access to clinical trial protocols, de-identified patient-level clinical trial data, and study-level clinical trial data. References Fang L, Gao P, Bao H, et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study[J]. Lancet Respir Med. 2018, 6(6): 421-430. Sancier K M. Medical applications of qigong[J]. Altern Ther Health Med, 1996, 2(1): 40-6. Chen X , Jiang W , Lin X , et al. Effect of an exercise-based cardiac rehabilitation program "Baduanjin Eight-Silken-Movements with self-efficacy building" for heart failure (BESMILE-HF study): study protocol for a randomized controlled trial[J]. Trials. 2018, 19(1):150 Van Helvoort H A, Heijdra Y F, Thijs H M, et al. Exercise-induced systemic effects in muscle-wasted patients with COPD[J]. Med Sci Sports Exerc. 2006, 38(9): 1543-52. Ng B H P , Tsang H W H , Jones A Y M , et al. Functional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trial.[J]. Journal of alternative and complementary medicine (New York, N.Y.). 2011, 17(3):243-251. Chao Y F, Chen S Y, Lan C, et al. The cardiorespiratory response and energy expenditure of Tai-Chi-Qui-Gong[J]. Am J Chin Med. 2002, 30(4): 451-61. Lan C, Chou S W, Chen S Y, et al. The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners[J]. Am J Chin Med. 2004, 32(1): 141-50. Yang Y, Chen K, Tang W, et al. Influence of Baduanjin on lung function, exercise capacity, and quality of life in patients with mild chronic obstructive pulmonary disease[J]. Medicine (Baltimore). 2020, 99(37): e22134. Figueiredo R I N, Azambuja A M, Cureau F V, et al. Inspiratory Muscle Training in COPD[J]. Respir Care. 2020, 65(8): 1189-1201. Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation[J]. Am J Respir Crit Care Med. 2006, 173(12): 1390-413. Vogelmeier C F, Criner G J, Martinez F J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary[J]. Am J Respir Crit Care Med. 2017, 195(5): 557-582. Cameron-Tucker H L, Wood-Baker R, Joseph L, et al. A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD[J]. Int J Chron Obstruct Pulmon Dis. 2016, 11: 1991-2000. Blackstock F C, Lareau S C, Nici L, et al. Chronic Obstructive Pulmonary Disease Education in Pulmonary Rehabilitation. An Official American Thoracic Society/Thoracic Society of Australia and New Zealand/Canadian Thoracic Society/British Thoracic Society Workshop Report[J]. Ann Am Thorac Soc. 2018, 15(7): 769-784. Jones P W, Quirk F H, Baveystock C M, et al. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire[J]. Am Rev Respir Dis. 1992, 145(6): 1321-7. Erratum: ATS Statement: Guidelines for the Six-Minute Walk Test[J]. Am J Respir Crit Care Med. 2016, 193(10): 1185. Graham B L, Steenbruggen I, Miller M R, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement[J]. Am J Respir Crit Care Med. 2019, 200(8): e70-e88. Martinez F J, Fabbri L M, Ferguson G T, et al. Baseline Symptom Score Impact on Benefits of Glycopyrrolate/Formoterol Metered Dose Inhaler in COPD[J]. Chest. 2017, 152(6): 1169-1178. Zhou Z, Zhou A, Zhao Y, et al. Evaluating the Clinical COPD Questionnaire: A systematic review[J]. Respirology. 2017, 22(2): 251-262. Layec G, Hart C R, Trinity J D, et al. Oxygen delivery and the restoration of the muscle energetic balance following exercise: implications for delayed muscle recovery in patients with COPD[J]. Am J Physiol Endocrinol Metab. 2017, 313(1): E94-e104. Marklund Sarah, Bui Kim-Ly, Nyberg Andre. Measuring and monitoring skeletal muscle function in COPD: current perspectives[J]. International journal of chronic obstructive pulmonary disease. 2019,14:1825-1838. Bi J, Yang W, Hao P, et al. WeChat as a Platform for Baduanjin Intervention in Patients With Stable Chronic Obstructive Pulmonary Disease in China: Retrospective Randomized Controlled Trial[J]. JMIR Mhealth Uhealth. 2021, 9(2): e23548. Liu S J, Ren Z, Wang L, et al. Mind⁻Body (Baduanjin) Exercise Prescription for Chronic Obstructive Pulmonary Disease: A Systematic Review with Meta-Analysis[J]. Int J Environ Res Public Health. 2018, 15(9). Van Gestel A J, Steier J. Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD)[J]. J Thorac Dis. 2010, 2(4): 215-22. O'brien K, Geddes E L, Reid W D, et al. Inspiratory muscle training compared with other rehabilitation interventions in chronic obstructive pulmonary disease: a systematic review update[J]. J Cardiopulm Rehabil Prev. 2008, 28(2): 128-41. Song R, Grabowska W, Park M, et al. The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis[J]. Parkinsonism Relat Disord. 2017, 41: 3-13. Zeng Y, Jiang F, Chen Y, et al. Exercise assessments and trainings of pulmonary rehabilitation in COPD: a literature review[J]. Int J Chron Obstruct Pulmon Dis. 2018, 13: 2013-2023. Rogers C, Keller C, Larkey L K. Perceived benefits of meditative movement in older adults[J]. Geriatr Nurs. 2010, 31(1): 37-51. Tables Table 1 Demographic data and baseline characteristics of the participants Variables BG group BT group CT group CG group Gender male 45(81.82%) 42(77.78%) 47(85.45%) 37(69.81%) female 10(18.18%) 12(22.22%) 8(14.55%) 16(30.19%) Age 66.7±6.7 68.0±6.5 67.3±7.1 66.7±8.1 Smoking Index ≤200 20(36.36%) 14(25.92%) 21(38.18%) 18(33.9%) (pack-years) 200-400 8(14.55%) 4(7.41%) 6(10.91%) 6(11.32%) >400 27(49.09%) 29(53.70%) 28(50.91%) 27(50.94%） Course of disease ≤5 17(30.91%) 19(35.19%) 21(38.18%) 22(41.51%) (year) (5-10) 24(43.64%) 21(38.89%) 24(43.64%) 18(33.96%) (10-20) 11(20.00%) 8(14.81%) 5(9.10%) 11(20.75%) >20 3(5.45%) 6(11.11%) 5(9.09%) 2(3.77%) Temperature,℃ 36.82(36.65,36.93) 36.84(36.6,36.95) 36.86(36.74,36.92) 36.84(36.62,37.06) Systolic pressure 121.01 ± 17.03 124.04 ± 16.52 120.05 ± 29.08 120.05 ± 20.50 Diastolic pressure 78.02 ± 11.53 80.03 ± 12.56 80.02 ± 18.05 80.07 ± 15.03 Respiratory rate 18.53 ± 2.43 19.06 ± 2.02 19.07 ± 2.53 19.04 ± 2.03 Heart rate (bp) 80.03 ± 10.00 81.03 ± 8.59 80.04 ± 9.06 81.03 ± 10.57 FEV1% 46.45±20.97 46.5 ± 14.73 46.9 ± 12.36 46.77 ± 13.64 6MWD (meters) 364.95± 84.34 366.04 ± 101.04 364.62 ± 102.13 365.16 ± 98.70 Score of CAT 19.87 ± 5.41 19.90 ± 6.38 20.181± 5.36 20.42 ± 6.38 T.C.M. score 5.00(4.00,7.50) 6.00(4.00,8.00) 5.00(4.00,7.50) 5.15 ± 2.83 SGRQ 31.00 ± 14.00 34.09 ± 11.90 33.35 ± 12.86 34.76 ± 12.20 mMRC 0 (n,%) 3 (5.5 %) 4 (7.41 %) 2 (3.6 %) 1 (1.89 %) mMRC 1 (n,%) 12 (21.8 %) 15 (27.78 %) 16 (29.1 %) 12 (22.64 %) mMRC 2 (n,%) 29 (52.7 %) 23 (42.59 %) 25 (45.5 %) 25 (47.17 %) mMRC 3 (n,%) 11 (20.0 %) 10 (18.52 %) 12 (21.8 %) 14 (26.42 %) mMRC 4 (n,%) 0 (0.0 %) 2 (3.70 %) 0 (0.0 %) 1 (1.89 %) Data are shown as mean ± SD or median (IQR), and categorical variables by number (%). BG: Baduanjin group; BT: breath training group; CT: combination training group; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George's respiratory questionnaire; T.C.M.: Traditional Chinese Medicine. Table 2 Assessment of outcome after 4-week PR intervention variables BG group BT Group CT Group Control group CAT 16.04±9.03 17.5818±5.56 18.03±10.05 18.78± 6.35 T.C.M. score 4.00(3.00,6.00) 5.00(3.50,7.00) 4.78±2.44 5.62±2.81 Temperature(℃) 36.82(36.51,37.05) 36.85(36.7,37.0) 36.84(36.73,36.95 ) 36.83(36.5,36.92) Systolic pressure 120.03±14.51 120.04±15.01 120.0±23.5 120.0±20.0 Diastolic pressure 80.02±9.52 75.05±19.07 78.0±15.5 79.03±12.55 Respiratory rate 19.07±2.53 20.03±3.06 19.0±3.0 19.06±2.04 Heart rate (bp) 82.15±6.51 82.31±6.87 79.44±6.51 81.02±7.05 mMRC 0 (n,%) 3(5.45%) 2(3.7%) 2(3.64%) 2(3.77%) mMRC 1 (n,%) 21(38.18%) 21(38.89%) 22(40.0%) 16(30.19%) mMRC 2 (n,%) 26(47.27%) 23(42.59%) 24(43.64%) 27(50.94%) mMRC 3 (n,%) 5(9.09%) 7(12.96%) 7(12.73%) 7(13.21%) mMRC 4 (n,%) 0(0.0%) 1(1.85%) 0(0.0%) 1(1.89%) Data are shown as mean ± SD or median (IQR), and categorical variables by number (%). BG: Baduanjin group; BT: breath training group; CT: combination training group; CG: controlled group; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; T.C.M.: Traditional Chinese Medicine. Table 3 Assessment of outcome after 8-week PR intervention variables BG group BT Group CT Group Control group CAT 15.02±9.01 16.04±6.52 15.84±6.12 18.25±6.02 T.C.M. score 4.00(3.00,5.50) 4.56±1.96 4.00(3.00,6.0) 5.42±2.55 Temperature,℃ 36.83(36.64,37.06) 36.75(36.43,37.06) 36.88(36.54,36.92) 36.84(36.65,37.03) Systolic pressure 120.02±10.55 123.05±18.03 120.01±21.55 120.04±21.56 Diastolic pressure 78.08±9.52 75.03±11.06 78.02±15.54 75.03±12.52 Respiratory rate 19.05±2.52 19.05±2.02 18.71±2.22 20.04±2.05 Heart rate (bp) 82.02±8.58 82.02±7.56 80.06±8.53 80.06±10.53 mMRC 0 (n,%) 2(3.63%) 4(7.41%) 2(3.63%) 2(3.77%) mMRC 1 (n,%) 29(52.73%) 22(40.74%) 23(41.82%) 17(32.08%) mMRC 2 (n,%) 21(38.18%) 22(40.7%) 24(43.64%) 26(49.06%) mMRC 3 (n,%) 3(5.45%) 5(9.26%) 6(10.91%) 7(13.21%) mMRC 4 (n,%) 0(0.0%) 1(1.85%) 0(0.0%) 1(1.89%) Data are shown as mean ± SD or median (IQR), and categorical variables by number (%). BT: breath training group; CT: combination training group; CG: controlled group; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; T.C.M.: Traditional Chinese Medicine. Table 4. Comparison of outcomes after 12- week PR intervention variables BG group BT Group CT Group Control group Temperature,℃ 36.92(36.72,37.04) 36.82(36.64, 37.07) 36.86(36.55,36.92) 36.84(36.55,37.06) Systolic pressure 120.08 ± 11.04 120.08 ± 10.53 120.06 ± 21.07 120.05 ± 23.53 Diastolic pressure 78.04 ± 8.56 75.06 ± 13.02 78.06 ± 12.54 76.05 ± 13.07 Respiratory rate 18.07 ± 3.04 19.03 ± 2.54 19.02 ± 3.06 19.04 ± 2.02 Heart rate (bp) 82.56 ± 7.76 82.02 ± 10.05 79.62 ± 8.45 80.04 ± 8.57 FEV1% 53.59±19.02 a 53.20±16.49 a 59.3±14.12 b 47.19±13.89 6MWD 405.58±102.06 a 408.09±111.01 a 451.98±113.63 b 364.27± 110.63 CAT 17.40±5.12 a 16.00±7.00 a 14.09±5.87 b 19.96±5.99 T.C.M. score 4.01±1.75 b 4.00(3.00,5.00) b 2.00(1.00,4.00) b 5.00(3.00,8.00) SGRQ 29.14±10.36 a 28.00±15.5 a 23.98±12.21 b 33.49±12.19 FEV1/FVC 59.78±9.22 58.49±11.36 58.30±8.71 55.25±11.59 mMRC 0 (n,%) 2 (3.64 %) 5 (9.26 %) 2 (3.64 %) 1 (1.89%) mMRC 1 (n,%) 29 (52.73 %) 23 (42.59 %) 30 (54.54 %) 19 (35.85 %) mMRC 2 (n,%) 22 (40.00 %) 20 (37.04 %) 21 (38.18 %) 26 (49.06 %) mMRC 3 (n,%) 2 (3.64 %) 5 (9.26 %) 2 (3.64 %) 6 (11.32 %) mMRC 4 (n,%) 0 (0.0 %) 1 (1.85 %) 0 (0.0 %) 1 (1.89 %) Data are shown as mean ± SD or median (IQR), and categorical variables by number (%). BT: breath training group; CT: combination training group; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George's respiratory questionnaire; T.C.M: Traditional Chinese Medicine. P value, difference among groups after 12- week PR intervention. a , with statistical difference when compared to the control group ( P <0.05); b , significant difference when compared to the control group ( P <0.01). Table 5. Comparison of outcomes after 3-month of follow up variables BG group BT Group CT Group Control group Temperature,℃ 36.74(36.55, 36.92) 36.84(36.63, 37.06 ) 36.76±0.30 36.74(36.52,36.92) Systolic pressure 120.03 ± 14.52 120.04 ± 16.05 120.06 ± 17.04 120.08 ± 21.05 Diastolic pressure 75.05 ± 10.53 78.08 ± 13.04 78.06 ± 13.04 75.06 ± 18.04 Respiratory rate 19.06 ± 3.03 19.06 ± 2.07 19.03 ± 3.06 19.05 ± 2.03 Heart rate (bp) 80.04 ± 8.56 82.03 ± 9.05 79.87 ± 7.82 80.02 ± 6.55 FEV1% 53.87±19.40 a 53.40±15.54 a 59.40±14.69 b 46.59±12.98 6MWD 408.31±110.54 a 408.84±115.01 a 454.87±119.75 b 365.22±113.09 CAT 17.00±5.88 a 17.00±8.00 a 14.49±6.16 b 19.00±11.00 T.C.M. score 3.00(2.00,4.00) b 4.00(2.00,5.00) b 2.00(1.00,3.00) b 5.00(3.00,8.00) SGRQ 28.93±10.54 a 27.00±13.50 a 22.00±19.50 b 33.65±12.32 FEV1/FVC 59.14±9.24 58.36±11.77 58.38±9.83 54.99±12.46 mMRC 0 (n,%) 7 (12.72 %) 4(7.41 %) 4(7.27 %) 1 (1.89 %) mMRC 1 (n,%) 35 (63.64%) 26 (48.15 %) 33 (60.00 %) 23 (43.39 %) mMRC 2 (n,%) 11 (20.00%) 18 (33.33 %) 18 (32.73 %) 20 (37.74 %) mMRC 3 (n,%) 2 (3.64 %) 5 (9.26 %) 0 (0.0 %) 8 (15.09%) mMRC 4 (n,%) 0 (0.0 %) 1 (1.85 %) 0 (0.0 %) 1 (1.89 %) Data are shown as mean ± SD or median (IQR), and categorical variables by number (%). BT: breath training group; CT: combination training group; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George's respiratory questionnaire; T.C.M: Traditional Chinese Medicine. P value, difference among groups after 3-month of follow up. a , with statistical difference when compared to the control group ( P <0.05); b , significant difference when compared to the control group ( P <0.01). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2847660","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":209348112,"identity":"3380368a-a8b3-499e-bc8c-0aa518ca9bc1","order_by":0,"name":"Xuan Chen","email":"","orcid":"","institution":"Shuguang Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Chen","suffix":""},{"id":209348113,"identity":"abe3b2ce-2ec5-49af-b325-68933cc25b33","order_by":1,"name":"Cuiping Fu","email":"","orcid":"","institution":"First Affiliated Hospital of Soochow University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cuiping","middleName":"","lastName":"Fu","suffix":""},{"id":209348114,"identity":"2ebce65a-a83d-4bcf-817b-45c703b7a489","order_by":2,"name":"Xiongbiao Wang","email":"","orcid":"","institution":"Putuo Hospital, Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiongbiao","middleName":"","lastName":"Wang","suffix":""},{"id":209348115,"identity":"2a9f4700-7f77-42b5-9503-4575282cea0f","order_by":3,"name":"Meng Sun","email":"","orcid":"","institution":"Shuguang Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Meng","middleName":"","lastName":"Sun","suffix":""},{"id":209348116,"identity":"4a4515d8-53b2-4bb9-bfb2-b5184b01737d","order_by":4,"name":"Jindong Shi","email":"","orcid":"","institution":"Shanghai Fifth People’s Hospital, Fudan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jindong","middleName":"","lastName":"Shi","suffix":""},{"id":209348117,"identity":"e6105580-227f-44c8-a039-f052cd2f014b","order_by":5,"name":"Wei Zhang","email":"","orcid":"","institution":"Shuguang Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""},{"id":209348118,"identity":"133466fd-a535-4b2a-a219-0b5dc1594fe7","order_by":6,"name":"Shanqun Li","email":"data:image/png;base64,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","orcid":"","institution":"Zhongshan Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shanqun","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2023-04-22 07:29:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2847660/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2847660/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":38609636,"identity":"9bc43a4f-cc39-4b81-82ca-aad9813b088f","added_by":"auto","created_at":"2023-06-15 14:58:24","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92762,"visible":true,"origin":"","legend":"\u003cp\u003eThe flow chart of recruitment and intervention process\u003c/p\u003e\n\u003cp\u003eBT: breath training group; CT: combination training group; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George's respiratory questionnaire; T.C.M: Traditional Chinese Medicine\u003c/p\u003e","description":"","filename":"image1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2847660/v1/199312329d729900baf804c1.jpeg"},{"id":38610909,"identity":"3000cfd1-5b71-49a5-831c-32bc5b30bf30","added_by":"auto","created_at":"2023-06-15 15:06:24","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53736,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of the 6MWD at the baseline, 12th week and 24-week of intervention.\u003c/p\u003e","description":"","filename":"image2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2847660/v1/875c25d5b2bdb7ddce8577fe.jpeg"},{"id":38609637,"identity":"9a64061d-bf3f-43f3-9b1e-37b013816b29","added_by":"auto","created_at":"2023-06-15 14:58:24","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52257,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of the FEV1 at the baseline, 12th week and 24-week of intervention.\u003c/p\u003e","description":"","filename":"image3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2847660/v1/97cc8c317f202da201b23418.jpeg"},{"id":38610910,"identity":"b48f39d4-12e3-43e9-909a-1ed9f14c2f78","added_by":"auto","created_at":"2023-06-15 15:06:24","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":56960,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of the CAT score at the baseline, 4th week, 8th week, 12th week and 24-week of intervention.\u003c/p\u003e","description":"","filename":"image4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2847660/v1/eac229d8a17953264968140f.jpeg"},{"id":38610911,"identity":"0c8ddcda-e062-4671-a385-be5f958c74ed","added_by":"auto","created_at":"2023-06-15 15:06:24","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":56144,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of the TCM symptom score at the baseline, 4th week, 8th week, 12th week and 24-week of intervention.\u003c/p\u003e","description":"","filename":"image5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2847660/v1/a2c641ccdf25efd9272f6d25.jpeg"},{"id":38609639,"identity":"69ced3ae-567e-49e0-99ca-16ea8229f83a","added_by":"auto","created_at":"2023-06-15 14:58:24","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":57782,"visible":true,"origin":"","legend":"\u003cp\u003eAssessment of the mMRC score at the baseline, 4th week, 8th week, 12th week and 24-week of intervention.\u003c/p\u003e","description":"","filename":"image6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2847660/v1/185f89056688687f3fb98186.jpeg"},{"id":45522821,"identity":"6511c716-9feb-4989-8bb1-78435dbcba69","added_by":"auto","created_at":"2023-10-31 07:59:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":636976,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2847660/v1/7d3a5fd8-f7fa-49d7-bcd3-810787ac25ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Baduanjin on pulmonary rehabilitation outcomes in patients with moderate chronic obstructive pulmonary disease: a multi-center randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eChronic obstructive pulmonary disease (COPD) is characterized by partially reversible airflow obstruction. In addition to the progressive deterioration of lung function, COPD is associated with a decrease in exercise tolerance, physical activity, muscle force, occupational performance, mental status, and activities of daily living and an increase in medical costs. The estimated prevalence of COPD in a representative sample of adults aged 40 years or older in China in 2014-2015 was 13.6%, indicating that COPD has become a major public health problem [1].\u003c/p\u003e\n\u003cp\u003eThe Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend using pulmonary rehabilitation (PR) for the non-pharmacological treatment of COPD. Baduanjin (also known as Eight-Section Brocades) is a regarded as traditional Chinese Qigong in China for more than 1000 years and has also been used in PR for COPD. Qigong is a mind-body exercise form that uses meditation, breathing, and movement to increase energy and enable the body to heal itself. The exercise and healing techniques used were developed in ancient China and Tibet. It is practiced for a variety of reasons and has countless health-related benefits. Since the establishment of the Chinese Health Qigong Association in 2004, Baduanjin has used in health improvement and rehabilitation and is being increasingly prescribed by health practitioners in China and abroad [2].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBaduanjin consists of eight different postures, and users are required to control breathing and perform movements to promote the flow of internal energy (\u0026ldquo;qi\u0026rdquo;) in the body. Taking these breathing and body movements together, Baduanjin is recognized as a mindful movement in tender intensity [3]. Baduanjin reduces muscle wasting [4] and disturbed breathing patterns, improving exercise capacity [5]. Thus, COPD patients, especially those with moderate stable stage, may benefit from Baduanjin. As an healthy Qigong, Baduanjin is suitable for COPD patients to practice at home, and increase metabolic equivalent (MET) [6] and aerobic capacity [7]. In addition, Baduanjin prevents pulmonary function impairment in mild COPD patients [8]. However, high-quality evidence of the effectiveness of Baduanjin in reducing or preventing lung function deterioration in COPD patients is limited. Moreover, the use of Baduanjin for PR in patients with moderate COPD has not been determined.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInspiratory muscle training (IMT) improves lung function in COPD patients [9]. The American Thoracic Society and European Respiratory Society stated that IMT could be integrated into systemic training programs for COPD patients [10]. However, whether Baduanjin alone, IMT alone or combined with IMT will be better for PR in COPD is unknown.\u003c/p\u003e\n\u003cp\u003eThis multi-center, prospective, single-blind randomized controlled trial assessed the effect of Baduanjin , IMT, and Baduanjin combined with IMT on pulmonary capacity in patients with moderate COPD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOutcomes were evaluated by researchers blinded to treatment allocation. The study was performed from January 1, 2021, to December 30, 2021, and recruited patients from 10 hospitals in Shanghai (Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai Pulmonary Hospital, Shanghai Putuo District Central Hospital, Shanghai Tong Ren Hospital, Shanghai Songjiang District Fangta Hospital, Shanghai Wusong Central Hospital, and Shanghai Pudong Hospital. All participants gave written informed consent. Institutional ethical approval was sought from Zhongshan Hospital before the study began (No. B2018-216R). The study protocol was registered in the clinical trial register as NCT03892629 (27/03/2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInstitutional ethical approval was sought from Zhongshan Hospital before the study began (No. B2018-216R). The inclusion criteria were: (1) age 40-80 years, (2) patients with COPD confirmed by medical records and airflow limitation in accordance with GOLD criteria\u0026nbsp;[11]\u0026nbsp;(forced expiratory volume in first second to forced vital capacity (FEV1/FVC) was less than 70%), measured after postbronchodilator, (3) COPD patients with GOLD stage 2 or 3 (percentage of forced expiratory volume in first second (FEV1%)\u0026nbsp;\u0026ge;30% and \u0026lt; 80% of predicted range), (4) participants signed the informed consent, (5) patients who did not enroll in other PR programs within 6 months before the beginning of the study, (6) absence of other disabling diseases, including stroke, heart disease, and Parkinson\u0026rsquo;s disease, (7) patients who were clinically stable, with no emergency department visits or hospital admissions due to pulmonary diseases within 4 weeks before the beginning of the study, (8) Written informed consent was obtained from participants. The exclusion criteria were patients with: (1) severe COPD, (2) restricted movements caused by other diseases, (3) acute COPD exacerbations, (3) contraindications to exercise training, (4) other severe acute or chronic organic diseases or mental disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and power calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 6-min walk distance (6MWD) test was used as a reference for sample size calculation\u0026nbsp;in COPD patients\u0026nbsp;[12]. The sample size was based on a minimum difference of 12 m in the 6MWD results between the control group (CG) and the Baduanjin group (BG). With a power of 80%, alpha of 5% (two-sided), and a drop-out rate of 10%, the minimum sample size per group was 60. Thus, 240 participants were recruited.\u003c/p\u003e\n\u003cp\u003eParticipants were randomly assigned to four different groups using random numbers generated by SPSS software, and randomization was performed by a researcher blinded to group allocation. Random number table will be placed in sealed opaque envelopes to blind the group allocation until the end of the trial.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention protocols\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were randomly assigned to four groups at 1:1:1:1 ratio. A minimum of 12 supervised sessions are recommended in PR programs [13]. Thus, we adopted a 12-week PR program. The BG and breathing training group (BTG) performed training 5 days per week, twice a day for 12 weeks, with 30-min sessions. Each participant in the BG received 30-min training sessions on Baduanjin for 5 days per week. Sessions in the first week were performed by a trained therapist, followed by home-based training with audiovisual material. The BTG was trained by professional therapists using a Tri-Ball\u003csup\u003e\u0026reg;\u003c/sup\u003e incentive spirometer for breathing exercises. The combined training group (CTG) underwent Baduanjin and Tri-Ball-based breathing training following the protocols described above. The BG, BTG, and CTG received home-based training for 11 weeks, performing the exercises presented in the videos, with 30 min of Baduanjin exercises and 30 min of breathing training, 5 days per week, twice per day for 12 weeks. The CG did not undergo PR or exercise training. All participants gave written informed consent and completed a 2-week run-in period. The participants were prescribed budesonide/formoterol (160/4.5\u0026nbsp;mg) in a single inhaler twice daily until the end of the study. In addition, all participants in the intervention groups recorded their activities in a log book, including the date, time of day, and exercise duration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected at five time points: at the beginning of the intervention (after the 2-week run-in period), at weeks 4 and 8 of the PR program, at the end of the 12-week program, and at 24-week follow-up. The primary outcome was exercise capacity (6MWD). The secondary outcomes were pulmonary function indicators, including forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), percentage of predicted FEV1 (FEV1 pred%), dyspnea (modified British Medical Research Council [mMRC] scale), COPD assessment test (CAT) scores, St. George\u0026rsquo;s respiratory questionnaire (SGRQ) scores\u0026nbsp;[14],\u0026nbsp;and TCM syndrome scores. Outcomes were assessed according to the American Thoracic Society (ATS) guidelines\u0026nbsp;[15-16]. The quantified and classified TCM syndrome scores were measured according to guidelines and consensus on COPD\u0026nbsp;[17, 18]. CAT, mMRC, and TCM scores, body temperature, blood pressure, respiratory rate, and heart rate were measured at each time point. The study flowchart is shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are presented as means \u0026plusmn; standard deviations for normally distributed continuous variables and numbers and percentages for categorical variables. The significance of differences between means of normally distributed continuous variables was assessed using unpaired Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. Non-normally distributed data were analyzed by Wilcoxon rank-sum test or Fisher\u0026rsquo;s exact test. Statistical analyses were performed using R software. A two-tailed \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic and baseline characteristics of the study population by group allocation are summarized in Table 1. Among 240 participants, 23 (9.58%) were lost to follow-up because of noncompliance with exercise regimens (three cases), worsening of subjective symptoms (eight cases), interruption of treatment (five cases), and missing data in logbooks (seven cases). A total of 217 participants (171 men [78.80%] and 46 women [21.20%]) were included in the analysis, 55 in the BG, 54 in the BTG, 55 in the CTG, and 53 in the CG. The mean age was 63 (46\u0026ndash;86) years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults of parameters above were showed at each time point. 6MWD, as the primary outcome, was improved in groups BG group and BT group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), and remarkably improved in combination training group compared to the control group(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01, figure 2). The parameter of FEV1% was increased in single PR intervention groups (BG group and BT group)(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), and markedly increased in CT group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01, figure 3). The CAT score in BG group or BT group or CT were lower than the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 figure 4). TCM symptom score in BG group or BT or CT group were lower than the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, figure 5). No obvious decrease was shown in CT group in CAT score and TCM symptom score compared to the BG or BT group ( figure 4 and figure 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData of CAT, mMRC, TCM score and basic vital signs at the 4th week was shown in table 2. Data of the 8th week were shown in table 3. Assessment of outcome after 12-week PR training was shown in table 4. Table 5 showed the data of intervention after 24-week follow up. \u0026nbsp;No statistic difference was shown in terms of mMRC score (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05, figure 6). No statistic difference between groups was noticed in SGRQ score \u0026nbsp;and some basic vital signs(Temperature(℃), Systolic pressure, Diastolic pressure, Respiratory rate, Heart rate (bp)) at each point (table 2-5).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study showed that Baduanjin, as a mindful movement intervention, improved FEV1% and 6MWD in COPD patients. Combining Baduanjin with additional inspiratory muscle training exerted better PR result than Banduanjin or inrespiratory muscle training alone. The improvement in pulmonary function and exercise capacity persisted after 24-week follow up. No improvement in CAT and TCM syndrome scores was noticed at 4-week and 8-week of PR. Body temperature, blood pressure, heart rate, and respiratory rate were stable in the intervention groups, demonstrating the safety of this PR study.\u003c/p\u003e\n\u003cp\u003eThe 12-week Baduanjin training increased 6MWD. Motor impairment in the lower limbs may lead to a progressive decline in activities of daily living. Baduanjin exercises involve postural adjustments, breathing regulation, and mental relaxation. Five of the eight sections of Baduanjin emphasized the lower extremity training with squat position holding, body weight shifting and mindful breathing. Studies revealed that skeletal muscle fatigue limited exercise capacity in a remarkable proportion of COPD patients[19, 20]. A possible mechanism by which Baduanjin improves exercise capacity in COPD patients is strengthening skeletal muscles, especially in the lower limbs.\u003c/p\u003e\n\u003cp\u003eIn our study, Baduanjin improved FEV1% in participants after 12-week Baduanjin intervention. Similar trends of improvement in FEV1% was also observed in another Retrospective Randomized Controlled Trial[21] involving Baduanjin exercise. Meta-analysis[22] included 14 RCTs showed that Baduanjin was effective in improving FEV 1% (Hedge\u0026rsquo;s g = 0.38, CI 0.21 to 0.56, p \u0026lt; 0.001,I2 = 54.74% ) as compared to usual care. Slow, intentional, and mindful breathing is a key element of Baduanjin.COPD patients benefit from slow and deep breathing, which improves autonomic function [23]. Respiratory muscle weakness contributes to breathlessness and exercise impairment in COPD [24]. Furthermore, Baduanjin coordinated diaphragmatic breathing with muscle stretching, relaxation and postural alignment. Thus, Baduanjin was helpful in strengthening the diaphragmatic muscle and improving breathing pattern in COPD patients. In our study, we found that Baduanjin improve FEV1% after 12-week training. Baduanjin could be effective in improving pulmoanry function in COPD patients.\u003c/p\u003e\n\u003cp\u003eBaduanjin is usually practiced with soft body stretching and focuses on self-awareness and relaxation. Baduanjin, as an aerobic exercise, could improve the quality of life[25]. Our results showed that participants recieved Baduanjin training had lower CAT, SGRQ, and TCM syndrome scores, demonstrating its potential benefit as PR intervention for COPD patients.\u003c/p\u003e\n\u003cp\u003eBaduanjin improved pulmonary function and exercise capacity to a greater extent than breathing training alone, demonstrated by better FEVI% and 6MWD in the BG. However, improvement in FEVI% and 6MWD were more prominant in the CTG than in the other three groups. Baduanjin combined with IMT improves PR outcomes in COPD patients. There were no significant differences in mMRC scores among the four groups after the 12-week intervention and at 24-week follow-up. However, the improvement in pulmonary function was higher in the BG and CTG. Breathlessness is defined as mMRC of \u0026ge;2 [26]. The percentage of participants in the CTG with mMRC of \u0026lt;2 was higher at 24-week follow-up than at the beginning of the intervention.\u003c/p\u003e\n\u003cp\u003eIn our cohort, the improvement in pulmonary function and physical capacity was maintained after 24-week follow up. Rehabilitation outcomes depend on self-management and intervention adherence. Compared with other traditional Chinese exercises such as Tai Chi, Baduanjin consists of eight movements that are less physically and cognitively demanding and are easier to learn and follow, improving compliance. The TRI-BALL\u003csup\u003e\u0026reg;\u003c/sup\u003e spirometer consists of three transparent chambers, each with a plastic ball. The balls are gradually raised in the chambers during inhalation, allowing patients to intuitively see the increase in inspiratory volume through the raise of balls. This positive feedback of inhalation performance could be a specific adherence strategy in pulmonary rehabilitation.\u003c/p\u003e\n\u003cp\u003eThis study has limitations. First, the effect of Baduanjin exercise on skeletal muscle function was not compared with other resistance exercise interventions, including weight lifting and elastic band exercises. Second, as an exercise intervention, the patients were not blinded to treatment interventions, potentially leading to bias. Third, the study was performed in one city, and the results are not representative of other regions of China. Therefore, additional studies with larger sample sizes are necessary to increase awareness of the effectiveness of Baduanjin in pulmonary rehabilitation [27].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this trial indicated that traditional Baduanjin exercise could prevent COPD lung function deterioration, and provide a simple, and daily pulmonary rehabilitation measure for the patients with moderate COPD.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOPD: chronic obstructive pulmonary disease; GOLD: Global Initiative for Chronic Obstructive Lung Disease; PR: pulmonary rehabilitation;MET: metabolic equivalent; IMT:Inspiratory muscle training; BG: Baduanjin group; BT: breath training; CT: combination training; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George\u0026apos;s respiratory questionnaire; T.C.M.: Traditional Chinese Medicine.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants was given written informed consent. Informed consent was obtained from all subjects and/or their legal guardian(s) before recruitment. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the research ethics committee of Zhongshan Hospital before the study began (No. B2018-216R). The study protocol was registered in the clinical trial register as NCT03892629. Informed consent was obtained from all subjects and/or their legal guardian(s)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request by healthcare providers, investigators, and researchers to address specific scientific or clinical objectives. The corresponding author is committed to reviewing requests from researchers for access to clinical trial protocols, de-identified patient-level clinical trial data, and study-level clinical trial data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the National Natural Science Foundation of China (82100109), National Key Research and Development Program of China (2018YFC1313600), Shanghai Science and Technology Commission（20DZ2272200）, and Shanghai Key Clinical Specialty Construction Project (No. shslczdzk05101), National Science Foundation of Jiangsu Province (BK20180198) .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Conception and design: Shanqun Li and Wei Zhang (2)Administrative support：Xiongbiao Wang (3) Provision of study materials or patients: Xuan Chen, Cuiping Fu and Xiongbiao Wang. (4) Collection and assembly of data: Xuan Chen, Cuiping Fu and Meng Sun (5) Data analysis and interpretation: Xuan Chen, Cuiping Fu and Jindong Shi (6) Manuscript writing: All authors. (7) Final approval of manuscript: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request by healthcare providers, investigators, and researchers to address specific scientific or clinical objectives. The corresponding author is committed to reviewing requests from researchers for access to clinical trial protocols, de-identified patient-level clinical trial data, and study-level clinical trial data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFang L, Gao P, Bao H, et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study[J]. Lancet Respir Med. 2018, 6(6): 421-430.\u003c/li\u003e\n\u003cli\u003eSancier K M. Medical applications of qigong[J]. Altern Ther Health Med, 1996, 2(1): 40-6.\u003c/li\u003e\n\u003cli\u003eChen X , Jiang W , Lin X , et al. Effect of an exercise-based cardiac rehabilitation program \"Baduanjin Eight-Silken-Movements with self-efficacy building\" for heart failure (BESMILE-HF study): study protocol for a randomized controlled trial[J]. Trials. 2018, 19(1):150\u003c/li\u003e\n\u003cli\u003eVan Helvoort H A, Heijdra Y F, Thijs H M, et al. Exercise-induced systemic effects in muscle-wasted patients with COPD[J]. Med Sci Sports Exerc. 2006, 38(9): 1543-52.\u003c/li\u003e\n\u003cli\u003eNg B H P , Tsang H W H , Jones A Y M , et al. Functional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trial.[J]. Journal of alternative and complementary medicine (New York, N.Y.). 2011, 17(3):243-251.\u003c/li\u003e\n\u003cli\u003eChao Y F, Chen S Y, Lan C, et al. The cardiorespiratory response and energy expenditure of Tai-Chi-Qui-Gong[J]. Am J Chin Med. 2002, 30(4): 451-61.\u003c/li\u003e\n\u003cli\u003eLan C, Chou S W, Chen S Y, et al. The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners[J]. Am J Chin Med. 2004, 32(1): 141-50.\u003c/li\u003e\n\u003cli\u003eYang Y, Chen K, Tang W, et al. Influence of Baduanjin on lung function, exercise capacity, and quality of life in patients with mild chronic obstructive pulmonary disease[J]. Medicine (Baltimore). 2020, 99(37): e22134.\u003c/li\u003e\n\u003cli\u003eFigueiredo R I N, Azambuja A M, Cureau F V, et al. Inspiratory Muscle Training in COPD[J]. Respir Care. 2020, 65(8): 1189-1201.\u003c/li\u003e\n\u003cli\u003eNici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation[J]. Am J Respir Crit Care Med. 2006, 173(12): 1390-413.\u003c/li\u003e\n\u003cli\u003eVogelmeier C F, Criner G J, Martinez F J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary[J]. Am J Respir Crit Care Med. 2017, 195(5): 557-582.\u003c/li\u003e\n\u003cli\u003eCameron-Tucker H L, Wood-Baker R, Joseph L, et al. A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD[J]. Int J Chron Obstruct Pulmon Dis. 2016, 11: 1991-2000.\u003c/li\u003e\n\u003cli\u003eBlackstock F C, Lareau S C, Nici L, et al. Chronic Obstructive Pulmonary Disease Education in Pulmonary Rehabilitation. An Official American Thoracic Society/Thoracic Society of Australia and New Zealand/Canadian Thoracic Society/British Thoracic Society Workshop Report[J]. Ann Am Thorac Soc. 2018, 15(7): 769-784.\u003c/li\u003e\n\u003cli\u003eJones P W, Quirk F H, Baveystock C M, et al. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire[J]. Am Rev Respir Dis. 1992, 145(6): 1321-7.\u003c/li\u003e\n\u003cli\u003eErratum: ATS Statement: Guidelines for the Six-Minute Walk Test[J]. Am J Respir Crit Care Med. 2016, 193(10): 1185.\u003c/li\u003e\n\u003cli\u003eGraham B L, Steenbruggen I, Miller M R, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement[J]. Am J Respir Crit Care Med. 2019, 200(8): e70-e88.\u003c/li\u003e\n\u003cli\u003eMartinez F J, Fabbri L M, Ferguson G T, et al. Baseline Symptom Score Impact on Benefits of Glycopyrrolate/Formoterol Metered Dose Inhaler in COPD[J]. Chest. 2017, 152(6): 1169-1178.\u003c/li\u003e\n\u003cli\u003eZhou Z, Zhou A, Zhao Y, et al. Evaluating the Clinical COPD Questionnaire: A systematic review[J]. Respirology. 2017, 22(2): 251-262.\u003c/li\u003e\n\u003cli\u003eLayec G, Hart C R, Trinity J D, et al. Oxygen delivery and the restoration of the muscle energetic balance following exercise: implications for delayed muscle recovery in patients with COPD[J]. Am J Physiol Endocrinol Metab. 2017, 313(1): E94-e104.\u003c/li\u003e\n\u003cli\u003eMarklund Sarah, Bui Kim-Ly, Nyberg Andre. Measuring and monitoring skeletal muscle function in COPD: current perspectives[J]. International journal of chronic obstructive pulmonary disease. 2019,14:1825-1838.\u003c/li\u003e\n\u003cli\u003eBi J, Yang W, Hao P, et al. WeChat as a Platform for Baduanjin Intervention in Patients With Stable Chronic Obstructive Pulmonary Disease in China: Retrospective Randomized Controlled Trial[J]. JMIR Mhealth Uhealth. 2021, 9(2): e23548.\u003c/li\u003e\n\u003cli\u003eLiu S J, Ren Z, Wang L, et al. Mind⁻Body (Baduanjin) Exercise Prescription for Chronic Obstructive Pulmonary Disease: A Systematic Review with Meta-Analysis[J]. Int J Environ Res Public Health. 2018, 15(9).\u003c/li\u003e\n\u003cli\u003eVan Gestel A J, Steier J. Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD)[J]. J Thorac Dis. 2010, 2(4): 215-22.\u003c/li\u003e\n\u003cli\u003eO'brien K, Geddes E L, Reid W D, et al. Inspiratory muscle training compared with other rehabilitation interventions in chronic obstructive pulmonary disease: a systematic review update[J]. J Cardiopulm Rehabil Prev. 2008, 28(2): 128-41.\u003c/li\u003e\n\u003cli\u003eSong R, Grabowska W, Park M, et al. The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis[J]. Parkinsonism Relat Disord. 2017, 41: 3-13.\u003c/li\u003e\n\u003cli\u003eZeng Y, Jiang F, Chen Y, et al. Exercise assessments and trainings of pulmonary rehabilitation in COPD: a literature review[J]. Int J Chron Obstruct Pulmon Dis. 2018, 13: 2013-2023.\u003c/li\u003e\n\u003cli\u003eRogers C, Keller C, Larkey L K. Perceived benefits of meditative movement in older adults[J]. Geriatr Nurs. 2010, 31(1): 37-51.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1\u0026nbsp;Demographic data and baseline characteristics of the participants\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"556\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003eBG group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003eBT group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003eCT group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003eCG group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e45(81.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e42(77.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e47(85.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e37(69.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.957537154989385%\"\u003e\n \u003cp\u003e10(18.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.991507430997878%\"\u003e\n \u003cp\u003e12(22.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.203821656050955%\"\u003e\n \u003cp\u003e8(14.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.656050955414013%\"\u003e\n \u003cp\u003e16(30.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e66.7\u0026plusmn;6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e68.0\u0026plusmn;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e67.3\u0026plusmn;7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e66.7\u0026plusmn;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eSmoking Index\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026le;200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e20(36.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e14(25.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e21(38.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e18(33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003e(pack-years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e200-400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e8(14.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e4(7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e6(10.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e6(11.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026gt;400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e27(49.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e29(53.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e28(50.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e27(50.94%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eCourse of disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026le;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e17(30.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e19(35.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e21(38.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e22(41.51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003e(year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e(5-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e24(43.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e21(38.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e24(43.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e18(33.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e(10-20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e11(20.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e8(14.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e5(9.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e11(20.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\"\u003e\n \u003cp\u003e3(5.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\"\u003e\n \u003cp\u003e6(11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\"\u003e\n \u003cp\u003e5(9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\"\u003e\n \u003cp\u003e2(3.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eTemperature,℃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.82(36.65,36.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.84(36.6,36.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.86(36.74,36.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.84(36.62,37.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eSystolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e121.01 \u0026plusmn; 17.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e124.04 \u0026plusmn; 16.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.05 \u0026plusmn; 29.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.05 \u0026plusmn; 20.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eDiastolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.02 \u0026plusmn; 11.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.03 \u0026plusmn; 12.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.02 \u0026plusmn; 18.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.07 \u0026plusmn; 15.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eRespiratory rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.53 \u0026plusmn; 2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.06 \u0026plusmn; 2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.07 \u0026plusmn; 2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.04 \u0026plusmn; 2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eHeart rate (bp)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.03 \u0026plusmn; 10.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e81.03 \u0026plusmn; 8.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.04 \u0026plusmn; 9.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e81.03 \u0026plusmn; 10.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\"\u003e\n \u003cp\u003eFEV1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e46.45\u0026plusmn;20.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e46.5 \u0026plusmn; 14.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e46.9 \u0026plusmn; 12.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e46.77 \u0026plusmn; 13.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003e6MWD (meters)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e364.95\u0026plusmn; 84.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e366.04 \u0026plusmn; 101.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e364.62 \u0026plusmn; 102.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e365.16 \u0026plusmn; 98.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003eScore of CAT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.87 \u0026plusmn; 5.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.90 \u0026plusmn; 6.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.181\u0026plusmn; 5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.42 \u0026plusmn; 6.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003eT.C.M. score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"top\"\u003e\n \u003cp\u003e5.00(4.00,7.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"top\"\u003e\n \u003cp\u003e6.00(4.00,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"top\"\u003e\n \u003cp\u003e5.00(4.00,7.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.15 \u0026plusmn; 2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003eSGRQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e31.00 \u0026plusmn; 14.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e34.09 \u0026plusmn; 11.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e33.35 \u0026plusmn; 12.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e34.76 \u0026plusmn; 12.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 0 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e3 (5.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e4 (7.41 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (3.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1.89 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 1 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (21.8 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (27.78 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e16 (29.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (22.64 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 2 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e29 (52.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e23 (42.59 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e25 (45.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e25 (47.17 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 3 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (20.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e10 (18.52 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e12 (21.8 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (26.42 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.439856373429084%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 4 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.617594254937163%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.87612208258528%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.28725314183124%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (3.70 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46678635547576%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.31238779174147%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1.89 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are shown as mean \u0026plusmn; SD or median (IQR), and categorical variables by number (%). BG: Baduanjin group; BT: breath training group; CT: combination training group; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George\u0026apos;s respiratory questionnaire; T.C.M.: Traditional Chinese Medicine.\u003c/p\u003e\n\u003cp\u003eTable 2 Assessment of outcome after 4-week PR intervention\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003evariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eBG group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003eBT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eCT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eCAT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e16.04\u0026plusmn;9.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e17.5818\u0026plusmn;5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.03\u0026plusmn;10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.78\u0026plusmn;\u0026nbsp;6.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eT.C.M. score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.00(3.00,6.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.00(3.50,7.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.78\u0026plusmn;2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.62\u0026plusmn;2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eTemperature(℃)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.82(36.51,37.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.85(36.7,37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.84(36.73,36.95 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.83(36.5,36.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eSystolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.03\u0026plusmn;14.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.04\u0026plusmn;15.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.0\u0026plusmn;23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.0\u0026plusmn;20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eDiastolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.02\u0026plusmn;9.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.05\u0026plusmn;19.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.0\u0026plusmn;15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e79.03\u0026plusmn;12.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eRespiratory rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.07\u0026plusmn;2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.03\u0026plusmn;3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.0\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.06\u0026plusmn;2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eHeart rate (bp)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.15\u0026plusmn;6.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.31\u0026plusmn;6.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e79.44\u0026plusmn;6.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e81.02\u0026plusmn;7.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 0 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e3(5.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e2(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e2(3.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e2(3.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 1 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e21(38.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e21(38.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e22(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e16(30.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 2 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e26(47.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e23(42.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e24(43.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e27(50.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 3 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e5(9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e7(12.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e7(12.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e7(13.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 4 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e1(1.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"bottom\"\u003e\n \u003cp\u003e1(1.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are shown as mean \u0026plusmn; SD or median (IQR), and categorical variables by number (%). BG: Baduanjin group; BT: breath training group; CT: combination training group; CG: controlled group; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; T.C.M.: Traditional Chinese Medicine.\u003c/p\u003e\n\u003cp\u003eTable 3 Assessment of outcome after 8-week PR intervention\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003evariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eBG group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eBT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eCT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eCAT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e15.02\u0026plusmn;9.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e16.04\u0026plusmn;6.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e15.84\u0026plusmn;6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.25\u0026plusmn;6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eT.C.M. score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.00(3.00,5.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.56\u0026plusmn;1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.00(3.00,6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.42\u0026plusmn;2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eTemperature,℃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.83(36.64,37.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.75(36.43,37.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.88(36.54,36.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.84(36.65,37.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eSystolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.02\u0026plusmn;10.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e123.05\u0026plusmn;18.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.01\u0026plusmn;21.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.04\u0026plusmn;21.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eDiastolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.08\u0026plusmn;9.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.03\u0026plusmn;11.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.02\u0026plusmn;15.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.03\u0026plusmn;12.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eRespiratory rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.05\u0026plusmn;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.05\u0026plusmn;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.71\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.04\u0026plusmn;2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eHeart rate (bp)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.02\u0026plusmn;8.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.02\u0026plusmn;7.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.06\u0026plusmn;8.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.06\u0026plusmn;10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 0 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e2(3.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e4(7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e2(3.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e2(3.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 1 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e29(52.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e22(40.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e23(41.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e17(32.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 2 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e21(38.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e22(40.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e24(43.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e26(49.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 3 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e3(5.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e5(9.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e6(10.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e7(13.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 4 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e1(1.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"bottom\"\u003e\n \u003cp\u003e1(1.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are shown as mean \u0026plusmn; SD or median (IQR), and categorical variables by number (%). BT: breath training group; CT: combination training group; CG: controlled group; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; T.C.M.: Traditional Chinese Medicine.\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison of outcomes after 12- week PR intervention\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003evariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eBG group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eBT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eCT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003eTemperature,℃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.92(36.72,37.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.82(36.64, 37.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.86(36.55,36.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.84(36.55,37.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003eSystolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.08 \u0026plusmn; 11.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.08 \u0026plusmn; 10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.06 \u0026plusmn; 21.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.05 \u0026plusmn; 23.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003eDiastolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.04 \u0026plusmn; 8.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.06 \u0026plusmn; 13.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.06 \u0026plusmn; 12.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e76.05 \u0026plusmn; 13.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003eRespiratory rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e18.07 \u0026plusmn; 3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.03 \u0026plusmn; 2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.02 \u0026plusmn; 3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.04 \u0026plusmn; 2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003eHeart rate (bp)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.56 \u0026plusmn; 7.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.02 \u0026plusmn; 10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e79.62 \u0026plusmn; 8.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.04 \u0026plusmn; 8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eFEV1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e53.59\u0026plusmn;19.02\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e53.20\u0026plusmn;16.49\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e59.3\u0026plusmn;14.12\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e47.19\u0026plusmn;13.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e6MWD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e405.58\u0026plusmn;102.06\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e408.09\u0026plusmn;111.01\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e451.98\u0026plusmn;113.63\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e364.27\u0026plusmn; 110.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eCAT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e17.40\u0026plusmn;5.12\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e16.00\u0026plusmn;7.00\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e14.09\u0026plusmn;5.87\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e19.96\u0026plusmn;5.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eT.C.M. score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e4.01\u0026plusmn;1.75\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e4.00(3.00,5.00)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e2.00(1.00,4.00)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e5.00(3.00,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eSGRQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e29.14\u0026plusmn;10.36\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e28.00\u0026plusmn;15.5\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e23.98\u0026plusmn;12.21\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e33.49\u0026plusmn;12.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eFEV1/FVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e59.78\u0026plusmn;9.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e58.49\u0026plusmn;11.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e58.30\u0026plusmn;8.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e55.25\u0026plusmn;11.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 0 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3.64 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e5 (9.26 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3.64 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 1 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e29 (52.73 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e23 (42.59 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e30 (54.54 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e19 (35.85 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 2 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e22 (40.00 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e20 (37.04 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e21 (38.18 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e26 (49.06 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 3 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3.64 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e5 (9.26 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e2 (3.64 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e6 (11.32 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 4 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.85 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.89 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eData are shown as mean \u0026plusmn; SD or median (IQR), and categorical variables by number (%). BT: breath training group; CT: combination training group; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George\u0026apos;s respiratory questionnaire; T.C.M: Traditional Chinese Medicine. \u003cem\u003eP\u003c/em\u003e value, difference among groups after 12- week PR intervention. \u003csup\u003ea\u003c/sup\u003e, with statistical difference when compared to the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05); \u003csup\u003eb\u003c/sup\u003e, significant difference when compared to the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003eTable 5. Comparison of outcomes after 3-month of follow up\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003evariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eBG group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eBT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003eCT Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eTemperature,℃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.74(36.55, 36.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.84(36.63, 37.06 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.76\u0026plusmn;0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e36.74(36.52,36.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eSystolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.03 \u0026plusmn; 14.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.04 \u0026plusmn; 16.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.06 \u0026plusmn; 17.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e120.08 \u0026plusmn; 21.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eDiastolic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.05 \u0026plusmn; 10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.08 \u0026plusmn; 13.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e78.06 \u0026plusmn; 13.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e75.06 \u0026plusmn; 18.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eRespiratory rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.06 \u0026plusmn; 3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.06 \u0026plusmn; 2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.03 \u0026plusmn; 3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.05 \u0026plusmn; 2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\"\u003e\n \u003cp\u003eHeart rate (bp)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.04 \u0026plusmn; 8.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e82.03 \u0026plusmn; 9.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e79.87 \u0026plusmn; 7.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.02 \u0026plusmn; 6.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003eFEV1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e53.87\u0026plusmn;19.40\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e53.40\u0026plusmn;15.54\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e59.40\u0026plusmn;14.69\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e46.59\u0026plusmn;12.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e6MWD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e408.31\u0026plusmn;110.54\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e408.84\u0026plusmn;115.01\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e454.87\u0026plusmn;119.75\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e365.22\u0026plusmn;113.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003eCAT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e17.00\u0026plusmn;5.88\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e17.00\u0026plusmn;8.00\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e14.49\u0026plusmn;6.16\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e19.00\u0026plusmn;11.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003eT.C.M. score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.00(2.00,4.00)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.00(2.00,5.00)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.00(1.00,3.00)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.00(3.00,8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003eSGRQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e28.93\u0026plusmn;10.54\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e27.00\u0026plusmn;13.50\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e22.00\u0026plusmn;19.50\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e33.65\u0026plusmn;12.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003eFEV1/FVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e59.14\u0026plusmn;9.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e58.36\u0026plusmn;11.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e58.38\u0026plusmn;9.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e54.99\u0026plusmn;12.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 0 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e7 (12.72 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e4(7.41 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e4(7.27 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1.89 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 1 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e35 (63.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e26 (48.15 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e33 (60.00 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e23 (43.39 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 2 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (20.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e18 (33.33 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e18 (32.73 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e20 (37.74 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 3 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e2 (3.64 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e5 (9.26 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e8 (15.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003emMRC 4 (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1.85 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 (1.89 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are shown as mean \u0026plusmn; SD or median (IQR), and categorical variables by number (%). BT: breath training group; CT: combination training group; CG: controlled group; FEV1/FVC: forced expiratory volume in one second/forced vital capacity; FEV1 %: percent of FEV1 predicted; mMRC: modified British medical research council questionnaire; CAT scale: COPD assessment test; SGRQ: St. George\u0026apos;s respiratory questionnaire; T.C.M: Traditional Chinese Medicine. \u003cem\u003eP\u003c/em\u003e value, difference among groups after 3-month of follow up. \u003csup\u003ea\u003c/sup\u003e, with statistical difference when compared to the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05); \u003csup\u003eb\u003c/sup\u003e, significant difference when compared to the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic obstructive pulmonary disease, Baduanjin, pulmonary rehabilitation, inspiratory muscle training","lastPublishedDoi":"10.21203/rs.3.rs-2847660/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2847660/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEffect of Baduanjin, as a traditional Chinese mindful movement, on patients with moderate chronic obstructive pulmonary disease (COPD), was still unknown. The aim of our study was to evaluate its efficiency on pulmonary function and exercise capacity in moderate COPD patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA multi-center randomized controlled trial about moderate COPD patients were collected from ten hospitals in Shanghai. Tri-Ball® Respiratory training was used as the control PR intervention in this trail to evaluate the efficiency of Baduanjin. After signing informed consent, all participants recruited were followed a two-week run-in period. Participants were randomly assigned into four groups, namely Baduanjin alone, Tri-Ball® Respiratory training alone, Baduanjin combined with respiratory training, and the control group. Each group lasted for 12 weeks. The outcome assessments were conducted at four time points, namely at the 4\u003csup\u003eth\u003c/sup\u003e week and 8\u003csup\u003eth\u003c/sup\u003e week during the intervention, at the end of 12-week pulmonary rehabilitation program, and at the end of the 24-week follow up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eA total of 240 participants were recruited in this prospective randomized controlled trail. After exclusion, 217 moderate COPD patients were analyzed in this study. After 12 weeks, Baduanjin traing showed improvement in pulmonary function (percent of FEV1 predicted, FEV1 pred%) and dyspnea (modified British medical research council questionnaire, mMRC scale), exercise capacity (six-minute walk distance, 6MWD), and therapeutic efficiency (COPD assessment test, CAT) in moderate COPD patients. Banduanjin presented better PR results than the control. Besides, combining Baduanjin with additional inspiratory muscle training presented better PR result than banduanjin or inrespiratory muscle exercise alone. The positive effect on parameter of pulmonary function, exercise capacity and therapeutic efficiency were perceived by subjects and continued to maintain after 24-week follow up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The results of this trial indicated\u003cstrong\u003e \u003c/strong\u003ethat traditional Baduanjin exercise could prevent COPD lung function deterioration, and provide a simple, and daily pulmonary rehabilitation measure for the patients with moderate COPD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration:\u003c/strong\u003e The study protocol has been registered with the Clinical Trial Registry (NCT03892629).\u003c/p\u003e","manuscriptTitle":"Effect of Baduanjin on pulmonary rehabilitation outcomes in patients with moderate chronic obstructive pulmonary disease: a multi-center randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-15 14:58:19","doi":"10.21203/rs.3.rs-2847660/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ce6df87-e38b-4388-8cd8-474cbca7c705","owner":[],"postedDate":"June 15th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-10-31T07:59:11+00:00","versionOfRecord":[],"versionCreatedAt":"2023-06-15 14:58:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2847660","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2847660","identity":"rs-2847660","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}