Effects of Liuzijue Qigong on respiratory function among patients with Parkinson’s disease:A randomized clinical trial

Effects of Liuzijue Qigong on respiratory function among patients with Parkinson’s disease:A randomized clinical 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 Effects of Liuzijue Qigong on respiratory function among patients with Parkinson’s disease:A randomized clinical trial Huimei YIN, Oumei Cheng, Xu Zhang, Fengying Quan, Yujiao Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4708812/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Respiratory dysfunction is a common nonmotor symptom in patients with Parkinson's disease that may be easily overlooked. Incorporating respiratory function rehabilitation into routine rehabilitation programs for these patients is important. However, previous studies have focused primarily on professional devices and training processes that require additional professional guidance, making wide implementation challenging. Methods In this assessor-masked, randomized clinical trial, eligible participants were randomized into an experimental group and a control group. The experimental group received Liu Zi Jue Qigong exercise for 12 weeks, while the control group underwent conventional rehabilitation exercises. Primary outcomes included measures of respiratory function, such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Secondary outcomes included motor symptoms, quality of life, depression, and anxiety. Results The results from a study involving 51 Parkinson's disease patients showed significant improvements in the FVC, FEV1, PEF, and MEP in the experimental group compared to those in the control group after the 12-week intervention. Additionally, there was a noticeable decrease in depression and anxiety scores in the experimental group, with statistically significant reductions compared to those in the control group. Conclusions Liuzijue Qigong exercise has the potential to enhance respiratory function and mental health in patients with Parkinson's disease in the early and middle stages. These findings could serve as a valuable reference for implementing home-based rehabilitation techniques for individuals with Parkinson's disease. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2200056762(Registration Date: February 15, 2022). Parkinson's disease LiuZijue Qigong Respiratory function Quality of life Figures Figure 1 Figure 2 Background Parkinson's disease (PD) is a prevalent neurodegenerative condition among elderly individuals characterized by a range of motor and nonmotor symptoms[1]. Respiratory dysfunction, although a common nonmotor symptom in PD patients, is often underestimated. Studies have reported that the incidence of restrictive ventilation dysfunction is 28%-94% [2–4], and the incidence of upper airway obstruction is 6.7%-67.0% [3,5,6]. The motor impairments and altered perception of hypoxemia in PD can mask respiratory symptoms, leading to potential complications such as aspiration pneumonia and dyspnea [7]. Research has shown that respiratory muscle weakness can contribute to various issues, such as swallowing difficulties, speech disorders, weak coughing, and breathlessness, in PD patients, significantly impacting their quality of life[2,8]. Additionally, respiratory failure is a leading cause of mortality in advanced PD patients [9,10]. Hence, integrating respiratory function rehabilitation into the overall care plan for Parkinson's disease patients is crucial for improving patient outcomes and quality of life. A recent systematic review on the effects of respiratory muscle training for patients with Parkinson's disease (PD) concluded that respiratory exercises have positive effects on PD patients, leading to improvements in respiratory function[11]. Specifically, inspiratory muscle training has been found to effectively enhance cardiopulmonary function and exercise capacity and reduce fatigue. On the other hand, expiratory muscle training can enhance airway clearance and protect the airway. However, the current training methods discussed in recent studies often involve the use of specialized devices and require additional professional guidance during practice, making them challenging to widely implement, especially for PD patients at home. Consequently, patient compliance tends to be low, and adherence to the training regimen can be difficult. Therefore, it is crucial to explore a convenient, simple, and user-friendly approach to respiratory rehabilitation that can be easily adopted by PD patients to promote better compliance and overall effectiveness. Liuzijue Qigong, a traditional Chinese health exercise, emphasizes breathing and exhalation. It involves the use of six specific sounds—“xū”, “hē”, “hū”, “sī”, “chuī”, and “xī”—along with relaxed, slow, and gentle movements to promote physical fitness and rehabilitation [12]. Liuzijue Qigong has been widely utilized in pulmonary rehabilitation for chronic conditions such as COPD, stroke, and coronary heart disease in China [13–15]. In this study, we aimed to explore the use of Liuzijue Qigong as a home exercise regimen to assess its impact on respiratory function and quality of life in Parkinson's disease patients. By doing so, we seek to offer PD patients a practical and suitable home rehabilitation technique. Methods Design This single-blind randomized controlled trial received approval from the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (reference No: 2021 − 550) and was registered on the Chinese Clinical Trials Registry Platform (Identifier: ChiCTR2200056762). The trial adhered to the Consolidated Standards of Reporting Trials guidelines and followed the ethical standards outlined in the Declaration of Helsinki. All participants provided written informed consent, and their data were anonymized. To prevent any "contamination" of the intervention study, participants were clearly informed during the informed consent process that the study was exploratory in nature and that its effectiveness could not be predetermined. Upon completion of the study, relevant information and videos will be made available for publication. Participants in the control group had the option to download and study this material if they were interested, but they were instructed not to practice it during the study to prevent interference with the results. Participants The study was conducted at the First Affiliated Hospital of Chongqing Medical University from July 2021 to March 2023. Participants were recruited through convenience sampling from the Outpatient Department of Neurology. The inclusion criteria were as follows: Individuals diagnosed with PD[16]. Patients at H-Y stage 1–3. The dosage and type of oral anti-Parkinson's drugs were stable for the past 3 months. The exclusion criteria included the following: Current use of medications that may affect muscle structure and lung function (such as corticosteroids, immunosuppressants, etc.). History of severe skeletal and spinal deformities. History of other diseases causing respiratory muscle damage. Patients with severe cognitive impairment. Patients with concurrent lung infections. The dropout criteria were defined as follows: Unwillingness to continue training and voluntary withdrawal during the trial. Loss to follow-up or missed scheduled revisits. Noncompliance with the study's training regimen (total training frequency < 70% or each training session less than 70% of the required time and intensity). 4. Concurrent adoption of other respiratory rehabilitation training methods or participation in other drug trials Screening, Baseline Testing, and Randomization After prescreening in the Neurology Outpatient Department, eligible participants underwent baseline assessments. Subsequently, the participants were randomly assigned to either the experimental or control group at a 1:1 ratio using the random number table method. Intervention Both groups were provided with an information booklet containing instructions for home practice and maintained their original doses of anti-Parkinson medications. Any changes in medication were carefully recorded by the observer, who also calculated whether the equivalent dose of levodopa was altered. The control group engaged in a home-based rehabilitation program that included gait training, core muscle group exercises, and activities focused on enhancing daily living abilities. The specific training components and intensity were tailored to each participant's functional status and exercise habits. The regimen was reviewed by two physiotherapists to ensure its effectiveness. Each training session lasted 30 minutes and was conducted once a day, five days a week, over a period of 12 weeks. Participants in the experimental group underwent Liuzijue Qigong training, which was designed based on the Liuzijue Qigong manual (People’s Sports Press, 2016, Fig. 1 ) published by the State Sports General Administration. This practice involved controlled inhalation through the nose and exhalation through various mouth forms, represented by the sounds Xu, He, Hu, Si, Chui, and Xi. The respiratory flow was required to be slow and continuous and synchronized with body movements (see supplemental appendix S1). Each sound was repeated six times, with each session lasting 30 minutes. Training was conducted once daily, five days a week, for a total of 12 weeks. After one week of learning, the participants officially commenced the trial. To support home practice, participants were provided with a video recording by the experimenter. While participants were not expected to achieve perfect pronunciation or exact limb movements, the primary focus was on mastering the coordination of breathing and pronunciation. Outcome measures All participants underwent standardized assessments conducted by the experimenter both before and after the 12-week intervention period. In cases where participants experienced motor complications such as wearing off or on-off phenomena, assessments were carried out during the drug onset or "on" period to ensure consistency and accuracy in the evaluation process. Primary outcome The primary outcome measure was respiratory function, which was assessed using a portable pulmonary function instrument (XEEK, X1, Xiamen, China) following the guidelines for pulmonary function and respiratory muscle strength examinations jointly published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) in the European Respiratory Journal. To ensure accuracy and reliability, each respiratory function index, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), was measured three times, and the best result was recorded as the final outcome. This approach was implemented to minimize random errors that could arise during the assessments. Secondary Outcomes In addition to the primary outcome measure of respiratory function, secondary outcomes included the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III), the 39-item Parkinson's Disease Questionnaire (PDQ-39), the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA). These secondary outcome measures were utilized to assess various aspects related to Parkinson's disease symptoms, quality of life, depression, and anxiety levels among the participants. Adverse Events During the intervention sessions, adverse events were monitored by assessing participants for any significant discomfort, pain, or harm resulting from the intervention. Participants were instructed to promptly inform the research team if they experienced any adverse events related to the study. This proactive approach ensured that any potential negative effects of the intervention could be identified and addressed promptly to safeguard the well-being of the participants. Statistical Methods The data analysis was conducted using the statistical software SPSS (version 25.0). Continuous variables with a normal distribution are presented as the mean ± standard deviation (SD), nonnormally distributed data are presented as the median (interquartile range [IQR]), and categorical variables are presented as the number (percentage). For variables that met the assumptions of a normal distribution and homogeneity of variance, a paired sample t test was used to analyze differences within the group, while an independent samples t test was used to compare differences between groups. In cases where the data did not meet the requirements for parametric tests, the Wilcoxon signed-rank test was employed to compare differences within the group, and the Mann‒Whitney U test was used to compare differences between groups. A p value less than 0.05 was considered to indicate a significant difference between the results. Results A total of 94 patients with Parkinson's disease were initially screened for the study. Of these, 19 patients did not meet the eligibility criteria, and an additional 15 patients declined to participate, resulting in an enrollment rate of 63.8% (Fig. 2 ). The 60 participants who were randomized were evenly divided into a control group and an experimental group, with 30 patients in each group. During the course of the experiment, 5 patients from the experimental group withdrew from the study, while 4 patients from the control group refused to participate in the follow-up. Ultimately, 51 participants (85%) completed the intervention, with 25 in the experimental group and 26 in the control group. This resulted in an overall dropout rate of 15% (9 out of 60). The compliance rates for home practice during the intervention period were 83.3% (25 out of 30) for the Liuzijue group and 86.7% (26 out of 30) for the control group. These compliance rates indicate the level of adherence to the prescribed home practice regimen during the study. Baseline Characteristics of the Participants Table 1 presents the baseline demographic and clinical characteristics of the participants included in the study. There were no statistically significant differences observed between the intervention and control groups. The mean (SD) age of the participants was 57.92 (9.14) years, with an age range of 49 to 82 years. Of the 51 participants, 27 were female, accounting for 52.94% of the total. The mean (SD) BMI (body mass index) of the participants was 20.74 (1.96). The mean (SD) duration of the disease among the participants was 6.09 (3.56) years, with a range of 1 to 12 years. Tabel 1 Baseline comparision of Demographics between the two groups(n = 51) Characteristic ALL (n=51) Experimental group (n=25) Control group (n=26) P value age, mean(SD),y 57.92(9.14) 58.80(8.61) 58.15(7.09) .730 a Sex (male/female), n 24/27 12/13 12/14 .432 b BMI(kg/m2),mean(SD) 20.74 (1.96) 20.42(2.16) 21.18(1.48) .641 Disease duration, Mean(SD),y 6.09 (3.56) 6.05(3.07) 6.15(4.47) .270 Hoehn-Yahr stage, median (IQR) 2(1.5,2.5) 2 （ 1.5,2.5 ） 2 （ 2,2.5 ） .059 c LEDD,mean(SD),mg 421.46(198.52) 393.35(253.43) 476.25(218.97) .165 MMSE,mean(SD) 28.35(1.46) 27.05(1.85) 28.75(1.32) .188 FVC,mean(SD),L 2.94(0.54) 2.98(0.75) 2.91(0.89) .829 FEV1,mean(SD),L 2.22(0.42) 2.18(0.54) 2.24(0.31) .935 PEF,mean(SD),L/s 5.16(1.14) 5.13(1.27) 5.19(1.34) .898 MIP,mean(SD),cmH2O 55.08(19.76) 55.15(23.15) 54.12(20.05) .903 MEP,mean(SD),cmH2O 94.15(43.41) 95.75(32.19) 93.55(38.61) .736 MDS-UPDRS- Ⅲ ,mean(SD) 20.89(13.21) 20.65(12.98) 22.65(11.91) .457 PDQ-39,mean(SD) 23.76(16.23) 24.15(13.75) 23.34(14.18) .457 HAMD,mean(SD) 7.59(7.64) 7.54(8.32) 7.67(8.03) .763 HAMA,mean(SD) 7.42(6.11) 7.16(7.34) 7.62(5.86) .395 Abbreviations:BMI,Body Mass Index;LEDD,levodopa equivalent daily dose;MMSE,Minimum Mental State Examination;FVC,forced vital capacity ;FEV1,forced expiratory volume in 1s;PEF,peak expiratory flow;MIP, maximal inspiratory pressure ;MEP,maximal expiratory pressure; MDS-UPDRS III, Movement Disorders Society United Parkinson’s Disease Rating Scale, Part III; PDQ-39, 39-item Parkinson’s Disease Questionnaire;HAMD,Hamilton Depression Scale; HAMA,Hamilton Anxiety Scale . a for continuous data, an independent t test was used. b for categorical data, a χ2 test was used. c for ordinal data , a rank sum test was used. Primary outcome Table 2 presents the comparisons of within-group outcomes, while Table 3 illustrates the changes in the main outcomes between the two groups after treatment. In this study, FVC, FEV1, PEF, MIP, and MEP were utilized to assess respiratory function. After the treatment period, the experimental group exhibited significant improvements in FVC, FEV1, PEF, and MEP (FVC: 0.13 [95% CI, -0.24 to -0.01]; P = 0.029; FEV1: -0.11 [95% CI, -0.18 to -0.02]; P = 0.015; PEF: -0.14 [95% CI, -0.31 to -0.03]; P = 0.049; MEP: -0.13 [95% CI, -1.67 to -0.04]; P = 0.045). Moreover, compared to those in the control group, these improvements were statistically significant (FVC: 0.46 [95% CI, 0.02 to 0.91]; P = 0.003; FEV1: 0.33 [95% CI, 0.01 to 0.76]; P = 0.021; MEP: -5.35 [95% CI, -0.54 to -12.16]; P = 0.047). Secondary Outcomes The study utilized the MDS-UPDRS-III and PDQ-39 as secondary outcome measures to evaluate the motor function and quality of life of the participants. In the experimental group, significant reductions in PDQ-39 scores were observed postintervention compared to preintervention (1.33 [95% CI, -0.35 to -2.51]; P = 0.036). In the control group, both the MDS-UPDRS-III and PDQ-39 scores decreased significantly from baseline (MDS-UPDRS-III: -0.84 [95% CI, -1.66 to 0.64]; P = 0.033; PDQ-39: 1.65 [95% CI, -1.66 to 2.64]; P = 0.046). At the end of the treatment period, there was no statistically significant difference in the improvement in the MDS-UPDRS-III and PDQ-39 scores between the two groups (MDS-UPDRS-III: 2.35 [95% CI, -6.35 to 11.05]; P = 0.588; PDQ-39: -1.56 [95% CI, -4.67 to 2.81]; P = 0.157). Furthermore, the mental states of the participants were assessed using HAMD and HAMA scores. In the experimental group, there were significant reductions in both the HAMD and HAMA scores at the end of the treatment period (HAMD: -0.98 [95% CI, -1.31 to -1.67]; P = 0.042; HAMA: -1.59 [95% CI, -2.34 to -0.89]; P = 0.037). Compared to those in the control group, the reductions in HAMD and HAMA scores were statistically significant (HAMD: 0.32 [95% CI, 0.12 to 0.57]; P = 0.043; HAMA: 0.35 [95% CI, 0.08 to 0.77]; P = 0.031). Tabel 2 Comparison of the Treatment Effects Between 2 Groups and Baseline Outcome Experimental group (n=25) Control group(n=26) Mean change from baseline (95% CI) P value Mean change from baseline (95% CI) P value FVC -0.13(-0.24 to -0.01) .029 0.36(-0.01 to 0.52) .069 FEV1 -0.11(-0.18 to -0.02) .015 -0.01(0.04 to 0.02) .378 PEF -0.14(-0.31 to -0.03) .049 0.27(-0.01 to 0.56) .054 MIP -1.2(-4.02 to 1.61 ) .061 -2.3(-10.13 to 5.53) .751 MEP -0.13(-1.67 to -0.04) .045 2.91(-0.95 to 6.75) .132 MDS-UPDRS- Ⅲ -0.31(-2.74 to 0.14) .074 -0.84(-1.66 to -0.64) .033 PDQ-39 -1.33(-0.35 to -2.51) .036 -1.65(-1.66 to -2.64) .046 HAMD -0.98(-1.31 to -1.67) .042 -0.71(-1.12 to 1.35) .106 HAMA -1.59(-2.34 to -0.89) .037 -0.66(-2.38 to 1.13) .269 Tabel 3 Comparison of outcomes Between Two Groups After treatment Outcome Experimental group (n=25) Control group (n=26) Difference (95% CI) P value FVC 3.37(0.31) 2.86(0.32) 0.46(0.02 to 0.91) 0.003 a FEV1 2.63(0.17) 2.29(0.16) 0.33(0.01 to 0.76) 0.021 a PEF 5.75(1.86) 5.23(1.63) 0.27(-1.48 to 0.80) 0.053 MIP 57.35(20.43) 53.30(18.19) 1.95(-12.03 to 15.94) 0.398 a MEP 104.46(30.53) 95.05(27.02) -5.35(-0.54 to -12.16) 0.047 MDS-UPDRS- Ⅲ 20.15(14.50) 20.30(12.62) 2.35(-6.35 to 11.05) 0.088 PDQ-39 19.33(12.53) 20.52(11.14) -1.56(-4.67 to 2.81) 0.157 HAMD 6.58(5.67) 7.22(7.35) 0.32(0.12 to 0.57) 0.043 HAMA 6.09(4.89) 6.79(5.38) 0.35(0.08 to 0.77) 0.031 Adverse Events One participant (4.0%) from the experimental group reported temporary mild backache, which resolved with the use of plaster. Two participants (7.7%) from the control group reported temporary mild knee pain when stretching but required no medical attention. No serious adverse events were reported. Discussion To our knowledge, this is the first randomized clinical trial targeted at determining the effectiveness of Liuzijue Qigong on respiratory function in patients with PD. Our results indicate that Liuzijue Qigong can improve the lung function, including expiratory function and respiratory muscle strength, of PD patients and has a beneficial effect on regulating the patient's mood. Liuzijue Qigong, a traditional Qigong practice centered around breathing and exhaling, involves six unique methods of exhaling accompanied by simple body movements and mental focus. It follows the fundamental principles of "nose breathing, mouth exhaling, deep and slow breathing" for respiratory training. This type of breathing, akin to pursed-lip breathing, utilizes specific sounds in practice to serve distinct purposes. For example, the sound "xu" in Liuzijue Qigong simulates pursed-lip breathing through slow exhalation with the accompanying sound, aiding in maintaining proper airway pressure, preventing premature closure of the airway, and reducing airway obstruction. By adjusting the breathing pattern through lowering the respiratory rate and prolonging exhalation, pulmonary ventilation is enhanced[17]. The controlled slow exhalation exercises in Liuzijue Qigong engage and strengthen the respiratory muscles, thereby improving respiratory efficiency and lung ventilation function. Unlike simple pursed-lip breathing, Liuzijue Qigong involves corresponding movements with each sound, primarily involving bilateral upper limb abduction or raising. These movements help increase the body's intake and expand chest capacity, ultimately enhancing respiratory function. Given that Parkinson's disease can lead to restricted chest expansion due to abnormal posture, gait, and muscular rigidity, resulting in reduced lung capacity and restrictive pulmonary disease[18], the combination of breathing techniques and movements in Liuzijue Qigong may offer advantages in improving respiratory function beyond simple pursed-lip breathing alone. Our study did not demonstrate improvements in physical outcomes related to motor symptoms or mobility compared to those of the control group. One possible explanation for this discrepancy could be the nature of the movements involved in Liuzijue Qigong. Liuzijue Qigong primarily focuses on breathing techniques and simple body movements, with less emphasis on active engagement of the legs. In contrast, the control group engaged in exercises specifically designed to target the motor symptoms of Parkinson's disease, such as gait training and balance training. These findings highlight the importance of considering the specific needs and symptoms of patients with PD when designing intervention programs. Tailoring interventions to address diverse aspects of the condition, including both motor and nonmotor symptoms, may lead to more comprehensive and effective treatment outcomes. The experimental group demonstrated a more significant reduction in depression and anxiety symptoms than did the control group at the conclusion of the intervention. Liuzijue Qigong, an exercise technique that harmonizes movement, breath, and mindfulness, emphasizes the guidance of qi with the mind and body. During practice, the use of elegant music and gentle movements aids in relaxing the body and mind, potentially stimulating the vagus nerve, thereby reducing stress and alleviating anxiety [19]. Moreover, the incorporation of abdominal core muscle training and limb-guiding actions within Liuzijue Qigong can improve body flexibility, enhance balance, and boost attention and concentration. These benefits contribute to the overall improvement of physical and mental health [20]. Additionally, the social interactions fostered by engaging in Liuzijue Qigong can help individuals with Parkinson's disease establish robust support networks, easing feelings of loneliness and psychological strain [21]. Numerous studies have demonstrated the positive impact of Qigong-based interventions on the physical and mental well-being of patients with chronic conditions [22,23]. Both groups exhibited significant decreases in PDQ-39 scores compared to preintervention scores, without any statistically significant differences. It is widely recognized that the quality of life of individuals with Parkinson's disease can be impacted in a multidimensional manner, encompassing physical function, mental health, and social support [24]. In our study, the control group experienced an improvement in quality of life primarily through the amelioration of motor symptoms. In contrast, Liuzijue Qigong contributed to overall enhancement by addressing both physical and mental states. This finding aligns with findings from another study, which also supports the effectiveness of Qigong in enhancing motor function, mental health, and quality of life in patients with mild to moderate Parkinson's disease. These results underscore the holistic benefits of integrating practices such as Liuzijue Qigong in the management of Parkinson's disease. By addressing both the physical and mental aspects of the condition, approaches such as Qigong offer a comprehensive and integrative strategy to improve the well-being of individuals with Parkinson's disease. Conclusions In summary, Liuzijue Qigong has shown promising benefits in improving patients' respiratory function, enhancing quality of life, and reducing stress levels, all of which are crucial for promoting the rehabilitation of individuals with Parkinson's disease. Moreover, the ease of operation and the flexibility of this method make it accessible and convenient for patients, as it is not constrained by space requirements. This makes it suitable for home-based practice and community settings, facilitating its widespread application and promotion among individuals with Parkinson's disease. Overall, the positive outcomes and practicality of Liuzijue Qigong suggest its potential as a valuable addition to the holistic care and management of Parkinson's disease. Study limitations This study specifically focused on Parkinson's disease patients in the early and middle stages, highlighting the need for further research to explore the effects of rehabilitation and feasibility of implementing these interventions for advanced-stage patients. Additionally, it is important to note that the sample size in this study was relatively small, and the follow-up duration was limited.In future studies, expanding the sample size and extending the follow-up period will be crucial for obtaining more comprehensive and objective evidence. By conducting research with a larger and more diverse group of participants over an extended period, we can gain deeper insights into the effectiveness and long-term benefits of interventions such as Liuzijue Qigong for individuals with Parkinson's disease across different stages of the condition. Abbreviations PD Parkinson's Disease FVC Forced Vital Capacity FEV1 Forced Expiratory Volume in 1s PEF Peak Expiratory Flow FEV1/FVC forced Expiratory Volume in1s/Forced Vital Capacity MIP Maximal Inspiratory Pressure MEP Maximal Expiratory Pressure H-Y Stage of Hoehn-Yahr MMSE Mini Mental State Examination MDS-UPDRS Movement Disorder Society-Unified Parkinson Disease Rating Scale HAMD Hamilton Depression Scale HAMA Hamilton Anxiety Scale PDQ-39 The Parkinson's disease Questionnaire-39 IMST Inspiratory Muscle Strength Training EMST Expiratory Muscle Strength Training BMI Body Mass Index LEDD the Levodopa Equivalent Doses of Day Declarations Ethics approval and consent to participate This single-blind randomized controlled trial received approval from the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (reference No: 2021-550) and was registered on the Chinese Clinical Trials Registry Platform (Identifier: ChiCTR2200056762). The trial adhered to the Consolidated Standards of Reporting Trials guidelines and followed the ethical standards outlined in the Declaration of Helsinki. All participants provided written informed consent, and their data were anonymized. Consent for publication Not Applicable. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions Competing interests The authors declare that they have no competing interests regarding the research, data analysis, and findings presented in this study on the Effects of Liuzijue Qigong on respiratory function in patients with Parkinson's disease. This study was conducted with the sole purpose of investigating and understanding the pulmonary function of individuals with Parkinson's disease to contribute to the existing body of knowledge in this field. No external funding or influences have affected the design, execution, or reporting of this research. Funding This research was supported by Chongqing medical scientific research project(Joint project of Chongqing Health Commission and Science and Technology Bureau,2022MSXM182). Authors' contributions Huimei Yin and Oumei Cheng designed the study and supervised the project. Xu Zhang and Yujiao Zhang collected the data. Fengying Quan supervise practice . Huimei Yin and Hongzhou Zuo wrote the initial paper. All the authors read and approved the final manuscript. Jianrong Zhou is responsible for the overall content as guarantor. Acknowledgements We sincerely thank all the participants for their cooperation. References Pringsheim, T., Jette, N., Frolkis, A., & Steeves, T. D. (2014). The prevalence of Parkinson's disease: a systematic review and meta-analysis. 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R., & Nijkrake, M. J. (2020). The Effects of Respiratory Training in Parkinson's Disease: A Systematic Review. Journal of Parkinson's disease , 10 (4), 1315–1333. https://doi.org/10.3233/JPD-202223IF: 5.2 Q1 Fitness Qigong Management Center of the State General Administration of Sports(2021) Fitness Qigong Liuzijue. People's Sports Press, Beijing Xu, S., Zhang, D., He, Q., Ma, C., Ye, S., Ge, L., Zhang, L., Liu, W., Chen, Z., & Zhou, L. (2022). Efficacy of Liuzijue Qigong in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Complementary therapies in medicine, 65, 102809. https://doi.org/10.1016/j.ctim.2022.102809F: 3.6 Q2 Zheng, Y., Zhang, Y., Li, H., Qiao, L., Fu, W., Yu, L., Li, G., Yang, J., Ni, W., Yong, Z., Wang, Y., & Fan, H. (2021). Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial. Archives of physical medicine and rehabilitation , 102 (3), 423–430. https://doi.org/10.1016/j.apmr.2020.07.007IF: 4.3 Q1 Li, D., Shen, M., Yang, X., Chen, D., Zhou, C., & Qian, Q. (2023). Effect of weight-bearing Liuzijue Qigong on cardiopulmonary function. Medicine , 102 (8), e33097. https://doi.org/10.1097/MD.0000000000033097IF: 1.6 Q3 Parkinson's Disease and Movement Disorders Group, Neurology Branch of Chinese Medical Association, Parkinson's Disease and Movement Disorders Branch of Chinese Medical Doctor Association. (2016).Diagnostic criteria for Parkinson's disease in China (2016 edition).Chinese Journal of Neurology, 49(4):268-271.https://doi.org/10.3760/cma.j.cn113694-20200331-00233 ZHANG Ziwei, YANG Jing, LI Wen, GUO Honghua,LIU Yameng,ZHANG Caihong. (2023).Network meta-analysis of nine exercise training modalities in pulmonary rehabilitation for COPD patients. Journal of Nursing, 38(02):85-91.https://doi.org/10.3870/j.issn.1001-4152.2023.02.085 Martinez-Pitre, P. J., Sabbula, B. R., & Cascella, M. (2023). Restrictive Lung Disease. In StatPearls . StatPearls Publishing. FAN Jing, LIU Xiaolei, KONG Min, WANG Xinyu,LONG Yiyan,ZHANG Yu.(2017).. Effects of fitness qigong on mood state and cognition in patients with moderate Parkinson's disease. Chinese Journal of Sports Medicine, 36(02):143-146+149. https://doi.org/10.16038/j.1000-6710.2017.02.008 PEI Yue. (2018). A comparative study on the physical and psychological effects of fitness qigong ba dan jin and yi jian jing on the body and psychology of female college students. Dissertation.Nanjing Institute of Physical Education HUANG Shengfei, LIU Fang, WEI Yanyan, SHENG Yanhong. (2022). Effects of Qigong Combined with Aromatherapy on Sleep Quality and Negative Mood in Colorectal Cancer Patients. Practical Clinical Medicine,23(06):59-63.https://doi.org/10.13764/j.cnki.lcsy.2022.06.019 JIE Kuncheng. (2020). Effects of fitness qigong on motor function, mental health and quality of life in patients with mild to moderate Parkinson's disease.Dissertation. Shanghai Institute of Sport, Kong, L., Ren, J., Fang, S., Li, Y., Wu, Z., Zhou, X., Hao, Q., Fang, M., & Zhang, Y. Q. (2023). Effects of traditional Chinese mind-body exercises for patients with chronic fatigue syndrome: A systematic review and meta-analysis. Journal of global health , 13 , 04157. https://doi.org/10.7189/jogh.13.04157IF: 7.2 Q1 Zhao, N., Yang, Y., Zhang, L., Zhang, Q., Balbuena, L., Ungvari, G. S., Zang, Y. F., & Xiang, Y. T. (2021). Quality of life in Parkinson's disease: A systematic review and meta-analysis of comparative studies. CNS neuroscience & therapeutics , 27 (3), 270–279. https://doi.org/10.1111/cns.13549IF: 5.5 Q1 Additional Declarations No competing interests reported. Supplementary Files supplementalappendixS1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Nov, 2024 Reviews received at journal 24 Oct, 2024 Reviews received at journal 09 Oct, 2024 Reviewers agreed at journal 30 Sep, 2024 Reviewers agreed at journal 30 Sep, 2024 Reviews received at journal 28 Sep, 2024 Reviewers agreed at journal 28 Sep, 2024 Reviewers invited by journal 25 Sep, 2024 Editor invited by journal 19 Jul, 2024 Editor assigned by journal 16 Jul, 2024 Submission checks completed at journal 16 Jul, 2024 First submitted to journal 08 Jul, 2024 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. 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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-4708812","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":331114582,"identity":"c88926ff-b4e6-41d8-8c2c-90e8795da20a","order_by":0,"name":"Huimei YIN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYBAC+4aDDQYfftjI2R9vIFKLAePhhsKZPWnGDGcOEKuF+XjDZx62Q4kNNxKI1GLOdrBxMw/PAWPGmY833mCosYkmqMWy52Cz4RyLO3LM0mnFFgzH0nIbCOq5cbDN4A3PM2M26RwzCcaGw0Rouf+w/QcP2+HEHskzRGoxOHCwwRCkZYYED5FaJIHxYggKZAMeoF8SiPELP8PxB+CoNGA/vPHGhxobIvyC7EiJBFKUQ7SQqmMUjIJRMApGBgAAuhVHi6gvVdUAAAAASUVORK5CYII=","orcid":"","institution":"the first Affiliated Hospital of Chongqing medical University","correspondingAuthor":true,"prefix":"","firstName":"Huimei","middleName":"","lastName":"YIN","suffix":""},{"id":331114583,"identity":"fba2e34d-3c92-40c5-8411-e5620d421bcf","order_by":1,"name":"Oumei Cheng","email":"","orcid":"","institution":"the first Affiliated Hospital of Chongqing medical University","correspondingAuthor":false,"prefix":"","firstName":"Oumei","middleName":"","lastName":"Cheng","suffix":""},{"id":331114584,"identity":"914e2ade-8af9-42fc-acf3-9dd102cb4611","order_by":2,"name":"Xu Zhang","email":"","orcid":"","institution":"the first Affiliated Hospital of Chongqing medical University","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Zhang","suffix":""},{"id":331114585,"identity":"5904cf4b-1907-491e-9a1d-ff26f68f1966","order_by":3,"name":"Fengying Quan","email":"","orcid":"","institution":"the first Affiliated Hospital of Chongqing medical University","correspondingAuthor":false,"prefix":"","firstName":"Fengying","middleName":"","lastName":"Quan","suffix":""},{"id":331114587,"identity":"f5c9e843-3e38-4883-ac54-ae094e1658ff","order_by":4,"name":"Yujiao Zhang","email":"","orcid":"","institution":"the first Affiliated Hospital of Chongqing medical University","correspondingAuthor":false,"prefix":"","firstName":"Yujiao","middleName":"","lastName":"Zhang","suffix":""},{"id":331114588,"identity":"2b782be5-e330-4dd6-b361-ddee7be61637","order_by":5,"name":"Hongzhou ZUO","email":"","orcid":"","institution":"the first Affiliated Hospital of Chongqing medical University","correspondingAuthor":false,"prefix":"","firstName":"Hongzhou","middleName":"","lastName":"ZUO","suffix":""},{"id":331114591,"identity":"a13ea540-a229-4261-802d-688c88a8dc35","order_by":6,"name":"Jianrong Zhou","email":"","orcid":"","institution":"Chongqing medical University","correspondingAuthor":false,"prefix":"","firstName":"Jianrong","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2024-07-09 03:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4708812/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4708812/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62647475,"identity":"995f9565-d033-4503-b8a6-020bea4caa85","added_by":"auto","created_at":"2024-08-16 21:29:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":357592,"visible":true,"origin":"","legend":"\u003cp\u003eThe body movements and mouth shape of Liuzijue Qigong\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4708812/v1/151f1d6a67afc9c093da17a2.png"},{"id":62647064,"identity":"907ec49b-bd04-4a85-aac5-8e8bfb741314","added_by":"auto","created_at":"2024-08-16 21:21:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34059,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Diagram\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4708812/v1/4c8639404fc81e545bf82b62.png"},{"id":62647859,"identity":"ce86588e-c9cb-41a5-b69d-749344ec1426","added_by":"auto","created_at":"2024-08-16 21:37:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1774390,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4708812/v1/1382408e-6c8d-43cc-8473-e1856937db6b.pdf"},{"id":62647063,"identity":"7665015b-f681-4b49-b2f6-11fb1f12a2bf","added_by":"auto","created_at":"2024-08-16 21:21:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14335,"visible":true,"origin":"","legend":"","description":"","filename":"supplementalappendixS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4708812/v1/f8b1ac10b0f9c15175458c17.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Liuzijue Qigong on respiratory function among patients with Parkinson’s disease:A randomized clinical trial","fulltext":[{"header":"Background","content":"\u003cp\u003eParkinson's disease (PD) is a prevalent neurodegenerative condition among elderly individuals characterized by a range of motor and nonmotor symptoms[1]. Respiratory dysfunction, although a common nonmotor symptom in PD patients, is often underestimated. Studies have reported that the incidence of restrictive ventilation dysfunction is 28%-94% [2\u0026ndash;4], and the incidence of upper airway obstruction is 6.7%-67.0% [3,5,6]. The motor impairments and altered perception of hypoxemia in PD can mask respiratory symptoms, leading to potential complications such as aspiration pneumonia and dyspnea [7]. Research has shown that respiratory muscle weakness can contribute to various issues, such as swallowing difficulties, speech disorders, weak coughing, and breathlessness, in PD patients, significantly impacting their quality of life[2,8]. Additionally, respiratory failure is a leading cause of mortality in advanced PD patients [9,10]. Hence, integrating respiratory function rehabilitation into the overall care plan for Parkinson's disease patients is crucial for improving patient outcomes and quality of life.\u003c/p\u003e \u003cp\u003e A recent systematic review on the effects of respiratory muscle training for patients with Parkinson's disease (PD) concluded that respiratory exercises have positive effects on PD patients, leading to improvements in respiratory function[11]. Specifically, inspiratory muscle training has been found to effectively enhance cardiopulmonary function and exercise capacity and reduce fatigue. On the other hand, expiratory muscle training can enhance airway clearance and protect the airway. However, the current training methods discussed in recent studies often involve the use of specialized devices and require additional professional guidance during practice, making them challenging to widely implement, especially for PD patients at home. Consequently, patient compliance tends to be low, and adherence to the training regimen can be difficult. Therefore, it is crucial to explore a convenient, simple, and user-friendly approach to respiratory rehabilitation that can be easily adopted by PD patients to promote better compliance and overall effectiveness.\u003c/p\u003e \u003cp\u003eLiuzijue Qigong, a traditional Chinese health exercise, emphasizes breathing and exhalation. It involves the use of six specific sounds\u0026mdash;\u0026ldquo;xū\u0026rdquo;, \u0026ldquo;hē\u0026rdquo;, \u0026ldquo;hū\u0026rdquo;, \u0026ldquo;sī\u0026rdquo;, \u0026ldquo;chuī\u0026rdquo;, and \u0026ldquo;xī\u0026rdquo;\u0026mdash;along with relaxed, slow, and gentle movements to promote physical fitness and rehabilitation [12]. Liuzijue Qigong has been widely utilized in pulmonary rehabilitation for chronic conditions such as COPD, stroke, and coronary heart disease in China [13\u0026ndash;15].\u003c/p\u003e \u003cp\u003eIn this study, we aimed to explore the use of Liuzijue Qigong as a home exercise regimen to assess its impact on respiratory function and quality of life in Parkinson's disease patients. By doing so, we seek to offer PD patients a practical and suitable home rehabilitation technique.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003e This single-blind randomized controlled trial received approval from the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (reference No: 2021\u0026thinsp;\u0026minus;\u0026thinsp;550) and was registered on the Chinese Clinical Trials Registry Platform (Identifier: ChiCTR2200056762). The trial adhered to the Consolidated Standards of Reporting Trials guidelines and followed the ethical standards outlined in the Declaration of Helsinki. All participants provided written informed consent, and their data were anonymized.\u003c/p\u003e \u003cp\u003eTo prevent any \"contamination\" of the intervention study, participants were clearly informed during the informed consent process that the study was exploratory in nature and that its effectiveness could not be predetermined. Upon completion of the study, relevant information and videos will be made available for publication. Participants in the control group had the option to download and study this material if they were interested, but they were instructed not to practice it during the study to prevent interference with the results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe study was conducted at the First Affiliated Hospital of Chongqing Medical University from July 2021 to March 2023. Participants were recruited through convenience sampling from the Outpatient Department of Neurology. The inclusion criteria were as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIndividuals diagnosed with PD[16].\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients at H-Y stage 1\u0026ndash;3.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe dosage and type of oral anti-Parkinson's drugs were stable for the past 3 months.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe exclusion criteria included the following:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCurrent use of medications that may affect muscle structure and lung function (such as corticosteroids, immunosuppressants, etc.).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of severe skeletal and spinal deformities.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of other diseases causing respiratory muscle damage.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients with severe cognitive impairment.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients with concurrent lung infections.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe dropout criteria were defined as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUnwillingness to continue training and voluntary withdrawal during the trial.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLoss to follow-up or missed scheduled revisits.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNoncompliance with the study's training regimen (total training frequency\u0026thinsp;\u0026lt;\u0026thinsp;70% or each training session less than 70% of the required time and intensity).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e4. Concurrent adoption of other respiratory rehabilitation training methods or participation in other drug trials\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eScreening, Baseline Testing, and Randomization\u003c/h2\u003e \u003cp\u003eAfter prescreening in the Neurology Outpatient Department, eligible participants underwent baseline assessments. Subsequently, the participants were randomly assigned to either the experimental or control group at a 1:1 ratio using the random number table method.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003eBoth groups were provided with an information booklet containing instructions for home practice and maintained their original doses of anti-Parkinson medications. Any changes in medication were carefully recorded by the observer, who also calculated whether the equivalent dose of levodopa was altered.\u003c/p\u003e \u003cp\u003eThe control group engaged in a home-based rehabilitation program that included gait training, core muscle group exercises, and activities focused on enhancing daily living abilities. The specific training components and intensity were tailored to each participant's functional status and exercise habits. The regimen was reviewed by two physiotherapists to ensure its effectiveness. Each training session lasted 30 minutes and was conducted once a day, five days a week, over a period of 12 weeks.\u003c/p\u003e \u003cp\u003e Participants in the experimental group underwent Liuzijue Qigong training, which was designed based on the Liuzijue Qigong manual (People\u0026rsquo;s Sports Press, 2016, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) published by the State Sports General Administration. This practice involved controlled inhalation through the nose and exhalation through various mouth forms, represented by the sounds Xu, He, Hu, Si, Chui, and Xi. The respiratory flow was required to be slow and continuous and synchronized with body movements (see supplemental appendix S1). Each sound was repeated six times, with each session lasting 30 minutes. Training was conducted once daily, five days a week, for a total of 12 weeks. After one week of learning, the participants officially commenced the trial. To support home practice, participants were provided with a video recording by the experimenter. While participants were not expected to achieve perfect pronunciation or exact limb movements, the primary focus was on mastering the coordination of breathing and pronunciation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cp\u003eAll participants underwent standardized assessments conducted by the experimenter both before and after the 12-week intervention period. In cases where participants experienced motor complications such as wearing off or on-off phenomena, assessments were carried out during the drug onset or \"on\" period to ensure consistency and accuracy in the evaluation process.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePrimary outcome\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The primary outcome measure was respiratory function, which was assessed using a portable pulmonary function instrument (XEEK, X1, Xiamen, China) following the guidelines for pulmonary function and respiratory muscle strength examinations jointly published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) in the European Respiratory Journal. To ensure accuracy and reliability, each respiratory function index, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), was measured three times, and the best result was recorded as the final outcome. This approach was implemented to minimize random errors that could arise during the assessments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSecondary Outcomes\u003c/h2\u003e \u003cp\u003eIn addition to the primary outcome measure of respiratory function, secondary outcomes included the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III), the 39-item Parkinson's Disease Questionnaire (PDQ-39), the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA). These secondary outcome measures were utilized to assess various aspects related to Parkinson's disease symptoms, quality of life, depression, and anxiety levels among the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eAdverse Events\u003c/h2\u003e \u003cp\u003eDuring the intervention sessions, adverse events were monitored by assessing participants for any significant discomfort, pain, or harm resulting from the intervention. Participants were instructed to promptly inform the research team if they experienced any adverse events related to the study. This proactive approach ensured that any potential negative effects of the intervention could be identified and addressed promptly to safeguard the well-being of the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Methods\u003c/h2\u003e \u003cp\u003eThe data analysis was conducted using the statistical software SPSS (version 25.0). Continuous variables with a normal distribution are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), nonnormally distributed data are presented as the median (interquartile range [IQR]), and categorical variables are presented as the number (percentage).\u003c/p\u003e \u003cp\u003eFor variables that met the assumptions of a normal distribution and homogeneity of variance, a paired sample t test was used to analyze differences within the group, while an independent samples t test was used to compare differences between groups. In cases where the data did not meet the requirements for parametric tests, the Wilcoxon signed-rank test was employed to compare differences within the group, and the Mann‒Whitney U test was used to compare differences between groups. A p value less than 0.05 was considered to indicate a significant difference between the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 94 patients with Parkinson's disease were initially screened for the study. Of these, 19 patients did not meet the eligibility criteria, and an additional 15 patients declined to participate, resulting in an enrollment rate of 63.8% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The 60 participants who were randomized were evenly divided into a control group and an experimental group, with 30 patients in each group. During the course of the experiment, 5 patients from the experimental group withdrew from the study, while 4 patients from the control group refused to participate in the follow-up. Ultimately, 51 participants (85%) completed the intervention, with 25 in the experimental group and 26 in the control group. This resulted in an overall dropout rate of 15% (9 out of 60). The compliance rates for home practice during the intervention period were 83.3% (25 out of 30) for the Liuzijue group and 86.7% (26 out of 30) for the control group. These compliance rates indicate the level of adherence to the prescribed home practice regimen during the study.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics of the Participants\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;1 presents the baseline demographic and clinical characteristics of the participants included in the study. There were no statistically significant differences observed between the intervention and control groups. The mean (SD) age of the participants was 57.92 (9.14) years, with an age range of 49 to 82 years. Of the 51 participants, 27 were female, accounting for 52.94% of the total. The mean (SD) BMI (body mass index) of the participants was 20.74 (1.96). The mean (SD) duration of the disease among the participants was 6.09 (3.56) years, with a range of 1 to 12 years.\u003c/p\u003e \u003cp\u003eTabel 1 Baseline comparision of Demographics between the two groups(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/div\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eALL\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=51)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental group (n=25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group (n=26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eage, mean(SD),y\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\"\u003e\n \u003cp\u003e\u003cstrong\u003e57.92(9.14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\"\u003e\n \u003cp\u003e\u003cstrong\u003e58.80(8.61)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e58.15(7.09)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.730\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex (male/female), n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\"\u003e\n \u003cp\u003e\u003cstrong\u003e24/27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\"\u003e\n \u003cp\u003e\u003cstrong\u003e12/13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e12/14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.432\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI(kg/m2),mean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.74 (1.96)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.42(2.16)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e21.18(1.48)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.641\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisease duration,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean(SD),y\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.09 (3.56)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.05(3.07)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.15(4.47)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.270\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHoehn-Yahr stage,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emedian (IQR)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2(1.5,2.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e1.5,2.5\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e2,2.5\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.059\u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLEDD,mean(SD),mg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e421.46(198.52)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e393.35(253.43)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e476.25(218.97)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.165\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMMSE,mean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e28.35(1.46)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e27.05(1.85)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e28.75(1.32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.188\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFVC,mean(SD),L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.94(0.54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.98(0.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.91(0.89)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.829\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEV1,mean(SD),L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.22(0.42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.18(0.54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.24(0.31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.935\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePEF,mean(SD),L/s\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.16(1.14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.13(1.27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.19(1.34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.898\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMIP,mean(SD),cmH2O\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e55.08(19.76)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e55.15(23.15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e54.12(20.05)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.903\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEP,mean(SD),cmH2O\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e94.15(43.41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.75(32.19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e93.55(38.61)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.736\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMDS-UPDRS-\u003c/strong\u003e\u003cstrong\u003eⅢ\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e,mean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.89(13.21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.65(12.98)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e22.65(11.91)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.457\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePDQ-39,mean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e23.76(16.23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e24.15(13.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e23.34(14.18)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.457\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAMD,mean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.59(7.64)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.54(8.32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.67(8.03)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.763\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.985507246376812%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAMA,mean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.108695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.42(6.11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.565217391304348%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.16(7.34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.62(5.86)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.395\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations:BMI,Body Mass Index;LEDD,levodopa equivalent daily dose;MMSE,Minimum Mental State Examination;FVC,forced vital capacity ;FEV1,forced expiratory volume in 1s;PEF,peak expiratory flow;MIP, maximal inspiratory pressure ;MEP,maximal expiratory pressure; MDS-UPDRS III, Movement Disorders Society United Parkinson\u0026rsquo;s Disease Rating Scale, Part III; PDQ-39, 39-item Parkinson\u0026rsquo;s Disease Questionnaire;HAMD,Hamilton Depression Scale;\u003c/p\u003e\n\u003cp\u003eHAMA,Hamilton Anxiety Scale .\u003c/p\u003e\n\u003cp\u003ea for continuous data, an independent t test was used.\u003c/p\u003e\n\u003cp\u003eb for categorical data, a \u0026chi;2 test was used.\u003c/p\u003e\n\u003cp\u003ec for ordinal data , a rank sum test was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eoutcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents the comparisons of within-group outcomes, while Table 3 illustrates the changes in the main outcomes between the two groups after treatment. In this study, FVC, FEV1, PEF, MIP, and MEP were utilized to assess respiratory function.\u0026nbsp;After the treatment period, the experimental group exhibited significant improvements in FVC, FEV1, PEF, and MEP (FVC: 0.13 [95% CI, -0.24 to -0.01]; P = 0.029; FEV1: -0.11 [95% CI, -0.18 to -0.02]; P = 0.015; PEF: -0.14 [95% CI, -0.31 to -0.03]; P = 0.049; MEP: -0.13 [95% CI, -1.67 to -0.04]; P = 0.045).\u0026nbsp;Moreover, compared to\u0026nbsp;those in\u0026nbsp;the control group, these improvements were statistically significant (FVC: 0.46 [95% CI, 0.02 to 0.91]; P = 0.003; FEV1: 0.33 [95% CI, 0.01 to 0.76]; P = 0.021; MEP: -5.35 [95% CI, -0.54 to -12.16]; P = 0.047).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eSecondary Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study utilized\u0026nbsp;the\u0026nbsp;MDS-UPDRS-III and PDQ-39 as secondary outcome measures to evaluate the motor function and quality of life of the participants. In the experimental group, significant reductions in PDQ-39 scores\u0026nbsp;were observed postintervention\u0026nbsp;compared to\u0026nbsp;preintervention\u0026nbsp;(1.33 [95% CI, -0.35 to -2.51]; P = 0.036). In the control group, both\u0026nbsp;the\u0026nbsp;MDS-UPDRS-III and PDQ-39 scores\u0026nbsp;decreased significantly\u0026nbsp;from baseline (MDS-UPDRS-III: -0.84 [95% CI, -1.66 to 0.64]; P = 0.033; PDQ-39: 1.65 [95% CI, -1.66 to 2.64]; P = 0.046).\u0026nbsp;At the end of the treatment period, there was no statistically significant difference in the improvement\u0026nbsp;in the\u0026nbsp;MDS-UPDRS-III and PDQ-39 scores between the two groups (MDS-UPDRS-III: 2.35 [95% CI, -6.35 to 11.05]; P = 0.588; PDQ-39: -1.56 [95% CI, -4.67 to 2.81]; P = 0.157).\u003c/p\u003e\n\u003cp\u003eFurthermore, the mental states of the participants were assessed using HAMD and HAMA scores. In the experimental group, there were significant reductions in both the HAMD and HAMA scores at the end of the treatment period (HAMD: -0.98 [95% CI, -1.31 to -1.67]; P = 0.042; HAMA: -1.59 [95% CI, -2.34 to -0.89]; P = 0.037). Compared to those in the control group, the reductions in HAMD and HAMA scores were statistically significant (HAMD: 0.32 [95% CI, 0.12 to 0.57]; P = 0.043; HAMA: 0.35 [95% CI, 0.08 to 0.77]; P = 0.031).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTabel 2 Comparison of the Treatment Effects Between 2 Groups and Baseline\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.960072595281307%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.201451905626136%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental group (n=25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.83847549909256%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group(n=26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.58700696055684%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean change from baseline\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.529002320185615%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.65893271461717%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean change from baseline\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.22505800464037%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFVC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.13(-0.24 to -0.01)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.36(-0.01 to 0.52)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.069\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEV1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.11(-0.18 to -0.02)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.01(0.04 to 0.02)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.378\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePEF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.14(-0.31 to -0.03)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.27(-0.01 to 0.56)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.054\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMIP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-1.2(-4.02 to 1.61 )\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.061\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-2.3(-10.13 to 5.53)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.751\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.13(-1.67 to -0.04)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.91(-0.95 to 6.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.132\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMDS-UPDRS-\u003c/strong\u003e\u003cstrong\u003eⅢ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.31(-2.74 to 0.14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e\u003cstrong\u003e.074\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.84(-1.66 to -0.64)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\"\u003e\n \u003cp\u003e\u003cstrong\u003e.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePDQ-39\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-1.33(-0.35 to -2.51)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-1.65(-1.66 to -2.64)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.98(-1.31 to -1.67)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e\u003cstrong\u003e.042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.71(-1.12 to 1.35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\"\u003e\n \u003cp\u003e\u003cstrong\u003e.106\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.920289855072465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.347826086956523%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-1.59(-2.34 to -0.89)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e\u003cstrong\u003e.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.66(-2.38 to 1.13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.326086956521738%\"\u003e\n \u003cp\u003e\u003cstrong\u003e.269\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTabel 3 Comparison of outcomes Between Two Groups After treatment\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.390374331550802%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental group (n=25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.073083778966133%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifference (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.33868092691622%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.390374331550802%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFVC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.37(0.31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.073083778966133%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.86(0.32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" 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\u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e104.46(30.53)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.073083778966133%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.05(27.02)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-5.35(-0.54 to -12.16)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.33868092691622%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.390374331550802%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMDS-UPDRS-\u003c/strong\u003e\u003cstrong\u003eⅢ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.15(14.50)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.073083778966133%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.30(12.62)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.35(-6.35 to 11.05)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.33868092691622%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.088\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.390374331550802%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePDQ-39\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e19.33(12.53)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.073083778966133%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e20.52(11.14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-1.56(-4.67 to 2.81)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.33868092691622%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.157\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.390374331550802%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.58(5.67)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.073083778966133%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.22(7.35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.32(0.12 to 0.57)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.33868092691622%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.390374331550802%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHAMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.09(4.89)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.073083778966133%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.79(5.38)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.59893048128342%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.35(0.08 to 0.77)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.33868092691622%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse Events\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne participant (4.0%) from the experimental group reported temporary mild backache, which resolved with the use of plaster. Two participants (7.7%) from the control group reported temporary mild knee pain when stretching but required no medical attention. No serious adverse events were reported.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first randomized clinical trial\u0026nbsp;targeted\u0026nbsp;at\u0026nbsp;determining\u0026nbsp;the effectiveness of Liuzijue Qigong\u0026nbsp;on respiratory\u0026nbsp;function in patients with PD. Our results indicate that Liuzijue Qigong can improve the lung function,\u0026nbsp;including expiratory function and respiratory muscle strength,\u0026nbsp;of PD patients and\u0026nbsp;has a beneficial effect on regulating the patient\u0026apos;s mood.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Liuzijue Qigong, a traditional Qigong practice centered around breathing and exhaling, involves six unique methods of exhaling accompanied by simple body movements and mental focus. It follows the fundamental principles of \u0026quot;nose breathing, mouth exhaling, deep and slow breathing\u0026quot; for respiratory training. This type of breathing, akin to pursed-lip breathing, utilizes specific sounds in practice to serve distinct purposes. For example, the sound \u0026quot;xu\u0026quot; in Liuzijue Qigong simulates pursed-lip breathing through slow exhalation with the accompanying sound, aiding in maintaining proper airway pressure, preventing premature closure of the airway, and reducing airway obstruction. By adjusting the breathing pattern through lowering the respiratory rate and prolonging exhalation, pulmonary ventilation is enhanced[17]. The controlled slow exhalation exercises in Liuzijue Qigong engage and strengthen the respiratory muscles, thereby improving respiratory efficiency and lung ventilation function. Unlike simple pursed-lip breathing, Liuzijue Qigong involves corresponding movements with each sound, primarily involving bilateral upper limb abduction or raising. These movements help increase the body\u0026apos;s intake and expand chest capacity, ultimately enhancing respiratory function. Given that Parkinson\u0026apos;s disease can lead to restricted chest expansion due to abnormal posture, gait, and muscular rigidity, resulting in reduced lung capacity and restrictive pulmonary disease[18], the combination of breathing techniques and movements in Liuzijue Qigong may offer advantages in improving respiratory function beyond simple pursed-lip breathing alone.\u003c/p\u003e\n\u003cp\u003eOur study did not demonstrate improvements in physical outcomes related to motor symptoms\u0026nbsp;or\u0026nbsp;mobility compared to\u0026nbsp;those of\u0026nbsp;the control group.\u0026nbsp;One possible explanation for this discrepancy could be the nature of the movements involved in Liuzijue Qigong. Liuzijue Qigong primarily focuses on breathing techniques and simple body movements, with less emphasis on active engagement of the legs. In contrast, the control group engaged in exercises specifically designed to target the motor symptoms of Parkinson\u0026apos;s disease, such as gait training and balance training.\u0026nbsp;These findings highlight the importance of considering the specific needs and symptoms of patients with\u0026nbsp;PD\u0026nbsp;when designing intervention programs. Tailoring interventions to address diverse aspects of the condition, including both motor and\u0026nbsp;nonmotor\u0026nbsp;symptoms, may lead to more comprehensive and effective treatment outcomes.\u003c/p\u003e\n\u003cp\u003eThe experimental group demonstrated a more significant reduction in depression and anxiety symptoms\u0026nbsp;than did\u0026nbsp;the control group at the conclusion of the intervention. Liuzijue Qigong, an exercise technique that harmonizes movement, breath, and mindfulness, emphasizes the guidance of qi with the mind and body. During practice, the use of elegant music and gentle movements aids in relaxing the body and mind, potentially stimulating the vagus nerve, thereby reducing stress and alleviating anxiety [19].\u0026nbsp;Moreover, the incorporation of abdominal core muscle training and limb-guiding actions within Liuzijue Qigong can improve body flexibility, enhance balance, and boost attention and concentration. These benefits contribute to the overall improvement of physical and mental health [20]. Additionally, the social interactions fostered by engaging in Liuzijue Qigong can help individuals with Parkinson\u0026apos;s disease establish robust support networks, easing feelings of loneliness and psychological strain [21].\u0026nbsp;Numerous studies have demonstrated the positive impact of Qigong-based interventions on the physical and mental well-being of patients with chronic conditions [22,23].\u003c/p\u003e\n\u003cp\u003eBoth groups exhibited significant decreases in PDQ-39 scores compared to\u0026nbsp;preintervention scores, without any statistically significant\u0026nbsp;differences. It is widely recognized that the quality of life of individuals with Parkinson\u0026apos;s disease can be impacted in a\u0026nbsp;multidimensional\u0026nbsp;manner, encompassing physical function, mental health, and social support [24].\u0026nbsp;In our study, the control group\u0026nbsp;experienced\u0026nbsp;an improvement in quality of life primarily through the amelioration of motor symptoms. In contrast, Liuzijue Qigong contributed to overall enhancement by addressing both physical and mental states. This\u0026nbsp;finding\u0026nbsp;aligns with findings from another study, which also supports the effectiveness of Qigong in enhancing motor function, mental health, and quality of life in patients with mild to moderate Parkinson\u0026apos;s disease.\u003c/p\u003e\n\u003cp\u003eThese results underscore the holistic benefits of integrating practices such as Liuzijue Qigong in the management of Parkinson\u0026apos;s disease. By addressing both the physical and mental aspects of the condition, approaches such as Qigong offer a comprehensive and integrative strategy to improve the well-being of individuals with Parkinson\u0026apos;s disease.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, Liuzijue Qigong has shown promising benefits in improving patients\u0026apos; respiratory function, enhancing quality of life, and reducing stress levels, all of which are crucial for promoting the rehabilitation of individuals with Parkinson\u0026apos;s disease. Moreover, the ease of operation and the flexibility of this method make it accessible and convenient for patients, as it is not constrained by space requirements. This makes it suitable for home-based practice and community settings, facilitating its widespread application and promotion among individuals with Parkinson\u0026apos;s disease. Overall, the positive outcomes and practicality of Liuzijue Qigong suggest its potential as a valuable addition to the holistic care and management of Parkinson\u0026apos;s disease.\u003c/p\u003e\n"},{"header":"Study limitations","content":"\u003cp\u003eThis study specifically focused on Parkinson\u0026apos;s disease patients in the early and middle stages, highlighting the need for further research to explore the effects of rehabilitation and feasibility of implementing these interventions for advanced-stage patients. Additionally, it is important to note that the sample size in this study was relatively small, and the follow-up duration was limited.In future studies, expanding the sample size and extending the follow-up period will be crucial for obtaining more comprehensive and objective evidence. By conducting research with a larger and more diverse group of participants over an extended period, we can gain deeper insights into the effectiveness and long-term benefits of interventions such as Liuzijue Qigong for individuals with Parkinson\u0026apos;s disease across different stages of the condition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003ePD\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Parkinson\u0026apos;s Disease \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eFVC\u003c/strong\u003e Forced Vital Capacity \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFEV1\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Forced Expiratory Volume in 1s \u0026nbsp; \u0026nbsp; \u003cstrong\u003ePEF \u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Peak Expiratory Flow\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFEV1/FVC\u003c/strong\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;forced Expiratory Volume in1s/Forced Vital Capacity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMIP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; Maximal Inspiratory Pressure \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cstrong\u003eMEP\u003c/strong\u003e \u0026nbsp; \u0026nbsp;\u0026nbsp;Maximal Expiratory Pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH-Y\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eStage of Hoehn-Yahr \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eMMSE\u003c/strong\u003e\u0026nbsp; Mini Mental State Examination\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDS-UPDRS\u003c/strong\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Movement Disorder Society-Unified Parkinson Disease Rating Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHAMD\u003c/strong\u003e\u0026nbsp; \u0026nbsp;Hamilton Depression Scale \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cstrong\u003eHAMA \u0026nbsp;\u0026nbsp;\u003c/strong\u003eHamilton Anxiety Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePDQ-39\u003c/strong\u003e \u0026nbsp;The Parkinson\u0026apos;s disease Questionnaire-39\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIMST\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Inspiratory Muscle Strength Training \u0026nbsp; \u003cstrong\u003eEMST\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Expiratory Muscle Strength Training\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBMI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u0026nbsp; Body Mass Index \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLEDD\u0026nbsp;\u003c/strong\u003e \u0026nbsp; \u0026nbsp;\u0026nbsp;the Levodopa Equivalent Doses of Day\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-blind randomized controlled trial received approval from the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (reference No: 2021-550) and was registered on the Chinese Clinical Trials Registry Platform (Identifier: ChiCTR2200056762). The trial adhered to the Consolidated Standards of Reporting Trials guidelines and followed the ethical standards outlined in the Declaration of Helsinki. All participants provided written informed consent, and their data\u0026nbsp;were\u0026nbsp;anonymized.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions\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 regarding the research, data analysis, and findings presented in this study on the Effects of Liuzijue Qigong on respiratory function in patients with Parkinson\u0026apos;s disease. This study was conducted with the sole purpose of investigating and understanding the pulmonary function of individuals with Parkinson\u0026apos;s disease to contribute to the existing body of knowledge in this field. No external funding or influences have affected the design, execution, or reporting of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by Chongqing medical scientific research project(Joint project of Chongqing Health Commission and Science and Technology Bureau,2022MSXM182).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuimei Yin\u003c/strong\u003e and\u0026nbsp;\u003cstrong\u003eOumei Cheng\u003c/strong\u003e designed the study and supervised the project.\u0026nbsp;\u003cstrong\u003eXu Zhang\u003c/strong\u003e and\u0026nbsp;\u003cstrong\u003eYujiao Zhang\u003c/strong\u003e collected the data.\u0026nbsp;\u003cstrong\u003eFengying Quan\u003c/strong\u003e supervise practice .\u003cstrong\u003eHuimei Yin\u003c/strong\u003e and\u0026nbsp;\u003cstrong\u003eHongzhou Zuo\u003c/strong\u003e wrote the initial paper. All the authors read and approved the final manuscript.\u0026nbsp;\u003cstrong\u003eJianrong Zhou\u003c/strong\u003e is responsible for the overall content as guarantor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the participants for their cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePringsheim, T., Jette, N., Frolkis, A., \u0026amp; Steeves, T. D. (2014). The prevalence of Parkinson\u0026apos;s disease: a systematic review and meta-analysis. \u003cem\u003eMovement disorders : official journal of the Movement Disorder Society\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(13), 1583\u0026ndash;1590. https://doi.org/10.1002/mds.25945IF: 8.6 Q1\u003c/li\u003e\n \u003cli\u003eSathyaprabha, T. N., Kapavarapu, P. K., Pall, P. K., Thennarasu, K., \u0026amp; Raju, T. R. (2005). 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Tutorial on maximum inspiratory and expiratory mouth pressures in individuals with idiopathic Parkinson disease (IPD) and the preliminary results of an expiratory muscle strength training program. \u003cem\u003eNeuroRehabilitation\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(1), 71\u0026ndash;79.IF: 2.0 Q2\u003c/li\u003e\n \u003cli\u003eChoi, H. G., Lim, J. S., Lee, Y. K., Sim, S., \u0026amp; Kim, M. (2019). Mortality and cause of death in South Korean patients with Parkinson\u0026apos;s disease: a longitudinal follow-up study using a national sample cohort. \u003cem\u003eBMJ open\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(9), e029776. https://doi.org/10.1136/bmjopen-2019-029776IF: 2.9 Q2\u003c/li\u003e\n \u003cli\u003eHobson, P., \u0026amp; Meara, J. (2018). Mortality and quality of death certification in a cohort of patients with Parkinson\u0026apos;s disease and matched controls in North Wales, UK at 18 years: a community-based cohort study. \u003cem\u003eBMJ open\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(2), e018969. https://doi.org/10.1136/bmjopen-2017-018969IF: 2.9 Q2\u003c/li\u003e\n \u003cli\u003evan de Wetering-van Dongen, V. A., Kalf, J. G., van der Wees, P. J., Bloem, B. R., \u0026amp; Nijkrake, M. J. (2020). The Effects of Respiratory Training in Parkinson\u0026apos;s Disease: A Systematic Review. \u003cem\u003eJournal of Parkinson\u0026apos;s disease\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(4), 1315\u0026ndash;1333. https://doi.org/10.3233/JPD-202223IF: 5.2 Q1\u003c/li\u003e\n \u003cli\u003eFitness Qigong Management Center of the State General Administration of Sports(2021) Fitness Qigong Liuzijue. People\u0026apos;s Sports Press, Beijing\u003c/li\u003e\n \u003cli\u003eXu, S., Zhang, D., He, Q., Ma, C., Ye, S., Ge, L., Zhang, L., Liu, W., Chen, Z., \u0026amp; Zhou, L. (2022). Efficacy of Liuzijue Qigong in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Complementary therapies in medicine, 65, 102809. https://doi.org/10.1016/j.ctim.2022.102809F: 3.6 Q2\u003c/li\u003e\n \u003cli\u003eZheng, Y., Zhang, Y., Li, H., Qiao, L., Fu, W., Yu, L., Li, G., Yang, J., Ni, W., Yong, Z., Wang, Y., \u0026amp; Fan, H. (2021). Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial. \u003cem\u003eArchives of physical medicine and rehabilitation\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e(3), 423\u0026ndash;430. https://doi.org/10.1016/j.apmr.2020.07.007IF: 4.3 Q1\u003c/li\u003e\n \u003cli\u003eLi, D., Shen, M., Yang, X., Chen, D., Zhou, C., \u0026amp; Qian, Q. (2023). Effect of weight-bearing Liuzijue Qigong on cardiopulmonary function. \u003cem\u003eMedicine\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e(8), e33097. https://doi.org/10.1097/MD.0000000000033097IF: 1.6 Q3\u003c/li\u003e\n \u003cli\u003eParkinson\u0026apos;s Disease and Movement Disorders Group, Neurology Branch of Chinese Medical Association, Parkinson\u0026apos;s Disease and Movement Disorders Branch of Chinese Medical Doctor Association. (2016).Diagnostic criteria for Parkinson\u0026apos;s disease in China (2016 edition).Chinese Journal of Neurology, 49(4):268-271.https://doi.org/10.3760/cma.j.cn113694-20200331-00233\u003c/li\u003e\n \u003cli\u003eZHANG Ziwei, YANG Jing, LI Wen, GUO Honghua,LIU Yameng,ZHANG Caihong. (2023).Network meta-analysis of nine exercise training modalities in pulmonary rehabilitation for COPD patients. Journal of Nursing, 38(02):85-91.https://doi.org/10.3870/j.issn.1001-4152.2023.02.085\u003c/li\u003e\n \u003cli\u003eMartinez-Pitre, P. J., Sabbula, B. R., \u0026amp; Cascella, M. (2023). Restrictive Lung Disease. In \u003cem\u003eStatPearls\u003c/em\u003e. StatPearls Publishing.\u003c/li\u003e\n \u003cli\u003eFAN Jing, LIU Xiaolei, KONG Min, WANG Xinyu,LONG Yiyan,ZHANG Yu.(2017).. Effects of fitness qigong on mood state and cognition in patients with moderate Parkinson\u0026apos;s disease. Chinese Journal of Sports Medicine, 36(02):143-146+149. https://doi.org/10.16038/j.1000-6710.2017.02.008\u003c/li\u003e\n \u003cli\u003ePEI Yue. (2018). A comparative study on the physical and psychological effects of fitness qigong ba dan jin and yi jian jing on the body and psychology of female college students. Dissertation.Nanjing Institute of Physical Education\u003c/li\u003e\n \u003cli\u003eHUANG Shengfei, LIU Fang, WEI Yanyan, SHENG Yanhong. (2022). Effects of Qigong Combined with Aromatherapy on Sleep Quality and Negative Mood in Colorectal Cancer Patients. Practical Clinical Medicine,23(06):59-63.https://doi.org/10.13764/j.cnki.lcsy.2022.06.019\u003c/li\u003e\n \u003cli\u003eJIE Kuncheng. (2020). Effects of fitness qigong on motor function, mental health and quality of life in patients with mild to moderate Parkinson\u0026apos;s disease.Dissertation. Shanghai Institute of Sport,\u003c/li\u003e\n \u003cli\u003eKong, L., Ren, J., Fang, S., Li, Y., Wu, Z., Zhou, X., Hao, Q., Fang, M., \u0026amp; Zhang, Y. Q. (2023). Effects of traditional Chinese mind-body exercises for patients with chronic fatigue syndrome: A systematic review and meta-analysis. \u003cem\u003eJournal of global health\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 04157. https://doi.org/10.7189/jogh.13.04157IF: 7.2 Q1\u003c/li\u003e\n \u003cli\u003eZhao, N., Yang, Y., Zhang, L., Zhang, Q., Balbuena, L., Ungvari, G. S., Zang, Y. F., \u0026amp; Xiang, Y. T. (2021). Quality of life in Parkinson\u0026apos;s disease: A systematic review and meta-analysis of comparative studies. \u003cem\u003eCNS neuroscience \u0026amp; therapeutics\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(3), 270\u0026ndash;279. https://doi.org/10.1111/cns.13549IF: 5.5 Q1\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Parkinson's disease, LiuZijue, Qigong, Respiratory function, Quality of life","lastPublishedDoi":"10.21203/rs.3.rs-4708812/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4708812/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRespiratory dysfunction is a common nonmotor symptom in patients with Parkinson's disease that may be easily overlooked. Incorporating respiratory function rehabilitation into routine rehabilitation programs for these patients is important. However, previous studies have focused primarily on professional devices and training processes that require additional professional guidance, making wide implementation challenging.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this assessor-masked, randomized clinical trial, eligible participants were randomized into an experimental group and a control group. The experimental group received Liu Zi Jue Qigong exercise for 12 weeks, while the control group underwent conventional rehabilitation exercises. Primary outcomes included measures of respiratory function, such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Secondary outcomes included motor symptoms, quality of life, depression, and anxiety.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results from a study involving 51 Parkinson's disease patients showed significant improvements in the FVC, FEV1, PEF, and MEP in the experimental group compared to those in the control group after the 12-week intervention. Additionally, there was a noticeable decrease in depression and anxiety scores in the experimental group, with statistically significant reductions compared to those in the control group.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLiuzijue Qigong exercise has the potential to enhance respiratory function and mental health in patients with Parkinson's disease in the early and middle stages. These findings could serve as a valuable reference for implementing home-based rehabilitation techniques for individuals with Parkinson's disease.\u003c/p\u003e\u003ch2\u003eTRIAL REGISTRATION\u003c/h2\u003e \u003cp\u003eChinese Clinical Trial Registry: ChiCTR2200056762(Registration Date: February 15, 2022).\u003c/p\u003e","manuscriptTitle":"Effects of Liuzijue Qigong on respiratory function among patients with Parkinson’s disease:A randomized clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-16 21:21:54","doi":"10.21203/rs.3.rs-4708812/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-15T13:32:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-24T08:28:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-09T07:36:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286820780760992284373040634641515983206","date":"2024-09-30T19:44:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107864504534963165187790927073108288400","date":"2024-09-30T19:22:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-28T13:50:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176183122096085056800160337827218587538","date":"2024-09-28T06:43:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-25T14:33:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-19T08:42:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-16T11:39:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-16T11:38:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2024-07-09T03:21:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5521d616-7e5f-43b1-9ce1-3df163c89e3f","owner":[],"postedDate":"August 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-01-21T11:08:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-16 21:21:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4708812","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4708812","identity":"rs-4708812","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}