[25vol24no1-05]The Effects of Breathing Meditation Qigong Therapy... 275 정대성 2025.08.19 120  25Vol24No1-05AnSJ.pdf (611 KB), 25vol24no1-05-kor.enw (1 KB), 25vol24no1-05-eng.enw (1 KB) [인용] So Jung An, Gye Bong Lee. The Effects of Breathing Meditation Qigong Therapy on Motor- and Non-Motor Symptoms in Patients with Parkinson’s Disease : Therapeutic Outcomes for Olfactory, Gustatory, Voice, and Swallowing Disorders. 醫療氣功. 2025;24(5):171-208 [개괄] 醫療氣功 MEDICAL GIGONG Vol.24. No.1. 2025.07.20. DOI: https://doi.org/10.22942/mg.2025.24.1.171 The Effects of Breathing Meditation Qigong Therapy on Motor- and Non-Motor Symptoms in Patients with Parkinson’s Disease : Therapeutic Outcomes for Olfactory, Gustatory, Voice, and Swallowing Disorders So Jung An1, Gye Bong Lee2 1South Baylo University Oriental Medicine 2Gachon University Graduate School-Department of Physical Education [Abstract] Objective: The present study aimed to investigate the therapeutic effects of An’s Breathing Meditation Qigong Therapy (ABMQT) on both non-motor (olfactory and gustatory disorder) and motor (voice and swallowing disorder) symptoms in patients with Parkinson’s disease (PD). Methods: Three female patients diagnosed with PD participated in ABMQT sessions consisting of twice a week for 24 weeks, with each session lasting 120-minutes. Outcome measures in pre- and post-test included the Korean Version of the Sniffin’ Sticks Test (KVSS) for olfactory function, KVSS for gustatory function, the Korean Voice disorder Index-30 (KVHI-30) for voice disorder, and the Korean Swallowing Disturbance Questionnaire (K-SDQ) for swallowing disorders. Pre- and post-intervention scores were compared to assess changes across all domains of disorders. Results: The findings indicate that ABMQT led to robust and consistent improvements across all measured domains. Mean KVSS scores increased from 0.67 ± 1.15 to 8.67 ± 0.58, indicating dramatic restoration of olfactory function. Gustatory test scores improved from 2.0 ± 1.0 to 4.0 ± 0.0, with all participants achieving the maximum score post-intervention. In addition, KVHI-30 average scores decreased from 84.33 ± 7.09 to 1.33 ± 1.15, reflecting near-complete resolution of voice disorder, with functional, physical, and emotional subscales all demonstrating 96.7–100% improvement. K-SDQ scores for swallowing disturbance decreased from 25.33 ± 6.43 to 0.67 ± 1.15, with functional, physical and emotional subscales all demonstrating 92.9~100% improvement. Conclusions: This study provides preliminary but robust evidence that ABMQT is a highly effective, non-invasive, and well-tolerated intervention for both non-motor and motor symptoms in PD, including olfactory and gustatory dysfunction, voice handicap, and dysphagia. Our findings suggest that ABMQT may facilitate neural plasticity, autonomic regulation, and neurotrophic factor activation, thus supporting functional recovery across distinct neuroanatomical pathways. The overall results highlight the potential of ABMQT as an integrative rehabilitation modality that can address the multifaceted symptomatology of PD and improve patients’ quality of life. Further large-scale, controlled trials with biomarkers and neuroimaging endpoints are warranted to elucidate the mechanistic underpinnings and generalizability of these effects. * Keywords: Parkinson’s disease, Olfactory dysfunction, Gustatory dysfunction, Voice disorder, Swallowing disorders, Breathing meditation qigong therapy [목차] Ⅰ. INTRODUCTION Ⅱ. RESEARCH METHODOLOGY Ⅲ. RESULTS OF THE STUDY Ⅳ. DISCUSSION Ⅴ. CONCLUSION Ⅵ. References [서론] 1. Research background Parkinson’s disease (PD) is currently the second most common progressive neurodegenerative disorder worldwide. It is characterized by abnormal aggregation of alpha-synuclein protein and degeneration of dopaminergic neurons in the substantia nigra pars compacta[1, 2]. Clinically, PD primarily manifests as a neuro-motor disorder, and the core motor features of Parkinsonism are defined by the presence of bradykinesia in combination with either resting tremor or rigidity[3]. With advances in neuroscience, however, PD is now being re-defined as a multisystem neurodegenerative disorder encompassing a wide spectrum of non-motor symptoms beyond motor dysfunction[1, 4, 5]. From the perspective of non-motor symptoms, PD presents with a variety of prodromal features several years prior to the onset of motor symptoms[5, 6]. Among these non-motor symptoms, chemosensory dysfunction—encompassing both olfactory and gustatory impairments—is particularly prominent. Both symptoms are considered prodromal features that manifest before the appearance of motor symptoms, thereby serving an important role in early diagnosis and disease progression monitoring[7, 8]. The pathogenesis of chemosensory dysfunction in PD is closely associated with the spread of alpha-synuclein pathology throughout the central nervous system. It is also characterized by the differential involvement of the anatomical structures of the olfactory and gustatory systems in the pathophysiological progression of the disease[6, 9]. More in detail, olfactory dysfunction is one of the earliest non-motor symptoms to appear in PD. Olfactory impairment is observed in 75–90% of patients with PD[9], and several studies have reported that more than 95% of PD patients exhibit olfactory dysfunction[10, 11]. According to systematic reviews and meta-analyses, the pooled prevalence of olfactory dysfunction in PD is estimated to be 64–67%, with a variation depending on the olfactory assessment method used[12]. The most noteworthy feature of olfactory dysfunction is that it can occur several years before the onset of motor symptoms. Longitudinal studies have shown that olfactory decline may precede the diagnosis of PD by approximately 4–10 years[9, 13], and there are even reports of its preceding diagnosis by up to 20 years[7]. This temporal precedence suggests the potential utility of olfactory dysfunction as a prodromal symptom and early biomarker of PD. Although research on gustatory dysfunction is relatively limited compared to studies on olfactory impairment, there has been a growing interest in gustatory function decline among patients with PD. According to systematic reviews and meta-analyses, gustatory dysfunction has been found to be significantly associated with PD, as confirmed by various taste assessment methods (e.g., taste strips, gustatory solutions, PTC/PTU recognition tests, electro-gustometry)[14]. Notably, patients with PD exhibit significantly elevated recognition thresholds for all basic tastes—including sweet, salty, sour, and bitter—indicating an overall decline in gustatory function[15]. While the motor symptoms of PD have been classically defined as resting tremor, rigidity, bradykinesia, and postural instability, recent studies have also recognized voice disorders and Swallowing disorders as significant motor manifestations of PD[16, 17]. These symptoms exert a direct and profound impact on the quality of life of patients with PD and , in particular, contribute to increased mortality as major causes of aspiration pneumonia and social isolation[18]. Voice disorder in PD is a prominent motor symptom, reported to occur in 75–90% of patients[19]. Recent large-scale studies indicate that 89% of individuals with PD experience voice and speech impairments[20], a prevalence comparable to core motor symptoms such as resting tremor. The characteristic manifestation of voice disorder is hypokinetic dysarthria, which arises from impaired central nervous system control of speech functions[21, 22]. Clinically, hypokinetic dysarthria in PD presents with diverse features, the most prominent being reduced vocal intensity (hypophonia), which often goes unrecognized by patients and leads to significant communication difficulties[21]. Phonetic analyses reveal monotone pitch (monopitch), monotonous loudness (monoloudness), diminished stress, rough or breathy voice quality, imprecise consonant articulation, inappropriate pauses, short bursts of speech, low pitch, and variable speech rate[22]. Swallowing disorders are a highly prevalent motor symptom in PD, with more than 80% of patients reported to experience swallowing difficulties during the disease course[23]. Remarkably, recent studies have indicated that over 90% of patients with PD exhibit Swallowing disorders, suggesting that it is among the most common symptoms associated with the disorder[17]. Swallowing disorders PD can be observed as aspiration of food even during the prodromal stage and is thus regarded as an important indicator for early diagnosis. Swallowing disorders in patients with PD leads to clinically serious consequences. Aspiration is the most dangerous complication of Swallowing disorders in PD, directly associated with malnutrition, dehydration, and increased mortality. Recent large-scale epidemiological studies have shown that patients with PD have a 4.21-fold higher risk of developing aspiration pneumonia compared to controls, and following the first occurrence of aspiration pneumonia, mortality rates among PD patients reach 23.9% in one month, 65.2% in one year, and 91.8% at five years[24]. These findings clearly demonstrate that aspiration pneumonia is a leading cause of death in patients with PD. In summary, non-motor symptoms such as olfactory and gustatory dysfunction, as well as motor symptoms including voice and swallowing disorders in patients with PD, are emerging as important clinical targets for early diagnosis, disease progression attenuation, and improvement of quality of life. Recent research has focused on exploring the potential for developing therapeutic approaches targeting these symptoms. In particular, non-pharmacological naturopathy such as breathing meditation qigong therapy, which are based on neurophysiological mechanisms and improvement of respiratory function, are anticipated to have potential efficacy in alleviating symptoms of PD. Such therapies may be used adjunctively or in combination with conventional pharmacological treatments, and there is a growing body of research evaluating their therapeutic effects on these symptoms. Breathing meditation qigong therapy is a non-invasive intervention aimed at strengthening the respiratory muscles and enhancing respiratory control. Recent meta-analyses have demonstrated that qigong-based therapies exert significant effects on motor symptoms in patients with PD[25]. Furthermore, qigong practice has been shown to produce statistically significant improvements in gait ability and balance[25]. The core of breathing meditation qigong therapy lies in restoring autonomic nervous system balance through conscious breath regulation and meditative focus. Systematic reviews have found that meditation and breathing therapies significantly reduce anxiety and improve sleep quality in patients with coronary artery disease, effects attributed to enhanced activation of the parasympathetic nervous system[26]. Notably, breath-based meditation has been reported to increase electroencephalographic activity and induce a unique state of cortical excitation, thereby reducing muscle tone[27]. Breathing meditation qigong therapy also promotes neuroplasticity via vagus nerve stimulation. Recent studies have shown that non-invasive vagus nerve stimulation significantly improves key gait parameters—including gait speed, stance time, and stride length—in patients with PD[28]. Of particular importance, vagus nerve stimulation has been associated with significant increases in serum brain-derived neurotrophic factor (BDNF) levels, reductions in tumor necrosis factor-α (TNF-α), and increases in glutathione levels[28]. These neurobiochemical changes suggest that breathing meditation practices may reduce neuroinflammation and provide neuroprotective effects. The therapeutic potential of breathing meditation qigong therapy for olfactory dysfunction in patients with PD can be approached from multiple perspectives. In clinical trials targeting non-motor symptoms, both the qigong-only group and the acupuncture–qigong combination group demonstrated significant improvements in the olfactory identification test (TSI) scores[29]. The neurobiological mechanism underlying the improvement of olfactory dysfunction is closely related to the activation of the vagus nerve–brain axis. Recent studies on the role of the vagus nerve in PD have reported that the vagus nerve provides the most direct communication pathway within the gut–brain axis[30]. Notably, a theory has been proposed in which α-synuclein, formed in the gut, spreads to the brainstem nuclei via the vagus nerve in the pathophysiology of PD, highlighting the therapeutic potential of vagus nerve stimulation[31]. The effects of breathing meditation practice on olfactory dysfunction may be explained by reductions in neuroinflammation and increases in neurotrophic factors. Meta-analyses of meditation-based interventions have shown that meditation significantly increases peripheral BDNF levels[32]. BDNF is a key factor promoting neuronal survival and regeneration, playing a critical role in neurogenesis and functional recovery of the olfactory system[33]. In PD, BDNF/TrkB signaling is decreased, which is associated with disease severity and long-term complications. The therapeutic potential of respiratory meditation qigong therapy for voice disorders in patients with PD is particularly noteworthy. For example, a systematic review of the effects of respiratory muscle strengthening training in PD reported that inspiratory muscle strength training (IMST) and expiratory muscle strength training (EMST) had positive effects on respiratory muscle strength, swallowing safety, phonatory aspects, and thoracic volume[34]. Notably, EMST significantly improved swallowing safety (as measured by PAS scores) and phonatory aspects (maximum subglottic pressure and maximum sound pressure level), with large effect sizes. These findings strongly suggest that respiratory-based interventions may have substantial effects on improving voice function in patients with PD. In addition, the therapeutic potential of respiratory meditation qigong therapy for Swallowing disorders in patients with PD can be observed in systematic reviews of the effects of respiratory muscle strengthening training. For example, the study by Lin[35] demonstrated that inspiratory muscle strength training (IMST) and expiratory muscle strength training (EMST) had positive effects on respiratory muscle strength, swallowing safety, phonatory aspects, and thoracic volume. In particular, EMST significantly improved swallowing safety (as measured by PAS scores) and phonatory aspects (maximum subglottic pressure and maximum sound pressure level), with large effect sizes. These findings strongly suggest that respiratory-based interventions may have substantial effects on improving swallowing function in patients with PD. To summarize, current clinical studies suggest the potential for respiratory training to positively influence both motor and non-motor symptoms in patients with PD. The results of these studies further require validation through ongoing clinical trials and long-term follow-up research. Notably, respiratory meditation qigong therapy is non-invasive, associated with minimal side effects, and allows for individualized, tailored treatment according to each patient’s condition. Thus, it holds significant potential as a therapeutic tool for alleviating motor and non-motor symptoms and improving quality of life in patients with PD. Therefore, it is necessary to develop specific therapeutic protocols for respiratory meditation qigong therapy and to conduct evaluations using objective measures to verify its effects on both motor and non-motor symptoms. Through this approach, the potential of respiratory meditation qigong therapy can be presented with scientific evidence, which is expected to contribute to the advancement of future integrative treatment models. 2. Research objectives The objective of the current study is to evaluate the effects of Breathing Meditation Qigong Therapy on the improvement of non-motor symptoms—specifically olfactory and gustatory dysfunctions—as well as motor symptoms of voice and swallowing disorders in patients with PD. Furthermore, this study aims to verify the clinical efficacy of Breathing Meditation Qigong Therapy as a novel non-pharmacological intervention that can complement the limitations of conventional pharmacological treatments for these comorbidities in patients with PD. The An’s Breathing Meditation Qigong Therapy (ABMQT) employed in this study is an integrative breathing meditation qigong intervention specifically designed to ameliorate non-motor symptoms in patients with PD, and recent clinical studies have demonstrated its therapeutic effects and clinical utility[36]. ABMQT primarily functions by delivering bioenergy to the olfactory tract, olfactory bulb, olfactory regions, and brain areas related to phonation, including the frontal and prefrontal cortices and the mesolimbic pathway. This mechanism is directly linked to the neurobiological underpinnings of olfactory dysfunction and voice disorders, which are prominently observed in patients with PD. ABMQT is characterized by its non-invasive and non-contact nature, and in actual clinical application, it is administered once weekly for 120 minutes per session over a 12-week period, which has been reported to impose minimal burden on subjects and to have a high safety profile[36]. Notably, the clinical efficacy of ABMQT was validated in a clinical study conducted by An & Ahn[36], in which four patients with idiopathic PD underwent ABMQT and all subjects exhibited improvements in olfactory and voice disorders based on clinical diagnostic findings. These results suggest that ABMQT may induce neuroplasticity and functional recovery by delivering bioenergy to specific regions of the nervous system, namely the olfactory system and brain areas related to phonation. This is significant in that it offers a new therapeutic paradigm capable of stimulating the recovery potential of the nervous system in a non-pharmacological and non-invasive manner, thereby complementing the limitations of existing pharmacological treatments for chronic neurodegeneration-related olfactory and voice disorder in patients with PD. ABMQT is interpreted as stimulating various neurophysiological pathways simultaneously—including restoration of autonomic nervous system balance, changes in cerebral blood flow and neurotransmitters, and activation of neurotrophic factors—through its integrative approach combining breathing, meditation, and qigong, thereby supporting its clinical value as a potential intervention for both motor and non-motor symptoms in patients with PD. The results of this study not only demonstrate the clinical value of Breathing Meditation Qigong Therapy as an integrative rehabilitation strategy but are also expected to contribute to the establishment of a new evidence-based therapeutic paradigm for the management of patients with PD in the future. 덧말