Effects of qigong exercise on post-stroke cognitive impairment: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Post-stroke cognitive impairment is common and negatively affects functional recovery and quality of life. Qigong is widely used in stroke rehabilitation, but its effects on cognitive outcomes remain uncertain.

OBJECTIVES

To evaluate the effects of qigong exercise on cognitive function after stroke and to explore whether effects vary across qigong types (Baduanjin, Yijinjing, Liuzijue, and Dao-yin-type exercises).

METHODS

We systematically searched seven databases from inception to January 2026: PubMed (87 records), Embase (112), Web of Science (106), the Cochrane Library (82), CNKI (224), Wanfang (230), and VIP (147). We included randomized controlled trials in people after stroke that compared qigong with control conditions, including the same usual rehabilitation alone, health education, sham exercise, or other non-qigong interventions. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The primary outcome was cognitive function measured by the Montreal Cognitive Assessment; the Mini-Mental State Examination was a supplementary outcome. Post-intervention mean and standard deviation values were preferentially extracted, and standard deviations were derived from standard errors when needed. Meta-analyses were performed in Review Manager 5.4.1 using mean differences with 95% confidence intervals under a random-effects model. Heterogeneity was assessed using I 2, with subgroup analyses by qigong type and sensitivity analyses to explore heterogeneity.

RESULTS

Sixteen RCTs were included; 14 reported MoCA and 2 reported MMSE. Qigong improved MoCA versus control (random-effects model: MD = 1.87, 95% CI 1.33-2.40; p < 0.00001; I 2 = 67%). Benefits were significant for Baduanjin (MD = 2.19, 95% CI 1.42-2.95) and Liuzijue (MD = 1.68, 95% CI 0.82-2.53), but not for Yijinjing (MD = 1.55, 95% CI - 0.28-3.38; p = 0.10); between-subgroup differences were not significant (p = 0.63). Two RCTs reported MMSE with improvement but high heterogeneity (MD = 5.82, 95% CI 2.53-9.12; p = 0.0005; I 2 = 89%).

CONCLUSION

Current evidence suggests that qigong improves cognitive function after stroke, with a significant increase in MoCA scores overall. Benefits were observed for Baduanjin and Liuzijue, whereas Yijinjing showed no statistically significant improvement. Two Dao-yin trials reported improved MMSE but with substantial heterogeneity. Further well-designed clinical trials are warranted to confirm these findings and clarify effects across qigong types and outcomes.

SYSTEMATIC REVIEW REGISTRATION: Registered in PROSPERO (CRD420261320472).