Is Baduanjin beneficial and safe for the rehabilitation of patients with acute myocardial infarction undergoing percutaneous coronary intervention? A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Baduanjin, a traditional Chinese exercise, is commonly used in China as a rehabilitation intervention for patients who have undergone percutaneous coronary intervention (PCI) following an acute myocardial infarction (AMI) (AMI-PCI). However, current evidence supporting its application remains limited.

OBJECTIVES: To assess the clinical benefits and safety of Baduanjin in the rehabilitation of patients with AMI-PCI.

METHODS: PubMed, the Cochrane Library, CNKI, VIP, and Wanfang were systematically searched for randomised controlled trials (RCTs) assessing the therapeutic effects and safety of Baduanjin in patients with AMI-PCI. The search was conducted up to 18 January 2025. Data were analysed using RevMan 5.4. For dichotomous outcomes, effect sizes were expressed as risk ratios (RRs) with 95% confidence intervals (CIs); the number needed to treat (NNT) was calculated where appropriate. For continuous outcomes measured on the same scale, the mean difference (MD) with 95% confidence interval (CI) was used. When outcomes were assessed using different instruments or scales, results were synthesised descriptively.

RESULTS: Thirteen studies involving 1293 participants (870 males and 423 females) were identified. Baduanjin significantly improved left ventricular ejection fraction (LVEF [MD = 6.20%, 95% CI (3.14, 9.25), Z = 3.98, P < 0.0001, 1003 participants] and 6-minute walk distance (6-MWD) [MD = 60.21 m, 95% CI (17.96, 102.46), Z = 2.79, P = 0.005, 589 participants]. It also led to clinically meaningful improvements in quality of life (QOL), as measured by the Seattle Angina Questionnaire [MD = 11.36, 95% CI (7.66, 15.06), Z = 6.02, P < 0.00001, 150 participants], the Angina Pectoris Quality of Life Questionnaire [MD = 3.71, 95% CI (0.92, 6.50), Z = 2.61, P = 0.009, 92 participants], and the WHOQOL-BREF [MD = 91.40, 95% CI (90.59, 92.21), Z = 220.28, P < 0.00001, 60 participants]. Significant reductions in anxiety and depression symptoms were observed across multiple instruments: on the Hamilton Anxiety Rating Scale, the mean reduction from baseline was greater in the Baduanjin group by 1.40 points [95% CI (0.47, 2.33), Z = 2.95, P = 0.003]; on the Generalized Anxiety Disorder-7 scale, post-intervention scores were lower in the Baduanjin group by 2.67 points [95% CI (2.20, 3.14), Z = 11.14, P < 0.00001]. Similarly, for depression, the mean reduction from baseline on the Hamilton Depression Rating Scale was greater by 2.80 points [95% CI (1.63, 3.97), Z = 4.71, P < 0.00001], and post-intervention scores on the Patient Health Questionnaire-9 were lower by 2.73 points [95% CI (2.25, 3.21), Z = 11.11, P < 0.00001]. Baduanjin did not appear to increase the risk of adverse events and may even reduce the incidence of certain cardiovascular adverse events [15/133 vs. 40/133, RR = 0.40, 95% CI (0.25, 0.65), Z = 3.75, P = 0.0002, NNT = 5].

CONCLUSIONS: The evidence suggests that Baduanjin may provide therapeutic benefits for patients with AMI-PCI, including improvements in cardiac function (LVEF), exercise capacity (6-MWD), QOL, and mental health. Moreover, the practice appears to be safe and may reduce the incidence of certain cardiovascular adverse events. These findings highlight the potential role of Baduanjin in the management and rehabilitation of patients with AMI-PCI, although further well-designed studies are warranted to confirm its efficacy.

PROSPERO REGISTRATION NUMBER: CRD 42025634145 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42025634145).