More engaged Health Qigong practitioners reported better psychological wellbeing in a survey of older adults in China, but the result shows an association rather than proof that the practice improved wellbeing. Among 1,173 valid questionnaires, the engagement-wellbeing correlation was 0.164, with a reported p-value below 0.001. A correlation shows that two measures vary together; it cannot establish which came first or whether one caused the other.
Building a measure for engagement
The study also set out to create a measure tailored to Health Qigong engagement among Chinese older adults. For the qualitative phase, 15 older practitioners with regular experience took part in semi-structured interviews about practice frequency, habits, attention, breathing coordination, autonomy and persistence. The researchers used grounded-theory-oriented coding, a way of grouping interview material into concepts, to derive the scale's dimensions and items.
Content was then reviewed in two Delphi rounds, a structured consultation with experts. The 12-member panel comprised four Health Qigong coaches or referees, three geriatric psychology scholars, three sports-measurement researchers and two geriatric social-work experts.
The final scale contains 18 items across three dimensions: continuous behavioral engagement, normative focused engagement and autonomous persistent engagement. In this sample, confirmatory factor analysis, which tests whether responses fit the proposed structure, supported the three-factor model. The overall Cronbach's alpha was 0.938, a measure of how consistently the items performed together.
What moved together
The same survey found positive relationships across all six pairs of measures: Health Qigong engagement, psychological wellbeing, resilience and perceived social support. Engagement had its largest correlation with resilience, at 0.453, followed by perceived social support at 0.331 and wellbeing at 0.164. All six results were reported with p-values below 0.001.
Wellbeing was also correlated with resilience at 0.160 and with perceived social support at 0.105; resilience and social support were correlated at 0.345. These are concurrent self-report relationships, so they describe a pattern in the participants' answers rather than a sequence of effects.
A possible link through resilience
A separate bootstrap analysis, which repeatedly resamples data to estimate uncertainty, tested whether resilience accounted statistically for part of the engagement-wellbeing relationship. It estimated an indirect association of 0.049, with a 95% confidence interval from 0.027 to 0.074. That represented 27.97% of the total association, while the direct component represented 72.03%. The pattern is consistent with resilience being related to part of the relationship, but it is not proof of causal mediation because the measures were collected cross-sectionally.
The role of perceived support
The model found that the strength of the engagement-resilience association varied with reported perceived social support. The estimated slope was 0.300 at low support, 0.362 at medium support and 0.424 at high support. The interaction coefficient was 0.062, with a 95% confidence interval from 0.010 to 0.114, and all three simple-slope tests had p-values below 0.001.
Put simply, engagement and resilience were more strongly associated among participants who reported more support. That pattern is observational: it does not show that social support amplified an effect of Health Qigong.
Who took part, and what remains uncertain
The questionnaires were collected from January to June 2025 from older practitioners recruited in six Chinese cities. Of 1,259 paper questionnaires distributed, 86 invalid forms were excluded, leaving 1,173 valid questionnaires and an effective response rate of 93.17%. Missing data were handled with multiple imputation by chained equations.
Among the analyzed participants, 470 were men, or 40.10%, and 703 were women, or 59.90%. The age profile was 616 people aged 60 to 70, or 52.50%; 371 aged 71 to 80, or 31.60%; and 186 over 80, or 15.90%.
That recruitment frame matters. The study examined people who were already Health Qigong practitioners, and its evidence came mainly from self-reported questionnaire measures rather than an assigned intervention. It did not collect objective practice measures or physical-health outcomes.
The findings therefore cannot be extended automatically to all older adults in China, younger people or clinical rehabilitation populations. The scale's performance outside this sample, including across regions and age groups, still needs testing.
Taken together, the findings offer a way to measure Health Qigong engagement and a map of associations among engagement, resilience, perceived support and wellbeing in this practitioner group. They do not show that Health Qigong causes better psychological wellbeing, that resilience is a causal pathway, or that the practice improves physical health. The authors declared that no financial support was received for the work or its publication.
Paper data and sources
Original title: Health Qigong engagement scale and wellbeing in Chinese older adults
Authors: Liu J, Fan F
Journal/Repository: Frontiers in public health
Status: Peer-reviewed
First online: 2026-10-08
DOI: Not available
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