Effects of Health Qigong Walking Practice on anxiety and serum metabolites in patients with Type 2 Diabetes Mellitus: A randomized controlled trial

The aim of this study is to evaluate the clinical efficacy of Health Qigong Walking Practice in alleviating anxiety and improving metabolic profiles in patients with type 2 diabetes mellitus (T2DM), and to explore the underlying mechanisms using serum metabolomics. 60 patients with a diagnosis of T2DM with anxiety were randomly assigned to a health education group (HEG), an aerobic exercise group (AEG), and a Health Qigong Walking Practice group (QTG) (n = 20 per group) using a table of random numbers. Self-Rating Anxiety Scale (SAS) scores and glucose-lipid metabolism markers—including fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL)—were assessed before and after a 12-week intervention. Untargeted serum metabolomics was conducted in the QTG to identify differential metabolites and metabolic pathways. After 12 weeks, both the QTG and AEG showed significant reductions in anxiety scores compared to the HEG (P < 0.05). However, the QTG demonstrated significantly greater improvements in glycemic control, particularly in PBG, compared to both control groups (P < 0.05). While conventional aerobic exercise showed limited effects on metabolic markers in this study, the holistic nature of Health Qigong Walking Practice, integrating movement, breathwork, and mindfulness, likely provided additional regulatory benefits. Metabolomics in the QTG revealed significant changes in metabolites, including glycyltyrosine, N-acetylmethionine, and glutamic acid, and pathway analysis highlighted alterations in histidine metabolism and nitrogen metabolism. Health Qigong Walking Practice significantly reduces anxiety and improves glucose-lipid metabolism in T2DM patients with anxiety. Its superiority over standard aerobic exercise in glycemic control may be mediated through the integrated regulation of movement, breath, and mind, which modulates key amino acid and nitrogen metabolism pathways. This mind-body intervention offers a promising adjunctive therapy for T2DM. • Health Qigong Walking Practice (QTG) significantly reduces anxiety in patients with T2DM. • QTG is superior to standard aerobic exercise in improving postprandial blood glucose (PBG). • The QTG intervention significantly altered the serum metabolomic profile of T2DM patients. • The intervention modulated key metabolic pathways, including histidine metabolism and nitrogen metabolism. • Changes in serum metabolites (e.g., N-acetylmethionine, glutamic acid) correlated significantly with anxiety and glycemic markers.