low back pain ( lbp ) is a very common disease in both developed and developing 
 countries1,2,3,4 , and it easily develops into a chronic disease5 .
most low back pain patients do not need to receive surgery 
 to alleviate the pain .
 chee - gong  ) is a method of complementary and alternative 
 medicine .
it is practiced to regulate breathing , movement , and awareness while doing 
 exercise7 .
typically , such practice 
 includes rhythmic breathing , stylized fluid movement and a peaceful state8 .
based on a series of recent reports , approximately 5% of china s population practice some 
 kind of qigong9,10,11 .
the history of 
 practicing qigong to cure and prevent diseases is more than 2000  years old . 

there are nearly 3,000 kinds of qigong and most of them are adaptations of 
 ancient styles .
the five animals exercises ( wuqinxi in chinese ) were 
 created by hua tuo , a very famous doctor in the history of china , and they are one of the 
 most popular kinds of qigong exercise .
the practitioners of 
 wuqinxi exercises imitate the specific movements and breathing patterns 
 of the five animals : the tiger , bear , crane , monkey , and deer .
the practitioner attempts to 
 integrate and harmonize breath posture and movement12 . a series of studies have indicated that exercise of the 
 lumbosacral multifidus could be beneficial for spinal control and alleviate lbp13,14,15
. however , a relationship between the 
 wuqinxi exercises and the lumbosacral multifidus has not been 
 reported . in this study
, we designed a prospective study to determine whether 
 wuqinxi exercises improve the function of the lumbosacral multifidus and 
 reduce low back pain .
the subjects of this study have given their written informed consent to the publication of 
 their case details .
informed consent was obtained from all volunteers , and all procedures 
 were approved by the ethnic committee of hebei medical university .
this study enrolled thirty male volunteers ( aged from 40 to 50  years , average age 
 41.33.5  years ; height range of 165 to 180 centimeters , average 170.44.1 centimeters ; and 
 a weight range of 60 to 75 kilograms , average 68.95.2 kilograms ) .
fifteen volunteers 
 performed the five animals exercises , the experimental group , and 15 volunteers performed 
 aerobic exercise ( walking ) , the control group , from may 1 , 2011 to may 1 , 2012 . on the 
 basis of the age , height and body weight , each volunteer in the experimental group was 
 matched with a person in the control group .
the exercise protocol was as follows : the 
 experimental group/ subjects did the entire five animals exercises 5 times per week , for 
 1  year ; the control group/ the subjects did 30  min aerobic exercise , 5 times per week , for 
 1  year .
the practitioners of wuqinxi exercises imitate the specific movements 
 and respiration patterns of 5 animals : the tiger , bear , crane , monkey , and deer .
stand with the arms hanging at the sides 
 and the feet slightly apart . with bated breath , like a monkey ,
raise the left hand up to 
 head level as if embracing a pillar and place the right hand on the abdomen as if holding 
 an apple .
the left foot is lifted up to knee level with the toes pointing downward while 
 keeping the right leg slightly bent .
keep this position , inhale and direct qi down to 
 abdomen again and again until beads of sweat start running down the face .
return to the 
 start position and repeat the whole process with  left  and  right  reversed . a surface emg system ( biovisioninc .
the reference electrode was positioned 
 over the olecranon of the elbow , as recommended by hermens et al.16 the emg signals were recorded from the multifidus muscle 
 at the l-5 level on the two sides .
the subjects are asked to perform full exion for 3 
 seconds then return to the start position .
the action 
 was guided by a video displayed by a computer so as to guarantee the consistency of 
 different actions between different practitioners .
the averages of surface 
 electromyography ( asemg ) in the processes of exion and extension were recorded and 
 analyzed using dasylab10.0 software .
all the parameters were measured both before and 
 after the 1  year exercise intervention .
statistical analyses were performed using spss 13.0 for windows ( spss inc , chicago , iii ) . 

two - way analysis of variance was used for the analysis of asemg in flexion , asemg in 
 extension , and fer .
the t - test was used to evaluate the fer of multifidus between the 
 experimental group and control group , the asemg in the process of flexion and extension on 
 both sides , and fer between the two sides all individuals .
this study enrolled thirty male volunteers ( aged from 40 to 50  years , average age 
 41.33.5  years ; height range of 165 to 180 centimeters , average 170.44.1 centimeters ; and 
 a weight range of 60 to 75 kilograms , average 68.95.2 kilograms ) .
fifteen volunteers 
 performed the five animals exercises , the experimental group , and 15 volunteers performed 
 aerobic exercise ( walking ) , the control group , from may 1 , 2011 to may 1 , 2012 . on the 
 basis of the age , height and body weight , each volunteer in the experimental group was 
 matched with a person in the control group .
the exercise protocol was as follows : the 
 experimental group/ subjects did the entire five animals exercises 5 times per week , for 
 1  year ; the control group/ the subjects did 30  min aerobic exercise , 5 times per week , for 
 1  year .
the practitioners of wuqinxi exercises imitate the specific movements 
 and respiration patterns of 5 animals : the tiger , bear , crane , monkey , and deer .
stand with the arms hanging at the sides 
 and the feet slightly apart . with bated breath , like a monkey ,
raise the left hand up to 
 head level as if embracing a pillar and place the right hand on the abdomen as if holding 
 an apple .
the left foot is lifted up to knee level with the toes pointing downward while 
 keeping the right leg slightly bent .
keep this position , inhale and direct qi down to 
 abdomen again and again until beads of sweat start running down the face .
return to the 
 start position and repeat the whole process with  left  and  right  reversed . a surface emg system ( biovisioninc .
the reference electrode was positioned 
 over the olecranon of the elbow , as recommended by hermens et al.16 the emg signals were recorded from the multifidus muscle 
 at the l-5 level on the two sides . the subjects are asked to perform full exion for 3 
 seconds then return to the start position .
the action 
 was guided by a video displayed by a computer so as to guarantee the consistency of 
 different actions between different practitioners .
the averages of surface 
 electromyography ( asemg ) in the processes of exion and extension were recorded and 
 analyzed using dasylab10.0 software .
all the parameters were measured both before and 
 after the 1  year exercise intervention .
statistical analyses were performed using spss 13.0 for windows ( spss inc , chicago , iii ) . 

two - way analysis of variance was used for the analysis of asemg in flexion , asemg in 
 extension , and fer .
the t - test was used to evaluate the fer of multifidus between the 
 experimental group and control group , the asemg in the process of flexion and extension on 
 both sides , and fer between the two sides all individuals .
there were no significant differences in the subjects , characteristics ( age , height , 
 weight ) between the two groups .
( p>0.05 ) the asemg in the process of flexion was lower than the asemg in the process of extension on 
 both sides of all volunteers ( p<0.05 ) .
there was no significant difference of fer between 
 the experimental group and the control group ( p>0.05 ) .
there was no significant 
 difference of fer between the two sides in any individual ( p>0.05 ) .
the comparison of asemg and fer of the left side between the two groups before 
 the exercise interventionasemg in flexion ( mv)asemg in extension ( mv)ferwuqinxi exercises group0.1340.048 * 0.2230.1240.6000.073control group0.1310.035 * 0.2140.0760.6120.054 * indicates a statistically signicant difference in asemg between 
 flexion and extension .
the comparison of asemg and fer of the right side between the two groups before 
 the exercise interventionasemg in flexion ( mv)asemg in extension ( mv)ferwuqinxi exercises group0.1490.053 * 0.2400.0910.6220.073control group0.2120.091 * 0.3350.0990.6320.095 * indicates a statistically signicant difference in asemg between 
 flexion and extension .
the unit of asemg is millivolts ( mv ) * indicates a statistically signicant difference in asemg between 
 flexion and extension the asemg in the process of flexion was lower than the asemg in the process of extension on 
 both sides of all volunteers ( p<0.05 ) .
the fer of experimental group was lower than that 
 of the control group ( p<0.05 ) .
there was no significant difference in fer between the two 
 sides in any individual ( p>0.05 ) .
the comparison of asemg and fer of the left side between the two groups after 
 the exercise interventionasemg in flexion ( mv)asemg in extension ( mv)ferwuqinxi exercises group0.1530.078 * 0.2750.1120.5550.093**control group0.1740.046 * 0.2640.0970.6590.084 * indicates a statistically signicant difference in asemg between 
 flexion and extension . *
* indicates a statistically signicant difference 
 in fer between the wuqinxi exercise and control groups and 4table 4 .
the comparison of asemg and fer of the right side between the two groups after 
 the exercise interventionasemg in flexion ( mv)asemg in extension ( mv)ferwuqinxi exercises group0.1690.064 * 0.2910.1010.5810.087**control group0.2700.101 * 0.3890.1390.6680.129 * indicates a statistically signicant difference in asemg between 
 flexion and extension . *
* indicates a statistically signicant difference 
 in fer between the wuqinxi exercise and control groups .
* indicates a statistically signicant difference in asemg between 
 flexion and extension . * * indicates a statistically signicant difference 
 in fer between the wuqinxi exercise and control groups * indicates a statistically signicant difference in asemg between 
 flexion and extension . * * indicates a statistically signicant difference 
 in fer between the wuqinxi exercise and control groups
qigong is a mental and physical exercise originating from traditional 
 chinese medicine and aims to improve health17 . in earlier studies ,
qigong was found to reduce 
 stress18 , 19 , anxiety20 , and 
 depression21as well as to improve 
 physical activity and balance22 .
twelve 
 months of wuqinxi exercise was reported to be beneficial for obese old 
 people , promoting blood antioxidant enzymes activities , enhancing lipid peroxidation and 
 increasing intestinal bacteria count23 .
a previous study reported that 64 healthy older people had practiced 
 wuqinxi exercise for 30 days , blood lipids levels and oxidative injury 
 decreased , indicating that the exercise was beneficial for the health of old people24 .
that study indicated that thirty days of 
 wuqinxi exercise significantly lowered the serum levels of total 
 cholesterol ( tc ) , triacylglycerol ( tg ) , malondialdehyde ( ldl - c ) and malondialdehyde ( mda ) , 
 while promoting the activity of sod24 . 

mda is a key oxidation product of peroxidized polyunsaturated fatty acids , and the mda level 
 is a crucial indicator of lipid peroxidation25 .
superoxide dismutase ( sod ) is an important intracellular 
 antioxidant enzyme of aerobic cells , and it may exert antitoxic effects against superoxide 
 radicals26 . therefore ,
practicing 
 wuqinxi exercise may alleviate the oxidative damage exerting a positive 
 effect on the human body .
exercise programmes to promote the  stability  of the lumbar spine are widely used in the 
 management of lbp patients27 , 28 .
previous studies have demonstrated they alleviate stress 
 on injured osseoligamentous structures , reducing pain and enhancing function28,29,30,31 . 

specic isometric exercises for the lumbar multidus of low load and tonic manner have been 
 proved to be beneficial for spinal control13,14,15
. 
 furthermore , exercise of the deep segmental bers of the lumbar multidus ( dm ) has been 
 indicated to reduce the recurrence of acute lbp29 , alleviate pain , and reduce disability in chronic lbp patients28 .
semg is a simple and non - invasive parameter of muscle activity , which is an objective 
 marker of lbp32 .
the flexion - extension 
 ratio ( fer ) is a good parameter of trunk muscle balance .
a 5-year prospective study 
 indicated that an imbalance in trunk muscle strength , i.e. , higher flexor muscle strength 
 than extensor muscle strength , might be one risk factor of low back pain33 .
furthermore , fer of the lumbar erector 
 muscle might be practically applied as an objective indicator in the diagnosis of 
 non - specific chronic low back pain in surface emg34 . in this study ,
the asemg in the process of flexion was lower than that of the asemg in the 
 process of extension both before and after the 1  year exercise intervention on both sides of 
 all volunteers .
there was no significant difference in fer between the experimental group 
 and the control group before the 1  year exercise intervention .
the fer of the experimental 
 group was lower than that of the control group after the 1  year exercise intervention .
there 
 was no significant difference between the two sides in any individual both before and after 
 the 1  year exercise intervention .
the results indicate that the wuqinxi 
 exercises can improve the function of the lumbosacral multifidus , and might offer an 
 alternative method for reducing low back pain .
finally , limitations of this study were the small population of each group , and the outcome 
 measures were too few . in a future study
   [ purpose ] to investigate the effect of the five animals ( wuqinxi ) 
 exercises on the lumbosacral multifidus . 
 [ subjects and methods ] this study enrolled two 
 groups of volunteers , 15 volunteers who did the five animals exercises , the experimental 
 group , and 15 volunteers who did aerobic exercise ( walking ) , the control group . both 
 before and after the 1  year exercise intervention , the average surface electromyography 
 ( asemg ) of the two groups in the process of exion and extension was recorded and analyzed 
 using dasylab10.0 software , and the flexion extension ratio ( fer ) was calculated . 
 
 [ results ] the asemg in the process of flexion was lower than the asemg in the process of 
 extension both before and after the 1  year exercise intervention on both sides of all 
 volunteers . 
 there was no significant difference in fer between the experimental group and 
 control group before the 1  year exercise intervention ; however , the fer of experimental 
 group was lower than that of the control group after the 1  year exercise intervention . 
 
 there was no significant difference between the two sides in any individual both before 
 and after the 1  year exercise intervention in both groups . 
 [ conclusion ] the 
  wuqinxi  exercises improved the function of the lumbosacral 
 multifidus , and might be an alternative method of reducing low back pain . 
INTRODUCTION
SUBJECTS AND METHODS
Subjects
RESULTS
DISCUSSION