(1) To evaluate the effects of Baduanjin exercises on emotion control, attention, and cognitive abilities compared to regular aerobic exercise and a control group on a waiting list.

Acupuncturist Long-term participation in Qigong will differ significantly from aerobic and waiting exercises in terms of emotional cognition and attention.

This single-center, parallel randomized controlled clinical trial will enroll 99 eligible subjects from Chengdu University of Traditional Chinese Medicine.

The trial aims to recruit 99 participants from the School of Acupuncture and Tuina at Chengdu University of Traditional Chinese Medicine. Recruitment will be facilitated through various channels, including campus radio broadcasts, on-campus advertising, and online platforms.

They will be randomly assigned in a 1:1:1 ratio to the Baduanjin group, the aerobic exercise group, or the waiting-list group.

The study’s physical and psychological outcomes will be evaluated at three key intervals: one week before the intervention, at 12 weeks (mid-intervention), and at 24 weeks (post-intervention). Additionally, 20 individuals from each group will be selected randomly for pre-and post-intervention fMRI scanning. The study’s process and timeline are depicted in Figure 1 and Table 1.

Prior to the trial, a detailed evaluation of the subjects’ medical histories will be conducted. Routine examinations, including blood, urine, and fecal tests, will be performed before and after the intervention. Electrocardiography tests will also be administered pre-intervention. All adverse events following the intervention will be descriptively documented in the Case Report Form (CRF). Severe adverse events will be closely monitored, managed, and followed up, with immediate reporting to the Ethics Committee within 24 h of occurrence (Harriss et al., 2019).

Given the nature of this trial, blinding of subjects and exercise coaches is not feasible. The random allocation sequence will be generated using SPSS 26.0 software (SPSS Inc., Chicago, IL, United States) to assign treatments. Allocation will be concealed in sealed, opaque envelopes, opened by the subject management center in sequential order according to subject serial numbers. Subjects will then be allocated to the respective trial groups and adhere to the exercise intervention protocol. A dedicated project manager, separate from the exercise coaches, will oversee the random allocation sequence and the blinding process. The project manager and exercise coaches will not participate in outcome assessments, and likewise, outcome assessors and the statistician will not be involved in subject screening or allocation. The study ensures a strict delineation of roles among researchers, operators, and statisticians.

Previous research (Health Qigong Management Center of General Administration of Sport of China, 2003) indicates that participants in both the Baduanjin and aerobic exercise groups engaged in 60-min sessions, three times weekly, for a duration of 24 weeks. Subjects’ energy expenditure and heart rate (HR) during training will be monitored using a Polar HR monitor (Mio Sports SD).

In accordance with the Health Qigong Management Center of General Administration of Sport of China (2003), the Baduanjin group will undergo 24 weeks of training. Each session will last 60 min, comprising a 10-min warm-up, 40 min of Baduanjin exercises, and a 10-min cool-down. This regimen encompasses 10 postures, including preparatory and finishing positions (Figure 2). Supervision and instruction will be provided by a senior social sports instructor with over 5 years of teaching experience. The week preceding the training will feature professional theoretical and movement instruction.

Participants in the aerobic exercise group will engage in brisk walking sessions, each lasting 60 min. This includes a 10-min warm-up, 40 min of brisk walking, and a 10-min rest period. Training duration and frequency will mirror those of the Baduanjin group. Professional coaches will guide these sessions, ensuring that exercise intensity remains within 55–75% of the participants’ reserve heart rate, consistent with Baduanjin group guidelines.

The waiting-list group will not participate in any specific exercise regimen. Instead, they will be instructed to maintain their regular activity habits and provide monthly exercise reports.

Primary outcomes focus on attention control, cognitive function, and emotional control, assessed using various tools:

Secondary outcomes involve additional emotion regulation measures and hand function assessments:

Situational Pain Questionnaire (SPQ) (Stangier et al., 2021): A self-report tool with robust psychometric properties. Interpersonal Reactivity Index (IRI) (Escrivá, 2004): Commonly used for empathy assessment. Profile of Mood States (POMS) (Shahid et al., 2011): Evaluates affective changes during the assessment period. Chinese version of the Connor-Davidson Mental Toughness Scale (CD-RISC-25) (Connor and Davidson, 2003): A brief self-rated tool for quantifying resilience.

Hand motor function is assessed using the Jamar Hand Grip Strength Meter (Wiegert et al., 2022), Jamar Finger Pinch Strength Meter (King, 2013), and Purdue Pegboard Test for manipulative dexterity (Tiffin and Asher, 1948). Hand sensory function is evaluated using the Touch-Test Mono-filament Test (Kaluga et al., 2014), Two-Point Discrimination Sensory Test (Dellon et al., 1987), and a Composite Acupuncture Test developed by the researchers (see Table 2 for details).

MRI data will be acquired using a 3.0-T GE MR750 scanner (GE 3.0 T MR750, Wauwatosa, WI, United States) with an eight-channel phase-array head coil at the University of Electronic Science and Technology of China’s MRI Center.

Scanning parameters include: Structural imaging: Repetition time (TR)/Echo time (TE) = 1900 ms/2.26 ms; slice thickness = 1 mm; 30 slices; matrix size = 128 × 128; field of view (FOV) = 256 × 256 mm. BOLD-fMRI: TR/TE = 2000 ms/30 ms; flip angle = 90°; 30 slices; matrix size = 128 × 128; FOV = 240 × 240 mm; slice thickness = 5 mm; total volume = 240. DTI: TR/TE = 6,800 ms/93 ms; FOV = 240 × 240 mm; matrix size = 128 × 128; slice thickness = 3 mm; two diffusion-weighted sequences with b = 1000s/mm² and b = 0 across 30 non-collinear directions.

A detailed statistical plan, including data requirements and processing methods, will be provided to the statisticians by the research team before data analysis. Statisticians, independent and blinded to the test settings, will execute the analysis as per this plan.

Data analysis will be conducted by an independent statistician using SPSS version 26.0 (SPSS Inc., Chicago, IL, United States). Two-tailed analyzes will be performed, with statistical significance set at p < 0.05.

Intention-to-treat analyzes will be applied wherever possible, complemented by subgroup and sensitivity analyzes to identify potential heterogeneity in results. Continuous variables will be expressed as means ± standard deviations, while categorical variables will be presented as numbers and percentages. The normality of continuous variables will be assessed using the Kolmogorov–Smirnov test. For normally distributed data, within-group differences will be evaluated using paired-sample t-tests, and between-group analyzes will employ Analysis of Variance (ANOVA) and the Kruskal–Wallis test. Non-parametric tests will be used for data with skewed distributions.

The fMRI data will be conducted pre-processing in accordance with SPM12¹ and MATLAB 2013b (MathWorks, Inc., Natick, MA, United States).

Data preprocessing will include discarding the first 5 time-points due to magnetic saturation effects, slice timing, head-motion correction, spatial normalization in Montreal Neurological Institute (MNI) space (resampled at 3 mm × 3 mm × 3 mm voxel size), filtering, and spatial smoothing with an 8-mm FWHM Gaussian kernel.

After preprocessing, the amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), functional connectivity (FC), and other brain functional parameters will be analyzed. The 3D-T1 data will be processed using voxel-based morphometry in SPM12 and the CAT12 toolbox in MATLAB (Ashburner and Friston, 2000). DTI data will undergo preprocessing and analysis with the Functional Software Library v4.1.9.² Fractional anisotropy (FA) indices and mean diffusivity (MD) maps will be derived after correcting for head motion and eddy currents in DTI images, followed by tensor model fitting. Correlation analyzes will involve Pearson correlation coefficients between clinical and fMRI data, primarily focusing on functional and structural changes in brain regions associated with emotions, attention, motor skills, and sensory perception.

This study will implement rigorous procedures to mitigate bias and enhance the reliability and reproducibility of the results.

To ensure uniform baseline results among subjects, strict screening and inclusion criteria have been established. Participants must be professionals with completed and verified theoretical and practical training in acupuncture. They should not have engaged in traditional fitness Qigong exercises (such as Baduanjin and Taiji) or mind–body practices (such as yoga and meditation) recently or previously.

For the Baduanjin and aerobic exercise groups, we have defined standardized training protocols, including specific movements, duration, and frequency. Experienced coaches (with over 5 years of practice) will supervise these sessions to guarantee consistency. Training sessions will be video recorded, and random assessments will be conducted to ensure adherence to established standards. The roles of researchers, operators, and statisticians have been distinctly defined, with professional statisticians undergoing specialized training prior to data analysis.

To maintain protocol adherence for all researchers to the study protocol, weekly group meetings will be held for effective communication and continuous learning. After the trial, participants will receive activity credit certificates and reimbursement. Any challenges encountered during the trial will be addressed promptly during these meetings.

In this study, participants aged between 18 and 25 years and who are right-handed will be selected to minimize confounding effects on brain function and structure related to age and handedness. In addition, all neuroimaging scans will be conducted using the same scanner operated by an expert professional.

Before scanning, subjects will receive comprehensive information about the process and environment, along with an emotional assessment. They will be advised to avoid excessive exercise, late nights, and the consumption of alcohol, tobacco, tea, and coffee for 3 days before the scan. During the scan, subjects will wear sponge earplugs and have foam padding around their heads to limit movement. They will be instructed to keep their eyes closed but remain awake. The scanning room will be maintained at 18°C–22°C with humidity above 60% and noise levels below 150 dB.P After the scan, the data will undergo thorough review by professionals, and any data affected by artifacts, signal loss, distortion, or noise interference due to head movement will be excluded from the analysis.

This trial faces several potential limitations. Firstly, due to the nature of the intervention, neither participants nor sports trainers can be blinded. While psychological outcomes are based on self-reports, assessments of hand function and imaging data will be conducted under blinded conditions. Secondly, the study’s single-university setting, a result of funding constraints, may limit the representativeness of the results. Thirdly, although the intervention spans 24 weeks, this duration does not fully capture the long-term effects of Qigong practice on acupuncturists, indicating the need for future multi-center, large-sample randomized controlled studies.