A total of 172 consecutive inpatients meeting inclusion criteria admitted to the Endocrinology Department of our hospital between January 2026 and June 2026 were selected as the study subjects. Among them, 130 were male and 69 were female, ranging in age from 42 to 78 years, with a mean age of (60.25 ± 5.36) years. Baseline indicators including age, gender, disease composition, fasting blood glucose and blood lipid of two groups were compared, all P > 0.05. The two groups were balanced and comparable at baseline. Exclusion criteria: patients with severe cardiovascular or cerebrovascular disease, severe osteoarthritis, acute complications, mobility impairments, impaired consciousness, or those unable to cooperate with exercise and health education. All patients provided informed consent to participate in this nursing intervention study, and this study was approved by the hospital’s Institutional Review Board.

This study is a parallel controlled trial. The control group followed the department’s standard exercise health education model, in which nurses provided verbal explanations of exercise contraindications and basic precautions upon admission, distributed printed exercise instruction sheets, and allowed patients to exercise independently, without group-led sessions or specialized exercise guidance. The observation group, in addition to standard nursing care, implemented an innovative health education model combining “visual instruction via QR codes on bulletin boards” with “morning Ba Duan Jin exercises led by nurses”. The specific measures are as follows.

2.2.1. Setting Up a Static Educational Display Area in the Hallway

To make full use of the public space in the ward corridors, a dedicated health education area for the Eight Brocades has been planned and established, complete with standardized display boards illustrating the eight movements of the Eight Brocades. Each display board corresponds to one standard movement, clearly presenting an illustrated guide, key points for proper execution, suitable demographics, primary health benefits, and corrections for common mistakes, enabling patients to easily compare and self-correct their form. At the same time, a dedicated high-definition QR code is permanently affixed next to each exercise display board. Patients can scan the code with their smartphones to watch free, slow-motion, step-by-step instructional videos for the corresponding exercise. The content covers a breakdown of key movement techniques, breathing coordination techniques, and precautions for home exercise, addressing both in-hospital learning and the need for ongoing guidance after discharge [4]. To effectively address the practical difficulty elderly patients face when trying to practice while holding a cell phone, fixed, user-friendly cell phone stands have been installed next to each QR code. Patients can place their phones on the stands to free up their hands and follow along with the videos step by step, enabling a fragmented, self-directed learning model of “scan and learn, learn and practice”. This setup accommodates the varying levels of acceptance among patients of different ages and learning abilities, effectively enhancing the accessibility and personalized suitability of health education.

2.2.2. Establishing a Standardized Morning Group Training Mechanism

The department has designated 7:45 a.m. each morning as the designated time for group Ba Duan Jin exercises. These sessions are held in open areas of the ward corridors, establishing a routine and regular exercise intervention program. A designated nurse—who has undergone specialized training and is proficient in the proper movements—serves as the instructor. Every day, the nurse leads the exercises punctually, demonstrating the standard movements throughout the session, correcting patients’ improper postures section by section, and ensuring consistent breathing rhythms and exercise intensity to prevent deviations that might occur when patients practice on their own. Keep exercise sessions between 15 and 20 minutes, adjusting flexibly based on the patient’s overall physical condition. Follow the principles of “gradual progression and exercising within one’s limits”; the ideal is to feel a slight warmth in the body without experiencing fatigue, in line with the rehabilitation requirements for mild exercise in patients with endocrine disorders [1].

2.2.3. Implementing End-to-End Safety Management in Nursing Care

Establish a comprehensive safety management system covering “pre-exercise assessment, in-exercise monitoring, and post-exercise follow-up” to systematically mitigate exercise-related risks and ensure that the exercise process remains safe and controllable [3]. Pre-exercise assessment: Nurses assess each patient’s blood glucose, blood pressure, and heart rate for the day, screen for symptoms such as hypoglycemia, dizziness, chest tightness, and bone and joint pain, and stratify patients based on their medical condition, age, and physical fitness. Clear exercise suspension standards: Fasting blood glucose 3.9 mmol/L or 16.7 mmol/L suspend exercise; SBP ≥ 160 mmHg or DBP ≥ 100 mmHg delay exercise. Patients with dizziness, chest tightness, severe joint pain, palpitations, persistent fatigue, acute infection must stop exercise. High-risk patients use simplified low-intensity Ba Duan Jin or suspend training, re-assessed every morning. Monitoring During Exercise: The supervising nurse should observe the patient’s complexion, breathing, demeanor, and limb movements throughout the exercise, and proactively ask the patient about their subjective feelings. If the patient experiences any discomfort—such as palpitations, cold sweats, dizziness, or weakness—the exercise should be stopped immediately and appropriate symptomatic treatment provided; Post-Exercise Guidance: After the exercise session, nurses provide targeted answers to patients’ questions and clarify any concerns, reinforcing key educational points such as the optimal timing and frequency of exercise, hypoglycemia prevention, and contraindications for postprandial exercise. At the same time, they document the patients’ exercise performance to serve as a basis for subsequent personalized exercise guidance. Key intervention points are strictly implemented in accordance with the exercise management guidelines outlined in the Chinese Guidelines for the Prevention and Treatment of Type2 Diabetes(2022 Edition) [5].

2.2.4. Establishing a System for Continuing Education and Outreach Both within and outside the Hospital

By leveraging QR codes as an educational tool, this approach breaks down time and space barriers to ensure the continuity of health education [4]. During their hospital stay, patients can repeatedly scan the QR code to rewatch instructional videos and master the proper movements; after discharge, they can review the material on their own at any time and maintain a regular exercise routine at home, thereby addressing the shortcoming of traditional in-hospital education, which often ends as soon as the patient is discharged. At the same time, nurses develop personalized at-home Baduanjin exercise plans for patients based on their exercise habits during hospitalization, specifying the daily duration, frequency, and precautions to help sustain the effects of the exercise intervention. These at-home exercise plans are formulated with reference to research findings on Baduanjin interventions for diabetes [2][6].

All indicators were assessed at the end of 3-month intervention; all evaluators were single-blinded without knowing patient grouping.

1) Mastery of Ba Duan Jin movements: Self-designed 16-item scale (0 - 100 scores). ≥90 = fully mastered, mastery rate = fully mastered cases/total × 100%.

2) Exercise adherence: Scale from Li Hongmei 2023; completing ≥80% planned training within 3 months was defined as adherence.

3) Nursing satisfaction: Hospital nursing satisfaction questionnaire (0 - 100 scores), ≥90 was satisfied.

4) Exercise-related adverse events: Palpitations, hypoglycemia, dizziness, joint pain, cold sweats during/after exercise; incidence = adverse event cases/total × 100%.

SPSS 26.0 was used, α = 0.05. Measurement data (blood lipid, scale scores) expressed as mean ± SD; inter-group: independent t-test, intra-group pre-post: paired t-test; Cohen’s d and 95% CI were reported. Count data used χ² test, OR and 95% CI supplemented. All exact P values rather than only P < 0.05 were presented with corresponding t/χ² statistics.

After 3 months of intervention, a comparison of the intervention outcomes between the two groups revealed that patients in the observation group had significantly higher rates of mastery of the Eight Brocades exercises, greater adherence to regular exercise, and higher satisfaction with health education than those in the control group. The incidence of adverse exercise events was also significantly lower in the observation group than in the control group, and the differences between the groups were statistically significant (P < 0.05). See Table 1 for details.

Table 1.Comparison of outcomes between the two groups after nursing intervention.

Note: Total sample size = 172, no less to follow-up.

Exercise adherence among patients in the observation group improved significantly, consistent with the findings of Peng Liuet al., confirming that standardized Ba Duan Jin combined with systematic health education can substantially improve exercise adherence among patients with chronic diseases [7]; the significant reduction in adverse events was attributed to the closed-loop exercise safety management model, which is consistent with the results of Yaping Wang et al.’s study on closed-loop exercise nursing [3].

After a regular Ba Duan Jin exercise intervention, patients in the observation group showed significant improvement in symptoms such as physical fatigue, insomnia, anxiety, and irritability, fluctuations in blood glucose and blood lipid levels tended to stabilize. Compared to pre-intervention levels and the control group, physical and mental recovery outcomes improved significantly. This fully demonstrates the value of traditional Chinese medicine health-preserving exercises in the rehabilitation of chronic endocrine diseases, consistent with the findings of Meijie Wang et al., who concluded that long-term practice of the Eight Brocades can stabilize glucose and lipid metabolism and improve the physical and mental well-being as well as quality of life of patients with chronic diseases [2].

Traditional exercise health education in endocrinology departments primarily relies on verbal instruction and printed materials. These methods are limited in format, the content is dry, and there is a lack of visual demonstrations. This makes it difficult for middle-aged and elderly patients to understand the information, and they often have trouble retaining it, leading to problems such as improper exercise form and haphazard training. Consequently, exercise adherence is low, and rehabilitation outcomes are suboptimal. This study innovatively adopted a visual education model combining “text and images on bulletin boards, QR code videos, and user-friendly stands”, integrating static text and images with dynamic video demonstrations to provide clear, intuitive, and easy-to-understand information, thereby effectively lowering the learning barrier for patients. The 24/7 educational hub in the hallway allows patients to engage in self-directed learning during their spare moments, addressing the limitations of centralized education sessions—such as limited time and incomplete coverage—and significantly enhancing the precision and effectiveness of health education. This demonstrates the unique advantages of QR code-based visual education in chronic disease health education.

This program ensures standardized, regulated, and safe exercise routines through nurses’ unified morning instruction. Patients with chronic endocrine conditions have unique clinical presentations and often experience fluctuations in blood glucose and blood pressure. Inappropriate exercise can easily trigger risks such as hypoglycemia and cardiovascular or cerebrovascular complications, posing significant safety hazards when patients exercise on their own. Therefore, the prevention and control of exercise-related risks in clinical settings is a key focus of chronic disease care [3]. This program ensures standardized, regulated, and safe exercise routines through nurses’ unified morning instruction, continuous movement correction, and comprehensive monitoring of patients’ conditions. Individualized risk assessments before exercise, dynamic monitoring during exercise, and targeted guidance after exercise have established a fully closed-loop safety care system. This system effectively prevents exercise-related adverse events and addresses the core challenges patients face—namely, “being afraid to exercise, not knowing how to exercise, and exercising incorrectly”. It fully embodies the principles of precision care for chronic diseases and patient-centered care. This closed-loop management approach is highly consistent with the closed-loop exercise nursing intervention system proposed by Yaping Wang et al. [3].

As a traditional Chinese medicine practice, the Eight Brocades features gentle, soothing movements that combine stillness and motion with even breathing. Requiring no special venue or equipment, it is well-suited to the physical capabilities of middle-aged and elderly patients with endocrine-related chronic conditions. Long-term, regular practice can unblock meridians, harmonize qi and blood, improve metabolic function, enhance insulin sensitivity, and stabilize glucose and lipid metabolism. At the same time, it can alleviate negative emotions such as anxiety and depression in patients, improve sleep and alleviate symptoms of physical fatigue, thereby achieving dual physical and psychological rehabilitation [2]. Compared to high-intensity aerobic exercise, Baduanjin is safer and more tolerable, making it more suitable for patients with chronic diseases to practice over the long term. It is a distinctive exercise rehabilitation program with significant value for promotion in the Department of Endocrinology, and its mechanisms for improving metabolism have been supported by a large body of clinical research [6].

The innovative health education model developed in this study is low-cost, highly practical, and easy to implement. It makes full use of existing public spaces in hospital wards, requires no additional equipment investment, and is highly replicable. At the same time, this model deeply integrates appropriate TCM techniques with modern visual health education, enriching the scope of high-quality nursing services in the Endocrinology Department and refining the exercise management system for chronic diseases. It not only enhances the quality of nursing education but also improves patients’ hospital stay experience and rehabilitation outcomes, aligning with the development requirements of TCM nursing and precision management of chronic diseases in the new era. This model can be widely applied in various internal medicine wards for chronic diseases.