Yoga

Yoga, first described in the Vedic texts of India, has been practiced for millennia. It involves regulated breathing, moving through various postures known as asanas, and meditation, aimed at achieving physical and psychological well-being. Many styles of yoga encompass some or all of these components. Yoga can have a positive impact on quality of life (QOL) in people with and without cancer, by reducing stress and fatigue and improving symptoms of certain inflammatory conditions. In the cancer setting alone, there are at least 10 randomized trials documenting the benefits of yoga on patients’ QOL.

SUMMARY: A growing body of evidence suggests regular practice of yoga can help control migraine, carpal tunnel syndrome, osteoarthritis, multiple sclerosis, asthma, hypertension, chronic low back pain, and irritable bowel syndrome.[1] Given the positive effects of yoga on chronic ailments, several groups have investigated its potential for improving the quality of life in cancer patients. Results are promising.

Two studies of yoga reported at the 2010 meeting of the American Society of Clinical Oncology (ASCO) found it significantly improved sleep quality and fatigue.[2,3]

A randomized, controlled multicenter trial[2] assessed a Yoga for Cancer Survivors program in 410 nonmetastatic-cancer survivors. Participants were randomized into standard-care monitoring or standard care plus yoga, which consisted of twice-weekly 57-minute sessions including pranayama (breathing exercises), 18 gentle Hatha and Restorative yoga asanas (postures), and meditation. Yoga intervention significantly improved sleep quality, fatigue, and QOL, while reducing sleep medication use.[2]

In the second study, from Bangalore, India, 66 breast cancer survivors with metastatic disease were randomized to 12 weeks of yoga or supportive therapy. Compared with the supportive-therapy group, women randomized to yoga showed significant

reductions in fatigue severity and interference, sleep parameters, and symptom distress. Also, there were significant reductions in salivary cortisol levels only in the yoga group. While emphasizing that larger randomized controlled trials are needed, the investigators concluded that the results “offer preliminary support for stress reduction benefits of yoga intervention.”[3]

Indeed, in studies of breast cancer patients and survivors, yoga improved mood and decreased stress levels,[4,5] and a separate study of breast cancer survivors found that a Yoga of Awareness program reduced the number of hot flashes, improved fatigue, and reduced joint pain, with benefits persisting up to 3 months.[6]

Tibetan yoga, which incorporates controlled breathing, visualization, mindfulness techniques, and low-impact postures, improved sleep quality in patients with lymphoma.[7] Yoga also reduced stress, increased the sense of well-being, and promoted more restful sleep in newly diagnosed cancer patients and cancer survivors.[8] An 8-week mindfulness-based stress-reduction program involving relaxation, meditation, and gentle yoga significantly improved symptoms of stress and overall quality of life in breast and prostate cancer outpatients.[9]

Conclusions from a meta-analysis of nine studies of yoga in cancer patients state that, although preliminary data on the effectiveness of yoga are encouraging, larger, controlled clinical trials are needed.[10]

ADVERSE REACTIONS: Adverse effects from yoga are rare, but subcutaneous emphysema[11] and pneumothorax have been reported.[12]

COMMENTS: Yoga, a mind-body approach involving breath control, meditation, and physical postures, originated in India thousands of years ago and is believed to benefit physical, mental, and spiritual health. It is also an integral component of Ayurveda. Yoga is popular in the US and is offered in health clubs; in yoga centers; and in many cancer hospitals, as part of disease management.

Current evidence indicates that yoga helps to reduce a variety of symptoms in the setting of cancer, greatly improving QOL. It is advisable that patients learn the proper technique from certified instructors who have experience working with cancer patients.

References:

REFERENCES

1. Kuttner L, Chambers CT, et al: A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag 11:217-223, 2006.

2. Mustian KM, Palesh O, Sprod L, et al: Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors (abstract 9013). J Clin Oncol 28:15S, 2010.

3. Raghavendra RM, Ajaikumar BS, Vadiraja HS, et al: Role of yoga in modulating fatigue, sleep disturbances, salivary cortisol, and immune measures in breast cancer survivors: A randomized controlled trial (abstract 9099). J Clin Oncol 28:15S, 2010.

4. Chandwani KD, Thornton B, Perkins GH, et al: Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 8:43-55, 2010.

5. Culos-Reed SN, Carlson LE, Daroux LM, et al: A pilot study of yoga for breast cancer survivors: Physical and psychological benefits. Psychooncology 15:891-897, 2006.

6. Carson JW, Carson KM, Porter LS, et al: Yoga of Awareness program for menopausal symptoms in breast cancer survivors: Results from a randomized trial. Support Care Cancer 17:1301-1309, 2009.

7. Cohen L, Warneke C, Fouladi RT, et al: Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 100:2253-2260, 2004.

8. Rosenbaum E, Gautier H, Fobair P, et al: Cancer supportive care, improving the quality of life for cancer patients. A program evaluation report. Support Care Cancer 12:293-301, 2004.

9. Carlson LE, Speca M, Patel KD, et al: Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 29:448-474, 2004.

10. Bower JE, Woolery A, Sternlieb B, et al: Yoga for cancer patients and survivors. Cancer Control 12:165-171, 2005.

11. Kashyap AS, Anand KP, Kashyap S: Complications of yoga. Emerg Med J 24:231, 2007.

12. Johnson DB, Tierney MJ, Sadighi PJ: Kapalabhati pranayama: Breath of fire or cause of pneumothorax? A case report. Chest 125:1951-1952, 2004.