Relaxation Therapy

Relaxation Therapy

PEP Topic 
Fatigue
Description 

Relaxation therapies differ in philosophy and method. The goal is to use the power of the mind and body to achieve a sense of relaxation and lowered metabolism. Relaxation therapy inteventions may incorporate breathing exercises and may involve relaxing the body and such techniques as diversion or visualization. Relaxation therapy differs from progressive muscle relaxation in that the specific technique of sequential muscle relaxation is not necessarily used. Simple visualizaion may involve imagining a relaxing setting and differs from guided imagery. In guided imagery, specific types of mental images are elicited to affect specific aspects of the experience. Simple relaxation therapy has been examined in anxiety, depression, fatigue, sleep-wake disturbances, and hot flashes.

Effectiveness Not Established

Research Evidence Summaries

Hayama, Y., & Inoue, T. (2012). The effects of deep breathing on 'tension-anxiety' and fatigue in cancer patients undergoing adjuvant chemotherapy. Complementary Therapies in Clinical Practice, 18, 94–98.

doi: 10.1016/j.ctcp.2011.10.001
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Study Purpose:

To investigate the effect of a deep breathing intervention, incorporated within conventional nursing care, on tension-anxiety and fatigue experienced by Japanese women with gynecologic cancer undergoing adjuvant chemotherapy for the first time.

To reduce tension-anxiety and fatigue through deep breathing that incorporated elements of exercise.

Intervention Characteristics/Basic Study Process:

The deep breathing intervention was initiated for patients in the intervention group. Each patient received 15 minutes of guidance from the researcher using a DVD and pamphlets. The intervention was performed with nursing assistance pre- and postchemotherapy, with the latter given on the second, fourth, and sixth days. The control group received treatment with the usual chemotherapy and nursing care.

Sample Characteristics:

  • The study was comprised of 23 women.
  • Mean age was 53.6 years (standard deviation [SD] = 9.4 years) in the intervention group and 61.7 years (SD = 9.8 years) in the control group.
  • All patients were diagnosed with gynecologic cancers, including uterine (54.5%), ovarian, cervical, and peritoneal carcinomatosis. Cancer stage ranged from I (54.5%) to III.
  • Patients were included in the study if they had a recent diagnosis, were postoperative and receiving their first administration of adjuvant chemotherapy, were literate in Japanese, and were willing to participate.
  • Patients were excluded if they were younger than 20 years and had received recent psychological treatment (including medication and psychotherapy) and/or recent asthma treatment.

Setting:

  • Single site
  • Inpatient
  • Osaka, Japan

Phase of Care and Clinical Applications:

  • Patients were undergoing the active treatment phase of care.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

The study used a randomized, controlled trial design.

Measurement Instruments/Methods:

  • Profile of Mood States (POMS)–Short Form (Japanese version):  tension-anxiety and fatigue subscales assessed pre- and posttherapy
  • Cancer Fatigue Scale (CFS), subscales of subjective fatigue:  physical, affective, and cognitive assessed pre- and posttherapy

Results:

There were no statistically significant differences between groups in terms of age, diagnosis, or cancer clinical stage or treatment type (p > 0.05). Prechemotherapy data showed no significant differences between the intervention and control groups in the previously mentioned measurement tools. The postchemotherapy tension-anxiety scores were lower in the intervention group (p = 0.01). Both groups showed significant reductions in tension-anxiety scores (both p = 0.00). The postchemotherapy physical and total fatigue scores of the intervention group were significantly lower than those of the control group (physical, p = 0.04; total, p = 0.04).

Conclusions:

The study demonstrated that the tension-anxiety and fatigue scores of patients undergoing chemotherapy for gynecologic cancers were lowered when the nurses assisted them with deep breathing for a short period in addition to providing conventional nursing care provided pre- and postchemotherapy. The prominent features of the study were that it used a program that combined three deep breathing techniques and was of short duration (10 minutes).

Limitations:

  • The study had a small sample size, with less than 30 patients.
  • The nurse-to-patient ratio for teaching was 1:1.
  • The study was limited to patients with gynecologic cancer and had a limited time period evaluated for fatigue (fatigue can worsen as chemotherapy continues). 
  • The study needs to be reproducible in different facilities and with a larger sample size. 
  • The study lacked an attentional control.

Nursing Implications:

These are very simple exercises that can be taught to patients and be performed even while they are receiving chemotherapy. In addition to usual nursing care, nurses can contribute to reducing patients’ tension-anxiety and fatigue by assisting them in performing deep breathing.

Kim, S. D., & Kim, H. S. (2005). Effects of a relaxation breathing exercise on fatigue in hematopoietic stem cell transplantation patients. Journal of Clinical Nursing, 14, 51–55.

doi: 10.1111/j.1365-2702.2004.00938.x
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Study Purpose:

The aim of the relaxation breathing exercise (RBE) intervention was to improve the function of immune cells.

Intervention Characteristics/Basic Study Process:

Before the intervention, a 30-minute recorded audiotape of RBE was given to the patients. RBE consisted of a three-step sequence, which combined relaxation breath and yoga-like positioning exercises:

  1. Preliminary exercises for 10 minutes
  2. Relaxation breathing for 10 minutes
  3. Finish exercises for 10 minutes.

The RBE intervention was provided to patients by one of the researchers at 4:00 pm every day for six weeks in the hospital. RBE was to be practiced in a supine position on a bed. For the control group, routine care (granulocyte-colony stimulating factor [G-CSF] injection and aseptic care) were given. Fatigue was measured at baseline and as posttest data in both groups.

Sample Characteristics:

  • The sample was comprised of 35 patients with leukemia or severe aplastic anemia.
  • Mean age was 32.9 years and 34.3 years for the exercise and control groups, respectively (range 20–48 years).
  • Most patients were married, and men and women were equally distributed in the exercise and control groups.
  • Patients were excluded if they were taking medication to relieve anxiety or depression.

Setting:

Patients were recruited from an inpatient hematopoietic stem cell transplant unit (single site).

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

The study was a randomized, pre-/posttest control group clinical trial:

  1. RBE group (n = 18)
  2. Control group (n = 17).

Measurement Instruments/Methods:

Revised Piper Fatigue Scale (PFS)

Results:

The RBE intervention resulted in a significant decline in mean fatigue scores for the RBE group (mean change = –3.2) compared to the control group (mean change = +0.3) (p = 0.0001). The RBE group had greater decreases in the behavioral/severity, affective meaning, sensory, and cognitive mood dimension compared to the control group. In pretest scores, fatigue scores were highest in the sensory dimension, followed by cognitive/mood and behavioral/severity in the RBE group. Sensory dimension was also the highest in the control group. At pretest, there were no significant differences in fatigue scores between groups.

Limitations:

  • The intervention was over a short period of time; therefore, the long-term effects of relaxation breathing exercises are unknown.
  • The study had a small sample size.

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