Yoga

Yoga

PEP Topic 
Sleep-Wake Disturbances
Description 

Yoga is an ancient Eastern science that incorporates stress-reduction techniques, such as regulated breathing, visual imagery, meditation, and various postures. Hatha yoga is a type of yoga. Yoga has been examined as an intervention for anxiety, depression, chemotherapy-induced nausea and vomiting, hot flashes, sleep-wake disturbances, pain, and fatigue in patients with cancer. It has also been examined as an intervention for caregiver strain and burden.

Effectiveness Not Established

Research Evidence Summaries

Bower, J. E., Garet, D., Sternlieb, B., Ganz, P. A., Irwin, M. R., Olmstead, R., & Greendale, G. (2012). Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer, 118, 3766–3775.

doi: 10.1002/cncr.26702
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Study Purpose:

To examine, relative to a health education control, the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent posttreatment fatigue.

Intervention Characteristics/Basic Study Process:

Outcome assessors of the performance tasks were blinded to group assignment. The intervention was briefly but fully described, and then participants were randomly assigned to a group that received a 12-week, Iyengar-based yoga intervention or a group that received 12 weeks of a health education (control group).

Sample Characteristics:

  • The sample was comprised of 31 women.
  • Mean age was 54.4 years (standard deviation [SD] = 5.7 years) in the intervention group and 53.3 years (SD = 4 years) in the control group.
  • All participants had stage 0 to II breast cancer.
  • Most participants were white.
  • The range of education was high school completion through graduate degree.
  • Twenty-four participants were completing radiotherapy, 17 were completing chemotherapy, and 22 were receiving hormone therapy.
  • In the intervention group, median time posttreatment was 1.7 years (range 0.7–4.1).
  • Breast cancer survivors with posttreatment fatigue were recruited through multiple mechanisms. Inclusion and exclusion criteria were applied.
  • The original enrollment target was 72 participants; researchers assumed a 20% loss to follow-up. Because of the stringent enrollment plan, the sample size was smaller than expected.
     

Setting:

  • Single site
  • Outpatient
  • University of California, Los Angeles
     

Phase of Care and Clinical Applications:

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

Study Design:

The study was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Fatigue Symptom Inventory (FSI)
  • Multidimensional Fatigue Symptom Inventory (MFSI), to assess vigor
  • Beck Depression Inventory II (BDI-II)
  • Pittsburgh Sleep Quality Index (PSQI)
  • Perceived Stress Scale (PSS)
  • Timed chair stands and functional reach test, to assess physical performance
  • Medical Outcomes Study (MOS)
     

Results:

Relative to the control group, fatigue severity in the intervention group declined significantly (p = 0.032) from baseline to posttreatment and over the three-month follow-up. In addition, relative to the control group, the yoga group had significant (p = 0.011) increases in vigor. Both groups had positive changes in symptoms of depression and perceived stress (p < 0.05). The authors noted no significant changes in sleep or physical performance. 

One adverse protocol-related event occurred:  a participant with a history of back problems experienced a back spasm in yoga class. After evaluation by her physician, she returned to class.

Conclusions:

A targeted yoga intervention led to a significant reduction in fatigue and improvement in vigor among breast cancer survivors with persistent fatigue symptoms. This conclusion should be understood in the context of the study:  participants were relatively healthy and without comorbid conditions found in the general population.

Limitations:

  • The study had a small sample size, with less than 100 participants.
  • Some participants had been living with cancer for more than five years, which was longer than most in the study had been living with cancer.
  • Because of the context of the study, researchers were unable to use a double-blind design.
  • The study included multiple conditions.
  • The results were not generalizable.

Nursing Implications:

This study offered minimal conclusive data in support of the intervention. Preliminary findings indicated that the yoga intervention is feasible and safe and has a positive effect on fatigue. A larger trial that includes participants with common comorbid conditions—a study more representative of the general population of women with breast cancer posttreatment—is warranted. Secondary outcomes included vigor, symptoms of depression, sleep, perceived stress, and physical performance.

Carson, J. W., Carson, K. M., Porter, L. S., Keefe, F. J., & Seewaldt, V. L. (2009). Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Supportive Care in Cancer, 17, 1301–1309.

doi: 10.1007/s00520-009-0587-5
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Study Purpose:

The study evaluated the effects of a yoga intervention on menopausal symptoms among breast cancer survivors.

Intervention Characteristics/Basic Study Process:

Patients were randomized to the yoga intervention or a wait-list control group. The intervention consisted of eight weekly, 120-minute, group classes led by a certified yoga instructor. Classes were videotaped and reviewed. Sessions involved 40 minutes of stretching poses, 10 minutes of breathing techniques, 25 minutes of meditation, 20 minutes of study of pertinent topics, and 25 minutes of group discussion. CD recordings were provided for home practice. Application of concepts to daily life were assigned weekly. Assessments were performed at baseline, posttreatment, and three months postintervention. Wait-list controls were reminded about the assessments they needed. Patients kept daily diaries to rate hot flashes and daily use of yoga.

Sample Characteristics:

  • The study was comprised of 37 women with a mean age of 54.4 years. 
  • Patients were an average of 4.9 years since diagnosis.
  • All patients had breast cancer, and 40.5% were stage IA.
  • Of the patients, 70.3% had prior chemotherapy, 13.5% were on tamoxifen during the study, 75.7% were married or partnered, 81.1% were Caucasian, and 80.3% had college or graduate level education.
  • Patients had no hormone therapy within three months.
  • Many patients were on antidepressants.
  • Of the patients, 50.5% were receiving aromatase inhibitors known to increase hot flashes.

Setting:

The study was performed in outpatient clinics at Duke University.

 

Phase of Care and Clinical Applications:

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

Study Design:

The study was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Patients kept daily hot flash and yoga use diaries. Hot flashes were scored on a 0-to-9 numeric scale.
  • In addition, a questionnaire assessed the perceived credibility of the intervention.

Results:

Those in the yoga group had a significantly better decline in hot flash frequency, severity, joint pain, fatigue, and sleep disturbance (p < 0.002). Patients in the control group had significantly better decline in the degree to which they were bothered by symptoms (p < 0.0001). There was no difference in night sweats. Mean yoga practice time spent in use of techniques was associated with less fatigue (p = 0.032). Yoga daily participation ranged from 7.3 to 64.6 minutes. There was a 76% completion rate in the yoga group.

Conclusions:

The findings suggested a potential benefit of a group yoga and support intervention for some symptoms in breast cancer survivors.

Limitations:

  • The study had a small sample size.
  • The study had no blinding or attentional control.
  • It is unclear if the benefits were derived from the yoga activities or the group activities provided. 
  • There was a relatively high drop-out rate, raising the question of the practicality of the intervention as designed. 
  • The sample included patients with high education levels and current marriage or partnership support.
  • Measurement of symptoms was not clearly described, and scoring was unclear.

Nursing Implications:

The findings suggested that yoga and support activities provided in a group setting may help patients with symptoms of hot flashes, sleep deprivation, and fatigue. There was no apparent effect on night sweats.  

Chandwani, K.D., Perkins, G., Nagendra, H.R., Raghuram, N.V., Spelman, A., Nagarathna, R., . . . Cohen, L. (2014). Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. Journal of Clinical Oncology, 32, 1058–1065. 

doi: 10.1200/JCO.2012.48.2752
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Study Purpose:

To test whether participation in yoga during radiation therapy would have long-term effects on fatigue, depression, and sleep disturbances

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to one of three groups: a yoga group, an exercise group, and a wait list control group. Yoga and exercise groups attended up to three 60-minute sessions per week during six weeks of radiation therapy. These were given one-on-one or in groups according to the patient’s convenience and schedule. Each received a CD and written program manual to encourage at-home practice. The yoga program included warm-up breathing, postures, deep relaxation, alternate nostril breathing, and meditation. The exercise program included exercises specifically recommended for women recovering from breast cancer treatment involving multiple positions and stretching. Study assessments were done at baseline, during the last week of treatment, and at one, three, and six months after treatment.

Sample Characteristics:

  • N = 132  
  • MEAN AGE = 52 (range = 26–79)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: All had breast cancer, 64% also were on chemotherapy. Over 60% had breast-conserving surgery
  • OTHER KEY SAMPLE CHARACTERISTICS: 16.5% were African American, 44% had at least some college education

Setting:

  • SITE: Single site  
  • SETTING TYPE: Outpatient  
  • LOCATION:MD Anderson in Houston, TX

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active anti-tumor treatment

Study Design:

  • RCT with active control

Measurement Instruments/Methods:

  • SF-36®
  • Brief Fatigue Inventory
  • Pittsburgh Sleep Quality Index
  • Centers for Epidemiological Studies–Depression scale
  • Salivary cortisol levels

Results:

Greater increases in physical component scores of the SF-36 were seen in the yoga group compared to both other groups at one and three months (p = .01). The yoga group (p = .04) and exercise group (p = .02) had greater reduction in fatigue compared to wait list controls at the end of treatment. These differences were not significant at other time points. Fatigue consistently declined over time in all patient groups. Sleep quality improved in all groups over time with no significant differences between groups.

Conclusions:

Both yoga and exercise were associated with reduced fatigue by the end of radiation treatment; however, these effects were not maintained over the following six months.

Limitations:

  • Risk of bias (no blinding)
  • Unintended interventions or applicable interventions not described that would influence results
  • Subject withdrawals ≥ 10%
  • Other limitations/explanation: Almost 30% were lost to follow-up despite payment of participants for completion of each study assessment. Other interventions that may have influenced outcomes were not described. No intent to treat analysis. Baseline fatigue was low on average across all groups

Nursing Implications:

Findings showed that both yoga and exercise programs during radiation therapy were beneficial in reducing fatigue. Fatigue declined over time in all patients, and effects seen by the end of treatment did not appear to last. The follow-up information here is limited by the high number lost to follow-up, showing the difficulty of conducting longitudinal examination of intervention effects. Nurses can recommend that patients participate in programs such as yoga and exercise during active cancer therapy.

Cohen, L., Warneke, C., Fouladi, R. T., Rodriguez, M. A., & Chaoul-Reich, A. (2004). 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.

doi: 10.1002/cncr.20236
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Intervention Characteristics/Basic Study Process:

The Tibetan yoga (TY) intervention involved seven weekly sessions with a yoga instructor who used imagery and exercise and included four aspects:  controlled breathing and visualization, mindfulness, two types of posture, and daily practice. Outcomes were psychological adjustment, sleep, and fatigue.

Sample Characteristics:

  • The sample comprised 39 (final N = 38) patients with lymphoma.
  • Mean age was 51 years in both groups.

Setting:

  • Community outpatient setting affiliated with a comprehensive cancer center
  • Southern United States

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment and long-term follow-up phases of care.

Study Design:

The study used a prospective, quasiexperimental design with two groups, including a wait-list control.

Measurement Instruments/Methods:

Pittsburgh Sleep Quality Index (PSQI)

Results:

The TY group reported significantly lower sleep disturbances scores (total PSQI) at follow-up (5.8 for TY versus 8.1 for the wait-list control). At follow-up, the TY group reported better subjective sleep quality, shorter latency, longer duration, and use of fewer sleep medications.

Limitations:

  • The study had a small sample size.
  • The study did not control for time since diagnosis.
  • Methods of yoga taught may vary with instructor.
  • Training in yoga is required.
  • Costs are incurred for a space for the class and an instructor.

Dhruva, A., Miaskowski, C., Abrams, D., Acree, M., Cooper, B., Goodman, S., & Hecht, F. M. (2012). Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial. Journal of Alternative and Complementary Medicine, 18, 473–479.

doi: 10.1089/acm.2011.0555
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Study Purpose:

To assess the feasibility and effects of pranayama (regulation and expansion of breath) among patients receiving chemotherapy. To test the efficacy of pranayama in alleviating common chemotherapy-associated symptoms (fatigue, sleep disturbance, stress, anxiety, and depression) and improving quality of life (QOL). To evaluate patients' responses to the use of pranayama in alleviating common chemotherapy-associated symptoms affecting QOL.

Intervention Characteristics/Basic Study Process:

Participants were randomized 1:1 in blocks of four. The allocation sequence was generated by the study statistician and then transferred to sealed numbered envelopes. The study staff enrolled participants and implemented the allocation sequence, which was concealed from the study staff until study assignment. Blinding of participants was impossible due to the intervention, which consisted of a 60-minute class once per week taught by yoga instructors and twice daily home practice that totaled 20 to 30 minutes per day, along with usual care during two cycles of chemotherapy. The control group received only usual care during the initial cycle of chemotherapy, and the pranayama intervention along with usual care during the second cycle of chemotherapy.

Sample Characteristics:

  • The sample was comprised of 16 patients.
  • Mean age was 56 years (standard deviation [SD] = 11.9 years) in the control group and 52.4 years (SD = 14.6 years) in the treatment group.
  • The treatment group was 75% female and 25% male; the control group was 100% female.
  • Patients were receiving intravenous chemotherapy for cancer (50% of participants had breast cancer, 50% had some other type of cancer).
  • Patients were included in the study if they had a visual analog scale (VAS) score for fatigue of at least 4 out of 10 and a Karnofsky Performance Status (KPS) of 60 or higher.
  • Patients were excluded from the study if they participated in ongoing yoga practice; had severe chronic obstructive pulmonary disease (COPD), class III or IV heart failure, child class C cirrhosis, or end-stage renal disease; or had received more than three prior chemotherapy regimens.
  • The sample was 62.5% white, and 7 out of 16 were employed.

Setting:

  • Single site
  • Outpatient
  • University medical center

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

The study was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Participants kept a daily diary in which they recorded the amount of time spent practicing pranayama.
  • At baseline, between the first and second cycle, and at the end of the study, the investigators took measures according to these instruments:
    • Piper Fatigue Scale (PFS)
    • General Sleep Disturbance Scale (GSDS)
    • Hospital Anxiety and Depression Scale (HADS)
    • Perceived Stress Scale (PSS)
    • Short Form 12 (SF-12 v1), to measure QOL.

Results:

Sixteen of 18 participants completed all study measures:  eight from the control group and eight from the treatment group. The study intervention had no adverse effects. Increased yoga practice was associated with statistically significant reductions in sleep disturbance (p = 0.04) and anxiety (p = 0.04). The mental component of QOL approached statistical significance (p = 0.05).

Conclusions:

This was the first study of a pure pranayama intervention for patients with cancer, and it demonstrated that yoga breathing is a feasible and safe intervention for this patient population. Any increase in the yoga breathing practice correlated with improvements of chemotherapy-associated symptoms and QOL. Researchers should confirm these findings by means of a larger study.

Limitations:

  • The study had a small sample size, with less than 30 participants.
  • The study had risks of bias due to lack of an attentional control and due to selection bias:  those who would elect to participate in a study of this kind may be more likely than others to benefit from it. In addition, the study included self-reported outcomes.

Nursing Implications:

Among patients with cancer who are undergoing chemotherapy, pranayama breathing techniques may help decrease sleep disturbance and anxiety and increase the mental component of QOL. Pranayama breathing, supplemented with reminders during and between treatments, seems to be an intervention that is feasible for this group of patients.

Mustian, K.M., Sprod, L.K., Janelsins, M., Peppone, L.J., Palesh, O.G., Chandwani, K., . . . Morrow, G.R. (2013). Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. Journal of Clinical Oncology, 31, 3233–3241.

doi: 10.1200/JCO.2012.43.7707
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Study Purpose:

To determine the effectiveness of a standardized yoga intervention compared to usual care for improving sleep quality among cancer survivors

Intervention Characteristics/Basic Study Process:

Patients were stratified by sex and baseline sleep disturbance and randomized to yoga or usual care groups. Patients in the yoga group participated in a program of gentle Hatha yoga and restorative yoga for four weeks. Sessions were provided in community-based sites (e.g., community centers, yoga studios) in groups of 10–15 patients. Study measures were obtained at baseline and at the end of the four-week sessions.

Sample Characteristics:

  • N = 221
  • MEAN AGE = 54.1 years
  • MALES: 4%, FEMALES: 96%
  • KEY DISEASE CHARACTERISTICS: 75% had breast cancer; 91% had previous surgery; 71% had chemotherapy; 66% had radiation therapy; 51% were on current hormone therapy; the average time since cancer treatment was 16.3 months.
  • OTHER KEY SAMPLE CHARACTERISTICS: 48% were not exercising at baseline; 72% were married or in a long-term relationship; all reported at least a level 3 of sleep disturbance on a 10-point numeric scale.

Setting:

  • SITE: Multi-site  
  • SETTING TYPE: Outpatient  
  • LOCATION: United States

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Transition phase after active treatment

Study Design:

  • RCT
    • Single-blind

Measurement Instruments/Methods:

  • Pittsburgh Sleep Quality Index
  • Actigraphy

Results:

Those assigned to the yoga intervention attended an average of 6.5 of 8 prescribed sessions. Compared to patients in the control group, participants in the yoga program showed greater improvement in global sleep quality (OR 10.79, p = .009), less daytime dysfunction (OR 0.381, p < .001), less sleep medication use (OR 0.561, p = .046), and improvement in subjective sleep quality (OR 0.631, p =.047). Global sleep quality, sleep disturbance, sleep efficiency, and subjective sleep quality also improved in patients in the control group. No significant differences were seen between groups in actigraphy findings.

Conclusions:

Participation in group yoga sessions had a positive impact on self-reported sleep quality among cancer survivors.

Limitations:

  • Baseline sample/group differences of import
  • Risk of bias (no appropriate attentional control condition)
  • Unintended interventions or applicable interventions not described that would influence results
  • Subject withdrawals of 10% or greater
  • Other limitations/explanation: At baseline, global sleep quality was higher in the intervention group; however, no analysis was provided of the significant of this difference. Use of other interventions for sleep are not discussed, other than sleep medication use, which is not defined. Sessions were done in groups, so to what extent effects seen were because of the yoga exercises versus the group activity and relationships is unclear. The dropout rate was almost 50% in both study groups.

Nursing Implications:

Findings suggest that participation in group yoga sessions may be effective in improving self-reported sleep quality among cancer survivors. This type of activity may not be acceptable to all patients, given the dropout rates seen in this study. However, for those who are interested in this type of intervention, nurses can let patients know that it can be of benefit.

Systematic Review/Meta-Analysis

Buffart, L. M., van Uffelen, J. G., Riphagen, I. I., Brug, J., van Mechelen, W., Brown, W. J., & Chinapaw, M. J. (2012). Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer, 12, 559.

doi: 10.1186/1471-2407-12-559
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Purpose:

STUDY PURPOSE: Evaluate effects of yoga on physical and psychosocial symptoms
TYPE OF STUDY:  Meta Analysis & Systematic Review

Search Strategy:

DATABASES USED: AMED, CINAHL, British Nursing Index, CENTRAL, EMBASE, PEDro, psycINFO, PubMed and SPORT-Discus
KEYWORDS:  States detailed search profiles available on request
INCLUSION CRITERIA:  RCT, adults with any cancer diagnosis, yoga intervention including physical postures, control group non exercise
EXCLUSION CRITERIA:  Yoga included as part of a larger intervention such as mindfulness based stress reduction were excluded

Literature Evaluated:

TOTAL REFERENCES RETRIEVED : N = 1909
EVALUATION METHOD AND COMMENTS ON LITERATURE USED Study method quality evaluated using a Delphi list previously developed and tested.  Low quality defined as <50% of possible total score.

Sample Characteristics:

FINAL NUMBER STUDIES INCLUDED; N(studies)  =  13
SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW:  Range 18-128
KEY SAMPLE CHARACTERISTICS:  12 studies involved breast cancer patients, 1 was in lymphoma

Phase of Care and Clinical Applications:

PHASE OF CARE:  Mutliple phases of care

Results:

Physical outcomes: Pain was evaluated in 4 studies, meta analysis of 2 of these showed a large effect size (d=-0.63, 95% CI -0.98, -0.31)
Psychosocial outcomes: Reduced anxiety (d=-0.77; 095% CI -1.08, -0.46) fatigue (d=-.051, 95% CI -0.79,-0.22)  Effects on sleep disturbance were small and insignificant.
Dropout rates ranged from 0-38%
Interventions ranged from planned 6 -15 sessions.  Some studies involved supervised yoga classes, and some involved home practice only.  Studies involved patients in active treatment and others involved cancer survivors who had completed treatment.

Conclusions:

Findings suggest that yoga may be helpful to reduce anxiety and fatigue in patients with cancer.

Limitations:

States 3 studies included participant blinding or double blinding – it is unclear how a participant would not know they were receiving a yoga intervention.  Varied methods of measurement were used in the studies included – there is no description of how these were handled in meta analysis.  There is no report of heterogeneity findings.   Most studies were very small sample sizes.  There was a wide range of drop -out rates and no information about how this was handled in analysis.  Studies did not include attentional control conditions, so it is unclear how much effect was due to group support versus the actual yoga activity.  No differentiation was made between group session interventions versus patients who did home practice alone after instruction.

Nursing Implications:

Findings do not provide strong support for effectiveness of yoga for sleep.  Findings do suggest that yoga may be helpful for patients to reduce anxiety and fatigue.  Nurses can support involvement in this type of activity for patients who are interested in participating in yoga.

Sharma, M., Haider, T., & Knowlden, A.P. (2013). Yoga as an alternative and complementary treatment for cancer: A systematic review. Journal of Alternative and Complementary Medicine, 19, 870-875.

doi: 10.1089/acm.2012.0632
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Purpose:

STUDY PURPOSE: To determine the efficacy of yoga as a treatment option in cancer

TYPE OF STUDY: Systematic review

Search Strategy:

DATABASES USED: CINAHL, MEDLINE, and Alt Healthwatch

KEYWORDS: Yoga and cancer and intervention or program

INCLUSION CRITERIA: Quantitative design; measured anxiety, depression, sleep disturbance, pain, quality of life, and/or stress as an outcome; published since 2010; English language; included any form of yoga as part of or the entire treatment of cancer

EXCLUSION CRITERIA: Not quantitative design

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: N = 135

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: No specific method of evaluating study quality is reported.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED: N = 13
  • SAMPLE RANGE ACROSS STUDIES: 536 total
  • TOTAL PATIENTS INCLUDED IN REVIEW: Range = 4-240
  • KEY SAMPLE CHARACTERISTICS: Six studies involved only patients with breast cancer; two involved parents of children or adolescents with cancer.

Phase of Care and Clinical Applications:

PHASE OF CARE: Mutliple phases of care

APPLICATIONS: Pediatrics

Results:

Of four studies examining effect on anxiety, two showed no effect and two showed a significant positive effect. One of these was a positive effect on parents. Two studies showed a positive effect for fatigue, and one showed no effect for fatigue. There were no effects seen for depression. One study showed a positive effect for sleep, and one showed no effect for sleep. One study of 18 breast cancer survivors showed a postitive effect for fatigue immediately after the intervention. Six of the studies used a randomized controlled trial (RCT) design. Duration and dosing of the yoga intervention varied substantially across studies. All of the studies used an instructor for the duration of the intervention. Methods of measurement used varied.

Conclusions:

Insufficient evidence exists to draw firm conclusions about yoga’s role and effect in cancer treatment.

Limitations:

There were few studies, and most had very small sample sizes. No information regarding the quality of the studies was included, other than general design, as this included both RCTs and quasiexperimental studies.

Nursing Implications:

There is limited evidence regarding the effects of yoga as a complementary approach in cancer treatment.

Zhang, J., Yang, K.H., Tian, J.H., & Wang, C.M. (2012). Effects of yoga on psychologic function and quality of life in women with breast cancer: A meta-analysis of randomized controlled trials. Journal of Alternative and Complementary Medicine, 18, 994-1002. 

doi: 10.1089/acm.2011.0514
Print

Purpose:

STUDY PURPOSE: To evaluate the effects of yoga in women with breast cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy:

DATABASES USED: PubMed, EMBASE, Cochrane Library, Chinese Biomedical Literature Database, and Chinese Digital Journals Database

KEYWORDS: Yoga or asana and breast cancer, and additional breast cancer terms

INCLUSION CRITERIA: Randomized controlled trial (RCT) comparing yoga or yoga-based intervention with a control group

EXCLUSION CRITERIA: Studies that included yoga as part of a larger intervention

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: N = 86

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane handbook was used for evaluation of methodological quality. Randomization was unclear in all but one study, and only one study blinded investigators. Three studies did not report complete outcome data, and dropouts were substantial percentages of the sample in all studies

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED: N = 6 included in meta-analysis  
  • SAMPLE RANGE ACROSS STUDIES: Range = 18-164
  • TOTAL PATIENTS INCLUDED IN REVIEW: N = 382
  • KEY SAMPLE CHARACTERISTICS: All were women with breast cancer aged ≥ 30 years.

Results:

Anxiety was measured in two studies, and meta-analysis showed no significant effect. Depression was measured in two studies, and meta-analysis showed no significant effect of yoga on depression. Fatigue was examined in five studies with no significant effect shown in meta-analysis. Sleep was measured in two studies with no significant effect shown in meta-analysis. Overall, quality of life was the only outcome measure in which a significant effect was seen from meta-analysis (SMD = 0.27, p = .03).

Conclusions:

Insufficient evidence exists to advocate for the use of yoga in patients with breast cancer. No significant effects were seen related to anxiety, depression, sleep disturbance, or fatigue in these patients.

Limitations:

A small number of studies were included, and all had methodological limitations. Yoga interventions differed and varied in frequency and duration.

Nursing Implications:

Insufficient evidence exists to show a benefit of yoga for women with breast cancer. High quality research is needed to evaluate the effects of yoga for symptom management.


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