Lötzke, D., Wiedemann, F., Rodrigues Recchia, D., Ostermann, T., Sattler, D., Ettl, J., . . . Büssing, A. (2016). Iyengar-yoga compared to exercise as a therapeutic intervention during (neo)adjuvant therapy in women with stage I–III breast cancer: Health-related quality of life, mindfulness, spirituality, life satisfaction, and cancer-related fatigue. Evidence-Based Complementary and Alternative Medicine (eCAM), 2016, 5931816. 

To test the effects of yoga on health-related quality of life, life satisfaction, cancer-related fatigue, mindfulness, and spirituality compared to conventional therapeutic exercises during (neo)adjuvant cytotoxic and endocrine therapy in women with stages I–III breast cancer

In a randomized controlled trial (N =119) (with data from 92 used for data analyses), women with breast cancer undergoing oncological treatment were randomly enrolled in a yoga intervention (YI) (n = 45) or a physical exercise intervention (PEI) (n = 47). Measurements were obtained before (t0) and after the intervention (t1), as well as three months after finishing the intervention (t2) using standardized questionnaires.

• N = 92   
• AGE = 40–62 years
• FEMALES: 100%
• CURRENT TREATMENT: Chemotherapy, radiation, combination radiation and chemotherapy, hormonal therapy
• KEY DISEASE CHARACTERISTICS: Breast cancer stage I–III 
• OTHER KEY SAMPLE CHARACTERISTICS: Exclusion criteria were (a) acute febrile or psychiatric diseases or (b) regular practice of yoga or experience practicing yoga

• SITE: Multi-site   
• SETTING TYPE: Multiple settings    
• LOCATION: Yoga at the center \"Yoga München GbR\" in Munich, physical exercise at the center \"Gesund. Reha rechts der IsarGmbH\" in Munich, and exercise at home

PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial with active control

• Cancer-specific European Organization of Research and Treatment of Cancer Core Quality of life (QLQ-C30) questionnaire for health-related quality of life
• Brief Multidimensional Life Satisfaction Scale
• 15-item Cancer Fatigue Scale (CFS-D)
• 14-item Freiburg Mindfulness Inventory (FMI)
• 15-item version of SpREUK questionnaire for spiritual attitudes and coping with Illness

Statistically significant results were found on most functional scales of the EORTC, which indicated the spontaneous recovery of patients’ quality of life after chemotherapy and/or radiation. The global health, role, and social functioning of patients in both groups improved significantly, yet neither group significantly differed from the other in these variables. Fatigue, dyspnea, appetite loss, constipation, and diarrhea improved in both groups. For “nausea and vomiting” and “pain,” significant changes were observed over time. No difference existed in life satisfaction, cancer-related fatigue, spirituality, and mindfulness between the groups.

High drop out rate may be related to the number of measurements. One of the concerns was that patients in treatment were having difficulty with the exercise and yoga programs thought to be from the side effects of the treatment. Further study focusing on one or two areas would be beneficial.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Key sample group differences that could influence results
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Questionable protocol fidelity
• Subject withdrawals ≥ 10%
• The number of lessons varied from 5 to 12, and the time lapse varied from 6 weeks to 25 weeks, which was not considered in the evaluation of the program.

The authors felt that this study may have been accepted by patients post-treatment or by using other forms of yoga. Self-care is becoming more common today, and yoga something you can do for yourself. Further investigation should be conducted to see how effective yoga is for patients with cancer.