Moadel, A. B., Shah, C., Wylie-Rosett, J., Harris, M. S., Patel, S. R., Hall, C. B., . . . Sparano, J. A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. Journal of Clinical Oncology, 25, 4387–4395.

Random assignment occurred in a 2:1 ratio to the intervention group or control group after stratification by treatment (chemotherapy or antiestrogen therapy). The yoga intervention consisted of twelve 1.5-hour weekly classes held at three locations within the cancer center. Participants were permitted to attend more than one class per week, with such activity documented. The yoga intervention was developed for use with patients with breast cancer by one of the study authors who was an oncologist and a certified yoga instructor. The intervention was based on Hatha yoga stretches and poses, breathing exercises, and meditation. All exercises were performed in a seated or reclined position. Patients were asked to practice yoga at home daily and were given an audiotape/CD for guidance in their home practice.

• Oncology outpatients were recruited from oncology clinics at a university medical center and from several private clinics between 2001 and 2005.
• The sample was comprised of 128 patients with breast cancer.
• Mean age was 54.81 years (range 28–75).
• Of the patients, 42% were Black, 31% were Hispanic, 23% were White, 76% had high school education or less, 69% were not married, 45% had stage I, and 53% had undergone lumpectomy.
• Of 164 women with breast cancer who consented, 128 (78%) completed the baseline and main follow-up (three-month) assessments.

Patients were undergoing the active treatment phase of care.

The study used a randomized, wait-list control design.

Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F)

No significant difference was found in fatigue change scores from baseline to three-month follow-up between the intervention and wait-list control groups. Both groups were significantly fatigued compared with normative values for the FACIT-F. Subanalysis of the change scores only among the subgroup of patients not on chemotherapy (n = 71) also failed to demonstrate an effect of the yoga intervention on fatigue. However, adherence analysis suggested that participants in the intervention group who were highly adherent with the yoga intervention had significantly improved in fatigue compared with those in the intervention group who were less adherent with the yoga intervention. The primary reason for attrition was lost to follow-up (15%), with attrition similar between the intervention (22%) and control (21%) groups. Those who dropped out were significantly more likely to be younger.

• The study had a small sample size (intervention group, n = 84).
• One can speculate that the effects of the intervention may have been obscured by the relatively high level of fatigue of the participants. In support of this possibility is the fact that fatigue was a statistically significant predictor of yoga class attendance.
• Yoga may be less feasible for patients who are on active treatment with radiation or chemotherapy or those who are already fatigued—adherence analysis revealed that greater fatigue, younger age, receiving radiotherapy, and not being on antiestrogen therapy together explained 40% of the variance in attendance at weekly yoga classes.