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.

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

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.

• 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.

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

• PHASE OF CARE: Transition phase after active treatment

• RCT
  • Single-blind

• Pittsburgh Sleep Quality Index
• Actigraphy

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.

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

• 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.

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.