Yagli, N.V., Sener, G., Arikan, H., Saglam, M., Inal Ince, D., Savci, S., . . . Ozisik, Y. (2015). Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors? Integrative Cancer Therapies, 14, 125–132. 

Patients were randomized to a yoga plus exercise group or an exercise alone group. Both groups did aerobic exercises three days per week for six weeks. The yoga program involved postures, meditation, and relaxation with imagery. Yoga was provided in 60-minute group sessions three days per week on the same day as exercise was done. Yoga was supervised by a certified therapist.

• N = 40  
• MEAN AGE = 48.6 years
• MALES: Not written, but it seems to be 0%, FEMALES: Not written, but it seems to be 100%
• KEY DISEASE CHARACTERISTICS: Patients with unilateral breast cancer who were mentally intact and whose cancer treatment was completed at least three years prior
• OTHER KEY SAMPLE CHARACTERISTICS: A cardiologist performed the cardiologic examinations. Exclusion criteria included chronic systemic disease and metastasis, relative and absolute contraindications for exercise training, drug therapy with a risk for exercise, types I and II diabetes mellitus, uncontrolled hypertension, and cardiac disease.

• SITE: Single site    
• SETTING TYPE: Outpatient    
• LOCATION: Turkey

• PHASE OF CARE: Late effects and survivorship

Randomized, controlled trial

• European Organisation for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC C30)
• Fatigue Severity Scale (FSS)
• Six-minute walk test
• Dynamometer for peripheral muscle strength
• Borg Fatigue Scale (BFS)
• Borg Dyspnea Scale (BDS)

• Dyspnea, fatigue, and leg fatigue perception were significantly decreased in both groups, and the improvement was similar in the two groups (P < 0.05).
• Peripheral muscle strength assessments improved in both groups (P < 0.05).
• Quality of life assessments improved in both groups (P < 0.05).
• Well-being, role function, and emotional and social functioning were statistically better in the group that included yoga compared with the aerobic exercise group (P < 0.05).
• FSS scores decreased more in the yoga and aerobic exercise groups compared to the group that received aerobic exercise alone (P < 0.05).

Aerobic exercise training and yoga improved functional capacity and QOL and reduced fatigue in patients with breast cancer. The addition of yoga to aerobic exercise was associated with greater improvements in fatigue perception and QOL measures.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Other limitations/explanation: There were several limitations in this study. A group that practiced yoga alone was not included, therefore the effects of yoga alone could not be reported. The exercise training period was six weeks. Longer exercise interventions are needed to determine their effects on other outcomes. The power analysis was performed post-hoc according to the primary outcome (6MWT) but revealed that the study had sufficient power (85%) to support our conclusions. Yoga was provided in a group setting, and there was no similar group activity in the exercise alone group. Group support may be responsible for some of the differences seen in perceptions and overall QOL. Areas for future research include appropriate levels of intensity for exercise training, the application of the program during cancer treatment, and the application of the program with patients receiving bilateral mastectomies.

The findings of this study suggest that the addition of yoga to exercise interventions may cause improvements in perception of dyspnea and fatigue among breast cancer survivors that are greater than the effects of exercise alone. Mind–body approaches should be considered as adjuvant interventions for fatigue.