Larkey, L.K., Roe, D.J., Smith, L., & Millstine, D. (2016). Exploratory outcome assessment of Qigong/Tai Chi Easy on breast cancer survivors. Complementary Therapies in Medicine, 29, 196–203.

Explore whether meditative movement improves cognitive function, quality of life, physical activity, and body mass index (BMI) in postmenopausal women with breast cancer who report clinically significant fatigue.

The intervention included two groups: meditative movement (consisting of Qigong and Tai Chi Easy movements) versus sham Qigong (consisting of similar movements without meditative components), both of which were referred to as rejuvenating movement to blind participants. Participants completed 14 one-hour sessions over 12 weeks with interventionists and were asked to complete 30-minute DVD-guided sessions at home five days per week. Study assessments were done before groups began, at the end of the groups (i.e., 12 weeks post-baseline), and three months after the groups ended.

• N = 87   
• AGE: mean = 58.8 years (SD = 8.94)
• FEMALES: 100%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Initial diagnosis of nonmetastatic, invasive breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS: 91% White, 59% completed some college, stage 0-III, no recurrence or other cancers, 69% on endocrine therapy, completed adjuvant chemotherapy and/or radiation therapy six months to five years before enrollment, currently reporting clinically significant fatigue; excluded for moderately severe or greater depressive symptoms, BMI > 32, comorbidities and medications affecting fatigue and sleep, smoking/excessive alcohol consumption, and routine mind-body practices.

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

PHASE OF CARE: Late effects and survivorship

Double-blind randomized controlled trial of meditative movement versus sham control with repeated measures

• Cognitive impairment: Functional Assessment of Cancer Therapy-Cognitive Function (subjective); Digit Span and Letter-Number Sequencing (attention and working memory)
• Other measures: SF-36 for quality of life, Brief Physical Activity Questionnaire

Feasibility: 86% completed the study, adherence to intervention sessions and home practice not reported; no adverse events

Cognitive impairment: No group differences at baseline. Both groups improved in self-reported cognitive function and attention/working memory tests (time effects, p < 0.05), but no differences were found between the groups (no group by time effect).

Other outcomes: No group differences at baseline. BMI decreased in the meditative movement group but increased in the sham control group (p = 0.0048).  All other outcomes showed similar pattern to cognitive impairment (i.e., significant time effects for both groups, but no group by time effects).

This exploratory pilot study suggests that meditative movement does not improve cognitive function more than gentle movement without mindfulness. Although both types of movement may improve cognitive impairment, it is unclear if improvement was due simply to participating in groups.

• Small sample (< 100)
• Measurement validity/reliability questionable 
• Findings not generalizable
• Subject withdrawals ≥ 10%
• Other limitations/explanation: This secondary analysis used data from a larger study not designed to evaluate cognitive function comprehensively. The neuropsychological tests used did not capture all domains of cognitive function. The participants reported very few cognitive problems at baseline (potential floor effect). In addition, the sample size was determined based on primary outcome of fatigue, so whether there was sufficient statistical power to detect differences in cognitive outcomes is unclear. Therefore, definitive conclusions cannot be drawn about cognitive impairment. This single-site pilot study is not generalizable to all postmenopausal women with breast cancer.

Study findings do not support suggesting meditative movement exercises such as Qigong or Tai Chi over other types of gentle physical activity to improve cognitive impairment reported by postmenopausal women with breast cancer. The findings do support future well-powered studies using these types of interventions.