Eyigor, S., Uslu, R., Apaydın, S., Caramat, I., & Yesil, H. (2018). Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial. Complementary Therapies in Clinical Practice, 32, 40–45.

To examine the effects of yoga on shoulder and arm pain, quality of life (QOL), depression, and physical performance in patients with breast cancer

A 10-week Hatha yoga program was evaluated in this study. Hatha yoga is a mind-body exercise program of breathing exercises, flexibility, and relaxation components. The program in this study was supervised by a certified trainer and the session was taught at a beginner level. Sessions lasted one hour and were offered two days per week. All study participants (intervention and control) received education about cancer, lymphedema, and coping with ADLs. This included a booklet with information on exercises to stimulate lymph circulation. All participants were asked to practice these exercises twice a day.

• N = 42   
• AGE: Mean age = 51.9 years
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Study participants had completed breast cancer treatment and had no evidence of disease. 
• OTHER KEY SAMPLE CHARACTERISTICS: Study participants had not participated in a regular exercise program in the past six months.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: An academic medical center in Turkey

PHASE OF CARE: Transition phase after active treatment

Randomized controlled trial (RCT) with a usual care control group. Study outcomes were assessed by personnel blinded to the study assignment.

Visual analog scale for pain, European Organization for Research and Treatment of Cancer Quality of Life Core 30 (EORTC QLQ-C30) questionnaire, Beck Depression Inventory, 6-minute walk test, and evaluation of lymphedema. Measures were completed pre- and post-treatment. Study measures were also completed at 2.5 months post-treatment, but because most of the control group did not show up for their follow-up visit, data for the control group were not included in the analysis.

The two study groups did not differ significantly on demographic characteristics, types of breast cancer treatment, and baseline study measure scores. The yoga group demonstrated a significant improvement in pain severity from baseline to post-treatment for shoulder (p = 0.01) and arm (p = 0.01) pain; however, there was no significant difference between the yoga and control groups in regard to pre- and post-treatment pain. The yoga group’s improvement in pain severity was maintained at 2.5 months post-treatment (p = 0.01). There was no difference in depression, 6-minute walk, and QOL scores between groups from baseline to post-treatment. The yoga group demonstrated significantly improved QOL from baseline to 2.5 months post-treatment for functional (p = 0.01) and symptom (p = 0.03) scores, and improvement in their 6-minute walk time (p = 0.04). No evidence of worsening of lymphedema was found in either study group.

It is unclear if the yoga intervention truly relieved the shoulder and arm pain of the women with breast cancer since the control group also experienced a decrease in pain severity from baseline to 10 weeks. Shoulder and arm pain may normally decrease over time for this patient population. However, the Hatha yoga program appears to be a safe intervention which could be recommended if patients are interested in pursuing it.

• Small sample (< 100)
• Other limitations/explanation: The control group did not complete the 2.5 month follow-up questionnaires, so there is no comparison group for the yoga group findings at this time point.
   

Although Hatha yoga was not found to be more effective than usual care in relieving shoulder and arm pain, it appears to be a safe form of exercise. In addition, women in this study liked it as evident by the 95.5% adherence rate. Nurses should have an understanding of Hatha yoga so, if patients ask about it, they can explain that it is a safe form of exercise but its effectiveness in relieving pain needs to be studied further.