Yoga

To evaluate the effects of a six-week yoga intervention on caregivers’ overall quality of life and psychological distress

Caregivers participated in a particular type of yoga called vinyasa yoga (VY) for 150 minutes per week, which was conducted in two 75-minute sessions for six weeks. Each VY session included breathing exercises, meditation, poses, and a particular subtype of VY called savasana that promotes relaxation and relieves stress.

• N = 12
• AGE = 18–65 years
• MALES: 8%, FEMALES: 92%
• KEY DISEASE CHARACTERISTICS: Participants were the informal, unpaid caregivers of patients with cancer. No information is provided about the type of cancer. 
• OTHER KEY SAMPLE CHARACTERISTICS: Caregivers who reported a level of distress that was disrupting their lives based on the National Comprehensive Cancer Center Distress Thermometer were included in the study. 

• SITE: Single site  
• SETTING TYPE: Other  
• LOCATION: Dalhousie University public recreational facility, Canada

• PHASE OF CARE: Multiple phases of care

• A single-group, pre- and post-test pilot study

• Profile of Mood States (POMS)
• TMD = total mood disturbance or overall psychological distress
• SF-36, version 2 to measure quality of life

The overall attendance rate was 65%. Participants had a mean baseline distress score of 6.5 out of 10. A significant difference was seen in TMD scores from baseline to post-intervention (p = 0.002). Although no significant difference was seen in the physical component score of SF-36 from baseline to post-intervention, a significant difference was seen in the mental component scores of SF-36 from baseline to post-intervention (p = 0.018). The effect in the intended outcome for TMD scores and MCS was large.

Cancer caregivers may benefit mentally with reduction in psychological distress from VY.

• Small sample (less than 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)
• Risk of bias(sample characteristics)
• Findings not generalizable
• Questionable protocol fidelity
• Other limitations/explanation: Although this study shows some positive findings, including reduction in psychological distress and improvement in the mental component of quality of life, small sample size and the absence of a control group reduce the strength of this study. Also, the majority of the participants were women, which reduces the generalization of the findings to both genders. Details regarding who conducted the yoga teaching and whether they are trained in yoga are not provided in the study.

VY seems to be a cost-effective approach to improve the quality of life and psychological distress in cancer caregivers. Nurses can encourage caregivers to participate in VY programs. RCTs with larger sample size are needed to find the true effect of yoga on cancer caregivers in terms of reducing psychological distress and improving quality of life.

To examine the feasibility and preliminary efficacy of Tibetan yoga practice as a supportive approach for patients and caregiver dyads during radiation therapy for lung cancer

Participants had two to three weekly sessions of yoga for 45–60 minutes over five to six weeks. The program included deep breathing awareness and visualization, guided meditation, compassion-based meditation, and gentle movements coordinated with specific breathing patterns. Patients and caregivers completed study measures at baseline and at the end of the program.

• N = 10 dyads  
• MEAN AGE = 71.22 years (patients, range = 61–82 years); 68.77 years (caregivers, range = 61–78 years)
• MALES: Patients 50%; caregivers 10%, FEMALES: Patients 50%; caregivers 90%
• KEY DISEASE CHARACTERISTICS: All patients had lung cancer and were receiving radiation therapy. 50% had stage IIIb disease. Average time since diagnosis was 2.88 months, range 1.13–5.97 months.
• OTHER KEY SAMPLE CHARACTERISTICS: Slightly greater than 50% of participants had some college level or higher education, 80% were white, and 75% had incomes greater than $50,000 per year.

• SITE: Single-site    
• SETTING TYPE: Outpatient  
• LOCATION: Texas

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care  

Single-group, prospective pilot study

• Center for Epidemiologic Studies Depression Scale (CES-D)
• Anxiety dimension of the Brief Symptom Inventory (BSI)
• Pittsburgh Sleep Quality Index (PSQI)
• Brief Fatigue Inventory (BFI)
• Medical Outcomes Study Short-Form Health Survey (SF 36)
• Functional Assessment of Cancer Therapy Spiritual Well Being Scale (FACT-Sp)
• Finding meaning in cancer scale

Ten of 19 consenting dyads completed the study and attended a mean of 12 sessions (range = 6–15). For patients, there was a significant increase in spiritual well-being (d = 1.12, p = .03), improvement in sleep (d = .60), and depressive symptoms (d = .52). There were small effects for anxiety. For caregivers, there were significant decreases in fatigue (d = .89, p = .03) and anxiety (d = .81, p =.04) and some reduction in sleep disturbance (d = .71, p =.08). Class attendance and home practice frequency was not associated with differences seen in symptoms for either patients or caregivers.

A couple-based yoga program was seen as feasible for patients, including those with advanced disease. Medium effect sizes were seen for depressive symptoms and sleep disturbance.

• Small sample (< 30)
• Risk of bias (no control group)
• Subject withdrawals ≥ 10%

Couple-based yoga sessions were shown to be feasible, and findings suggest that this type of supportive care during radiation therapy may be beneficial in some patients and caregivers for symptoms of fatigue, anxiety, depression, and sleep disturbances. The high drop-out rate suggests that many patients may not be interested or able to participate in such a program, but for those who are interested, it may be helpful. The fact, however, that the number of sessions attended and frequency of home practice were not related to the magnitude of results seen causes one to question whether it was the yoga practice or general support and attention provided that caused effects.