Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life

Spiritual Interventions to Improve Quality of Life and Spiritual Well-Being: A Systematic Review and Meta-analysis

This study aimed to systematically assess the evidence regarding the efficacy of spiritual interventions on quality of life and spiritual well-being among patients with cancer. PubMed, CINAHL, PsycINFO, Embase, MEDLINE (via EBSCOhost), and Web of Science databases were searched. Studies were included if these reported spiritual interventions for adult patients with cancer. Quality assessment of the included studies were conducted using the Critical Appraisal Tool for Randomized Controlled Trials from Joanna Briggs Institute. The review was registered in PROSPERO (CRD42021277873). A total of ten randomized controlled trials that enrolled 1332 patients with cancer were included. Spiritual interventions of the included studies involve: meaning-centered, mindfulness, dignity therapy, yoga, spiritual counseling, and body-mind-spirit group therapy. The length of the interventions ranged from 2 to 12 sessions. Further analysis shows spiritual interventions improve spiritual well-being (N = 479, 95% CI = 0.36 to 1.97, p < 0.0001), and Quality of Life (N = 706, 95% CI = 0.07 to 0.40, p = 0.004). Spiritual interventions are proved to be effective to improve spiritual well-being and quality of life. It is important for nurses and healthcare professionals to integrate spiritual interventions to improve the quality of care including patients' spiritual well-being and quality of life.

Yoga for fatigue in people with cancer

BACKGROUND

Cancer-related fatigue (CRF) is one of the most prevalent symptoms in individuals with cancer. Various types of exercise have shown beneficial effects. While previous systematic reviews suggest exercise may improve CRF and quality of life, evidence specifically about yoga's impact, as well as evidence on long-term effects, is limited. Previous syntheses offer promising but inconclusive findings on yoga's effectiveness. This review is one of a suite of five reviews exploring exercise for cancer-related fatigue.

OBJECTIVES

To assess the effects of yoga versus no yoga on cancer-related fatigue in people with cancer: • before, during, and after anticancer treatment; • in the short, medium, and long term; • and effects on quality of life (QoL), adverse events, depression, and anxiety.

SEARCH METHODS

We used CENTRAL, MEDLINE, Embase, five other databases and two trials registers, together with reference checking, citation searching and contact with study authors to identify studies that are included in the review. The latest search date was October 2023.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing yoga to no yoga. We included studies in adults (aged 18 and older) with any type of cancer and anticancer therapy who received yoga before, during, or after anticancer therapy. We included trials evaluating at least one of the main outcomes (CRF or QoL). Yoga had to last for at least five sessions, and involve face-to-face instruction. We excluded trials with fewer than 20 participants randomised per group.

DATA COLLECTION AND ANALYSIS

The outcomes of interest in this review are cancer-related fatigue (CRF), quality of life (QoL), adverse events, depression, and anxiety. We used standard methods expected by Cochrane. For analyses, we pooled results within the same period of outcome assessment (i.e. short, medium, and long term), and employed a random-effects model. We assessed risk of bias with the Cochrane risk of bias (RoB) 1 tool, and used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We included 21 RCTs with 2041 people with cancer who received yoga during (13 studies) or after (eight studies) anticancer therapy; none examined yoga initiated before therapy. Here we present results on CRF and QoL; findings on adverse events, depression, and anxiety are in the full review. Yoga during anticancer therapy The evidence is very uncertain about the effect of yoga compared to no yoga on: short-term CRF (standardised mean difference (SMD) 0.07, 95% confidence interval (CI) -0.18 to 0.32; mean difference (MD) on Brief Fatigue Inventory (BFI; lower values mean better outcome) of 0.16, 95% CI -0.41 to 0.71; 3 studies, 253 participants); medium-term CRF (MD on Multidimensional Fatigue Inventory (MFI; lower values mean better outcome) of -1.30, 95% CI -3.50 to 0.90; 1 study, 67 participants); and long-term CRF (MD 0.09 on BFI, 95% CI 1.16 to 0.98; 2 studies, 155 participants) (all very low-certainty evidence). Yoga may have a small beneficial effect or no effect compared to no yoga on short-term QoL (SMD 0.25, 95% CI 0.04 to 0.45; MD on Quality of Life Questionnaire-C30 (QLQ-C30; higher values mean better outcome) of 5.28, 95% CI 0.84 to 9.56; 4 studies, 374 participants) and medium-term QoL (MD on QLQ-C30 of 7.63, 95% CI 6.71 to 21.97; 2 studies, 151 participants), but the evidence is very uncertain (all very low-certainty evidence). None of the included studies reported long-term QoL. Yoga after anticancer therapy Yoga probably has a beneficial effect compared to no yoga on short-term CRF (SMD -0.26, 95% CI -0.42 to -0.09; MD 2.55, 95% CI 0.88 to 4.12; higher values mean better outcome; 5 studies, 602 participants; moderate-certainty evidence). Yoga might have a beneficial effect or no effect compared to no yoga on medium-term CRF, but the evidence is very uncertain (MD 3.02, 95% CI -1.48 to 7.52; 1 study, 54 participants (higher values mean better outcome; very low-certainty evidence). None of the included studies reported long-term CRF. Yoga may have a small beneficial effect or no effect compared to no yoga on short-term QoL (SMD 0.19, 95% CI -0.09 to 0.47; MD -3.27, 95% CI -8.08 to 1.55; higher values mean better outcome; 4 studies, 275 participants) and medium term QoL (MD 7.06, 95% CI -1.38 to 15.50; 1 study, 54 participants; higher values mean better outcome), but the evidence is very uncertain (all very low-certainty evidence). None of the included studies reported long-term QoL. A key limitation of the review was the included studies' methodological constraints: participants' awareness of treatment assignments (yoga or control) potentially introduced bias. Additionally, sample sizes were too small to determine medium- and long-term effects conclusively. Further research is needed to evaluate the sustainability of yoga's impact on cancer-related fatigue, quality of life, and adverse events.

AUTHORS' CONCLUSIONS

Our review provides uncertain evidence of the beneficial effects of yoga initiated during or after anticancer therapy compared to no yoga for people with cancer. Although there are indications supporting the use of yoga to address CRF, the uncertainty of the evidence underscores the need for caution in its implementation. Future RCTs should employ rigorous methodologies, enrol sufficient participants, and use appropriate controls.

The effect of art therapy on quality of life and fatigue in breast cancer patients: a meta-analysis

Breast cancer imposes a substantial global health burden, with survivors frequently experiencing post-treatment quality of life deficits and chronic fatigue. While art therapy has gained recognition as a potential adjuvant intervention, its therapeutic value remains debated. To evaluate art therapy's efficacy, we conducted an exhaustive search of major electronic databases through October 2023, identifying 22 eligible RCTs reported in 22 papers that met predefined inclusion criteria from major databases including Web of Science Core Collection, Cochare, Embase, and Pubmed. Study quality was assessed using Cochrane risk-of-bias tools, with data extraction and analysis performed in RevMan 5.3. In this meta-analysis, we aimed to investigate the effect of art therapy on quality of life and fatigue in breast cancer patients. As of October 2023, relevant randomized controlled studies were searched from relevant electronic databases and articles were screened, quality evaluated, and data related to quality of life and fatigue were extracted and analysed using RevMan 5. 3. A total of 22 randomized controlled studies from 22 papers were included in this analysis. The results obtained according to this analysis included the effect of art on quality of life in breast cancer: SMD=0.38 (95% CI, 0.25 to 0.51; P≤0.00001), the fatigue-related indices: SMD=-0.03 (95% CI, -0.21 to 0.15; P=0.73). The effect of intervention time less than two months: SMD=0.21 (95% CI, -0.01 to 0.43; P=0.07), more than or equal to two months: SMD=0.45 (95% CI, 0.28 to 0.62; P<0.00001). Different types of interventions: art therapy in painting and calligraphy: SMD=0.09 (95% CI, -0.17 to 0.35; P=0.49), music-included art therapy: SMD=0.51 (95% CI, 0.32 to 0.70, P<0.00001), music-out-of-treatment art therapy: SMD=0.44 (95% CI, 0.19 to 0.69; P=0.0005). Follow-up time greater than or equal to six months: SMD=0.14 (95% CI, -0.09 to 0.36; P=0.22), follow-up time less than six months: SMD=-0.34 (95% CI, -0.64 to -0.04; P=0.03). In summary, this analysis demonstrated that art therapy improved quality of life, but the effects of fatigue reduction only occur within six months, with the degree of the benefits being correlated with the type, length, and timing of the intervention.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier CRD42023476055.

Which specific modes of exercise training are most effective for breast related cancer fatigue? Network meta-analysis

Objective

The objective of this study was to examine the impact of various exercise modalities on Cancer-Related Fatigue (CRF) among breast cancer patients.

Methods

A computerized search was conducted on databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang Database up to October 2023. Selection criteria were applied to include or exclude studies, resulting in the inclusion of 65 articles for comparison of the effects of 12 distinct exercise interventions on individuals with breast cancer.

Results

The 65 studies used 12 different measures of exercise. Network meta results show that Compared with Other exercise (OE), Baduanjin exercise (BE), Qigong (QG), Control group (CG), Tai Chi (TC) improved significantly in CFR. The effect of Yoga (YG) on improving sleep quality is better than Control group (CG) and Baduanjin exercise (BE). Compared with Control group (CG), Tai Chi (TC) and Yoga (YG) are more beneficial to improve the quality of life of breast cancer patients. Tai Chi (TC) is better than Multimodal exercise (ME), Other exercise (OE), Baduanjin exercise (BE), Pilates exercise (PE), Yoga (YG), Qigong (QG), Dance exercise (DE), Qigong (QG) in improving depression in breast cancer patients.

Conclusion

The study revealed that Tai Chi demonstrates positive effects in ameliorating CRF, enhancing quality of life, and alleviating depressive symptoms among breast cancer patients. Moreover, yoga exhibits favorable effects in improving sleep quality in this patient group. Nevertheless, additional randomized controlled trials (RCTs) are warranted in the future to delve deeper into the effectiveness and underlying mechanisms of these exercise interventions.

Effect of different exercise types on quality of life in patients with breast cancer: A network meta-analysis of randomized controlled trials

BACKGROUND

Exercise is a rehabilitation strategy for patients with breast cancer; however, the optimal type of exercise remains uncertain. This study aimed to compare the effects of five exercise types on the quality of life of patients with breast cancer and provide a basis for their exercise rehabilitation.

METHODS

As of May 2024, we searched four databases: Embase, PubMed, Web of Science, and Cochrane Library, and included randomized controlled trials that analyzed the effect of exercise on the quality of life of patients with breast cancer. A network meta-analysis was performed using a frequency-based framework.

RESULTS

Forty-five papers involving 4092 participants were included. The five types of exercises included were all significant in the direct comparison with the control group, except yoga and mind-body exercises. Aerobic, resistance, and combination exercises were associated with quality of life. However, in indirect comparisons, only mind-body exercise versus resistance exercise had a significant effect. The effect of exercise on the quality of life(total health status) of patients with breast cancer was ranked based on surface under the cumulative ranking curve (SUCRA) values combined with effect sizes as follows: aerobic exercise (SUCRA = 84.1) > combined exercise (SUCRA = 78.8) > resistance exercise (SUCRA = 66.4) > yoga (SUCRA = 39.3) > mind-body exercise (SUCRA = 27.2) > usual care (SUCRA = 4.1).

CONCLUSIONS

Exercise can rehabilitate the quality of life of patients with breast cancer, and aerobic exercise may be the best type of exercise to improve their quality of life(total health status).

The effect of YOCAS©® yoga on cancer-related fatigue and quality of life in older (60+) vs. younger (≤ 59) cancer survivors: Secondary analysis of a nationwide, multicenter, phase 3 randomized controlled trial

INTRODUCTION

Older cancer survivors consistently express the need for interventions to reduce cancer-related fatigue (CRF) and maintain quality of life (QOL). Yoga is a promising treatment to address CRF and QOL. However, research comparing the efficacy of yoga for improving fatigue and QOL in older survivors (60+) vs. younger adult survivors (≤59)is limited. Our objective was to examine the effects of yoga on CRF and QOL in older survivors vs. younger survivors.

MATERIALS AND METHODS

We conducted a secondary analysis of a nationwide, multicenter, phase 3 randomized controlled trial. For this study, participants who provided evaluable pre- and post-intervention data on the Functional Assessment for Chronic Illness Therapy-Fatigue (FACIT-F) and the Functional Assessment for Cancer Therapy-General (FACT-G) were eligible. The yoga intervention comprises gentle Hatha and Restorative Yoga and includes breathing exercises, physical alignment postures, and mindfulness.

RESULTS

Of the 177 participants included in the study, 30.1 % were aged 60+ and 69.9 % were aged ≤59. More younger participants had breast cancer (82.0 % vs. 59.2 %. p = 0.009), surgery (98.9 % vs. 77.8 %, p < 0.001), and chemotherapy (80.5 % vs. 55.6 %, p = 0.001). There were no differences in the cancer stage (66.1 % stage I or II). There were statistically significant and clinically meaningful within-group improvements from baseline to post-intervention in CRF for participants aged ≤59 and participants aged 60+ (4.0 ± 0.7, p < 0.001 vs. 3.1 ± 1.0, p = 0.003). Both age groups also demonstrated improvements in QOL (3.2 ± 0.8, p < 0.001 vs. 2.1 ± 1.2, p = 0.078), physical (1.6 ± 0.3, p < 0.001 vs. 0.8 ± 0.5, p = 0.084), functional (0.7 ± 0.3, p = 0.048 vs. 1.0 ± 0.5, p = 0.037), and emotional well-being. There were no significant between-group differences between the age groups. Most younger and older participants reported that yoga helped improve their sleep quality (92.8 % vs 88.5 %) and they would recommend it to other survivors (98.2 % vs 90.4 %).

DISCUSSION

Older cancer survivors who undergo gentle Hatha and restorative yoga performed two to three times per week for four weeks at a low to moderate level of intensity have similar improvements in CRF and QOL compared to participants aged ≤59. For older survivors experiencing these toxicities, it is reasonable for clinicians to prescribe yoga.

CLINICALTRIALS

govidentifier: NCT00397930.

Association of Perception, Interest, and Barriers of Learning and Practicing Yoga with Levels of Stress in Life among Residents Living in Saudi Arabia

BACKGROUND

Yoga as a mind-body activity and clinical studies on yoga's effects on physical and mental health have produced encouraging results. However, there is little research done on the population's perception and interest toward practicing yoga in KSA. Thus, the current study was undertaken to evaluate the perception, interest, and barriers of learning and practicing yoga with levels of stress in life among residents of Saudi Arabia.

METHODOLOGY

This is an observational, cross-sectional study in which people were polled using questionnaires. The study included people of both genders aged 18-70, and Google Forms were distributed through various online platforms. The collected data were statistically analyzed.

RESULTS

The study included 906 subjects in total. Participants were mostly female (64%) and non-Saudi residents (70.9%) between the ages of 31 and 51 years, with moderate levels of stress in life. About 58.6% of the study participants were aware of the benefits of yoga. The Chi-square analysis shows low-stress subjects (67.5%) knew more about yoga and meditation, whereas no-stress subjects (35.7%) practiced yoga. About 14.9% of high-stressed people consulted a yoga therapist. The majority of high (15.3%), medium (12%), and no-stressed (19.6%) did yoga for mental health and focus, whereas the low-stressed (19.3%) did it for physical health. C.

ONCLUSION

Most of the study population knew yoga's physical, psychological, and spiritual benefits. The study found a relationship between the everyday stress levels of Saudi Arabian citizens and their opinions about, interest in, and obstacles to taking up yoga. More experimental and longitudinal studies are needed to confirm this hypothesis.

Testing home-based exercise strategies in underserved minority cancer patients undergoing chemotherapy (THRIVE) trial: a study protocol

Background

Higher rates of physical inactivity and comorbid conditions are reported in Hispanic/Latinx and Black cancer patients receiving chemotherapy compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in exercise oncology clinical trials are low among disadvantaged and racial and ethnic minority groups. Here, we will examine the effect of an exercise intervention using a novel, accessible, and cost-effective home-based exercise approach among Hispanic/Latinx and Black cancer patients receiving chemotherapy on exercise participation and cardiovascular disease risk.

Methods

The THRIVE trial is an 8-month prospective, three-arm study of 45 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control (AC) group. Eligible patients include those with breast, colorectal, or prostate cancer, who are sedentary, overweight or obese, self-identify as Hispanic/Latinx or Black, and plan to receive chemotherapy. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. Patients randomized to the AC group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at post-intervention. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8.

Discussion

The THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy.

Clinical trial registration

https://classic.clinicaltrials.gov/ct2/show/NCT05327452, identifier (NCT#05327452).

The Impact of Chronic Diseases on Mental Health: An Overview and Recommendations for Care Programs

PURPOSE OF REVIEW

The current achievement of medical advancement is noteworthy; however, the occurrence of chronic diseases is increasing day by day, with a significant percentage of affected people are suffering from a mental health crisis. This article aims to present a thorough yet brief review of methods that can be employed to build the emotional wellness of chronic patients.

RECENT FINDINGS

The mental health care strategies include resilience-building, coping skills training, professional counseling, and lifestyle adaptations. Additionally, the article highlights the efficacy of several modern interventions, such as mindfulness-based therapies, cognitive behavioral therapy, eye movement desensitization, and recovery from stress therapy. The global burden of chronic illness emphasizes the pressing need to mitigate mental health problems among chronic patients. By providing actionable insights, our study clears the path for targeted interventions and holistic approaches for chronic disease patients. Moreover, the article suggests to policymakers and clinicians the need for collaboration and multifaceted interventions.

Experiences and perceived benefits of remotely delivered dance/movement therapy for adult cancer patients: a multi-method program evaluation

BACKGROUND

Dance/movement therapy (DMT) is increasingly used as a complementary treatment to address psychological and physical wellbeing. However, it is unknown how it can be leveraged in adult cancer care. This mixed methods program evaluation aimed to assess patient-reported benefits and satisfaction with the virtual DMT in an academic oncology setting.

METHODS

We developed, implemented, and evaluated a 6-week virtual, synchronous DMT program aiming to improve physical health, address mental distress, and foster social connection for cancer patients. We used deidentified program evaluation data to assess impact of DMT on patient-reported outcomes and patients' satisfaction with the DMT program. Pre- and post-session data were analyzed using descriptive statistics and a paired t-test. Qualitative data were captured through semi-structured interviews and analyzed using thematic analysis.

RESULTS

Results from 39 participants (mean age 64.7 ± 9.8), majority female (89.7%) with a history of breast cancer (43.6%), showed high satisfaction (100%) and unanimous program recommendation (100%). Significant improvements were noted in anxiety (- 0.42 ± 0.76, p = .009), distress (- 0.35 ± 0.80, p = .036), and sense of joy (0.73 ± 1.18, p = .004), with a non-significant trend in increased physical activity (0.38 ± 0.98, p = .057). Thematic findings indicated that DMT participation (1) facilitated engagement in physical activity for improved physical health, (2) fostered creative expression, (3) improved mental state, and (4) helped build social connections and support.

CONCLUSION

Our DMT program shows promise as a component of integrative cancer care. The mixed-method evaluation provides insightful information to generate hypotheses for future RCT studies aiming to evaluate the specific effects of DMT on patient experience and outcomes.

Effects of yoga on impulsivity in patients with and without mental disorders: a systematic review

BACKGROUND

Yoga can be used as a complementary intervention to conventional treatments, whether pharmacological or non-pharmacological. Sustained practice of yoga can generate a series of benefits for individuals' quality of life and improve their physical fitness.

OBJECTIVE

To investigate the potential effects of yoga as an adjunct intervention in conditions involving impulse control issues, such as attention deficit hyperactivity disorder (ADHD), borderline personality disorder, bipolar affective disorder, and substance use disorders.

METHODS

We performed a systematic review of placebo-controlled, randomized trials of yoga in patients with impulsivity. PubMed, Web of Science, and Science Direct databases were searched for trials published up to January, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations.

RESULTS

Out of 277 database results, 6 RCT were included in this systematic review. To assess the level of attention and impulsiveness, the following scales were analyzed: Barratt Impulsiveness, UPPS-P Impulsive Behavior scale, Conners' Continuous Performance Test IIª and Conners' Parent Rating Scale-Revised: Long.

CONCLUSIONS

Yoga didn't have a significant improvement in impulsivity when compared to placebo. There are many tools to assess impulsivity, but they mean different concepts and domains consisting in a weakness on comparison of yoga effects.

PROSPERO REGISTRATION

CRD42023389088.

Chairside Yoga Therapy Alleviates Symptoms in Patients Concurrently Receiving Outpatient Cancer Infusions: A Promising Feasibility Study

Purpose: To evaluate effectiveness of chairside yoga therapy on perceptions of fatigue, pain, nausea, anxiety, and distress among oncology patients concurrently receiving outpatient cancer infusion therapy. Design: This prospective pilot study used pre-/post-survey design in convenience sample of cancer patients in outpatient setting. Methods: Researchers developed and administered the Outpatient Cancer Symptom Assessment Scale (OCSAS) comprised of cancer- or treatment-related symptoms commonly reported in the oncology population (nausea, pain, fatigue, anxiety, and distress). Following IRB approval, symptoms were rated using Likert scale of 0 (not present) to 10 (severe) before and after chairside yoga therapy delivered concurrently with outpatient infusions. Qualitative data was collected related to patients' overall infusion experience. Findings: Participants (n = 82) reported positive patient experiences and statistically less pain (p < 0.001), fatigue (p < 0.001), anxiety (p < 0.001), and distress (p < 0.001) following the yoga intervention compared to baseline. Nausea was not significantly impacted by the yoga intervention. Conclusions: Yoga therapy received concurrently during outpatient cancer infusion is consistent with a holistic and integrative approach to care for the oncology population. Yoga therapy offers promise for reducing symptoms which negatively impact quality of life, including pain, fatigue, anxiety, and distress. Qualitative data suggests patients' overall infusion experience was enhanced with yoga therapy.

Various interventions for cancer-related fatigue in patients with breast cancer: a systematic review and network meta-analysis

Purpose

To investigate the effects of various intervention approaches on cancer-related fatigue (CRF) in patients with breast cancer.

Method

Computer searches were conducted on PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases from their establishment to June 2023. Selection was made using inclusion and exclusion criteria, and 77 articles were included to compare the effects of 12 interventions on patients with breast cancer.

Results

Seventy-seven studies with 12 various interventions were examined. The network findings indicated that cognitive behavioral therapy (CBT) (SMD, -1.56; 95%CI, -3.08~-0.04), Chinese traditional exercises (CTE) (SMD, -0.85; 95%CI, -1.34~-0.36), aerobic exercise (AE) (SMD, -0.77; 95%CI, -1.09~-0.45), multimodal exercise (ME) (SMD, -0.75; 95%CI, -1.26~-0.25), music interventions (MI) (SMD, -0.74; 95%CI, -1.45~-0.03), and yoga (YG) (SMD, -0.44; 95%CI, -0.83 to -0.06) can reduce CRF more than the control group (CG). For relaxation exercises (RE) (MD, -6.69; 95%CI, -9.81~-3.57), MI (MD, -5.45; 95%CI, -7.98~-2.92), AE (MD, -4.34; 95%CI, -5.90~-2.78), ME (MD, -3.47; 95%CI, -4.95~-1.99), YG (MD, -2.07; 95%CI, -3.56~-0.57), and mindfulness training (MD, -1.68; 95%CI, -2.91~-0.46), PSQI improvement was superior to CG. In addition, for CTE (MD, 11.39; 95%CI, 4.11-18.66), YG (MD, 11.28; 95%CI, 1.63-20.93), and AE (MD, 9.34; 95%CI, 0.26~18.42), Functional Assessment of Cancer Therapy-Breast improvement was superior to CG.

Conclusion

Cognitive behavioral therapy (CBT) is the most effective measure for alleviating CRF in patients with breast cancer and Relaxation exercises (RE) is the most effective measure for improving sleep quality. In addition, Chinese traditional exercises (CTE) is the best measure for enhancing quality of life. Additional randomized controlled trials (RCTs) are expected to further investigate the efficacy and mechanisms of these interventions.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023471574.

No effects were found in favor of Hatha or Iyengar yoga exercises for improving cancer-related fatigue, depression symptoms, or quality of life: a systematic review with meta-analysis and metaregression

OBJECTIVE

To summarize the evidence on the effectiveness of Hatha or Iyengar yoga exercises on cancer-related fatigue, depression symptoms, and the overall quality of life in adults with cancer.

METHODS

A systematic review with meta-analysis was conducted. The CINAHL (via EBSCOhost), Embase, PubMed, and SPORTDiscus (via EBSCOhost) databases were searched from inception to 7th November 2022. Clinical trials evaluating cancer-related fatigue, depression symptoms, and the overall quality of life were included. The risk of bias was assessed using the Cochrane Risk of Bias tool 2. The Template for Intervention Description and Replication (TIDieR) checklist was used to check if the interventions reviewed were described in detail to be implemented in the clinical setting. The Grading of Recommendations, Assessment, Development, and Evaluations approach was used to rate the certainty of evidence. Meta-regressions, sensitivity analyses, and subgroup meta-analyses were conducted to explore sources of heterogeneity.

RESULTS

Eleven studies were included (N = 777 participants). Overall, Hatha, Iyengar, and the combination of both yoga styles did not improve any of the outcomes of interest. In addition, five studies had a high risk of bias, and six studies had some concerns about biases. Weaknesses in reporting modifications during the development of the study were observed (TIDieR item 10). The certainty of evidence ranged from low to very low across the outcomes.

CONCLUSIONS

We could not make sound clinical recommendations with the current quality of the findings.

Effect of Exercise Therapy on Cancer-Related Fatigue in Patients With Breast Cancer: A Systematic Review and Network Meta-analysis

OBJECTIVE

This study aimed to explore the efficacy of different exercise therapies in reducing fatigue in patients with breast cancer.

DESIGN

PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China Biology Medicine, China National Knowledge Infrastructure, Database of Chinese Sci-tech Periodicals, and Wanfang databases were searched from their inception to March 2022. The authors independently screened all randomized controlled trials of exercise therapy in patients with breast cancer. A network meta-analysis was performed using Stata 16.0 software.

RESULTS

Seventy-eight studies were analyzed, with 167 comparisons and 6235 patients. The network results showed that stretching (standardized mean difference = -0.74, confidence interval = -1.43 to -0.06), yoga (standardized mean difference = -0.49, confidence interval = -0.75 to -0.22), combined exercise (standardized mean difference = -0.47, confidence interval = -0.70 to -0.24), aerobic exercise (standardized mean difference = -0.46, confidence interval = -0.66 to -0.26), and resistance exercise (standardized mean difference = -0.42, confidence interval = -0.77 to -0.08) significantly reduced fatigue. Pairwise comparisons confirmed that yoga, combined exercise, aerobic exercise, and resistance exercise were positively associated with fatigue relief. However, no significant association was identified between reduced fatigue and traditional Chinese exercises or stretching.

CONCLUSIONS

The most effective exercise therapy to relieve cancer-related fatigue in patients with breast cancer was yoga, followed by combined aerobic and resistance exercises. It is expected that more randomized controlled trials will be conducted to further explore the efficacy and mechanisms of exercise.

The Effect of Yoga Practice on Cervical Tactile Acuity and Body Awareness

Body-mind-based holistic methods of relaxation and improved well-being, such as yoga and meditation, improve body awareness and have often been used to enhance quality of life and the ability to cope with pain. We aimed to compare tactile sensory acuity and body awareness in healthy sedentary individuals who practiced yoga regularly and in control participants who had not practiced yoga. Participants were 60 individuals, aged between 18 and 35 years who were divided into two groups according to whether they had previously practiced yoga. We used the two-point discrimination (TPD) test to determine participants' tactile acuity, as measured with a digital calliper at the C7, C5, C3, C1 and T1 spinal segments and with the Body Awareness Questionnaire (BAQ). The TPD measurements of individuals who practiced yoga and meditation had a lower discriminatory threshold compared to those who had not practiced yoga (p < .001), and the self-reported BAQ score of yoga practitioners was higher than that of the controls (p < .001). We found a positive correlation between the length of the prior duration of yoga experience and self-reported body awareness (r = .567, p < .001). There was a significant negative correlation (r = -.379, p = .015) between the C5 segment and the TPD measurements, but not for the other cervical spinal segments (p > .05). There was a negative correlation between the length of prior yoga practice and the TPD measurements in all cervical segments (p < .001). The most negative correlation was found at the C7 segment (r = -.844, p < .001) and the least negative correlation was found at the C3 segment (r = -.669, p < .001). These data suggest that yoga and meditation practices may improve well-being and diminish pain by increasing body awareness and tactile sensory acuity in the cervical region.

Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis

OBJECTIVE: To determine the most effective exercise modalities for managing cancer-related fatigue during and after cancer treatment. DESIGN: Network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: Seven electronic databases were systematically searched from inception to January 2022. STUDY SELECTION CRITERIA: Randomized controlled trials testing the effects of exercise on relieving cancer-related fatigue in adult patients with cancer. DATA SYNTHESIS: An NMA of 56 studies was conducted, and the PRISMA-NMA guidelines were followed when reporting results. To determine the most effective interventions, the surface under the cumulative ranking curve (SUCRA) value was calculated for each exercise modality. RESULTS: Combined aerobic and resistance exercise (standardized mean difference [SMD], 1.57; credible interval [CrI], 1.03-2.10), yoga (SMD, 1.02; CrI: 0.44, 1.60), and regular physical activity (SMD, 1.07; CrI: 0.21, 1.92) could significantly alleviate cancer-related fatigue compared to control groups (usual care, wait-list, and regular physical activity). Combined aerobic and resistance exercise (SUCRA, 97.2%) had the highest probability of efficacy, followed by yoga (SUCRA, 75.5%) and regular physical activity (SUCRA, 74.1%). During cancer treatment, combined aerobic and resistance exercise (SUCRA, 94.5%) ranked first in efficacy, followed by regular physical activity (SUCRA, 82.1%) and yoga (SUCRA, 73.8%). After cancer treatment, only combined aerobic and resistance exercise (SMD, 0.99; CrI: 0.13, 1.84) had a significant effect on cancer-related fatigue. CONCLUSION: Combined aerobic and resistance exercise, yoga, and regular physical activity were the most effective exercise modalities for alleviating cancer-related fatigue. Combined aerobic and resistance exercise is recommended during and after cancer treatment. J Orthop Sports Phys Ther 2023;53(6):1-10. Epub: 23 March 2023. doi:10.2519/jospt.2023.11251.

A systematic review and meta-analysis of psychosocial interventions for immigrant and limited English proficient cancer patients

OBJECTIVE

Immigrants, particularly those who are less acculturated and limited English proficient (LEP), often lack access to culturally and linguistically appropriate psychosocial care in cancer survivorship. We sought to determine what psychosocial interventions are available for immigrant and/or LEP cancer patients and to assess treatment and patient factors that may correlate with better psychosocial outcomes for this population.

METHODS

We conducted a systematic review and meta-analysis of studies published through August 2022 of interventions conducted with immigrant and/or LEP cancer patients aimed at improving psychosocial outcomes (i.e., quality of life, depression, cancer-related distress, and anxiety). Using Covidence, a software program for systematic review management, four independent raters screened 16,123 records with a systematic process for reconciling disagreement, yielding 48 articles (45 studies) for systematic review and 21 studies for meta-analysis.

RESULTS

Most studies were conducted with Spanish-speaking patients with breast cancer. Study participants (N = 5400) were primarily middle-aged (mean = 53 years old), female (90.0%), and Hispanic (67.0%). The weighted average effect size (g) across studies was 0.14 (95% CI 0.03-0.26) for quality of life (18 studies), 0.04 (95% CI -0.08 to 0.17) for depression (8 studies), 0.14 (95% CI -0.03 to 0.31) for cancer-related distress (6 studies), and 0.03 (95% CI -0.11 to 0.16) for anxiety (5 studies).

CONCLUSION

The interventions under review had small but beneficial effects on psychosocial outcomes for immigrant and LEP cancer patients. Notably, effect sizes were smaller than those found in previous meta-analyses of psychosocial interventions conducted in majority U.S.-born, non-Hispanic White, English-speaking cancer patient samples. More research is needed to identify key components and adaptations of interventions that benefit immigrant and LEP cancer patients to strengthen their effects for this growing yet underserved population.

The effects of a complex yoga-based intervention on healthy psychological functioning

Background

Yoga based interventions were found to have a positive impact on various indicators of psychological functioning, such as perceived stress, satisfaction with life, positive and negative affectivity. Additionally, such interventions improved bodily or interoceptive awareness and spirituality.

Methods

The present study assessed the effects of a 3-month long complex yoga-based intervention compared to a passive control group in a Hungarian community sample. The final sample consisted of 44 intervention (Mage = 47.5, SD = = 8.76) and 29 control participants (Mage = 47.4, SD = 9.47). The aforementioned constructs were measured 1 week before and after the intervention.

Results

The intervention reduced participants’ perceived stress (p = &lt;0.001, ηp2 = 0.153) and negative affectivity (p = 0.019, ηp2 = 0.113), improved spirituality (p = 0.048, ηp2 = 0.054) and various aspects of interoceptive awareness such as noticing (p = &lt;0.001, ηp2 = 0.169) attention regulation (p = &lt;0.001, ηp2 = 0.211), self-regulation (p = 0.002, ηp2 = 0.190) body listening (p = 0.010, ηp2 = 0.097), trusting (p = 0.026, ηp2 = 0.070), but did not impact positive affectivity and satisfaction with life.

Conclusion

A 3-months long complex yoga-based intervention has a positive impact on many aspects of healthy psychological functioning.

Non-pharmacologic interventions for improving cancer-related fatigue (CRF): A systematic review of systematic reviews and pooled meta-analysis

INTRODUCTION

Literature encloses numerous systematic reviews (SRs) on nonpharmacologic interventions for improving cancer-related fatigue (CRF). The effect of these interventions remains controversial, and the available SRs have not been synthesized yet. We conducted a systematic synthesis of SRs and meta-analysis to determine the effect of nonpharmacologic interventions on CRF in adults.

MATERIAL AND METHODS

We systematically searched 4 databases. The effect sizes (standard mean difference) were quantitatively pooled using a random-effects model. Chi-squared (Q) and I-square statistics (I²) tested the heterogeneity.

RESULTS

We selected 28 SRs, including 35 eligible meta-analyses. The pooled effect size (standard mean difference, 95% CI) was -0.67 (-1.16, -0.18). The subgroup analysis by types of interventions showed a significant effect in all the investigated approaches (complementary integrative medicine, physical exercise, self-management/e-health interventions).

CONCLUSIONS

There is evidence that nonpharmacologic interventions are associated with CRF reduction. Future research should focus on testing these interventions on specific population clusters and trajectories.

PROSPERO REGISTRATION

CRD42020194258.

Diet and physical activity interventions in Black and Latina women with breast cancer: A scoping review

Background

A growing number of lifestyle interventions are being developed to promote weight loss and adoption of a healthful lifestyles among breast cancer survivors; yet Black and Latina women remain underrepresented.

Purpose

We performed a scoping review of the available peer-reviewed literature to describe and compare the content, design, methods, and primary outcomes of current diet and/or physical activity (PA) interventions after a breast cancer diagnosis among Black and Latina women.

Methods

We queried PubMed, EMBASE, CINAHL, MEDLINE, and Clinicaltrials.gov up to October 1, 2022, to identify all randomized controlled trials of diet and/or PA after diagnosis of breast cancer with a majority (>50%) of Black or Latina participants.

Results

Twenty-two randomized controlled trials were included in this review (five efficacy, twelve pilot, five on-going). Nine trials were among Latinas (two diet, four PA, and three diet/PA), six among Blacks (one PA and five diet/PA) and seven included both populations (five PA and two diet/PA), all of which examined different endpoints. Two of the five efficacy studies achieved their a priori outcome (one diet trial improved short term dietary intake; one PA trial achieved clinically significant improvements in metabolic syndrome score), both in Latinas. Eight pilot trials intervened on both diet and PA and three of them found favorable behavioral changes. Three (two for Latinas and one for Blacks) out of the nine diet and PA trials and three (all for Latinas) efficacy trials incorporated a culturally focused approach (i.e., traditional foods, music, Spanish content, bicultural health coaches, spirituality). Overall, four trials, including one efficacy trial, had one-year follow-up data, with three finding sustained behavior change. Electronic/mobile components were incorporated in five trials and one involved informal care givers. Most of the trials were geographically limited to the Northeast USA (n=8, NY, NC, DC, NJ) and Texas (n=4).

Conclusions

Most of the trials we identified were pilot or feasibility studies and of short duration, demonstrating the need for large randomized controlled efficacy lifestyle interventions among Black and Latina breast cancer survivors. Culturally tailored programing was limited but is an important component to incorporate in future trials in these populations.

Exploring feasibility, perceptions of acceptability, and potential benefits of an 8-week yoga intervention delivered by videoconference for young adults affected by cancer: a single-arm hybrid effectiveness-implementation pilot study

BACKGROUND

Young adults affected by cancer face physical and psychological challenges and desire online supportive care. Yoga can be delivered online and may improve physical and psychological outcomes. Yet, yoga has rarely been studied with young adults affected by cancer. To address this, an 8-week yoga intervention was developed, and a pilot study was deemed necessary to explore feasibility, acceptability, implementation, and potential benefits.

METHODS

A mixed-methods, single-arm hybrid effectiveness-implementation pilot study evaluating the yoga intervention was conducted. Feasibility was assessed by tracking enrollment, retention, attendance, completeness of data, and adverse events. Acceptability was explored through interviews. Implementation metrics included training time, delivery resources, and fidelity. Potential effectiveness was evaluated by exploring changes in physical (i.e., balance, flexibility, range of motion, functional mobility) and psychological (i.e., quality of life, fatigue, resilience, posttraumatic growth, body image, mindfulness, perceived stress) outcomes at pre- (week 0), post- (week 8), and follow-up (week 16) time points. Data were analyzed with descriptive statistics, repeated measures analysis of variance, and content analysis.

RESULTS

Thirty young adults participated in this study (recruitment rate = 33%). Retention to study procedures was 70%, and attendance ranged from 38 to 100%. There were little missing data (< 5%) and no adverse events. Though most participants were satisfied with the yoga intervention, recommendations for improvement were shared. Sixty study-specific training hours and > 240 delivery and assessment hours were accrued and fidelity was high. Functional mobility, flexibility, quality of life (energy/fatigue, social well-being), body image (appearance evaluation), mindfulness (non-reactivity), and perceived stress improved significantly over time (all p< 0.050; [Formula: see text]). No other significant changes were observed (all p> 0.050; [Formula: see text]).

CONCLUSIONS

The yoga intervention may confer physical and psychological benefits, though intervention and study-specific modifications are required to improve feasibility and acceptability. Requiring study participation and providing greater scheduling flexibility could enhance recruitment and retention. Increasing the frequency of classes offered each week and offering more opportunities for participant interaction could improve satisfaction. This study highlights the value of doing pilot work and provides data that has directly informed intervention and study modifications. Findings could also be used by others offering yoga or supportive care by videoconference to young adults affected by cancer.

TRIAL REGISTRATION

Not available-not registered.

Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis

BACKGROUND

Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project.

METHODS

PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence.

RESULTS

A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions.

CONCLUSION

PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.

Beyond Correct Postures and Flexible Bodies: Exploring the Relevance of Yoga in End-of-Life care

Since the mid-twentieth century, Yoga has emerged as a multi-million US dollar global fitness industry. It has drawn worldwide followers to practice postural and breathing techniques. However, the fitness model only elucidates how to live well and not how to die well. This article contends that the body-centric approach has little relevance to those who are dying. It espouses that yogic values like transcendence, holistic healing, harmony, and death-acceptance that qualify a 'good' death are regrettably lost in modern times. In conclusion, the soteriological aim needs to be retained in the modern yogic discourse to live well and die gracefully.

Meta-Analysis of Randomized Controlled Trials on Yoga, Psychosocial, and Mindfulness-Based Interventions for Cancer-Related Fatigue: What Intervention Characteristics Are Related to Higher Efficacy?

Simple Summary

Many individuals with cancer suffer from persistent exhaustion due to cancer therapy, known as cancer-related fatigue (CRF). Yoga, psychosocial, and mindfulness-based interventions are recommended to reduce CRF. However, it is not clear yet how interventions need to be designed to maximize their efficacy. This meta-analysis aimed to identify intervention characteristics associated with greater reductions in CRF. A total of 70 interventions with 6387 participants were included in the analysis. Our results found a positive effect of yoga, psychosocial, and mindfulness-based interventions, while all invention types revealed large differences in intervention effects. In psychosocial interventions, using a group setting and working on cognition was related to higher efficacy. Regarding yoga and mindfulness-based interventions, no specific intervention characteristics emerged as more favorable than others. Overall, this meta-analysis suggests opportunities to optimize psychosocial interventions for CRF, whereas the design of yoga and mindfulness-based interventions seems to allow for variation.

Abstract

Cancer-related fatigue (CRF) is a burdensome sequela of cancer treatments. Besides exercise, recommended therapies for CRF include yoga, psychosocial, and mindfulness-based interventions. However, interventions conducted vary widely, and not all show a significant effect. This meta-analysis aimed to explore intervention characteristics related to greater reductions in CRF. We included randomized controlled trials published before October 2021. Standardized mean differences were used to assess intervention efficacy for CRF and multimodel inference to explore intervention characteristics associated with higher efficacy. For the meta-analysis, we included 70 interventions (24 yoga interventions, 31 psychosocial interventions, and 15 mindfulness-based interventions) with 6387 participants. The results showed a significant effect of yoga, psychosocial, and mindfulness-based interventions on CRF but with high heterogeneity between studies. For yoga and mindfulness-based interventions, no particular intervention characteristic was identified to be advantageous for reducing CRF. Regarding psychosocial interventions, a group setting and work on cognition were related to higher intervention effects on CRF. The results of this meta-analysis suggest options to maximize the intervention effects of psychosocial interventions for CRF. The effects of yoga and mindfulness-based interventions for CRF appear to be independent of their design, although the limited number of studies points to the need for further research.

Integrative oncology: Addressing the global challenges of cancer prevention and treatment

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care.

A systematic review and meta-analysis of effects of psychosocial interventions on spiritual well-being in adults with cancer

Objective

Spiritual well-being (SpWb) is an important dimension of health-related quality of life for many cancer patients. Accordingly, an increasing number of psychosocial intervention studies have included SpWb as a study endpoint, and may improve SpWb even if not designed explicitly to do so. This meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on SpWb in adults with cancer and tested potential moderators of intervention effects.

Methods

Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which SpWb was an outcome. Doctoral-level rater pairs extracted data using Covidence following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Standard meta-analytic techniques were applied, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis.

Results

Forty-one RCTs were identified, encompassing 88 treatment effects among 3883 survivors. Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < 0.0001). Studies assessing the FACIT-Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [-0.02, 0.23], p = 0.03]. No other intervention, clinical, or demographic characteristics significantly moderated effect size.

Conclusions

Psychosocial interventions are associated with small-to-medium-sized effects on SpWb among cancer survivors. Future research should focus on conceptually coherent interventions explicitly targeting SpWb and evaluate interventions in samples that are diverse with respect to race and ethnicity, sex and cancer type.

Enhancing Access to Yoga for Older Male Veterans After Cancer: Examining Beliefs About Yoga

BACKGROUND

Yoga is an effective clinical intervention for cancer survivors. Most studies of the positive effects of yoga on cancer patients report on predominantly middle-aged women with breast cancer. Less is known about the use of yoga in older adults, veterans, and those from diverse racial or ethnic backgrounds.

METHODS

We examined strategies to enhance access to yoga in older veterans after cancer, focusing on education (study 1) and intervention (study 2). Study 1 included 110 participants with a median (SD) age of 64.9 (9.4) years who were mostly male (99%) cancer survivors who were interviewed 12 months after their cancer diagnosis. Study 2 included 28 participants with a median (SD) age of 69.2 (10.9) years who were mostly male (96%) cancer survivors who participated in a yoga program within 3 years of their cancer diagnosis. Standardized interviews assessed interest in and barriers to yoga while self-reporting assessed health-related quality of life and beliefs about yoga.

RESULTS

In study 1, interest in yoga increased from 5.5 to 31.8% (χ 2 = 22.25, P < .001) following education. In open-ended questions 4 themes related to negative beliefs or barriers emerged: lack of knowledge or skepticism, disinterest or dislike, physical health barriers, and logistical barriers. In study 2, beliefs were more positive following intervention for expected benefits (t = 4.44, P < .001), discomfort (t = 4.92, P < .001), and social norms (t = 4.38, P < .001) related to yoga. Physical function improved after participation in a yoga class, especially for those with higher beliefs in yoga prior to class. Age was not associated with beliefs about yoga in either sample.

CONCLUSIONS

A portion of older veterans who are cancer survivors were interested in yoga but faced access barriers. Implications for practice and research include increasing knowledge about yoga benefits and addressing physical health and logistical barriers to enhance access to yoga for older veterans.

Feasibility and acceptability of a faith-based mind-body intervention among African American adults

Physical activity reduces cancer risk, yet African American adults remain insufficiently active, contributing to cancer health disparities. Harmony & Health (HH) was developed as a culturally adapted mind-body intervention to promote physical activity, psychosocial well-being, and quality of life among a church-based sample of overweight/obese, insufficiently active African American adults. Men and women were recruited to the study through an existing church partnership. Eligible participants (N = 50) were randomized to a movement-based mind-body intervention (n = 26) or waitlist control (n = 24). Participants in the intervention attended 16 mind-body sessions over 8 weeks and completed a physical assessment, questionnaires on moderate-to-vigorous physical activity (MVPA) and psychosocial factors, and accelerometry at baseline (T1), post-intervention (T2), and 6 week follow-up (T3). Eighty percent of participants (94% women, M age = 49.7 ± 9.4 years, M body mass index = 32.8 ± 5.2 kg/m2) completed the study, and 61.5% of intervention participants attended ≥10 mind-body sessions. Participants self-reported doing 78.8 ± 102.9 (median = 40.7, range: 0-470.7) min/day of MVPA and did 27.1 ± 20.7 (median = 22.0, range: 0-100.5) min/day of accelerometer-measured MVPA at baseline. Trends suggest that mind-body participants self-reported greater improvements in physical activity and psychosocial well-being from baseline to post-intervention than waitlist control participants. HH is feasible and acceptable among African American adults. Trends suggest that the mind-body intervention led to improvements in physical activity and psychosocial outcomes. This study extends the literature on the use of mind-body practices to promote physical and psychological health and reduce cancer disparities in African American adults.

The Relationship Between Yoga and Spirituality: A Systematic Review of Empirical Research

OBJECTIVE

Both yoga practice and spirituality are associated with beneficial mental health outcomes. Within yoga research, however, spirituality is still a widely neglected area. The present systematic review aims to explore empirical studies, which do, in fact, investigate the relationship between yoga and spirituality in order to provide an overview and future directions for research on this topic. The review examines whether available empirical research supports an association between yoga practice and spirituality and, if so, which specific aspects of spirituality are associated with yoga practice.

METHODS

The systematic review followed the PRISMA guideline (Prospero registration number: CRD42020155043). Empirical studies written in English, German, or Hungarian language were selected from a database search in Google Scholar, PsycINFO, and Science Direct. A total of 30 studies met the final inclusion criteria.

RESULTS

According to the quantitative and qualitative studies reviewed, yoga practice seems to be positively associated with spirituality. This association concerns various aspects of spirituality, such as spiritual aspirations, a search for insight/wisdom, an integrative worldview, a sense of meaning and peace, faith, hope, compassion, and happiness within. To harness the potential spiritual benefits of yoga, regular practice appears to be essential. Yoga practitioners seem to have both physical and spiritual motives for practicing. At least in Western societies, however, physical intentions are more prevalent than spiritual ones. The meaning of spirituality for yoga practitioners is also discussed. Due to risk of bias of the majority of the reviewed studies, however, outcomes must be taken with caution.

CONCLUSION

Yoga practice may be positively associated with several aspects of spirituality. For more evidence, further investigation of the topic is suggested. Particularly, we propose the inclusion of holistic forms of yoga practice and a comparison of Eastern and Western approaches to yoga.

Effects of yoga in inflammatory bowel diseases and on frequent IBD-associated extraintestinal symptoms like fatigue and depression

Quality of life (QoL) of persons with inflammatory bowel diseases (IBD) is often impaired by symptoms that do not primarily relate to intestinal inflammation. Among the most challenging extraintestinal symptoms are depression and fatigue, which are also frequent in other chronic diseases like multiple sclerosis, rheumatoid arthritis and cancer. Yoga as an ancient Indian tradition containing postures, breathing exercises and meditation may positively influence those symptoms. This review evaluates the current literature with regard to the effect of yoga-based interventions in persons with IBD and with regard to QoL, depression and fatigue in other somatic disorders. A systematic literature search yielded three trials examining the effects of yoga in patients with IBD and 37 trials addressing depressive syndromes or fatigue in somatic disorders. In summary, both in-person and video-based yoga classes are feasible, acceptable and safe as complementary treatment in patients with IBD and significantly improve anxiety and impaired quality of life. Current literature does not provide information on the effect of yoga on depression and fatigue in patients with IBD, but research from other somatic disorders or patients with depressive disorders implies the potential of yoga in this regard for persons with IBD. This should be specifically addressed in interventional trials with standardized yoga modules including patients with IBD suffering from fatigue, depression and/or impaired QoL.

A Meta-Analysis: Intervention Effect of Mind-Body Exercise on Relieving Cancer-Related Fatigue in Breast Cancer Patients

Objective

This paper aims to systematically evaluate the intervention effect of mind-body exercise on cancer-related fatigue in breast cancer patients.

Methods

Databases including PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, and SINOMED were retrieved to collect randomized controlled trials on the effects of mind-body exercise on relieving cancer-related fatigue in breast cancer patients. The retrieval period started from the founding date of each database to January 6, 2021. Cochrane bias risk assessment tools were used to evaluate the methodological quality assessment of the included literature, and RevMan 5.3 software was used for meta-analyses.

Results

17 pieces of researches in 16 papers were included with a total of 1133 patients. Compared with the control group, mind-body exercise can improve cancer-related fatigue in breast cancer patients. The combined effect size SMD = 0.59, 95% CI was [0.27, 0.92], p < 0.00001. Doing Tai Chi for over 40 minutes each time with an exercise cycle of ≤6 weeks can improve cancer-related fatigue in breast cancer patients more significantly. Sensitivity analysis shows that the combined effect results of the meta-analysis were relatively stable.

Conclusion

Mind-body exercise can effectively improve cancer-related fatigue in breast cancer patients.

Yoga for cancer survivors with chemotherapy-induced peripheral neuropathy: Health-related quality of life outcomes

Background

Yoga is a meditative movement therapy focused on mind‐body awareness. The impact of yoga on health‐related quality of life (HRQOL) outcomes in patients with chemotherapy‐induced peripheral neuropathy (CIPN) is unclear.

Methods

We conducted a pilot randomized wait‐list controlled trial of 8 weeks of yoga (n = 21) versus wait‐list control (n = 20) for CIPN in 41 breast and gynecological cancer survivors with persistent moderate to severe CIPN. HRQOL endpoints were Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and Insomnia Severity Index (ISI). The Treatment Expectancy Scale (TES) was administered at baseline. We estimated mean changes and 95% confidence intervals (CIs) from baseline to weeks 8 and 12 and compared arms using constrained linear mixed models.

Results

At week 8, HADS anxiety scores decreased −1.61 (−2.75, −0.46) in the yoga arm and −0.32 (−1.38, 0.75) points in the wait‐list control arm (p = 0.099). At week 12, HADS anxiety scores decreased −1.42 (−2.57, −0.28) in yoga compared to an increase of 0.46 (−0.60, 1.53) in wait‐list control (p = 0.017). There were no significant differences in HADS depression, BFI, or ISI scores between yoga and wait‐list control. Baseline TES was significantly higher in yoga than in wait‐list control (14.9 vs. 12.7, p = 0.019). TES was not associated with HADS anxiety reduction and HADS anxiety reduction was not associated with CIPN pain reduction.

Conclusions

Yoga may reduce anxiety in patients with CIPN. Future studies are needed to confirm these findings.

Clinical Trial Registration Number: ClinicalTrials.gov Identifier: NCT03292328.

Yoga therapy to reduce fatigue in cancer: effects of reminder e-mails and long-term efficacy

Objective

To examine the efficacy of reminder e-mails to continue yoga therapy on practice frequency and fatigue in cancer patients and long-term effects of yoga on fatigue, depression, and quality of life.

Methodology

One hundred two cancer patients who completed an 8-week yoga therapy were randomly allocated to two groups: reminder (N = 51) vs. no-reminder group (N = 51). After completing yoga therapy, the reminder group received weekly e-mails for 24 weeks, which reminded them of practicing yoga, whereas the no-reminder group did not. Primary outcomes were fatigue and practice frequency, and long-term outcomes were fatigue, depression, and quality of life. Data were assessed using questionnaires after yoga therapy (T1) and 6 months after completing yoga therapy (T2).

Result

A significantly stronger reduction of general (p = 0.038, d = 0.42) and emotional fatigue (p = 0.004, d = 0.59) and a higher increase of practice frequency (p = 0.015, d = 0.52) between T1 and T2 were found for the reminder group compared to the no-reminder group. In the mediation model, practice frequency as a mediator partially explained the changes in emotional fatigue (indirect effect B =  − 0.10). Long-term effects of yoga therapy regarding fatigue, depression, and quality of life were found (F > 7.46, p < 0.001, d > 0.54).

Conclusion

Weekly reminder e-mails after yoga therapy can positively affect general and emotional fatigue and help cancer patients with fatigue establish a regular yoga practice at home. However, higher practice frequency did not lead to higher physical or cognitive fatigue improvement, suggesting other factors that mediate efficacy on physical or cognitive fatigue, such as mindfulness or side effects of therapy.

Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008-2016

PURPOSE

In recent years, breast cancer detection and treatment have advanced. As a result, increased attention to breast cancer survivorship should have improved their health-related quality of life (HRQoL). Our aim was to examine the trends in the HRQoL of female breast cancer survivors between 2008 and 2016, to determine whether or not the increased focus on survivorship has translated into improved HRQoL. Furthermore, stratified analyses were conducted by race/ethnicity and age group and these were compared to a similar group of women without a breast cancer history.

METHODS

Repeated cross-sectional analyses using the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the trends in physical component scores (PCS-12) and mental component scores (MCS-12) among breast cancer survivors and a similar population of women without a breast cancer history. Analyses stratified by race/ethnicity and age group were also conducted.

RESULTS

Among breast cancer survivors, after adjusting for confounders, there was no change in PCS-12 scores over time, but the MCS-12 scores increased by 0.27 points (95% CI 0.09-0.45). Those without a history of breast cancer had mean PCS-12 scores that were 0.13 points greater each year (95% CI 0.02-0.24) while their mean MCS-12 scores were 0.10 (95% CI 0.00-0.21) points greater each year. After stratifying by race/ethnicity, Hispanic breast cancer survivors had a small increase in PCS-12 (β: 0.65; 95% CI 0.01-1.29), and MCS-12 scores (β: 0.70; 95% CI 0.06-1.33) over time. Similar small effects were found when stratified by age group, both among breast cancer survivors and those without a history of breast cancer. The younger age group (< 50 years) reported poorer MCS-12 than the older population (age 50 years and above).

CONCLUSION

Our study generated findings showing the trends in the HRQoL of breast cancer survivors and compared these to a similar population of women without a history of breast cancer. This paper highlights the importance of focusing on the mental health of young breast cancer survivors to improve their prospects at a good quality of life post-breast cancer diagnosis and treatment.

Role of integrative medicine in the continuum of care of breast cancer patients in the Indian context

Breast cancer is the most frequently diagnosed cancer among women in both transitioned and transitioning countries and has become a major women's health problem. Although recent advances in our understanding of the biological nature of cancer, improved awareness coupled with better early detection facilities, use of chemotherapy, hormone therapy, and targeted therapy have significantly improved survival from cancer, there are many gaps in providing individual-centric, holistic care. Integrative medicine refers to the use of traditional medicine alongside conventional preventive or therapeutic interventions (allopathic medicine) as a comprehensive, individual-centered, evidence-based care. The three pillars of complementary medicine (lifestyle modifications, mind-body practices, and use of natural products) have the potential for cancer prevention and improving quality-of-life and even treatment response in cancer patients when combined with conventional oncology care. Therefore, continued research into integrative therapies is required to extend the benefits to a broader patient population and improve outcomes in breast and other common cancers. In the present review article, the possible role of integrative medicine across the breast cancer care continuum has been discussed along with the concept of integrating complementary practices into mainstream health delivery. We have focused on breast cancer as a model cancer that is well amenable to prevention, early detection and stage appropriate treatment. However, our observations are pertinent for other common cancers, for which there are several opportunities for improving the continuum of care, especially in developing countries like India.

Effectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: A systematic review

OBJECTIVE

To assess the effectiveness of physical activity interventions in improving objective and patient-reported outcomes in HNC survivors.

INTRODUCTION

Multiple guidelines recommend that head and neck cancer (HNC) survivors participate in regular physical activity. Physical activity is associated with improved outcomes and mortality in healthy individuals as well as in certain cancer populations. However, the effectiveness of physical activity interventions in HNC survivors is inadequately understood.

METHODS AND RESULTS

Our literature search through December 2018 identified 2,392 articles. After de-duplication, title and abstract review, full-text review and bibliographic search, 20 studies met all inclusion criteria. Inclusion criteria included any full-body physical activity intervention in HNC survivors that did not target discrete organ sites or functions (e.g. swallowing). Study cohorts included 749 predominantly male participants with a mean age range of 48-63 years. At their conclusion, physical activity interventions were associated with at least one significant improvement in an objective or patient-reported outcome in 75% of studies. Aerobic capacity and fatigue were the most commonly improved outcomes. None of the included studies evaluated associations with survival or recurrence. Although traditional aerobic and resistance interventions were more common, a greater proportion of alternative physical activity (yoga and Tai Chi) interventions demonstrated improved objective and patient-reported outcomes.

CONCLUSION

Physical activity interventions in HNC survivors often conferred some improvement in objective and patient-reported outcomes. Additional highly-powered, randomized controlled studies are needed to establish the optimal type, intensity, and timing of physical activity interventions as well as their impact on oncologic outcomes.

Effects of Yoga on Phase Angle and Quality of Life in Patients with Breast Cancer: A Randomized, Single-Blind, Controlled Trial

INTRODUCTION

Phase angle (PA), a parameter that is obtained from body composition analysis, is an indicator of cellular health status. A lower PA in cancer patients can lead to a decrease in functional status and quality of life (QoL) and increased mortality. Studies have shown that physical activity increases PA. In this study, we aimed to examine the effects of Hatha yoga on PA, body composition, and QoL in patients with breast cancer.

METHODS

Thirty-one patients were randomized into the yoga (group 1, n = 15) and the control group (group 2, n = 16). Hatha yoga was practiced twice a week for 10 weeks in the intervention group. The PA of the patients was assessed using a body analysis instrument, and QoL was evaluated with an EORTC QLQ questionnaire both before treatment and at week 10.

RESULTS

Group 1 had significant improvements in the posttreatment EORTC QLQ functional and global scores (p < 0.05). In group 2, a significant improvement was observed in the EORTC QLQ symptom subscale (p = 0.035). PA values did not show any improvements in both groups (p > 0.05). Comparison of the 2 groups revealed no differences.

CONCLUSION

Yoga may have beneficial effects on QoL in patients with breast cancer but does not have a significant effect on PA. There is a need for further studies to make a definitive statement.

The Effectiveness of Yoga on Cancer-Related Fatigue: A Systematic Review and Meta-Analysis

PROBLEM IDENTIFICATION

The aim of this article is to evaluate the effectiveness of yoga on cancer-related fatigue (CRF) in patients undergoing chemotherapy and/or radiation therapy.

LITERATURE SEARCH

Relevant English and Chinese articles were retrieved from medical databases and included in this analysis. Standardized critical appraisal instruments from the Joanna Briggs Institute were adopted for the quality assessment.

DATA EVALUATION

16 randomized controlled trials met the inclusion criteria.

SYNTHESIS

Yoga interventions had a positive effect in reducing CRF among patients undergoing chemotherapy and/or radiation therapy, but the adherence to yoga was low. Mixed types of yoga, in addition to supervised and self-practicing strategies, were associated with increased patient adherence and improved CRF.

IMPLICATIONS FOR PRACTICE

Yoga appears to be a safe and effective exercise for the management of CRF during chemotherapy and/or radiation therapy; however, additional high-quality studies are needed to define an optimal yoga intervention strategy.

Effects of yoga on improving quality of life in patients with breast cancer: a meta-analysis of randomized controlled trials

BACKGROUND

Complications of breast cancer treatment can cause physical and psychosocial distress in patients. Yoga demonstrates substantial potential as a supportive therapy for patients with breast cancer. Our aim is to conduct a meta-analysis of randomized controlled trials to evaluate the effectiveness of yoga in enhancing the quality of life (QoL) of patients with breast cancer.

METHODS

We searched for studies published before March 2020 in the PubMed, Embase, and Cochrane Library databases. Individual effect sizes were standardized, and the pooled effect size was calculated using a random effect model. Measured outcomes included QoL, anxiety and depression, stress, fatigue, pain severity, and sleep quality.

RESULTS

In total, 26 trials involving 2069 patients were reviewed. Significant enhancement in QoL was observed immediately after the yoga intervention. The pooled mean differences in social (weighted mean difference [WMD]: 1.36, 95% confidence interval [CI] 0.12-2.61), emotional (WMD: 1.46, 95% CI 0.26-2.66), and functional well-being (WMD: 2.04, 95% CI 0.21-3.87) were significantly higher in the yoga group than in the control group. Patients practicing yoga exhibited significant improvements in physical well-being, mental well-being, and sleep quality as well as reductions in anxiety, depression, stress, fatigue, and pain severity after the intervention.

CONCLUSIONS

Yoga may enhance QoL in patients with breast cancer experiencing post-treatment complications. Therefore, we recommend yoga as a supportive therapy for patients with breast cancer to relieve post-treatment distress.

Real-World Experiences With Yoga on Cancer-Related Symptoms in Women With Breast Cancer

Purpose

Integrative therapies such as yoga are potential treatments for many psychological and physical symptoms that occur during and/or after treatment for cancer. The purpose of the current study was to evaluate the patient-perceived benefit of yoga for symptoms commonly experienced by breast cancer survivors.

Methods

1,049 breast cancer survivors who had self-reported use of yoga on a follow up survey, in an ongoing prospective Mayo Clinic Breast Disease Registry (MCBDR), received an additional mailed yoga-focused survey asking about the impact of yoga on a variety of symptoms. Differences between pre- and post- scores were assessed using Wilcoxon Signed Rank Test.

Results

802/1,049 (76%) of women who were approached to participate, consented and returned the survey. 507/802 (63%) reported use of yoga during and/or after their cancer diagnosis. The vast majority of respondents (89.4%) reported some symptomatic benefit from yoga. The most common symptoms that prompted the use of yoga were breast/chest wall pain, lymphedema, and anxiety. Only 9% of patients reported that they had been referred to yoga by a medical professional. While the greatest symptom improvement was reported with breast/chest wall pain and anxiety, significant improvement was also perceived in joint pain, muscle pain, fatigue, headache, quality of life, hot flashes, nausea/vomiting, depression, insomnia, lymphedema, and peripheral neuropathy, (all p-values <0.004).

Conclusion

Data supporting the use of yoga for symptom management after cancer are limited and typically focus on mental health. In this study, users of yoga often reported physical benefits as well as mental health benefits. Further prospective studies investigating the efficacy of yoga in survivorship are warranted.

Stress reduction strategies in breast cancer: review of pharmacologic and non-pharmacologic based strategies

Breast cancer is the most common cancer diagnosed in women. It is associated with multiple symptoms in both patients and caregivers, such as stress, anxiety, depression, sleep disturbance, and fatigue. Stress appears to promote cancer progression via activation of the sympathetic nervous system releasing epinephrine and norepinephrine as well as activation of hypothalamic-pituitary-adrenal axis releasing cortisol. These stress hormones have been shown to promote the proliferation of cancer cells. This review focuses on stress-reducing strategies which may decrease cancer progression by abrogating these pathways, with a main focus on the β-adrenergic signaling pathway. Patients utilize both non-pharmacologic and pharmacologic strategies to reduce stress. Non-pharmacologic stress-reduction strategies include complementary and alternative medicine techniques, such as meditation, yoga, acupuncture, exercise, use of natural products, support groups and psychology counseling, herbal compounds, and multivitamins. Pharmacologic strategies include abrogating the β2-adrenergic receptor signaling pathway to antagonize epinephrine and norepinephrine action on tumor and immune cells. β-Blocker drugs may play a role in weakening the pro-migratory and pro-metastatic effects induced by stress hormones in cancer and strengthening the anti-tumor immune response. Preclinical models have shown that non-selective β1/2-blocker use is associated with a decrease in tumor growth and metastases and clinical studies have suggested their positive impact on decreasing breast cancer recurrence and mortality. Thus, non-pharmacological approaches, along with pharmacological therapies part of clinical trials are available to cancer patients to reduce stress, and have promise to break the cycle of cancer and stress.

If we offer, will they come: Perceptions of yoga among Hispanics

OBJECTIVE

Yoga is underutilized by the Hispanics. This study examined perceptions of benefits and barriers to yoga among Hispanic adults, to provide information that may increase their participation in this practice.

SETTING

Participants were recruited from a Community Center serving low-income Hispanics.

DESIGN

Self-administered cross-sectional questionnaires assessing benefits and barriers to yoga were conducted in Spanish and English. Fisher's exact test was used to examine perceptions of yoga by gender, age, and prior experience.

RESULTS

Participants (ages 18-85, 65 % women, n = 121) reported several benefits to yoga. Hispanic women, individuals 65 y or older, and those with prior experience, perceived more benefits. Barriers to yoga also differed by demographics. Men reported that time and the perception that they would have to do unrealistic pretzel-like poses as deterrents to yoga practice; younger individuals perceived yoga to be boring, and those with no experience perceived lack of flexibility and feeling like an outsider in class, as barriers to yoga. The most common barrier, across subgroups, was the cost associated with yoga practice. The majority of participants reported being willing to attend yoga classes if offered at a low cost.

CONCLUSION

Perceived barriers related to yoga reflect a lack of knowledge about yoga and what it entails and the cost of classes. Despite these barriers, Hispanic adults from a low-income population said they would be willing to attend yoga classes if offered at a low cost. Understanding and addressing these barriers can help researchers and health practitioners improve diversity in yoga classes and research.

The Effect of Yoga Interventions on Cancer-Related Fatigue and Quality of Life for Women with Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background:

Women with breast cancer (BC) are living longer with debilitating side effects such as cancer-related fatigue (CRF) that affect overall well-being. Yoga promotes health, well-being and may be beneficial in reducing CRF. Although there have been previous systematic reviews and meta-analyses, the effects of yoga on CRF and quality of life (QOL) remain unclear, particularly in comparison with other types of physical activity (PA). Our objective is to carry out a systematic review and meta-analysis of the effects of yoga on CRF and QOL in women with BC.

Methods:

Electronic databases were searched (MEDLINE, Embase Classic+Embase and EMB Reviews, Cochrane Central CT) from inception to May 2018. Randomized controlled trials were included if they were full text, in English, included a yoga intervention, a comparator (including non-PA usual care or alternate PA intervention), and reported on CRF or QOL. Effects of yoga were pooled using standardized mean difference (SMD) via a random effects model.

Results:

Of the 2468 records retrieved, 24 trials were included; 18 studies compared yoga to a non-PA comparator and 6 to a PA comparator. Yoga demonstrated statistically significant improvements in CRF over non-PA (SMD −0.30 [−0.51; −0.08]) but not PA (SMD −0.17 [−0.50; 0.17]) comparators. Additionally, yoga demonstrated statistically significant improvements in QOL over non-PA (SMD −0.27 [−0.46; −0.07]) but not PA (SMD 0.04 [−0.22; +0.31]) comparators.

Discussion:

This meta-analysis found that yoga provides small to medium improvements in CRF and QOL compared to non-PA, but not in comparison to other PA interventions.

Work volition in women with fibromyalgia: a phenomenological analysis

AIMS AND OBJECTIVES

This study develops a working model characterizing work volition among women suffering from fibromyalgia syndrome (FMS) to better understand the vocational challenges these women face, the drivers behind their ambitions, and the coping strategies they implement.

MATERIALS AND METHODS

A qualitative phenomenological study was conducted consisting of semi-structured interviews with 15 women diagnosed with FMS who are currently employed. The interviews were analyzed according to the principles of Interpretative Phenomenological Analysis.

RESULTS

The findings point to the enormous efforts these women make to ration their energy and preserve their careers by implementing calming cognitive, social, and solution-focused strategies. Several motivational factors governing work volition emerged from the interviews: (1) a drive for esteem, power, and control; (2) achieving self-actualization and a sense of meaning in life by nurturing of others; (3) preserving a sense of existence through their career achievements; and (4) pushing beyond their physical limits. They reported implementing four calming, cognitive-focused, social support, and solution-focused strategies to reduce pain.

CONCLUSIONS

Work plays an important role in grounding these women's sense of vitality and normalcy. This is coupled with their enormous efforts to pursue and preserve their careers by calming the mind and the body. Paradoxically, however, these efforts appear to aggravate their physical exhaustion and distress. The complexity of maintaining a career when diagnosed with FMS as well as issues of general physical and mental health are discussed.Implications for rehabilitationCareer has an existential significance for women with Fibromyalgia.Motivational factors for work volition were identified; these include ambition for esteem, the obtaining of meaning, and gaining a sense of existence.Enormous efforts have been taken to save energy and preserve careers.Women are trapped between their desire to work and the need to conserve energy.Body-mind interventions are recommended for women's rehabilitation.

Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer

PURPOSE

Examine the effects of an 8-week yoga therapy on fatigue in patients with different types of cancer.

METHODS

A total of 173 cancer patients suffering from mild to severe fatigue were randomly allocated to yoga intervention (n = 84) (IG) versus waitlist control group (CG) (n = 88). Yoga therapy consisted of eight weekly sessions with 60 min each. The primary outcome was self-reported fatigue symptoms. Secondary outcomes were symptoms of depression and quality of life (QoL). Data were assessed using questionnaires before (T0) and after yoga therapy for IG versus waiting period for CG (T1).

RESULTS

A stronger reduction of general fatigue (P = .033), physical fatigue (P = .048), and depression (P < .001) as well as a stronger increase in QoL (P = .002) was found for patients who attended 7 or 8 sessions compared with controls. Within the yoga group, both higher attendance rate and lower T0-fatigue were significant predictors of lower T1-fatigue (P ≤ .001). Exploratory results revealed that women with breast cancer report a higher reduction of fatigue than women with other types of cancer (P = .016) after yoga therapy.

CONCLUSION

The findings support the assumption that yoga therapy is useful to reduce cancer-related fatigue, especially for the physical aspects of fatigue. Women with breast cancer seem to benefit most, and higher attendance rate results in greater reduction of fatigue.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00016034.

Radiotherapy-Induced Fatigue in Breast Cancer Patients

Background

A large proportion of breast cancer patients who undergo adjuvant radiotherapy suffer from radiotherapy-induced fatigue. The possible causative factors of this specific side effect are diverse.

Summary

Prevalence, duration, and severity of radiotherapy-induced fatigue are dependent on the type of radiotherapy, as well as on the irradiated volume, dose scheme, on the number of radiation fields, the combination with other treatments, diurnal rhythm, smoking, and time-to-hospitalization. Recommended treatments include non-pharmacologic interventions, such as physical and psychosocial interventions. Pharmacologic therapies include treatment with methylphenidate and modafinil. In addition to its early detection with standardized instruments, adequate education to breast cancer patients about risks and predisposing factors of radiotherapy-induced fatigue is essential. Multidimensional strategies help to maintain the patients' quality of life and therefore guarantee treatment adherence and efficacy.

Key Messages

Radiotherapy-induced fatigue is an underreported, underdiagnosed, and undertreated side effect. This review provides an overview of radiotherapy-induced fatigue in breast cancer patients receiving adjuvant radiotherapy.

Realizing Yoga's all-access pass: a social justice critique of westernized yoga and inclusive embodiment

In the 21^st century, the ancient mind-body practice of yoga has surged in popularity among western enthusiasts for its numerous health benefits. Particularly, a growing evidence base supports yoga for cultivating positive embodiment and reducing risk for disordered eating. Nevertheless, amidst its rise are concerns about yoga's departure from its spiritual foundations and increasing assimilation into the appearance- and commercial-driven exercise and fitness culture. Consequently, an exclusionary identity has been perpetuated in shaping norms surrounding who can and does practice yoga, which contradicts earlier egalitarian visions of a yoga for all. Therefore, we adopt a social justice lens in offering a focused analysis of the intersection of yoga, embodiment, and inclusion for select marginalized social identities typically underrepresented among yoga practitioners and in yoga scholarship. Data are synthesized from both qualitative and quantitative sources and integrate an understanding of how confined media representations of "the yoga body" and other practical constraints may undermine the perceived access to the practice for members of diverse groups. We conclude with inviting future considerations towards fostering more interdisciplinary community-based research partnerships among the variety of stakeholders invested in advancing the accessibility and inclusion of yoga and positive embodiment for all bodies.

Online yoga to reduce post traumatic stress in women who have experienced stillbirth: a randomized control feasibility trial

BACKGROUND

About 1 in every 150 pregnancies end in stillbirth. Consequences include symptoms of post traumatic stress disorder (PTSD), depression, and anxiety. Yoga has been used to treat PTSD in other populations and may improve health outcomes for stillbirth mothers. The purpose of this study was to determine: (a) feasibility of a 12-week home-based, online yoga intervention with varying doses; (b) acceptability of a "stretch and tone" control group; and (c) preliminary efficacy of the intervention on reducing symptoms of PTSD, anxiety, depression, perinatal grief, self-compassion, emotional regulation, mindfulness, sleep quality, and subjective health.

METHODS

Participants (N = 90) were recruited nationally and randomized into one of three groups for yoga or exercise (low dose (LD), 60 min per week; moderate dose (MD), 150 min per week; and stretch-and-tone control group (STC)). Baseline and post-intervention surveys measured main outcomes (listed above). Frequency analyses were used to determine feasibility. Repeated measures ANCOVA were used to determine preliminary efficacy. Multiple regression analyses were used to determine a dose-response relationship between minutes of yoga and each outcome variable.

RESULTS

Over half of participants completed the intervention (n = 48/90). Benchmarks (≥70% reported > 75% satisfaction) were met in each group for satisfaction and enjoyment. Participants meeting benchmarks (completing > 90% of prescribed minutes 9/12 weeks) for LD and MD groups were 44% (n = 8/18) and 6% (n = 1/16), respectively. LD and MD groups averaged 44.0 and 77.3 min per week of yoga, respectively. The MD group reported that 150 prescribed minutes per week of yoga was too much. There were significant decreases in PTSD and depression, and improvements in self-rated health at post-intervention for both intervention groups. There was a significant difference in depression scores (p = .036) and grief intensity (p = .009) between the MD and STC groups. PTSD showed non-significant decreases of 43% and 56% at post-intervention in LD and MD groups, respectively (22% decrease in control).

CONCLUSIONS

This was the first study to determine the feasibility and preliminary efficacy of an online yoga intervention for women after stillbirth. Future research warrants a randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT02925481. Registered 10-04-16.