The study reviewed here suggests that gentle yoga may ease sleep and fatigue problems and improve sleep quality in cancer survivors. The research results will be presented at the 2010 American Society of Clinical Oncology (ASCO) annual meeting in June.
Cancer treatment and the associated stress and worry may cause sleep problems, which can then lead to feeling tired and fatigued during the day. Sleep problems and other treatment side effects can decrease quality of life for cancer survivors.
In this study, 410 people who had been treated for early-stage cancer were having sleep problems 2 months to 2 years after treatment ended.
The participants were split into two groups.
Half of the survivors took part in a four-week yoga program called UR Yoga for Cancer Survivors (YOCAS). YOCAS is designed specifically for cancer survivors and involves gentle yoga postures, as well as breathing exercises, meditation, and visualization. The 75-minute yoga classes were done twice per week for 4 weeks.
The other half of the survivors were monitored for 4 weeks, but didn't participate in the yoga program. The researchers evaluated the participants' sleep quality, daytime sleepiness, and overall quality of life at the beginning of the study and 4 weeks later, after the yoga program ended.
At the start of the study, most of the survivors in each group had poor sleep quality. After 4 weeks, there were noticeable differences between the survivors who did yoga and the survivors who were only monitored:
An expert who reviewed the study said that because it was short -- only 4 weeks -- it wasn't really possible to conclude that yoga was the only reason the cancer survivors had fewer sleep problems. Still, the results are promising and other studies have shown that several complementary and holistic medicine techniques, including yoga, can help improve quality of life during and after breast cancer treatment.
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CHICAGO (MedPage Today) -- Gentle stretching, breathing, and other exercises in a regular yoga program may ease sleep and fatigue problems common among cancer survivors, a randomized trial found.
Sleep quality rose 22% after just four weeks of yoga, a benefit significant at P<0.05 compared with the 12% improvement from baseline on usual care, reported Karen Mustian, PhD, MPH, University of Rochester Medical Center in Rochester, N.Y., and colleagues.
Yoga had an even greater effect on fatigue, with a 42% reduction among yoga participants versus 12% among controls (P<0.05), she said at a press conference in advance of her presentation at the American Society of Clinical Oncology meeting here.
Similar yoga classes done in the community would also likely fight these side effects, which affect the majority of cancer survivors, Mustian noted.
Kathryn Schmitz, PhD, MPH, FACSM, of the, University of Pennsylvania School of Medicine, said that the concept of recommending yoga or any exercise is still a novel one for many in the cancer community, who for years were likely to regard cancer survivors as poor candidates for an exercise intervention. Schmitz was not involved in the study, but offered her comments in response to an ABC/MedPage Today query.
Even now, she said, clinicians typically advise cancer patients to "take it easy."
"What we conclude based on a really thorough review of [yoga programs] is that it is absolutely safe for cancer survivors during and post treatment to be physically active, and indeed there are tremendous benefits to doing so."
ASCO president Douglas W. Blayney, MD, of the University of Michigan in Ann Arbor, agreed that the results are "readily applicable" for a huge patient population.
"This emphasizes the increasing importance of ameliorating complications of therapy in long-term cancer survivors," he said at the press conference. "There are literally millions of patients to whom it might be applicable in the U.S."
Yoga isn't the only form of exercise to show benefits for cancer survivors.
Walking programs and resistance training, for example, are considered to be excellent behavioral options to counteract fatigue in particular, Mustian said at the press conference.
Although there haven't been any head-to-head studies to suggest which type of exercise is most effective, yoga may have some advantages beyond just getting patients moving, Mustian speculated.
Small studies have suggested that the deep breathing training and mindfulness aspects of yoga may help regulate parasympathetic nervous system activity and the hypothalamic-pituitary-adrenal axis, she explained.
Her group's phase II/III trial included 410 survivors of early stage cancers (96% women, 75% breast cancers) from nine community clinical oncology centers who reported at least moderate problems with sleep in the two to 24 months after finishing adjuvant cancer therapy.
They were randomized to standard care monitoring alone or with a four-week yoga program with 75-minute sessions twice weekly.
At baseline, 83% to 84% of patients met the clinical cutoff criteria for impaired sleep quality with a Pittsburgh Sleep Quality Index score over 5. But by the end of the trial, 31% of yoga participants had recovered compared with the 16% of control group patients who saw scores drop below 5 (P<0.05).
This advantage came despite a comparative drop in use of sleeping pills among yoga participants (-21% versus +5%, P<0.05).
Other findings included significantly less daytime sleepiness after the yoga program (-29% versus -5% from baseline, P<0.05) and a 6% mean improvement in quality of life score among yoga participants compared with no change in the control group (P<0.05).
The researchers tested a program designed for cancer survivors (UR Yoga for Cancer Survivors, YOCAS®) that included only gentle yoga postures in standing, seated, transitional, and lying-down positions along with breathing exercises, meditation, and visualization.
These components can be found in typical Hatha or restorative yoga classes in communities across the country, Mustian said.
However, she cautioned that the results may not generalize to more rigorous or heated forms of yoga in cancer survivors.
"It's important for folks to know that not all yoga is the same, may not provide the same benefits, and may or may not be safe," Mustian said in an interview with ABC News.
Michael Irwin, PhD, a professor of psychiatry and biobehavioral science at UCLA's David Geffen School of Medicine, also cautioned, in an e-mail, that the study findings are probably not enough on which to make solid clinical recommendations.
He pointed out, for example, that this was a short-term study. He said he would really like to see data about long-term effects.
The study was funded by grants from the National Cancer Institute.
The researchers reported no conflicts of interest.
This article was developed in collaboration with ABC News.
Primary source: American Society of Clinical Oncology Source reference: Mustian KM, et al "YOCAS® yoga significantly improves sleep, fatigue and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors" ASCO 2010; Abstract 9013.
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