Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials

BMC Cancer

Laurien M Buffart²  Jannique GZ van Uffelen⁴  Ingrid I Riphagen³  Johannes Brug²  Willem van Mechelen¹  Wendy J Brown⁴  Mai JM Chinapaw¹ 

[1] EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands

[2] EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands

[3] Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

[4] School of Human Movement Studies, The University of Queensland, Queensland, Australia

关键词: Cancer;    Quality of life;    Psychosocial function;    Physical function;    Randomized controlled trial;    Yoga;   

Others  :  1080052
DOI  :  10.1186/1471-2407-12-559

 received in 2012-02-15, accepted in 2012-11-21,  发布年份 2012

【 摘 要 】

Background

This study aimed to systematically review the evidence from randomized controlled trials (RCTs) and to conduct a meta-analysis of the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors.

Methods

A systematic literature search in ten databases was conducted in November 2011. Studies were included if they had an RCT design, focused on cancer patients or survivors, included physical postures in the yoga program, compared yoga with a non-exercise or waitlist control group, and evaluated physical and/or psychosocial outcomes. Two researchers independently rated the quality of the included RCTs, and high quality was defined as >50% of the total possible score. Effect sizes (Cohen’s d) were calculated for outcomes studied in more than three studies among patients with breast cancer using means and standard deviations of post-test scores of the intervention and control groups.

Results

Sixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer. The median quality score was 67% (range: 22–89%). The included studies evaluated 23 physical and 20 psychosocial outcomes. Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression (d = −0.69 to −0.75), moderate reductions in fatigue (d = −0.51), moderate increases in general quality of life, emotional function and social function (d = 0.33 to 0.49), and a small increase in functional well-being (d = 0.31). Effects on physical function and sleep were small and not significant.

Conclusion

Yoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported. In patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for psychosocial outcomes.

【 授权许可】

   
2012 Buffart et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Australian Institute of Health and Welfare: Cancer survival and prevalence in Australia. CAT no CAN 38, Canberra; 2008.
• [2]IKCnet.Dutch Cancer Registration: Survival. 2009. http://www.ikcnet.nl webcite
• [3]Courneya KS, Friedenreich CM: Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med 1999, 21:171-179.
• [4]Courneya KS: Exercise in cancer survivors: an overview of research. Med Sci Sports Exerc 2003, 35:1846-1852.
• [5]Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, et al.: Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 2000, 5:353-360.
• [6]Dimeo FC: Effects of exercise on cancer-related fatigue. Cancer 2001, 92:1689-1693.
• [7]Emslie C, Whyte F, Campbell A, Mutrie N, Lee L, Ritchie D, et al.: 'I wouldn't have been interested in just sitting round a table talking about cancer'; exploring the experiences of women with breast cancer in a group exercise trial. Health Educ Res 2007, 22:827-838.
• [8]Cheema B, Gaul CA, Lane K, Fiatarone Singh MA: Progressive resistance training in breast cancer: a systematic review of clinical trials. Breast Cancer Res Treat 2008, 109:9-26.
• [9]Conn CA, Kozak WE, Tooten PC, Gruys E, Borer KT, Kluger MJ: Effect of voluntary exercise and food restriction in response to lipopolysaccharide in hamsters. J Appl Physiol 1995, 78:466-477.
• [10]De Backer IC, Schep G, Backx FJ, Vreugdenhil G, Kuipers H: Resistance training in cancer survivors: a systematic review. Int J Sports Med 2009, 30:703-712.
• [11]Galvao DA, Newton RU: Review of exercise intervention studies in cancer patients. J Clin Oncol 2005, 23:899-909.
• [12]Jacobsen PB, Donovan KA, Vadaparampil ST, Small BJ: Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol 2007, 26:660-667.
• [13]Kangas M, Bovbjerg DH, Montgomery GH: Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull 2008, 134:700-741.
• [14]Kirshbaum MN: A review of the benefits of whole body exercise during and after treatment for breast cancer. J Clin Nurs 2007, 16:104-121.
• [15]Knols R, Aaronson NK, Uebelhart D, Fransen J, Aufdemkampe G: Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol 2005, 23:3830-3842.
• [16]Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH: An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2010, 4:87-100.
• [17]Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenreich CM, et al.: Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med 2008, 35:116-122.
• [18]Midtgaard J, Baadsgaard MT, Moller T, Rasmussen B, Quist M, Andersen C, et al.: Self-reported physical activity behaviour; exercise motivation and information among Danish adult cancer patients undergoing chemotherapy. Eur J Oncol Nurs 2009, 13:116-121.
• [19]Rogers LQ, Courneya KS, Verhulst S, Markwell SJ, McAuley E: Factors associated with exercise counseling and program preferences among breast cancer survivors. J Phys Act Health 2008, 5:688-705.
• [20]Whitehead S, Lavelle K: Older breast cancer survivors' views and preferences for physical activity. Qual Health Res 2009, 19:894-906.
• [21]Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Vallance JK, et al.: A longitudinal study of exercise barriers in colorectal cancer survivors participating in a randomized controlled trial. Ann Behav Med 2005, 29:147-153.
• [22]Perna FM, Craft L, Carver CS, Antoni MH: Negative affect and barriers to exercise among early stage breast cancer patients. Health Psychol 2008, 27:275-279.
• [23]Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Fairey AS: Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors. Psychooncology 2004, 13:857-866.
• [24]Ernst E, Cassileth BR: The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 1998, 83:777-782.
• [25]Bernstein BJ, Grasso T: Prevalence of complementary and alternative medicine use in cancer patients. Oncology (Williston Park) 2001, 15:1267-1272.
• [26]Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, et al.: Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 2005, 16:655-663.
• [27]Lipton L: Using yoga to treat disease: an evidence-based review. JAAPA 2008, 21:34-36. 38, 41
• [28]Telles S, Ramaprabhu V, Reddy SK: Effect of yoga training on maze learning. Indian J Physiol Pharmacol 2000, 44:197-201.
• [29]Raub JA: Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med 2002, 8:797-812.
• [30]Tran MD, Holly RG, Lashbrook J, Amsterdam EA: Effects of Hatha Yoga Practice on the Health-Related Aspects of Physical Fitness. Prev Cardiol 2001, 4:165-170.
• [31]Blank SE, Kittel J, Haberman MR: Active practice of Iyengar Yoga as an intervention for breast cancer survivors. Int J Yoga Therapy 2010, 15:51-59.
• [32]Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL: Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer 2009, 17:1301-1309.
• [33]Galantino M, Cannon N, Hoelker T, Iannaco J, Quinn L: Potential benefits of walking and yoga on perceived level of cognitive decline and persistent fatigue in women with breast cancer. Rehabil Oncol 2007, 25:3-16.
• [34]Ross A, Thomas S: The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med 2010, 16:3-12.
• [35]Smith KB, Pukall CF: An evidence-based review of yoga as a complementary intervention for patients with cancer. Psychooncology 2009, 18:465-475.
• [36]Bower JE, Woolery A, Sternlieb B, Garet D: Yoga for cancer patients and survivors. Cancer Control 2005, 12:165-171.
• [37]Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY: Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. Evid Based Complement Alternat Med 2011. Epub
• [38]Verhagen AP, de Vet HC, de Bie RA, Boers M, van den Brandt PA: The art of quality assessment of RCTs included in systematic reviews. J Clin Epidemiol 2001, 54:651-654.
• [39]Chinapaw MJ, van Uffelen JG, Riphagen I, van Mechelen W: The functional effects of physical exercise training in frail older people: a systematic review. Sports Med 2008, 38:781-793.
• [40]van Uffelen JG, Chinapaw MJ, Hopman-Rock M, van Mechelen W: The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review. Clin J Sport Med 2008, 18:486-500.
• [41]Verhagen AP, Karels C, Bierma-Zeinstra SM, Feleus A, Dahaghin S, Burdorf A, et al.: Exercise proves effective in a systematic review of work-related complaints of the arm, neck, or shoulder. J Clin Epidemiol 2007, 60:110-117.
• [42]Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G: The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med 2010, 40:211-223.
• [43]Lipsey MW: Design sensitivity; statistical power for experimental research. Sage, Newbury Park; 1990.
• [44]Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A: Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004, 100:2253-2260.
• [45]Higgins JP, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003, 327:557-560.
• [46]Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, et al.: Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther 2009, 8:37-46.
• [47]Vadiraja HS, Rao MR, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, et al.: Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Complement Ther Med 2009, 17:274-280.
• [48]Vadiraja HS, Rao RM, Hongasandra NR, Nagarathna R, Rekha M, Vanitha N, et al.: Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial. Int J Yoga 2009, 2:73-79.
• [49]Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, Srinath BS, Ravi BD, et al.: Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. Eur J Cancer Care (Engl) 2007, 16:462-474.
• [50]Rao RM, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, Diwakar RB, et al.: Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial. Complement Ther Med 2009, 17:1-8.
• [51]Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, Gopinath KS, et al.: Effects of an integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther 2007, 6:242-250.
• [52]Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S: A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology 2006, 15:891-897.
• [53]Danhauer SC, Mihalko SL, Russell GB, Campbell CR, Felder L, Daley K, et al.: Restorative yoga for women with breast cancer: findings from a randomized pilot study. Psychooncology 2009, 18:360-368.
• [54]Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB, et al.: Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol 2007, 25:4387-4395.
• [55]Chandwani KD, Thornton B, Perkins GH, Arun B, Raghuram NV, Nagendra HR, et al.: Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 2010, 8:43-55.
• [56]Banasik J, Williams H, Haberman M, Blank SE, Bendel R: Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. J Am Acad Nurse Pract 2011, 3:135-142.
• [57]Littman AJ, Bertram LC, Ceballos R, Ulrich CM, Ramaprasad J, McGregor B, et al.: Randomized controlled pilot trial of yoga in overweight and obese breast cancer survivors: effects on quality of life and anthropometric measures. Support Care Cancer 2012, 20:267-277.
• [58]Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, et al.: Yoga for persistent fatigue in breast cancer survivors: A randomized controlled trial. Cancer 2012, 118:3766-3775.
• [59]Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, et al.: Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993, 25:71-80.
• [60]Oken BS, Zajdel D, Kishiyama S, Flegal K, Dehen C, Haas M, et al.: Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Altern Ther Health Med 2006, 12:40-47.
• [61]Pullen PR, Nagamia SH, Mehta PK, Thompson WR, Benardot D, Hammoud R, et al.: Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail 2008, 14:407-413.
• [62]Bowman AJ, Clayton RH, Murray A, Reed JW, Subhan MM, Ford GA: Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons. Eur J Clin Invest 1997, 27:443-449.
• [63]Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya KS: Pilot evaluation of an iyengar yoga program for breast cancer survivors. Cancer Nurs 2010, 33:369-381.
• [64]de Jong N: Courtens AM, bu-Saad HH, Schouten HC: Fatigue in patients with breast cancer receiving adjuvant chemotherapy: a review of the literature. Cancer Nurs 2002, 25:283-297.
• [65]Cramp F, Daniel J: Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008, (2):CD006145.
• [66]Duijts SF, Faber MM, van Oldenburg HS BM, Aaronson NK: Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors--a meta-analysis. Psychooncology 2011, 20:115-126.
• [67]Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM: The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol) 2010, 22:208-221.
• [68]Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G: Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev 2009, (1):CD006953.
• [69]Brawley LR, Culos-Reed SN, Angove J, Hoffman-Goetz L: Understanding the barriers to phyiscal activity for cancer patients: review and recommendations. J Psychosoc Oncol 2002, 20:1-21.
• [70]Courneya KS, Friedenreich CM: Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complement Med 1997, 3:215-226.