Abstract
Yoga-based exercise has proven to be beneficial for practitioners, including cancer survivors. This study reports on the improvements in physical fitness for 20 breast cancer survivors who participated in a six-month yoga-based (YE) exercise program. Results are compared to a comprehensive exercise (CE) program group and a comparison (C) exercise group who chose their own exercises. “Pre” and “post” fitness assessments included measures of anthropometrics, cardiorespiratory capacity, strength and flexibility. Descriptive statistics, effect size (d), dependent sample ‘t’ tests for all outcome measures were calculated for the YE group. Significant improvements included: decreased % body fat (−3.00%, d = −0.44, p < 0.001); increased sit to stand leg strength repetitions (2.05, d = 0.48, p = 0.003); forward reach (3.59 cm, d = 0.61, p = 0.01); and right arm sagittal range of motion (6.50°, d = 0.92, p= 0.05). To compare YE outcomes with the other two groups, a one-way analysis of variance (ANOVA) was used. YE participants significantly outperformed C participants on “forward reach” (3.59 cm gained versus −2.44 cm lost), (p = 0.009) and outperformed CE participants (3.59 cm gained versus 1.35 cm gained), but not statistically significant. Our results support yoga-based exercise modified for breast cancer survivors as safe and effective.
Daniel C. Hughes, PhD,1 Nydia Darby, DPT,2 Krystle Gonzalez, BS,3 Terri Boggess, PhD,4 Ruth M. Morris, MPH,1 and Amelie G. Ramirez, DrPH1
Physiother Theory Pract. 2015 Oct; 31(7): 451–460.
Abstract
Diaphragmatic breathing is relaxing and therapeutic, reduces stress, and is a fundamental procedure of Pranayama Yoga, Zen, transcendental meditation and other meditation practices. Analysis of oxidative stress levels in people who meditate indicated that meditation correlates with lower oxidative stress levels, lower cortisol levels and higher melatonin levels. It is known that cortisol inhibits enzymes responsible for the antioxidant activity of cells and that melatonin is a strong antioxidant; therefore, in this study, we investigated the effects of diaphragmatic breathing on exercise-induced oxidative stress and the putative role of cortisol and melatonin hormones in this stress pathway. We monitored 16 athletes during an exhaustive training session. After the exercise, athletes were divided in two equivalent groups of eight subjects. Subjects of the studied group spent 1 h relaxing performing diaphragmatic breathing and concentrating on their breath in a quiet place. The other eight subjects, representing the control group, spent the same time sitting in an equivalent quite place. Results demonstrate that relaxation induced by diaphragmatic breathing increases the antioxidant defense status in athletes after exhaustive exercise. These effects correlate with the concomitant decrease in cortisol and the increase in melatonin. The consequence is a lower level of oxidative stress, which suggests that an appropriate diaphragmatic breathing could protect athletes from long-term adverse effects of free radicals.
Martarelli D1, Cocchioni M, Scuri S, Pompei P.
Evid Based Complement Alternat Med. 2011;2011:932430. doi: 10.1093/ecam/nep169. Epub 2011 Feb 10.
Abstract
35 male volunteers whose ages ranged from 20 to 46 years were studied in two sessions of yoga-based guided relaxation and supine rest. Assessments of autonomic variables were made for 15 subjects, before, during, and after the practices, whereas oxygen consumption and breath volume were recorded for 25 subjects before and after both types of relaxation. A significant decrease in oxygen consumption and increase in breath volume were recorded after guided relaxation (paired t test). There were comparable reductions in heart rate and skin conductance during both types of relaxation. During guided relaxation the power of the low frequency component of the heart-rate variability spectrum reduced, whereas the power of the high frequency component increased, suggesting reduced sympathetic activity. Also, subjects with a baseline ratio of LF/HF > 0.5 showed a significant decrease in the ratio after guided relaxation, while subjects with a ratio < or = 0.5 at baseline showed no such change. The results suggest that sympathetic activity decreased after guided relaxation based on yoga, depending on the baseline levels.
Vempati RP1, Telles S.
Psychol Rep. 2002 Apr;90(2):487-94.
Abstract
Objective: To compare the effect of a custom-designed yoga program with 2 other balance training programs. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A group of older adults (N=39; mean age, 74.15 +/- 6.99y) with a history of falling. Interventions: Three different exercise interventions (Tai Chi, standard balance training, yoga) were given for 12 weeks. Main Outcome Measures: Balance performance was examined during pre- and posttest using field tests, including the 8-foot up-and-go test, 1-leg stance, functional reach, and usual and maximal walking speed. The static and dynamic balances were also assessed by postural sway and dynamic posturography, respectively. Results: Training produced significant improvements in all field tests (P<.005), but group difference and time x group interaction were not detected. For postural sway, significant decreases in the area of the center of pressure with eyes open (P =.001) and eyes closed (P =.002) were detected after training. For eyes open, maximum medial-lateral velocity significantly decreased for the sample (P =.013). For eyes closed, medial-lateral displacement decreased for Tai Chi (P<01). For dynamic posturography, significant improvements in overall score (P=.001), time on the test (P=.006), and 2 linear measures in lateral (P=.001) and anterior-posterior (P<001) directions were seen for the sample. Conclusions: Yoga was as effective as Tai Chi and standard balance training for improving postural stability and may offer an alternative to more traditional programs.
Ni, Meng & Mooney, Kiersten & Richards, Luca & Balachandran, Anoop & Sun, Mingwei & Harriell, Kysha & Potiaumpai, Melanie & Signorile, Joseph. (2014).
Archives of physical medicine and rehabilitation. 95. . 10.1016/j.apmr.2014.04.022.
Abstract
OBJECTIVE:
The aim of the present study is to highlight the beneficial effects of yoga practice on bio-parameters, such as oxidative stress, antioxidant components, immune functions, and secretion of stress hormones, in healthy young people.
STUDY DESIGN:
This study was conducted on healthy volunteers recruited from among university students, who were divided into two groups: a control (no yoga intervention, n=13) group and a yoga (n=12) group. Yoga practice was with an instructor for 90 minutes once a week spread over 12 weeks, with recommendations to practice daily at home for 40 minutes with the help of a DVD. The yoga program consisted of yoga body poses (asanas), exercises involving awareness, voluntary regulation of breath (pranayama), and meditational practices. Whole blood samples were collected when the volunteers had fasted for 8 hours at 0 and 12 weeks. The oxidative stress/antioxidant components, immune-related cytokines, and stress hormones were evaluated in serum or plasma.
RESULTS:
Serum levels of nitric oxide, F2-isoprostane, and lipid peroxide were significantly decreased by yoga practice (p<0.05 or p=0.01), whereas serum total glutathione (GSH) contents, activities of GSH-peroxidase, and GSH-s-transferase were remarkably increased after yoga practice compared with the control group (p<0.05 or p=0.01). Yoga practice also significantly increased immune-related cytokines, such as interleukin-12, and interferon-γ, in serum (p<0.05 or p=0.01). Yoga practice significantly reduced the plasma levels of adrenalin (p<0.05) and increased plasma levels of serotonin compared with the control group (p<0.05).
CONCLUSIONS:
Regular yoga practice remarkably attenuated oxidative stress and improved antioxidant levels of the body. Moreover, yoga beneficially affected stress hormone releases as well as partially improved immune function.
Lim SA1, Cheong KJ1.
J Altern Complement Med. 2015 Sep;21(9):530-8. doi: 10.1089/acm.2014.0044. Epub 2015 Jul 16.
Kaushik D, Shah PK, Mukherjee N, Ji N, Dursun F, Kumar AP, Thompson IM Jr, Mansour AM, Jha R, Yang X, Wang H, Darby N, Ricardo Rivero J, Svatek RS, Liss MA. Effects of yoga in men with prostate cancer on quality of life and immune response: a pilot randomized controlled trial. Prostate Cancer Prostatic Dis. 2022 Sep;25(3):531-538. doi: 10.1038/s41391-021-00470-w. Epub 2021 Nov 23. PMID: 34815548; PMCID: PMC9124736.
Abstract
Background: Diagnosis and treatment of prostate cancer is associated with anxiety, fear, and depression in up to one-third of men. Yoga improves health-related quality of life (QoL) in patients with several types of cancer, but evidence of its efficacy in enhancing QoL is lacking in prostate cancer.
Methods: In this randomized controlled study, 29 men newly diagnosed with localized prostate cancer were randomized to yoga for 6 weeks (n = 14) or standard-of-care (n = 15) before radical prostatectomy. The primary outcome was self-reported QoL, assessed by the Expanded Prostate Index Composite (EPIC), Functional Assessment of Cancer Therapy-Prostate (FACT-P), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Functional Assessment of Cancer Therapy-General (FACT-G) at baseline, preoperatively, and 6 weeks postoperatively. Secondary outcomes were changes in immune cell status and cytokine levels with yoga.
Results: The greatest benefit of yoga on QoL was seen in EPIC-sexual (mean difference, 8.5 points), FACIT-F (6.3 points), FACT-Functional wellbeing (8.6 points), FACT-physical wellbeing (5.5 points), and FACT-Social wellbeing (14.6 points). The yoga group showed increased numbers of circulating CD4+ and CD8+ T-cells, more production of interferon-gamma by natural killer cells, and increased Fc receptor III expression in natural killer cells. The yoga group also showed decreased numbers of regulatory T-cells, myeloid-derived suppressor cells, indicating antitumor activity, and reduction in inflammatory cytokine levels (granulocyte colony-stimulating factor [0.55 (0.05-1.05), p = 0.03], monocyte chemoattractant protein [0.22 (0.01-0.43), p = 0.04], and FMS-like tyrosine kinase-3 ligand [0.91 (-0.01, 1.82), p = 0.053].
Conclusions: Perioperative yoga exercise improved QoL, promoted an immune response, and attenuated inflammation in men with prostate cancer. Yoga is feasible in this setting and has benefits that require further investigation.
https://pubmed.ncbi.nlm.nih.gov/34815548/
Patel DI, Almeida GJ, Darby NT, Serra MC, Calderon T, Lapetoda A, Gutierrez B, Ramirez AG, Hughes DC. Therapeutic yoga reduces pro-tumorigenic cytokines in cancer survivors. Support Care Cancer. 2022 Dec 15;31(1):33. doi: 10.1007/s00520-022-07536-y. PMID: 36517621; PMCID: PMC9750838.
Abstract
Introduction
Chronic inflammation can remain many years after the completion of cancer treatment and is associated with cancer recurrence. The purpose of this study was to examine how a 16-week therapeutic yoga program (TYP) modulates the cytokine profile in heterogeneous cancer survivors.
Methods
Eligible participants were 18 years of age or older and clinically diagnosed with cancer. Consenting participants were asked to attend three, 75-min sessions weekly of TYP with meditation. Seventeen patients provided blood samples at baseline and end of study. Eight cytokines (interferon (IFN)-γ; interleukin (IL)-1b, IL-1ra, IL-4, IL-6, IL-8, IL-10; and tumor necrosis factor (TNF)-α), three receptors (sIL-6R, sTNFRI, sTNFRII), and C-reactive protein (CRP) were quantified.
Results
Patients were 59.6 ± 7.3 years old; over half (56%) were overweight or obese BMI ≥ 25 kg/m2); majority were female (71%) and breast cancer survivors (65%), of which 44% were Hispanic. Marked reductions were observed in all cytokines except IL-4, with significant reductions (p < 0.05) found in IL-1b (− 13%) and IL-1ra (− 13%). No significant changes were observed in soluble cytokine receptors or CRP.
Conclusions
TYP led to significant reduction in circulating cytokines associated with chronic inflammation in a heterogeneous sample of cancer survivors.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00520-022-07536-y.
Keywords: Recurrence, Survivorship, Physical activity, Immunology, Body composition
https://pmc.ncbi.nlm.nih.gov/articles/PMC9750838/
Ortiz A, Darby N, Almeida G, Calderon T, Patel D, Zhang T, Hughes DC. Physical Performance Effects Associated with a 16-Week Therapeutic Yoga Intervention in Survivors of Cancers in the South Texas Region: A Pilot Study. Int J Yoga Therap. 2024 Dec 1;34(2024):Article 21. doi: 10.17761/2024-D-24-00013. PMID: 39696883.
Abstract
Yoga is recognized as a complementary practice that improves physical, mental, and spiritual health in survivors of cancer. The present study assessed associations between a holistic approach and physical function for 30 survivors of cancer in south Texas. Cancer survivors (86% female) of diverse backgrounds (62% underrepresented minorities) performed a battery of physical function tests, including a 6-minute walk test, to assess cardiorespiratory function, isometric shoulder and elbow-flexor strength, dominant-arm grip strength, dominant-arm shoulder range of motion via inclinometer, sit-and-reach test to assess trunk and lower-extremity flexibility, and a 30-second sit-to-stand test to assess lower-extremity endurance. Participants were reassessed 16 weeks after starting the intervention. The intervention involved a 75-minute live-streamed therapeutic yoga program, including meditation, three times a week and daily psychosocial support text messaging through a telehealth platform to increase efficacy in promoting health-enhancing behaviors. Repeated-measures analysis of variance was used to assess changes in physical performance between sessions. Statistically significant improvements were observed for the 6-minute walk test (+35.68 m; p = 0.020), elbow-flexor strength (+7.44 kg; p < 0.001), dominant-hand grip strength (+3.19 kg; p < 0.004), sit-and-reach test (+5.25 cm; p = 0.010), and dominant-arm shoulder range of motion in flexion (+11.18 degrees, p = 0.012) and abduction (+17.06 degrees, p = 0.036). A 16-week live-streamed therapeutic yoga intervention performed three times a week, coupled with daily psychosocial support messaging, was associated with improved cardiorespiratory endurance by increasing the distance walked in 6 minutes, improving upper-extremity strength and range of motion, and increasing the flexibility of back and hamstring muscles.
Keywords: aging; cardiorespiratory function; mobility; strength; therapeutic yoga.
https://pubmed.ncbi.nlm.nih.gov/39696883/
Hughes DC, Gorzelitz J, Ortiz A, Cohen L, Parma DL, Boggess T, Darby NT, Balaji S, Ramirez AG. Impact of Six Months of Three Different Modalities of Exercise on Stress in Post-Treatment Breast Cancer Survivors. Cancers (Basel). 2024 Oct 4;16(19):3398. doi: 10.3390/cancers16193398. PMID: 39410018; PMCID: PMC11475836.
Abstract
Background/objectives: Extensive evidence suggests that exercise is physically and mentally beneficial for cancer survivors. This study reports on changes in self-reported stress, physiological biomarkers for stress (salivary cortisol), and HR-QOL constructs for fifty breast cancer survivors participating in one of three different exercise programs over 6 months.
Methods: Fifty post-treatment breast cancer survivors were randomized to either therapeutic yoga-based exercise (YE), comprehensive exercise (CE) (aerobic, resistance, flexibility), or choosing (C) their own exercise activities. Participants completed the Perceived Stress Scale (PSS), Medical Outcomes Short-Form 36® (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). Five samples of salivary cortisol were collected on two consecutive days. The 10 samples were used to calculate the diurnal rhythm slope. Outcome measures were repeated after six months.
Results: All groups improved in HR-QOL measures of PSS; PSQI sleep quality components of latency and daytime functioning; and five of the ten SF-36 scales (Mental Component Scale, Social Functioning subscale, Mental Health subscale, Physical Component Scale, Physical Functioning subscale). Although the CE group observed the most favorable change in cortisol (-0.183), where cortisol slope changes approached significance (p = 0.057), but no significant decrease in cortisol between groups were noted.
Conclusions: Our results suggest that it is the engagement of, rather than the specific type of exercise, which is associated with improved HR-QOL. However, longer-term studies with better adherence monitoring and larger sample sizes are needed to better determine clinical impact.
Keywords: breast cancer; cortisol; exercise; stress; yoga.
https://pubmed.ncbi.nlm.nih.gov/39410018/
Miller MJ, Hughes DC, Darby NT, Calderon T, Patel DI, Serra MC, Ramirez AG, Ortiz A, Almeida GJ. Balance Changes in Adult Cancer Survivors Participating in a 16-Week Therapeutic Yoga Program. Integr Cancer Ther. 2025 Jan-Dec;24:15347354241313048. doi: 10.1177/15347354241313048. PMID: 39811878; PMCID: PMC11733873.
Abstract
Introduction: Balance problems arising from cancer and its treatments can significantly impact daily functionality and quality of life. Improving balance as part of a cancer treatment plan could result in better patient outcomes. Thus, the aim of this study was to determine whether an integrative therapeutic yoga intervention can improve balance in a heterogenous population of cancer survivors (CS).
Methods: This is a secondary analysis of data from a 16-week feasibility study where therapeutic yoga was supplemented with psychosocial support to maximize health-related quality of life in adult CS of any stage and site. In this study, we investigated balance, as it has been shown to be an important outcome in CS due to its role in physical function and quality of life. The intervention included therapeutic yoga three times per week for 16 weeks and daily psychosocial support provided via text message. Participants’ balance was assessed while standing on a pressure mat with feet together, eyes opened and closed, for 30 seconds in each condition. Data on the “sway path distance” (displacement of the center of gravity) in the two conditions were obtained. Changes in balance after the intervention (from baseline to follow-up) were analyzed using paired-sample t-tests. Changes in balance were also assessed using responder analysis. We described the proportion of participants that improved their balance or not based on 10% difference from baseline scores.
Results: Of the 29 participants included, 22 (76%) completed post-assessments. Changes in both balance assessment conditions were not statistically significant (eyes opened: 80.06 ± 374.99, p = .702; eyes closed: -1.82 ± 24.01, p = .068). Responder analysis showed that 8 participants improved their balance with eyes opened, while 8 worsened, and 6 did not change. Analysis of balance with eyes closed showed that 5 improved, 8 worsened, and 9 did not change.
Conclusion: This secondary analysis of data from a heterogenous cohort of adult CS did not support our hypothesis at the group level. However, at the individual level, responder analysis indicated improved balance in some survivors. Future research is needed to determine factors related to the cancer experience which might mediate balance outcomes to inform better integrative interventions.
Keywords: balance; cancer survivorship; functionality; yoga.
https://pubmed.ncbi.nlm.nih.gov/39811878/
