Bending the Rules

CURE, Spring 2011, Volume 10, Issue 1

Yoga has earned accolades as a complementary therapy, and now studies are confirming its value.

Meghan Kearney, a social worker in San Francisco, calls yoga her savior. In 2007, 32-year-old Kearney underwent a mastectomy and chemotherapy for stage 1 breast cancer.

“During all my surgeries and treatment, I felt like my body was not my own,” she says. “All the doctors had far more control over my body than I did.” Kearney says she began practicing yoga around two years after diagnosis. “I started very slowly. I was still in pain from my surgeries, and the rest of my body was very tight from all the stress.”

She began taking weekly restorative yoga classes and found two postures—chest opener and hip opener—to be very helpful.

“Yoga has been amazing, calming my body and my mind. Especially as I face a second potential diagnosis of cancer, the only thing that has kept me calm physically and mentally has been yoga.”

Anecdotal evidence supporting the benefits of yoga for improving the quality of life for cancer patients and survivors has led to its acceptance as a complementary therapy, and new studies on yoga for specific long-term effects may expand that acceptance even further.

Yoga as a philosophy and practice has existed for centuries. While its roots are thought to be in India, yoga is varied and is practiced in several different forms around the world (see sidebar). In the U.S., yoga commonly involves synchronizing various postures (asanas) and breathing methods (pranayama) in conjunction with meditation to release tension and increase a calm state of mind.

Last summer at the American Society of Clinical Oncology (ASCO) annual meeting, researchers from the University of Rochester Medical Center in Rochester, N.Y., presented results of a four-week yoga program created for cancer survivors that indicated yoga can reduce fatigue and improve sleep in cancer survivors.

Karen Mustian, PhD, an assistant professor of radiation oncology and community and preventive medicine at the University of Rochester Medical Center and an exercise psychologist specializing in cancer, oversaw the study, which included 410 non-metastatic cancer survivors. Although breast cancer survivors represented 75 percent of this group, survivors of all cancer types were initially recruited with the qualification of having sleep disturbances in the previous two years after completing treatment.

“Because many cancer survivors still have unresolved fatigue after treatment, we wanted to see if yoga could help reduce that quality-of-life issue,” Mustian says.

Each week, study participants had two, 75-minute sessions for the four weeks using YOCAS (Yoga for Cancer Survivors), which was developed by Mustian and her team. This program included breathing exercises, gentle Hatha and restorative yoga postures and mindfulness exercises. Postures included those performed in standing, sitting and lying positions.

Because many cancer survivors still have unresolved fatigue after treatment, we wanted to see if yoga could help reduce that quality-of-life issue.

Of study participants, 22 percent had improved sleep compared with 12 percent in the group who did not participate in the yoga classes. But the largest improvement was in the reduction of fatigue: Yoga participants showed a 42 percent reduction in their fatigue symptoms while those who did not participate had only a 12 percent reduction in fatigue. Mustian says many of the poses created were modified from traditional yoga, including using bolsters and pillows or doing postures standing, seated or lying down.

“This study was short-term, and the results we saw might not be applicable to all individuals in the cancer community. We need to do more studies to see the long-term benefits of yoga programs,” Mustian says.

While Mustian’s study focused on fatigue and insomnia, other yoga studies have examined other quality-of-life issues. In a 2007 study, Alyson Moadel, PhD, and Chirag Shah, MD, a certified yoga instructor and oncologist at the Albert Einstein College of Medicine at Montefiore Medical Center in Bronx, N.Y., worked with a group of underserved breast cancer patients and survivors to determine if yoga would improve their quality of life. Around half were in treatment, which included chemotherapy, radiation or hormonal therapy, during the study, which was published in 2007 in the Journal of Clinical Oncology. The 128 participants were divided into a group assigned to a yoga class once a week (but could participate more than once, if desired) for 12 weeks, and the remainder were put on a wait list for the classes.

Shah modified yoga positions to meet the needs of the participants. According to Moadel, the program included physical stretches and poses, breathing exercises and meditation. All exercises were performed in a seated or reclining position with blocks, mats and blankets used for support. Participants were given audiotapes to practice yoga at home. In the group that participated in the yoga classes, 13 percent showed improvements in quality-of-life issues, such as mood and emotional well-being, versus only 2 percent in the wait-listed participants. The wait-list group showed a greater decrease in social well-being, 13 percent compared with 2 percent for patients in the yoga classes.

Researchers hypothesized that even though yoga did not improve social well-being, “It may have served to promote a sense of social support and connection.”

How and why yoga improves mood is yet to be determined, but a 12-week study conducted by Chris C. Streeter, MD, a psychiatrist at the Boston University School of Medicine, provided some interesting clues. Streeter randomized 34 healthy adults to either a 60-minute yoga session or a 60-minute walking program three times a week.

Before the participants engaged in yoga or walking, the level of the brain neurotransmitter gamma-aminobutyric acid (GABA) was measured by using MRI technology. After the activities, participants were tested again.

“We know that in people who are depressed, GABA is low,” Streeter says, “and when you treat them, the GABA level goes up.”

Streeter found that the GABA levels of those who took part in yoga increased while the walkers’ levels did not. He was quick to point out that this research was not to determine which activity was better but to examine activities with similar metabolic demands.

“The differences weren’t huge,” Streeter says, “but what was highly significant was that those who did yoga felt better. They were less anxious and their mood went up.”

Streeter says the results indicate that a behavioral intervention such as yoga, which is associated with chemical changes and better mood, should be used as an adjunct to help people feel better.

“This is a hard-core measurement to [support] what people have been saying for years,” Streeter says. “The science is catching up with the practice.”