Multicenter, Randomized Controlled Trial of Yoga for Sleep Quality Among Cancer Survivors

Abstract

Purpose Thirty percent to 90% of cancer survivors report impaired sleep quality post-treatment, which can be severe enough to increase morbidity and mortality. Lifestyle interventions, such as exercise, are recommended in conjunction with drugs and cognitive behavioral therapy for the treatment of impaired sleep. Preliminary evidence indicates that yoga—a mind-body practice and form of exercise—may improve sleep among cancer survivors. The primary aim of this randomized, controlled clinical trial was to determine the efficacy of a standardized yoga intervention compared with standard care for improving global sleep quality (primary outcome) among post-treatment cancer survivors. Patients and Methods In all, 410 survivors suffering from moderate or greater sleep disruption between 2 and 24 months after surgery, chemotherapy, and/or radiation therapy were randomly assigned to standard care or standard care plus the 4-week yoga intervention. The yoga intervention used the Yoga for Cancer Survivors (YOCAS) program consisting of pranayama (breathing exercises), 16 Gentle Hatha and Restorative yoga asanas (postures), and meditation. Participants attended two 75-minute sessions per week. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index and actigraphy pre- and postintervention. Results In all, 410 survivors were accrued (96% female; mean age, 54 years; 75% had breast cancer). Yoga participants demonstrated greater improvements in global sleep quality and, secondarily, subjective sleep quality, daytime dysfunction, wake after sleep onset, sleep efficiency, and medication use at postintervention (all P ≤ .05) compared with standard care participants. Conclusion Yoga, specifically the YOCAS program, is a useful treatment for improving sleep quality and reducing sleep medication use among cancer survivors.

Post-operative exercises after breast cancer surgery: Results of a RCT evaluating standard care versus standard care plus additional yoga exercise

“…Reviews and metaanalyses evaluating the effect of yoga in randomised controlled trials (RCT) in women with breast cancer conclude there is moderate to good evidence that yoga may be a useful practice during recovery from treatment [11][12][13]. Despite an emerging number of large RCTs measuring the effectiveness of yoga on fatigue [14,15], sleep quality [16], QoL [17], and during radiotherapy [18], there is scope for more investigation into its physical benefits, in particular its role following breast cancer surgery.…”

Energy Expenditure in Yoga versus Other Forms of Physical Activity

“…In addition, yoga has been shown to have health benefits that include; decreased stress, 10,11 mitigation of pain symptoms, 12-14 improved mood and diminished depression, 15,16 increased flexibility, 17,18 and enhanced sleep. 19,20 Yoga has also been shown to reduce resting blood pressure and heart rate 21 and to potentially impact negative agerelated cardiovascular effects. 22 Given these findings, Vinyasa yoga may be a viable form of physical activity to elicit significant health benefits.…”

“…While not the focus of this study, these benefits may include decreased stress, 10,11 a mitigation of pain, 12-14 enhanced mood and diminished depression, 15,16 increased flexibility, 17,18 and enhanced sleep, 19,20 and these may contribute to improved weight control. Moreover, adults with obesity may experience additional health benefits from yoga that include reductions in resting blood pressure and heart rate.…”

“…9 Often seen as a healing, alternative medicine, yoga is supported by evidence to decrease stress, 10,11 mitigate pain, [12][13][14] enhance mood and diminish depression, 15,16 increase flexibility, 17,18 and to enhance sleep. 19,20 In addition, yoga has been shown to reduce resting blood pressure and heart rate 21 and to potentially impact negative age-related cardiovascular effects. 22 However, yoga has not been extensively studied to determine its potential impact as a form of physical activity to prevent and treat obesity.…”

Commentary on the Non-Pharmacological Treatment of Restless Legs Syndrome

“…Yoga, specifically the YOCAS program significantly enhanced sleep quality in cancer survivors [6]. Wang et al 2015 reviewed the literature on the effect of meditative techniques on sleep quality.…”