Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research

Abstract

Background Myeloproliferative neoplasm (MPN) patients suffer from significant symptoms, inflammation and reduced quality of life. Yoga improves these outcomes in other cancers, but this hasn’t been demonstrated in MPNs. The purpose of this study was to: (1) explore the limited efficacy (does the program show promise of success) of a 12-week online yoga intervention among MPN patients on symptom burden and quality of life and (2) determine feasibility (practicality: to what extent a measure can be carried out) of remotely collecting inflammatory biomarkers. Methods Patients were recruited nationally and randomized to online yoga (60 min/week of yoga) or wait-list control (asked to maintain normal activity). Weekly yoga minutes were collected with Clicky (online web analytics tool) and self-report. Those in online yoga completed a blood draw at baseline and week 12 to assess inflammation (interleukin-6, tumor necrosis factor- alpha [TNF-α]). All participants completed questionnaires assessing depression, anxiety, fatigue, pain, sleep disturbance, sexual function, total symptom burden, global health, and quality of life at baseline, week seven, 12, and 16. Change from baseline at each time point was computed by group and effect sizes were calculated. Pre-post intervention change in inflammation for the yoga group was compared by t-test. Results Sixty-two MPN patients enrolled and 48 completed the intervention (online yoga = 27; control group = 21). Yoga participation averaged 40.8 min/week via Clicky and 56.1 min/week via self-report. Small/moderate effect sizes were generated from the yoga intervention for sleep disturbance (d = − 0.26 to − 0.61), pain intensity (d = − 0.34 to − 0.51), anxiety (d = − 0.27 to − 0.37), and depression (d = − 0.53 to − 0.78). A total of 92.6 and 70.4% of online yoga participants completed the blood draw at baseline and week 12, respectively, and there was a decrease in TNF-α from baseline to week 12 (− 1.3 ± 1.5 pg/ml). Conclusions Online yoga demonstrated small effects on sleep, pain, and anxiety as well as a moderate effect on depression. Remote blood draw procedures are feasible and the effect size of the intervention on TNF-α was large. Future fully powered randomized controlled trials are needed to test for efficacy. Trial registration This trial was retrospectively registered with clinicaltrials.gov (ID: NCT03503838 ) on 4/19/2018.

Yoga for depression and anxiety symptoms in people with cancer: A systematic review and meta‐analysis

“…After removal of duplicate studies and exclusion during the title and abstract level review, 46 full texts remained. Following application of the eligibility criteria, 26 articles were eligible for inclusion 44–68 . Reasons for exclusion of the other 21 articles is presented in Table S1.…”

“…Eighteen studies were conducted in participants diagnosed with breast cancer (the study by Culos‐Reed et al. was primarily in breast and therefore included in this group), 45,47,49–53,56–59,62–68 two studies in mixed cancers, 46,69 and one study each in the following cancers: colorectal, 55 lymphoma, 54 thoracic, 61 head and neck, 44 myeloproliferative neoplasms 48 and glioma 60 …”

“…Participants in eight studies had completed conventional cancer treatment (e.g., surgery, chemotherapy,and radiation), 44,45,52,56–58,65,68 participants in twelve studies were undergoing treatment at the start of the study, 47,50,51,53,59–64,66,67 and participants in six studies were at various stages of cancer treatment 46,48,49,54,55,69 …”

Impact of Host, Lifestyle and Environmental Factors in the Pathogenesis of MPN

“…One possible mechanism could be due to the influence of increased adiposity in the bone marrow which leads to enhanced megakaryocyte maturation and accelerated proplatelet formation in mice [80]. Interventions using yoga in MPN have been performed [81,82], however no interventional studies using more rigorous physical activity with the intent of weight reduction in MPN have been performed.…”

The Society for Integrative Oncology Practice Recommendations for online consultation and treatment during the COVID-19 pandemic

“…Two were systematic reviews [ 21 , 22 ], six were clinical trials [ 23 – 28 ], and one was an observational study [ 29 ]. While these articles concluded that integrative oncology therapies, such as mind-body and behavioral therapies [ 22 , 23 , 25 – 28 ], yoga [ 24 ], and exercise [ 21 ], could be feasibly offered in a virtual format and positively affect physical and psychosocial well-being, symptom management, and overall quality of life, limited pragmatic recommendations were provided regarding how to address the unique challenges of online integrative consultations/treatment. The studies examining the feasibility of online interventions provided the most useful suggestions, including the need to maintain the confidentiality of online group sessions, provide initial and on-going technical support, and address slow Internet access and limited technological knowledge [ 25 – 28 ].…”