Evidence-Based Complementary and Alternative Medicine / 2012 / Article / Tab 1

Review Article

The Evolution of Mindfulness-Based Physical Interventions in Breast Cancer Survivors

Table 1

Summary of studies involving yoga interventions in breast cancer survivors (in order of the publication date).

Reference Intervention (type/duration)Study designN and characteristics Main outcomesResults/comments (group by time interactions reported for the controlled studies and time effects for noncontrolled studies)

Galantino et al. [24], 2012Hatha yoga
10 weeks, 90′ sessions, 2x/week
One-arm qualitative, exploratory design10
Aromatase inhibitors associated arthralgias
Performance accomplishment
Structured experience
Verbal support
Physical feedback
Themes discovered:
 (i) empowerment (importance of  camaraderie, community, and sharing)
 (ii) pain relief
 (iii) increased physical fitness (energy,  flexibility, and function); relieved stress/anxiety
 (iv) transferability of yoga through breathing

Bower et al. [17], 2011Iyengar yoga versus health education
12 weeks, 90′ sessions, 2x/week
Persistent fatigue
Stages I-II
Fatigue (FSI)
Vigor (MFSI)
Depression (BDI-II)
Sleep (PSQI)
Decreased fatigue *  
Increased vitality*  
Increased vigor*  
More  confident on managing fatigue*  
Decreased depressive symptoms*  
No difference in sleep

Galantino et al. [9], 20118 weeks, twice a weekOne arm 10
Postmenopausal with AIs-induced arthralgias
Balance (Functional reach)
Flexibility (Sit and Reach)
Pain (BPI)
Function (PSFS)
Improvements in balance, flexibility, function, pain severity, and QOL  
Trend towards reduced pain interference
80% adherence to the home program

Banasik et al. [25], 2011Iyengar yoga versus wait list
8 weeks, 90′ sessions, 2x/week
Stage II-IV
Fatigue Likert scale
Salivary cortisol
No difference in QOL
Decreased fatigue*  
No difference in the slope of cortisol

T. Kovačič and M. Kovačič [26, 27], 2011Yoga in daily life system + PT versus PT
4 weeks
RCT 32
Immediately after surgery
Self-esteem (RSES)
General health (GHQ-12)
Symptoms (RSCL)
Stress (PSS)
Improved self-esteem *  
Less distress during hospitalization and afterwards*  

Littman et al. [28], 2011Viniyoga (at home or classes) versus wait list
5x/week for 6 months
Obese and overweight women (BMI ≥ 24)
Feasibility (time to recruit, retention, adherence)
Fatigue (FACIT-F)
Weight and height
Waist and hip circumference
12 months to recruit
Attendance was 20 classes and 56 at home practices in 6 months
51% were satisfied the program
Trend towards improved QOL and fatigue
Decreased waist circumference by3.1cm*  
No change in weight, BMI, and hip circumference

Bower et al. [29], 2011Iyengar yoga
12 weeks, 90′ sessions, twice weekly
One arm 12
Persistent fatigue
Fatigue (FSI)
Depression (BDI-II)
Sleep (PSQI)
QOL (SF-36)
Physical function (8-foot walk test, chair stands)
Program Evaluation
Decreased fatigue and number of days with fatigue/week *  
Improved vitality, depression, and general health*  
No difference in sleep
Trend towards decreased pain
All improvements persisted at 3 months after intervention*  
Improvement in physical function*  
High satisfaction with the program

Desai et al. [30],
Any type of yogaSurvey of yoga use300
Users of AIs
Sociodemographics of yoga
17.7% breast cancer survivors used versus 6% in general population
Yoga use associated with white race, lower BMI, higher education, higher socioeconomic status, part-time employment, stage II cancer,previous chemotherapy, and previous radiotherapy*  
In multivariate analysis, yoga use was associated with higher education and lower BMI*  

Speed-Andrews et al. [31], 2010Iyengar yoga
12 week classes
One arm 24QOL (SF-36, FACT-B)
Fatigue (FSI)
Stress (PSS)
Anxiety (STAI)
Depression (CESSDS)
Body image (brief body image scale)
Self-esteem (Rosenberg Self-Esteem Scale)
Happiness (the happiness measure)
Motivational outcomes
Program evaluation
Improved generic QOL (mental health,  vitality,  pain, and roleemotional) *  
Trend of improvement in breast specific-QOL
Trend of improvement on stress, depression, body image, and self-esteem
Strong motivational response
Very high satisfaction with the program, very high perceived benefit

Ülger and Yaǧli [32], 20108 yoga sessionsOne arm20QOL (NHP)
Stress (STAI-I, STAI-II)
Satisfaction with the program
Improved QOL *  
Decreased anxiety*  
High satisfaction with yoga program

Chandwani et al.
[33], 2010
yoga versus wait list
6 weeks 2x/week
Undergoing radiotherapy
Meaning finding
Intrusive thoughts
Improved health perception, physical functioning scores, more intrusive thoughts, and greater meaning finding *  
No difference in fatigue, depression, sleep

Vadiraja et al. [34], 2009Integrated yoga program (18–24, 60′ sessions) plus brief supportive therapy (every 10 days) versus brief supportive therapy (every 10 days)RCT88
Stage II-III
Undergoing radiotherapy
QOL (EORTCQOL C30) functional scales
Affect (PANAS)
Improved positive affect *  
Improved emotional function*  
Improved cognitive function*  
Decrease in negative affect*  
Positive correlation between positive affect and physical, emotional, cognitive, and social function and global QOL * 

Carson et al. [35], 2009Yoga of awareness versus wait list
8 weeks
Stage I-II
Hot flashes before, after, and at 3 months after interventionDecreased hot flash frequency, severity, and total score *  
Improved joint pain, fatigue, sleep, bother, vigor, negative mood* (maintained at 3 months) More time practicing  positively correlated with less fatigue, less bother, and more acceptance *    

Vadiraja et al. [36], 2009Integrated yoga program (18–24, 60′ sessions) plus brief supportive therapy (every 10 days) versus brief supportive therapy (every 10 days)RCT88
Stage II-III
Undergoing radiotherapy
6 AM salivary cortisol level before and after radiotherapy
Self-rated anxiety, depression, and stress before and after radiation therapy
Significant decreased anxiety, depression, perceived stress, and salivary cortisol *  
Cortisol level positively correlates with anxiety and depression *    

Vadiraja et al. [37], 2009Integrated yoga program (18–24, 60′ sessions) plus brief supportive therapy (every 10 days) versus brief supportive therapy (every 10 days)RCT88
Stage II-III
Undergoing radiotherapy
Symptoms (RSCL)
QOL (EORTCQOL C30) symptom scale
Decreased fatigue *  
Decreased insomnia*  
Decreased appetite loss*  
Decreased psychological distress*  
No change in physical distress
No change inactivity level
Distress positively correlated with fatigue, nausea, vomiting, pain, dyspnea, insomnia, appetite loss, and constipation

Danhauer et al.
[38], 2009
Restorative yoga versus wait list
Weekly 75′ sessions × 10 weeks
34% in active treatment
Physical Health (SF-12)
Fatigue (FACT-Fatigue)
Spiritual well-being (FACIT-Sp)
Depression (CES-D)
Sleep (PSQI)
Affect (PANAS)
Program Evaluation
Improved mental health, depression, positive affect, and spirituality *  
Greatest benefit on participants with higher negative affect and lower emotional well-being at baseline*  
Trend towards decreased sleep latency and increased QOL
Recruitment 19%, adherence 58%- higher in women with higher baseline physical health and QOL
High satisfaction with class, no adverse events

Rao et al. [39], 2009Integrated yoga program (1–7 weekly 60′ sessions for 24 weeks) plus 3-4 brief supportive therapy every 10 days versus brief supportive therapy every 10 daysRCT98
Stage II-III
Anxiety (STAI)
Symptom checklist
Decreased anxiety andsymptom severity *  
Anxiety states positively correlate with symptoms severity and distress *   

Rao et al. [40, 41],
Integrated yoga program versus supportive therapy + exercise rehabilitation
4 weeks
Stage II-III
Immediately at diagnosis
Anxiety (STAI)
Depression (BDI)
Symptom checklist
Hospital stay
Drain retention
Time to suture removal
Postoperative complications
Decreased anxiety, depression, and treatment-related symptoms after surgery *  
Increased QOL after surgery Less decrease in CD56% after surgery*  
Decrease in IgA levels after surgery*  
Significant decrease in hospital stay, drain retention, days to suture removal*  
Decreased TNFαafter surgery*  

Danhauer et al.
[42], 2008
Restorative yoga
Weekly 75′ sessions × 10 weeks
One-arm pilot 51
Breast and ovarian cancer ( 𝑁 = 1 4 with breast cancer)
Physical Health (SF-12)
Spiritual well-being (FACIT-Sp)
Fatigue (FACT-Fatigue)
Depression (CES-D)
Anxiety (STAI)
Affect (PANAS)
Program evaluation
Improvedmental health, QOL, fatigue, depression, state anxiety, and negative effect *  
No change in positive affect and spiritual well-being
Better adherence was associated with better physical health
High satisfaction with the program (88% positive)

Rao et al. [43],
Integrated yoga versus brief supportive therapyRCT37
Stage II-III
Active cancer treatments
NK cell % after surgery, radiation, and chemoNK cell% was higher after chemo *  
No difference in NK percentage after surgery and after chemo

Raghavendra et al.
[44], 2007
Integrated yoga by instructor (at chemo and every 10 days and at home 60′ daily) versus supportive therapy (30–60′ at chemo and every 10 days)RCT62
Stage II-III
Post radiation
Undergoing chemotherapy
Nausea and emesis (MANE)
Anxiety (STAI)
Depression (BDI)
Symptom check list
Treatment-related toxicity and side-effects (WHO Toxicity criteria)
Reduced frequency and intensity of chemo-associated nausea *  
Trend towards reduced frequency and intensity of chemo-associated vomiting*  
Reduced  intensity and frequency of anticipatory nausea and vomiting*  
Nausea and vomiting (both anticipatory and after chemo),   positively correlated with anxiety, depression, distress, and chemo-related toxicity and negatively with QOL*  
Decreased anxiety, depression, and distress*  
Increased QOL*  
Decreased treatment toxicity *  *  

Moadel et al. [45], 2007Hatha yoga versus wait list
12 weekly −90′ sessions
Ethnically diverse
Fatigue (FACIT-F)
Spirituality (FACIT-Sp)
Depressed mood Index
mood (POMS)
Program evaluation
Less decrease in social well-being *  
Subgroup analysis for nonchemo patients: improved QOL, emotional, social, and  spiritual well-being,  distressed mood, anxiety, and irritability*  
Adherence was positively associated with physical well-being and negatively associated with fatigue and distressed mood*  
Breathing and meditation components were rated higher than the social connection

Banerjee et al. [46], 2007Integrated yoga versus supportive counseling plus light exercise
90′ sessions for 6 weeks, frequency not specified
RCT 68
Radiation therapy
Anxiety/depression (HADS)
Stress (PSS)
DNA damage assay
Decreased anxiety, depression perceived stress, and DNA damage *  

Carson et al. [47], 2007Yoga of awareness
Weekly sessions for 8 weeks
One arm 21
Metastatic disease
Daily measures of pain, fatigue, distress, invigoration, acceptance, and relaxation
Focus group feedback
Focus Group Questionnaire
Increase in daily invigoration and acceptance *  
Trend towards improvements in pain and relaxation
Greater yoga practice positively associated with decreased pain, increased invigoration, and acceptance*  
Greater yoga practice positively associated with decreased next-day pain and fatigue and increased invigoration, relaxation, and acceptance*  
Program was considered overall very helpful

Culos-Reed et al. [48], 2006 Modified Hatha yoga versus wait list
7 weeks of weekly 75′ sessions
RCT 38Mood (POMS)
Response to stress (SOSI)
Physical activity (LSI)
Fitness (CPA-FLA)
Improvements in  QOL, emotional functioning, and diarrhea *  
Trend toward improved emotional irritability, gastrointestinal symptoms, cognitive disorganization, mood, tension, depression, and confusion
No difference in physical activity and fitness

AIs: Aromatase Inhibitors; BCPTSS: Breast Cancer Symptom Scale; BDS: Beck Depression Scale; BDI: Beck Depression Inventory; BPI: Brief Pain Inventory; CAM: Complementary and Alternative Medicine; CES-D: Center for Epidemiologic Studies-Depression Scale; CPA-FLA: Canadian Physical Activity, Fitness and Lifestyle Appraisal; EORTC QLQ-C30: European Organization for Research and Treatment Core Quality of Life Questionnaire-C30; FACT-B: Functional Assessment of Cancer Therapies-Breast; FACT-G: Functional Assessment of Cancer Therapies-General; FACIT-F: Functional Assessment of Chronic Illness Therapy-Fatigue; FACIT-Sp: Functional Assessment of Chronic Illness Therapy-Spirituality; FLIC: Functional Living Index for Cancer; FSI: Fatigue Symptom Inventory; GHQ-12: General Health Questionnaire-12; HADS: Hospital Anxiety and Depression Scale; IL-2R: Interleukin 2 Receptor; INF: Interferon; LOT-R: Life Orientation Test-Revised; LSI: Leisure Score Index; MANE: Morrow Assessment of Nausea and Emesis; MFSI: Multidimensional Fatigue Symptom Inventory; NHP: Nottingham Health Profile; PANAS: Positive and Negative Affect Schedule; POMS: Profile of Mood States; PSFS: Patient-Specific Functional Scale; PSQI: Pittsburgh Sleep Quality Inventory; PSS: Perceived Stress Scale; RCT: randomized controlled study (yoga versus control group); QOL: Quality of Life; RSCL: Rotterdam Symptom Checklist; RSES: Rosenberg; Self-Esteem Scale; SF-12: Short Form-12 Health Survey; SF-36: Medical Outcome Studies Short Form; SOSI: Symptoms of Stress Inventory; STAI: State Trait Anxiety Inventory; TNF: Tumor Necrosis Factor; bold text with*  : statistically significant ( 𝑃 < 0 . 0 5 ).