By Keith I. Block, MD
Many people facing a diagnosis of cancer are looking for ways to release stress and tension. Yoga and mindfulness training -- that is, practices intended to cultivate present-moment awareness and relaxation -- are two of the best-studied options in this regard. But can such practices really help people with cancer? To answer this question, in this blog posting I examine some of the most recent research findings concerning the potential benefits of yoga and mindfulness after a cancer diagnosis.
First off, there is little doubt that yoga can play a key role in helping you relax and enjoy a better quality of life, as indicated by a meta-analysis published online ahead-of-print in the 9 March 2011 issue of Evidence-Based Complementary & Alternative Medicine. This analysis included a total of 10 studies in which cancer patients practicing yoga were compared to those not practicing yoga or receiving nothing more than “supportive therapy.” Based on comprehensive psychological assessments and pooling the findings from all ten studies, the yoga groups showed statistically significant lower levels of anxiety, emotional distress, depression, and overall stress, when compared to the cancer patients in the control group.
Yoga incorporates a blend of elements: relaxation, meditation, imagery, controlled breathing, stretching and movement. Of my patients who practice yoga and/or mindfulness training on a regular basis, most report a greater sense of calm and improved sleep. Also, yoga can help with recovery from cancer treatments. For example, breast cancer patients may experience limited arm motion due to scarring from surgery and radiotherapy; yoga can increase flexibility as well as range of motion in the affected arm.
I mentioned above that better sleep is among the frequently reported benefits of practicing yoga. Exercise and sleep do seem to go hand in hand. Over the years, I have met many people who swear by this interrelationship: the better their exercise habits, the deeper and more satisfying their sleep tends to be. And because cancer patients frequently have problems with sleep, there is good reason to consider sleep as one of the worthwhile benefits of an integrative physical care program that includes yoga and possibly mindfulness training as well.
Researchers at the M. D. Anderson Cancer Center in Houston, Texas, recently conducted a randomized trial of cancer patients practicing Tibetan yoga, which involves a combination of movement and meditation. Reporting in a 2004 issue of the journal Cancer, Lorenzo Cohen, Ph.D., and his M.D. Anderson colleagues found that those patients who practiced Tibetan yoga for seven weeks had better overall sleep quality compared with lymphoma patients who did not practice yoga. The yoga-practicing patients went to sleep faster, slept longer, and used less sleep medication than their non-practicing counterparts.
All of the patients in the yoga group reported that they found the program was beneficial, and over half the group said they practiced at least twice a week during the follow-up period. While there was a trend toward improvement in such factors as fatigue, depression, and anxiety, the only statistically significant difference between the two groups was sleep quality. As might be expected, patients practicing Tibetan yoga also had better energy levels and less daytime sleepiness.
Developed over thousands of years, the movements of Tibetan yoga are gentle and subtle. The two forms used in the intervention group, called Tsa lung and Trul khor, involve controlled breathing, visual imagery, and maintaining awareness of the present moment. Dr. Cohen hypothesized that Tibetan yoga might serve as a stress reduction practice for people with cancer—much like going to the gym is for many people who sit behind a desk all day. Based on the study’s outcome, he concluded that Tibetan yoga is particularly useful for people receiving and recovering from chemotherapy. In addition, one of the key findings in studying cancer patients who practice Tibetan yoga is that they also have more favorable cortisol profiles. This is very important, as cortisol is a stress hormone associated with chronic anxiety, depression, poor immune function, and a worsening prognosis for breast cancer patients.
A recent study of the effects of Mindfulness-Based Stress Reduction (MBSR) found that these practices led to statistically significant reductions in blood pressure, heart rate, and respiratory rate, along with a more relaxed, present-moment awareness. The MBSR training also led to a statistically significant effect on the morning cortisol level, as reported online ahead-of-print in the October 2010 issue of Western Journal of Nursing Research.
More research is needed to determine whether the favorable effects of yoga and mindfulness training on cortisol levels hold true. However, if other studies find such an effect, it could very well be that such practices would help extend survival in people with cancer. My belief is that any practice that improves the quality of life and overall functioning of a person is worth pursuing, not only because quality of life itself is a worthwhile goal, but it has, in fact, been associated with improved survival.