The effects of the Bali Yoga Program (BYP-BC) on reducing psychological symptoms in breast cancer patients receiving chemotherapy: results of a randomized, partially blinded, controlled trial

Abstract

Background Several cognitive behavioral interventions have been reported to reduce psychological symptoms in breast cancer (BC) patients. The goal of this study was to evaluate the effects of a yoga intervention in reducing depression and anxiety symptoms in BC patients. Methods This study was a randomized, partially blinded, controlled trial comparing a standardized yoga intervention to standard care. It was conducted at three medical centers in Montreal, Canada. Eligible patients were women diagnosed with stage I-III BC receiving chemotherapy. Participants were randomly assigned to receive yoga intervention immediately (experimental group, n=58) or after a waiting period (n=43 control group). The Bali Yoga Program for Breast Cancer Patients (BYP-BC) consisted of 23 gentle Hatha asanas (poses), 2 prayanamas (breathing techniques), shavasanas (relaxation corpse poses) and psychoeducational themes. Participants attended eight weekly sessions lasting 90 min each and received a DVD for home practice with 20- and 40-min sessions. Participants in the wait list control group received standard care during the 8-week waiting period. Results A total of 101 participants took part in the final intention-to-treat analyses. The repeated measures analyses demonstrated that depression symptoms increased in the control group (p=0.007), while no change was reported in the BYP-BC group (p=0.29). Also, depression symptoms decreased in the WL control group after receiving the BYP-BC intervention (p=0.03). Finally, there was no statistical significance in terms of anxiety symptoms (p=0.10). Conclusions Results support the BYP-BC intervention as a beneficial means of reducing and preventing the worsening of depression symptoms during chemotherapy treatment.

Yoga for symptom management in oncology: A review of the evidence base and future directions for research

“…Dose varied widely, with classes lasting up to 90 minutes and occurring from 1 to 6 days per week over 1 to 8 weeks. Furthermore, in most studies, home practice was prescribed . For the post‐treatment yoga studies, interventions were designed as gentle stretching and strengthening exercises, including breathing techniques (Pranayama), postures (Asanas), meditation, and relaxation.…”

“…Among studies that were conducted during treatment, several did not report or only partially reported adherence . Some studies reported the mean number of classes attended (eg, 5.5 of 8 possible classes) and mean hours of home practice (eg, 2.25 hours per week) . Others reported adherence ranging up to 81% of participants attending all classes and 100% engaging in 5 to 7 days of home practice per week .…”

“…Furthermore, in most studies, home practice was prescribed. 23,26,30,33,34,37,[41][42][43]45 For the post-treatment yoga studies, interventions were designed as gentle stretching and strengthening exercises, including breathing techniques (Pranayama), postures (Asanas), meditation, and relaxation. Sessions were group-based and used a variety of yoga styles: Hatha 48,49,56,60,61,70 (n = 4), Iyengar 48,50 (n = 2), gentle/restorative 52,63 (n = 2), and Satyananda 58 (n = 1).…”

“…23,26,30,34,40,42 Some studies reported the mean number of classes attended (eg, 5.5 of 8 possible classes) 41,43 and mean hours of home practice (eg, 2.25 hours per week). 41 Others reported adherence ranging up to 81% Rao 2017, 24 Raghavendra 2007, 25 Rao 2008, 26,27 2009, 28 46 38 Mixed (I-III) WL 15 Carson 2009 47 37 Breast (I-II) WL 16 Banasik 2011 48 18 Breast (II-IV) WL 17 Littman 2012 Kiecolt-Glaser 2014, 56 Derry 2015 57 200 Breast (0-IIIA) WL 24 Loudon 2014, 58 2016 59 28 Breast (0-III) WL 25 Cramer 2015 60 40 Breast (I-III) WL 26 Hughes 2015, 61 Long Parma 2015 62 94 Breast (NR) PE c 27 Taylor 2018 63 33 Breast (I-III) WL 28 Rao 2017, 64 Vadiraja 2017 65 91 Breast (IV) SC Combined (during and post-treatment) 29 Cohen 2004 66 39 Lymphoma (I-IV) C WL 30 Moadel 2007 Cancer June 15, 2019 of participants attending all classes 39 and 100% engaging in 5 to 7 days of home practice per week. 34 Among studies that were conducted post-treatment, reporting of program adherence also varied (10 studies reported some measure of adherence).…”

Improvement of well-being in cancer patients by yoga training

“…Studies on yoga benefits in cancer patients suffer from heterogeneity with various types of yoga interventions, duration, exposure, practices, and indications. 29 For example, different types of yoga training, such as Bali Yoga, 30,31 Vivekananda Yoga, 32 and Hatha Yoga, 33 among others might have a different influence on the observed effects, but evidence comparing various yoga types is still absent. In addition, the duration, schedules, and frequency of yoga support with or without specialized supervision differed in many published investigations to date.…”