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 design	N and characteristics	Main outcomes	Results/comments (group by time interactions reported for the controlled studies and time effects for noncontrolled studies)
Galantino et al. [24], 2012	Hatha yoga; 10 weeks, 90′ sessions, 2x/week	One-arm qualitative, exploratory design	10; 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], 2011	Iyengar yoga versus health education; 12 weeks, 90′ sessions, 2x/week	RCT	31; Persistent fatigue; Stages I-II; Postmenopausal	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], 2011	8 weeks, twice a week	One arm	10; Postmenopausal with AIs-induced arthralgias	Balance (Functional reach); Flexibility (Sit and Reach); Pain (BPI); Function (PSFS); QOL (FACT-B)	Improvements in balance, flexibility, function, pain severity, and QOL; Trend towards reduced pain interference; 80% adherence to the home program
Banasik et al. [25], 2011	Iyengar yoga versus wait list; 8 weeks, 90′ sessions, 2x/week	RCT	18; Stage II-IV	QOL (FACT-B); 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], 2011	Yoga 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], 2011	Viniyoga (at home or classes) versus wait list; 5x/week for 6 months	RCT	63; Obese and overweight women (BMI ≥ 24)	Feasibility (time to recruit, retention, adherence); QOL (FACT-G, FACT-B); 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 by −3.1cm*; No change in weight, BMI, and hip circumference
Bower et al. [29], 2011	Iyengar yoga; 12 weeks, 90′ sessions, twice weekly	One arm	12; Persistent fatigue	Fatigue (FSI); Depression (BDI-II); Sleep (PSQI); Pain (BCPTSS); 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],; 2010	Any type of yoga	Survey of yoga use	300; Users of AIs	Sociodemographics of yoga; users	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], 2010	Iyengar yoga; 12 week classes	One arm	24	QOL (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], 2010	8 yoga sessions	One arm	20	QOL (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	RCT	61; Undergoing radiotherapy	QOL; Fatigue; Meaning finding; Intrusive thoughts; Sleep; Depression/anxiety	Improved health perception, physical functioning scores, more intrusive thoughts, and greater meaning finding *; No difference in fatigue, depression, sleep
Vadiraja et al. [34], 2009	Integrated yoga program (18–24, 60′ sessions) plus brief supportive therapy (every 10 days) versus brief supportive therapy (every 10 days)	RCT	88; 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], 2009	Yoga of awareness versus wait list; 8 weeks	RCT	37; Stage I-II; Vasomotor; symptoms	Hot flashes before, after, and at 3 months after intervention	Decreased 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], 2009	Integrated yoga program (18–24, 60′ sessions) plus brief supportive therapy (every 10 days) versus brief supportive therapy (every 10 days)	RCT	88; 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], 2009	Integrated yoga program (18–24, 60′ sessions) plus brief supportive therapy (every 10 days) versus brief supportive therapy (every 10 days)	RCT	88; Stage II-III; Undergoing radiotherapy; Mastectomy	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	RCT	44; 34% in active treatment	Physical Health (SF-12); QOL (FACT-B); Fatigue (FACT-Fatigue); Spiritual well-being (FACIT-Sp); Depression (CES-D); Sleep (PSQI); Affect (PANAS); Feasibility; 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], 2009	Integrated 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 days	RCT	98; Stage II-III; Radiotherapy; Chemotherapy	Anxiety (STAI); Symptom checklist	Decreased anxiety andsymptom severity *; Anxiety states positively correlate with symptoms severity and distress ^*
Rao et al. [40, 41],; 2008	Integrated yoga program versus supportive therapy + exercise rehabilitation; 4 weeks	RCT	98; Stage II-III; Immediately at diagnosis	Anxiety (STAI); Depression (BDI); QOL (FLIC); Symptom checklist; Lymphocytes,; Immunoglobulins; Cytokines; 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=14 with breast cancer)	Physical Health (SF-12); QOL (FACT-G); Spiritual well-being (FACIT-Sp); Fatigue (FACT-Fatigue); Depression (CES-D); Anxiety (STAI); Affect (PANAS); Feasibility; 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],; 2008	Integrated yoga versus brief supportive therapy	RCT	37; Stage II-III; Active cancer treatments	NK cell % after surgery, radiation, and chemo	NK 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)	RCT	62; Stage II-III; Postmastectomy; Post radiation; Undergoing chemotherapy	Nausea and emesis (MANE); Anxiety (STAI); Depression (BDI); QOL (FLIC); 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], 2007	Hatha yoga versus wait list; 12 weekly −90′ sessions	RCT	128; Ethnically diverse	QOL (FACT-B, FACT-G); Fatigue (FACIT-F); Spirituality (FACIT-Sp); Depressed mood Index; mood (POMS); Adherence; 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], 2007	Integrated 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], 2007	Yoga 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	38	Mood (POMS); Response to stress (SOSI); QOL (EORTC QLQ-C30); 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<0.05).