Yoga

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Support Care Cancer. Author manuscript; available in PMC 2018 April 01.
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Published in final edited form as:

Support Care Cancer. 2017 April ; 25(4): 1357–1372. doi:10.1007/s00520-016-3556-9.
Review of Yoga Therapy During Cancer Treatment

Suzanne C. Danhauer1, Elizabeth L. Addington1,2, Stephanie J. Sohl1, Alejandro Chaoul3,
and Lorenzo Cohen3
1Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest
School of Medicine, Winston-Salem, NC, USA
2Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine,
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Chicago, IL, USA

3Departmentof Palliative, Rehabilitation, and Integrative Medicine, The University of Texas, MD
Anderson Cancer Center, Houston, TX, USA
Abstract
Purpose—Reviews of yoga research that distinguish results of trials conducted during (versus
after) cancer treatment are needed to guide future research and clinical practice. We therefore
conducted a review of non-randomized studies and randomized controlled trials of yoga
interventions for children and adults undergoing treatment for any cancer type.
Methods—Studies were identified via research databases and reference lists. Inclusion criteria:
(1) children or adults undergoing cancer treatment; (2) intervention stated as yoga or component of
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yoga; and (3) publication in English in peer-reviewed journals through October 2015. Exclusion
criteria: (1) samples receiving hormone therapy only; (2) interventions involving only meditation;
and (3) yoga delivered within broader cancer recovery or mindfulness-based stress reduction
programs.
Results—Results of non-randomized (adult: n=8, pediatric: n=4) and randomized controlled

trials (adult: n=13, pediatric: n=0) conducted during cancer treatment are summarized separately
by age group. Findings most consistently support improvement in psychological outcomes (e.g.,
depression, distress, anxiety). Several studies also found that yoga enhanced quality of life, though
further investigation is needed to clarify domain-specific efficacy (e.g., physical, social, cancer-
specific). Regarding physical and biomedical outcomes, evidence increasingly suggests that yoga
ameliorates sleep and fatigue; additional research is needed to advance preliminary findings for
other treatment sequelae and stress/immunity biomarkers.
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Corresponding Author: Suzanne C. Danhauer, PhD, [email protected], Phone: (336) 716-7402, Fax: (336) 716-7554.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
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Note: An earlier version of this manuscript was published in 2016 as a chapter in The Principles and Practice of Yoga in Health Care
by Handspring Publishing Limited.
Conflict of Interest
All authors have no conflicts of interest to report. This review article did not involve primary or secondary data analysis; all source
articles reviewed by authors are available from the source journals.
Danhauer et al. Page 2
Conclusions—Among adults undergoing cancer treatment, evidence supports recommending

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yoga for improving psychological outcomes, with potential for also improving physical symptoms.
Evidence is insufficient to evaluate the efficacy of yoga in pediatric oncology. We describe
suggestions for strengthening yoga research methodology to inform clinical practice guidelines.
Keywords
yoga; cancer; chemotherapy; radiation therapy; symptoms; mind-body
Worldwide, more than 14 million people are diagnosed with and more than 8.2 million
people die from cancer each year [1]. Behavioral risk factors such as high body mass index
(BMI), tobacco use, physical inactivity, unhealthy diets, and excessive use of alcohol
contribute to cancer etiology, progression and outcomes [1-3]. Moreover, chronic stress and
depression can have direct and indirect effects on cancer by changing biology and
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influencing behaviors [4-6].
Cancer diagnosis and treatment can also increase distress and cause biomedical sequelae
such as pain, sleep disturbances, fatigue, nausea/vomiting, and chemotherapy-induced
immunosuppression. Some consequences of cancer are temporary, but many persist, leaving
patients to manage them long term. Further, these effects increase patients’ vulnerability to
other illnesses. To manage these effects, people may use mind-body practices such as yoga,
which is one of the most frequently used complementary modalities among men and women
with cancer in the United States [7-9].
Psychophysiological Rationale for the Use of Yoga during Cancer

Treatment
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Stress can have extensive physiologic effects [10], including telomere shortening, increased
inflammatory cytokines and decreased cell-mediated immunity, which are associated with
increased cancer risk and poorer cancer-related outcomes [4, 11-13]. Although stress may
not directly cause cancer, it can promote cancer growth and progression through
neuroendocrine pathways (e.g., sympathetic nervous system, hypothalamic-pituitary-adrenal
axis) that increase inflammation, promote angiogenesis, reduce anoikis, and decrease the
efficacy of chemotherapy [4, 6, 14]. Biobehavioral interventions such as yoga therefore have
the potential to improve cancer outcomes by decreasing stress and disrupting its effects on
cancer biology [4, 11, 15].
Previous reviews assessing the potential for yoga to benefit cancer survivors have not
differentiated people receiving active cancer treatment from post-treatment survivors
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[16-18]. Initial attempts to examine the efficacy of yoga during cancer treatment versus post-
treatment survivorship remain inconclusive [19]. Therefore, the need remains for research to
evaluate the role of yoga during distinct phases of cancer survivorship [16, 20]. This review
thus focuses specifically on people during cancer treatment.
Methods
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To identify trials of yoga for people undergoing cancer treatment, search terms including
yoga, cancer and related/Medical Subject Headings terms (e.g., neoplasm) were entered in
CINAHL, MEDLINE, PsycINFO, and PubMed. Reference lists of identified articles were
used to find additional relevant reports. Inclusion criteria were: (1) sample including
children or adults undergoing cancer treatment; (2) intervention stated as yoga or component
of yoga; and (3) published in English in peer-reviewed journals, through October 2015.
Exclusion criteria included: (1) samples receiving hormone therapy only; (2) interventions
involving only meditation; and (3) yoga delivered as part of a larger cancer recovery or
mindfulness-based stress reduction program. Results of non-randomized studies (Table 1)
and randomized controlled trials (RCTs) are summarized separately (Table 2). Details of
each yoga intervention protocol are summarized in Table 3.
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Results
Pediatric Studies: Non-Randomized Trials of Yoga during Cancer Treatment
No RCTs of yoga during cancer treatment in pediatric samples have been published. Only
four single-arm pilot studies have been published in pediatric oncology [32-35]. Participants
included a mean of 10 children with heterogeneous cancer diagnoses. All studies included
parents/caregivers as yoga participants [32-34] and/or proxy respondents [32-33, 35].
Intervention Characteristics—Two pediatric studies used specific styles of yoga [33,

34]; two did not specify yoga style. All four included multiple yoga components, such as a
combination of movements, breathing, relaxation and meditation. However, none provided
detailed class sequences or treatment fidelity. Dose varied from a single 45-minute session to
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8-24, 60-minute sessions, with 1 to 3 sessions per week, spread over 3-12 weeks. Three
interventions were implemented as group classes [33-35]; one study did not specify delivery
format [32]. None reported whether they provided instructions for home practice. Instructors
in all studies were trained in teaching yoga, though only two studies used instructors with
training specific to cancer or therapeutic yoga [33, 35].
Feasibility—Three of the four pediatric studies examined feasibility, attrition and

adherence. Recruitment rates ranged from 42% to 55% [32, 34-35]. The majority (90% of
children, 100% of adolescents) completed participation in the single-session study [34]. In
the study of a 3-week program, 10 of 11 participants met the a priori criterion for feasibility
(60% of sessions attended), and the median number of sessions attended was 9 [32].
Adherence to yoga sessions in the 12-week program was 55%, with 73% completing the
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assessments; reasons for non-adherence included vacation and illness [33]. Participants
withdrew from multi-session trials for reasons such as time/scheduling conflicts and
disliking yoga or viewing it as “not ‘fast paced’ enough” [32, 35]. Two pediatric studies
specified that no adverse events related to yoga occurred [32, 35].
Outcomes—In two studies reporting on pediatric QOL, one documented statistically

significant improvement in physical function [33], and one reported clinically important
differences on all QOL factors as rated by children and parents/caregivers [35]. Additional
outcomes included statistically significant increases in children’s functional mobility,

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flexibility, and physical activity [35] and statistically significant decreases in state anxiety
among adolescents and parents participating in yoga [34]. Qualitative data supported these
findings. Participants in pediatric studies described yoga as relaxing and helpful for
managing stress/anxiety [32, 34]. They additionally noted improved energy, sleep and mood,
decreased nausea, and reduced use of pain medication [32].
Adult Studies of Yoga during Cancer Treatment: Non-Randomized Trials (Table 1)

Participant Demographics—Nine adult non-randomized studies (Table 1) enrolled a
total N=155 (average N=17), primarily Caucasian (78%) and female (81%) participants
[21-29]. Various cancer types (e.g., lymphoma, gynecologic, breast, lung) and all stages (0-
IV) were represented. Treatments received while participating in yoga interventions included
chemotherapy (n=61) and radiation (n=40), when specified.
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Intervention Characteristics—Seven interventions were based in a specific yoga style

or combination of yoga traditions (see Table 3). Most included multiple components of
yoga, such as movement, breathing, meditation, and/or yogic philosophy [21-22, 24, 26-29],
whereas two studies included only movements [23] or breathing [25]. Two studies also
included facilitated group discussions [21, 26]. Three of the nine articles presented specific
class sequences, and five indicated that movements were adapted to individual needs. One
study ensured treatment fidelity by using an intervention manual and reviewing videotaped
sessions [21].
Dose of yoga varied (i.e., ranged from 1-18 total sessions, 15-120 minutes, every 3 weeks to
3 sessions per week, duration 3-10 weeks). Five interventions were delivered as group
classes, and two included caregivers with patients; one occurred individually in the
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chemotherapy chair. Five studies additionally provided instructions for practicing at home,
and one provided access to online classes.
Feasibility—Recruitment rates reported by five studies ranged from 16% (letters sent) to
74% (approached in person) [22, 26-29]. In another study, recruitment challenges prevented
study completion [24]. Seven studies reported attrition rates ranging from 8% (selected from
an ongoing yoga class) to 43% (selected from women receiving treatment), for reasons such
as traveling distance, change in interest, scheduling difficulties, and health issues [21-23,
26-29]. One study reported that those who completed the intervention had higher baseline
levels of fatigue than those who withdrew, suggesting that symptoms may motivate
participation [21]. Conversely, physical function at baseline was marginally significantly
worse among patients who withdrew versus those who completed another study [27].
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Seven studies with a range of 1-10 planned sessions reported adherence to in-person yoga
sessions ranging from 59-88% [21, 24, 26-29]. Particularly high adherence rates were
achieved in studies that included family caregivers [27-28] or a group discussion component
[21, 26]. Five studies also described adherence to home practice, which varied widely. For
example, in a case study of four women, home adherence was bimodal, with two participants
at 80% adherence and two participants under 50% [24]. Studies measuring home practice by
number of occurrences reported means between 2-3, range 0-9 [26-28], while another study
described home practice as an average of 21 minutes per day [21]. In the five studies that
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assessed satisfaction with yoga, mean satisfaction ratings were high (i.e., >=9/10), and the
majority rated yoga as useful or helpful [21-22, 26-28].
Outcomes—The nine non-randomized adult trials reported on a variety of outcomes

including quality of life (QOL) and mental, physical, and spiritual health. Because these
studies typically lack comparison groups and adequate power to detect statistically
significant changes, outcomes provide preliminary data on effects of yoga that warrant
further examination in fully-powered trials. In this early phase of study, effect sizes
(indicators of clinical significance; e.g., Cohen’s d: ≤ 0.2 small, ≤ 0.5 medium, ≤ 0.8 large)
and qualitative data are especially informative [30-31].
Statistically and/or clinically significant improvements in mental health included anxiety,

depression, mood, negative affect, relaxation and overall mental health [22, 27-29], which
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were further corroborated by qualitative feedback [22, 24, 28]. Additional qualitative
findings included improvements in cognition, benefit finding, spiritual well-being, social
support, self-efficacy and coping [21-24, 28].
Physical health significantly improved in terms of physical QOL, fatigue, invigoration,

most-bothersome symptom, and upregulation of genes involved in immunity [22-23, 25].
Qualitative reports supported these findings and suggested increased strength, relief of
tension, physical invigoration, and use of yoga in other situations (e.g., when trying to sleep,
during medical testing) [22-24]. In addition, yoga demonstrated a medium effect size and a
dose-response effect on sleep [27-28].
Adult Studies of Yoga during Cancer Treatment: Randomized Controlled Trials (Table 2)
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Participant Demographics—Thirteen randomized studies (Table 2), reported in 23

manuscripts, were reviewed with a total N = 1022, including n = 504 assigned to yoga and n
= 518 assigned to a control group [36-58]. Studies were relatively small, averaging 39
participants per study (range 8-84) assigned to yoga, and included mostly women with
breast cancer (n = 927; 91%). Age of participants ranged from 18-79. Only 5 studies
reported participants’ race/ethnicity, with 51% Caucasian, 25% African American, 18%
Latino, 2% Asian, and 4% other or unspecified race participants [40, 42-43, 47, 58]. RCTs
that specified participants’ cancer stage included the following: DCIS (n = 28), I (n = 170),
II (n = 243), III (n = 186), and IV (n = 68). Treatments received while participating included
surgery (n = 121), chemotherapy (n = 239), radiation (n = 660), and unspecified medical
treatment (n = 164).
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Intervention Characteristics—Among studies that described yoga style, three were

based in general yoga traditions and six used a specific style of yoga (see Table 3). Most
adult RCTs included a combination of yoga components, such as movements, breathing, and
meditation. Three studies omitted yoga movements; two focused solely on breathing, while
another featured breathing, concentration and an intention to manage uncertainty and fear
[39, 43-46].
Dose, where specified, varied from 7-18 sessions, lasting 60-90 minutes each session, with 1
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session per day to 3 sessions per week, spread over 1-12 weeks. Six studies delivered yoga
in group classes [38, 41-42, 44-47, 57], five in one-on-one sessions [40, 43, 48-52, 54-56,
58], and two did not specify the format [36, 39]. Most (9 of 13) provided audio or printed
materials for home practice. Few studies provided information about the qualifications of the
yoga instructors delivering their intervention (see Table 3), and only one reported using an
instructor with cancer-specific yoga teacher training [42].
Feasibility—Across three studies, attrition averaged 20% prior to or immediately after

randomization (i.e., before beginning yoga classes) [40, 43, 58], but one trial reported 56%
attrition immediately following randomization among participants assigned to yoga [37]. In
studies with sufficient information to compare, attrition was greater among yoga participants
in two studies [37, 47], among control participants in three studies [38, 48-49, 51-52, 54-56],
and approximately equal across groups in four studies [41-43, 58]. Two trials reported 100%
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completion [39, 57].
Although participants’ satisfaction with the yoga interventions was reported by only two
studies, perceived benefits and enjoyment were generally high [41-42]. With the exception
of three studies [41-42, 47], most reported high levels of adherence (>70% completing the
majority of classes). Rates of home practice, when reported, were variable. In a trial of
pranayama, participants averaged 3.2 hours per week of home practice [43]. In studies
including movement, up to 19% did not engage in home practice, while more than half
practiced at home at least 3 days per week [40, 44-47].
Outcomes—Several of the 13 RCTs demonstrated significant improvements in yoga

participants’ mental health, including positive and negative affect, distress, depression, and
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anxiety [38, 42-46, 48-49, 52-56]. Yoga participants, compared to controls, also reported
significantly better emotional, mental, social, physical, and general QOL [42-43, 48].
Although outcomes such as self-esteem, spiritual well-being and cognitive function were
measured infrequently, yoga participants reported favorable results in these domains as well
[42, 44-47, 56].
Regarding physical and biomedical outcomes, yoga participants had better self-reported
health than controls in two studies, including the only trial with an active control group [40,
58]. Treatment-related side effects, including sleep, fatigue, pain, appetite loss, nausea and
vomiting, sequelae-related distress, and toxicity, improved among yoga participants in
several studies [39, 41, 48-49, 52, 54, 57]. One study documented better post-operative
outcomes, including decreased drain retention, earlier suture removal, and shorter
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hospitalization, among yoga vs. control participants [51].
Two studies examined stress hormone regulation. Compared to controls, yoga participants
had lower 6:00 am and mean pooled levels of salivary cortisol [54-56] and a steeper cortisol
slope [58], which may predict improved survival [59-60]. In the other two studies
investigating physiologic results, yoga participants demonstrated a favorable immune
response (i.e., serum immunoglobulins and lymphocytes, TNF-alpha) [51-52] and decreased
DNA damage [38, 51-52].
Discussion
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Summary and Limitations

Among children undergoing cancer treatment, only four single-arm pilot studies of yoga
have been published. Initial findings from these non-randomized trials support the
feasibility, safety and potential efficacy of yoga in pediatric oncology. However, its
effectiveness cannot be determined until more rigorous trials are conducted (e.g., RCTs,
larger sample sizes).
Nine non-randomized studies and 13 RCTs have examined the effects of yoga for adults
undergoing treatment for cancer. Results from both non-randomized and randomized trials
most consistently support the efficacy of yoga to improve psychological outcomes such as
depression, distress, and anxiety. Several studies, particularly RCTs, also documented
improved QOL among yoga participants, though further investigation is needed to clarify the
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efficacy of yoga for different types of QOL (e.g., mental, social, physical, cancer-specific)
and for spiritual well-being. Researchers less frequently reported physical and biomedical
outcomes, though it is unknown whether this stems from a tendency not to measure these
outcomes or not to publish null findings. In both non-randomized trials and RCTs, sleep and
fatigue were the most commonly measured non-psychological outcomes, generating a
growing body of evidence that yoga ameliorates sleep and fatigue among people undergoing
treatment for cancer. Additional studies are needed to advance preliminary findings for other
effects of treatment (e.g., nausea, surgical outcomes, cognitive function) and biomarkers of
stress and immunity.
Findings are constrained by multiple limitations of previous research samples and methods.
For example, the vast majority of studies have relied exclusively on self-reported measures.
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In addition, with only a few exceptions, samples predominantly include females with breast
cancer. People with Stage IV cancer of any type are rarely included in yoga trials, despite the
fact that yoga may be gentle enough for individuals with advanced disease and potentially
affect important outcomes (e.g., distress, QOL).
Generalizability is further limited by variability in intervention protocols. Most studies

combined several elements of yoga (e.g., movement, breathing, meditation), but intervention
delivery (e.g., group vs. individual; instructor-delivered vs. home practice) and dose of yoga
(i.e., frequency, duration) have varied widely among studies, as have retention and adherence
rates. The amount of yoga practice needed to yield effects therefore remains unknown. In
some studies yoga participants improved on outcomes such as psychological distress, fatigue
and immunity while the waitlist control group worsened [38, 51, 57]. However, only two
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studies included an active control group [44-46, 58]. As a result, “active ingredients” (e.g.,
movement, breathing) cannot be distinguished from non-specific, but potentially effective,
components of yoga interventions (e.g., social support, attention).
Recruitment methods and other elements of study design may also affect participation,
outcomes and generalizability. For example, enrollment and retention rates may be
especially high when sampling from people already enrolled in yoga classes. Researchers
have rarely published details of their yoga teachers’ training and experience specifically with
people with cancer, although these factors may influence participants’ adherence and
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efficacy of interventions. Information about studies’ treatment fidelity efforts also is scant,
compounding the difficulty of interpreting and applying results.
Despite these limitations, studies have demonstrated that yoga is likely to benefit adult
cancer patients during active treatment. Moreover, no studies reported any adverse events of
practicing yoga during treatment. Thus, there is sufficient evidence to recommend yoga to
adults undergoing cancer treatment, especially women with breast cancer [61].
Future Directions
Although the number and quality of studies of yoga for cancer patients have increased
recently, more rigorous methodology is still needed to advance the science in this field.
Guidelines are available for developing yoga interventions for use in RCTs; researchers
should consider the rationale for selecting the yoga style, dose, components, sequence,
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modifications, instructors, and home practice, as well as the measurement of intervention

fidelity [62]. Developing criteria for reporting on these interventions and other elements of
study methodology, similar to the STRICTA framework for acupuncture research [63],
would further improve the interpretation and applicability of yoga research findings. We
additionally offer suggestions below for improving the following elements of yoga research:
(1) sample selection; (2) recruitment, retention, and adherence; (3) research design; and (4)
inclusion of objective and novel measures. We conclude with the suggestion to examine
yoga as more than a combination of movement, breathing and relaxation, but rather as a
broader lifestyle intervention.
Based on this review, future studies of yoga for people undergoing cancer treatment should
consider several suggestions for improving the sample selection. First, yoga research with
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pediatric and adolescent oncology patients is scant, but existing feasibility data and
preliminary outcomes indicate that more trials with younger age groups are warranted. As
yoga research with pediatric oncology samples expands, it is important to ensure these
studies explore the clinical implications of developmental and familial components (e.g.,
young children vs. adolescents; inclusion of siblings or parents) that may influence
outcomes.
Regardless of patients’ age, offering yoga to all may be useful for buffering treatment
effects. However, given the differing adverse effect profiles of various cancer treatments,
better specification of the efficacy of yoga for improving outcomes and decreasing symptom
burden will require study samples with limited heterogeneity of treatment types or with
power to examine treatment type as a moderator. Furthermore, future work should consider
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eligibility requirements that select participants with a demonstrated clinical need – for
example, a minimal level of symptoms (e.g., distress, fatigue, cognitive impairment) or a
history of depression or anxiety. This targeted approach to recruitment may enhance our
understanding of the efficacy of yoga for treating specific symptoms and help reach those
most in need, thereby maximizing the limited funding available for this type of program.
Barriers to recruitment, retention, and adherence include difficulties with scheduling and
travel, changes in interest or symptoms, and health issues [21-23, 27, 29]. Studies suggest
that symptoms or health concerns can both promote and inhibit participation. When
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designing studies of yoga for people undergoing cancer treatment, flexibility of design and
scheduling may be needed to accommodate patients’ treatment-related symptoms and other
competing demands (e.g., medical appointments). For example, interventions could include
inpatient, outpatient, and home-based alternatives [35, 64]. Offering yoga from home via
technologies such as multi-point videoconferencing could increase patients’ access to
cancer-specific yoga classes with a qualified instructor and with others in treatment.
Including a family member in yoga interventions may also facilitate recruitment and
retention of cancer patients, in addition to improving caregivers’ health and well-being [21,
24, 27-29]. Finally, some evidence suggests that participants practice yoga in other settings
(e.g., during medical tests) and that outcomes improve with increased engagement in yoga
[22, 24, 47]. Therefore, carefully documenting adherence to instructor-led and autonomous
practice is essential for understanding the dose and potential efficacy of yoga interventions,
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as well as the minimum amount of in-person instruction patients need to practice yoga safely
on their own.
From the biomedical perspective, the ideal research design is a randomized, double blind,
placebocontrolled trial, but double-blinded trials of mind-body interventions are challenging.
Using an activity that has face validity as the active control can at least blind participants to
whether or not they are in the “real” intervention. For example, a single-blinded RCT of tai
chi vs. wellness education plus stretching for people with fibromyalgia was presented to
participants as a study examining the effects of two different kinds of exercise [65]. Studies
without an active control group (i.e., wait-list control studies) cannot attribute results
specifically to yoga because non-specific aspects of the intervention (e.g., attention, social
support) may confer some benefit. Moreover, including a third group of participants
receiving usual care [58] can help to determine whether practicing yoga during cancer
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treatment can prevent or buffer the negative side effects of treatment.
While self-reported outcomes remain important, future studies of yoga during cancer
treatment should incorporate more objective measures (e.g., pro-inflammatory cytokines,
cortisol, heart rate variability, actigraphy, genomic and epigenetic measures). Qualitative
results suggest point to additional constructs that may be important to quantify in future
studies; for example, participants have described improvements in coping, self-efficacy, self-
compassion, relief of tension, physical and mental strength/invigoration, and social support
[21-24, 34]. Cognitive function is another important and relatively unexplored potential
benefit of yoga for cancer patients, which can be assessed with objective behavioral and
neuroimaging measures. Finally, research has not yet determined whether yoga interventions
influence healthcare utilization and costs. Examining these bottom-line outcomes could
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provide data to support incorporating yoga into clinical settings [66].
Clinical Implications and Conclusions

The current evidence is sufficient to recommend yoga to adults undergoing cancer treatment,
particularly women with breast cancer [61, 70]. Results from existing studies suggest that
yoga will lead to improvements in or buffer treatment-related changes in mental health,
fatigue, sleep quality, and other aspects of quality of life. Support for additional benefits may
become apparent with further research. Treatment-related symptoms and stress may
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motivate some people with cancer to participate in yoga [7, 21], and barriers to participating
in yoga during cancer treatment may be lower than other types of exercise [9]. Some
research shows an association between frequency in in yoga participation and improved
outcomes [e.g., 27-28]. As such, reducing barriers by offering variable class schedules and
formats, incorporating the use of novel technologies, and including family members is
recommended. Notably, none of the trials in this review reported any adverse events.
Therefore, compared to higher-impact forms of exercise, yoga may be especially safe and
appealing to people receiving cancer treatment.
In conclusion, research has demonstrated that yoga interventions can improve psychological
distress, QOL, physical function, and some biological outcomes among adults receiving
cancer treatment. However, the potential for yoga to benefit people with cancer may not
have been fully captured yet. Yoga theoretically extends beyond the elements that most
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studies include (i.e., movement, breathing, meditation). Its broader philosophy and approach
may influence healthful living as a whole (i.e., food choices, exercise, life purpose,
relationships). Initial studies suggest that holistic lifestyle interventions have great potential
for integration with biomedical cancer treatments [67-68]. Cancer survivors tend to live
longer after diagnosis if they have normal BMI, are physically active, eat a primarily plant-
based diet, abstain from tobacco, avoid harmful use of alcohol, and are not depressed [1-3,
14, 69]. Future research therefore could examine whether a comprehensive yoga approach
facilitates these outcomes, thereby helping people manage side effects of cancer treatments,
improving clinical outcomes, and perhaps extending and enhancing survival.
Acknowledgments
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Elizabeth L. Addington is currently supported by NIH/NCI training grant CA193193 at Northwestern University
Feinberg School of Medicine.
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Table 1
Non-Randomized Studies of Yoga for Adults during Cancer Treatment
Author Design/Sample Cancer Type and Adherence Outcome Measures Results

Treatment
Danhauer et al.
Last Name - Design - Cancer type - Completing protocol (n - Timing of assessment ***p<0.001
Year - N (n or % by Sex) - Stage or %) - Primary measures **p<0.01
Country - Age: Mean (SD; range) - Treatment(s) received - Class adherence (% or # *p<0.05
- Race/ethnicity during the study of classes)
Carson et al., - Single-arm pilot - Breast (N=13) - n=13 - Baseline (daily for 2 weeks prior to - Main effect for change over time:
2007 [21] - N=21 (100% F) - Metastatic - Mean # of sessions intervention), post-intervention (Weeks invigoration,** acceptance*
USA - 59 (NR; 44-75) - Chemotherapy (n=7) attended: 7 of 8 (range 6-8) - Lagged effects from one day to the next:
- n=11 Caucasian, n=2 African 5-8) - Daily VAS of pain, fatigue, distress, pain,* fatigue,*
American invigoration, acceptance, relaxation invigoration,** acceptance,* relaxation*
- Satisfaction (0-10 ratings) - Satisfaction: overall helpfulness M=9.6;
- Qualitative responses Likelihood to recommend M=10
- Qualitative: sessions useful, applying
skills to life, self-compassion, group
support
Danhauer et al., - Single-arm pilot - Ovarian (n=37), Breast - n=43 completed post- - Baseline, post-intervention (Week 10), - Week 10: overall mental health,*
2008 [22] - N=51 (100% F) (n=14) intervention follow-up; Final Follow-Up (Week 18) depressive symptoms,** negative affect,**
USA - 58.9 (11.2; 34-82) - 0-IV n=38 completed final - QOL (SF-12 MCS/PCS), depressive overall QOL,* physical QOL,** fatigue*
- n=45 Caucasian, n=5 African - Chemotherapy (n=29); follow-up symptoms (CES-D), affect (PANAS), - 88% liked class “quite a bit” or “very
American, n=1 Asian/Pacific Radiation (n=5) - Mean # of classes anxiety (STAI), cancer-specific QOL much”
Islander attended: 5.9 of 10 (FACT-G), spirituality (FACIT-Sp), - Qualitative: group experience, physical
(SD=3.2) fatigue (FACT Fatigue), satisfaction, and emotional benefits, relaxation
- 51% attended >7 of 10 qualitative responses
classes, 26% attended 0-2
classes
Duncan et al., - Single-arm pilot - Breast (n=10), - 100% provided post- - Baseline, weeks 5 and 10 of the - Week 10: Most-bothersome symptom,***
2008 [23] - N=24 (n=23 F, n=1 M) gynecologic (n=4), intervention data program, and 6 weeks after the program FACT-G,*** FACIT-Sp,*** POMS-SF
Canada - 49 (NR) lymphoma (n=3); other - NR - Most bothersome symptom (Measure TMD***
- n=20 Caucasian (n=7) Your Medical Outcome Profile 2 - Qualitative: reported additional benefits
- NR instrument), FACT-G, FACIT-Sp, (physical, relaxation), props useful,
- n=16 undergoing POMS-SF appreciated intro to mindfulness, social
treatment (type NR) at - Qualitative Responses provided by n=6 support
baseline selected participants
Galantino et - Case series - Breast (N=4) - NR - Baseline, 6, and 12 weeks during - No quantitative findings reported
al., 2012 [24] - N=4 (100% F) - II - 60%–70% class chemotherapy, and at 1 and 3 months - Qualitative: yoga appeared to impact
USA - 54.8 (NR; 44-65) - Chemotherapy (n=4); adherence after study conclusion cognition, specifically reduced errors and
- N=4 Caucasian Radiation (n=2) - Home adherence: 80% - CogState, Perceived Cognition increased speed. Flexibility, balance, mood
for n=2, <50% for n=2 Questionnaire, FACT-B, POMS, Sit and changes and QOL also maintained/
Reach, Functional Reach, qualitative improved
responses
Kumar & - NR - CLL (N=8) - NR - NR - Increased gene expression* (AK, BC, NM
Balkrishna, - N=8 (100% M) - NR - NR - Gene expression BX, R-26, hCG) in practitioners vs. an
2009 [25] - NR (NR; 18-55) - NR apparently non-randomized control group
India - NR (details NR on this group)
Page 15

Treatment
McCall et al., - 3-arm feasibility pilot - Breast (n=6), prostate - n=13 - Pre- and post-intervention - Satisfaction with amount: n=1 offered “the
2015 [26] - N=15 (n=11 F) (n=2), other (n=7) - Mean # of yoga sessions: - Satisfaction, HRQOL (QOL-CA/CS right amount of yoga,” n=1 too much, n=9
Canada - 51.3 (NR; 33-72) - I-IV A: 4, B: 5, C: 12.8 mean difference), perceived utility of not enough
- NR - Chemo (n=7), radiation - Mean # of online yoga yoga (0-10), cost efficiency, qualitative - Satisfaction with yoga practice: A 6.5, B
(n=8) sessions: A: 2.5, B: 0, C: 0 responses 9, C 8.8
Danhauer et al.
- HRQOL: A 0.7 (1.3), B -0.1 (0.8), C 0.2

(0.5)
- Utility of yoga: A 8.5, B 7.3, C 9
- Cost-efficiency: A NR, B 100%, C 53%; 0
in B and C used online classes
- Qualitative: participants in all groups
preferred small, cancer-specific classes;
stretching, breathing, meditation and
postures for strength and relaxation; found
group discussion helpful; barriers: fatigue,
side effects, cost, transportation, disinterest
Milbury et al., - Single-arm pilot - Lung (n=10) - 10/14 dyads (71%) - Baseline and during last week of - Patients: spiritual well-being.* Medium
2014 [27] - N=10 patients (n=5 F, n=5 M); - I and III - Mean # of classes patients’ radiotherapy effect sizes for sleep disturbances and
USA N=10 caregivers (n=9 F, n=1 - Radiation (n=10), attended: 12 of 18 - All completed by patients and depressive symptoms; small effect sizes for
M) Chemotherapy (n=7) (SD=2.91; range: 6-15) caregivers. Distress (CES-D), anxiety anxiety and QOL
- Patients 71.22 (6.16; 61-82); - Home practice M=2.63 dimension (BSI-18), sleep disturbance - Majority (92.2%) rated program as useful
caregivers = 68.77 (5.99; 61-78) times (SD= 2.62; range (PSQI), fatigue (BFI), health-related or very useful
- Patients: n=8 Caucasian, n =1 0-9) QOL (SF-36 PCS, MCS), spiritual well-
Hispanic; caregivers: n=8 being (FACIT-Sp), Finding Meaning in
Caucasian, n =1 Hispanic Cancer scale; satisfaction
Milbury et al., - Single-arm pilot - Non-small cell lung - n=9 dyads (60%) - Baseline and last week of radiation - Patients: anxiety,* mental QOL.* Medium
2015 [28] - N=15 patients (n=4 F, n=11 cancer (N=15) - M=10 classes attended - Distress (BSI-18), sleep (PSQI), effect sizes for benefit finding, sleep,
USA M); N=15 caregivers (n=6 F, - I-IIIB (SD=3.15, range 4-14); fatigue (BFI), HRQOL (SF-36), spiritual spiritual well-being, increased somatization
n=9 M) - Chemoradiation 78% of dyads attended well-being (FACIT-Sp well-being), - Dose response for patients’ sleep
- Patients: 62.16 (14.03; 33-81); (N=15) >50% of classes benefit finding (BFCS), emotional - Immediately post-session, 79% felt
caregivers 58.95 (15.67; 28-78) - Home practice: as intimacy (PCR) relaxed, 75% calm, 68% content, 46%
- Patients: n=8 White, n =1 individual, M=2.18 times happy; sessions rated as easy to moderate
Latino/Hispanic; caregivers: (SD=1.94, range 0-7); as exertion
n=9 White dyad, M=0.52 times - 89% rated yoga “very useful;” 100%
(SD=1.04, range 0-4) reported that all components of yoga
intervention were useful
Sohl et al., - Single-arm pilot - Ovarian (N=7) - NR - VAS for anxiety and relaxation - Large effect sizes for immediate change in
2012 [29] - N=7 (100% F) - NR - Session 1: n=7 (100%); assessed immediately pre- and post- anxiety, d=−0.82; relaxation, d=0.83
USA - 61.7 (6.7; NR) - Chemotherapy (N=7) session 2: n=4 (57%); session - Qualitative: use yoga practices such as
- n=7 Caucasian, n=1 Hispanic session 3: n=3 (43%) - Qualitative responses relaxation and breathing during daily
activity (i.e., prayers, bedtime)
Notes. ALL = acute lymphocytic leukemia; AML = acute myeloid leukemia; BFCS = Benefit Finding in Cancer Scale; BFI = Brief Fatigue Inventory; BMT = bone marrow transplant; BSI-18 = Brief
Symptom Inventory-18; CES-D = Centers for Epidemiological Studies-Depression; CLL= chronic lymphocytic leukemia; CML = chronic myeloid leukemia; CNS = central nervous system; FACT-Fatigue
= Functional Assessment of Cancer Therapy – Fatigue; FACT-G = Functional Assessment of Cancer Therapy –General; FACIT-Sp= Functional Assessment of Chronic Illness Therapy-Spiritual; MCS =
Mental Component Summary; NR = not reported; PANAS = Positive and Negative Affect Scale; PCR = Perceived Closeness and Responsiveness; PCS = Physical Component Summary; POMS = Profile of
Mood States; POMS-SF = POMS-Short Form; PSQI = Pittsburgh Sleep Quality Index; QOL = quality of life; SF-12 = Medical Outcomes Study 12-item short-form; SF-36 = Medical Outcomes Study 36-
item short-form; STAI = State Trait Anxiety Inventory; VAS = Visual Analog Scale
Page 16
Table 2
Randomized Controlled Trials of Yoga for Adults during Cancer Treatment

Treatment
Danhauer et al.
Last Name - Control group(s) - Cancer type - Completing protocol (n or %) - Timing of assessment ***p<0.001
Year - N (n or % by Sex) - Stage - Class adherence (% or # of - Primary measures **p<0.01
Country - Age: Mean (SD; range) - Treatment(s) classes) *p<0.05
- Race/ethnicity received during the
study
Archer & - TAU - Gynaecologic - yoga: 56%, control: 97% - Pre- and post-intervention, 4 month - QOL: NR
Forshaw, 2015; - N=66 (100% F) (N=66) - NR follow-up - Breathing: used often outside of formal
Archer et al., - NR - NR - QOL (EORTC QLQ-C30); pain, yoga practice to enhance relaxation and
2015 [36-37] - NR - Surgery, chemo, anxiety, fatigue and global QOL sleep, manage rumination, and increase
UK radiation (n’s NR) (VAS weekly diary); qualitative/focus body awareness
groups - Movements: intimidating for participants
without yoga experience or with more
comorbidities, others enjoyed physical
activity and benefitted in strength,
flexibility and pain management
- Social: group class decreased isolation,
increased sense of community, allowed
exchange of information and support
Banerjee et al., - Supportive counseling - Breast (N=58) - n=35 yoga; n=23 control - Pre- and post-radiation - Anxiety,*** depression,*** stress,***
2007 [38] - N=68 (100% F) - II–III - NR - Anxiety and depression (HADS), DNA damage.***
India - 44 (1.3; NR) - Radiation (N=58) stress (PSS), DNA damage (alkaline - HADS and PSS increased in control
- NR single-cell gel electrophoresis) group vs. decrease in yoga group
Chakrabarty et - TAU - Breast (N=160) - NR - Pre- and post-radiation - Fatigue***
al., 2015 [39] - N=160 (100% F) - 1-3 - NR - Fatigue (CRFS)
India - yoga: 43.57 (8.5; NR); - Radiation (N=160)
control: 43.57 (8.5; NR)-
NR
Chandwani et al., - Waitlist - Breast (N=61) - N=81 enrolled; n=10 withdrew - Pre-RT/yoga (T1) and 1 week (T2), - Sleep, depression, fatigue and anxiety
2010 [40] - N=61 (100% F) - 0-III prior to randomization; n=10 1 month (T3) and 3 months (T4) after were all NS; yoga reported better physical
US - yoga: 51.39 (7.97; - Radiation (N=61) withdrew prior to radiation last RT session QOL,* general health,** and physical
37.1-67.6); control: 54.02 - n at T1, T2, T3, T4: yoga=30, 27, - QOL (SF-36), fatigue (BFI), sleep function* than control at T2
(9.96; 31.8-67.9) 26, 27; control=31, 31, 27, 29 (PSQI), depression (CES-D), anxiety - At T3, intrusion**
- n=3 African American, - 15 (50%) completed all 12 classes (STATE), intrusion and avoidance - At T4, benefit finding**
n=47 Caucasian, n=5 - 8 (28%) attended 11 (IES), benefit finding (BFS) - Intrusive thoughts at T3 were positively
Hispanic, n=1 Asian/ - 1 (3%) attended 10 associated with BFS at T4
Pacific Islander, n=3 Other - 1 each attended 2, 3, 4, 5, 7, 8
classes
- 8 (28%) practiced daily, 12 (40%)
>2 times per week, 8 (28%) 2times
per week, 1 (3%) no home practice
Chandwani et al., - Stretching, waitlist - Breast (N=163) - N=191 consented; n=13 withdrew - pre-RT/yoga (T1) and 1 week (T2), - Depression and sleep NS at all time
2014 [58] - N=163 (100% F) - 0-III prior to randomization; n=15 1 month (T3), 3 months (T4) and 6 points; at T2, fatigue* with yoga and
US - yoga: 52.38 (1.35; - Radiation (N=163) withdrew after randomization months (T5) after last RT session stretch both lower than control but not
26-77); stretch: 51.14 different from each other
Page 17

Treatment
(1.32; 25-79); waitlist: - n at T1, T2, T3, T4, T5: yoga: 53, - QOL (SF-36), fatigue (BFI), sleep - at T3, yoga physical QOL better than
52.11 (1.34; 30-69) 49, 39, 41, 43; stretch: 56, 52, 44, (PSQI), depression (CES-D); salivary control*, physical function** and general
- n=25 African American, 41, 43; waitlist: 54, 48, 43, 42, 46 cortisol health** better than stretch
n=97 Caucasian, n=17 - 87% yoga and 85% stretch - at T4, yoga physical QOL* better than
Hispanic, n=7 Asian/ attended >=12 of 18 classes control, yoga physical function* and
Danhauer et al.
Pacific Islander, n=4 Other - n=3 per group attended <50% general health* better than stretch and
classes control
- at T5, yoga physical function* better than
control
- cortisol slope steeper in yoga at T2 (vs.
stretch* and control**) and at T3 (vs.
control*)
Cohen et al., - Waitlist - Lymphoma (N=39) - n=19 in each group (1 yoga - 1-3 weeks prior to start of yoga - On average, TY participants rated each
2004 [41] - N=39 (n=12 F) - I–IV patient dropped out before classes; then 1 week, 1 month and 3 element (breathing, mindfulness,
USA - 51 (NR) - Chemotherapy beginning classes); months after last session movement, etc.) as beneficial (~4.5 on 5
- NR (n=24) - n=6 / 32% attended all 7 sessions; - Distress (IES); anxiety (STATE); point scale)
5 / 26% attended 5-6; 6 / 32% depression (CES-D); fatigue (BFI); - TY group reported better overall sleep,**
attended 2-3; 2 / 10% attended only sleep disturbance (PSQI) sleep quality,* sleep latency,** duration,*
1 session; 19 / 84% of yoga group and less sleep medication use*
and 14 / 74% of controls completed
at least 1 of 3 follow-up
assessments
Danhauer et al, - Waitlist - Breast (N=44) - Mean # yoga classes attended = - Baseline (week 0) and week 10 - Group effects for mental functioning**,
2009 [42] - N=44 (100% F) - 0-IV 5.7; n=11 attended ≤7 of 10 classes, (within 1 week of last class); depression*, positive affect**, spiritual
USA - yoga: 54.3 (9.6; 38-76); - Chemotherapy n=6 attended 3-6, n=5 attended ≤2; - Perceived health and functioning well-being (peace/meaning)***
control: 57.2 (10.2; 41-79) (n=11); radiation - complete data analyzed from 13 (SF-12), QOL (FACT-B), fatigue - Baseline × group interactions for negative
- n=39 Caucasian, n=3 during study (n=9) yoga and 14 control (9 yoga and 7 (FACT-Fatigue), spiritual well-being affect,* emotional well-being*; significant
African American, n=2 control did not return (FACIT-Spirituality), depression relationship between # classes and physical
Asian/Pacific Islander questionnaire, 1 control dropped (CES-D), sleep (PSQI), affect functioning,* breast cancer QOL,* physical
out) (PANAS) well-being,** functional well-being**
- 92% liked class quite a bit - very much.
Scale 0-4 mean rating teach competent 3.8,
teacher made class enjoyable 3.7, liked
classes 3.7, classes helpful 3.2, will
continue 2.5
Dhruva et al., - Waitlist - Breast (n=8); Other - 3 yoga, 2 control withdrew - Baseline, midpoint (after cycle 1), - Amount of practice was associated with
2012 [43] - N=23 (n=2 M) (n=8) immediately after randomization study end decreased sleep disturbance,* decreased
USA - yoga: 52.4 (14.6; NR); - Non-metastatic and - n=9 per group completed - Fatigue (revised PFS), sleep anxiety,* and improved mental QOL*
control: 56.0 (11.9; NR) metastatic treatment; n=8 per group analyzed disturbance (GSDS), anxiety and - No statistical analyses presented for the
- n=10 Caucasian - Chemotherapy - 100% class attendance in control, depression (HADS), stress (PSS), between group effects
(n=23) 97% in yoga group QOL (SF-12)
- average home practice 2.4h/week
control, 3.2h/week yoga
Kovacic et al., - Standard physiotherapy - Breast (N=32) - NR - Baseline (post-surgery), 1 week - Distress (GHQ and RSCL),** anxiety**
2013; Kovacic & - N=32 (100% F) - I–II - All participants completed home after attendance, 4 weeks after and self-esteem* at T2 and T3; perceived
Kovacic 2011a, - NR - Surgery, followed by practice 5-7 times per week attendance stress** at T3 (not measured at T2)
2011b [44-46] - NR chemotherapy and - distress (GHQ-12; RSCL-
Slovenia radiation (N=32) psychological subscale); perceived
stress (PSS); self-esteem (RSE);
anxiety (STAI)
Page 18

Treatment
Moadel et al., - TAU - Breast (N=164) - n=16 yoga, 8 control lost to - Baseline, 1 month, 3 month, 6month - Social well-being decreased more in
2007 [47] - N=164 (100% F) - I–IV follow-up; n=5 yoga, 3 control - QOL (FACT); fatigue (FACIT- control group compared to yoga group
USA - 54.82 (9.95; 28-75) - 48% receiving refused further participation; n=3 Fatigue); spiritual and existential from baseline to 3mo*
- n=54 African American, medical treatment yoga, 1 control withdrew due to well-being (FACIT-Sp); distressed - within yoga group, those attending >6
n=40 Hispanic, n=29 (e.g., 27% change in health status (attrition: mood (POMS) classes had less fatigue than 1-6* and 0
Danhauer et al.
Caucasian, n=5 Other chemotherapy and 22% yoga, 21% control) classes,*** better physical well-being than
30% antiestrogen - 32% of yoga participants with 1-6* and than 0** classes, and less distress
therapy at baseline) baseline and 3mo data attended 0 than 0** classes
classes, 39% attended >6 of 12
classes; 19% reported 0 home
practice, 51% few times/week
Raghavendra et - Supportive therapy - Breast (N=98) - n=18 yoga, 20 control completed; - Pre-surgery, post-surgery, during - Lower state anxiety* and symptom
al., 2007; Rao et - N=98 (100% F) - II–III 12 yoga, 17 controls discontinued and after RT and chemo distress* at all time points in yoga vs.
al., 2009, 2008a, - 49.2 (9.6; NR) - Surgery followed by post-surgery + 15 yoga, 13 controls - Anxiety (STAI); depression (BDI); control completers; intention-to-treat
2008b, 2008c, - NR standard protocol of did not receive standard regimen of treatment-related symptoms (study- analysis showed women randomized to
2015 [48-53] radiation and radiation/chemotherapy specific measure); nausea and yoga had lower anxiety post-surgery* and
India chemotherapy vomiting (MANE); QOL (FLIC); lower depression during radiation** and
post-operative outcomes; immune during chemo***; yoga reduced post-
biomarkers (serum and plasma) chemo nausea frequency** and severity,**
vomiting severity,* QOL during chemo;***
yoga fewer days drain retention, suture
removal and hospital stay post-surgery; no
difference in post-op complications, IL2r
alpha or IFN-gamma; yoga group TNF-
alpha significantly decreased*** while
control group TNF-alpha significantly
increased*
Taso et al., 2014 - TAU - Breast (N=60) - 100% completion; 80% adherence - Pre-intervention, 4 weeks (mid), 8 - Time by group interactions: anxiety and
[57] - N=60 (100% F) - I–III - n=3 attended 13-14 of 16 classes; weeks (post) and 4-week follow-up depression both NS; fatigue*** and effect
Taiwan - 49.27 (10.23; NR) - Chemotherapy n=13 attended all 16 classes - Depression and anxiety (POMS), of fatigue on daily life;*** within
- NR (N=60) fatigue (BFI-Taiwan) experimental group main effects:
fatigue*** and fatigue effect on daily
life*** at 8week post (vs. fatigue and its
effect on daily life increased, both***,
within the control group)
- Among individuals with low fatigue,
intervention reduced fatigue and its effects
on daily life at post-test* and follow-up*
Vadiraja et al., - Supportive counseling - Breast (N=88) - n=2 yoga dropouts; 11 control - Pre- and post-RT - Anxiety,*** depression,* perceived
2009a, 2009b, - N=88 (100% F) - I–III dropouts; - Anxiety and depression (HADS); stress,*** psychological distress;***
2009c [54-56] - yoga: 46.7 (9.3; NR); - Adjuvant radiation - 30% attended 10-20 of 36 perceived stress (PSS); distress, fatigue,** insomnia,** appetite loss,**
India control: 48.5 (10.2; NR) (n=75) sessions; 57% attended 20-25; 14% physical and functional status and pain,* nausea/vomiting;* positive affect,**
- NR attended >25 of 36 sessions global QOL (RSCL); treatment- negative affect,** emotional** and
related symptoms (EORTC QOL cognitive* function; 6am* and mean
C30); affect (PANAS); diurnal pooled diurnal cortisol*
salivary cortisol
Note. BFI=Brief Fatigue Inventory; BFS=Benefit Finding Scale; CES-D=Center for Epidemiologic Studies Depression Scale; CRFS=Cancer-Related Fatigue Scale; EORTC=European Organization for the
Research and Treatment of Cancer; F=female; FLIC=Functional Living Index of Cancer; GSDS=General Sleep Disturbance Scale; HADS=Hospital Anxiety and Depression Scale; HADS-A=HADS-
Anxiety; HADS-D=HADS Depression; IES=Impact of Events Scale; M=male; MANE=Morrow Assessment of Nausea and Emesis Questionnaire; NR = not reported; PANAS=Positive and Negative Affect
Page 19
Scale; PFS=Piper Fatigue Scale; PSQI=Pittsburgh Sleep Quality Index; RCT=randomized controlled trial; RSCL=Rotterdam Symptom Checklist; RSE=Rosenberg Self-Esteem Scale; SF-12=Medical
Outcomes Study 12-item short-form survey; SF-36=Medical Outcomes Study 36-item short-form survey; STATE=Speilberger State Anxiety Inventory State Portion; TAU = treatment as usual
Danhauer et al.
Page 20
Table 3
Yoga Protocol Details for Adult Studies
Author, year - Name/Style of yoga - Duration, Frequency - Instructor Qualifications - Specific class sequence
- Intervention components1 - Delivery - Cancer-Specific Yoga - Modifications available?
- Home Practice Training - Progression
Danhauer et al.
- Treatment fidelity assessed?

Archer & Forshaw, 2015; - Hatha - 10 weekly 60-minute sessions - NR - NR
Archer et al., 2015 - NR, although qualitative - NR - NR - NR
[36-37] responses discussed breathing and - NR - NR
movements - NR
Banerjee et al., 2007 [38] - VYASA - 90-minute sessions for 6 weeks, frequency NR - NR - NR
- Movements, pranayama, - NR - NR - NR
meditation, yoga nidra, chanting - Audio recordings provided - NR
- NR
Carson et al., 2007 [21] - Broad spectrum of traditional - 8 weekly 120-minute sessions - Jointly led by a yoga teacher - Manual was developed
yogic techniques - Group classes registered with national Yoga - Yes
- Movements, pranayama, - 10 minutes daily with CDs or audiotapes, illustrated Alliance and a clinical health - NR
meditation, study of pertinent handbooks psychologist - Yes
topics, group discussions - Extensive experience in
teaching yoga to medical
patients
Chakrabarty et al., 2015 - NR - 20 minutes twice/day, 5 days/week for 6 weeks - NR - Sequence provided
[39] - Pranayama - NR - NR - Yes
- NR - NR
- NR
Chandwani et al., 2010 - VYASA - 60-minute sessions, up to 2 times per week for 6 weeks - VYASA-trained teachers - Provided in publication
[40] - Movements, pranayama, - Group classes (most implemented individually due to - NR - NR
savasana, meditation, yama and scheduling) - NR
niyama - Daily, with audio CD and printed manual - NR
Chandwani et al., 2014 - VYASA - 60-minute sessions, up to 3 times per week for 6 weeks - VYASA-trained teachers - Provided in publication
[58] - Movements, breathing, savasana, - Group classes (most implemented individually due to - NR - NR
meditation scheduling) - NR
- Audio CD and printed manual provided - NR
Cohen et al., 2004 [41] - Tibetan (Tsa lung and Trul khor) - 7 weekly sessions, duration NR - Experienced TY instructor - NR
- Breathing, visualization, - Group classes - NR - NR
meditation, movements - Daily, with printed materials; audiotape provided after - NR
final session - NR
Danhauer et al., 2008 [22] - Restorative - 10 weekly 75-minute sessions - Registered with National - Sequence provided
- Movements, breathing, deep - Group classes Yoga Alliance - Yes
relaxation, guiding principle of - NR - Integral Yoga Therapy in - NR
ahimsa (non-violence) Cancer and Chronic Illness - NR
Danhauer et al., 2009 [42] - Restorative - 10 weekly 75-minute sessions - Registered with National - Sequence provided
- Movements, breathing, deep - Group classes Yoga Alliance - Yes
relaxation, guiding principle of - NR - Integral Yoga Therapy in - NR
ahimsa (non-violence) Cancer and Chronic Illness - NR
Page 21
Dhruva et al., 2012 [43] - NR - 4 weekly 60-minute sessions - Yoga instructors with training - NR
- Breathing - Group classes (most sessions had 1-2 participants) in therapeutic yoga - NR
- 2 times/day for 20-30 minutes total - Experience teaching yoga to - NR
Danhauer et al.
people with cancer - Yes

Duncan et al., 2008 [23] - Iyengar - 4 weekly 90-minute sessions - NR - Provided in publication
- NR - Group classes - NR - NR
- NR - NR
- NR
Galantino et al., 2012 - Iyengar-inspired - 70-minute sessions twice/week for 6 weeks and once/ - Certified yoga instructors - Provided in publication
[24] - Postures, breathing, meditation week for next 6 weeks (12 weeks total) - NR - Yes
- Group classes - Decreased use of props
- 15 minutes 3 times/week, beginning in week 6 - NR
Kovacic et al., 2013; - Yoga in Daily Life (YIDL) - Daily 45-minute sessions for 1 week post-surgery - 7 years experience with - Provided in publication
Kovacic & Kovacic - Breathing, relaxation, meditation - Group classes YIDL - NR
2011a, 2011b [44-46] - Post-intervention: daily for 3 weeks with audio - 3 years experience with - NR
recording oncology patients - NR
Kumar & Balkrishna, - Swami Ramdev Yog - NR - NR - 7 sequences of Swami Ramdev Yog
2009 [25] - Breathing - NR - NR - NR
- NR - NR
- NR
McCall et al., 2015 [26] - NR - A, low-dose: 45-minute intro; B, medium-dose: 45- - NR - Outline provided in publication
- Pranayama, relaxation, asana, minute intro + 120 minute workshop + online class - NR - Yes
meditation, group discussion access; C, high-dose: 45-minute intro + 60-minute - NR
weekly class × 3 weeks + online class access - NR
Milbury et al., 2014 [27] - Tibetan (Tsa lung) - 2-3 weekly sessions (45-60 minutes) over 5-6 weeks - NR
- Breathing, visualization, - Individual sessions per dyad - NR
meditation, movements - On days not meeting with instructor, with printed - Sessions 1-4 focused on gradually
materials and CD introducing techniques, sessions 5-15
focused on refining and practicing the
techniques
- NR
Milbury et al., 2015 [28] - Vivekananda Yoga - 2-3 60-minute sessions/week for 5-6 weeks - NR - Available
- Movements, breathing, - NR - NR - Yes
relaxation, meditation - Printed materials - Sessions 1-4 focused on gradually
introducing techniques, sessions 5-15
focused on refining and practicing the
techniques
- NR
Moadel et al., 2007 [47] - Hatha - 12 weekly 90-minute sessions - NR - NR
- Movements (all seated or reclined - Group classes - NR - NR
with props), breathing, meditation - NR - NR
- NR
Raghavendra et al., 2007; - VYASA - 4 sessions pre- and post-surgery; 3 weekly sessions - Jointly led by naturopathic - NR
Rao et al., 2009, 2008a, during 6 weeks of radiation; 1 session every 10 days physician and Yoga Institute - NR
during chemotherapy certified yoga therapist - NR
Page 22
2008b, 2008c, 2015 - Movements, breathing, - Individual - NR - NR
[48-53] meditation, relaxation with - Audio recordings
imagery, chanting
Danhauer et al.
Sohl et al., 2012 [29] - Key skills from multiple - 3 15-minute sessions - NR - NR
traditions (e.g., Integral Yoga, - Individual, during chemotherapy infusions - Integral Yoga Therapy in - Yes
Urban Zen Integrative Therapy) - Printed materials Cancer and Chronic Illness - NR
- Seated movements, breathing/ - NR
relaxation, meditation, theme of
self-compassion
Taso et al., 2014 [57] - Anusara - Twice weekly 60-minute sessions for 8 weeks - “Experienced instructor” - NR
- Movements, breathing, - NR - NR - NR
meditation - NR - NR
- NR
Vadiraja et al., 2009a, - VYASA - 60-minute sessions, 3-6 sessions per week over 6 - NR - Available
2009b, 2009c [54-56] - Movements, breathing, weeks - NR - NR
meditation, relaxation with - NR - NR
imagery - On days not attending yoga sessions, with audio - NR
recordings
1
English and Sanskrit terms are used interchangeably (i.e., breathing/pranayama, movements/asana), according to the terminology used in the original reports
NR = not reported, TY = Tibetan Yoga, VYASA = Vivekananda Yoga Anusandhana Samsthana
Page 23

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Review of Yoga Therapy During Cancer Treatment

Chicago, IL, USA

Results—Results of non-randomized (adult: n=8, pediatric: n=4) and randomized controlled

Conclusions—Among adults undergoing cancer treatment, evidence supports recommending

influencing behaviors [4-6].

Psychophysiological Rationale for the Use of Yoga during Cancer

Intervention Characteristics—Two pediatric studies used specific styles of yoga [33,

Feasibility—Three of the four pediatric studies examined feasibility, attrition and

Outcomes—In two studies reporting on pediatric QOL, one documented statistically

outcomes included statistically significant increases in children’s functional mobility,

Adult Studies of Yoga during Cancer Treatment: Non-Randomized Trials (Table 1)

Intervention Characteristics—Seven interventions were based in a specific yoga style

Outcomes—The nine non-randomized adult trials reported on a variety of outcomes

Statistically and/or clinically significant improvements in mental health included anxiety,

Physical health significantly improved in terms of physical QOL, fatigue, invigoration,

Participant Demographics—Thirteen randomized studies (Table 2), reported in 23

Intervention Characteristics—Among studies that described yoga style, three were

Feasibility—Across three studies, attrition averaged 20% prior to or immediately after

completion [39, 57].

Outcomes—Several of the 13 RCTs demonstrated significant improvements in yoga

hospitalization, among yoga vs. control participants [51].

Summary and Limitations

Generalizability is further limited by variability in intervention protocols. Most studies

modifications, instructors, and home practice, as well as the measurement of intervention

treatment can prevent or buffer the negative side effects of treatment.

provide data to support incorporating yoga into clinical settings [66].

Clinical Implications and Conclusions

and mechanisms. Psychosom Med. 2011; 73:724–730. doi: PSY.0b013e318235be76 [pii];10.1097/

Forum. 2010; 37(1):E7–E15. doi: K51346575M543440 [pii];10.1188/10.ONF.E7–E15. [PubMed:

Acad Sci USA. 2004; 101:17312–17315. doi: 0407162101 [pii];10.1073/pnas.0407162101.

j.jpainsymman.2006.08.009. [PubMed: 17349503]

Clin Path. 2009; 62:1052–1053.

analysis. Complement Ther Med. 2015; 23(1):55–62. [PubMed: 25637153]

10.1089/acm.2010.0653 [PubMed: 22106845]

Trial. Indian J Palliat Care. 2015; 21(2):174–181. [PubMed: 26009671]

10.1097/jnr.0000000000000044 [doi];00134372-201409000-00004. [PubMed: 25111109]

patients: A randomized clinical trial. Cancer. 2008; 113:3450–3458. DOI: 10.1002/cncr.23969

Non-Randomized Studies of Yoga for Adults during Cancer Treatment

Author Design/Sample Cancer Type and Adherence Outcome Measures Results

Author Design/Sample Cancer Type and Adherence Outcome Measures Results

- HRQOL: A 0.7 (1.3), B -0.1 (0.8), C 0.2

Randomized Controlled Trials of Yoga for Adults during Cancer Treatment

Author Design/Sample Cancer Type and Adherence Outcome Measures Results

Author Design/Sample Cancer Type and Adherence Outcome Measures Results

Author Design/Sample Cancer Type and Adherence Outcome Measures Results

Yoga Protocol Details for Adult Studies

- Treatment fidelity assessed?

people with cancer - Yes

NR = not reported, TY = Tibetan Yoga, VYASA = Vivekananda Yoga Anusandhana Samsthana

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