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Yoga Improves Inflammation, Fatigue, and Vitality in Breast Cancer Survivors

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Key Points

  • Yoga was associated with a significant reduction in fatigue, significant increase in vitality, and significant reduction in levels of proinflammatory cytokines.
  • Increased yoga practice was associated with greater improvements in fatigue and vitality and a greater decrease in inflammatory markers.

In a study reported in the Journal of Clinical Oncology, Kiecolt-Glaser et al found that yoga reduced levels of inflammatory cytokines and fatigue and increased vitality in breast cancer survivors.

Study Details

In the study, 200 women with stage 0 to IIIA breast cancer who had completed cancer treatment within the past 3 years (except for tamoxifen or aromatase inhibitors) and had completed  adjuvant therapy or radiation ≥ 2 months prior to enrollment were randomized to 12 weeks of twice weekly 90-minute hatha yoga classes (n = 100) or a wait-list control (n = 100). The main outcome measures were lipopolysaccharide-stimulated levels of the proinflammatory cytokines interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha and scores on the Multidimensional Fatigue Symptom Inventory-Short Form, the vitality scale from the Medical Outcomes Study 36-item Short Form, and the Center for Epidemiological Studies–Depression scale, all measured at baseline and immediately after and 3 months after the intervention period.

The yoga and control groups were generally balanced for age (mean, 52 and 51 years), body mass index (mean, 27.9 and 27.6 kg/m2), race/ethnicity (89% and 88% white), current smoking (4% and 8%), activity level, marital status (68% and 72% married), education level (29% and 34% college graduates, 39% and 38% postgraduate), employment status (full- or part-time for 71% and 66%), and annual income (< $75,000 for 38% and 40%, $75,000–$99,999 for 23% in both, ≥ $100,000 for 30% and 29%).

The two groups were also well matched for type of treatment (surgery alone in 13% in both; surgery and radiation in 28% and 24%; surgery and chemotherapy in 23% in both; surgery, radiation, and chemotherapy in 36% and 40%), disease stage (0 in 9% in both, I in 46% and 43%, IIA in 27% and 25%, IIB in 10% and 13%, and IIIA in 8% and 10%), HER2-negative status (74% and 72%), estrogen receptor–positive status (81% and 78%), progesterone receptor–positive status (73% and 69%), use of tamoxifen/aromatase inhibitors (72% and 71%), postmenopausal status (76% and 77%), mean time since diagnosis (7.5 and 8.5 months), and mean time since treatment (7.1 and 8.5 months).

Improvements in Fatigue and Vitality

After adjusting for baseline levels, mean fatigue did not differ between groups at the immediate post-treatment evaluation (P = .058) but was significantly reduced in the yoga group at 3 months (P = .002). Vitality was significantly increased in the yoga group immediately post-treatment (P = .01) and at 3 months (P = .01). Depressive symptoms did not differ between groups at either time point.

Increasing frequency of yoga practice was more strongly associated with reduced fatigue and increased vitality, with a 10-minute per day increase in practice being associated with a significant reduction in fatigue (P = .019, P < .001) and a significant increase in vitality (P = .016, P = .0045) at both time points, but no change in depressive symptoms.

Reduced Inflammation

There were no significant differences between groups in proinflammatory cytokine levels at immediate post-treatment assessment, but the yoga group had significantly reduced interleukin-1 beta (20% lower geometric mean, P = .037), interleukin-6 (15% lower geometric mean, P = .027), and tumor necrosis factor-alpha (13% lower geometric mean, P = .027) at 3 months. At 3 months, a 10-minute-per-day increase in yoga practice was associated with a 5% decrease in geometric mean interleukin-6 (P = .01) and an 8% decrease in geometric mean interleukin-1 beta  (P = .03) but no significant change in tumor necrosis factor-alpha.

The investigators concluded, “Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.”

Janice K. Kiecolt-Glaser, of The Ohio State University College of Medicine, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by grants from the National Institutes of Health. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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