Tibetan Yoga Practice May Improve Sleep Quality for Patients With Breast Cancer Undergoing Chemotherapy

Key Points

  • 227 women with stage I to III breast cancer undergoing chemotherapy were randomized to one of three groups: a Tibetan yoga program, a simple stretching program, or a waitlist control group receiving usual care.
  • There were no statistically significant group differences in total sleep disturbances or fatigue levels over time, but participants in the Tibetan yoga group reported fewer daily disturbances 1 week post-treatment than either of the other groups.
  • Patients who practiced yoga reported fewer daily disturbances 3 months post-treatment, as well as better sleep quality and efficiency at 6 months post-treatment. These patients also reported fewer daily disturbances at 3 months and better sleep efficiency at 6 months relative to the usual care control group.

Participating in twice-weekly practice of Tibetan yoga may reduce sleep disturbances and improve sleep quality in breast cancer patients receiving chemotherapy, according to a study published by Chaoul et al in Cancer. The study, led by researchers from The University of Texas MD Anderson Cancer Center, found that women who practiced Tibetan yoga at least two times a week reported less daytime disturbances and better sleep quality/sleep efficiency over time compared to those practicing less often and to women in an active control group receiving usual care.

Sleep disturbances and fatigue are two of the most frequent and debilitating side effects experienced by cancer patients undergoing chemotherapy, explained lead author Lorenzo Cohen, PhD, Professor of Palliative, Rehabilitation, and Integrative Medicine and Director of the Integrative Medicine Program at MD Anderson. Patients often describe poor sleep quality, insomnia, and excessive drowsiness. 

“Previous research has established that yoga effectively reduces sleep disturbances for cancer patients, but have not included active control groups or long-term follow-up,” said Dr. Cohen. “This study hoped to address previous study limitations.”

Study Design

For the randomized study, 227 women with stage I to III breast cancer undergoing chemotherapy at MD Anderson Cancer Center were randomized to one of three groups: a Tibetan yoga program, a simple stretching program, or a waitlist control group receiving usual care. Participants in the Tibetan yoga program and the stretching program attended four 75–90 minute classes during their chemotherapy treatment.

Participants in the Tibetan yoga program were taught one-on-one by a trained instructor, with each class focusing on controlled breathing, visualization, meditation, and postures. Patients were encouraged to additionally practice daily at home outside of class.

Prior to starting the interventions, participants completed baseline questionnaires and wore an actigraphy watch, which monitors rest and activity cycles 24 hours a day for 7 days to assess sleep quality. Follow-up assessments were conducted 1 week after the end of intervention and 3, 6, and 12 months later.

Sleep disturbances and fatigue were assessed using the self-reported Pittsburgh Sleep Quality Index and the Brief Fatigue inventory. Participants also wore actigraphs 24 hours a day for 7 days at each study time point to measure sleep.

Findings

There were no statistically significant group differences in total sleep disturbances or fatigue levels over time, but participants in the Tibetan yoga group reported fewer daily disturbances 1 week post-treatment than either of the other groups.

Additionally, long-term sleep benefits emerged over time for those who practiced Tibetan yoga at least two times a week. Compared to those who practiced less often, these patients reported fewer daily disturbances 3 months post-treatment, as well as better sleep quality and efficiency at 6 months post-treatment. These patients also reported fewer daily disturbances at 3 months and better sleep efficiency at 6 months relative to the usual care control group.

“While the effects of this intervention were modest, it is encouraging to see that the women who practiced yoga outside of class had improved sleep outcomes over time,” said Dr. Cohen.

The study and findings were limited by several factors, including a lack of blinded group assignments and challenges with recruiting patients undergoing chemotherapy, resulting in just a 56% participation rate.

Planned future research will focus on shorter in-class instruction and increasing patient engagement in yoga practice outside of the instructional classes.

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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