SUMMARY: Breast cancer is the most common cancer among women in the US and about 1 in 8 women (12%), will develop invasive breast cancer during their lifetime. Approximately, 233,000 new cases of invasive breast cancer will be diagnosed in 2014 and 40,000 women will die of the disease. According to the SEER database, the 5 year survival of women with early stage breast cancer is well over 90%. This is mainly because of early detection and effective therapies. A third of these cancer survivors however are likely to be physically inactive due to fatigue, general deconditioning and effects of cancer treatment. There is a reduction in their cardiorespiratory fitness. Chronic inflammation has been implicated in decreased physical functioning, disability and mortality, even in those who are in remission. Regular exercise has been shown to reduce inflammation and fatigue. The authors in this study evaluated the impact of Yoga, which provides graded exercise, on inflammation, mood and fatigue. Yoga by definition is a physical, mental, and spiritual practice and hatha Yoga which is practiced in the Western countries, consists of physical and mental strength building exercises and postures. In this randomized controlled study, 200 breast cancer survivors between ages 27 and 76 years, were assigned to either the Yoga group (N=100) or control/no Yoga group (N=100). Both groups were well balanced with no significant difference between the groups in measures of activity, fatigue, body mass index or depressive symptoms. Enrolled patients were stratified by cancer stage and whether radiation therapy was given or not. Participants had Stage 0 – Stage IIIa breast cancer and had completed cancer treatment within the past three years and were at least 2 months post surgery, adjuvant chemotherapy or radiation treatment. Patients in the Yoga group participated in a 90 minute Yoga class, twice a week for 12 weeks (3 months). The protocol included the measurement of cytokines associated with inflammation and they included Interleukin-6 (IL-6), Interleukin-1beta (IL-1b) and Tumor Necrosis Factor-alfa (TNFa). In addition, other validated instruments were utilized to measure Fatigue and Vitality. Immediately following 12 weeks of Yoga intervention, there was a significant improvement in the Vitality score in the Yoga group (P=0.01) and at 3 months post intervention, the Vitality score was even higher (P=0.01). Fatigue was significantly lower 3 months post intervention, in the Yoga group (P=0.002). At 3 months post intervention, all inflammatory cytokines were lower as well, in the Yoga group – IL-6 (P=0.027), TNFa (P=0.027) and IL-1b (P=0.037). More frequent Yoga practice resulted in greater benefits, with improved sleep and decreased inflammation. It should be noted that sleep problems are 2-3 times more common in cancer survivors and close to two thirds of the cancer survivors experience insomnia. The authors concluded that this is the first and largest randomized controlled study that has demonstrated that practice of Yoga or similar such activities, can substantially reduce inflammation and Fatigue and improve Vitality in breast cancer survivors. Kiecolt-Glaser JK, Bennett JM, Andridge R, et al. J Clin Oncol 2014;32:1040-1049
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