Background
Methods
Literature search
Study inclusion criteria
Selection process and quality assessment
Data extraction
Meta-analysis
Results
Author, year | Diagnosis; treatment | number of participants (n); gender (%women); mean age (sd) and/or range | eligibility criteria |
---|---|---|---|
Banasik, 2011 [56] | Breast cancer, (>2 mo) post-treatment | n = 18 (9Y, 9C) % women: 100% Age: 62.9 (7.1) years |
Inclusion women with stages II-IV breast cancer at least 2 months post-treatment. |
Exclusion receiving Herceptin therapy, pregnant or lactating, had past or current history of other neoplasm, active serious infection or immune deficiency; history of psychiatric disorders or alcohol or drug abuse; steroid therapy or physical condition preventing yoga. | |||
Banerjee, 2007 [51] | Breast cancer, during radiotherapy | n = 58 (35Y, 23C) % women: 100% Age: 44 (1.3) years |
Inclusion Recently operated breast cancer, age between 30 and 70 years, Zubrod’s performance status 0–2 (ambulatory >50% of the time), high school education, treatment plan of radiotherapy or both radiotherapy and chemotherapy, consent to participate in the study. |
Exclusion Having any concurrent medical condition likely to interfere with the treatment; major psychiatric, neurological illness, or autoimmune disorders; cardiovascular illness; any known metastases. No exposure to other mutagens, smoking or alcohol for at least 3 months prior to pre-radiation blood donation. | |||
Blank, 2003 [31] | Breast cancer stage I-III receiving antiestrogen or aromatase inhibitor hormonal therapy | N = 18 (9Y, 9C) % women: 100% Age: 48 – 69 years |
Inclusion minimum of eight weeks post chemotherapy, estrogen receptor positive status, surgery for lumpectomy, modified mastectomy or full mastectomy (with/without reconstruction), a life expectancy greater than six months, adequate blood cell counts and kidney, liver, and cardiac function, physical and mental ability to attend all the Yoga training sessions. |
Exclusion women on Herceptin therapy, current steroid therapy, or other known immunomodulating medications, pregnancy or current lactation, a past or current history of another neoplasm, active serious infection or immune deficiency, documented alcohol or drug abuse, history of psychiatric disorders requiring use of psychotropic medication. | |||
Bower, 2012 [58] | Breast cancer state 0 – II, at least 6 months after adjuvant cancer therapy. | n = 31 (16Y, 15C) % women: 100% Age: 54.4 (5.7) years |
Inclusion originally diagnosed with stage 0 to II breast cancer; completed local and/or adjuvant cancer therapy (with the exception of hormone therapy) at least 6 months previously; ages 40 to 65 years; postmenopausal; no other cancer in last 5 years; experiencing persistent cancer-related fatigue. |
Exclusion chronic medical conditions or regular use of medications associated with fatigue; evidence that fatigue was driven primarily by a medical or psychiatric disorder other than cancer; evidence that fatigue was driven primarily by other noncancer-related factors; physical problems or conditions that could make yoga unsafe; a body mass index (BMI) >31 kg/m2. | |||
Carson, 2009 [32] | Breast cancer; no current treatment (4.9 ± 2.4 years since diagnose) | n = 37 (17Y, 20C) % women: 100% Age: 54.4 (7.5) years |
Inclusion Experiencing at least one hot flash per day on 4 or more days per week; no signs of active breast cancer; no current cytotoxic chemotherapy; diagnosed with breast cancer at stages IA-IIB ≥ 2 years before; no hormone replacement therapy currently or within prior 3 months; stabilized on constant regime of menopausal symptom medications and supplements for at least 3 weeks; if taking antidepressants, stabilized at a fixed dose for at least 3 months. |
Exclusion resided ≥ 70 miles from research site; unavailable to attend the intervention on the day and at the time offered; currently engaged in intensive yoga practice (> 3 days/week); having received treatment for serious psychiatric disorders (e.g. schizophrenia) in the previous 6 months; not English speaking | |||
Chandwani, 2010 [55] | Breast cancer, during radiotherapy | N = 61 % women: 100% Age: 51.4 (8.0) range 37–68 years |
Inclusion Women with stage 0-III breast cancer; ≥ 18 years; able to read, write and speak English; scheduled to undergo radiotherapy. |
Exclusion Patients who had any major psychiatric diagnosis or physical limitations that would prohibit participation in the yoga program. | |||
Cohen, 2004 [44] | Lymphoma (18% Hodgkin), 61,5% active treatment | n = 39 % women: 61.5% Age: 51 years |
Inclusion Patients with lymphoma who were either receiving chemotherapy or had received it within the past 12 months; ≥ 18 years; able to read and speak English. |
Exclusion Patients with major psychotic illnesses. | |||
Culos-Reed, 2006 [52] | Breast cancer (85%); no current treatment (> 3 mo post-treatment) | n = 38 % women: 95% Age: 51.2 (10.3) years |
Inclusion Cancer survivors who were currently not undergoing active treatment; no additional health concerns; ≥ 18 years; minimum 3 months post-treatment. |
Danhauer, 2009 [53] | Breast cancer; 34% actively undergoing treatment | n = 44 % women: 100% Age: 55.8 (9.9) years |
Inclusion Women ≥ 18 years; diagnosed with breast cancer; 2 to 24 months post-primary treatment (surgery) following initial diagnosis and/or had a recurrence of breast cancer within the past 24 months (regardless of treatment status); physically able to attend restorative yoga; able to understand English; free of medical contraindications reported by their physician. |
Littman, 2011 [57] | Breast cancer; > 3 mo post-treatment | n = 63 % women: 100% Age: 60 (7.9) years |
Inclusion Age between 21 and 75 years; completion of breast cancer treatment (stage 0-III) at least 3 months prior, BMI ≥24 kg/m2 (or ≥23 kg/m2 if of Asian descent). |
Exclusion Myocardial infarction or stroke in the previous 6 months, diabetes, current yoga practice, pregnancy or plans to become pregnant, factors that might lead to poor retention and yoga practice. | |||
Moadel, 2007 [54] | Breast cancer; 48% medical treatment | n = 128 % women: 100% Age: 54.8 (9.9) range 28–75 years |
Inclusion Age ≥ 18 years; new/recurrent breast cancer (stages I-III) diagnosis within previous 5 years; high performance status (Eastern Cooperative Oncology Group performance status of < 3); ability to speak English or Spanish; not actively practicing yoga. |
Raghavendra, 2007 [49] | Breast cancer, during chemotherapy | n = 62 % women: 100% Age: n = 33 < 50 yrs; n = 29 > 50 yrs |
Inclusion Recently diagnosed with operable breast cancer; aged between 30 and 70 years; Zubrod’s performance status 0–2; high school education; having a treatment plan with surgery followed by adjuvant chemotherapy or by both adjuvant radiotherapy and chemotherapy; consenting to participate in the study. |
Exclusion history of intestinal obstruction and any known sensitivity to any class of antiemetics. | |||
Rao, 2009 [50] | Breast cancer, during adjuvant chemotherapy and radiotherapy | n = 98; % women: 100% Age: ? |
Inclusion Recently diagnosed with operable breast cancer; aged between 30 and 70 years; Zubrod’s performance status 0–2; high school education; having a treatment plan with surgery followed by adjuvant radiotherapy and chemotherapy; consenting to participate in the study. |
Exclusion Having a concurrent medical condition likely to interfere with the treatment; any major psychiatric, neurological illness or autoimmune disorders; secondary malignancy. | |||
Breast cancer (stage II and III), during adjuvant | n = 88; % women: 100% Age: 46 (9.1) yrs yoga; 48.4 (10.2) yrs C. |
Inclusion Recently diagnosed with operable breast cancer; aged between 30 and 70 years; Zubrod’s performance status 0–2; high school education; having a treatment plan with surgery followed by adjuvant chemotherapy or by both adjuvant radiotherapy and chemotherapy; consenting to participate in the study. | |
Exclusion Having a concurrent medical condition likely to interfere with the treatment; any major psychiatric, neurological illness or autoimmune disorders; any known metastases; prescribed concurrent chemotherapy cycles during radiotherapy. |
Author, year | Yoga program (Y); Duration and frequency (D); Home practice (H) vs comparison (C) | Attendance |
---|---|---|
Banasik 2011 [56] |
Y Iyengar yoga given by expert Iyenger instructors, with focus on training and accepting the physical form of the body without specific meditation component. | Average 14 classes out of 16 (87.5%), range 12 – 15. |
D 8 weeks, twice a week, 90 min per session | ||
H -
| ||
C wait-list | ||
Banerjee, 2007 [51] |
Y Meditative practice, slow stretching and loosening exercises, motivation and counseling, yoga asanas, group awareness practices, pranayama, deep relaxation (yoga nidra) given by expert yoga trainers. | ? |
D 6-weeks; 90 min per session | ||
H Patients were provided with audio and video tools to practice at home and were followed up via telephone during weekends to ensure continuity of the practice. | ||
C Supportive counseling and advised to take light exercise. | ||
Blank, 2003 [31] |
Y Iyengar Yoga, including seated meditation, active asana, restorative poses, savasana. | ? |
D 8 weeks, 2 times per week | ||
H 1 home practice per week | ||
C wait-list control | ||
Bower, 2012 [58] |
Y Iyengar yoga classes were taught by a certified Junior Intermediate Iyengar yoga instructor and an assistant under the guidance of a senior teacher. | The mean number of yoga classes attended was 18.9 of 24 classes (78%), and the median was 22 of 24 classes (92%). |
D 12 weeks, twice a week, 90 min. | ||
H -
| ||
C Health education classes were conducted for 120 min once a week for 12 weeks. Classes were led by a PhD-level psychologist with clinical experience in the treatment of breast cancer survivors. | ||
Carson, 2009 [32] |
Y Yoga of Awareness given by certified yoga teacher: 40 min yoga poses, 10 min breathing techniques, 25 min meditation, 20 min of study pertinent topics and 25 min group discussion | Average 6 classes out of 8 (75%). 3 women less than 4 classes (3/17 = 17.6%) |
D 8 weeks, once a week, 120 min | ||
H Patients were encouraged to practice daily at home with aid of CD recordings and illustrated hand books. | ||
C Wait-list control | ||
Chandwani, 2010 [55] |
Y The multidimensional yoga module was given a trained yoga instructor: 10 warm-up movements synchronized with breathing, 25 min maintenance in selected postures, 10 min deep relaxation, 5 min pranayama, 10 min mediation. | 15 (50%) all 12 classes; 8 (28%) attended 11 classes; 1 (3%) attended 10 classes; 1 only 2 classes. One attended 3 classes, one 4, one 5, one 7 and one 8 classes. Average number of classes was 10.2 (85%); SD: 2.96; range 2 – 12. Home practice: 8 (28%) reported practicing |
D 6 weeks, 2 times per week; 60 min per session | ||
H Patients were encouraged to practice type full yoga once per day outside the classes, supported by a 60-min audio CD of the yoga program and a manual with photographs and instructions. | ||
C Wait-list control | ||
Cohen, 2004 [44] |
Y Tibetan yoga sessions given by experienced instructor, divided into 4 aspects: controlled breathing and visualization, mindfulness, and postures. | 32% all sessions; 26% 5 or 6 sessions; 32% 2 or 3 sessions; 10% 1 session |
D 7 weekly sessions | ||
H Patients were encouraged to practice the techniques at least once per day, supported by audiotape that walked them though all of the techniques. | ||
C Wait-list control | ||
Culos-Reed, 2006 [52] |
Y Classes were led by a certified yoga instructed and included 10 min gentle breathing; 50 min Yoga asanas; 15 min savasana. | |
D 7 weeks, 75 min. | ||
H - | ||
C Wait-list control | ||
Danhauer, 2009 [53] |
Y Restorative yoga classes were taught by a yoga instructor with cancer-specific yoga training and combined yoga asanas, pranayama, savasana. | Mean 5.8 (3.4) classes out of 10 (58%) 2 (10%) women 100%; 3 (14%) 0% of classes |
D 10 weekly 75-min classes | ||
H - | ||
C Wait-list control | ||
Littman, 2011 [57] |
Y Viniyoga, a Hatha therapeutic type o f yoga given by certified experienced yoga instructors: 5–10 min centering exercises to promote relaxation and internal focus, 50–60 min of seated and standing poses, 10–15 min guided relaxation, breathing exercises and meditation. | Mean 19.6 (range 1–61; median 20.5) classes. Home practice: 55.8 times (range 2 – 102; median 62). |
D 6 months, 5 times per week including at least one 75-min class | ||
H patients were given a DVD, VD and booklets of four home practices lasting 20–30 min each. | ||
C Wait-list control | ||
Moadel, 2007 [54] |
Y Classes were given by a certified yoga instructor and included 3 yoga components: physical stretches and poses, breathing exercises, and meditation. | High adherence (>6 classes): n = 33 (; Low adherence (1–6 classes), n = 24; No adherence (0 classes), n = 27. Average attendance 7 out of 12 classes (58%). |
D 12 weekly 1.5 hrs classes (more allowed) | ||
H Patients were asked to practice yoga at home daily and given an audiotape/compact disk for guidance. | ||
C Wait-list control | ||
Raghavendra, 2007 [49] |
Y Integrated yoga program administered by an instructor: asanas, breathing exercise, pranayama, meditation and yogic relaxation techniques with imagery. | ? |
D 30 min before the start of the chemotherapy infusion (once in 10 days, number of cycles 4–8). | ||
H Patients were provided with audiotapes of these exercises for home practice and asked to practice daily for 1 h for 6 days/week during intervals between chemotherapy cycles. | ||
C Supportive therapy and coping preparation | ||
Rao, 2009 [50] |
Y Integrated yoga program administered by an instructor: asanas, breathing, pranayama, mediation and yogic relaxation techniques with imagery. | ? |
D Four sessions during pre- and post operative period, 3 in-person sessions per week for 6 weeks during radiotherapy. During chemotherapy, subjects underwent person sessions during their hospital visits for chemotherapy administration (once in 21 days) and an additional yoga session once in 10 days. | ||
H Patients were given booklets, audiotapes with instructions on practices for home practice. | ||
C Supportive therapy sessions | ||
Y Integrated yoga program administered by an instructor: asanas, breathing, pranayama, mediation and yogic relaxation techniques with imagery. | 29.7% attended 10-20% supervised sessions, 56.7% attended 20–25, 13.7% attended >25 supervised sessions over a 6-week period. Attend minimal 3x/wk for 6 weeks → 18 classes. | |
D Minimum of 3 in-person sessions per week for 6 weeks during radio treatment; 1 hour per session. In total between 18–24 yoga sessions. | ||
H Patients were given booklets, audiotapes with instructions on practices for home practice. | ||
C Supportive therapy with education. 15-min counseling sessions once every 10 days during 6 weeks (3 or 4 sessions in total). |
Author, year | Physical outcomes |
Between group difference
| Psychosocial outcomes |
Between group difference
|
---|---|---|---|---|
Banasik, 2011 [56] | FACT | FACT | ||
- Physical well-being | N.S. | - emotional well-being | N.S. | |
- Functional well-being | N.S. | - social well-being | N.S. | |
Cortisol, morning | N.S. | Breast cancer concerns | N.S. | |
Cortison, noon | P = 0.004 | Fatigue | P = 0.003 | |
Cortisol, 5 p.m. | P = 0.004 | |||
Cortisol, 10 p.m. | N.S. | |||
Banerjee, 2007 [51] | DNA damage | 14,5% less DNA damage in Yoga group; p < 0.001 | Anxiety (HADS-A) | 48% reduction in yoga group vs 28% increase in controls; p < 0.001 |
Depression (HADS-D) | 57.5% decrease in yoga vs 24% decrease in controls; p < 0.001 | |||
Perceived stress (PSS) | 26.9% reduction in yoga vs 7% increase in controls; p < 0.001 | |||
Blank, 2003 [31] | 25% had relieved joint aches and shoulder stiffness | NA | 100% perceived direct stress reduction | NA |
88% felt more relaxed in daily life, more aware of body posture, improved body image | NA | |||
63% had improved mood and less anxiety | NA | |||
Bower, 2012 [58] | Lower extremity strength and endurance (timed chair stands) | 1.31 (−5.00; 2.38, N.S. | Fatigue (FSI) | −1.24 (−0.04; -2.45), p < 0.05 |
Flexibility (functional reach test) | −2.00 (5.76; -9.98), N.S. | Vigor | 4.80 (1.86; 7.74), p < 0.05 | |
Depression (BDI) | −5.80 (−1.74; -9.86), p < 0.05 | |||
Sleep quality (PSQI) | 0.20 (2.78; -2.38), N.S. | |||
Perceived stress (PSS) | −1.77 (1.71; -5.26), N.S. | |||
Carson, 2009 [32] | Hot flash frequency | P = 0.0017 | Negative mood | P = 0.099 |
Hot flash severity | P = 0.0019 | Relaxation | P = 0.543 | |
Hot flash total | P < 0.0001 | Vigor | P = 0.005 | |
Joint pain | P < 0.0001 | Acceptance | P = 0.058 | |
Night sweats | N.S. | Symptom-related bother | P < 0.0001 | |
Fatigue | P = 0.001 | |||
Sleep disturbance | P = 0.007 | |||
Chandwani, 2010 [55] | SF-36 | SF-36 | ||
- Physical component summary | ES = 0.44; P = 0.04 | - Mental component summary | N.S. | |
- Physical function | ES = 0.46; p = 0.04 | - Mental health | N.S. | |
- body pain | N.S. | - Role physical | N.S. | |
- Role emotional | N.S. | |||
- Social function | N.S. | |||
- vitality | N.S. | |||
- General HRQoL | ES = 0,47; p = 0.005 | |||
Depression (CES-D) | N.S. | |||
Anxiety (STAI) | N.S. | |||
Distress (IES) | ||||
- Intrusion | N.S. | |||
- Avoidance | N.S. | |||
Fatigue (BFI) | N.S. | |||
Sleep (PSQI) | N.S. | |||
Benefit finding (BFS) | N.S. | |||
Cohen, 2004 [44] | Distress (IES) | N.S. | ||
Anxiety (STAI) | N.S. | |||
Depression (CES-D) | N.S. | |||
Sleep disturbances (PSQI) | ||||
- Total score | P = 0.004 | |||
- Sleep quality | P = 0.02 | |||
- Sleep latency | P = 0.01 | |||
- Sleep duration | P = 0.03 | |||
- Sleep efficiency | N.S. | |||
- Sleep medications | P = 0.02 | |||
- Daytime dysfunction | N.S. | |||
Fatigue (BFI) | N.S. | |||
Culos-Reed, 2006 [52] | Physical activity (LSI) | N.S. | Mood (POMS) | |
Weight | N.S. | - Total mood | P < 0.10 | |
Systolic and diastolic blood pressure | N.S. | - Tension-anxiety | P < 0.10 | |
Hand grip strength | N.S. | - Depression-dejection | P < 0.10 | |
Distance walked | N.S. | - Confusion-bewilderment | P < 0.10 | |
Perceived exertion | N.S. | - Vigor | N.S. | |
Flexibility (sit and reach) | N.S. | - Anger-hostility | N.S. | |
EORTC-QLQ-C30 | Symptoms of stress (SOSI) | |||
- Physical function | N.S. | - Peripheral manifestations | N.S. | |
- pain | N.S. | - Cardiopulmonary symptoms | N.S. | |
- nausea and vomiting | N.S. | - Symptoms of arousal | N.S. | |
- dyspnea | P < 0.05 | - Upper respiratory symptoms | N.S. | |
- appetite | N.S. | - Central neurological symptoms | N.S. | |
- constipation | N.S. | - Gastrointestinal symptoms | P < 0.10 | |
- diarrhea | P < 0.05 | - Muscle tension | N.S. | |
- Habitual patterns | N.S. | |||
- Depression | N.S. | |||
- Anxiety/fear | N.S. | |||
- Emotional irritability | P < 0.10 | |||
- Cognitive disorganization | P < 0.10 | |||
HRQoL (EORTC QLQ-C30) | ||||
- global quality of life | P < 0.01 | |||
- emotional function | P < 0.05 | |||
- cognitive function | N.S. | |||
- social function | N.S. | |||
- role function | N.S. | |||
- fatigue (POMS) | N.S. | |||
- sleep disturbance | N.S. | |||
Danhauer, 2009 [53] | Physical function (SF-12) | N.S. | Mental health (SF-12) | P = 0.004 |
FACT | Depression (CES-D) | P = 0.026 | ||
- Physical well-being | N.S. | Fatigue (FACT-fatigue) | N.S. | |
- Functional well-being | N.S. | Negative affect (PANAS-NA) | P = 0.014 | |
Positive affect (PANAS-PA) | P = 0.01 | |||
FACT-General | P = 0.052 | |||
- Social well-being | N.S. | |||
- Emotional well-being | P = 0.042 | |||
Spiritual well being (FACIT Sp) | ||||
- peace/meaning | P = 0.0009 | |||
- role of faith | N.S. | |||
Sleep disturbances (PSQI) | ||||
- Total score | N.S. | |||
- Sleep quality | N.S. | |||
- Sleep latency | P = 0.078 | |||
- Sleep duration | N.S. | |||
- Sleep efficiency | N.S. | |||
- Sleep medications | P = 0.10 | |||
- Daytime dysfunction | N.S. | |||
Littman, 2011 [57] | FACT | Overall QoL (FACT-G) | N.S. | |
- Physical well-being | N.S. | Breast-cancer subscale | N.S. | |
- Functional well-being | N.S. | - Social well-being | N.S. | |
Physical Activity (MAQ) | N.S. | - Emotional well-being | N.S. | |
BMI | N.S. | - social/family well-being | N.S. | |
Waist circumference | −3.1 (−5.7; -0.4) | Fatigue (FACIT-F) | N.S. | |
Hip circumference | N.S. | |||
weight | N.S. | |||
Moadel, 2007 [54] | FACT | Overall QoL (FACT-G) | P < 0.01† | |
- Physical well-being | N.S. | - Social well-being | ES = −0.22 (−3.78 to −0.36); P = 0.018 | |
- Functional well-being | N.S. | - Emotional well-being | P = 0.018*; P < 0.05† | |
Fatigue (FACT-fatigue) | N.S. | |||
Spiritual well-being (FACIT Sp) | P = 0.009† | |||
Distressed Mood (DMI) | P < 0.05† | |||
- Anxious/sad | P = 0.046† | |||
- Irritability | P = 0.0275† | |||
- Confusion | N.S. | |||
Raghavendra, 2007 [49] | Nausea frequency | P = 0.01 | Anxiety (STAI) | P < 0.001 |
Nausea severity | P < 0.01 | Depression (DBI) | P < 0.001 | |
Vomiting frequency | P = 0.06 | Number of distressful symptoms | P = 0.002 | |
Vomiting severity | P = 0.05 | Severity of symptoms | P < 0.001 | |
Total toxicity score | P < 0.001 | Symptom distress | P < 0.001 | |
Overall quality of life (FLIC) | P < 0.001 | |||
Rao, 2009 [50] | State anxiety (STAI) | ES = 0.33; P < 0.05 (ITT) | ||
Trait anxiety (STAI) | ES = 0.24; NS (ITT) | |||
Symptom distress | P = 0.001 | |||
Vadiraja, 2009a [46] | Cortisol level at 6 am | ES = 0.24;P < 0.05 | Anxiety (HADS-A) | ES = 0.31; P < 0.001 |
Cortisol level at 9 am | N.S. | Depression (HADS-D) | ES = 0.31; P < 0.01 | |
Cortisol level at 9 pm | N.S. | perceived stress (PSS) | ES = 0.36; P < 0.001 | |
Mean pooled diurnal cortisol | ES = 0.27; P < 0.05 | |||
Vadiraja, 2009b [47] | EORTC QLQ-C30 | Positive Affect (PANAS) | ES = 0.59; P = 0.007 | |
- Physical function | ES = 0.16; N.S. | Negative Affect (PANAS) | ES = 0.84; P = 0.001 | |
HRQoL (EORTC QLQ-C30) | ||||
- Role function | ES = 0.19; N.S. | |||
- Emotional function | ES = 0.71; P = 0.001 | |||
- Cognitive function | ES = 0.48; P = 0.03 | |||
- Social function | ES = 0.21; N.S. | |||
Vadiraja 2009c [48] | Physical distress (RSCL) | ES = 0.33; p = 0.02 | Psychological distress (RCSL) | ES = 0.39; p < 0.001 |
EORTC-QLQ-C30 | EORTC QLQ-C30 | |||
- pain | ES = 0.14; N.S. | - fatigue | ES = 0.33; N.S. | |
- nausea and vomiting | ES = 0.05; N.S. | - insomnia | ES = 0.47; N.S. | |
- dyspnea | ES = 0.01; N.S. | |||
- appetite loss | ES = 0.38; N.S. | |||
- diarrhea | ES = 0.01; N.S. | |||
- constipation | ES = 0.14; N.S. | |||
Activity level | ES = 0.14; N.S. |
Quality assessment
First author, year | 1 | 2 | 3 | 4a
| 5 | 6 | 7 | 8 | 9 | score | % |
---|---|---|---|---|---|---|---|---|---|---|---|
Banasik, 2011 [56] | Y | Y | Y | Y | SR | Y C
| N | N | N | 5 | 63% |
Banerjee, 2007 [51] | Y | Y C
| Y | Y | Y | Y C
| Y C
| N | N | 7 | 78% |
Blank, 2003 [31] | Y | ? | ? | Y | N | ? | N | N | N | 2 | 22% |
Bower, 2012 [58] | Y | Y | Y | Y | Y | ? | Y | Y | Y | 8 | 89% |
Carson, 2009 [32] | Y | Y | Y | Y | Y | N C
| N | N | Y | 6 | 67% |
Chandwani, 2010 [55] | Y | Y C
| Y | Y | SR | Y C
| N | N, ES no CI | Y | 6 | 75% |
Cohen, 2004 [44] | Y | Y | Y | Y | NC (SR) | N C
| N | N, only 95% CI | N | 4 | 50% |
Culos-Reed, 2006 [52] | Y | Y | Y | Y | Y C
| Y C
| N | N | Y | 7 | 78% |
Danhauer, 2009 [53] | Y | Y | Y | Y | NC
| N C
| N | N | Y | 5 | 56% |
Littman, 2011 [57] | Y | Y C
| Y | Y | Y C
| Y d
| N | Y | N | 7 | 78% |
Moadel, 2007 [54] | Y | Y C
| Y b
| Y | NC
| N C
| N | Y | Y | 6 | 67% |
Raghavendra, 2007 [49] | Y | Y | Y | Y | SR | N | N | N | N | 4 | 50% |
Rao, 2009 [50] | Y | Y | Y | Y | SR | N | N | Y | Y | 6 | 67% |
Vadiraja, 2009a [46] | Y | Y | Y | Y | ? | ? | N | N, ES no CI | N | 4 | 50% |
Vadiraja, 2009b [47] | Y | Y | Y | Y | SR | ? | N | Y | Y | 6 | 75% |
Vadiraja, 2009c [48] | Y | Y | Y | Y | SR | ? | N | N, ES no CI | Y | 5 | 56% |
Study population
Yoga program
Effects
PHYSICAL | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Reference | [56] | [51] | [31] | [58] | [32] | [55] | [44] | [52] | [53] | [57] | [54] | [49] | [50] | [46] | [47] | [48] |
Year | 2011 | 2007 | 2003 | 2011 | 2009 | 2010 | 2004 | 2006 | 2009 | 2011 | 2007 | 2007 | 2009 | 2009a | 2009b | 2009c |
Sample size | 18 | 58 | 18 | 31 | 37 | 61 | 39 | 38 | 44 | 63 | 128 | 62 | 98 | 88 | 88 | 88 |
Treatment | AT | RT | HT | AT | AT | RT | Mix | AT | Mix | AT | mix | CT | CT + RT | RT | RT | RT |
Quality | high | high | low | high | high | high | high | high | high | high | high | high | high | high | high | high |
Physical function
| ||||||||||||||||
Physical function | N.S. | ↑ | N.S. | N.S. | N.S. | N.S. | N.S. | |||||||||
Functional well being | N.S. | N.S. | N.S. | N.S. | ||||||||||||
Physical symptoms
| ||||||||||||||||
Pain | ↓ | N.S. | N.S. | N.S. | ||||||||||||
Nausea vomiting | N.S. | ↓ | N.S. | |||||||||||||
Toxicity | ↓ | |||||||||||||||
Diarrhoea | ↓ | N.S. | ||||||||||||||
Constipation | N.S. | N.S. | ||||||||||||||
Appetite | N.S. | N.S. | ||||||||||||||
Dyspnea | ↓ | N.S | ||||||||||||||
Hot flashes | ↓ | |||||||||||||||
Night sweats | N.S. | |||||||||||||||
Activity/fitness
| ||||||||||||||||
Physical Activity | N.S. | N.S. | N.S. | |||||||||||||
Weight | N.S. | N.S. | ||||||||||||||
Body mass index | N.S. | |||||||||||||||
Waist circumference | ↓ | |||||||||||||||
Hip circumference | N.S. | |||||||||||||||
Flexibility | N.S. | N.S. | ||||||||||||||
Strength | N.S. | N.S. | ||||||||||||||
Fitness/distance walked | N.S. | |||||||||||||||
Perceived exertion | N.S. | |||||||||||||||
Biological Variables
| ||||||||||||||||
DNA Damage | ↓ | |||||||||||||||
Cortisol | ↓ | ↓ | ||||||||||||||
Blood pressure | N.S. |
PSYCHOSOCIAL | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Reference | [56] | [51] | [31] | [58] | [32] | [55] | [44] | [52] | [53] | [57] | [54] | [49] | [50] | [46] | [47] | [48] |
Year | 2011 | 2007 | 2003 | 2011 | 2009 | 2010 | 2004 | 2006 | 2009 | 2011 | 2007 | 2007 | 2009 | 2009a | 2009b | 2009c |
Sample size | 18 | 58 | 18 | 31 | 37 | 61 | 39 | 38 | 44 | 63 | 128 | 62 | 98 | 88 | 88 | 88 |
Treatment | AT | RT | HT | AT | AT | RT | Mix | AT | Mix | AT | Mix | CT | CT + RT | RT | RT | RT |
Quality | high | high | low | high | high | high | High | high | high | high | high | high | high | high | high | high |
Distress | ↓ | ↓ | N.S. | ↓ | N.S. | N.S. | ↓ | ↓ | ↓ | ↓ | ||||||
Anxiety | ↓ | ↓ | N.S. | N.S. | ↓ | ↓ | ↓ | ↓ | ||||||||
Depression | ↓ | ↓ | N.S. | N.S. | ↓ | ↓ | ↓ | N.S. | ||||||||
Fatigue | ↓ | ↓ | ↓ | N.S. | N.S. | N.S. | N.S. | N.S. | ||||||||
Sleep disturbance | N.S. | ↓ | N.S. | ↓ | N.S. | ↓ | ||||||||||
General HRQoL | ↑ | ↑ | ↑ | ↑ | N.S. | ↑ | ↑ | |||||||||
Emotional function | N.S. | N.S. | ↑ | N.S. | ↑ | ↑ | ||||||||||
Social function | N.S. | N.S. | N.S. | N.S. | N.S. | ↑ | N.S. | |||||||||
Role function | N.S. | N.S. | ||||||||||||||
Cognitive function | ↑ | |||||||||||||||
Positive affect | ↑ | ↑ | ||||||||||||||
Negative affect | ↑ | ↑ | ||||||||||||||
Vigor | ↑ | ↑ | ||||||||||||||
Mood | ↑ | ↑ | ||||||||||||||
Anger-hostility | ↓ | |||||||||||||||
Spirituality | ↑ | ↑ | ||||||||||||||
Relaxation | ↑ | ↑ | ||||||||||||||
Confusion | N.S. | |||||||||||||||
Mental Health | N.S. | ↑ | ||||||||||||||
Acceptance | ↑ |
Physical outcomes
Outcome | # studies | Pooled effect | Test of heterogeneity | |||||
---|---|---|---|---|---|---|---|---|
Physical outcomes
|
d
| 95% CI | Z | P | I2
| Q | P | |
Physical function | 6 | 0.60 | −0.05 to 1.25 | 1.81 | 0.07 | 87.51 | 40.03 | <0.0001 |
5a
| 0.17 | −0.06 to 0.40 | 1.48 | 0.14 | 0.00 | 1.20 | 0.88 | |
Functional well-being | 4 | 0.31 | 0.04 to 0.58 | 2.24 | 0.03 | 0.00 | 1.25 | 0.74 |
Psychosocial outcomes
|
d
|
95% CI
|
Z
|
P
|
I
2
|
Q
|
P
| |
Distress | 7 | −0.95 | −1.49 to −0.49 | −4.04 | <0.001 | 80.79 | 31.24 | <0.001 |
6b
| −0.75 | −1.09 to −0.42 | −4.39 | <0.001 | 59.59 | 12.37 | 0.03 | |
Anxiety | 7 | −1.25 | −1.93 to −0.56 | −3.64 | <0.001 | 91.45 | 70.20 | <0.001 |
6b
| −0.77 | −1.08 to −0.46 | −4.86 | <0.001 | 58.42 | 12.03 | 0.03 | |
Depression | 7 | −1.47 | −2.42 to −0.53 | −3.05 | 0.002 | 93.29 | 89.46 | <0.001 |
6b
| −0.69 | −1.02 to −0.37 | −4.21 | <0.001 | 42.15 | 8.64 | 0.12 | |
Fatigue | 7 | −0.51 | −0.79 to −0.22 | −3.46 | 0.001 | 43.52 | 10.62 | 0.10 |
Sleep disturbance | 4 | −0.26 | −0.53 to 0.02 | −1.82 | 0.07 | 0.00 | 1.25 | 0.74 |
General HRQoL | 7 | 0.88 | 0.25 to 1.50 | 2.75 | 0.006 | 86.49 | 44.41 | <0.001 |
6a
| 0.61 | 0.16 to 1.06 | 2.50 | 0.008 | 69.79 | 16.55 | 0.005 | |
5a,c
| 0.37 | 0.11 to 0.62 | 2.85 | 0.004 | 0.00 | 3.40 | 0.49 | |
Emotional function | 5 | 0.49 | 0.16 to 0.81 | 2.93 | 0.003 | 26.58 | 5.45 | 0.24 |
Social function | 6 | 0.33 | 0.12 to 0.54 | 3.12 | 0.002 | 0.00 | 1.94 | 0.86 |