Background
Methods
Study design
Participants
Eligibility criteria
Control group
Yoga intervention group
Practice and time allocated | Sanskrit |
---|---|
Settling and Breathing 10 minutes (DVD 10 minutes)
| |
Settling with awareness*
| Kaya Sthairyam [1] |
Mindfulness (inner silence)*
| Antar Mouna level one [2] |
Abdominal, thoracic, clavicular breath*
| Pranayama [3] |
Full yoga breath*
| Pranayama [3] |
Postures 35 minutes (DVD 25 minutes)[3] | |
1a Neck turns*
| Greeva Sanchalana |
1b Add outward rotation of opposite arm*
| Utthanpadasana-variation |
3 Knee hugs-leg lock pose*
| Supta Pawanmuktasana |
4 Shoulder circles*
| Shandha Chakra |
5 Bent arm opening, chest towards knees*
| Naukasana-variation combined with Namaskarasana-variation of arms |
6 Lying Archer*
| Akarna Dhanurasana-variation |
7 Lying rotation*
| Supta Udarakarshanasana-variation |
8 Arm/leg stretch*
| Supta Pawanmuktasana |
9 Sitting rowing*
| Nauka Sanchalanasana |
10 Standing archer*
| Akarna Dhanurasana |
11 Modified rope climbing*
| Rajju Karshanasana-variation |
12 Modified arm raise, knee bend*
| Tadasana-variation |
13 Modified side bend*
| Trikonasana-variation |
14 Standing rotation*
| Kati Chakrasana |
15 Standing Cat*
| Marjari-asana_variation |
16 Modified one legged prayer balance*
| Eka Pada Pranamasana |
17 Sitting neck turns*
| Greeva Sanchalana |
Mindfulness, Pranayama, Meditation 10 minutes
| |
Settling with awareness and stillness | Kaya Sthairyam |
*Mindfulness practice (inner silence) | Antar Mouna level one Weeks 1-4 |
Antar Mouna level one Weeks 5-8 | |
Alternate nostril breathing | Nadi Shodan [3] |
*Visualisation One-pointed focus-lymph system | Dharana [2] |
Meditation One-pointed focus candle | Tratak [3] Weeks 7 and 8 |
Relaxation-meditation 20 minutes (DVD 10 minutes)
| |
*Deep relaxation | Yoga Nidra [4] |
Discussion yoga themes 10 minutes
|
Outcome measures
Lymphoedema
Tissue induration
Sensations, pain and fatigue and their limiting effects
Quality of life
Data analysis
Results
Participant flow and compliance
Baseline demographics and medical characteristics
Characteristics | Intervention (n = 12) | Cotnrol (n = 11) | P valuea
|
---|---|---|---|
Mean ± SD | Mean ± SD | ||
Age (years) | 55.1 ± 2.5 | 60.5 ± 3.6 | 0.230 |
BMI (kg/m2) | 29.1 ± 4.6 | 25.1 ± 4.5 | 0.023 |
Range | 36-65 | 34-80 | |
Number nodes removed | 14.3 ± 2.3 | 11.2 ± 2.7 | 0.429 |
Number of positive nodes | 1.5 ± 0.5 | 3.7 ± 2.3 | 0.321 |
How long lymphoedema (years) | 4.9 ± 1.6 | 5.1 ± 1.9 | 0.900 |
How long post-surgery | 1.2 ± 0.4 | 1.9 ± 0.7 | 0.822 |
n(%)
|
n(%)
|
P value
b
| |
Living arrangements
| |||
Live alone | 2(14) | 3(27) | 0.912 |
Live with others | 10(83) | 8(73) | |
Employment
| |||
Home, retired | 5(42) | 8(73) | 0.280 |
Employed | 7(58) | 3(27) | |
Fitness (self-scored) | |||
Low | 2(17) | 1(9) | |
Medium | 8(67) | 8(73) | 0.913 |
High | 2(17) | 2(18) | |
Breast cancer surgery
| |||
Lumpectomy | 5(42) | 3(27) | 0.882 |
Mastectomy | 7(58) | 8(73) | |
Type of lymph dissection
| |||
Sentinel node | 0 | 1(9) | 0.980 |
Axillary clearance | 12(100) | 10(91) | |
Stage of breast cancer
| |||
DCIS | 0 | 1(9) | 0.976 |
1 | 3(25) | 4(36) | |
2 | 6(50) | 5(45) | |
3 | 3(25) | 1(9) | |
Treatment and effects
| |||
Chemotherapy | 8(66) | 6(54) | 0.867 |
Effects chemotherapy | 7(58) | 4(36) | 0.525 |
Radiotherapy | 9(75) | 7(64) | 0.890 |
Effects radiotherapy | 8(67) | 3(27) | 0.198 |
Most common area of radiotherapy
| |||
Chest | 7(58) | 7(64) | 0.909 |
Axilla | 2(17) | 2(18) | |
Axilla and chest | 3(25) | 2(18) | |
Other post-surgery effetcs
| |||
Post-surgery infection | 3(25) | 3(27) | 0.725 |
Post-surgery cording | 3(25) | 3(27) | 0.725 |
Post-surgery fluid removal | 9(75) | 9(82) | 0.913 |
Outcomes
Lymphoedema status
Volume of arm lymphoedema
Group mean ± SD b-8 | Between group changes 0-8 | Group mean ± SD 8b-12 | Between group changes 8b-12 | ||||||
---|---|---|---|---|---|---|---|---|---|
Variable Gp(n)
|
Week 0 M ± SD
|
Week 8 M ± SD
|
∆int-∆con 0–8 MD; (95%
Cl)
|
P(0–8)
|
Variable Gp(n)
|
Week 8b M ± SD
|
Week 12 m ± SD
|
∆int-∆con 8b-12 MD; (95%
CI)
|
P(8b-12)
|
Lymphoedema L-dex (BIS) | |||||||||
Con (11) | 6.49 ± 14.14 | 7.66 ± 12.64 | -1.03; (-4.17 to 2.10) | 0.519 | Con(10) | 8.68 ± 12.83 | 7.83 ± 13.59 | 2.57; (-1.04 to 6.18) | 0.163 |
Int(12) | 5.89 ± 9.07 | 6.03 ± 8.24 | Int(9) | 4.96 ± 6.40 | 6.67 ± 7.08 | ||||
Arm volume | |||||||||
Con(11) | 59.89 ± 78.53 | 60.75 ± 80.69 | -30.28; (-69.33 to 8.78) | 0.129 | Con(10) | 67.65 ± 82.39 | 58.17 ± 100.42 | 35.20; (3.09 to 67.32) | 0.032 |
Int(12) | 101.45 ± 75.08 | 72.03 ± 80.77 | Int(9) | 60.82 ± 82.84 | 86.53 ± 78.29 | ||||
Tissue induration (Tonometry) Forearm affected | |||||||||
Con(11) | 13.96 ± 3.82 | 14.06 ± 4.80 | 0-1.89; (-4.88 to 1.16) | 0.227 | Con(10) | 13.65 ± 4.85 | 12.45 ± 4.36 | -0.43; (-2.77 to 1.92) | 0.42 |
Int(12) | 15.78 ± 4.79 | 14.02 ± 3.59 | Int(9) | 13.87 ± 3.68 | 12.26 ± 2.41 | ||||
Forearm non-affected | |||||||||
Con(11) | 15.61 ± 4.17 | 15.81 ± 5.20 | -140; (-4.59 to 1.78) | 0.387 | Con(10) | 15.37 ± 5.27 | 12.66 ± 4.00 | 0.10; (-3.09 to 3.30) | 0.95 |
Int(12) | 15.92 ± 5.51 | 14.72 ± 5.42 | Int(9) | 14.68 ± 6.23 | 12.07 ± 4028 | ||||
Upper arm affected | |||||||||
Con(11) | 10.66 ± 5.57 | 12.54 ± 5.91 | -3.20; (-641 to 0) | 0.050 | Con(9) | 12.08 ± 6.02 | 8.92 ± 5.19 | 0.95; (-1.40 to 3.30) | 0.43 |
Int(12) | 11.10 ± 6.09 | 9.77 ± 3.33 | Int(9) | 9.63 ± 3.53 | 7.42 ± 4.39 | ||||
Upper arm non-affected | |||||||||
Con(10) | 10.14 ± 4.42 | 12.05 ± 6026 | -2.88; (-5.82 to 0.06) | 0.055 | Con(10) | 11.46 ± 6.34 | 7.97 ± 5.18 | 0.53; (-1.98 to 3.03) | 0.68 |
Int(12) | 9.88 ± 4.09 | 8.91 ± 3.621 | Int(9) | 8.17 ± 3.54 | 5.21 ± 3.10 | ||||
Chest affected | |||||||||
Con(11) | 6.78 ± 2.39 | 5.53 ± 3.41 | -0.36; (-2.63 to 1.91) | 0.758 | Cont(10Int(9) | 5.22 ± 3.43 | 5.76 ± 1.50 | -0.60; (-2.94 to 1.73) | 0.61 |
Int(12) | 6.34 ± 2.01 | 4.73 ± 1.75 | 4.23 ± 1.14 | 4.17 ± 1.09 | |||||
Chest non-affected | |||||||||
Con(11) | 5.59 ± 1.84 | 4.76 ± 2.65 | -0.34; (-2.85 to 2.17) | 0.878†
| Con(10) | 4.70 ± 2.79 | 6.18 ± 5.00 | -1.22; (-5.33 to 2.90) | 0.56 |
Int(12) | 6.06 ± 1.87 | 4.90 ± 1.97 | Int(9) | 4.98 ± 2.23 | 5.25 ± 1.60 | ||||
Upper back affected | |||||||||
Con(11) | 16.17 ± 2.39 | 16.76 ± 4.32 | 0.19; (-3.77 to 4.16) | 0.924 | Con(10) | 16.48 ± 4.45 | 13.21 ± 5.06 | 1.10; (-1.51 to 3.70) | 0.41 |
Int(12) | 16.06 ± 4.18 | 16.84 ± 4.82 | Int(9) | 15.81 ± 4.28 | 13.63 ± 2.930 | ||||
Upper back non-affected | |||||||||
Con(11) | 14.32 ± 3.87 | 15.13 ± 5.54 | -1.42; (-4.85 to 2.02) | 0.419 | Con(10) | 15.04 ± 5.79 | 14.43 ± 4.32 | -0.48; (-3.90 to 2.95) | 0.78 |
Int(12) | 15.55 ± 4.21 | 15.05 ± 4.86 | Int(9) | 14.66 ± 5.33 | 13.58 ± 3.83 |
Extra-cellular fluid
Tissue induration
Degree of sensations, pain, fatigue and their limiting effects
VAS | Group mean ± SD b-8 | Between group changes 0-8 | Group mean ± SD 8b-12 | Between group changes 8b-12 | |||||
---|---|---|---|---|---|---|---|---|---|
Variable Gp(n)
|
Week 0 M ± SD
|
Week 8 M ± SD
|
∆int-∆con 0–8 MD; (95%
CI)
|
P(0–8)
|
Variable Gp(n)
|
Week 8b M ± SD
|
Week 12 M ± SD
|
∆int-∆con 8b-12 MD; (95%
CI)
|
P(8b-12)
|
Sensations
| |||||||||
Con(11) | 1.97 ± 1.89 | 2.01 ± 2.15 | -0.55; (02.33 to 1.23) | 0.345†
| Con(10) | 2.20 ± 2.17 | 2.20 ± 2.12 | 0.30; (-1.21 to 1.81) | 0.698 |
Int(12) | 2.39 ± 2.12 | 1.88 ± 1.83 | Int(9) | 1.96 ± 1.59 | 2.26 ± 2.29 | ||||
Pain
| |||||||||
Con(11) | 1.69 ± 2.31 | 1.44 ± 2.24 | 0.06; (-0.74 to 0.87) | 0.878 | Con(10) | 1.57 ± 2.31 | 1.16 ± 1.48 | 0.81; (-0.33 to 1.95) | 0.165 |
Int(12) | 0.99 ± 1.53 | 0.80 ± 1.48 | Int(9) | 1.00 ± 1.67 | 1.40 ± 1.84 | ||||
Fatigue
| |||||||||
Con(11) | 1.71 ± 2.21 | 2.06 ± 2.52 | -1.05; (-2.50 to 0.41) | 0.117†
| Con(10) | 2.26 ± 2.56 | 1.57 ± 1.54 | 0.42; (-1.45 to 2.30) | 0.551†
|
Int(12) | 2.58 ± 2.60 | 1.88 ± 2.23 | Int(9) | 2.37 ± 2.50 | 2.10 ± 1.77 | ||||
Sensations limit activity
| |||||||||
Con(11) | 1.35 ± 2.81 | 0.93 ± 1.90 | -0.18; (-1.66 to 1.30) | 0.793†
| Con(10) | 1.01 ± 1.98 | 0.8 ± 1.70 | 0.37; (-0.49 to 1.22) | 0.399 |
Int(12) | 1.43 ± 1.76 | 0.83 ± 0.74 | Int(9) | 1.20 ± 1.54 | 1.10 ± 1.54 | ||||
Pain limit activity
| |||||||||
Con(11) | 0.57 ± 1.10 | 1.31 ± 2.39 | -0.99; (-2.06 to 0.09) | 0.362†
| Con(10) | 1.42 ± 2.49 | 0.89 ± 1.59 | 0.72; (-0.80 to 2.24) | 0.353 |
Int(12) | 0.81 ± 1.44 | 0.56 ± 0.58 | Int(9) | 0.61 ± 0.58 | 0.80 ± 0.93 | ||||
Fatigue limit activity
| |||||||||
Con(11) | 0.69 ± 1.51 | 1.34 ± 2.57 | -1.0-; (-2.44 to 0.27) | 0.315†
| Con(10) | 1.46 ± 2.67 | 1.07 ± 1.74 | 0.61; (-0.78 to 2.00) | 0.389 |
Int(12) | 1.38 ± 1.85 | 0.93 ± 0.95 | Int(9) | 1.03 ± 0.95 | 1.26 ± 1.24 |
Quality of life
QOL | Group mean ± SD b-8 | Between group changes 0-8 | Group mean ± SD 8b-12 | Between group changes 8b-12 | |||||
---|---|---|---|---|---|---|---|---|---|
Variable Gp(n)
|
Week 0 M ± SD
|
Week M ± SD
|
∆int-∆con 0–8 MD; (95%
CI)
|
P(0–8)
|
Variable Gp(n)
|
Week 8b M ± SD
|
Week 12 M ± SD
|
∆int-∆con 8b-12 MD; (95%
CI)
|
p(8b-12)
|
Total QOL
| |||||||||
Con(11) | 7.91 ± 1.22 | 7.45 ± 1.44 | 1.04; (-0.19 to 2.26) | 0.437†
| Con(10) | 7.40 ± 1.51 | 7.40 ± 1.51 | 0.44; (-0.38 to 1.27) | 0.290 |
Int(12) | 6.83 ± 2.55 | 7.42 ± 1.24 | Int(9) | 7.33 ± 0.87 | 7.78 ± 1.09 | ||||
Function
| |||||||||
Con(11) | 1.36 ± 0.40 | 1.30 ± 0.36 | -0.13; (-0.34 to 0.09) | 0.364†
| Cont(10) | 1.31 ± 0.38 | 1.35 ± 0.33 | 0.13; (-0.07 to 0.33) | 0.210 |
Int(12) | 1.48 ± 0.48 | 1.30 ± 0.31 | Int(9) | 1.34 ± 0.33 | 1.51 ± 0.14 | ||||
Appearance
| |||||||||
Con(11) | 1.56 ± 0.81 | 1.56 ± 0.86 | -0.07; (-0.34 to 0.20) | 0.627 | Con(10) | 1.60 ± 0.69 | 1.60 ± 0.69 | 0.10; (-.25 to 0.45) | 0.578 |
Int(11) | 1.50 ± 0.34 | 1.43 ± 0.33 | Int(9) | 1.42 ± 0.37 | 1.52 ± 0.37 | ||||
Symptoms
| |||||||||
Con(11) | 1.69 ± 0.37 | 1.82 ± 0.54 | -0.44; (-0.74 tro -0.13) | 0.038†
| Con(10) | 1.90 ± 0.49 | 1.73 ± 0.47 | 0.17; (-0.05 to 0.39) | 0.124 |
Int(12) | 2.11 ± 0.61 | 1.81 ± 0.40 | Int(9) | 1.91 ± 0.38 | 1.91 ± 0.40 | ||||
Emotions
| |||||||||
Con(11) | 1.71 ± 0.56 | 1.61 ± 0.49 | -0.18; (-0.62 to 0.26) | 0.430 | Con(10) | 1.62 ± 0.52 | 1.60 ± 0.56 | 0.04; (-0.24 to 0.31) | 0.801 |
Int(12) | 1.86 ± 0.74 | 1.58 ± 0.7 | Int(9) | 1.44 ± 0.45 | 1.46 ± 0.43 |