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Yoga

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Yoga

Common Names

  • Hatha
  • Vinyasa
  • Restorative yoga
  • Yin yoga
  • Many other forms

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What Is It

Yoga is an ancient practice that uses breathing exercises, moving through specific postures, focused awareness, and meditation to achieve physical and emotional health benefits.

How It Works

Studies show that yoga can help patients with many types of chronic conditions. Cancer survivors report reduced fatigue, better sleep, less stress, and improved strength, mood, and quality of life.

Among less active cancer survivors, restorative yoga may be easier and also have benefits. Regular practice also increases benefits.

Both the American Society of Clinical Oncology and Society of Integrative Oncology (ASCO and SIO) recommend yoga for anxiety, stress reduction, depression, mood disturbance, and improved quality of life in cancer patients.

Purported uses and benefits
  • Anxiety
    Many clinical studies indicate that yoga can reduce anxiety.
  • Depression
    Studies link yoga practice to reduced depression and positive mood.
  • Breathing difficulty
    Yoga may help shortness of breath and anxiety in patients with COPD and lung cancer.
  • Fatigue
    Several studies show yoga can reduce fatigue in cancer patients.
  • Hot flashes
    Yoga may help cancer patients with hot flashes and related symptoms.
  • Pain
    Yoga can help reduce pain and inflammation.
  • PTSD
    Several programs show it is possible to use yoga in certain populations with post-traumatic stress disorder.
  • Sleep quality and sleep medication use
    A large study suggests improved sleep quality and less sleep medication use in cancer survivors with sleep problems.
  • Stress
    Several studies support use of yoga for reducing stress.
Special Point

Cancer patients interested in beginning yoga should first ask their physician, because certain cancer treatments can cause physical limitations.

Is It Safe
  • Side effects from yoga are rare, but may occur from inappropriate regimens or practicing without supervision.
  • Cancer survivors may have additional limitations due to surgery, chemotherapy, or radiotherapy. That’s why MSK offers yoga workshops and our Integrative Medicine at Home program. Both help patients learn proper techniques and modifications with certified instructors who have experience working with cancer patients.
  • Pregnant women and individuals with hypertension or glaucoma should use caution when practicing certain yoga postures.
Who Can Provide this Service

Certified instructors who have experience working with cancer patients.

Where Can I Get Treatment

Yoga classes are offered at hospitals, major cancer clinics, and at community centers. MSK offers yoga workshops for patients and caregivers, and as part of our online program, Integrative Medicine at Home, to support recovery and well-being of cancer patients everywhere.

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For Healthcare Professionals

Clinical Summary

Yoga is an ancient practice integral to Ayurveda, the traditional healing system in India.

Key components include regulated breathing (pranayama), moving through postures (asansas), meditation (dhyana), and optimal coping principles (swadhyaya) to cultivate physical and emotional health, and spiritual growth.

Yoga can help reduce

  • Anxiety, stress
  • Fatigue
  • Pain
  • Inflammation

It can also help improve

  • Strength
  • Posture
  • Breathing
  • Sleep
  • Immune function

Cancer survivors may have special limitations due to surgery, chemotherapy, or radiotherapy. That’s why MSK offers yoga workshops and our Integrative Medicine at Home program. Both help patients learn proper techniques and modifications with certified instructors who have experience working with cancer patients.

Yoga for chronic health conditions
In various patient-groups, yoga can help improve breathing (1) (5), inflammation (46) (50), pain (9) (10) (48), and blood pressure (16) (50). It may also help with weight maintenance (7), but time commitment was a barrier in both obese patients (63) and sedentary cancer survivors (54).

Benefits for psychological conditions
Studies of yoga for depression (11) (12) (49), anxiety (4) (11) (13) (14) (15) (16) (61) (62), and post-traumatic stress disorder (14) (17) (18) (47) have shown benefit. Yoga practice may also return a sense of control to one’s experience (4) (19).

Improved symptoms in cancer patients
The ability of yoga to reduce stress and distress (30) (31) (32), increase well-being and quality of life (34), and impart more restful sleep in both newly diagnosed and long-term cancer survivors is well documented (2) (23) (24) (25) (26) (27) (28) (29) (51) (64), with potential for reduced sleep medications (28) (29). It also reduced fatigue (56) (57) (64) and climacteric symptoms (22) (33).

Pilot studies also indicate yoga can promote an immune response, reduce inflammation (65), and improve neuropathy symptoms including objective measures like functional reach which is used to predict fall risk (66).

Oncology guidelines recommend yoga
The American Society of Clinical Oncology and Society of Integrative Oncology (ASCO and SIO) recommend yoga for anxiety, stress reduction, depression, mood disturbance, and improved quality of life in cancer patients (52) (53).

Cancer survivors may have special limitations due to surgery, chemotherapy, or radiotherapy. Consulting their treatment team for appropriate referrals can guide patients to certified yoga instructors with cancer patient experience to learn proper techniques and modifications.

MSK offers yoga workshops for patients and caregivers, and as part our online program, Integrative Medicine at Home, to support recovery and well-being of cancer patients everywhere.

Purported uses and benefits
  • Anxiety
  • Depression
  • Breathing difficulty
  • Fatigue
  • Hot flashes
  • Pain
  • PTSD
  • Sleep
  • Stress
Mechanism of Action

Because components of yoga practice include postural alignment and engagement of the extremities, yoga raises somatic self-awareness, educating the user of states in which the body experiences balance and calm, and identifying symptoms that may be problematic (3). The engagement of the mind, attention to comfort, and deep relaxed abdominal breathing reduces gastrointestinal symptoms by disrupting chronic patterns of functional disability and maladaptive coping strategies often experienced with irritable bowel syndrome (4).

Some studies have shown that the meditative component of yoga increases blood flow to the brain, releases endogenous dopamine, and reduces respiratory rate (6). The changes in breathing patterns that accompany various yoga practices may also alter airway hyper-responsiveness (5). Yoga postures and controlled breathing interact with both the somatic nervous system and endocrine mechanisms, thereby affecting insulin kinetics (8). Neuroplastic mechanisms for its antidepressant effects include elevated serum brain-derived neurotrophic factor levels (36). Yoga relieves stress and anxiety by increasing levels of the neurotransmitter GABA (13) and improving hypothalamic-pituitary-adrenal axis functioning (25). Improvements in fatigue, sleep disturbance, anxiety, and quality of life are also attributed to increased parasympathetic and decreased sympathetic activities, stimulation of the vagus nerve, and reduction in allostatic load which optimizes homeostasis in stress response systems (14), thereby replacing the flight-or-fight response with the relaxation response (19). By eliciting the relaxation response, long-term practice has been shown to promote mitochondrial resiliency via ATPase and insulin function upregulation and downregulation of NF-kB-dependent pathways (35).

Contraindications
  • Pregnant women and individuals with hypertension or glaucoma should use caution when practicing certain yoga postures.
  • Cancer patients interested in beginning yoga should first consult their physician. Because of limitations due to surgery, chemotherapy and radiotherapy, it is also advisable to learn the proper technique from certified instructors who have experience working with cancer patients.
Adverse Reactions
  • Rare, due to improper practice: Hematoma (12) (37) (58), nerve damage (38), aggravation of glaucoma (39) (40), embolism (41), ligament rupture (42), spontaneous pneumothorax (43) (44) and bilateral ulnar artery thrombosis (59).
  • Musculoskeletal effects including osteoarthritis, chronic back, neck or shoulder pain, tendon shortening or sciatica were associated with hand-, shoulder- and head stands; and following yoga self-study without supervision (60).
Practitioners and Treatments

Yoga classes are offered at hospitals, cancer clinics, and community centers. MSK offers yoga courses for our patients and caregivers, and as part of a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.

References
  1. Norweg A, Collins EG. Evidence for cognitive-behavioral strategies improving dyspnea and related distress in COPD. Int J Chron Obstruct Pulmon Dis. 2013;8:439-451.
  2. Bower JE, Woolery A, Sternlieb B, et al. Yoga for cancer patients and survivors. Cancer Control. 2005;12(3):165-171.
  3. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280(18):1601-1603.
  4. Kuttner L, Chambers CT, Hardial J, et al. A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag. 2006;11(4):217-223.
  5. Manocha R, Marks GB, Kenchington P, et al. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial. Thorax. 2002;57(2):110-115.
  6. Rajesh B, Jayachandran D, Mohandas G, et al. A pilot study of a yoga meditation protocol for patients with medically refractory epilepsy. J Altern Complement Med. 2006;12(4):367-371.
  7. Kristal AR, Littman AJ, Benitez D, et al. Yoga practice is associated with attenuated weight gain in healthy, middle-aged men and women. Altern Ther Health Med. 2005;11(4):28-33.
  8. Malhotra V, Singh S, Tandon OP, et al. The beneficial effect of yoga in diabetes. Nepal Med Coll J. 2005;7(2):145-147.
  9. John PJ, Sharma N, Sharma CM, et al. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007;47(5):654-661.
  10. Posadzki P, Ernst E. Yoga for low back pain: a systematic review of randomized clinical trials. Clin Rheumatol. 2011;30(9):1257-1262.
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  14. Streeter CC, Gerbarg PL, Saper RB, et al. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012;78(5):571-579.
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  16. Lakkireddy D, Atkins D, Pillarisetti J, et al. Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation: the YOGA My Heart Study. J Am Coll Cardiol. 2013;61(11):1177-1182.
  17. Staples JK, Hamilton MF, Uddo M. A yoga program for the symptoms of post-traumatic stress disorder in veterans. Mil Med. 2013;178(8):854-860.
  18. Telles S, Singh N, Joshi M, et al. Post traumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: a randomized controlled study. BMC Psychiatry. 2010;10:18.
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  20. Shannahoff-Khalsa DS. Patient perspectives: Kundalini yoga meditation techniques for psycho-oncology and as potential therapies for cancer. Integr Cancer Ther. 2005;4(1):87-100.
  21. Carson JW, Carson KM, Porter LS, et al. Yoga for women with metastatic breast cancer: results from a pilot study. J Pain Symptom Manage. 2007;33(3):331-341.
  22. Carson JW, Carson KM, Porter LS, et al. Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer. 2009;17(10):1301-1309.
  23. Rosenbaum E, Gautier H, Fobair P, et al. Cancer supportive care, improving the quality of life for cancer patients. A program evaluation report. Support Care Cancer. 2004;12(5):293-301.
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  25. Carlson LE, Speca M, Patel KD, et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29(4):448-474.
  26. Vadiraja HS, Raghavendra RM, Nagarathna R, et al. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther. 2009;8(1):37-46.
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  28. Mustian KM, Sprod LK, Janelsins M, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol. 10 2013;31(26):3233-3241.
  29. Cohen L, Warneke C, Fouladi RT, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004;100(10):2253-2260.
  30. Moadel AB, Shah C, Wylie-Rosett J, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol. 2007;25(28):4387-4395.
  31. Culos-Reed SN, Carlson LE, Daroux LM, et al. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology. 2006;15(10):891-897.
  32. Carlson LE, Doll R, Stephen J, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer. J Clin Oncol. 2013;31(25):3119-3126.
  33. Bower JE, Garet D, Sternlieb B, et al. Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer. 2012;118(15):3766-3775.
  34. Chandwani KD, Perkins G, Nagendra HR, et al. Randomized, Controlled Trial of Yoga in Women With Breast Cancer Undergoing Radiotherapy. J Clin Oncol. 2014;32(10):1058-65.
  35. Fouladbakhsh JM, Davis JE, Yarandi HN. Using a standardized Viniyoga protocol for lung cancer survivors: a pilot study examining effects on breathing ease. J Complement Integr Med. 2013;10.
  36. Bhasin MK, Dusek JA, Chang BH, et al. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS One. 2013;8(5):e62817.
  37. Naveen GH, Thirthalli J, Rao MG, et al. Positive therapeutic and neurotropic effects of yoga in depression: A comparative study. Indian J Psychiatry. 2013;55(Suppl 3):S400-404.
  38. Choi Y, Lee D. A case of rectus sheath hematoma caused by yoga exercise. Am J Emerg Med. 2009;27(7):899 e891-892.
  39. de Barros DS, Bazzaz S, Gheith ME, et al. Progressive optic neuropathy in congenital glaucoma associated with the Sirsasana yoga posture. Ophthalmic Surg Lasers Imaging. 2008;39(4):339-340.
  40. Gallardo MJ, Aggarwal N, Cavanagh HD, et al. Progression of glaucoma associated with the Sirsasana (headstand) yoga posture. Adv Ther. 2006;23(6):921-925.
  41. Bertschinger DR, Mendrinos E, Dosso A. Yoga can be dangerous—glaucomatous visual field defect worsening due to postural yoga. Br J Ophthalmol. 2007;91(10):1413-1414.
  42. Reutter D, Hunziker R, Husmann M. Computed angiogram of the upper extremities for diagnosing a rare cause of brachial arterial embolism: the ’Pitcher Syndrome’. Eur Heart J. 2010;31(22):2782.
  43. Patel SC, Parker DA. Isolated rupture of the lateral collateral ligament during yoga practice: a case report. J Orthop Surg (Hong Kong). Dec 2008;16(3):378-380.
  44. Kashyap AS, Anand KP, Kashyap S. Complications of yoga. Emerg Med J. 2007;24(3):231.
  45. Johnson DB, Tierney MJ, Sadighi PJ. Kapalabhati pranayama: breath of fire or cause of pneumothorax? A case report. Chest. May 2004;125(5):1951-1952.
  46. Moonaz SH, Bingham CO, Wissow L, et al. Yoga in Sedentary Adults with Arthritis: Effects of a Randomized Controlled Pragmatic Trial. J Rheumatol. 2015 Jul;42(7):1194-202.
  47. Rhodes A, Spinazzola J, Van der Kolk B. Yoga for Adult Women with Chronic PTSD: A Long-term Follow-up Study. J Altern Complement Med.  2016;Mar;22(3):189-96.
  48. Saper RB, Lemaster C, Delitto A, et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. Jul 18 2017;167(2):85-94.
  49. Prathikanti S, Rivera R, Cochran A, et al. Treating major depression with yoga: A prospective, randomized, controlled pilot trial. PLoS One. 2017;12(3):e0173869.
  50. Supriya R, Yu AP, Lee PH, et al. Yoga training modulates adipokines in adults with high-normal blood pressure and metabolic syndrome. Scand J Med Sci Sports. 2018 Mar;28(3):1130-1138.
  51. Chaoul A, Milbury K, Spelman A, et al. Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy. Cancer. 2018 Jan 1;124(1):36-45.
  52. Lyman GH, Greenlee H, Bohlke K, et al. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. Jun 11 2018:Jco2018792721.
  53. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. May 6 2017;67(3):194-232.
  54. Lapen K, Benusis L, Pearson S, et al. A Feasibility Study of Restorative Yoga Versus Vigorous Yoga Intervention for Sedentary Breast and Ovarian Cancer Survivors. Int J Yoga Therap. Aug 17 2018.
  55. Dong B, Xie C, Jing X, Lin L, Tian L. Yoga has a solid effect on cancer-related fatigue in patients with breast cancer: a meta-analysis. Breast Cancer Res Treat. 2019 Aug;177(1):5-16.
  56. Zetzl T, Renner A, Pittig A, Jentschke E, Roch C, van Oorschot B. Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer. Support Care Cancer. 2020 Oct 7.
  57. Armer JS, Lutgendorf SK. The Impact of Yoga on Fatigue in Cancer Survivorship: A Meta-Analysis. JNCI Cancer Spectr. 2019 Dec 17;4(2):pkz098.
  58. Pessia B, Ciarrocchi A, Marinelli S, Pietroletti R. Acute chest pain and esophageal mucosal injury following an extreme yoga position Case report. Ann Ital Chir. 2019 Sep 30;8:S2239253X19030573
  59. Kim LN, Sammel AM. Images in Vascular Medicine. A downward dog seldom bites: A rare case of bilateral ulnar artery thrombosis from yoga. Vasc Med. 2020 Aug;25(4):383-384.
  60. Cramer H, Quinker D, Schumann D, Wardle J, Dobos G, Lauche R. Adverse effects of yoga: a national cross-sectional survey. BMC Complement Altern Med. 2019 Jul 29;19(1):190.
  61. Brenes GA, Divers J, Miller ME, et al. Comparison of cognitive-behavioral therapy and yoga for the treatment of late-life worry: A randomized preference trial. Depress Anxiety. Dec 2020;37(12):1194-1207.
  62. Brenes GA, Munger Clary HM, Miller ME, et al. Predictors of preference for cognitive-behavioral therapy (CBT) and yoga interventions among older adults. J Psychiatr Res. Jun 2021;138:311-318.
  63. Jakicic JM, Davis KK, Rogers RJ, et al. Feasibility of Integration of Yoga in a Behavioral Weight-Loss Intervention: A Randomized Trial. Obesity (Silver Spring). Mar 2021;29(3):512-520.
  64. Lin PJ, Kleckner IR, Loh KP, et al. Influence of Yoga on Cancer-Related Fatigue and on Mediational Relationships Between Changes in Sleep and Cancer-Related Fatigue: A Nationwide, Multicenter Randomized Controlled Trial of Yoga in Cancer Survivors. Integr Cancer Ther. Jan-Dec 2019;18:1534735419855134.
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  66. Bao T, Zhi I, Baser R, et al. Yoga for Chemotherapy-Induced Peripheral Neuropathy and Fall Risk: A Randomized Controlled Trial. JNCI Cancer Spectr. Dec 2020;4(6):pkaa048.
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