Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer

Holger Cramer, Romy Lauche, Petra Klose, Silke Lange, Jost Langhorst, Gustav J Dobos, Holger Cramer, Romy Lauche, Petra Klose, Silke Lange, Jost Langhorst, Gustav J Dobos

Abstract

Background: Breast cancer is the cancer most frequently diagnosed in women worldwide. Even though survival rates are continually increasing, breast cancer is often associated with long-term psychological distress, chronic pain, fatigue and impaired quality of life. Yoga comprises advice for an ethical lifestyle, spiritual practice, physical activity, breathing exercises and meditation. It is a complementary therapy that is commonly recommended for breast cancer-related impairments and has been shown to improve physical and mental health in people with different cancer types.

Objectives: To assess effects of yoga on health-related quality of life, mental health and cancer-related symptoms among women with a diagnosis of breast cancer who are receiving active treatment or have completed treatment.

Search methods: We searched the Cochrane Breast Cancer Specialised Register, MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), Indexing of Indian Medical Journals (IndMED), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal and Clinicaltrials.gov on 29 January 2016. We also searched reference lists of identified relevant trials or reviews, as well as conference proceedings of the International Congress on Complementary Medicine Research (ICCMR), the European Congress for Integrative Medicine (ECIM) and the American Society of Clinical Oncology (ASCO). We applied no language restrictions.

Selection criteria: Randomised controlled trials were eligible when they (1) compared yoga interventions versus no therapy or versus any other active therapy in women with a diagnosis of non-metastatic or metastatic breast cancer, and (2) assessed at least one of the primary outcomes on patient-reported instruments, including health-related quality of life, depression, anxiety, fatigue or sleep disturbances.

Data collection and analysis: Two review authors independently collected data on methods and results. We expressed outcomes as standardised mean differences (SMDs) with 95% confidence intervals (CIs) and conducted random-effects model meta-analyses. We assessed potential risk of publication bias through visual analysis of funnel plot symmetry and heterogeneity between studies by using the Chi2 test and the I2 statistic. We conducted subgroup analyses for current treatment status, time since diagnosis, stage of cancer and type of yoga intervention.

Main results: We included 24 studies with a total of 2166 participants, 23 of which provided data for meta-analysis. Thirteen studies had low risk of selection bias, five studies reported adequate blinding of outcome assessment and 15 studies had low risk of attrition bias.Seventeen studies that compared yoga versus no therapy provided moderate-quality evidence showing that yoga improved health-related quality of life (pooled SMD 0.22, 95% CI 0.04 to 0.40; 10 studies, 675 participants), reduced fatigue (pooled SMD -0.48, 95% CI -0.75 to -0.20; 11 studies, 883 participants) and reduced sleep disturbances in the short term (pooled SMD -0.25, 95% CI -0.40 to -0.09; six studies, 657 participants). The funnel plot for health-related quality of life was asymmetrical, favouring no therapy, and the funnel plot for fatigue was roughly symmetrical. This hints at overall low risk of publication bias. Yoga did not appear to reduce depression (pooled SMD -0.13, 95% CI -0.31 to 0.05; seven studies, 496 participants; low-quality evidence) or anxiety (pooled SMD -0.53, 95% CI -1.10 to 0.04; six studies, 346 participants; very low-quality evidence) in the short term and had no medium-term effects on health-related quality of life (pooled SMD 0.10, 95% CI -0.23 to 0.42; two studies, 146 participants; low-quality evidence) or fatigue (pooled SMD -0.04, 95% CI -0.36 to 0.29; two studies, 146 participants; low-quality evidence). Investigators reported no serious adverse events.Four studies that compared yoga versus psychosocial/educational interventions provided moderate-quality evidence indicating that yoga can reduce depression (pooled SMD -2.29, 95% CI -3.97 to -0.61; four studies, 226 participants), anxiety (pooled SMD -2.21, 95% CI -3.90 to -0.52; three studies, 195 participants) and fatigue (pooled SMD -0.90, 95% CI -1.31 to -0.50; two studies, 106 participants) in the short term. Very low-quality evidence showed no short-term effects on health-related quality of life (pooled SMD 0.81, 95% CI -0.50 to 2.12; two studies, 153 participants) or sleep disturbances (pooled SMD -0.21, 95% CI -0.76 to 0.34; two studies, 119 participants). No trial adequately reported safety-related data.Three studies that compared yoga versus exercise presented very low-quality evidence showing no short-term effects on health-related quality of life (pooled SMD -0.04, 95% CI -0.30 to 0.23; three studies, 233 participants) or fatigue (pooled SMD -0.21, 95% CI -0.66 to 0.25; three studies, 233 participants); no trial provided safety-related data.

Authors' conclusions: Moderate-quality evidence supports the recommendation of yoga as a supportive intervention for improving health-related quality of life and reducing fatigue and sleep disturbances when compared with no therapy, as well as for reducing depression, anxiety and fatigue, when compared with psychosocial/educational interventions. Very low-quality evidence suggests that yoga might be as effective as other exercise interventions and might be used as an alternative to other exercise programmes.

Conflict of interest statement

HC: none known.
RL: none known.
PK: none known.
SL: none known.
JL: none known.
GD: none known.

Figures

2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

3
Forest plot of comparison: 1 Yoga versus no therapy, outcome: 1.1 Health‐related quality of life short‐term.

4
Funnel plot of comparison: 1 Yoga versus no therapy, outcome: 1.1 Health‐related quality of life short‐term.

5
Forest plot of comparison: 1 Yoga versus no therapy, outcome: 1.5 Fatigue short‐term.

6
Funnel plot of comparison: 1 Yoga versus no therapy, outcome: 1.5 Fatigue short‐term.

**1.1. Analysis**
Comparison 1 Yoga versus no therapy, Outcome 1 Health‐related quality of life short‐term.

**1.2. Analysis**
Comparison 1 Yoga versus no therapy, Outcome 2 Health‐related quality of life medium‐term.

**1.3. Analysis**
Comparison 1 Yoga versus no therapy, Outcome 3 Depression short‐term.

**1.4. Analysis**
Comparison 1 Yoga versus no therapy, Outcome 4 Anxiety short‐term.

**1.5. Analysis**
Comparison 1 Yoga versus no therapy, Outcome 5 Fatigue short‐term.

**1.6. Analysis**
Comparison 1 Yoga versus no therapy, Outcome 6 Fatigue medium‐term.

**1.7. Analysis**
Comparison 1 Yoga versus no therapy, Outcome 7 Sleep disturbances short‐term.

**2.1. Analysis**
Comparison 2 Yoga versus psychological interventions, Outcome 1 Health‐related quality of life short‐term.

**2.2. Analysis**
Comparison 2 Yoga versus psychological interventions, Outcome 2 Depression short‐term.

**2.3. Analysis**
Comparison 2 Yoga versus psychological interventions, Outcome 3 Anxiety short‐term.

**2.4. Analysis**
Comparison 2 Yoga versus psychological interventions, Outcome 4 Fatigue short‐term.

**2.5. Analysis**
Comparison 2 Yoga versus psychological interventions, Outcome 5 Sleep disturbances short‐term.

**3.1. Analysis**
Comparison 3 Yoga versus exercise, Outcome 1 Health‐related quality of life short‐term.

**3.2. Analysis**
Comparison 3 Yoga versus exercise, Outcome 2 Fatigue short‐term.

**4.1. Analysis**
Comparison 4 Yoga versus no therapy: subgroup analysis: current treatment status, Outcome 1 Health‐related quality of life short‐term.

**4.2. Analysis**
Comparison 4 Yoga versus no therapy: subgroup analysis: current treatment status, Outcome 2 Health‐related quality of life medium‐term.

**4.3. Analysis**
Comparison 4 Yoga versus no therapy: subgroup analysis: current treatment status, Outcome 3 Depression short‐term.

**4.4. Analysis**
Comparison 4 Yoga versus no therapy: subgroup analysis: current treatment status, Outcome 4 Anxiety short‐term.

**4.5. Analysis**
Comparison 4 Yoga versus no therapy: subgroup analysis: current treatment status, Outcome 5 Fatigue short‐term.

**4.6. Analysis**
Comparison 4 Yoga versus no therapy: subgroup analysis: current treatment status, Outcome 6 Fatigue medium‐term.

**4.7. Analysis**
Comparison 4 Yoga versus no therapy: subgroup analysis: current treatment status, Outcome 7 Sleep disturbances short‐term.

**5.1. Analysis**
Comparison 5 Yoga versus psychological interventions: subgroup analysis: current treatment status, Outcome 1 Health‐related quality of life short‐term.

**5.2. Analysis**
Comparison 5 Yoga versus psychological interventions: subgroup analysis: current treatment status, Outcome 2 Depression short‐term.

**5.3. Analysis**
Comparison 5 Yoga versus psychological interventions: subgroup analysis: current treatment status, Outcome 3 Anxiety short‐term.

**5.4. Analysis**
Comparison 5 Yoga versus psychological interventions: subgroup analysis: current treatment status, Outcome 4 Fatigue short‐term.

**5.5. Analysis**
Comparison 5 Yoga versus psychological interventions: subgroup analysis: current treatment status, Outcome 5 Sleep disturbances short‐term.

**6.1. Analysis**
Comparison 6 Yoga versus exercise: subgroup analysis: current treatment status, Outcome 1 Health‐related quality of life short‐term.

**6.2. Analysis**
Comparison 6 Yoga versus exercise: subgroup analysis: current treatment status, Outcome 2 Fatigue short‐term.

**7.1. Analysis**
Comparison 7 Yoga versus no therapy: subgroup analysis: time since diagnosis, Outcome 1 Health‐related quality of life short‐term.

**7.2. Analysis**
Comparison 7 Yoga versus no therapy: subgroup analysis: time since diagnosis, Outcome 2 Health‐related quality of life medium‐term.

**7.3. Analysis**
Comparison 7 Yoga versus no therapy: subgroup analysis: time since diagnosis, Outcome 3 Depression short‐term.

**7.4. Analysis**
Comparison 7 Yoga versus no therapy: subgroup analysis: time since diagnosis, Outcome 4 Anxiety short‐term.

**7.5. Analysis**
Comparison 7 Yoga versus no therapy: subgroup analysis: time since diagnosis, Outcome 5 Fatigue short‐term.

**7.6. Analysis**
Comparison 7 Yoga versus no therapy: subgroup analysis: time since diagnosis, Outcome 6 Fatigue medium‐term.

**7.7. Analysis**
Comparison 7 Yoga versus no therapy: subgroup analysis: time since diagnosis, Outcome 7 Sleep disturbances short‐term.

**8.1. Analysis**
Comparison 8 Yoga versus psychological interventions: subgroup analysis: time since diagnosis, Outcome 1 Health‐related quality of life short‐term.

**8.2. Analysis**
Comparison 8 Yoga versus psychological interventions: subgroup analysis: time since diagnosis, Outcome 2 Depression short‐term.

**8.3. Analysis**
Comparison 8 Yoga versus psychological interventions: subgroup analysis: time since diagnosis, Outcome 3 Anxiety short‐term.

**8.4. Analysis**
Comparison 8 Yoga versus psychological interventions: subgroup analysis: time since diagnosis, Outcome 4 Fatigue short‐term.

**8.5. Analysis**
Comparison 8 Yoga versus psychological interventions: subgroup analysis: time since diagnosis, Outcome 5 Sleep disturbances short‐term.

**9.1. Analysis**
Comparison 9 Yoga versus exercise: subgroup analysis: time since diagnosis, Outcome 1 Health‐related quality of life short‐term.

**9.2. Analysis**
Comparison 9 Yoga versus exercise: subgroup analysis: time since diagnosis, Outcome 2 Fatigue short‐term.

**10.1. Analysis**
Comparison 10 Yoga versus no therapy: subgroup analysis: stage of cancer, Outcome 1 Health‐related quality of life short‐term.

**10.2. Analysis**
Comparison 10 Yoga versus no therapy: subgroup analysis: stage of cancer, Outcome 2 Health‐related quality of life medium‐term.

**10.3. Analysis**
Comparison 10 Yoga versus no therapy: subgroup analysis: stage of cancer, Outcome 3 Depression short‐term.

**10.4. Analysis**
Comparison 10 Yoga versus no therapy: subgroup analysis: stage of cancer, Outcome 4 Anxiety short‐term.

**10.5. Analysis**
Comparison 10 Yoga versus no therapy: subgroup analysis: stage of cancer, Outcome 5 Fatigue short‐term.

**10.6. Analysis**
Comparison 10 Yoga versus no therapy: subgroup analysis: stage of cancer, Outcome 6 Fatigue medium‐term.

**10.7. Analysis**
Comparison 10 Yoga versus no therapy: subgroup analysis: stage of cancer, Outcome 7 Sleep disturbances short‐term.

**11.1. Analysis**
Comparison 11 Yoga versus psychological interventions: subgroup analysis: stage of cancer, Outcome 1 Health‐related quality of life short‐term.

**11.2. Analysis**
Comparison 11 Yoga versus psychological interventions: subgroup analysis: stage of cancer, Outcome 2 Depression short‐term.

**11.3. Analysis**
Comparison 11 Yoga versus psychological interventions: subgroup analysis: stage of cancer, Outcome 3 Anxiety short‐term.

**11.4. Analysis**
Comparison 11 Yoga versus psychological interventions: subgroup analysis: stage of cancer, Outcome 4 Fatigue short‐term.

**11.5. Analysis**
Comparison 11 Yoga versus psychological interventions: subgroup analysis: stage of cancer, Outcome 5 Sleep disturbances short‐term.

**12.1. Analysis**
Comparison 12 Yoga versus exercise: subgroup analysis: stage of cancer, Outcome 1 Health‐related quality of life short‐term.

**12.2. Analysis**
Comparison 12 Yoga versus exercise: subgroup analysis: stage of cancer, Outcome 2 Fatigue short‐term.

**13.1. Analysis**
Comparison 13 Yoga versus no therapy: subgroup analysis: yoga intervention, Outcome 1 Health‐related quality of life short‐term.

**13.2. Analysis**
Comparison 13 Yoga versus no therapy: subgroup analysis: yoga intervention, Outcome 2 Health‐related quality of life medium‐term.

**13.3. Analysis**
Comparison 13 Yoga versus no therapy: subgroup analysis: yoga intervention, Outcome 3 Depression short‐term.

**13.4. Analysis**
Comparison 13 Yoga versus no therapy: subgroup analysis: yoga intervention, Outcome 4 Anxiety short‐term.

**13.5. Analysis**
Comparison 13 Yoga versus no therapy: subgroup analysis: yoga intervention, Outcome 5 Fatigue short‐term.

**13.6. Analysis**
Comparison 13 Yoga versus no therapy: subgroup analysis: yoga intervention, Outcome 6 Fatigue medium‐term.

**13.7. Analysis**
Comparison 13 Yoga versus no therapy: subgroup analysis: yoga intervention, Outcome 7 Sleep disturbances short‐term.

**14.1. Analysis**
Comparison 14 Yoga versus psychological interventions: subgroup analysis: yoga intervention, Outcome 1 Health‐related quality of life short‐term.

**14.2. Analysis**
Comparison 14 Yoga versus psychological interventions: subgroup analysis: yoga intervention, Outcome 2 Depression short‐term.

**14.3. Analysis**
Comparison 14 Yoga versus psychological interventions: subgroup analysis: yoga intervention, Outcome 3 Anxiety short‐term.

**14.4. Analysis**
Comparison 14 Yoga versus psychological interventions: subgroup analysis: yoga intervention, Outcome 4 Fatigue short‐term.

**14.5. Analysis**
Comparison 14 Yoga versus psychological interventions: subgroup analysis: yoga intervention, Outcome 5 Sleep disturbances short‐term.

**15.1. Analysis**
Comparison 15 Yoga versus exercise: subgroup analysis: yoga intervention, Outcome 1 Health‐related quality of life short‐term.

**15.2. Analysis**
Comparison 15 Yoga versus exercise: subgroup analysis: yoga intervention, Outcome 2 Fatigue short‐term.

**16.1. Analysis**
Comparison 16 Yoga versus no therapy: sensitivity analysis: random sequence generation, Outcome 1 Health‐related quality of life short‐term.

**16.2. Analysis**
Comparison 16 Yoga versus no therapy: sensitivity analysis: random sequence generation, Outcome 2 Health‐related quality of life medium‐term.

**16.3. Analysis**
Comparison 16 Yoga versus no therapy: sensitivity analysis: random sequence generation, Outcome 3 Depression short‐term.

**16.4. Analysis**
Comparison 16 Yoga versus no therapy: sensitivity analysis: random sequence generation, Outcome 4 Anxiety short‐term.

**16.5. Analysis**
Comparison 16 Yoga versus no therapy: sensitivity analysis: random sequence generation, Outcome 5 Fatigue short‐term.

**16.6. Analysis**
Comparison 16 Yoga versus no therapy: sensitivity analysis: random sequence generation, Outcome 6 Fatigue medium‐term.

**16.7. Analysis**
Comparison 16 Yoga versus no therapy: sensitivity analysis: random sequence generation, Outcome 7 Sleep disturbances short‐term.

**17.1. Analysis**
Comparison 17 Yoga versus psychological interventions: sensitivity analysis: random sequence generation, Outcome 1 Health‐related quality of life short‐term.

**17.2. Analysis**
Comparison 17 Yoga versus psychological interventions: sensitivity analysis: random sequence generation, Outcome 2 Depression short‐term.

**17.3. Analysis**
Comparison 17 Yoga versus psychological interventions: sensitivity analysis: random sequence generation, Outcome 3 Anxiety short‐term.

**17.4. Analysis**
Comparison 17 Yoga versus psychological interventions: sensitivity analysis: random sequence generation, Outcome 4 Fatigue short‐term.

**17.5. Analysis**
Comparison 17 Yoga versus psychological interventions: sensitivity analysis: random sequence generation, Outcome 5 Sleep disturbances short‐term.

**18.1. Analysis**
Comparison 18 Yoga versus exercise: sensitivity analysis: random sequence generation, Outcome 1 Health‐related quality of life short‐term.

**18.2. Analysis**
Comparison 18 Yoga versus exercise: sensitivity analysis: random sequence generation, Outcome 2 Fatigue short‐term.

**19.1. Analysis**
Comparison 19 Yoga versus no therapy: sensitivity analysis: allocation concealment, Outcome 1 Health‐related quality of life short‐term.

**19.2. Analysis**
Comparison 19 Yoga versus no therapy: sensitivity analysis: allocation concealment, Outcome 2 Depression short‐term.

**19.3. Analysis**
Comparison 19 Yoga versus no therapy: sensitivity analysis: allocation concealment, Outcome 3 Anxiety short‐term.

**19.4. Analysis**
Comparison 19 Yoga versus no therapy: sensitivity analysis: allocation concealment, Outcome 4 Fatigue short‐term.

**19.5. Analysis**
Comparison 19 Yoga versus no therapy: sensitivity analysis: allocation concealment, Outcome 5 Sleep disturbances short‐term.

**20.1. Analysis**
Comparison 20 Yoga versus psychological interventions: sensitivity analysis: allocation concealment, Outcome 1 Health‐related quality of life short‐term.

**20.2. Analysis**
Comparison 20 Yoga versus psychological interventions: sensitivity analysis: allocation concealment, Outcome 2 Depression short‐term.

**20.3. Analysis**
Comparison 20 Yoga versus psychological interventions: sensitivity analysis: allocation concealment, Outcome 3 Anxiety short‐term.

**20.4. Analysis**
Comparison 20 Yoga versus psychological interventions: sensitivity analysis: allocation concealment, Outcome 4 Fatigue short‐term.

**20.5. Analysis**
Comparison 20 Yoga versus psychological interventions: sensitivity analysis: allocation concealment, Outcome 5 Sleep disturbances short‐term.

**21.1. Analysis**
Comparison 21 Yoga versus exercise: sensitivity analysis: allocation concealment, Outcome 1 Health‐related quality of life short‐term.

**21.2. Analysis**
Comparison 21 Yoga versus exercise: sensitivity analysis: allocation concealment, Outcome 2 Fatigue short‐term.

**22.1. Analysis**
Comparison 22 Yoga versus no therapy: sensitivity analysis: blinding of outcome assessment, Outcome 1 Health‐related quality of life short‐term.

**22.2. Analysis**
Comparison 22 Yoga versus no therapy: sensitivity analysis: blinding of outcome assessment, Outcome 2 Depression short‐term.

**22.3. Analysis**
Comparison 22 Yoga versus no therapy: sensitivity analysis: blinding of outcome assessment, Outcome 3 Anxiety short‐term.

**22.4. Analysis**
Comparison 22 Yoga versus no therapy: sensitivity analysis: blinding of outcome assessment, Outcome 4 Fatigue short‐term.

**22.5. Analysis**
Comparison 22 Yoga versus no therapy: sensitivity analysis: blinding of outcome assessment, Outcome 5 Sleep disturbances short‐term.

**23.1. Analysis**
Comparison 23 Yoga versus no therapy: sensitivity analysis: incomplete outcome data, Outcome 1 Health‐related quality of life short‐term.

**23.2. Analysis**
Comparison 23 Yoga versus no therapy: sensitivity analysis: incomplete outcome data, Outcome 2 Health‐related quality of life medium‐term.

**23.3. Analysis**
Comparison 23 Yoga versus no therapy: sensitivity analysis: incomplete outcome data, Outcome 3 Depression short‐term.

**23.4. Analysis**
Comparison 23 Yoga versus no therapy: sensitivity analysis: incomplete outcome data, Outcome 4 Anxiety short‐term.

**23.5. Analysis**
Comparison 23 Yoga versus no therapy: sensitivity analysis: incomplete outcome data, Outcome 5 Fatigue short‐term.

**23.6. Analysis**
Comparison 23 Yoga versus no therapy: sensitivity analysis: incomplete outcome data, Outcome 6 Fatigue medium‐term.

**23.7. Analysis**
Comparison 23 Yoga versus no therapy: sensitivity analysis: incomplete outcome data, Outcome 7 Sleep disturbances short‐term.

**24.1. Analysis**
Comparison 24 Yoga versus psychological interventions: sensitivity analysis: incomplete outcome data, Outcome 1 Depression short‐term.

**24.2. Analysis**
Comparison 24 Yoga versus psychological interventions: sensitivity analysis: incomplete outcome data, Outcome 2 Fatigue short‐term.

**24.3. Analysis**
Comparison 24 Yoga versus psychological interventions: sensitivity analysis: incomplete outcome data, Outcome 3 Sleep disturbances short‐term.

**25.1. Analysis**
Comparison 25 Yoga versus exercise: sensitivity analysis: incomplete outcome data, Outcome 1 Health‐related quality of life short‐term.

**25.2. Analysis**
Comparison 25 Yoga versus exercise: sensitivity analysis: incomplete outcome data, Outcome 2 Fatigue short‐term.

**26.1. Analysis**
Comparison 26 Yoga versus no therapy: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 1 Health‐related quality of life short‐term.

**26.2. Analysis**
Comparison 26 Yoga versus no therapy: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 2 Health‐related quality of life medium‐term.

**26.3. Analysis**
Comparison 26 Yoga versus no therapy: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 3 Depression short‐term.

**26.4. Analysis**
Comparison 26 Yoga versus no therapy: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 4 Anxiety short‐term.

**26.5. Analysis**
Comparison 26 Yoga versus no therapy: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 5 Fatigue short‐term.

**26.6. Analysis**
Comparison 26 Yoga versus no therapy: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 6 Fatigue medium‐term.

**26.7. Analysis**
Comparison 26 Yoga versus no therapy: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 7 Sleep disturbances short‐term.

**27.1. Analysis**
Comparison 27 Yoga versus psychosocial/educational interventions: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 1 Health‐related quality of life short‐term.

**27.2. Analysis**
Comparison 27 Yoga versus psychosocial/educational interventions: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 2 Depression short‐term.

**27.3. Analysis**
Comparison 27 Yoga versus psychosocial/educational interventions: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 3 Anxiety short‐term.

**27.4. Analysis**
Comparison 27 Yoga versus psychosocial/educational interventions: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 4 Fatigue short‐term.

**27.5. Analysis**
Comparison 27 Yoga versus psychosocial/educational interventions: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 5 Sleep disturbances short‐term.

**28.1. Analysis**
Comparison 28 Yoga versus exercise: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 1 Health‐related quality of life short‐term.

**28.2. Analysis**
Comparison 28 Yoga versus exercise: sensitivity analysis: no missing data retrieved from study authors or imputed, Outcome 2 Fatigue short‐term.

References

References to studies included in this review Banasik 2011 {published data only}

1. Banasik J, Williams H, Haberman M, Blank SE, Bendel R. Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Journal of the American Academy of Nurse Practitioners 2011;23(3):135‐42.

Banerjee 2007 {published data only}

1. Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, Gopinath KS, et al. Effects of an integrated yoga program in modulating psychological stress and radiation‐induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integrative Cancer Therapies 2007;6(3):242‐50.

Bernardi 2013 {published data only (unpublished sought but not used)}

1. Bernardi MLD, Costa Amorim MH, Zandonade E, Forghieri Santaella D, Assis Novais Barbosa J. The effects of hatha yoga exercises on stress and anxiety levels in mastectomized women. Ciência & Saúde Coletiva 2013;18(12):3621‐32.

Bower 2012 {published data only}

1. Bower JE, Garet D, Ganz PA, Sternlieb B, Irwin M, Olmstead R, et al. Randomized controlled trial of Iyengar yoga for cancer‐related fatigue: results of a targeted intervention for fatigued breast cancer survivors. Psychosomatic Medicine 2011;73(3):A14.
1. Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin M, Olmstead R, et al. Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer 2012;118(15):3766‐75.

Carson 2009 {published data only}

1. Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL. Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Supportive Care in Cancer 2009;17(10):1301‐9.

Chakrabarty 2015 {published and unpublished data}

1. Chakrabarty J, Vidyasagar M, Fernandes D, Joisa G, Varghese P, Mayya S. Effectiveness of pranayama on cancer‐related fatigue in breast cancer patients undergoing radiation therapy: a randomized controlled trial. International Journal of Yoga 2015;8(1):47‐53.

Chandwani 2010 {published data only}

1. Chandwani KD, Thornton B, Perkins GH, Arun B, Raghuram NV, Nagendra HR, et al. Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. Journal of the Society for Integrative Oncology 2010;8(2):43‐55.
1. Cohen L, Chandwani K, Thornton B, Perkins G. Randomized trial of yoga in women with breast cancer undergoing radiation treatment. Journal of Clinical Oncology 2006;24(18 Suppl):469s.
1. Cohen L, Chandwani KD, Perkins G, Thornton B, Arun B, Raghuram NV, et al. Randomized trial of yoga in women with breast cancer undergoing radiation treatment: long‐term effects. Journal of Clinical Oncology 2008;26(15 Suppl):9639.

Chandwani 2014 {published data only}

1. Chandwani KD, Perkins G, Nagendra HR, Raghuram NV, Spelman A, Nagarathna R, et al. Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. Journal of Clinical Oncology 2014;32(10):1058‐65.
1. Cohen L, Chandwani K, Raghuram N, Haddad R, Perkins G, Spelman A, et al. Yoga for women with breast cancer undergoing radiotherapy (XRT): a randomized clinical trial with an active stretching control group. BMC Complementary and Alternative Medicine 2012;12:O38.
1. Cohen L, Chandwani K, Raghuram NV, Haddad R, Perkins GH, Spelman A, et al. Effect of yoga on QOL, cortisol rhythm, and HRV for women with breast cancer undergoing radiotherapy. Journal of Clinical Oncology 2011;29(15):9009.
1. Haddad R, Chandwani K, Perkins G, Spelman A, Johnson K, Fortier A, et al. Randomized, controlled trial of yoga for women with breast cancer undergoing radiotherapy. Psychosomatic Medicine 2011;73(3):A119‐20.

Cramer 2015 {published data only}

1. Cramer H, Rabsilber S, Lauche R, Kummel S, Dobos G. Yoga and meditation for menopausal symptoms in breast cancer survivors ‐ A randomized controlled trial. Cancer 2015;121(13):2175‐84.

Danhauer 2009 {published data only}

1. Danhauer SC, Mihalko SL, Russel GB, Campbell CR, Felder L, Daley K, et al. Restorative yoga for women with breast cancer: finding from a randomized pilot study. 2009 Psycho‐Oncology;18(4):360‐8.

Kiecolt‐Glaser 2014 {published data only}

1. Kiecolt‐Glaser JK, Bennett JM, Andrigde R, Peng J, Shapiro CL, Malarkey WB, et al. Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. Journal of Clinical Oncology 2014;32(10):1040‐9.

Kovacic 2013 {published data only}

1. Kovacic T, Zagoricnik M, Kovacic M. Impact of relaxation training according to the Yoga In Daily Life system on anxiety after breast cancer surgery. Journal of Complementary & Integrative Medicine 2013;10(1):153‐64.

Littman 2012 {published data only}

1. Littman AJ, Bertram LC, Ceballos R, Ulrich CM, Ramaprasad J, McGregor B, et al. Randomized controlled pilot trial of yoga in overweight and obese breast cancer survivors: effects on quality of life and anthropometric measures. Supportive Care in Cancer 2012;20(2):267‐77.

Lötzke 2016 {published data only}

1. Lötzke D, Wiedemann F, Rodrigues Recchia D, Ostermann T, Sattler D, Ettl J, et al. Iyengar‐yoga compared to exercise as a therapeutic intervention during (neo)adjuvant therapy in women with stage I‐III breast cancer: health‐related quality of life, mindfulness, spirituality and cancer‐related fatigue. Evidence‐Based Complementary and Alternative Medicine 2016;2016:5931816.
1. Wiedemann F, Buessing A, Halle M, Kiechle M, Kohls N, Ostermann T, et al. Iyengar yoga compared to exercise in women with stage I‐III breast cancer: feasibility of therapeutic interventions during adjuvant cytotoxic or endocrine therapy. Journal of Clinical Oncology 2013;31(15):e20623.
1. Wiedemann F, Buessing A, Halle M, Kiechle M, Kohls N, Ostermann T, et al. Yoga compared to exercise as a therapeutic intervention during (neo)adjuvant chemotherapy in women with stage I‐III breast cancer. Cancer Research 2011;71(24 Suppl):OT3‐02‐02.

Loudon 2014 {published data only}

1. Loudon A, Barnett T, Piller N, Immink MA, Williams AD. Yoga management of breast cancer‐related lymphoedema: a randomised controlled pilot‐trial. BMC Complementary and Alternative Medicine 2014;14:214.

Moadel 2007 {published data only}

1. Moadel AB, Shah C, Patel S, Wylie‐Rosett J, Siedlecki H, Porcelli T, et al. Randomized controlled trial of yoga for symptom management during breast cancer treatment. Proceedings of the American Society of Clinical Oncology. 2003:726.
1. Moadel AB, Shah C, Wylie‐Rosett J, Harris MS, Patel SR, Hall CB, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. Journal of Clinical Oncology 2007;25(28):4387‐95.

Mustian 2013 {published and unpublished data}

1. Janelsins M, Peppone L, Heckler C, Sprod L, Mohile S, Morrow G, et al. YOCAS® Yoga: improved memory and memory‐mediated improvements in fatigue and quality of life (QOL) in a nationwide phase III RCT. Supportive Care in Cancer 2013;21:S280‐1.
1. Janelsins MC, Peppone LJ, Heckler CE, Sprod L, Mohile SG, Chandwani KD, et al. YOCAS yoga, fatigue, memory difficulty, and quality of life: results from a URCC CCOP randomized, controlled clinical trial among 358 cancer survivors. Journal of Clinical Oncology 2012;30(15):9142.
1. Mustian K, Palesh O, Sprod L, Peppone L, Mohile S, Morrow G. YOCAS(registered trademark) yoga significantly improves multidimensional domains of cancer‐related‐fatigue: a URCC CCOP randomized, controlled, clinical trial among 410 cancer survivors. Supportive Care in Cancer 2010b;18:S97‐8.
1. Mustian KM, Janelsins M, Sprod L, Peppone L, Mohile S, Frizzell B, et al. YOCAS yoga significantly improves circadian rhythm, anxiety, mood and sleep: a randomized, controlled clinical trial among 410 cancer survivors. Supportive Care in Cancer 2011b;1:S317‐8.
1. Mustian KM, Palesh O, Sprod L, Peppone LJ, Heckler CE, Yates JS, et al. Effect of YOCAS yoga on sleep, fatigue, and quality of life: a URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. Journal of Clinical Oncology 2010a;28(15):9013.
1. Mustian KM, Sprod L, Peppone LJ, Mohile SG, Janelsins MC, Palesh O, et al. Effect of YOCAS yoga on circadian rhythm, anxiety, and mood: a URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. Journal of Clinical Oncology 2011a;29(15):9034.
1. Mustian KM, Sprod LK, Janelsins M, Peppone LJ, Palesh OG, Chandwani K, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. Journal of Clinical Oncology 2013;31(26):3233‐41.
1. Peppone L, Janelsins MC, Kamen C, Peoples AR, Heckler C, Kirshner JJ, et al. Effect of YOCAS® yoga on fatigue and circadian activity rhythms among breast cancer patients receiving hormone therapy: a URCC CCOP randomized, controlled clinical trial. Supportive Care in Cancer 2013a;21:S291.
1. Peppone LJ, Janelsins MC, Kamen C, Mohile SG, Sprod LK, Gewandter JS, et al. The effect of YOCAS(R) yoga for musculoskeletal symptoms among breast cancer survivors on hormonal therapy. Breast Cancer Research and Treatment 2015;150(3):597‐604.
1. Peppone LJ, Janelsins MC, Peoples AR, Kamen CS, Kirshner JJ, Gaur R, et al. Effect of YOCAS yoga on insomnia and sleep medication usage among breast cancer patients receiving hormone therapy: a URCC CCOP randomized, controlled clinical trial. Journal of Clinical Oncology 2013b;31(15 Suppl):9531.
1. Peppone LJ, Mohile SG, Janelsins MC, Sprod L, Gewandter JS, Heckler CE, et al. YOCAS yoga for musculoskeletal symptoms in breast cancer patients receiving aromatase inhibitors: a URCC CCOP randomized, controlled clinical trial. Journal of Clinical Oncology 2012b;30(15).
1. Peppone LJ, Mohile SG, Janelsins MC, Sprod LK, Gewandter JS, Heckler CE, et al. The effect of YOCAS® yoga on aromatase inhibitor‐induced musculoskeletal symptoms in breast cancer patients: a URCC CCOP randomized, controlled clinical trial. Supportive Care in Cancer 2012a;20:S139.

Pruthi 2012 {published and unpublished data}

1. Pruthi S, Solberg Nes L, Boughey J, Huebner M, Borg B, Jenkins S, et al. A randomized controlled pilot study assessing quality of life, stress and feasibility of yoga practice in women newly diagnosed with breast cancer. BMC Complementary and Alternative Medicine 2012b;12:P231.
1. Pruthi S, Stan DL, Jenkins SM, Huebner M, Borg BA, Thomley BS, et al. A randomized controlled pilot study assessing feasibility and impact of yoga practice on quality of life, mood, and perceived stress in women with newly diagnosed breast cancer. Global Advances In Health and Medicine 2012a;1(5):30‐5.

Raghavendra 2007 {published data only}

1. Ajaikumar BS, Raghavendra RM, Patil S, Ravi DB, Srinath SB, Gopinath KS, et al. Antidepressant effects of a yoga program in breast cancer patients undergoing conventional treatment: a randomized controlled trial. Journal of Clinical Oncology. 2008; Vol. 26 (Suppl 15):9556.
1. Gopinath KS, Rao R, Raghuram N, Rama Rao N, Shirley T, Vinay C, et al. Evaluation of yoga therapy as a psychotherapeutic intervention in breast cancer patients on conventional combined modality of treatment. Prodeedings of American Society of Clinical Oncology. 2003; Vol. 22:26.
1. Gopinath SK, Rao RM, Sanjeevarao VH, Diwakar RB, Basavalingaiah AS, Patil S, et al. Effects of an integrated yoga program on mood states, distress, quality of life, diurnal cortisol rhythms and natural killer cell counts in metastatic breast cancer survivors. Cancer Research 2011;71(24 Suppl):P3‐08‐01.
1. Raghavendra RM, Ajaikumar BS, Vadiraja HS, Patil S, Diwakar RB, Sashidhara P, et al. Role of yoga in modulating fatigue, sleep disturbances, salivary cortisol, and immune measures in breast cancer survivors: a randomized controlled trial. Journal of Clinical Oncology 2010;28(15):9099.
1. Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, Srinath BS, Ravi BD, et al. Effects of an integrated yoga programme on chemotherapy‐induced nausea and emesis in breast cancer patients. European Journal of Cancer Care 2007;16(6):462‐74.
1. Rao MR, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, Diwakar RB, et al. Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial. Complementary Therapies in Medicine 2009;17(1):1‐8.
1. Rao RM, Nagendra HR, Raghuram N, Vinay C, Chandrashekara S, Gopinath KS, et al. Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery. International Journal of Yoga 2008;1(1):11‐20.
1. Rao RM, Raghuram HR, Nagendra HR, Usharani MR, Gopinath KS, Diwakar RB, et al. Effects of an integrated yoga program on self‐reported depression scores in breast cancer patients undergoing conventional treatment: a randomized controlled trial. Indian Journal of Palliative Care 2015;21(2):174‐81.

Siedentopf 2013 {published data only (unpublished sought but not used)}

1. Isabell UB, Maja R. Yoga supports physical and mental well‐being after breast cancer surgery. Abstracts of XVI International Congress of ISPOG ‐ Journal of Psychosomatic Obstetrics and Gynecology. 2010; Vol. 31 (Suppl 1):P63.
1. Siedentopf F, Utz‐Billing I, Gairing S, Schoenegg W, Kentenich H, Kollak I. Yoga for patients with early breast cancer and its impact on quality of life ‐ a randomized controlled trial. Geburtshilfe und Frauenheilkunde 2013;73(4):311‐7.

Taso 2014 {published and unpublished data}

1. Taso CJ, Lin HS, Lin WL, Chen SM, Huang WT, Chen SW. The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: a randomized controlled trial. The Journal of Nursing Research 2014;22(3):155‐64.

Vadiraja 2009 {published data only}

1. Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, 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. Integrative Cancer Therapies 2009;8(1):37‐46.
1. Vadiraja HS, Rao MR, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, et al. Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Complementary Therapies in Medicine 2009;17(5‐6):274‐80.
1. Vadiraja SH, Rao MR, Nagendra RH, Nagarathna R, Rekha M, Vanitha N, et al. Effects of yoga on symptom management in breast cancer patients: a randomized controlled trial. International Journal of Yoga 2009;2(2):73‐9.

Vardar Yağlı 2015 {published data only}

1. Vardar Yagli N, Sener G, Afrikan H, Saglam M, Inal Ince D, Savci S, et al. Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors?. Integrative Cancer Therpies 2015;14(2):125‐32.
1. Vardar‐Yagli N, Sener G, Afrikan H, Saglam M, Inal‐Ince D, Savci S, et al. Effects of yoga and aerobic exercise training on functional capacity, respiratory muscle strength, and quality of life in breast cancer survivors. European Respiratory Journal. 2013; Vol. 42 (Suppl 57):P1316.

Wang 2014 {published data only}

1. Wang G, Wang S, Jiang P, Zeng C. Effect of Yoga on cancer related fatigue in breast cancer patients with chemotherapy. Zhong Nan da Xue Xue Bao 2014;39(10):1077‐82.

References to studies excluded from this review Blank 2005 {published data only}

1. Blank S, Kittel J, Haberman M. Active practice of Iyengar yoga as an intervention for breast cancer survivors. International Journal of Yoga Therapy 2005;15(1):51‐9.

Kumar 2013 {published data only}

1. Kumar N, Bhatnagar S, Velpandian T, Patnaik S, Menon G, Mehta M, et al. Randomized controlled trial in advance stage breast cancer patients for the effectiveness on stress marker and pain through Sudarshan Kriya and Pranayam. Indian Journal of Palliative Care 2013;19(3):180‐5.

Ojha 2012 {published data only}

1. Ohja K, Goyal RK, Sharma S, Sharma S, Yadav N. A case study: investigation of yoga's potential to treat breast cancer survivors facing cancer related fatigue. Journal of Yoga and Physical Therapy 2012;2(5).

References to studies awaiting assessment Cohen 2015 {published data only (unpublished sought but not used)}

1. Cohen L, Spelman A, Engle R, Arun B, Harrison C, Perkins G, et al. Three‐arm randomized trial of Tibetan yoga in breast cancer patients. Psychosomatic Medicine 2015;77(3):A70.
1. Cohen L, Spelman A, Engle R, Arun B, Wei Q, Harrison C, et al. Randomized trial of Tibetan yoga in breast cancer patients undergoing chemotherapy. Journal of Clinical Oncology 2014;32(15 Suppl):9539.

Dominique 2010 {published data only (unpublished sought but not used)}

1. Dominique L, Gilles D, Annelie A, Madan B, Pierre D, Ginette M. Impact of the Yoga Bali method on quality of life and depressive symptoms among women diagnosed with breast cancer undergoing chemotherapy. Psycho‐Oncology 2010;19:S139‐40.

Kumari 2015 {published data only (unpublished sought but not used)}

1. Kumari P, Kumari S, Kapoor A, Narayan S, Maharia S, Nirban RK, et al. A phase III open label randomized controlled trial of yoga in women with breast cancer undergoing radiotherapy. Supportive Care in Cancer 2015;1:S356.

Luu 2014 {published data only}

1. Luu X, Rifkind K, Dhage S, Castaneda M, Zeng X, Joseph KAP. The effects of yoga on urban underserved breast cancer patients. Journal of Clinical Oncology 2014;32(15 Suppl).

Stan 2013 {published data only (unpublished sought but not used)}

1. Stan D, Croghan K, Croghan I, Jenkins S, Pruthi S. Randomized trial of yoga versus strengthening exercises in breast cancer survivors with persistent fatigue. Supportive Care in Cancer 2015;1:S81‐2.
1. Stan D, Loprinzi CL, Ruddy KJ. Breast cancer survivorship issues. Hematology/Oncology Clinics of North America 2013;27(4):805‐27.

Additional references Abrahams 2016

1. Abrahams HJ, Gielissen MF, Schmits IC, Verhagen CA, Rovers MM, Knoop H. Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta‐analysis involving 12 327 breast cancer survivors. Annals of Oncology 2016;27(6):965‐74.

Andrykowski 2008

1. Andrykowski MA, Lykins E, Floyd A. Psychological health in cancer survivors. Seminars in Oncology Nursing 2008;24(3):193‐201. [PUBMED: 18687265]

Balshem 2011

1. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 2011;64(4):401‐6.

Berry 2005

1. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine 2005;353(17):1784‐92. [PUBMED: 16251534]

Bower 2006

1. Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, et al. Fatigue in long‐term breast carcinoma survivors: a longitudinal investigation. Cancer 2006;106(4):751‐8. [PUBMED: 16400678]

Broad 2012

1. Borad WJ. How yoga can wreck your body. The New York Times 5 January 2012.

Brown 2005

1. Brown RP, Gerbarg PL. Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II ‐ clinical applications and guidelines. Journal of Alternative and Complementary Medicine 2005;11(4):711‐7.

Brozek 2009

1. Brozek JL, Akl EA, Alonso‐Coello P, Lang D, Jaeschke R, Williams JW, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy 2009;64(5):669‐77.

Buffart 2012

1. Buffart LM, Uffelen JG, Riphagen II, Brug J, Mechelen W, Brown WJ, et al. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta‐analysis of randomized controlled trials. BMC Cancer 2012;12:559. [PUBMED: 23181734]

Büssing 2011

1. Büssing A, Edelhauser F, Weisskircher A, Fouladbakhsh JM, Heusser P. Inner correspondence and peacefulness with practices among participants in eurythmy therapy and yoga: a validation study. Evidence‐Based Complementary and Alternative Medicine 2011;Article ID 329023. [PUBMED: 20953427]

Carroll 2012

1. Carroll BJ, Iranmanesh A, Keenan DM, Cassidy F, Wilson WH, Veldhuis JD. Pathophysiology of hypercortisolism in depression: pituitary and adrenal responses to low glucocorticoid feedback. Acta Psychiatrica Scandinavica 2012;125(6):478‐91. [PUBMED: 22211368]

Chong 2011

1. Chong CS, Tsunaka M, Tsang HW, Chan EP, Cheung WM. Effects of yoga on stress management in healthy adults: a systematic review. Alternative Therapies in Health and Medicine 2011;17(1):32‐8. [PUBMED: 21614942]

Cochran 1954

1. Cochran WG. The combination of estimates from different experiments. Biometrics 1954;10(1):101‐29.

Cohen 1998

1. Cohen J. Statistical power analysis for the behavioral sciences. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, 1998.

Compton 2012

1. Compton CC, Byrd DR, Garcia‐Aguilar J, Kurtzman SH, Olawaiye A, Washington MK. AJCC Cancer Staging Atlas. A Companion to the Seventh Edition of the AJCC Cancer Staging Manual and Handbook. 2nd Edition. New York: Springer, 2012.

Cramer 2012a

1. Cramer H, Lange S, Klose P, Paul A, Dobos G. Can yoga improve fatigue in breast cancer patients? A systematic review. Acta Oncologia 2012;51(4):559‐60.

Cramer 2012b

1. Cramer H, Lange S, Klose P, Paul A, Dobos G. Yoga for breast cancer patients and survivors: a systematic review and meta‐analysis. BMC Cancer 2012;12:412. [PUBMED: 22988934]

Cramer 2013

1. Cramer H, Lauche R, Haller H, Langhorst J, Dobos G, Berger B. "I'm more in balance": a qualitative study of yoga for patients with chronic neck pain. Journal of Alternative and Complementary Medicine 2013;19(6):536‐42. [PUBMED: 23336342]

Cramer 2016

1. Cramer H, Lauche R, Langhorst J, Dobos G. Is one yoga style better than another? A systematic review of associations of yoga style and conclusions in randomized yoga trials. Complementary Therapies in Medicine 2016;25:178‐87.

Culos‐Reed 2012

1. Culos‐Reed SN, Mackenzie MJ, Sohl SJ, Jesse MT, Zahavich AN, Danhauer SC. Yoga & cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors. Evidence‐Based Complementary and Alternative Medicine 2012;Article ID 642576. [PUBMED: 23125870]

De Michaelis 2005

1. Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, UK: Continuum International Publishing Group, 2005.

Desai 2013

1. Desai K, Mao JJ, Su I, Demichele A, Li Q, Xie SX, et al. Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors. Supportive Care in Cancer 2013;21(1):43‐51.

Devi 1986

1. Devi SK, Chansauria JP, Udupa KN. Mental depression and kundalini yoga. Ancient Science of Life 1986;6(2):112‐8. [PUBMED: 22557558]

Ferlay 2013

1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0. Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer, 2013. .

Feuerstein 1998

1. Feuerstein G. The Yoga Tradition. Prescott: Hohm Press, 1998.

Floyd 2009

1. Floyd A, Moyer A. Group vs. individual exercise interventions for women with breast cancer: a meta‐analysis. Health Psychology Review 2009;4(1):22‐41. [PUBMED: 20607139]

Fouladbakhsh 2010

1. Fouladbakhsh JM, Stommel M. Gender, symptom experience, and use of complementary and alternative medicine practices among cancer survivors in the U.S. cancer population. Oncology Nursing Forum 2010;37(1):E7‐15. [PUBMED: 20044334]

Garabeli Cavalli Kluthcovsky 2012

1. Garabeli Cavalli Kluthcovsky AC, Urbanetz AA, Carvalho DS, Pereira Maluf EM, Schlickmann Sylvestre GC, Bonatto Hatschbach SB. Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health‐related quality of life. Supportive Care in Cancer 2012;20(8):1901‐9.

Guyatt 2008

1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6.

Harder 2012

1. Harder H, Parlour L, Jenkins V. Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review. Supportive Care in Cancer 2012;20(12):3055‐64. [PUBMED: 23052917]

Hartvig 2006

1. Hartvig P, Aulin J, Hugerth M, Wallenberg S, Wagenius G. Fatigue in cancer patients treated with cytotoxic drugs. Journal of Oncology Pharmacy Practice 2006;12(3):155‐64. [PUBMED: 17022870]

Higgins 2003

1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60.

Higgins 2011

1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐.

Hopwood 2010

1. Hopwood P, Sumo G, Mills J, Haviland J, Bliss JM. The course of anxiety and depression over 5 years of follow‐up and risk factors in women with early breast cancer: results from the UK Standardisation of Radiotherapy Trials (START). Breast 2010;19(2):84‐91. [PUBMED: 20042336]

Ibrahim 2011

1. Ibrahim EM, Al‐Homaidh A. Physical activity and survival after breast cancer diagnosis: meta‐analysis of published studies. Medical Oncology 2011;28(3):753‐65. [PUBMED: 20411366]

Irwin 2009

1. Irwin ML, Varma K, Alvarez‐Reeves M, Cadmus L, Wiley A, Chung GG, et al. Randomized controlled trial of aerobic exercise on insulin and insulin‐like growth factors in breast cancer survivors: the Yale exercise and survivorship study. Cancer Epidemiology, Biomarkers & Prevention 2009;18(1):306‐13. [PUBMED: 19124513]

Jones 2016

1. Jones JM, Olson K, Catton P, Catton CN, Fleshner NE, Krzyzanowska MK, et al. Cancer‐related fatigue and associated disability in post‐treatment cancer survivors. Journal of Cancer Survivorship 2016;10(1):51‐61.

Kalueff 2007

1. Kalueff AV, Nutt DJ. Role of GABA in anxiety and depression. Depression and Anxiety 2007;24(7):495‐517. [PUBMED: 17117412]

Kim 2009

1. Kim CJ, Kang DH, Park JW. A meta‐analysis of aerobic exercise interventions for women with breast cancer. Western Journal of Nursing Research 2009;31(4):437‐61. [PUBMED: 19176403]

Kjaer 2002

1. Kjaer TW, Bertelsen C, Piccini P, Brooks D, Alving J, Lou HC. Increased dopamine tone during meditation‐induced change of consciousness. Brain Research. Cognitive Brain Research 2002;13(2):255‐9. [PUBMED: 11958969]

Levine 2012

1. Levine AS, Balk JL. Yoga and quality‐of‐life improvement in patients with breast cancer: a literature review. International Journal of Yoga Therapy 2012;22:95‐9. [PUBMED: 23070679]

Li 2016

1. Li J, Humphreys K, Eriksson M, Dar H, Brandberg Y, Hall P, et al. Worse quality of life in young and recently diagnosed breast cancer survivors compared with female survivors of other cancers: a cross‐sectional study. International Journal of Cancer 2016;139(11):2415‐25.

Lin 2011

1. Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY. Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta‐analysis. Evidence‐Based Complementary and Alternative Medicine 2011;Article 659876. [PUBMED: 21437197]

Maass 2015

1. Maass SW, Roorda C, Berendsen AJ, Verhaak PF, Bock GH. The prevalence of long‐term symptoms of depression and anxiety after breast cancer treatment: a systematic review. Maturitas 2015;82(1):100‐8.

McNeely 2006

1. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta‐analysis. CMAJ: Canadian Medical Association Journal 2006;175(1):34‐41. [PUBMED: 16818906]

Mishra 2012a

1. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health‐related quality of life for cancer survivors. The Cochrane Database of Systematic Reviews 2012, Issue 8.

Mishra 2012b

1. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health‐related quality of life for people with cancer during active treatment. The Cochrane Database of Systematic Reviews 2012, Issue 8.

Moher 2009

1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses: the PRISMA statement. Annals of Internal Medicine 2009;151(4):1‐7.

Neilson 2009

1. Neilson HK, Friedenreich CM, Brockton NT, Millikan RC. Physical activity and postmenopausal breast cancer: proposed biologic mechanisms and areas for future research. Cancer Epidemiology, Biomarkers & Prevention 2009;18(1):11‐27. [PUBMED: 19124476]

NIH 2012

1. National Institutes of Health. What is complementary and alternative medicine?. (accessed 1 December 2016) 2012.

Pan 2015

1. Pan Y, Yang K, Wang Y, Zhang L, Liang H. Could yoga practice improve treatment‐related side effects and quality of life for women with breast cancer? A systematic review and meta‐analysis. Asia‐Pacific Journal of Clinical Oncology 2015 Jan 6 [Epub ahead of print].

Patrick 2003

1. Patrick DL, Ferketich SL, Frame PS, Harris JJ, Hendricks CB, Levin B, et al. National Institutes of Health state‐of‐the‐science conference statement: symptom management in cancer: pain, depression, and fatigue. Journal of the National Cancer Institute 2003;95(15):1110‐7. [PUBMED: 12902440]

RevMan [Computer program]

1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.

Rottmann 2016

1. Rottmann N, Hansen DG, Hagedoorn M, Larsen PV, Nicolaisen A, Bidstrup PE, et al. Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study. Journal of Cancer Survivorship 2016;10(5):915‐26.

Schmidt 2012

1. Schmidt ME, Chang‐Claude J, Vrieling A, Heinz J, Flesch‐Janys D, Steindorf K. Fatigue and quality of life in breast cancer survivors: temporal courses and long‐term pattern. Journal of Cancer Survivorship 2012;6(1):11‐9.

Schulz 2010

1. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ (Clinical research ed.) 2010;340:c332.

Shannahoff‐Khalsa 2005

1. Shannahoff‐Khalsa DS. Patient perspectives: Kundalini yoga meditation techniques for psycho‐oncology and as potential therapies for cancer. Integrative Cancer Therapies 2005;4(1):87‐100.

Smith 2009

1. Smith KB, Pukall CF. An evidence‐based review of yoga as a complementary intervention for patients with cancer. Psycho‐Oncology 2009;18(5):465‐75. [PUBMED: 18821529]

Stafford 2013

1. Stafford L, Judd F, Gibson P, Komiti A, Mann GB, Quinn M. Screening for depression and anxiety in women with breast and gynaecologic cancer: course and prevalence of morbidity over 12 months. Psycho‐Oncology 2013;22(9):2071‐8.

Streeter 2010

1. Streeter CC, Whitfield TH, Owen L, Rein T, Karri SK, Yakhkind A, et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. Journal of Alternative and Complementary Medicine 2010;16(11):1145‐52. [PUBMED: 20722471]

Streeter 2012

1. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma‐aminobutyric‐acid, and allostasis in epilepsy, depression, and post‐traumatic stress disorder. Medical Hypotheses 2012;78(5):571‐9. [PUBMED: 22365651]

Syvälahti 1994

1. Syvälahti EK. Biological aspects of depression. Acta Psychiatrica Scandinavica Supplementum 1994;377:11‐5. [PUBMED: 7914394]

Vadiraja 2009

1. Vadiraja SH, Rao MR, Nagendra RH, Nagarathna R, Rekha M, Vanitha N, et al. Effects of yoga on symptom management in breast cancer patients: a randomized controlled trial. International Journal of Yoga 2009;2(2):73‐9.

Van Onselen 2012

1. Onselen C, Cooper BA, Lee K, Dunn L, Aouizerat BE, West C, et al. Identification of distinct subgroups of breast cancer patients based on self‐reported changes in sleep disturbance. Supportive Care in Cancer 2012;20(10):2611‐9.

Vedamurthachar 2006

1. Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, Subbakrishna DK, Sureshbabu SV, et al. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. Journal of Affective Disorders 2006;94(1‐3):249‐53. [PUBMED: 16740317]

Visovsky 2006

1. Visovsky C. Muscle strength, body composition, and physical activity in women receiving chemotherapy for breast cancer. Integrative Cancer Therapies 2006;5(3):183‐91. [PUBMED: 16880422]

Zhang 2012

1. Zhang J, Yang KH, Tian JH, Wang CM. Effects of yoga on psychologic function and quality of life in women with breast cancer: a meta‐analysis of randomized controlled trials. Journal of Alternative and Complementary Medicine 2012;18(11):994‐1002. [PUBMED: 22909345]

Source: PubMed

Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer

Abstract

Conflict of interest statement

Figures

References

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások