Affect and mindfulness as predictors of change in mood disturbance, stress symptoms, and quality of life in a community-based yoga program for cancer survivors

Integrative model for self-perception of well-being in cancer

PURPOSE

Continual illness uncertainty can affect how people perceive and interpret their well-being. Some cognitive and spiritual factors may be involved in the management of disruptive thoughts and emotions that can emerge during the experience of cancer.

MATERIAL AND METHODS

An evidence-based integrative model was developed to evaluate and show the role that mindfulness, acceptance, self-efficacy, uncertainty, meaning, and purpose in life play in the self-perception of well-being in individuals with cancer. This evidence-based integrative model was conducted using relevant and selected studies.

RESULTS

An integrative model for self-perception of well-being has been proposed. This model integrates evidence-based findings and provides clear principles for clinicians and researchers. This integrative model proposes that mindfulness, acceptance, self-efficacy perception, and uncertainty can predict how people with cancer perceive their well-being. The model also posits that meaning and purpose in life can act as mediators or moderators of this prediction.

CONCLUSIONS

This integrative model involves the multidimensionality of human beings and facilitates the understanding of some key factors for the design of therapeutic approaches such as Acceptance & Commitment Therapy or Meaning-Centered Psychotherapy.IMPLICATIONS FOR REHABILITATIONMindfulness, acceptance, self-efficacy, uncertainty, meaning, and purpose in life can be highly relevant for clinical oncology.An integrative model is proposed to understand the combined influence of these factors on patients with cancer.This model may favor a better integration of well-known interventions, such as Mindfulness-based approaches, Acceptance and Commitment Therapy (ACT), and Meaning-Centered Psychotherapy (MCP).

Course and predictors of eating disorder symptoms, anxiety symptoms, and pandemic-related eating disorder concerns among adults with eating disorders during the first year of the COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic and public health mitigation measures have negatively impacted individuals with eating disorders (ED). We evaluated changes in and predictors of ED symptoms, pandemic-related ED concerns, and anxiety symptoms across the first 12 months of the COVID-19 pandemic among individuals with self-reported EDs in the United States (US), Sweden (SE), and the Netherlands (NL).

METHOD

Participants in the US (N = 510), SE (N = 982), and NL (N = 510) completed an online survey assessing ED symptoms (binge eating, restriction, compensatory behaviors, and anxiety about being unable to exercise), general anxiety symptoms, and pandemic-related ED concerns about accessing food, lack of structure and social support, being in a triggering environment, and food and treatment costs. In the US and NL, respondents completed surveys beginning April 2020 and continuing monthly for a year. In SE, respondents completed baseline surveys in May 2020, a six-month follow-up around December 2020, and a 12-month follow-up in May 2021.

RESULTS

Three patterns emerged: (1) a curvilinear course with the highest level of symptoms at baseline, declining through November 2020, and increasing through the rest of the year; (2) a linear declining course over time; and (3) a stable course with no changes. Worries about COVID-19 infection, lockdown, concerns about lack of structure and social support, and concerns about accessing food consistent with one's recovery meal plan predicted increases in ED symptoms.

DISCUSSION

ED symptoms tracked with pandemic-related concerns in people with EDs. Conceptualizing predictors of symptoms may inform therapy and public health resources that reduce the impact of pandemics on mental health.

PUBLIC SIGNIFICANCE

Our findings suggest that the COVID-19 pandemic had negative impacts on people with eating disorders, including amplification of mental health symptoms and stressors around peak periods of infection and COVID-19 restrictions. These findings inform medical providers, policy-makers, and community-based supports about the information and resource needs of this group to ensure efficient dissemination in future public health emergencies and during the ongoing COVID-19 pandemic.

Community-based interventions designed to optimize health behaviors among cancer survivors: an integrative systematic review

PURPOSE

The purpose of this review was to synthesize the evidence on community-based health behavior optimization interventions (physical activity, nutrition, weight management) with a focus on cancer survivors at risk for poor health outcomes.

METHODS

This integrative review followed the methods and protocol outlined by the Joanna Briggs Institute Methods Manual for systematic reviews and was reported using PRISMA-Scr. Four databases, namely, PubMed, CINAHL, Web of Science, SportDiscus, were searched in March 2021 to identify articles addressing health behaviors among cancer survivors.

RESULTS

The review included 43 articles describing unique interventions developed through community-based participatory research (CBPR). The majority of community-based interventions were designed to optimize exercise/physical activity (76.7%) exclusively or in combination with nutrition. Non-Hispanic White persons constituted most participants. Most interventions took place as a part of an established community program and recruited from existing community programs to evaluate intervention effects on specific health outcomes. Of the interventions, 88.3% improved at least one outcome measurement.

CONCLUSION

The current studies have built on the strengths and resources of the community using existing programs. There was a lack of diversity in socioeconomic status and racial/ethnic background among participants of most interventions and inputs from partners such as cancer survivors, community, and healthcare organizations. Multiple health behavior interventions with longitudinal studies are needed for racial/ethnic minoritized cancer survivors. Future research should focus on achieving mutual benefits through iterative processes to develop sustainable community/research partnerships, ensuring long-term commitment, and disseminating knowledge gained from CBPR to and by all involved partners to improve health behaviors.

Enhancing Access to Yoga for Older Male Veterans After Cancer: Examining Beliefs About Yoga

BACKGROUND

Yoga is an effective clinical intervention for cancer survivors. Most studies of the positive effects of yoga on cancer patients report on predominantly middle-aged women with breast cancer. Less is known about the use of yoga in older adults, veterans, and those from diverse racial or ethnic backgrounds.

METHODS

We examined strategies to enhance access to yoga in older veterans after cancer, focusing on education (study 1) and intervention (study 2). Study 1 included 110 participants with a median (SD) age of 64.9 (9.4) years who were mostly male (99%) cancer survivors who were interviewed 12 months after their cancer diagnosis. Study 2 included 28 participants with a median (SD) age of 69.2 (10.9) years who were mostly male (96%) cancer survivors who participated in a yoga program within 3 years of their cancer diagnosis. Standardized interviews assessed interest in and barriers to yoga while self-reporting assessed health-related quality of life and beliefs about yoga.

RESULTS

In study 1, interest in yoga increased from 5.5 to 31.8% (χ 2 = 22.25, P < .001) following education. In open-ended questions 4 themes related to negative beliefs or barriers emerged: lack of knowledge or skepticism, disinterest or dislike, physical health barriers, and logistical barriers. In study 2, beliefs were more positive following intervention for expected benefits (t = 4.44, P < .001), discomfort (t = 4.92, P < .001), and social norms (t = 4.38, P < .001) related to yoga. Physical function improved after participation in a yoga class, especially for those with higher beliefs in yoga prior to class. Age was not associated with beliefs about yoga in either sample.

CONCLUSIONS

A portion of older veterans who are cancer survivors were interested in yoga but faced access barriers. Implications for practice and research include increasing knowledge about yoga benefits and addressing physical health and logistical barriers to enhance access to yoga for older veterans.

Exercise interventions for people diagnosed with cancer: a systematic review of implementation outcomes

PURPOSE

Exercise is efficacious for people living after a cancer diagnosis. However, implementation of exercise interventions in real-world settings is challenging. Implementation outcomes are defined as 'the effects of deliberate and purposive actions to implement new treatments, practices, and services'. Measuring implementation outcomes is a practical way of evaluating implementation success. This systematic review explores the implementation outcomes of exercise interventions evaluated under real-world conditions for cancer care.

METHODS

Using PRISMA guidelines, an electronic database search of Medline, PsycInfo, CINAHL, Web of Science, SportsDiscus, Scopus and Cochrane Central Registry of Controlled Trials was conducted for studies published between January 2000 and February 2020. The Moving through Cancer registry was hand searched. The Implementation Outcomes Framework guided data extraction. Inclusion criteria were adult populations with a cancer diagnosis. Efficacy studies were excluded.

RESULTS

Thirty-seven articles that described 31 unique programs met the inclusion criteria. Implementation outcomes commonly evaluated were feasibility (unique programs n = 17, 54.8%) and adoption (unique programs n = 14, 45.2%). Interventions were typically delivered in the community (unique programs n = 17, 58.6%), in groups (unique programs n = 14, 48.3%) and supervised by a qualified health professional (unique programs n = 14, 48.3%). Implementation outcomes infrequently evaluated were penetration (unique programs n = 1, 3.2%) and sustainability (unique programs n = 1, 3.2%).

CONCLUSIONS

Exercise studies need to measure and evaluate implementation outcomes under real-world conditions. Robust measurement and reporting of implementation outcomes can help to identify what strategies are essential for successful implementation of exercise interventions.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding how exercise interventions can be successful implemented is important so that people living after a cancer diagnosis can derive the benefits of exercise.

Thai Buddhism-Based Mindfulness for Pain Management in Thai Outpatients with Cancer: A Pilot Study

OBJECTIVE

This study aimed to evaluate Thai Buddhism-based Mindfulness (TBbM) feasibility based on recruitment and retention rates and to obtain preliminary data regarding changes (effect sizes) in pain severity and other outcomes when comparing control to intervention participants following TBbM use.

METHODS

A randomized controlled trial was conducted in the Outpatient Department at Sawanpracharak Hospital, Thailand, from April 2018 to February 2019. Seventeen participants completed the pretest and posttest. Both groups (control group [n = 10] and intervention group [n = 7]) received usual care and watched a 25-min educational video about cancer pain. The intervention group participated in a 3-day mindfulness training program at a Buddhist temple and continued practicing at home for 8 weeks. Data were collected at baseline and at 1 and 2 months postintervention.

RESULTS

One-hundred and thirty-five participants met the eligibility criteria; 112 (82%) declined to participate and 6 of 23 (26%) were lost to follow-up/dropped out. Control and intervention participants had an average age of 44 (± 8.77) and 56 years (± 7.41), respectively. When compared to the control group, the TBbM participants reported no statistically significant improvements in pain or other outcomes. While not statistically significant, the effect size indicated that pain did improve in the TBbM group (Cohen's d = 0.41).

CONCLUSIONS

Given the suboptimal recruitment and retention rates, modification of the intervention is warranted. Further, our findings suggest that the intervention had a moderate effect on pain. To evaluate efficacy, future adequately powered studies are needed to test a more feasible TBbM intervention.

A conceptual model describing mechanisms for how yoga practice may support positive embodiment

Yoga practice has been associated with various indices of positive embodiment in correlational and intervention studies. Yet, systematic, theoretically-grounded models detailing specific mechanisms by which yoga supports positive embodiment are lacking. In this article, we present a conceptual model that describes mechanisms (i.e., mediators and moderators) that can be used to guide research to help answer how, for whom, and under what conditions yoga practice may promote positive embodiment. Based on existing theoretical frameworks and empirical findings, this model suggests that (a) yoga practice may cultivate embodying experiences during yoga (e.g., state mindfulness), (b) these embodying experiences may build stable embodying experiences that generalize beyond the yoga context (e.g., trait mindfulness), and (c) these stable embodying experiences may then promote embodying practices (e.g., mindful self-care). This mediational chain is likely moderated by the yoga context (e.g., instructional focus, presence of mirrors, diversity of bodies represented) and yoga practitioners' social identities (e.g., body size, physical limitations), social and personal histories (e.g., experiences with weight stigma and trauma), and personality traits and motives (e.g., body comparison, appearance-focused motives to practice yoga). Using the structure of this conceptual model, we offer researchers ideas for testable models and study designs that can support them.

Age moderates the association between psychological distress and engagement in mindfulness among cancer patients and survivors: A population-based study

PURPOSE

We aim to evaluate the relationship between psychological distress and engagement in mindfulness among a national representative sample of cancer survivors.

SAMPLE AND DESIGN

Using the 2017 National Health Interview Survey, our final analytical sample included 3068 participants who reported having been diagnosed with cancer.

METHODS AND ANALYSIS

We used logistic regression analysis to assess the association and to test age as a moderator. We also conducted follow-up analysis using Fisher's r-to-z transformation. All analyses were adjusted for complex sample weights.

FINDINGS

Cancer survivors who had subclinical and clinical psychological distress were more likely to engage in mindfulness, OR = 1.59, 95% CI [1.24, 2.02] and OR = 1.45, 95% CI [1.02, 2.05], respectively. Age significantly moderated such association with the relationship much stronger among those who are younger (younger than 65 years old) than those who are older (65 years or older), b = 0.97, 95% CI [0.95, 0.99].

CONCLUSIONS

The relationship between psychological distress and engagement in mindfulness differs significantly by a survivor's age. Psychosocial oncological providers need to account for a survivor's age when delivering mindfulness based care to address psychological distress.

IMPLICATIONS

Providers should be mindful of a survivor's age when recommending mindfulness oriented practices.

Long-Term Changes of Symptoms of Anxiety, Depression, and Fatigue in Cancer Patients 6 Months After the End of Yoga Therapy

BACKGROUND

Symptoms of anxiety, depression, and cancer-related fatigue are commonly associated with cancer. Cancer patients increasingly use complementary and alternative treatments, such as yoga, to cope with psychological and physical impairments. In the present article, long-term changes of anxiety, depression, and fatigue in cancer are examined 6 months after a yoga intervention.

METHOD

We used an observational design based on a randomized controlled study in cancer patients with mixed diagnoses to evaluate long-term changes of symptoms of anxiety, depression, and fatigue 6 months after the end of yoga therapy. We measured anxiety symptoms with the Generalized Anxiety Disorder scale (GAD-7), depressive symptoms with the Patient Health Questionnaire-2 (PHQ-2), and fatigue with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Fatigue Scale (EORTC QLQ-FA13). Yoga therapy was provided in yoga classes of 60 minutes each once a week for 8 weeks in total. The exercises provided contained both body and breathing activities as well as meditation.

RESULTS

A total of 58 patients participated in the study. Six months after the end of yoga therapy, symptoms of anxiety, depression, and fatigue were significantly reduced compared with baseline. However, symptoms of anxiety and fatigue slightly increased during the follow-up period, whereas symptoms of depression remained stable.

CONCLUSION

Our results are promising and support the integration of yoga interventions in supportive cancer treatment concepts but should be confirmed by randomized controlled trials. Long-term effects of yoga therapy on cancer patients should be the subject of further research.

A Systematic Review: Mindfulness Intervention for Cancer-Related Pain

Moderate-to-severe pain is a common problem experienced by patients with cancer. Although analgesic drugs are effective, adverse side effects are common and some analgesic drugs are addictive. Nonpharmacological treatment may be a way to treat cancer pain without causing negative side effects. Mindfulness is used as an effective nonpharmacological treatment to improve quality of life (QoL) and to address psychological problems including distress, anxiety, stress, and depression. However, the effect of mindfulness on pain severity has not been sufficiently investigated. Therefore, a systematic review was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. The search was conducted in PubMed, Ovid MEDLINE, and CINAHL and included only empirical studies published from 2008 to 2017. Search terms included mindfulness, mindfulness-based intervention, meditation, cancer, pain, and cancer-related pain. Six studies met the search criteria. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL. However, most studies reviewed were conducted in the United States and Denmark. Further research is needed to test culturally appropriate mindfulness interventions to reduce pain.

Alternative Exercise Traditions in Cancer Rehabilitation

Alternative exercise traditions (AETs) such as Pilates, yoga, Tai Chi Chuan, Qigong, and various forms of dance offer the potential to improve diverse outcomes among cancer survivors by reducing adverse symptoms and mood disorders, and by enhancing function. Additionally AETs have emerged as a potential means to address deficits in current disease-focused care delivery models which are marked by prevalent under-treatment of symptoms and physical impairments. Relative to therapeutic exercise in allopathic models, many AETs are comparatively affordable and accessible. AETs have the further potential to simultaneously address needs spanning multiple domains including social, physical, and psycho-emotional. AETs additionally offer the salient benefits of promoting integrated whole body movement and concurrently enhancing strength, coordination, balance, posture, flexibility, and kinesthetic awareness. Despite AETs' benefits, compelling concerns leave many clinicians ambivalent and reluctant to endorse or even discuss them. One issue is the extensive heterogeneity across and even within specific AETs. An additional concern is that the one-size-fits-many nature of AET group classes undermines an instructor's capacity to individualize dose, type, frequency, and intensity, which are cornerstones of effective therapeutic exercise. Inconsistencies in AET practitioner expertise and certification, as well as the extent of practitioner familiarity with vulnerabilities unique to cancer populations, may also be problematic. At this juncture, an extensive literature of inconsistent quality that spans diverse cancer populations frustrates efforts to precisely determine the effect size of any specific AET in improving a specific outcome; Although systematic reviews and meta-analyses have concluded that AETs have beneficial effects, they consistently identify a high risk of bias in a majority of trials related to a lack of blinding, poor allocation concealment, small sample sizes, and incomplete outcome data.

Resilience and positive affect contribute to lower cancer-related fatigue among Chinese patients with gastric cancer

AIMS AND OBJECTIVES

To investigate the prevalence of cancer-related fatigue and explore the relationship between resilience, positive affect, and fatigue among Chinese patients with gastric cancer.

BACKGROUND

Cancer-related fatigue is the most distressing symptom reported frequently by cancer patients during both treatment and survival phases. Resilience and positive affect as vital protective factors against cancer-related fatigue have been examined, but the underlying psychological mechanisms are not well understood.

DESIGN

A cross-sectional study.

METHODS

Two hundred and three gastric cancer patients were enrolled from three hospitals in China. The Cancer Fatigue Scale, the positive affect subscale of the Positive and Negative Affect Schedule and the Connor-Davidson Resilience Scale (CD-RISC10) were administered. Hierarchical linear regression modelling was conducted to examine the association between resilience and cancer-related fatigue, and the mediating effect of positive affect.

RESULTS

The incidence of clinically relevant fatigue among patients with gastric cancer was 91.6%. Regression analysis showed that resilience was negatively associated with cancer-related fatigue, explaining 15.4% of variance in cancer-related fatigue. Mediation analysis showed that high resilience was associated with increased positive affect, which was associated with decreased cancer-related fatigue.

CONCLUSIONS

Cancer-related fatigue is prevalent among patients with gastric cancer. Positive affect may mediate the relationship between resilience and cancer-related fatigue.

RELEVANCE TO CLINICAL PRACTICE

Interventions that attend to resilience training and promotion of positive affect may be the focus for future clinical and research endeavours.

Effects of Maharishi Yoga Asanas on Mood States, Happiness, and Experiences during Meditation

Context/Background

Many studies showed positive effects of Yoga Asanas. There is no study on Maharishi Yoga Asanas yet. This research replicated and expanded observed improvements on the profile of mood states (POMS) as a result of 2-week Maharishi Yoga Asanas course. Thirteen college students taking part in a 4-week course on Maharishi Yoga Asanas were matched with 13 students taking other courses at the university.

Aims and Objective

The main objective of the study was to assess the effects of Maharishi Yoga Asanas on mood states, degree of happiness, and experiences in Transcendental Meditation (TM) practice.

Methods

All students were given two psychological tests and additional question before and after their 4-week course: POMS, Meditation Depth Questionnaire, and question about the degree of happiness.

Results

Repeated measure MANOVA showed the 4-week Maharishi Yoga Asanas course resulted in significant increase in happiness during the day and significant improvements in (1) sense of personal self, (2) transpersonal qualities, and (3) transpersonal self during their TM practice.

Conclusion

This research shows that Maharishi Yoga Asanas affect more than body and mind. Rather they influence much deeper levels of one's subjectivity including one's transpersonal self.

A pilot yoga physical education curriculum to promote positive body image

We examined the effects of a pilot yoga-based physical education (PE) curriculum by testing for change in trait body surveillance, physical self-worth, and body appreciation. Further, we examined the relationships among change in body image variables and the role of state mindfulness in predicting state body surveillance during classes. Adolescents participated in 12 weeks of yoga-based (n=20; M_age=16.45, 90% female) or traditional (n=23;M_age=14.52, 57% female) PE. Results showed significant (p=.004), moderate decreases in trait body surveillance and minimal nonsignificant (p=.11) increases in physical self-worth. Change in trait body surveillance was inversely related to change in physical self-worth and body appreciation in yoga participants. Multi-level modeling analyses revealed that more mindful students also surveyed their body less during class. Intentionally structured yoga participation may support positive body image among adolescents.

Evaluation of a specialized yoga program for persons with a spinal cord injury: a pilot randomized controlled trial

Objectives

The purpose of this randomized controlled trial was to evaluate the effects of a specialized yoga program for individuals with a spinal cord injury (SCI) on pain, psychological, and mindfulness variables.

Materials and methods

Participants with SCI (n=23) were outpatients or community members affiliated with a rehabilitation hospital. Participants were randomized to an Iyengar yoga (IY; n=11) group or to a 6-week wait-list control (WLC; n=12) group. The IY group participated in a twice-weekly 6-week seated IY program; the WLC group participated in the same yoga program, after the IY group’s yoga program had ended. Pain, psychological, and mindfulness measures were collected at two time points for both groups (within 1–2 weeks before and after program 1 and at a third time point for the WLC group (within 1 week after program 2).

Results

Linear mixed-effect growth models were conducted to evaluate the main effects of group at T2 (postintervention), controlling for T1 (preintervention) scores. T2 depression scores were lower (F_1,18=6.1, P<0.05) and T2 self-compassion scores higher (F_1,18=6.57, P< 0.05) in the IY group compared to the WLC group. To increase sample size and power, the two groups were combined and analyzed across time by comparing pre- and postintervention scores. Main effects of time were found for depression scores, (F_1,14.83=6.62, P<0.05), self-compassion, (F_1,16.6=4.49, P<0.05), mindfulness (F_1,16.79=5.42, P<0.05), mindful observing (F_1,19.82=5.06, P<0.05), and mindful nonreactivity, (F_1,16.53=4.92, P<0.05), all showing improvement after the intervention.

Discussion

The results indicated that a specialized 6-week yoga intervention reduced depressive symptoms and increased self-compassion in individuals with SCI, and may also have fostered greater mindfulness.

Yoga Helps Put the Pieces Back Together: A Qualitative Exploration of a Community-Based Yoga Program for Cancer Survivors

Objective. A qualitative research methods approach was used to explore the experiences of participants in an ongoing community-based yoga program developed for cancer survivors and their support persons. Methods. 25 participants took part in a series of semistructured focus groups following a seven-week yoga program and at three- and six-month follow-ups. Focus groups were transcribed verbatim and analyzed using a process of inductive thematic analysis. Results. The group was comprised of 20 cancer survivors, who were diagnosed on average 25.40 (20.85) months earlier, and five support persons. Participants had completed the yoga program an average of 3.35 (3.66) times previously and attended approximately 1.64 (0.70) of three possible focus groups. Four key themes were identified: (1) safety and shared understanding; (2) cancer-specific yoga instruction; (3) benefits of yoga participation; (4) mechanisms of yoga practice. Conclusions. Qualitative research provides unique and in-depth insight into the yoga experience. Specifically, cancer survivors and support persons participating in a community-based yoga program discussed their experiences of change over time and were acutely aware of the beneficial effects of yoga on their physical, psychological, and social well-being. Further, participants were able to articulate the mechanisms they perceived as underpinning the relationship between yoga and improved well-being as they developed their yoga practice.

Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application

Background

Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors.

Objective

This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app.

Methods

The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively.

Results

Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes.

Conclusions

All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population.

Effects of Exercise Interventions and Physical Activity Behavior on Cancer Related Cognitive Impairments: A Systematic Review

This systematic review analyzes current data on effects of exercise interventions and physical activity behavior on objective and subjective cancer related cognitive impairments (CRCI). Out of the 19 studies which met all inclusion criteria, five RCTs investigated rodents, whereas the other 14 trials explored humans and these included six RCTs, one controlled trial, two prospective noncontrolled trials, one case series, one observational study, and three cross-sectional studies. The results from animal models revealed positive effects of exercise during and after chemotherapy or radiation on structural alterations of the central nervous system, physiological as well as neuropsychological outcomes. The overall study quality in patient studies was poor. The current data on intervention studies showed preliminary positive effects of Asian-influenced movement programs (e.g., Yoga) with benefits on self-perceived cognitive functions as well as a reduction of chronic inflammation for breast cancer patients in the aftercare. Exercise potentially contributes to the prevention and rehabilitation of CRCI. Additional RCTs with standardized neuropsychological assessments and controlling for potential confounders are needed to confirm and expand preliminary findings.

Evaluating Emotional Well-Being after a Short-Term Traditional Yoga Practice Approach in Yoga Practitioners with an Existing Western-Type Yoga Practice

The purpose of the present study was to examine the influence of a traditional yoga practice approach (morning daily practice, TY) compared to that of a Western yoga practice approach (once-twice weekly, evening practice, WY) on determinants of emotional well-being. To that end, in a pre/posttest between-subject design, measures of positive (PA) and negative affect (NA), mindfulness, perceived stress, and arousal states were taken in 24 healthy participants (20 women; mean age: 30.5, SD = 8.1 years) with an already existing WY practice, who either maintained WY or underwent a 2-week, five-times-per-week morning practice (TY). While WY participants maintained baseline values for all measures taken, TY participants showed significant beneficial changes for PA, NA, and mindfulness and a trend for improved ability to cope with stress at the completion of the intervention. Furthermore, TY participants displayed decreased subjective energy and energetic arousal. Altogether, findings indicate that the 2-week TY is beneficial over WY for improving perceived emotional well-being. The present findings (1) undermine and inspire a careful consideration and utilization of yoga practice approach to elicit the best benefits for emotional well-being and (2) support yoga as an evidence-based practice among healthy yoga practitioners.

The Essential Properties of Yoga Questionnaire: Development and Methods

Yoga interventions have considerable heterogeneity, are multi-dimensional, and may impact health in different ways. However, most research reports regarding the effects of yoga on health and wellbeing do not adequately describe the components of the yoga interventions being used. Thus, drawing comparisons across studies or understanding the relative effects of specific aspects of a yoga intervention are rarely possible. To address this problem, we created the Essential Properties of Yoga Questionnaire (EPYQ) Project, an NCCAM-funded set of studies to develop a translational tool for yoga researchers. Here we describe the methods and developmental processes used in the EPYQ Project in detail. The project consists of four main phases. Phase I was designed to gain a comprehensive understanding of the relevant aspects of yoga by conducting a comprehensive systematic literature review and conducting focus groups with stakeholders including a wide variety of yoga teachers and students. In Phase II, a pool of potential questionnaire items was developed for the prototypic questionnaire using information from Phase I. Cognitive interviews were conducted with the preliminary EPYQ items to assess the perceived clarity, meaning, and importance of each item. In Phase III, the prototypic questionnaire was administered to two large samples of yoga students and instructors. Military personnel and veterans who practiced or taught yoga (n = 329) were recruited to participate. Factor analysis and item response theory were used to identify factors and select the final questionnaire items. Phase IV is ongoing and will collect reliability and validity data on the final instrument. Results are expected to be available in 2016. The EPYQ will provide an objective tool for describing the amount of various components of yoga interventions, eventually allowing researchers to link specific yoga components to health benefits, and facilitating the design of yoga interventions for specific health conditions.

Complementary and Alternative Medicine Use Among Overweight and Obese Cancer Survivors in the United States

PURPOSE

The purpose of the study was to determine the prevalence of complementary and alternative medicine (CAM) use among US cancer survivors; examine whether use varies by underweight/normal weight, overweight, and obese body mass index status; determine reasons for use; and document disclosure rates of CAM use to medical professionals.

METHODS

Data for 1785 cancer survivors were obtained from the 2007 National Health Interview Survey and CAM supplement. The prevalence and associations of CAM use in the previous 12 months were compared among underweight/normal weight, overweight, and obese adult cancer survivors.

RESULTS

Nearly 90% of cancer survivors used at least one type of CAM therapy in the 12 months preceding the survey. Those who were overweight, but not obese, were more likely to use a CAM modality compared to normal/underweight respondents. Over two thirds (71%) reported using CAM therapy for general health and wellness and 39.3% used CAM because a health care provider recommended it. Disclosure rates of CAM use to conventional medical professionals varied widely by CAM modality.

CONCLUSIONS

An overwhelming majority of US cancer survivors use CAM for a variety of reasons. Overweight cancer survivors may be more likely to use CAM than those who are underweight, normal weight, or obese. Cancer survivors should be screened by medical providers for the use of CAM therapies; furthermore, prospective clinical research evaluating the efficacy and safety of biologically based CAM therapies, often used by cancer survivors, is important and necessary for the well-being of this population.

Yoga as an adjunct treatment for alcohol dependence: a pilot study

OBJECTIVES

This pilot study explores the feasibility of yoga as part of a treatment program for alcohol dependence.

DESIGN

Eighteen alcohol dependent patients were randomized to receive either treatment as usual or treatment as usual plus yoga. Assessments were taken at baseline and six month follow-up.

SETTING

'Riddargatan 1': an outpatient alcohol treatment clinic located in Stockholm, Sweden.

INTERVENTIONS

Treatment as usual consisted of psychological and pharmacological interventions for alcohol dependence. The 10-week yoga intervention included a weekly group yoga session. Participants were encouraged to practice the yoga movements at home once per day.

MAIN OUTCOME MEASURES

Alcohol consumption (timeline follow-back method, DSM-IV criteria for alcohol dependence, and the Short Alcohol Dependence Data questionnaire), affective symptoms (the Hospital Anxiety and Depression Scale), quality of life (Sheehan Disability Scale) and stress (the Perceived Stress Scale and saliva cortisol).

RESULTS

Yoga was found to be a feasible and well accepted adjunct treatment for alcohol dependence. Alcohol consumption reduced more in the treatment as usual plus yoga group (from 6.32 to 3.36 drinks per day) compared to the treatment as usual only group (from 3.42 to 3.08 drinks per day). The difference was, however, not statistically significant (p = 0.17).

CONCLUSIONS

Larger studies are needed to adequately assess the efficacy and long-term effectiveness of yoga as an adjunct treatment for alcohol dependence.