Fisher, M.I., Donahoe-Fillmore, B., Leach, L., O'Malley, C., Paeplow, C., Prescott, T., & Merriman, H. (2014). Effects of yoga on arm volume among women with breast cancer related lymphedema: A pilot study. Journal of Bodywork and Movement Therapies, 18, 559-565. 

PURPOSE: To study the effects of yoga on limb volume in women with breast cancer-related lymphedema

SECONDARY OBJECTIVES: To determine the effects of eight weeks of yoga on quality of life, self-reported arm function, and grip strength

Participants attended eight weeks of Hatha yoga three times a week. Participants went to the studio two times per week (60 minutes) and watched a prerecorded DVD at home (45 minutes) once per week. They all wore compression sleeves. 

• N = 6  
• AVERAGE AGE = 57 years (49–69 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer and lymphedema
• OTHER KEY SAMPLE CHARACTERISTICS: Female breast cancer survivors diagnosed with ipsilateral upper extremity lymphedema and independent mobility not requiring assistance
• EXCLUSION CRITERIA: Congestive heart failure, chronic obstructive pulmonary disease, pacemakers, pregnancy, previous heart surgery, current radiation or chemotherapy, or current yoga practice  

• SITE: Single site    
• SETTING TYPE: Home    
• LOCATION: Dayton, Ohio

• PHASE OF CARE: Late effects and survivorship

Pilot study with a pre- and postintervention design

• Date of breast cancer and lymphedema diagnosis, breast cancer therapies, and height and weight data were collected one week prior to start of classes.  
• Functional Assessment of Cancer Therapy, Breast (FACT-B)
• Disabilities of the Arm and Shoulder, and Hand (DASH)
• Jamar^® dynamometer (strength and grip)
• Volumeter (arm volume, best of three measurements was used)
• Descriptions of the poses were included in the study.
• Measurements were recorded at baseline, after the completion of four classes, and after the completion of all classes (eight weeks).  

• Significant reduction in arm volume (p = 0.02)
• No effect on quality of life, self-reported arm function, or hand grip strength

It was too early to conclude that yoga benefits breast cancer-related lymphedema. Many variables may affect arm reduction such as body mass index and duration of disease. Participants had lymphedema for greater than seven years, and their lymphedema may have been less influenced by activity and therapy. It is likely that the length of the intervention is was long enough to affect quality of life.

• Small sample (< 30)
• Baseline sample/group differences of import
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)
• Risk of bias (sample characteristics)
• Other limitations/explanation: A control group and a third group doing a different activity would have enhanced this study.    

Many evidenced-based guidelines encouraging exercise, including yoga, exist for the breast cancer patient population. However, there is a lack of data available regarding the effects of yoga on lymphedema. Nurses can confidently refer patients to an instructor-based program or a physical therapist for safe upper body exercise. More studies with rigorous designs are needed to examine the impact of yoga on patients with cancer-related lymphedema.