Loudon, A., Barnett, T., Piller, N., Immink, M.A., & Williams, A.D. (2014). Yoga management of breast cancer-related lymphoedema: A randomised controlled pilot-trial. BMC Complementary and Alternative Medicine, 14, 214.

DOI Link

Study Purpose

To determine how women with stage 1 breast cancer-related lymphedema (BCRL) are affected by yoga

Intervention Characteristics/Basic Study Process

Participants were randomly assigned into the intervention group or control group. The intervention group received a weekly, 90-minute yoga class including breathing practices, physical postures, meditation, and relaxation techniques in the Satyananda yoga tradition. Participants also were given a DVD with a 45-minute yoga session to be practiced daily at home. The DVD was a shorter version of the class. Participants were encouraged to make modifications as needed. Participants logged their daily practice and were given the choice to wear their compression sleeves. The control group received usual care, and a wait-list control was used.
 
Specially trained lymphedema therapists performed the measurements and were blinded to the group allocation. Participants abstained from alcohol for 12 hours and caffeine and exercise for two hours prior to testing as this is especially important for for bioimpedance spectroscopy measurements. 

Sample Characteristics

  • N = 23  
  • AVERAGE AGE = 57.6 years (SD = 10.5 years, range = 34–80 years) 
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Stage 1 unilateral arm BCRL
  • OTHER KEY SAMPLE CHARACTERISTICS: Completed treatment for breast cancer (surgery, radiotherapy, and chemotherapy) at least six months prior to study; aged greater than 18 years; sufficient English literacy to provide informed consent; exclusion criteria included recurrent cancer, infection, complex lymphedema therapy, pregnancy, pacemakers (would affect bioimpedance spectroscopy readings), and severe psychological illness

Setting

  • SITE: Multi-site    
  • SETTING TYPE: Multiple settings    
  • LOCATION: Australia

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care

Study Design

Multi-center, randomized, controlled pilot trial using a parallel design with participants allocated to the intervention or control groups on a 1:1 ratio

Measurement Instruments/Methods

  • Primary outcome measures were arm volume of lymphedema (measured by circumference) and extracellular fluid (measured by bioimpedance spectroscopy).
  • Secondary outcome measures were tissue induration (measured by tonometry), levels of sensations, pain, and fatigue (limiting effects measured by a Visual Analog Scale [VAS] and quality of life based on the Lymphoedema Quality of Life Tool [LYMQOL]).

Results

At week 8, the intervention group had a greater decrease in tissue induration in the affected upper arm compared to the control group (p = 0.050) and a greater reduction in the symptom subscale for quality of life (p = 0.038). There was no difference in arm volume of lymphedema or extracellular fluid between groups at week 8. However, at week 12, arm volume increased more for the intervention group than the control group (p = 0.032).

Conclusions

The outcomes of this small pilot trial provided preliminary evidence that an eight-week Satyananda yoga intervention did not exacerbate lymphedema and improved tissue induration ing the affected upper arm as well as quality of life subscale symptoms. However, the fact that these improvements were not maintained at the one-month follow-up when arm volume was increased suggested that yoga needs to be ongoing. This is one of few studies that addresses tissue induration.

Limitations

  • Small sample (< 30)
  • Baseline sample/group differences of import
  • Other limitations/explanation: Higher body mass index of the participants in the yoga group compared to the control group at baseline, which may have confounded the results

Nursing Implications

Yoga may reduce tissue induration in the upper arm affected by lymphedema and decrease its associated symptoms. However, additional research trials with longer durations, higher levels of lymphedema, and larger numbers are warranted before definitive conclusions can be made.