Improve Sleep and Relieve Fatigue in Cancer Survivors with Yoga

Improve Sleep and Relieve Fatigue in Cancer Survivors with Yoga


By John M. de Castro, Ph.D.


We recommend that doctors prescribe this low-risk, low-cost treatment to all cancer patients with cancer-related fatigue. We would like them to prescribe gentle hatha yoga but they need to refer to appropriate yoga instructors who have experience of working with cancer patients.” – Po-Ju Lin


Because of great advances in treatment, many patients today are surviving cancer. But cancer survivors frequently suffer from anxiety, depression, mood disturbance, post-traumatic stress disorder (PTSD), sleep disturbance, fatigue, sexual dysfunction, loss of personal control, impaired quality of life, and psychiatric symptoms which have been found to persist even ten years after remission. Also, cancer survivors can have to deal with a heightened fear of reoccurrence. This is particularly true with metastatic cancer. So, safe and effective treatments for the symptoms in cancer and the physical and psychological effects of the treatments are needed.


Mindfulness training has been shown to help with general cancer recovery . Yoga is both an exercise and a mindfulness practice that has also been shown to be helpful with the residual symptoms in cancer survivors, the psychological and physical ability to deal with cancer treatment and improves sleep. So, it’s reasonable to further explore the potential benefits of yoga practice to improve sleep and relieve fatigue in patients who have survived cancer.


In today’s Research News article “Influence of Yoga on Cancer-Related Fatigue and on Mediational Relationships Between Changes in Sleep and Cancer-Related Fatigue: A Nationwide, Multicenter Randomized Controlled Trial of Yoga in Cancer Survivors.” (See summary below or view the full text of the study at:, Lin and colleagues recruited patients who had survived a variety of different cancers, and who had completed primary care and who had sleep disturbance, from centers all over the U.S. They were randomly assigned them to receive standard care plus yoga training or standard care alone. Yoga training occurred for 75 minutes, twice a week, for 4 weeks and consisted of breathing exercises, physical alignment postures, and mindfulness exercises. They were measured before and after treatment for cancer related fatigue, including general, physical, emotional, mental, and vigor domains, and sleep, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, sleep medication use, and daytime dysfunction.


They found that in comparison to baseline and the treatment-as-usual group, the participants who received yoga training had significant improvements in all domains of fatigue with moderate effect sizes. The yoga group also had significant improvements in sleep, including increases in overall sleep quality and subjective sleep quality and decreases in daytime dysfunction. Finally, they found, employing path analysis, that yoga training improved fatigue directly and indirectly by improving sleep that in turn improved sleep.


These are potentially important findings. Fatigue and sleep disturbance are difficult residual problems. There is a need to have long-term follow-up of these patients to determine whether yoga practice produces sustained relief of sleep disturbance and fatigue. Nevertheless, the findings show that at least on the short-term, yoga practice can address these symptoms and as a result improve the well-being and quality of life of cancer survivors. In addition, practicing yoga has been shown to produce widespread benefits for the physical and psychological health of practitioners. So, yoga practice would seem to be an excellent additional treatment for patients who have survived cancer.


So, improve sleep and relieve fatigue in cancer survivors with yoga.


“Two randomized controlled trials in breast cancer patients (one in patients undergoing radiation and one in breast cancer survivors) showed yoga practice significantly improved fatigue.” – Carrie Newsom


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


Lin, P. J., Kleckner, I. R., Loh, K. P., Inglis, J. E., Peppone, L. J., Janelsins, M. C., … Mustian, K. M. (2019). Influence of Yoga on Cancer-Related Fatigue and on Mediational Relationships Between Changes in Sleep and Cancer-Related Fatigue: A Nationwide, Multicenter Randomized Controlled Trial of Yoga in Cancer Survivors. Integrative cancer therapies, 18, 1534735419855134. doi:10.1177/1534735419855134



Background: Cancer-related fatigue (CRF) often co-occurs with sleep disturbance and is one of the most pervasive toxicities resulting from cancer and its treatment. We and other investigators have previously reported that yoga therapy can improve sleep quality in cancer patients and survivors. No nationwide multicenter phase III randomized controlled trial (RCT) has investigated whether yoga therapy improves CRF or whether improvements in sleep mediate the effect of yoga on CRF. We examined the effect of a standardized, 4-week, yoga therapy program (Yoga for Cancer Survivors [YOCAS]) on CRF and whether YOCAS-induced changes in sleep mediated changes in CRF among survivors. Study Design and Methods: Four hundred ten cancer survivors were recruited to a nationwide multicenter phase III RCT comparing the effect of YOCAS to standard survivorship care on CRF and examining the mediating effects of changes in sleep, stemming from yoga, on changes in CRF. CRF was assessed by the Multidimensional Fatigue Symptom Inventory. Sleep was assessed via the Pittsburgh Sleep Quality Index. Between- and within-group intervention effects on CRF were assessed by analysis of covariance and 2-tailed t test, respectively. Path analysis was used to evaluate mediation. Results: YOCAS participants demonstrated significantly greater improvements in CRF compared with participants in standard survivorship care at post-intervention (P < .01). Improvements in overall sleep quality and reductions in daytime dysfunction (eg, excessive napping) resulting from yoga significantly mediated the effect of yoga on CRF (22% and 37%, respectively, both P < .01). Conclusions: YOCAS is effective for treating CRF among cancer survivors; 22% to 37% of the improvements in CRF from yoga therapy result from improvements in sleep quality and daytime dysfunction. Oncologists should consider prescribing yoga to cancer survivors for treating CRF and sleep disturbance.



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