Improve Cancer Survivor Quality of Life with Exercise or Mindfulness

Improve Cancer Survivor Quality of Life with Exercise or Mindfulness


By John M. de Castro, Ph.D.


“One of the main reasons people with cancer use meditation is to help them to feel better. Meditation can reduce anxiety and stress. It might also help control problems such as: pain, difficulty sleeping, tiredness, feeling sick, high blood pressure.” – Cancer Research UK


Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.


But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.


Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress,  sleep disturbance, and anxiety and depression. In today’s Research News article “Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors.” (See summary below or view the full text of the study at: ), Duncan and colleagues summarize the published scientific reviews of randomized controlled trials on the effects of non-drug interventions on the quality of life of adult cancer survivors. The interventions included fell into a number of categories including physical (e.g. aerobic exercise, yoga), psychological education,  peer support, and mind-body therapies (Mindfulness-Based Stress Reduction (MBSR), cognitive behavioral therapy (CBT), psychotherapy, relaxation training).


They discovered 21 published reviews of 362 randomized controlled trials. They found that the literature supported the efficacy of aerobic exercise, yoga, cognitive behavioral therapy (CBT), and Mindfulness-Based Stress Reduction (MBSR) in improving the quality of life in cancer survivors. Hence, published scientific randomized controlled trials of non-drug treatment approaches demonstrate that the quality of life of cancer survivors can be improved with exercise, CBT, and mindfulness practices such as MBSR and yoga.


It was not reported how these practices might improve quality of life in cancer survivors. But, it can be speculated that because cancer treatments are physically demanding and of themselves produce physical debilitation, that exercise is a useful countermeasure to help overcome the physical losses occurring in treatment. It can also be speculated that mindfulness training may be helpful by improving the survivor’s ability to regulate the emotions produced by a cancer diagnosis and its treatment. These include anxiety, depression, fear, catastrophizing etc. By improving the ability to feel these emotions but react to them adaptively and thereby not amplifying them, the survivors may help to improve their emotional well-being and as a result their quality of life.


So, improve cancer survivor quality of life with exercise or mindfulness.


“We already know that psychosocial interventions like mindfulness meditation will help you feel better mentally, but now for the first time we have evidence that they can also influence key aspects of your biology,” – Linda Carlson


CMCS – Center for Mindfulness and Contemplative Studies


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


Study Summary


Duncan, M., Moschopoulou, E., Herrington, E., Deane, J., Roylance, R., Jones, L., … Bhui, K. (2017). Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors. BMJ Open, 7(11), e015860.


Strengths and limitations of this study

  • This is a systematic review of reviews and evidence synthesis of non-pharmacological interventions in cancer survivors.
  • Longer term studies are needed and studies of greater methodological quality that adopt similar reporting standards.
  • Definitions of survivor varied and more studies are needed for different types of cancer, and specifically for patients who have poor quality of life.
  • More studies are needed that investigate educational, online and multidisciplinary team-based interventions.
  • This review has some limitations in the methodology. Studies not in English and grey literature were not included. This was a review of reviews: we did not review individual studies focused on specific cancers or stage, and we did not reassess the quality of the primary studies included in each review.




Over two million people in the UK are living with and beyond cancer. A third report diminished quality of life.


A review of published systematic reviews to identify effective non-pharmacological interventions to improve the quality of life of cancer survivors.

Data sources

Databases searched until May 2017 included PubMed, Cochrane Central, EMBASE, MEDLINE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.

Study selection

Published systematic reviews of randomised trials of non-pharmacological interventions for people living with and beyond cancer were included; included reviews targeted patients aged over 18. All participants had already received a cancer diagnosis. Interventions located in any healthcare setting, home or online were included. Reviews of alternative therapies or those non-English reports were excluded. Two researchers independently assessed titles, abstracts and the full text of papers, and independently extracted the data.


The primary outcome of interest was any measure of global (overall) quality of life.

Analytical methods

Quality assessment assessing methdological quality of systematic reviews (AMSTAR) and narrative synthesis, evaluating effectiveness of non-pharmacological interventions and their components.


Of 14 430 unique titles, 21 were included in the review of reviews. There was little overlap in the primary papers across these reviews. Thirteen reviews covered mixed tumour groups, seven focused on breast cancer and one focused on prostate cancer. Face-to-face interventions were often combined with online, telephone and paper-based reading materials. Interventions included physical, psychological or behavioural, multidimensional rehabilitation and online approaches. Yoga specifically, physical exercise more generally, cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) programmes showed benefit in terms of quality of life.


Exercise-based interventions were effective in the short (less than 3–8 months) and long term. CBT and MBSR also showed benefits, especially in the short term. The evidence for multidisciplinary, online and educational interventions was equivocal.

Improve Depression and Cognitive Decline with Yoga

Improve Depression and Cognitive Decline with Yoga


By John M. de Castro, Ph.D.


“For years, we’ve been told to keep our minds sharp by doing crosswords and playing Sudoku. But yoga and meditation are more effective than memory exercises for combating the mental decline that often precedes Alzheimer’s. People who practised yoga regularly were also less likely to be depressed and anxious, and were better able to cope with stress. Regular practice could be a simple, safe and low-cost solution to improving brain fitness and ward off ageing.” Madlen Davies


The aging process involves a systematic progressive decline in every system in the body, the brain included. This includes our mental abilities which decline with age including impairments in memory, attention, and problem solving ability. It is inevitable and cannot be avoided. But there are more serious declines.


Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Alzheimer’s disease is the most common type of dementia and accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. Mild cognitive impairment (MCI) is an intermediate stage between the expected cognitive decline of normal aging and the more-serious decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.


There is some hope for age related cognitive decline, however, as there is evidence that they can be slowed. There are some indications that physical and mental exercise can reduce the rate of cognitive decline and lower the chances of dementia. For example, contemplative practices such as meditation, yoga, and tai chi or qigong have all been shown to be beneficial in slowing or delaying physical and mental decline with aging. Mindfulness practices have been shown to improve cognitive processes while gentle mindful exercises such as Tai Chi and Qigong have been shown to slow age related cognitive decline.


These age-related declines in mental ability are associated with mood disturbance, particularly depression. So, depression is a potentially modifiable risk factor for cognitive decline in aging. In today’s Research News article “The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline.” See summary below: Mathersul and Rosenbaum review the published research literature on the effectiveness of yoga and exercise to relieve depression and restrain cognitive decline.


They find that the published literature demonstrates that exercise, including aerobic exercise and strength training improve cognitive ability even in younger individuals and also relieves depression. In addition, the published literature demonstrates that yoga practice is also effective in reducing depression and also restraining cognitive decline. The hormonal system particularly the hypothalamic-pituitary adrenal axis that produces cortisol and sympathetic nervous system, involved in the stress response, may be the common intermediaries as both are associated with cognitive decline and depressions and both are reduced by both yoga and exercise. But, this speculation has yet to be definitively tested.


These findings are interesting but are correlational and do not demonstrate causal links between yoga and exercise effects on depression and, in turn, age related cognitive decline. It remains to future research to clarify this issue. Regardless, it is clear that both exercise and yoga are effective to reducing depression and cognitive decline in aging, making them excellent practices for healthy aging.


So, improve depression and cognitive decline with yoga.


“This ancient Indian practice of exercise, breathing, and meditation has been around for about 5,000 years, and now researchers are finding out why millions of Americans practice yoga to ease depression, anxiety, and stress. In fact, the American Yoga Association says just a few minutes of yoga three times every day can balance your body and mind and get your depression on the run.” – Chris Lliades


CMCS – Center for Mindfulness and Contemplative Studies


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


Study Summary

Danielle C. Mathersul and Simon Rosenbaum, “The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline,” Evidence-Based Complementary and Alternative Medicine, vol. 2016, Article ID 4612953, 9 pages, 2016. doi:10.1155/2016/4612953



Currently, there are no effective pharmaceutical treatments to reduce cognitive decline or prevent dementia. At the same time, the global population is aging, and rates of dementia and mild cognitive impairment (MCI) are on the rise. As such, there is an increasing interest in complementary and alternative interventions to treat or reduce the risk of cognitive decline. Depression is one potentially modifiable risk factor for cognitive decline and dementia. Notably, exercise and yoga are two interventions known to both reduce symptoms of depression and improve cognitive function. The current review discusses the efficacy of exercise and yoga to ameliorate depression and thereby reduce the risk of cognitive decline and potentially prevent dementia. Potential mechanisms of change, treatment implications, and future directions are discussed.

Relieve Depression with Meditation and Exercise

Meditation Exercise Brain depression2 Alderman

By John M. de Castro, Ph.D.


“Studies have already suggested that physical activity can play a powerful role in reducing depression; newer, separate research is showing that meditation does, too. Now some exercise scientists and neuroscientists believe there may be a uniquely powerful benefit in combining the two.” – Melissa Dahl


Major Depressive Disorder (MDD) is a severe mood disorder that includes mood dysregulation and cognitive impairment. It is estimated that 16 million adults in the U.S. (6.9% of the population suffered from major depression in the past year and affects females (8.4%) to a great extent than males (5.2%). It is second-leading cause of disability in the world following heart disease. The usual treatment of choice for MDD is drug treatment. In fact, it is estimated that 10% of the U.S. population is taking some form of antidepressant medication. But a substantial proportion of patients (~40%) do not respond to drug treatment. In addition, the drugs can have nasty side effects. So, there is need to explore other treatment options.


It has been shown that aerobic exercise can help to relieve depression. But, depressed individuals lack energy and motivation and it is difficult to get them to exercise regularly. As a result, aerobic exercise has not been used very often as a treatment. Recently, it has become clear that mindfulness practices are effective for the relief of major depressive disorder and as a preventative measure to discourage relapses. Mindfulness can be used as a stand-alone treatment or in combination with drugs. It is even effective when drugs fail to relieve the depression.


As yet there has been no attempt to combine aerobic exercise and mindfulness training for major depressive disorder. It is possible that mindfulness practice may improve depression sufficiently to energize the individual to engage in aerobic exercise. So, the combination may be uniquely beneficial. In today’s Research News article “MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity”

Alderman and colleagues employ a combination of 20 minutes of minutes of sitting meditation followed immediately by 10 minutes of walking meditation with 30 minutes of aerobic exercise either on a treadmill or stationary bicycle. They tested the impact of this combination on a group of adults with major depressive disorder and a group of healthy non-depressed individuals.


They found that the treatment reduced depression in both groups but to a much greater extent with the depressed patients, reducing it by 40%. The treatment also reduced ruminative thinking in both groups. They also found that the combined aerobic exercise and mindfulness training changed the brains response to a cognitive task. After training there was a larger N2 (negative response) observed in the brains evoked electrical activity (ERP) and a larger P3 (positive response) in the ERP in response to the cognitive task.


The P3 response in the evoked potential (ERP) occurs around a quarter of a second following the stimulus presentation. It is a positive change that is maximally measured over the central frontal lobe. The P3 response has been associated with the engagement of attention. So, the P3 response is often used as a measure of brain attentional processing with the larger the positive change the greater the attentional focus. The N2 response in the evoked potential (ERP) generally precedes the P3 response. It is a negative change that is maximally measured over the frontal lobe. The N2 response has been associated with the engagement of attention to a new or novel stimulus. So, the N2 response is often used as a measure of brain attentional processing with the large the negative changes an indication of greater discrimination of new stimuli.


The findings indicate that the combination training improves brain electrical activity indicators of attention and stimulus discrimination during a cognitive task. It was also found that the size of the N2 response was negatively related to the amount of decrease in ruminative thought. Ruminative thought which requires attention to memories of the past and attention to the present cannot occur at the same time. So, by improving attention the training appeared to improve attention to the present and thereby decrease rumination which is a major contributor to the depressed state.


These are interesting and exciting results that suggest that the combination of mindfulness and aerobic exercise training may be a potent and effective treatment for major depressive disorder. This is particularly important as aerobic exercise and mindfulness training both have many other physical and psychological benefits and have minimal side effects. They may, in part, be effective by improving attention and thereby decreasing rumination in depressed patients. Given the design of the present study it is not possible to determine if the combination is more effective the either component alone or the sum of their independent effectiveness. Future research should address this issue.


So, relieve depression with meditation and exercise.


“We know these therapies can be practiced over a lifetime and that they will be effective in improving mental and cognitive health. The good news is that this intervention can be practiced by anyone at any time and at no cost.” – Brandon Alderman


CMCS – Center for Mindfulness and Contemplative Studies



Study Summary


B L Alderman, R L Olson, C J Brush and T J Shors. MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity. Translational Psychiatry (2016) 6, e726; doi:10.1038/tp.2015.225. Published online 2 February 2016



Mental and physical (MAP) training is a novel clinical intervention that combines mental training through meditation and physical training through aerobic exercise. The intervention was translated from neuroscientific studies indicating that MAP training increases neurogenesis in the adult brain. Each session consisted of 30 min of focused-attention (FA) meditation and 30 min of moderate-intensity aerobic exercise. Fifty-two participants completed the 8-week intervention, which consisted of two sessions per week. Following the intervention, individuals with major depressive disorder (MDD; n=22) reported significantly less depressive symptoms and ruminative thoughts. Typical healthy individuals (n=30) also reported less depressive symptoms at follow-up. Behavioral and event-related potential indices of cognitive control were collected at baseline and follow-up during a modified flanker task. Following MAP training, N2 and P3 component amplitudes increased relative to baseline, especially among individuals with MDD. These data indicate enhanced neural responses during the detection and resolution of conflicting stimuli. Although previous research has supported the individual beneficial effects of aerobic exercise and meditation for depression, these findings indicate that a combination of the two may be particularly effective in increasing cognitive control processes and decreasing ruminative thought patterns.