CHAMPAIGN, Ill. - After breast cancer surgery, increased self-consciousness and perceptions of disfigurement prompt some women to shy away from involvement in group fitness and recreational activities during a time when they might benefit the most physically and emotionally.
"(Yoga) really was the perfect exercise for this group of women because of the whole mind-body connection, the stretching and the opening up of the chest," said Kimberly J. Shinew, a professor of recreation, sport and tourism at Illinois.
Photo by L. Brian Stauffer
However, a new study by researchers at the University of Illinois and Indiana University indicates that participating in group yoga sessions can help female breast cancer survivors overcome self-consciousness about their appearance and self-imposed limitations on physical activities after surgery, improving their overall fitness and enhancing their quality of life. The study appeared recently in the International Journal of Yoga Therapy.
Participants, who were recruited from a cancer center's breast cancer database, engaged in group sessions of Hatha yoga for 2.5 hours per week and practiced postures/sequences at home three times a week for a total of 90 minutes. Women in the control group attended a traditional light exercise group for 30 minutes each week during which they engaged mainly in seated exercises focused on improving their core and
At the end of the eight-week study, yoga participants reported substantial psychological benefits - their body images had improved, and they felt freed from the psychological barriers they had constructed that limited their physical activities.
Additionally, their confidence in their attractiveness had been renewed, lowering their concern about dressing to conceal the physical changes produced by the surgery.
Yoga participants also reported numerous physical benefits as well - reduced pain, better muscle tone and sense of balance, greater upper and lower body strength and flexibility, and weight loss. Becoming more physically fit improved other aspects of their lives, the women said. Yoga became a catalyst for engaging in other activities and taking time for themselves.
To be eligible to join the study, women had to be at least nine months post treatment, finished with radiation or chemotherapy and not awaiting further surgery.
Oncologists at the cancer center suggested the nine-month benchmark because by that time subjects would have gotten beyond the acute stress and side effects associated with the cancer diagnosis and treatment and would have settled into any chronic conditions that might occur.
Participants in the study ranged in age from 33 to 84, with the mean age of the women who completed the study at just over 56. Most were Caucasian, married, worked full time and rated their health as good or very good.
Although a number of studies have explored the potential benefits of yoga for breast cancer survivors, including its use as a tool in managing pain and fatigue, this is believed to be the first study to examine yoga's impact on the psychological constraints that discourage survivors from participating in leisure and recreational activities.
Hatha yoga is an Indian practice that uses a combination of postures, breathing and meditation to enhance physical, mental, intellectual and spiritual well-being. The yoga postures/sequences chosen for the group sessions focused on stretching the chest, improving balance, core and overall strength and flexibility, and managing stress, and were modified as necessary for participants' individual needs. A certified yoga teacher led the classes and modeled the postures in photographs, which were assembled into a workbook that participants used to perform the routines at home.
"It really was the perfect exercise for this group of women because of the whole mind-body connection, the stretching and the opening up of the chest," said Kimberly J. Shinew, a professor of recreation, sport and tourism at Illinois. "Given the scar tissue, particularly in the chest area, that's probably why this was such a beneficial activity for them."
Another important benefit: the sense of community formed by the women in the yoga group, which provided social support.
Most of the participants had not participated in yoga before, and some said they never would have joined a support group "where they'd go and discuss their experiences, but because this was activity based, they could focus on the activity and not the illness or themselves," Shinew said. "Something that was certainly confirmed was the whole concept of being with similar others when you exercised. Social comparison theory talks about how we're constantly comparing ourselves to other people. We thought that would be there but we didn't realize how strongly it would come out in the findings."
Although the women who participated in the light exercise group began the study demonstrating better agility on a timed test as measured by how quickly they could rise from a chair unassisted and walk 3 meters, there were no significant differences between their group's and the yoga group's performance on that test or any other fitness measures by the end of the study.
Breast cancer is the second most frequently diagnosed cancer (after skin cancer) and the second leading cause of cancer death (after lung cancer) among American women. More than 207,000 new cases were expected to be diagnosed and more than 39,000 American women were expected to die from the disease during 2010, according to the most recent estimates from the National Cancer Institute. However, improved detection and treatment technologies have raised the five-year mean survival rate to 89 percent.
Pei-Chun Hsieh and Marieke Van Puymbroeck, faculty members in the department of recreation, park and tourism studies at Indiana University at Bloomington, and Arlene Schmid, who holds appointments at Roudebush Veteran Affairs Medical Center, Indianapolis, and in the department of occupational therapy at Indiana University-Purdue University at Indianapolis, were co-authors on the study.