Effectiveness of Yoga Interventions in Breast Cancer-Related lymphedema: A systematic review

Ching-Wen Weia,b, Yi-Chen Wuc, Pei-Yi Chend, Pei-En Chene, Ching-Chi Chif,g,∗∗, Tao-Hsin Tungh,i,∗ Complementary Therapies in Clinical Practice 36 (2019) 49–55

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Effectiveness of Yoga Interventions in Breast Cancer-Related lymphedema: A systematic review

Ching-Wen Weia,b, Yi-Chen Wuc, Pei-Yi Chend, Pei-En Chene, Ching-Chi Chif,g,∗∗, Tao-Hsin Tungh,i,∗ Complementary Therapies in Clinical Practice 36 (2019) 49–55

Objectives: To synthesize recent empirical evidence on yoga-based interventions for patients with breast cancer-related lymphedema.

Methods: We searched the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE databases for studies published between October 2007 and September 2018 in any language. Risk of bias and methodological quality were evaluated using the PRISMA statement and checklist and the Cochrane Collaboration tool.

Results: There was significant improvement in lymphedema status, range of shoulder motion and spinal mobility after an 8-week yoga intervention, whereas there was no consistency in quality of life following yoga intervention. Additionally, there was no difference in lymphedema status, extracellular fluid and tissue resistance outcomes in the affected arm following a long-term yoga practice.

Conclusion: The current findings could not be clearly demonstrated that yoga programme intervention as an addition to usual care is superior to along usual care, and keep yoga exercise does not provide significant added benefits.

Main findings

  • Small sample size N=5
  • Three studies were RCTs comparing yoga with routine care [13–15]. The other two studies were quasi-experimental designs measuring outcome variables before and after a yoga intervention in a single group.
  • Sample size ranged from 6 to 23, with a total of 85 participants across all studies. All participants were women aged between 42 and 72 years old.
  • All participants had undergone mastectomy, axillary lymph node removal, and/or chemical and radiation therapy before enrollment. In two studies the eligibility criteria were that participants had completed breast cancer treatment at least 6 months ago and were suffering from lymphedema, in two studies the sample suffered from lymphedema and in one study the sample comprised patients at high risk of lymphedema.
  • The three RCTs used very similar types of yoga intervention class and trial durations.
  • There is no consistency in the results of these five studies. In summary, one pre-post quasi-experimental study and two RCTs concluded that 8-week yoga intervention improved lymphedema, spine mobility, but which were no consistency in QOL. One study showed no change. Others found that there was significant improvement of muscle strength after a 4-week follow up post yoga intervention completed. However, there is no significant outcome following a long-term (6month) yoga practice.
  • This systemic review found that despite there is no consistency in duration, practice times, assessment and outcome measure of yoga intervention, there is significant improvement of lymphedema, disease-related musculoskeletal condition, and quality of life following yoga intervention.
  • Based on the results, medical teams should develop the yoga protocol to prevent or reduce BCRL, and the yoga protocol should include meditation and breathing exercise, yoga exercises, and cooldown exercises as three main components. For better BCRL improvement, the program should contain 60-minute, more than 8-week, once or twice weekly class session and daily home practice with video use remaining 5–6 days with progressive and alternative strategies.