The effects of yoga and self-esteem on menopausal symptoms and quality of life in breast cancer survivors—A secondary analysis of a randomized controlled trial

Anna K. Kocha, Sybille Rabsilberd, Romy Laucheb, Sherko Kümmele, Gustav Dobosb, Jost Langhorsta, Holger Cramerb, Maturitas 105 (2017) 95–99

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The effects of yoga and self-esteem on menopausal symptoms and quality of life in breast cancer survivors—A secondary analysis of a randomized controlled trial

Anna K. Kocha, Sybille Rabsilberd, Romy Laucheb, Sherko Kümmele, Gustav Dobosb, Jost Langhorsta, Holger Cramerb,  Maturitas 105 (2017) 95–99

Objectives: Previous research has found that yoga can enhance quality of life and ease menopausal symptoms of breast cancer survivors. The study examined whether self-esteem mediated the effects of yoga on quality of life, fatigue and menopausal symptoms, utilizing validated outcome measures.

Study design: This is a secondary analysis of a randomized controlled trial comparing the effects of yoga with those of usual care in 40 breast cancer survivors who suffered from menopausal symptoms. All participants completed all 3 assessments (week 0, week 12, and week 24) and provided full data.

Main outcome measures: Outcomes were measured using self-rating instruments. Mediation analyses were performed using SPSS. Results: Self-esteem mediated the effect of yoga on total menopausal symptoms (B = −2.11, 95% BCI [−5.40to −0.37]), psychological menopausal symptoms (B= −0.94, 95% BCI [−2.30 to −0.01]), and urogenital menopausal symptoms (B = −0.66, 95% BCI [−1.65 to −0.15]), quality of life (B= 8.04, 95% BCI [3.15–17.03]), social well-being (B= 1.80, 95% BCI [0.54–4.21]), emotional well-being (B= 1.62, 95% BCI [0.70–3.34]), functional well-being (B= 1.84, 95% BCI [0.59–4.13]), and fatigue (B = 4.34, 95% BCI [1.28–9.55]). Self-esteem had no effect on somato vegetative menopausal symptoms (B= −0.50, 95% BCI n.s.) or on physical well-being (B= 0.79, 95% BCI n.s.).

Conclusions: Findings support the assumption that self-esteem plays a vital role in the beneficial effect of yoga and that yoga can have long-term benefits for women diagnosed with breast cancer and undergoing menopausal transition.

Main findings

  • The yoga group received weekly traditional Hatha yoga sessions that included meditation. Those yoga sessions were 90 min long and based on the teachings of Sivananda Saraswati. Yoga took place over a period of 3 months. The meditation was derived from the Karma Kagyu school of Tibetan Buddhism according to Lama Ole Nydah.
  • Practices were adapted to the womeńs needs.
  • Measures included: self esteem, menopausal symptoms, breast cancer quality of life and fatigue.
  • The direct effects of yoga on the different outcomes were not significant.
  • This analysis indicates that self-esteem plays a vital role in theeffects of yoga on menopause-related outcomes. The effect of yoga on total menopausal symptoms, psychological menopausal symptoms, and urogenital menopausal symptoms, quality of life, social wellbeing, emotional well-being, functional well-being, and fatigue was mediated by self-esteem. No mediation was found for physical wellbeing or somatovegetative menopausal symptoms.
  • it might be that yoga positively influences cortisol levels, which in turn increase well-being and quality of life, or that yoga inhibits the production of proinflammatory cytokines interleukin-6, which in turn leads to decreased fatigue [36]. Those biological processes were not within the scope of the present study.
  • There was no long-term follow-up beyond 24 weeks and a selection bias is possible. The small sample size is another limitation.