The Effect of Yoga on Arm Volume, Strength, and Range of Motion in Women at Risk for Breast Cancer-Related Lymphedema

Melissa Mazor, Jeannette Q. Lee, Anne Peled, Sarah Zerzan, Chetan Irwin, Margaret A. Chesney, Katherine Serrurier, Hani Sbitany, Anand Dhruva, Devorah Sacks, and Betty Smoot. The Journal Of Alternative And Complementary Medicine Volume 00, Number 00, 2017, pp. 1–7

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The Effect of Yoga on Arm Volume, Strength, and Range of Motion in Women at Risk for Breast Cancer-Related Lymphedema

Melissa Mazor, Jeannette Q. Lee, Anne Peled, Sarah Zerzan, Chetan Irwin, Margaret A. Chesney, Katherine Serrurier, Hani Sbitany, Anand Dhruva,  Devorah Sacks,  and Betty Smoot. The Journal Of Alternative And Complementary Medicine Volume 00, Number 00, 2017, pp. 1–7

Objectives: To assess the feasibility, safety, and initial estimates of efficacy of a yoga program in postoperative care for women at high risk for breast cancer-related lymphedema (BCRL). Design: Single-group pretest–post-test design.

Settings/Location: Patients were recruited from the University of California, San Francisco Carol Franc Buck Breast Care Center.

Subjects: Twenty-one women were enrolled in the study. Women were >18 years of age, had undergone surgical treatment for breast cancer, and were at high risk for BCRL.

Intervention: The women participated in an Ashtanga yoga intervention for 8 weeks. Sessions consisted of once/week instructor-led practice and once/week home practice. Particular attention was given to poses that emphasized upper body strength and flexibility, while avoiding significant time with the upper extremity (UE) in a dependent position.

Outcome measures: UE volume was assessed through circumferential forearm measurement, which was converted to volume using the formula for a truncated cone. Range of motion (ROM) was assessed for the shoulders, elbows, and wrists, using a standard goniometer. UE strength was assessed for shoulder abduction, elbow flexion, wrist flexion, and grip using a dynamometer.

Results: Twenty women completed the yoga intervention, with 17 returning for final assessment. Mean age was 52 (–9.1) years and body mass index was 24.8 (–5.1) kg/m2. Post intervention, mean volume in the at-risk UE was slightly reduced (p=0.397). ROM for shoulder flexion (p<0.01) and external rotation (p<0.05) significantly increased bilaterally. Shoulder abduction ROM significantly improved for the unaffected limb (p=0.001). Following intervention, strength improved on the affected side for shoulder abduction and grip strength, and bilaterally for elbow flexion (p<0.05 for all).

Conclusions: These preliminary findings suggest that yoga is feasible and safe for women who are at risk for BCRL and may result in small improvements in shoulder ROM and UE strength

Main findings

  • Patients with breast cancer who have participated in yoga programs demonstrate high levels of adherence to and enthusiasm for the classes, as well as continued independent yoga practice at the completion of formal sessions.
  • There are limited studies that evaluate the impact of yoga on BCRL.
  • No studies have specifically investigated the safety and benefit of yoga interventions for women who do not have but are at high risk for BCRL. Therefore, the aims of this study were to assess the feasibility of incorporating a yoga program into postoperative care for breast cancer patients at high risk for BCRL and to collect pilot data on the safety and efficacy of the yoga program in these women.
  • Measurements included: volume via tape measure, strength and range of movement.
  • The women participated in a twice-weekly 60-min Ashtanga-based yoga practice for 8 weeks. The yoga sessions consisted of a once per week instructor-led practice and a once per week home session with an illustrated instruction manual. The in-person yoga sessions were led by one of two yoga instructors with specific training in working with patients with cancer
  • Sample size small N=17.
  • No treatment adverse effects.
  • There were statistically significant increases in bilateral shoulder flexion and unaffected-side shoulder abduction ROM.
  • Increases in UE strength following the intervention were also small. Importantly, limb volume did not increase in the at-risk UE. While there was a small decrease in affected limb volume, this small average reduction did not reach statistical significance.
  • The low attrition rate (i.e., <5%; 1 out of 21 women) found in this study suggests that yoga may offer an alternative exercise regimen, which promotes patient adherence and provides physiologic and mental health benefits.