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Integrative Therapies in Cancer Rehabilitation

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Nicole Radich

on 7 November 2013

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Transcript of Integrative Therapies in Cancer Rehabilitation

Integrative Therapies
in Cancer Rehabilitation

Types of Mind-Body medicines

Mind-body medicine uses a variety of techniques to maximize the power of thoughts and emotions to influence physical health
Meditation
Biofeedback
Prayer
Hypnosis
Yoga
Imagery
Creative outlets


Meditation
Meditation is a mind-body process that uses concentration to relax the body and calm the mind
Most meditative techniques started in Eastern religious or spiritual traditions.
Today, many people use meditation outside of its traditional religious or cultural settings, for health and well-being.

Biofeedback
Use of electronic device to help people learn to control one's body functions that are usually unconscious
Breathing
Heart rate
Muscle Tension

Prayer
Hypnosis
Yoga
Guided Imagery
NIH National Center for Complementary and Alternative Medicine states that meditation can reduce:
Chronic pain
Anxiety
High blood pressure
Cholesterol
Substance abuse
Post-traumatic stress disorder
Blood cortisol levels that are increased by stress
Benefits of Meditation
Method of Meditating

There are many different styles of meditation but usually have the same underlying ideas
Choose a quiet place away from distractions
Sit or rest quietly with eyes closed
Focus to separate oneself mentally from the world


Meditation reduced stress and mood disturbance in patients with cancer
Evidence is lacking from large, methodologically sound studies


Why Meditate?
Creative Outlets
Arias, A., Steinberg, K., Banga, A., & Trestman, R. Systematic review of the efficacy of meditation techniques as treatments for medical illness.Journal Of Alternative & Complementary Medicine, 12.8 (2006): 817-832.
Faller, Hermann , Michael Schuler, Matthias Richard, Ulrike Heckl, Joachim Weis, and Roland Küffner. "Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: Systematic Review and Meta-Analysis." Journal of clinical oncology 31.6 (2013): 782-793. 
Interventions had a significant effect on emotional distress and quality of life
Longer interventions produced more sustained effects
Low quality of reporting was present in many trials
Types of Biofeedback
Electromyograph
Uses surface electrodes to detect muscle action potentials
Thermal biofeedback
Detects skin temperature
Photoplethysmograph
Measures relative blood flow through digits
Electoencephalograph
Measures electrical activation of the brain
Electrocardiograph
Measures electrical activity of the heart

Biofeedback and Relaxation Training
Burish, T. G., & Jenkins, R. A. Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy. Health Psychology, 11.1 (1992): 17-23.
Tsai, P., Chen, P., Lai, Y., Lee, M., & Lin, C. (2007). Effects of electromyography biofeedback-assisted relaxation on pain in patients with advanced cancer in a palliative care unit. Cancer Nursing,30(5), 347-353
The positive in the results for biofeedback were most likely due to the relaxation training the accompanied the biofeedback
Biofeedback provided with relaxation training is effective in reducing cancer-related pain
Prayer is a form of communication that can be spoken or unspoken
Belief is based on spiritual rather than biological
Prayer falls into
3 main categories

Address to God
A spoken or unspoken address to God, a deity, or a saint
Addressing of God
The act or practice of making spoken or unspoken addresses to God, a deity, or a saint
Something wished fo
r
Something that is wanted or hoped for very much
Believed to decrease negative effects and speed up recovery from disease

Health conditions
Heart disease
Hypertension
Stroke
Colitis
Cancer

Health Claim of Prayer
Currently no scientific evidence exists to prove that prayer can heal cancer or any other disease
Prayer is recommended for cancer patients to improve psychological health
Provide a coping mechanism
Develop a source of happiness

Cancer Related Uses of Prayer
Patients with greater religious expression presented
Lover levels of negative emotions
Higher levels of health self-efficacy and functional well-being
May be due to coping mechanism
Putting trust in God
Believing in an after life



Prayer and Psychosocial Health
Shaw, B., Han, J., Kim, E., Gustafson, D., Hawkins, R., Cleary, J., & ... Lumpkins, C. (2007). Effects of prayer and religious expression within computer support groups on women with breast cancer. Psycho-Oncology, 16(7), 676-687

Intercessory prayer is the act of praying on behalf of others

The experimental group receiving intercessory prayer showed significant improvement in  spiritual, emotional, and functional well-being 

Intercessory Prayer
Olver, I., & Dutney, A. (2012). A randomized, blinded study of the impact of intercessory prayer on spiritual well-being in patients with cancer. Alternative Therapies In Health And Medicine, 18(5), 18-27.
People who are hypnotized can not be made to do something that they do not wish to do
A hypnotist can help patient gain better control of behavior, emotions, and some physical attributes
Hypnotherapy can be used to create certain outcomes
Pain control
More peaceful emotions
Less stress, fear, or anxiety

Hypnosis Control
Hypnosis is "a special psychological state with certain physiological attributes, resembling sleep only superficially and marked by a functioning of the individual at a level of awareness other than the ordinary conscious state”
Creates state of deep relaxation, quiets conscious mind, and opens unconscious mind to suggestions
Cost savings of almost $800 per patient
Pre-surgery had decrease of 22% of analgesia and 34% sedation
Post surgery had 53% less pain, 74% less nausea, 46% less fatigue, 47% less discomfort, and 74% less emotional upset

Hypnosis and Surgery
Hypnosis Effect with Chemotherapy

Statistically significant reductions was found in anticipatory and chemotherapy-induced nausea and vomiting

Hypnosis before breast cancer surgery eases pain, cuts costs. (2007). Harvard Women's Health Watch, 15(3), 6
Richardson, J., Smith, J., McCall, G., Richardson, A., Pilkington, K., & Kirsch, I. (2007). Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. European Journal Of Cancer Care, 16(5), 402-412.
Guided Imagery is a mental exercise to influence the condition of a person
Commonly used to create an image in the mind to bring about desired physical response
Can also utilize sounds, smells, tastes, or other sensations to bring about desired effect

May be able to:
Help people overcome phobias
Decrease depression
Reduce stress
Increase motivation
Promote relaxation
Increase control over one’s life
Improve communication
Remove unwanted behaviors

Possible Problems Treated with Guided Imagery
Supports of Guided Imagery claim :
Decrease nausea and vomiting from chemotherapy
Relieve stress associated with having cancer
Enhance the immune system
Help with weight gain
Combat depression
Decrease pain
:
Benefits of Guided Imagery with Cancer
Natural killer (NK) cell cytotoxicity and IL-2—activated NK cell activity were measured prior to surgery and 4 weeks post surgery
T-tests showed increased NK cell cytotoxicity and IL-2 for the intervention group compared to control group
Immune Response with Guided Imagery
Evidence of Guided Imagery
Lengacher, C., Bennett, M., Gonzalez, L., Gilvary, D., Cox, C., Cantor, A., et al. (2008). Immune Responses to Guided Imagery. Biological Research for Nursing,9(3), 205-214.
Roffe, L., Schmidt, K., & Ernst, E. (2005). A systematic review of guided imagery as an adjuvant cancer therapy. Psycho-Oncology,14(8), 607-617.
Serra, D., Robertson-Paris, C., Chadha, M., Carper, E., Fleishman, S., & Harrison, L. (2009). Outcomes of Guided Imagery (GI) in Patients Receiving Radiation Therapy for Breast Cancer. CANCER RESEARCH, 69(24).
Significant differences noted in anxiety, comfort and emotional response to chemotherapy
No evidence for change in physical symptoms (nausea and vomiting)

Measurements taken before and after GI intervention
Significant improvement noted in
Decreased respiratory rate
Drop in pulse rate
Drop in systolic and diastolic blood pressure
Increase in skin temperature
Due to increased in peripheral capillary flow secondary to a decrease in the sympathetic response

The ability to express oneself through abstract ideas and actions to bring upon an improved psychological state
Writing
Art
Dance
Music

Art Therapy
Use of create activities to express emotions
Examples are drawing, painting, and sculpting
Believed to help people
Express hidden emotions
Reduce stress, fear, and anxiety
Provide a sense of freedom
Has not been extensively studied

Significant improvement was noted in
P<0.001
Increase in calm, relaxed, and pleasant feeling
Decrease in anxiety
P<0.05
Increase in security, rest, comfort, self conscious, content, and joyful
Decrease in tension, upset, misfortunes, nervousness, jittery, and high strung
Satisfaction with treatment was high and 92% would go through art therapy again

Art Therapy Outcomes with Cancer
Dance therapy is movement of the body to alter the mental and physical condition of a person
Physically
Improve mobility, muscle coordination, and reduce muscle tension
Mentally
Improve self awareness, self-confidence and interpersonal interaction while reducing stress
Few scientific studies have been carried out to study effect

Dance Therapy
Large beneficial effect on quality of life and fatigue
No effect of dance/movement therapy on body image
Studies are at a high risk for bias
Effect of Dance Therapy and Cancer
Nainis, N., Paice, J., Ratner, J., Wirth, J., Lai, J., & Shott, S. (2006). Relieving Symptoms in Cancer: Innovative Use of Art Therapy. Journal of Pain and Symptom Management, 31(2), 162-169.
Bradt, J., Goodill, S., & Dileo, C. (2011). Dance/Movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, 10.
(Côté, A., & Daneault, S., 2012)
Improvement in Sleep and Psychological condition
Effect of yoga on patients with cancer: our current understanding. 
Yoga improved many symptoms significantly
Higher quality of sleep, decrease in symptoms of anxiety and depression, improvement in spiritual well-being
The benefits, lack of side effects, and the cost-benefit ratio make yoga a good option for an alterative medicine
Studies analyzed may be subject to bias

(Bower J, Garet D, and Sternlieb B., 2011).
"Yoga for persistent fatigue in breast cancer survivors: results of a pilot study.”
11 participants completed the 12-week Iyengar yoga program
Significant improvement was noted in fatigue scores pre- and post-intervention
Maintained 3-months post-intervention
Study also showed significant improvement in physical function, depressed mood, and quality of life

Yoga’s Effect on Fatigue
(Desai K , Galantino M, Li S, Boyle M, Hurtubise B, and Mao J., 2012)
Willingness to Participate in Yoga
"Factors associated with willingness to participate in a yoga clinical trial among breast cancer survivors."
Higher likelihood of WTP
Young age (under 55 and 55-65)
Higher education (college education or higher)
Previous use of yoga
Barriers to WTP
Responsibilities at home
Didn’t want to be experimented on

Various styles of yoga typically combine physical postures, breathing techniques, and meditation
Utilizes ethical standards, dietary guidelines, physical movements, and meditation to create a union of mind, body, and spirit
Basics of Yoga
Yoga is a mind and body practice
Originates in ancient Indian philosophy
A conscious mental process using certain techniques to suspend the stream of thoughts and relax the body and mind

Smith, K., & Pukall, C. (2009)
An evidence-based review of yoga as a complementary intervention for patients with cancer. 
Current evidence prevent the application of yoga as a treatment in a wide range of patients
Studies are promising and should be further researched to be able to apply to patients

Limited Amount of Studies on Yoga
Significant change with
Reduction of distress, anxiety, and depression (large change)
Reduction of fatigue (moderate change)
Increase in general quality of life, emotional function and social function (moderate change)
Increase in functional well-being (small change) 
Psychological Benefits of Yoga with Breast Cancer -Systematic Reviews
(Boehm, K., Ostermann, T., Milazzo, S., & Bussing, A., 2012)
Effects of yoga interventions on fatigue: a meta-analysis.
19 studies were analyzed in the review
Effects of yoga on cancer patients with fatigue was small
Authors do not recommend to treat fatigue in cancer patients with yoga

Meta-Analysis on Fatigue
(Chandwani K. D., Thornton B., Perkins G. H., Arun B., Raghuram N. V., Nagendra H. R., Wei Q., & Cohen L., 2010)
Yoga Improves Quality of Life and Benefit Finding in Women Undergoing Radiotherapy for Breast Cancer.
Yoga classes were taught bi-weekly during the 6 weeks of radiotherapy
Before radiotherapy and then again 1 week, 1 month, and 3 months after the end of radiotherapy
Yoga group reported significantly better
General health perception ( p = .005) and physical functioning scores ( p = .04) 1 week postradiotherapy;
Higher levels of intrusive thoughts 1 month postradiotherapy ( p = .01)
greater benefit finding 3 months postradiotherapy ( p = .01).

Yoga’s effect with Radiotherapy
(Slocum-Gori S, Howard A, Balneaves L, & Kazanjian A., 2013)
Investigating the Perceived Feasibility of Integrative Medicine in a Conventional Oncology Setting: Yoga Therapy as a Treatment for Breast Cancer Survivors. 
Both health care providers and breast cancer survivors are supportive of implementation
Six emerging themes:
Availability of resources and accessibility of yoga therapy- who will pay?
Credibility and transparency of yoga therapy- need to produce strong evidence
Understanding of yoga therapy- perception could be a barrier
Educational component- health care provides need to be thoroughly educated on benefits and contraindications
Therapeutic context- need good space to conduct yoga sessions
Integration of yoga therapy- how to proceed?

Ability to Implement Yoga
Hatha
Slow paced and gentle
Iyengar yoga
Most concerned with bodily alignment
Ashtanga
Fast-paced, intense style
Kudalini
Emphasis on breathing with physical movement
Viniyoga
Individualizing the program to each person

Types of Yoga
(Banasik, J., Williams, H., Haberman, M., Blank, S. E., & Bendel, R., 2011).
Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. 
Women were randomly assigned to the
Experimental group of practicing yoga for 90 min two times a week for 8 weeks
Control group with wait-listed individuals
The yoga group had
Lower morning and 5 p.m. salivary cortisol
Improved emotional well-being and fatigue scores

Yoga’s Effect on Diurnal Salivary Cortisol
(Culos-Reed, S., Mackenzie, M., Sohl, S., Jesse, M., Zahavich, A., & Danhauer, S., 2012).
Yoga and Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors. 
Thirteen studies from 2004-2011 met the necessary criteria to assess clinical significance
The study found that yoga displayed a positive clinical significance on
Quality of life
Psychosocial
Physical symptom indices (to a lesser degree)

Review of Yoga Outcomes
(Ulger, O., & Yagli, N., 2010)
Effects of yoga on the quality of life in cancer patients. 
Women currently undergoing breast cancer treatment completed 8 sessions of a yoga program
A significant improvement from the pre and post test was found in
Quality of life
STAI-I (reactions of anxiety)
STAI-II (permanence of anxiety)
Satisfaction
Improvement in Quality of Life
Meta-Analysis on Psychological Effects
Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis.
10 articles were analyzed
PEDro Scale scores were between 4 and 7
Significant improvement was found in psychological health
Anxiety
Depression
Distress
Stress

References
Duncan, M.D., A. Leis, and J.W. Taylor-Brown. "Impact and outcomes of an Iyengar yoga program in a cancer centre." Current Oncology 15(2008): 72-78.
Ten 90 minute weekly Iyengar yoga classes
significant improvements in their self-identified worst symptom, QOL, spiritual well-being, and mood disturbances
Moadel, Alyson, Chirag Shah, Judith Wylie-Rosett, and Melanie Harris. "Randomized control trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life." Journal of Clinical Oncology. 26(2007): 1-9.
12 Weeks of 1.5 hour weekly classes of yoga
Favorable outcomes were seen in the treatment group in emotional well-being, social well-being, spiritual well-being, and distressed mood
Yoga and Breast Cancer

Rao, Raghavendra, Nagarathna Raghuram, H.R. Nagendra, and K.S. Gopinath. "Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: A randomized control trial." Complementary Therapies in Medicine. 17(2009): 1-8.
24 Weeks of of asanas (postures), breathing exercises, pranayama (voluntarily regulated nostril breathing), meditation, and yogic relaxation techniques
Decrease in self-reported anxiety state and trait anxiety.
Rao, Raghavendra, Nagarathna Raghuram H.R. Nagendra, and K.S. Gopinath. "Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients." European Journal of Cancer Care. 16(2007): 462-474.
Yoga program that contained asanas, pranayama, mediataion, and yogic relaxation.
done 30 minutes before their chemotherapy sessions. Subjects were also asked to practice these techniques for 1 day, 6 days per week.
Significant decrease in the frequency and intensity for post-chemotherapy induced nausea and vomiting. A positive correlation was seen between Morrow Assessment of Nausea and Emesis scores and anxiety, depression, and distressful symptoms
Rao, Raghavendra, Shirley Telles, Hongasandra Nagendra, and Raghuram Nagarathna. "Effects of yoga on natural killer cell counts in early breast cancer patients.“
The yoga program consisted of 6 postures, regulated breathing, relaxation while supine, and imagery. Participants attended 1 hour yoga sessions 3 times a week. Along with patient educatoin
Significant decreases were not seen in the yoga group. The NK cell percentage was higher in the yoga group post-chemotherapy as well



Yoga and Breast Cancer

Cramer, H., Lange, S., Klose, P., Paul, A., & Dobos, G. (2012). Yoga for breast cancer patients and survivors: a systematic review and meta-analysis. BMC Cancer, 12(1), 412-424.
Culos-Reed, S., Mackenzie, M., Sohl, S., Jesse, M., Zahavich, A., & Danhauer, S. (2012). Yoga and Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors. Evidence-based Complementary and Alternative Medicine,2012, 1-17
Desai K , Galantino M, Li S, Boyle M, Hurtubise B, and Mao J. (2012).   "Factors associated with willingness to participate in a yoga clinical trial among breast cancer survivors." BMC Complementary and Alternative Medicine 12(1) 281.
Lin, K., Hu, Y., Lin, H., & Tsauo, J. (2011). Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. Evidence Based Complementary Alternative Medicine, 2011.
Slocum-Gori S, Howard A, Balneaves L, & Kazanjian A. (2013). Investigating the Perceived Feasibility of Integrative Medicine in a Conventional Oncology Setting: Yoga Therapy as a Treatment for Breast Cancer Survivors. Integrative Cancer Therapies , 12(2), 103-112
Smith, K., & Pukall, C. (2009). An evidence-based review of yoga as a complementary intervention for patients with cancer. Psycho-Oncology, 18(5), 465-475
Ulger, O., & Yagli, N. (2010). Effects of yoga on the quality of life in cancer patients. Complementary Therapies in Clinical Practice, 16(2), 60-63.
Banasik, J., Williams, H., Haberman, M., Blank, S. E., & Bendel, R. (2011). Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Journal Of The American Academy Of Nurse Practitioners, 23(3), 135-142
Boehm, K., Ostermann, T., Milazzo, S., & Bussing, A. (2012). Effects of yoga interventions on fatigue: a meta-analysis.Evidence Based Complementary Alternative Medicine, 2012.
Buffart, L. M., van Uffelen, J. Z., Riphagen, I. I., Brug, J., van Mechelen, W., Brown, W. J., & Chinapaw, M. M. (2012). Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer, 12(1), 1-21.
Chandwani K. D., Thornton B., Perkins G. H., Arun B., Raghuram N. V., Nagendra H. R., Wei Q., & Cohen L. (2010). Yoga Improves Quality of Life and Benefit Finding in Women Undergoing Radiotherapy for Breast Cancer. Journal Of The Society For Integrative Oncology, 8(2), 43-55.
Bower J, Garet D, and Sternlieb B. (2011). "Yoga for persistent fatigue in breast cancer survivors: results of a pilot study."Evidence-based Complementary and Alternative Medicine.
Côté, A., & Daneault, S. (2012). Effect of yoga on patients with cancer: our current understanding. Canadian Family Physician Médecin De Famille Canadien, 58(9), e475-e479
Danhauer, Suzanne C., Shannon L. Mihalko, Gregory B. Russell, and Cassie R. Campbell. "Restorative yoga for women with breast cancer: findings from a randomized pilot study." Psycho-Oncology. (2009)
The intervention group included 24 participants that received 10 weekly 75 minute RY classes. The classes included postures, breathing, and deep relaxation.
Improvements were seen in mental health, depression, fatigue, positive affect, and spirituality in the yoga group.
Carson, James W., Kimberly M. Carson, Laura S. Porter, and Francis J. Keefe. "Yoga awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial." Support Care Cancer. (2009)
an 8 weekly 120 minute yoga classes that consisted of yoga poses, meditation, and breathing exercises.
Significantly greater improvements were seen in hot flash frequency and severity, in levels of joint pain, fatigue, sleep disturbances, symptom related bother, and vigor
Danhauer, Suzanne C., Janet A. Tooze, Deborah F. Farmer, and Cassie R. Campbell. "Restorative yoga for women with ovarian or breast cancer: findings from a pilot study." Journal of Society for Integrative Oncology. 6(2008): 47-58.
10 weekly 75 minute RY classes that included physical postures, breathing, and relaxation
Significant improvements were seen in depression, negative affect, anxiety, mental health, and overall quality of life.

Yoga References
Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials  (Buffart, L. M., van Uffelen, J. Z., Riphagen, I. I., Brug, J., van Mechelen, W., Brown, W. J., & Chinapaw, M. M., 2012).
Yoga for breast cancer patients and survivors: a systematic review and meta-analysis (Cramer, H., Lange, S., Klose, P., Paul, A., & Dobos, G., 2012).
Short term significant improvement in anxiety, depression, perceived stress, and psychological distress
Change in quality of life could not be differentiate from bias

(Lin, K., Hu, Y., Lin, H., & Tsauo, J., 2011).
Mind-Body Medicines
Alternative Medicine . (n.d.). Mayo Clinic . Retrieved April 1, 2013, from www.mayoclinic.com/health/alternative-medicine/PN00001/NSECTIONGROUP=2
American Art Therapy Association. (n.d.). American Art Therapy Association. Retrieved April 25, 2013, from http://www.arttherapy.org
Art Therapy. (n.d.). American Cancer Society | Information and Resources for Cancer: Breast, Colon, Lung, Prostate, Skin. Retrieved April 25, 2013, from http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/art-therapy
Biofeedback. (n.d.). University of Maryland Medical Center | Home. Retrieved May 2, 2013, from http://www.umm.edu/altmed/articles/biofeedback-000349.htm
Dance Therapy. (n.d.). American Cancer Society | Information and Resources for Cancer: Breast, Colon, Lung, Prostate, Skin. Retrieved April 26, 2013, from http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/dance-therapy
Home Page . (n.d.). NCCAM. Retrieved March 11, 2013, from http://nccam.nih.gov/
Hypnosis. (n.d.). American Cancer Society | Information and Resources for Cancer: Breast, Colon, Lung, Prostate, Skin. Retrieved April 25, 2013, from http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/hypnosis
Imagery. (n.d.). American Cancer Society | Information and Resources for Cancer: Breast, Colon, Lung, Prostate, Skin. Retrieved April 24, 2013, from http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/imagery
Meditation. (n.d.). American Cancer Society | Information and Resources for Cancer: Breast, Colon, Lung, Prostate, Skin. Retrieved April 24, 2013, from http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/meditation
Yoga Style Guide. (n.d.). Complete Introduction to Yoga Basics: How to Get Started, Yoga Pose Photos, Popular Styles, Workouts, News, Reviews. Retrieved April 26, 2013, from http://yoga.about.com/od/typesofyoga/a/yogatypes.htm
All Images Taken from Bing Images
References

Mary Lou Galantino, PT, PhD, MSCE
Richard Stockton College of NJ
University of Pennsylvania

Wellness Coaching
Galantino ML, Schmid P, Teixeira J, Botis S, Dagan C, Leonard SM, Milos AAa
Purpose of the study
To determine the feasibility and benefits of wellness coaching in improving health, fitness, well-being, and overall quality of life; both the immediate 3 month changes, and one year sustainability for cancer survivors
Hospital Anxiety and Depression Scale – change in depression subscale (p=.039)
Exercise Stage Assessment (p=.005)
Total QOL – Cancer Survivor – (p=.009)
Significant Results
Wellness coaching is a promising intervention for cancer survivors.
Results for heterogeneous cancer population:
Significant reduction in depression scores, improvement in QOL, and exercise readiness
Positive trends were noted in all variables
Longitudinal data indicated sustainability of positive changes for the WC intervention
Conclusion
Initial session:
90 minutes
A wellness vision
Three month behavioral plan with first week’s SMART goals
Five follow up sessions:
30-40 minutes
Completed over three months
Review of goals, what went well, challenges, strategies, refocus to vision/3 month goals, coaching tools as needed
The following frequency of responses were identified:
Primary benefits of coaching to live a healthier lifestyle:
Goal setting, awareness of food choices, & exercise
Health, fitness, and well-being improvements in last 3 months:
Exercise and increasing healthy food choices
Small changes made and confident in maintaining:
Exercise & eating healthier
Most helpful in working with coach:
Motivation & feedback
All participants recommend program to other survivors
Cancer Survivors: Open-Ended Results of wellness coaching
“Moving, getting up and being active. I have moved away from a sedentary lifestyle that I was feeling trapped in after my cancer. I make healthier choices in my eating. I quit smoking. I feel like I established a new pattern of health behavior.”

“Just having someone to talk to that understands what I’m going through. Having someone to lean on and give me advice on what to do if I’m in trouble.”
Personal Responses
What is a “Wellness Coach”?
The National Consortium for Credentialing of Health & Wellness Coaches defines provides a definition of the job description of a Wellness Coach :
“Health and Wellness Coaches are professionals from diverse backgrounds and education who work with individuals and groups in a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness. Successful coaching takes place when coaches apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change.” (National Consortium for Credentialing of Health & Wellness Coaches, 2013)
Coaching Sessions
Longitudinal Benefits of Wellness Coaching Intervention for Cancer Survivors
Impact of yoga on objective functional outcomes, pain, and health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA)
Impact of Yoga on Breast Cancer Survivors with AIAAs
(Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ, 2012)
Impact of Yoga on Functional Outcomes in Breast Cancer Survivors With Aromatase Inhibitor–Associated Arthralgias
Postmenopausal women with stage I to III breast cancer who reported AIAA were enrolled in a single-arm pilot trial that consisted of a yoga program held twice a week for 8 weeks.
The Functional Reach (FR) and Sit and Reach (SR) were evaluated as primary outcomes.
Pain, as measured by the Brief Pain Inventory (BPI), self-reported Patient Specific Functional Scale (PSFS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) were secondary outcomes.
Results:
Participants experienced significant improvement in balance, as measured by FR, and flexibility, as measured by SR.
The PSFS improved from 4.55 to 7.21, and HR-QOL measured by FACT-B also improved; both P < .05. The score for the Pain Severity subscale of the BPI reduced. No adverse events nor development or worsening of lymphedema was observed.
Conclusion:
Preliminary data suggest that yoga may reduce pain and improve balance and flexibility in BCSs with AIAA. A randomized controlled trial is needed to establish yoga as a treatment that provides objective functional improvement in BCSs related to AIAA.
A Qualitative Exploration of the Impact of Yoga on Breast Cancer Survivors with Aromatase Inhibitor-associated Arthralgias
Ten postmenopausal women with stage I-III breast cancer and AI associated arthralgia (AIAA) were recruited from New Jersey breast cancer clinics.
They received yoga interventions based upon the theoretical framework of the social cognitive theory.
Structured community-based yoga classes were held twice a week for eight weeks for 90 minutes and were instructed to continue in a home-based yoga program.
Higher quality of sleep, decrease in symptoms of anxiety and depression, improvement in spiritual well-being
The benefits, lack of side effects, and the cost-benefit ratio make yoga a good option for an alterative medicine
Studies analyzed may be subject to bias

(Galantino ML, Greene L, Archetto B, Baumgartner M, Hassall P, Murphy JK, Umstetter J, Desai K, 2012)
A qualitative exploration of the impact of yoga on breast cancer survivors with aromatase inhibitor-associated arthralgias.
Ten postmenopausal women with stage I-III breast cancer and AI associated arthralgia (AIAA) were recruited from southern New Jersey breast cancer clinics.
Yoga Intervention structured using the the social cognitive theory (SCT) as the theorhetical framework:
Community-based yoga classes met twice a week for eight weeks for 90 minutes
Participants were instructed to continue in a home-based yoga program
Participants completed journal reflections as well as received weekly phone calls to monitor their experiences.


Results and Interprtation:
Qualitative analysis revealed emergent themes as identified through both instructor and participant observation and weekly phone call documentation:
Empowerment: Importance of Camaraderie, Community, and Sharing; Pain Relief; Increased Physical Fitness (Energy, Flexibility, and Function); Relieved Stress/Anxiety and Transferability of Yoga through Breathing
The yoga intervention was found to be an effective physical activity and support group for the participants that fostered improvements in quality of life (QOL) and reduction in AIAA.
Participants were also highly motivated to improve physical fitness levels and reduce pain.
Benefits from alternative forms of exercise such as yoga were found to be a structured environment that can be transferable in other situations.
Information, structured physical guidance in yoga postures, support, and feedback are eeded in order to encourage physical activity for BCS experiencing pain.
Implications:
Interventions to support BCS with AIAA are needed. Yoga appears to have a positive impact on the side effects of hormonal therapies. Additional research is required in the development of other interventions.
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