Short course of Tibetan yoga improved sleep in cancer patients

04/15/04

HOUSTON - The first study to look at the use of Tibetan yoga by cancer patients found the combination of movement and meditation led to a significant sleep benefit, say researchers at The University of Texas M. D. Anderson Cancer Center.

In the small study, reported in the April 15 online issue of the journal Cancer, lymphoma patients who practiced Tibetan yoga for seven weeks went to sleep faster, slept longer, had better overall sleep quality, and used less sleep medication, compared with a "control" group of patients with lymphoma who did not use yoga, say the investigators.

There were, however, no differences between the groups in other "quality of life" measures, including anxiety, depression and fatigue. The most likely reason for this is the study's brief time frame, says the lead author of the study, Lorenzo Cohen, Ph.D., an associate professor in the Departments of Behavioral Science and Palliative Care & Rehabilitation Medicine, and the Director of the Integrative Medicine Program at M. D. Anderson Cancer Center.

"From the Tibetan tradition, practitioners tell us that these techniques need to be practiced for at least six months before benefits are seen," says Cohen. "Although the shortness of this study was a limitation, it is remarkable that after seven weekly classes we were able to see significant improvements in overall sleep quality across a three month follow-up time frame."

Cohen and his colleagues, who include investigators from Rice University in Houston, are continuing their study of Tibetan yoga as a potential stress reducer in cancer patients. One ongoing study in breast cancer patients is measuring levels of stress hormones and immune function in patients practicing Tibetan yoga.

"The objective of using yoga in patients who have been, or are being, treated for cancer is not necessarily to increase length of life, but to improve the quality of life," says Cohen. "In cancer patients, fatigue is not necessarily directly related to the quality of sleep but given such a small study, the fact that sleep was improved suggests that the health effects of yoga should be further explored."

Yoga is an ancient Eastern tradition that usually includes regulated breathing, moving through various postures and meditation. Although different forms of yoga are practiced in many Eastern countries, the yoga practiced in the West primarily comes from the Indian tradition, specifically the form known as Hatha yoga, says Cohen. Less commonly practiced are the yogic practices from Tibet, which have used "for thousands of years, what today we call mind-body techniques," he says.

Two Tibetan practices in particular, "Tsa lung" and "Trul khor" incorporate controlled breathing and visualization, mindfulness techniques and postures, and little is known about this form of yoga and no research has examined its benefits says Cohen.

Still, because the movements are gentle and simple with an emphasis on controlled breathing, visualization and mindfulness techniques, "we believe this form of yoga may be particularly useful for patients undergoing and recovering from chemotherapy," he says.

In the study, 39 patients were randomized either to yoga or to a wait-list. There was an even distribution of cancer stage across the participants, and 15 patients in each group were not currently receiving treatment for their lymphoma.

Patients randomized to the yoga group were asked to attend seven weekly yoga sessions at M. D. Anderson, which were led by co-author Alejandro Chaoul-Reich, a doctoral student in religious studies at Rice University and a long-time practitioner of the yoga style. "Everything we did with the patients was in direct consultation with the Tibetan community and the Tibetan masters who teach these ancient practices," Cohen says. "We remained true to the Tibetan tradition."

Not all participants attended all of the sessions; in fact, eight patients (42 percent) attended three or fewer, but they were all encouraged to practice the techniques at least once a day during the seven-week study.

In self-reported evaluations, all of the patients in the yoga group said they found the program was useful and more than 50 percent said they practiced some aspect of the program at least twice a week during the follow-up period. While there was a trend toward improvement in such factors as depression, fatigue, anxiety and unwanted thoughts, the difference between the two groups in sleep quality was significant, the researchers found.

The study was funded by a grant from the Bruce S. Gelb Foundation. Co-authors also include Carla Warneke and Alma Rodriguez, from M. D. Anderson Cancer Center; and Rachel Fouladi, Ph.D., from Simon Fraser University.

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