By Dr. Brian Lawenda, Conner Middelmann and Jenifer Linville (Founder, Unity Yoga of Tri-Cities, Richland, WA)
If the thought of strenuous exercise scares you, you might want to try yoga. More and more people undergoing cancer treatment and cancer thrivers are taking up yoga. This trend has been driven in part by patients actively seeking out complementary treatment modalities they can undertake on their own, and in part by the growing body of evidence supporting yoga’s benefits and safety, prompting a growing increasing number of allopathic physicians to recommend it to their patients.
Why Yoga Is Great For Cancer Patients and Survivors:While initial studies have identified various ways in which yoga may support people undergoing cancer treatment, the research on yoga for cancer patients and survivors is still in its infancy. Nonetheless, a 2019 review shows promising results of randomized studies in cancer patients and survivors:
- Improves stress/distress during treatment
- Improves post‐treatment disturbances in sleep and cognition.
- Improves biomarkers of stress, inflammation, and immune function.
- May improve anxiety, depression, pain, cancer‐specific symptoms, (such as lymphedema) and positive psychological outcomes (such as benefit‐finding and life satisfaction)
What Style of Yoga Suits You?While there are sweat-inducing types of yoga, there are also several styles of yoga that are slow, gentle, restful and enjoyable – even for exercise-phobes. Depending on one’s level of fitness (which can change drastically both during and after treatment) or activity preference, different styles of yoga are more suitable than others to meet an individual’s needs. For most people in the west, the term “yoga” equates to a variety of physical poses (asanas) such as the poetically named “half-moon pose,” “gate pose” and “downward-facing dog.” There are many different types of yoga; the most commonly practiced form in the U.S. is Hatha yoga. Hatha yoga emphasizes the use of yoga postures (asanas) and breathing exercises (pranayama) to achieve health and spirituality. There are various subsets of Hatha yoga, such as Iyengar yoga, Ashtanga yoga, Vinyasa (power yoga), Kundalini yoga, Bikram yoga (hot yoga) and Restorative yoga (supportive). Each of these takes a slightly different approach to yoga practice. For example, Kundalini yoga emphasizes breathwork and spirituality while Restorative yoga uses blocks, props, bolsters and blankets to support relaxation with comfort. Group yoga classes are commonly available. Fitness-based group yoga classes are frequently offered by gyms. Specialized group yoga classes, such as Gentle Yoga, Chair Yoga, and Restorative Yoga are typically affiliated with yoga studios where students are taught to use specific equipment for personalized alignment and safety.
Talk With The Yoga Instructor Before You GoCancer patients often experience a multitude of treatment side-effects – both physical (e.g., lymphedema, nausea and vomiting, fatigue, pain, peripheral neuropathy, sleep disturbances, cognitive impairment (“chemo brain”), weakened immune systems and psychological distress (e.g., anxiety, depression, generalized emotional distress). Yoga can alleviate many of these troubling symptoms, both during and after cancer treatment physically by improving circulation and respiratory capacity and emotionally by cultivating self-awareness, presence, and compassion. Even though some styles of yoga are generally gentle and safe, cancer patients and survivors should take some precautions. Before a class, always tell your yoga teacher about your health status; if possible, find an instructor who specializes in yoga for cancer patients so that they understand any constraints you might face. If choosing a group yoga class, consult an experienced yoga teacher with a yoga center that offers various approaches, telling them about any health challenges you may be facing. While yoga has become increasingly popular, not all instructors are prepared to provide modifications without some advanced warning, so it is best to contact the studio or instructor to discuss needs or limitations before your first visit. For one-on-one instruction, which is most appropriate for students dealing with post-surgical or chronic health, pain, or mobility issues, consultation with a certified Yoga Therapist is recommended.
- The International Association of Yoga Therapists has a directory where you can search for yoga therapists in your area https://iayt.site-ym.com/?MemberSearch.
PrecautionsThe health status of a person with cancer can change frequently, so it’s important to assess your status at each visit. Talk with your yoga instructor before taking their class. Hot yoga, such as Bikram moves through a fixed series of traditional poses in a 90-minute session, in a room with an air temperature of 105℉ (40℃) degrees and 40 percent humidity. While this style is not a contraindication for all patients and cancer survivors, there are risks. For a person who’s unfit or not used to hot yoga, they might experience some level of heat intolerance, dehydration, nausea, lightheadedness or confusion. If you are at risk of lymphedema, the heat may exacerbate this risk. Here is a list of precautions compiled by yoga teacher Ellen Fein:
- Consult with your medical team after surgery; certain yoga postures should not be practiced immediately after surgery.
- Immune status: Cancer affects patients’ immune status, making them more vulnerable to illness and infection. The room, mats and props should be clean before anyone with a compromised immune status uses them. Students with weakened immune systems are advised to bring a clean sheet or blanket from home to put under them so they do not have direct body contact with the floor. Students in a therapeutic class who have symptoms of cold, fever, flu, or any other active infectious condition should not to come to class.
- Along with compromised immunity, people undergoing treatment can have low blood platelet counts (which can lead to bruising and bleeding). They should avoid props such as resistance bands and yoga straps that apply direct pressure to the skin because they can cause bleeding.
- Cancer patients often have a port or central line, a device placed in the chest so that drugs can be delivered directly into a vein. These devices can remain in for months. Some doctors advise their patients to limit certain physical movements if they carry a central lines or port, especially those where the head is lower than the heart (e.g., inversions or standing forward bends, such as the downward-facing dog pose). Other doctors impose no restrictions, so make sure you understand your doctor’s instructions. If you don’t; know, always err on the side of caution.
- Cancer can spread, or metastasize, from its original site to other organs, including the bones, and patients may not always know which parts of their bodies are affected. If they have any tumors in their bones, or if bones have been radiated as part of treatment, people with cancer may be vulnerable to fractures—typically in the spine, pelvis, or ribs—because the bone is weakened. Any yoga postures that stress the bones should be avoided: bound or closed poses, anything that uses leverage or torque (e.g., seated twist, bound triangle, bound side angle, and most hand-to-big toe variations). There can be situations where the bones are so weakened that anything that stresses the spine in extension or flexion can be risky. When in doubt, yoga practice should be kept as gentle as possible there is some medical guidance.
- Yoga practitioners should avoid putting direct pressure on any tumors they know are present. For instance, prone poses such as cobra can be a problem for people with pelvic or abdominal tumors. If you feel pain during yoga practice, easy off immediately and come out of the pose. There is no such thing as “work through the pain” in yoga. A key tenet of yoga is “do no harm” (ahimsa) – which includes not causing or enduring pain.
- Lymphedema is a condition that arises from removal of lymph nodes, resulting in fluid accumulation (typically in the arms or legs) because the lymph drainage system is no longer working correctly. Most often this condition is seen in breast cancer patients, but it is not limited to them. This condition can vary greatly from patient to patient, but generally, long holds of poses that extend the affected limb overhead should be avoided. It is best to move in and out of such a pose briefly and avoid stays. Also, it’s a good idea to avoid direct weight bearing on the affected limb.
- You should not experience any pain when practicing yoga postures or breathing exercises. If you experience any sharp or stabbing sensations, numbness, shortness of breath, or dizziness, come out of the posture and rest in a relaxing position. Alert the instructor or ask for help if the symptoms persist. If you are experiencing respiratory problems, lightheadedness or have low blood pressure, avoid prolonged standing and balancing poses and take care when coming to standing from being seated or folded forward.