Effect of Yoga and Mediational Influence of Fatigue on Walking, Physical Activity, and Quality of Life Among Cancer Survivors

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Po-Ju LinDepartment of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Brian J. AltmanDepartment of Biomedical Genetics, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Nikesha J. GilmoreDepartment of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Kah Poh LohDepartment of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Richard F. DunneDepartment of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Javier BautistaDepartment of Mathematics, University of Rochester, Rochester, New York

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Chunkit FungDepartment of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Michelle C. JanelsinsDepartment of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Luke J. PepponeDepartment of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Marianne K. MelnikCancer Research Consortium of West Michigan NCORP, Grand Rapids, Michigan

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Kim O. GococoNCORP of the Carolinas (Greenville Health System), Greenville, South Carolina

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Michael J. MessinoSoutheast Clinical Oncology Research Consortium NCORP, Winston Salem, North Carolina

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Karen M. MustianDepartment of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York

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Background: Cancer-related fatigue (CRF) negatively affects survivors’ walking, engagement in physical activity (PA), and quality of life (QoL). Yoga is an effective therapy for treating CRF; however, evidence from large clinical trials regarding how reducing CRF through yoga influences CRF’s interference with survivors’ walking, engagement in PA, and QoL is not available. We examined the effects of yoga and the mediational influence of CRF on CRF’s interference with walking, PA, and QoL among cancer survivors in a multicenter phase III randomized controlled trial. Patients and Methods: Cancer survivors (n=410) with insomnia 2 to 24 months posttreatment were randomized to a 4-week yoga intervention—Yoga for Cancer Survivors (YOCAS)—or standard care. A symptom inventory was used to assess how much CRF interfered with survivors’ walking, PA, and QoL. The Multidimensional Fatigue Symptom Inventory-Short Form was used to assess CRF. Two-tailed t tests and analyses of covariance were used to examine within-group and between-group differences. Path analysis was used to evaluate mediational relationships between CRF and changes in CRF’s interference with walking, PA, and QoL among survivors. Results: Compared with standard care controls, YOCAS participants reported significant improvements in CRF’s interference with walking, PA, and QoL at postintervention (all effect size = −0.33; all P≤.05). Improvements in CRF resulting from yoga accounted for significant proportions of the improvements in walking (44%), PA (53%), and QoL (45%; all P≤.05). Conclusions: A significant proportion (44%–53%) of the YOCAS effect on CRF’s interference with walking, PA, and QoL was due to improvements in CRF among cancer survivors. Yoga should be introduced and included as a treatment option for survivors experiencing fatigue. By reducing fatigue, survivors further improve their walking, engagement in PA, and QoL.

Submitted March 28, 2022; final revision received August 22, 2022; accepted for publication September 27, 2022.

Author contributions: Conception and design: Lin, Mustian. Data analysis: Lin, Bautista. Data interpretation: Lin, Bautista, Mustian. Writing—original draft: Lin. Writing—review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the National Cancer Institute at the National Institutes of Health under awarded number U10CA037420 with supplemental funding from the Office of Cancer Complementary and Alternative Medicine, UG1CA189961 with supplemental funding from the Division of Cancer Prevention, R01CA181064, and T32CA102618.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Correspondence: Po-Ju Lin, PhD, MPH, Division of Supportive Care in Cancer, Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, 265 Crittenden Boulevard, Box 658, Rochester, NY 14642. Email: Po-Ju_Lin@URMC.Rochester.edu

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