Our study is a phase III randomised clinical trial testing the effectiveness of a yoga intervention that we developed for cancer survivors. That particular yoga intervention incorporates gentle hatha yoga, restorative yoga; we use postures, breathing exercises and mindfulness exercises all integrated for this particular yoga intervention. We deliver it over the course of four weeks, we do two in-person sessions each week and we also do home practice. The participants are taught by certified yoga instructors with a background in yoga and oncology. Also the participants are given a yoga kit with a mat, straps, a manual and access to videos to help them with their home practice.

Could you outline the methodology?

One of the things that’s really amazing about this phase III randomised clinical trial is that it’s nationwide across the United States. We are working with the NCI community oncology research programme. This is a nationwide-funded clinical trial network that’s supported by the National Cancer Institute that allows us to develop these types of trials and provide access to them through community oncology practices. This means that patients that don’t get treated at these large, famous, academic cancer centres, they’re being treated locally in their communities, have access to our trials.

What’s great about this is when we tested this trial and we looked at the outcomes of this trial on mood disturbance, anxiety, fatigue and ultimately also insomnia, this is actually a real-world setting, it’s a practical setting. This means that these patients are receiving yoga right there in their community, they’re not having to travel long distances in order to access this. The oncologists are able to integrate this and refer patients in their practices to these local community resources once our trial is over and it’s established that it’s beneficial. In fact, we did see that it was beneficial for overall mood disturbance, anxiety and fatigue.

We had also previously shown that it worked for treating insomnia in these survivors and in this trial one of the things we were interested in is what was the relationship between changes in mood disturbance, anxiety and fatigue and if that subsequently influenced their sleep. We did find that for overall mood disturbance and fatigue, if we lower that, that that explains a pretty large proportion of the variability in why we would see changes subsequently in their insomnia. So it means if we reduce their mood disturbance and their fatigue we also have a great chance of improving their insomnia in these patients.

What impact could these findings have?

The impact of these findings is really pivotal. As we have grown the body of research in oncology regarding yoga and what it can do for cancer patients, especially the kind of yoga that we did which is a gentle hatha and restorative yoga, it’s not the vigorous yoga, it’s not heated yoga, it’s a very gentle, accessible form of yoga, to people. In terms of what this means for patients, it means that if you can access yoga in your community, when I started this work over 20 years ago we didn’t have access to yoga in most communities in the United States. Now you can find yoga in schools, you can find yoga in cancer centres and many community programmes that support survivors also offer yoga; you can find it in YMCAs, you can find it in fitness centres, it’s much more accessible than it used to be.

So for patients it means if you can seek this out in your community and you can find a class or a session that actually provides gentle hatha or restorative yoga, if you can participate in this an average of three times a week for approximately 180 minutes a week, you could expect to see your mood disturbance get better, your fatigue get better, your anxiety get better and your insomnia or sleep problems get better. That means you have a really accessible behavioural intervention, it’s non-pharmaceutical so we’re not adding another drug into your treatment regimen, and it’s multitargeted. That means with this one thing you’re going to get a wide variety of benefits in terms of side effects that you might be experiencing as a survivor.

For clinicians who see patients, this includes oncologists, nurses, social workers, councillors and so forth, it provides yet another option. One of the things that becomes important, especially when you’re asking patients to think about behaviour change or anything that is more like a lifestyle change, it’s not just simply taking another pill, is it needs to be something that they like. Oftentimes, if we provide more choices then patients choose things that they like. So this provides another choice. And as we think about supportive care for patients going forward in the world of oncology, the more opportunities we can give for choices that are of benefit for them personally and individually, the more likely they are to adopt the behaviour, do the behaviour and achieve the benefits from that.