Annals of Behavioral Medicine

, Volume 49, Issue 2, pp 165–176 | Cite as

Randomized Controlled Trial of Qigong/Tai Chi Easy on Cancer-Related Fatigue in Breast Cancer Survivors

  • Linda K. Larkey
  • Denise J. Roe
  • Karen L. Weihs
  • Roger Jahnke
  • Ana Maria Lopez
  • Carol E. Rogers
  • Byeongsang Oh
  • Jose Guillen-Rodriguez
Original Article

Abstract

Background

Many breast cancer survivors experience fatigue, mood, and sleep disturbances.

Purpose

This study aims to compare a meditative movement practice, Qigong/Tai Chi Easy (QG/TCE) with sham Qigong (SQG), testing effects of meditation/breath aspects of QG/TCE on breast cancer survivors’ persistent fatigue and other symptoms.

Methods

This double-blind, randomized controlled trial tested 12 weeks of QG/TCE versus SQG on fatigue, depression, and sleep among 87 postmenopausal, fatigued breast cancer survivors, stages 0–III, age 40–75.

Results

Fatigue decreased significantly in the QG/TCE group compared to control at post-intervention (p = 0.005) and 3 months follow-up (p = 0.024), but not depression and sleep quality. Improvement occurred over time for both interventions in depression and sleep quality (all p < 0.05).

Conclusions

QG/TCE showed significant improvement over time compared to SQG for fatigue, but not depression or sleep. Both QG/TCE and SQG showed improvement for two prevalent symptoms among breast cancer survivors, depression and sleep dysfunction.

Keywords

Fatigue Qigong Tai Chi Breast neoplasm Survivor symptoms 

Supplementary material

12160_2014_9645_MOESM1_ESM.docx (29 kb)
ESM 1DOCX 28.6 kb
12160_2014_9645_MOESM2_ESM.docx (43 kb)
ESM 2DOCX 43.2 kb

References

  1. 1.
    Schmidt ME, Chang-Claude J, Vrieling A, Heinz J, Flesch-Janys D, Steindorf K. Fatigue and quality of life in breast cancer survivors: Temporal courses and long-term pattern. J Cancer Survivorship. 2012;6(1):11–19.CrossRefGoogle Scholar
  2. 2.
    Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It’s not over when it’s over: Long-term symptoms in cancer survivors—A systematic review. Int J Psychiatry Med. 2010;40(2):163–181.CrossRefPubMedGoogle Scholar
  3. 3.
    Epplein M, Zheng Y, Zheng W, et al. Quality of life after breast cancer diagnosis and survival. J Clin Oncol. 2011;29(4):406–412.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Cavalli Kluthcovsky A, Urbanetz A, Carvalho D, Pereira Maluf E, Schlickmann Sylvestre G, Bonatto HS. Fatigue after treatment in breast cancer survivors: Prevalence, determinants and impact on health-related quality of life. Support Care Cancer. 2012;20(8):1901.CrossRefGoogle Scholar
  5. 5.
    Noal S, Levy C, Hardouin A, et al. One-year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer. Int J Radiat Oncol Biol Phys. 2011;81(3):795–803.CrossRefPubMedGoogle Scholar
  6. 6.
    Reinertsen KV, Cvancarova M, Loge JH, Edvardsen H, Wist E, Fosså SD. Predictors and course of chronic fatigue in long-term breast cancer survivors. Journal of Cancer Survivorship. 2010;4(4):405–414.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Donovan KKA. Course of fatigue in women receiving chemotherapy and/or radiotherapy for early stage breast cancer. J Pain Symptom Manag. 2004;28(4):373–380.CrossRefGoogle Scholar
  8. 8.
    Ryan JL, Carroll JK, Ryan EP, Mustian KM, Fiscella K, Morrow GR. Mechanisms of cancer-related fatigue. Oncologist. 2007;12(Supplement 1):22–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Bower JE, Ganz PA, Irwin MR, Kwan L, Breen EC, Cole SW. Inflammation and behavioral symptoms after breast cancer treatment: Do fatigue, depression, and sleep disturbance share a common underlying mechanism? J Clin Oncol. 2011;29(26):3517–3522.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Anderson KO, Getto CJ, Mendoza TR, et al. Fatigue and sleep disturbances in patients with cancer, patients with clinical depression, and community-dwelling adults. J Pain Symptom Manag. 2003;25(4):307–318.CrossRefGoogle Scholar
  11. 11.
    Neefjes EC, van der Vorst MJ, Blauwhoff-Buskermolen S, Verheul HM. Aiming for a better understanding and management of cancer-related fatigue. Oncologist. 2013;18(10):1135–1143.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Palesh O, Aldridge-Gerry A, Ulusakarya A, Ortiz-Tudela E, Capuron L, Innominato PF. Sleep disruption in breast cancer patients and survivors. J Natl Compr Cancer Netw. 2013;11(12):1523–1530.Google Scholar
  13. 13.
    Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL. Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manag. 2010;39(3):535–547.CrossRefGoogle Scholar
  14. 14.
    Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2008. DOI: 10.1002/14651858.CD006145.pub3.Google Scholar
  15. 15.
    Sprod L, Hsieh C, Hayward R, Schneider C. Three versus six months of exercise training in breast cancer survivors. Breast Cancer Res Treat. 2010;121(2):413–419.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM. The effect of physical exercise on cancer-related fatigue during cancer treatment: A meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol). 2010;22(3):208–221.CrossRefGoogle Scholar
  17. 17.
    Brown JC, Huedo-Medina TB, Pescatello SM, Ferrer RA, Johnson BT, Pescatello LS. The efficacy of exercise interventions on fatigue among cancer survivors: A meta-analysis. Med Sci Sports Exerc. 2010;42(5):264–265.CrossRefGoogle Scholar
  18. 18.
    Elkins G, Fisher W, Johnson A. Mind–body therapies in integrative oncology. Curr Treat Options in Oncol. 2010;11(3–4):128–140.CrossRefGoogle Scholar
  19. 19.
    Carlson LE. Meditation and yoga. In: Holland JC, Breitbart WS, Jacobsen PB, Lederberg MS, Loscalzo MJ, McCorkle R, eds. Psycho-oncology. 2nd ed. USA: Oxford University Press; 2010:429.CrossRefGoogle Scholar
  20. 20.
    Larkey LK, Jahnke R, Etnier J, Gonzalez J. Meditative movement as a category of exercise: Implications for research. J Phys Act Health. 2009;6(2):230–238.PubMedGoogle Scholar
  21. 21.
    Saquib J, Madlensky L, Kealey S, et al. Classification of CAM use and its correlates in patients with early-stage breast cancer. Integr Cancer Ther. 2011;10(2):138–147.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Craft LL, VanIterson EH, Helenowski I, Rademaker AW, Courneya KS. Exercise effects on depressive symptoms in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiol Biomark Prev. 2012;21(1):3–19.CrossRefGoogle Scholar
  23. 23.
    Schwartz AAL. Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Pract. 2000;8(1):16–24.CrossRefPubMedGoogle Scholar
  24. 24.
    Jahnke R. The healing promise of Qi: Creating extraordinary wellness through qigong and tai chi. New York: McGraw-Hill; 2002.Google Scholar
  25. 25.
    Jahnke R, Larkey LK, Rogers C, Etnier J, Lin F. A comprehensive review of health benefits of qigong and tai chi. Am J Health Promot. 2010;24(6):1–25.CrossRefGoogle Scholar
  26. 26.
    Chodzko-Zaiko W, Jahnke RA, Working Group. National expert meeting on qigong and tai chi: Consensus report. 2005(October 24). Available at http://www.wisdomtaichi.com/Consensus_Article.pdf. Accessed 16 July 2014.
  27. 27.
    Rogers CE, Larkey LK, Keller C. A review of clinical trials of tai chi and qigong in older adults. West J Nurs Res. 2009;31(2):245–279.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Bhattacharya S, Pandey US, Verma NS. Improvement in oxidative status with yogic breathing in young healthy males. Indian J Physiol Pharmacol. 2002;46(3):349–354.PubMedGoogle Scholar
  29. 29.
    Joseph C, Porta C, Casucci G, et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension. 2005;46(4):714–718.CrossRefPubMedGoogle Scholar
  30. 30.
    Martarelli D, Cocchioni M, Scuri S, Pompei P. Diaphragmatic breathing reduces exercise-induced oxidative stress. eCAM. 2009:nep169.Google Scholar
  31. 31.
    Tsang HWH, Fung KMT. A review on neurobiological and psychological mechanisms underlying the anti-depressive effect of qigong exercise. J Health Psychol. 2008;13(7):857–863.CrossRefPubMedGoogle Scholar
  32. 32.
    Kamei T, Toriumi Y, Kimura H, Ohno S, Kumano H, Kimura K. Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation. Percept Mot Skills. 2000;90(3 pt. 1):1027–1032.CrossRefPubMedGoogle Scholar
  33. 33.
    Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29(4):448–474.CrossRefPubMedGoogle Scholar
  34. 34.
    Kristeller JL, Hallett CB. An exploratory study of a meditation-based intervention for binge eating disorder. J Health Psychol. 1999;4(3):357–363.CrossRefPubMedGoogle Scholar
  35. 35.
    Lillis J, Hayes S, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Ann Behav Med. 2009;37(1):58–69.CrossRefPubMedGoogle Scholar
  36. 36.
    Kristeller JL, Wolever RQ. Mindfulness-based eating awareness training for treating binge eating disorder: The conceptual foundation. Eat Disord. 2011;19(1):49–61.CrossRefPubMedGoogle Scholar
  37. 37.
    Carlson L, Speca M, Faris P, Patel K. One year pre-post intervention follow up of, immune, endocrine and blood pressure outcomes of mindfulness based stress reduction (MBSR) in breast and prostate cancer patients. Brain Behav Immun. 2007;21:1038–1049.CrossRefPubMedGoogle Scholar
  38. 38.
    Lengacher CA, Johnson–Mallard V, Post–White J, et al. Randomized controlled trial of mindfulness–based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology. 2009;18(12):1261–1272.CrossRefPubMedGoogle Scholar
  39. 39.
    Jahnke RA, Larkey LK, Rogers C. Dissemination and benefits of a replicable tai chi and qigong program for older adults. Geriatr Nurs. 2010;31(4):272–280.CrossRefPubMedGoogle Scholar
  40. 40.
    Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: Physical and psychological benefits. Psycho-Oncology. 2006;15(10):891–897.CrossRefPubMedGoogle Scholar
  41. 41.
    Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL. Yoga of awareness program for menopausal symptoms in breast cancer survivors: Results from a randomized trial. Support Care Cancer. 2009;17(10):1301–1309.CrossRefPubMedGoogle Scholar
  42. 42.
    Ulger O, Yagli NV. Effects of yoga on the quality of life in cancer patients. Complement Ther Clin Pract. 2010;16(2):60–63.CrossRefPubMedGoogle Scholar
  43. 43.
    Moadel AB, Shah C, Wylie-Rosett J, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects on quality of life. J Clin Oncol. 2007;25(28):4387–4395.CrossRefPubMedGoogle Scholar
  44. 44.
    Danhauer SC, Mihalko SL, Russell GB, et al. Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psychooncology. 2009;18(4):360–368.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya KS. Pilot evaluation of an iyengar yoga program for breast cancer survivors. Cancer Nurs. 2010;33(5):369–381.CrossRefPubMedGoogle Scholar
  46. 46.
    Bower JE, Garet D, Sternlieb B, et al. Yoga for persistent fatigue in breast cancer survivors. Cancer. 2012;118(15):3766–3775.CrossRefPubMedCentralPubMedGoogle Scholar
  47. 47.
    Janelsins MC, Davis PG, Wideman L, et al. Effects of tai chi chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clin Breast Cancer. 2011;11(3):161–170.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Mustian KM, Palesh OG, Flecksteiner SA. Tai chi chuan for breast cancer survivors. Med Sport Sci. 2008;52:209–217.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    Rausch S, M., Robins, Jolynne, Walter J, M., McCain N, L. Tai chi as biobehavioral intervention for women with breast cancer. Brain Behav Immun. 2006;20(e58–e59).Google Scholar
  50. 50.
    Galantino ML, Capito L, Kane RJ, Ottey N, Switzer S, Packel L. The effects of tai chi and walking on fatigue and body mass index in women living with breast cancer: A pilot study. Rehabil Oncol. 2003;21(1):17–22.Google Scholar
  51. 51.
    Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai chi chuan, health-related quality of life and self-esteem: A randomized trial with breast cancer survivors. Support Care Cancer. 2004;12(12):871–876.CrossRefPubMedGoogle Scholar
  52. 52.
    Oh B, Butow PN, Mullan BA, et al. Effect of medical qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: A randomized controlled trial. Supportive Care in Cancer. 2011:1–8.Google Scholar
  53. 53.
    Oh B, Butow P, Mullan B, et al. Impact of medical qigong on quality of life, fatigue, mood and inflammation in cancer patients: A randomized controlled trial. Ann Oncol. 2010;21(3):608-614.CrossRefPubMedCentralPubMedGoogle Scholar
  54. 54.
    Oh B, Butow PN, Mullan BA, et al. Effect of medical qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: A randomized controlled trial. Support Care Cancer. 2012;20(6):1235-1242.CrossRefPubMedGoogle Scholar
  55. 55.
    Campo RA, Agarwal N, LaStayo PC, et al. Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of qigong. Journal of Cancer Survivorship. 2013:1–10.Google Scholar
  56. 56.
    Chen, Z., Meng, Z., Milbury, K., Bei, W., Zhang, Y., Thornton, B. Qigong improves quality of life in women undergoing radiotherapy for breast cancer. Cancer. 2013:n-a.Google Scholar
  57. 57.
    Lee MS, Chen KW, Ernst E. Supportive cancer care with qigong. Supportive Cancer Care with Chinese Medicine. 2010:77–94.Google Scholar
  58. 58.
    Oh B, Butow P, Mullan B, et al. A critical review of the effects of medical qigong on quality of life, immune function, and survival in cancer patients. Integr Cancer Ther. 2012;11(2):101–110.CrossRefPubMedGoogle Scholar
  59. 59.
    Courneya KS, Mackey JR, Jones LW. Coping with cancer: Can exercise help? Phys Sportsmed. 2000;28(5):49–58.CrossRefPubMedGoogle Scholar
  60. 60.
    Brown LF, Kroenke K, Theobald DE, Wu J. Comparison of SF-36 vitality scale and Fatigue Symptom Inventory in assessing cancer-related fatigue. Support Care Cancer. 2011;19(8):1255–1259.CrossRefPubMedGoogle Scholar
  61. 61.
    Ware Jr JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. conceptual framework and item selection. Med Care. 1992:473–483Google Scholar
  62. 62.
    Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. J Clin Oncol. 2000;18(4):743–743.PubMedGoogle Scholar
  63. 63.
    Hann DM, Denniston MM, Baker F. Measurement of fatigue in cancer patients: Further validation of the fatigue symptom inventory. Qual Life Res. 2000;9(7):847–854.CrossRefPubMedGoogle Scholar
  64. 64.
    Donovan KA, Jacobsen PB, Small BJ, Munster PN, Andrykowski MA. Identifying clinically meaningful fatigue with the fatigue symptom inventory. J Pain Symptom Manag. 2008;36(5):480.CrossRefGoogle Scholar
  65. 65.
    Buysse D, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.CrossRefPubMedGoogle Scholar
  66. 66.
    Beck AT, Steer RA, Carbin MG. Psychometric properties of the beck depression inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77–100.CrossRefGoogle Scholar
  67. 67.
    Galantino ML et al. The effects of Tai Chi and walking on fatigue and body mass index in women living with breast cancer: A pilot study. Rehabil Oncol. 2003;21:17–22.Google Scholar
  68. 68.
    Taylor–Piliae, Ruth E, et al. Change in perceived psychosocial status following a 12–week Tai Chi exercise programme. J Adv Nurs. 2006;54(3):313–329.CrossRefPubMedGoogle Scholar
  69. 69.
    Irwin, Michael R., Richard Olmstead, and Sarosh J. Motivala. Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of Tai Chi Chih. Sleep-New York then Westchester-31.7. 2008: 1001.Google Scholar
  70. 70.
    Yeh, Gloria Y, et al. Tai chi exercise in patients with chronic heart failurea randomized clinical trial tai chi in patients with chronic heart failure. Arch Intern Med. 2011;171(8):750–757.CrossRefPubMedCentralPubMedGoogle Scholar
  71. 71.
    Linde K, Streng A, Jürgens S, et al. Acupuncture for patients with migraine: A randomized controlled trial. JAMA. 2005;293(17):2118–2125.CrossRefPubMedGoogle Scholar
  72. 72.
    Yeh GY, Kaptchuk TJ, Shmerling RH. Prescribing tai chi for fibromyalgia—are we there yet? N Engl J Med. 2010;363(8):783-784.CrossRefPubMedGoogle Scholar
  73. 73.
    Yeh ML, Lee TI, Chen HH, Chao TY. The influences of chan-chuang qi-gong therapy on complete blood cell counts in breast cancer patients treated with chemotherapy. Cancer Nurs. 2006;29(2):149–155.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2014

Authors and Affiliations

  • Linda K. Larkey
    • 1
    • 2
  • Denise J. Roe
    • 3
  • Karen L. Weihs
    • 4
  • Roger Jahnke
    • 5
  • Ana Maria Lopez
    • 6
  • Carol E. Rogers
    • 7
  • Byeongsang Oh
    • 8
    • 9
  • Jose Guillen-Rodriguez
    • 6
  1. 1.College of Nursing & Health InnovationArizona State UniversityPhoenixUSA
  2. 2.Mayo Clinic Cancer CenterMayo ClinicScottsdaleUSA
  3. 3.Mel & Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonUSA
  4. 4.Department of PsychiatryUniversity of ArizonaTucsonUSA
  5. 5.Institute of Integral Qigong and Tai ChiHealth Action IncorporatedSanta BarbaraUSA
  6. 6.Arizona Cancer CenterUniversity of ArizonaTucsonUSA
  7. 7.University of Oklahoma Health Sciences CenterOklahomaUSA
  8. 8.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  9. 9.Harvard Medical SchoolHarvard UniversityBostonUSA

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