Messer Sarah, Oeser Annika, Wagner Carina, Wender Andreas, Cryns Nora, Scherer Roberta W, Mishra Shiraz I, Monsef Ina, Holtkamp Ulrike, Andreas Marike, Bröckelmann Paul J, Ernst Moritz, Skoetz Nicole
Cochrane Haematology, Cochrane ESU Germany/UK, Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Cochrane Database Syst Rev. 2025 May 27;5(5):CD015520. doi: 10.1002/14651858.CD015520.
BACKGROUND: Cancer-related fatigue (CRF) is one of the most prevalent symptoms in individuals with cancer. Various types of exercise have shown beneficial effects. While previous systematic reviews suggest exercise may improve CRF and quality of life, evidence specifically about yoga's impact, as well as evidence on long-term effects, is limited. Previous syntheses offer promising but inconclusive findings on yoga's effectiveness. This review is one of a suite of five reviews exploring exercise for cancer-related fatigue. OBJECTIVES: To assess the effects of yoga versus no yoga on cancer-related fatigue in people with cancer: • before, during, and after anticancer treatment; • in the short, medium, and long term; • and effects on quality of life (QoL), adverse events, depression, and anxiety. SEARCH METHODS: We used CENTRAL, MEDLINE, Embase, five other databases and two trials registers, together with reference checking, citation searching and contact with study authors to identify studies that are included in the review. The latest search date was October 2023. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing yoga to no yoga. We included studies in adults (aged 18 and older) with any type of cancer and anticancer therapy who received yoga before, during, or after anticancer therapy. We included trials evaluating at least one of the main outcomes (CRF or QoL). Yoga had to last for at least five sessions, and involve face-to-face instruction. We excluded trials with fewer than 20 participants randomised per group. DATA COLLECTION AND ANALYSIS: The outcomes of interest in this review are cancer-related fatigue (CRF), quality of life (QoL), adverse events, depression, and anxiety. We used standard methods expected by Cochrane. For analyses, we pooled results within the same period of outcome assessment (i.e. short, medium, and long term), and employed a random-effects model. We assessed risk of bias with the Cochrane risk of bias (RoB) 1 tool, and used GRADE to assess the certainty of the evidence. MAIN RESULTS: We included 21 RCTs with 2041 people with cancer who received yoga during (13 studies) or after (eight studies) anticancer therapy; none examined yoga initiated before therapy. Here we present results on CRF and QoL; findings on adverse events, depression, and anxiety are in the full review. Yoga during anticancer therapy The evidence is very uncertain about the effect of yoga compared to no yoga on: short-term CRF (standardised mean difference (SMD) 0.07, 95% confidence interval (CI) -0.18 to 0.32; mean difference (MD) on Brief Fatigue Inventory (BFI; lower values mean better outcome) of 0.16, 95% CI -0.41 to 0.71; 3 studies, 253 participants); medium-term CRF (MD on Multidimensional Fatigue Inventory (MFI; lower values mean better outcome) of -1.30, 95% CI -3.50 to 0.90; 1 study, 67 participants); and long-term CRF (MD 0.09 on BFI, 95% CI 1.16 to 0.98; 2 studies, 155 participants) (all very low-certainty evidence). Yoga may have a small beneficial effect or no effect compared to no yoga on short-term QoL (SMD 0.25, 95% CI 0.04 to 0.45; MD on Quality of Life Questionnaire-C30 (QLQ-C30; higher values mean better outcome) of 5.28, 95% CI 0.84 to 9.56; 4 studies, 374 participants) and medium-term QoL (MD on QLQ-C30 of 7.63, 95% CI 6.71 to 21.97; 2 studies, 151 participants), but the evidence is very uncertain (all very low-certainty evidence). None of the included studies reported long-term QoL. Yoga after anticancer therapy Yoga probably has a beneficial effect compared to no yoga on short-term CRF (SMD -0.26, 95% CI -0.42 to -0.09; MD 2.55, 95% CI 0.88 to 4.12; higher values mean better outcome; 5 studies, 602 participants; moderate-certainty evidence). Yoga might have a beneficial effect or no effect compared to no yoga on medium-term CRF, but the evidence is very uncertain (MD 3.02, 95% CI -1.48 to 7.52; 1 study, 54 participants (higher values mean better outcome; very low-certainty evidence). None of the included studies reported long-term CRF. Yoga may have a small beneficial effect or no effect compared to no yoga on short-term QoL (SMD 0.19, 95% CI -0.09 to 0.47; MD -3.27, 95% CI -8.08 to 1.55; higher values mean better outcome; 4 studies, 275 participants) and medium term QoL (MD 7.06, 95% CI -1.38 to 15.50; 1 study, 54 participants; higher values mean better outcome), but the evidence is very uncertain (all very low-certainty evidence). None of the included studies reported long-term QoL. A key limitation of the review was the included studies' methodological constraints: participants' awareness of treatment assignments (yoga or control) potentially introduced bias. Additionally, sample sizes were too small to determine medium- and long-term effects conclusively. Further research is needed to evaluate the sustainability of yoga's impact on cancer-related fatigue, quality of life, and adverse events. AUTHORS' CONCLUSIONS: Our review provides uncertain evidence of the beneficial effects of yoga initiated during or after anticancer therapy compared to no yoga for people with cancer. Although there are indications supporting the use of yoga to address CRF, the uncertainty of the evidence underscores the need for caution in its implementation. Future RCTs should employ rigorous methodologies, enrol sufficient participants, and use appropriate controls.
背景:癌症相关疲劳(CRF)是癌症患者中最常见的症状之一。各种类型的运动已显示出有益效果。虽然先前的系统评价表明运动可能改善CRF和生活质量,但关于瑜伽影响的具体证据以及长期效果的证据有限。先前的综合分析对瑜伽的有效性给出了有前景但不确定的结果。本综述是探索运动对癌症相关疲劳影响的五项综述之一。 目的:评估瑜伽与不进行瑜伽对癌症患者癌症相关疲劳的影响:• 在抗癌治疗前、治疗期间和治疗后;• 在短期、中期和长期;• 以及对生活质量(QoL)、不良事件、抑郁和焦虑的影响。 检索方法:我们使用了CENTRAL、MEDLINE、Embase、其他五个数据库和两个试验注册库,同时进行参考文献核对、引文检索并与研究作者联系,以识别纳入综述的研究。最新检索日期为2023年10月。 选择标准:我们纳入了将瑜伽与不进行瑜伽进行比较的随机对照试验(RCT)。我们纳入了年龄在18岁及以上、患有任何类型癌症并接受抗癌治疗的成年人的研究,这些人在抗癌治疗前、治疗期间或治疗后接受了瑜伽。我们纳入了评估至少一项主要结局(CRF或QoL)的试验。瑜伽必须持续至少五节课程,并包括面对面指导。我们排除了每组随机分配参与者少于20人的试验。 数据收集与分析:本综述感兴趣的结局是癌症相关疲劳(CRF)、生活质量(QoL)、不良事件、抑郁和焦虑。我们使用了Cochrane预期的标准方法。对于分析,我们在相同的结局评估期(即短期、中期和长期)内汇总结果,并采用随机效应模型。我们使用Cochrane偏倚风险(RoB)1工具评估偏倚风险,并使用GRADE评估证据的确定性。 主要结果:我们纳入了21项RCT,共2041名癌症患者,他们在抗癌治疗期间(13项研究)或之后(8项研究)接受了瑜伽;没有研究考察在治疗前开始的瑜伽。这里我们展示关于CRF和QoL的结果;关于不良事件、抑郁和焦虑的结果在完整综述中呈现。抗癌治疗期间的瑜伽 与不进行瑜伽相比,关于瑜伽对以下方面影响的证据非常不确定:短期CRF(标准化均值差(SMD)0.07,95%置信区间(CI)-0.18至0.32;简短疲劳量表(BFI;值越低结局越好)的均值差(MD)为0.16,95%CI -0.41至0.71;3项研究,253名参与者);中期CRF(多维疲劳量表(MFI;值越低结局越好)的MD为-1.30,95%CI -3.50至0.90;1项研究,67名参与者);以及长期CRF(BFI的MD为0.09,95%CI -1.16至0.98;2项研究,155名参与者)(所有证据确定性都非常低)。与不进行瑜伽相比,瑜伽对短期QoL可能有小的有益影响或无影响(SMD 0.25,95%CI 0.04至0.45;生活质量问卷-C30(QLQ-C30;值越高结局越好)的MD为5.28,95%CI 0.84至9.56;4项研究,374名参与者)和中期QoL(QLQ-C30的MD为7.63,95%CI 6.71至21.97;2项研究,151名参与者),但证据非常不确定(所有证据确定性都非常低)。纳入的研究均未报告长期QoL。抗癌治疗后的瑜伽 与不进行瑜伽相比,瑜伽对短期CRF可能有有益影响(SMD -0.26,95%CI -0.42至-0.09;MD 2.55,95%CI 0.88至4.12;值越高结局越好;5项研究,602名参与者;中等确定性证据)。与不进行瑜伽相比,瑜伽对中期CRF可能有有益影响或无影响,但证据非常不确定(MD 3.02,95%CI -1.48至7.52;1项研究,54名参与者(值越高结局越好;证据确定性非常低)。纳入的研究均未报告长期CRF。与不进行瑜伽相比,瑜伽对短期QoL可能有小的有益影响或无影响(SMD 0.19,95%CI -0.09至0.47;MD -3.27,95%CI -8.08至1.55;值越高结局越好;4项研究,275名参与者)和中期QoL(MD 7.06,95%CI -1.38至15.50;1项研究,54名参与者;值越高结局越好),但证据非常不确定(所有证据确定性都非常低)。纳入的研究均未报告长期QoL。本综述的一个关键局限性是纳入研究的方法学限制:参与者对治疗分配(瑜伽或对照)的知晓可能引入偏倚。此外,样本量太小,无法最终确定中期和长期效果。需要进一步研究来评估瑜伽对癌症相关疲劳、生活质量和不良事件影响的可持续性。 作者结论:我们的综述提供了不确定的证据,表明与不进行瑜伽相比,在抗癌治疗期间或之后开始的瑜伽对癌症患者有有益效果。尽管有迹象支持使用瑜伽来解决CRF,但证据的不确定性强调了在实施时需要谨慎。未来的RCT应采用严格的方法,招募足够的参与者,并使用适当的对照。
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