E-ISSN:2456-3110

Review Article

Chemotherapy

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 1 JANUARY
Publisherwww.maharshicharaka.in

Exploring the Role of Yoga in Alleviating Chemotherapy - Induced Fatigue and Nausea-Vomiting in Women with Breast Cancer - A Narrative Review

Anaghashree S1*, Archana K2, Shetty A3, Shetty VS4
DOI:10.21760/jaims.10.1.21

1* Anaghashree S, Post Graduate Scholar, Department of Clinical Yoga, Alvas College of Naturopathy and Yogic Sciences, Moodbidre, Karnataka, India.

2 Archana K, Professor, Department of Clinical Yoga, Alvas College of Naturopathy and Yogic Sciences, Moodbidre, Karnataka, India.

3 Anupritha Shetty, Associate Professor, Department of Clinical Yoga, Alvas College of Naturopathy and Yogic Sciences, Moodbidre, Karnataka, India.

4 Vanitha S Shetty, Principal, Department of Clinical Yoga, Alvas College of Naturopathy and Yogic Sciences, Moodbidre, Karnataka, India.

Cancer is a leading cause of death worldwide, accounting for approximately 9.6 to 10 million deaths across the world in 2023. Breast cancer is the most frequently diagnosed cancer (with more than 2.3 million new cases/year) and the leading cause of cancer death in females worldwide. Even though survival rates are continually increasing, breast cancer is often associated with long-term psychological distress, chronic pain, fatigue and impaired quality of life. There are around 364 studies (2024) done on the effect of yoga on breast cancer. Yoga comprises advice for an ethical lifestyle, spiritual practice, physical activity, breathing exercises and meditation. It is a complementary therapy that is commonly recommended for breast cancer-related impairments and has been shown to improve physical and mental health in people with different cancer types. In conclusion, Yoga has emerged as a valuable complementary therapy in the management of chemotherapy induce fatigue and nausea- vomiting offering physical, emotional, and psychological benefits.

Keywords: Breast Cancer, Women and Yoga, Yoga and Cancer, chemotherapy and Yoga

Corresponding Author How to Cite this Article To Browse
Anaghashree S, Post Graduate Scholar, Department of Clinical Yoga, Alvas College of Naturopathy and Yogic Sciences, Moodbidre, Karnataka, India.
Email: 		Anaghashree S, Archana K, Shetty A, Shetty VS, Exploring the Role of Yoga in Alleviating Chemotherapy - Induced Fatigue and Nausea-Vomiting in Women with Breast Cancer - A Narrative Review. J Ayu Int Med Sci. 2025;10(1):155-159.
Available From
https://jaims.in/jaims/article/view/3971

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-12-14 2024-12-24 2025-01-04 2025-01-14 2025-01-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Not required 12.52

© 2025by Anaghashree S, Archana K, Shetty A, Shetty VSand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2025;10(1)155
Download PDFBack To ArticleIntroductionAims and ObjectivesDiscussionConclusionReferences
Anaghashree S et al. Exploring the Role of Yoga in Alleviating Chemotherapy

Introduction

Today’s woman is a multi-tasker. Illness or death of a woman negatively impacts children, spouse, family and community. Women need to understand importance of their health and its effects on their family and loved ones as it is key to a healthy community.[1] Ancient texts and modern science have made mankind aware of fact that yoga is a science which is practical and useable with guaranteed scope of growth at all levels of human existence- physical, mental, emotional, psychological and spiritual. Today, everyone knows that yoga helps a female at all stages of their life. It is highly beneficial from menarche to menopause along with pre and postnatal periods. Cancer is a leading cause of death worldwide, accounting for approximately 9.6 to 10 million deaths across world in 2023. Breast cancer is most frequently diagnosed cancer (with more than 2.3 million new cases/year) and leading cause of cancer death in females worldwide. Approximately only 0.5–1% of breast cancers occur in men and is mostly seen in women. Breast cancer can affect women at any age after adolescence, however its prevalence rises with age. Even though survival rates are continually increasing, breast cancer is often associated with long-term psychological distress, chronic pain, fatigue and impaired quality of life. There are around 364 studies (2024) done on effect of yoga on breast cancer. Yoga comprises advice for an ethical lifestyle, spiritual practice, physical activity, breathing exercises and meditation.[2] It is a complementary therapy that is commonly recommended for breast cancer-related impairments and has been shown to improve physical and mental health in people with different cancer types. A meta-analysis provides updated clinical practice guidelines from Society for Integrative Oncology on use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance.[3] Meditation and Yoga are recommended to improve all symptoms along with quality of life. Evidence supports recommendation of Yoga as a supportive intervention for improving health-related quality of life and reducing fatigue, anxiety, low mood and sleep disturbances.[2]

Another study suggests that personalized yoga therapy is beneficial for QoL and weight maintenance among women undergoing chemotherapy for early-stage or locally advanced breast cancer. Weight maintenance associated with yoga therapy may be of clinical significance in this population given the poorer prognosis associated with weight gain in breast cancer survivors.[4] In cancer survivors, higher levels of physical activity decrease pain intensity. Due to the multi-morphism of cancer pain, certain mind-body therapies are efficient in reducing the severity of cancer pain and improving other parameters as mentioned above. Betterment of quality of life of breast cancer survivors is also the need of the hour.[5]

Aims and Objectives

To Explore the Effect of Yoga as an Adjuvant therapy for Chemotherapy-induced fatigue, nausea-vomiting

Discussion

Role of Yoga in Oncology

According to 21 International Peer Reviewed Publications Yoga can be used as an effective tool in the treatment of oncological diseases in different stages.

Table 1: Role of Yoga in oncology

SurgeryWound Healing, Immunity, Pain management, Anxiety
ChemotherapyNausea and Emesis, Fatigue, Stress, Mood
RadiotherapySpeech Articulation, Fatigue, Myofascial Pain
Supportive CarePain management, Immunity, QoL, Constipation, Fatigue

Prevalence of symptom burden and distress in cancer patients

jaims_3971_01.jpg
Figure 1: Prevalence of symptom burden and it’s distress


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Anaghashree S et al. Exploring the Role of Yoga in Alleviating Chemotherapy

Fatigue and Nausea - Vomiting are the first two most common and highest distressing symptoms which can be seen in cancer patients who are under treatment.

1. Cancer Related Fatigue

Although better diagnostics and treatment modalities have reduced mortality, a large number of survivors face cancer treatment-related long-term symptoms.[6] Around 75-90% of cancer survivors experience persistent fatigue of unknown origin, causing significant impairment in quality of life. Despite the prevalence and impact of this symptom, currently, there are no empirically validated treatments for persistent cancer-related fatigue (CRF).

CRF is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.[7] Approximately one in four breast cancer survivors suffer from severe fatigue. It is obvious that the number of breast cancer patients with fatigue is enormous and the management of CRF is urgent. The meta-analysis including 2183 participants demonstrated that Yoga can be considered as an alternative therapy to relieve fatigue in breast cancer patients who have completed chemotherapy or are undergoing treatment. An 8-week program with 60/90-min yoga class had a significant effect.[8] Another study suggests that Yoga practice is able to reduce stress and inflammation levels over time. And suggested further studies to include a larger number of patients to increase the power and to consider other inflammatory or pro-inflammatory factors and long-term Yoga program to gain more evidence on Yoga practice benefits.[9] In a clinical trial, acute effects of Yoga on fatigue, autonomic function, and blood biomarkers were investigated. The effect yoga on fatigue was assessed by the Profile of Mood Status (POMS) questionnaire immediately before and after the session. Autonomic nervous function (heart rate variability) and blood biomarkers (cortisol, DHEA-S, TNF-α, IL-6, IFN-γ, IFN-α, prolactin, carnitine, TGF-β1, BDNF, MHPG, and HVA) were compared before and after the session. Decreases in fatigue scores correlated with changes in plasma levels of TGF-β1 and BDNF. In contrast, increased vigor positively correlated with HVA.[10]

Yoga has also been reported to improve dysfunctions of the HPA axis, e.g. the blunted cortisol diurnal slope and to reduce peripheral pro-inflammatory markers such as nuclear factor kappa B (NF-κB) and TNF-α in cancer patients.[11]

2. Chemotherapy Induced Nausea and Vomiting

Nausea and emesis are two major side effects of chemotherapy and known to be partly psychological rather than purely pharmacological in nature (66-91%).[12] Yoga as a complimentary modality is extensively known to reduce anxiety, physiological arousal and stress associated with chemotherapy. Despite recent advances in the understanding of chemotherapy induced nausea and vomiting (CINV) and development of new generation antiemetic agents, nausea and vomiting continue to be the most feared distressing side effect of chemotherapy.[13]

The occurrence of nausea and vomiting relative to chemotherapy administration can be classified as either acute (within first 24 hrs with a peak of 5-6 hours), delayed (after 24 hours of administration) or anticipatory (nausea and emesis prior to subsequent doses of chemotherapy). This inadequacy in CINV control stems from the fact that antiemetic regimens are tailored to manage acute emesis only and not delayed emesis and nausea,[14] where Yoga can be a solution. A study conducted by Raghavendra RM, et.al.,2007 suggested that Yoga intervention helped reduce post-chemotherapy-related nausea and vomiting compared with supportive therapy and coping preparation in stage II and III breast cancer subjects receiving adjuvant chemotherapy. There was a trend towards reduction in post-chemotherapy related vomiting in the Yoga group.[15]

Another comprehensive review demonstrated the potential of Yoga as a complementary therapy for managing CINV. While the outcomes of the studies vary, evidence suggests that yoga can significantly reduce vomiting and improve quality of life, especially when combined with standard antiemetic therapy.[16] In an RCT, a group of Yoga practices were designed in such a way that they relax abdominal region and calm down the mind which might help reduce muscular contractions in the gastrointestinal tract that accompany post CINV or may decrease the sensitivity of chemoreceptor trigger zone to vomiting response (stimuli).


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As per Yoga texts chemotherapy induced nausea and vomiting is as a result of sluggish flow of down-ward life force called Apana Vayu due to antiemetic therapy resulting in derangement in the digestive fire called Samana Vayu. Practice of supine postures with Uttanapadasana (Extended stretch foot pose), Pavanamuktasana (Wind relieving pose) and prone such as Bhujangasana (Cobra pose), Makarasana (Crocodile pose) will help restore the downward flow of Apana Vayu which translates to earlier gastric emptying thereby reducing symptoms of nausea and vomiting. These asanas have prokinetic action that acts on the gastric musculature to relieve symptoms.[16] Practice of cooling pranayama like Shitali and Sheetakari Pranayama involves swallowing air through mouth and exhalation through nostrils. This is known to distend the abdomen and stimulate gastric emptying, leading to decrease feeling of nausea and vomiting.[18]

Conclusion

In conclusion, Yoga has emerged as a valuable complementary therapy in the management of chemotherapy induce fatigue and nausea- vomiting offering physical, emotional, and psychological benefits. By reducing stress, alleviating treatment-related side effects, improving physical function, and enhancing overall quality of life, yoga supports patients during treatment and survivorship. While it is not a substitute for medical treatment, integrating Yoga into a holistic care plan can empower patients, promote healing, and foster resilience. Future research is essential to further validate its efficacy and establish standardized practices, but the existing evidence underscores the profound potential of Yoga as a supportive tool during and after chemotherapy care.

References

1. Yoga for women's health. The Times of India. . . [Crossref][PubMed][Google Scholar]

2. Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017 Jan 3;1(1):CD010802. [Crossref][PubMed][Google Scholar]

3. Bath C. ASCO endorses guidelines for integrative therapies during and after breast cancer treatment. . . [Crossref][PubMed][Google Scholar] [Crossref][PubMed][Google Scholar]

4. Greaney SK, Amin N, Prudner BC, Compernolle M, Sandell LJ, Tebb SC, et al. Yoga therapy during chemotherapy for early-stage and locally advanced breast cancer. Integr Cancer Ther [Internet]. 2022 Nov 22;21:15347354221137285. [Crossref][PubMed][Google Scholar]

5. Maindet C, Burnod A, Minello C, George B, Allano G, Lemaire A. Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management. Support Care Cancer. 2019 Aug;27(8):3119-32. [Crossref][PubMed][Google Scholar]

6. Amritanshu RR, Rao RM, Nagaratna R, Veldore VH, Usha Rani MU, Gopinath KS, et al. Effect of long-term yoga practice on psychological outcomes in breast cancer survivors. Indian J Palliat Care. 2017. [Crossref][PubMed][Google Scholar]

7. Levy MH, Back A, Benedetti C, Billings JA, Block S, Boston B, et al. NCCN clinical practice guidelines in oncology: palliative care. J Natl Compr Cancer Netw JNCCN. 2009;7(4):436-73. [Crossref][PubMed][Google Scholar]

8. Dong B, Xie C, Jing X, Lin L, Tian L. Yoga has a solid effect on cancer-related fatigue in patients with breast cancer: a meta-analysis. Breast Cancer Res Treat. 2019 Aug;177(1):5-16. [Crossref][PubMed][Google Scholar]

9. Micheletti S, Serra P, Tesei A, Azzali I, Arienti C, Ancarani V, et al. Effects of yoga practice on physiological distress, fatigue and QOL in patients affected by breast cancer undergoing adjuvant radiotherapy. Tech Innov Patient Support Radiat Oncol. 2022;24:32-9. [Crossref][PubMed][Google Scholar]

10. Oka T, Tanahashi T, Sudo N, Lkhagvasuren B, Yamada Y. Changes in fatigue, autonomic functions, and blood biomarkers due to sitting isometric yoga in patients with chronic fatigue syndrome. Biopsychosoc Med. 2018;12:3. [Crossref][PubMed][Google Scholar]


J Ayu Int Med Sci 2025;10(1)158
Anaghashree S et al. Exploring the Role of Yoga in Alleviating Chemotherapy

11. Oka T, Tanahashi T, Chijiwa T, Lkhagvasuren B, Sudo N, Oka K. Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial. Biopsychosoc Med. 2014 Dec;8(1):27. [Crossref][PubMed][Google Scholar]

12. Chemotherapy-induced nausea and vomiting: Optimizing prevention and management - PMC. . . 2014 Dec;8(1):27. [Crossref][PubMed][Google Scholar] [Crossref][PubMed][Google Scholar]

13. Chemotherapy-induced nausea and vomiting: Pathogenesis, recommendations, and new trends - Science Direct. . . 2014 Dec;8(1):27. [Crossref][PubMed][Google Scholar] [Crossref][PubMed][Google Scholar] [Crossref][PubMed][Google Scholar]

14. Schiff E, Ben-Arye E. Complementary therapies for side effects of chemotherapy and radiotherapy in the upper gastrointestinal system. Eur J Integr Med. 2011 Apr 1;3(1):11-6. [Crossref][PubMed][Google Scholar]

15. Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, Srinath BS, Ravi BD, et al. Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. Eur J Cancer Care (Engl). 2007 Nov;16(6):462-74. [Crossref][PubMed][Google Scholar]

16. Giridharan S. Efficacy of yoga as complementary therapy in managing chemotherapy-induced nausea and vomiting: a comprehensive review. Int J Sci Acad Res. 2024;5:6909-14. [Crossref][PubMed][Google Scholar]

17. Usharani MR, Nandini PKL, Raghavendra RM, Kavya M, Aishvarrya S, Shekhar GP, et al. Comparison of yoga vs. relaxation on chemotherapy-induced nausea and vomiting outcomes: a randomized controlled trial. J Integr Oncol. 2014;3(1):116 [Crossref][PubMed][Google Scholar]

18. Rp V, S T. Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels. Psychol Rep. 2002 Apr;90(2). [Crossref][PubMed][Google Scholar]

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