Yoga therapy looks at the levels and quality of our energy, lifestyle, core beliefs and ethics, emotional intelligence, and finally at our ability to manage our minds and thought processes. Yoga postulates that disease in the body is an outcome of imbalance among these levels of existence. While medical doctors’ focus on treating disease symptoms, yoga therapy focuses on the whole human being and restoring balance. Yoga therapy facilitates transformation, which leads to improved long-term health, well-being, and quality of life.

Medical doctors take responsibility for providing a diagnosis and then attempt a cure through prescriptions or surgery when needed. Yoga therapists take responsibility for empowering clients with yogic tools; when practiced over a longer period, these tools can restore balance and enhance self-healing. Yoga therapists know and understand yogic sciences, which offer a variety of therapeutic techniques such as pranayama (breath work), meditation, yoga nidra, asana (physical postures), mudras (gestures), mantras, and chanting. Skillfully applied to an individual case, these tools effectively assist with health predicaments.

To be clear, I do not postulate that yoga can replace medical care. Both approaches can be applied simultaneously to patients’ benefit. Moreover, yoga can complement and fill gaps left when conventional care has done its job.

Take, for instance, the conclusion of conventional cancer treatment, which usually means accumulated toxins—from chemotherapy and/or radiation—in the body. The treatments are long and the side-effects creep up slowly, so patients may initially have little awareness of their poor state. Research shows that more than 70% of patients suffer from mental and physical fatigue, cognitive dysfunction (brain fog), depression, mental confusion and loss of short-term memory, and pent-up anger after ending their treatments. They may have felt terrible for a long time and don’t know when—or if—they will feel any better.

Yoga therapy has an important role to play. Yoga therapy is not in the business of curing cancer, but this is indeed miraculous healing.

More than a quarter of all cancer patients visit complementary and alternative medicine providers during treatment to manage common cancer-related symptoms and side effects.

1.  Mind-body practices are a type of complementary and alternative medicine. These practices include acupuncture, massage therapy, meditation, relaxation techniques, spinal manipulation, and yoga.
2.  Yoga, an integrative practice that originated in ancient India, links the physical, emotional, spiritual, and mental health domains. Yoga practices include physical postures focused on movement and stretching, breathing techniques, deep relaxation, guided imagery, and meditation.
3. Philosophically, the goal of yoga is to increase mastery of the body and breath to achieve mastery of the mind, with the final goal of cultivating deeper spiritual awareness and connection.
4. Yoga therapy can be highly adaptable for persons with cancer. In fact, yoga therapy can help persons with limited mobility, as well as active individuals.
5. It is important to differentiate between yoga and yoga therapy. A general public yoga class can certainly ease everyday aches, pains, and mood complaints; however, a yoga therapy session is tailored to the individual or patient population and addresses physical, mental, and emotional needs.

Yoga therapists provide services to cancer patients in a variety of settings—from outpatient to inpatient—including patients at end of life. Multiple studies have demonstrated the effectiveness of yoga therapy for symptom management in patients with cancer, including its potential to decrease fatigue, pain, anxiety, depression, and insomnia and improve flexibility, balance, mood, and overall quality of life.

Evidence suggests that chronic stress can promote cancer growth and progression. The underlying mechanisms for the effects of chronic stress are complex and involve chronic activation of the sympathetic nervous system and the hypothalamic pituitary-adrenal axis. Hormones (e.g., norepinephrine, cortisol) are constantly released in differing levels from these pathways and can result in many different effects, including the stimulation of cancer invasion, angiogenesis, and inflammation, which can reduce the efficacy of chemotherapy drugs.

Multiple studies have demonstrated a correlation between yoga therapy and decreased stress in cancer patients. Yoga therapy has also been associated with decreased inflammation and reduction of many of the common symptoms found in the cancer patient population.

So, where do you start?
Cancer patients and survivors wholly unfamiliar with the practice of yoga should talk with their doctor about programs that may be specific to their condition. A yoga practice focusing on restorative postures, relaxation, and meditation is very helpful for fatigue, anxiety, depression, and other symptoms of cancer and cancer treatment.”

Four poses to get started:

1. Seated Spinal Twist-
This pose can help with digestion and nausea. Start by sitting cross-legged on the floor.

1. Breathe deeply.
2. On the exhale, slowly twist your body to look over your right shoulder, placing
   your left hand on your right knee and your right hand behind your body.
3. Breathe deeply and hold the stretch.

2. Legs up the Wall-
Also known as Viparita Karani, this pose can help combat fatigue.

1. Sit on the floor with your left side against the wall.
2. Turn to the left and bring your legs up against the wall as you lower your body into a prone position.
3. Scoot your buttocks against the wall.
4. Your shoulders and head will rest on the floor while your legs stretch up the wall in this relaxed position.

3. Reclined Bound Angle-
Supta Baddha Konasana can also reduce fatigue and stress.

1. Begin seated and bring your feet together in front of you, with the soles facing one another, knees bent and heels pointing toward your groin.
2. Slowly lie back, supporting yourself with your arms until your back is against the
   floor.
3. Relax and breathe deeply, with arms out to your sides.

4. Seated Meditation-
A beginner pose, seated meditation helps you to focus on breathing and mindfulness.

1. Sit on the floor with your legs crossed in front of you.
2. Feel your sitting bones in contact with the floor.
3. Lengthen your spine to sit up tall, and gently drop your chin down slightly so your neck is aligned with your spine.
4. Breathe deeply and try to keep your mind from wandering.

“We know that life is painful — that getting cancer and going through cancer treatment is extremely painful, emotionally as well as physically. “But as yogis, we are also taught that suffering is optional, that we can transform our suffering into awakening with the recognition that everything in life is for our awakening.

 But yoga can be transformative for cancer patients who are able to put it into practice.

Benefits of yoga in cancer patients
As with many types of complementary therapy one of the main reasons that people with cancer use yoga is because it makes them feel good. Yoga teachers promote it as a natural way to help you relax and cope with stress, anxiety and depression.

Generally, it can help to lift your mood and enhance well-being. Some people with cancer say it helps calm their mind so that they can cope better with their cancer and its treatment. Others say it helps to reduce symptoms and side effects such as pain, tiredness, sleep problems and depression.

Yoga can sometimes help you to move around more quickly and easily after surgery for cancer. A yoga session usually lasts between 60 and 90 minutes. You can attend group classes or see a private teacher.

What it involves will depend on the style of yoga you choose:-

• But you will usually do a series of postures and breathe work, which will end with some relaxation time.
• Wear clothing that you find easy to move and stretch in.
• You usually need a non-slip mat. Your teacher might provide these or you can bring your own.
• You should only practice yoga on your own at home after you have learnt the safe and proper way to do the postures. You could injure yourself if you don’t do them correctly.

1. Lower fatigue                                        
Several studies have linked yoga with reduced fatigue in cancer patients. Several studies have reported a significant decrease in fatigue through the use of yoga, patients’ fatigue decreased the more yoga sessions they did per week.

2. Reduce stress
Battling a life-threatening disease is physically, emotionally, and mentally stressful. Yoga may be able to help with this aspect of cancer as well. One study found that practicing a seven-week yoga routine was able to reduce the likelihood of developing “mood disturbance” by up to 65 percent. It has found that the reduction in stress also improves quality of life, appetite, and could be responsible for reduction in pain.

3. Improve physical functioning
In addition to everything on your mind, cancer affects your ability to move. Spending time in the hospital or sick at home can make the body stiff and sore and make it more difficult to complete daily tasks. As a regular form of exercise, yoga is a gentle way to stay limber and active. Regular yoga practice can improve functional well-being in both cancer patients and survivors.

4. Sleep better
A combination of physical and mental stress can make sleep difficult, but healing the body requires ample rest. Yoga can help with insomnia and make it easier for cancer patients to relax at night. It has found yoga to be able to help improve sleep quality, efficiency, and duration.

5. Lower risk of recurrence
“It has been shown to result in decreased body fat density, which can help to reduce the risk of cancer recurrence.” Obesity is a risk for cancer, and managing your risks is important even after a diagnosis and recovery. Regular exercise through yoga is just one way of keeping the risk at bay.

Side effects and precautions
Yoga is generally very safe if you do it properly, under instruction from a qualified teacher.

The teachers usually recommend the following safety measures:

• Allow at least 3 hours after eating before doing yoga.
• Don’t do yoga alone at home until you’ve practiced it with a qualified teacher.
• Tell your teacher about any medical problems you have, including back and joint problems, before you begin.
• Stop and tell your teacher if any posture is painful for you.
• Never try difficult postures, such as head and shoulder stands, without first being shown how to do this by a qualified teacher.
• Women who are pregnant, or have their period, shouldn’t practice certain postures (your teacher will advise you about which these are).

Yoga has been shown to improve sleep and reduce fatigue for cancer patients and survivors:
Fatigue is one of the most frequently reported side effects among cancer survivors. Approximately 25-30% of cancer survivors report persistent fatigue for five to ten years post-treatment. Recent research suggests yoga interventions improve sleep and reduce persistent fatigue, which can boost quality of life, psychosocial adjustment, and inflammatory pathways. A randomized controlled study conducted in 2004 investigated the effects of seven weekly 75-minute yoga sessions for patients with lymphoma. The regular practice of controlled breathing, mindfulness techniques, and low-impact postures improved overall sleep, sleep quality and duration, and decreased participants’ use of sleeping pills. A more recent study found that three months of 90-minute biweekly  yoga classes significantly improved persistent fatigue for patients with breast cancer. A meta-analysis of 13 RCTs similarly found a small but significant effect of yoga interventions on fatigue. A systematic review of 24 studies found yoga interventions for women with breast cancer improve sleep quality, decrease fatigue, and increase quality of life compared to no therapy. The review also found that yoga interventions were more effective than psychosocial and educational interventions in reducing depression, anxiety, and fatigue. In a randomized controlled trial that compared a specialized yoga intervention to health education for breast cancer survivors, participants who practiced yoga experienced clinically significant improvements in fatigue and vigor. The yoga intervention included twice weekly 90-minute hatha yoga classes for twelve weeks. At three months, the yoga group reported less fatigue and more vitality. The group also showed decreased inflammation compared to those in the health education group. A 10-minute increase in the duration of yoga practice per day produced even greater changes.

Yoga has been shown to reduce various types of pain:
In non-cancer populations, yoga has been shown to reduce many forms of pain, including arthritis pain, back pain, and carpal tunnel pain. For those with cancer, recent studies suggest yoga can reduce joint pain, muscle and body aches, and musculoskeletal symptoms. Up to 50% of breast cancer survivors who use aromatase inhibitors (AIs) experience musculoskeletal symptoms such as joint and muscle pain. These symptoms often cause patients to stop taking AIs altogether. A recent study conducted a secondary analysis on data from a phase II/III randomized controlled trial examining a yoga intervention for breast cancer survivors. The yoga intervention consisted of gentle Hatha and restorative yoga postures, breathing, and mindfulness exercises. The 75-minute sessions were delivered in a group setting, twice weekly for four weeks. Compared with standard care, 88% of yoga participants reported reductions in musculoskeletal symptom severity. The yoga group reported significantly greater reductions in pain, muscle aches, time spent in bed, and feelings of weakness, sluggishness, and heaviness in the body.

Yoga has been shown to improve strength, range of motion, and bone health:
Cancer treatments such as radiation, chemotherapy, and medications can decrease muscle and bone strength, flexibility, and health over both short- and long-term periods. As a result, cancer survivors have an increased risk of osteopenia and osteoporosis. These conditions can result in back pain, loss of spinal flexion, and fractures, making it difficult to perform daily tasks, exercise, and maintain a healthy lifestyle. Regular yoga practice increases muscle strength and flexibility, supports a full range of movement in different joints, and improves balance. A 2010 review found that yoga is as effective or better than other forms of exercise at improving a variety of health-related outcome measures, including muscle strength and flexibility. This was true for patients with chronic diseases and for those in good health. Many yoga poses involve weight bearing, which has been shown to strengthen bones, increase spinal flexion, and improve posture. A seminal two-year pilot study of yoga and osteoporosis found that the participants (average age: 68) who did 10 specified yoga postures per day (about 10 minutes) experienced improvements in bone density. Several of the patients who had osteoporosis improved enough to be reclassified to osteopenia.  The same study then followed the volunteers over a ten-year period to determine the long-term effects of a 12-minute yoga regimen (n=741) and found increased bone mineral density in the spine, hips, and femur of moderately and fully compliant participants.

Cancer-specific yoga should incorporate physical postures, breathing techniques, relaxation techniques like yoga nidra, and meditation:
Physical postures might include a series of seated, standing, transitional, and supine poses. These poses can help build strength, flexibility and breath capacity, as well as facilitate lymphatic drainage and weight management. Breathing exercises might include slow, controlled, diaphragmatic, and movement-coordinated breath work. These practices can help patients and survivors reduce stress and improve sleep. Meditations might include body scanning (progressive relaxation), breath awareness and mindfulness. Meditation can help survivors manage anxiety and pain, as well as improve overall quality of life. The volume and application of the physical postures and the meditation exercises is adaptable to fit the needs of the participants. But all elements should be focused on addressing common treatment side effects and be adapted for each individual’s abilities, goals, and physical and emotional status.

A word of caution
Before you begin any yoga practice make sure that you tell your yoga teacher about your condition. They can adapt the exercises to suit your needs. It is important to take things gently at first to minimize the risk of injury. Yoga is a safe, effective, and low-cost modality that must be included in the continuum of care. For the most part, the onus is on patients themselves to seek out, pay for, participate in, and assess the therapeutic benefits of yoga programs. This is no small task for healthy people. For patients dealing with illness, multi-stage treatment plans, and crippling medical costs, these barriers can deter patients from seeking out a yoga practice or exercise regime at the onset. Removing these burdens will require the involvement of knowledgeable physicians who can refer patients and survivors to vetted classes, interventions, and yoga professionals. Physicians and medical professionals are uniquely well positioned to encourage patients to integrate yoga in their treatment plans and should be equipped with research on its benefits. Insurance and wellness benefits programs can help make yoga programs more available to cancer patients and survivors, and community-based groups that are committed to full-spectrum cancer recovery have an essential role to play.