Is the combination of yoga with meditation effective in improving menopausal symptoms among breast cancer survivors?
Date of publication of randomized controlled trial: March 2015
Design
Randomized controlled trial (RCT).
Participants
40 women (mean age range: 43.3 to 55.1 years) who had been treated for histologically confirmed, nonmetastatic breast cancer (International Union Against Cancer stages I-III). Patients had suffered from at least mild menopausal symptoms, which was reflected by a value of at least 5 points on the Menopause Rating Scale (MRS).
Intervention
Traditional Hatha yoga was performed. The classes were provided once a week for 12 weeks and each session lasted for 90 minutes. Women were encouraged to practice yoga and meditation daily at home.
Comparator
Comparison: Yoga plus meditation versus waiting list without any interventions.
Major Outcomes
Outcome 1: Change in total menopausal symptoms severity measured on the MRS at week 12;
Outcome 2: Change in total menopausal symptoms severity measured on the MRS at week 24;
Outcome 3: Change in somatovegetative symptoms severity measured on the MRS at week 12;
Outcome 4: Change in psychological symptoms severity measured on the MRS at week 12;
Outcome 5: Change in urogenital symptoms severity measured on the MRS at week 12.
For all above outcomes, higher score indicated more severe symptoms.
Settings
The trial was conducted in outpatient setting.
Comparison    Yoga plus meditation versus waiting list without any interventions
Main Results
Compared to waiting list without any interventions, total menopausal symptoms were significantly lower among patients in yoga plus meditation group at week 12 (mean difference (MD): −5.6, 95% CI: −9.2 to −1.9) and week 24 (MD: −4.5, 95% CI: −8.3 to −0.7). Moreover, significant mean difference favoring yoga plus meditation group was observed for all MRS subscales in assessing somatovegetative (MD: −1.8, 95% CI: −3.5 to −0.14), psychological (MD: −2.4, 95% CI: −4.2 to −0.5), and urogenital menopausal symptoms subscales (MD: −1.5, 95% CI: −2.7 to -0.2) at week 12.
Comparison: Yoga plus meditation versus waiting list without any interventions for symptom management
Outcomes No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1(40) 11.6 (7.2) / 19 18.7(8.0)/ 21 Not applicable as there is only 1 trial −5.6 (−9.2 to −1.9) 0.004 Moderate
2 1(40) 13.0 (7.3)/ 19 19.0 (8.2)/ 21 Not applicable as there is only 1 trial −4.5 (−8.3 to −0.7) 0.023 Moderate
3 1(40) 5.8 (3.6)/ 19 7.4 (2.9) / 21 Not applicable as there is only 1 trial −1.8 (−3.5 to −0.14) 0.035 Moderate
4 1(40) 3.5(2.8) / 19 7.1 (4.4) / 21 Not applicable as there is only 1 trial −2.4 (−4.2 to −0.5) 0.012 Moderate
5 1(40) 2.3 (2.4)/ 19 4.2 (2.8)/ 21 Not applicable as there is only 1 trial −1.5 (−2.7 to -0.2) 0.025 Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Comparison    Yoga plus meditation versus waiting list without any interventions
Main Results
Compared to waiting list without any interventions, total menopausal symptoms were significantly lower among patients in yoga plus meditation group at week 12 (mean difference (MD): −5.6, 95% CI: −9.2 to −1.9) and week 24 (MD: −4.5, 95% CI: −8.3 to −0.7). Moreover, significant mean difference favoring yoga plus meditation group was observed for all MRS subscales in assessing somatovegetative (MD: −1.8, 95% CI: −3.5 to −0.14), psychological (MD: −2.4, 95% CI: −4.2 to −0.5), and urogenital menopausal symptoms subscales (MD: −1.5, 95% CI: −2.7 to -0.2) at week 12.
Comparison: Yoga plus meditation versus waiting list without any interventions for symptom management
Outcomes 1 2 3 4 5
No. of studies (Total number of participants) 1(40) 1(40) 1(40) 1(40) 1(40)
Mean (SD)/ No. of participants Intervention 11.6 (7.2) / 19 13.0 (7.3)/ 19 5.8 (3.6)/ 19 3.5(2.8) / 19 2.3 (2.4)/ 19
Comparator 18.7(8.0)/ 21 19.0 (8.2)/ 21 7.4 (2.9) / 21 7.1 (4.4) / 21 4.2 (2.8)/ 21
MD (95% CI) −5.6 (−9.2 to −1.9) −4.5 (−8.3 to −0.7) −1.8 (−3.5 to −0.14) −2.4 (−4.2 to −0.5) −1.5 (−2.7 to -0.2)
p value 0.004 0.023 0.035 0.012 0.025
Overall quality of evidence* Moderate Moderate Moderate Moderate Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to waiting list without any interventions, total menopausal symptoms severity was significantly reduced among patients in yoga plus meditation group at week 12 and 24. Yoga plus meditation also provided significant alleviation on somatovegetative, psychological, and urogenital symptoms at week 12. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
No serious adverse events were observed in the trial. Six women in the yoga and meditation group reported adverse events. Two adverse events were panic attack (n=1) and foot pain (n=1), they were not temporarily related to yoga practice. The remaining 4 adverse events, which were temporarily and probably causally related to the yoga intervention, were transient muscle soreness (n = 3) and unilateral hip pain (n = 1). Six women in the waiting list group also reported adverse events, including sciatica (n = 1), port pain (n = 1), elbow pain (n = 1), knee pain (n = 2), and panic attacks (n = 1).
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25739642
The synopsis is based on the following article:
Cramer H, Rabsilber S, Lauche R, Kümmel S, Dobos G. Yoga and meditation for menopausal symptoms in breast cancer survivors—A randomized controlled trial. Cancer. 2015 Jul 1;121(13):2175-84.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.