The Impact of Yoga on Quality of Life and Psychological Distress in Caregivers for Patients With Cancer

Andi Céline Martin

Melanie R. Keats

yoga, quality of life, distress, caregiver, cancer
ONF 2014, 41(3), 257-264. DOI: 10.1188/14.ONF.257-264

Purpose/Objectives: To assess the effects of a six-week Vinyasa yoga (VY) intervention on caregivers' overall quality of life (QOL) and psychological distress.

Design: A single-group, pre- and post-test pilot study.

Setting: University public recreational facility.

Sample: 12 informal caregivers for patients with cancer.

Methods: Caregivers participated in a six-week VY intervention and completed measures of QOL and psychological distress pre- and postintervention. Program satisfaction was measured with open-ended survey questions.

Main Research Variables: QOL, psychological distress, and program satisfaction.

Findings: Significant improvements were found in the mental component score of overall QOL and in overall psychological distress. Several subdomains of QOL and psychological distress were also improved significantly. Open-ended survey question responses revealed participants perceived physical and mental benefit from the intervention, highlighting improvements in flexibility, core and upper-body strength, balance, breathing, and energy.

Conclusions: Informal caregivers may benefit mentally and physically from participating in VY.

Implications for Nursing: Caregivers of patients with cancer characterize a group worthy of attention, research, and interventions focusing on their healthcare needs.

Jump to a section


    Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211. doi:10.1016/0749-5978(91)90020-T
    Baider, L. (2011). Unsteady balance: The constraints of informal care. Journal of Pediatric Hematology/Oncology, 33(Suppl. 2), S108-S111. doi:10.1097/MPH.0b013e318230ddb2
    Blanchard, C.M., Courneya, K.S., Rodgers, W.M., & Murnaghan, D.M. (2002). Determinants of exercise intention and behavior in survivors of breast and prostate cancer: An application of the theory of planned behavior. Cancer Nursing, 25, 88-95. doi:10.1097/00002820-200204000-00002
    Blum, K., & Sherman, D.W. (2010). Understanding the experience of caregivers: A focus on transitions. Seminars in Oncology Nursing, 26, 243-258. doi:10.1016/j.soncn.2010.08.005
    Boyle, D., Blodgett, L., Gnesdiloff, S., White, J., Bamford, A.M., Sheridan, M., & Beveridge, R. (2000). Caregiver quality of life after autologous bone marrow transplantation. Cancer Nursing, 23, 193-203. doi:10.1097/00002820-200006000-00006
    Braun, M., Mikulincer, M., Rydall, A., Walsh, A., & Rodin, G. (2007). Hidden morbidity in cancer: Spouse caregivers. Journal of Clinical Oncology, 25, 4829-4834. doi:10.1200/JCO.2006.10.0909
    Cameron, J.I., Shin, J.L., Williams, D., & Stewart, D.E. (2004). A brief problem-solving intervention for family caregivers to individuals with advanced cancer. Journal of Psychosomatic Research, 57, 137-143. doi:10.1016/S0022-3999(03)00609-3
    Canadian Society for Exercise Physiology. (2012). Canadian Physical Activity and Sedentary Behaviour Guidelines Handbook. Retrieved from
    Castro, C.M., Wilcox, S., O'Sullivan, P., Baumann, K., & King, A.C. (2002). An exercise program for women who are caring for relatives with dementia. Psychosomatic Medicine, 64, 458-468.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
    Collins, L.G., & Swartz, K. (2011). Caregiver care. American Family Physician, 83, 1309-1317.
    Coulter, H.D. (2001). Anatomy of Hatha yoga. A manual for students, teachers, and practitioners. Marlboro, VT: Body and Breath.
    Couper, J., Bloch, S., Love, A., Macvean, M., Duchesne, G.M., & Kissane, D. (2006). Psychological adjustment of female partners of men with prostate cancer: A review of the literature. Psycho-Oncology, 15, 937-953. doi:10.1002/pon.1031
    Courneya, K.S., & Friedenreich, C.M. (1999). Utility of the theory of planned behavior for understanding exercise during breast cancer treatment. Psycho-Oncology, 8, 112-122.
    Courneya, K.S., Friedenreich, C.M., Arthur, K., & Bobick, T.M. (1999). Understanding exercise motivation in colorectal cancer patients: A prospective study using the theory of planned behavior. Rehabilitation Psychology, 44, 68-84. doi:10.1037/0090-5550.44.1.68
    Downs, D.S., & Hausenblas, H.A. (2005). Applying the theories of reasoned action and planned behavior to exercise: A meta-analytic update. Journal of Physical Activity and Health, 2, 76-97.
    Edwards, B.K., Howe, H.L., Ries, L.A., Thun, M.J., Rosenberg, H.M., Yancik, R., … Feigal, E.G. (2002). Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden. Cancer, 94, 2766-2792. doi:10.1002/cncr.10593
    Etkin, C.D., Prohaska, T.R., Connell, C.M., Edelman, P., & Hughes, S.L. (2008). Antecedents of physical activity among family caregivers. Journal of Applied Gerontology, 27, 350-367. doi:10.1177/0733464808315276
    Fraser, T. (2006). Total Astanga: The step-by-step guide to power yoga at home for everybody. New York, NY: Duncan Baird.
    Given, B.A., Given, C.W., & Kozachik, S. (2001). Family support in advanced cancer. CA: A Cancer Journal for Clinicians, 51, 213-231. doi:10.3322/canjclin.51.4.213
    Grunfeld, E., Coyle, D., Whelan, T., Clinch, J., Reyno, L., Earle, C.C., … Glossop, R. (2004). Family caregiver burden: Results of a longitudinal study of breast cancer patients and their principal caregivers. Canadien Medical Association Journal, 170, 1795-1801. doi:10.1503/cmaj.1031205
    Hill, K., Smith, R., Fearn, M., Rydberg, M., & Oliphant, R. (2007). Physical and psychological outcomes of a supported physical activity program for older carers. Journal of Aging and Physical Activity, 15, 257-271.
    Hinnen, C., Ranchor, A.V., Sanderman, R., Snijders, T.A., Hagedoorn, M. & Coyne, J.C. (2008). Course of distress in breast cancer patients, their partners, and matched control couples. Annals of Behavioral Medicine, 36, 141-148. doi:10.1007/s12160-008-9061-8
    Hodges, L.J., Humphris, G.M., & Macfarlane, G. (2005). A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Social Science and Medicine, 60, 1-12. doi:10.1016/j.socscimed.2004.04.018
    Hsieh, H.F., & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277-1288. doi:10.1177/1049732305276687
    Jacobs, B.P., Mehling, W., Avins, A.L., Goldberg, H.A., Acree, M., Lasater, J.H., … Maurer, S. (2004). Feasibility of conducting a clinical trial on Hatha yoga for chronic low back pain: Methodological lessons. Alternative Therapies in Health and Medicine, 10, 80-83.
    Kaminoff, L. (2007). Yoga anatomy. Windsor, Canada: Human Kinetics.
    Keats, M.R., Culos-Reed, S.N., Courneya, K.S., & McBride, M. (2007). Understanding physical activity in adolescent cancer survivors: An application of the theory of planned behavior. Psycho-Oncology, 16, 448-457. doi:10.1002/pon.1075
    Kim, Y., & Given, B.A. (2008). Quality of life of family caregivers of cancer survivors. Cancer, 112(Suppl.), 2556-2568. doi:10.1002/cncr.23449
    Kim, Y., Kashy, D.A., Spillers, R.L., & Evans, T.V. (2010). Needs assessment of family caregivers of cancer survivors: Three cohorts comparison. Psycho-Oncology, 19, 573-582. doi:10.1002/pon.1597
    Kim, Y., & Schulz, R. (2008). Family caregivers' strains: Comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. Journal of Aging and Health, 20, 483-503. doi:10.1177/0898264308317533
    King, A.C., & Brassington, G. (1997). Enhancing physical and psychological functioning in older family caregivers: The role of regular physical activity. Annals of Behavioral Medicine, 19, 91-100.doi:10.1007/BF02883325
    Kitrungroter, L., & Cohen, M.Z. (2006). Quality of life of family caregivers of patients with cancer: A literature review. Oncology Nursing Forum, 33, 625-632. doi:10.1188/06.ONF.625-632
    Lim, K., & Taylor, L. (2005). Factors associated with physical activity among older people—a population-based study. Preventive Medicine, 40, 33-40. doi:10.1016/j.ypmed.2004.04.046
    Manne, S.L., Norton, T.R., Ostroff, J.S., Winkel, G., Fox, K., & Grana, G. (2007). Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction. Journal of Family Psychology, 21, 380-388. doi:10.1037/0893-3200.21.3.380
    Mant, J., Carter, J., Wade, D.T., & Winner, S. (2000). Family support for stroke: A randomised controlled trial. Lancet, 356, 808-813. doi:10.1016/S0140-6736(00)02655-6
    Matthews, B.A. (2003). Role and gender differences in cancer-related distress: A comparison of survivor and caregiver self-reports. Oncology Nursing Forum, 30, 493-499. doi:10.1188/03.ONF.493-499
    McCall, T. (2007). Yoga as Medicine: The yogic prescription for health and healing. New York, NY: Bantam Dell.
    McCorkle, R., Siefert, M.L., Dowd, M.F., Robinson, J.P., & Pickett, M. (2007). Effects of advanced practice nursing on patient and spouse depressive symptoms, sexual function, and marital interaction after radical prostatectomy. Urologic Nursing, 27, 65-77.
    McNair, D.M., & Heuchert, J.W.P. (2005). Profile of Mood States technical update. North Tonawanda, NY: Multi-Health Systems.
    McNair, D.M., Lorr, M., & Droppelman, L.F. (1971). Manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.
    Mellon, S., Northouse, L.L., & Weiss, L.K. (2006). A population-based study of the quality of life of cancer survivors and their family caregivers. Cancer Nursing, 29, 120-131. doi:10.1097/00002820-200603000-00007
    Michalsen, A., Grossman, P., Acil, A., Langhorst, J., Lüdtke, R., Esch, T., … Dobos, G.J. (2005). Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Medical Science Monitor, 11, 555-561.
    Moadel, A., Shah, C., Wylie-Rosett, J., Harris, M.S., Patel, S.R., Hall, C.B., & Sparano, J.A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects of quality of life. Journal of Clinical Oncology, 25, 4387-4395. doi:10.1200/JCO.2006.06.6027
    Northouse, L.L., Mood, D.W., Montie, J.E., Sandler, H.M., Forman, J.D., Hussain, M., … Kershaw, T. (2007). Living with prostate cancer: Patients' and spouses' psychological status and quality of life. Journal of Clinical Oncology, 25, 4171-4177. doi:10.1200/JCO.2006.09.6503
    Oken, B.S., Zajdel, D., Kishiyama, S., Flegal, K., Dehen, C., Haas, M., … Leyva, J. (2006). Randomized, controlled, six-month trial of yoga in healthy seniors: Effects on cognition and quality of life. Alternative Therapies in Health and Medicine, 12, 40-47.
    Osborne, J.W., & Overbay, A. (2004). The power of outliers (and why researchers should always check for them). Practical Assessment, Research and Evaluation, 9(6). Retrieved from
    Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2005). Yoga for depression: The research evidence. Journal of Affective Disorders, 89, 13-24. doi:10.1016/j.jad.2005.08.013
    Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18, 250-267.
    Pinquart, M., & Sörensen, S. (2007). Correlates of physical health of informal caregivers: A meta-analysis. The Journals of Gerontoloy. Series B, Psychological Sciences and Social Sciences, 62(2), P126-P137.
    Price, I. (2000). Determining if skewness and kurtosis are significantly non-normal. Retrieved from
    Rabin, E.G., Heldt, E., Hirakata, V.N., Bittlebrunn, A.C., Chachamovich, E., & Fleck, M.P.A. (2009). Depression and perceptions of quality of life of breast cancer survivors and their male partners [Online exclusive]. Oncology Nursing Forum, 36, E153-E158. doi:10.1188/09.ONF.E153-E158
    Rivera, H.R. (2009). Depression symptoms in cancer caregivers. Clinical Journal of Oncology Nursing, 13, 195-202. doi:10.1188/09.CJON.195-202
    Sareen, S., Kumari, V., Gajebasia, K.S., & Gajebasia, N.K. (2007). Yoga: A tool for improving the quality of life in chronic pancreatitis. World Journal of Gastroenterology, 13, 391-397.
    Schulz, R., Martire, L.M., & Klinger, J.N. (2005). Evidence-based caregiver interventions in geriatric psychiatry. Psychiatric Clinics of North America, 28, 1007-1038.
    Segrin, C., & Badger, T.A. (2010). Psychological distress in different social network members of breast and prostate cancer survivors. Research in Nursing and Health, 33, 450-464. doi:10.1002/nur.20394
    Sjövall, K., Attner, B., Lithman, T., Noreen, D., Gunnars, B., Thomé, B., & Olsson, H. (2009). Influence on the health of the partner affected by tumor disease in the wife or husband based on a population-based register study of cancer in Sweden. Journal of Clinical Oncology, 27, 4781-4786. doi:10.1200/JCO.2008.21.6788
    Speed-Andrews, A.E., Stevinson, C., Belanger, L.J., Mirus, J.J., & Courneya, K.S. (2010). Pilot evaluation of an Iyengar yoga program for breast cancer survivors. Cancer Nursing, 33, 369-381. doi:10.1097/NCC.0b013e3181cfb55a
    Swartz, J.J., & Keir, S.T. (2007). Program preferences to reduce stress in caregivers of patients with brain tumors. Clinical Journal of Oncology Nursing, 11, 723-727. doi:10.1188/07.CJON.723-727
    Ulger, O., & Yagli, N.V. (2010). Effects of yoga on the quality of life in cancer patients. Complementary Therapies in Clinical Practice, 16, 60-63. doi:10.1016/j.ctcp.2009.10.007
    Van Puymbroeck, M., Payne, L.L., & Hsieh, P.C. (2007). A phase I feasibility study of yoga on the physical health and coping of informal caregivers. Evidence-Based Complementary and Alternative Medicine, 4, 519-529. doi:10.1093/ecam/nem075
    Vedhara, K., Shanks, N., Anderson, S., & Lightman, S. (2000). The role of stressors and psychosocial variables in the stress process: A study of chronic caregiver stress. Psychosomatic Medicine, 62, 374-385.
    Vitaliano, P.P., Zhang, J., & Scanlan, J.M. (2003). Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin, 129, 946-972.
    Waelde, L.C., Thompson, L., & Gallagher-Thompson, D. (2004). A pilot study of a yoga and meditation intervention for dementia caregiver stress. Journal of Clinical Psychology, 60, 677-687. doi:10.1002/jclp.10259
    Waldron, E.A., Janke, E.A., Bechtel, C.F., Ramirez, M., & Cohen, A. (2013). A systematic review of psychosocial interventions to improve cancer caregiver quality of life. Psycho-Oncology, 22, 1200-1207. doi:10.1002/pon.3118
    Warburton, D.E., Nicol, C.W., & Bredin, S.S. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal, 174, 801-809. doi:10.1503/cmaj.051351
    Ware, J.E., Kosinski, M., & Dewey, J.E. (2000). How to score Version 2 of the SF36 Health Survey. Lincoln, RI: QualityMetric.
    Woolery, A., Myers, H., Sternlieb, B., & Zeltzer, L. (2004). A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies in Health and Medicine, 10, 60-63.