What is Palliative care?
The Marie Curie website describes palliative care as the treatment and support provided to people with a life-limiting illness. Most people think of advanced cancer when palliative care is mentioned but it also includes people with advanced heart failure, lung diseases and neurological problems such as multiple sclerosis. In my experience, it is one of the medical specialties which places great emphasis on a more holistic approach. In palliative care, the healthcare team aims to improve the quality of life of the patient and their family; they treat the whole person and not just the illness.
Yoga in Palliative care
Yoga is nuanced and the beauty of the practice is that it is inclusive. It allows practitioners to adapt postures to suit participants with a variety of physical abilities.
I have had the privilege of teaching yoga at my local hospice and used a chair- based approach to allow for maximal participation. The classes have been very fulfilling and have shown me first-hand how yoga can have immediate benefits on people with chronic and complex illnesses.
What does the current evidence show?
I was surprised to learn that the research into the effects of yoga in palliative care is scant. There have been many studies looking into the effects of yoga in patients with cancer and other studies looking at patients with advanced chronic illnesses but few looking specifically at yoga in the palliative care setting.
One article published showed the impact of a relaxed form of yoga on pain, sleep and tiredness in people with cancer. It found that patients had improved sleep, were less fatigued and required less pain-relieving medications. While it was not specific to palliative care, the findings are transferrable and suggest that yoga can be used to combat sleep and pain-related issues that patients in palliative care struggle with.
A review article suggested that yoga can reduce the heightened stress response associated with anxiety and depression which often co-exist in patients with a life- limiting diagnosis. This is because Yoga is thought to downregulate the sympathetic nervous system and the body processes involved in the release of stress hormones such as cortisol.
A small study looked at home- based yoga practice in females with advanced cancer. These classes were led by an experienced yoga teacher and participants reported feeling more relaxed and generally more energetic following the sessions. They also felt that yoga helped them to cope more positively with the emotional implications and physical symptoms of their diagnoses. Given the size of this study, a similar study design would be beneficial to look at the effects on a larger focus group.
A further study looked at the benefits of a gentle form of yoga for patients and their carers at a palliative care day unit. At the end of the 12 week course the authors reported that, despite their deteriorating health conditions, the patients benefitted from improvements in physical, mental and emotional well-being. The carers reported a positive impact on their stress and coping mechanisms.
Yoga in Palliative care is a subject I feel very passionate about and I am pleased to report that the current evidence suggests that gentle yoga can be a beneficial addition to conventional palliative care treatment.
I also appreciate that it may be difficult for people to access yoga studios, but the current pandemic has shown us that we can conduct virtual home- based sessions, allowing a wider audience to derive the positive benefits associated with yoga.
While the evidence is positive so far, more research is required to further promote yoga as a tool to improve the quality of life in palliative care patients.
The work at Nutritank is key in providing further information and educational resources surrounding beneficial nutrition and lifestyle measures to medical students and healthcare professionals. I share their vision and I am honoured to be asked to contribute.
Vallath N. Perspectives on yoga inputs in the management of chronic pain. Indian J Palliat Care. 2010;16:1
Sengupta P. Health impacts of yoga and pranayama: a state-of-the-art review. Int J Prev Med. 2012;3:444
Carr T, Quinlan E, Robertson S, Duggleby W, Thomas R, Holtslander L. Yoga as palliation in women with advanced cancer: a pilot study. Int J Palliat Nurs. 2016;22:111-117
McDonald A, Burjan E, Martin S. Yoga for Patients and Carers in a Palliative Day Care Setting. Int J Palliat Nurs. 2006;12(11):519-23