Here's what Dr. Yoga had to say about incorporating yoga into your daily routine, and managing stress at every stage of treatment and recovery.
Live Better With: Hi – it's great to speak with you. To start, can you tell us more about your background and how you got involved in yoga for cancer patients?
Dr. Yoga: I studied at Cambridge [University] and I received an undergraduate degree in Natural Sciences there. Then I moved on to do a doctorate programme at Imperial College London at the Faculty of Medicine, specialising in Translational breast cancer and Drug Programs. I was looking for drug targets and identifying new ways to treat breast cancer patients.
After that, I decided to move away from trial studies and towards more of a management role. I've now worked in the private healthcare sector for about seven years.
I started doing yoga when I was at Cambridge to help manage my flexibility and prevent sports injuries. I took my teacher training in India, and it was quite intense — six days a week from about 4am to 8 or 9pm at night.
Live Better With: And so how did you begin focusing on yoga for breast cancer patients?
Dr. Yoga: I then had a bunch of colleagues who knew I was interested in promoting teaching at Maggie's Centre, where they run yoga classes for cancer patients. I started doing 1-to-1 sessions and running group yoga classes for breast cancer patients. My background is in breast cancer, and I happened to teach yoga, so I began to research the connection a little more.
I discovered that there were a lot of clinical studies where they had incorporated yoga practices into the breast cancer treatment programs, and demonstrated the benefits of yoga for breast cancer patients. I recently attended the American Society of Clinical Oncology Conference (ASCO 2017). At the conference, they were recommending that moderate exercise – approximately 150 minutes per week – should be "prescribed" to cancer patients to improve their wellbeing.
In the UK, we are just starting to incorporate more yoga and exercise into our recovery plans for cancer patients.
Live Better With: Is this why you wrote the book?
Dr. Yoga: Yes. I wrote the book to widen access for patients who can't go to centres in person to learn how to do yoga, or who don't feel like travelling. My goal is to give people recovery exercises that are backed up by research.
The book combines sequences to help recovery and mobility through gentle yoga sequences.
Live Better With: Some of our readers don't really know what yoga is, or they've heard of it but they don't know what it involves. How would you explain yoga?
Dr. Yoga: "Yoga" is a Sanskrit word that means "yolk." It's normally described as a practice or a path that can lead towards stillness — spiritually, mentally, and physically. In the Western world, most people care about the physical practice and less about the spiritual practice.
Live Better With: And why do you think it's especially good for cancer patients to practice yoga?
Dr. Yoga: There are clinical trials and studies that have shown how yoga is beneficial for cancer patients. Cancer Research UK, back in 2012, looked at 23 trial papers that had been published, and they reported that there were many benefits that came from doing yoga, including helping patients to cope with anxiety, fatigue, chemo brain, depression, and stress. It improved the patients' sleep quality and their mood as well, and also improved their range of flexibility, even for patients who had undergone surgery.
Live Better With: Wow, so yoga is basically helpful for everything?
Dr. Yoga: I think the most significant finding was by Professor Cohen at MD Anderson in the US. They did a randomised, controlled clinical trial looking at the benefits of yoga for breast cancer patients who had undergone radiotherapy. They showed that the blood cortisol levels in people who practised yoga dropped the most dramatically — they had the sharpest fall. Cortisol is the stress hormone, and the higher your cortisone levels are, the more stress you feel. High cortisol levels are implicated in worse outcomes for breast cancer patients. So there's a clear reason to be practising yoga if you're coping with breast cancer.
Qualitatively, also, the breast cancer patients reported that they had a much better sense of wellbeing. So both physically, and in the mind, the cancer patients reported feeling less depressed. Yoga is a kind of mindfulness technique that helps patients to cope with transitioning to post-surgery or post-treatment.
Live Better With: Do you find that you have to modify a lot of the yoga programs for patients living with cancer?
Dr. Yoga: Yes, so that's what the book is about. Breast cancer patients who have gone through surgery will need specific changes to the poses because there will be things they won't be able to do. So it needs to be adapted, and it depends on the circumstances of the patients. Ideally, everyone would have access to a therapist who can tell them how to modify the pose, but that's not always possible.
The book tries to summarise the key modifications that are required for cancer patients: if you have these conditions, what can you do and what can't you do. Patients will have to make some changes, but there are plenty of simple yoga poses for breast cancer patients that work well.
Live Better With: What makes your book unique to other cancer yoga books out there?
Dr. Yoga: I do it slightly differently in my book. What I've done is, rather than giving random poses across the book, I've formed three different yoga sequences for cancer patients, which are made up of the most common poses that can be practised. And I've broken them down with progressive difficulty levels/stages, depending on which stage the cancer patient is at. Some sequences tend to be more gentle and more suitable for patients who have just had a major surgery or who are still undergoing treatment.
The first sequence is called the Gentle Healing sequence – it's full of restoring poses for breast cancer patients, and is perfect for people recovering from surgery or undergoing treatments like chemotherapy with side effects like muscular pain, insomnia, and swollen hands and legs. This flow will help them with those things.
The second sequence is a more active yoga sequence for breast cancer patients who have already completed treatment, or who have ongoing treatments, and would like to start building their core strength a little bit more in their practice.
And then the third yoga sequence is for breast cancer patients who have worked through the first two sequences and they want a really challenging routine.
I've built these sequences in steps so that breast cancer patients can move their practice along.
Live Better With: And so for people who have trouble with mobility, do you have tips for how they might modify their practice?
Dr. Yoga: If they really can't move, I have a breathing sequence at the end of the book that's suitable for all to do. Patients with mobility problems can focus on the breathing exercises (known as "pranayama" in Sanskrit) in the book, which helps them to calm their minds, and which helps them to improve their wellbeing. Then they can start the active postures when they're ready to start moving again and or when they aren't on bedrest anymore. So it's suitable for all breast cancer patients, really.
Live Better With: We know you've worked with lots of different cancer patients over the course of your career, both in medicine and yoga. Do you have any general advice for someone who has been recently diagnosed or who is undergoing treatment?
Dr. Yoga: If they've been recently diagnosed, and they aren't going through treatment yet but they are going to have surgery, there have been studies that show that doing "pre-hab" exercises [exercise before treatment begins] can help to speed up recovery after surgery. Also, if you start doing yoga before your surgery, it de-stresses you and makes you feel more relaxed so you're not as stressed about the whole thing.
Live Better With: Okay, and during treatment, the idea is just to stay as active as you feel you're able to?
Dr. Yoga: Yes – there are lots of studies out there that say exercise is good for breast cancer patients. So I would say that it obviously depends on how the individual person is feeling, but that they should include gentle exercise within their treatment programs as appropriate. I would also recommend that every patient speaks to their oncologist about how to incorporate these strategies into their daily routine.
Dr. Yoga's new book, Yoga for Breast Cancer Survivors, has been reviewed and endorsed by several leading oncologists.
10% of the sales from the book will go directly to support Maggie's Centres. You can find and purchase the book on our website in the "Mind & Brain" section.