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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 16  |  Issue : 1  |  Page : 6-8

Integration of yoga in the management of patients undergoing surgery for Prostate Cancer: A pilot study


1 Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
2 Department of Biostatistics, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Date of Submission17-Jan-2020
Date of Acceptance19-Feb-2020
Date of Web Publication07-Jul-2020

Correspondence Address:
Dr. Ginil Kumar Pooleri
Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMJM.AMJM_1_20

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  Abstract 


Introduction: Integration of yoga in health-care management has beneficial effects in the management of many health-related issues with improved outcomes with no added cost. We conducted a pilot study to study the feasibility of yoga in the integrated management of patients with localized prostate cancer undergoing robotic-assisted radical prostatectomy. Methods: This prospective pilot study included twenty patients who underwent robotic-assisted radical prostatectomy between June 2019 and November 2019. The overall effects of yoga on health-related quality of life, recovery of urinary continence, and erectile function were the primary endpoints of our study. Results: Patients in the yoga group had significantly better continence rates at 1 month (90% vs. 50%) with better functional outcomes as compared to the control group at 1-month follow-up. The difference in sexual recovery was not significant in each group at 1-month follow-up.Conclusion: Yoga can be safely integrated in the postoperative management of patients undergoing radical prostatectomy with no short-term adverse side effects on overall outcomes.

Keywords: Integrated medicine, prostate cancer, robotic surgery, yoga


How to cite this article:
Nair DC, Laddha A, Thomas A, Ravindran GC, Pooleri GK. Integration of yoga in the management of patients undergoing surgery for Prostate Cancer: A pilot study. Amrita J Med 2020;16:6-8

How to cite this URL:
Nair DC, Laddha A, Thomas A, Ravindran GC, Pooleri GK. Integration of yoga in the management of patients undergoing surgery for Prostate Cancer: A pilot study. Amrita J Med [serial online] 2020 [cited 2020 Nov 28];16:6-8. Available from: https://www.ajmonline.org.in/text.asp?2020/16/1/6/289134




  Introduction Top


Yoga is considered as “Art of Living” and is practiced in many parts of India and around the world. The history of yoga dates back to over 5000 years ago, although researchers believe it may be 10,000 years old.[1] Integration of yoga in modern medicine is discussed worldwide and has beneficial effects in the management of many health-related issues with improved outcomes with no added cost.[2] To address these issues, we wanted to study, in a prospectively randomized way, the effect of yoga in addition to the conventional management of patients undergoing prostatic surgery. We conducted a pilot study to study the feasibility of yoga in the integrated management of patients with localized prostate cancer undergoing robotic-assisted radical prostatectomy.


  Methods Top


This prospective pilot study included twenty patients who underwent robotic-assisted radical prostatectomy between June 2019 and November 2019. Randomization for the present study was done using block randomization. Patients were informed about the study, and written informed consent was taken. Patients not willing to take part in the study or not willing for yoga or those who were actively doing yoga before the diagnosis were excluded from the study before randomization. The overall effects of yoga on health-related quality of life, recovery of urinary continence, and erectile function were the primary end points of our study. Demographic profiles including age and prostate-specific antigen (PSA) were compared.

Standard management of all patients included Kegel exercises that are started in preoperative period usually around 2 weeks before surgery and continued in the postoperative period once the patient is pain free usually from the 2nd day of surgery. Patients who are randomized to yoga group started yoga in addition to standard Kegel exercises during the same phase. Yoga included pranayama (the breathing exercise) which is started in the immediate postoperative period after surgery. Other yoga methods are started preoperatively and later reinstated once the patient is catheter free after 2 weeks and include Tadasana (also known as mountain pose and is considered foundation pose for all standing posture in yoga). Patients are instructed to stand feet hip-width apart and hands resting by the sides. Other yoga methods are started preoperatively and later reinstated once the patient is catheter free after 2 weeks. In Tadasana (also known as mountain pose and is considered foundation pose for all standing posture in yoga), patients are instructed to stand feet hip width apart and hands resting by the sides, following which they are asked to keep a yoga brick between the thighs, engage inner thighs and advised to life the brick upwards. In Utkatasana (also known as Chair pose), patient is instructed to start as in mountain pose with arms out in front and parallel to the floor, following which they bend the knees and push hips in a squatting position pretending to sit on a chair up to knee levels. Next one to follow is Titli Asana(also known as Butterfly Pose) in which patients are advised to sit with legs outstretched straight in front, feet together without touching each other with back, neck, and head straight and in comfortable position, following this they are asked to place hands on legs, and movement of knees up and down is done same as the wings of butterfly. Yoga and kegels are continued in the postoperative period till full recovery.

Statistical analysis was done using IBM SPSS 20 (SPSS Inc, Chicago, IL, USA). For all the continuous variables, the results are given in mean ± standard deviation, and for categorical variables as percentage. To compare the pre- and post-operative scores, Wilcoxon signed-rank test was applied, and to compare the mean difference of numerical variables between groups, Mann–Whitney U-test was applied. P < 0.05 was considered statistically significant.


  Results Top


In our study, both groups were comparable with regard to age (yoga group 66.5 ± 6.187 years vs. control group 61.0 ± 9.119 years, P = 0.225) and PSA values (Yoga group 18.79 ± 13.6 vs. control group 16.9 ± 12.97, P = 0.821). Overall, in both groups, there was no difference in sexual function at 1 month with average 5 point Shims score postoperative score of 3.216 ± 4.216 in the yoga group versus 4.0 ± 7.379 in the control group (P = 0.12, not significant). Patients in the yoga group had significantly better outcomes with 90% of patients (n = 9) in comparison to 50% (n = 5) of patients had urinary continence at 1-month follow-up [Table 1]. Patients in the Yoga group had overall significantly better outcomes in the Functional Assessment of Cancer Therapy-General Scores when compared to patients in the control group, Subgroup analysis outcomes in physical well-being and social/family well-being were significantly better in yoga group, while emotional well-being and functional well-being outcomes were comparable in both groups [Table 2].
Table 1: Continence in yoga and control groups

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Table 2: Functional assessment of cancer therapy -general scores

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  Discussion Top


Stress is known to have detrimental effects on the outcome of any surgical procedure and reduction of surgical stress response after laparoscopic surgery with enhanced recovery has shown to improve immune response and outcomes after surgery.[3] Yoga has shown benefits in improvement in overall cardiovascular health when integrated with modern medicine. Existing data supports that Yoga is cost-effective has beneficial supportive role in overall improvement of health and well-being of individual with no side effects.[4]

Diagnosis of cancer is associated with considerable stress and depressive episodes in many patients, and it is compounded due to fear associated with surgery in many patients. Stress is compounded due to fear of surgery. Stress is also associated with poor wound healing as it is associated with increased production of pro-inflammatory cytokines.[5] Good preoperative counseling and yoga should help in the alleviation of some part of this stress. Yoga has shown to be beneficial in early recovery after surgery with better wound healing and early discharge from hospital. The proposed mechanism is reduction in the levels of pro-inflammatory cytokines.[6],[7],[8] Behavioral and relaxation methods have shown to improve postoperative outcomes.[9],[10],[11],[12]

Integration of yoga with enhanced recovery protocol after robotic surgery should logically have positive effect on outcomes after surgery in the immediate postoperative period as shown by our preliminary data. Selection of proper yoga methods under guidelines with focus on breathing exercise should decrease pulmonary complications, and in addition, it should increase oxygen consumption which may help in better wound healing in postoperative period.[13] All our patients were instructed to continue incentive spirometry and chest physiotherapy with pranayama as per the study protocol. Other yoga methods such as Tadasana, Utkatasana, and Titli Asana specifically focused on pelvic floor should help in the early recovery of urinary incontinence and sexual function in patients undergoing prostate surgery with overall long-term better quality of life. Our pilot study confirms good compliance and easy acceptance among patients with no adverse outcomes. Patient who had yoga and kegels after surgery did better in every aspect in the immediate postoperative follow-up. This pilot study pays way for larger prospective study, which should help in studying the outcomes in larger population with longer follow-up.


  Conclusion Top


Yoga can be safely integrated in the postoperative management of patients undergoing radical prostatectomy and help in early recovery and superior postoperative outcomes in the immediate postoperative period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: https://www.yogabasics.com/learn/history-of-yoga. [Last accessed on 28 Dec 2019].  Back to cited text no. 1
    
2.
Palbag S. Integration of yoga in modern healthcare system: A dream to reality. BLDE Univ J Health Sci 2018;3:9-11.  Back to cited text no. 2
  [Full text]  
3.
Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, et al. Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 2012;255:216-21.  Back to cited text no. 3
    
4.
Tripathy JP, Thakur JS. Integration of yoga with modern medicine for promotion of cardiovascular health. Int J Non-Commun Dis 2017;2:64-8.  Back to cited text no. 4
  [Full text]  
5.
Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry 2005;62:1377-84.  Back to cited text no. 5
    
6.
Rao RM, Nagendra HR, Raghuram N, Vinay C, Chandrashekara S, Gopinath KS, et al. Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Int J Yoga 2008;1:33-41.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Rojas IG, Padgett DA, Sheridan JF, Marucha PT. Stress-induced susceptibility to bacterial infection during cutaneous wound healing. Brain Behav Immun 2002;16:74-84.  Back to cited text no. 7
    
8.
Broadbent E, Petrie KJ, Alley PG, Booth RJ. Psychological stress impairs early wound repair following surgery. Psychosom Med 2003;65:865-9.  Back to cited text no. 8
    
9.
Blankfield RP. Suggestion, relaxation, and hypnosis as adjuncts in the care of surgery patients: A review of the literature. Am J Clin Hypn 1991;33:172-86.  Back to cited text no. 9
    
10.
Lang EV, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000;355:1486-90.  Back to cited text no. 10
    
11.
Holden-Lund C. Effects of relaxation with guided imagery on surgical stress and wound healing. Res Nurs Health 1988;11:235-44.  Back to cited text no. 11
    
12.
Emery CF, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Frid DJ. Exercise accelerates wound healing among healthy older adults: A preliminary investigation. J Gerontol A Biol Sci Med Sci 2005;60:1432-6.  Back to cited text no. 12
    
13.
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997;78:606-17.  Back to cited text no. 13
    



 
 
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  [Table 1], [Table 2]



 

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