Impact of Yoga Practice on Mitigating Side Effects, Enhancing Quality of Life, and Promoting Longevity Among Cancer Thrivers in Kerala, India

Impact of Yoga Practice on Mitigating Side Effects, Enhancing Quality of Life, and Promoting Longevity Among Cancer Thrivers in Kerala, India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Yoga Practice on Mitigating Side Effects, Enhancing Quality of Life, and Promoting Longevity Among Cancer Thrivers in Kerala, India Damodara Krishnanadha Pai, Padmanabhan Thekkeveettil, Harsha Gangadharan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8139011/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Purpose:This study investigates the impact of customized yoga practice on mitigation of side effects, quality of life and longevity in cancer survivors in Kannur, Kerala, India. Method: An observational study was conducted among 323 cancer survivors, categorized into four groups: breast, head and neck, gynaecological, and other types. Participants were trained in yoga postures customized to the needs unique to different cancer types and the post-treatment sequelae, and followed up from 2006 to 2024. The outcomes were recorded using a subjective improvement scale of 0-10 to assess the positive effects of yoga on the reduction of symptoms, enhancement of QOL at baseline, 0-2, 3-6, and 7+ years Results: Findings indicate that consistent yoga practice significantly increased survival rates and reduced disability. Survivors of Breast cancer showed the most pronounced benefits, followed by head and neck. Gynaecological survivors demonstrated moderate improvement in early years, with marked increases after 7+ years. Regular yoga practice enhances resilience and coping ability, contributing to long-term well-being and longevity. Conclusion:Yoga improves longevity, quality of life, and reduces treatment-related side effects in survivors. This study's findings confirm yoga as a holistic, low-risk intervention that enhances physical and psychological well-being, daily functioning, and overall quality of life. Notably, despite challenges in tracking long-term survivors, our sample size of 323 (2.31% of the State of Kerala's estimated 14,000 survivors in the 2000s) is substantial, underscoring the study's significance and reliability. Cancer survivors yoga mitigation of side effects quality of life physical well-being psychological distress improvement scale Figures Figure 1 1. Introduction Survivorship and rehabilitation have become a major thrust area in Oncology with the increased longevity of individuals after cancer treatment. Yoga practices have been playing a major role in complementing cancer treatment [ 1 ]. Initially, yoga was only considered a simple exercise, but in the developing era of cancer care and in patient navigation, its potential for being a complementary factor for therapeutic care is also appreciated [ 2 ]. Yoga practice has also been shown to decrease the severity of symptoms associated with various cancers.[ 3 ] The yoga practice in cancer patients over the years shows that yoga not only manages physical challenges but also emotional and psychological aspects [ 4 , 5 ]. Cancer research also explores complementary approaches along with medical cancer therapy that help to increase the life expectancy and quality of life (QoL) [ 6 , 7 ]. Yoga, one of the most ancient exercise practices that combines breathing exercises, postural variations, and emphasis on meditation, has been shown to make remarkable improvements in physical, emotional, and spiritual well-being among cancer survivors [ 8 ]. Yoga is considered to be a simple practice that can be done regularly for a fixed time duration without any additional resources [ 9 , 10 ] The major trauma for cancer survivors is the various side effects, like fatigue, reduced mobility, and muscular weakness. Yoga has proven to be a promise in counteracting these side effects [ 7 , 11 ]. Physical vitality of patients, muscular strength, and joint mobility have been enhanced with gentle stretching postures/poses, which have also helped to improve the flexibility of survivors [ 2 ]. Cancer diagnosis peaks various emotional disturbances like fear, anxiety, and feelings of isolation. Yoga practice becomes a healing factor to address this emotional burden in individuals after treatment. [ 4 ]. Enhanced emotional balance, reduced psychological distress, and mindfulness are also procured with the practice of yoga [ 11 ]. Each person has a different cancer journey, and it is unique; their needs and physical limitations differ. Post-treatment side effects vary according to individuals. Therefore, the importance of the implementation of a customised yoga programme is to be considered [ 8 ]. Asanas such as Shalabh asana (Locust Pose), Tad asana (Mountain Pose), Padahastasana (Hand Under Foot Pose), Surya Namaskar (Sun Salutation), Pavanamuktasana (Wind-Relieving Pose), Gomukhasana (Cow Face Pose), Udarakarshanasana (Abdominal Twist), and Udaraharshasana (Abdominal-Strengthening Poses) can provide targeted benefits to patients after treatment [ 8 ]. The above-mentioned yoga postures help to aid in supporting both physical and functional recovery and improve digestion, spinal health, and enhance abdominal strength. As evidence continues to mount, the integration of yoga into standard cancer care is becoming not only feasible but essential. Yoga can never be a replacement for conventional cancer treatment, but is a potent adjuvant therapy for an overall holistic way towards healing [ 1 , 2 ]. Yoga also proves its multidisciplinary approach for effective cancer care with its wide range of benefits, including physical rehabilitation, immune modulation to emotional support, and mental clarity. [ 7 ]. The long-term effects of yoga on side-effect relief, longevity, and quality of life (QoL) in cancer survivors were examined in the present paper over a duration of 18 years (2006–2024). The host institution is a Non-Governmental Organisation working in the field of early cancer detection from the grassroots level and their rehabilitation through improving the QoL for the last 36 years. The study was carried out in those who were recommended by an oncologist during follow-ups and mostly belonged to marginalized communities residing in the north of Kerala, India, as the first analysis in this population. Symbolically 18 members of this cohort group shared personal stories of their fight with and survival from cancer with the national public radio network, All India Radio, in their native language. Their own experience in their own words always highlights the supportive role played by yoga in their recovery and healing process. 2. Study Aims and Objectives 2.1 Primary Aim To explore the therapeutic potential of yoga as a complementary intervention in the post-treatment recovery of patients with various cancers, including breast, oral, throat, cervix, uterus, lung, thyroid, uterine, and other malignancies, over a period of 18 years in Kannur, Kerala, for the first time. 2.1.1 To assess and evaluate the challenges of cancer survivors post-treatment To evaluate the difficulties, including pain, difficulty in speech and swallowing, fatigue, hand oedema, and rigidity of neck, faced by the recruits after their treatment that even affect their daily activities and their emotional well-being. 2.1.2 To assess the effect of cancer rehabilitation with yoga practice: To evaluate yoga’s effectiveness through a holistic approach and non-pharmacological methods in reducing post-cancer treatment symptoms and improving QoL. 2.1.3. To assess the effect of yoga practice on survivorship of cancer thrivers : To assess how consistent customised yoga practice can affect the survival rates of cancer thrivers post-treatment. 3. Methodology The primary objective was to assess the effectiveness of integrated yoga therapy as a complementary approach in alleviating side effects, improving quality of life and symptom burden among post-treatment cancer survivors. Yoga was introduced after the completion of major oncological treatments, such as surgery, chemotherapy, and/or radiotherapy, and continued as part of their survivorship care plan. The focus was on: 1. Psychological and emotional well-being 2. Improvement in baseline physical difficulties 3. Long-term survivorship outcomes, including functionality and longevity 3.1 Study Design This was an observational longitudinal study involving 323 cancer survivors who voluntarily enrolled in a yoga program between 2006 and 2024. These groupings allowed for comparative analysis of the outcomes across different cancer-affected organs, recognizing the distinct physiological and psychological challenges faced by each subgroup. Participants were divided into four groups: Group 1: Breast cancer survivors (n = 122) Group 2: Head and neck cancer survivors (n = 118) Group 3: Survivors of cervical, ovarian, and uterine cancers (n = 37) Group 4: Survivors of other cancers, including colorectal, lung, skin cancer, sarcoma (n= 46) 3.2 Personalised Intervention The yoga regimen for each group was customised. 1. The recruits of group 1 thrivers with breast cancer They performed yoga with thrust on yoga postures like Trataka, Sukshma vyayama, Surya namaskaram variation, Vrikshasana, Prana mudras, Nadishdha Pranayama. 2. The recruits of Group 2 thrivers with head and neck cancers Those recovered from head and Neck cancers were given more training in yoga postures like Jivavamula Dauti, ajna chakra dhyana, and selected sookshama yogic vyayama. 3 . Recruits of the 3rd group were women recovered from gynaecological cancers, including cervix, ovary and uterus They were practicing yoga postures with thrust on suryanamaskaram yoga with variations, adaptive asanas, vajroli mudra, nadishudhi pranayama and ujjai pranayama, selected sukshma yogic asanas, and ajapa japa. 4. The recruits of group 4, including colorectal, lung, and skin sarcoma They were subjected to yoga postures like vajrasana, vipareethakaranimudra with a pillow, bhujanga, shashankasana, jalandhara bandha, pranamudra, abdominal breathing, yogic breathing, nadi shudhi, Kayotsarga, manipura chakra dhyana, along with other simple yoga postures Participants were encouraged to continue yoga practice at home after initial training and were asked to come for periodical review, assessment, and adjustments, and were provided with corrective advice if required. Each session of yoga practice was delivered systematically, and the improvement was assessed continuously. The customised yoga program was made convenient for the recruits with alterations if required. All 323 participants underwent a comprehensive baseline assessment by experienced Physicians along with yoga experts to evaluate the severity and type of difficulties experienced following their primary cancer treatments. These assessments included: .Psychological issues (fear of recurrence, anxiety, sleep disturbances) Physical symptoms (pain, fatigue, restricted mobility) Limitation of Functional Activity (difficulty in daily activities) Reduction in Disability Rate Participants were then randomized into yoga intervention groups based on their cancer category and followed over time to monitor changes and improvements associated with regular integrated yoga therapy. The progress or lack of improvement in symptom alleviation was monitored periodically and recorded by Physicians and a yoga expert. 3.3 Data Collection Data were collected using self-assessment questions and survival tracking. The questionnaires contained basic activity tracking and the reduction of their difficulties in the practice of yoga. The questionnaire was standardized based on the type of cancer and measures needed for improving quality of life, with the help of a yoga expert and a team of experts. 1. Group 1 individuals portrayed mostly upper limb oedema, joint pain, fatigue, and lethargy 2. Group 2 recruits showed difficulty in speech, neck rigidity, general weakness, and drooling of saliva 3. Group 3 recruits presented with back pain, general weakness 4. Group 4 recruits complained more of joint pain, lethargy, cough, and general weakness Participants rated improvements in Quality of Life with alleviation of side effects and ease of performing daily activities on a 0–10 number scale. Assessments were conducted at baseline, 0–2 years, 3–6 years, and 7+ years post-enrolment. Survival rates of the recruits were also evaluated. The status of persons at the time of recruitment to the yoga programme, and how their quality of life improved on various stages of continuous yoga practice, were assessed through their qualitative assessment. 4. Results Analytical tools, Descriptive statistics, and cross-tabulations were used to analyse the mean improvement scores and distribution of qualitative outcomes, mild, moderate, and good, across the four cancer types and treatment durations. The present study involved a total of 323 cancer survivors recruited over 18 years, from 2006 to 2024, categorized into four primary Groups based on cancer types. The improvement is recorded in a scale of 0-10, in which values 1-3 are recorded as mild improvement, which means the change in the difficulties of the recruits is mild, 4-6 scoring signifies that the post treatment symptom has moderate improvement, and 7-10 shows that the recruits have good improvement from their base symptoms through yoga therapy. TABLE 1 IMPROVEMENT IN YEARS 0-2 YEARS IN 323 RECRUITS IMPROVEMNET BREAST HEAD& NECK CERVIX, UTERUS, OVARY CANCERS LUNG, COLORECTAL AND OTHERS MILD 1.7 (n=81) 1.3 (n=112) 1.14 (n=35) 1.32 (n=43) MODERATE 4.6 (n=41) 4.2 (n=6) 4 (n=2) 4 (n=3) GOOD 0 0 0 0 TOTAL 122 118 37 46 Table 1 illustrates the positive impact of yoga on cancer survivors across various timeframes, with benefits categorised as mild, moderate, or substantial. Notably, within the 0–2-year timeframe, yoga practice yielded the following benefits: - Breast cancer According to Table 1, in the initial 0-2 years, breast cancer survivors showed: - Mild improvement (66.3%, valued at 1.7) in 81 patients - Moderate improvement (33.6%, valued at 4.6) in 41 patients - No good improvement was observed in this duration In contrast, other cancer groups showed: Head and Neck Cancer: 94.9% (112 patients) exhibited mild improvement (valued at 1.3), while 5.05% (6 patients) showed moderate improvement (valued at 4.1) Gynaecological Cancer: 94.5% (35 patients) had mild improvement (valued at 1.4), and 5% (2 patients) had moderate improvement (valued at 4) Other Cancers (lung, colorectal, skin, sarcoma): 93.4% (43 patients) showed mild improvement (valued at 1.32), and 6.52% (3 patients) had moderate improvement (valued at 4 These findings suggest that in the first two years, yoga practice primarily resulted in mild improvement across all cancer survivor groups, with the breast cancer group also exhibiting a notable 33.6% moderate improvement. This table highlights the potential benefits of yoga in alleviating post-treatment side effects in cancer survivors. TABLE 2 IMPROVEMENT IN YEARS 3-6 YEARS IN 318 RECRUITS IMPROVEMENT BREAST HEAD & NECK CERVIX, UTERUS, OVARY CANCERS LUNG, COLORECTAL AND OTHERS MILD 2.3 (n=11) 2.3 (n=55) 2.2 (n=23) 1.96 (n=32) MODERATE 4.9 (n=68) 4.2 (n=60) 4.9 (n=14) 4.6 (n=12) GOOD 7 (n=6) 7 (n=2) 0 0 TOTAL 119 117 37 45 Table 2 illustrates the positive impact of yoga on cancer survivors across various timeframes, with benefits categorised as mild, moderate, or substantial. Notably, within the 3–6-year timeframe, yoga practice yielded the following benefits: - Breast Cancer: - 9.2% (45 patients) showed mild improvement (valued at 2.3) - 57.14% (68 patients) showed moderate improvement (valued at 4.9) - 5.8% (6 patients) showed good improvement (valued at 7) Head and Neck Cancer: - 47% (55 patients) showed mild improvement (valued at 2.3) - 51 .2% (60 patients) showed moderate improvement (valued at 4.2) - 1.7% (2 patients) showed good improvement (valued at 7) Gynaecological Cancer: - 62.1% (23 patients) showed mild improvement (valued at 2.2) - 37.8% (14 patients) showed moderate improvement (valued at 4.9) - No good improvement was observed Other Cancers (lung, colorectal, skin): - 71.1% (32 patients) showed mild improvement (valued at 1.96) - 26.6% (12 patients) showed moderate improvement (valued at 4.6) - No good improvement was observed These findings indicate that as the duration of yoga practice increased, breast cancer and head and neck cancer survivors showed more moderate improvement, whereas gynaecological cancer and other cancer survivors primarily showed mild improvement in the 3–6-year period. TABLE 3 IMPROVEMENT IN 7+ YEARS IN 267 RECRUITS IMPROVEMENT BREAST HEAD & NECK CERVIX, UTERUS, OVARY CANCERS LUNG, COLORECTAL, AND OTHERS MILD 2.81 (n=11) 1 (n=17) 3 (n=2) 2.4 (n=11) MODERATE 4.7 (n=44) 4.5 (n=68) 5.2 (n=21) 4.96 (n=27) GOOD 7.9 (n=41) 7.8 (n=20) 7.6 (n=5) 9 (n=3) TOTAL 96 105 28 38 Table 3 illustrates the positive impact of yoga on cancer survivors across various time frames, with benefits categorised as mild, moderate, or substantial. Notably, a 7+ years’ timeframe, yoga practice yielded the following benefits: - - Breast Cancer: - 11.4% (11 patients) showed mild improvement (valued at 2.81) - 45.8% (44 patients) showed moderate improvement (valued at 4.7) - 42.7% (41 patients) showed good improvement (valued at 7.9) - Head and Neck Cancer: - 16.1% (17 patients) showed mild improvement (valued at 1) - 64.7% (68 patients) showed moderate improvement (valued at 4.5) - 19% (20 patients) showed good improvement (valued at 7.8) - Gynaecological Cancer: - 7.14% (2 patients) showed mild improvement (valued at 3) - 75% (21 patients) showed moderate improvement (valued at 5.2) - 17.8% (5 patients) showed good improvement (valued at 7.6) - Other Cancers (lung, colorectal, skin): - 28.9% (11 patients) showed mild improvement (valued at 2.4) - 71.05% (27 patients) showed moderate improvement (valued at 4.96) - 7.8% (3 patients) showed good improvement (valued at 9) These findings suggest that after 7+ years of yoga practice, a significant proportion of cancer survivors in each group showed moderate to good improvement, indicating the potential long-term benefits of yoga in cancer survivorship. This tabulation reveals that the breast cancer survivor group demonstrated good improvement with consistent yoga practice, exceeding 40%, compared to other participant groups, particularly after 7 years. Despite the relatively low cancer survival rates in Kerala during the study period (2006-2024), we successfully recruited and followed up with 323 patients, assessing their improvement through yoga practice and its impact on their quality of life. 4.1 Breast Cancer Group Common symptoms included upper limb edema, persistent fatigue, and generalized tiredness. After yoga-based rehabilitation, participants reported notable improvements, such as: - Reduction in edema, particularly upper limb swelling associated with lymphedema - Enhanced energy levels - Improved mood and emotional balance - Regained upper limb mobility and reduced post-surgical stiffness 4.2 Head and Neck Cancer Group This group experienced difficulties in speech articulation, swallowing, drooling, neck rigidity, and fatigue. Post-yoga intervention, participants reported modest improvements, including: - Better control over speech and articulation - Improved swallowing comfort - Reduced neck rigidity and pain - Slight improvements in energy levels However, the extent of recovery was less pronounced compared to the breast cancer group, likely due to the complexity of symptoms involving the oral and neck musculature. 4.3 Gynaecological Cancer Group This group primarily experienced back pain and general weakness. After consistent yoga practice, participants reported - Decreased difficulty in daily activities - Reduced general ache and body pain The qualitative improvement reported by the recruits showed that the improvement in this group was more pronounced after 7+ years, with a gradual increase in benefits over time. 4.4 Other Cancer Group Patients with various cancer types (colorectal, skin, testis, and lung) experienced back pain, pelvic discomfort, joint pain, chronic fatigue, and general physical weakness. After yoga therapy, participants reported: - Moderate reduction in musculoskeletal discomfort - Mild to moderate gains in strength and flexibility - Increased awareness of body posture and breathing control Notably, this group displayed good improvement overall after 7 years, although it took a longer duration of yoga practice to elicit benefits, possibly due to the heterogeneity of cancer types and treatment regimens. 4.5 Comparison of Improvement and Longevity The comparative analysis revealed that 122 participants with breast cancer demonstrated the greatest improvement in symptom reduction and perceived health status. This group was more likely to continue yoga as a long-term treatment and reported improvements in emotional and physical health. The head and neck cancer group showed modest benefits, with yoga improving muscular flexibility and reducing stiffness and speech and swallowing complaints. The gynaecological cancer group demonstrated moderate gains in the early years but limited benefits after 7+ years. The Other Cancers Group showed minimal to moderate qualitative improvements in the 0-2- and 3-6-year assessments, primarily related to general body pain and fatigue. 4.6 Impact on Quality of Life and Longevity The study found that customized yoga therapy significantly improved the overall quality of life (QoL) of diverse cancer survivors. Participants reported increased longevity, improved symptom management, enhanced emotional well-being, and enhanced functional recovery. Yoga practice reduced post-treatment side effects, such as fatigue, psychological distress, and musculoskeletal pain. 4.7 Survival Outcomes Participants who maintained regular yoga practice demonstrated higher quality-enhanced survival rates over 18 years. Breast cancer survivors showed more improvement in survival rates with integrated yoga therapy compared to head and neck cancer survivors and other cancer types. 4.8 Quality of Life Improvements Yoga-practicing participants reported significant improvements in physical functioning, emotional resilience, and social engagement. Side effects such as fatigue, nausea, and anxiety decreased substantially by year 2. 4.9 Reduction in Disability Rates There was a substantial improvement in the reduction of disability rates. Many participants regained the ability to perform daily activities independently within 3 years of regular yoga practice. 5. Discussion This study's findings provide strong evidence that yoga is a valuable adjunct therapy for improving longevity and quality of life (QoL) in cancer survivors. Consistent participation in yoga practices yielded physical, emotional, and functional improvements across various patient populations, aligning with holistic healing principles. Yoga appears to mitigate treatment-related side effects, including cancer-related fatigue, musculoskeletal pain, lymphedema, and psychosocial concerns.[ 8 , 7 ] The benefits of yoga extend beyond physical improvements, offering a non-pharmacologic and self-empowering way to cope with long-term recovery challenges. By incorporating gentle movement, breathing techniques, and relaxation, patients experienced reduced anxiety and increased energy levels.[ 12 ] Notably, breast cancer survivors demonstrated the most marked improvement in QoL, potentially due to earlier yoga integration, higher awareness and access, and more supportive care [ 6 ]. The improvement in upper limb lymphedema, fatigue, and psychological burden highlights yoga's benefits for physical and emotional health [ 13 ]. This study contributes to the existing evidence base on yoga's role in oncology rehabilitation, offering a unique long-term perspective spanning nearly two decades. The findings strengthen the argument for integrating yoga into routine survivorship care, particularly in resource-limited settings [ 14 ]. The sample size of 323 recruits in this study is substantial relative to the total population. Notably, the cancer survival rate in the 2000s was around 40% of detected cases in a year, whereas it has now increased to approximately 60%. In Kerala, the reported cancer cases in the 2000s were around 35,000 annually, with 40% (14,000) surviving. Our study recruits represent 2.31% of the total survivor population of the State. Given the challenges of tracking cancer survivors over an extended period, our sample size of 323 is considerable. The relevance of a scientific study is often proportional to the ratio of its sample size to the total population. In this context, we proudly claim that our 18-year study with 323 participants is unique and holds substantial scientific relevance . Additional studies, particularly randomized controlled and biomarker-based, are needed to clarify the specific ways in which yoga provides its benefits and to develop standardized yoga protocol frameworks for diverse oncology populations [ 15 ]. 6. Conclusion This extensive research underscores the transformative power of yoga in enhancing the longevity and quality of life of cancer survivors. By embracing yoga as a lifestyle practice, individuals experienced profound improvements in physical, emotional, and psychological well-being. Yoga's benefits extended to resolving fatigue, pain, and lymphedema, reducing functional disability, and promoting holistic wellness [ 16 ]. The findings highlight yoga's potential as a psychosomatic rehabilitation approach, empowering individuals to take control of their healing journey [ 17 ]. Notably, early integration of yoga into breast cancer rehabilitation had a significant impact on functional autonomy, wellness, and quality of life [ 18 ]. This study contributes to the growing evidence base on yoga's role in oncology, providing long-term insights into its benefits. Given its accessibility, adaptability, and low cost, yoga can be a valuable complement to conventional cancer treatment. Integrating yoga into standard survivorship care, particularly in resource-constrained settings, holds promise for improving patient outcomes. Ultimately, yoga offers a holistic and patient-centred approach, enhancing medical treatment and fostering long-term healing. By promoting awareness, emotional equilibrium, and adaptive coping, yoga empowers cancer survivors to navigate their journey with greater resilience and confidence. As a testament to its impact, Malabar Cancer Care Society's 36-year commitment to providing free yoga and counselling services has touched countless lives. Further research is needed to fully elucidate yoga's benefits and develop standardised protocols for diverse oncology populations. Nevertheless, this study's findings underscore the potential of yoga to revolutionise survivorship care and inspire a healthier, more empowered cancer survivor experience. Declarations Data Availability Statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics Declaration Ethics Approval and Consent to Participate This study was approved as part of the institutional community audit by the MCCS Ethics Committee. All participants provided verbal informed consent before participation. The study adhered to the principles of the Declaration of Helsinki and ensured confidentiality and anonymization of personal identifiers. Informed consent was obtained to publish images shown in the manuscript from all the persons involved in the image All the recruits involved in the study are above the age of 16 Funding Declaration: There was no funding support for the study. Clinical trial number: Not Applicable Ethics Approval and Consent to Participate declarations: Included Consent to Publish declaration: Included Email address of corresponding author: [email protected] Corresponding author: Dr V C Ravindran Points requiring clarification as per email 29th November Points requiring clarification Clarifications 1. Ethical approval Ethical approval included 2. Accordance/Ethical Guidelines statement Ethical Guidelines statement included 3. Informed consent for study participation Informed consent included. All participants involved in the study are above the age of 16. 4. Consent to Publish Identifying Information/Image The informed consent obtained also includes consent to publish images relevant to the study from the persons involved in the image in the manuscript. 5. Data availability statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request Author Contribution 1. D. Krishnanadha Pai (First Author and Alternate Corresponding Author)As President of Malabar Cancer Care Society (MCCS), Sri D. Krishnanadha Pai leveraged his extensive experience in comprehensive cancer care to initiate and lead a groundbreaking research study on yoga for cancer care, starting in 2006. He spearheaded this bold initiative, overcoming challenges and remaining pivotal throughout the study.2. Dr. T.V. Padmanabhan (Second Author)Dr. T.V. Padmanabhan, a PhD holder in yoga and former head of the yoga division at Kannur University and Coordinator of the Yoga Department at Kerala Central University, played a crucial role in guiding the yoga research study. He provided leadership for customised yoga practice and training, bringing his expertise to the forefront.3. Dr. Harsha Gangadharan (Third Author)Dr. Harsha Gangadharan led the data procurement and tabulation efforts, fostering positive relationships with cancer survivors. Her contributions ensured the smooth progression of the research study.4. Dr. Lopamudra Das (Fourth Author)Dr. Lopamudra Das, a seasoned scientist with extensive experience in cancer research, provided invaluable support and guidance for data analysis and scientific evaluation. Her expertise significantly enhanced the study's validity.5.Deepthi T.K.(Fifth Author)As the guiding spirit behind the yoga training and practice for cancer survivors, Ms. Deepthi T.K. collaborated with Dr. Padmanabhan to lead the yoga program. Her dedication and support were instrumental in the study's success.6. Dr. V.C. Ravindran (Corresponding Author)As a physician in modern medicine, Dr. V.C. Ravindran offered critical support, services, and guidance, ensuring the proper evaluation of yoga's benefits for cancer survivors. He bridged the gap between traditional yoga practice and modern medicine, instilling confidence in the participants. Acknowledgement 1) Dr MR Rajagopal for his advice and inspiration to initiate the Study 2) Late Dr BV Bhat for his support and guidance to conduct the Yoga study Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Bower JE, Woolery A, Sternlieb B, Garet D. Yoga for cancer patients and survivors: A systematic review. Cancer Control. 2012;19(3):273–82. Smith KB, Pukall CF. An evidence-based review of yoga as a complementary intervention for patients with cancer. Psycho-oncology. 2009;18(5):465–75. Peppone 3LPJ, Janelsins LJ. Yoga for the Management of Cancer Treatment-Related Toxicities. Curr Oncol Rep. 2018;20(1):5. [DOI] [PMC free article] [PubMed] [Google Scholar. Banasik J, Williams H, Haberman M, Blank SE, Bendel R. Yoga practice improves physical and emotional measures in cancer survivors. Integr Cancer Ther. 2011;10(4):384–91. 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Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, Srinath BS, Ravi BD, Kulkarni DK. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial. Integr Cancer Ther. 2007;6(3):242–50. https://doi.org/10.1177/1534735407306214 . Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":178297,"visible":true,"origin":"","legend":"\u003cp\u003eYoga practiced by survivors at host institution.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8139011/v1/808b2d075c92174e6507a8c1.jpg"},{"id":99788394,"identity":"5929b878-288b-45ee-9806-b6fc957cc212","added_by":"auto","created_at":"2026-01-08 12:46:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1291103,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8139011/v1/34a71264-b85f-4ced-8205-eb935c116e25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Yoga Practice on Mitigating Side Effects, Enhancing Quality of Life, and Promoting Longevity Among Cancer Thrivers in Kerala, India","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSurvivorship and rehabilitation have become a major thrust area in Oncology with the increased longevity of individuals after cancer treatment. Yoga practices have been playing a major role in complementing cancer treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Initially, yoga was only considered a simple exercise, but in the developing era of cancer care and in patient navigation, its potential for being a complementary factor for therapeutic care is also appreciated [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Yoga practice has also been shown to decrease the severity of symptoms associated with various cancers.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The yoga practice in cancer patients over the years shows that yoga not only manages physical challenges but also emotional and psychological aspects [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cancer research also explores complementary approaches along with medical cancer therapy that help to increase the life expectancy and quality of life (QoL) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Yoga, one of the most ancient exercise practices that combines breathing exercises, postural variations, and emphasis on meditation, has been shown to make remarkable improvements in physical, emotional, and spiritual well-being among cancer survivors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Yoga is considered to be a simple practice that can be done regularly for a fixed time duration without any additional resources [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe major trauma for cancer survivors is the various side effects, like fatigue, reduced mobility, and muscular weakness. Yoga has proven to be a promise in counteracting these side effects [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Physical vitality of patients, muscular strength, and joint mobility have been enhanced with gentle stretching postures/poses, which have also helped to improve the flexibility of survivors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Cancer diagnosis peaks various emotional disturbances like fear, anxiety, and feelings of isolation. Yoga practice becomes a healing factor to address this emotional burden in individuals after treatment. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Enhanced emotional balance, reduced psychological distress, and mindfulness are also procured with the practice of yoga [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Each person has a different cancer journey, and it is unique; their needs and physical limitations differ. Post-treatment side effects vary according to individuals. Therefore, the importance of the implementation of a customised yoga programme is to be considered [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAsanas such as Shalabh asana (Locust Pose), Tad asana (Mountain Pose), Padahastasana (Hand Under Foot Pose), Surya Namaskar (Sun Salutation), Pavanamuktasana (Wind-Relieving Pose), Gomukhasana (Cow Face Pose), Udarakarshanasana (Abdominal Twist), and Udaraharshasana (Abdominal-Strengthening Poses) can provide targeted benefits to patients after treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The above-mentioned yoga postures help to aid in supporting both physical and functional recovery and improve digestion, spinal health, and enhance abdominal strength.\u003c/p\u003e \u003cp\u003eAs evidence continues to mount, the integration of yoga into standard cancer care is becoming not only feasible but essential. Yoga can never be a replacement for conventional cancer treatment, but is a potent adjuvant therapy for an overall holistic way towards healing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Yoga also proves its multidisciplinary approach for effective cancer care with its wide range of benefits, including physical rehabilitation, immune modulation to emotional support, and mental clarity. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe long-term effects of yoga on side-effect relief, longevity, and quality of life (QoL) in cancer survivors were examined in the present paper over a duration of 18 years (2006\u0026ndash;2024). The host institution is a Non-Governmental Organisation working in the field of early cancer detection from the grassroots level and their rehabilitation through improving the QoL for the last 36 years. The study was carried out in those who were recommended by an oncologist during follow-ups and mostly belonged to marginalized communities residing in the north of Kerala, India, as the first analysis in this population. Symbolically 18 members of this cohort group shared personal stories of their fight with and survival from cancer with the national public radio network, All India Radio, in their native language. Their own experience in their own words always highlights the supportive role played by yoga in their recovery and healing process.\u003c/p\u003e"},{"header":"2. Study Aims and Objectives","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Primary Aim\u003c/h2\u003e \u003cp\u003eTo explore the therapeutic potential of yoga as a complementary intervention in the post-treatment recovery of patients with various cancers, including breast, oral, throat, cervix, uterus, lung, thyroid, uterine, and other malignancies, over a period of 18 years in Kannur, Kerala, for the first time.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003e2.1.1 To assess and evaluate the challenges of cancer survivors post-treatment\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eTo evaluate the difficulties, including pain, difficulty in speech and swallowing, fatigue, hand oedema, and rigidity of neck, faced by the recruits after their treatment that even affect their daily activities and their emotional well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 To assess the effect of cancer rehabilitation with yoga practice:\u003c/h2\u003e \u003cp\u003eTo evaluate yoga\u0026rsquo;s effectiveness through a holistic approach and non-pharmacological methods in reducing post-cancer treatment symptoms and improving QoL.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.1.3. To assess the effect of yoga practice on survivorship of cancer thrivers\u003c/b\u003e: To assess how consistent customised yoga practice can affect the survival rates of cancer thrivers post-treatment.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Methodology","content":"\u003cp\u003eThe primary objective was to assess the effectiveness of integrated yoga therapy as a complementary approach in alleviating side effects, improving quality of life and symptom burden among post-treatment cancer survivors. Yoga was introduced after the completion of major oncological treatments, such as surgery, chemotherapy, and/or radiotherapy, and continued as part of their survivorship care plan.\u003c/p\u003e\n\u003cp\u003eThe focus was on:\u003c/p\u003e\n\u003cp\u003e1. Psychological and emotional well-being\u003c/p\u003e\n\u003cp\u003e2. Improvement in baseline physical difficulties\u003c/p\u003e\n\u003cp\u003e3. Long-term survivorship outcomes, including functionality and longevity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1\u003c/strong\u003e \u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was an observational longitudinal study involving 323 cancer survivors who voluntarily enrolled in a yoga program between 2006 and 2024. These groupings allowed for comparative analysis of the outcomes across different cancer-affected organs, recognizing the distinct physiological and psychological challenges faced by each subgroup. Participants were divided into four groups:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eGroup 1: Breast cancer survivors (n = 122)\u003c/li\u003e\n \u003cli\u003eGroup 2: Head and neck cancer survivors (n = 118)\u003c/li\u003e\n \u003cli\u003eGroup 3: Survivors of cervical, ovarian, and uterine cancers (n = 37)\u003c/li\u003e\n \u003cli\u003eGroup 4: Survivors of other cancers, including colorectal, lung, skin cancer, sarcoma (n= 46)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Personalised Intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe yoga regimen for each group was customised.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1. \u003cu\u003eThe recruits of group 1 thrivers with breast cancer\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThey performed yoga with thrust on yoga postures like Trataka, Sukshma vyayama, Surya namaskaram variation, Vrikshasana, Prana mudras, Nadishdha Pranayama.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2. \u003cu\u003eThe recruits of Group 2 thrivers with head and neck cancers\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThose recovered from head and Neck cancers were given more training in yoga postures like Jivavamula Dauti, ajna chakra dhyana, and selected sookshama yogic vyayama.\u003c/p\u003e\n\u003cp\u003e3\u003cem\u003e\u003cu\u003e. Recruits of the 3rd group were women recovered from gynaecological cancers, including cervix, ovary and uterus\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;They were practicing yoga postures with thrust on suryanamaskaram yoga with variations, adaptive asanas, vajroli mudra, nadishudhi pranayama and ujjai pranayama, selected sukshma yogic asanas, and ajapa japa.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. \u003cem\u003e\u003cu\u003eThe recruits of group 4, including colorectal, lung, and skin sarcoma\u003c/u\u003e\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThey were subjected to \u0026nbsp;yoga postures like vajrasana, vipareethakaranimudra with a pillow, bhujanga, shashankasana, jalandhara bandha, pranamudra, abdominal breathing, yogic breathing, nadi shudhi, Kayotsarga, manipura chakra dhyana, along with other simple yoga postures\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants were encouraged to continue yoga practice at home after initial training and were asked to come for periodical review, assessment, and adjustments, and were provided with corrective advice if required. Each session of yoga practice was delivered systematically, and the improvement was assessed continuously. The customised yoga program was made convenient for the recruits with alterations if required. All 323 participants underwent a comprehensive baseline assessment by experienced Physicians along with yoga experts to evaluate the severity and type of difficulties experienced following their primary cancer treatments. These assessments included:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e.Psychological issues (fear of recurrence, anxiety, sleep disturbances)\u003c/li\u003e\n \u003cli\u003ePhysical symptoms (pain, fatigue, restricted mobility)\u003c/li\u003e\n \u003cli\u003eLimitation of Functional Activity (difficulty in daily activities)\u003c/li\u003e\n \u003cli\u003eReduction in Disability Rate\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eParticipants were then randomized into yoga intervention groups based on their cancer category and followed over time to monitor changes and improvements associated with regular integrated yoga therapy. The progress or lack of improvement in symptom alleviation was monitored periodically and recorded by Physicians and a yoga expert.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using self-assessment questions and survival tracking. The questionnaires contained basic activity tracking and the reduction of their difficulties in the practice of yoga. The questionnaire was standardized based on the type of cancer and measures needed for improving quality of life, with the help of a yoga expert and a team of experts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Group 1 individuals portrayed mostly upper limb oedema, joint pain, fatigue, and lethargy\u003c/p\u003e\n\u003cp\u003e2. Group 2 recruits showed difficulty in speech, neck rigidity, general weakness, and drooling of saliva\u003c/p\u003e\n\u003cp\u003e3. Group 3 recruits presented with back pain, general weakness\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Group 4 recruits complained more of joint pain, lethargy, cough, and general weakness\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants rated improvements in Quality of Life with alleviation of side effects and ease of performing daily activities on a 0–10 number scale. Assessments were conducted at baseline, 0–2 years, 3–6 years, and 7+ years post-enrolment. Survival rates of the recruits were also evaluated. \u0026nbsp;The status of persons at the time of recruitment to the yoga programme, and how their quality of life improved on various stages of continuous yoga practice, were assessed through their qualitative assessment.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cp\u003eAnalytical tools, Descriptive statistics, and cross-tabulations were used to analyse the mean improvement scores and distribution of qualitative outcomes, mild, moderate, and good, across the four cancer types and treatment durations. The present study involved a total of 323 cancer survivors recruited over 18 years, from 2006 to 2024, categorized into four primary Groups based on cancer types. The improvement is recorded in a scale of 0-10, in which values 1-3 are recorded as mild improvement, which means the change in the difficulties of the recruits is mild, 4-6 scoring signifies that the post treatment symptom has moderate improvement, and 7-10 shows that the recruits have good improvement from their base symptoms through yoga therapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTABLE 1\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003eIMPROVEMENT IN YEARS 0-2 YEARS IN 323 RECRUITS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eIMPROVEMNET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eBREAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHEAD\u0026amp; NECK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eCERVIX, UTERUS, OVARY CANCERS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eLUNG, COLORECTAL AND OTHERS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMILD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.7 (n=81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.3 (n=112)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e1.14 (n=35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1.32 (n=43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMODERATE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.6 (n=41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.2 (n=6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e4 (n=2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4 (n=3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eGOOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cu\u003e0\u003c/u\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cu\u003e0\u003c/u\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTOTAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cu\u003e46\u003c/u\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1 illustrates the positive impact of yoga on cancer survivors across various timeframes, with benefits categorised as mild, moderate, or substantial. Notably, within the 0\u0026ndash;2-year timeframe, yoga practice yielded the following benefits: -\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBreast cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;According to Table 1, in the initial 0-2 years, breast cancer survivors showed:\u003c/p\u003e\n\u003cp\u003e- Mild improvement (66.3%, valued at 1.7) in 81 patients\u003c/p\u003e\n\u003cp\u003e- Moderate improvement (33.6%, valued at 4.6) in 41 patients\u003c/p\u003e\n\u003cp\u003e- No good improvement was observed in this duration\u003c/p\u003e\n\u003cp\u003eIn contrast, other cancer groups showed:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHead and Neck Cancer:\u003c/strong\u003e 94.9% (112 patients) exhibited mild improvement (valued at 1.3), while 5.05% (6 patients) showed moderate improvement (valued at 4.1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGynaecological Cancer:\u003c/strong\u003e 94.5% (35 patients) had mild improvement (valued at 1.4), and 5% (2 patients) had moderate improvement (valued at 4)\u003c/p\u003e\n\u003cp\u003eOther Cancers (lung, colorectal, skin, sarcoma): 93.4% (43 patients) showed mild improvement (valued at 1.32), and 6.52% (3 patients) had moderate improvement (valued at 4\u003c/p\u003e\n\u003cp\u003eThese findings suggest that in the first two years, yoga practice primarily resulted in mild improvement across all cancer survivor groups, with the breast cancer group also exhibiting a notable 33.6% moderate improvement. This table highlights the potential benefits of yoga in alleviating post-treatment side effects in cancer survivors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTABLE 2\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003eIMPROVEMENT IN YEARS 3-6 YEARS IN 318 RECRUITS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eIMPROVEMENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eBREAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eHEAD \u0026amp; NECK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCERVIX, UTERUS, OVARY CANCERS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eLUNG, COLORECTAL AND OTHERS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMILD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2.3 (n=11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2.3 (n=55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.2 (n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1.96 (n=32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMODERATE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.9 (n=68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4.2 (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e4.9 (n=14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.6 (n=12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eGOOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7 (n=6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e7 (n=2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTOTAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 illustrates the positive impact of yoga on cancer survivors across various timeframes, with benefits categorised as mild, moderate, or substantial. Notably, within the 3\u0026ndash;6-year timeframe, yoga practice yielded the following benefits: -\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBreast Cancer:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 9.2% (45 patients) showed mild improvement (valued at 2.3)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 57.14% (68 patients) showed moderate improvement (valued at 4.9)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 5.8% (6 patients) showed good improvement (valued at 7)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eHead and Neck Cancer:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 47% (55 patients) showed mild improvement (valued at 2.3)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 51 \u0026nbsp; .2% (60 patients) showed moderate improvement (valued at 4.2)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 1.7% (2 patients) showed good improvement (valued at 7)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eGynaecological Cancer:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 62.1% (23 patients) showed mild improvement (valued at 2.2)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 37.8% (14 patients) showed moderate improvement (valued at 4.9)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - No good improvement was observed\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eOther Cancers (lung, colorectal, skin):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 71.1% (32 patients) showed mild improvement (valued at 1.96)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 26.6% (12 patients) showed moderate improvement (valued at 4.6)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - No good improvement was observed\u003c/p\u003e\n\u003cp\u003eThese findings indicate that as the duration of yoga practice increased, breast cancer and head and neck cancer survivors showed more moderate improvement, whereas gynaecological cancer and other cancer survivors primarily showed mild improvement in the 3\u0026ndash;6-year period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTABLE 3\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003eIMPROVEMENT IN 7+ YEARS IN 267 RECRUITS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eIMPROVEMENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eBREAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eHEAD \u0026amp; NECK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCERVIX, UTERUS, OVARY CANCERS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eLUNG, COLORECTAL, AND OTHERS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMILD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e2.81 (n=11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1 (n=17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3 (n=2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2.4 (n=11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMODERATE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.7 (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4.5 (n=68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e5.2 (n=21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.96 (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eGOOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e7.9 (n=41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7.8 (n=20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e7.6 (n=5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e9 (n=3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTOTAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 illustrates the positive impact of yoga on cancer survivors across various time frames, with benefits categorised as mild, moderate, or substantial. Notably, a 7+ years\u0026rsquo; \u0026nbsp;timeframe, yoga practice yielded the following benefits: -\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Breast Cancer:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 11.4% (11 patients) showed mild improvement (valued at 2.81)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 45.8% (44 patients) showed moderate improvement (valued at 4.7)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 42.7% (41 patients) showed good improvement (valued at 7.9)\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eHead and Neck Cancer:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 16.1% (17 patients) showed mild improvement (valued at 1)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 64.7% (68 patients) showed moderate improvement (valued at 4.5)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 19% (20 patients) showed good improvement (valued at 7.8)\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eGynaecological Cancer:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 7.14% (2 patients) showed mild improvement (valued at 3)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 75% (21 patients) showed moderate improvement (valued at 5.2)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 17.8% (5 patients) showed good improvement (valued at 7.6)\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eOther Cancers (lung, colorectal, skin):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 28.9% (11 patients) showed mild improvement (valued at 2.4)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 71.05% (27 patients) showed moderate improvement (valued at 4.96)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; - 7.8% (3 patients) showed good improvement (valued at 9)\u003c/p\u003e\n\u003cp\u003eThese findings suggest that after 7+ years of yoga practice, a significant proportion of cancer survivors in each group showed moderate to good improvement, indicating the potential long-term benefits of yoga in cancer survivorship.\u003c/p\u003e\n\u003cp\u003eThis tabulation reveals that the breast cancer survivor group demonstrated good improvement with consistent yoga practice, exceeding 40%, compared to other participant groups, particularly after 7 years. Despite the relatively low cancer survival rates in Kerala during the study period (2006-2024), we successfully recruited and followed up with 323 patients, assessing their improvement through yoga practice and its impact on their quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Breast Cancer Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCommon symptoms included upper limb edema, persistent fatigue, and generalized tiredness. After yoga-based rehabilitation, participants reported notable improvements, such as:\u003c/p\u003e\n\u003cp\u003e- Reduction in edema, particularly upper limb swelling associated with lymphedema\u003c/p\u003e\n\u003cp\u003e- Enhanced energy levels\u003c/p\u003e\n\u003cp\u003e- Improved mood and emotional balance\u003c/p\u003e\n\u003cp\u003e- Regained upper limb mobility and reduced post-surgical stiffness\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Head and Neck Cancer Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis group experienced difficulties in speech articulation, swallowing, drooling, neck rigidity, and fatigue. Post-yoga intervention, participants reported modest improvements, including:\u003c/p\u003e\n\u003cp\u003e- Better control over speech and articulation\u003c/p\u003e\n\u003cp\u003e- Improved swallowing comfort\u003c/p\u003e\n\u003cp\u003e- Reduced neck rigidity and pain\u003c/p\u003e\n\u003cp\u003e- Slight improvements in energy levels\u003c/p\u003e\n\u003cp\u003eHowever, the extent of recovery was less pronounced compared to the breast cancer group, likely due to the complexity of symptoms involving the oral and neck musculature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Gynaecological Cancer Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis group primarily experienced back pain and general weakness. After consistent yoga practice, participants reported\u003c/p\u003e\n\u003cp\u003e- Decreased difficulty in daily activities\u003c/p\u003e\n\u003cp\u003e- Reduced general ache and body pain\u003c/p\u003e\n\u003cp\u003eThe qualitative improvement reported by the recruits showed that the improvement in this group was more pronounced after 7+ years, with a gradual increase in benefits over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 Other Cancer Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with various cancer types (colorectal, skin, testis, and lung) experienced back pain, pelvic discomfort, joint pain, chronic fatigue, and general physical weakness. After yoga therapy, participants reported:\u003c/p\u003e\n\u003cp\u003e- Moderate reduction in musculoskeletal discomfort\u003c/p\u003e\n\u003cp\u003e- Mild to moderate gains in strength and flexibility\u003c/p\u003e\n\u003cp\u003e- Increased awareness of body posture and breathing control\u003c/p\u003e\n\u003cp\u003eNotably, this group displayed good improvement overall after 7 years, although it took a longer duration of yoga practice to elicit benefits, possibly due to the heterogeneity of cancer types and treatment regimens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.5 Comparison of Improvement and Longevity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe comparative analysis revealed that 122 participants with breast cancer demonstrated the greatest improvement in symptom reduction and perceived health status. This group was more likely to continue yoga as a long-term treatment and reported improvements in emotional and physical health. The head and neck cancer group showed modest benefits, with yoga improving muscular flexibility and reducing stiffness and speech and swallowing complaints.\u003c/p\u003e\n\u003cp\u003eThe gynaecological cancer group demonstrated moderate gains in the early years but limited benefits after 7+ years. The Other Cancers Group showed minimal to moderate qualitative improvements in the 0-2- and 3-6-year assessments, primarily related to general body pain and fatigue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.6 Impact on Quality of Life and Longevity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that customized yoga therapy significantly improved the overall quality of life (QoL) of diverse cancer survivors. Participants reported increased longevity, improved symptom management, enhanced emotional well-being, and enhanced functional recovery. Yoga practice reduced post-treatment side effects, such as fatigue, psychological distress, and musculoskeletal pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.7 Survival Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants who maintained regular yoga practice demonstrated higher quality-enhanced survival rates over 18 years. Breast cancer survivors showed more improvement in survival rates with integrated yoga therapy compared to head and neck cancer survivors and other cancer types.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.8 Quality of Life Improvements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYoga-practicing participants reported significant improvements in physical functioning, emotional resilience, and social engagement. Side effects such as fatigue, nausea, and anxiety decreased substantially by year 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.9 Reduction in Disability Rates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a substantial improvement in the reduction of disability rates. Many participants regained the ability to perform daily activities independently within 3 years of regular yoga practice.\u003c/p\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis study's findings provide strong evidence that yoga is a valuable adjunct therapy for improving longevity and quality of life (QoL) in cancer survivors. Consistent participation in yoga practices yielded physical, emotional, and functional improvements across various patient populations, aligning with holistic healing principles. Yoga appears to mitigate treatment-related side effects, including cancer-related fatigue, musculoskeletal pain, lymphedema, and psychosocial concerns.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe benefits of yoga extend beyond physical improvements, offering a non-pharmacologic and self-empowering way to cope with long-term recovery challenges. By incorporating gentle movement, breathing techniques, and relaxation, patients experienced reduced anxiety and increased energy levels.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eNotably, breast cancer survivors demonstrated the most marked improvement in QoL, potentially due to earlier yoga integration, higher awareness and access, and more supportive care [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The improvement in upper limb lymphedema, fatigue, and psychological burden highlights yoga's benefits for physical and emotional health [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study contributes to the existing evidence base on yoga's role in oncology rehabilitation, offering a unique long-term perspective spanning nearly two decades. The findings strengthen the argument for integrating yoga into routine survivorship care, particularly in resource-limited settings [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe sample size of 323 recruits in this study is substantial relative to the total population. Notably, the cancer survival rate in the 2000s was around 40% of detected cases in a year, whereas it has now increased to approximately 60%. In Kerala, the reported cancer cases in the 2000s were around 35,000 annually, with 40% (14,000) surviving. Our study recruits represent 2.31% of the total survivor population of the State. Given the challenges of tracking cancer survivors over an extended period, our sample size of 323 is considerable. The relevance of a scientific study is often proportional to the ratio of its sample size to the total population. In this context, we proudly claim that our 18-year study with 323 participants is unique and holds substantial scientific relevance\u003c/em\u003e. Additional studies, particularly randomized controlled and biomarker-based, are needed to clarify the specific ways in which yoga provides its benefits and to develop standardized yoga protocol frameworks for diverse oncology populations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis extensive research underscores the transformative power of yoga in enhancing the longevity and quality of life of cancer survivors. By embracing yoga as a lifestyle practice, individuals experienced profound improvements in physical, emotional, and psychological well-being. Yoga's benefits extended to resolving fatigue, pain, and lymphedema, reducing functional disability, and promoting holistic wellness [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings highlight yoga's potential as a psychosomatic rehabilitation approach, empowering individuals to take control of their healing journey [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Notably, early integration of yoga into breast cancer rehabilitation had a significant impact on functional autonomy, wellness, and quality of life [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study contributes to the growing evidence base on yoga's role in oncology, providing long-term insights into its benefits. Given its accessibility, adaptability, and low cost, yoga can be a valuable complement to conventional cancer treatment. Integrating yoga into standard survivorship care, particularly in resource-constrained settings, holds promise for improving patient outcomes.\u003c/p\u003e \u003cp\u003eUltimately, yoga offers a holistic and patient-centred approach, enhancing medical treatment and fostering long-term healing. By promoting awareness, emotional equilibrium, and adaptive coping, yoga empowers cancer survivors to navigate their journey with greater resilience and confidence. As a testament to its impact, Malabar Cancer Care Society's 36-year commitment to providing free yoga and counselling services has touched countless lives.\u003c/p\u003e \u003cp\u003eFurther research is needed to fully elucidate yoga's benefits and develop standardised protocols for diverse oncology populations. Nevertheless, this study's findings underscore the potential of yoga to revolutionise survivorship care and inspire a healthier, more empowered cancer survivor experience.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved as part of the institutional community audit by the MCCS\u003c/p\u003e\n\u003cp\u003eEthics Committee. All participants provided verbal informed consent before\u003c/p\u003e\n\u003cp\u003eparticipation. The study adhered to the principles of the Declaration of Helsinki and\u003c/p\u003e\n\u003cp\u003eensured confidentiality and anonymization of personal identifiers.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained to publish images shown in the manuscript from all the persons involved in the image\u003c/p\u003e\n\u003cp\u003eAll the recruits involved in the study are above the age of 16\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFunding Declaration: There was no funding support for the study.\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eClinical trial number: Not Applicable\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEthics Approval and Consent to Participate declarations: Included\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConsent to Publish declaration: Included\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEmail address of corresponding author:\u0026nbsp;\u003c/strong\u003e\u003cstrong\[email protected]\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCorresponding author: Dr V C Ravindran\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ePoints requiring clarification as per email 29th November\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoints requiring clarification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClarifications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e1. Ethical approval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eEthical approval included\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e2. Accordance/Ethical Guidelines statement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eEthical Guidelines statement included\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e3. Informed consent for study participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eInformed consent included.\u003c/p\u003e\n \u003cp\u003eAll participants involved in the study are above the age of 16.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e4. Consent to Publish Identifying Information/Image\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026nbsp;The informed consent obtained also includes consent to publish images relevant to the study from the persons involved in the image in the manuscript.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e5. Data availability statement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026nbsp;The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e1. D. Krishnanadha Pai (First Author and Alternate Corresponding Author)As President of Malabar Cancer Care Society (MCCS), Sri D. Krishnanadha Pai leveraged his extensive experience in comprehensive cancer care to initiate and lead a groundbreaking research study on yoga for cancer care, starting in 2006. He spearheaded this bold initiative, overcoming challenges and remaining pivotal throughout the study.2. Dr. T.V. Padmanabhan (Second Author)Dr. T.V. Padmanabhan, a PhD holder in yoga and former head of the yoga division at Kannur University and Coordinator of the Yoga Department at Kerala Central University, played a crucial role in guiding the yoga research study. He provided leadership for customised yoga practice and training, bringing his expertise to the forefront.3. Dr. Harsha Gangadharan (Third Author)Dr. Harsha Gangadharan led the data procurement and tabulation efforts, fostering positive relationships with cancer survivors. Her contributions ensured the smooth progression of the research study.4. Dr. Lopamudra Das (Fourth Author)Dr. Lopamudra Das, a seasoned scientist with extensive experience in cancer research, provided invaluable support and guidance for data analysis and scientific evaluation. Her expertise significantly enhanced the study's validity.5.Deepthi T.K.(Fifth Author)As the guiding spirit behind the yoga training and practice for cancer survivors, Ms. Deepthi T.K. collaborated with Dr. Padmanabhan to lead the yoga program. Her dedication and support were instrumental in the study's success.6. Dr. V.C. Ravindran (Corresponding Author)As a physician in modern medicine, Dr. V.C. Ravindran offered critical support, services, and guidance, ensuring the proper evaluation of yoga's benefits for cancer survivors. He bridged the gap between traditional yoga practice and modern medicine, instilling confidence in the participants.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e1) Dr MR Rajagopal for his advice and inspiration to initiate the Study 2) Late Dr BV Bhat for his support and guidance to conduct the Yoga study\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBower JE, Woolery A, Sternlieb B, Garet D. Yoga for cancer patients and survivors: A systematic review. Cancer Control. 2012;19(3):273\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith KB, Pukall CF. An evidence-based review of yoga as a complementary intervention for patients with cancer. 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Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial. Integr Cancer Ther. 2007;6(3):242\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1534735407306214\u003c/span\u003e\u003cspan address=\"10.1177/1534735407306214\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cancer survivors, yoga, mitigation of side effects, quality of life, physical well-being, psychological distress, improvement scale","lastPublishedDoi":"10.21203/rs.3.rs-8139011/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8139011/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose:This study investigates the impact of customized yoga practice on mitigation of side effects, quality of life and longevity in cancer survivors in Kannur, Kerala, India.\u003c/p\u003e\n\u003cp\u003eMethod: An observational study was conducted among 323 cancer survivors, categorized into four groups: breast, head and neck, gynaecological, and other types. Participants were trained in yoga postures customized to the needs unique to different cancer types and the post-treatment sequelae, and followed up from 2006 to 2024. The outcomes were recorded using a subjective improvement scale of 0-10 to assess the positive effects of yoga on the reduction of symptoms, enhancement of QOL at baseline, 0-2, 3-6, and 7+ years\u003c/p\u003e\n\u003cp\u003eResults: Findings indicate that consistent yoga practice significantly increased survival rates and reduced disability. Survivors of Breast cancer showed the most pronounced benefits, followed by head and neck. Gynaecological survivors demonstrated moderate improvement in early years, with marked increases after 7+ years. Regular yoga practice enhances resilience and coping ability, contributing to long-term well-being and longevity.\u003c/p\u003e\n\u003cp\u003eConclusion:Yoga improves longevity, quality of life, and reduces treatment-related side effects in survivors. This study's findings confirm yoga as a holistic, low-risk intervention that enhances physical and psychological well-being, daily functioning, and overall quality of life. Notably, despite challenges in tracking long-term survivors, our sample size of 323 (2.31% of the State of Kerala's estimated 14,000 survivors in the 2000s) is substantial, underscoring the study's significance and reliability.\u003c/p\u003e","manuscriptTitle":"Impact of Yoga Practice on Mitigating Side Effects, Enhancing Quality of Life, and Promoting Longevity Among Cancer Thrivers in Kerala, India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 13:47:46","doi":"10.21203/rs.3.rs-8139011/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-14T17:39:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-13T14:32:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-12T10:50:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-10T15:19:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154153055690425184738880717029975197898","date":"2026-01-01T06:40:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94177268249821481498634548226908968554","date":"2025-12-30T05:49:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128882037832539687666910691405409023641","date":"2025-12-28T16:31:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300008935213445688018654358588686261665","date":"2025-12-28T15:23:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T04:20:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187369396548883256321074729248842658479","date":"2025-12-19T03:44:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84733499455727812124865434145805532293","date":"2025-12-18T05:44:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T13:55:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-08T10:03:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-06T10:21:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-05T03:03:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Psychology","date":"2025-12-05T02:57:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"add4472f-e815-4744-ab20-290457c7ae37","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T11:54:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 13:47:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8139011","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8139011","identity":"rs-8139011","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}