Specialist exercise programmes designed to help support cancer patients during and after treatment. There are many forms of exercise and movement that could be beneficial, such as yoga, tai chi, qi gong and many others.

Research shows that exercise can help with the side effects of cancer treatment such as fatigue, pain, nausea and vomiting. It can also improve your mood and feelings of confidence. Too much exercise can make you tired, so can too little. Its important to find your own level. More importantly, the research shows that exercise can reduce the risk of the cancer coming back.

Tai Chi

Tai Chi is an internal Chinese martial art. It uses slow, intentional and graceful body movements and controlled breathing, to improve muscle strength, balance and flexibility.

Tai Chi practice involves slow-motion flow, and is a mind-body exercise combining movement, meditation and deep breathing.

Tai Chi has its conceptual background in Chinese philosophy and draws on Chinese theories of the body. Importantly, the idea of ‘qi’ (vital energy). Tai Chi is focused on developing ‘qi’. It also focuses on working with the flow of yin (softness) and yang (hardness) (1).

Tai Chi is widely practiced as a low-stress exercise method for people with health issues. As it is equipment-free, it is considered a good alternative to ‘traditional’ exercise (2).

Tai Chi is widely practiced due to its physical and psychological health benefits, and has been linked to improved immune function, and relief from symptoms such as depression, pain, fatigue and sleep difficulty. Due to these potential positive effects on quality of life, Tai Chi may be beneficial to cancer patients.

There have not been conclusive studies investigating the effects of Tai Chi specifically on cancer treatment and prevention, therefore the effects of Tai on cancer specifically are inconclusive (3, 4).

There are five key styles of Tai Chi (6):

• Chen – this is the oldest style, and the most dynamic. It gives more of a cardio and physical workout
• Yang – this is the most widely practiced form, and has a consistently slow pace
• Wu – this form emphasises the extension of the body by leaning forwards and background instead of remaining upright as in other styles
• Sun – this incorporates unique footwork and circular hand movements
• Hao – this is the rarest style, and focuses more on internal balance rather than outer movements

Tai Chi Brief History

The History of Tai Chi is rooted in Chinese culture, and its exact origins and development are still unclear.

Legend attributes Tai Chi to a Taoist Monk, Zhang San Feng, in the 13th century. He was apparently inspired to create Tai Chi after observing a snake and a crane in combat, noticing the snake dodging the crane’s strikes and using its own energy against it.

Historical evidence suggests a more gradual development, with influence from different historical martial arts styles and figures. A key figure is Chen Wang-ting, who was a 17th century military officer, who created forms of Tai Chi that he passed down to his family.

Over time, further styles of Tai Chi emerged, and today Tai Chi is practiced worldwide for its physical and mental health benefits (5).

Qi Gong

Qigong is a system of coordinated body postures, movement, breathing techniques and meditation. It can be used for health, martial-arts training and spirituality, and has roots in Chinese philosophy.

Qigong is rooted in Chinese philosophy and martial arts, and places focus on balancing ‘qi’ (life energy). It involves slow coordinated movement, meditation and breathing. It differs from Tai Chi, as forms are freer, and it can be practiced sitting, standing or lying down. Usually, during qigong practice, breathing is slow and deep, movements are gentle and smooth, and there is a focus on visualisation (1).

There have not been any published studies that found a linked between qigong and anti-cancer effects or reducing cancer risk/recurrence. Review papers exploring different studies on the effect of qigong and cancer suggest that more high-quality studies need to be done to make definitive conclusions (2).

There is some research that suggests qigong may have some beneficial effects on cancer patients, as it may be linked to improved cortisol levels and immune activation. More widely, there have also been studies that suggest qigong may mitigate side-effects of cancer, thus improving quality of life. This includes symptoms such as fatigue, sleep quality, stress, anxiety, and depression. (1, 3, 4)

Qigong has many forms; in literature 75 ancient forms and 56 contemporary forms have been outlined. They can under three categories (7):

• Medical Qigong – a healer transmits ‘qi’ to the patients, it involves slow and relaxed exercise
• Martial Qigong – this is more strenuous and dynamic
• Meditation Qigong – this form focuses on mind-body integration and spiritual fulfilment, often visualisation of ‘qi’ flowing throughout the body is practices

Qi Gong Brief History

Qigong has roots in Chinese culture, being over 2000 years old. The term comes from ‘qi’ meaning life energy, and ‘gong’ meaning cultivation/practice.

Its exact origins are unclear; however qigong has roots in ancient Chinese traditions, Taoist philosophy and Buddhist practices (5).

In c. 1133 BC the first concept of ‘qi’ was recorded in ‘The Book of Change’. In c. 450 BC Lao Tzu, the founder of Taoism, described breathing techniques that focused on ‘qi’. From this, qigong-like practices developed in ancient China. A key development in c. 500 AD was from a Buddhist monk Ta Mo, who is credited with unifying the spiritual and martial branches of qigong. Over time, qigong developed into various different forms, and became key an important focus in traditional Chinese mediation (5).

During the 20th Century, qigong and other traditional practices faced suppression during the Chinese Cultural Revolution, being viewed as ‘archaic’. Interest in these traditional practices regained after the Cultural revolution, and in the 1980s qigong gained popularity both within China and internationally (6).

Yoga

Yoga is an ancient practice that utilises breathing exercises, meditation and stretching to improve balance, strength, and flexibility. The use of established poses emphasises the mind-body connection, and can involve physical, mental, and spiritual practices.

Yoga is an ancient practice, mainly composing of breathing and different poses. These poses are movements which can involve standing, kneeling, sitting and lying down, all designed to increase strength and flexibility. It is practiced in a range of methods by all Indian religions, including Hinduism, Buddhism, Sikhism and Jainism (1).

The actual experience of practicing yoga is variable, and dependent on different factors. For example, yoga can be done in more social classes with a larger group, or privately with a teacher. Additionally, the postures and breathing will vary depending on the style of yoga chosen, however often a mat will be needed (2).

Yoga has been linked to an improved quality of life for many people, due to a range of positive consequences. Yoga has been linked to an improved inner balance in the body, of factors such as body weight, blood sugar/insulin levels, hormone levels and inflammation (3)

There is no published evidence to suggest that yoga alone reduces cancer risk, however it is still recommended in integrative cancer practices. This is because there is a relatively small risk of harm, and it is considered generally safe. Supervision is recommended for patients who have undergone recent surgery or have an increased risk of bone loss (4).

Yoga also has wider health benefits and is linked to improved effects on psychological functioning for cancer patients. These include having beneficial effects with anxiety, stress, depression, and sleep disruption (4). Yoga classes also can provide social support for people with cancer, and the focus on breathwork and meditation can make classes a relaxing yet social experience (5).

There are a range of different styles of yoga, some key forms are described below (10):

• Kundalini Yoga – this involves breath work and chanting to accompany the different poses
• Vinyasa Yoga/’flow yoga’ – in this practice, the aim is to flow from one pose to another
• Hatha yoga – the emphasis is on balance, and it is often recommended for beginners due to being ‘gentler’
• Ashtanga yoga – in this form, there are only six poses, usually taught in order
• Yin yoga – this is a slower form of yoga, and poses can be held from one to over five minutes. There is an emphasis on deep stretching
• Iyengar Yoga – this form involves props and detailed instructions; it is considered more ‘classical’
• Bikram Yoga – this is a form of hot yoga, practised in a hot room, and has strict rules/guidelines

Yoga Brief History

Yoga developed in ancient India; however, the exact origins are still unclear and can be traced back over 5000 years.

There are two main theories about the origins of yoga (6):

1) The linear model:

This theory proposes that yoga has Vedic origins. This means they arose from the ‘Vedas’ which are a body of religious texts important in Hinduism. The linear model suggests that yoga was later influenced by Buddhism.

2) The synthesis model:

This theory suggests yoga is a mix of indigenous non-Vedic Indian practices, which were later influenced by Vedic ideas

The earliest references to yogic practices have been identified in the ‘Vedas’, which were codified between c. 1200 and 900 BCE.

More systemic yoga concepts emerge in Indian texts dating c. 500–200 BCE. From c. 200 BCE – 500 CE distinct yoga systems emerged. Key texts dating from this time compiled yogic methods and practices. In the Middle Ages, satellite yoga forms, such as Hatha yoga, developed (7).

It was not until the mid-19th Century that the Western public became aware of yoga. In the 1980s, Swami Vivekananda became the first teacher to disseminate yoga to a Western audience, touring Europe and the United States (1). Since then, yoga has become a key exercise and practice worldwide, and in 2015 June the 21st has been established as the International Day of Yoga (9).

Although all yoga is potentially therapeutic and healing, yoga therapy is the specific application of yogic tools. For Yoga Therapy for Cancer, please visit our dedicated page for this therapy.

Historically advice has been given based on the ‘rest is best’ principle, but the latest thinking is that a moderate level of exercise is beneficial during and after cancer treatment.

Evidence suggests that being physically active during and after cancer can:

• Improve physical and psychological wellbeing
• Reduce the risk of consequences of treatment
• Improve overall survival rates and reduce the risk of recurrence
• Reduce the risk of co-morbidities (two or more medical conditions)

Tai Chi

Sources:

2) Yang, Lin et al. “Tai Chi for cancer survivors: A systematic review toward consensus-based guidelines.” Cancer medicine vol. 10,21 (2021): 7447-7456. doi:10.1002/cam4.4273

(4) Luo X-C, Liu J, Fu J, Yin H-Y, Shen L, Liu M-L, Lan L, Ying J, Qiao X-L, Tang C-Z and Tang Y (2020) Effect of Tai Chi Chuan in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Front. Oncol. 10:607. doi: 10.3389/fonc.2020.00607

Useful Links:

(1) Migala, J. (2022) What is Tai Chi? A guide to Tai Chi for Beginners, EverydayHealth.com.

(3) Tai Chi or qigong (2023) CancerChoices.

(5) Activif Team (2021) A complete history of Tai Chi (from the east to the west), Activif.

(6) Tai Chi forms, JI HONG TAI CHI & QI GONG MISSISSAUGA.

How do experts use Tai Chi or Qigong? (2023) CancerChoices.

Qi Gong

Sources:

(2) Wayne, P.M., Lee, M., Novakowski, J. et al. Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis. J Cancer Surviv 12, 256–267 (2018)

(4) Qigong: What you need to know (2022) National Center for Complementary and Integrative Health.

Useful Links:

(1) How do experts use Tai Chi or Qigong? (2023) CancerChoices.

(3) Tai Chi or qigong (2023a) CancerChoices.

(5) Holden, L. and Meyer, L. (2021) History of qigong, Holden QiGong.

(6) Holley, D. (1990) Culture : Filling a void with ‘qigong’ in China : Millions have turned to the practice, which mixes exercise and meditation. officials fear unpredictable political consequences., Los Angeles Times.

(7) Chia, K. (2011) Tai Chi, Difference between Tai Chi and Qigong.

Yoga

Sources:

(3) Smith KB, Pukall CF. An evidence-based review of yoga as a complementary intervention for patients with cancer. 2009. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

(5) DiStasio, Susan A, MS, ANP-CS,A.P.R.N., R.Y.T. 2008, “Integrating Yoga Into Cancer Care”, Clinical journal of oncology nursing, vol. 12, no. 1, pp. 125-30.

Rao RM, Amritanshu R, Vinutha HT, et al. Role of Yoga in Cancer Patients: Expectations, Benefits, and Risks: A Review. Indian J Palliat Care. 2017;23(3):225-230. doi:10.4103/IJPC.IJPC_107_17

Useful Links:

(1) Explore the ancient roots of Yoga – Google Arts & Culture, Google.

(2) Yoga for beginners: A complete guide to get started, Yoga Basics.

(4) Yoga (2023) CancerChoices.

(6) About yoga, La Lar.

(7) Hkt (2021) Yoga, HKT Consultant.

(8) International Yoga Day, World Health Organization.

(9) Yoga Medicine (2022) Types of yoga: A guide to the different styles, Yoga Medicine – Education – Experience – Results.

How do experts use yoga? (2023) CancerChoices.

Tomlinson, K. (2020) What to expect in your first yoga class, Ekhart Yoga.

Varies according level of support offered.

For more research and science on tai chi or qigong, visit CancerChoices
For more research and science on yoga, visit CancerChoices

Research by: Divya Balain, Yes To Life Online Volunteer Researcher