Feasibility, acceptability, and preliminary efficacy of Tai Chi versus mindful yoga on psycho-spiritual distress in patients with advanced cancer : a mixed-method pilot randomized controlled trial

Abstract

Purpose: Psycho-spiritual distress is prevalent and distressing among advanced cancer patients. While mind-body exercises have shown promise in alleviating psychological distress, their effectiveness in advanced cancer patients is still being explored. This study aimed to explore the feasibility and acceptability, and preliminary efficacy of two mind-body exercises—Tai Chi and mindful yoga—each rooted in distinct philosophies, compared to control among patients with advanced cancer. Methods: We conducted a three-armed mixed-method pilot randomized control trial. Participants were randomized into Tai Chi, mindful yoga, or control groups. Over 12-week, 60-min Tai Chi classes were held twice a week, 120-min mindful yoga classes weekly, and control group received written exercise guidelines. Feasibility outcomes were assessed through questionnaires and semi-structured interviews at 12-week. Effect outcomes were assessed by questionnaire and physical functioning test at baseline, 12-week (post-intervention), and 24-week (12-week post-intervention). Results: Forty-six patients with advanced cancer, with a mean age 61 years, were enrolled. Both Tai Chi and mindful yoga demonstrated satisfactory feasibility and acceptability, with attendance rates exceeding 86%, satisfactory levels of self-practice, and high satisfaction and credibility. Compared with control group, Tai Chi and mindful yoga groups showed preliminary reductions in depression and improvements in balance ability at 12 and 24 weeks. Additionally, mindful yoga showed additional preliminary enhancements in mindfulness and spiritual outcomes at 24-week. Qualitative interviews revealed three themes that contextualize and may underpin the improvements in depression, mindfulness, spiritual well-being, and physical functioning. Conclusion: Tai Chi and mindful yoga were feasible, well-accepted, and showed promising trends in psycho-spiritual, mindfulness, and physical outcomes. A large-scale trial is warranted to confirm these findings.