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Aiming to ease and prolong the lives of people
living with cancer and other serious illnesses

Supportive Research Material for Physical Activity and Guided Visualisation

In Mind In Body pioneers a technique which combines the benefits of Physical Activity and Guided Visualisation, to bring hope and belief to people living with cancer and other illnesses by creating an environment within our bodies to maximise our own natural healing, thereby improving responses to conventional treatment.

Benefits of Physical Activity

1. Physical activity can reduce mortality and the recurrence of Cancer, particular breast and prostate.

Research has shown that by participating in regular exercise, the chances of cancer recurrence can be severely reduced. Regular exercise can help promote recovery from treatment to all round health, helping reduce reoccurrence. Furthermore not only will it reduce reoccurrence, but reduce mortality levels.

  • An update of controlled physical activity trials in cancer survivors – Mar’ 2011- Dr.Speck and his other researchers found, through literary review, that physical activity can lead to an improvement in physical activity levels, aerobic fitness, muscular strength, functional quality of life, anxiety, and self-esteem
  • Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies – Apr’ 2010 – Working together, Dr.Ibrahim and Dr.Al-Homaidh, studied the effects of physical activity in breast cancer sufferers, discovering that it lead to a decrease in all causes of mortality, breast cancer deaths, and the recurrence of breast cancer, ending by highly recommending physical activity as a means of treatment.
  • Physical activity and survival after breast cancer diagnosis – May 2005 – Holmes, MD et al. wanted to focus on the risk of death from breast cancer and what effect physical activity had. They concluded that by performing the equivalent of walking at least 3-5 hours a week at an average pace, mortality could be severely reduced.
  • Physical activity and survival after diagnosis of invasive breast cancer – Feb’ 2008 – Holick CN, Newcomb PA, Trentham-Dietz A et al. set out to discover the effects of increased physical exercise post diagnosis. The study highlighted how inactive women could still reduce mortality rates with physical exercise post breast cancer diagnosis.
  • Physical activity and survival after colorectal cancer diagnosis – July 2006 – While Physical activity had been proven to reduce the risk of developing cancer J.A. Meyerhardt et al. investigated its effects on cancer survival. Through conducting an observational study of 573 people with stage I to III colorectal cancer, it was concluded that recreational physical activity may reduce the risk of colorectal cancer recurrence, and overall mortality.
  • Cancer of the Prostate Strategic Urologic Research Endeavor – May 2011- while investigating the effects of  physical activity after diagnosis and risk of prostate cancer progression, E.L. Richman, S.A. Kenfield and M.J. Stampfer found that as little as a regular brisk walk was capable of reducing the progression or recurrence of prostate cancer
  • The British Association of Sport and Exercise Sciences Expert Statement on Exercise and Cancer survivorship – Summer 2011 – A. Campbell, C. Stevinson and H. Crank, three of the assosciations top researchers, stated that through regular exercise, improvements in aerobic and muscular fitness, quality of life and reduced fatigue can be expected leading to increased survivorship

2. Physical activity can reduce or prevent debilitating side effects caused by cancer treatment:

Cancer treatment can cause many debilitating side effects, including increased fatigue, muscle soreness and weakening, bone health decreasing and even mood. Physical activity has been proven as a remedy to these side effects, from reducing the effects to preventing them all together.

  • Exercise interventions for upper-limb dysfunction due to breast cancer treatment – Jun’ 2010 – McNeely and co. were investigating the weakening of the shoulder joint that can occur from breast cancer treatment and found that regular physical activity can significantly improve both strength and range of movement at the shoulder joint
  • Cramp and Daniel. Physical activity for the management of cancer-related fatigue in adults – Nov’ 2012 – After eighty studies, examining two thousand and eighty three patients, Dr. Camp and Dr. Daniel found that physical exrcise can be extremely beneficial to patients experiencing cancer related fatigue
  • A Review of Exercise in Interventions to Improve Bone Health in Adult Cancer Survivors – Sep’ 2010 – Doctors Winter-Stone, Schwartz and Nail discovered that physical activity can improve bone health, decreasing the risk of bone breaks and fractures
  • The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer – Sep’ 2004 – Some cancer patients are unable to participate in physical activity as readily as others. However Dr. Headley and co. found that even performing seated exercises can significantly improve well being and reduce fatigue
  • The effect of a physical exercise program in palliative care: a phase II study – May 2006 – Even for those with incurable cancer, physical activity can improve physical capacity and emotional functioning, as well as reducing fatigue, according to Oldervoll and his team
  • Porock D, Kristjanson LJ, Tinnelly K, Duke T, Blight J. An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study – Autumn 2000 – When studying patients with advanced breast cancer, Porock, Kristjanson, Tinnelly, Duke and Blight saw a reduce in fatigue, quality of life scores increase and anxiety levels decrease. Most notable however was the sense of self satisfaction felt by all patients
  • Resistance Exercise in men Receiving Androgen Deprivation Therapy for Prostate Cancer – May 2003 – In a 12 week study of 82 men, Segal and other researchers recorded reduced fatigue levels, improved quality of life scores and increased muscular fitness levels in all patients
  • Effects of acute exercise on state anxiety in breast cancer survivors – Nov’2001 – Blanchard, Courneya and Laing noted that physical activity can be effective in reducing anxiety in breast cancer sufferers
  • Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes – May 2003 – Courneya, this time working with Mackey, Bell, Jones, Field and Fairey noticed that regular physical activity had beneficial effects on Quality of life scores and pulmonary functions in cancer survivors
  • The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer – Sep’ 2004 – In this study into seated exercise it was seen that it could be just as effective into other physical activity in preventing fatigue and maintain physical well being
  • Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer – Jul’ 1997 – According to research by Dr. V. Mock and others as little as regular walking can be effective in decreasing side effects of cancer treatment, such as; fatigue, decreased physical functioning and emotional distress
  • Fatigue and Quality of Life Outcomes of Exercise During Cancer Treatment – Jan’ 2002 – Dr. Victoria Mock and her team recorded that a programme of ninety minutes physical activity, three times per week, significantly reduced emotional distress and fatigue, whilst improving quality of life scores and physical functioning
  • Psychological and fitness changes associated with exercise participation among women with breast cancer – Nov’ 2002 – This study of 24 women saw that women participating in regular physical activity experienced much improved self confidence in their body image, plus reducing stress

Benefits of Guided Visualisation

Reduces fear and other feelings of powerlessness that can occur when one learns of a life-threatening medical diagnosis like cancer. These feelings are known to inhibit the body’s natural ability to heal.

  • Jeanne Achterberg, well known for her medical use of imagery, states in Imagery In Healing (1985), that imagery can provide an element of strong internal control, leading to a reduction in stress and therefore relieving the body’s various biophysical responses to stress.
  • L. Baider, et al. examined the long-term effects of relaxation and guided imagery on patients recently diagnosed with cancer at Hadassah University Hospital, and results showed a decrease in psychological distress and an increase in the patient’s sense of internal control [Gen Hosp Psychiatry 2001 Sep-Oct;23(5):272-7].
  • A study by J. A. Royle, et al. of Ontario, found that guided imagery was the intervention best used by nurses to decrease patient anxiety [Can Oncol Nurs J 1996 Feb;6(1):20-5].
  • C. H. McKinney et al. from the University of Miami found that 13 weeks of guided imagery and music showed significant decreases in cortisol level (the “stress hormone” strongly correlated with mood disturbances, as well as demonstrating a significant reduction in depression, fatigue, and total mood disturbance. The study also [Health Psychol 1997 Jul;16(4):390-400].

Reduces depression and helps a person gain confidence and optimism. Depression is known to suppress the immune system.

  • Fawzy et al. in the late 1980’s found significant evidence that freeing cancer patients from depression increased the wide array of cancer cells [Fawzy F I, Cousins N, Fawzy N W et al 1990 A structured psychiatric intervention for cancer patients: I. Changes over time in methods of copying and effective disturbance. Archives of General Psychiatry 47:720-5].
  • Fawzy et al. found that information on the cancer and training in stress management and coping skills, showed participants exhibiting less fatigue, depression, mood disturbances, as well as increased vigor [Fawzy F I, Kemeny M E, Fawzy N W et al. 1990 A structured psychiatric intervention for cancer patients: II. Changes over time in immunological measures. Archive of General Psychiatry 47:729-35].
  • D. S. Burns at the Group/Walther Cancer Institute found that individuals who participated in guided imagery sessions scored better on both mood scores and quality of life scores than those who did not. Interestingly, these scores continued to improve in the experimental group, even after sessions were complete, indicating that guided imagery is effective in improving mood and quality of life in cancer patients [J. Music Ther. 2001 Spring; 38(1):51-65].
  • B. L. Rees reported that patients receiving 4 weeks of relaxation and guided imagery scored significantly lower on trait anxiety, state anxiety, and depression, while scoring significantly higher on measurements of self-esteem [J. of Holistic Nursing. 13(3): 255-267. Sept. 1995].

Reduces tension and stress so that the body can put its focus on healing.

  • C.L. Norred at the University of Colorado Health Sciences Center Department of Anesthesiology in Denver found that guided imagery may be an integrative therapy that can minimize preoperative anxiety [AORN J 2000 Nov; 72(5):838-40, 842-3].
  • K. L. Kwekkeboom studied the increase in the patients’ use of relaxation strategies (breathing, imagery, music, meditation) vs. pharmacologic strategies for the management of pain after discharge from surgical hospitalization in Iowa [Cancer Nurs 2001 Oct;24(5):378-86].
  • S. A. Lambert found that guided imagery and relaxation therapy significantly lowered postoperative pain ratings and shortened the hospital stays, as well as decreased the postoperative anxiety [J Dev Behav Pediatr 1996 Oct;17(5):307-10].
  • D. L. Tusek and R. E. Cwynar of Ohio acknowledge that patients often describe the experience in a hospital as overwhelming, evoking fear, anger, helplessness, and isolation. Tusek and Cwynar view guided imagery as one of the most well-studied complementary therapies being used that can improve the patient experience and outcome by providing a significant source of strength, support, and courage as they prepare for a procedure or manage the stresses of a hospital stay [AACN Clin Issues 2000 Feb;11(1):68-76].
  • D.L. Tusek, R. Cwynar, and D.M. Cosgrove studied the effect of listening to taped guided imagery for patients undergoing cardiovascular surgeries and concluded that guided imagery can decrease length of stay, pain, and anxiety [J of Cardiovascular Management. 22-28. March-April 1999].
  • C. Holden-Lund found that the use of an audiotape series employing relaxation with guided imagery demonstrated significantly less state anxiety, lower cortisol levels one day following surgery, and less surgical wound erythema than the control group. Thus, the guided imagery tapes demonstrated stress-relieving outcomes closely associated with healing [Res Nurs Health 1988 Aug; 11(4):235-44].
  • C Renzi et al. found that listening to guided imagery tapes before, during, and after surgery showed results in which there was a trend for reduction in pain following surgery and a significant improvement in the quality of sleep [Int J Colorectal Dis 2000 Nov;15(5-6):313-6].
  • Gaston-Johansson et al. of Johns Hopkins University School of Nursing in Baltimore, Maryland showed significant benefits from the use of information, cognitive restructuring, and relaxation with guided imagery in patients with breast cancer who underwent autologous bone marrow/peripheral blood stem cell transplantation. This strategy was found to be effective in significantly reducing anxiety, nausea, and nausea combined with fatigue 7 days after surgery when the side effects of treatment are usually the most severe [Cancer Nurs 2000 Aug; 23(4):277-85].
  • D.A. Rapkin, M. Straubing, and J.C. Holroyd from the University of California, Los Angeles explored the value of imagery-hypnosis on recovery from head and neck cancer surgery and found there were fewer surgical complications and less blood loss during surgery [Int J Clin Exp Hypn 1991 Oct; 39(4): 215-26].
  • Omlor et al. found that preoperative relaxation techniques significantly reduced the number of postoperative hematomas as well as the amount of pain medication being required after surgery [Zentralbl Chir 2000; 125(4):380-5; discussion 385-6].

Reduces pain by alleviating many symptoms of treatment by relaxing muscular tension as well as altering the mind’s perception of the pain itself.

  • Lawrence LeShan found that psychological conditions had an enormous influence not only on the production of cancer, but also on the disease’s evolution and even on the person’s response to a particular treatment (LeShan L, Worthington R 1956 Personality as a factor in the pathogenesis of cancer: a review of the literature. British Journal of Medical Psychology 29:49-56).
  • Journal of Consulting and Clinical Psychology: 1991 Aug; 59(4): 518-25 concluded that relaxation therapy is effective in reducing adverse consequences of chemotherapy, for a study involving 81 cancer patients showed relaxation therapy to decrease nausea and anxiety during chemotherapy.
  • L. G. Walker et al. of the University of Aberdeen Medical School found that cancer patients receiving standard care plus relaxation training and imagery were more relaxed and easy going during the study, experiencing a higher quality of life overall during primary chemotherapy [Br J Cancer 1999 Apr; 80(1-2): 262-8].
  • K. Kolcaba and C. Fox measured the effectiveness of customized guided imagery for increasing comfort in early stage cancer. They found that listening to a guided imagery audiotape once a day for the duration of the study indicated a significant overall increase in comfort over time, and was especially salient in the first three weeks of therapy. [Oncol Nurs Forum 1999 Jan-Feb; 26(1): 67-72].
  • K. L. Syrjala et al. of the Fred Hutchinson Cancer Research Center in Seattle, WA concluded in their study that stand-alone relaxation and imagery training reduces cancer treatment-related pain [Pain 1995 Nov; 63(2): 189-98].
  • L. M. Troesch et al. of the Arthur G. James Cancer Hospital and Research Institute at Ohio State University in Columbus found that those patients using a chemotherapy-specific guided-imagery audiotape expressed a significantly more positive experience with chemotherapy, finding guided imagery to be an effective intervention to promote patient involvement in self-care practices and to increase patient coping abilities during symptom occurrence [Oncol Nurs Forum 1993 Sep; 20(8): 1179-85].
  • K. L. Kaufman et al. at Ohio State University tried a self-hypnotic, cue-controlled relaxation, and guided imagery intervention that showed a marked and clinically significant reduction in nausea and vomiting as well as a concurrent increase in sleep duration [J Adolesc Health Care 1989 Jul; 10(4): 323-7].

Enhances the immune system and healing responses with its ability to boost the number of immune cells as well as the activity of cells affected by treatments like chemotherapy and radiotherapy.

  • Kiecold-Glaser and Ronald Glaser, studying a group of elderly people, found that over a month of relaxation training three times per week significantly increased their natural killer lymphocytes and T cell activity [Cousins N 1989 Head first. Dutton, NY].
  • Howard Hall, measuring the effects of healthy people imagining their white blood cells as strong as powerful sharks, found a number of subjects could demonstrate an increase in the number of lymphocytes as well as an increased responsiveness of the immune system after the session as compared to before [Hall H R 1983 Hypnosis and the immune system. American Journal of Clinical Hypnosis, 25:92-103].
  • James Pennebaker found that “confessional writing,” of the type that occurs when journaling, led to salubrious changes in the immune system and better health in general. He felt that there is structuring and resolving of the harmful effects of those “hidden” feelings and images going on through the process of writing. [Pennebaker J W 1990 Opening up: the healing power of confidence in others. Avon, NY].
  • Dr. Alan Watkins states that every idea, thought and belief has a neurochemical consequence, which is what makes imagery such a significant mind-body bridge. He writes that the flow of neuropeptides from the CNS, which enhances or inhibits one’s immunology through two major neuroimmunomodulatory pathways; neuroendocrine and autonomic, are critically important in maintaining health and fighting disease [Watkins A 1997 Mind-body medicine. Churchill Livingstone, NY].
  • V. W. Donaldson in NC at the Center for Stress Management examined the effects of mental imagery on the immune system response, and specifically, on depressed white blood cell (WBC) counts. Results indicated significant increases in WBC count for all patients over a 90-day period, even when possessing disease and illnesses that would have predicted a decrease in WBC count [Appl Psychophysiol Biofeedback 2000 Jun; 25(2):117-28].

Increases confidence and optimism as depression is relieved and mood is enhanced

  • R. Sloman from the University of Sydney in Australia observed that progressive muscle relaxation combined with guided imagery has the potential to promote relief of cancer pain. The techniques appear to produce a relaxation response that may break the pain-muscle-tension-anxiety cycle and facilitate pain relief through a calming effect. This technique seems to provide a self-care strategy that, to a limited extent, shifts the locus of control from clinician to patient [Nurs Clin North Am 1995 Dec; 30(4): 697-709].
  • R. J. Moore and D. Spiegel from the Anderson Cancer Center in Houston, TX observed a desire for and a benefit from patients being able to attach meaning to the disease and its treatment. They felt that this is why many are drawn to guided imagery as a tool in the management of cancer-related anxiety and pain by using it to reconnect to the self, to make sense of their experiences with breast cancer, and for managing cancer pain in a manner that increases one’s sense of control, thereby alleviating the suffering of the survivor [1096-2190 2000 Mar 21; 2(2): 115-126].

Deepens intuition and “will to live” by enabling an individual to investigate and react intuitively to information about their diagnosis and treatment empowering them to make choices and decide to live life to the fullest.

  • Howard Hall found that using symbolic work like drawings and dreams generally encouraged clients with critical illnesses to find ways of living that brought zest and enthusiasm to their daily lives, showing far superior results in survival time to those receiving only classic strategies [Hall H R 1983 Hypnosis and the immune system [American Journal of Clinical Hypnosis, 25:92-103].
  • C. Maack & P. Nolan in Hamburg, Germany report that the main gains conveyed by former clients of GIM therapy are (a) getting more in touch with one’s emotions, (b) gaining insights into some problems, (c) spiritual growth, (d) increased relaxation, and (e) discovering new parts of oneself. These changes appeared to stabilize over a period of time but even continued to improve after termination of therapy, especially in the mental and transpersonal areas [J Music Ther 1999; 36(1):39-55].