Dose effects of relaxation practice on immune responses in women newly diagnosed with breast cancer: an exploratory study

Oncol Nurs Forum. 2011 May;38(3):E240-52. doi: 10.1188/11.ONF.E240-E252.


Purpose/objectives: To determine the dose effects of relaxation practice on immune responses and describe the types of relaxation techniques preferred and the extent of relaxation practice over 10 months.

Design: Descriptive, prospective, repeated measures.

Setting: An interdisciplinary breast clinic at a university-affiliated comprehensive cancer center in the United States.

Sample: 49 women with newly diagnosed breast cancer and undergoing adjuvant therapy who participated in a stress management intervention.

Methods: Relaxation practice was assessed twice a month for 10 months with immune measurements (e.g., natural killer cell activity; lymphocyte proliferation; interferon [IFN]-γ; interleukin [IL]-2, -4, -6, and -10) at the beginning and end of 10-month practice.

Main research variables: Relaxation practice (representing the concepts of stress and adherence), relaxation technique, and immune response.

Findings: After adjusting for covariates, the extent of relaxation practice significantly contributed to the variance of natural killer cell activity, lymphocyte proliferation, IL-4, and IL-10 responses in a positive direction; the higher the relaxation practice, the higher the immune responses. In comparison, IFN-γ, IL-2, and IL-6 responses were not affected. The deep-breathing method was most preferred by participants, followed by progressive relaxation and imagination or visualization. The mean weekly frequency of relaxation practice was 5.29 (SD = 3.35), and the mean duration of relaxation practice was 19.16 (SD = 10.81) minutes per session.

Conclusions: Persistent relaxation practice may have positive effects on multiple immune responses in a dose-dependent manner.

Implications for nursing: Allowing the choice of preferred techniques and emphasizing the importance of long-term adherence, a relaxation program may need to be routinely offered to women under high stress.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use
  • Biomarkers / metabolism
  • Breast Neoplasms* / drug therapy
  • Breast Neoplasms* / immunology
  • Breast Neoplasms* / nursing
  • Chemotherapy, Adjuvant / nursing
  • Female
  • Holistic Nursing / methods*
  • Humans
  • Immune System / physiology*
  • Middle Aged
  • Oncology Nursing / methods*
  • Pilot Projects
  • Prospective Studies
  • Relaxation Therapy / methods*
  • Stress, Psychological / immunology
  • Stress, Psychological / nursing
  • Stress, Psychological / therapy


  • Antineoplastic Agents
  • Biomarkers