UNIVERSITY OF CALGARY

UNIVERSITY OF CALGARY
Exploring the Relationships between Yoga Practice, Affect and Attention Regulation,
Health Outcomes and Program Adherence in Cancer Survivors
by
Michael John Mackenzie
A DISSERTATION
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY
FACULTY OF KINESIOLOGY
CALGARY, ALBERTA
NOVEMBER, 2012
© Michael John Mackenzie 2012

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Abstract
Yoga practice has been reported to lead to improvements in health-related quality
of life (HRQL), psychological functioning, and symptom indices in cancer survivors.
Yoga is defined in the Yoga Sutras of Patanjali as a path towards, “stilling the
fluctuations of the mind (YS I.2).” Importantly, meditative states experienced within yoga
practice are correlated to neurophysiological systems that moderate both positive affect
and internalised attention. Despite preliminary findings, little attention has been paid to
the psychophysiological mechanisms by which benefits are accrued via yoga practice.
The impetus for the present studies was to explore the mechanisms by which yoga
practice stills the fluctuations of the mind in cancer survivors. Three studies examined: 1)
the clinical significance of patient–reported outcomes in yoga interventions for cancer
survivors; 2) longitudinal associations between yoga participation, affect, and
mindfulness as predictors of mood, stress and HRQL outcomes in an ongoing
community-based yoga program; 3) associations between valence, activation, attention,
perceived exertion, cardiac activity, and participant descriptions of a single yoga session
for cancer survivors.
The clinical significance review confirmed yoga practice was related to clinically
significant improvements in HRQL, psychological health, and symptom experience.
Longitudinal findings suggest improvements in mood, stress and HRQL were related to
affect and attention (mindfulness) regulation, but not previous yoga experience. Previous
yoga experience, affect and mindfulness were related to yoga practice maintenance. Lab
study findings suggest both affect and attention improved in a single yoga session and
were related to cardiac activity. Participant descriptions confirmed these findings and

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further suggested regulation of attention via breath awareness elicited positive affective
responses to yoga.
This research develops current theory in yoga practice, affect and attention
regulation by modelling processes and outcomes, resulting in a detailed exploration of
yoga in cancer settings. Examining these proposed theoretically-based mechanisms for
yoga’s salutary effects enables greater understanding not only of “if” yoga works, but
also “how.” This knowledge can be used to develop innovative yoga interventions with
the express aim of improving mental health and HRQL in cancer survivors.

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Preface
In the course of this dissertation, Chapter 2 was prepared and published in
Evidence-Based Complementary and Alternative Medicine
(www.hindawi.com/journals/ecam/2012/642576/abs/). The idea for the manuscript was
initially conceptualised by Drs. Culos-Reed and Danhauer and Michael Mackenzie was
brought in as a collaborator. Mr. Mackenzie was subsequently responsible for completing
the literature review, methods, data analysis and results section and significantly
contributing to both the introduction and discussion. This was completed under the
guidance of Drs. Culos-Reed and Danhauer. All authors provided critical reviews of the
manuscript and contributed intellectual content. The published article was reproduced in
its entirety and included as a chapter in this document with permission from the
publisher. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited
(creativecommons.org/licenses/by/3.0/).
Culos-Reed SN, Mackenzie MJ, Sohl SJ, Jesse MT, Ross-Zahavich AN, Danhauer SC.
Yoga & Cancer Interventions: A review of the clinical significance of patient-reported
outcomes for cancer survivors. Evidence-Based Complementary and Alternative
Medicine: eCAM 2012; 1-17.

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Acknowledgements
I am incredibly grateful to many people for their varied contributions and support
of this work over the past few years.
Thank you to my dissertation committee for all their work in moving this project
forward. Particular thanks go to Dr. Nicole Culos-Reed for her mentorship, patience and
gentle hand in guiding this work. Dr. Linda Carlson has been my mentor for many years
and someone I still grow with and learn from. Dr. Dave Paskevich has also been a
wonderful mentor these past three years. His thoughts and opinions have always been
welcome additions to this work. I also thank Dr. Telles and Dr. Page for taking time out
of their extremely busy schedules to be part of this process.
The Health and Wellness Lab has been my home the past three years. Thanks to
Dr. Carolina Chamarro, Lauren Capozzi, Amanda Wurz, Kathryn Wytsma, Katie Krenz,
Jessica Danyluk, Tanya Williamson, Lynette Stephenson, and Marni Armstrong for being
an integral part of this journey. Thanks also to Tyla Arnason, Anne Cox, Sophie
Dufresne, Jeanine Goranson, Catherine Townley, Heather Jackson, Helen Cheung and
Linda Crawford, our amazing Yoga Thrive teachers who have been so central to the
research process. My greatest debt is to those cancer survivors and their support persons
who chose to be a part of our research program. They have shared so much and asked for
little in return. Thank you.
Linda Carlson’s Lab has also been a place of great learning and friendship. Dr.
Laura Labelle, Dr. Sheila Garland and Kristin Zernicke have been indispensible to this
work and are always good for a fresh viewpoint and a warm beverage. Many thanks to
Linda, Laura and Sheila for reading drafts of Chapters 3 and 4.