When Jnani Chapman teaches yoga, she relies on some of the same prompts heard in yoga classes around the country. "Use your breath to release the clutter in your mind," she encourages in soothing tones. "As you inhale, acknowledge whatever's on your mind at the moment. As you exhale, breathe those thoughts out and away."

While Chapman's strategy is standard, the "clutter" plaguing her students is not. After class, a few of the women give voice to their distractions. "I think about dying all the time," says Beth softly.

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"I've heard about yoga for fitness and for spiritual pursuits. But now yoga is being used in medical settings... Has anyone else used yoga as a complementary health approach?"

The other students nod, unsurprised. "There are times when I feel grateful to be alive and I have a good day. Then I find a lump on my neck and I plunge back into despair," says Mary. "I've spent a lot of time veering between the gratefulness and despair."

Yoga, the women agree, serves as both respite and ballast, a safe and quiet place that allows them to relax, exhale.

Beth and Mary, both of whom have been battling cancer for years, are just two of the dozens of women who have taken advantage of the yoga classes taught by Chapman and sponsored by the Carol Frank Buck Breast Care Center and the Ida and Joseph Frank Cancer Resource Center of the University of California San Francisco (UCSF).

At the country's most prestigious cancer centers, rolled-up sticky mats and yoga straps are a common sight.

Chapman also teaches women receiving treatment for breast cancer for the Breast Cancer Complementary Support Program, a 12-week series collaboratively supported by UCSF, at the UCSF Osher Center for Integrative Medicine, and the Institute of Health and Healing at California Pacific Medical Center.

The classes, offered several days a week free of charge, attract both current patients and alumni alike, says Chapman, who says she might have in one class a woman in remission for eight years and, in another, a patient whose metastatic cancer has spread to her bones and who is coping with end-of-life issues.

Fortunately for cancer patients, Chapman's classes are not unique. At the country's most prestigious cancer centers--M.D. Anderson in Houston and Sloan-Kettering in New York City, to name two--rolled-up sticky mats and yoga straps are a common sight. Yoga is routinely prescribed by oncologists as a way for cancer patients to reduce stress and retain or regain movement and muscle tone.

Research studies published in the New England Journal of Medicine and Cancer Journal support yoga's capacity to relieve the pain and insomnia that plague people with life-threatening illnesses. Even the conservative-minded American Cancer Society allows that yoga "contributes to overall physical fitness and it can help reduce the pain of some chronic illness," with the cautionary note that yoga "should not be expected to slow the growth or spread of a cancer."

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"I needed to have a depression time to get me through one of my cancer issues. I prayed the other night and for the first time actually felt that I was being listened to and answered. Does this sound strange?"

With cancer rates on the rise, Chapman, who is also a registered nurse and licensed massage therapist, reports a growing need for instructors trained to adapt yoga for people with cancer. She herself established a teacher-training program for yoga instructors two years ago.

Chapman has also worked with Dean Ornish, M.D., to shape the yoga practiced at his cardiac rehabilitation programs, and she teaches yoga at the Commonweal Cancer Help Center in Bolinas, California.

Why yoga for cancer?

Anyone who takes even a single yoga class, whether within an ashram or at the local Y, learns that yoga means "yoke." Specifically, yoga links mind and body. One way of doing this is through attention on full, diaphragmatic breathing; when the mind wanders, it is directed back to the breath.

Many "healthy" people live from their necks up, wholly in their minds.

Although it might seem simple, it is in fact quite challenging. "We all walk around with a rift between mind and body," says Chapman. The nature of the rift ranges from outright body loathing--as seen in people who struggle with their weight or the aging process--to simple disregard: Many "healthy" people live from their necks up, wholly in their minds.

Among people with cancer, the rift is epidemic

--as well as deeper and more damaging. Betrayal, shame, and fear are just a few of the emotions cancer patients feel about their bodies.

"For me, yoga's main benefit is the reestablishment of a sense of my body as being 'on my side' after months of wondering why my cells had chosen this aberrant course," says Merrie, a breast-cancer survivor who also attended Chapman's class.

Many of Chapman's students report that the rift is not just emotional: When the body is debilitated by months of disease and treatment, patients lose trust in their ability even to bend at the waist, let alone ride a bike or jog or whatever their pre-cancer pursuits may have been.

Instructor Debra Mulnick, who is in training with Chapman, describes a leukemia patient who considered yoga classes a "safe setting" in which to entrust her body after stem-cell treatment and six months of bed rest.

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"I think that long term illness comes for very valid reasons that pertain to our learning more about spirit and living a balanced life."

"Patients may remember standing on one leg or sitting cross-legged, but they have no confidence they can do this now," says Mulnick, who teaches yoga at the Mountain States Tumor Institute in Boise, Idaho. "We start every class with a body scan to identify areas of discomfort or tension. I always encourage students to take the movement only as far as they are able."

Yoga for when you need it most

There's a bustle and busy-ness to having cancer, Chapman observes. Upon diagnosis, the list of things we all wish we had time to do takes on urgency. The frustration: These tasks press at a time when on some days, "we can't even swallow our own spit," says cancer patient Beth, with grim humor.

But we can breathe, says Chapman, who teaches students that yogic breathing is a "practical tool" that not only brings awareness to everyday chores but also lowers stress in advance of treatment and during MRIs.

Betrayal, shame, and fear are just a few of the emotions cancer patients feel about their bodies.

Stephen Cope, author of "Yoga and the Quest for the True Self" (Bantam Books, 1999), describes stress-related breathing as shallow, ragged, and irregular. By contrast, yogic breathing is characterized by a deliberate rate of respiration that slows a racing heart and sends oxygen to every muscle fiber and organ.

"I do breathing exercises when my doctor calls," says Mary, a smile softening her angular face.

This technique would not only calm Mary physically but could also help her choose the best course of action in response to whatever news her doctor delivered, says Shanti Norris, executive director of the Smith Farm Cancer Help Program based in Washington, D.C. Yogic breathing "makes us concentrate, listen neutrally without rushing to judgment or fear, process information in a much more balanced and thoughtful way, without overreacting," says Norris. And that, Norris affirms, is doing yoga.

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