Yoga is a practice originating in India which usually consists of physical exercises (stretches or asanas), breathing techniques and meditation or relaxation. It is taught in yoga classes or on a one-to-one basis, can be practised by the individual or is incorporated into stress management programmes. Yoga is claimed to have a range of physical, psychological and spiritual benefits.

Tai chi combines breathing techniques with sequences of slow graceful movements. It is sometimes referred to as a ‘meditation in motion’. It has been proposed that partaking in tai chi may result in energy expenditure equivalent to that of brisk walking, which may improve the aerobic capacity, flexibility, strength, mood and quality of life of cancer survivors.

Pomegranate (Punica granatum Lythraceae) is the edible fruit of the pomegranate plant, a small tree native to parts of Southeast Asia and cultivated in China, India, the Mediterranean region and parts of the USA (Lansky 2007, Jurenka 2008). The outer leathery skin (pericarp) encloses numerous seeds, each surrounded by a translucent sac that contains the juice. Thin, bitter-tasting membranes form a network throughout the fruit. Various parts of the fruit can be utilised or consumed; most commonly the seeds and juice (NMD 2021). Common names include dadim fruit, dadima, granada, grenade, Shi Liu Pi (NMD 2021). The pomegranate has been described in ancient texts including those of Greek mythology, has been held sacred by many of the world’s religions and is featured in several medical coats of arms (Langley 2000). Thought to have originated in Iran and Afghanistan, cultivation and use of the pomegranate spread through Asia, Mediterranean countries and parts of America (Lansky 2007, Langley 2000). Pomegranate has been part of folk medicine in many cultures and is used in several systems of medicine, including Ayurvedic and Unani medicine, for a variety of health problems (Jurenka 2008). Parts of the plant, such as its bark, petals and peel continue to be used in the Middle East, Asia and South America to treat conditions ranging from diarrhoea and dysentery to gum disease (Longtin 2003, Ismail 2012). Pomegranate has been used in the Indian subcontinent for the treatment of intestinal worms, nosebleeds, ulcers, sore throats (Ismail 2012). In the West, interest in the medical potential of pomegranate began slowly in the 1990s, stimulated by researchers in Israel who reported benefits on cardiovascular health (Longtin 2003). Pomegranate juice is widely used as a beverage. A survey of patients attending a cancer centre in England revealed that 1.7% (7 out of 422 patients) used pomegranate (Zavery 2010). Another survey, also in the UK, reported use by 13.6% of women with breast cancer (McLay 2012).

Echinacea (coneflower) products are herbal preparations derived from the root and above ground parts of the flowering plants Echinacea purpurea, Echinacea pallida and Echinacea angustifolia. Echinacea has a long history of medicinal use and is widely used in the treatment and prevention of upper respiratory tract infections. Claims in relation to cancer are that it can support the immune system, reduce the adverse effects of chemotherapy and radiotherapy and has some anticancer effects.

Reiki, a form of energy healing that originated in Japan, is a system of natural healing administered by the laying on of hands and by transferring energy from the Reiki practitioner to the recipient. It is sometimes used as a palliative or supportive treatment of cancer patients. Only few studies of Reiki have been published; most have methodological limitations and are thus not conclusive.

Mindfulness-based clinical interventions are mind-body modalities that may encompass multiple components: psycho-educational elements, mindfulness meditation exercises, cognitive-behavioral interventions and movement exercises. Core practices are sitting meditation (breath awareness, focused attention), body scan (awareness of sensations in the body, 45 minute exercise), Hatha Yoga (mindful movement), walking meditation and insight meditation. The two most used mindfulness-based clinical interventions in oncology are mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), 8-week standardised group programs. MBCT further includes elements from cognitive behavioural therapy.