literature review of yoga

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Yoga Impacts Cognitive Health: Neurophysiological Changes and Stress Regulation Mechanisms

Voss, Stephanie 1 ; Cerna, Jonathan 2 ; Gothe, Neha P. 1,2,3,4

1 Department of Kinesiology and Community Health

2 Neuroscience Program

3 Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Champaign, IL

4 Bouvé College of Health Sciences, Northeastern University, Boston, MA

Address for correspondence: Neha P. Gothe, Ph.D., Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 906 S Goodwin Ave, Freer Hall 350, Urbana, IL 61801 (E-mail: [email protected] ; 217.300.6183).

Accepted for publication : October 21, 2022.

Editor: Marni D. Boppart, Sc.D., FACSM.

Yoga, a physical and contemplative practice, offers the practitioner a unique mind-body exercise experience demonstrating preliminary efficacy in improving cognitive health. We examine the evidence for underlying mechanisms that explain the yoga-cognition relationship in healthy older adults. The cognitive benefits of yoga may be the result of improved stress regulation and neurocognitive resource efficiency that facilitate bidirectional brain-body communication.

Yoga may improve cognition in older adults as the result of improved stress regulation and neurocognitive resource efficiency.

• Mounting evidence highlights the role of yoga practice in improving cognition.
• Few studies have examined the mechanisms underlying the yoga-cognition relationship.
• Preliminary studies underscore the role of stress regulation and improved neurocognitive health as mediators.
• Mechanisms discussed in this review corroborate the evidence for yoga as a lifestyle behavior to combat age-related cognitive decline.

INTRODUCTION

Yoga’s origins date back more than 2000 years to ancient India. The original term yug means “to unite,” and it signifies the harmony or unification of the mind, body, and spirit. Yoga is often depicted metaphorically as a tree and comprises eight branches: yama (universal ethics), niyama (individual ethics), asana (physical postures), pranayama (breath work), pratyahara (control of the senses), dharana (concentration), dyana (meditation), and samadhi (bliss) and is considered a way of life. Over the course of its existence and spread across the globe, the practice of yoga largely has evolved to a combination of three of the eight branches: physical postures, breath work, and meditation, which fall under the umbrella of Hatha yoga, the most popular form of practice. Styles of yoga vary greatly in their emphasis on each of the eight branches of yoga; therefore, for the purpose of this review, we only include yoga studies that incorporate these three elements.

The active attentional component of yoga may incur cognitive benefits over and above the habitual bodily movements involved in traditional forms of exercise. A mindful movement practice, yoga enables the practitioner to move slowly and safely into physical postures while concentrating on relaxing the body, breathing fully, and developing awareness of bodily sensations and passing thoughts. In addition, breathing and meditation exercises are practiced to calm and focus the mind and develop greater self-awareness. This focused effort and attentional practice of yoga seems to mimic the conventionally assessed cognitive functions including attention, memory, and higher order executive functions.

With a rising proportion of older and elderly adults in the populations of developed countries ( 1 ), there is a growing interest in identifying interventions that may improve brain health and ameliorate the effects of age-related cognitive decline in healthy adults. We published the first metaanalysis examining the acute and chronic effects of yoga on cognition ( 2 ). A significant moderate effect of yoga on cognition (g = 0.33) was observed for randomized controlled trials, with the strongest effect for attention and processing speed (g = 0.29), followed by executive function (g = 0.27) and memory (g = 0.18). Acute studies also demonstrated a significant overall effect of yoga on cognition (g = 0.56). The effect was strongest for memory (g = 0.78), followed by attention and processing speed (g = 0.49) measures and executive functions (g = 0.39). These studies compared yoga, primarily Hatha yoga, against a variety of conditions ranging from breath awareness, music, stretching and strengthening, aerobic exercise, and waitlist control among healthy adult populations. Although collectively, yoga practice was associated with moderate improvements in cognitive function, none of these studies examined the possible mechanisms underlying the yoga-cognition relationship.

This review proposes two primary mechanisms contributing to the cognitive benefits of yoga: improved stress regulation and improved neurocognitive resource efficiency. Although the benefits of yoga for stress and stress-related physical and mental health, mood, and psychological functioning have received extensive attention in recent reviews ( 3–6 ), this review specifically reviews the mechanisms underlying the relationship between yoga and cognitive health in older adults. Our first mechanism highlights the role of improved stress regulation potentially underlying the yoga-cognition relationship and our second mechanism hypothesizes that improvements in cognition ( 2 ) and brain structure and function ( 7 ) in response to yoga practice are the result of improved neurocognitive resource efficiency ( Fig. 1 ).

Stress Regulation

Interventions, such as yoga, that improve stress regulation and limit inflammation may provide neuroprotective cognitive benefits to older adults by limiting prolonged exposure to elevated cortisol and interleukin 6 (IL-6) levels. Longitudinal data link chronically elevated cortisol levels (measured through a 30-d period, yearly for 5 yr) to hippocampal atrophy and memory deficits in older adults ( 8 ). In addition, elevated cortisol is associated with increased risk for cognitive decline and Alzheimer’s disease (AD) ( 10 ), and IL-6 levels are well known to increase with advancing age ( 11 ) and are associated with increased risk for cognitive decline in older adults ( 9 ).

Improved stress regulation may be particularly beneficial for preserving cognitive function in older adults because the aging brain is more vulnerable to prolonged cortisol and cytokine exposure ( 9,12,13 ). Stress reduction and relaxation are popular reasons for engaging in yoga practice ( 14 ); however, the physiological effects of yoga on the stress response may be more complex than simply reducing stress. Rather, yoga may improve stress regulation by providing practitioners with the self-regulatory tools to tolerate stressful experiences “off the mat,” balancing homeostatic mechanisms and reducing allostatic load via the integration of bottom-up physiological mechanisms and top-down cognitive control (for a review on self-regulatory mechanisms, see Gard et al . (2014) ( 15 )). Although the precise mechanisms underlying the yoga-stress-cognition relationship remain to be elucidated, we hypothesize that improved stress regulation likely contributes to the cognitive benefits of yoga.

Stress Reactivity

Measures of stress reactivity are particularly useful to yoga researchers in determining how individuals respond to stressful stimuli experienced in daily life. For the purpose of this review, we define stress reactivity as the psychophysiological changes in response to an acute stressor as measured by changes in hypothalamic-pituitary-adrenal (HPA) axis activity, affect, and inflammatory response. Sympathetic activation is an important component of stress reactivity; however, although the yoga literature demonstrates beneficial effects on markers such as heart rate and blood pressure ( 3–5 ), little work has been done to examine the relationship between yoga, markers of sympathetic activation, and cognition. We include affective changes within the concept of stress reactivity because the emotional state is an important filter regulating the impact of stress on cognition ( 13 ) and emotionally laden information is known to impair cognitive processing ( 16 ).

To our knowledge, a single study to date specifically examines the yoga-stress-cognition relationship, demonstrating that attenuated stress reactivity predicts improved executive functioning in older adults in response to a yoga intervention ( 17 ). A group of sedentary older adults participated in an 8-wk Hatha yoga intervention and demonstrated improved performance on the running span task, n-back working memory, and task-switching paradigm postintervention when compared with stretching controls. Attenuated cortisol in response to a mild cognitive stressor and self-reported stress and anxiety levels predicted improvements in executive functioning in the yoga group, whereas elevated cortisol responses in the control group predicted poorer performance on the cognitive tasks. Notably, there were no differences in prestressor cortisol levels, suggesting that an 8-wk intervention was insufficient to produce significant changes in basal stress markers. However, these findings demonstrate that short-term practice seems to be sufficient to reduce stress reactivity and improve affect, suggesting that yoga may provide neurocognitive benefits to older adult practitioners via a more adaptive response to acute cognitive stressors. Yoga practice encourages detachment from negative thoughts and emotions during physical postures. Therefore, it is plausible that yoga provided these individuals with the psychosocial resources to selectively disengage from negative, stress-induced cognitive processing to concentrate on the cognitive demands of the task, associated with decreased HPA axis activity.

Immunological findings also support the premise that yoga improves stress reactivity ( 18 ). Yoga practitioners with a minimum of 2 yrs of regular yoga practice and novices each participated in a single session of restorative Hatha yoga and two control conditions on three separate visits. A single yoga session improved positive affect in both yoga practitioners and controls, but no inflammatory or endocrine responses were unique to a single yoga session. However, compared with novices, yoga practitioners demonstrated lower heart rate during a mild cognitive stressor and produced less lipopolysaccharide-stimulated IL-6 in response to the stressor, indicative of decreased stress and emotional reactivity. Differences in stress response between yoga practitioners and novices were hypothesized to explain differences in basal IL-6 levels between groups, where novices had levels 41% higher across sessions and were 4.75 times more likely to have detectable C-reactive protein (CRP) levels. These findings suggest that regular yoga practice promotes a more adaptive physiological response to acute stressors, and dampened stress reactivity could account for differences in basal inflammatory markers and the long-term health benefits of regular yoga practice ( 18 ). Collectively, the aforementioned two studies suggest that short-term yoga practice is sufficient to improve stress reactivity and cognitive function, but long-term yoga practice is essential to shift the homeostatic balance toward more automatic, adaptive, and efficient psychophysiological responses ( 15 ).

Chronic Stress and Inflammation

Regular yoga practice may provide neuroprotective benefits by contributing to an overall reduction in elevated cortisol and IL-6 levels, associated with chronic stress, age-related cognitive decline ( 8,9,12 ), and increased risk for neurodegenerative disorders, including AD and multiple sclerosis ( 19 ). Numerous reviews report the beneficial effects of yoga on autonomic, neuroendocrine, and immune markers of chronic stress in healthy and clinical adult populations ( 4,20,21 ), but the physiological mechanisms underlying how yoga may protect against chronic stress and systemic inflammation warrant further study.

Findings from clinical trials in breast cancer survivors provide insight into how yoga may regulate inflammatory processes ( 22,23 ). Breast cancers survivors randomized into a 12-wk Iyengar yoga intervention demonstrated reductions in upstream inflammation-related gene activity compared with a health education control ( 22 ). Yoga participants demonstrated reductions in proinflammatory nuclear factor kappa B (NF-κB) and cAMP response binding element (CREB) transcription factor activity, indicating decreased inflammation-related gene expression, despite no significant changes in downstream inflammatory markers (CRP and IL-6) or cortisol. The authors posit that mind-body practices with yogic elements may reduce inflammation via the NF-κB pathway. In addition, yoga increased antiinflammatory glucocorticoid receptor (GR) activity, suggesting that yoga may increase the sensitivity of GR to the antiinflammatory effects of cortisol, rather than daily cortisol secretion ( 22 ). Indeed, GR resistance is linked to chronic stress ( 24,25 ) and the inability to downregulate the acute inflammatory response leading to subsequent inflammatory disease processes ( 24,26 ). These findings are particularly noteworthy because GR resistance may be essential in regulating stress reactivity because decreased GR sensitivity could contribute to elevated cortisol levels ( 24 ).

A separate trial found that the regularity and frequency of yoga practice is essential for reducing systemic inflammation in breast cancer survivors ( 23 ), consistent with systematic review revealing that more than 1000 min of yoga practice was associated with greater reductions in inflammation ( 20 ). Breast cancer survivors randomized into a 12-wk Hatha yoga intervention demonstrated reductions in fatigue and downstream inflammatory markers (IL-6, tumor necrosis factor-α, and IL-1β) at 3 months postintervention, but not immediately after intervention, when compared with a waitlist control ( 23 ). Notably, increased frequency of practice postintervention was associated with greater reductions in fatigue, IL-6, and IL-1β, where an increase of 10 min of yoga practice per day was associated with a 5% decrease in mean IL-6 and an 8% decrease in mean IL-1β. Given the apparent benefits of yoga on inflammatory gene expression ( 22 ) and the value of regular, long-term practice in a clinical population ( 23 ), these mechanisms warrant further study in the yoga-stress-cognition relationship.

Emotional Reactivity

Cross-sectional neuroimaging findings suggest that yoga practitioners are able to selectively disengage from aversive stimuli ( 27,28 ), providing them with a more adaptive response to stressors and decreased cognitive interference from emotionally laden information. Stress and emotional regulation are intimately linked processes, where brain regions involved in emotion processing, such as the amygdala and ventrolateral prefrontal cortex (vlPFC) ( 16 ), are among the aging brain regions vulnerable to prolonged glucocorticoid exposure ( 12 ). In addition, improved emotional regulation of negative stimuli predicts steeper cortisol slopes in older adults ( 29 ), and acute administration of synthetic cortisol has been shown to increase emotional interference ( 30 ). Yoga practitioners with at least 3 yrs of ongoing Hatha yoga experience demonstrate increased vlPFC activation — associated with inhibitory cognitive control over emotional distraction ( 16 ) — when presented with negative emotional distractors ( 27 ). Effectively, yoga practitioners are able to selectively disengage from negative emotional processing to focus on the cognitive demands of the task ( 27 ). Both yoga practitioners and controls demonstrated an increased amygdala response during negative emotional stimuli, reflecting limbic reactivity to emotional stimuli. However, only controls demonstrated a decrease in positive affect associated with the magnitude of amygdala response, suggesting that limbic reactivity was uncoupled from downstream effects on affect in yoga practitioners ( 27 ). Additional indirect findings report that expert yoga practitioners, with a mean of 9.6 yrs of regular practice, demonstrate improved pain tolerance as mediated by insular gray matter volume (GMV) ( 28 ). Notably, yoga practitioners were equipped with cognitive strategies cultivated during regular yoga practice to tolerate pain, a stressor experienced off the mat. These included parasympathetically activating and interoceptive strategies such as breathing, observation, and acceptance versus ignoring or distracting techniques used by controls ( 28 ). These findings suggest that yoga practitioners are able to downregulate and reappraise their emotional response to aversive emotional and pain stimuli, contributing to structural neurological and behavioral changes, and may reflect a more adaptive response to stressors. Yoga may, therefore, enable practitioners to shift neurocognitive resources away from aversive stimuli to limit interference from emotionally laden information and enhance cognitive efficiency.

NEUROCOGNITIVE RESOURCE EFFICIENCY

The concept of neurocognitive resource efficiency used in this review builds and borrows from previous constructs laid in the literature ( 1,31 ) and will be used as an umbrella term that aims to capture structural ( e.g. , changes in GMV), functional ( e.g. , regional BOLD activation and network connectivity), and behavioral differences ( e.g. , processing speed, selective and sustained attention; higher order processes: crystallized and fluid intelligence) between controls and yoga practitioners as well as changes that might ensue as a result of yoga practice, primarily in the context of age-related decline.

In the context of age-related cognitive decline ( 1 ), yoga may improve cognition in older adults by enhancing overall neurocognitive resource efficiency ( 7 ), allowing yoga practitioners to selectively disengage from task-irrelevant stimuli ( 27 ), create more resilient resting-state and tasking-functional networks ( 32 ), and protect against age-related structural decline ( 33 ). The hippocampus is a commonly examined region in yoga-cognition research because hippocampal neurogenesis is one of the most consistent effects of exercise training ( 34 ) and is susceptible to age- ( 35 ) and stress-induced atrophy ( 8 ) associated with cognitive deficits in AD ( 10 ).

By attending to physical postures, mental processes, and controlled breathing, yoga practitioners are thought to derive ample psychophysiological benefits ( 15 ). The literature points to structural and functional advantages in beginners, as well as regular yoga practitioners ( 7 ), from acute to chronic effects in cognition ( 2 ). Emerging evidence suggests that yoga practice might improve discrete ( 2 ) and higher order ( 32 ) cognitive processes likely related to positive reorganizational changes, resulting in densely interconnected intrinsic connectivity networks ( 36,37 ), and ultimately leading to higher neurocognitive resource efficiency ( Fig. 2 ).

Primary Structural and Functional Benefits

Cross-sectional findings demonstrate that yoga practitioners with at least 3 yrs of experience demonstrate greater GMV in frontal, limbic, temporal, occipital, and cerebellar regions and fewer cognitive failures compared with matched controls ( 38 ). GMV was positively correlated with years of experience and negatively correlated with cognitive failures, suggesting that years of yoga experience contributes to enhanced cognitive function associated with structural and neurological differences ( 38 ). Yoga practitioners with a minimum of 3 yrs of experience also demonstrate greater left hippocampal volume, a key region in learning and memory-related processes, when compared with matched controls ( 39 ). Within the same cohort, activation of the left dorsolateral prefrontal cortex (dlPFC) was lower in the encoding phase of the working memory task, despite no differences in accuracy or reaction time between groups, suggesting greater neural efficiency in yoga practitioners when initially processing and storing information ( 39 ). These neurological findings corroborate results from metaanalyses on behavioral cognitive function ( 2 ), with the strongest effect of yoga on measures of attention and processing speed. Furthermore, yoga practitioners with approximately 10 yrs of experience did not demonstrate the classic trajectory of age-related GMV decline, displayed in matched controls, providing evidence for neuroprotective effects of yoga ( 33 ). Of note, frequency of physical postures followed by yogic meditation practice was the best predictor of hippocampal GMV ( 33 ), emphasizing the importance of breathing and meditation in combination with physical practice. Years of practice were also positively correlated with GMV in left hemisphere orbitofrontal cortex and mid-insula, suggested by authors to reflect improved emotional and autonomic regulation ( 33 ), aligning with effects of yoga on stress ( 18 ) and emotional regulation ( 27 ). More recent findings suggest that yoga may provide neuroprotective benefits even after only 12 wks of intervention ( 40 ). In this study, women with subjective cognitive decline and risk factors for AD participating in a Kundalini yoga plus Kirtan Kriya yoga intervention did not demonstrate reductions in GMV as demonstrated by a memory enhancement training control group, aligning with the cross-sectional findings described earlier.

Improved Neural Network Flexibility

Yoga practice may contribute to complex reorganization of neural structures and dynamics, resulting in distinctive resting-state and task-related network connectivity ( 32,41 ). The aforementioned findings support the benefits of yoga on hippocampal volume ( 33,39 ), which also is associated with higher fluid intelligence, defined as the ability to cope with novel challenges using abstract reasoning, thereby enabling flexible, adaptive behavior ( 42 ). These findings imply that this region might act a key moderator/mediator supporting higher fluid intelligence and improving network flexibility due to the high within-network density in the brain ( 43 ). Interestingly, fluid intelligence, hippocampal volume, and higher order cognitive functions are highly susceptible to age-related decline ( 44 ), but simultaneously show considerable plasticity to yoga training ( 32 ).

Middle-aged Kripalu yoga and meditation practitioners show lower rates of decline in fluid intelligence, more integrated brain networks, greater global efficiency, greater trade-off recruitment between segregated and integrated networks, and more resilient networks compared with controls ( 32 ). More resilient neural networks reflect less decline in global efficiency, a measure of integration between functionally adjacent brain regions, on removal of key nodes after simulated aging-related neural damage ( 32 ). Trait mindfulness also positively correlated with network resiliency and global efficiency and negatively correlated with characteristic path length, indicating greater overall network efficiency and integration, respectively ( 32 ). These results suggest that age-related decline in fluid intelligence might be attenuated by higher trait mindfulness, developed in regular yoga and meditation practice ( 45 ). Kripalu yoga is a form of Hatha yoga with an emphasis on meditation that could induce regular states of mindfulness. Although individuals with higher trait mindfulness and fluid intelligence may reflect a self-selection bias to practice yoga, other factors that could influence cognitive function were controlled including age, sex, education, crystallized intelligence, physical activity, and cognitive engagement in daily life. Therefore, network architecture seems to be affected by yoga practice, and network modularity and flexibility may contribute to higher order cognitive outcomes such as fluid intelligence ( 32 ). By contributing to more efficient and integrated neural networks, yoga practice may lead to increased “cognitive bandwidth” available for cognitive demands to enhance overall neurocognitive resource efficiency.

Using the same group of aging Kripalu and meditation practitioners, Gard et al . ( 41 ) conducted a follow-up study with an exploratory, network-based approach to examine local differences in resting-state functional networks, rather than global resting-state properties ( 32 ). Connectivity of the caudate nucleus (CN) was revealed to be a central node distinguishing between practitioners and controls, and network-based analyses demonstrated stronger connectivity of left and right CN to a number of brain regions, with no differences between yoga and meditation practitioners. The CN demonstrates age-related decline in volume ( 35 ), and authors hypothesize that increased caudate connectivity may mediate reductions in age-related cognitive decline, as indexed by lower rates of age-related decline in fluid intelligence from their earlier study ( 32 ), and contribute to cognitive and behavioral flexibility ( 41 ). These findings demonstrate increased local and global connectivity, aligning with network-based differences observed among experienced yoga practitioners during resting conditions ( 36 ).

Reorganizational Changes in the Default Mode Network

Yogic postures, breathing and meditation practices all rely on a strong attentional component, inferring that regular practice may impact connectivity in networks that decrease in activity during attention-demanding tasks, such as the default mode network (DMN). The DMN is related to episodic memory, self-referential, and discrete emotional processing, among other cognitive processes ( 46 ). Importantly, DMN connectivity is susceptible to age-related cognitive decline ( 47 ) and is improved by physical activity ( 48 ) and yoga practice ( 49 ). Elderly Hatha yoga practitioners, with at least 8 yrs of yoga practice, demonstrate greater anteroposterior connectivity between structures such as the medial prefrontal cortex (mPFC) and angular gyrus, as compared with controls ( 36 ). In addition, a 12-wk Kundalini and Kirtan Kriya yoga intervention in older adults with mild cognitive impairment showed an increase in DMN functional connectivity, which positively correlated with verbal memory recall when compared with memory enhancement training ( 49 ). These findings suggest that yoga may enhance functional DMN connectivity to provide neuroprotective benefits during aging. Despite variations regarding specific areas within the DMN that increase or decrease in connectivity in the yoga-cognition relationship ( 7 ), protective effects against age-related decline in neural architecture and functionality are clearly apparent. In addition, the dlPFC, ventromedial PFC, posterior cingulate cortex (PCC), and the anterior cingulate cortex (ACC) have been repeatedly implicated in studies assessing regional differences ( 39 ) and within/between large-scale brain network connectivity ( 32,33 ) such as the DMN connectivity ( 36 ), and inform our mechanistic framework.

The PCC is a highly informative midline structure in our model of improved neurocognitive resource efficiency. Yoga practitioners demonstrate greater PCC GMV compared with controls, and weekly hours of yoga-related meditation, performed in addition to postures, positively predicts PCC GMV in practitioners ( 33 ). The yoga literature has primarily focused on regional activation ( 7 ); however, deactivation of key nodes may be more informative. Complementary findings demonstrate that advanced meditation practitioners consistently and volitionally deactivate DMN hubs such as the PCC and mPFC ( 50,51 ), associated with subjective experiences of “concentration” and “effortless doing” ( 51 ) and decreased mind wandering ( 50 ). Less mind wandering may decrease distractions related to task-irrelevant stimuli and reduce lapses in attention ( 50 ). Depth of mental silence ( i.e. , less mind wandering), was associated with GMV and functional connectivity in 23 Sahaja yoga practitioners (meditation-focused yoga practice), with an average of 14 yrs of practice ( 52 ). Greater right ACC GMV was significantly correlated with subjective report of depth of mental silence in practitioners. Similar positive associations were found between the resting-state functional connectivity between the right ACC and bilateral insula, and decreased connectivity between the ACC/mPFC and parahippocampal gyrus, a key mediotemporal node of the DMN. The authors suggest that these findings provide evidence for enhanced functional connectivity in regions essential for attention and emotion regulation that are associated with depth of mental silence in experienced Sahaja yoga practitioners ( 52 ). In the same cohort of practitioners, increased functional connectivity between the left insula and mid-ACC was associated with lower interference in reaction time in a selective attention/interference inhibition task ( 53 ). Deactivation in the PCC could lead to an increased signal-to-noise ratio and thus, greater availability of cognitive resources and improve functional coupling between task-related networks ( 36 ).

Reorganizational Changes in Attentional Networks

Yoga instructors direct novice practitioners to attend to bodily sensations, breathing, and passing thoughts. As practitioners become more adept, they progress to open monitoring of thoughts, sensations, and experiences, thereby compounding task demand as perceptual, sensory, and cognitive load increases. Greater cognitive load may shield against distraction and enhance attentional abilities by suppressing task-irrelevant information ( 54 ). Higher cognitive load demonstrates an inhibitory effect on antagonistic cortical and subcortical regions ( 54 ). These findings suggest that higher cognitive load enhances a state of high focal-task engagement by concomitantly activating fronto-insular regions related to attention-demanding tasks, while also preemptively suppressing activity in the bilateral amygdala, which could contribute to emotional distraction, and inform our mechanistic framework of the yoga-cognition relationship.

Task-related networks such as the dorsal attentional network (DAN), frontoparietal/central executive network (CEN), and cingulo-opercular network (CO) ( 46,55 ) are engaged during attention-demanding tasks. Meditation practitioners with an active Hatha yoga practice of at least 3 yrs demonstrate stronger interregional coupling within DAN regions as well as stronger coupling between the ACC, dlPFC, and PCC compared with controls, indicating stronger coupling in attention and emotion regulation networks ( 37 ). Notably, a review of the yoga literature shows clear engagement of these attentional networks ( 56 ). Strong coupling between key nodes of the DAT, CEN, and CO have been found with key nodes of the DMN, such that older adults with mild cognitive impairment randomized to a 12-wk yoga intervention demonstrated significant improvements in verbal memory correlated with increased resting-state functional connectivity between the PCC, ACC, right middle frontal cortex, and left lateral occipital cortex ( 49 ). Interestingly, experienced yoga practitioners with an average of 10 yrs of practice had the largest left frontal operculum volumes ( 33 ), a key node in the CO responsible for tonic attention/alertness ( 55 ), involved in language and hierarchical sequence processing ( 57 ). The authors suggest that an increased volume could reflect sequencing a personal practice, as experienced yoga practitioners are more likely to do ( 33 ). Alternatively, recruitment of key nodes in the CO, such as the anterior operculum, anterior insula, and ACC ( 41,53 ), instead of CEN- and DAT-related regions (arguably more costly to engage), may represent a strategic switch to sustain attention and hence, performance. The overlapping engagement of attentional networks with visual, salience, and default networks might indicate that, over time, yoga participants repeatedly engage key nodes between networks and systematically increase node and edge functional coupling, possibly leading to a shielding against task-irrelevant distractors and resulting in higher neural efficiency. As yoga practitioners develop proficiency, they may become more efficient in their usage of neurocognitive and attentional resources, contributing to improvements in cognitive function ( 32,39,49 ).

YOGA AS A HOLISTIC PRACTICE

A key limitation to this review, and the yoga literature as a whole, is the inherent difficulty in comparing findings across heterogeneous yoga interventions and styles. Although much of modern yoga practiced in the Western world falls under the umbrella of Hatha yoga, including physical postures, meditation, and breath work, stylistic differences still abound. Some forms of yoga place a greater emphasis on chanting, meditation, and breath work ( e.g. , Kirtan Kriya, restorative); some emphasize vigorous physical activity ( e.g. , Bikram, Vinyasa, or power yoga), some follow strict traditional sequencing or alignment guidelines ( e.g. , Ashtanga, Iyengar yoga), and some are designed for specific populations ( e.g. , prenatal, trauma-informed yoga). In addition, the type of breathing and meditation practices can vary dramatically between sessions and styles of yoga, where breathing practices can have differential effects on autonomic arousal, and meditation practices may challenge distinct cognitive processes by emphasizing focused attention versus open awareness. However, it is becoming increasingly apparent that integrating the core components of yoga (postures, breath work, and meditation) is essential for deriving its cognitive benefits and may lead to summative or synergistic effects.

Studies comparing styles of yoga are rare but provide emerging insight into the components of yoga practice essential for cognitive health. A 7-wk integrated yoga program incorporating all eight limbs of yoga demonstrated greater reductions in cortisol and anxiety levels compared with a yoga-as-exercise group (emphasizing physical postures) and a questionnaire control group ( 58 ). An acute intervention comparing a single 30-min meditative (Hatha) yoga to a 30-min power (Vinyasa) yoga session demonstrated comparable findings ( 59 ). Anxiety scores and salivary cortisol levels were significantly lower after the meditative yoga session, but not power yoga. Combined, these findings suggest that the inclusion of meditation and breathing practices in addition to the physical postures, three of the eight limbs of yoga, are essential for yoga’s effects on stress regulation, a key mechanism in our model of yoga and cognitive health.

To the authors’ knowledge, only one study to date has specifically compared two types of yoga on objective cognitive outcomes ( 60 ), in which sedentary breast and ovarian cancer survivors were randomized into 12 wks of either restorative yoga (minimal physical exertion and more meditative practice) or vigorous yoga (more physical exertion (approximately 60%–70% maximal heart rate) and minimal meditative practice). Only the restorative yoga group (mean age, 55 yr) demonstrated significant improvements in overall cognitive function and fluid intelligence as measured by the NIH Toolbox Cognition domain, whereas participants in the vigorous yoga group (mean age, 58 yr) only improved in crystallized intelligence assessed at week 24. These findings suggest that the inclusion of breathing and meditative practices in restorative yoga had a greater impact on fluid cognitive function, such as processing speed, problem solving, and memory, than vigorous yoga with an emphasis on physical activity. Although limited by small sample sizes and lack of usual care control groups, these findings provide intriguing and preliminary implications that the cognitive benefits of yoga can be attributed to more than physical activity.

PARALLEL FINDINGS

The meditation and exercise literature provide complementary insight into the yoga-cognition relationship. Meditation improves attention and decreases stress reactivity ( 61 ), and higher levels of physical fitness are associated with decreased cortisol reactivity, decreased anxiety, and more favorable mood in response to psychosocial stress using the Trier Social Stress Test ( 62 ). Yoga practices are often referred to as “moving meditation”; accordingly, by combining an active attentional practice with physical movement, yoga may influence stress regulation via comparable mechanisms. Similar hypotheses exist in the exercise literature; the Cross-Stressor Adaptation hypothesis suggests that exposure to the stress of physical exercise promotes generalization to nonphysical stressors ( 63 ) and the mindfulness stress buffering hypothesis posits that mindfulness practice improves health outcomes by attenuating negative appraisal and stress reactivity to aversive stimuli ( 64 ). These align with self-regulatory mechanisms in yoga, in which yoga is believed to provide practitioners with the self-regulatory strategies to sustain the physical stress of an asana practice that can be generalized to stressors off the mat ( 15 ).

Parallel findings from the exercise and meditation literature suggest that the cognitive benefits of yoga may be attributed to more than physical activity; the combination of postures, breathing, and meditation practices seem to be essential to improving stress regulation and neurocognitive efficiency. Aerobic exercise is well accepted to enhance neurocognitive functioning ( 34 ). Similar to yoga practitioners, meditation practitioners demonstrate similar improvements in functional connectivity, flexibly coupling attentional networks with the DMN and other networks ( 65,66 ). Complementary findings on emotional reactivity to aversive painful stimuli in mindfulness practitioners suggest an uncoupling of the emotional experience from the aversive pain stimulus ( 67 ), paralleling findings in the yoga literature described earlier. Differences between mindfulness practitioners and controls were hypothesized to reflect an attentional shift to cognitive reappraisal and nonjudgmental sensory awareness of painful stimuli ( 67 ). Contemplative practices that aid practitioners in downregulating emotional reactivity may allow them to shift neurocognitive resources by neutrally reappraising aversive stimuli to focus on other cognitive demands and enhance cognitive efficiency. In addition, theoretical arguments posit that bidirectional signaling via interoceptive processing ( 15 ) and stimulation of the vagus nerve along the gut-brain axis ( 68 ) may facilitate mind-body integration in yoga practice but remain to be systematically explored in examining the yoga-cognition relationship.

CONCLUSIONS

A recurrent theme in the yoga literature is the value of regular, long-term yoga practice, contributing to improvements in stress reactivity ( 18 ), markers of chronic stress and inflammation ( 18,20 ), emotional reactivity ( 27 ), GMV ( 7,33,39 ), as well as neurocognitive behavioral responses ( 2,38 ), collectively improving neurocognitive efficiency. Short-term practice may initially improve stress regulation to form the foundations of a more adaptive stress response ( 17 ), reduce chronic stress, systemic inflammation, and contribute to positive changes in brain structure and functional connectivity networks with consistent long-term practice. Although regular, long-term yoga practice seems to be beneficial, determining the optimal frequency and duration of yoga practice to improve brain health remains challenging to interpret from the yoga literature. Many of the studies included in this review present cross-sectional findings with expert practitioners with at least 3 yrs of experience, or interventional studies typically lasting 12 wks; therefore, yoga practice effects on cognition between these study durations remain to be investigated. In addition, there is a need for more nuanced studies examining the differential effects of specific postures and breathing/meditation practices. Bidirectional signaling pathways, along with exploration of stylistic differences and optimal dosage effects, present an exciting avenue for future yoga-cognition research.

Acknowledgments

The authors would like to acknowledge the contribution of Martín Irani for his assistance in the generation of Figure 2 A.

This review was supported in part by grant R01 AG066630 from the National Institute on Aging.

• Cited Here |
• View Full Text | PubMed | CrossRef |
• Google Scholar
• PubMed | CrossRef |

yoga; brain; default mode network; aging; cognitive decline; cortisol; functional connectivity

• + Favorites
• View in Gallery

Readers Of this Article Also Read

Strength training: in search of optimal strategies to maximize neuromuscular..., sex differences in athletic performance: perspectives on transgender athletes, eccentric exercise as a potent prescription for muscle weakness after joint..., exercise as a therapy to maintain telomere function and prevent cellular..., ketogenic diets and mitochondrial function: benefits for aging but not for....

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

A Systematic Review of Yoga for Mental and Physical Health in College Students

Related Papers

Effects of Yoga on psychological health issues.

Tamanna Das

This study is conducted to know the effects of Yoga on perceived stress, anxiety and depression among undergraduate students. A two way split blot design ( Pre - Post Test ) was used which compared the outcome between the 60 college students from 1st and 3rd year. They were divide into two group randomly i.e. Yoga group ( experimental group) and Non yoga group (control group). Yoga group was given yogic exercise for 4 weeks. To assess perceived stress PSS was used, whereas BAI and BDI was administered to check their level of anxiety and depression. The result revealed that there is significant difference between the Pre and post test in the reduction of perceived stress, anxiety and depression among Yoga group while Non yoga group reveals no significant changes and finally a positive correlation was obtained between perceived stress, anxiety and depression among Yoga group and non yoga group in pre-test and post- test.

Academia Letters

Anne-Marie Raskin

Anil Kothari

Yoga is a holistic multidimensional system of health that was used by ancient sages to achieve states of transcendence and develop special mental abilities and wellbeing. Essentially a yoga therapy is a type of alternative therapy that uses Asanas (Physical postures), Pranayamas (Breathing techniques), Dhyana (Meditation), Shatkarma (Internal cleansing), Mudras (Hand postures) and Bandhas (Locks) to reduce the impact of exaggerated stress responses which in turn decreases physiological arousal and may be helpful for both anxiety and depression. This review presents a summary of scientific evidences from randomized controlled trials, review articles and Hatha yoga texts on the effects of yoga in promoting mental health by alleviating the symptoms of mental disorders.

Evidence-Based Complementary and Alternative Medicine

Murilo Marchioro

Introduction. Yoga is a holistic system of varied mind-body practices that can be used to improve mental and physical health and it has been utilized in a variety of contexts and situations. Educators and schools are looking to include yoga as a cost-effective, evidence-based component of urgently needed wellness programs for their students.Objectives. The primary goal of this study was to systematically examine the available literature for yoga interventions exclusively in school settings, exploring the evidence of yoga-based interventions on academic, cognitive, and psychosocial benefits.Methods. An extensive search was conducted for studies published between 1980 and October 31, 2014 (PubMed, PsycInfo, Embase, ISI, and the Cochrane Library). Effect size analysis, through standardized mean difference and Hedges’g, allowed for the comparison between experimental conditions.Results and Conclusions. Nine randomized control trials met criteria for inclusion in this review. Effect size...

International Journal of Health, Physical Education and Computer Science in Sports, ISSN No: 2231-3265

M Kamraju , Mohd Akhter Ali , Manisha Pendyala , Sanja Devi

Yoga is widely practiced as a way to plug physical, psychological, and spiritual well-being, while kind of studies has documented the efficacy of yoga for functioning in healthy individuals and people experiencing illness or pain. We propose an analog between the physical, psychological, and spiritual effects of the practice of yoga in students behavior. Physical systems activated through yoga practice include musculoskeletal, cardiopulmonary, autonomic system nervosum, and endocrine functioning. Psychological benefits include enhanced coping, self-efficacy, and positive mood. Spiritual mechanisms which may be understood within a Western medical model include acceptance and mindful awareness. We present empirical evidence that supports the involvement of those domains. However, additional well-conducted research is required to further establish the efficacy of yoga for health states and to know how posture, breath, and meditative activity affect the body, mind, and spirit. In this study, we are mainly concerned with secondary data for the evaluation of yoga’s influence on students.

IP innovative publication pvt ltd

IP Innovative Publication Pvt. Ltd.

Aim: This study found that the effectiveness of yoga in decreasing depression and improve the quality of life among the people practicing yoga. Materials and Methods: In the total study population, vouleenters categorized into control (N=30) and study group (N=30). We evaluate Depression and quality of life using standard methods. Finally, we analyzed results before and after yoga intervention at the end of one month. Data were analyzed statistically to compare the score between control and study group. Results: Results revealed a decrease in depression and improved quality of life significantly (p<0.001) in the study group compared to control group. Conclusion: In conclusion, Yoga was an alternative approach to control all the psychological problems.

Journal of Behavioral Health Services & Research

Lynn Hickey Schultz

The goal of this study was to evaluate potential mental health benefits of yoga for adolescents in secondary school. Students were randomly assigned to either regular physical education classes or to 11 weeks of yoga sessions based upon the Yoga Ed program over a single semester. Students completed baseline and end-program self-report measures of mood, anxiety, perceived stress, resilience, and other mental health variables. Independent evaluation of individual outcome measures revealed that yoga participants showed statistically significant differences over time relative to controls on measures of anger control and fatigue/inertia. Most outcome measures exhibited a pattern of worsening in the control group over time, whereas changes in the yoga group over time were either minimal or showed slight improvements. These preliminary results suggest that implementation of yoga is acceptable and feasible in a secondary school setting and has the potential of playing a protective or preventive role in maintaining mental health.

Journal of Evolution of medical and Dental Sciences

Manjula Mehta

International Journal of Yoga

Elizabeth Monk Turner

Purakala, peer - reviewed, UGC-CARE listed,Vol. -31, Issue - 30, ISSN: 0971-2143, May -

Alkshendra Kunal Ashok

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

RELATED PAPERS

Dr Arun Pratap Singh

International Journal of Yoga Therapy

Jeff Tarrant

Michael de Manincor

International Journal of Scientific Research in Science, Engineering and Technology IJSRSET

Michael de Manincor , Monica Schweickle

International Journal of Environmental Research and Public Health

Chia-Liang (Leo) Dai

Hariom Sharma

OBM Integrative and Complementary Medicine

Kelsey Dietrich

American Journal of Preventive Medicine

IRA-International Journal of Management & Social Sciences (ISSN 2455-2267)

Jyoti Kumar Arora

Advances in social science, education and humanities research

Sarah Hafiza

Stress and Health

Journal of Mid-life Health

Sujit Chandratreya

Nitu Kumari

International Journal of Movement Education and Social Sciences

Deepti Joshi, PhD

Yogesh Jogsan

isara solutions

International Res Jour Managt Socio Human

Patty Cabral

International Journal of Yogic, Human Movement and Sports Sciences

Dr Jacksan Fernandes

Journal of the Indian Academy of Applied Psychology

Parul Kumari

Journal of Yoga and Physiotherapy

Indian J Psychiatry

Ananda B Bhavanani , Suriya Kumar , Eswaran Subramaniam

BMC Complementary and Alternative Medicine

Holger Cramer

Mark A Tolmachoff

Frontiers in Psychiatry

Shirley Telles

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• VA Author Manuscripts

Yoga as a treatment for chronic low back pain: A systematic review of the literature

Douglas g. chang.

1 Department of Orthopaedic Surgery, University of California, San Diego, USA

Jacquelyn A. Holt

Marisa sklar.

3 Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, USA

Erik J. Groessl

2 VA San Diego Healthcare System, San Diego, USA

Chronic low back pain (CLBP) affects millions of people worldwide, and appears to be increasing in prevalence. It is associated not only with pain, but also with increased disability, psychological symptoms, and reduced quality of life. There are various treatment options for CLBP, but no single therapy stands out as being the most effective. In the past 10 years, yoga interventions have been studied as a CLBP treatment approach. The objective of this paper is to review the current literature supporting the efficacy of yoga for CLBP.

A literature search through the beginning of 2015 was conducted in Pub Med for randomized control trials addressing treatment of CLBP with yoga.

In this review we evaluate the use of yoga as a treatment for CLBP. Specifically we evaluate how yoga impacts physical functioning and disability, pain, and associated psychological symptoms. We also evaluate possible mediators of the effect of yoga and the safety of yoga.

With few exceptions, previous studies and the recent randomized control trials (RCTs) indicate that yoga can reduce pain and disability, can be practiced safely, and is well received by participants. Some studies also indicate that yoga may improve psychological symptoms, but these effects are currently not as well established.

Introduction

About one fourth of United States adults report low back pain, lasting a whole day or more, at some point within the past 3 months [ 1 ]. It is the most common cause of limited activity in people below the age of 45, is the second most frequent reason for visits to a physician, the third most common reason for surgery, and the fifth most common cause of hospital admission in the United States [ 2 ].

The majority of individuals with back pain and sciatica recover from an acute episode in 4–8 weeks [ 3 – 5 ]. 80–90% return to work within 12 weeks post injury [ 6 ]. However 25–80% of low back pain patients experience some form of recurrent back problem in the following year [ 4 , 5 , 7 , 8 ]. Among those who suffer from an episode of low back pain, one year later as many as 33% have moderate intensity pain, and 15% may have severe pain [ 7 ].

People suffering from chronic low back pain have other associated problems such as anxiety [ 9 – 11 ], depression [ 12 , 13 ], and disability [ 2 , 14 ], with a reduced quality of life [ 15 , 16 ]. Rates of major depression are 20% for persons with chronic back pain, compared to 6% for pain-free individuals [ 13 ].

The word “yoga” literally means “yoking”, or “joining together” for a harmonious relationship between body, mind and emotions to unite individual human spirit with divine spirit or the True Self [ 17 , 18 ]. Yoga involves a process of physical and mental training towards self-realization, the practice of which has eight component limbs. The eight components guide conduct within society, personal discipline, postures/poses (“asanas”), breathing, concentration, contemplation, meditation and absorption/stillness. As classically described, yoga poses comprise just one of the eight components of a broader discipline of physical, mental, and spiritual health. Modern Hatha yoga usually combines elements of postural positioning, breathing, concentration, and meditation. A typical Hatha yoga program involves a group led by an instructor for a ~ 60–90 minute session. The instructor provides guidance for correct postures, breathing and focus. They often encourage positive self-images. Iyengar yoga has a focus on holding postures, and the use of modifications (such as blocks, belts, chairs, blankets) to accommodate individual physical abilities. Other yoga styles exist and the experience in one style or class can be very different. The intensity can range from gentle to strenuous, with some types of yoga providing a cardiovascular workout, and others focused on relaxation and calmness. Another experiential factor comes from the yoga center itself, which can provide a sense of social and spiritual community.

Yoga popularity has grown tremendously in the past several years. National Health Interview Survey data conducted by the Centers for Disease Control and Prevention (CDC) show increased usage for complementary and alternative medicine (CAM) treatments [ 19 ]. In 2007, yoga was the 7 th most commonly used CAM therapy. CAM therapies are used mostly to treat musculoskeletal conditions, in particular back pain and to a lesser degree neck pain.

CLBP pain affects millions of people. There are many treatment options, but few have strong evidence for being effective [ 20 , 21 ]. Several randomized control trials (RCT) about yoga’s effect on low back pain have been completed; however they have varying outcome measures about pain and functional disability. A few meta-analysis studies were completed with 2011 searches, generally showing a positive effect, but limited in general by a relatively small total number of eligible RCTs [ 22 – 25 ].

Holtzman et al. conducted an electronic search in 2011 to identify 8 yoga articles, with a focus on pain and functional disability [ 23 ]. Ward et al. searched through different databases, also in 2011, to identify 17 articles on functional disability, pain and depression [ 24 , 25 ]. However the relevance and quality of the articles was limited. Of the 17 articles, 12 were focussed on back pain. These 12 included two pilot studies considered of poor methodological quality, and only three of the identified CLBP studies were considered to have an acceptable adherence to the intervention. Cramer et al. also searched through 2011 articles and focused on the outcomes of pain, disability, and quality of life. They used yet another statistical method to winnow a list of yoga and low back pain papers down to 8 studies [ 22 ]. Although the Holtzman et al., Ward et al. and Cramer et al. studies used very different search strategies, they all winnowed down their findings in different, semi-objective fashions to an essentially identical, smaller list of yoga studies for further consideration.

This report is unique with updates not available in the older review articles [ 21 – 25 ]. This paper reviews randomized control trials, as well as randomized studies, comparing yoga to current exercise interventions. In addition, this paper reviews the findings in the existing literature as they relate to physical functioning and disability, pain, and psychological factors, as well as a review of findings on the biological mechanisms of yoga on back pain.

Materials and Methods

A search in PubMed was conducted in the beginning of 2015 for randomized control trials of yoga and low back pain. The initial search of “yoga and back pain” identified 128 articles. Study reports without abstracts were excluded, returning 106 articles. Titles and abstracts were then screened for relevance to yoga and back pain, resulting in 27 articles (see Figure 1 ).

Flow chart representing the search and selection of articles for review.

These articles underwent full text review. For this project, inclusion criteria included (1) yoga was actually studied as an intervention, (2) research subjects had medically diagnosed low back pain, (3) low back pain was chronic, (4) an original article, (5) a clinical trial, (6) study involved n≥20 subjects, (7) published in English. 14 study reports were determined to be eligible for review after this full text screening. These studies underwent extensive review and were rated using the Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence criteria [ 26 , 27 ]. Most of the papers reviewed are level 2–4, with the majority being level 2 ( Table 1 ). Due to the variety of outcome measures reported in the articles reviewed, we divided this paper into several outcome categories including: impact of yoga on physical functioning and disability, the impact of yoga on pain, psychological impacts of yoga, and biological mechanism of yoga on back pain.

Physical functioning and disability

Yoga treatment studies of CLBP typically utilize some measure of physical functioning and disability as a primary outcome. Such outcomes can be tied to physiological performance, or validated questionnaires with specific behavioral items. Most yoga studies do demonstrate beneficial effects for adults suffering from CLBP ( Table 1 ).

A small randomized controlled trial, pilot study demonstrated trends for the yoga group in terms of improved balance and flexibility, and decreased disability and depression [ 28 ]. However, the study was weakened by the small sample size (n=22 participants) and a high dropout rate among the control group. As such, no statistical significance was observed.

The impact of Iyengar yoga therapy was assessed in a 16-week, randomized controlled trial involving subjects with non-specific CLBP compared to an educational control group [ 29 ]. The yoga subjects had less pain (Short Form-McGill Pain Questionnaire) and lower functional disability (Pain Disability Index) than the controls. Unfortunately there was a 30% drop-out rate in this study. Williams et al. conducted another 24-week study that showed significantly greater reductions in functional disability (Oswestry Disability Index), pain intensity (Visual Analog Scale) and depression (Beck Depression Inventory-Second Edition) among the subjects randomized to the yoga intervention group [ 30 ]. Both of these studies were limited by a reliance on self-report measures, a relatively healthy study population, and lack of controls for attention and physical activity between the treatment and control groups [ 29 ].

80 patients with CLBP participated in an intensive seven day long, residential yoga program. The effect of yoga on disability (Oswestry Disability Index), quality of life (World Health Organization Quality of Life-BREF) and flexibility was studied [ 31 , 32 ]. The intervention group practiced daily meditation, yoga exercise, chanting and went to lectures. The control group followed a daily routine of exercise, non-yogic breathing exercises, educational lectures and additionally filled their time watching nature programs. This control is different than the usual or no care control used in other studies. There was a significant difference in disability between groups, with the yoga group experiencing a greater improvement than the control group. The yoga group showed a greater increase in flexibility and reduction in pain (section 1 of the Oswestry Disability Index) than the control group [ 31 , 32 ].

Predictors of outcome were studied in 53 adults who were already involved either with yoga or a physical therapy intervention to treat CLBP. No significant differences in disability (Roland-Morris Disability Questionnaire) were seen at 6 weeks [ 33 ]. A major finding in both groups was that back pain self-efficacy was the most important predictor of pain, health status and disability. Self-efficacy refers to an individual’s belief in the capacity to change outcomes through their own actions, and was measured by the Back Pain Self-Efficacy Scale. A significant limitation of this study is the presence of self-selection bias because the participants were already enrolled/self-selected into the yoga or physical therapy groups prior to the study.

The effects of yoga on balance and gait were studied in an 8 week pilot study involving adult women (n=27) with musculoskeletal problems, such as osteoarthritis and low back pain [ 34 ]. The subjects’ balance and gait parameters were statistically improved compared to the pre-study values. The small sample size and lack of control group in this study make it difficult to attribute the improvements exclusively to the yoga intervention. Additionally the study failed to describe the nature of the relatively young (age 30–45 yrs) subjects’ musculoskeletal problems in any detail.

The effect of yoga on physical functioning has been described in two large randomized trials [ 35 , 36 ]. Sherman et al. studied yoga compared to stretching or a self-care book approach for patients with chronic low back pain [ 35 ]. In all the groups, function and symptoms improved over time. The yoga and stretching groups reported similarly improved results compared to the self-care group. The authors concluded that yoga benefits are due mainly to the benefits of physically stretching and strengthening the body, and not due to yoga’s mental aspect.

Tilbrook et al. studied the long-term effectiveness of a 12-week yoga program versus a back pain education booklet for low back pain patients [ 36 ]. The yoga group had significantly better back function (Roland-Morris Disability Questionnaire) than the usual care group at 3, 6, and 12 months follow-up. This study did not see any difference between interventions, in a secondary outcome, the Aberdeen Back Pain Scale for health related function and pain [ 37 , 38 ]. However this scale is noted to have significant weaknesses and is not suggested anymore for use [ 39 ].

A randomized dosing trial compared once versus twice-weekly yoga classes for CLBP in predominantly low income, racially diverse and more severely impaired populations [ 40 ]. Subjects (n=95) completed a 12-week intervention. Pain and back-related function improved in both groups, with no difference between the once and twice-weekly groups. There were several study limitations including the inability to blind participants, the use of self-reported measures, lack of a non-yoga control group, differential adherence between groups, high use of non study treatments, and no long-term follow up. The results suggest in an underserved population, weekly yoga classes do not increase benefit and present more difficult compliance issues.

A four-week, randomized control trial of a virtual reality-based Wii yoga program versus physical therapy and trunk stabilizing exercise in 30 middle-aged women with low back pain was presented [ 41 ]. Significantly improved outcomes were observed in both groups, for pain (visual analog scale), function (Oswestry low-back pain Disability Index, Roland-Morris Disability Questionnaire), and fear (fear avoidance beliefs questionnaire) scores. There were financial and time benefits provided to the middle aged women by the home, virtual reality based program. Limitations of this study included the lack of a traditional yoga control group, and the lack of frequency and dosing of exercise information in the control group. Another limitation is the specific age range and gender of the subjects, but as discussed by the authors the target group is middle aged women who have significant demands on their time and money for housekeeping and childrearing activities.

A number of studies demonstrate yoga’s effectiveness in reducing chronic low back pain. Williams et al. evaluated clinical levels of pain (using the Short Form-McGill Pain Questionnaire), pain-related fears to movement (Tampa Scale of Kinesiophobia), and pain beliefs (Survey of Pain Attitudes) [ 29 ]. The yoga intervention resulted in a two times greater reduction in pain, and reduced pain medication usage, compared to the educational control group. There was no significant difference in pain attitudes or movement fears, perhaps due to the study not having enough statistical power for these outcomes. Williams et al. further demonstrated the effectiveness of a 24 week Iyengar yoga program on improving chronic low back pain [ 30 ]. Individuals randomized to the yoga group showed greater improvements in pain intensity than in the control group.

A single group, pre-post study of military veterans who participated in a clinical yoga program at a large VA medical center showed improvement for pain between baseline and 10-weeks [ 42 ]. Pain was measured using a visual pain scale modification of the visual analog scale. Among the various indicators of the yoga “dosing” (i.e. amount of intervention), decreased pain was significantly correlated to the actual attendance. Additional analysis of this same study demonstrated that females experienced greater improvements in pain compared to the males [ 43 ]. The women had significantly greater improvements on depression, pain “on average”, energy, and Short-form 12 mental health. No gender difference was demonstrated for pain “at its worse”, total pain score, or Short-Form 12 physical health.

Saper et al. studied the effect of yoga on back pain among low income, racially diverse subjects [ 40 ]. The average low back pain intensity for the previous week (as measured by the Visual Analog Scale), was significantly reduced from 7 to 5 after the 12 week intervention, regardless of whether subjects attended once-or twice-weekly yoga classes [ 40 ].

Sherman et al. measured pain “bothersomeness” instead of pain severity because of the complex nature of pain [ 44 ]. Subjects rated their back pain during the previous week on an 11-point scale, from “not at all” to “extremely” bothersome, in response to a 12-week yoga, exercise or book education intervention. All interventions were helpful, but the yoga and exercise groups improved

Back pain “bothersomeness” was studied in individuals already involved either with yoga or a physical therapy intervention [ 33 ]. Both interventions helped, and there were no significant group differences between yoga and physical therapy after 6 weeks of treatment. However, the baseline characteristics of the yoga group were such that they demonstrated less back pain and disability to begin with.

A randomized control trial evaluated the impact of Iyengar yoga on pain intensity (Visual Analog Scale) and health related quality of life in subjects with nonspecific chronic low back pain [ 45 ]. The study compared yoga therapy to conventional exercise therapy, with 6 month follow up. Both interventions resulted in significant benefits, with the yoga intervention having the greater impact.

Psychological impact of yoga

Yoga’s effect on psychological health has not been well characterized in the scientific literature to date. Galantino et al. conducted a pilot study of depression and a Hatha yoga intervention [ 28 ]. As mentioned, this study had a small sample size and a high dropout rate. They demonstrated a non-significant trend towards decreased depression in their yoga intervention group.

Groessl et al. studied the effect of yoga on depression and quality of life (Short-Form 12 version 2) in veterans with back pain [ 42 ]. They found significant improvements in depression, and a trend towards significant improvements for the Mental Health Scale of the SF-12. The improvement in depression tended to be associated with the subjects’ self-reported amount of home practice.

The impact of Iyengar yoga on depression (Beck Depression Inventory) was studied in subjects with CLBP [ 30 ]. The subjects randomized to the yoga group showed greater improvements in depression than those in the control group. One limit of the study was that yoga group received more attention than the self-directed control group. Another limit was the lack of controls for physical activity between the groups.

Tekur et al. found their yoga group experienced significantly greater improvements in the psychological subscale of their quality of life scale (World Health Organization Quality of Life-BREF) compared with the controls [ 32 ]. However, this residential-based study involved additional elements (i.e. 8 hours a day of interactive lectures, chanting, meditation sessions) than typical Hatha or Iyengar yoga interventions. Furthermore, this was only a short-term (i.e. 1 week follow up) study.

One randomized controlled trial [ 36 ] and an affiliated pilot study [ 46 ]studied yoga versus “usual care” with the mental health ShortForm 12. The pilot study found no significant difference, but it was under-powered (n =20) [ 46 ]. Their follow-up study was adequately powered. They still found no significant difference in mental health function at the 3-, 6- and 12 month assessments (although the 3- and6-month assessments demonstrated a trend towards improvement)[ 36 ].

Biological mechanisms of yoga on back pain

A few studies have explored the mechanisms by which yoga might affect back pain. Sherman et al. and Lee et al. investigated several possible mediators, including serotonin, cortisol, dehydroepiandrosterone (DHEA), and brain derived neurotrophic factor (BDNF) [ 47 , 48 ]. Additionally Sherman et al. investigated psychological factors that may mediate the effect of yoga on back pain.

These factors included cognitive appraisal measures (fear avoidance, self-efficacy and self-awareness), affect and stress (psychological distress, perceived stress and positive states of mind), physical activity, and neuroendocrine function [ 47 ]. Neuroendocrine function was measured with cortisol and DHEA levels from saliva samples. The goal was to identify which measure had the biggest effect on back-related dysfunction (Roland-Morris Disability Questionnaire) in the yoga versus stretching versus self-care groups. Self-efficacy, and hours of back exercise were the most significant contributors to the effect of yoga. Sleep disturbance also played a small role. No effect was seen from cortisol or DHEA levels. Yoga and stretching had similar effects. One limit was the fairly healthy study population.

Lee et al. investigated the effect of yoga on pain, BDNF, and serotonin in premenopausal women with chronic low back pain [ 48 ]. The yoga group had decreased pain, increased BDNF and unchanged serotonin. The untreated control group had increased pain, decreased BDNF and decreased serotonin. This suggested that the beneficial effects of yoga are associated with elevated serum BDNF levels and maintained serotonin levels. There were several limitations including small sample size, gender bias, and a control group that could better account for group socialization effects. It’s also not clear why the control group exhibited increased pain after the intervention.

Safety of yoga

Low back pain itself is a persistent condition with a known high rate of recurrence and a high rate of incomplete resolution [ 8 , 49 ]. Therefore in studying subjects with back pain, it would not be surprising to see occasional adverse events. Overall, however, it does not appear that yoga presents a significantly increased risk for normal individuals or patients with back pain. In one study, among 30 subjects randomized to yoga, one adverse event was reported [ 29 ]. That subject had symptomatic osteoarthritis and was diagnosed with a herniated disc during the study. Medical review of the adverse event by the Institutional Review Board determined it was unrelated to the yoga postures.

No serious adverse events were reported among 101 subjects in yoga versus exercise trial [ 44 ]. One yoga participant discontinued class due to migraine headaches, one exercise participant ‘strained’ her back and sought care from a chiropractor. More recently, Sherman et al. found an equal number of mild to moderate adverse events (mostly temporarily increased back pain) among the subjects in both the yoga and a more traditional stretching intervention [ 35 ]. One of the 87 yoga class subjects experienced a serious event, a herniated disc. One in the self care control group reported increased pain. Despites these adverse events, overall the yoga and stretching groups had moderately improved outcomes.

8% of 156 yoga participants and 1% of 157 usual care participants reports adverse events in the study by Tilbrook et al. [ 36 ]. In the yoga group, 11 events were nonserious and related to temporarily increased pain. 1 event was serious, and occurred in an individual with a history of severe pain after any physical activity. In the usual care group there was actually a death, and also an injury unrelated to the intervention.

In a comprehensive review of non-pharmacological and non-invasive therapies for chronic low back pain, there were discovered only rare reports of serious adverse events [ 50 ]. However, better reporting of harms was suggested as a need.

Low back pain risk factors include previous back pain episodes, high physical demands of work, low job satisfaction, age, back weakness, and smoking [ 51 – 53 ]. Care seeking and disability due to chronic low back pain depend more on psychosocial issues than on individual clinical features or workplace physical demands [ 53 ]. Identifying and addressing these psychosocial factors helps improve outcomes and limit costs [ 20 ].

Among the treatments for CLBP, there is variable evidence to support effectiveness of non-pharmacologic [ 50 ], and medication [ 54 ]management. Yoga, in comparison to spinal manipulation, physical therapy, and acupuncture, may be more cost effective because it can be delivered in a group format and self-administered at home. However, actual cost analysis of yoga interventions is needed.

This literature review suggests that yoga is effective in reducing pain and disability, and improving both physical and mental function. The Sherman et al. study employ used a three-arm intervention, and thus, provides important “comparative effectiveness” data by comparing yoga to a conventional stretching program led by physical therapists and a self-care book from primary care providers [ 35 ]. A few key points derive from their work, which is supported also by other research [ 33 ]. Yoga was not superior in effectiveness compared to conventional stretching. Self-efficacy and hours of back exercise may be the most important factors for both conventional exercise therapy and yoga.

To this point, compared to traditional exercise programs derived physical therapy, yoga could provide superior compliance and benefit in the long term. Yoga poses, once learned, might be more easily remembered by patients because the poses and their associated names tend to have universal recognition. Yoga programs, even ‘adaptive’ or ‘senior’ classes, are accessible in most cities, at studios, local gyms, recreation centers and hotel wellness centers. In contrast, patients finishing a physical therapy program may receive a variety of suggested exercises with no standardization, and little similar to what another physical therapist might dispense. Patients can lose, forget or not even receive a home exercise program from their therapists at the conclusion of a formal physical therapy prescription. Long term outcome studies are needed to explore this hypothesis because most yoga studies to date have lasted less than 26 weeks, with the exception of the study by Tilbrook et al. [ 36 ].

Yoga, with its spiritual and psychological underpinnings, potentially might provide greater mental health benefits compared to traditional physical therapy. However, the impact of yoga on depression has been evaluated in only a small number of studies. Significant effects on depression were found in two studies [ 30 , 42 ], but only non-significant trends were found for the Mental Health Scale SF-12 [ 42 ]. Sherman et al. found that self-efficacy and also sleep were important psychological benefits of yoga on low back pain [ 47 ]. With the high rates of depression among sufferers of CLBP, further research in this area is needed [ 20 ]. To what extent yoga may impact other mental health conditions (e.g. anxiety disorders, which are not as well measured by the SF-12) is also an important research direction.

Lastly, safety data from the largest and most recent trials suggest about a 10–15% incidence of temporarily increased low back pain, and two identified cases of herniated disc. It appears that yoga participation is not without risks. However, the great majority of participants do appear to experience considerable benefits without many problems.

Overall, yoga is an intervention which appears to be well positioned, as the healthcare system shifts from caring mostly for patients with acute illness to caring mostly for patients with chronic disease, and where healthcare providers seek to design preventative strategies against the chronic conditions of modern society. More specifically, because it is a reflective activity, yoga may find particular application among military veterans who must live with the long term effects of wartime trauma [ 55 ].

Yoga appears as effective as other non-pharmacologic treatments in reducing the functional disability of back pain. It appears to be more effective in reducing pain severity or “bothersomeness” of CLBP when compared to usual care or no care. Yoga may have a positive effect on depression and other psychological co-morbidities, with maintenance of serum BDNF and serotonin levels. Yoga appears to be an effective and safe intervention for chronic low back pain.

Acknowledgments

This research was partly supported by the grant, NIH/VA RRDC RX000474

• Posts (RSS)
• Comments (RSS)
• Mission Statement
• Board and Contact
• Weight, Glucose, Hypertension, Cholesterol
• Yoga as a self-care strategy
• Mindfulness-based stress reduction and health benefits.
• Meditation as psychotherapy
• Yoga for anxiety
• Yoga for depression
• Hatha Yoga for Depression
• Does Mindfulness Meditation Improve Anxiety and Mood Symptoms?
• An introduction to kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders.
• Yoga in cardiac health
• Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function
• The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus
• Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga
• Meditation practices for health
• Yoga for menopausal symptoms
• Hatha yoga therapy management of urologic disorders
• An evidence-based review of yoga as a complementary intervention for patients with cancer
• Hemodynamic observations on a yogic breathing technique claimed to help eliminate and prevent heart attacks
• Therapeutic effects of yoga for children
• Clinical trials of meditation practices in health care
• Yoga in stroke rehabilitation
• Yoga as a therapeutic intervention
• Using yoga to treat disease
• Benchmarks used in researching yoga’s effect

Literature Review of Research on Yoga Benefits

• Yoga for Arthritis
• Yoga as Adjunctive Therapy for Migraines
• Hatha Yoga to treat Stress, Anxiety and Attentional Suppression
• Pranayama and Yoga Nidra for Cancer Treatment and Treatment-Related Anxiety and Depression
• The Benefits of Yoga and Meditation for Cellular Health and Aging
• Queer and Trans Yoga: Practices of Utopia in Hostile Times
• Kundalini Yoga – cognitive benefits for older women at risk of Alzheimer’s disease
• Easing Fatigue and Anxiety Related to Multiple Sclerosis
• Iyengar Yoga and Rheumatoid Arthritis
• Yoga as an Exercise Prescription for the Pregnancy or Postpartum Period
• Yoga Impact on Insomnia and Systolic Blood Pressure
• Effects of Yoga in People with Type 2 Diabetes
• Yoga for Trauma Survivors
• Short In-Class Survey to Measure Success!
• Teacher and Student Mid-Term and End-Term Surveys
• Want a Yoga Program at Your Organization?
• How Studios Can Help
• Become a Member
• Join Our Board
• Sponsor a Class
• Teaching Yoga in Service Settings
• What to Teach, Where, and How: Yoga Class Preferences of a Non-Studio-Based Outreach Yoga Community
• Motivations for Service
• 10 Commandments of Yoga Outreach
• Program Set Up Guide
• Site Visits
• Breathing Guide
• Responding to Abreactions
• Program Set Up Questionnaire
• Training Directory
• Yoga Activist Trainings
• Evaluate Trainings
• Request Scholarships
• What is a Yoga Outreach Teacher?
• What is a Yoga Outreach Understudy?
• Your First Yoga Class
• Student Practice Guides
• Grants & Features
• Fundraising
• Yoga Outreach Organization Directory
• Donate Mats
• Requesting Mats
• Program Reach
• Internships
• Donate Now!

At the request of Jasmine Chehrazi, Founder of  YogaActivist.org , a group of nine graduate students enrolled in the Master of Public Health (M.P.H.) program at The George Washington University conducted a literature review on the health benefits of yoga. The review provides  YogaActivist.org with information needed to further develop its network of studio-supported yoga outreach programs to diverse communities, both locally and nationally. Specifically, the review highlights the dynamic interplay between stress, weight, and other disease indicators—all of which can be addressed, if not mitigated, through routine participation in yoga.

The group of M.P.H. students searched for relevant articles in academic, peer-reviewed journals, including, but not limited to, the Journal of General Internal Medicine, Journal of Psychiatric Practice, Alternative Therapies in Health and Medicine, International Journal of Nursing Studies, Journal of Affective Disorders, Rehabilitation Oncology, and Topics in Clinical Nutrition. The search was by no means exhaustive, but the group found and summarized 19 different articles demonstrating the effectiveness of yoga in promoting physiological and mental health, as well as in controlling disease and disease indicators. While the 19 studies differ in study type, design, purpose, sample size, target population, yoga method(s) and technique(s), length of follow-up, and overall findings, they together demonstrate the widespread applicability of yoga to diverse populations, irrespective of gender, age, race/ethnicity, weight, or health status.

Through the literature review, the nine students found documentation of yoga’s effectiveness in treating musculoskeletal conditions, improving mental health, reducing stress and anxiety, increasing cortisol levels (associated with self-esteem and tenacity and lower levels of nervousness and depression), improving pulmonary function among asthmatic children, increasing exercise self-efficacy, reducing and/or controlling blood pressure, slowing weight gain, controlling diabetes mellitus, and improving overall mood. Such benefits extend to individuals across the life span. While yoga alone is insufficient to reverse disease or substantially improve health status, the literature suggests that yoga, when combined with other intervention measures, can reap significant physiological and mental health benefits for diverse populations. Yoga is a personal, non-competitive physical activity. When practiced correctly and routinely, yoga provides individuals of all ages with the motivation and self-efficacy needed to live and maintain healthier lifestyles.

Below is a summary of each of the 19 articles regarding the effectiveness of yoga interventions in promoting health. The summaries are categorized by the primary health or behavioral objective of each study.

Yoga and Mental Health

1) Lee SW, Mancuso CA, Charlson ME. Prospective study of new participants in a community-based mind-body training program. J Gen Intern Med. 2004;19(7):760-5.

FINDING: A 3-month yoga program improved mental health scores and other quality of life measures. Yoga Type: Dahn-hak. 1) stretching exercises for large muscle groups and shoulders, neck,hips, back, and knees, 2) postures are held for “energy accumulation 3) 5- to 10-minute meditation intended to facilitate “energy awareness”, 4) repetition of the large muscle group stretches. Yoga Frequency/Duration : 1-hour class offered 2-to-3 times per week for 3 months.

OBJECTIVE: To measure changes in health-related quality of life associated with 3 months of mind-body training as practiced in community-based settings.

METHODS: A prospective cohort study was done in eight centers for the practice of mind-body training in the metropolitan New York City area with 194 adults, and 171 completed the follow-up survey.  Participants typically attended a 1-hour class two to three times per week.  They were given a questionnaire before the classes began and 3 months later with questions about mental and physical health from validated survey instruments.

RESULTS: At baseline, new participants reported lower scores than U.S. norms for 7 of 8 domains of the Medical Outcomes Study SF-36 general health questionnaire.  After 3 months of training, within patient change scores improved in all domains (P< .0001), including a change of +15.5 in the mental health domain. In hierarchical regression analysis, younger age, baseline level of depressive symptoms and a history of hypertension were independent predictors of greater improvement in the SF-36 mental health score. Five participants (2.9%) reported a musculoskeletal injury.

2) Uebelacker LA, Epstein-Lubow G, Gaudiano, BA. Hatha. Yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. J Psychiatr Pract. 2010;16:22–33.

FINDING:  A review of eight clinical trials showed the yoga may help treat depression.  Note: Methodological concerns with most trials. Yoga Type : Some asana-focused, some meditation-focused Yoga Frequency/Duration : Varied in length from 3 days to 12 weeks and in intensity from daily to once per week.

OBJECTIVE: Review the literature of studies evaluating the efficacy of yoga for the treatment of depression and possible mechanisms .

METHODS: Studies were included in the review if they were clinical trials with one of the intervention arms involving a predominantly yoga intervention and a requirement for participants to have a diagnosed depressive disorder or elevated depression symptoms.

RESULTS: Eight trials were found. The number of participants ranged from 28 to 89.  Of the five studies that compared yoga to no/minimal treatment, four found some evidence that yoga was superior to the control group, and the final one did not directly compare the two groups. Studies varied in length of intervention from 3 days to 12 weeks and in intensity from daily to once per week, and different types of yoga were used (some asana-focused and some meditation-focused). Effect sizes of differences varied widely, and methodological differences and flaws threatening internal validity make it difficult to draw generalizable conclusions.

3) Birdee GS, Legedza, AT, Saper RB. Characteristics of yoga users: results of a national survey. J Gen Intern Med . 2008;23(10):1653-1658.

FINDING: A national survey of yoga users showed it to be helpful for overall health and well being, mental health, and musculoskeletal conditions. Yoga Type: N/A Yoga Frequency/Duration : Self-report that person had practiced yoga during past 12 months (and not tai chi or qi gong)

OBJECTIVE: To characterize yoga users, medical reasons for use, perceptions of helpfulness, and disclosure of use to medical professionals.

METHODS: A cross-sectional study was done using data from the National Health Interview Survey Alternative Medicine Supplement with 31,044 respondents. Survey participants were asked if they had practiced yoga during the past 12 months. If they had practiced yoga, but not tai chi or qi gong, they were asked whether they practiced yoga for medical conditions and if it helped their condition and also how important yoga was in maintaining their general health and well-being.

RESULTS: The prevalence of yoga use for health in the U.S. was 5.1percentwith a mean age of 39.5. Most yoga users (58%) felt that yoga was an important part of maintaining their health and well-being. A smaller percentage of yoga users reported using yoga to treat specific medical conditions (16%). Among medical conditions, 10.5percentand 3.3percentof yoga users reported using yoga to specifically treat musculoskeletal and mental health conditions, respectively. A majority of these yoga users reported yoga as helpful for their mental health (83%) and musculoskeletal condition (76%).

4) Woolery A, Myers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults with elevated symptoms of depression. Alter Ther Health Med . 2004;10(2):60-63.

FINDING: A 5-week program of yoga showed reductions in depression and anxiety among young adults. Yoga Type : Iyengar Yoga Frequency/Duration : Two 1-hour classes per week for 5 weeks

OBJECTIVE: To determine the short-term effect of yoga on mood in mildly depressed young adults.

METHODS: Twenty-eight 18-29 year olds with mild depression were randomly assigned to an intervention group or a wait-list control group. The intervention group participated in a 5-week yoga program of two 1-hour classes per week. Measurements of depression and anxiety levels were made using the Beck Depression Inventory (BDI), State Trait Anxiety Inventory (STAI), and Profile of Mood States (POMS) survey instruments before classes began, midway through the program and at the program’s completion. Morning cortisol levels were also taken at the same time points.

RESULTS: The yoga group showed a significantly greater reduction in depression compared to the control group (p<.001). A similar pattern was seen for trait anxiety (p<.001) Significant pre- to post-class reductions were seen in depression-dejection, tension-anxiety, anger-hostility, fatigue-inertia, confusion-bewilderment, and total mood disturbance. Yoga participants also showed higher morning cortisol levels, which are associated with self-esteem, hardiness, and tenacity, and lower levels of nervousness and depression.

5) Chen KM, Chen MH, Chao HC, Hung HM Lin, HS, et al. Sleep quality, depression state, and health status of older adults after silver yoga exercises: cluster randomized trial. Inter J Nurs Stud. 2008;4:154-163.

FINDING: A 6-month yoga program improved sleep quality, depression, and perceived health status among older adults who reside in the community. Yoga Type : Warm up, hatha yoga gentle stretching, relaxation, and guided-imagery meditation. Yoga Frequency/Duration : 70 minutes three times per week for six months.

OBJECTIVE: To test the effects of six months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially among the indicators of sleep quality, depression, and self-perception of health status.

METHODS: A cluster randomized trial was conducted in eight senior citizen activity centers in southern Taiwan. Participants were randomly assigned into either the experimental (n = 62) or the control (n = 66) group based on their attendance at selected senior activity centers. A 70-minute silver yoga exercise program was implemented three times per week for six months as the intervention for the participants in the experimental group.

RESULTS: The mental health indicators of the participants in the experimental group were significantly improved in comparison to the participants in the control group after the silver yoga interventions (all p < .05). Many of the indicators improved after three months of the intervention and were maintained throughout the six month study. These indicators included subjective sleep quality (as measured by the Pittsburgh Sleep Quality Index (PSQI) score), daytime dysfunction, physical and mental health perception, and depression state.Silver yoga exercise sessions were taught 3 times per week, for 70 minutes each session, over 6 months.  Each 70-minute session included a warm up, hatha yoga gentle stretching, relaxation, and guided-imagery meditation.  No additional details regarding postures or sequence are provided.  For consistency over the course of the intervention, yoga instructors followed a pre-recorded tape made by the principal investigator which verbally guided them through the sequence of postures for each session.

6 ) Gupta N, Khera S, Vempati RP, Sharma R, Bijlani RL. Effect of yoga based lifestyle intervention on state and trait anxiety. Indian J Physiol Pharmacol. 2006;50(1): 41-47.

FINDING: Short educational program for stress management and lifestyle modification based on yoga leads to reduction in anxiety. Yoga Type : Asanas and pranayama Yoga Frequency/Duration : 8-day outpatient course, 3-4 hours/day, over 10 days (with a 2-day weekend break)

OBJECTIVES: To study the short-term impact of a comprehensive, yet brief, lifestyle intervention based on yoga in diseased and normal individuals.

METHODS: The research subjects had a history of hypertension, coronary artery disease, diabetes mellitus, obesity, psychiatric disorders and thyroid disorders. The intervention consisted of asanas, pranayanama, relaxation techniques, group support, individualized advice, lectures and films on philosophy of yoga, and the place of yoga meditation in daily life, meditation, and stress management.

RESULTS: Outcome measures were anxiety scores taken on the first and last days of the course. Among diseased individuals, improvement was seen in anxiety levels.

7) Galantino ML, Cannon N, Hoelker T, Iannaco J, Quinn L. Potential benefits of walking and yoga on perceived levels of cognitive decline and persistent fatigue in women with breast cancer. Rehab Oncol. 2007;25(3):3-12.

FINDING: Exercise, specifically walking and yoga, have been proven effective in enhancing quality of life and decreasing fatigue in breast cancer populations. Yoga Type : variable Yoga Frequency/Duration : variable

OBJECTIVE: To investigate available evidence for the effect of walking and yoga on breast cancer survival following chemotherapy.

METHODS: Authors searched randomized clinical controlled trials, systematic reviews, cohort studies, and case series for information regarding the effect of walking and yoga on quality of life, persistent fatigue, and perceived levels of cognitive decline in breast cancer populations.

RESULTS: Yoga proved to be beneficial in breast cancer populations, leading to improvements in sleep quality, strength, flexibility, and quality of life. The three main components of yoga—asanas (yoga physical postures), pranayama (breathing exercises/patterns), and dhyana (meditation)—have been shown to decrease fatigue and improve perceptions of vitality.

8 ) Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK, et al. Antidepressant efficacy of Sudarshan Kriya yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000;57(1-3):255-259.

FINDING: Once daily practice of Sudarshan Kriya yoga (SKY) was found to be equally effective to medication and nearly as effective as electro-shock therapy in the remission of depression among patients. Yoga Type : Sudarshan Kriya yoga was used with some changes.  To make it widely acceptable to patients and the medical profession, some of the adventitious components (e.g., briefing about positive attitudes to life ‘living in the present’, etc.) were dropped as were the meditative aspects. The physiological technique consisting of only specified rhythms of breathing. This adaptation for clinical purposes was designated Sudarshan Kriya Yoga. There were three sequential components interspersed with normal breating while sitting with eyes closed. The procedure closed with 10-15 minutes of Yoga Nidra (tranquil state) in supine position. Yoga Frequency/Duration : Six 45-minute sessions during mornings per week.  For patients with marked diurnal retardation, afternoon sessions were also recommended.  Mean number of sessions was 20.

OBJECTIVE: To investigate the efficacy of yoga practice as it compares to traditional treatments of clinical depression.

METHODS: Randomized, control study of 45 patients hospitalized with severe depression (as defined by the Beck Depression Inventory and Hamilton Rating Scale for Depression). The patients were divided into three groups with the first receiving electroconvulsive therapy three times weekly for four weeks. The second group was administered imiprimine, an antidepressant medication, at typical dosing. The last group was trained in SKY and encourages to practice it daily. Pre/Post test surveys focused on depressive effects.

RESULTS: Patients practicing SKY were noted to have a 67percentremission rate of their symptoms showed it to be as effective as imiprimine and nearly as effective as electroconvulsive therapy. Though compelling, the findings are subject to possible selection bias due to inadequate group sizes for statistical validity. However, they are highly suggestive that further investigation into the clinical efficacy of yoga practice is warranted and could present itself as a low-risk/high-reward alternative to traditional depression treatments.

9) Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, Subbakrishna DK, et al. Antidepressant efficacy and hormonal effects of Sudarshan Kriya Yoga (SKY) in alcohol dependent individuals. J Affect Disord. 2006;94:249-253.

FINDING: Practice of yoga was found to demonstrate antidepressant effects in a randomized control trial among consenting patients participating in alcohol detoxification programs. Measures of cortisol, ACTH and prolactin revealed a possible biological mechanism for yoga’s effects. Yoga Type : The SKY consisted of three distinctive breathing periods (Pranayama):1. Ujjayi pranayama: Consists of slowdeep breathing. Each cycle includes breathing in, holding, breathing out and holding.2. Bhastrika pranayama consists of forced inhalation and exhalation 20 times. Ujjayi and Bhastrika pranayama requires about 12–15 min.3. Cyclical breathing consists of slow, medium, and fast cycles of breathing practiced for a total duration of 30min.These three procedures are done in sitting posture (Sukhasana) with eyes closed. This was followed by Yoga Nidra (lying in a tranquil state) for about 20 min. Yoga Frequency/Duration : One 65-minute session once per day for two weeks.

OBJECTIVE: To determine the effectiveness of yoga practice in the treatment of depression among individuals participating in alcohol dependence detoxification.

METHODS: After a week of detoxification management, subjects were recruited to participate in a randomized-control study. There were a total of 60 subjects who participated in a two-week study. The control group was provided standard detoxification, while the intervention group practiced daily sessions of breathing exercises and yoga practice. Effects were measured with the use of the Beck Depression Inventory (BDI) pre/post each session and morning plasma cortisol, ACTH and prolactin measures were taken prior to and following the two-week intervention.

RESULTS: Both the control and intervention groups displayed a reduction in self-reported depression symptoms according to the BDI. Additionally, there was a noted correlation between depression symptom reduction and reduction of morning plasma cortisol levels among the intervention group participants. Physical measures of cortisol suggest a biological pathway for the observed results among program participants. The small group size is a possible confounder of these results. Also, it was noted by those administering the study that depression symptoms declined in all patients over that same period. However, the level of reduction and the effects on cortisol measures suggest a biological pathway of depression reduction in those practicing yoga.

Yoga and Stress in Children

10) Mendelson T, Greenberg, MT, Dariotis, JK, Gould, LF, Rhoades, BL, et al. Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. J Abnorm Child Psychol. May 4, 2010; DOI:10.1007/s10802-010-9418-x.

FINDING: A 12-week intensive yoga program improved involuntary stress responses in 4 th and 5 th graders. Yoga Type : Yoga-inspired postures and movement series, including bending, stretching, and fluid movement. Poses were selected to enhance muscle tone and flexibility, and students were taught the health benefits of the poses. Students also practiced breathing, starting with beginner exercises and gradually moving to more advanced ones. These exercises trained the youths to use their breath to center and calm themselves. At the end of each class, youth lay on their backs with their eyes closed while the instructors guided them through a mindfulness practice, which involved attending to a specific focus for several minutes, such as paying attention to each breath or sending out positive energy to others. The brief period of discussion prior to the guided mindfulness practice in which instructors offered didactic information about topics such as identifying stressors, using mindfulness techniques to respond to stress, cultivating positive relationships with others, and keeping one’s mind and body healthy. This information was oftenwoven into the subsequent guided mindfulness practice (e.g., using the breath to create calm if something stressful has happened). Yoga Frequency/Duration : Four 45-minute session per week for 12 weeks.

OBJECTIVE: To assess the feasibility, acceptability, and preliminary outcomes of a school-based mindfulness and yoga intervention.

METHODS: Ninety-seven 4 th and 5 th graders in the inner city of Baltimore participated in a 4-day per week 12-week yoga and mindfulness program at school. Each yoga session lasted 45 minutes and occurred during a non-academic time period. Students were given a questionnaire to assess their stress response, depressive symptoms, and relations with peers and school, all of which used validated instruments.

RESULTS: Many students were eager to join the program, and a focus group showed that participants had a positive experience with the program.  The intervention group’s survey responses showed significant improvements in involuntary stress responses as compared to controls (p<.001). Significant different were also seen on three subscales, including rumination, intrusive thoughts, and emotional arousal (p<.01).

11) Stueck M, Gloeckner N. Yoga for children in the mirror of science: working spectrum and practice fields of the training of relaxation with elements of yoga for children. Early Child Dev Care. 2005;175:371-377.

FINDING: In a small study, a 15-week program of yoga and relaxation training improved stress responses in preteens. Yoga Type : 1) Relaxation. Used technique called ‘journey through the body’, which consists of different concentration tasks on single body parts. Other used first relaxation techniques are breathing techniques from yoga (ujjayi, nadhi shodana, alternating breathing). 2) Yoga exercises. a) 23 different yoga exercises (based on Shivananda-Yoga, Rishikesh/India) b) individual complex of yoga exercises c) participants can develop their own complex yoga and instruct others. 3) Series of activities such as massage techniques (partner massage, ball massage), meditation (candle meditation), sensory exercises (discovering of objects by touching and smelling), and interactive exercises (‘trust game’, ‘jumping lotus flower’) as well as six different imagery techniques. Yoga Frequency/Duration : One 1-hour session per week for 15 weeks.

OBJECTIVE: To determine whether yoga can assist in reducing stress responses in preteens.

METHODS: Forty-eight 11-12-year olds with abnormal exam anxiety participated in the study with 21 students assigned to the experimental group to participate in a 15-session program of relaxation, yoga, and other meditation and social interaction exercises. Each session lasted one hour. A questionnaire with stress-related items was given to students before the sessions began, immediately after the 15-week program, and three months after the program ended.

RESULTS: Students involved in the program showed improvement in several stress measures. Significant effects were seen in a comparison immediately after the training: decreased aggression, decreased helplessness in school, decreased physical complaints, improved stress coping abilities. In a comparison 3-months later, the following effects were seen: improvements in emotional balance, decreased anxiety, decreased shyness in social contacts, and decreased impulsiveness. In the first post-test measurement, parents also reported their students as being calmer and more balanced (71.4%), less impulsive, aggressive and hot-tempered (38.1%), more concentrated (38.1%), and having fewer complaints (38.1%).  Comparisons to the control group were not statistically measured.

Yoga and Attention Problems in Children

12) P eck HL, Kehle TJ, Bray MA, Theodore LA. Yoga as an intervention for children with attention problems. School Psych Rev. 2005;34z:415-424.FINDING: A small study showed an improvement in “time on task” for elementary school students with attention problems. Yoga Type : “Yoga Fitness for Kids” DVD by Gaiam (2003). Deep breathing, postures, and relaxation exercises.  Poses included frog, downward dog and bridge. Movement in a gamelike manner interspersed between poses. Ended with guided imagery while lying on their backs. Yoga Frequency/Duration : Two 30-minute sessions per week for 3 weeks.

OBJECTIVE: To investigate the effectiveness of yoga for improving time on task in children with attention problems.

METHODS: Ten students ages 6-10 with attention problems (but not diagnosed with Attention Deficit Hyperactivity Disorder (ADHD)) participated in a 30-minute yoga videotape program twice per week for 3 weeks. Measurements were made of children’s “time on task”, defined as the percentage of intervals observed where the students had eye contact with the teacher or assigned task and performed the requested classroom assignments in 10-minute observations. Measurements occurred twice per week as follows: baseline for 3-7 weeks (varying by grade level), intervention for 3 weeks, and follow-up for 3 weeks.  Measurements occurred at the same time each day, and a child of the same gender (for each child in the program) in each classroom was chosen as a comparison.

RESULTS: An improvement in the mean “time on task” was seen both immediately following the intervention (effect size 1.5 to 2.7) and in the follow-up period (effect size 0.77 to 1.95). No change was seen in the comparison group.

Yoga and Asthma in Children

13) Jain SC, Rai L, Valecha A, Jha, UK,  Bhatnagar SO ,  Ram K . Effect of yoga training on exercise tolerance in adolescents with childhood asthma. J Asthma . 1991;28(6):437-442.

FINDING: Yoga training improved pulmonary function and exercise capacity in children and teens with asthma. Yoga Type : Yogic cleansing procedures, postures, and breathing. Yoga Frequency/Duration : Daily for 90 minutes in morning and 1 hour in evening for 40 days.

OBJECTIVE: To determine if yoga can improve pulmonary function and exercise capacity in children with asthma.

METHODS: A study of 46 children with a mean age of 15.8 years and a history of asthma was performed. Children participated in 40 days of yoga training, and measurements were made of forced expiratory volume, distance walked in a 12-minute time period and overall physical fitness as assessed by a modified Harvard Step Test. Twenty-six patients were followed for up to two years and asthma symptoms and medication requirements were measured.

RESULTS: Improvements were seen in expiratory volume, distance walked in a 12-minute time period and overall physical fitness.  Of patients followed for up to two years, children showed a continued reduction in asthma symptoms and less need for medication.  Fourteen of the children with mild asthma who continued yoga every day for 15-30 minutes remained asymptomatic.NOTE: This article was not available through GWU. The data were obtained from the abstract and from a review article: Galantino ML, Galbavy R, Quinn L. Therapeutic effects of yoga for children: a systematic review of the literature.  Pediatr Phys Ther . 2008;20(1):66-80.

Yoga and Obesity, Diabetes, and Cardiovascular Disease

14) Kristal AR, Littman AJ, Benitez D, White E. Yoga practice is associated with attenuated weight gain in healthy, middle-ages men and women. Altern Ther Health Med. 2005;11(4):28-33.

FINDING: Practicing yoga for four or more years slowed weight gain in middle-ages adults. Yoga Type : N/A Yoga Frequency/Duration : Self-report of number of days per week and minutes per day they practiced yoga and the number of years. Yoga practice was grouped into three categories of increasing intensity.

OBJECTIVE: To examine whether yoga practice is associated with a lower mean 10-year weight gain after age 45.

METHODS: 15,550 adults ages 53 to 57 were recruited into the Vitamin and Lifestyle cohort study between 2000 and 2002.  A validated physical activity questionnaire was given to the participants, which asked about a variety of activities including yoga.  Participants reported the number of years in the last 10 years that they did each activity and the number of days per week and minutes per day.  Yoga practice was grouped into three categories of increasing intensity. Self-reported weight and height were used to calculate participants’ current BMI, and the weight change was calculated from the difference between their current weight and their weight at age 45 (also by self-report).

RESULTS: Individuals with a BMI less than 25 who practiced yoga for four or more years had a 3.1 lb. lower weight gain than those who had not practiced yoga. Individuals who were overweight and practiced yoga for four or more years showed an 18.5 lb. lower weight gain. All models were adjusted for other physical activity, dietary factors, and other obesity-related variables.

15) Sahay BK. Role of yoga in diabetes. J Assoc of Physicians India . 2007; 55 :121-126.

FINDING: Yoga has a role in diabetes control and prevention. Yoga Type : Pranayama Yoga Frequency/Duration : N/A

OBJECTIVE: To assess the role of yoga on glycemic control, insulin kinetics, body composition, exercise tolerance, and co-morbidities including hypertension and dyslipidemia.

METHODS: Individuals with diabetes and without diabetes were randomized to different groups and performed yogic practices for 45 minutes each day, which was followed by relaxation practices.

RESULTS: The studies confirmed that yoga has a useful role in the control of diabetes mellitus. Fasting and postprandial blood glucose levels decreased significantly. There were significant changes in insulin kinetics and those of counter-regulatory hormones such as cortisol. There was a decrease in fatty acids. There was an increase in lean body mass and a decrease in body fat percentage. The number of insulin receptors was increased, and there was an improvement in insulin sensitivity and a decline in insulin resistance.

16) Yang K, Bernardo LM, Sereika SM, Conroy MB, Balk J, et al. Utilization of a 3-month yoga program for adults at high risk for type 2 diabetes: a pilot study. Evid Based Complement Alternat Med . Published on-line: August  18, 2009 doi:10.1093/ecam/nep117. 1-7.

FINDING: Yoga may help to lower adult risk for type 2 diabetes, reduce cardio-metabolic risk factors, and increase exercise self-efficacy. Yoga Type : Vinyasa Yoga Frequency/Duration : 1-hour sessions, 2 times per week, for 3 months. Each session began with a 5-7 min warm-up and ended with a 10 min relaxation period.

OBJECTIVE: To conduct a pilot study to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes.

METHODS: Twenty-three adults were randomly assigned to either a yoga intervention group, which participated in a 3-month yoga intervention with 1-hour Vinyasa style yoga sessions twice per week, or an educational group, which received general health educational materials every 2 weeks. Participants had to: (1) be between 45 and 65 years of age; (2) be non-exercisers (no more than 30 minutes twice per week) for the previous year; (3) have a family history of type 2 diabetes, and; (4) have at least one cardio-metabolic risk factor. All participants completed questionnaires and had blood tests at baseline and at the end of the 3-month program to measure blood pressure, blood glucose, insulin, lipid levels, and body weight, as well as to assess exercise self-efficacy.

RESULTS: Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides, and exercise self-efficacy. Findings suggest that a yoga program would possibly help to lower adults’ risk for type 2 diabetes, as well as reduce cardio-metabolic risk factors for adults at high risk for type 2 diabetes.

17) Guarracino JL, Savino S, Edelstein S. Yoga participation is beneficial to obesity prevention, hypertension control, and positive quality of life. Top Clin Nutr . 2006;21(2):108-113.

FINDING: Yoga may be beneficial in controlling weight, blood pressure, and mood. Yoga Type : Hatha and relaxation yoga. Yoga Frequency/Duration : The majority of study participants (55.7%) had practiced yoga for less than 1 year, followed next by those who had practiced yoga for more than 5 years (31.4%). The majority of participants (57.1%) practiced yoga for 1-2 hours per week, followed by those who spent less than 1 hour per week practicing yoga (24.3%).

OBJECTIVE: To evaluate the effects of hatha and relaxation yoga on obesity, blood pressure, and quality of life.

METHODS: Seventy healthy women and men ages 18 years or older were recruited from 3 fitness centers in Massachusetts after completing a 1-hour yoga class and were asked to complete a survey. The survey was used to measure how the participants felt after the yoga class, and questions included those related to yoga frequency and duration, other physical activity and duration, past and present medication use, food consumption behavior, demographic information, and data related to height, weight, blood pressure, tricep skinfold, and waist and mid-arm circumference.

RESULTS: According to survey results of the 70 participants, hatha and relaxation yoga had a statistically significant role in controlling weight, hypertension, and mood. Of the participants, those who had practiced yoga for less than 1 year had a significantly higher systolic blood pressure (mean 117.13) than those who had practiced yoga for 1-4 years (mean 107.56). However, the survey participants’ mean BMI (24.41) was significantly different from the BMI used as a cutoff for determining obesity (30.0), thus suggesting that individuals who practice hatha and relaxation yoga may not generally be obese.

18) Yang K. A review of yoga programs for four leading risk factors of chronic diseases. Evid Based Complement Alternat Med . 2007;4(4):487-491.

FINDING: Yoga programs may be effective in reducing body weight, blood pressure, blood glucose, and cholesterol. Yoga Type : Other than duration and frequency, most articles did not describe the yoga sessions in detail. Of the few articles that did identify the type of yoga studied, the most common was Hatha yoga. Yoga Frequency/Duration : The most common duration and frequency of yoga sessions in the studies were 30-60 min per session, with sessions meeting daily for 4-10 weeks. Many studies also used sessions meeting 2-3 times per week for 8-12 weeks.

OBJECTIVE: To review published studies of yoga programs and to determine the effect of yoga interventions on chronic disease risk factors, such as overweight, hypertension, high glucose level, and high cholesterol.

METHODS: A systemic search was conducted, yielding 32 articles from electronic databases published between 1980 and 2007. Of the 32 articles reviewed, 12 described experimental studies, 18 described quasi-experimental studies, and 2 described observational studies. Only 7 of the studies were conducted in the United States, and only 16 of the studies focused on subjects with diabetes, hypertension, or cardiovascular disease.

RESULTS: In analyzing the 32 articles, the authors found that yoga interventions are generally effective in reducing body weight, blood pressure, blood glucose level, and cholesterol level. However, only a few studies examined long-term effects.

Yoga and other Health Issues

19) Pullen PR, Thompson WR, Benardot D, Brandon LJ, Mehta PK, et al. The Benefits of yoga for African American heart failure patients. Med Sci Sports and Exerc. 2010:42(4): 651-657.

FINDING: Yoga improves cardiovascular endurance for African Americans who have suffered from heart failure. Yoga Type : Pranayama and Asanas. Yoga Frequency/Duration : 5 minute warm-up, including breathing exercises a 40 minute period of postures, ending with a 15 minute relaxation phase. Patients attended a total of 16 supervised sessions over an 8-10 week period.

OBJECTIVE: To see if yoga can improve physical and psychological parameters (cardiovascular endurance (VO2peak), flexibility, quality of life (QoL) and inflammatory markers) among patients with heart failure (HF), particularly among African Americans.

METHODS: Forty patients (38 AA, 1 Asian, 1 Caucasian) with systolic or diastolic HF were randomized to the yoga group (YG, N=21) or the control group (CG, N=19). All patients were asked to follow a home walking program. Pre- and post-measurements included a treadmill stress test to peak exertion, flexibility, interleukin-6 (IL-6), C- reactive protein (CRP), and extra cellular-super oxide dismutase (EC-SOD). QoL was assessed by the Minnesota Living with Heart Failure Questionnaire (MLwHFQ).

RESULTS: Yoga therapy offered additional benefits to the standard medical care of predominantly AA HF patients by improving cardiovascular endurance, QoL, inflammatory markers and flexibility.

Featured Teacher: Jean Di Carlo-Wagner

After battling and surviving stage III colon cancer, Jean Di Carlo-Wagner was inspired to share with other cancer patients and survivors the healing powers of yoga practice.

Teacher Feature: Jena Duncan

Jena Duncan has been involved in supporting and coordinating queer and trans yoga for several years, and began teaching in 2017. Jena uses they/them pronouns. “Yoga has given me the opportunity to live a more vibrant, free, and connected life. Queer and trans yoga has given me the chance to be fully seen for all […]

[email protected]     © 2022 Yoga Activist | Design donated by David Onate

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Yoga in the schools: a systematic review of the literature

Affiliation.

• 1 University at Buffalo, State University of New York, NY, USA. [email protected]
• PMID: 23070680

Objective: The objective of this research was to examine the evidence for delivering yoga-based interventions in schools.

Methods: An electronic literature search was conducted to identify peer-reviewed, published studies in which yoga and a meditative component (breathing practices or meditation) were taught to youths in a school setting. Pilot studies, single cohort, quasi-experimental, and randomized clinical trials were considered.

Research: quality was evaluated and summarized.

Results: Twelve published studies were identified. Samples for which yoga was implemented as an intervention included youths with autism, intellectual disability, learning disability, and emotional disturbance, as well as typically developing youths.

Conclusion: Although effects of participating in school-based yoga programs appeared to be beneficial for the most part, methodological limitations, including lack of randomization, small samples, limited detail regarding the intervention, and statistical ambiguities curtailed the ability to provide definitive conclusions or recommendations. Findings speak to the need for greater methodological rigor and an increased understanding of the mechanisms of success for school-based yoga interventions.

PubMed Disclaimer

Similar articles

• Yoga in school settings: a research review. Khalsa SB, Butzer B. Khalsa SB, et al. Ann N Y Acad Sci. 2016 Jun;1373(1):45-55. doi: 10.1111/nyas.13025. Epub 2016 Feb 25. Ann N Y Acad Sci. 2016. PMID: 26919395 Review.
• Review: Yoga and mindfulness for youth with autism spectrum disorder: review of the current evidence. Semple RJ. Semple RJ. Child Adolesc Ment Health. 2019 Feb;24(1):12-18. doi: 10.1111/camh.12295. Epub 2018 Aug 13. Child Adolesc Ment Health. 2019. PMID: 32677240 Review.
• School-based Yoga Programs in the United States: A Survey. Butzer B, Ebert M, Telles S, Khalsa SB. Butzer B, et al. Adv Mind Body Med. 2015 Fall;29(4):18-26. Adv Mind Body Med. 2015. PMID: 26535474 Free PMC article. Review.
• 2013 SYR Accepted Poster Abstracts. [No authors listed] [No authors listed] Int J Yoga Therap. 2013;23 Suppl:32-53. Int J Yoga Therap. 2013. PMID: 24176784 Clinical Trial.
• Yoga and Mindfulness Interventions for Preschool-Aged Children in Educational Settings: A Systematic Review. Sun Y, Lamoreau R, O'Connell S, Horlick R, Bazzano AN. Sun Y, et al. Int J Environ Res Public Health. 2021 Jun 5;18(11):6091. doi: 10.3390/ijerph18116091. Int J Environ Res Public Health. 2021. PMID: 34198737 Free PMC article. Review.
• Promoting mental health and wellbeing in schools: the impact of yoga on young people's relaxation and stress levels. Hagen I, Skjelstad S, Nayar US. Hagen I, et al. Front Psychol. 2023 May 17;14:1083028. doi: 10.3389/fpsyg.2023.1083028. eCollection 2023. Front Psychol. 2023. PMID: 37265958 Free PMC article.
• 'It stretches your body but makes you feel good too': A qualitative study exploring young people's perceptions and experiences of yoga. Cartwright T, Doronda T. Cartwright T, et al. J Health Psychol. 2023 Aug;28(9):789-803. doi: 10.1177/13591053221146840. Epub 2023 Jan 12. J Health Psychol. 2023. PMID: 36633013 Free PMC article.
• Scoping Review of Yoga in Schools: Mental Health and Cognitive Outcomes in Both Neurotypical and Neurodiverse Youth Populations. Hart N, Fawkner S, Niven A, Booth JN. Hart N, et al. Children (Basel). 2022 Jun 8;9(6):849. doi: 10.3390/children9060849. Children (Basel). 2022. PMID: 35740786 Free PMC article. Review.
• Preksha Dhyāna meditation induces alterations at the transcriptome level in novice and healthy college students. Abomoelak B, Pragya SU, Griswold AJ, Mehta N, Uddin P, Veeramachaneni P, Mehta N, Pragya SC, El Enshasy HA, Mehta D. Abomoelak B, et al. Saudi J Biol Sci. 2022 Apr;29(4):2299-2305. doi: 10.1016/j.sjbs.2021.11.060. Epub 2021 Dec 3. Saudi J Biol Sci. 2022. PMID: 35531197 Free PMC article.
• "I Just Find It Easier to Let Go of Anger": Reflections on the Ways in Which Yoga Influences How Young People Manage Their Emotions. Hagen I, Skjelstad S, Nayar US. Hagen I, et al. Front Psychol. 2021 Nov 22;12:729588. doi: 10.3389/fpsyg.2021.729588. eCollection 2021. Front Psychol. 2021. PMID: 34880804 Free PMC article.

Publication types

• Search in MeSH
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.