Yoga in school settings: a research review

Program evaluation of a school-based mental health and wellness curriculum featuring yoga and mindfulness

BACKGROUND

Interest in the effectiveness of mindfulness-based interventions such as yoga in primary schools has grown. Evidence shows promise, as youth who engage in yoga to promote mindfulness show improved coping skills, increased socio-emotional competence and prosocial skills, academic performance, attention span, and ability to deal with stress.

OBJECTIVE

This study reports the results of a program evaluation of a universal health and wellness curriculum, Pure Power, designed to teach youth yoga techniques, mindfulness, and emotion regulation.

METHODS

A non-randomized comparison design examined outcomes among participants from schools that completed the intervention with highest fidelity of implementation (n = 461) and from students in matched comparison schools (n = 420). Standard measures of coping, emotion regulation and emotion dysregulation, spelling, and math achievement were collected.

RESULTS

Analyses suggest the youth in the intervention schools demonstrated relative improvement on measures of emotion regulation, spelling, and math.

CONCLUSIONS

Challenges in implementation in real-life settings are vital to identify. The data provide some real-world evidence for the effectiveness of a universal health and wellness curriculum on emotion regulation and positive academic outcomes. Training school staff to deliver the intervention may foster implementation. Future research should test the effectiveness of who delivers the intervention; for example, teacher-delivered groups vs. other wellness personnel.

The impact of yoga on stress, metabolic parameters, and cognition of Indian adolescents: Cluster randomized controlled trial

Background

This project aimed to assess the impact of yoga on stress, metabolic parameters and cognition (attention & concentration) in adolescents, aged 13-15 years from public and private schools in two cities (Chennai and New Delhi) in India.

Methods

The study recruited 2000 adolescents from 24 schools in a cluster randomized controlled trial design. The yoga group participants underwent 17 yoga sessions, which included: pranayama, basic asanas, meditation and relaxation exercises. Yoga sessions, were held in the school premises once a week. A total of five awareness talks on healthy lifestyle were delivered once a month to the education group. ADOlescence Stress Scale (ADOSS), salivary cortisol, metabolic and clinical parameters and Letter Cancellation Test (LCT) score were measured at baseline and post-intervention (5-6 months).

Results

The yoga group showed statistically significant differences in the mean ADOSS score, metabolic parameters, salivary cortisol, and LCT scores compared to the education group. In the intention- to- treat analysis, a significant reduction [5.11, 95% CI (4.78, 5.36), p = 0.001] in ADOSS score was seen in the yoga group compared to education.

Conclusion

Implementation of a 17-week standardized yoga program at the school level significantly decreased stress, improved attention and concentration, metabolic and clinical parameters in Indian adolescents.

Trial registration

Clinical Trials Registry, India (CTRI/2017/08/009203).

'It stretches your body but makes you feel good too': A qualitative study exploring young people's perceptions and experiences of yoga

Whilst research suggests that yoga can positively impact physical and psychological wellbeing, understanding of youth's experiences is limited with no non-clinical studies in the UK. Ten focus groups explored perceptions and experiences of yoga among 35 youth (10-18 years). Inductive thematic analysis revealed that yoga was viewed as a holistic mind-body practice cultivating greater awareness and enhanced physical performance. Youth described yoga as providing tools that developed confidence, stress-management and emotional self-regulation. Social and relational impacts of yoga were highly valued. Despite the perceived biopsychosocial benefits of yoga, gendered and media representations of yoga may serve as a barrier to uptake.

Effect of yoga on the social responsiveness and problem behaviors of children with ASD in special schools: A randomized controlled trial

CONTEXT

Autism spectrum disorder (ASD) is the most common neurodevelopmental disorder and is increasingly reported among school-age children in India. Many children with ASD attend special schools which extend support for learning basic functional and academic skills. Problem behaviors and lack of social responsiveness are frequently associated with children with ASD in a school environment. Many evidence-based studies have explored various interventions in mitigating the lack of social responsiveness and problem behaviors in children. Few studies have examined the impact of yoga on social responsiveness and problem behaviors in special schools.

OBJECTIVE

The objective of the study was to highlight the effect of school-based yoga on the social responsiveness and problem behaviors of children with ASD in special schools. Forty-three children with ASD from four special schools participated in the study.

DESIGN

A randomized controlled trial (RCT) design was employed for the study. Children with ASD (n = 43) from four special schools were assessed by their teachers for social responsiveness and problem behaviors with the Social Responsiveness Scale-2 (SRS-2) and Aberrant Behavior Checklist-2 (ABC-2) at the baseline and after the yoga intervention.

INTERVENTION

Structured yoga of 45 min for 12 weeks was conducted across four special schools with simple yoga practices conducive to children with ASD.

RESULTS

Significant changes were observed post-intervention in the mean scores of the social communication aspect in social responsiveness (p = .021), irritability (p = .041), and social withdrawal (p = .047) aspects of problem behaviors.

Promoting mental health and wellbeing in schools: the impact of yoga on young people's relaxation and stress levels

This study aimed to examine students' experiences with yoga interventions in school. The findings revealed that practicing yoga made young people more aware of their need to relax and positively impacted their mental health and wellbeing. We explored the emphasis on relaxation among our study participants and how relaxation is related to other aspects, such as their experience of stress and sleep habits. This article is based on qualitative data gathered from teenagers in Norway who participated in the Norwegian part of the European research project "Hippocampus: Promoting Mental Health and Wellbeing among Young People through Yoga." The project introduced yoga to young people in schools with an emphasis on those who were disadvantaged, including those with mental health issues and other challenges related to their background. Data were collected from nine individual, semi-structured interviews and 133 logs collected in the spring of 2019. The major themes identified through the interviews and log material included becoming more relaxed and aware of the need to unwind. Thus, the focus on relaxation is based on the importance of the participants assigned to this theme. The study results suggest that yoga enhanced the students' awareness and skills and empowered them to make healthier lifestyle choices. We viewed the importance of relaxation from a salutogenic perspective, focusing on the factors that contribute to good health in contrast to a pathogenic perspective, where curing diseases is the goal.

School-Based meditation in adolescents: an integrative literature review

OBJECTIVES

Utility of cognitive-behavioral practice interventions in school settings have been discussed by the scientific community regarding their possibility of insertion in the educational field. In this way, this review article analyzes the scientific production on the practice of meditation offered at school in adolescents, since the appropriation of studies that point to reflections and perspectives of meditative practice can favor the development of new pedagogical trajectories in the school environment.

CONTENT

The electronic databases VHL, PubMed, and CAPES were consulted, using the combination of the terms related to meditation, adolescents, and school. This analysis resulted in eight articles, including field research and reviews, published between 2010 and 2021.

SUMMARY

The articles showed improvement in emotional coping skills, social relationships, self-regulation, control of mood levels, stress, depression, and anger, and significant gains in self-reflection and academic attention. They pointed out that elementary and high school students present more significant responses, and these factors, such as duration, frequency, and systematization of the session, can interfere with these responses.

OUTLOOK

These results indicate that meditation practice in adolescents can be a valuable strategy for health promotion and educational training in the school environment.

Yoga and Mindfulness for Social-Emotional Development and Resilience in 3-5 Year-Old Children: Non-Randomized, Controlled Intervention

Background

Early childhood is the key life course period for development of social-emotional skills, providing the foundation for school readiness and resilience in later life. Age-appropriate yoga and mindfulness programs may contribute to the development of critical skills in children. Young children from minoritized communities that face structural racism and health disparities may benefit from programs that support social-emotional development and contribute to future academic success. Systematic reviews of yoga interventions for young children have indicated the potential for effectiveness in supporting social-emotional development, executive function, and physical activity. However, studies of yoga and mindfulness with non-White children are sparse and, overall, the evidence base to date for such programs remains limited by non-controlled studies and the variable quality of studies evaluating programs in early childhood settings.

Methods

The analysis of data from a non-randomized, controlled intervention aimed to assess the effect of exposure to a yoga and mindfulness program for early childhood development of social-emotional skills in a majority Black/African American urban preschool setting in southeastern US. Children in the intervention received group yoga and mindfulness led by a certified children's yoga teacher who also had training and experience as a school teacher. Intervention participants engaged in activities for 20 minutes once per week for 32 weeks, while the control group had no yoga. The final sample included 579 in the historical control group and 122 in the intervention group.

Results

Results indicated that children who participated in the yoga and mindfulness program had higher total protective factor (TPF) subscores on the Devereux Early Childhood Assessment over time than children who did not receive yoga and mindfulness programming, and that the difference was statistically significant (P<0.05). Participation in the intervention group significantly predicted increases in initiative score, self-control score, and TPF score, as well as a decrease in the behavioral concerns.

Discussion

School based yoga and mindfulness programming can support social-emotional skills and resilience in young children. Additional studies with larger sample sizes and randomization are needed on use of yoga and mindfulness in young children for social-emotional development, particularly for Black/African American children and others from minoritized communities.

Positive Psychological Effects of School-Based Yoga and Mindfulness Programs for At-Risk Hispanic Adolescents

This quasi-experimental study investigates differences in the impact of school-based yoga interventions and mindfulness practices on psychological well-being impact factors in at-risk Hispanic adolescent high school students compared to similar students enrolled in traditional physical education classes. Due to the global COVID-19 pandemic, experimental conditions were delivered virtually. The BRUMS and PANAS-C were utilized to assess psychological well-being constructs of mood and affect. Statistical analyses included Friedman's test for nonparametric data, comparisons of pre post change scores between yoga and physical education classes, and longitudinal data trends for each subscale from the study's inception to conclusion. The findings show that school-based yoga participants exhibited higher levels of improved mood and affect with large effect sizes than those enrolled in a standard physical education (PE) class during the 12 weeks of the intervention. Implications and further directions are discussed.

Conocimiento del yoga en alumnado adolescente y su perspectiva sobre su inclusión en la Educación Física

El yoga ha demostrado ser un ejercicio efectivo para evitar enfermedades físicas y mentales desde las primeras etapas del crecimiento, mejorando, por tanto, la salud de los niños y adolescentes, y, por ende, la salud del adulto. Este estudio tuvo como objetivo conocer el grado de juicio y comprensión por parte de alumnado adolescente sobre la práctica del yoga, así como la perspectiva de estos, sobre la inclusión del yoga en la educación. Se realizó una encuesta anónima a 269 participantes en diferentes institutos de Andalucía (España). El conocimiento por parte de los alumnos adolescentes estudiantes sobre el yoga es muy limitado. Sin embargo, el alumnado consideró relevante la práctica del yoga bien como asignatura optativa o curricular, por lo que, aún el desconocimiento del alumnado adolescente sobre el yoga en general, existió un grado de consciencia en favor de esta actividad en la mejora de la educación

The effects of yoga on mental health in school-aged children: A Systematic Review and Narrative Synthesis of Randomised Control Trials

It is becoming increasingly common for frontline clinicians to see children and teenagers struggle with their mental health. Since mental health issues have increased over the past ten years in the UK, they are now the leading cause of disability and cost the British economy £105 billion annually. The review discusses the evidence base underpinning the effect of yoga on children's mental health and summarises the results of 21 research papers. The Cumulative Index to Nursing and Allied Health Literature, PsycINFO, ERIC, Web of Science, PubMed, Medline and Cochrane Library were searched through Ovid from January 2008 until May 2022. The keywords 'yoga OR mindfulness - AND school AND children OR child OR youth OR adolescent' were used. The search was limited to studies in the English language. The quality of each study was rated against Version 2 of the Cochrane risk-of-bias tool for randomised control trials and a set of inclusion and exclusion criteria. The evidence for yoga therapies in children is encouraging, although studies include methodological flaws such as small sample sizes and sparse information on interventions. This review has highlighted that yoga interventions may be implemented in schools as a preventative and therapeutic measure for mental health issues.

Effect of Yoga and Mindfulness Intervention on Symptoms of Anxiety and Depression in Young Adolescents Attending Middle School: A Pragmatic Community-Based Cluster Randomized Controlled Trial in a Racially Diverse Urban Setting

Mental health conditions in childhood and adolescence are increasing in the U.S. population and require early intervention, as highlighted by a recent Surgeon General's Advisory on Protecting Youth Mental Health. These health issues, which have been exacerbated by the COVID-19 pandemic, impair functioning, and may lead to longer term reductions in quality of life. Young adolescents are likely to experience stressors including academic pressure, feelings of loneliness and isolation, and excessive exposure to social media, all of which have been made worse by the pandemic and associated disruptions. Universal preventive programs at school serve as an important strategy for equipping youth with coping skills to address current and future social and emotional challenges. Yoga and mindfulness programs have emerged as a promising preventive approach for schools and have proven feasible and acceptable. The current study evaluated a universal, school-based mindfulness and yoga program among youth aged 11-14 in a racially diverse, urban setting in the United States. Outcomes of interest included symptoms of anxiety and depression. Anxiety and depression symptoms decreased in the intervention group, although these differences were not statistically significant. In the control group, anxiety symptoms decreased but depression symptoms increased. The resulting time effect indicated a significant decrease in anxiety symptoms, while the time by group effect revealed a strong trend in depression symptoms. Future research should investigate the utility of yoga and mindfulness interventions for early adolescents in a larger population, and the differences in intervention effect among subgroups, with attention to longer term outcomes.

A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study

STUDY OBJECTIVES

Poor sleep impedes children's cognitive, emotional, and psychosocial development. Pediatric sleep dysregulation is common, and children who live in communities of low socioeconomic status experience additional risk factors for short sleep duration and poor sleep quality. School-based training in mindfulness and yoga-informed practices can improve children's behavior and well-being, but effects on objectively measured sleep are unknown.

METHODS

Effects of a school-based health and mindfulness curriculum, which taught practices such as paced breathing, on sleep and stress were examined in 115 children (49 girls, ages 8 to 11 at baseline). Fifty-eight children in a community of low socioeconomic status received the curriculum twice weekly for 2 years. Fifty-seven children in a socioeconomic status-matched community engaged in their usual physical education class instead. In-home ambulatory polysomnography and perceived social stress were measured in all children at 3 time points: at baseline (ie, prior to curriculum exposure) and at 2 yearly follow-ups.

RESULTS

Children receiving the curriculum gained an average of 74 minutes of total sleep time, and 24 minutes of rapid eye movement sleep, per night over the 2-year study period. Children not receiving the curriculum experienced a decrease in total sleep time averaging 64 minutes per night, with no changes in rapid eye movement sleep. Sleep improved within the first 3 months of curriculum exposure, in a dose-dependent fashion. Higher curriculum engagement (eg, using the breathing exercises outside of class) was associated with larger gains in total and rapid eye movement sleep duration. Aggregate within-group changes in social stress were not significant. However, among children receiving the curriculum, those who experienced larger gains in total and rapid eye movement sleep duration also experienced larger increases in perceived social stress.

CONCLUSIONS

A school-based health and mindfulness curriculum improved children's objectively measured sleep over 2 years. Social stress did not mediate these effects; instead, mindfulness training may have increased awareness of environmental stressors, while developing tools to reduce stress vulnerability.

CITATION

Chick CF, Singh A, Anker LA, et al. A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study. J Clin Sleep Med. 2022;18(9):2261-2271.

A randomized controlled trial of the influence of yoga for women with symptoms of post-traumatic stress disorder

Background

Survivors in motor vehicle accident (MVA) may have posttraumatic stress disorder (PTSD). Yoga is a complementary approach for PTSD therapy.

Methods

This randomized controlled trial explored whether yoga intervention has effects on reducing the symptoms of PTSD in women survived in MVA. Participants (n = 94) were recruited and randomized into control group or yoga group. Participants attended 6 45-minuite yoga sessions in 12 weeks. Depression Anxiety Stress Scales (DASS) and Impact of Events Scale-Revised (IES-R) were used to assess psychological distress.

Results

Post-intervention IES-R total score of yoga group was significantly lower than that of control group (p = 0.01). At both post-intervention and 3-months post intervention, the DASS-21 total scores of yoga group were both significantly lower than those of control group (p = 0.043, p = 0.024). Yoga group showed lower anxiety and depression level compared to control group at both post-intervention (p = 0.033, p < 0.001) and post-follow-up (p = 0.004, p = 0.035). Yoga group had lower levels of intrusion and avoidance compared to control group after intervention (p = 0.002, p < 0.001).

Conclusion

Results illustrate that yoga intervention may alleviate anxiety and depression and improve the symptoms of PTSD in women with PTSD following MVA.

Identifying barriers and facilitators to implementing mindfulness-based programmes into schools: A mixed methods study

Mindfulness-based initiatives have been shown to improve psychological wellbeing and increase academic engagement in school settings. The current study explored barriers and facilitators to the implementation of mindfulness-based (MB) programmes in schools. Ninety-five teachers completed an online survey, and six principals were interviewed, with questions for both informed by the Theoretical Domains Framework (TDF). Quantitative data was analysed via descriptive statistics and independent sample t tests. Qualitative interview data were analysed via thematic analysis. Teachers reported facilitators to successful MB programme implementation as self-efficacy and motivation, knowledge about MB programmes, acceptance of responsibility to deliver MB programmes and belief of negative consequences if MB programmes are not delivered. Principals reported organisational-level facilitators as having a school-wide positive education framework relevant to the school context, taking a long-term approach, school leaders supporting the initiatives and understanding the evidence behind MB programmes and empowering staff to engage in mindfulness. Individual-level facilitators included staff buy-in and commitment to practice and understanding mindfulness. Barriers included time, resources/money, staff buy-in and competing strategic priorities within the school. These findings are important for consideration by policymakers determining the way forward for more widespread implementation of MB programmes in Australia.

"I Just Find It Easier to Let Go of Anger": Reflections on the Ways in Which Yoga Influences How Young People Manage Their Emotions

In this article we discuss how young people experienced a school-based yoga intervention. We pay particular attention to how yoga provides a space for young people to deal with their emotions. We base our discussion on qualitative data from young people in Norway who participated in the European research project “Hippocampus: Promoting Mental Health and Wellbeing among Young People through Yoga.” The qualitative results are based on experiences described by these young people in individual semi-structured interviews and in diaries or logs. Our data include nine interviews performed in the spring of 2019 with young people of Norwegian and refugee background in their late teens and early twenties. There were also 133 logs noted by the students exposed to the yoga intervention. In the qualitative interviews, young people talk about yoga and emotional management, improved sleep habits, and regulation. They also report improved ability to regulate and cope with stress. Yoga seemed especially beneficial for refugee trauma. In this article, we have chosen to focus on the utterances of young people about emotions, as those were quite dominant in our data, especially in the interview material. We have identified instances of emotional regulation, but also of emotional processes and changes of emotions, all of which were related to these young students practicing yoga. The impact of yoga on emotions illustrates the potential of yoga to improve the well-being and mental health of young people.

Effect of six months pranayama training on stress-induced salivary cortisol response among adolescents-Randomized controlled study

BACKGROUND

A combination of yoga practices has been documented to reduce stress and stress-induced cortisol levels. The objective of the current study is to examine the effects of six months of a single pranayama practice (Bhramari [Bhr. P]) on reducing salivary cortisol response to the cold pressor test (CPT) among adolescents.

METHODS

Twenty-six healthy adolescents between the ages of 11 and 19 were randomly assigned to either yoga group (n-13) or control group (n-13). Yoga group participants were trained to do Bhr. P for 45 min, thrice a week for six months. All participants underwent CPT at baseline and at end of six months. Saliva samples were collected at baseline (t0), at 20 min (t1), 40 min (t2), and 60 min after the CPT (t3).

RESULTS

Contradictory to our hypothesis, participants in the yoga group exhibited a higher salivary cortisol response to the CPT at t1 (p = 0.04) when compared to the control group. However, the t3 salivary cortisol levels showed a statistically significant reduction (p = 0.03) in yoga group when compared to the control group. A significant interaction with time (F (1, 88) = 316.5, p = .001, ηp²:0.91) and between the group × time (F (3, 88) = 2.83, p = 0.04, ηp²:0.8) was found after the intervention.

CONCLUSIONS

An increase in the cortisol responsiveness observed in the study is an indication of the adaptive capability achieved through regular yoga training, evidenced by an initial rise in cortisol followed by a rapid fall below baseline after 60 min. Further research is required to conclusively determine the changes in cortisol levels over time in response to stress in long-term yoga practitioners.

Association of yogic breathing with perceived stress and conception of strengths and difficulties in teenagers

BACKGROUND

Mental health problems are increasing at an alarming rate throughout the world, and teenagers are no exception. They experience high levels of stress in their formative years which often leads to poor social behavior. In the present study, we examine the effect of Sudarshan Kriya Yoga (SKY), a yogic breathing technique on perceived stress and social behavior of school going teenagers.

METHOD

A cross-sectional survey was conducted. Teenagers who practiced SKY daily constituted the study group and teenagers who did not practice any form of yoga or meditation formed the control group. Child Perceived Stress scale (C-PSS) and Strength and Difficulty questionnaire (SDQ) were used to evaluate the mental health and social behavior of both groups.

RESULTS

Lower stress scores were observed among students who practiced SKY compared to their peers. A significant difference was observed between the groups with respect to emotional problems, conduct problems, peer problems, and pro-social behavior. Gender wise comparison highlighted that the females from the SKY group scored lower on emotional problems sub-scale compared to their counterparts from control group. Results also highlighted an improved peer to peer interaction among both boys and girls in the SKY group.

CONCLUSION

The results indicate the practice of SKY is associated with reduced stress, improved self-awareness, and social behavior.

Using Yoga to Reduce Anxiety in Children: Exploring School-Based Yoga Among Rural Third- and Fourth-Grade Students

INTRODUCTION

Anxiety is becoming more common in children and can negatively affect social and academic performance. The purpose of this study was to explore the impact of 10 min of yoga on anxiety in third- and fourth-graders over 8 weeks.

METHOD

Participants completed 10 min of yoga daily during the school week. Participants completed the Screen for Child Anxiety Related Emotional Disorders anxiety screening tool at the beginning and after the program.

RESULTS

Paired sample t test noted a significant difference between pretest and posttest raw scores in the category of generalized anxiety disorder. On average, participants had significantly decreased raw anxiety scores after completing the program (mean = -0.0308), t₍₆₀₎ = -3.137, p < .05.

DISCUSSION

This study demonstrates that yoga practiced as little as 10 min a day over 8 weeks can have a significant impact on decreasing anxiety in children aged 8-10 years.

Mind-Body Physical Activity Interventions and Stress-Related Physiological Markers in Educational Settings: A Systematic Review and Meta-Analysis

Mind–Body Physical Activity (MBPA) in educational settings is one possible preventive strategy for ameliorating stress-related physiological health parameters. The objectives of this study were to conduct a systematic review of the literature with meta-analyses on the effects of MBPA on stress-related physiological health markers in primary, secondary, and higher education students. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the search for peer-reviewed articles published in English was conducted in PubMed, EBSCOhost, PsychInfo, Scopus, and Cochrane Library databases. Criteria for inclusion consisted of empirical studies targeting the student population (primary, secondary, higher education), studies examining the effectiveness of an MBPA intervention, studies including a control or comparison group (pre-test/post-test studies excluded), studies targeting physiological marker outcomes such as heart rate, blood glucose, cortisol, and blood pressure, and finally, studies examining interventions implemented within educational settings. Twenty-six interventions were eligible for the review and quantitative synthesis, which comprised a total of 1625 participants, with 783 students serving within the control/comparison group. There were statistically significant and large pooled effects for MBPA effectiveness for lowering heart rate (Hedges’ g = −1.71, 95% Confidence Interval (CI): −2.43, −0.98), cortisol (Hedges’ g = −1.32, 95% CI: −2.50, −0.16), and systolic and diastolic blood pressure (Hedges’ g = −1.04, 95% CI: −1.53, −0.58). These effects tended to be stronger in older students compared to younger students. Most analyses were characterized as having high heterogeneity and only 10 of the 26 studies were characterized as good quality (38.4%). MBPA interventions may have a positive impact on specific physiological health markers in students, especially in students within higher education. However, higher-quality research is needed in this area.

Qualitative study of yoga for Young adults in school sports

OBJECTIVES

Distress and stress-related diseases are an increasing public health problem at schools. This qualitative study was nested in a non-randomized, controlled trial studying the effects of a 10-week yoga course as an alternative for regular school sports in two secondary schools in Germany.

METHODS

We conducted a qualitative evaluation in 3 focus groups with 6 participants each. The focus groups were audio-recorded, transcribed verbatim, pseudonymised and analysed using qualitative content analysis. Furthermore open questions were asked in questionnaires.

RESULTS

The analysis of the participants' interviews (mean age 19.6 ± 2.9 years, n = 10 female, n = 8 male) resulted in 4 key topics: 1. encountering yoga, 2. yoga practice, 3. effects and benefits of yoga, and 4. yoga in the school context. Yoga was very well accepted by most participants. They reported a variety of physical and psychological benefits as well as overall restorative effects. The relief of pain or other physical ailments, higher mobility and flexibility, improved posture and improved sleep were mentioned by the participants. Some participants used the new exercises and experiences (e.g. working with the breath) in their everyday life. The possibility for self-responsible action was a welcome change from the perceived pressure and heteronomy in normal (school) life. Controversial was the question of whether yoga - if it is part of school sport - should be assessed or graded, and whether it should be compulsory or voluntary.

CONCLUSION

Yoga can offer both physical and psychological benefits in young adults as well as offer general regenerative effects. Yoga by sensitizing the participants to negative patterns of behaviour can encourage healthy behaviour.

A Randomized Study on the Effects of Minds in Motion and Yoga on Motor Proficiency and Academic Skills Among Elementary School Children

BACKGROUND

Physical activity is critical for the healthy development and well-being of children. Specifically, physical activity is associated with improvements in coordination, balance, attention, and behavior among elementary school-aged children. However, for many children, particularly those belonging to minority groups, opportunities to engage in quality physical activity programs outside school settings are limited. The purpose of this study was to examine the whether a physical activity program called Minds in Motion (MiM) The Maze before school, as compared with yoga, meets the criteria of the Comprehensive School Physical Activity Program framework as a before-school program to improve overall physical activity and academic performance among elementary school-age students.

METHODS

A total of 48 children attending an urban public school with large minority representation in the Midwest were randomly assigned to MiM-The Maze or yoga. Participants were assessed on motor proficiency, behavior, balance, and academic skills before and after training. Training consisted of either yoga or MiM-The Maze 30 minutes per day before school, 5 times per week for 12 weeks.

RESULTS

MiM-The Maze and yoga group students showed significant improvements in academic skills.

CONCLUSIONS

MiM-The Maze is feasible and affordable before-school program to promote students' classroom behavior in elementary school students.

An Evaluation of Yoga and Meditation to Improve Attention, Hyperactivity, and Stress in High-School Students

Objective: Problems with attention and stress are common in children and predict academic difficulties and other behavioral and emotional problems. Mind-body interventions such as yoga and meditation improve attention and reduce stress. In this study, we examined the impact of Hatha yoga on attention and stress in ninth graders. Design: A total of 174 ninth graders from a Texas high school were enrolled in the study. Teachers assigned students to a yoga group (YG) or control group (CG) based on their class schedule. The YG participated in 25-min Hatha yoga classes twice weekly over 12 weeks (n = 123). The CG included 51 students. Student self-reports on measures of inattention and hyperactivity (the strengths and weaknesses of ADHD [attention-deficit/hyperactivity disorder] symptoms and normal behavior rating scale for ADHD) and stress (perceived stress scale) were obtained at baseline and at 12 weeks. Results: There were no significant differences in baseline levels of inattention (p = 0.86), hyperactivity (p = 0.25), and perceived stress (p = 0.28) between the YG and CG. Regarding inattention scores, there was a significant interaction of group and time (b = -1.09, standard error [SE] = 0.30, p < 0.001). Pairwise t-tests showed a significant reduction in inattention for the YG (d = 0.27) but a significant increase in inattention for the CG. Regarding hyperactivity, there was no significant interaction of group and time (b = -0.43, SE = 0.26, p = 0.1). Pairwise t-tests demonstrated a significant reduction in hyperactivity for the YG (d = 0.22), but not the CG. The interaction of group and time was not significant in predicting the slope of change in perceived distress (b = -0.93, SE = 1.19, p = 0.43). Pairwise t-tests did not show a significant reduction in perceived distress for either group. Conclusion: These findings suggest that Hatha yoga may improve attention and hyperactivity in high school students.

School-related physical activity interventions and mental health among children: a systematic review and meta-analysis

BACKGROUND

Low levels of physical activity, sedentary behaviour and mental health problems are issues that have received considerable attention in the last decade. The aim of this systematic review and meta-analysis was to investigate effects of interventions targeting school-related physical activity or sedentary behaviour on mental health in children and adolescents and to identify the features of effective interventions.

METHODS

Scientific articles published between January 2009 and October 2019 fulfilling the following criteria were included: general populations of children and adolescents between age 4 and 19, all types of school-related efforts to promote physical activity or reduce sedentary behaviour. Study selection, data extraction and quality assessment were done by at least two authors independently of each other. Data were analysed with a random effects meta-analysis and by narrative moderator analyses.

RESULTS

The literature search resulted in 10265 unique articles. Thirty-one articles, describing 30 interventions, were finally included. Eleven relevant outcomes were identified: health-related quality of life, well-being, self-esteem and self-worth, resilience, positive effect, positive mental health, anxiety, depression, emotional problems, negative effect and internalising mental health problems. There was a significant beneficial effect of school-related physical activity interventions on resilience (Hedges' g = 0.748, 95% CI = 0.326; 1.170, p = 0.001), positive mental health (Hedges' g = 0.405, 95% CI = 0.208; 0.603, p = < 0.001), well-being (Hedges' g = 0.877, 95% CI = 0.356; 1.398, p = < 0.001) and anxiety (Hedges' g = 0.347, 95% CI = 0.072; 0.623, p = 0.013). Heterogeneity was moderate to high (I² = 59-98%) between studies for all outcomes except positive effect, where heterogeneity was low (I² = 2%). The narrative moderator analyses of outcomes based on 10 or more studies showed that age of the children moderated the effect of the intervention on internalising mental health problems. Interventions in younger children showed a significantly negative or no effect on internalising mental health problems while those in older children showed a significant positive or no effect. Moreover, studies with a high implementation reach showed a significant negative or no effect while those with a low level of implementation showed no or a positive effect. No signs of effect moderation were found for self-esteem, well-being or positive mental health. Risk of publication bias was evident for several outcomes, but adjustment did not change the results.

CONCLUSIONS

School-related physical activity interventions may reduce anxiety, increase resilience, improve well-being and increase positive mental health in children and adolescents. Considering the positive effects of physical activity on health in general, these findings may reinforce school-based initiatives to increase physical activity. However, the studies show considerable heterogeneity. The results should therefore be interpreted with caution. Future studies should report on implementation factors and more clearly describe the activities of the control group and whether the activity is added to or replacing ordinary physical education lessons in order to aid interpretation of results.

TRIAL REGISTRATION

PROSPERO, CRD42018086757.

Yoga in school sports improves functioning of autonomic nervous system in young adults: A non-randomized controlled pilot study

Background

Yoga in school is a beneficial tool to promote the good health and well-being of students by changing the way they react to stress. The positive effects of yoga—taught in schools—on children, youth and young adults have been demonstrated in former studies using mostly subjective psychometric data.

Aim

The present trial aims to evaluate the potential effects of yoga on autonomic regulation in young adults by analyzing heart rate variability (HRV).

Methods

This study is a non-randomized, explorative, two-arm-pilot study with an active control group. Fourteen healthy young adults took part in a 10-week yoga program (90 min once a week) in school and were compared to a control group of 11 students who participated in conventional school sports (90 min once a week over 10 weeks). 24-hour electrocardiograms (ECGs) were recorded at baseline and following the 10-week intervention. From 20-minute of nocturnal sleep phases, HRV parameters were calculated from linear (time and frequency domain) and nonlinear dynamics (such as symbolic dynamics and Poincaré plot analysis). Analyses of variance (ANOVA) followed by t-tests as post-hoc tests estimating both statistical significance and effect size were used to compare pre-post-intervention for the two groups.

Results

The statistical analysis of the interaction effects did not reveal a significant group and time interaction for the individual nocturnal HRV indices. Almost all indices revealed medium and large effects regarding the time main effects. The changes in the HRV indices following the intervention were more dramatic for the yoga group than for the control group which is reflected in predominantly higher significances and stronger effect sizes in the yoga group.

Conclusion

In this explorative pilot trial, an increase of HRV (more parasympathetic dominance and overall higher HRV) after ten weeks of yoga in school in comparison to regular school sports was demonstrated, showing an improved self-regulation of the autonomic nervous system.

Yoga in school sport - A non-randomized controlled pilot study in Germany

OBJECTIVES

Distress is an increasing public health problem for adolescents and young adults. We aimed to evaluate potential effects of a 10-week 90-minute once-a-week yoga course.

METHODS

A non-randomized controlled study with a school sport control group was implemented in two German secondary schools. Primary outcome was stress on the Perceived Stress Scale from baseline to week 10. Secondary outcomes included depression/anxiety, attention, quality of life, mood, visual analogue scales (for pain, headache, neck tension, exhaustion, sleep), and yoga-efficacy. Parameters were assessed at pre-baseline (before holidays), baseline (after 3-week holidays, before interventions started), week 10, and at a 6-months follow-up. An intention-to-treat analysis using ANCOVA was performed.

RESULTS

92 participants (67 % female; 19.6 ± 2.2 years) were included into the study. No significant differences were observed between the groups with regard to PSS, at either 10 weeks (Δ=-1.4; 95 % CI: -3.6;0.8; p = 0.22) or 6 months (Δ = 2; 95 % CI: -0.2;4.2, p = 0.08). Only VAS headache in favour of yoga and HADS-D in favour of school sport showed significant group differences at the 6-months follow-up. Significant intra-group mean changes for the primary outcome and several secondary outcomes were found in the yoga group.

CONCLUSIONS

Young adults in German secondary school settings might benefit from yoga, as the found effects were more prominent in the yoga group. However, the effects might be attributed to non-specific effects due to the chosen study design. Further studies are needed, which include high-quality study designs including randomization, longer-term follow-ups and larger sample sizes.

Yoga as an Intervention for the Reduction of Symptoms of Anxiety and Depression in Children and Adolescents: A Systematic Review

Purpose: The purpose of this review is to evaluate the implementation and effectiveness of yoga for the reduction of symptoms of anxiety and depression in youth. To our knowledge, there are no systematic reviews to date looking at the reduction of symptoms of both anxiety and depression. Methods: Numerous scientific databases were searched up to November 2018 for experimental studies assessing changes in symptoms of anxiety and/or depression in youths following yoga interventions. Quality and level of evidence were assessed, and information was synthesized across studies. Results: Twenty-seven studies involving youth with varying health statuses were reviewed. Intervention characteristics varied greatly across studies revealing multiple factors that may impact intervention efficacy, however 70% of the studies overall showed improvements. For studies assessing anxiety and depression, 58% showed reductions in both symptoms, while 25% showed reductions in anxiety only. Additionally, 70% of studies assessing anxiety alone showed improvements and 40% of studies only assessing depression showed improvements. Conclusion: The studies reviewed, while of weak to moderate methodological quality, showed that yoga, defined by the practice of postures, generally leads to some reductions in anxiety and depression in youth regardless of health status and intervention characteristics.

Nicotine Use Disorders in Adolescents

Rates of certain tobacco products have decreased over the past decade, but nicotine use disorder is still prevalent among adolescents. New trends in tobacco use, such as in the use of electronic cigarettes, are creating alarm. This article reviews nicotine addiction and measurement in adolescents, along with potential health risks and comorbidities. Various psychosocial and pharmacologic interventions are reviewed along with novel interventions that show promise for reducing tobacco use in this vulnerable population.

Evaluating the impact of a brief yoga intervention on preadolescents' body image and mood

Yoga is an embodying activity that promotes body awareness, body connection, body responsiveness, and appreciation of body functionality, and it therefore may be a beneficial school-based intervention for children's body image. The present study examined the impact of a 4-week yoga intervention on pre-adolescent girls' and boys' body image (body appreciation, body esteem, and body surveillance) and mood (positive and negative affect) 1-week post-intervention and at 6-week follow-up. British children (N = 344; 54.4% female) aged 9-11 years were recruited from four schools, two of which were randomly assigned to the yoga intervention and two to a physical education control condition. Overall, girls reported greater body image concern and negative mood than boys. Unexpectedly, both groups reported increased body appreciation, body esteem, and positive mood, and decreased body surveillance and negative affect from baseline to post-intervention and/or follow-up. Both girls and boys in the yoga intervention evaluated the sessions very favourably; the majority desired to participate in more lessons. Potential explanations for these findings are discussed.

Effect of mindfulness and yoga on quality of life for elementary school students and teachers: results of a randomized controlled school-based study

Objective

To assess the impact of a yoga curriculum in an elementary school on student quality of life, and to assess teacher and staff perception of potential barriers to, and benefits of, introducing yoga and mindfulness into the classroom.

Methods

A randomized controlled trial was utilized to assess the impact of a brief intervention on third-grade students who screened positive for symptoms of anxiety. Students were randomized to an intervention group of 20 students receiving small-group yoga/mindfulness activities for 8 weeks between October 2016 and February 2017, and a control group of 32 students receiving care as usual. The Brief Multidimensional Students' Life Satisfaction Scale-Peabody Treatment Progress Battery and the Pediatric Quality of Life Inventory (PedsQL) served as outcomes. Teachers were invited to participate in two professional development sessions about introducing yoga and mindfulness into the classroom, and completed a survey following each of the sessions.

Results

In generalized estimating equation models adjusted for time, the yoga-based intervention was associated with a 14.17 unit increase in student emotional PedsQL (p-value 0.001) and a 7.43 unit increase in psychosocial PedsQL (p-value 0.01). Results were not attenuated by adjustment. Teachers and staff reported using yoga more frequently in the classroom following the second of two professional development sessions (p-value <0.05). Perceived barriers to introducing yoga to the classroom were similar at two data collection time points, while perceived benefits remained high.

Conclusion

The intervention was associated with a significant improvement in emotional and psychosocial quality of life in the intervention group when compared to the control group, suggesting that yoga/mindfulness interventions may improve symptoms of anxiety among students. Yoga/mindfulness activities may facilitate stress management among elementary school students and may be added as a complement to social and emotional learning activities.

Effects of a Kundalini Yoga Program on Elementary and Middle School Students' Stress, Affect, and Resilience

OBJECTIVE

The Your Own Greatness Affirmed (YOGA) for Youth program delivers yoga to urban inner-city schools with the goal of providing practical benefits that support underserved children at high risk of behavioral and emotional problems. A 10-week YOGA for Youth program delivered 1 to 2 times per week was implemented in 3 schools in urban neighborhoods to examine the effect of the program on student stress, affect, and resilience.

METHODS

Thirty children were administered the Perceived Stress Scale, the Positive and Negative Affect Schedule, and the Resilience Scale before and after the yoga program. After the program, informal qualitative interviews were conducted with school teachers, yoga teachers, and students to determine the overall impact of the yoga program.

RESULTS

The quantitative results of this study indicated that the yoga program significantly improved students stress (p < 0.05), positive affect (p < 0.05), and resilience (p < 0.001). The qualitative results indicated that students, school teachers, and yoga teachers all found the program to be beneficial for students' well-being.

CONCLUSION

Taken together, these data suggest that the YOGA for Youth program may provide students in low-income urban schools with behavioral skills that will protect against risk factors associated with the development of behavioral and emotional problems.

Systematic review of meditation-based interventions for children with ADHD

Meditation-based interventions such as mindfulness and yoga are commonly practiced in the general community to improve mental and physical health. Parents, teachers and healthcare providers are also increasingly using such interventions with children. This review examines the use of meditation-based interventions in the treatment of children with Attention-Deficit Hyperactivity Disorder (ADHD). Electronic databases searched included PsycINFO, Medline, CINAHL, and AMED. Inclusion criteria involved children (aged to 18 years) diagnosed with ADHD, delivery of a meditation-based intervention to children and/or parents, and publication in a peer-reviewed journal. Studies were identified and coded using standard criteria, risk of bias was assessed using Risk of Bias in Non-randomised Studies- of interventions (ROBINS-I), and effect sizes were calculated. A total of 16 studies were identified (8 that included children in treatment, and 8 that included combined parent-child treatment). Results indicated that risk of bias was high across studies. At this stage, no definitive conclusions can be offered regarding the utility of meditation-based interventions for children with ADHD and/or their parents, since the methodological quality of the studies reviewed is low. Future well designed research is needed to establish the efficacy of meditation-based interventions, including commonly used practices such as mindfulness, before recommendations can be made for children with ADHD and their families.

Enhancing yoga participation: A qualitative investigation of barriers and facilitators to yoga among predominantly racial/ethnic minority, low-income adults

Yoga is underutilized among racial/ethnic minorities and low-income populations. To enhance participation among these demographic groups and to inform a future clinical trial, we conducted a qualitative formative investigation, informed by the Social Contextual Model of health behavior change, to identify barriers and facilitators to yoga that could impact study participation. We recruited twenty-four racially/ethnically diverse adults, with and without prior yoga experience, from a low-income, urban housing community to participate in either an individual interview or focus group. A thematic data analysis approach was employed. Barriers to yoga engagement included the perception that yoga lacks physicality and weight loss benefits, fear of injury, lack of ability/self-efficacy to perform the practices, preference for other physical activities, and scheduling difficulties. Facilitators of yoga engagement included a quality yoga instructor who provides individualized instruction, beginner level classes, and promotional messaging that highlights the potential benefits of yoga, such as stress reduction.

Characteristics of Yoga Practitioners, Motivators, and Yoga Techniques of Choice: A Cross-sectional Study

Background

The characteristics of yoga practitioners and factors motivating people to practice yoga have been studied in the US and in Australia. This study aimed to determine the characteristics of yoga users in India, the factors that motivate them to practice yoga, and the yoga techniques of choice.

Materials and methods

The study was a one-time, cross-sectional survey based on convenience sampling. Inclusion criteria were (a) a minimum of 1 week experience of yoga and (b) at least 10 years of age. 14,250 people received the survey. After excluding those who did not meet the inclusion criteria or filled in the survey incompletely or incorrectly, 5,157 respondents were included in the study.

Results

Out of 5,157 respondents, there were more males (67.3%), aged between 21 and 44 years (33.7% of the sample surveyed), educated up to high school (62.5%), students (39.3%), and those who had between 1 and 12 months of experience in yoga (54.4%). The first most common reason to practice yoga for all respondents was physical fitness. Three of the remaining reasons to practice yoga differed significantly with age: (i) yoga for disease management (χ² = 17.62, p < 0.005), (ii) yoga as a hobby (χ² = 10.87, p < 0.05), and (iii) yoga based on the guru’s (teacher’s) instructions (χ² = 20.05, p < 0.001). The yoga technique of choice [i.e., (i) asanas (χ² = 23.17, p < 0.001), (ii) pranayama (χ² = 19.87, p < 0.001), or (iii) meditation (χ² = 9.64, p < 0.05)] differed significantly across age groups.

Conclusion

In India, a yoga practitioner was more likely to be male, between 21 and 44 years of age, high school educated, and a student. The reasons to practice yoga and the yoga technique of choice differed significantly with age.

A Qualitative Examination of Yoga for Middle School Adolescents

The present study was part of a group randomized controlled trial in which 7^th grade students were assigned to a yoga intervention or physical-education-as-usual. Sixteen students were randomly selected from the yoga condition to participate in one-on-one interviews. Qualitative analyses revealed 13 themes that were organized into two categories: Usability (student perceptions of the usefulness, learnability, and convenience of the yoga intervention) and Effect (student perceptions of the direct results of the yoga intervention). Students reported both positive and negative opinions of yoga, especially when making direct comparisons between yoga and physical education. Students had particularly positive opinions regarding the beneficial effects of yoga on stress, sleep, and relaxation. Student opinions regarding the effects of yoga on self-regulation, social interaction, substance use, and academic performance were also generally positive, although somewhat mixed. Results suggest that qualitative research shows promise for providing an in-depth perspective on the impact of mind-body interventions in schools.

Evaluation of Yoga for Preventing Adolescent Substance Use Risk Factors in a Middle School Setting: A Preliminary Group-Randomized Controlled Trial

Adolescence is a key developmental period for preventing substance use initiation, however prevention programs solely providing educational information about the dangers of substance use rarely change adolescent substance use behaviors. Recent research suggests that mind-body practices such as yoga may have beneficial effects on several substance use risk factors, and that these practices may serve as promising interventions for preventing adolescent substance use. The primary aim of the present study was to test the efficacy of yoga for reducing substance use risk factors during early adolescence. Seventh-grade students in a public school were randomly assigned by classroom to receive either a 32-session yoga intervention (n = 117) in place of their regular physical education classes or to continue with physical-education-as-usual (n = 94). Participants (63.2 % female; 53.6 % White) completed pre- and post-intervention questionnaires assessing emotional self-regulation, perceived stress, mood impairment, impulsivity, substance use willingness, and actual substance use. Participants also completed questionnaires at 6-months and 1-year post-intervention. Results revealed that participants in the control condition were significantly more willing to try smoking cigarettes immediately post-intervention than participants in the yoga condition. Immediate pre- to post-intervention differences did not emerge for the remaining outcomes. However, long-term follow-up analyses revealed a pattern of delayed effects in which females in the yoga condition, and males in the control condition, demonstrated improvements in emotional self-control. The findings suggest that school-based yoga may have beneficial effects with regard to preventing males' and females' willingness to smoke cigarettes, as well as improving emotional self-control in females. However additional research is required, particularly with regard to the potential long-term effects of mind-body interventions in school settings. The present study contributes to the literature on adolescence by examining school-based yoga as a novel prevention program for substance use risk factors.

Medical Yoga Therapy

Medical yoga is defined as the use of yoga practices for the prevention and treatment of medical conditions. Beyond the physical elements of yoga, which are important and effective for strengthening the body, medical yoga also incorporates appropriate breathing techniques, mindfulness, and meditation in order to achieve the maximum benefits. Multiple studies have shown that yoga can positively impact the body in many ways, including helping to regulate blood glucose levels, improve musculoskeletal ailments and keeping the cardiovascular system in tune. It also has been shown to have important psychological benefits, as the practice of yoga can help to increase mental energy and positive feelings, and decrease negative feelings of aggressiveness, depression and anxiety.

Yoga research review

This paper is a review of empirical studies, review and meta-analysis publications on yoga from the last few years. The review includes demographics/prevalence of yoga as a practice, bibliometric analyses of the yoga publications and the use of yoga for physical fitness and cognitive function. Most of the studies reviewed here involve yoga effects on psychiatric and medical conditions. These include pregnancy, prenatal and postpartum depression; stress, PTSD, anxiety, and obesity; cardiovascular conditions including hypertension; pain syndromes including arthritis, headaches and low back pain; autoimmune conditions including asthma, type II diabetes and multiple sclerosis; immune conditions including HIV and breast cancer; and aging problems including balance, osteoporosis and Parkinson's. The methods and results of those studies are briefly summarized along with their limitations and suggestions for future research. Basically yoga has been more effective than control and waitlist control conditions, although not always more effective than treatment comparison groups such as other forms of exercise. More randomized controlled studies are needed in which yoga is compared to active exercise groups. Having established the physical and mental health benefits of yoga makes it ethically questionable to assign participants to inactive control groups. Shorter sessions should be investigated for cost-effectiveness and for daily practice. Multiple physical and physiological measures need to be added to the self-report research protocols and potential underlying mechanisms need to be further explored. In the interim, the studies reviewed here highlight the therapeutic effects of yoga, a practice that could come to be called yoga therapy.