A summary of the main research into yoga for adolescents

Yoga is a mind-body intervention incorporating physical postures, breathing techniques, meditation, relaxation and practical yoga philosophy interwoven with posture sessions, aiming to help people deal with anxiety, stress and depression.

There is a growing body of evidence demonstrating the physiological, cognitive and psychological benefits of yoga and meditation on stress management in children and adolescents who face a host of social expectations, school demands and exigencies of social media, and in school teachers for whom multiple sources of chronic stress, including workload, young people and parents, can result in low morale and burnout.

Yoga can improve reasoning, working memory, self-confidence, resilience, mood and self-regulation skills pertaining to emotions and stress, hence provide lifelong skills[1]. Offering yoga as part of the secondary school curriculum can facilitate universal coverage, thus reducing inequalities and contributing to improved wellbeing for young people.

There have been numerous studies of the effects of yoga in schools. Enough in fact for there to have been five different systematic reviews of the international research published since 2012 on the effects of yoga in schools [2][3][4][5][6]. Miller et al (2020) in the most recent systematic review included 39 randomised controlled trials (RCTs) of 8 to 18 year olds in a number of settings, with 26 in schools. Sample sizes ranged between 12 and 283 participants with varied intervention types and durations (30 to 120 minutes) and follow-up periods were between one and twelve months. The RCTs took place in seven countries: US (n = 18), India (n =16) and one study each in Australia, Korea, Haiti, Columbia and the Netherlands.

Out of the 39 RCTs, 34 showed significant improvements in at least one of the following categories of outcomes:  psychological/behavioural, cognitive and physiological/physical functioning. Ferreira-Vorkapic (2015) in their review of nine trials in the US (n=6) and India (n=3) found significant effect sizes favouring the intervention groups for mood indicators, tension and anxiety, self-esteem and memory.

These reviews also identified some limitations of the work. In general sample sizes were low, which makes it hard to generalise from the results, and there was also a problem of comparability as few studies assessed similar outcomes or used similar approaches, and sometimes were focused on very specific populations rather than whole school populations. The consensus from the reviews is that yoga interventions are feasible to deliver in the school context and have the potential to benefit young people, but the lack of robust evidence means that more definitive studies are needed.

In the UK there are two yoga studies with young people: the Westminster 3-arm feasibility RCT[7] (Teen Yoga provided advice in the development of this study) and the Hippocampus project [8](led by Teen Yoga) which concluded in 2019.

The Westminster feasibility RCT was based in one mainstream disadvantaged London secondary school, and tested the implementation of 10-weeks teen yoga (arm 1) and mindfulness (arm 2) classes, delivered by external yoga and mindfulness instructors respectively, compared to usual personal, social, health and economic (PSHE) curriculum lessons for young people aged 12-13 years (Year 8). The intervention manual for yoga classes for young people was refined over two cohorts to produce an intervention with high fidelity (self-report) and acceptability for pupils from a disadvantaged multicultural community. Qualitative interviews with young people (n=45) and staff (n=19) who had been part of the intervention suggested a range of benefits for pupils’ stress and wellbeing, anger management, calmness, and physical health and fitness, in addition to increased focus and concentration.  The study also highlighted some challenges of implementation such as class size and mixed gender classes.

The Hippocampus project developed a yoga-based intervention with multiple components to support disadvantaged young people (n=600) in five European countries. In the UK, this was conducted in a deprived school in Somerset where teachers first received weekly sessions of adult yoga classes over a period of 10 weeks followed by the pupils receiving the 10-week teen yoga. Teachers were also encouraged to teach the young people techniques they had learnt. These sessions were delivered during lunch times, before and after school. research. For both staff and young people there was a statistically significant  improvement in wellbeing, reduction in perceived stress and reduction in sleep related problems. In addition to this clarity of thinking, optimism confidence, calmness and energy all increased, while nervousness and stress, anger and a sense of overload due to lack of control were all reduced. The findings also suggested  improved self-regulation across the cohort

The results are very positive and though Hippocampus especially dealt with a larger sample size, there is a need for more research to be done, to provide the evidence that would back up the extensive experiential evidence of the benefits of yoga for young people, particularly as a mental health prevention approach.This is important because for many years there have been decreasing levels of wellbeing and increased prevalence of common mental health problems among young people. Data prior to the pandemic indicates that one in seven 11-16 year olds have a mental health disorder[9].. This is not just a problem of adolescence: 50% of adults with mental health problems experience their first problems by the age of 14[10] [2].

With the pandemic, there is early evidence to suggest that emotional and behavioural difficulties, and inattention in young people, has increased, especially among those from low-income families[11]. The problem is exacerbated by changes to schools’ funding affecting the level of pastoral support to young people and long waiting times to access Child & Adolescent Mental Health Services. In the UK, mental ill health is the single largest cause of disability, contributing 23% of the total burden (cancer is 16%). The estimated wider economic annual cost of mental illness in England is £105 billion [12].

There is also emerging evidence that prevention strategies can have highly beneficial effects that would reduce the pressure on healthcare provision. Research into the economic benefits of early interventions that can delay or prevent onset of common mental health disorders have led to the prioritisation of such interventions[13] [14].  Schools play a vital role in supporting mental health in young people and encouraging wellbeing through whole-school approaches[15]. Furthermore, Schools are identified as key organisations that can provide holistic support to young people and help mitigate the social and psychological (as well as the educational) effects of the current SARS-CoV-2 pandemic[16].

Teen Yoga, as an effective mental health prevention strategy within schools, is well positioned to contribute to this work, both through our accumulation of experiential evidence and feedback for the work we do in schools across the UK. We are also continuing to explore ways to demonstrate the benefits and the social impact of yoga for young people through research initiatives of different kinds.

We are very open to collaboration.

Referencing Source

[1] Khalsa, S.B.S., et al., The principles and practice of yoga in health care. 2017: SAGE Publications, Incorporated.
[2] Chung, S.-C., Yoga and meditation in youth education: a systematic review. The Lancet, 2018. 392: p. S24.
[3] Ferreira-Vorkapic, C., et al., Are there benefits from teaching yoga at schools? A systematic review of randomized control trials of yoga-based interventions. Evidence-Based Complementary and Alternative Medicine, 2015. 2015.
[4] Khalsa, S.B.S. and B. Butzer, Yoga in school settings: A research review. Annals of the New York Academy of Sciences, 2016. 1373(1): p. 45-55.
[5] Miller, S., et al., Systematic Review of Randomized Controlled Trials Testing the Effects of Yoga with Youth. Mindfulness, 2020: p. 1-18.
[6] Serwacki, M. and C. Cook-Cottone, Yoga in the schools: a systematic review of the literature. International journal of yoga therapy, 2012. 22(1): p. 101-110.
[7] Edwards, A., N. Miller, and T. Cartwright, The impact of yoga on adolescent wellbeing: A naturalistic, mixed-methods study. Positive Psychology under review
[8] https://hippocampusproject.eu
[9] NHS Digital. Mental Health of Children and Young People in England, 2017 [PAS]. 2018 2018  [cited 2019 June 10]; Available from: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017.
[10] Kessler, R.C., et al., Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 2005. 62 (6): p. 593-602.
[11] Pearcey, S., et al., Report 05: Changes in children and young people’s mental health symptoms and ‘caseness’ during lockdown and patterns associated with key demographic factors. Co-Space study COVID-19: Supporting parents, adolescents and children during epidemics 2020.
[12] Department of Health, No health without mental health: A cross-Government mental health outcomes strategy for people of all ages. Supporting document – The economic case for improving efficiency and quality in mental health. 2016: London
[13] Edwards, T.R. and E. McIntosh, Applied public health economics for public health practice and research. 2019: Oxford University Press.
[14] Knapp, M., D. McDaid, and M. Parsonage, Mental health promotion and mental illness prevention: The economic case. 2011.
[15] NHS England, Future in mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing. London: Department of Health, 2015.
[16] A Recovery Curriculum: Loss and life for our children and schools post pandemic. 2020 [cited 2020 September 14]; Available from: https://www.ssatuk.co.uk/blog/a-recovery-curriculum-loss-and-life-for-our-children-and-schools-post-pandemic/.

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