Bending and Breathing for Health and Wellness: A Systematic Review of Yoga Interventions with Children and Youth

Background and Purpose: Between 10% and 20% of children and youth have clinical levels of anxiety and depression, and research also suggests that their levels of stress have also been increasing (Shaffer et al., 1996; Stueck & Gloeckner, 2005). The reported efficacy of the practices of yoga with adult populations and the growing acceptance of these Eastern-based practices in the U.S., has encouraged the use of these practices with children and adolescents (Black et al., 2009). Previous reviews have examined yoga studies conducted in Eastern and Western settings, and there is concern that the acceptability, feasibility and outcomes across these settings may not be comparable. They also have not examined the differential effectiveness of yoga on psychosocial outcomes between adolescents and younger children (Birdee et al., 2010; Galantino et al., 2004). This systematic review addresses the following research questions: (1) What interventions involving yoga that have empirically tested with children and youth in the U.S.? (2) What psychosocial outcomes do they measure? (3) What is the methodological rigor of these studies? (4) For which psychosocial outcomes (depression, anxiety, self-esteem, and stress) are yoga interventions most effective? (5) For which age groups are yoga interventions most effective across each outcome?

Methods: Peer-reviewed articles were systematically examined from the Cochrane Central for Controlled Trials (CENTRAL), CINAHL, MEDLINE, PsycINFO, and ERIC. Each database was searched from its inception until April 15, 2011. Yoga intervention studies were included in the final review if they met the following criteria: (1) the sample was from the U.S.; 2) the sample was between the ages of 4 and 18; (3) the study design was either an RCT or quasi-experimental. Interventions were rated using the Methodological Quality Rating Scale (MQRS; Miller et al., 2995), and the outcome attainment index (Rhee & Auslander, under review).

Results: The initial search rendered 422 studies, which were screened to exclude those conducted outside of the U.S., not including children or youth, or not meeting study design criteria. Seventeen studies met all review inclusion criteria. Five studies measured depression, 11 anxiety, 10 self-esteem, and 7 stress. Eight of the 17 studies demonstrated high methodological rigor (n=5 with an adolescent sample; n=3 with younger children). Taking into account methodological rigor, yoga was most effective in reducing stress across both age groups (n=5), but there was also strong support for yoga as an effective intervention for anxiety (n=4). There was strong support for anxiety reduction with adolescents, and for stress reduction with younger children.

Conclusions and Implications: The few yoga interventions that test effects on psychosocial outcomes with children and youth in the U.S. indicate the potential for yoga as an effective method of especially for stress and anxiety reduction. As yoga requires regular and ongoing practice, it could be a good fit for integration in primary and secondary schools. Considering the number of comorbid disorders associated with stress and anxiety, yoga is a holistic method that needs further exploration and rigorous testing with children and youth.