This report summarizes the current evidence on the effects of yoga interventions on various components of mental and physical health, by focussing on the evidence described in review articles. Collectively, these reviews suggest a number of areas where yoga may well be beneficial, but more research is required for virtually all of them to firmly establish such benefits. The heterogeneity among interventions and conditions studied has hampered the use of meta-analysis as an appropriate tool for summarizing the current literature. Nevertheless, there are some meta-analyses which indicate beneficial effects of yoga interventions, and there are several randomized clinical trials (RCT's) of relatively high quality indicating beneficial effects of yoga for pain-associated disability and mental health. Yoga may well be effective as a supportive adjunct to mitigate some medical conditions, but not yet a proven stand-alone, curative treatment. Larger-scale and more rigorous research with higher methodological quality and adequate control interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct treatment that is relatively cost-effective, may be practiced at least in part as a self-care behavioral treatment, provides a life-long behavioural skill, enhances self-efficacy and self-confidence and is often associated with additional positive side effects.
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1. Introduction
The conceptual background of yoga has its origins in ancient Indian philosophy. There are numerous modern schools or types of yoga (i.e., Iyengar, Viniyoga, Sivananda, etc.), each having its own distinct emphasis regarding the relative content of physical postures and exercises (asanas), breathing techniques (pranayama), deep relaxation, and meditation practices that cultivate awareness and ultimately more profound states of consciousness. The application of yoga as a therapeutic intervention, which began early in the twentieth century, takes advantage of the various psychophysiological benefits of the component practices. The physical exercises (asanas) may increase patient's physical flexibility, coordination, and strength, while the breathing practices and meditation may calm and focus the mind to develop greater awareness and diminish anxiety [1], and thus result in higher quality of life. Other beneficial effects might involve a reduction of distress, blood pressure, and improvements in resilience, mood, and metabolic regulation [2].
Khalsa stated that a majority of the research on yoga as a therapeutic intervention was conducted in India and a significant fraction of these were published in Indian journals, some of which are difficult to acquire for Western clinicians and researchers [3]. In their bibliometric analysis from 2004, they found that 48% of the enrolled studies were uncontrolled, while 40% were randomized clinical trials (RCT), and 12% non-RCT (N-RCT). Main categories which were addressed were psychiatric, cardiovascular, and respiratory disorders [3].
Despite a growing body of clinical research studies and some systematic reviews on the therapeutic effects of yoga, there is still a lack of solid evidence regarding its clinical relevance for many symptoms and medical conditions. For many specific indications and conditions, there is inconsistent evidence with several studies reporting positive effects of the yoga interventions, but other studies are less conclusive. In some instances, these discrepancies may result from differences between the study populations (e.g., age, gender, and health status), the details of the yoga interventions, and follow-up rates.
In this paper, we summarize the current evidence on the clinical effects of yoga interventions on various components of mental and physical health. In general, the respective reviews (Table 1) and an Agency for Healthcare Research and Quality Report (AHRQ) evidence report on “Meditation Practices for Health,” which cites also studies on yoga [30], include a heterogeneous set of studies with varying effect sizes, heterogeneous diagnoses and outcome variables, often limited methodological quality, small sample sizes, varying control interventions, different yoga styles, and strongly divergent duration of interventions.a
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