Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials

Cramer, Holger; Lauche, Romy; Anheyer, Dennis; Pilkington, Karen; Manincor, Michael J de; Dobos, Gustav; Ward, Lesley

doi:10.1002/da.22762

Cited by 202 publications

(154 citation statements)

References 62 publications

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“…Our results contrast with previous findings of yoga’s effectiveness in reducing symptoms in mood and anxiety disorders [ 51 – 59 ]. A previous meta-analysis on yoga for depression found medium-large effect sizes for yoga compared to usual care (standardized mean difference (SMD) of -0.69), for yoga compared to relaxation (SMD of -0.62), and for yoga compared to exercise (SMD of -0.59) [ 51 ].…”

Section: Discussioncontrasting

confidence: 99%

“…The effects of yoga on mood and anxiety disorders have been reviewed by several authors [ 51 – 59 ]. These systematic reviews and two meta-analyses concluded that there is some evidence of yoga being effective for mood and anxiety disorders, but all mention serious methodological drawbacks of the included randomized controlled trials (RCTs).…”

Section: Introductionmentioning

confidence: 99%

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Hatha yoga for acute, chronic and/or treatment-resistant mood and anxiety disorders: A systematic review and meta-analysis

et al. 2018

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BackgroundThe aim of this study was to systematically investigate the effectiveness of hatha yoga in treating acute, chronic and/or treatment-resistant mood and anxiety disorders.MethodsMedline, Cochrane Library, Current Controlled Trials, Clinical Trials.gov, NHR Centre for Reviews and Dissemination, PsycINFO and CINAHL were searched through June 2018. Randomized controlled trials with patients with mood and anxiety disorders were included. Main outcomes were continuous measures of severity of mood and anxiety symptoms. Cohen’s d was calculated as a measure of effect size. Meta-analyses using a random effects model was applied to estimate direct comparisons between yoga and control conditions for depression and anxiety outcomes. Publication bias was visually inspected using funnel plots.ResultsEighteen studies were found, fourteen in acute patients and four in chronic patients. Most studies were of low quality. For depression outcomes, hatha yoga did not show a significant effect when compared to treatment as usual, an overall effect size of Cohen’s d -0.64 (95% CI = -1.41, 0.13) or to all active control groups, Cohen’s d -0.13 (95% CI = -0.49, 0.22). A sub-analysis showed that yoga had a significant effect on the reduction of depression compared to psychoeducation control groups, Cohen’s d -0.52 (95% CI = -0.96, -0.08) but not to other active control groups, Cohen’s d 0.28 (95% CI = -0.07, 0.63) For studies using a follow-up of six months or more, hatha yoga had no effect on the reduction of depression compared to active control groups, Cohen’s d -0.14 (95% CI = -0.60, 0.33). Regarding anxiety, hatha yoga had no significant effect when compared to active control groups, Cohen’s d -0.09 (95% CI = -0.47, 0.30). The I2 and Q-statistic revealed heterogeneity amongst comparisons. Qualitative analyses suggest some promise of hatha yoga for chronic populations.ConclusionsThe ability to draw firm conclusions is limited by the notable heterogeneity and low quality of most of the included studies. With this caveat in mind, the results of the current meta-analysis suggest that hatha yoga does not have effects on acute, chronic and/or treatment-resistant mood and anxiety disorders compared to treatment as usual or active control groups. However, when compared to psychoeducation, hatha yoga showed more reductions in depression. It is clear that more high-quality studies are needed to advance the field.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hatha yoga for acute, chronic and/or treatment-resistant mood and anxiety disorders: A systematic review and meta-analysis

et al. 2018

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“…This was associated with frequency of yoga practice rather than overall length of practising. Importantly, our survey found that participants perceived yoga as helpful in managing a wide range of health conditions, most notably musculoskeletal conditions and mental health, consistent with findings in the USA2 and clinical trials 11 13. This suggests that yoga is used in the UK to manage health conditions and support well-being and has further potential to support self-care of debilitating and costly health disorders.…”

Section: Discussionsupporting

confidence: 79%

“…There is growing evidence that yoga is an effective multi-component health intervention that reduces stress, increases physical activity and improves well-being 5–7. Clinical studies provide preliminary support for the effectiveness of yoga as an adjunct treatment for a range of chronic conditions such as depression,8 9 anxiety,10 11 lower back pain12 13 and type 2 diabetes 14 15. Potential physiological mechanisms include down-regulation of the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system and reduced inflammatory markers 6 16 17.…”

Section: Introductionmentioning

confidence: 99%

Yoga practice in the UK: a cross-sectional survey of motivation, health benefits and behaviours

et al. 2020

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ObjectivesDespite the popularity of yoga and evidence of its positive effects on physical and mental health, little is known about yoga practice in the UK. This study investigated the characteristics of people who practise yoga, reasons for initiating and maintaining practice, and perceived impact of yoga on health and well-being.Design, setting and participantsA cross-sectional online anonymous survey distributed through UK-based yoga organisations, studios and events, through email invites and flyers. 2434 yoga practitioners completed the survey, including 903 yoga teachers: 87% were women, 91% white and 71% degree educated; mean age was 48.7 years.Main outcome measuresPerceived impact of yoga on health conditions, health outcomes and injuries. Relationships between yoga practice and measures of health, lifestyle, stress and well-being.ResultsIn comparison with national population norms, participants reported significantly higher well-being but also higher anxiety; lower perceived stress, body mass index and incidence of obesity, and higher rates of positive health behaviours. 47% reported changing their motivations to practise yoga, with general wellness and fitness key to initial uptake, and stress management and spirituality important to current practice. 16% of participants reported starting yoga to manage a physical or mental health condition. Respondents reported the value of yoga for a wide range of health conditions, most notably for musculoskeletal and mental health conditions. 20.7% reported at least one yoga-related injury over their lifetime. Controlling for demographic factors, frequency of yoga practice accounted for small but significant variance in health-related regression models (p<0.001).ConclusionThe findings of this first detailed UK survey were consistent with surveys in other Western countries. Yoga was perceived to have a positive impact on physical and mental health conditions and was linked to positive health behaviours. Further investigation of yoga’s role in self-care could inform health-related challenges faced by many countries.

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“…It became not only popular due to its positive physical and psychological effects in the healthy [2][3][4]. It also showed preventive and therapeutic effects in patients with various common diseases, including cardiovascular diseases [5][6][7], especially high blood pressure [8,9], neuro-psychiatric disorders [10,11] such as ADHD [12,13], post-traumatic stress disorder [14,15], anxiety disorders [16][17][18], depression [19][20][21] and schizophrenia [22,23]. In particular, the significant reduction in stress [24][25][26], and the positive effects on diseases that often occur in old age, such as Alzheimer's [27] and Parkinson's [28], and where conventional medicine is still limited in cure, makes Yoga an exciting current therapeutic modality.…”

Section: Introductionmentioning

confidence: 99%

10-Week Hatha Yoga Increases Right Hippocampal Density Compared to Active and Passive Control Groups: A Controlled Structural cMRI Study

Garner¹,

Reith²,

Krick³

2019

J Neuroimaging Psychiatry Neurol

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Background:The current study was designed to evaluate potential Yoga specific changes of brain structure in comparison with an active sport group and a passive control group. Materials and Methods:We conducted a longitudinal structural MRI study to investigate changes in gray matter (GM) density following a Yoga intervention. In order to check the repeatability of the results two data acquisition periods (cohorts) with the same study design were done. Yoga naive subjects (n = 19/n = 20) received a Yoga intervention once a week for 75 minutes over a period of 10 weeks. Control groups included active sport subjects (n = 10/n = 22) and passive subjects (n = 17/n = 14). All participants could choose their group assignment by their own preference. A longitudinal and group comparison was done by voxelbased-morphometric analyses before and after the intervention. In addition, blood pressure was taken before and after the study period as a controlling instrument. Finally, the results of the two cohorts were reported into a comprising data set for a general conclusion on Yoga effects. Results:Initially, hippocampal GM density in the Yoga group was significantly lower than in both control groups already before the intervention. It was equally and independently present in both cohorts. The longitudinal MRI measurements showed a significant increase in the right hippocampal GM density as a specific effect of the Hatha Yoga intervention. Coincidentally, the blood pressure measurement detected a significant reduction in both systolic and diastolic blood pressure in the Yoga group but not in the sport or passive group. Conclusions:Various neurodegenerative and neuropsychiatric diseases as well as long lasting stress lead to structural shrinkage of the hippocampal GM. In contrast, stress reduction was shown to be associated with an increase in the hippocampal GM density. The Yoga specific effect in this study can be considered as positive impact on both stress management and its underlying neural structure. These effects have been already proven in prevention and therapy of neurodegenerative and neuropsychiatric diseases. The Yoga-induced stress reduction can be furthermore supported by the findings of blood pressure reduction. Blood pressure is well known as an indirect indicator for stress reduction. Since the GM density was detected lower in the two Yoga cohorts twice compared to both control groups, one may postulate a pre-existing but unconscious higher stress vulnerability when voluntarily deciding for the Yoga intervention.

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Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials

Cited by 202 publications

References 62 publications

Hatha yoga for acute, chronic and/or treatment-resistant mood and anxiety disorders: A systematic review and meta-analysis

Hatha yoga for acute, chronic and/or treatment-resistant mood and anxiety disorders: A systematic review and meta-analysis

Yoga practice in the UK: a cross-sectional survey of motivation, health benefits and behaviours

10-Week Hatha Yoga Increases Right Hippocampal Density Compared to Active and Passive Control Groups: A Controlled Structural cMRI Study

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