Journal of Integrative Medicine xxx (2017) xxx–xxx

Contents lists available at ScienceDirect

Journal of Integrative Medicine

journal homepage: www.jcimjournal.com/jim
www.journals.elsevier.com/journal-of-integrative-medicine

Review

The benefits of yoga in children

Chandra Nanthakumar
Faculty of University Foundation Studies, HELP University, Bukit Damansara, 50490 Kuala Lumpur, Malaysia

a r t i c l e i n f o a b s t r a c t

Article history: The number of children suffering from stress and anxiety in Malaysia is on the rise. Evidence shows that
Received 7 July 2017 mind–body therapies such as mindfulness therapy, meditation and yoga have been practiced in many
Accepted 24 October 2017 other countries to reduce and/or manage the psychological effects of stress and anxiety. This review arti-
Available online xxxx
cle looks at the intervention of yoga as a meditative movement practice in helping school children man-
age stress and anxiety. Articles were retrieved using a combination of databases including PubMed/
Keywords: MEDLINE, and PsycINFO. Not only peer-reviewed articles, but also those written in English language were
Yoga
included in this review. All studies reviewed had incorporated some form of meditative movement exer-
Stress
Physiology
cise. The intervention encompassed asanas (postures), pranayama (expansion of life force), dharana (con-
Anxiety centration) and dhyana (meditation), which are the different paths in yoga. A total of eight articles met
Child the inclusion criteria and were reviewed. The findings of this review reveal that the practice of yoga has
brought about, among other things, improvement in managing and reducing stress and anxiety. Despite
the limitations in most, if not all of the studies reviewed, in terms of heterogeneity and sample size, yoga
appears to be an effective modality for helping children cope with stress and anxiety. It appears that if
schools in Malaysia can incorporate yoga as part of the physical education curriculum, it will definitely
benefit the students.

Please cite this article as: Nanthakumar C. The benefits of yoga in children. J Integr Med. 2017; xx(x):
xxx–xxx
Ó 2017 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2. Yoga as meditative movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
4. Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
5. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
6. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

1. Introduction and this lack of mobility has been linked to various kinds of health
issues such as obesity and physical and mental health issues [1].
Children are constantly being exposed to state-of-the-art tech- What is more, learning and teaching do not only happen during
nology, which has mushroomed over the past decade. Even though school hours. It continues after school when children are required
media technologies such as computers and cell phones are knowl- to surf the web to look for current information for their assign-
edge resources for all, their intense use has become disquieting; ments. At home, parents may exert pressure on their children to
there appears to be a decline in physical activity among these users, excel in their studies. However, when children do not perform well,
their level of confidence can be affected, contributing to student
E-mail address: chandratk@help.edu.my anxiety. In the meantime, parents and teachers may choose to

https://doi.org/10.1016/j.joim.2017.12.008
2095-4964/Ó 2017 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.

Please cite this article in press as: Nanthakumar C. The benefits of yoga in children. J Integr Med. (2017), https://doi.org/10.1016/j.joim.2017.12.008
2 C. Nanthakumar / Journal of Integrative Medicine xxx (2017) xxx–xxx
ignore signs of mental stress in the children and continue to add
pressure in the hope of making them competitive.
Sleep is often compromised when children are unable to meet
deadlines set by schools or other learning institutions. The National
Sleep Foundation recommends 8.50–9.25 h of sleep for teenagers,
but teens only get 7.4–8.1 h [2]. Research has shown that when
teens are deprived of sleep, they get anxious or stressed [1].
According to the Health Ministry in Malaysia, mental health
problems are on the rise among Malaysian students. Mental health
disorders affected one in ten individuals in 2011, but that number
has risen to one in five in 2016 [3], the same rate as in the United
States [4]. It has been revealed that anxiety and depression are the
main kinds of mental health problems among students. In a survey
of 10,123 adolescents, aged 13–18 years, in the United States, it
was found that 31.9% were suffering from anxiety disorders [5].
Anxiety occurs naturally in children to varying degrees, but in
some cases it can escalate and produce an anxiety disorder. Anxi-
ety is generally a state of unwarranted fear of nervousness about
real or imagined circumstances. There are many symptoms, and
they may vary from one person to another, affecting physical and
mental health. Common symptoms include elevated heart rate,
profuse perspiration and feeling queasy due to excess release of
adrenaline, noradrenaline and cortisol [6]. Other sources have
reported that anxiety causes stomachaches, headaches and dizzi-
ness in children [7].
The effects of anxiety on the mind also vary. While some expe-
rience a sense of fear and distress in the absence of real danger, or
the inability to relax, others may experience a sense of disorienta-
tion or brain fogginess [8]. High levels of anxiety are detrimental as
they can affect both concentration and memory, which are para-
mount for academic success [8].
Research has revealed that mind–body cognitive therapy, mind-
ful awareness and mind–body movements, like yoga, are effective
in reducing cortisol concentrations, hence enhancing mood and
well-being. However, most of these studies were done on adults
[9–12].
While there have been numerous studies on the effects of mind-
fulness practice and meditation on various mental health issues
and general well-being in children, research on the effects of clas-
sical yoga, as a meditative movement, on mental health issues in
children is relatively scarce [13]. The available literature, more
than a decade old, on the impact of yoga in children has shown that
this mind–body practice has demonstrated positive effects in the
control of anger, depression, stress, body dissatisfaction, anxiety
as well as improving positive emotion [14–16].
The Convention on the Rights of a Child [17] defines a ‘‘child” as a
person who is below 18 years of age. In this paper, all the children
who had participated in the studies reviewed were between 7 and
18 years of age. Mental health covers a wide range of disorders,
including eating disorders, dissociative disorders (i.e., affecting a
person’s memory), psychosis, obsessive–compulsive disorder, aut-
ism, attention deficit hyperactive disorder, anxiety, depression and
post-traumatic stress disorder [18]. For the purposes of this review,
only studies that have employed therapeutic yoga in children suf-
fering from stress and anxiety are included. Studies conducted in
the last seven years have been retrieved and scrutinized. If the
findings of this review shed some light on the therapeutic effects
of yoga on children, the next step would be to propose a hatha yoga
curriculum to the Malaysian Education Ministry to either supple-
ment or replace the current physical education lessons in schools.
2. Yoga as meditative movement
Among the meditative movements practiced world-wide today,
yoga is one of the most popular mind–body disciplines. Even
Please cite this article in press as: Nanthakumar C. The benefits of yoga in children. J Integr Med. (2017), https://doi.org/10.1016/j.joim.2017.12.008
though yoga is an ancient practice, it is pragmatic in its approach.
Having emerged in India in the 6th century, classical yoga, as clas-
sified by Patanjali, the founder of yoga, encompasses eight paths
[19]. These include yama (universal ethics), niyama (individual
ethics), asanas (postures), pranayama (expansion of life force),
prathyhara (withdrawal of senses), dharana (concentration),
dhyana (meditation) and lastly samadhi (blissful state). The prac-
tice of yoga is so flexible that it allows individuals to concentrate
on the paths that are beneficial to them and pay less attention to
the others.
Yoga as a complementary therapy for various physiological dis-
eases and psychological disorders has been widely studied in
adults [20,21]. Nonetheless, studies on the therapeutic use of yoga
in children is not as extensive as with adults [21]. Existing research
indicates that yoga can have multiple benefits, including improv-
ing flexibility, promoting weight loss and enhancing emotional
and psychosocial health [22].
Given that mental health is a growing problem in schools and
other learning institutions, there is an effort to provide children
with the tools necessary to cope with the behavioral expectations
placed upon them [23]. Children face not only intellectual chal-
lenges at school, but also interpersonal demands which may
require highly developed self-regulation skills, such as mindful-
ness, resilience and anger control. Studies have also revealed that
stress reactivity in children is related to blood pressure readings,
levels of adiposity and negative behaviors [24–26]. According to
Morgan et al. [27] children who underwent high levels of psycho-
logical stress had greater total adiposity than those who were less
stressed. Similarly, Roemmich et al. [24] pointed out that children
who experienced larger increases in heart rate reactivity to an
interpersonal stressor had a much larger percentage of body fat
and body mass index percentile. Increases in total adiposity and
heart rate, if unresolved, can lead to diseases such as type 2 dia-
betes, hypertension and cardiovascular diseases as early as child-
hood [28].
While there may be other solutions, the practice of yoga offers
one opportunity to develop skills (i.e., mindfulness, resilience and
anger control) to address the underlying stress. Evidence from
research maintains that an array of yoga techniques can result in
positive effects in an individual’s physiological and mental health
through the down-regulation of the hypothalamo–pituitary–
adrenal axis and sympathetic nervous system [29,30]. Studies also
suggested that yoga may develop students’ mind–body awareness,
self-regulation and physical fitness, which in turn, enhance behavior,
and mental, physical and emotional health. The 81 studies
reviewed by Ross and Thomas [29] comprised not only a variety
of trial designs, but also a variety of sub-populations (college stu-
dents, adults and senior citizens). It should be noted that even
though all the studies employed a yoga intervention, the structure
of the yoga session, type of yoga and frequency of yoga class varied
from study to study.
3. Methods
A comprehensive search was carried out of studies that had
focused on yoga as an intervention for children suffering from
stress and anxiety. The articles were identified using a combination
of databases, including PubMed, MEDLINE, and PsycINFO. Using
pertinent key words and phrases such as ‘‘intervention of yoga,”
‘‘anxiety,” ‘‘depression” and ‘‘stress,” and limiting the search to
only full text and peer-reviewed articles written in English, over
1000 articles were identified. In order to streamline the review,
only studies that had been conducted with children below 18 years
of age, and were published in the last 7 years were included. Stud-
ies of children suffering from multiple diseases were excluded, as
 C. Nanthakumar / Journal of Integrative Medicine xxx (2017) xxx–xxx 3

were studies of children with special needs. Studies that incorpo-

mirror-tracing task; NR: not reported; PANAS-C: Positive and Negative Affect Schedule; PE: physical education; PIML: People in My Life; POMS-SF: Profile of Mood States-Short form; PSS: Perceived Stress Scale; RS: Resilience
CAMM: Child Acceptance and Mindfulness Measure; CCM: constant comparative method; CG: control group; EP: Emotion Profile; IPPA: Inventory of Positive Psychological Attitudes-32R; MAT: mental arithmetic task; MTT:
No significant difference between the YG

Improvement in mental health especially

rated the intervention of yoga in children for mental health disor-

worsened in the CG; YG showed greater

Involuntary stress levels dropped in the
YG; significant reduction in rumination
ders such as attention deficit hyperactive disorder, autism,

Negative affect improved in YG, but

psychosis, eating disorders, obsessive–compulsive disorder or

mindfulness compared to the CG

and CG for the stress reactivity

health-related aspects of physical fitness were also excluded.
Only studies that employed classical yoga were considered to

and depression in the YG

have met the inclusion criteria. Due to the existence of a variety
of yoga styles, only interventions that included asana, pranayama,

in stress regulation
dharana and dhyana were included, although the duration of the
yoga classes and their frequency varied considerably from study
to study. Both qualitative and quantitative studies were included;

Findings
some were randomized controlled studies while others were
uncontrolled studies. Studies that focused on mindfulness or med-
itation as a stand-alone practice were excluded from this review.

Interviews-one-on-one and
POMS-SF; IPPA; STAXI-2;
YEQ; PSS; RS; PANAS-C;

recorded: questionnaire
EP; RSQ; SMFQ-C; PIML

face-to-face and audio

4. Results

Instruments used

MTT and MAT

A total of eight studies met the inclusion criteria and were
reviewed for this article. All the studies were conducted in the Uni-

CAMM
ted States of America. Evidently the intervention of yoga in these
studies was heterogeneous. Not only did the program duration
vary, but also the frequency of yoga sessions ranged from 30-

YG: awareness practice, breathing, asanas, vinyasa, meditation,

minute daily over five weeks to once a week sessions over a year.

YG: kripalu yoga-asanas (partner asanas included), breathing

30 min of yoga, 2 or 3 times of week for 12 weeks (32 yoga
While some of the studies were randomized controlled trials

YG: Asanas, breathing techniques, and guided mindfulness

2–3 sessions per week for 10 weeks (28 sessions in total)

and shavasana; CG: did PE (soccer, volleyball and indoor

(RCTs) [31–34] as summarized in Table 1, others were either

YG: asanas, breathing, deep relaxation, and meditation

techniques, deep relaxation, and meditation; CG: PE

uncontrolled or merely qualitative evaluations [35–38] as summa-

50 min of intervention 3 times a week for 15 weeks

walking), physically active on 75% of the total time

rized in Table 2. One study was controlled in such a way that it

45 min of yoga for 4 d a week over 12 weeks

employed a paired-sample research design [38].
In study conducted by Mendelson et al. [31] the yoga group
(YG), compared to the control group (CG), experienced a reduction
in involuntary stress reactions after practicing yoga for 12 weeks. It
appears that the mindfulness component in the yoga session was
effective in enhancing self-regulatory capacities and in reducing

techniques; CG: PE as usual

Description of intervention

worry in youth. The results from this study are encouraging, as fac-
tors such as rumination and intrusive thoughts have been linked to
not only depression, but also somatic diseases like high blood pres-
practices; CG: NR

sessions in total)
sure [39,40].
Just as in the study of Mendelson et al. [31] participants in the
study of Noggle et al. [32] were in favor of yoga. Most participants,
after having participated in the 10-week program, confirmed the
benefits of yoga. One participant in the study declared that yoga
was not only a good stress reliever, but also a relaxant for the
YG: 15 (10 males; 5
females); PE: 15 (7
Summary of randomized controlled trials using intervention of yoga in children.

Sample population

nerves. Overall the YG exhibited greater mindfulness compared

males; 8 females)

YG: 47; PE: NR

YG: 48; CG: 44

YG: 36; CG: 15

to the CG. Also, mood improved in the YG, while it deteriorated

in the CG. Findings of this study agree with those of Ross and Tho-
mas [29], suggesting that yoga may be as effective, if not superior
to exercise for improving health outcomes and specifically reduc-
NR
92

51

30

ing stress. However, the Perceived Stress Scale and the Inventory
of Positive Psychological Attitudes, although internally consistent
Mean age: (17.1 ± 0.6) years
The 4th graders with age of

Majority: African-American
graders with age of (10.6 ±

The 11th and 12th graders

Age: 10–11 (10.80 ± 0.41)

(Cronbach’s a = 0.86 and 0.97 respectively), hardly revealed any

The 9th and 10th graders
(9.7 ± 0.7) years; the 5th
The 4th and 5th graders

The 6th grade students

Basic demographics of

difference between the YG and the CG.

Age: (15 ± 1) years

In an RCT study of qualitative mode, Conboy et al. [34] found

that the participants experienced not only improved mental
health, especially in stress regulation, but also improvement in
population

nationality
0.7) years

years old

their academic and athletic performance after a 12-week kripalu

yoga intervention. Though the findings on academic and athletic
performance due to yoga intervention are not the main focus of
this review, many students who are athletes found yogic breathing
Mendelson et al. [31]

extremely beneficial in their performance on the track. It is infor-

Conboy et al. [34]
Noggle et al. [32]

Hagins et al. [33]

mative that many students found yoga to help them be aware of

Authors (year)

their own negativity, thus reducing their tendency to be emotion-

ally reactive. In fact, some of these young children found this
(2012)

(2013)

(2013)
(2010)

mind–body movement practice useful to enhance their levels of

Table 1

positive emotions. In the interview sessions, these students

deduced and revealed that yogic breathing and the asanas had

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4 C. Nanthakumar / Journal of Integrative Medicine xxx (2017) xxx–xxx

helped them relax when they were stressed or even filled with

ANT-C: Attention Network Test; BRUMS: Brunel University Mood Scale; CCM: constant comparative method; ELISA: enzyme-linked immunosorbent assay; PANAS-C: Positive and Negative Affect Schedule; PE: physical education;
A reduction in stress levels and increased self-regulation

Moods improved after the intervention of YG and PE; the

anger.

and 3rd graders showed improvement in behavior and

levels; better able to deal with stress/anxiety. The 2nd
While these three studies [31–34] reported positive outcomes

The 2nd graders showed significant drop in cortisol

Able to control their behavior (anger) in stressful
due to intervention with yoga, a 15-week study on the 6th grade

YG experienced greater improvement in mood

students failed to produce similar results [33]. The findings in
the latter study revealed hardly any difference in the stress reactiv-
ity between the YG and the CG. It is rather surprising, as sources of
situations; improved self-esteemed

potential bias were reduced drastically by ensuring that the demo-

graphic population, attendance, and engagement index values
were equivalent across both groups. In addition, this study was a
randomized one with blinded investigators. However, it may be
ability to control anger

noteworthy that some of the YG participants in this study were

not too pleased doing yoga when they realized that their counter-
parts, who were assigned to the CG, had engaged in more active
sports like basketball or soccer. At this point, it is unclear whether
Findings

these feelings influenced the outcome of the study. It may be

important to consider the mechanics of randomization and manag-
ing participant expectations during the study design stage.
On the other hand, the findings of the qualitative evaluations
Instruments used

ANT-C and ELISA

and uncontrolled studies in this review have shed some insight

interviews (in
focus groups)

BRUMS and

on the effectiveness of yoga for helping children cope with stress

Recorded

PANAS-C

and anxiety.
In an 8-week, qualitative, uncontrolled study conducted by
CCM

Case-Smith et al. [35] the yoga intervention had very positive

results for the third grade students. The yoga program provided
Five 35-minute yoga lessons per week for 3 weeks followed
Yoga for classrooms (Y4C): pranayama, asanas, meditation
sessions for remaining 4 d in a week over a duration of 8

the participants with stress-management strategies which helped

45-minute yoga sessions per week plus 15-minute yoga

learning history & rules of sports/activity & practicing it

YG: asanas, breathing techniques, and mindfulness; PE:
Participants were interviewed at the end of the session

them relax. Self-esteem was also heightened in these young partic-

ipants. Besides being able to control their behavior, the students
One to two yoga session per week over one year

enjoyed the yoga activity, as it supported their well-being without

by five 35-minute lessons of PE for one week

having to go through any pressure for performance. Similarly, par-

Duration: 0.5 h per session for 10 weeks

ticipants in Wang and Hagin’s [37] one-year yoga intervention

study experienced the same benefits; the children revealed that
Yoga: asanas, breathing, meditation

yoga had helped them overcome stressful situations. However,

the children in this study did not experience the benefit of body
Description of intervention

techniques and relaxation

awareness that was reported by Case-Smith et al. [35].

Felver et al. [38] on the other hand, used a paired-sample
research design, where the 9th and 10th grade participants did
yoga for three weeks and then alternated it with physical educa-
tion. Moods improved in the participants after being subjected to
both types of intervention; nevertheless, the YG experienced
weeks

greater improvement than the physical education group.

To date, there is not much data available on the effects of yoga
Summary of non-randomized controlled trials using intervention of yoga in children.

on cortisol concentration in children. Cortisol, a glucocorticoid hor-

population

mone produced by the adrenal glands, is the primary hormone

Sample

released in response to stress. Its main function is to restore home-

21

36

74

47

ostasis following exposure to stress. Studies have shown a positive

correlation between elevated levels of cortisol and anxiety, which
The 3rd graders: 12 girls and 9 boys

Students from 4 schools put into six

48% male, 52% female; mean age in

is one of the negative effects of stress [41,42]. The immune system

Basic demographics of population

The 2nd and 3rd grade students

is suppressed by cortisol molecules when stress levels are high and

Urban middle and high school

semi-structured focus groups

Mean age in years: 7.4 ± 0.5

consequently the body becomes susceptible to diseases such as

The 9th and 10th graders

depression, diabetes, autoimmune disorders and cardiovascular

students (grades 5–12)
(20 boys and 16 girls)

disorders [30]. Studies have shown that yoga may have an imme-
years: 15.75 ± 0.75

diate down-regulating effect on hypothalamo-pituitary-adrenal

axis and sympathetic nervous system, thus producing a calming
effect on the body and mind [30].
In an uncontrolled pilot study, Butzer et al. [36] revealed that
the third grade students in their study showed greater improve-
ment in academic performance and greater ability to cope with
Wang et al. [37] (2016)

Felver et al. [38] (2015)

stress and anxiety after a 10-week yoga intervention. Having said

Case-Smith et al. [35]

that, it is rather difficult to infer that yoga brought about the

Butzer et al. [36]

tremendous change in the cortisol concentration in these children,

Authors (year)

YG: yoga group.

due to the absence of a control group. There may have been other
(2015)
(2010)

factors influencing the levels of this stress hormone in the body

[43]. These young children may have been in awe of the new type
Table 2

of ‘‘exercise regime” (coordinating the movements in the asanas

with breath and learning new breathing techniques), which

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 C. Nanthakumar / Journal of Integrative Medicine xxx (2017) xxx–xxx
affected their temperament in a positive way. Alternatively, they
may have inadvertently taken a liking to the yoga instructor. Stud-
ies have shown that among other parameters, coping style and
temperament can affect cortisol concentration [44].
5. Discussion
Therapeutic yoga, which is one of the meditative movement
practices, appears to be effectual in helping children cope with
stress and anxiety. It engages not only the body, but more impor-
tantly, the mind in promoting well-being [44]. Most of the studies
scrutinized in this review appear to have produced satisfactory
outcomes. According to Hennington [45] yoga can be approached
comprehensively in stress management. Woodyard [22] reported
that yogic practices encompassing asanas, pranayama and mind-
fulness/meditation sessions bring about a calming effect to the
mind, thus diminishing stress and anxiety levels. This is not sur-
prising as these effects were observed in most of the studies
reviewed in this article.
Improvement in the participants’ self-regularity capacities has a
pronounced effect on the development of core competencies that
will promote positive behavioral, emotional and academic out-
comes. The findings in an RCT study [31], for example, which con-
curs with that of Greenberg [40], imply that meditative
movements like yoga help release tension and blockage of energy
in the joints or organs [46]. The flow of prana (life force) is
smoothed as tension is released, generating a sense of well-being
and balance in the body, mind and spirit. Also the findings of most
studies in this review are in agreement with those of Kauts and
Sharma [47] and Telles et al. [48] Their studies revealed that
children’s physical and mental well-being, resilience, mood and
self-regulation skills, pertaining to emotions and stress, increased
after experiencing therapeutic yoga. The results from these studies
[31–42], despite their limitations, do seem to imply that a yoga cur-
riculum would benefit the students’ psychosocial and emotional
well-being. The benefits of yoga are evident and schools must be
willing to incorporate this activity as part of the school curriculum.
One interesting finding in one of the qualitative studies in this
review is that breathing techniques appealed to the participants
[34]. Nevertheless, this is not surprising, as adult studies have
demonstrated that pranayama induces change in brain activity
and lowers oxidative stress [49]. The parasympathetic nervous sys-
tem is activated, thus reducing the heart rate. Similarly, during
shavasana (corpse pose) or deep relaxation (yoga nidra), activity
of the sympathetic nervous system is reduced [49,50]. It is amazing
how the children in Conboy et al.’s [34] study had logically
deduced that, when they were stressed or angry, they could prac-
tice pranayama to de-stress themselves. It appears that if the
awareness of the benefits of yoga can be spread to a larger popula-
tion, children may not need to depend on medication whenever
they are stressed. Instead of heading to a clinic for every stress
or anxiety attack, these children may opt for yoga.
However, in this review, most, if not all, of the studies were lim-
ited by not only a small sample size but also heterogeneity in the
sample population. In focus group interviews, peer dynamics
may have impacted the participants’ responses; this is because
most participants knew one another [34]. Hence their comments
could have been skewed in some way. Also, data regarding partic-
ipant characteristics, such as family history and socio-economic
status, peer relationships, and psychiatric diagnosis (if any) prior
to the study, were not collected in all the studies. All this informa-
tion would have been useful in providing more meaningful contex-
tual details to interpret the results. Some studies, on the other
hand, lacked control groups, which made it hard to determine
whether the results obtained were due to yoga intervention or
something else.
Please cite this article in press as: Nanthakumar C. The benefits of yoga in children. J Integr Med. (2017), https://doi.org/10.1016/j.joim.2017.12.008
5
6. Conclusion
The intervention of yoga, encompassing asanas, pranayama,
prathyhara, dharana and dhyana, appears effective in helping chil-
dren overcome stress and anxiety. The restorative postures, shava-
sana (corpse pose), and pranayama (expansion of life force) lull one
into a state of prathyhara (withdrawal of senses), which enables
downtime for the nervous system. The practice of yoga, if done
consistently, may enable children to connect with their inner
world through the coordination of mind, body and breath to
achieve greater heights of mindfulness. Higher states of tranquility
are achieved, paving the way to a healthier physical, mental and
emotional life. This meditative movement practice appears to be
a cost-effective way for dealing with stress and anxiety.
While more in-depth research into the assessment of psychoso-
cial and educational outcomes in response to therapeutic yoga is
needed, schools in Malaysia should seriously consider opening
their classroom doors to this meditative movement regime, as it
appears to be a viable practice supporting the psychosocial needs
of today’s children. As a pilot experiment, it is suggested that yoga
sessions be implemented either as part of the routine physical edu-
cation lesson or after school hours as an extra co-curricular activ-
ity. If resources are limited, children with psychosocial and
emotional issues may be prioritized for access to yoga sessions.
Since yoga is secular and can be practiced by anyone, independent
of race, gender or creed, schools may either hire or send existing
physical education teachers for intensive training so that they
can be certified to teach yoga. The Malaysian Ministry of Education,
in turn, may consider providing support in terms of funding for
teacher training in yoga. The next step would be to monitor behav-
ioral changes in students and take it from there. In the meantime,
schools may approach non-governmental organizations, like the
Malaysian Yoga Society, to provide volunteer yoga instructors.
Conflict of interest
The author declares there is no conflict of interest.
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