Yoga: Effectiveness and Safety (original) (raw)

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What is yoga and how does it work?

Yoga is an ancient and complex practice, rooted in Indian philosophy. It began as a spiritual practice but has become popular as a way of promoting physical and mental well-being.

Although classical yoga also includes other elements, yoga as practiced in the United States typically emphasizes physical postures (asanas), breathing techniques (pranayama), and meditation (dyana).

There are many different yoga styles, ranging from gentle practices to physically demanding ones. Differences in the types of yoga used in research studies may affect study results. This makes it challenging to evaluate research on the health effects of yoga.

Yoga and two practices of Chinese origin—tai chi and qigong—are sometimes called “meditative movement” practices. All three practices include both meditative elements and physical ones.

What are the health benefits of yoga?

Research suggests that yoga may:

• Help improve general wellness by relieving stress, supporting good health habits, and improving mental/emotional health, sleep, and balance.
• Relieve neck pain, migraine or tension-type headaches, and pain associated with knee osteoarthritis. It may also have a small benefit for low-back pain.
• Help people with overweight or obesity lose weight.
• Help people quit smoking.
• Help people manage anxiety symptoms or depression.
• Relieve menopause symptoms.
• Be a helpful addition to treatment programs for substance use disorders.
• Help people with chronic diseases manage their symptoms and improve their quality of life.

What does research show about yoga for wellness?

Studies have suggested possible benefits of yoga for several aspects of wellness, including stress management, mental/emotional health, promoting healthy eating/activity habits, sleep, and balance.

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• Stress management.
  • A 2020 review of 12 recent studies (672 total participants) of a variety of types of yoga for stress management in healthy adults found beneficial effects of yoga on measures of perceived stress in all the studies.
  • Of 17 older studies (1,070 total participants) of yoga for stress management included in a 2014 review, 12 showed improvements in physical or psychological measures related to stress.
• Mental/emotional health. In a 2018 review of 14 studies (involving 1,084 total participants) that assessed the effects of yoga on positive aspects of mental health, most found evidence of benefits, such as improvements in resilience or general mental well-being.
• Promoting healthy eating/activity habits. Several studies of different types have shown that participation in yoga programs may motivate people to adopt healthier lifestyle habits.
  • In a 2021 study in which 60 women with obesity were randomly assigned to 12 yoga sessions or a waiting list, the beneficial effect of yoga on body mass index (BMI, an estimate of body fat based on height and weight) was found to depend on changes in physical activity and daily fruit and vegetable intake.
  • A 2018 survey of young adults (involving 1,820 participants) showed that practicing yoga regularly was associated with better eating and physical activity habits. In interviews, survey respondents said they thought yoga encouraged greater mindfulness and motivated them to participate in other forms of activity and to eat healthier. In addition, they saw the yoga community as a social circle that encourages connection, where healthy eating is commonplace.
  • In questionnaires and interviews, participants in a 2022 British study of a yoga intervention for people who were at risk for certain health conditions said that they had made changes in their lifestyles in response to the yoga program. They reported reducing consumption of unhealthy foods, increasing fruit and vegetable intake, and increasing their overall levels of physical activity.
• Sleep. Yoga has been shown to be helpful for sleep in multiple studies of cancer patients, women with sleep problems, and older adults. Individual studies of population groups including health care workers, people with arthritis, and women with menopause symptoms have also reported improved sleep from yoga.
• Balance. In a 2014 review, 11 of 15 studies (688 total participants) that looked at the effect of yoga on balance in healthy people showed improvements in at least one outcome related to balance.Several newer studies have provided additional evidence supporting a beneficial effect of yoga on balance in community-dwelling older adults.

Can yoga help with pain management?

Research has been done on yoga for several conditions that involve pain, including low-back pain, neck pain, headaches, and knee osteoarthritis. For low-back pain, a large amount of research has been done, and the evidence suggests a slight benefit. For the other conditions, the evidence looks promising, but the amount of research is relatively small.

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• Low-back pain.
  • A 2022 review of 21 studies (2,223 total participants) of yoga interventions for low-back pain found that yoga is slightly better than no exercise, but the small difference may not be important to patients. There was evidence that participating in yoga was associated with slight improvements in physical function (ability to be active) and mental quality of life (emotional problems) in people with low-back pain. It was unclear whether there was any difference between the effects of yoga and those of other types of exercise.
  • A 2020 report by the Agency for Healthcare Research and Quality evaluated 10 studies of yoga for low-back pain (involving 1,520 total participants) and found that yoga improved pain and function in both the short term (1 to 6 months) and intermediate term (6 to 12 months). The effects of yoga were similar to those of exercise and massage.
  • A clinical practice guideline issued by the American College of Physicians in 2017 recommends using nondrug methods for the initial treatment of chronic low-back pain. Yoga is one of several suggested nondrug approaches.
• Neck pain. A 2019 review of 10 studies (686 total participants) found that practicing yoga reduced the intensity of neck pain, decreased disability related to neck pain, and improved range of motion in the neck.
• Headaches.
  • A 2020 review of 6 studies (240 participants) of yoga for chronic or episodic headaches (tension headaches or migraines) found evidence of reductions in headache frequency, headache duration, and pain intensity, with effects seen mostly in people with tension headaches. Because of the small numbers of studies and participants, as well as limitations in the quality of the studies, these results should be considered preliminary.
  • A 2022 review of 6 studies (445 participants) of yoga for migraine suggested that yoga was associated with decreases in pain intensity, headache frequency, and headache duration, and reduced the impact of migraine on daily life. However, most of the studies included small numbers of people, and the types of yoga therapy varied among studies, so the results are not conclusive. Also, most of the studies were done in Asia, and their findings might not apply to other populations.
• Knee osteoarthritis.
  • A 2019 review of 9 studies (640 total participants) showed that yoga may be helpful for improving pain, function, and stiffness in people with osteoarthritis of the knee. However, the number of studies was small, and the research was not of high quality.
  • A 2019 guideline from the American College of Rheumatology and the Arthritis Foundation conditionally recommends yoga for people with knee osteoarthritis based on similarities to tai chi, which has been better studied and is strongly recommended by the same guideline.

Is practicing yoga a good way to lose weight?

There’s evidence that yoga may help people lose weight.

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• A 2022 review of 22 studies (1,178 participants) of yoga interventions for people with overweight or obesity showed reductions in body weight, BMI, body fat, and waist size.
• In 2013, a review supported by the National Center for Complementary and Integrative Health (NCCIH) looked at 17 yoga-based weight-control programs and found that most of them led to gradual, moderate reductions in weight. The programs with the best results included at least some of these elements:
  • Longer and more frequent yoga sessions (at least 75 to 90 minutes, at least 3 times per week).
  • A longer duration of the overall program (3 months or more).
  • A yoga-based dietary component.
  • A residential component (such as a full weekend to start the program).
  • A larger number of elements of yoga.
  • Home practice.

Can yoga help you quit smoking?

There’s evidence that yoga may help people stop smoking.

• A 2019 NCCIH-funded study with 227 participants compared yoga classes with general wellness classes as additions to a conventional once-weekly counseling program. The people in the yoga group were 37 percent more likely to have quit smoking by the end of the 8-week program. However, 6 months after treatment, there was no difference between the groups in the proportion of people who were still not smoking.
• A study published in 2020 showed a reduction in cigarette cravings after a single yoga session, as compared with a wellness education session. The study participants were people who were trying to cut back or stop smoking.

How does yoga affect mental health?

Yoga can be a helpful addition to treatment for depression. It may also be helpful for anxiety symptoms in a variety of populations, but there’s little evidence of a benefit for people with anxiety disorders. Yoga might have benefits for people with post-traumatic stress disorder (PTSD).

Depression

• In a 2017 review of 23 studies (involving 1,272 participants) of people with depressive symptoms (although not necessarily diagnosed with depression), yoga was helpful in reducing symptoms in 14 of the studies.
• A 2020 review of 7 studies (260 participants) of yoga interventions for people who had been diagnosed with major depressive disorder concluded that yoga may have small additional benefits for depression symptoms when used along with other forms of treatment.

Anxiety

• A 2019 review of 38 studies (2,295 participants) of yoga for anxiety symptoms found that yoga had a substantial beneficial effect, with the greatest effects seen in studies performed in India. The studies included a variety of different groups of people, including healthy people such as students and military personnel, patients with various physical or mental health conditions, and caregivers.
• A 2021 review looked at the evidence on yoga for people who have been diagnosed with anxiety disorders. The reviewers identified some promising results, but they were unable to reach conclusions about whether yoga is helpful because not enough rigorous studies have been done.
• A 2021 study of Kundalini yoga for generalized anxiety disorder (226 participants, 155 of whom completed the study), supported by NCCIH, found that Kundalini yoga improved symptoms but was less helpful than cognitive behavioral therapy, an established first-line treatment for this condition.

Post-Traumatic Stress Disorder

• A 2018 evaluation of 7 studies (284 participants) of yoga for people with post-traumatic stress disorder (PTSD) found only low-quality evidence of a possible benefit.

Can yoga help with menopause symptoms?

Yoga seems to be at least as effective as other types of exercise in relieving menopause symptoms. A 2018 evaluation of 13 studies (more than 1,300 participants) of yoga for menopause symptoms found that yoga reduced physical symptoms such as hot flashes as well as psychological symptoms such as anxiety or depression.

Is yoga helpful for substance use disorders?

A small amount of research has looked at the possible benefits of incorporating yoga into treatment programs for various types of substance use disorders (opioid, alcohol, or tobacco use disorders or others). In a 2021 review of 8 studies (1,889 participants), 7 studies showed evidence of beneficial effects in terms of reduced use of the substance or reduction in symptoms such as pain, stress, or anxiety.

Is yoga helpful for people with chronic diseases?

There’s promising evidence that yoga may help people with some chronic diseases manage their symptoms and improve their quality of life. Thus, yoga could be a helpful addition to treatment programs.

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• Cancer
  • In a 2018 evaluation of 138 studies on the use of yoga in patients with various types of cancer (10,660 total participants), most of the studies found that yoga improved patients’ physical and psychological symptoms and quality of life.
  • A 2021 review looked at 26 studies of yoga for depressive symptoms (1,486 participants) and 16 studies of yoga for anxiety symptoms (977 participants) in people with cancer. Small-to-moderate beneficial effects were seen for both types of symptoms.
  • Many yoga studies have focused on women who have or have had breast cancer. A 2022 review examined 23 studies that looked at the effects of yoga interventions on various symptoms in women with breast cancer during active cancer treatment. The majority of the studies showed significant benefits of yoga on quality of life, fatigue, nausea/vomiting, sleep quality, anxiety, depression, stress, or wound healing, suggesting that yoga may be helpful for symptom management.
  • A review of 8 studies (92 participants) suggested that yoga may have benefits for sleep, anxiety, fatigue, and quality of life in children and adolescents with cancer.
• Chronic obstructive pulmonary disease (COPD). A 2019 review of 11 studies (586 participants) of breathing-focused yoga interventions for people with Parkinson’s disease found beneficial effects of these interventions on exercise capacity, lung function, and quality of life.
• HIV/AIDS. A 2019 review of 7 studies (396 participants) of yoga interventions for people with HIV/AIDS found that yoga was a promising intervention for stress management.
• Asthma. There is evidence that yoga may be helpful for asthma symptoms and quality of life in both adults and children.
  • A 2016 review of 15 studies of yoga for asthma (involving 1,048 total participants, most of whom were adults) concluded that yoga probably leads to small improvements in quality of life and symptoms.
  • A 2020 review of 9 studies (1,230 participants) of yoga-based interventions for children or adolescents with asthma found that the use of yoga was associated with improvements in lung function, stress/anxiety, and quality of life. However, because of wide variation in both the populations who were studied and the yoga interventions that were tested, it was unclear which components of yoga and how much yoga are needed to provide benefits.
• Multiple sclerosis. Two recent reviews on yoga for people with multiple sclerosis showed little evidence of benefits. One review found a significant benefit only for fatigue (comparable to the effect of other types of exercise), and the other found no benefits for any aspect of quality of life.
• **Parkinson’s disease.**A 2022 review (14 studies, 444 participants) suggests that yoga may have benefits for mobility, balance, and quality of life for people with mild-to-moderate Parkinson’s disease. The studies that were reviewed also suggest that yoga interventions are safe and acceptable for people with this condition.

What does research show about practicing yoga during pregnancy?

Physical activities such as yoga are safe and desirable for most pregnant women as long as appropriate precautions are taken. Yoga may have health benefits for pregnant women, such as decreasing stress, anxiety, and depression.

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• Being physically active is safe and beneficial for most pregnant women. However, some precautions need to be taken.
  • If you are pregnant, you should be evaluated by your health care provider to make sure there’s no medical reason why you shouldn’t exercise.
  • You may need to modify some activities, including yoga, during pregnancy. You should avoid “hot yoga” while you are pregnant because it can cause overheating. You also need to avoid activities, including yoga poses, that involve long periods of being still or lying on your back. Talk with your health care provider about how to adjust your physical activity during pregnancy.
• A 2022 analysis of 29 studies of pregnancy yoga interventions (2,217 participants) found that these programs reduced anxiety, depression, perceived stress, and duration of labor and increased the likelihood of a normal vaginal birth. However, because the yoga programs varied widely and because some of the studies had weaknesses in their methods, additional rigorous research is needed to better understand the effects of yoga during pregnancy and to find out what types of yoga programs are best in terms of both effectiveness and safety.

Does yoga have benefits for children?

Research suggests that yoga may have several potential benefits for children.

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• A 2020 review of 27 studies (1,805 total participants) of yoga interventions in children or adolescents found reductions in anxiety or depression in 70 percent of the studies, with more promising results for anxiety. Some of the studies involved children who had or were at risk for various physical or mental health disorders and others involved groups of children in schools. The quality of the studies was relatively weak, and the results cannot be considered conclusive.
• A 2021 review evaluated 9 studies (289 total participants) of yoga interventions for weight loss in children or adolescents with obesity or overweight. Some of the studies evaluated yoga alone; others evaluated yoga in combination with other interventions such as changes in diet. The majority of the yoga interventions had beneficial effects on weight loss and related behavior changes. The studies were small, and some did not use the most rigorous study designs.
• There is a growing body of evidence on the use of yoga in school settings.
  • A 2022 review of 21 studies (2,227 participants) of school-based yoga interventions in students age 5 to 15 showed promising results suggesting that yoga may enhance mental health among children and adolescents.
  • Yoga interventions in educational settings have also been studied in preschool-aged children (age 3 to 5). A 2021 review of studies of yoga and mindfulness practices in this age group suggested that these practices may have benefits for social-emotional functioning, although more research is needed before definite conclusions can be reached.
  • A small amount of evidence suggests that school-based yoga programs may have academic and psychological benefits for neurodiverse children.

What are the risks of yoga?

Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. The most common injuries are sprains and strains, and the parts of the body most commonly injured are the knee or lower leg. Serious injuries are rare. The risk of injury associated with yoga is lower than that for higher impact physical activities.

Older adults may need to be particularly cautious when practicing yoga. The rate of yoga-related injuries treated in emergency departments is higher in people age 65 and older than in younger adults.

To reduce your chances of getting hurt while doing yoga:

• Practice yoga under the guidance of a qualified instructor. Learning yoga on your own without supervision has been associated with increased risks.
• If you’re new to yoga, avoid extreme practices such as headstands, shoulder stands, the lotus position, and forceful breathing.
• Be aware that hot yoga has special risks related to overheating and dehydration.
• Pregnant women, older adults, and people with health conditions should talk with their health care providers and the yoga instructor about their individual needs. They may need to avoid or modify some yoga poses and practices. Some of the health conditions that may call for modifications in yoga include preexisting injuries, such as knee or hip injuries, lumbar spine disease, severe high blood pressure, balance issues, and glaucoma.

How popular is yoga in the United States?

According to a national survey, the percentage of U.S. adults who practiced yoga increased from 5.0 percent in 2002 to 15.8 percent in 2022.

For children, there are data from 2017; in that year, 8.4 percent of U.S. children age 4 to 17 practiced yoga.

Why do Americans practice yoga?

National survey data from 2012 showed that 94 percent of adults who practiced yoga did it for wellness-related reasons, while 17.5 percent did it to treat a specific health condition. Some people reported doing both.

Do different groups of people have different experiences with yoga?

Much of the research on yoga in the United States has been conducted in predominantly female, non-Hispanic White, well-educated people with relatively high incomes. Other people—particularly members of minority groups and those with lower incomes—have been underrepresented in yoga studies.

Different groups of people may have different yoga-related experiences, and the results of studies that did not examine a diverse population may not apply to everyone.

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• Differences related to age. In one survey, people age 40 to 54 were more likely to be motivated to practice yoga to increase muscle strength or lose weight, while those age 55 or older were more likely to be motivated by age-related chronic health issues. People age 65 and older may be more likely to need treatment for yoga-related injuries.
• Differences related to gender. A study found evidence for differences between men and women in the effects of specific yoga poses on muscles. A study in veterans found preliminary evidence that women might benefit more than men from yoga interventions for chronic back pain.
• Differences related to Hispanic ethnicity. U.S. national survey data show lower participation in yoga among Hispanic adults, compared to non-Hispanic White adults (8.0 percent vs. 17.1 percent of adults in 2017). A small 2021 survey of U.S. Hispanic adults with low incomes showed that cost was the most common barrier to participation in yoga. Other perceived barriers included concern about the need for physical flexibility (especially among men and those with no prior experience with yoga), thinking that they would feel like outsiders in a yoga class (among those with no prior experience), and considering yoga boring (among young adults).

Research Funded by NCCIH

NCCIH is sponsoring a variety of yoga studies, including:

• An evaluation of emotion regulation as a mechanism of action in yoga interventions for chronic low-back pain.
• A study of yoga for chronic pain in people who are being treated for opioid use disorder.
• A study of the effects of yoga postures and slow, deep breathing in people with hypertension (high blood pressure).

Tips To Consider

• Don’t use yoga to postpone seeing a health care provider about a medical problem.
• Ask about the training and experience of the yoga instructor you’re considering.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Website: https://www.nccih.nih.gov

Email: info@nccih.nih.gov (link sends email)

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Acknowledgments

NCCIH thanks Inna Belfer, M.D., Ph.D., and David Shurtleff, Ph.D., NCCIH, for their review of the 2023 update of this publication.

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Last Updated: August 2023