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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 though yoga is an ancient practice, it is pragmatic in its approach.
pressure in the hope of making them competitive. Having emerged in India in the 6th century, classical yoga, as clas-
Sleep is often compromised when children are unable to meet sified by Patanjali, the founder of yoga, encompasses eight paths
deadlines set by schools or other learning institutions. The National [19]. These include yama (universal ethics), niyama (individual
Sleep Foundation recommends 8.50–9.25 h of sleep for teenagers, ethics), asanas (postures), pranayama (expansion of life force),
but teens only get 7.4–8.1 h [2]. Research has shown that when prathyhara (withdrawal of senses), dharana (concentration),
teens are deprived of sleep, they get anxious or stressed [1]. dhyana (meditation) and lastly samadhi (blissful state). The prac-
According to the Health Ministry in Malaysia, mental health tice of yoga is so flexible that it allows individuals to concentrate
problems are on the rise among Malaysian students. Mental health on the paths that are beneficial to them and pay less attention to
disorders affected one in ten individuals in 2011, but that number the others.
has risen to one in five in 2016 [3], the same rate as in the United Yoga as a complementary therapy for various physiological dis-
States [4]. It has been revealed that anxiety and depression are the eases and psychological disorders has been widely studied in
main kinds of mental health problems among students. In a survey adults [20,21]. Nonetheless, studies on the therapeutic use of yoga
of 10,123 adolescents, aged 13–18 years, in the United States, it in children is not as extensive as with adults [21]. Existing research
was found that 31.9% were suffering from anxiety disorders [5]. indicates that yoga can have multiple benefits, including improv-
Anxiety occurs naturally in children to varying degrees, but in ing flexibility, promoting weight loss and enhancing emotional
some cases it can escalate and produce an anxiety disorder. Anxi- and psychosocial health [22].
ety is generally a state of unwarranted fear of nervousness about Given that mental health is a growing problem in schools and
real or imagined circumstances. There are many symptoms, and other learning institutions, there is an effort to provide children
they may vary from one person to another, affecting physical and with the tools necessary to cope with the behavioral expectations
mental health. Common symptoms include elevated heart rate, placed upon them [23]. Children face not only intellectual chal-
profuse perspiration and feeling queasy due to excess release of lenges at school, but also interpersonal demands which may
adrenaline, noradrenaline and cortisol [6]. Other sources have require highly developed self-regulation skills, such as mindful-
reported that anxiety causes stomachaches, headaches and dizzi- ness, resilience and anger control. Studies have also revealed that
ness in children [7]. stress reactivity in children is related to blood pressure readings,
The effects of anxiety on the mind also vary. While some expe- levels of adiposity and negative behaviors [24–26]. According to
rience a sense of fear and distress in the absence of real danger, or Morgan et al. [27] children who underwent high levels of psycho-
the inability to relax, others may experience a sense of disorienta- logical stress had greater total adiposity than those who were less
tion or brain fogginess [8]. High levels of anxiety are detrimental as stressed. Similarly, Roemmich et al. [24] pointed out that children
they can affect both concentration and memory, which are para- who experienced larger increases in heart rate reactivity to an
mount for academic success [8]. interpersonal stressor had a much larger percentage of body fat
Research has revealed that mind–body cognitive therapy, mind- and body mass index percentile. Increases in total adiposity and
ful awareness and mind–body movements, like yoga, are effective heart rate, if unresolved, can lead to diseases such as type 2 dia-
in reducing cortisol concentrations, hence enhancing mood and betes, hypertension and cardiovascular diseases as early as child-
well-being. However, most of these studies were done on adults hood [28].
[9–12]. While there may be other solutions, the practice of yoga offers
While there have been numerous studies on the effects of mind- one opportunity to develop skills (i.e., mindfulness, resilience and
fulness practice and meditation on various mental health issues anger control) to address the underlying stress. Evidence from
and general well-being in children, research on the effects of clas- research maintains that an array of yoga techniques can result in
sical yoga, as a meditative movement, on mental health issues in positive effects in an individual’s physiological and mental health
children is relatively scarce [13]. The available literature, more through the down-regulation of the hypothalamo–pituitary–
than a decade old, on the impact of yoga in children has shown that adrenal axis and sympathetic nervous system [29,30]. Studies also
this mind–body practice has demonstrated positive effects in the suggested that yoga may develop students’ mind–body awareness,
control of anger, depression, stress, body dissatisfaction, anxiety self-regulation and physical fitness, which in turn, enhance behavior,
as well as improving positive emotion [14–16]. and mental, physical and emotional health. The 81 studies
The Convention on the Rights of a Child [17] defines a ‘‘child” as a reviewed by Ross and Thomas [29] comprised not only a variety
person who is below 18 years of age. In this paper, all the children of trial designs, but also a variety of sub-populations (college stu-
who had participated in the studies reviewed were between 7 and dents, adults and senior citizens). It should be noted that even
18 years of age. Mental health covers a wide range of disorders, though all the studies employed a yoga intervention, the structure
including eating disorders, dissociative disorders (i.e., affecting a of the yoga session, type of yoga and frequency of yoga class varied
person’s memory), psychosis, obsessive–compulsive disorder, aut- from study to study.
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- 3. Methods
fering from stress and anxiety are included. Studies conducted in
the last seven years have been retrieved and scrutinized. If the A comprehensive search was carried out of studies that had
findings of this review shed some light on the therapeutic effects focused on yoga as an intervention for children suffering from
of yoga on children, the next step would be to propose a hatha yoga stress and anxiety. The articles were identified using a combination
curriculum to the Malaysian Education Ministry to either supple- of databases, including PubMed, MEDLINE, and PsycINFO. Using
ment or replace the current physical education lessons in schools. 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
2. Yoga as meditative movement 1000 articles were identified. In order to streamline the review,
only studies that had been conducted with children below 18 years
Among the meditative movements practiced world-wide today, of age, and were published in the last 7 years were included. Stud-
yoga is one of the most popular mind–body disciplines. Even ies of children suffering from multiple diseases were excluded, as
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
C. Nanthakumar / Journal of Integrative Medicine xxx (2017) xxx–xxx 3
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
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
Instruments used
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-
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
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 ±
nationality
0.7) years
years old
(2013)
(2013)
(2010)
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
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
BRUMS and
PANAS-C
and anxiety.
In an 8-week, qualitative, uncontrolled study conducted by
CCM
36
74
47
disorders [30]. Studies have shown that yoga may have an imme-
years: 15.75 ± 0.75
due to the absence of a control group. There may have been other
(2015)
(2010)
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
C. Nanthakumar / Journal of Integrative Medicine xxx (2017) xxx–xxx 5
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
6 C. Nanthakumar / Journal of Integrative Medicine xxx (2017) xxx–xxx
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