Evidence-based Review of Yoga Interventions for Adolescent Health and Well-being in US Schools

Abstract

The adolescent behavioral health crisis has intensified pressures to foster both physical health and mental well-being, particularly in the post-COVID-19. Yoga, as a holistic approach, has been integrated into existing curricula and positive behavioral interventions. This review examines the implementation and impact of yoga interventions in the U.S., with a focus on adolescent students in secondary schools, to identify effective strategies and provide recommendations to ensure the sustainable integration of yoga into school-based behavioral health initiatives. The articles were systematically searched from EBSCOhost, PubMed, and Web of Science databases. Inclusion criteria were: yoga component with physical elements, implemented in U.S. secondary schools as part of PE curricular or school interventions, and published in English in peer-reviewed journals. This review synthesizes findings from 17 studies on yoga interventions, highlighting notable benefits across physical and psychosocial outcomes. While most interventions are integrated into the school day, some alterations, including the afterschool and virtual formats, have emerged, providing insight into accessibility to school health promotion. The review suggests that ongoing research to refine intervention designs, address implementation barriers, and expand the reach of yoga interventions to racially and ethnically diverse populations is warranted. Overall, this review advocates for integrating yoga into health promotion initiatives, which provide adolescents with practical tools to enhance their well-being in the educational setting.

Introduction

The current adolescent behavioral health crisis has placed unparalleled pressure on schools, which are struggling to promote both academic success and well-being among students in the post-COVID-19 era. Adolescence, aged 10–19 years, defined by the World Health Organization (WHO),[1] is a critical developmental period marked by rapid physical, cognitive, and emotional changes.[2] A recent report from the Centers for Disease Control and Prevention (CDC) indicated that poor mental health, including persistent sadness or hopelessness, among adolescent students remains a trending concern.[3] According to the CDC report, the school-wide positive behavioral interventions are essential for reducing disruptive classroom behavior and fostering a positive learning environment, thereby promoting students’ physical and mental health. Yoga interventions build on this foundation by integrating holistic wellness practices to enhance cognitive, behavioral, and mental well-being among students.[4] While yoga interventions are most extensively used in India,[5,6,7] similar interventions are growing in secondary schools across the United States (U.S.).[8,9,10] These interventions typically include breathing exercises, yoga postures, relaxation techniques, and other meditation practices.[11,12] Students often transferred the skills acquired in yoga interventions to real-world situations, both academically and personally.[12,13] Challenges to the successful implementation of these yoga interventions in secondary schools include poor program fidelity and logistical issues.[14,15] To address these challenges, we aim to review the implementation and practices of yoga interventions for adolescents in U. S. schools.

Yoga interventions in schools: Enhancing physical, mental, and behavioral health in adolescents

Yoga interventions implemented in India typically follow traditional yogic practices, including a traditional yogic diet, asanas (postures), pranayama (breathing exercises), and mantra chanting.[16,17,18] In the U. S., yoga is gaining popularity as a school-wide behavioral intervention, with interventions like Kripalu Yoga being implemented in the middle and high schools.[19] Participation in school-based yoga interventions fosters a wide range of physical, mental, and behavioral benefits, promotes a positive learning environment, and may facilitate academic success in adolescents.

Yoga interventions in schools yield physical health benefits for students. Namely, Gupta and Anjana[11] found significant decreases in body fat, BMI, waist measurement, and blood pressure in students who participated in a 5-month yoga intervention in Chennai and New Delhi. Additionally, students in the intervention group showed significantly lower salivary cortisol levels, a stress indicator, compared to those who did not participate.[11] This suggests yoga helps reduce stress in adolescents. Other benefits include increased energy levels and physical conditioning, such as balance, strength, and flexibility.[20] Moreover, yoga interventions provide a physical activity option for nonathletic students. In studies comparing yoga intervention to traditional physical education (PE), nonathletic students preferred yoga interventions and enjoyed it more.[15,21] Thus, yoga interventions provide a valuable fitness opportunity for students who do not enjoy PE.

Yoga interventions positively impact the mental and behavioral health of adolescents. While past findings are promising, particularly for at-risk and disadvantaged adolescents,[22,23] yoga interventions also yield positive results in general education settings. Yoga interventions have been found to reduce depression, anxiety, and stress in adolescents.[9,16,24] Students participating in school-based yoga interventions also report significant reductions in school-related stress and anxiety, including lower test anxiety.[5,20,25] Therefore, yoga interventions may foster mental, emotional, and behavioral well-being among students affected by the behavioral health crisis.

Yoga interventions may play an instrumental role in addressing the behavioral health crisis by reducing classroom disruptions and supporting an ideal learning environment. Specifically, with their focus on mindfulness and relaxation, yoga interventions help adolescents better manage anger and aggression by applying these practices in real-world situations, as studies show significant reductions in these behaviors.[26,27,28] Yoga fosters social-emotional competence in adolescents by practicing mindfulness and self-reflection, which promote emotional regulation and improve coping skills.[13,29]

Yoga benefits may contribute to learning behavior, with some studies showing better classroom engagement and enhanced focus during tasks.[10,30,31] While some findings suggest yoga may not directly improve cognitive performance, it may help reduce classroom disruptions and improve behavioral outcomes.[32] Wang and Hagins[33] speculated that yoga practices, particularly relaxation techniques, can enhance classroom behavior by reducing anxiety and promoting emotional regulation. The disparities in behavioral and cognitive outcomes highlight the need for further research to understand the efficacy of yoga interventions for adolescent students in schools and the factors behind these varying results.

Key challenges to school-based yoga interventions include implementation, fidelity, and long-term sustainability.[28] Past studies suggest for long-term benefits, yoga must be practiced consistently over time.[31] Students in school-based yoga interventions often report challenges that prevent them from practicing yoga after the intervention ends. Barriers include difficulty finding time to practice outside of school and locating free yoga classes for adolescents.[15] These challenges pose a risk to students’ regression without continued practice. Given the critical need for accessible and sustainable solutions to the adolescent health crisis, it is imperative to understand the practical aspects of implementing these programs in a school setting.

Thus, this review aims to synthesize the current evidence on the implementation and practices of yoga interventions for adolescents in U. S. schools. By examining the existing literature, we seek to identify effective strategies, highlight key challenges, and provide recommendations to ensure the successful and sustainable integration of yoga into school-based behavioral health initiatives.

Methods

Data sources and search strategy

The search strategy was designed to comprehensively identify studies related to the implementation and impact of yoga interventions in secondary educational settings. For the purpose of this review, we defined adolescents as individuals aged 10–19 years, in line with the WHO definition.[1] The age group of middle school and high school students falls under this age range. Hence, the search strategy was conducted using the keywords “yoga” and “secondary education” (OR “middle school” OR “high school”)” in selected databases relevant to the targeted topics. The following databases were searched in October 2024: EBSCOhost (including Academic Search Premier, Alt HealthWatch, CINAHL, ERIC, PsycINFO, and SPORTDiscus), PubMed (including MEDLINE), and Web of Science. These databases were chosen due to their comprehensive coverage of research in the areas of education, health promotion, and complementary practices, ensuring access to high-quality and peer-reviewed literature. A secondary search was conducted by reviewing the reference lists of selected articles and searching on Google Scholar, using the same keywords.

Data collection process

All research team members collaborated to identify, screen, and select the final articles included in this review. The first two authors independently assessed the eligibility of the identified articles and drafted the manuscript, with several meetings held to discuss the articles during the screening process and the manuscript development process. The third, fourth, and fifth authors also reviewed these articles based on the selection criteria to ensure a comprehensive evaluation of the selected studies and contributed to editing the manuscript.

Eligibility criteria

The following criteria were applied in this review study. Inclusion criteria were programs that: (1) incorporated a yoga component with physical elements, (2) were implemented in secondary school settings in the U. S. (either integrated into the school schedule or offered before or after school), (3) were designed as part of a PE curriculum, pilot studies, quasi-experimental designs, or randomized controlled trials, and (4) were written in English and published in peer-reviewed journals. Exclusion criteria were: (1) studies that focused solely on meditation or relaxation techniques without physical components such as postures (asana) and controlled breathing (pranayama), (2) studies implemented in the elementary school or college settings, (3) studies conducted outside of the U. S., and (4) protocols, review/commentary, dissertations, and conference presentations.

Selection process and data synthesis

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)[32] guidelines to illustrate the data extraction process [Figure 1]. Our initial search yielded 531 articles. We applied inclusion criteria when screening titles and abstracts for eligibility. Full-text reviews were conducted for articles where eligibility could not be determined based on the title and abstract alone. Studies without full text, nonpeer-reviewed articles, non-intervention studies, nonsecondary school settings, nonyoga interventions, non-U.S.-based studies, and nonEnglish articles were excluded. Ultimately, our search identified 17 studies that met the inclusion criteria [Table 1].

Figure 1.

PRISMA flow diagram for school-based yoga intervention for adolescent students studies

Table 1.

School-based yoga interventions for adolescent students in the U.S. (n=17)

Authors/years	Participants	Interventions/designs	Comparison group	Outcomes
Khalsa et al./2012	n=121, 11th and 12th-grade students (mean age: 16.8 years); enrolled in a rural Massachusetts secondary school	Followed the Yoga Ed curriculum; 30–40-min sessions two to three times per week for 11 weeks Preliminary RCT	Participated in a traditional PE course	The yoga group showed statistically significant improvement in resilience (P=0.014), anger control (P=0.028), and fatigue (P=0.009) over time
Noggle et al./2012	n=51, 11th and 12th-grade students (mean age: 17.1–17.3 years) at a rural Massachusetts secondary school	Followed a Kripalu-based program; 40-min sessions 2–3 times per week for 10 weeks (28 total sessions) Preliminary RCT	Participated in a traditional PE course	The yoga group demonstrated significant improvement in total mood disturbance (P=0.015), tension-anxiety (P=0.002), and negative affect (P=0.006)
Conboy et al./2013	n=28, 9th and 10th-grade students (mean age: 15) at a rural Massachusetts secondary school	Followed the KYIS curriculum; 30-min sessions 2–3 times per week for 12 weeks Qualitative interview study	Mixed control group; some students participated in a traditional PE course, while others had a mixture of yoga and PE	Participants reported the benefits of yoga in many contexts, including athletic performance, kinesthetic awareness, psychological benefits, and emotion management
Frank et al./2014	n=49, 9th–12th-grade students in a California alternative public high school setting	Followed the transformative life skills program; 30-min sessions three to four times per week for one academic semester Pretest–posttest design	Pre- and posttest design; no comparison group used	Participants demonstrated significant improvement in emotion regulation indicators including involuntary engagement (P=0.01), involuntary action (P=0.01), rumination (P=0.01), intrusive thoughts (P=0.01), physical arousal (P=0.01), and emotional arousal (P=0.01); improvement in anxiety (P=0.01), depression (P=0.01), and global symptom index (P=0.01)
Butzer et al./2015	n=95, 9th and 10th-grade students in a public Massachusetts high school	Followed the KYIS; 35–40-min sessions 2–3 times per week for 12 weeks (scheduling differences resulted in two classrooms receiving 28 total sessions while one classroom received 29 sessions) Group-RCT	Participated in a traditional PE course	The control group experienced a sharper decline in GPA from Q1 to Q3 (P=0.03). Results suggest that yoga might have a protective effect on academic performance by preventing declines in GPA
Felver et al./2015	n=47, 9th and 10th-grade students (mean age: 15 years and nine months) in a rural Massachusetts public high school	Followed the KYIS; modified to contain 35–40 min sessions five times per week for 3 nonconsecutive weeks alternating with a traditional PE class (15 sessions total) Quasi-experimental paired-sample controlled trial	Within group control condition; students alternated between yoga and traditional PE classes and were examined after yoga and PE conditions, respectively	The yoga group reported significant improvements in mood and affect, but only for anger (P=0.013), depression (P=0.028), and fatigue (P=0.034) after the yoga class relative to the PE class
Dariotis et al./2016	n=22, middle school students (median age: 11) from low-income urban communities	Yoga program implemented by the HLF; adapted to implement 45-min sessions twice weekly for 16 weeks Qualitative focus group design	No comparison group used	Key themes included a lack of differentiation between stress and negative emotions among students and interpersonal conflict as a key stressor. In regard to the yoga program, students reported improved impulse control and emotional regulation, and a reduction in interpersonal conflict following the intervention
Fishbein et al./2016	n=85, 9th–12th-grade students (mean age: 16.7 years) attending a school for at-risk students	Mindful yoga curriculum developed by Miller et al., 2014; 50-min sessions three times weekly for 7 weeks Pilot RCT	Control students did not attend the yoga sessions	Yoga group showed trends toward decreased alcohol use (significance at P<0.10), improved teacher-rated social skills (P<0.10), and a slight nonsignificant increase in skin conductance as a measure of stress response compared to the control group
Hagins/2016	n=112, 9th–11th-grade students (mean ages: 15.20 and 15.44) from a single public high school in New York City	Sonima Foundation yoga curriculum; 45-min sessions two times per week for one academic year (58 total sessions) Cluster-RCT	Participated in a traditional PE course	Higher participation in the yoga program was significantly associated with higher mean year GPA (P=0.002). Overall, participants who attended 49 yoga classes had significantly improved mean-year GPA compared to those who participated in 49 PE sessions (P=0.009)
Wang/2016	n=74, urban middle and high schools that primarily serve minority youth	Sonima Foundation yoga curriculum; implementation varied based on unique school schedules, but students generally received at least 1–2 45-min yoga sessions per week for one academic year Qualitative focus group design	Only students in the yoga group participated in the qualitative interviews	Participants reported the following perceived benefits postprogram: Improvements in self-regulation, mindfulness, reduction of stress, increased self-esteem, and improved academic performance. Reported physical benefits include improved physical conditioning, energy levels, and increased athletic performance
Butzer, LoRusso, Shin et al./2017	n=211, 7th-grade students from a public secondary school in Boston, Massachusetts	KYIS; modified to include 35-min sessions 1–2 times per week for 6 months; increased to 32 sessions from the original 24-session curriculum Preliminary group-RCT	Participated in a traditional PE course	Participants in the control group were significantly more willing to smoke cigarettes immediately postintervention compared to the yoga group (P=0.03). Female participants in the yoga intervention reported improvements in emotional self-control, whereas this was consistent among males in the PE group (P<0.001)
Butzer, LoRusso, Windsor et al./2017	n=211, 7th-grade students from a public secondary school in Boston, Massachusetts	KYIS; modified to include 35-min sessions one to two times per week for 6 months; increased to 32 sessions from the original 24-session curriculum Randomized postintervention qualitative interview design	Only students in the yoga group participated in the qualitative interviews	Participants reported applying yoga techniques and philosophy to various areas of their life. Participants also shared particularly positive opinions regarding the beneficial effects of yoga on stress, sleep, and relaxation, although there were mixed opinions of positive effects on social interaction, self-regulation, substance use attitudes, and academic performance
McClendon/2018	n=22, African American high school students attending a rigorous college preparatory school	Unspecified yoga program developed and implemented by the research team; 1 h and 15 min sessions held four times weekly for 3 weeks Quasi-experimental non-RCT	Participated in the track program	Yoga group participants experienced a nonsignificant 13% decrease in stress levels compared to the control group
Felver et al./2020	n=23, 6th-grade students	Kripalu Yoga in the School’s curriculum; 45-min sessions one to three times per week for 7 weeks (15 yoga sessions total); embedded into PE curriculum, so students still participated in traditional PE Quasi-experimental non-RCT	Participated in an art and music class	Participants in the yoga group significantly increased social-emotional competence compared to the art and music group (P=0.009)
Sanchez/2021	n=49, at-risk Hispanic high school students from a dual-enrollment high school environment	Yoga curriculum developed from a framework developed by Butzer et al., 2016; 60-min sessions twice weekly for 12 weeks delivered remotely via zoom (24 yoga sessions total) Qualitative postintervention design	No comparison group used	Positively impacted participant’s self-awareness, self-management, and decision-making
Wang/2021	n=25, 10th-grade students at an urban charter high school in Brooklyn, New York	Mindful movement program; 30–45-min sessions 5 days per week for eighteen weeks Qualitative focus group design	No comparison group used	Participants identified the most growth in self-awareness, self-management, and decision-making, whereas improvements in social awareness and relationship skills were not discussed as often
Davis et al./2022	n=18, high school students in rural Montana who had a moderate to high ACE score	Yogis In Service Trauma-Informed Yoga curriculum (outlined in Cook-Cottone et al., 2017); 45-min sessions twice weekly for 7 weeks Pretest–posttest design	One-group pre- and post-test research conditions; no comparison group	Participants reported significant reductions in anxiety (P=0.017) self-reported strengths and difficulties (P=0.026), and emotional symptoms (P=0.032) postintervention

The included studies are presented in chronological order. PE: Physical education, KYIS: Kripalu Yoga in the Schools, HLF: Holistic Life Foundation, RCT: Randomized controlled trial, ACE: Adverse childhood experiences, GPA: Grade point average

Results

Overview of the yoga interventions reported in the review

A total of 17 studies met the inclusion and exclusion criteria for this review. All included studies were conducted in the U. S. and implemented as school-based interventions in middle or high school settings. The studies were published between 2012 and 2022. Of these interventions, four were implemented in middle schools, 12 in high schools, and one in both middle and high schools. Sixteen interventions were integrated into the regular school day, while only one was held after school. Sample sizes ranged from 18 to 211 participants. The duration of the interventions ranged from 3 weeks to one academic year. Additionally, 10 of the interventions were comparative interventions, where students in the control group participated in an alternative activity, or no activity at all. Specifically, seven studies compared yoga with traditional PE classes, one study compared yoga with an extracurricular track program, one study compared yoga with an arts and music class, and one study compared yoga with no alternative activity at all. In terms of the research design, there were six qualitative studies, six randomized controlled trials (RCTs; three studies were randomized at the individual level and three were randomized at the group level), three quasi-experimental designs, and two pretest–posttest designs. Table 1 summarizes school-based yoga interventions aimed at improving wellness, academic performance, and behavioral outcomes among U. S. adolescent students in middle and high schools.

Implemented yoga intervention/curricula

Kripalu yoga in the schools

The Kripalu Yoga in the Schools (KYIS) intervention was the most used curriculum in this review, with seven studies reporting its implementation. Noggle et al.[15] were the first to implement the Kripalu-based intervention with 11^th and 12^th graders at a rural Massachusetts high school, examining the psychological effects of yoga in an academic setting. This intervention was integrated into the school day as a comparative PE intervention, with two to three Kripalu-based yoga sessions held weekly for ten weeks. Each session followed the Yoga Ed format: 5 min of centering, 5 min of warm-up, 15 min of yoga postures, and 5 min of closing relaxation.[15] Like Yoga Ed, each session included a talking point connected to yoga philosophy to enhance cognitive and social skills.[15,25] Notably, Noggle et al.[15] extended the intervention to 40-min sessions instead of the traditional 30-min sessions, standardizing the KYIS intervention.

Conboy et al.[14] implemented the KYIS intervention with 9^th and 10^th graders in a rural Massachusetts high school as a comparative PE study. Yoga sessions were held 2–3 times per week for 12 weeks to understand student perspectives on the curriculum and its perceived benefits. The study was designed as a comparative intervention, with some participants attending both PE and yoga, while others had PE replaced entirely by yoga, differing from studies offering either yoga or PE exclusively.[14]

In 2015, Butzer et al.[29] implemented the KYIS program with similar 9^th and 10^th graders as Conboy et al.[14] to examine the effects of yoga on academic performance. Butzer et al.[29] placed a greater emphasis on mindfulness and meditation principles compared to previous studies. Particularly, it incorporated experiential activities tied to the main lesson, along with additional warm-up and closing exercises.[29]

Felver et al.[34] implemented the KYIS intervention with 9^th and 10^th graders in a Massachusetts high school to explore yoga’s effects on adolescent mood and affect. The study adopted Butzer et al.’s[31] modified schedule, emphasizing mindfulness and meditation, but reduced the number of sessions from 28 to 15. Moreover, sessions were held five times per week over three non-consecutive weeks, alternating with PE classes.[34]

Butzer et al.[29] also implemented the KYIS intervention with 7^th graders in a Boston middle school to evaluate the effectiveness of yoga on substance use risk factors. Intervention modifications included increasing the total number of sessions from 24 to 28–32 sessions, with additional review sessions after every three lessons. Later that year, the research team conducted a qualitative analysis to explore adolescents’ views on the perceived benefits of the intervention through focus groups.[20]

In 2020, Felver et al.[35] implemented the KYIS intervention among 6^th-grade students in a New York middle school to examine its effect on social-emotional well-being. The intervention was modified to include a comparative group where students attended either a PE course with embedded KYIS yoga components or a control condition where students attended a music and art class. This was the only study in the review that included a nonphysical activity-based comparative condition. The total number of sessions was reduced to 15, and each session was extended to 45 min and conducted over 7 weeks.[35]

Yoga Ed

Khalsa et al.[25] implemented the Yoga Ed curriculum in a public high school over 11 weeks. Each 30-min session consisted of a 5-min relaxation period, a 5-min warm-up, 15 min of physical yoga poses, and a 5-min closing relaxation. The yoga sessions were extended to accommodate a 40-min class period, and students in the intervention group attended 2–3 sessions per week, totaling 23–32 sessions throughout the intervention. Each session included a theme or talking point designed to promote cognitive skills and yoga philosophy, such as non-violent attitudes and stress management.[25]

Holistic Life Foundation

Dariotis et al.[36] implemented the Holistic Life Foundation (HLF) intervention in an urban middle school. The original curriculum included 45-min sessions, held four times per week, with discussions on health and mindfulness topics incorporated into yoga lessons, including centering, physical poses, breathwork, and guided reflection. However, the intervention was modified to 45–min sessions held twice a week for 16 weeks.[36]

Mindfulness-based yoga interventions

Fishbein et al.[21] implemented a mindfulness-based yoga intervention at a credit-retrieval high school for at-risk adolescents based on a framework developed by Miller et al.[37] The original framework consisted of 20-min mindfulness sessions emphasizing the BOLD (Breathe, Observe, Let Go, and Do It Again) principles. Fishbein et al.[21] adapted the intervention to fit the school schedule, extending sessions to 50 min, held three times per week for 7 weeks. The modified curriculum emphasized daily goals for students and alternating mindfulness themes guided by the instructor. The modified schedule included a 5-min warm-up, 30 min of yoga postures, and 10 min of meditation. Mindfulness discussion prompts were also incorporated into the lessons to engage students in self-reflection.[21]

Sonima Foundation curriculum

Hagins and Rundle[10] implemented the Sonima Foundation curriculum in an urban high school as a comparative PE intervention. The curriculum included structured thematic units and teacher-led discussions on key mindfulness concepts. Yoga sessions included 1–3 min of seated mental and physical centering, 5–7 min of discussion on a theme, 20–25 min of postures and breathing, and 5 min of closing meditation. Sessions were held twice a week throughout the academic year. Wang and Hagins[34] conducted a qualitative analysis of the Hagins and Rundle Sonima Foundation yoga intervention.[10]

Transformative life skills

Frank et al.[23] implemented the Transformative Life Skills (TLS) intervention in an alternative public high school in California. The curriculum consisted of 4 units, divided into 12 lessons, which could be delivered in 15, 30, or 60-min sessions. Thirty-minute TLS sessions were held 3-4 times a week during homeroom class for one semester. The intervention, designed for at-risk youth, began each session with behavioral expectations, followed by yoga lessons that promoted skills related to the unit theme.[23]

Mindful movement

Wang and Tice-Brown[38] implemented the Mindful Movement intervention in a high school to assess the effect of yoga philosophy on cognitive processes. The curriculum included 2–3 min of breathwork, 20 min of postures, 3–7 min of conscious relaxation, and additional reflective activities. Sessions were held for 45 min for 4 consecutive days and 30 min on the 5^th day, spanning 18 weeks. Since the Mindful Movement curriculum emphasizes self-reflection, participants were encouraged to engage in routine journaling throughout the intervention.[38]

Tailoring yoga interventions for specific populations

Yoga for minority groups

McLendon and Scott[39] implemented a hatha-yoga-based intervention after school in a college preparatory high school, focusing on Black students, making it one of the two studies in this review to focus on a minority population. The intervention consisted of breathwork and physical yoga postures. Sessions were held after school, lasting 1 h and 15 min, four times per week for three weeks, with students either receiving yoga intervention or participating in an after-school track program.[39]

Sanchez and Kazen[22] implemented a yoga curriculum based on Butzer et al.’s framework[29] with at-risk Hispanic high school students in Texas. The intervention included mind–body awareness, self-regulation, and physical postures, with 5 min of breathing exercises, 40 min of yoga exercises, 5 min of deep relaxation, and a 10-min QandA/check-in with the instructor. These 60-min mindfulness yoga sessions were delivered twice weekly over 12 weeks. This was the only yoga intervention delivered virtually, with lessons originally planned in person but adapted to a virtual platform due to COVID-19 restrictions.[22]

Trauma-informed yoga

Davis et al.[8] implemented the Yogis in service trauma-informed yoga intervention to improve mood and thought patterns in high-risk adolescents in a rural Montana high school. This study focused on adolescents with a history of adverse childhood experiences (ACE). The intervention emphasized intention, goal setting, and self-reflection, with each session beginning with goal setting, reflection, and intentional breathing, followed by physical postures and concluded with meditative reflection. Participants were encouraged to keep a reflective journal to track changes in mood and thought patterns.[8]

Discussion

This review examined the role of yoga in secondary education curricula. It synthesized findings from 17 studies that evaluated school-based yoga interventions in secondary schools across the U. S. It included six qualitative studies, and among 10 comparative studies, 64% (n = 6) applied the randomized control trial at the individual or group level. Overall, this review indicated that yoga interventions yielded positive psychosocial outcomes (e.g., impulse control, anxiety reduction, and mindfulness), improved physical benefits (e.g., kinesthetic awareness and physical conditioning), enhanced academic performances (e.g., GPA), and reduced risk behaviors related to substance use (e.g., alcohol and cigarette use) among secondary school students. Additionally, the review highlighted several key findings regarding intervention design and implementation.

In this review, we found that the KYIS intervention is the most widely implemented, with 41% of studies (n = 7) featuring its use. The standardized design of this intervention typically includes centering breathwork, yoga posture movements, and closing relaxation. Furthermore, it also incorporates yoga philosophy to foster cognitive and social development. Generally, the KYIS intervention’s structured framework allows flexibility, enabling educators/practitioners to tailor the intervention to target specific behavioral outcomes. Continued research and implementation of such interventions to further demonstrate their impact on educational and health outcomes is warranted.[19]

Two interventions were exclusively offered to racial/ethnic minority populations.[22,39] Spadola and et al.’s study[40] identified barriers to yoga participation among racial and ethnic minority adolescents, including transportation issues, costs, and negative perceptions of yoga. Offering free or affordable yoga sessions within school settings could address the transportation and cost issues. School-based yoga programs could also be advertised by highlighting their positive benefits and adaptability to students with varying physical abilities.[40] One recent study found that a school-based yoga intervention positively impacts the life skill development among ethnically diverse adolescents.[41] Future research and school-based interventions should focus on racially and ethnically diverse adolescent populations to expand the literature on yoga’s impact.

Most yoga interventions in this review were delivered during the school day, with one[39] offered exclusively after school. This indicates that integrating yoga into the existing school curriculum is feasible and could help maximize student participation. Moreover, one yoga intervention was delivered virtually due to the COVID-19 pandemic.[22] This provides insights into remote delivery methods, expanding accessibility, and increasing engagement for all students. Future research is warranted to examine the effectiveness of virtual-based school yoga interventions among adolescent students. These alterations of intervention delivery, including the after-school and virtual formats, provide insight into accessibility to school health promotion initiatives, especially for students experiencing logistical barriers.

The most common research design used in the studies was qualitative studies (n = 6) and RCTs (n = 6), followed by quasi-experimental designs (n = 3) and pretest–posttest designs (n = 2). The use of qualitative analyses provides a deeper understanding of students’ experiences and perceptions of yoga interventions. Conboy and colleagues,[14] for example, explored student perspectives on yoga versus traditional PE and found that students reported improved mood and greater overall well-being. Similarly, other yoga interventions,[36,38] featuring mindfulness practices, enhanced students’ personal wellness following participation. It underscores the need for continued research to explore the impact of specific components of yoga interventions on target outcomes.

Limitations of the studies

Although the studies included in this review provide valuable contributions to understanding the role of yoga interventions in adolescent students in schools, several limitations should be noted. First, many studies included small sample sizes, which lowers the statistical power and generalizability of the findings. Second, many studies did not apply behavioral theories to guide their intervention design or interpretation of research findings, which limits the ability to understand the mechanisms underlying the observed outcomes. Third, a significant limitation in many studies is the absence of process evaluation. This makes it unclear whether the reported outcomes are due to the intervention itself or not. Finally, another limitation in the reviewed studies is the lack of long-term follow-up assessments, which leaves it unknown whether the benefits of yoga can be sustained.

Limitations of this review

Several limitations exist in this review study. First, this review exclusively focused on yoga interventions incorporating the physical component, emphasizing the importance of active body movement in promoting personal well-being. Interventions that utilized solely yogic relaxation techniques, yoga lectures, or mindfulness meditation were excluded from this review. Furthermore, this evidence-based review was limited to empirical studies published in peer-reviewed academic journals. Another limitation is the inclusion of both qualitative and quantitative reviews. Last, the review aimed to examine yoga interventions exclusively in the U. S., providing insights into their integration within this specific educational and cultural context. However, excluding yoga interventions outside the U. S. limits our understanding of how different yoga approaches and designs may impact student outcomes.

Recommendation for future research

The review’s findings and limitations highlight the need for future research with larger, more diverse samples, clearer theoretical frameworks, and comprehensive evaluations of implementation and long-term impact. While the scope of this review focuses on the impact of yoga interventions for adolescent students in the U. S. schools, future research should expand to include international populations.

The use of a theoretical framework could help identify what mechanisms lead to behavior change. Behavioral theories providing a comprehensive framework, such as the reasoned action approach[42] or the multi-theory model (MTM) of health behavior initiation and sustenance[43] can be considered for future studies. Similarly, process evaluations are essential for understanding whether the reported outcomes are the result of the intervention itself. Future studies can consider applying the Reach, Quality Control, Fidelity, Satisfaction, Management (RQFSM) model[44] or REAIM model[45] to assess which aspects of implementation work and which do not. The reviewed yoga interventions vary in duration, with most lasting from several weeks to a few months. Future studies should examine whether extended yoga interventions or short interventions are equally effective for target outcomes or not. Moreover, the study also highlights the potential of virtual interventions for students unable to attend in-person classes due to logistical barriers. Future research should explore the effectiveness of virtual yoga interventions as a way to reach larger student populations.

Finally, future studies should continue employing RCTs, as they are the gold standard in experimental research design. The study also suggests using qualitative analyses in future research to gain insights into students’ experiences after yoga participation.

Implications for health policy and practice

The review suggests that yoga interventions can be integrated into the existing school curriculum to enhance mental well-being and physical abilities, while also fostering a more supportive school environment. When offered during school days, these interventions become more feasible and inclusive. This review highlights several yoga interventions that demonstrated a standardized, while flexible design. The intervention includes breathwork, yoga postures, and relaxation techniques combined with yoga philosophy or mindfulness, allowing educators to tailor it to students’ specific needs.

In addition, most interventions lasted from several weeks to an academic year, which allows for assessing meaningful changes in psychosocial and physical outcomes. Future yoga interventions should be offered consistently over time to observe expected behavior changes. Yoga intervention should also be offered for free in schools and promoted as inclusive and accessible to all abilities. Finally, expanding access to yoga interventions for racially and ethnically diverse students is crucial to ensure the yoga benefits reach all populations.

Conclusion

This evidence-based review highlights that yoga interventions in U. S. schools have the potential to enhance adolescent students’ well-being. Yoga interventions incorporated into the educational system allow schools to promote not only physical health but also emotional adaptability, self-regulation, and learning engagement. These findings may inform educators and policymakers regarding the effectiveness of yoga interventions in secondary education. However, continued research is essential to optimize intervention design and integrate yoga as a fundamental component of health promotion strategies for schools.

Human subjects approval statement

Preparation of this paper did not involve primary research or data collection involving human subjects, and therefore, no institutional review board examination or approval was required.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.