Yoga for Burnout in Nurses: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Nurses often experience significant physical and psychological stress, leading to various individual, familial, social, and organizational issues that predispose them to burnout. Burnout has detrimental effects on the health and well-being of nurses. This systematic review and meta-analysis estimates the effectiveness of yoga on burnout among nurses. Four electronic databases – PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for randomized controlled trials (RCTs) that evaluated the effect of yoga on burnout among nurses. The preferred reporting items for systematic reviews and meta-analyses guidelines were utilized. A total of 88 studies were screened, and 3 RCTs were retained for the meta-analysis. The standardized mean differences (SMDs) were estimated using a random and fixed-effect model with 95% confidence intervals (CIs). There was a significant effect of yoga on three components of burnout: emotional exhaustion (SMD −0.71; 95% CI −1.27–−0.15 [P < 0.01]), depersonalization (SMD −0.59; 95% CI −0.88– –0.30 [P < 0.01]), and personal achievement (SMD 0.76; 95% CI 0.26–1.25 [P < 0.01]). Moreover, the research studies showed high heterogeneity (I² = 0%–72%), and of the 3 trials, 2 were considered to be at low risk based on the Cochrane risk of bias 2 tool. Therefore, yoga is an effective and economical method that nurses can use to reduce burnout and improve the quality of care provided to patients. Integration of yoga-based practices into the healthcare routine has promising benefits, but more substantial findings are essential for developing evidence-based guidelines (International Prospective Register of Systematic Reviews registration: CRD42024591915).

Introduction

Persistent interpersonal and emotional stressors within the workplace lead to burnout. It makes an individual emotionally exhausted and depersonalized, decreasing personal accomplishment.[1] Nurses who work in highly stressful environments for extended hours experience the highest levels of burnout among all healthcare providers.[2,3] Research indicates that the prevalence of burnout in nurses ranges between 35% and 45% which increased to 70.5% in perioperative, labor, and delivery settings in the COVID-19 pandemic.[4,5,6] Burnout results in significant and prolonged reactions to persistent interpersonal and emotional stressors within the workplace. It typically manifests as emotional exhaustion (EE), feelings of depersonalization (DP), and a diminished sense of personal accomplishment. Burnout affects far beyond the individual nurse, influencing their general health and leading to substance abuse, weakened interpersonal relationships, depression, and suicidal ideation. Moreover, burnout poses significant threats to the workforce and the quality of healthcare, resulting in higher attrition rates, increased medication errors, and decreased patient satisfaction.[7,8,9]

In light of these challenges, organizations need to invest in initiatives that promote the wellness of nurses and physicians, thereby reducing burnout in a global.[10,11] Clinical trials provide compelling evidence that mind–body practices play a crucial role in enhancing self-care and resolving.[11] Yoga is a powerful mind–body approach that significantly enhances well-being, self-care, and the promotion of health. It is not only cost-effective but also excels at reducing stress and burnout.[12,13] Initially, yoga was understood primarily as a spiritual and meditative practice. However, it has evolved into a multifaceted discipline that integrates various techniques, combining mental and physical health.[14] It is a comprehensive approach that ensures overall advantages for individuals.

Nurses across various specialties have consistently reported improved outcomes after incorporating mind–body techniques into their routines. A study among nurses revealed that those who completed an 8-week yoga intervention experienced markedly higher levels of self-care, along with reduced EE and feelings of DP.[15,16] Another study, which examined a 6-month yoga program involving 120 nurses, reported similar outcomes as a significant reduction in stress levels.[17] Several recent reviews have documented the advantages of interventions aiming individual healthcare personnel, emphasizing how effective mindfulness-based practices are in enhancing wellness.[18,19]

Numerous systematic reviews explored the impact of mindfulness education and yoga programs on healthcare providers across various contexts. For instance, a study explored the application of yoga for alleviating stress and burnout among medical personnel, while another study performed a meta-analysis to assess the effects of mindfulness-based approaches on health workers.[19] Furthermore, another study also evaluated the advantages of this approach specifically on medical personnel.[20] Other reviews have focused on specific groups; for example, Murray et al.[21] focused on interventions aimed at improving the psychological well-being of general practitioners, and DeChant et al.[22] studied the effects of organization-directed workplace interventions on physician burnout. To date, there appears to be a gap in the literature, as no systematic review has specifically addressed the impact of yoga on burnout among nurses, even though burnout rates among nurses are the highest compared to other healthcare personnel.

Therefore, this systematic review and meta-analysis has the primary objective of evaluating the effectiveness of yoga in addressing burnout among nurses. In addition, the secondary objective seeks to determine the pooled statistical effect of yoga therapy on burnout levels in this critical group of healthcare providers.

Methods

This systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.[23] The protocol for this review was registered in the International Prospective Register of Systematic Reviews database (registration number: CRD42024591915).

Research question

The primary research question was formulated using the PICOT framework:

• Population: Nurses working in clinical and academic settings

• Intervention: Any form of yoga intervention

• Comparison: Standard care or other interventions

• Outcome: Burnout among nurses, measured by validated instruments

• Type of studies: Randomized controlled trials (RCTs).

Search strategy

A comprehensive literature search was conducted in four major electronic databases: PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature. The search strategy was developed with assistance from a health sciences librarian and was conducted between September 2024 and November 2024.

The following search terms were used in various combinations using Boolean operators (AND, OR): (“yoga”[MeSH Terms] OR “yoga”[Title/Abstract] OR (“yogic”[All Fields] OR (“pranayama”[All Fields] OR “pranayamas”[All Fields]) OR “asana*”[All Fields] OR “progressive muscle relaxation”[All Fields] OR “yoga relaxation”[All Fields])) AND (“nurses”[MeSH Terms] OR (“nursing staff”[All Fields] OR “nurse clinician”[All Fields] OR ((“nurse s”[All Fields] OR “nurses”[MeSH Terms] OR “nurses”[All Fields] OR “nurse”[All Fields] OR “nurses s”[All Fields]) AND (“academician”[All Fields] OR “academicians”[All Fields])) OR “nurse managers”[All Fields] OR “nurse practitioners”[All Fields] OR “nurse midwives”[All Fields] OR “nurse specialist”[All Fields])) AND (“burnout, professional”[MeSH Terms] OR (“burnout, professional”[MeSH Terms] OR (“burnout”[All Fields] AND “professional”[All Fields]) OR “professional burnout”[All Fields] OR (“professional”[All Fields] AND “burnout”[All Fields])) OR (“psychological burnout”[All Fields] OR “emotional exhaustion”[All Fields] OR “occupational burnout”[All Fields] OR “professional burnout”[All Fields] OR “mental exhaustion”[All Fields])).

Eligibility criteria

Inclusion criteria

Studies were eligible for inclusion if they met the following criteria:

1. Population: Registered nurses working in hospitals, clinics, nursing homes, educational institutions, or any healthcare settings, regardless of specialty or position

2. Intervention: Any form of yoga, including but not limited to Hatha yoga, Kundalini yoga, Laughter yoga, and Integrated yoga practices involving asanas (postures), pranayama (breathing exercises), relaxation techniques, and meditation

3. Comparison: Standard care, waitlist control, alternative interventions, or no intervention

4. Outcome: Burnout measured quantitatively using any valid or reliable burnout assessment instrument

5. Study design: RCTs

6. Language: Publications in English.

Exclusion criteria

Studies were excluded based on the following criteria:

1. Nonavailability of full texts

2. Nonrandomized or quasiexperimental study designs

3. Studies that did not assess burnout as an outcome

4. Studies involving healthcare professionals other than nurses, when separate data for nurses were not provided

5. Review articles, systematic reviews, meta-analyses, case studies, editorials, expert opinions, conference abstracts, and unpublished dissertations or theses.

Study selection process

In two phases, two independent reviewers (AJ and SS) conducted the study selection process. Initially, titles and abstracts of all found articles were screened after the removal of duplicate articles based on the eligibility criteria. Subsequently, full texts of articles that were possibly eligible were retrieved and evaluated for final inclusion. Any disagreements between the reviewers were settled through a discussion, and when required, a third reviewer (PJ) was consulted to attain consensus. After the full-text review stage, the reasons for the exclusion of articles were documented.

Data extraction

Data extraction was done by two reviewers (AJ and SS) independently through Rayyan software. The extracted data included:

1. Study characteristics: author, year, country, study design, sample size, intervention/control, participant characteristics, yoga intervention, control group, primary outcome measures, and results

2. Intervention characteristics: Yoga Intervention, description of intervention, duration, delivery sessions, intervention provider, modality, and setting.

The data extraction was closely checked by a third reviewer (US) to make sure they were accurate and complete. Efforts were made to contact the authors of the primary studies who had not provided complete or clear information or unavailability of full texts.

Quality assessment and evidence quality

By assessing the methodological quality of the RCTs that were included using the Cochrane collaboration’s risk of bias (RoB 2) tool,[24] five domains, namely bias arising from the randomization process, bias due to deviations from intended interventions, bias arising from missing outcome data, bias in measurement of the outcome, and bias in the selection of the reported results were evaluated for their potential to be sources of bias in the clinical trials. The domains were each rated as “low risk,” “some concerns,” or “high risk” of bias. An overall judgment of bias was made for each study, taking into account the domain-specific judgments, two reviewers (AJ and SS) independently assessed the RoB, and any disagreements were resolved through discussion.

The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method.[25] The GRADE takes into account five factors, namely RoB, inconsistency, indirectness, imprecision, and publication bias that might increase or decrease the credibility of the evidence. The quality of evidence had been coded as high, moderate, low, or very low.

Data synthesis and analysis

The qualitative as well as quantitative syntheses were performed. For the qualitative synthesis, the characteristics and findings of the included studies were presented in a narrative form, whereas for the quantitative synthesis, a meta-analysis was performed by MetaAnalysisOnline.com.[26]

Burnout was the primary outcome, as determined by the Maslach Burnout Inventory (MBI), which has three subscales: personal accomplishment (PA), DP, and EE. Each subscale’s standardized mean differences (SMDs) and 95% confidence interval (CI) were determined because the outcome measure (MBI) was the same in all included trials. Improvement is indicated by negative values for EE and DP (less burnout), and improvement (more PA) is indicated by positive values for PA. The fixed-effects model was applied to meta-analysis when the I² heterogeneity statistics was below 50%, and the random-effects model was applied in case of high heterogeneity (i.e., I² ≥50%) with P < 0.05.[27]

Publication bias

The funnel plots for each of the burnout subscales were inspected visually to check for publication bias. Furthermore, statistical test was not applied as there were less than ten studies that were selected, as this was suggested by the Cochrane Handbook for Systematic Reviews of Interventions.[28]

Results

Study selection

The initial electronic database search yielded a total of 88 potentially relevant studies. After removing 38 duplicate articles, 50 studies were screened by title and abstract. Out of which, 39 articles were excluded for not meeting the inclusion criteria. The full texts of the remaining 11 articles were retrieved and assessed for eligibility. Following this review, 6 articles were excluded with reasons [Figure 1]. The most common reasons for excluding the articles were non-RCT design (n = 2), participants not limited to nurses (n = 2), burnout not measured as an outcome (n = 2), and full text not available (n = 1). In the end, three RCTs were included in the meta-analysis, whereas four RCTs satisfied all inclusion requirements and were added to the qualitative synthesis.

Figure 1.

Preferred Reporting Items for Systematic Reviews and meta-analyses flow diagram of study selection process

Characteristics of included studies

Three RCTs with a total of 240 participants (122 in yoga intervention groups and 118 in control groups) and 195 (98 in yoga intervention groups and 97 in control groups) were included in the qualitative synthesis and meta-analysis consecutively. The characteristics of these studies are summarized in Table 1. All three studies were published between 2015 and 2024, with sample sizes ranging from 40 to 101 participants. Two studies were conducted in the United States (Alexander et al.,[29] 2015; Urso et al.,[31] 2022) and one in Iran (Faramarzi S et al.,[32] 2024)and one in Turkey (Si S Çeli K A and Kılınç T et al.,[30] 2022). The study by Urso et al.[31] (2022) was identified in the search but was not included in the meta-analysis due to incomplete data availability.

Table 1.

Characteristics of included studies

Author(s)	Year	Country	Study design	Sample size (intervention/control)	Participant characteristics	Yoga intervention	Control	Primary outcome measures	Results
Alexander et al.[29]	2015	USA	RCT	20/20	Nurses in a hospital setting	Kundalini yoga, 8-week intervention, self-care techniques, mindfulness, stress management	Usual care	Self-care, mindfulness, burnout (EE and depersonalization)	Yoga group showed significant improvement in self-care (P<0.001), mindfulness (P=0.028), EE (P=0.008), and depersonalization (P=0.007) compared to the control group, which showed no change
Si S Çeli K A and Kılınç T[30]	2022	Turkey	RCT	51/50	Nurses caring for COVID-19 patients	Laughter yoga, 8 sessions over 4 weeks, twice a week	No intervention	Perceived stress, burnout, life satisfaction	Laughter yoga significantly reduced perceived stress and burnout while increasing life satisfaction (P<0.05), while the control group showed no significant change
Faramarzi S et al.[32]	2024	Iran	RCT	27 (yoga)/27 (aerobic)/27 (control)	Nurses with moderate to high burnout	Integral yoga, 24 sessions, 3 times per week, 70-min sessions	Aerobics or no intervention	Burnout (MBI: EE, depersonalization, personal accomplishment)	Both yoga and aerobics reduced burnout compared to the control. Yoga was more effective than aerobics in reducing EE (P=0.007)
Urso et al.[31]	2022	USA	Pilot study	24/21	Nursing staff in an oncological ICU	Mindfulness-based yoga intervention (LOTUS), 8-week program, 1-h weekly sessions	No intervention	Burnout, stress, anxiety, depression, and professional efficacy	No significant reduction in burnout, stress, anxiety, and depression, but professional efficacy significantly improved in the yoga group compared to the control (P=0.0336)

RCT: Randomized controlled trial, ICU: Intensive care unit, MBI: Maslach burnout inventory, EE: Emotional exhaustion, LOTUS: Living optimally in times under stress

The included studies evaluated the different forms of yoga interventions [Table 2] such as Kundalini yoga focusing on breathing techniques,[29] Laughter yoga,[30] Integral yoga consisting of asanas, breathing exercises, relaxation, meditation, and self-knowledge,[31] and mindfulness-based yoga (LOTUS).[32] The duration of interventions ranged from 4 to 8 weeks, with session frequencies varying from one to three times per week. All studies used the MBI to assess burnout among nurses.

Table 2.

Description of interventions in the included studies

Author (year)	Yoga intervention	Description of intervention	Duration (weeks)	Delivery sessions	Intervention provider	Modality	Setting
Alexander et al., (2015)[29]	Kundalini yoga	Focused on self-care, stress reduction, mindfulness, deep breathing, and postural alignment. Included meditations and relaxation techniques	8	Weekly sessions	Experienced yoga instructor (osteopathic physician)	In-person	Teaching hospital
Sis Celik and Kilinc (2022)[30]	Laughter yoga	Included deep breathing, stretching, playful exercises, and laughter techniques. Conducted online to ensure accessibility during the pandemic	4	8 sessions (twice a week)	Research team via online sessions	Online (zoom)	Nurses in COVID-19 clinics
Urso et al., (2022)[31]	Mindfulness-based yoga (LOTUS)	Personalized yoga therapy including relaxation, meditation, and breathing techniques. Adapted for individual needs	8	Weekly 1-h sessions	Certified yoga therapist and yoga instructor	In-person (small groups)	Oncological ICU
Faramarzi et al., (2024)[32]	Integral yoga	Traditional yoga integrating physical exercises (asanas), breathing (pranayama), relaxation, and meditation. Sessions held in a temperature-controlled gym	8	24 sessions (3 times per week)	Qualified yoga trainer	In-person (group-based)	Private sports gym

ICU: Intensive care unit,LOTUS: Living optimally in times under stress

Risk of bias assessment

The methodological quality of the included studies was assessed using the Cochrane RoB 2 tool. Two studies[30,31] were judged to have a low overall RoB, while one study[29] had some concerns. Study 1 intended intervention (D2) and no available information regarding the randomization process (D1), despite showing low RoB in domains related to missing outcome data (D3), outcome measurement (D4), and selection of reported results (D5). This resulted in an overall assessment of “some concerns” for Study 1.[29] In contrast, both Study 2 and Study 3 (Faramarzi S et al.,[32] 2024 and Si S Çeli K A and Kılınç T et al.,[30] 2022) exhibited robust methodological rigor with low RoB across all five domains, including randomization, intervention adherence, data completeness, outcome measurement, and selective reporting, yielding an overall assessment of low RoB for these studies.[30,31] These findings suggest that while all three studies contribute valuable evidence to the research question, results from studies 2 to 3 may warrant higher confidence due to their more robust methodological quality compared to Study 1. The detailed risk of bias assessment for each domain is presented in Figures 2 and 3.

Figure 2.

Risk of bias summary

Figure 3.

Risk of bias assessment using the Cochrane risk of bias tool

Effects of yoga interventions on burnout

The meta-analysis examined the effects of yoga interventions on three components of burnout as measured by the MBI: EE, DP, and PA. Forest plots for each component are presented in Figures 4-6.

Figure 4.

Forest plot for emotional exhaustion

Figure 5.

Forest plot for depersonalization

Figure 6.

Forest plot for personal accomplishment

Emotional exhaustion

The pooled estimate of meta-analysis using a random effect model showed a significant reduction in EE scores in the yoga intervention groups compared to control groups with SMD = −0.71; 95% CI −1.27–−0.15 (P < 0.01). The heterogeneity among studies was high (I² = 72%, P = 0.03), indicating inconsistency in the effects across studies [Figure 4], which can be attributed to small number of studies included in analysis. The sources of this heterogeneity could not be fully explored through subgroup analyses. The pooled mean difference in EE domain of burnout was −6.36 points (95%CI; −8.47–−4.25), which signifies 6.36-point reduction in burnout EE scores.

Depersonalization

The pooled estimate of meta-analysis using a fixed-effect model identified a significant reduction in DP scores in the yoga intervention groups compared to control groups with SMD = −0.59; 95% CI −0.88–−0.30 (P < 0.01). The heterogeneity was low (I² = 0%, P = 0.50), indicating consistency in the effects across studies [Figure 5]. The pooled mean difference in DP domain of burnout was −2.31 points (95%CI; −3.44–−1.18), which signifies 2.31-point reduction in burnout DP scores.

Personal accomplishment

The pooled estimate of meta-analysis using a fixed-effect model showed a significant increase in PA scores in the yoga intervention groups compared to control groups SMD = 0.76; 95% CI 0.26–1.25 (P < 0.01). There was high heterogeneity among studies (I² = 62%, P = 0.07), suggesting some variability in the effects across studies [Figure 6]. Due to the small number of included studies, the sources of this heterogeneity could not be fully explored through subgroup analyses. The pooled mean difference in PA domain of burnout was 4.54 points (95%CI; 3.14–5.94), which signifies 4.54-point improvement in burnout PA scores.

Publication bias

Funnel plots were created for each outcome to assess publication bias. It showed asymmetry for EE, DP, and PA, suggesting potential publication bias for these outcomes [Figures 7-9]. Due to the small number of included studies (n = 3), formal statistical tests for publication bias were not performed.

Figure 7.

Funnel plots for publication bias assessment–emotional exhaustion

Figure 8.

Funnel plots for publication bias assessment–depersonalization

Figure 9.

Funnel plots for publication bias assessment–personal accomplishment

Quality of evidence

The quality of evidence for each outcome was assessed using the GRADE approach and is summarized in Table 3. With regard to all the outcomes, EE, DP, and PA, the quality of evidence was rated as moderate to significant heterogeneity (I² = 62%–72%) and possible publication bias.

Table 3.

Summary of findings and grading of recommendations assessment, development, and evaluation assessment

Outcome	Number of studies (participants)	Effect size SMD (95% CI)	Heterogeneity (I2) (%)	Quality of evidence (GRADE)	Comments
EE	3 (195)	−0.77 (−1.07–−0.48)	72	⊕⊕⊕⊖ Moderate	Downgraded only for inconsistency (high heterogeneity, I2=72%) and possible publication bias
Depersonalization	3 (195)	−0.59 (−0.88–−0.30)	0	⊕⊕⊕⊖ Moderate	Downgraded only for publication bias, with consistency being a strength (I2=0%)
Personal accomplishment	3 (195)	0.83 (0.53–1.12)	62	⊕⊕⊕⊖ Moderate	Downgraded for inconsistency (high heterogeneity, I2=62%) and but not for publication bias, as it showed less asymmetry

SMD: Standardized mean difference, CI: Confidence interval, GRADE: Grading of recommendations assessment, development, and evaluation, EE: Emotional exhaustion

Discussion

This systematic review definitively illustrates the effectiveness of the yoga approach, highlighting that increasing the incorporation of yoga is a powerful strategy for nurses to achieve stable psychophysical well-being. The experimental group exhibited a significant enhancement in PA, alongside a notable reduction in EE and DP compared to the control group. Notably, it reports a significant reduction in burnout among nurses who engaged in yoga, improving the quality of care they provided to patients.

High levels of burnout in the domains were prevalent in EE and DP, whereas low level of PA was prevalent among primary care nursing personnel as reported in a meta-analysis, which correctly aids in the prediction of mortality in healthcare professionals, including nurses.[33,34,35] This is the first systematic review and meta-analysis designed to summarize and evaluate the overall impact of yoga on mitigating burnout in nurses. The meta-analysis data indicate that yoga effectively diminishes burnout symptoms in nurses, although with a small-to-moderate effect size.

Previous meta-analyses reported the substantial decreases of 2.6 points,[36] 4.68 points,[37] and 5.89 points[38] in EE domain among primary healthcare professionals following interventions. The pooled mean difference revealed a significant reduction of 6.36 points in EE following yoga intervention. This outcome is higher than the observations noted in other meta-analyses, underscoring the efficacy of yoga in alleviating burnout among nurses. A reduction of 5.89 points in the EE domain of burnout scores should be regarded as a clinically significant change. Consequently, yoga may serve as a useful approach to avoid and mitigate EE in nurses.

With regard to DP, previous meta-analyses reported the substantial decreases of 2.01 points[37] and 1.96 points[38] among primary healthcare professionals following interventions. The pooled mean difference revealed a significant reduction of 2.31 points in EE following yoga intervention. This outcome is higher than the observations noted in other meta-analyses, underscoring the efficacy of yoga in alleviating burnout among nurses. A reduction of 2.31 points in the DP domain of burnout scores should be regarded as a clinically significant change. Consequently, yoga may be utilized as an effective approach to reduce DP in nurses.

Previous meta-analyses reported the substantial decreases of 3 points[37] and 2.05 points[38] in the personal achievement domain among primary healthcare professionals following interventions. The pooled mean difference revealed a significant improvement of 4.54 points in personal achievement following yoga intervention. This outcome is higher than the observations noted in other meta-analyses, underscoring the efficacy of yoga in alleviating burnout among nurses. An improvement of 4.54 points in the personal achievement domain of burnout scores should be regarded as a clinically significant change. Accordingly, based on these findings, yoga may be particularly pertinent in preventing and enhancing the reduced sense of personal achievement in nurses.

The findings of this study align with those reported by Cocchiara et al. They conducted a systematic review among healthcare professionals and identified yoga as an effective intervention for the management of stress and burnout.[16] Di Mario et al. conducted an umbrella review that yielded comparable findings, indicating that yoga and mindfulness-based interventions can effectively support healthcare professionals in reducing burnout. The authors advocate for implementing these interventions in workplace settings to enhance well-being.[39] However, the validation factors are limited; thus, the improvements observed cannot be conclusively attributed solely to the intervention. Only one study reported follow-up assessments extending beyond the intervention period, finding no significant differences between yoga and aerobic exercise groups, which underscores that the overall evidence remains compelling yet inconclusive.[32] Previous systematic reviews have similarly indicated a reduction in stress levels and burnout following yoga interventions, whether utilized independently or in conjunction with other modalities, while also noting the insufficiency of RCTs and studies with follow-up assessments beyond the intervention period.[16,40]

The overall effectiveness of yoga on burnout was moderate, which can be attributed to high heterogeneity and the possible publication bias. The sources of this heterogeneity could not be fully explored through subgroup analyses due to the inclusion of small number of studies. Nevertheless, the high heterogeneity can be attributed to work place setting, as one of the RCT was conducted during COVID-19. Moreover, differences in implementation of yoga such as type of yoga intervention provided to the nurses in the experimental group, mode of delivery of yoga intervention (in person, online, or in a small group), duration, and the setting in which yoga was provided might have contributed to this high heterogeneity findings.

Yoga interventions have been found to be beneficial for nurses and other health care providers, substantially reducing burnout and improving psychological well-being. Simple yoga practices can be provided in any physical setting, even in a workplace setting. The most effective approach involves individualized, one-to-one yoga sessions for 4–8 weeks, with at least one session per week.[16,41,42] In addition, it is recommended that yoga be incorporated into the nursing curriculum to address the demands of professional nursing practice and serve as a proactive measure for mitigating burnout and stress.[43]

Healthcare administrators must acknowledge the significance of integrating a simple yet effective approach, such as yoga, to mitigate burnout among healthcare professionals. Implementing yoga practices can lead to a reduction in costs associated with financial and welfare benefits for healthcare providers. By adopting simple yoga exercises that can be adapted to various settings, healthcare institutions can engage nurses in mindfulness and resilience training directly within their workplace environment. To gain a comprehensive understanding of the long-term effects of yoga as an intervention, longitudinal studies are necessary. Furthermore, it is essential to consider coping strategies, individual differences, and leadership styles as these factors play a substantial role in the prevalence of burnout. Therefore, a holistic approach is essential when designing and conducting these studies, ensuring a thorough exploration of the complexities involved.

The strengths of this systematic review and meta-analysis are evident. It incorporated all four major databases, ensuring comprehensive data coverage, and all the studies utilized the MBI tool for thorough outcome assessment. The studies included in this review exhibit a very low risk of bias and earned moderate to high ratings in the SJR system, reinforcing the validity of the findings. A low risk of potential bias was ensured by double-blind reviewing of the literature, consensus meetings when needed, the inclusion of numerous databases to accurately represent the existing research, are the other strengths of this review.

However, some of the limitations were acknowledged by the researchers, particularly the low numerical consistency of available studies, which resulted in a small study population for the meta-analysis. Moreover, small number of studies resulted in the prevention of formal statistical testing of publication bias and limited exploration of heterogeneity sources through subgroup analyses and made the assessment of publication bias visually difficult to interpret definitively. In addition, the review was confined to English language articles, which somewhat restricts the breadth of insights. Therefore, in order to get more precise results with high-quality evidence, future high-quality clinical research needs to be investigated. The optimal time frame for attaining the intended results in engaging yoga of different types at different levels also needs further research.

Conclusion

Nurse burnout is a critical and widespread challenge that carries significant consequences for individuals, the healthcare profession, and society. This systematic review and meta-analysis substantiates the efficacy of yoga as a feasible and accessible intervention, demonstrating its significant reduction of burnout among nurses, particularly in all the domains of EE, DP, and personal achievement. Despite the moderate quality of evidence due to variability and small sample size, the findings advocate incorporating structured yoga sessions within healthcare settings. Future studies should prioritize multicenter RCTs with larger sample size utilizing established methodologies and extended follow-up periods. Practitioners can proactively mitigate burnout by integrating yoga-based therapies into occupational health frameworks, and nurse educators can incorporate yoga and self-care instruction into nursing curricula. Incorporating yoga into routine practice may enhance nurse well-being, elevate patient care standards, and cultivate a resilient workforce within healthcare systems. Achieving this requires a united effort among nurses, healthcare organizations, policymakers, and researchers to develop effective strategies for preventing and mitigating nurse burnout.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.