Research Summaries for Yoga Therapists are a service

provided by IAYT to help yoga therapists navigate the twists

and turns of the research landscape. The full reference can

be found here:

Evans, S., Galantino, M. L., Lung, K., & Zeltzer, L. (2016).Yoga therapy for pediatrics. In: S. B. S. Khalsa, L. Cohen, T.McCall, & S. Telles (Eds.), The principles and practice of

yoga in health care, 403–422. Pencaitland, United Kingdom:Handspring Publishing.

Objective of this review

This review focused on a specific population rather than aspecific disease outcome. The objective was to provide anoverview of yoga research for the pediatric and adolescentpopulation with any health problems.

General methods

Multiple databases were systematically searched using theterms child, adolescent, or pediatric along with yoga for arti-cles up to October 2014. Of the articles found, only 13 ran-domized controlled trials (RCTs) were included in this review.Studies with any illness or disability were included. Childrenand adolescents up to the age of 26 were included. Studieswith parents were only included if the study outcomes werespecific to children with any illness or disability.

The review was divided into two distinct categories:

1. yoga for children with physical health challenges and

2. yoga for psychosocial wellbeing in children.

1. Physical health challenges

Who was studied?

• Two studies examined yoga for irritable bowel syndrome(IBS). IBS was defined by abdominal pain and alteredbowel habits.

• One study was conducted for polycystic ovarian syn-drome (PCOS) in adolescent girls. PCOS is anendocrine disorder that causes an imbalance in sex hor-mones and is associated with infertility and weight gain.

• One study was conducted for an adolescent populationwith visual impairment (VI) to determine cardiopulmonaryeffects, as previous studies indicated that young peoplewith VI have signs of higher levels of anxiety than age-matched peers.

• One study was conducted on children with poor physicalcoordination.

How were the studies conducted?

IBS:

• In both studies, yoga was compared to a waitlist controlgroup for teens and young adults with IBS.

• Sample sizes ranged from 25–30 participants; agesranged from 11–26 years.

• Styles of yoga used were Iyengar and Hatha. • Participants practiced either a daily home routine using a

video for 4 weeks or twice a week for 6 weeks. Classduration ranged from 1 to 1.5 hours.

• Outcomes included measures for IBS symptoms, pain,psychosocial well-being, and quality of life.

Research Summary for Yoga Therapists:

Yoga Therapy for Pediatrics

©2017 International Association of Yoga Therapists. All rights reserved.

By Pam Jeter and Timothy McCall

PCOS:

• Holistic yoga was performed daily for 12 weeks andinvolved poses, breathing, meditation, and yogic lifestyleeducation.

• The yoga group was compared to an active control con-dition to treat PCOS that consisted of physical move-ment, non-yoga breathing, and supine rest.

• Outcomes were based on the State-Trait AnxietyInventory (STAI) and glucose metabolism and endocrineparameters.

• Sample size was not reported.

VI:

• An unspecified style of yoga was conducted for 1 hourdaily, 5 days a week, for 3 weeks.

• The control group participated in physical activity.• Outcomes (not related to vision) were based on heart

rate, respiratory rate, and skin resistance.• Sample size was not reported.

Poor physical coordination:

• An unspecified yoga style was conducted for 30-minutesessions, 3 times/week for 4 weeks.

• The control group participated in physical education.• Outcomes were measured using the Children's Body

Satisfaction Test and the Human Figure Drawing Test.• Sample size was not reported.

What did the researchers find?

IBS:

• One study found improved physical functioning com-pared to controls; it was not clear whether this improve-ment was statistically significant. Clinically meaningfulreductions in abdominal pain were reported. Qualitativedata found yoga to be enjoyable and a useful pain-cop-ing strategy that increased sense of wellbeing.

• The second study found reduced functional disability,emotion-focused avoidance, anxiety, and gastrointestinalsymptoms when baseline measures were compared topostintervention measures.

PCOS:

• Changes in trait anxiety, but not in state anxiety, weresignificant after yoga compared to physical exercise.

• A decrease in glucose metabolism was reported in theyoga group compared to controls.

• No significantly different improvements in body massindex (BMI), waist circumference, hip circumference, orwaist-to-hip ratio were reported.

• It was reported that a number of endocrine parametersinvolved in PCOS normalized in the yoga-user group,including testosterone and luteinizing hormone.

• Menstrual frequency also significantly differed betweenthe groups postintervention, reflecting normalized men-struation in the yoga group.

• Yoga was found to be more effective than physical exer-cise for improving glucose metabolism.

VI:

• A decrease in breathing rate was found in the yogagroup, compared to no changes in the controls. No sig-nificant changes were reported for heart rate or skinresistance.

Poor physical coordination:

• Decreased negative responses in the Children's BodySatisfaction Test were reported.

• Reduced emotional indicators and improvements in theHuman Figure Drawing Test were reported, indicating animprovement in symptoms.

• No changes were observed in the controls. • Statistical significance was not reported.

Were adverse events reported?

No adverse events were reported.

2. Psychosocial wellbeing

Who was studied?

Yoga was evaluated for alleviation of psychosocial healthproblems in children and adolescents and as a means ofpromoting psychosocial health in healthy children and ado-lescents; ages ranged between 6 and 21 years old.

How were the studies conducted?

• Eight RCTs were included that addressed a variety ofhealth issues, including attention deficit hyperactivity dis-order (ADHD), intellectual disability, eating disorders,and emotional and behavioral functioning, stress, andmental health in well children.

• Interventions included Viniyoga, Ashtanga yoga, school-based mindfulness and yoga intervention, the Yoga Edprogram, Kripalu yoga, and other nonspecific yoga prac-tices.

• Control groups used were cooperative activities andgames, usual routine, standard care, physical educationclasses, and waitlist.

• The frequency and duration of the yoga protocolsspanned from daily to weekly sessions and from 8weeks to 10 months.

• Validated outcomes were based on Conners’ ParentRating Scale-Revised (CPRS–R), Conners’ TeacherRating Scale–Revised, the Eating Disorder Examination(EDE), IQ tests, and the Test of Variables of Attention.

©2017 International Association of Yoga Therapists. All rights reserved.

Yoga Therapy for Pediatrics

What did the researchers find?

• ADHD (one study): Improvements were found on fivesubscales of the CPRS–R evaluating behavior andattention (emotional ability, restlessness/impulsiveness,and ADHD indices); the control group also showedimprovements on three CPRS–R subscales (hyperactivi-ty, anxiety/shyness, and social problems).

• Intellectual disability (one study): Improved IQ andsocial adaptation parameters were found in the yogagroup compared to the control group, although theanalysis for this study was brought into question.

• Eating disorders (one study): The yoga group showedgreater reduction in symptoms, lower EDE scores, andlower food preoccupation after each session; bothgroups maintained current BMI and anxiety and depres-sion scores over time.

• Emotional and behavioral functioning in well chil-

dren (one study): The yoga group showed that negativeaffect increased compared to controls (negative finding).

• Stress in well children (one study): Improvement inself-esteem and self-regulation was found in bothgroups; however, the yoga group also showed anincrease in the appraisal of stress and an increase in fre-quency of coping compared to the control group(negative finding).

• Stress in underserved, well youth (one study): Theyoga group was found to have significantly improvedscores in voluntary engagement, rumination, intrusivethoughts, and emotional arousal compared to the con-trols.

• Mental health and well children (two studies): Onestudy found that the yoga group improved on anger-con-trol outcomes and fatigue/inertia compared to the con-trols. The second study found that total mood distur-bance, mood anxiety, and negative affect decreasedcompared to the controls.

Were adverse events reported?

No adverse events were reported.

What were the limitations?

Given the small number of studies and the small samplesizes in each health category for children and adolescents,these studies are preliminary at best. It is difficult to establisha bird’s eye view of the body of evidence with so many dif-ferent outcomes. In most cases, either the lack of clearreporting on methodological safeguards against bias or thestandard for rigor in methodological design was not met, lim-iting the interpretation of the results. The studies also dif-fered substantially in design, population, yoga intervention,frequency, and duration, making it difficult to compare acrossother studies and limiting the generalizability of findings.Several studies were limited by weak statistical analysis,restricting the ability to detect real differences between theyoga and control groups.

Risk of selection bias was unclear due to the lack ofreporting on randomization procedures in most studies. Therisk of detection bias could not be determined, as blindingprocedures were often not reported. The level of attritionbias also could not be ascertained because dropout rateswere not adequately documented.

Adverse event reporting is used to determine whetherany deleterious incidents related to the protocol occurredduring the intervention trial and is used to evaluate safety.Not all studies followed standard reporting guidelines andmay not have reported adverse events. It is possible thatadverse events did not occur in any of the studies, but with-out substantive reporting in all of the studies, it is impossibleto draw conclusions about the safety of the yoga interven-tions.

Take-away message

Yoga research shows promising results in terms of yoga’sbenefit for children and adolescents. However, given thequality of the available evidence, the variety of outcomesand yoga styles, and the moderate effects found in the stud-ies provided, it is difficult to draw conclusions about safetyand efficacy until more rigorous studies are conducted.

Yoga therapy can be used with children as an adjunct toclinical care with the following recommendations: 1) theduration, frequency, and approach to the yoga practiceshould be determined on a case-by-case basis; and 2) theyoga therapist should open a dialogue with the client’s treat-ing physician.

It is important to note that while the majority of the yogastudies showed promising effects, two studies in well chil-dren showed negative effects. The authors note that the rea-son for this finding may have simply been the children’s new-found awareness of stress in their lives due to increasedmindfulness of emotions.

Clinical relevance

Although the limited number of studies and methodologicalproblems prevent firm conclusions, the studies to date sug-gest that yoga may have utility in a wide variety of physicaland psychological disorders in children and adolescents. The conclusions point to the need for further, wider, andmore rigorous studies. As the research to date offers littleconcrete advice to yoga therapists, they are advised to basetheir work with younger clients on their training and clinicalexperience.

©2017 International Association of Yoga Therapists. All rights reserved.

Yoga Therapy for Pediatrics