group randomized, controlled evaluation of yoga for ... · yoga yoga positive negative n.s. p
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Group randomized, controlled evaluation of yoga for adolescent mental health within a high school curriculum
Jessica J. Noggle & Sat Bir S. Khalsa, Brigham and Women’s Hospital, Harvard Medical School
Background• Yoga – a multi-component mind-body practice
including:– Physical postures– Breathing exercises– Relaxation techniques– Meditation techniques
• Traditional goals – optimal physical, emotional and cognitive functioning; ultimately higher states of consciousness similar to other meditation techniques
• Modern application – to prevent/treat stress-related mental and physical ailments1
• Yoga reduces psychophysiological arousal in adults2-4
• Initial studies on youth suggest similar results, e.g. better mood & reduced stress, anxiety5,6; need for: – Randomized, controlled trials– School setting to reach most youth
• In 2007, 2.1% youth <18 practicing yoga7
ObjectiveTo evaluate feasibility & efficacy of yoga
for adolescent mental health using a group randomized, controlled trial
within a school curriculum
Conclusions• Yoga prevented deterioration of affect, anxiety
& confusion over the semester relative to physical education
• For students attending yoga regularly, anger control was also maintained
• Kripalu yoga was feasible with older adolescents– 11th & 12th graders
• Suggestions for future studies:– Larger sample size– More balanced groups– Younger adolescents– Academic performance (grades)– Cognitive behavioral testing– More representative student body
Acknowledgements• Yoga teachers Janna Delgado & Iona Brigham, project
leader Debbie Cohen, research & teaching assistants at Kripalu
• Monument Mountain Regional High School• Funded by the Institute for Extraordinary Living, Kripalu
Center for Yoga and Health
Yoga Intervention• 10-wk progressive program, 2 to 3 Kripalu yoga
classes/wk lasting 30 to 40 min each– ~25 yoga classes/student
• 2 senior Kripalu yoga instructors & 5 assistants– 1 teacher + 1 assistant/class
• Key Kripalu yoga principles:– Self-inquiry– Compassionate awareness– Emotion regulation
• Each class consisted of: – 5-min centering
• Including breathing techniques– 5-min warm-up– 15 to 25-min postures– 5-min relaxation
References1 - Khalsa SBS, 2004 Indian J Physiol Pharmacol 48:269-852 - Jevning et al., 1992 Neurosci Biobehav Rev 16:415-243 - Ray et al., 2001 Indian J Physiol Pharmacol 45:37-534 - Pal et al., 2004 Indian J Med Res 120:115-215 - Galantino et al., 2008 Pediatr Phys Ther 20:66-806 - Birdee et al., 2009 Acad Pediatr 9:212-207 - Barnes et al., 2008 National Health Statistics Report
12:24pp
Study Profile
Do you think the yoga was valuable enoughthat you would recommend it to your friends?
Average Visual Analog Score0 20 40 60 80 100
Num
ber o
f Sub
ject
s
0
5
10
15
20
Notatall
Verymuch
so
Did you find that the yogawas helpful for you in general?
Average Visual Analog Score0 20 40 60 80 100
Num
ber o
f Sub
ject
s
0
5
10
15
20
Notatall
Verymuch
so
Acceptability
Baseline End Program
Ave
rage
STA
XI S
core
20
21
22
23
24
25
Yoga
Controlp<0.05
Anger Control
Yoga Control
Ave
rage
Diff
eren
ce S
core
-8
-6
-4
-2
0
2
4
Total Mood DisturbanceTension-AnxietyDepression-DejectionAnger-HostilityVigor-ActivityFatigue-InertiaConfusion-Bewilderment
Improving
Worsening
*
*
* p<0.05
*
*
Mood
Baseline End ProgramBaseline End Program
Ave
rage
PA
NA
S-C
Sco
re
30
35
40
45
50
Control
Control
Yoga
Yoga
Positive Negativen.s. p<0.05
Affect
• 73% of students rated yoga as more than helpful for them in general (60 to 100 VAS)
• 31% of students gave highest rating (90-100 VAS) for recommending yoga to their friends
• Positive affect remained unchanged in both groups after one semester (ANCOVA controlling baseline)
• Negative affect worsened in controls while remaining stable in the yoga group
• Negative mood states improved in yoga group & worsened in control group (2 significant & 3 trends)– Exceptions: Vigor-Activity & Fatigue-Inertia
improved in both groups (trends)
• Ability to control expression of anger worsened in control group & remained stable in yoga group
Studentsattending25% ormoreyoga
classes
5 not analyzed
Eligibility 15
3 excluded − 1 previous yoga− 2 dropped PE
21 16 16 16
Enrollment 15 20 16 16 14
RandomCluster
Allocation15 20 16 16 14
Intervention 15 20 15 15 13
Analysis 15 58
3 dropped − 1 medical leave− 2 left study
− 5 attended <25%
• 5 PE class periods cluster randomized to:
– PE (yellow)
– Yoga (green)
• # students/class period in boxes