The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
As yoga has gained popularity as a therapeutic intervention, its safety has been questioned in the lay press. Thus, this review aimed to systematically assess and meta-analyze the frequency of adverse events in randomized controlled trials of yoga. MEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through February 2014. Of 301 identified randomized controlled trials of yoga, 94 (1975-2014; total of 8,430 participants) reported on adverse events. Life-threatening, disabling adverse events or those requiring intensive treatment were defined as serious and all other events as nonserious. No differences in the frequency of intervention-related, nonserious, or serious adverse events and of dropouts due to adverse events were found when comparing yoga with usual care or exercise. Compared with psychological or educational interventions (e.g., health education), more intervention-related adverse events (odds ratio = 4.21, 95% confidence interval: 1.01, 17.67; P = 0.05) and more nonserious adverse events (odds ratio = 7.30, 95% confidence interval: 1.91, 27.92; P < 0.01) occurred in the yoga group; serious adverse events and dropouts due to adverse events were comparable between groups. Findings from this review indicate that yoga appears as safe as usual care and exercise. The adequate reporting of safety data in future randomized trials of yoga is crucial to conclusively judge its safety.
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Yoga for Chronic Neck Pain: A Pilot Randomized Controlled Clinical Trial
Michalsen, A., Traitteur, H., Lüdtke, R., Brunnhuber, S., Meier, L., Jeitler, M., Büssing, A., & Keßler, C. S. (2012) · Journal of Pain · doi:10.1016/j.jpain.2012.08.004 · Cited by 84 · see citing works
Utilization of 3‐Month Yoga Program for Adults at High Risk for Type 2 Diabetes: A Pilot Study
Yang, K., Bernardo, L. M., Sereika, S. M., Conroy, M. B., Balk, J., & Burke, L. E. (2009) · Evidence-based Complementary and Alternative Medicine · doi:10.1093/ecam/nep117 · Cited by 84 · see citing works
J.Carter, J., L.Gerbarg, P., Brown, R., Ware, R., & Katzman, M. (2013) · Journal of Traumatic Stress Disorders & Treatment · doi:10.4172/2324-8947.1000108 · Cited by 84 · see citing works
Yoga for asthma: a systematic review and meta-analysis
Cramer, H., Posadzki, P., Dobos, G. J., & Langhorst, J. (2014) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2014.03.014 · Cited by 80 · see citing works
Self-citationInnes, K. E., & Selfe, T. K. (2012) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2012/294058 · Cited by 79 · see citing works
Martins, R. F., & Silva, J. L. P. E. (2013) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2012.0715 · Cited by 78 · see citing works
Gould, L. F., Dariotis, J. K., Mendelson, T., & Greenberg, M. T. (2012) · Journal of Community Psychology · doi:10.1002/jcop.21505 · Cited by 78 · see citing works
Colgrove, Y., & Sharma, N. K. (2012) · Journal of Yoga & Physical Therapy · doi:10.4172/2157-7595.1000112 · Cited by 73 · see citing works
Nagarathna, R., Ebnezar, J. N. P., Yogitha, B., & Nagendra, H. (2012) · International Journal of Yoga · doi:10.4103/0973-6131.91708 · Cited by 72 · see citing works
Yoga for rheumatic diseases: a systematic review
Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. J. (2013) · Lara D. Veeken · doi:10.1093/rheumatology/ket264 · Cited by 72 · see citing works
Self-citationYoga intervention for adults with mild-to-moderate asthma: a pilot study
Sabina, A. B., Williams, A.-L., Wall, H. K., Bansal, S., Chupp, G. L., & Katz, D. L. (2005) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)61131-3 · Cited by 71 · see citing works
Iyengar Yoga for Distressed Women: A 3-Armed Randomized Controlled Trial
Michalsen, A., Jeitler, M., Brunnhuber, S., Lüdtke, R., Büssing, A., Musial, F., Dobos, G. J., & Keßler, C. S. (2012) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2012/408727 · Cited by 70 · see citing works
Self-citationChan, R. W., Immink, M. A., & Hillier, S. (2012) · PubMed · Cited by 70 · see citing works
Hagins, M., Rundle, A., Consedine, N., & Khalsa, S. B. (2014) · The Journal of Clinical Hypertension · doi:10.1111/jch.12244 · Cited by 68 · see citing works
Soudarssanane, M. B., Subramanian, H., Jayalakshmy, R., Thiruselvakumar, D., Navasakthi, D., Sahai, A., & Saptharishi, L. (2011) · Indian Journal of Community Medicine · doi:10.4103/0970-0218.86519 · Cited by 68 · see citing works
Ebnezar, J. N. P., Nagarathna, R., Yogitha, B., & Nagendra, H. (2011) · International Journal of Yoga · doi:10.4103/0973-6131.85486 · Cited by 65 · see citing works
Telles, S., Yadav, A., Kumar, N., Sharma, S., Visweshwaraiah, N. K., & Balkrishna, A. (2013) · Medical Science Monitor · doi:10.12659/msm.883743 · Cited by 63 · see citing works
Nagarathna, R., Usharani, M., Rao, A. R. C., Chaku, R., Kulkarni, R., & Nagendra, H. R. (2012) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-012-0078-y · Cited by 61 · see citing works
Complimentary effect of yogic sound resonance relaxation technique in patients with common neck pain
Yogitha, B., Nagarathna, R., John, E., & Nagendra, H. (2010) · International Journal of Yoga · doi:10.4103/0973-6131.66774 · Cited by 59 · see citing works
Ikai, S., Uchida, H., Suzuki, T., Tsunoda, K., Mimura, M., & 藤井, 康. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.07.017 · Cited by 57 · see citing works
Vaishali, K., Kumar, V., Adhikari, P., & Unnikrishnan, B. (2012) · Physical & Occupational Therapy In Geriatrics · doi:10.3109/02703181.2012.656835 · Cited by 57 · see citing works
Progressive muscle relaxation, yoga stretching, and ABC relaxation theory
Ghoncheh, S., & Smith, J. C. (2003) · Journal of Clinical Psychology · doi:10.1002/jclp.10194 · Cited by 55 · see citing works
Silver Yoga Exercises Improved Physical Fitness of Transitional Frail Elders
Chen, K., Fan, J.-T., Wang, H., Wu, S.-J., Li, C., & Lin, H. (2010) · Nursing Research · doi:10.1097/nnr.0b013e3181ef37d5 · Cited by 54 · see citing works
Effect of a Home-Based Simple Yoga Program in Child-Care Workers: A Randomized Controlled Trial
Sakuma, Y., Sasaki-Otomaru, A., Ishida, S., Kanoya, Y., Arakawa, C., Mochizuki, Y., Seiishi, Y., & Sato, C. (2012) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2011.0080 · Cited by 52 · see citing works
Impact of Yoga Nidra on Menstrual Abnormalities in Females of Reproductive Age
Rani, M., Singh, U., Agrawal, G. G., Natu, S. M., Kala, S., Ghildiyal, A., & Srivastava, N. (2013) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2010.0676 · Cited by 51 · see citing works
Hegde, S. V., Adhikari, P., Shetty, S., Manjrekar, P., & D’Souza, V. (2013) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2013.08.013 · Cited by 50 · see citing works
Nagarathna, R., Deshpande, S., & Nagendra, H. (2008) · International Journal of Yoga · doi:10.4103/0973-6131.41034 · Cited by 48 · see citing works
The Effect of Community Exercise Interventions for People with MS Who Use Bilateral Support for Gait
Hogan, N., Kehoe, M., Larkin, A., & Coote, S. B. (2014) · Multiple Sclerosis International · doi:10.1155/2014/109142 · Cited by 46 · see citing works
Franzblau, S. H., Echevarria, S., Smith, M. M., & Cantfort, T. E. V. (2008) · Journal of Interpersonal Violence · doi:10.1177/0886260508314329 · Cited by 46 · see citing works
Köhn, M., Lundholm, U. P., Bryngelsson, I., Anderzén‐Carlsson, A., & Westerdahl, E. (2013) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2013/215348 · Cited by 45 · see citing works
Pal, A., Srivastava, N., Narain, V. S., Agrawal, G., & Rani, M. (2013) · Eastern Mediterranean Health Journal · doi:10.26719/2013.19.5.452 · Cited by 43 · see citing works
A Group-Based Yoga Therapy Intervention for Urinary Incontinence in Women
Huang, A. J., Jenny, H. E., Chesney, M. A., Schembri, M. E., & Subak, L. L. (2014) · Urogynecology · doi:10.1097/spv.0000000000000072 · Cited by 42 · see citing works
Park, J., McCaffrey, R. G., Dunn, D. J., & Goodman, R. (2011) · Holistic Nursing Practice · doi:10.1097/hnp.0b013e318232c5f9 · Cited by 42 · see citing works
Understanding and Preventing Yoga Injuries
Fishman, L. M., Saltonstall, E., & Genis, S. (2009) · International Journal of Yoga Therapy · doi:10.17761/ijyt.19.1.922087896t1h2180 · Cited by 41 · see citing works
Predictors of yoga use among internal medicine patients
Cramer, H., Lauche, R., Langhorst, J., Paul, A. E., Michalsen, A., & Dobos, G. J. (2013) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-13-172 · Cited by 39 · see citing works
Self-citationKim, S., Bemben, M. G., & Bemben, D. A. (2012) · Europe PMC (PubMed Central) · Cited by 39 · see citing works
Vogler, J., O’Hara, L., Gregg, J., & Burnell, F. (2011) · International Journal of Yoga Therapy · doi:10.17761/ijyt.21.1.e15852u665l710r1 · Cited by 37 · see citing works
Nagarathna, R., Deshpande, S., & Nagendra, H. (2009) · International Journal of Yoga · doi:10.4103/0973-6131.43287 · Cited by 34 · see citing works
A Survey of Musculoskeletal Injury among Ashtanga Vinyasa Yoga Practitioners
Mikkonen, J., Pedersen, P., & McCarthy, P. W. (2008) · International Journal of Yoga Therapy · doi:10.17761/ijyt.18.1.l0748p25k2558v77 · Cited by 33 · see citing works
Iranzo, M. À. C. I., Arnall, D. A., Camacho, C. I., & Tomás, J. M. (2013) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0b013e31829938bb · Cited by 33 · see citing works
Active Practice of Iyengar Yoga as an Intervention for Breast Cancer Survivors
Blank, S. E., Kittel, J., & Haberman, M. (2005) · International Journal of Yoga Therapy · doi:10.17761/ijyt.15.1.72j576wvm84107p6 · Cited by 32 · see citing works
Franzblau, S. H., Smith, M. M., Echevarria, S., & Cantfort, T. E. V. (2006) · International Journal of Yoga Therapy · doi:10.17761/ijyt.16.1.d8qw1532m0121w35 · Cited by 25 · see citing works
The Effect of Yoga Therapy on Selected Psychological Variables Among Male Patients with Insomnia
Sobana, R. (2013) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2012/5056.2669 · Cited by 24 · see citing works
Discovering the Physical and Psychological Benefits of Yoga for Cancer Survivors
Culos-Reed, S. N., Carlson, L. E., Daroux, L. M., & Hately-Aldous, S. (2004) · International Journal of Yoga Therapy · doi:10.17761/ijyt.14.1.b762r67612407556 · Cited by 22 · see citing works
Do side-effects/injuries from yoga practice result in discontinued use? Results of a national survey
Holton, M., & Barry, A. (2014) · International Journal of Yoga · doi:10.4103/0973-6131.133900 · Cited by 17 · see citing works
Yoga and Social Support Reduce Prenatal Depression, Anxiety and Cortisol
Field, T. M. (2012) · Journal of Yoga & Physical Therapy · doi:10.4172/2157-7595.1000124 · Cited by 11 · see citing works
Ebnezar, J. N. P., & Yogitha, B. (2012) · Journal of Yoga & Physical Therapy · doi:10.4172/2157-7595.1000114 · Cited by 9 · see citing works
EFFICACY OF MIND SOUND RESONANCE TECHNIQUE IN COMMON NECK PAIN
Yogitha, B., & Ebnezar, J. N. P. (2012) · Cited by 8 · see citing works
Singh, H., Sharma, A., & Johar, S. (2011) · Cited by 7 · see citing works
Is Yoga Really Dangerous? A Systematic Review of Adverse Events Reported in the Medical Literature
Fishbein, D., Barrett, L., Teranishi, R., Saper, R. B., & Kruger, J. (2014) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2014.5052.abstract · Cited by 5 · see citing works
Self-citationYogitha, B., & Ebnezar, J. N. P. (2012) · Journal of Yoga & Physical Therapy · doi:10.4172/2157-7595.1000108 · Cited by 5 · see citing works
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Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care
Tick, H., Nielsen, A., Pelletier, K. R., Bonakdar, R. A., Simmons, S., Glick, R. M., Ratner, E. F., Lemmon, R., Wayne, P. M., & Zador, V. (2018) · EXPLORE · doi:10.1016/j.explore.2018.02.001 · Cited by 388 · see citing works
“A systematic review and metaanalysis of RCTs found yoga to be as safe as usual care and exercise.(359) No association between yoga practice and joint problems was found in a large survey of women aged 62– 67.”
BackgroundYoga for anxiety: A systematic review and meta-analysis of randomized controlled trials
Cramer, H., Lauche, R., Anheyer, D., Pilkington, K., de Manincor, M., Dobos, G., & Ward, L. (2018) · Depression and Anxiety · doi:10.1002/da.22762 · Cited by 329 · see citing works
“While this systematic review found there was no conclusive evidence for the effective use of yoga in anxiety disorders, yogamay, however, be considered a safe (Cramer et al., 2015; Reddy & Vijay, 2016), ancillary intervention for patients unwilling to commit to other forms of exercise.”
BackgroundSelf-citationYoga treatment for chronic non-specific low back pain
Wieland, L. S., Skoetz, N., Pilkington, K., Vempati, R., D’Adamo, C. R., & Berman, B. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010671.pub2 · Cited by 258 · see citing works
Breedvelt, J., Amanvermez, Y., Harrer, M., Karyotaki, E., Gilbody, S. M., Bockting, C., Cuijpers, P. J., & Ebert, D. D. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00193 · Cited by 248 · see citing works
Field, T. M. (2016) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2016.06.005 · Cited by 225 · see citing works
“suggested that yoga was as safe as exercise and usual care [5].”
BackgroundUnwanted effects: is there a negative side of meditation? A multicentre survey
Cebolla, A., Demarzo, M., Martins, P., Soler, J., & Garcia-Campayo, J. (2017) · PLOS ONE · doi:10.1371/journal.pone.0183137 · Cited by 192 · see citing works
A systematic review of yoga for major depressive disorder
Cramer, H., Anheyer, D., Lauche, R., & Dobos, G. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.02.006 · Cited by 192 · see citing works
Self-citationArmour, M., Smith, C. A., Steel, K. A., & MacMillan, F. (2019) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-019-2433-8 · Cited by 167 · see citing works
“Previous systematic reviews have shown that yoga is a relatively safe intervention compared to usual care or exercise [95].”
BackgroundTreating major depression with yoga: A prospective, randomized, controlled pilot trial
Prathikanti, S., Rivera, R., Cochran, A., Tungol, J. G., Fayazmanesh, N., & Weinmann, E. (2017) · PLOS ONE · doi:10.1371/journal.pone.0173869 · Cited by 157 · see citing works
Role of Yoga in Cardiac Disease and Rehabilitation
Guddeti, R. R., Dang, G., Williams, M. A., & Alla, V. M. (2018) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000372 · Cited by 140 · see citing works
Hoenders, R. H. J., Ghelman, R., Portella, C. F. S., Simmons, S., Locke, A., Cramer, H., Gallego-Pérez, D. F., & Jong, M. C. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1395698 · Cited by 165 · see citing works
Self-citationA systematic review and meta-analysis on the effects of yoga on weight-related outcomes
Lauche, R., Langhorst, J., Lee, M. S., Dobos, G. J., & Cramer, H. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2016.03.013 · Cited by 115 · see citing works
“…controlled trials found no evidence for serious yoga-associated adverse events or an accumulation of adverse events compared to usual care or exercise (Cramer et al., 2015b), evidencewas limited because only one third of the trials actually reported safety and most of them insufficiently.”
BackgroundSelf-citationCramer, H., Haller, H., Dobos, G., & Lauche, R. (2016) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2016/5859729 · Cited by 105 · see citing works
Self-citationImpact of Yoga on cognition and mental health among elderly: A systematic review
Chobe, S. V., Chobe, M. P., Metri, K., Patra, S. K., & Raghuram, N. (2020) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102421 · Cited by 102 · see citing works
Kligler, B., Bair, M. J., Banerjea, R., DeBar, L., Ezeji-Okoye, S., Lisi, A., Murphy, J. L., Sandbrink, F., & Cherkin, D. C. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4323-z · Cited by 95 · see citing works
Yoga for menopausal symptoms—A systematic review and meta-analysis
Cramer, H., Peng, W., & Lauche, R. (2017) · Maturitas · doi:10.1016/j.maturitas.2017.12.005 · Cited by 96 · see citing works
Self-citationYoga as Antihypertensive Lifestyle Therapy: A Systematic Review and Meta-analysis
Wu, Y., Johnson, B. T., Acabchuk, R. L., Chen, S., Lewis, H., Livingston, J., Park, C. L., & Pescatello, L. S. (2019) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2018.09.023 · Cited by 93 · see citing works
Yoga for treating low back pain: a systematic review and meta-analysis
Anheyer, D., Haller, H., Lauche, R., Dobos, G. J., & Cramer, H. (2021) · Pain · doi:10.1097/j.pain.0000000000002416 · Cited by 88 · see citing works
Self-citationJames-Palmer, A., Anderson, E. Z., Zucker, L., Kofman, Y., & Daneault, J. (2020) · Frontiers in Pediatrics · doi:10.3389/fped.2020.00078 · Cited by 99 · see citing works
“A previous systematic review regarding safety of yoga in adults supports this observation; concluding that while yoga appears as safe as usual exercise, adequate reporting of adverse events is crucial for future studies (63).”
BackgroundAdverse effects of yoga: a national cross-sectional survey
Cramer, H., Quinker, D., Schumann, D., Wardle, J., Dobos, G., & Lauche, R. (2019) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-019-2612-7 · Cited by 95 · see citing works
Self-citationYoga for metabolic syndrome: A systematic review and meta-analysis
Cramer, H., Langhorst, J., Dobos, G. J., & Lauche, R. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316665729 · Cited by 79 · see citing works
Self-citationCramer, H., Ostermann, T., & Dobos, G. J. (2017) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2017.08.026 · Cited by 78 · see citing works
Self-citationRodrigues-Krause, J. D. C., Farinha, J. B., Krause, M. D. S., & Reischak-Oliveira, Á. (2016) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2016.09.004 · Cited by 73 · see citing works
Yoga and Quality of Life in Women with Primary Dysmenorrhea: A Systematic Review
McGovern, C. E., & Cheung, C. (2018) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.12729 · Cited by 77 · see citing works
Bridgett, R., Klose, P., Duffield, R., Mydock, S., & Lauche, R. (2017) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2017.0191 · Cited by 68 · see citing works
Self-citationNg, Q. X., Venkatanarayanan, N., Loke, W., Yeo, W. S., Lim, D. Y., Chan, H. W., & Sim, W.-S. (2018) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2018.10.016 · Cited by 68 · see citing works
Role of yoga for patients with type II diabetes mellitus: A systematic review and meta-analysis
Kumar, V., Jagannathan, A., Philip, M., Thulasi, A., Angadi, P., & Nagarathna, R. (2016) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2016.02.001 · Cited by 67 · see citing works
Yoga for chronic non-specific low back pain
Wieland, L. S., Skoetz, N., Pilkington, K., Harbin, S., Vempati, R., & Berman, B. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010671.pub3 · Cited by 69 · see citing works
Donesky, D., Selman, L. E., McDermott, K. A., Citron, T., & Howie‐Esquivel, J. (2017) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2015.0279 · Cited by 66 · see citing works
“29 The authors concluded that recommending yoga to healthy or chronically ill adults should not be discouraged on the basis of safety.”
The Safety of Baduanjin Exercise: A Systematic Review
Fang, J., Zhang, L., Wu, F., Ye, J., Cai, S., & Lian, X. (2021) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2021/8867098 · Cited by 61 · see citing works
Jayawardena, R., Ranasinghe, P. D., Chathuranga, T., Atapattu, P. M., & Misra, A. (2018) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2018.04.008 · Cited by 60 · see citing works
Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis
DiRenzo, D., Crespo-Bosque, M., Gould, N. F., Finan, P. H., Nanavati, J., & Bingham, C. O. (2018) · Current Rheumatology Reports · doi:10.1007/s11926-018-0787-4 · Cited by 57 · see citing works
“MBIs that contain a yoga component must be carefully reviewed and tailored for patients with RA to avoid injury [30].”
BackgroundEffectiveness of yoga for major depressive disorder: A systematic review and meta-analysis
Wu, Y., Yan, D., & Yang, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1138205 · Cited by 54 · see citing works
“A previous review (76) looked at the safety of yoga interventions and the frequency of adverse events from randomized controlled trials and found that the frequency and severity of yoga-related adverse events were comparable to that associated with physical activity or usual care.”
BackgroundYoga for secondary prevention of coronary heart disease: A systematic review and meta-analysis
Li, J., Gao, X., Hao, X., Kantas, D., Mohamed, E. A., Zheng, X., Xu, H., & Zhang, L. (2020) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102643 · Cited by 53 · see citing works
Lin, I.-H., Huang, C., Chou, S., & Shih, C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095368 · Cited by 53 · see citing works
“A previous meta-analysis investigated the safety regarding yoga, and the results showed that injuries or adverse effects related to yoga are rare [34].”
BackgroundBatrakoulis, A. (2022) · Diseases · doi:10.3390/diseases10040107 · Cited by 57 · see citing works
“Figure 1 summarizes the effects of yoga interventions on cardiometabolic health, physical performance, and well-being in overweight and obese individuals [34,43,46,56,57].”
BackgroundCramer, H., Quinker, D., Pilkington, K., Mason, H., Adams, J., & Dobos, G. J. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.10.026 · Cited by 50 · see citing works
Self-citationDanon‐Hersch, N., Al‐Gobari, M., Burnand, B., & Rodondi, P. (2021) · Psycho-Oncology · doi:10.1002/pon.5821 · Cited by 51 · see citing works
“Mind–body therapies are not expensive and have few negative side effects.(12) Nevertheless, there is no consensus on a standard definition of mind– body techniques, and some mind–body definitions partly overlap with the definition of complementary medicine (CM): according to the National Center for Complementary and I…”
BackgroundEffects of yoga on eating disorders—A systematic review
Ostermann, T., Vogel, H., Boehm, K., & Cramer, H. (2019) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2019.07.021 · Cited by 46 · see citing works
Self-citationBringmann, H. C., Bringmann, N., Jeitler, M., Brunnhuber, S., Michalsen, A., & Sedlmeier, P. (2020) · Complementary Medicine Research · doi:10.1159/000512333 · Cited by 43 · see citing works
The Efficacy of Body-Oriented Yoga in Mental Disorders
Klatte, R., Pabst, S., Beelmann, A., & Rosendahl, J. (2016) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2016.0195 · Cited by 42 · see citing works
Increasing Trend of Yoga Practice Among U.S. Adults From 2002 to 2017
Zhang, Y., Lauche, R., Cramer, H., Munk, N., & Dennis, J. A. (2021) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2020.0506 · Cited by 42 · see citing works
Self-citationMandal, S., Misra, P., Sharma, G., Sagar, R., Kant, S., Dwivedi, S., Lakshmy, R., & Goswami, K. (2021) · Journal of Evidence-Based Integrative Medicine · doi:10.1177/2515690x21991998 · Cited by 35 · see citing works
“This systematic review included the studies done among participants with some diagnosed medical conditions.(33) Another systematic review and meta-analysis done by Vollbehr et al.”
BackgroundYoga as a Therapy for Irritable Bowel Syndrome
D’Silva, A., MacQUEEN, G. M., Nasser, Y., Taylor, L., Vallance, J. K., & Raman, M. (2019) · Digestive Diseases and Sciences · doi:10.1007/s10620-019-05989-6 · Cited by 39 · see citing works
Östh, J., Diwan, V. K., Jirwe, M., Diwan, V., Choudhary, A., Mahadik, V. K., Pascoe, M. C., & Hallgren, M. Å. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027386 · Cited by 36 · see citing works
“Interventions involving yoga are generally considered safe(73); adverse events are rare but may include muscle strains and soreness.(73) To reduce these risks, all exercise sessions will be designed for older adults and delivered by qualified instructors and PTs with experience in physical activity prescription.”
BackgroundA Systematic Review of Mechanisms of Change in Body-Oriented Yoga in Major Depressive Disorders
Meister, K., & Juckel, G. (2017) · Pharmacopsychiatry · doi:10.1055/s-0043-111013 · Cited by 34 · see citing works
“yoga presents a generally safe intervention [6], follows a clear biological rationale in altering the stress diathesis model that may influence the onset and relapse of MDD and has utility as a self-management technique that empowers the person as a whole rather than (narrowly) affecting just symptomatology [2, 5, 7–1…”
BackgroundYoga bei psychischen Störungen
Meister, K., & Becker, S. (2018) · Der Nervenarzt · doi:10.1007/s00115-018-0537-x · Cited by 32 · see citing works
The safety of tai chi: A meta-analysis of adverse events in randomized controlled trials
Cui, H. S., Wang, Q., Pedersen, M., Wang, Q., Lv, S., James, D. L., & Larkey, L. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.06.004 · Cited by 32 · see citing works
The effect of yoga on pulmonary function in patients with asthma: A meta-analysis
Anshu, Singh, N., Deka, S., Saraswati, P., Sindhwani, G., Goel, A., & Kumari, R. (2022) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2022.101682 · Cited by 32 · see citing works
Yoga for treating urinary incontinence in women
Wieland, L. S., Shrestha, N., Lassi, Z. S., Panda, S., Chiaramonte, D. R., & Skoetz, N. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012668.pub2 · Cited by 31 · see citing works
Nyer, M., Gerbarg, P. L., Silveri, M. M., Johnston, J., Scott, T. M., Nauphal, M., Owen, L., Nielsen, G. H., Mischoulon, D., Brown, R. P., et al. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.02.006 · Cited by 29 · see citing works
“10 between the LDG or HDG (though we were not able to conduct statistical tests on these data; please see Method Section), consistent with previous reports of dosage not being a determining factor in increased adverse events in yoga trials(11).”
MethodResultDenham‐Jones, L., Gaskell, L., Spence, N., & Pigott, T. (2021) · Musculoskeletal Care · doi:10.1002/msc.1576 · Cited by 29 · see citing works
Romero-García, P. A., Ramírez-Pérez, S., Miguel-González, J. J., Guzmán-Silahua, S., Castañeda-Moreno, J. A., Komninou, S., & Rodríguez-Lara, S. (2024) · Healthcare · doi:10.3390/healthcare12151547 · Cited by 23 · see citing works
“The systematic review also reported a low bias risk and low heterogeneity among the trials [105].”
Yao, C., & Tseng, C.-H. (2019) · Topics in Geriatric Rehabilitation · doi:10.1097/tgr.0000000000000242 · Cited by 25 · see citing works
Liu, A., Chu, I., Lin, H., Liang, J.-M., Hsu, H.-T., & Wu, W. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168402 · Cited by 25 · see citing works
“It has been reported that yoga is safe as a usual form of care and exercise [11].”
BackgroundRemote Delivery of Yoga Interventions Through Technology: Scoping Review
James-Palmer, A., Anderson, E. Z., & Daneault, J. (2022) · Journal of Medical Internet Research · doi:10.2196/29092 · Cited by 24 · see citing works
Yoga and Integrative Healthcare
Bhargav, H., Holla, B., Ramakrishna, K. K., Shivakumar, V., Gokulakrishnan, K., Varambally, S. S., & Gangadhar, B. N. (2022) · International Journal of Yoga · doi:10.4103/ijoy.ijoy_56_22 · Cited by 24 · see citing works
“Yoga is noninvasive and accordingly is not expected to have any drug interactions.[25] Integration of yoga, therefore, with other medical systems should pose no challenge.”
BackgroundKraemer, K. M., Jain, F. A., Mehta, D. H., & Fricchione, G. L. (2022) · Seminars in Neurology · doi:10.1055/s-0042-1742287 · Cited by 23 · see citing works
Integrative Medicine Strategies for Changing Health Behaviors
Wolever, R. Q., Caldwell, K. L., McKernan, L. C., & Hillinger, M. G. (2017) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2017.02.007 · Cited by 23 · see citing works
Injury in yoga asana practice: Assessment of the risks
Wiese, C., Keil, D., Rasmussen, A. S., & Olesen, R. (2018) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2018.09.151 · Cited by 23 · see citing works
Tran, B. X., Harijanto, C., Vu, G. T., & Ho, R. (2020) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102350 · Cited by 21 · see citing works
Nejadghaderi, S. A., Mousavi, S. E., Fazlollahi, A., Asghari, K. M., & Garfin, D. R. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116098 · Cited by 24 · see citing works
“…studies (not specific to PTSD) with 8,430 participants revealed no significant differences in the frequency of intervention-related adverse events, nonserious or serious adverse events, or dropouts because of adverse events when comparing yoga with routine care/no treatment (Cramer et al., 2015).”
Applications of Yoga in Psychiatry: What We Know
Nyer, M., Nauphal, M., Roberg, R., & Streeter, C. C. (2018) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20170055 · Cited by 20 · see citing works
Eyigör, S., Apaydın, Ş., Yeşil, H., Tanıgör, G., & Bıçaklı, D. H. (2021) · Complementary Medicine Research · doi:10.1159/000515494 · Cited by 20 · see citing works
Mind-body therapy for treating fibromyalgia: a systematic review
Steen, J. P., Kannan, V., Zaidi, A., Cramer, H., & Ng, J. Y. (2024) · Pain Medicine · doi:10.1093/pm/pnae076 · Cited by 27 · see citing works
“86 Some notable AEs reported in the literature include psychotic symptoms and an increased susceptibility to false memories associated with mindfulness, 87 as well as musculoskeletal injuries linked to yoga.”
Self-citationYoga as adjunctive therapy in the treatment of people with anorexia nervosa: a Delphi study
Rizzuto, L., Hay, P., Noetel, M., & Touyz, S. W. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00467-9 · Cited by 18 · see citing works
“Keywords: Anorexia Nervosa, Delphi, Yoga, Exercise in the field of AN; or (v) published peer-reviewed journal article(s) and/ or book(s) that are focused on AN.”
InfluentialMascaro, J. S., Waller, A. V., Wright, L., Leonard, T., Haack, C., & Waller, E. K. (2019) · Integrative Cancer Therapies · doi:10.1177/1534735419861692 · Cited by 17 · see citing works
Yoga and the Need of Its Integration in Modern Medicine
Santra, G. (2022) · Journal of the Association of Physicians of India · doi:10.5005/japi-11001-0142 · Cited by 17 · see citing works
Lauche, R., Schumann, D., Sibbritt, D. W., Adams, J., & Cramer, H. (2017) · Rheumatology International · doi:10.1007/s00296-017-3744-z · Cited by 17 · see citing works
Self-citationSheeran, L., Hemming, R., Deursen, R. W. M. V., & Sparkes, V. (2018) · Cogent Engineering · doi:10.1080/23311916.2018.1442109 · Cited by 17 · see citing works
“Whilst the 2-minute trial duration may limit relevance of this research to prolonged sitting in today’s sedentary lifestyles, the trial duration appropriately reflects the duration of the postures adopted within exercise practices such as Yoga used for healthy and LBP individuals typically between 30 to 60 s in length…”
MethodYoga and mental health: what every psychiatrist needs to know
Bhargav, H., George, S., & Varambally, S. S. (2022) · BJPsych Advances · doi:10.1192/bja.2022.22 · Cited by 17 · see citing works
Lee, L. J., Shamburek, R. D., Son, H., Wallen, G. R., Cox, R., Flynn, S. L., Yang, L., Bevans, M. F., Wehrlen, L., & Ross, A. C. (2022) · PLoS ONE · doi:10.1371/journal.pone.0277009 · Cited by 16 · see citing works
“Iyengar yoga utilizes highly standardized teaching methods, and is the yoga style most often used in RCTs [25].”
MethodHalappa, N. G. (2023) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2023.04.055 · Cited by 16 · see citing works
Muñoz‐Vergara, D., Grabowska, W. A., Yeh, G. Y., Khalsa, S. B. S., Schreiber, K. L., Huang, C. A., Zavacki, A. M., & Wayne, P. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269300 · Cited by 15 · see citing works
“improving our understanding of the systemic and localized effects of yogic stretching-related injuries in humans [79,80].”
BackgroundOka, T., Wakita, H., & Kimura, K. (2017) · BioPsychoSocial Medicine · doi:10.1186/s13030-017-0090-z · Cited by 15 · see citing works
The Effect of Yoga on Menstrual Disorders: A Systematic Review
Oates, J. (2017) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2016.0363 · Cited by 15 · see citing works
“12,48,49 Yoga practice is growing exponentially, 24 particularly in the population most likely to experience menstrual distress: women of childbearing age.”
Sahasrabudhe, S. D., Orme, M. W., Jones, A., Tillu, G. S., Salvi, S. S., & Singh, S. J. (2021) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2021-000966 · Cited by 15 · see citing works
Tele-yoga for the management of Parkinson disease: A safety and feasibility trial
James-Palmer, A., & Daneault, J. (2022) · Digital Health · doi:10.1177/20552076221119327 · Cited by 16 · see citing works
Mishra, P., Harris, T. J., Greenfield, S., Hamer, M., Lewis, S., Singh, K., Nair, R., Mukherjee, S., Manjunath, N. K., Tandon, N., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095514 · Cited by 13 · see citing works
“This is consistent with prior work on reporting similar symptoms among Yoga participants [33].”
ResultThe Future of Yoga for Mental Health Care
Chawla, V., Brems, C., Freeman, H., Ravindran, A. V., & Noordsy, D. L. (2023) · International Journal of Yoga · doi:10.4103/ijoy.ijoy_25_23 · Cited by 13 · see citing works
“A systematic review and meta‐analysis of 94 RCTs of yoga found no significant differences in terms of safety risk found between yoga versus comparative exercise in participants across the lifespan.[18] However, not all studies report adverse events.”
BackgroundCharacteristics of women who practice yoga in different locations during pregnancy
Cramer, H., Frawley, J., Steel, A., Hall, H. G., Adams, J., Broom, A. F., & Sibbritt, D. W. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008641 · Cited by 15 · see citing works
Self-citationYoga for the treatment of depression: Five questions to move the evidence-base forward
Nauphal, M., Mischoulon, D., Uebelacker, L. A., Streeter, C. C., & Nyer, M. (2019) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2019.08.012 · Cited by 13 · see citing works
Aksu, A., & YILMAZ, D. V. (2024) · Health Care For Women International · doi:10.1080/07399332.2024.2303526 · Cited by 12 · see citing works
“In addition, yoga can reduce the negative effects of stress on the immune system, fight inflammation, reduce symptoms like pain and insomnia, and increase the quality of life (Cramer et al., 2015; Armour et al., 2019).”
Campo, M. A., Shiyko, M. P., Kean, M. B., Roberts, L., & Pappas, E. (2017) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2017.05.022 · Cited by 12 · see citing works
Portz, J. D., Schmid, A. A., Fruhauf, C. A., Fox, A., Puymbroeck, M. V., Sharp, J. L., & Leach, H. J. (2023) · JMIR Formative Research · doi:10.2196/39158 · Cited by 10 · see citing works
“Although adverse events are rare in yoga research [29], online delivery poses additional challenges if a participant falls or injures themself.”
BackgroundSud, A., Lai, K. S. P., Cheng, D. K.-Y., Chung, C., Pico-Espinosa, O. J., & Rice, D. B. (2020) · Pain Physician · doi:10.36076/ppj.2021.24.61-72 · Cited by 11 · see citing works
Safety of Complementary and Alternative Medicine (CAM) Treatments and Practices
Bellanger, R. A., Seeger, C., & Smith, H. E. (2017) · Side effects of drugs annual · doi:10.1016/bs.seda.2017.06.015 · Cited by 11 · see citing works
Patwardhan, A., & Lloyd, L. E. (2017) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587216689183 · Cited by 11 · see citing works
Gunjiganvi, M., Mathur, P., Kumari, M., Madan, K., Kumar, A., Sagar, R., Sagar, S., Gupta, A., Mishra, B., Mir, A. H., et al. (2021) · World Journal of Surgery · doi:10.1007/s00268-021-06057-9 · Cited by 10 · see citing works
Öz, M., & Ülger, Ö. (2024) · Perceptual and Motor Skills · doi:10.1177/00315125241292235 · Cited by 12 · see citing works
“Systematic reviews and meta-analyses examining the safety of these approaches in individuals with cLBP have reported minor (temporary pain exacerbations, etc.) or no adverse events (Cramer et al., 2015; Saragiotto et al., 2016).”
Braun, S. E., Deeb, G. R., Carrico, C. K., & Kinser, P. A. (2019) · Journal of Evidence-Based Integrative Medicine · doi:10.1177/2515690x19855303 · Cited by 10 · see citing works
Yao, C., Lee, B., Hong, H., & Su, Y. (2023) · Healthcare · doi:10.3390/healthcare11071024 · Cited by 12 · see citing works
“Yoga is a low-impact and moderate-intensity exercise characterized by its slowness, training of core muscles, flexibility, physical coordination, non-competitiveness, and ease of access; therefore, yoga is highly recommended as an exercise program for the elderly to improve their fitness [9,18,20].”
BackgroundZakers, A., & Cimolai, V. (2023) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2022.08.014 · Cited by 9 · see citing works
Role of Yoga practices on cognitive functions
Yadav, A., Verma, S., Panwar, M., & Yadav, N. K. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns3.6341 · Cited by 9 · see citing works
Lauche, R., Sibbritt, D. W., Adams, J., & Cramer, H. (2019) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2019.03.001 · Cited by 9 · see citing works
Self-citationFlehr, A., Barton, C., Coles, J. Y., Gibson, S. J., Lambert, G. W., Lambert, É., Dhar, A. K., & Dixon, J. B. (2019) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-019-2642-1 · Cited by 9 · see citing works
“There have also been a number of RCTs investigating the efficacy of yoga for pain, specifically with regard to safety [28] and pain improvements [29].”
BackgroundTeets, R., Nielsen, A., Moonaz, S. H., Anderson, B., Mah, D. M., Walter, E., Milanes, M., Jyung, H., Soto-Cossio, L. E., Meißner, P., et al. (2023) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130231202515 · Cited by 9 · see citing works
“72,73”
The North American yoga therapy workforce survey
Sullivan, M. B., Leach, M., Snow, J. E., & Moonaz, S. H. (2017) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2017.01.006 · Cited by 8 · see citing works
Yoga as a Holistic Treatment for Chronic Illnesses: Minimizing Adverse Events and Safety Concerns
Telles, S., Sharma, S. K., Kala, N., & Balkrishna, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00661 · Cited by 8 · see citing works
“This may be due to the fact that in such studies the yoga interventions were designed and delivered under the supervision of experienced yoga teachers (Cramer et al., 2015b) whereas in the four studies mentioned above on the adverse effects associated with yoga practice the subjects were either (i) practicing the yoga…”
Safety of Complementary and Alternative Medicine (CAM) Treatments and Practices
Bellanger, R. A., Ramsinghani, S., Franklin, C., & Seeger, C. (2016) · Side effects of drugs annual · doi:10.1016/bs.seda.2016.08.011 · Cited by 8 · see citing works
- Authors
- Cramer, H., Ward, L., Saper, R., Fishbein, D., Dobos, G., & Lauche, R.
- Affiliations
- University of Technology Sydney (AU)
- Boston University (US)
- University of Duisburg-Essen (DE)
- Corresponding author
- Cramer, Holger
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-06-26
- Volume
- 182
- Issue
- 4
- Pages
- 281-293
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2154895014
- Cited by
- 207
- References
- 147
- Citations by year
- 2026: 10 · 2025: 22 · 2024: 22 · 2023: 22 · 2022: 24 · 2021: 17 · 2020: 11 · 2019: 20 · 2018: 21 · 2017: 25 · 2016: 10 · 2015: 3
- FWCI
- 4.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- yoga, safety, adverse events, serious adverse events, dropout, physical activity, usual care, health education, safety reporting, randomized controlled trials
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Male, Middle Aged, Safety, Wounds and Injuries, Yoga, Randomized Controlled Trials as Topic, Databases, Bibliographic, Mind-Body Therapies, Young Adult
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