The DOI matches its Crossref record; 144 of the 147 references it cites were found in a registry or an index.
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 practices are well tolerated25,26”
From Individualized, Single Session Yoga Therapy to Reduce Physical and Emotional Symptoms in Hospitalized Hematological Cancer Patients. (2019) · cites this paper as [25]
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“improving our understanding of the systemic and localized effects of yogic stretching-related injuries in humans [79,80].”
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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
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
“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
“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
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 14
Aksu, A., & YILMAZ, D. V. (2024) · Health Care For Women International · doi:10.1080/07399332.2024.2303526 · Cited by 12
“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
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
“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 12
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
Patwardhan, A., & Lloyd, L. E. (2017) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587216689183 · Cited by 11
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
Öz, M., & Ülger, Ö. (2024) · Perceptual and Motor Skills · doi:10.1177/00315125241292235 · Cited by 14
“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
Yao, C., Lee, B., Hong, H., & Su, Y. (2023) · Healthcare · doi:10.3390/healthcare11071024 · Cited by 12
“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
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
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
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
“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 10
“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
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
“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
Metadata
- 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 › Public Health, Environmental and Occupational Health › 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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