A Systematic Review of Yoga Interventions on the Mental Health of Nursing Professionals and Students

Abstract

This systematic review aimed to evaluate the impact of yoga interventions on preventing and alleviating mental health issues, including stress, anxiety, burnout, depression, and other related factors among nursing professionals and students. The review adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42024512366). A comprehensive literature search was conducted in Google Scholar and PubMed using keywords such as “nursing students,” “nursing professionals,” “yoga interventions,” and “mental health.” Eligible studies were randomized controlled trials (RCTs) published from 1 st January 2014 to 31 st December 2024, involving nursing population and yoga-based interventions targeting mental health outcomes. The risk of bias was assessed using the CASP tool. The search identified 14 RCTs (967 participants, predominantly female, age range - 18 to 69 years) that met the eligibility criteria. The yoga intervention varied in duration (10 minutes to 1 hour per session), frequency (once to five times weekly), and protocols (Laughter yoga being the most common). Mental health outcomes such as stress, anxiety, burnout, mindfulness, depression, quality of sleep, and life satisfaction were assessed. Most studies reported significant improvements in these outcomes in the yoga intervention groups compared to control groups. Nine studies showed a significant stress reduction, and 3 studies found a decrease in anxiety. No adverse effects were reported, and dropout rates varied between 0% to 52.1%. Yoga was found to be effective in improving mental health and well-being among nursing professionals and students. Yoga mainly reduced stress, anxiety, burnout, and depression, suggesting its potential as a low-cost, accessible intervention for mental health management in this population. Future studies should focus on refining protocols and exploring long-term effects to establish yoga as an integral part of mental health care for nursing professionals and students.

Full text

© 2025 International Journal of Yoga | Published by Wolters Kluwer ‑ Medknow 13
Introduction
Nurses, with a workforce of approximately 6
million, form the backbone of the healthcare
delivery system in India.[1] After enrolling
in nursing programs, students transition into
professional roles through employment in
hospitals and clinics. In this phase, they
encounter numerous challenges in clinical
settings, as their responsibilities are heavily
centered on patient care.[2,3] Given the
complexities of disease conditions, patients
often respond unpredictably to nurses, who
must manage these situations while providing
critical care and supporting patient recovery.
These demands can lead to signicant mental
exhaustion, and without eective coping
mechanisms, nurses are at risk of developing
various mental health issues.
Address for correspondence:
Mr. Rahul Geeta Arya,
Department of Yoga and
Spirituality, S‑VYASA University,
Bengaluru, Karnataka, India.
E‑mail: rahularyasvyasa@
gmail.com
Abstract
This systematic review aimed to evaluate the impact of yoga interventions on preventing and
alleviating mental health issues, including stress, anxiety, burnout, depression, and other related
factors among nursing professionals and students. The review adhered to the PRISMA guidelines
and was registered in PROSPERO (CRD42024512366). A comprehensive literature search was
conducted in Google Scholar and PubMed using keywords such as “nursing students,” “nursing
professionals,” “yoga interventions,” and “mental health.” Eligible studies were randomized
controlled trials (RCTs) published from 1st January 2014 to 31st December 2024, involving
nursing population and yoga‑based interventions targeting mental health outcomes. The risk
of bias was assessed using the CASP tool. The search identied 14 RCTs (967 participants,
predominantly female, age range ‑ 18 to 69 years) that met the eligibility criteria. The yoga
intervention varied in duration (10 minutes to 1 hour per session), frequency (once to ve
times weekly), and protocols (Laughter yoga being the most common). Mental health outcomes
such as stress, anxiety, burnout, mindfulness, depression, quality of sleep, and life satisfaction
were assessed. Most studies reported signicant improvements in these outcomes in the yoga
intervention groups compared to control groups. Nine studies showed a signicant stress
reduction, and 3 studies found a decrease in anxiety. No adverse eects were reported, and
dropout rates varied between 0% to 52.1%. Yoga was found to be eective in improving mental
health and well‑being among nursing professionals and students. Yoga mainly reduced stress,
anxiety, burnout, and depression, suggesting its potential as a low‑cost, accessible intervention
for mental health management in this population. Future studies should focus on rening
protocols and exploring long‑term eects to establish yoga as an integral part of mental health
care for nursing professionals and students.
Keywords: Anxiety, burnout, depression, mental health, nursing professionals, nursing students,
randomized controlled trial, stress, systematic review, yoga
A Systematic Review of Yoga Interventions on the Mental Health of
Nursing Professionals and Students
Systematic Review
Rahul Geeta Arya,
Deepsikha
Srivastava1,
B. R. Divya,
Madhu2, Hemant
Bhargav3
Departments of Yoga and
Spirituality and 1Yoga and Life
Sciences, Swami Vivekananda
Anusandhana Samsthana
(S‑VYASA), 3Department of
Integrative Medicine, National
Institute of Mental Health and
Neurosciences (NIMHANS),
Bengaluru, Karnataka,
2Department of Yoga, Central
University of Haryana,
Mahendragarh, Haryana, India
A recent survey conducted in 2023
involving 13,867 psychiatric nurses across
41 hospitals reported alarming rates of
mental health problems: burnout was
prevalent in 38.6% of participants, while
depression, anxiety, and stress aected
26.3%, 36.4%, and 12.5%, respectively.[4]
Similarly, in China, a retrospective analysis
of 730 nurses from 2018 to 2020 revealed
that night shift work signicantly
contributed to chronic conditions such as
poor sleep quality, depression, high uric
acid levels, triglycerides, and even breast
cancer.[5‑8]
Nursing students are also particularly
vulnerable to mental health challenges.
Research indicates that mental health
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Access this article online
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com/IJOY
DOI: 10.4103/ijoy.ijoy_195_24
Quick Response Code:
How to cite this article: Arya RG, Srivastava D,
Divya BR, Madhu, Bhargav H. A systematic review
of yoga interventions on the mental health of
nursing professionals and students. Int J Yoga
2025;18:13-26.
Submitted: 09-Sep-2024 Revised: 10-Dec-2024
Accepted: 15-Jan-2025 Published: 22-Apr-2025

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 202514
issues are particularly prevalent among nursing
professionals and students (NPS).[9,10] A meta‑analysis of
42 studies involving 14,894 nursing students found that
they frequently experience bullying (38.8%), physical
aggression (10.2%), and sexual aggression, predominantly
perpetrated by patients (64.2%) and physicians (18.6%)
during their clinical placements.[11] Such exposure to hostile
environments places them at high risk for mental health
deterioration.[12] Despite the increasing awareness of these
challenges, recent comprehensive analyses highlight a
critical gap in eective mental health interventions tailored
specically for nurses and nursing students.[13,14] Various
therapeutic approaches, such as cognitive behavioral
therapy, mindfulness therapy, and others, are commonly
used to address these challenges. While these therapies are
eective in the short term, they often lack the long‑term
benets of a holistic approach to health. Yoga, in contrast,
follows the panch kosha principle, which addresses
physical, pranic, mental, cognitive, and spiritual health,[15]
oering a more comprehensive approach.
Yoga, an ancient mind–body practice, has shown promise
in enhancing mental resilience. Several systematic reviews
have highlighted its benecial eects on healthcare
professionals, including nurses, physicians, psychologists,
and paramedics, among others.[16‑20] Most studies agree
that yoga is an eective approach to managing both
physiological and psychological issues.[16,19] For instance,
Dutta et al.[19] reported that yoga improves the quality
of life and physical tness in patients with chronic heart
failure, while Mishra et al.[20] demonstrated its potential
as a complementary intervention for various chronic
inammatory conditions.
Yoga has proven benecial for managing chronic health
conditions in NPS and is emerging as a complementary
treatment. Numerous studies highlight yoga’s positive
impact on psychological health in both healthy and diseased
populations.[21‑25] A 2016 bibliographic analysis conrmed
yoga’s eectiveness for a range of mental and physical
health issues,[26] and a 2021 systematic review of 25 studies
emphasized yoga’s benets for health professionals and
students across diverse environments.[16] Cohen’s 2023
systematic review of 33 studies found that workplace
interventions, including yoga, improve well‑being,
engagement, and resilience, and reduce burnout among
healthcare workers.[27] Despite this, there has been no
rigorous review focused on yoga’s impact on the mental
well‑being of NPS. This systematic review seeks to
ll that gap by summarizing research on the potential
benets of yoga in improving mental health outcomes
for NPS. Although the mental health burden among NPS
is well‑documented, systematic reviews on mental health
interventions have primarily focused on physicians and
general healthcare workers,[28,29] with limited attention to
NPS specically. This systematic review addresses this gap
by exploring the eects of yoga interventions on the mental
health of NPS, oering a novel perspective in the domain
of their mental heath and well‑being.
Aim
This study aimed to evaluate the impact of yoga
interventions on the prevention and alleviation of mental
health issues, including stress, anxiety, and depression,
among NPS.
Methods
The present systematic review adhered to the Preferred
Reporting Items for Systematic Reviews and Meta‑Analysis
(PRISMA) guidelines.[30] The review protocol was registered
in the PROSPERO database under the registration number
CRD42024512366.
Search strategy
All authors nalized the keywords after a thorough
discussion. Subsequently, two authors (RGA and M)
developed the search strategy by extensively exploring
relevant publications on the topic. Any disagreements were
resolved by consulting three other authors (DBR, DS, and
HB). From January 18, 2024 till February 18, 2024, the
Google Scholar and PubMed electronic databases were
thoroughly searched using the terms “nursing students,”
“nursing professionals,” “yoga interventions,” and “mental
health.” In addition, manual and snowball search techniques
were employed to ensure that no relevant articles were
overlooked. After the literature search, two authors (RGA
and M) independently reviewed the abstracts and examined
potentially suitable full articles to ensure they met the
eligibility criteria.
Study selection process
The two authors (RGA and M) independently conducted
the study selection procedure. Any uncertainties in the
study selection process were discussed with three other
authors (DBR, DS, and HB). All ve authors (RGA, DBR,
DS, M, and HB) reached a consensus on the nal inclusion
and exclusion criteria. Duplicates were removed using the
Zotero database. After duplication removal, the remaining
articles were screened based on the eligibility criteria.
Full‑text articles were then obtained for all qualifying
studies. For those whose full text was not accessible, RGA
and M contacted the journals and authors to request the full
text. The full‑text articles were rescreened using the same
eligibility standards. A second screening of the rejected
full‑text articles was performed to ensure that no relevant
studies were overlooked. DBR and DS screened the records
independently, with one author screening and the other
reviewing the decisions. HB evaluated the overall quality
of the studies while remaining blind to the conclusions of
the other authors. Due to insucient and inconsistent data,
a meta‑analysis was not conducted.

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 2025 15
Study design
This review included quantitative research studies,
specically prospective randomized controlled trials
(RCTs), that employed either invasive or noninvasive
methods for data collection.
Inclusion and exclusion criteria
The study question was developed using the PICO
technique, which stands for Population, Intervention
(design), Control, and Outcome.[31] Included studies were
required to meet the following criteria: they must identify
“yoga” as the intervention,[32,33] including asanas, relaxation
practices, breathing exercises, pranayama, and meditation.
Target nursing professionals or nursing students as the
population; be randomized controlled clinical trials published
between 2014 and 2024. In addition, studies must address
mental health variables and be published in peer‑reviewed
English‑language journals. Excluded studies were those that
involved yoga combined with other multimodal interventions
(e.g., yoga and Tai Chi), studies where the sample did not
exclusively comprise nursing professionals or students, and
studies with unavailability of full‑text articles.
Study risk of bias assessment
The Critical Appraisal Skills Program (CASP) (https://casp‑
uk.net/casp‑tools‑checklists/) questions for RCTs were used
to evaluate the studies included in this review. Studies were
rated as high, moderate, or poor quality based on various
factors such as selection bias, assessor blinding, handling
of missing data, randomization quality (if applicable), and
reporting procedures. RGA and M independently created
tables, and after both reviewers reached an agreement,
the nal table of CASP items and results was nalized.
DBR reviewed the research after the team completed the
calibration exercise with the risk of bias tools, and the other
reviewer, DS, validated the ndings. Any disagreements
were resolved by consulting a third reviewer (HB). Based
on the CASP (RCT) guidelines, three studies[34‑36] were
classied as high quality, eight studies[37‑44] as moderate
quality, and three studies[45‑47] as low quality. Table 1
provides an overview of the CASP quality assessments.
Data extraction
Two review authors (RGA and M) independently
extracted the data using an Excel document designed
according to PRISMA guidelines. The following
information was extracted: author/publication year,
population, sample size, gender, age‑range and mean,
yoga protocol, total duration of the study, frequency of
the intervention, total number of yoga interventions per
week, sample size (intervention group/control group),
cognitive and psychological measurements, ndings,
attendance, dropout rates, and any adverse eects. Any
discrepancies were resolved through consultation with
additional authors (DBR, DS, and HB).
Table 1: Summary of critical appraisal skills program quality assessment for randomized controlled trials
Author Clear
focus?
Randomized
assignment
All
participants
accounted
for?
Blinding
to
treatment?
Groups
similar
at
start?
Groups
treated
equally?
Size/
precision of
treatment
eect?
Applicable
to local
contact?
All
important
outcomes
considered?
Do benets
outweigh
harms/
costs?
Overall
Hilcove et al., 2021a ✓ ✓ ✓ ✓ ‑✗ ✗ ‑ ‑ ✓Moderate
Alexander et al., 2015a ✓‑✓ ✗ ✗ ✗ ✓ ‑ ‑ ‑ Low
Si S Çeli K and Kılınç, 2022 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ High
Dönmez et al., 2023a ✓ ✓ ✓ ✓ ‑✓ ✓ ✓ ✓ ✓ High
Mandal et al., 2021a ✓ ✓ ✗ ✗ ‑✓‑ ‑ ✓ ✓ Moderate
Ozturk and Tezel, 2021a ✓ ✓ ✓ ✗ ✓ ‑✓‑✓ ✓ Moderate
Fang and Li, 2015a ✓ ✓ ✓ ‑✓‑✗ ✓ ‑✓Moderate
Ozturk and Tekkas‑Kerman, 2022b ✓ ✓ ✓ ✗ ✗ ‑✓‑ ‑ ✓Low
Rostami and Ghodsbin, 2019a ✓ ✓ ✓ ✗ ‑ ‑ ✗‑✓ ✓ Moderate
Mathad et al., 2017b ✓‑✓‑ ‑ ✓ ✓ ✓ ✓ ✓ Moderate
Kim, 2014a ✓ ✓ ✓ ✗ ✓ ‑✗ ✓ ‑✓Moderate
W.J et al., 2021a ✓‑✓ ✗ ‑✗ ✗ ‑✓ ✓ Low
Miyoshi, 2019a ✓ ✓ ✓ ✗ ✓ ✗ ✗ ✓ ✓ ✓ High
Patil et al., 2018 ✓ ✓ ✓ ✓ ✓ ✗ ✗ ✓ ‑✓Moderate
✓: Yes, ‑: Unclear, ✗: No

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 202516
Data items
The primary outcome variables of this review were mental
health measurements, including stress, anxiety, depression,
burnout, quality of life, mindfulness, sleep quality, life
satisfaction, condence, and other related factors.
Data synthesis
A narrative synthesis of the results was conducted and
organized based on the characteristics of the target
population, the intervention, and the outcomes. Narrative
synthesis is a method that evaluates study evidence from a
variety of sources to conclude.[48] This approach allowed us
to focus on synthesizing the results rather than conducting
a meta‑analysis, which is recommended when the subject
matter is new and lacks clarity.[48]
Results
Search results
From January 18, 2014, to February 18, 2024, an online
literature search returned 18,710 results from the Google
Scholar (18,604) and PubMed (116) databases. After
removing duplicates and irrelevant publications, 18,597
studies were excluded. Of the remaining 113 studies, 80
were excluded based on the inclusion and exclusion criteria.
An additional 19 articles were excluded for the following
reasons: 2 studies had samples not exclusively consisting
of nursing participants, 3 studies focused on data unrelated
to the review topic, 4 studies lacked adequate evaluation,
5 studies had irrelevant outcomes, and 5 studies included
interventions other than yoga. Ultimately, 14 RCT studies
met the eligibility criteria and were included in this review
to assess the impact of yoga interventions on the mental
well‑being of NPS participants [Figure 1]. To minimize
reporting bias, only RCTs were included in this study.
Study characteristics and study quality
As shown in Table 2, all studies included in this review
were RCTs focused on nursing professionals or nursing
students, examining the eects of yoga on mental
health‑related outcomes. The majority of the studies were
conducted in Turkey (n = 4), India (n = 4), and the United
States (n = 2), and one study each was conducted in China,
Korea, Japan, and Iran. Nine studies[34,36‑38,40,41,44,45,47] targeted
nursing professionals, while ve studies[35,39,42,43,46] focused
on nursing students. The total number of participants across
all studies was 967, with ages ranging from 18‑69 years,
and 886 of them were female.
The duration of the yoga interventions varied widely, ranging
from 10 min to 1 h per session, delivered over periods
ranging from 4 weeks to 24 weeks, except in one study[35]
that assessed an immediate impact of the intervention. In
terms of frequency, yoga was delivered once weekly in
two studies[43,45] twice weekly in ve studies,[34,38‑40,46] three
times weekly in two studies,[36,41] 3–5 times weekly in
two studies,[37,44] and regularly in the rest.[42,47] In addition,
some studies incorporated home‑based individual practice
components, with nine interventions delivered oine and
ve delivered through DVDs, CDs, or online platforms.
The yoga protocols varied across studies, with laughter yoga
(LY) being the most common approach[34,35,39,46] (n = 4),
followed by mindfulness‑based yoga[37] (n = 1), mahamantra
yoga[47] (n = 1), restorative yoga[36] (n = 1), integrated
yoga[42,44] (n = 2), and general yoga protocols[38,40,41,43,45]
(n = 5). The control groups included participants who
received no intervention[34,35,37‑43,45‑47] (n = 12), one study
used a cross‑over design,[36] and one study used physical
activity as the control.[44]
Instructor qualications were reported in ve studies,[37‑39,43,45]
while in one study,[46] the corresponding author was directly
Figure1:PreferredReportingItemsforSystematicReviewsandMeta‑Analysisowdiagram

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 2025 17
Table 2: Fourteen randomized controlled trial studies
Author/year Population Sample
(1038)
Gender Age
range/
mean
(years)
Type of yoga Yoga
protocol
Number of
participants in
control group/
interverntion
Cognitive and
psychological
Findings Attendance Drop
out
Adverse
eect
Hilcove et al.,
2021c
Nurses and
HCPs
80 Male ‑ 4
Female
‑ 74
42.45 MB yoga
practice
6‑week
MB yoga
intervention,
3–5 times
each week at
home through
DVD/CD
Intervention
group – 41
Control group
‑ 37
Perceived Stress
Scale
Maslach Burnout
Inventory
Vitality subscale
of the Medical
Outcomes Study
Short Form–36
Global Sleep
Quality item
Mindfulness
Awareness Survey
Subscale of the
Brief Serenity
Scale
Diurnal Salivary
Cortisol
The MB yoga
intervention used in this
study had a statistically
signicant eect on the
health and well‑being
of nurses and HCPs
based on pre–post
measures of perceived
stress, burnout, vitality,
sleep quality, rarity, and
mindfulness
98.7% 2No adverse
eect
Alexander
et al., 2015c
Nurses 40 Male ‑ 1
Female
‑ 39
46.38 General
Yoga (Basics
of postural
alignment, deep
breathing, and
monitoring
the mind
with simple
meditations)
8‑week yoga
intervention,
weekly
session
Yoga group
‑ 20
Control group
‑ 20
HPLP
FMI
MBI
Yoga participants
reported signicantly
higher self‑care
the control group
demonstrated no change
throughout the study,
but the yoga group
showed a signicant
improvement in
scores from pre‑ to
post‑intervention for
self‑care (P<0.001),
mindfulness (P=0.028),
emotional exhaustion
(P=0.008), and
depersonalization
(P=0.007) outcomes
NA NA Not
reported
Contd...

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 202518
Table 2: Contd...
Author/year Population Sample
(1038)
Gender Age
range/
mean
(years)
Type of yoga Yoga
protocol
Number of
participants in
control group/
interverntion
Cognitive and
psychological
Findings Attendance Drop
out
Adverse
eect
Sıs Çelık and
Kılınç, 2022
Nurses 120 Male ‑ 19
Female
– 82
28.86 Laughter Yoga Total 8
sessions for 4
weeks, twice
a week, per
session 1‑h
practice
Experimental.
group ‑ 60
Control group
‑ 60
PSS
MBI
Life Satisfaction
Scale
The experimental
group was found to be
statistically signicant
(P<0.05), whereas the
dierence between the
pre‑and post‑test score
averages of the nurses
in the control group was
not signicant (P>0.05)
in all the parameters
NA 19 Not
reported
Dönmez et al.,
2023b
2nd year
undergraduate
nursing
students
88 Male –
12
Female
‑ 76
20.79 Laughter Yoga Immediate
study, four
sessions
lasting
approximately
40 min. Each
of the four
sessions lasted
for 10 min
Intervention
group ‑ 44
Control group
‑ 44
State‑Trait Anxiety
Inventory
PSSNS
Students’ Vital
Signs Evaluation
Form
SSSCLS
Laughter yoga helped
nursing students reduce
their state anxiety and
perceived stress levels
related to simulation
training and improved
their self‑condence
and satisfaction with
learning
100% 0Not
reported
Mandal et al.,
2021b
Nursing sta 110 Male ‑ 30
Female
‑ 80
33.75 General Yoga
Module
Two sessions
in a week
each with a
duration of
50 min for 12
consecutive
weeks were
conducted
Intervention
group – 19
Waitlisted
control group
– 32
Perceived Stress
Scale Score
ProQOL
Cortisol
HS‑CRP
The nding showed that
supervised structured
yoga may be ecacious
in reducing stress
Minimum
20 sessions
in the
12‑week
period was
considered
a
completed
intervention
59 No
participant
reported
any
injury or
morbidities
requiring
medical
attention
due to
the yoga
sessions
Ozturk and
Tezel, 2021b
1st year
nursing
students
75 Male –
15
Female
‑ 57
Not
reported
Laughter yoga Eight sessions
of laughter
yoga, that is,
two sessions
per week for
4 weeks
Each laughter
yoga session
lasted about
40–45 min
Intervention
group ‑ 36
Control group
‑ 36
Brief symptom
inventory
Cortisol level
Laughter yoga can
provide an eective
means to help 1st‑year
nursing students cope
with stress and reduce
mental symptoms
Not
reported
3Not
reported
Contd...

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 2025 19
Table 2: Contd...
Author/year Population Sample
(1038)
Gender Age
range/
mean
(years)
Type of yoga Yoga
protocol
Number of
participants in
control group/
interverntion
Cognitive and
psychological
Findings Attendance Drop
out
Adverse
eect
Fang and Li,
2015b
Sta nurse 120 Females
only
(n=105)
35.59 General Yoga
(physical
postures,
loosening
exercises,
breathing
exercises, and
meditation)
Two times
every week
for 50–60
min each time
after work
hours till 6
months
Yoga group=54
Nonyoga
group=51
C‑PSQI
QMWS
Our ndings indicate
that 58.1% of the 105
nurses analysed had
sleep disorders
A regular yoga
intervention can
improve sleep quality
and reduce work
stress in sta nurses
employed by a general
hospital
Nursing experience,
age and yoga
interventions are
independent factors
that contribute to
subjective sleep
disturbances
Not
reported
15 Not
reported
Ozturk and
Tekkas‑Kerman,
2022b
First Year
Nursing
Students
70 Girls
only
(n=61)
19.59 Online laughter
therapy
twice weekly
for four
weeks, each
laughter
therapy
session lasted
about 40–45
min
Intervention
group=32
Control
group=29
DASS‑42
The De Jong
Gierveld Loneliness
Scale
Online laughter therapy
sessions signicantly
reduced depression but
did not aect anxiety,
stress, and loneliness
Not
reported
9Not
reported
Rostami and
Ghodsbin,
2019b
Nurses
working in
ICU
70 Females
only
(n=70)
29.9 General Yoga
(In each
session of yoga
classes, three
aspects of
mind control,
breathe control,
and slow body
movements
were worked
out.)
Three weekly
sessions
of yoga
exercises for
6 months, per
session ‑‑‑‑‑‑‑
Intervention
group=35
Control
group=35
Quality of Life
brief questionnaire
(WHOQoL‑Bref)
The intervention of yoga
exercises was eective
in improving the quality
of life of nurses working
in the ICU
Not
reported
0Not
reported
Contd...

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 202520
Table 2: Contd...
Author/year Population Sample
(1038)
Gender Age
range/
mean
(years)
Type of yoga Yoga
protocol
Number of
participants in
control group/
interverntion
Cognitive and
psychological
Findings Attendance Drop
out
Adverse
eect
Mathad et al.,
2017b
Nursing
students
100 Females
only
(n=80)
19.5 Integrated
approach to
yoga therapy
8 weeks daily,
each session
was 60–70
min
Yoga group
‑ 40
Waitlist control
group ‑ 40
FMI
SCS‑SF
CD‑RISC
SWLS
JSE‑HPS
PSS
88‑week yoga
interventions was
signicantly eective
in improving
self‑compassion and
mindfulness among
nursing students in the
experimental group and
were then compared
to the waitlist control
group. Even though there
were improvements in
resilience, satisfaction
in life, and perceived
stress, results were not
statistically signicant
Not
reported
20 Not
reported
Dol Kim.S
2014 (Kim,
2014)
Nursing
students
27 Females
only
(n=24)
21 Physical
exercise (Surya
Namaskara)
combined with
relaxation and
meditation
(Shavasana and
Yoga Nidra)
60 min 1 day
a week for 12
weeks
Yoga group
‑ 12
Control group
‑ 15
Life Stress Scale
for college students,
postprandial blood
glucose levels
Yogic exercises would
reduce life stress and
lower postprandial blood
glucose levels in nursing
students
Not
reported
3Not
reported
W.J et al.,
2021b
Nursing
professionals
30 Females
only
(n=30)
28.5 Mahamantra 20 min each
day for 45
days
Intervention
gorup ‑ 15
Control group
‑ 15
Serum stress
markers
Metabolic
parameters
PSS
Mahamantra chanting
is a simple, economical,
and eective intervention
technique to be followed
on a routine basis to
alleviate stress and
burnout among nursing
healthcare professionals
Not
reported
0Not
reported
Miyoshi, 2019b Night shift
nurses
20 Females
only
(n=20)
28.7 Restorative
yoga
1‐h guided
group yoga
session,
minimum 3
times a week
followed by 4
weeks of at‐
home practice
for 5–15 min
Yoga group
‑ 10
Control group
‑ 10
Brief Job Stress
Questionnaire
Restorative yoga may be
eective for alleviating
occupational stress
among female nurses
working the night shift
100% 0No
Contd...

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 2025 21
involved in delivering the intervention. However, eight
studies[34‑36,40‑42,44,47] did not provide any information on the
qualications of the yoga instructors. Dosage details for
the yoga interventions were not adequately reported in ve
studies,[34‑36,40‑42,44,47] while 12 studies[36‑47] provided sucient
implementation details. Only one study[35] adhered to the
TIDieR checklist recommendations, and none followed the
CLARIFY checklist. In addition, seven studies[34‑36,43,44,46,47]
did not specify the qualications of the authors, although all
studies did report the corresponding author’s qualications
and institute names. However, four studies[38,43,44,47] did not
mention the designation of the corresponding author.
Ethical approval was obtained for all studies, although
ve studies[40,41,43‑45] did not provide an ethical registration
number and nine studies[37,40‑47] did not have a clinical
registration number listed. The dropout rates across all
studies ranged from 0% to 52.1%. Four studies[36,44,45,47]
reported no dropouts, one study[38] had a dropout
rate >20%, while the remaining studies had dropout rates
of <16% (0%–15.8%). No adverse eects of the yoga
interventions were reported in any of the studies.
This detailed overview highlights the diversity in
intervention protocols, study designs, and outcomes,
emphasizing the potential benets and limitations of yoga
interventions for mental health in NPS. Despite variations
in implementation and reporting, these studies’ ndings
underscore yoga’s promising role in improving mental
health and well‑being among NSP participants.
Results of primary outcomes
Four studies[38,39,43,47] employed both invasive and
noninvasive methods, while 10 studies[34‑37,40‑42,44‑46]
exclusively utilized noninvasive approaches. The primary
outcomes assessed in this review included stress, anxiety,
burnout, mindfulness, depression, quality of sleep, quality
of life, life satisfaction/condence, and other related
mental health measures. These outcomes were selected to
evaluate the impact of yoga interventions on the mental
well‑being of NPS, providing valuable insights into the
eectiveness of yoga as a therapeutic tool for mental
health improvement.
Stress
A total of 11 studies assessed stress using either invasive
(glucose/cortisol/serum) or noninvasive measures. Of these,
9 studies[34‑40,43,47] found a signicant reduction in stress,
while two studies[42,46] reported no signicant dierence.
However, the experimental group consistently showed a
greater reduction in stress levels compared to the control
group.
Anxiety
Three studies[35,39,46] investigated anxiety using
self‑measurement, and all found a signicant reduction
in the experimental group compared to the control group.
Table 2: Contd...
Author/year Population Sample
(1038)
Gender Age
range/
mean
(years)
Type of yoga Yoga
protocol
Number of
participants in
control group/
interverntion
Cognitive and
psychological
Findings Attendance Drop
out
Adverse
eect
Patil 2018 Nurses in
hospital
88 Females
only
(n=88)
32.75 Integrated Yoga
and physical
exercises
1 h/day and 5
days a week
for 6 weeks
Integrated yoga
group – 44
Physical
exercise group
‑ 44
WHOQOLBREF Integrated yoga was
showed improvements in
physical, psychological,
and social health
domains of QOL
better than physical
exercises among nursing
professionals with CLBP
Not
reported
0No any
serious
adverse
eect
MB: Mindfulness‑based, WHOQOL‑BREF: World Health Organization quality of lifebref, HCPs: Healthcare professionals, HPLP: Health Promoting Lifestyle Prole II, FMI: Freiburg
Mindfulness Inventory, MBI: Maslach Burnout Inventory, PSSNS: Perceived Stress Scale for Nursing Students, SSSCLS: Student Satisfaction and Self‑Condence in Learning Scale,
ProQOL: Professional quality of life, HS‑CRP: High‑sensitivity C‑reactive protein, C‑PSQI: Pittsburgh Sleep Quality Index in Chinese, QMWS: Questionnaire on medical Worker’s
Stress, FMI: Freiburg Mindfulness Inventory, SCS‑SF: Self‑Compassion Scale‑short form, CD‑RISC: Connor–Davidson Resilience Scale, SWLS: Satisfaction with Life Scale,
JSE‑HPS: Jeerson Scale of Empathy HPS‑Version, PSS: Perceived Stress Scale, ICU: Intensive care unit, NA: Not available, DASS: Depression Anxiety Stress Scale, CLBP: Chronic
low back pain

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 202522
All of these studies employed LY as an intervention
and concluded that LY helps achieve physiological and
psychological benets in NPS.
Burnout
Three studies[34,37,45] examined burnout using
self‑measurement and all found a signicant reduction
in the experimental group compared to the control
group. Burnout, characterized by emotional exhaustion,
depersonalization, and reduced personal accomplishment,
is often linked to chronic workplace stress. Factors such
as long hours, a competitive work environment, and lack
of trust from employers contribute to stress and burnout in
NPS.[49]
Mindfulness
Three studies[37,42,45] measured mindfulness through
self‑assessment and found a signicant improvement in
the experimental group compared to the control group.
Mindfulness, dened as a focused awareness of the present
moment, is linked to reduced stress and improved mental
well‑being.
Depression
Two studies[39,46] measured depression through
self‑assessment, and both reported a signicant reduction in
the experimental group compared to the control group.
Quality of sleep
Two studies[37,40] assessed sleep quality using self‑reports
and both showed signicant improvement in the
experimental group compared to the control group.
Quality of life
Three studies[41,44] used self‑assessment to evaluate the
quality of life, with one study[38] reporting improvement but
not statistically signicant. The lack of statistical signicance
in this study was attributed to the randomization process and
high dropout rates (55%) related to intervention timing and
personal reasons such as family health issues. Excluding this
study, other studies showed signicant improvements in the
experimental group compared to the control group.[41,44]
Life satisfaction/condence
Three studies[35,42,45] used self‑assessment to evaluate life
satisfaction and condence, and all showed signicant
improvement in the experimental group compared to the
control group.
Discussion
The ndings of this systematic review highlight the
promising role of yoga interventions in improving the
mental health and well‑being of NPS. The review identied
14 RCTs that evaluated the impact of yoga on various
mental health outcomes, including stress, anxiety, burnout,
depression, sleep quality, quality of life, and mindfulness.
The results of these studies suggest that yoga is an eective
intervention for managing mental health issues commonly
experienced by NPS, especially stress, anxiety, burnout and
depression. This is in line with recent systematic reviews
that highlight yoga’s eectiveness in preventing and treating
mental health issues, outperforming other forms of exercise
and nonexercise interventions. Yoga has been shown to
reduce burnout,[38,46,50,51] stress,[38,50,52,53] anxiety,[54‑58] and
depression,[54,56‑59] across various populations previously.
Meta‑analyses further conrm its role in alleviating
depression in both healthy and clinical populations,
emphasizing its broad applicability.[60,61] In addition, yoga
has demonstrated benets in improving sleep quality
among healthcare workers and patients,[51,61] and enhancing
life satisfaction in adults,[62] which is essential for overall
psychological well‑being. Below, we discuss the ndings
based on our key outcome variables.
Stress reduction
A signicant reduction in stress levels was observed
in 9 out of the 11 studies that measured stress, with
the experimental groups consistently reporting greater
improvements compared to the control groups. These
ndings are in line with existing literature, which suggests
that yoga’s mind–body approach, involving both physical
postures and breathing exercises, can signicantly modulate
the body’s stress response by lowering cortisol levels and
promoting relaxation. The consistent reduction in stress
levels underscores yoga’s potential as a valuable tool for
coping with the chronic stress that often aects NPS due to
the high demands of their roles.
Anxiety and burnout
Yoga interventions, particularly LY, signicantly reduced
anxiety and burnout in NPS. Anxiety was reduced in all
three studies that assessed it, and burnout was alleviated
in all three studies that examined it. Burnout, characterized
by emotional exhaustion, depersonalization, and reduced
personal accomplishment, is a well‑documented concern
in healthcare professions, especially among nurses. The
mental and physical relief provided by yoga, through
deep breathing, mindfulness, and relaxation techniques,
may be particularly benecial in addressing the emotional
exhaustion and stress‑related symptoms of burnout. These
ndings suggest that yoga can be an eective preventive
and therapeutic intervention for reducing burnout, which is
linked to chronic workplace stress.
Mindfulness and depression
Yoga’s positive impact on mindfulness and depression
was evident, with three studies demonstrating signicant
improvements in mindfulness and two studies reporting
reductions in depression. Mindfulness, which involves
cultivating awareness of the present moment, has been
associated with reductions in stress and improvements in
mental well‑being. The practice of yoga fosters mindfulness

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 2025 23
through breath control (pranayama) and meditative focus,
contributing to a heightened sense of self‑awareness
and emotional regulation. The reduction in depressive
symptoms observed in this review aligns with other studies
that have suggested yoga’s potential as a complementary
treatment for depression, particularly for individuals in
high‑stress environments such as healthcare settings.
Sleep quality and quality of life
Yoga signicantly improved sleep quality in two studies,
which is particularly important for NPS, who often face
irregular working hours, including night shifts. Poor
sleep quality has been linked to various mental and
physical health issues, including burnout and depression.
By promoting relaxation and reducing stress, yoga
interventions help regulate the nervous system, contributing
to better sleep patterns. Similarly, while quality of life
improvements were statistically signicant in two studies,
one study did not nd a signicant eect. This may be
attributed to high dropout rates and variations in the timing
and frequency of interventions. Nevertheless, the overall
trend suggests that yoga positively impacts the subjective
well‑being of NPS, enhancing their overall life satisfaction
and condence.
Yoga protocols and intervention design
The diversity of yoga protocols in the included studies is
worth noting. While LY was the most commonly employed
method, other forms of yoga, such as mindfulness‑based
yoga, integrated yoga, and general yoga protocols, were
also used. While specic type of yoga may inuence
the outcomes, the core components of yoga – breathing
exercises, physical postures, and meditation – are essential
in promoting mental well‑being. The variety in intervention
duration (from 4 weeks to 24 weeks) and frequency (once
a week to several times a week) further highlights the
exibility of yoga as an intervention, which can be tailored
to t the schedules of busy healthcare professionals and
students.
Mechanisms of action of yoga
Yoga has been shown to impact the hypothalamic–
pituitary–adrenal axis by reducing cortisol levels, which
are typically elevated during stress. In addition, yoga’s
stretching exercises enhance parasympathetic nerve activity,
helping regulate stress hormones. Systematic reviews
highlight that yoga can positively inuence physiological
and psychological parameters, leading to stress reduction in
adults.[63,64] The release of endorphins induced by yoga can
help reduce depressed mood[65] and increase mood‑elevating
anti‑stress factors, which also alleviate anxiety and enhance
pain tolerance.[66‑68] Meta‑analyses have demonstrated that
yoga practices, including LY, are eective complementary
methods for reducing anxiety levels across various
conditions.[61,69‑71] Yoga practices also help calm the mind
with a positive approach, improve emotional resilience,
and reduce burnout levels in healthcare workers, including
nurses.[30,51] In addition, yoga enhances blood ow and
hemoglobin, increasing oxygen delivery to body cells
and improving overall function.[72] Meditation practices
stimulate dopamine secretion and inuence conscious
states at the synaptic level.[73] Research has also shown
that yoga reduces depression by acting at the hypothalamic
level, lowering cortisol, and promoting an “anti‑stress”
eect.[74] Moreover, yoga practices reduce nerve tension,
balance the sympathetic nervous system, alleviate fatigue,
support deep sleep, and stimulate endorphin secretion, all
of which contribute to better sleep quality.[75] Furthermore,
yoga strengthens muscles, improves exibility, enhances
respiratory and cardiovascular functions, aids in addiction
recovery, and promotes overall well‑being and quality
of life.[72] Reviews have also reported improvements
in the quality of life for both healthy and unhealthy
populations through regular yoga practice.[76‑79] Regular
yoga practice increases the synthesis of positive chemicals
such as dopamine, serotonin, oxytocin, and endorphins,
which contribute to feelings of happiness, warmth, and
relaxation.[73,80,81] Yoga also fosters a positive attitude
toward both good and challenging experiences.[82]
Limitations and future directions
While the ndings of this review are promising, several
limitations must be considered. First, the quality of
the studies varied, with some studies lacking adequate
reporting on instructor qualications, intervention details,
and adherence to standardized reporting guidelines
such as the TIDieR checklist. These issues may aect
the reproducibility of the interventions and their
generalizability. In addition, the dropout rates varied
signicantly across studies, and while no adverse eects
were reported, the impact of dropout bias on the overall
results should not be overlooked. Another limitation is
the lack of long‑term follow‑up in most studies. The
short‑term eects of yoga on mental health outcomes are
well‑documented, but it is unclear whether these benets
are sustained over time. Future research should include
longer follow‑up periods to assess the long‑term ecacy
of yoga interventions and whether they can lead to lasting
improvements in mental health for NPS. Finally, while this
review focused exclusively on RCTs, which provide the
highest level of evidence, further research should explore
the mechanisms underlying yoga’s eectiveness. Studies
investigating how yoga aects physiological markers such
as cortisol, heart rate variability, and brain activity could
provide a deeper understanding of how yoga helps regulate
the stress response and improve mental well‑being.
Conclusion
This systematic review provides evidence that yoga
interventions are eective in reducing stress, anxiety,
burnout, depression, and other mental health issues among

Arya, et al.: Yoga for mental health of NPS: A review
International Journal of Yoga | Volume 18 | Issue 1 | January-April 202524
NPS. Yoga’s holistic approach, which integrates physical,
mental, and spiritual well‑being, makes it a valuable tool
for managing the unique challenges faced by NPS. As
the mental health burden among healthcare professionals
continues to rise, yoga oers a promising, accessible,
and cost‑eective solution to support their mental health
and well‑being. Future studies should focus on rening
intervention protocols, addressing methodological
limitations, and exploring long‑term outcomes to further
establish yoga as an essential component of mental health
care for NPS.
Credit authorship contribution statement
Rahul Geeta Arya: Writing‑review and editing,
Writing – original draft, Methodology, Investigation,
Formal Analysis, Conceptualization. Deepshika
Srivastava: Editing, Results, Discussion, Conclusion. Divya
BR: Methodology, Investigation, Formal Analysis. Madhu:
Screening, Inclusion and Exclusion, Intervention, Tables
and Graph. Hemant Bhargav: Writing – review and editing,
Methodology, Investigation, Supervision, Abstract, Formal
analysis, conceptualization.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
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