SYSTEMATIC REVIEW/META-ANALYSIS

Yoga and Cognition: A Meta-Analysis of Chronic

and Acute Effects
Neha P. Gothe, PhD, and Edward McAuley, PhD

ABSTRACT
Objectives: To review and synthesize the existing literature on the effects of yoga on cognitive function by determining ef-
fect sizes that could serve as a platform to design, calculate statistical power, and implement future studies.
Methods: Through electronic databases, we identified acute studies and randomized controlled trials (RCTs) of yoga that
reported cognitive outcomes. Inclusion criteria included the following: use of an objective measure of cognition and suffi-
cient data reported to estimate an effect size. The meta-analysis was conducted using Comprehensive Meta-Analysis soft-
ware. A random-effects model was used to calculate the overall weighted effect sizes, expressed as Hedge g.
Results: Fifteen RCTs and 7 acute exposure studies examined the effects of yoga on cognition. A moderate effect (g = 0.33,
standard error = 0.08, 95% confidence interval = 0.18–0.48, p < .001) of yoga on cognition was observed for RCTs, with the
strongest effect for attention and processing speed (g = 0.29, p < .001), followed by executive function (g = 0.27, p = .001)
and memory (g = 0.18, p = .051). Acute studies showed a stronger overall effect of yoga on cognition (g = 0.56, standard
error = 0.11, 95% confidence interval = 0.33–0.78, p < .001). The effect was strongest for memory (g = 0.78, p < .001),
followed by attention and processing speed measures (g = 0.49, p < .001) and executive functions (g = 0.39, p < .003).
Conclusions: Yoga practice seems to be associated with moderate improvements in cognitive function. Although the studies
are limited by sample size, heterogeneous population characteristics, varied doses of yoga interventions, and a myriad of
cognitive tests, these findings warrant rigorous systematic RCTs and well-designed counterbalanced acute studies to com-
prehensively explore yoga as a means to improve or sustain cognitive abilities across the life span.
Key words: executive function, memory, mind-body exercise, effect size.

INTRODUCTION of physical activity which may assist in achieving recom-

mended levels of physical activity for individuals who have

T he National Institutes of Health define complementary

and alternative medicine (CAM) (1) as a group of di-
verse medical and health care systems, practices, and
disabilities or symptoms that prevent them from performing
traditional forms of exercise.
Few systematic and comprehensive reviews of scientific
products that are not currently considered to be part of con- research on yoga have been published recently. Lin et al. (3)
ventional medicine. CAMs encompass a range of mind- conducted a meta-analysis assessing the effects of yoga on
body methodologies, such as yoga, tai-chi, and meditation psychological health, quality of life, and physical health of
that may be beneficial to the health of their practitioners. patients with cancer. They concluded that the yoga groups
Yoga is an ancient Indian science and way of life that in- showed significantly greater improvements in psychologi-
cludes the practice of specific postures, regulated breathing, cal health: anxiety, depression, distress, and stress when
and meditation. It is designed to bring balance and health compared with the waitlist or supportive groups. Posadzki
to the physical, mental, emotional, and spiritual dimen- and Ernst (4) conducted a systematic review to assess the
sions of the individual. Yoga is often depicted metaphor- effectiveness of yoga as a treatment option for low back
ically as a tree and comprises eight aspects: yama (universal pain. The authors concluded that yoga does lead to a
ethics), niyama (individual ethics), asana (physical pos-
tures), pranayama (breath control), pratyahara (control of CAM = complementary and alternative medicine, CI = confidence
the senses), dharana (concentration), dyana (meditation), interval, DMN = default mode network, HPA = hypothalamic-pituitary
adrenal, RCT = randomized controlled trial, SE = standard error
and samadhi (bliss) (2). Yoga maybe an alternative form

From the Division of Kinesiology, Health and Sport Studies (Gothe), Wayne State University, Detroit, Michigan; Department of Kinesiology and Com-
munity Health (McAuley), University of Illinois at Urbana, Champaign, Illinois.
Address correspondence and reprint requests to Neha P. Gothe, PhD, Division of Kinesiology, Health and Sport Studies, Wayne State University,
Detroit, MI 48202. E-mail: [email protected]
Received for publication June 2, 2014; revision received March 19, 2015.
DOI: 10.1097/PSY.0000000000000218
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 Yoga and Cognition

significantly greater reduction in low back pain than usual The purpose of this meta-analysis was to review the
care, education, or conventional therapeutic exercises. The existing evidence-base examining the effectiveness of yoga
effect of practicing yoga for the management of Type 2 di- in improving cognitive performance. We examined the over-
abetes was assessed in a systematic review, and the authors all effect sizes for chronic (long-term yoga interventions) and
concluded that short-term benefits for patients with diabetes acute (immediate, single bouts) yoga practice as well as the
may be achieved from practicing yoga (5). Ross and effect sizes for specific domains of cognitive performance,
Thomas (6) reviewed studies comparing the effects of yoga including attention and processing speed, executive function,
and exercise and concluded that in both healthy and dis- and memory that could serve as a platform for design-
eased populations, yoga may be as effective as or better than ing, powering, and implementing future studies. We also
aerobic exercise at improving a variety of health-related out- identify the limitations and methodological issues observed
come measures. Although yoga has been extensively used across studies and provide future directions to examine not
as an adjunct therapy for diseased patients and physical only the effects of yoga on cognition but also the underlying
symptoms, there are no published reviews that address the mechanisms explaining the yoga-cognition relationship.
effects of this mind-body therapy on cognitive functioning.
Research on physical activity and cognition emerged in METHODS
the late 1970s with Spirduso's (7) pioneering study suggest-
ing that older adults who regularly participated in physical Literature Search and Study Selection
activity had faster psychomotor speed, relative to their sed- The following databases were used to locate yoga studies that have exam-
entary counterparts, on simple and choice reaction-time ined effects on cognition: MEDLINE, PsycINFO, PubMed, Indian Council
of Medical Research, and Cochrane from inception to January 2014. We
tests. Since then, numerous studies have been conducted to
used the search terms that were constructed around two concepts—yoga
examine the relationship between chronic or long-term and cognition—to identify all the relevant published articles investigating
physical activity as well as acute or transient effects of phys- this relationship. Mindfulness and transcendental meditation studies were
ical activity on cognitive performance. Reviews have con- excluded from this meta-analysis as they have been reviewed elsewhere
cluded that a positive relationship exists between chronic (17,18). Reference lists of articles were also scanned to locate relevant lit-
erature. Unpublished data from dissertations and conference proceedings
(8–12) and acute bouts of physical activity (13,14) and cog-
were also obtained when available.
nition. Physical activity in these reviews has been defined Study inclusion criteria included the following: a) randomized controlled
primarily as walking and strength training, and little is trials (RCTs) or studies that used counterbalanced repeated-measures de-
known about physical activity–based CAM therapies like signs to examine acute effects of yoga on cognition, b) objective measures
yoga. Mind-body therapies such as yoga involve an active of cognition assessing at least one or more domains by using paper-pencil
or computer-based measures, and c) sufficient data reported in the studies
attentional component and therefore may incur cognitive
to estimate an effect size. Because the purpose of this review was to exam-
benefits over and above the habitual bodily movements in- ine the state of yoga-cognition literature and provide future direction, we
volved in traditional forms of exercise. Hatha yoga is the included studies conducted with all age groups and participant characteris-
most common form of yoga practiced in North America tics, as long as they met the three basic inclusionary criteria.
and involves the practice of physical postures in conjunction
with awareness of the breath to help develop mental focus Data Abstraction and Analysis
and to connect the mind, body, and spirit (15). There are For each RCT, authors extracted the following study details: participant
characteristics, details of the intervention and control groups, blinding, drop-
many different styles of hatha yoga characterized by the rate out rate, and cognitive measures. Except for dropout, similar information
at which postures are performed, such as environmental was extracted for acute yoga studies. The quality of the RCTs was assessed
temperature, physical intensity and level of difficulty, em- using the five-point Jadad scale (19); however, blinding of participants
phasis on body alignment and relaxation, and use of props. was not considered feasible and the maximum possible score was therefore
4 rather than 5. Cognitive tests used in all studies were classified into three
However, postures, breathing, and meditative exercises are
categories: a) attention and processing speed, which is the sustained focus of
the three basic elements common to most styles of yoga cognitive resources, selective concentration, and rapid processing of infor-
practice. Yoga therapy enables the practitioner to move mation (20); b) executive function, which is a set of cognitive skills respon-
slowly and safely into the modified postures concentrating sible for the planning, initiation, sequencing, and monitoring of complex,
initially on relaxing their body, breathing fully, and develop- goal-directed behavior, working memory (i.e., short-term storage and ma-
ing awareness of the sensations in their body and thoughts in nipulation of information) (21); and c) memory, which involves retention,
recollection, and recognition of previously encountered information.
their mind. Yoga requires focused effort in completing the Comprehensive Meta-Analysis software package (22) was used to con-
pose, controlling the body, and breathing at a steady rate. duct the analyses (BioStat, Englewood, NJ). In case of multiple interven-
In addition, breathing (pranayama) and meditation exer- tion groups, the means and standard deviations were averaged across
cises are practiced to calm and focus the mind and develop other study conditions and compared against the yoga condition. Hedge g
greater self-awareness (16). This focused effort and atten- was calculated for each cognitive test reported in the articles. Most of the
studies used multiple cognitive tests, often spanning each of the three cog-
tional practice of yoga could generalize to conventionally nitive domains. We therefore calculated a) an overall effect size for each
assessed cognitive functions including attention, memory, study and overall cognition, and b) an average effect size for each of the
and higher-order executive functions. three cognitive domains. Study-specific effect size estimates were weighted

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 TABLE 1. Study Characteristics of the RCTs Included in the Meta-Analysis
First Author
(Year) Sample n (M [SD] Age, y) Groups Type of Yoga Duration of Intervention Cognitive Tests Effect Size

Madden Older adults n = 85 (66.98 [4.5]) Aerobic n = 25 Not described 4 mo, 2 d/wk, Letter search, word comparison APS: 0.15
(1989) Yoga n = 28 60 min/class
Waitlist n = 26
Blumenthal Older adults n = 101 (67 [4.9]) Aerobic n = 34 Not described 4 mo, 2 d/wk, Stroop, verbal/nonverbal fluency, APS: 0.25
(1989) Yoga and flexibility 60 min/class Trail making B, EF: 0.07
n = 34 WAIS–Digit Symbol,
WAIS–Digit Span, Benton

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Waitlist n = 34 MEM:
Visual Retention, Selective 0.08
Reminding, Randt
Memory, 2 + 7 Digits and
Letters
Manjunath School girls n = 20 (age range, Yoga n = 10 Hatha yoga 1 month, 7 d/wk, Tower of London EF:
SYSTEMATIC REVIEW/META-ANALYSIS

(2001) 10–13 y) Physical training n = 10 75 min/class 1.17***

Oken (2004) Multiple sclerosis patients n = 69 Yoga n = 26 Iyengar yoga 6 mo, 1 d/wk, Stroop, CERAD, Letter Number Se- APS: 0.06

786
(49 [9.2]) Stationary bike n = 21 90 min/wk quencing, EF: 0.10
Waitlist n = 22 Simple and Choice RT, WCST, MEM:
Useful 0.34
Field of View, WAIS-similarities
Oken (2006) Healthy seniors n = 135 (72.1 Yoga n = 44 Iyengar yoga 6 mo, 1 d/wk, Stroop, CERAD, Letter Number APS: 0.23
[4.8]) Walking n = 47 90 min/wk Sequencing, EF: 0.15
Waitlist n = 44 Useful Field of View, Covert MEM:
Orienting, 0.06
Simple and Choice RT, WCST
Sharma (2006) Adults with depression n = 30 yoga n = 15 yoga 8 wk, 3 d/wk, Letter Cancellation, Trail Making APS: 0.21
(31.77 [8.62]) Standard antidepressant 30 min/class A and B, EF: 0.04
n = 15 Ruff Figural Fluency,
WAIS–Digit Span
Chattha (2008) Perimenopausal women n = 108 Yoga n = 59 Integrated Approach of 8 wk, 5 d/wk, Six Letter Cancellation APS:
(48.5 [3.8]) Control n = 61 Yoga Therapy 60 min/class 0.77***
Velinkonja Multiple sclerosis patients n = 20 Yoga n = 10 Hatha yoga 10 wk, 1 d/wk Neuropsychological assessment APS:
(2010) (age range, 26–50 y) battery–Mazes 1.14*

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Sports Climbing n = 10 Duration per class test, Tower of London, EF: 0.07
not reported Brickenkamp d2 test

September 2015
 Chaya (2010) School children n = 200 (7.69 Yoga n = 100 Hatha yoga 3 mo, 6 d/wk, Malin's Intelligence Scale for APS:
[0.88]) 45 min/class Indian Children, 0.098
Physical activity n = 100 Indian adaptation of WISC-II EF: 0.05
MEM:
0.14
Bowden Healthy adults n = 35 (age not Iyengar yoga n = 9 Iyengar yoga 5 wk, 2 d/wk, 2-back EF: 0.66
(2012) reported) Brain wave vibration 75 min/class
n = 12
Mindfulness n = 12
Bilderbeck Prisoners n = 167 (36.08 [12.14]) Yoga n = 45 Hatha yoga 10 wk, 1 d/wk, Go/No-Go EF: 0.39
(2013) Control n = 55 120 min/class
Hariprasad Older adults from resident homes Yoga n = 68 Hatha yoga 6 mo total Rey's Auditory Verbal Learning, APS:

Psychosomatic Medicine, V 77 • 784-797

(2013) (75.62 [6.91]) Rey's complex 0.48*
Month 1: supervised figure, Digit and spatial span, EF: 0.47*
60 min daily Controlled Oral
Waitlist n = 58 Months 2–3: supervised Word Association, Stroop, Trail MEM:
60 min weekly Making 0.39
A and B
Months 4–6:
unsupervised,

787
home practice
Telles (2013) School children n = 98 (10.5 [1.3]) Yoga n = 49 Hatha yoga 3 mo, 5 d/wk, Stroop APS: 0.07
Physical exercise n = 49 45 min/class EF: 0.11*
Gothea (2013) Older adults n = 118 (62.0 [5.6]) Yoga n = 61 Hatha yoga 8 wk, 3 d/wk, Attention Network, Trail Making A APS:
60 min/class and B, 0.299
Stretching and Pattern Comparison EF: 0.47
strengthening n = 57
Gothe (2014) Older adults n = 118 (62.0 [5.6]) Yoga n = 61 Hatha yoga 8 wk, 3 d/wk, Task switching, N-back, Running EF: 0.31
Stretching and 60 min/class Memory Span
strengthening n = 57

RCTs = randomized controlled trials; M = mean; SD = standard deviation; APS = attention and processing speed; WAIS = Wechsler's Adult Intelligence Scale; EF = executive function; MEM = memory;
CERAD = Consortium to Establish a Registry for Alzheimer's Disease; RT = reaction time; WCST = Wisconsin Card Sorting Test; WISC = Wechsler's Intelligence Scale for Children.
* p < .05, *** p < .001.
a
Published abstract.

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Yoga and Cognition

September 2015
 SYSTEMATIC REVIEW/META-ANALYSIS

by the study sample size and combined to form the overall study effect size. was combined with educational lectures on healthy
Forest plots were constructed to display overall effect sizes for acute studies life-style domains of diet, exercise, and stress management.
and RCTs. Given the small number of acute studies, forest plots by cogni-
tive domain were constructed only for RCTs. All effect sizes were coded
The comparison groups in these RCTs included waitlist,
such that positive numbers always reflected improvements in performance, walking, stretching and strengthening, mindfulness, station-
and negative numbers reflected deterioration in performance. As the target ary bike, and physical training groups. The frequency and du-
populations of the studies varied for both acute and RCTs, a random-effects ration of practice also varied widely from 1/wk to 5/wk,
analysis was conducted to provide a conservative estimate of treatment and classes lasted between 45 and 120 minutes. The for-
effects (23). Homogeneity of treatment effects was also assessed using the
Q statistic. mat of the intervention varied from group/individual to
supervised/home practice within the RCTs.
Among acute studies (Table 2), five examined the effects
RESULTS of Hatha yoga and cyclic meditation, whereas two studies
exclusively examined yogic breathing practices. Cyclic
Study Selection meditation is a technique that combines stimulating and
Our search generated a total of 40 references. Fourteen calming the mind with the goal of achieving a deeper men-
studies were excluded because they did not meet the inclu- tal balance or equilibrium. The sessions lasted between nine
sionary criteria: nonrandomized trial (n = 3) (24–26), not an rounds of breathing exercises to 45 minutes. Duration of the
acute study with repeated measures across all conditions yoga session was not reported in one acute study.
(n = 1) (27), case studies or insufficient information to esti- Table 3 lists the cognitive tests used by study authors
mate effect sizes (n = 5) (28–32), used self-report or be- to assess attention and processing speed, executive func-
havioral observation to assess cognitive function (n = 2) tion, and memory. The Stroop, Trail Making A and B,
(33,34), or examined neuroanatomical outcomes such as Wechsler Adult Intelligence Scale (forward and back-
event related potentials (n = 3) (35–37). Four other studies ward digit span), and Six Letter Cancellation Test were
were excluded because they were cross-sectional observa- the most commonly used measures that were assessed
tional studies conducted with yoga practitioners or teachers in three studies each. Executive function measures made
(38–41). Thus, a total of 22 studies were retained for the up the largest pool of measures, followed by attention—
meta-analysis, of which 15 were RCTs (42–56) and 7 exam- processing speed and memory tests.
ined acute yoga effects (57–63) on cognition. One (62) of the
seven acute yoga studies was a peer-reviewed published ab- Study Quality
stract, but we were able to extract all the necessary data to Table 4 summarizes the study quality for the 15 RCTs.
calculate effect sizes. The overall findings did not differ Jadad scores for the 15 studies ranged from 1 to 4, with a
when the study was included or excluded from the analyses. mean of 2.93/4.00 (0.88). Most RCTs (13/15) used random
Eleven of the 22 studies were conducted in India, 8 in the sampling by advertising in local media outlets. For the re-
United States, 2 in the United Kingdom, and 1 in Slovenia. maining two RCTs, participants were recruited from an out-
patient clinic (n = 1), and no sampling details were reported
Study Characteristics for the other RCT. One of the 15 studies lacked appropriate
Tables 1 and 2 summarize the study characteristics including randomization, where authors acknowledged the limitation
participant ages, type and duration of the intervention groups of using block (senior resident homes) randomization tech-
(for RCTs) or conditions (for acute studies), and cognitive nique without accounting for baseline characteristics of the
measures used in the 15 RCTs and 7 acute yoga studies, re- participants. However, the results did not differ when the
spectively. Most of the studies were conducted with adults study was excluded from the analyses. The remaining 14
(12 RCTs and 5 acute), whereas yoga studies with children studies randomized participants on the basis of on age and
(<18 years of age) made up the minority (3 RCTs and 2 acute). sex. Blinding of participants to their allotted treatment con-
RCTs (Table 1) ranged from 1 to 6 months in duration dition is not feasible in physical activity–based trials. This
and commonly used Hatha yoga (8/15 RCTs) protocols. criterion was therefore not evaluated or included in the
Three RCTs included Iyengar yoga practice; one studied Jadad scores for the RCTs. Several studies (6/15) used a
the Integrated Approach of Yoga Therapy and one fo- single-blind approach by blinding assessors; however, this
cused on sahaj yoga. No yoga protocol or syllabus was was not completely effective because authors reported rare
reported for two RCTs. Iyengar yoga is a form of Hatha instances where participants disclosed their treatment allo-
yoga, which uses “props” such as chairs, blankets, or cation to their assessors. One study also reported blinding
straps that support the practitioner in performing the of assessors only at baseline and not at the follow-up time
physical postures of yoga. The sahaj yoga intervention point. Information about withdrawals and dropouts was re-
focused on the meditative aspect of yoga practice, and ported in 11 of 15 RCTs. This information was inconsis-
the Integrated Approach of Yoga Therapy involved tently reported where some studies only included follow-up
yoga postures, breathing, and meditative practice that sample sizes, whereas others followed the Consolidated

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 TABLE 2. Study Characteristics of the Acute Yoga Studies Included in the Meta-Analysis

First Author Duration of

(Year) Sample n (M [SD] Age, y) Study Design Yoga Condition Other Conditions Yoga Session Cognitive Tests Effect Size
Bhavanani Male school children Pre-post Mukh Bhastrika None 9 rounds of Auditory and Visual APS:
(2003) n = 22 (14.5 [1.25]) (yogic breathing) breathing reaction time 0.63***

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Telles (2008) Young adults n = 11 Repeated-measures Kapalabhati Breathing awareness Duration not Six Letter APS:
(20.9 [2.3]); middle counterbalanced (yogic breathing) reported Cancellation 0.64***
age n = 48
(30-59 y); older adults
n = 16 (60+ y)
Subramanya Male adults n = 57 Repeated-measures Cyclic meditation Supine rest, control 22.5 min Digit-Letter APS:
(2009) (26.5 [4.6]) counterbalanced Substitution, 1.04***
Letter-Copying,

789
Circle-Dotting
Pradhan (2010) School children Repeated-measures Cyclicmeditation+hatha Supine rest 22.5 min Six Letter APS: 0.05
n = 208 (13.84 [0.98]) counterbalanced yoga Cancellation
Telles (2012) Male army recruits 3 independent groups Hatha yoga Meditation music control, 45 min Digit-Letter APS: 0.06
n = 160 (32.0 [6.35]) breathing awareness Substitution
a
Gothe (2012) Female college students Repeated-measures Hatha yoga Aerobic exercise, Control 20 min Word Memory MEM:
n = 30 (20.07 [1.95]) counterbalanced 0.78***
Gothe (2013) Female college students Repeated-measures Hatha yoga Aerobic exercise, Control 20 min Erikson's Flanker, APS: 0.17
n = 30 (20.07 [1.95]) counterbalanced N-back EF:
0.39***

M = mean; SD = standard deviation; APS = attention and processing speed; MEM = memory; EF = executive function.
*** p < .001.
a
Published abstract.

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Yoga and Cognition

September 2015
 SYSTEMATIC REVIEW/META-ANALYSIS

TABLE 3. Classification of the Neurocognitive Tests Used in Acute Yoga Studies and RCTs by Cognitive Domain

Attention and Processing Speed Executive Function Memory

RCTs Simple reaction time (2) Stroop interference (3) CERAD delayed recall (2)
Choice reaction time (2) WAIS letter number sequencing (2) 15-concrete noun word list
easy/difficult (2)
Six Letter Cancellation (3) Wisconsin card sorting task (2) Long-term word recognition
easy/difficult (2)
WAIS–Digit Symbol WAIS similarities (1) Benton Visual Retention Test (1)
Substitution (1)
Ruff 2 and 7 letters and digits (1) Useful field of view (2) Immediate story recall (1)
Trail Making Part A (2) Attention network task—incongruent (1) Selective reminding (2)
Covert orienting spatial Verbal fluency (1) Word comparison (1)
attention (1)
Attention network Nonverbal fluency (1) Sternberg's memory search task (1)
task—congruent (1)
Pattern comparison (1) Trail Making Part B (3) Rey's complex figure test (1)
Brickenkamp d2 test (1) WAIS forward/backward digit span (3)
N-back—1 and 2 back AC (1)
Running memory span (1)
Task switching (1)
Ruff figural fluency (1)
Go/No-Go task (1)
Tower of London (1)
Controlled Oral Word Association (1)
Mazes test (1)
Acute studies Erickson's Flanker—congruent (1) Erikson's Flanker—incongruent (1) Word Memory (1)
N-back—0 back reaction time (1) N-back—1 and 2 back reaction
time (1)
Six Letter Cancellation (2)
Digit letter substitution (1)
Letter-copying (1)
Circle-dotting (1)
Auditory and visual RT (1)

RCTs = randomized controlled trials; CERAD = Consortium to Establish a Registry for Alzheimer's Disease; WAIS = Wechsler's Adult Intelligence Scale.
The number in the parentheses indicates the number of studies that used the test. Malin's Intelligence Scale for Indian Children, an adaptation of WISC-II,
which spans attention and processing speed as well as executive function, was also used in one study (Chaya 2010).

Standards of Reporting Trials (64) detailing the flow of the studies at g = 0.33 (SE = 0.08, 95% CI = 0.18–0.48,
study and reasons for dropout or withdrawal. p < .001; Q14 = 20.79, p = .107) seen in Figure 2.

Overall Effect Sizes Attention and Processing Speed

Overall effect sizes for acute and chronic studies were calcu- Six of the seven acute studies used cognitive tests measur-
lated before examining specific cognitive domains. The fun- ing attention and processing speed. A single session of yoga
nel plot of the 15 effect sizes versus standard errors (SEs) for was associated with moderate improvements in attention
the RCTs and 7 effect sizes and SEs for acute studies sug- and processing speed g = 0.49 (SE = 0.14, 95% CI = 0.22–
gested against publication bias. As seen in Figure 1, the over- 0.77, p < .001). There was significant heterogeneity among
all effect size for acute studies was g = 0.58 (SE = 0.11, 95% the six studies (Q5 = 51.46, p < .001)
confidence interval [CI] = 0.33–0.78, p < .001; Q6 = 51.51, Similar results were observed for 11 of 15 RCTs that
p < .001) which was higher than the effect size for chronic used attention and processing speed measures. As seen in

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 Yoga and Cognition

TABLE 4. Study Quality Assessment for the RCTs

Random Appropriate Blinding of Withdrawals and Dropouts Total Jadad

Study Sampling Randomization Assessors Reported Score
Madden (1989) Yes Yes NR Yes 3/4
Blumenthal Yes Yes NR Yes 3/4
(1989)
Manjunath Yes Yes NR NR 2/4
(2001)
Oken (2004) Yes Yes Yesa Yes 4/4
Oken (2006) Yes Yes Yesa Yes 4/4
Sharma (2006) No Yes NR NR 1/4
Chattha (2008) Yes Yes Yesb Yes 4/4
Velinkonja NR Yes Yes NR 2/4
(2010)
Chaya (2010) Yes Yes Yes Yes 4/4
Bowden (2012) Yes Yes NR Yes 3/4
Bilderbeck Yes Yes NR Yes 3/4
(2013)
Hariprasad Yes Noc Yes Yes 3/4
(2013)
Telles (2013) Yes Yes NR Nod 2/4
Gothee (2013) Yes Yes No Yes 3/4
Gothe (2014) Yes Yes No Yes 3/4
M (SD) 2.93 (0.88)

RCTs = randomized controlled trials; NR = not reported; M = mean; SD = standard deviation.

a
Despite precautions, authors reported rare instances of unblinding.
b
Assessor blinded only at baseline, prerandomization.
c
Limitation acknowledged by the authors: block randomization without accounting for baseline characteristics.
d
Authors report the number of participants who “could not complete assessments,” withdrawals/dropouts not reported.
e
Published abstract.

Figure 3, the effect size was moderate, g = 0.299 (SE = 0.08, was found, g = 0.39 (SE = 0.13, 95% CI = 0.14–0.65,
95% CI = 0.14–0.46, p = .001). The effect was consistent p = .003).
across all RCTs (Q10 = 14.53, p = .150). On the other hand, 13 of the 15 RCTs examined effects
of yoga on executive function measures as seen in Figure 4.
Executive Function The effect size was g = 0.27 (SE = 0.08, 95% CI = 0.12–
Only one of the seven acute yoga studies examined effects 0.42, p = .001) and consistent across all RCTs (Q12 = 16.05,
on executive function measures. A significant modest effect p = .189)

FIGURE 1. Overall effect of yoga on cognition for the seven acute yoga studies. CI = confidence interval.

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 SYSTEMATIC REVIEW/META-ANALYSIS

FIGURE 2. Overall effect size for the 15 RCTs. RCTs = randomized controlled trials; CI = confidence interval.

Memory and participant characteristics. A closer examination of

The acute effects of yoga on memory were examined in the three domains of cognition suggested specificity of
only one published abstract. The effect size was large yoga effects that were also unique to the nature of the study
and significant, g = 0.78 (SE = 0.10, 95% CI = 0.59– (i.e., RCTs versus acute). The effect sizes for each of the do-
0.98, p < .001). mains were significant, except for RCTs that examined
As in the acute studies, memory was investigated in only memory, which was marginally significant. However, taken
5 of the 15 RCTs. The effect size was marginally signifi- together, these findings suggest that practice of yoga has the
cant, g = 0.18 (SE = 0.09, 95% CI = 0.00–0.35, p = .051) potential to improve specific domains of cognitive func-
and was consistent across the 5 RCTs (Q4 = 1.87, tioning. This relationship needs to be systematically studied
p = .760), as seen in Figure 5. in the future by overcoming the limitations discussed below
and designing methodologically sound and rigorous acute
DISCUSSION studies and RCTs.
The purpose of this review was to evaluate in totality the ef- There is merit in investigating both chronic and acute
fectiveness of yoga in improving cognitive function includ- effects of yoga on cognition. Studies included in this meta-
ing attention and processing speed, executive function, and analysis ranged from counterbalanced acute exercise proto-
memory. The overall effect sizes were 0.33 for RCTs and cols to RCTs. Among RCTs, attention and processing speed
0.56 for acute studies, suggesting that yoga practice has a and executive function processes showed the largest benefit
modest effect on cognition regardless of cognitive task from yoga practice. The effect on memory processes was

FIGURE 3. Effect of yoga on attention and processing speed (n = 11). Individuals randomized to the yoga group exhibited improved
attention and processing speed relative to controls (g = 0.299). Each study is denoted with a square, with larger sample sizes
corresponding to larger marks. CI = confidence interval.

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 Yoga and Cognition

FIGURE 4. Effect of yoga on executive function (n = 13). Individuals randomized to the yoga group exhibited improved executive
function performance (g = 0.267). Each study is denoted with a square, with larger sample sizes corresponding to larger marks. CI =
confidence interval.

marginally significant. This trend is consistent with the aer- exercises (particularly: pranayama and kapalabhati) are
obic exercise and cognition literature (65). Acute yoga stud- consistently associated with improvements in performance
ies seem to show consistent improvements and stronger on measures of cognition. The yogic breathing technique
effect sizes on cognitive domains in comparison to RCTs. of pranayama involves a slow deep breath inspired with
This is also consistent with the physical activity literature the predominant use of the abdominal musculature and
where acute aerobic exercise has shown to improve cogni- the diaphragm. The breath is held momentarily in full inha-
tion (13,14). However, given the handful of studies, conclu- lation within the limits of comfort and concludes with a
sions need to be drawn with caution. One area of future yoga slow and controlled exhalation. Kapalabhati is another
research needs to examine the possibility of its fleeting ef- breath regulation technique that is a part of Hatha yoga
fects on cognition and include multiple follow-up time practice. It involves changing the rate and depth of breath-
points following the acute yoga bout. In addition, examining ing by high-frequency breathing (i.e., approximately at
the cumulative effects of serial bouts of yoga is warranted. 2.0 Hz) with forceful exhalation. Indeed, kapalabhati in
The foundation of yoga practice lies in the adoption and Sanskrit translates to kapala = forehead and bhati = shining,
maintenance of specific body postures and its associated which symbolically suggests that this practice stimulates
controlled breathing techniques. There are many different the brain (66). Future work in the field needs to parse out
forms of yoga; however, all involve physical movement, the independent effects of each of these elements involved
breathing, and meditative exercises. One of the shortcom- in the holistic practice of yoga.
ings of this literature is insufficient information about the Studies that have reported significant improvements in
yoga intervention and the proportion of time spent in the cognition have proposed a number of psychosocial and
practice of each of these common elements. From the stud- physiological mechanisms that may underlie the yoga—
ies reviewed here, it seems that the breathing and meditative cognition relationship. Preliminary evidence suggests that

FIGURE 5. Effect of yoga on memory (n = 5). Individuals randomized to the yoga group showed marginally significant improvements in
memory performance (g = 0.18). Each study is denoted with a square, with larger sample sizes corresponding to larger marks. CI =
confidence interval.

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 SYSTEMATIC REVIEW/META-ANALYSIS

yoga has a down-regulating effect on both the sympathetic (80) and arthritis (81). Given the various modifiable forms
nervous system and the hypothalamic-pituitary adrenal of yoga and its suitability for individuals with different
(HPA) axis in response to stress (6). Stress, in general, functional abilities, it seems to be a promising cost-
may lead to anxiety and depression, involving chronic sym- effective and feasible mode of activity to promote physical
pathetic activation and activation of HPA axis (67). Other and psychological well-being in older adults. This is evi-
analogous mind-body techniques, including mindfulness- dent from most RCTs in this meta-analysis that were con-
based stress reduction (68), transcendental meditation (69) ducted with healthy, aging older adults. Its potential to
and tai-chi (70), have been shown to elicit a similar relaxa- sustain cognitive functions and ward off age-related cogni-
tion response along the sympathetic nervous system and tive declines need to be fully explored. Despite its growing
HPA axis activity. Anxiety remains is a critical moderator popularity, yoga-related injuries have also come into the
within the field of cognition because it is associated with spotlight suggesting the need to exercise caution during
adverse effects on two central executive functions involv- yoga practice. An extensive survey conducted with 1336
ing attentional control: inhibition and set shifting (71). It yoga therapists, teachers, and clinicians across 34 countries
is plausible that changes in stress-related physiological sys- found that the most common yoga injuries related to poor
tems and mood may be among the mechanisms that lead to technique or alignment, previous injury, excessive effort,
improved cognitive performance after yoga practice; how- and improper or inadequate instruction (82).
ever, this relationship has yet to be systematically examined The current meta-analysis is challenged by several limi-
within acute studies and RCTs. tations. The study quality and methodologies differed
In the physical activity-cognition literature, experiencing within the RCTs and acute yoga studies. Different combina-
novel activities (72) and anaerobic interventions have been tions of type, frequency, and duration of yoga were used,
shown to have unique cognitive benefits on brain structure making it difficult to arrive at an optimal recommendation
and function (73). From this neuroscientific perspective, tasks of yoga for improving cognitive performance. The small
that involve mind wandering, memory consolidation, thought number of studies also makes it difficult to conduct moder-
focused inward to the self (self-referential thinking), and tak- ator analyses to examine effect sizes for different doses of
ing the perspective of others into one's own view of the yoga. Most of the studies were conducted in India where re-
world have been associated with the default mode network searchers more consistently incorporated breathing and
(DMN). This is a network of brain regions that are active meditative protocols compared with other countries. The
when the individual is at rest but not focused on the outside heterogeneity of cognitive measures and insufficient de-
world (74,75). There is evidence that supports a relationship scriptions of the yoga interventions for replication are two
between the DMN and executive function, where increased major limitations that should be addressed in future work.
DMN function has been associated with better working CAM researchers need to not only focus on establishing
memory performance in young adults (76), and better perfor- the link between yoga and cognition but also examine its ef-
mance on a range of executive function tasks in older adults fectiveness in comparison to traditional forms of exercise
(73,77–79). The breathing and meditative practices of yoga such as walking, cycling, and strength training that have
largely parallel the self-referential thoughts and involve been extensively investigated for their cognitive benefits.
learning and consolidation functions that have been associ- It would be ideal to ascertain post–yoga performance on
ated with the DMN. Future research should explore the cognitive tasks used in the physical activity literature and
structural and functional brain changes as a result of yoga compare these traditional and nontraditional modalities.
in an effort to identify the neurobiological underpinnings At the same time, researchers need to design adequate con-
of the yoga-cognition relationship. Although there are no trol groups that control for potential confounders such as
definitive mechanisms studied in the yoga-cognition litera- social support and attention from research staff and yoga in-
ture, these models provide a basis for future studies to ex- structors. It is also possible that individuals practicing yoga
amine mediators of the yoga-cognition relationship and may have unique outcome expectations that might influ-
further establish an evidence base in this area. ence their performance on cognitive tests. Future studies
Given its simplicity and diverse forms, yoga is easily need to account for these factors and design appropriate at-
adaptable for most ages and clinical populations. The sam- tentional control groups.
ple characteristics in this meta-analysis were diverse rang- Our findings are preliminary and should be confirmed
ing from school children to healthy seniors and clinical through higher-quality RCTs and well-designed acute yoga
but cognitively healthy populations. The low intensity and studies. Research examining the benefits of physical activ-
modifiable nature of this exercise maybe the reason why ity has progressed to a point where neuroimaging tech-
yoga has been primarily perceived as an adjunct therapy niques such as functional magnetic resonance imaging are
for clinical conditions, which is evident from the large num- used to study cognition during task performance (83). In
ber of studies conducted with patients with cancer (3), dia- comparison to such state-of-the-art methodologies, much
betic patients (5), and patients with heart-related conditions needs to be done in the field of yoga and cognition to

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 Yoga and Cognition

thoroughly assess the generality or specificity of the cogni- 17. Chiesa A, Calati R, Serretti A. Does mindfulness training im-
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analysis will serve as a significant platform for researchers meditation on cognitive function—a systematic review of
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DJM, Gavaghan DJ, McQuay HJ. Assessing the quality of re-
Source of Funding and Conflicts of Interest: No finan- ports of randomized clinical trials: is blinding necessary? Con-
cial support was received for this research. The authors de- trol Clin Trials 1996;17:1–12.
20. Lezak MD, Howieson DB, Loring DW. Neuropsycholog-
clare no conflicts of interest.
ical Assessment. 4th ed. New York: Oxford University
Press; 2004.
21. Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter
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