Reimagining Adolescent Well-Being Through Yoga as a Public Health Paradigm

Anithamol Babu^1,2*Akhil P. Joseph^1*Jacob Bose¹Kalpana Sarathy²

• ¹Marian College Kuttikkanam Autonomous, Kuttikkanam, India
• ²Tata Institute of Social Sciences - Guwahati Campus, Guwahati, India

Empirical evidence remains encouraging yet methodologically uneven. Across the review of reviews in Table 1-each of which applied explicit inclusion criteria encompassing (a) include studies with participants aged ≤18 years from PubMed database, (b) yoga as the primary intervention, (c) Reviews on RCT or controlled experimental design, (d) mental health outcomes such as anxiety, depression, stress, resilience, attention, or metabolic indicators, (e) English-language publications, and (f) school-or community-based settings-school-based and adolescents-focused yoga interventions (17 repeated RCTs across reviews are listed in Table 2-supplementary file (Khalsa et al., 2012;Noggle et al., 2012;Velásquez et al., 2015;Mendelson et al., 2010;Haden et al., 2014;Halliwell et al., 2018;White, 2012;Case-Smith et al., 2010;Conboy et al., 2013;Klatt et al., 2013;Frank et al., 2014Frank et al., , 2017;;Koenig et al., 2012;Mehta et al., 2012;Hariprasad et al., 2013;Blom et al., 2017;Bazzano et al., 2022)) consistently demonstrated reductions in stress, anxiety, and depressive symptoms, alongside improvements in attention, resilience, and coping, positioning yoga as a low-cost, scalable Positive classroom climate, inclusive school culture, intersectoral collaboration, and public health integration. Empathy, peer connectedness, and supportive classroom relationships. Mindfulness, adaptive selfregulation, and emotional balance. Improved autonomic regulation, stress resilience, cardiometabolic health, and attentional control. postures, breath regulation, and mindful presence and relaxation"preventive tool within school health systems (James-Palmer et al., 2020;Khunti et al., 2023;Weaver & Darragh, 2015;Andermo et al., 2020;Cai et al., 2025;Dray et al., 2017;Fulambarkar et al., 2023;Hart et al., 2022;Luo et al., 2024;Weaver & Darragh, 2015;Kerekes et al., 2024;Miller et al., 2020). However, the evidence base remains constrained by small samples, heterogeneous intervention designs, short-duration programmes, and limited generalizability across contexts (James-Palmer et al., 2020;Khunti et al., 2023;Weaver & Darragh, 2015). Moreover, yoga often exhibits similar benefits to general physical activity in healthy populations, with distinct advantages most evident among adolescents with elevated symptoms (Hendriks et al., 2017). While sports, arts-based programs, and social-emotional learning initiatives have also demonstrated promise as scalable and low-cost strategies to promote adolescent well-being, yoga offers distinctive contributions. Team sports can strengthen cooperation, discipline, and physical health, but may not explicitly cultivate attentional control or stress regulation. Arts-based interventions enhance creativity and emotional expression yet often require specialised facilitators and resources. Yoga combines physical activity with mindfulness and breath regulation, bridging somatic, cognitive, and emotional domains. In LMIC contexts where resources are constrained, its minimal equipment requirements and cultural resonance position yoga as a complement rather than a competitor to these established approaches. For yoga to be credibly positioned as a public health intervention, it must be tested comparatively against cognitive-behavioural therapy, structured social-emotional learning curricula, and multi-sport programs to establish whether it provides unique or effective benefits. Thus, yoga should be embedded within a tiered school mental health model, complementing rather than replacing established interventions. Teacher training and peer leadership programs should prioritise trauma-informed facilitation and developmental appropriateness. Curricular content must be adapted to cultural and linguistic contexts through participatory design involving students, educators, and caregivers, rather than imposed as standardised packages.Monitoring and evaluation must combine psychometric tools with ecological indicators such as classroom behaviour, school attendance, and peer relationships, while avoiding exclusive reliance on Western measurement frameworks. Above all, ethical safeguards must guarantee voluntariness, secular framing, and cultural sensitivity, while ensuring that neurodiverse students and children with disabilities are not marginalised. In addition, two implementation safeguards are essential: (a) the introduction of simple contraindication screening and physical-safety protocols to identify students for whom certain postures or breathing techniques may pose risks; and (b) clear opt-in/opt-out participation pathways to respect religious, ethical, and cultural diversity within school communities. These safeguards should be embedded into school-level operational guidelines, ensuring that teachers receive basic training to identify musculoskeletal vulnerabilities, respiratory conditions, and sensory sensitivities that may require modified or alternative practices. Equally important is the establishment of transparent communication mechanisms-such as informed participation forms, parental briefing notes, and culturally sensitive programme descriptions-that enable families to make autonomous decisions without fear of stigma or exclusion.Therefore, the issue of differentiated learners becomes central. Adolescents are not a homogeneous population; classrooms contain students who learn at varying rates (fast, moderate, and slow learners), as well as those with sensory sensitivities, attention regulation difficulties, or social communication differences. Yoga programs must therefore incorporate flexible pedagogical designs. For fast learners, advanced postures or leadership roles can sustain engagement, while for slower learners, sequences should be broken into stepwise, scaffolded instructions with repeated practice. Importantly, yoga instruction engages multiple learning modalities simultaneously. Kinesthetic learners benefit from physical postures and movement; visual learners are supported through demonstration, diagrams, and visual sequencing, while auditory learners gain from guided breathing instructions and verbal cues. This multimodal structure makes yoga uniquely adaptable to diverse classroom needs, as it allows students to internalise practices through multiple channels of engagement, enhancing both accessibility and retention. Supporting neurodiverse learners requires structured adaptations, including simplified postures, enhanced visual supports, and sensory-sensitive environments with features such as dimmed lighting and reduced noise. These adaptations enable participation without marginalisation and signal that inclusivity is a design principle rather than an afterthought. Encouragingly, evidence from sensory-sensitive and co-designed yoga adaptations demonstrates that such approaches can enhance engagement and reduce overload, reinforcing that inclusivity is a foundational design principle rather than an afterthought (Khin, 2022).Implementation models from LMIC schools provide useful insights. For example, Anusuya et al. (2021) conducted an RCT on yoga-based relaxation techniques, reporting improvements in classroom attentiveness and a reduction in anxiety. In Sri Lanka, a six-month yoga-based intervention delivered to Grade 8 students in a post-conflict region-comprising slowbreathing techniques, Surya Namaskāram, and mindfulness -yielded significant reductions in both internalising and externalising behavioural symptoms, as well as reported qualitative improvements in school achievement, family dynamics, and individual health (Sivashankar et al., 2022). These examples demonstrate that yoga can be implemented sustainably when adapted to a cultural context, integrated into existing school timetables, and supported through teacher training rather than relying on external specialists.Integration into the school curriculum can also draw lessons from existing physical activity programs that have been successfully embedded into daily routines. For instance, structured movement breaks are commonly introduced in classrooms to improve attention and behaviour, particularly among students with ADHD. Similarly, physical education classes have long been used to promote health, teamwork, and resilience. Yoga can be embedded into these models by incorporating short practices at the beginning of the school day, using brief sequences during transitions, or integrating modules into physical education curricula. These practical applications demonstrate that yoga can complement existing strategies, offering additional benefits of breath regulation, mindfulness, and emotion regulation within familiar school structures.Cultural reflexivity remains equally important. The institutionalisation of yoga in schools risks reducing an indigenous practice into a depoliticised stress-management technique, while reproducing caste, class, and gender exclusions. When presented as a universal "Eastern" tradition, yoga risks being appropriated into global health discourses in ways that erase its contested histories (McCartney, 2019). To avoid cultural tokenism and epistemic erasure, its implementation must embrace plural ontologies of well-being, centre marginalised voices, and resist homogenising knowledge systems. Reflexive implementation is particularly critical in LMICs, where social inequities shape access to both education and health. The path forward lies in combining evidence, inclusivity, and reflexivity. Yoga offers a culturally acceptable, embodied entry point for adolescents in contexts where stigma and resource scarcity constrain mental health engagement. However, the integration must be deliberate: supported by intersectoral collaboration between health and education ministries, embedded into teacher training institutes, financed through sustainable partnerships, and evaluated independently by research institutions. Future studies must move beyond short-term efficacy to include comparative effectiveness trials, cost-benefit analyses in resource-constrained systems, gender-sensitive delivery models, and longitudinal tracking of outcomes such as school retention, academic achievement, and violence prevention.Thus, evidence indicates that yoga's benefits are modest yet meaningful. These findings underscore the importance of translating empirical insights into policy frameworks that are scalable, inclusive, and culturally grounded. Future research must rigorously evaluate longterm outcomes, sustainability, and implementation fidelity, ensuring that structured, symptomfocused interventions are led by skilled facilitators who are responsive to contextual needs. To overlook yoga as a transient wellness trend would be shortsighted, for its embodied and culturally legible nature uniquely positions it to bridge the gap between clinical mental health paradigms and everyday practices of emotional regulation within LMIC school settings. The real challenge, then, is not whether yoga should be part of adolescent health policy, but how it can be implemented without reproducing inequities or erasing its cultural complexity. If anchored within a biopsychosocial-ecological framework, co-designed with diverse learners and neurodivergent youth, and embedded in tiered school mental health systems, yoga can serve as a pragmatic and justice-oriented entry point into broader psychosocial support. Its value lies not in replacing established interventions but in expanding the terrain of what is possible-normalising care practices within schools, fostering resilience in contexts of scarcity, and opening space for culturally resonant approaches to adolescent well-being. In this light, yoga should not be perceived as either a universal remedy or a negligible trend; rather, it represents an emerging pedagogical and public health experiment, the outcomes of which will depend on whether it is pursued with reflexivity, inclusivity, and a sustained commitment to evidence-informed practice.