Aggregate Effects of Yoga-Based Volitional Breathing Interventions on Perceived Stress and Anxiety Levels Among Medical Students Worldwide: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis of seven studies found that yoga-based volitional breathing (pranayama) interventions significantly reduced self-perceived stress and anxiety among medical students worldwide. The pooled effect size was large (standardized mean difference = -1.25), though heterogeneity was high. Short-term programs (8 weeks or less) showed a significantly larger effect than longer programs. The single randomized controlled trial included, which had a low risk of bias, also showed a very large effect. The authors conclude that pranayama interventions are a powerful and viable mental health promotion approach for medical students, while noting that additional high-quality trials are needed.

Study at a glance

Abstract

Medical education has long been acknowledged as a very stressful career path that exposes students to greater chances of anxiety and burnout. The purpose of this systematic review and meta-analysis was to determine the overall impact of yoga-based volitional breathing (pranayama) interventions on self-perceived stress and anxiety among medical students worldwide. The review analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and seven databases were searched from 2010 to 2025. Potential studies were limited to those that concerned interventions involving only pranayama. Seven studies were included, comprising one randomized controlled trial (RCT) and six single-arm studies. A random-effects model was used to compute standardized mean differences (SMD). The meta-analysis of the seven studies in general revealed a significant, large decrease in stress/anxiety (SMD = -1.25, 95% CI: -1.64 to -0.86, p < 0.001), but heterogeneity (I² = 67%) was high. Subgroup analysis indicated a significantly larger effect for short-term (≤8 weeks) programs (SMD = -1.68, 95% CI: -3.13 to -0.22) compared to long-term (>8 weeks) programs (SMD = -1.06, 95% CI: -1.46 to -0.65), with the between-group difference being statistically significant (Q = 9.71, p = 0.002). There were no notable differences in the main outcome measure or by mode of delivery. The effect size of the single RCT, which had a low risk of bias, was very large (SMD = -1.78). It was established that pranayama interventions had significant stress and anxiety reductions in medical students. Although additional high-quality RCTs are required, these results support the inclusion of a structured pranayama intervention in student wellness programs as a powerful and viable mental health promotion approach.