Place: Kochi India

a quantitative study exploring stress in adults

who practice yoga in yoga centre in kochi, kerala,
India'
Proposal
Abstract
Background- The impact of yoga practice on managing stress and the physiological response that
yoga has on the stressful state is the point of focus in this research study. Ancient yogic practice
in the Kerala region of India and the benefits to improve mindfulness and reducing life-style
disorders is a major focus.

Methodology- the study proposes quantitative data analysis for the purpose of collecting data.
The suggested population is 50 people and the recruitment is made on the basis of their link to
yoga. People who have experience stress and have been practicing yoga for more than a year
would be recruited for participating in the survey process.

Search Strategy: The medical databases which were searched for relevant articles are NCBI and
Entrez. Apart from that Google Scholar has also been searched for relevant articles on the
research topic. After applying the appropriate inclusion and exclusion criteria, 18 articles were
retrieved from which 5 most relevant articles were selected for the literature review.

Literature Review: For the systematic review, 5 articles have been extensively evaluated which
has yielded the common inference that yoga helps in stress management. A literature gap has
been identified which is the absences of the effect of yoga in managing stress in the adolescent
population.
Table of Contents
Abstract............................................................................................................................................2

Background......................................................................................................................................4

3. Search Strategy............................................................................................................................5

3.1 Databases Searched and Reason............................................................................................5

3.2 Date Parameters Used and Reason........................................................................................5

3.3 Key Terms Used....................................................................................................................5

3.4 Number of Articles Retrieved................................................................................................5

3.5 Inclusion and exclusion Criteria............................................................................................5

4. Literature Review........................................................................................................................6

4.1 Evaluation of Retrieved Articles...........................................................................................6

4.2 Literature Gap........................................................................................................................8

Aim-.................................................................................................................................................9

Objective:.........................................................................................................................................9

Methodology....................................................................................................................................9

Data collection approaches..........................................................................................................9

Selection of the method.............................................................................................................10

Limitations.................................................................................................................................11

Ethics.........................................................................................................................................11

References......................................................................................................................................13

Appendices....................................................................................................................................17
Background
Stress is a global public health risk problem. The physiological response of yoga to stressful
conditions is most positive. Physiological response to stress is associated with increased
heartbeat and release of adrenalin that leads to sweating and increased blood pressure (Singh,
U.P., 2018). The ancient science of Yoga is focused on integrated body movements and
breathing exercises, that improve flexibility, enhances muscular strength, and helps to improve
the cardiovascular system as well as hormonal function. Yoga practice is known to enhance
mind-fullness and has been found to be mood-enhancing without the regular practices of
conventional anti-depressants (Alaguraja et al ., 2019). Advanced breathing techniques also
ensure that maximal oxygen intake is made possible that helps in ensuring the reduction of
stress-induced painful physical responses. In the opinion of Stephens, (2017), yoga is now used
as a treatment of many medical conditions that are stress-induced. The practice of Yoga
improves blood glucose levels, improves the feeling of positive energy, and helps to alleviate
depression.

Yoga is known as an ancient healing practice and its popularity all over India cannot be
undermined. In Kerala, there is a village called Kunnamthanam, where the mass practice of yoga
has been known to check lifestyle disorder in a stressful environment (indiatoday.in 2020). There
has been a positive effect on the blood pressure of the population in the 500 villages due to the
regular practice of yoga. The practice of Yoga in India is well known, however, in Kerala, there
is a strong presence of many foreigners from various parts of the world who are trying to
understand and adopt the various yogic practices. The Amritanandamoyi Ashram in Kollam is
known to be the home of many foreign nationals who have adopted the yogic way of life by
regular practice of yoga to alleviate stress-related physical conditions
(timesofindia.indiatimes.com 2020). Medical science has realised that fight or flight response
has the undesirable effect of drawing away blood from the extremities, however, yoga has the
positive effect of on the physic-nervous system thus bring back all aspects of the physiological
functions back to normalcy (Tanwer, S., 2018). The importance of the topic lies in this that one
is able to assess the value that yoga practices can render to rectifying the stress-induced ailments
in the human body. There is a lot of focus on government policy to influence people to adopt
yoga with the help of networking by the Ministry of Ayush (ccryn.gov.in. 2020).

3. Search Strategy

3.1 Databases Searched and Reason

Several medical databases were searched for retrieving suitable articles and journals for this
research proposal. The most suitable medical database portal is Entrez which is considered as a
biological research community and contains clinical papers regarding various domains of
medical science. Another significant database which was searched is National Centre for
Biotechnology Information (NCBI). This database provides highly relevant journals and articles
which is suitable for the research area. Google Scholar was also searched for retrieving suitable
articles for the review which was constructed by the researcher. In this database, a huge number
of academic journals and articles are freely available for use which makes it convenient to
retrieve articles.

3.2 Date Parameters Used and Reason

Since medical science is a dynamic area and keeps changing continuously, therefore, the date
parameters which are used for the search strategy is 2015 to 2020. It was considered appropriate
because the data and inferences would be recent which will help the researcher to analyse the
areas which are of significant importance. Further, any article which is beyond t2015 is being
considered as irrelevant to the study undertaken.

3.3 Key Terms Used

The key terms that are used in this study are “yoga”, “yoga for stress relieve”, “stress relieve”,
“role of yoga”, “stress management”. These key terms were used to search the relevant articles
because they are related to the topic of research that is undertaken.

3.4 Number of Articles Retrieved

The number of articles that were retrieved were 18 articles and then it was narrowed down to 5
articles for the literature review by applying the inclusion and exclusion criteria being considered
by the researcher.
3.5 Inclusion and exclusion Criteria
The inclusion criteria which were considered for retrieving the articles are the date parameters of
2015 to 2020. Then the researcher searched for the usage of the type of methodology that was
used in conducting the research by the researcher. If the methodology was strong then it was
considered to be included in the research. Also, those papers which was written after considering
a large sample size were included because a large sample helps to eliminate significant statistical
errors. The exclusion criteria which was applied to retrieve the articles is the scope of the paper.
If the scope was not relevant to the focus area of the research, then it was excluded from
consideration. Further, another exclusion which was applied was the small sample size of less
than 10 being used in the methodologies of the paper.

4. Literature Review

4.1 Evaluation of Retrieved Articles

According to the views of authors Riley & Park(2015), yoga is increasingly used by medical
personnel for stress management in individuals along with treating other medical conditions.
Stress has been defined as a psychological condition which is caused in individuals after
significant work overload and physiological factors. Therefore, yoga is highly recommended for
reducing stress which is provided as an evidence by the authors after examining 35 published
articles of which 25 articles have established the fact that yoga reduces stress. The authors have
also inferred that practicing yoga helps in increasing the mindfulness in individuals which helps
in combating stress and tension. The methodology which was used by the authors to analyse the
empirical evidence collected through several external journals is a systematic literature review.
The strength of the paper is following the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines for framing the review. Further, the authors have used
strong inclusion and exclusion criteria for selecting and narrowing the articles used for the
literature review. At first about 926 journals were retrieved out of which 71 were included and
then narrowed down to 5 articles for the review. However, the study does not state any
significant limitation in the research.

The authors Sudhanshu, Sharma, Vadiraja, Rana, & Singhal (2017) have stated the significance
of yoga in combating several psychological and physiological complications in individuals. The
authors have observed that stress is a significant factor for causing periodontal diseases which
needs to be mitigated in order to prevent and manage such diseases. The authors have conducted
a quantitative study by collecting data from a sample of outpatient who were then divided into
two groups for the statistical tests. The empirical results that are obtained assured that the
hypothesis assumed by the authors that stress can be reduced through yoga holds true. The
strength of the study is identified to be using the Cohen’s perceived stress questionnaire which
will be yielding appropriate results for the focus area of the research and then dividing the
samples collected for conducting the statistical tests. One group was considered as the Test
Group and the other as the Control Group for the statistical analysis. The limitation of the study
was the scope of the paper only limited to periodontal diseases and not considering other mental
and physical ailments.

Substance usage has always been considered harmful and has a long-term effect after quitting
which is known as relapsing effect. According to the authors Kuppili, Parmar,Gupta&
Balhara(2018), yoga can be helpful for mitigating the ill effects of substance use and the
replacing effect after quitting. It has been observed by the authors that the replacing effect is
predominant in almost 40% to 60% cases which causes stress and anxiety. Therefore, it was
inferred by the authors that yoga and other related therapies can be applied in the process of drug
disorder treatment which is a promising and effective intervention. The methodology used by the
authors is qualitative which have been administered with the help of a systematic literature
review for which about 314 studies have been retrieved and after applying the suitable inclusion
and exclusion criteria as 16 were selected for the review. There was a significant biasness
identified in the study pertaining to difference in thew study sample selected and the
considerably low sample size. The notable limitation of the study is that it fails to state the long-
term effects of yoga therapy for substance use and combating stress.

Stress is a common condition among college students due to the immense academic pressure
they face. This is why it has been opined by Tripathi, Kumari & Ganpat (2018), that yoga affects
the stress levels and moods in individual in a positive manner and improves it drastically. The
authors have observed that about 40% to 50% college students are inactive which can cause
stress in them. Therefore, it has been argued by them that practicing yoga will not only make
them active but also help in stress management. The methodology which is used in the study is a
review of several external works that was extensively analysed by the authors to understand the
usage of yoga in stress management in college students. The strength of the study is identified to
be the scope of the research which is strong as stress is very common in college students. Certain
suggestions have also been made in the paper regarding the yoga practices which can be
administered by college students. However, the most significant limitation of the study is the
absence of any data collection from college students via primary data collection methods.
Empirical evidences are also absent from the paper which does not make the research attempted
by the authors a strong work.

As per the views of Shohani et. al. (2018), modern lifestyle of individuals has increased the
levels of anxiety, depression and stress which needs to be managed properly through non-
invasive treatments to avoid heavy medication with strong side-effects. The authors have stated
the hypotheses that stress can be managed with the help of yoga which has long-term positive
effects on individuals. Furthermore, they have inferred practicing yoga can help to reduce drug
intake for physical and mental illness. The strength of the paper is that it has used the SPSS
version 20 to analyse the data collected from 52 women regarding the focus area of the study.
The primary data collection method used for the study was the questionnaire is DASS-21
(Depression Anxiety Stress Scale-21) which would help in collecting appropriate data for the
study. Cronbach Alpha was used to test the validity and reliability of the data collected from
primary sources. However, a significant limitation which was observed in the study is that the
study was confined to women only.

4.2 Literature Gap

The literature gap which is observed from the above analysis is that there is no mention of role of
yoga in stress management in adolescent population who also suffer from stress and anxiety due
to increasing performance pressure.
Aim-
The aim of the study is to understand the role of yoga in reducing stress. In order to narrow down
the area and have a better understanding of the implications, the study has selected Kochi as the
selected area for study.

Objective:
 To understand the implications of Yoga on mental health
 To understand the implications of Yoga on stress
 To gather 1st hand information from practitioner at Kochi to have a deeper understanding
of three implications

Methodology

Data collection approaches

The selection of method determines the success of a project. In order to understand the role of
Yoga in dealing with stress, a wide number of literatures have to be reviewed. However, this
would not be sufficient for the project and for bringing a definitive conclusion. Therefore, among
the three key types of data collection approaches, qualitative, quantitative and mixed approach.
Quantitative data is one among the most effective approach that is used for understanding the
perceptions of involved stakeholders by using such tools that results to numeric information
(Heale & Twycross, 2015). This method helps to initiate a boarder study which may not be done
by using other methods. For example by using survey methods, developing questionnaire with
close ended questions can be delivered to a large population like 50-10 or even more and since
the information would form a numeric result it would be easier to fetch conclusion. The process
is designed in such a way that it’s difficult to generalize the information generated through
quantitative result. This is also due to the fact that few variables are used in such research and
close ended questions are used. This process is also considered as a time effective as well as cost
effective process. This is due to the modern technological digital innovation that presents
multiple platforms, such as Survey Monkey which case easily provide a template for arranging
such research work and spreading it to the research population (Bentley, Daskalova & White,
2017). This platforms also helps to form the data charts and graphs based on the responses
therefore the research is required just to interpret the data either by using regression analysis or
in case of limited expertise, manually. However, this method also lacks the scope for
understanding thoughts and behaviors of the participants as results are based on numeric
information neither the participants are asked to detail the reason for their perceptions (Creswell
& Creswell, 2017). The participants are given limited choice to response as they are asked to
choose from the added options which may not be accurately their choice.

Qualitative data on the other hand gives a huge scope to describe the opinions of the participants.
This method refers to such process where descriptive and non numeric information is generated.
This method gives a high importance on “why” rather than “what” (Bengtsson, 2016). This
process also creates the possibilities for understanding new insights into the perceptions of the
targeted population. The participants are encouraged to say how they feel and what they feel in
certain areas. Therefore, this method is mostly about understanding behavioral changes and
human perceptions. However, there is a major limitation to the study that is the limitation of the
number of population that could be asked to be involved with the project. Since the process
involves understanding perceptions and every participant is encouraged to describe their
perceptions the process is time consuming and involving a lot of people is not feasible. Therefore
the outcome remains limited to the very little population involved.

In order to mitigate the issues of both of the two methods, the mix methodology is used. This
methodology combines the both, the numeric information collection process that is quantitative
data collection and the non numeric data collection process that is qualitative data collection.
The variables that are not used in quantitative data, are automatically incorporated in qualitative
data collection (Johnson & Christensen, 2019). There are some major limitations in qualitative
study as well which could be mitigated by using the alternative method that is qualitative.
Therefore, mixed method is considered as one of the most effective method for creative enriched
information. However, since the process is time consuming and requires a lot of efforts, this
method is mostly avoided in the case of small scale research.

Selection of the method

The main area of focus for this study is the usage of yoga in dealing with mental stress. The main
significance of the study is understanding the major benefits of yoga on people who have the
mental disorder. The population for research has to be a bit high to come to a definitive
conclusion. Therefore only quantitative method would be adopted for the study. 50 practitioners
of 1 to 2 yoga centers in Kochi in Kerala, the southern part of India would be asked to coordinate
for the study and take part in the interview process. The reason for selecting this place is that,
yoga is highly practiced in this part of the country. People who have faced the issue of and are
diagnosed with stress issues, and have been practicing yoga for 1 plus year would be asked for
participation.

Limitations
A few limitations are part of every research study as it is hardly possible to ensure that all aspects
of the topic or data can be addressed. Due to qualitative data, there is a small sample size that is
part of the research that is much smaller than what would have been adequate to represent this
research topic. Another major limitation of this study is that most respondents are from Kerala
and hence it is a very constricted sample size. Stress is a global health issue and preferably, a
more widespread geographical area selection would have been the best solution to understand
and interpret the impacts of yoga practice on stress. There is very little focus on the policies that
have been taken up by the Indian government to promote yoga for handling stress that has also
not been dealt with concentrated effort.
Another limitation of the research study is that the impact of yoga on an emotional well-being
level or at a physiological level to handle the stress associated with more aggravated mental
illnesses like Alzheimer's or schizophrenia have not been catered to. The concentration has been
more on the fight-or-flight mode induced stress conditions that yoga is known to alleviate.
Another limitation of this research is that only yoga-practicing respondents have been chosen
and hence there has been a lot of gaps that are associated with not having the feedback of the
people who do not practice yoga. Stress alleviation without yogic practice has not at all been
considered and that is the reason why whether with gradual passing of time stress alleviation
without yoga could not be evaluated.

Ethics
Ethical considerations are epitome when it comes to research studies. From the initial stage, an
effort is taken so that clarity, transparency, confidentiality are maintained (Laakso & Polonioli,
2018). There are consent forms that are involved were maintaining privacy and ensuring
anonymity are given tremendous importance. In any effective research, project effort is taken so
that data obtained are used with due permission and data storage has to be treated with all lawful
considerations that are prevalent in the land of the research study. In this research, all research
confidentiality related clauses that are associated with both India and the United Kingdom have
been adhered to. Approvals have been taken from all the said organisations that have been
involved in the research study. On approaching this research study there have been approvals and
permission taken on an individual and organisational basis in order to ensure that there is no
breach of the faith associated with the sharing of information. Ethical standards of storing and
usage of data are of utmost importance and all the decisions that are arrived at in the consent
form stage are adhered to. Another ethical aspect that has been concentrated upon is that all the
information that has been procured that are secondary data shall be given acknowledgment
without any risk of any plagiarised content. Tremendous focus on the confidentiality aspect of
the data and the participants’ identity privacy protection is given a lot of importance.
References

Alaguraja, M.K., Yoga, P., Rathinaraj, M.J., and Selvakumar, M.K., 2019. A study on yoga
intervention on maximal oxygen uptake among stress patients. Indian Journal of Applied
Research, 9(9).

Bengtsson, M. (2016). How to plan and perform a qualitative study using content
analysis. NursingPlus Open, 2, 8-14.

Bentley, F. R., Daskalova, N., & White, B. (2017, May). Comparing the reliability of Amazon
Mechanical Turk and Survey Monkey to traditional market research surveys.
In Proceedings of the 2017 CHI Conference Extended Abstracts on Human Factors in
Computing Systems (pp. 1092-1099).

Bistricky, S. L., Harper, K. L., Roberts, C. M., Cook, D. M., Schield, S. L., Bui, J., & Short, M.
B. (2018). Understanding and promoting stress management practices among college
students through an integrated health behavior model. American Journal of Health
Education, 49(1), 12-27.

ccryn.gov.in. 2020. [online] Available at: <http://ccryn.gov.in/sites/default/files/Yogafest.pdf>

[Accessed 3 August 2020].

Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed
methods approaches. Sage publications.

Devi, S., & Kala, S. (2015). Role of yoga-nidra and shirodhara on hypertensive
patients. International journal of yoga and allied sciences, 4(1), 22-27.

Dumbala, S., Bhargav, H., Satyanarayana, V., Arasappa, R., Varambally, S., Desai, G., &
Bangalore, G. N. (2020). Effect of yoga on psychological distress among women
receiving treatment for infertility. International Journal of Yoga, 13(2), 115.
Gonçalves, A. V., Makuch, M. Y., Setubal, M. S., Barros, N. F., & Bahamondes, L. (2016). A
qualitative study on the practice of yoga for women with pain-associated
endometriosis. The journal of alternative and complementary medicine, 22(12), 977-982.

Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence-
based nursing, 18(3), 66-67.

indiatoday.in 2020, Jacob, 2020. Kerala's Kunnamthanam Yoga Model To Be Adopted By 500

Indian Villages. [online] India Today. Available at:
<https://www.indiatoday.in/india/kerala/story/kunnamthanam-s-temples-churches-and-
ngos-work-for-complete-yoga-village-title-1193419-2018-03-20> [Accessed 3 August
2020].

Johnson, R. B., & Christensen, L. (2019). Educational research: Quantitative, qualitative, and

mixed approaches. SAGE Publications, Incorporated.

Kuppili, P. P., Parmar, A., Gupta, A., & Balhara, Y. P. S. (2018). Role of yoga in management of
substance-use disorders: A narrative review. Journal of neurosciences in rural
practice, 9(1), 117.

Laakso, M., & Polonioli, A. (2018). Open access in ethics research: an analysis of open access
availability and author self-archiving behaviour in light of journal copyright
restrictions. Scientometrics, 116(1), 291-317.

Lin, S. L., Huang, C. Y., Shiu, S. P., & Yeh, S. H. (2015). Effects of yoga on stress, stress
adaption, and heart rate variability among mental health professionals—A randomized
controlled trial. Worldviews on Evidence‐Based Nursing, 12(4), 236-245.

Martin, L., Oepen, R., Bauer, K., Nottensteiner, A., Mergheim, K., Gruber, H., & Koch, S. C.
(2018). Creative arts interventions for stress management and prevention—a systematic
review. Behavioral Sciences, 8(2), 28.

Nalgirkar, S. P., Vinchurkar, S. A., Saoji, A. A., & Mohanty, S. (2018). Yoga as a therapeutic
intervention in the management of dysfunctional uterine bleeding: a controlled pilot
study. Journal of mid-life health, 9(1), 8.
Perciavalle, V., Blandini, M., Fecarotta, P., Buscemi, A., Di Corrado, D., Bertolo, L., ... & Coco,
M. (2017). The role of deep breathing on stress. Neurological Sciences, 38(3), 451-458.

Riley, K. E., & Park, C. L. (2015). How does yoga reduce stress? A systematic review of
mechanisms of change and guide to future inquiry. Health psychology review, 9(3), 379-
396.

Rogers, K. A., & MacDonald, M. (2015). Therapeutic yoga: symptom management for multiple
sclerosis. The Journal of Alternative and Complementary Medicine, 21(11), 655-659.

Shamekhi, A., Bickmore, T., Lestoquoy, A., & Gardiner, P. (2017, April). Augmenting group
medical visits with conversational agents for stress management behavior change.
In International Conference on Persuasive Technology (pp. 55-67). Springer, Cham.

Shohani, M., Badfar, G., Nasirkandy, M. P., Kaikhavani, S., Rahmati, S., Modmeli, Y., ... &
Azami, M. (2018). The effect of yoga on stress, anxiety, and depression in
women. International journal of preventive medicine, 9.

Singh, U.P., 2018. Psychophysiological Effects of Yoga for Adults With Occupational Stress:
Yoga in the Workplace. In Research-Based Perspectives on the Psychophysiology of
Yoga (pp. 359-382). IGI Global.

Stephens, I., 2017. Medical yoga therapy. Children, 4(2), p.12.

Sudhanshu, A., Sharma, U., Vadiraja, H. S., Rana, R. K., & Singhal, R. (2017). Impact of yoga
on periodontal disease and stress management. International journal of yoga, 10(3), 121.

Tanwer, S., 2018. Yoga and stress management. Asian Journal of Multidimensional Research
(AJMR), 7(9), pp.345-348.

Tetrick, L. E., & Winslow, C. J. (2015). Workplace stress management interventions and health
promotion. Annu. Rev. Organ. Psychol. Organ. Behav., 2(1), 583-603.

timesofindia.indiatimes.com 2020, News, C. and News, K., 2020. International Yoga Day

Special: Foreigners At Home In Kerala With Yoga | Kochi News - Times Of India.
[online] The Times of India. Available at:
 <https://timesofindia.indiatimes.com/city/kochi/international-yoga-day-special-
foreigners-at-home-in-kerala-with-yoga/articleshow/69886413.cms> [Accessed 3 August
2020].

Tripathi, M. N., Kumari, S., & Ganpat, T. S. (2018). Psychophysiological effects of yoga on
stress in college students. Journal of education and health promotion, 7.

Vaghela, N., Mishra, D., Mehta, J. N., Punjabi, H., Patel, H., & Sanchala, I. (2019). Awareness
and practice of aerobic exercise and yoga among hypertensive patients in Anand
city. Journal of education and health promotion, 8.

Wimberly, A. S., Engstrom, M., Layde, M., & McKay, J. R. (2018). A randomized trial of yoga
for stress and substance use among people living with HIV in reentry. Journal of
substance abuse treatment, 94, 97-104.
Appendices
Appendix 1: Search Strategy

Search strategy
What databases did you look at and why?

Several medical databases were searched for retrieving suitable articles and journals for this
research proposal. The most suitable medical database portal is Entrez which is considered
as a biological research community and contains clinical papers regarding various domains
of medical science. Another significant database which was searched is National Centre for
Biotechnology Information (NCBI). This database provides highly relevant journals and
articles which is suitable for the research area. Google Scholar was also searched for
retrieving suitable articles for the review which was constructed by the researcher. In this
database, a huge number of academic journals and articles are freely available for use
which makes it convenient to retrieve articles.

What date parameters did you use and why?

Since medical science is a dynamic area and keeps changing continuously, therefore, the
date parameters which are used for the search strategy is 2015 to 2020. It was considered
appropriate because the data and inferences would be recent which will help the researcher
to analyse the areas which are of significant importance. Further, any article which is
beyond t2015 is being considered as irrelevant to the study undertaken.

The key terms used – and why?

The key terms that are used in this study are “yoga”, “yoga for stress relieve”, “stress
relieve”, “role of yoga”, “stress management”. These key terms were used to search the
relevant articles because they are related to the topic of research that is undertaken.

What was the number of articles you retrieved for the literature review?
18 articles

What inclusion and exclusion criteria did you use to reduce the number of papers and why?
The inclusion criteria which were considered for retrieving the articles are the date
parameters of 2015 to 2020. Then the researcher searched for the usage of the type of
methodology that was used in conducting the research by the researcher. If the
methodology was strong then it was considered to be included in the research. Also, those
papers which was written after considering a large sample size were included because a
large sample helps to eliminate significant statistical errors. The exclusion criteria which
was applied to retrieve the articles is the scope of the paper. If the scope was not relevant to
the focus area of the research, then it was excluded from consideration. Further, another
exclusion which was applied was the small sample size of less than 10 being used in the
methodologies of the paper.

How did you reduce the number of papers after applying inclusion/exclusion criteria?
As per the relevance and scope of the research undertaken by the author.

What was your final number of papers?

5 articles

Complete the table:

Key terms Database used Database used Database used Total articles
NCBI ENTREZ Google
Scholar
“yoga”, “yoga Retrieved= 10 Retrieved= 5 Retrieved= 10 18
for stress Included= 7
Included= 3 Included= 8
relieve”, Excluded= 3
“stress Excluded= 2 Excluded= 2
relieve”, “role
of yoga”,
“stress
management”
Appendix 2: Article 1

Data extraction table qualitative

Full reference of article:Riley, K. E., & Park, C. L. (2015). How does yoga reduce stress? A
systematic review of mechanisms of change and guide to future inquiry. Health psychology
review, 9(3), 379-396.

Category Summary points

General questions
What country was the study N/A
conducted in?
Sample / population
How many people were 926 articles
approached to take part?

How many took part. 71 articles selected

How many people dropped out? 855 articles

Why did people not take part? Not appropriate to the research
How were the participants The articles were selected as per their relevance
recruited?
Was there a gate keeper? Were
they recruited through a clinic
Characteristics of participants? N/A
E.g. Sex, age ethnicity
Who was excluded from the Articles which were not relevant to the area of focus
study?
Data collection
What setting was the data GP laboratory
collected?
For example, was it in a GP
practice or was it at the
participant’s home?
What research tools were used A systematic literature review
collect the data?
E.g. - semi structured interview,
focus groups
How were the interview N/A
questions / topic areas or
observation schedule devised?
Was the interview/question topic N/A
areas or observation schedule
piloted?
Analysis
How was the data analysed? A systematic literature review was conducted by the
What framework? authors for the study.
PRISMA guidelines applied
Results
What were the main findings? The authors have also inferred that practicing yoga helps in
e.g. that themes or key points were increasing the mindfulness in individuals which helps in
found combating stress and tension.
Rigour
Were trustworthiness and Yes
credibility reported? Details: By the reference of external articles
If so how were they achieved?
Ethical considerations
Was the study granted ethical Yes
approval Details: By relevant authorities
Did the researchers ensure N/A
informed consent or anonymity, or
confidentiality for participants?
Were there any ethics Ethical consideration was obtained from the relevant
implications? authorities.
Discussion
Did the authors discuss the results Yes
taking into consideration the Details: A detailed reference list
findings of previous research on
the same topic?
Did the authors identify any Yes
strengths or limitations
Critique strengths and weaknesses The strength of the paper is following the Preferred
of the paper Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) guidelines for framing the review.
However, the study does not state any significant limitation
in the research.
Appendix 3: Article 2

Data extraction table quantitative

Full reference of article: Sudhanshu, A., Sharma, U., Vadiraja, H. S., Rana, R. K., & Singhal,
R. (2017). Impact of yoga on periodontal disease and stress management. International journal
of yoga, 10(3), 121.

Questions Summary points

What country was the study conducted India
in?
Sample / population
How many people were approached to 100
take part in the study?
How many actually took part in the 80
study?
How many people dropped out? 20
Why did people not take part? Incomplete information
Sample size and justification Yes
E.g. any power calculation Details: To eliminate error and outlier detection
How were the participants recruited? The participants who were suffering from periodontal
disease.
Characteristics of participants? Age: 15-45 years
Sex, age ethnicity Sex: Both male and female
Ethnicity: Indian
Who was excluded from the study? Samples not fulfilling the age criteria
Data collection
What setting was the data collected in? GP practice laboratory
For example, was it in a GP practice
laboratory?
What research tools were used collect Cohen’s perceived stress questionnaire
the data?
E.g. - the measures were used e.g.
Hospital Anxiety depression scale, a
structured survey
Did the measure have specificity, Yes
sensitivity, reliability/validity) Details: Specific and highly sensitive
If the researchers made their own No
questionnaire or survey did, they pilot
it?
Who completed the The subjects approached
measures/questionnaire?
When / were the Pre-intervention
measures/questionnaire administrated?
For example, Pre intervention post
intervention
Length of follow up if any? No

Analysis
How were data analysed? Cross-sectional analysis using statistics
What statistical tests were used? Regression Analysis

Results
What were the main findings? The empirical results that are obtained assured that the
hypothesis assumed by the authors that stress can be
reduced through yoga holds true.
Rigour
Validity and reliability Yes
Were they reported, how were they The results were achieved after performing a survey
achieved? and testing the data obtained using statistical tests.
How did the researchers ensure rigour? By applying regression analysis.
Ethical considerations
Was the study granted ethical approval Yes
Details: By relevant authorities
Did the researchers ensure informed Yes
consent or anonymity, or confidentiality Details: By researchers
for participants?
Were there any ethics implications? Yes
Details: Confidentiality assured and consent obtained
Discussion
Did the authors discuss the results Yes
taking into consideration the findings of Details: A detailed reference list
previous research on the same topic?
Did the authors identify any strengths No
or limitations
Critique of the paper
Strengths of the paper The strength of the study is identified to be using the
Cohen’s perceived stress questionnaire which will be
yielding appropriate results for the focus area of the
research and then dividing the samples collected for
conducting the statistical tests.
Weaknesses of the paper The limitation of the study was the scope of the paper
only limited to periodontal diseases and not
considering other mental and physical ailments.
Appendix 4: Article 3

Data extraction table qualitative

Full reference of article:Kuppili, P. P., Parmar, A., Gupta, A., & Balhara, Y. P. S. (2018). Role
of yoga in management of substance-use disorders: A narrative review. Journal of neurosciences
in rural practice, 9(1), 117.

Category Summary points

General questions
What country was the study India
conducted in?
Sample / population
How many people were 314 articles
approached to take part?

How many took part. 16 articles selected

How many people dropped out? 298 articles

Why did people not take part? Not appropriate to the research
How were the participants The articles were selected as per their relevance and peer
recruited? reviewed articles were preferred with emphasis on female
Was there a gate keeper? Were sample collection.
they recruited through a clinic
Characteristics of participants? N/A
E.g. Sex, age ethnicity
Who was excluded from the Articles which were not relevant to the area of focus
study?
Data collection
What setting was the data GP laboratory
collected?
For example, was it in a GP
practice or was it at the
participant’s home?
What research tools were used A systematic literature review
collect the data?
E.g. - semi structured interview,
focus groups
How were the interview N/A
questions / topic areas or
observation schedule devised?
Was the interview/question topic N/A
areas or observation schedule
piloted?
Analysis
How was the data analysed? A systematic literature review was conducted by the
What framework? authors for the study.
Results
What were the main findings? It was inferred by the authors that yoga and other related
e.g. that themes or key points were therapies can be applied in the process of drug disorder
found treatment which is a promising and effective intervention.
Rigour
Were trustworthiness and Yes
credibility reported? Details: By the reference of external articles
If so how were they achieved?
Ethical considerations
Was the study granted ethical Yes
approval Details: By relevant authorities
Did the researchers ensure N/A
informed consent or anonymity, or
confidentiality for participants?
Were there any ethics Ethical consideration was obtained from the relevant
implications? authorities and plagiarism was avoided.
Discussion
Did the authors discuss the results Yes
taking into consideration the Details: A detailed reference list
findings of previous research on
the same topic?
Did the authors identify any Yes
strengths or limitations
Critique strengths and weaknesses There was a significant biasness identified in the study
of the paper pertaining to difference in thew study sample selected and
the considerably low sample size. The notable limitation of
the study is that it fails to state the long-term effects of
yoga therapy for substance use and combating stress.
Appendix 5: Article 4

Data extraction table qualitative

Full reference of article:Tripathi, M. N., Kumari, S., & Ganpat, T. S. (2018).
Psychophysiological effects of yoga on stress in college students. Journal of education and
health promotion, 7.

Category Summary points

General questions
What country was the study India
conducted in?
Sample / population
How many people were 246 articles
approached to take part?

How many took part. 17 articles selected

How many people dropped out? 229 articles

Why did people not take part? Not appropriate to the research
How were the participants Peer reviewed articles were preferred
recruited?
Was there a gate keeper? Were
they recruited through a clinic
Characteristics of participants? N/A
E.g. Sex, age ethnicity
Who was excluded from the Articles which were not relevant to the research.
study?
Data collection
What setting was the data GP laboratory
collected?
For example, was it in a GP
practice or was it at the
participant’s home?
What research tools were used A systematic literature review
collect the data?
E.g. - semi structured interview,
focus groups
How were the interview N/A
questions / topic areas or
observation schedule devised?
Was the interview/question topic N/A
areas or observation schedule
piloted?
Analysis
How was the data analysed? Extensive analysis of external related works through a
What framework? systematic literature review.
Results
What were the main findings? The authors have observed that about 40% to 50% college
e.g. that themes or key points were students are inactive which can cause stress in them.
found Therefore, it has been argued by them that practicing yoga
will not only make them active but also help in stress
management.
Rigour
Were trustworthiness and Yes
credibility reported? Details: By the reference of external articles
If so how were they achieved?
Ethical considerations
Was the study granted ethical Yes
approval Details: By relevant authorities
Did the researchers ensure N/A
informed consent or anonymity, or
confidentiality for participants?
Were there any ethics Ethical consideration was obtained from the relevant
implications? authorities and plagiarism was avoided.
Discussion
Did the authors discuss the results Yes
taking into consideration the Details: A detailed reference list
findings of previous research on
the same topic?
Did the authors identify any Yes
strengths or limitations
Critique strengths and weaknesses The strength of the study is identified to be the scope of the
of the paper research which is strong as stress is very common in
college students. Certain suggestions have also been made
in the paper regarding the yoga practices which can be
administered by college students. However, the most
significant limitation of the study is the absence of any data
collection from college students via primary data collection
methods. Empirical evidences are also absent from the
paper which does not make the research attempted by the
authors a strong work.
Appendix 6: Article 5

Data extraction table quantitative

Full reference of article: Shohani, M., Badfar, G., Nasirkandy, M. P., Kaikhavani, S., Rahmati,
S., Modmeli, Y., ... & Azami, M. (2018). The effect of yoga on stress, anxiety, and depression in
women. International journal of preventive medicine, 9.

Questions Summary points

What country was the study conducted Nepal
in?
Sample / population
How many people were approached to 60
take part in the study?
How many actually took part in the 52
study?
How many people dropped out? 8
Why did people not take part? Incomplete information
Sample size and justification Yes
E.g. any power calculation Details: To eliminate error
How were the participants recruited? Only women participants

Characteristics of participants? Age: Above 30 years

Sex, age ethnicity Sex: Female
Ethnicity: Nepali
Who was excluded from the study? Men were excluded
Data collection
What setting was the data collected in? GP practice laboratory
For example, was it in a GP practice
laboratory?
What research tools were used collect The questionnaire is DASS-21 (Depression Anxiety
the data? Stress Scale-21)
E.g. - the measures were used e.g.
Hospital Anxiety depression scale, a
structured survey
Did the measure have specificity, Yes
sensitivity, reliability/validity) Details: Cronbach Alpha was used to test the validity
and reliability of the data collected from primary
sources.
If the researchers made their own No
questionnaire or survey did, they pilot
it?
Who completed the The subjects approached
measures/questionnaire?
When / were the Pre-intervention
measures/questionnaire administrated?
For example, Pre intervention post
intervention
Length of follow up if any? No

Analysis
How were data analysed? Statistical Tests through SPSS version 20
What statistical tests were used? Regression Analysis

Results
What were the main findings? The authors have stated the hypotheses that stress can
be managed with the help of yoga which has long-
term positive effects on individuals. Furthermore, they
have inferred practicing yoga can help to reduce drug
intake for physical and mental illness.
Rigour
Validity and reliability Yes
Were they reported, how were they The results were achieved after performing a survey
achieved? and testing the data obtained using statistical tests.
How did the researchers ensure rigour? By applying regression analysis.
Ethical considerations
Was the study granted ethical approval Yes
Details: By relevant authorities of Ilam University
Did the researchers ensure informed Yes
consent or anonymity, or confidentiality Details: By researchers
for participants?
Were there any ethics implications? Yes
Details: Confidentiality assured and consent obtained
Discussion
Did the authors discuss the results Yes
taking into consideration the findings of Details: A detailed reference list
previous research on the same topic?
Did the authors identify any strengths No
or limitations
Critique of the paper
Strengths of the paper The strength of the paper is that it has used the SPSS
version 20 to analyse the data collected from 52
women regarding the focus area of the study.
Weaknesses of the paper However, a significant limitation which was observed
in the study is that the study was confined to women
only.