Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 47  |  Issue : 1  |  Page : 22-29

Efficacy of a 4-week yogic lifestyle education for promoting holistic health in Indian school adolescents


Department of Psychology, Mahatma Gandhi Antarrashtriya Hindi Viswavidyalaya, Wardha, Maharashtra, India

Date of Web Publication9-Dec-2016

Correspondence Address:
Arun Pratap Singh
Department of Psychology, Mahatma Gandhi Antarrashtriya Hindi Viswavidyalaya, Wardha - 442 005, Maharashtra
India
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DOI: 10.4103/0044-0507.195455

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  Abstract 

Context: Need for yogic lifestyle education in schools is being recognized eloquently. However, effectiveness of yogic lifestyle for enhancing adolescent health in schools remains partially or minimally attempted.
Aims: To examine the relevance of yogic lifestyle education in improving holistic aspects of adolescent health in schools.
Method: A four week field experiment was conducted among a sample of 100 students enrolled in a residential school located in a semi-urban setting by using a 2 (control and intervention group) ×2 (male and female students) ×2 (pre and post-test) factorial design. Standardized self-report adolescent health questionnaires were used before and after yogic lifestyle education to assess its holistic effects.
Results: ANOVA was used to analyze efficacy of yogic lifestyle education in promoting different aspects of adolescent health. Results revealed that yogic lifestyle education group participants' responses displayed significantly greater enhancement on a variety of self-reported positive health outcomes and a reduction on different negative health outcomes than the control group participants.
Conclusions: Yogic lifestyle education programme has promising potential to not only reduce health problems but also enhance positive aspects of health in school going adolescents.

Keywords: Adolescents, dietary habits, self-reported health, sleep, yoga, lifestyle


How to cite this article:
Singh AP. Efficacy of a 4-week yogic lifestyle education for promoting holistic health in Indian school adolescents. Yoga Mimamsa 2015;47:22-9

How to cite this URL:
Singh AP. Efficacy of a 4-week yogic lifestyle education for promoting holistic health in Indian school adolescents. Yoga Mimamsa [serial online] 2015 [cited 2019 Jun 17];47:22-9. Available from: http://www.ym-kdham.in/text.asp?2015/47/1/22/195455


  Introduction Top


In the last few decades, younger segments of Indian population is increasingly becoming vulnerable to multiple lifestyle problems. Adolescent lives are being jeopardized not only by increase in fast-food consumption, sedentary leisure, irregular sleep, lack of physical activity, unhealthy daily routine habits but also by reduction in intake of fruits and vegetables (Braithwaite et al., 2014; Singh & Misra, 2012; Sunitha & Gururaj, 2014). A majority of causes of adolescent morbidity and mortality are either moderated or mediated by such alterations in adolescent lifestyle (Thirlaway & Upton, 2009). The experience of stress and aggressive behavior are directly linked with intake of fast foods (Pereira et al., 2005). Obesity is increasingly becoming prevalent in younger generations (Sunitha & Gururaj, 2014). A number of adjustment disorders, relational problems, anxiety, and mood disorders appear to be related with irregular sleep and unnatural daily routine (Bailly, Bailley-Lambin, Querleu, Beauscart, & Collinet, 2004).

Prompted by such a scenario, many countries have updated their policies to accommodate lifestyle issues and concerns in health education (Planning Commission, 2002; U.S. Department of Health and Human Services, 1998). The idea of promoting health and wellness in schools through incorporation of positive living in modern notions of health and well-being has gained momentum (Walsh, 2011). In the last few decades, a relatively new branch of psychology, positive psychology, devoted for exploring strategies for enhancing happiness in human beings, has begun to realize the positive role of particular types of dietary patterns and yogic practices in maintaining and promoting happiness (Carr, 2007). Emerging knowledge on health promotive value of many religious practices (i.e., recitation of religious scriptures, prayer, chanting mantras, visiting religious places, etc.) do indicate rich possibilities for their utility in improving several health-related outcomes (Anjana & Raju, 2002; Ghaligi, Nagendra, & Bhatt, 2006).

In the backdrop of the scenario mentioned above, persuading adolescents to adopt yogic lifestyle in their lives is a huge challenge for us. Due to plasticity as a key characteristic, adolescence is a more suitable developmental period to inculcate healthy living choices than later periods of life (Newton, 1995). Previous studies show that the longer an individual waits before engaging in promotive behaviours, the less likely, he/she is to begin or more likely, he/she is to quit if he/she does begin (Donovan, Jessor, & Jessor, 1983). Therefore, the need for special attention to ensure promotion of school adolescent health and well-being through culturally sensitive and contextualized lifestyle education has been warranted by scholars across the world (Call, Reidel, Hein, Vonnie, & Kipke, 2002; Thirlaway & Upton, 2009). Many agencies have emphasized cost-effectiveness, preventive, and heath promotive value of such interventions in school setting. However, contrastingly most of the school-based health education programs have been constrained to reduction of a cluster of risk behaviors (i.e., reproductive, drug abuse, etc.) while not paying attention to adverse alterations ensuing in dietary habits, daily routine, and sleep. In addition, despite immense possibilities of relevance of yogic lifestyle, most of the studies on effectiveness of yoga to promote adolescent health and well-being appear decontextualized and limited to explore efficacy of only three basic techniques-“Hathayoga, vipassana, and meditation (Cornelissen, Misra, & Varma, 2011).

Yogic lifestyle education, an alternative approach to impart healthy lifestyle, is comparably more cost-effective and holistic in effects than mainstream health care services and practices. By helping our adolescents to imbibe healthy lifestyle habits earlier, we can not only enhance health and well-being but also address multiple individual and societal concerns (i.e., aggression, violence, sexual crime, etc.) concomitantly and prevent onset of lifestyle diseases (diabetes, CVDs, stroke, cancer, etc.) later during adulthood; but implementation of yoga in modern times has been rather confined to some postures, breathing practices, and relaxation, which only treat addiction related disorders, improve sleep quality, manage stress, reduce depression, improve anxiety and symptoms of cancer, diabetes, CVDs, and many other chronic and acute diseases in younger and elder generation (Woodyard, 2011). If we analyze long-held Indian notion of yoga, then we notice that yoga has been practiced and preached by Indian seers as a way of living. Several experiential accounts of yoga practitioners demonstrate that only by holistic changes in diet, sleep, and daily routine we can alleviate multiple physical, emotional, and social sufferings and promote positive psychophysical attributes (Ram, 1987; Ramdeo, 2006). With this scenario, the present work was oriented and designed accordingly. It was expected that positive lifestyle changes propelled through Yogic Lifestyle Education Programme would promote comprehensive aspects of health and well-being in adolescents.

Aims

The objective of this study was to investigate impact of positive changes in diet, sleep, religiosity, postures, deep breathing practices, and relaxation according to yogic recommendations on reduction of illness, depression, anxiety, insomnia, negative body image, and alienation, and promoting digestive capacity, self-esteem, goal clarity, adjustment, and empathy.


  Method Top


Participants

Due to the specific requirements of the study (i.e., individualized monitoring of lifestyle, facilities for conducting intervention, support of teaching staff), a sample of 100 students in campus at a residential school situated in a semi-urban setting were recruited. Their age ranged between 12 and 18 years (Mintervention = 14.5 years; SD = 1.89; Mcontrol = 14.4 years; SD = 1.89). None of the participants revealed signs of any chronic disease or physical disability.

Design

The study protocol was approved by the Departmental Research Committee at the University of Delhi prior to participant recruitment. The conduct of study involved 2 × 2 × 2 factorial design. It constituted two levels of type of group (Control and Intervention), gender (Boys and Girls), and testing occasions (Pretest and Posttest). Yogic Lifestyle Education Programme (YLSEP) was conducted according to following design displayed in [Figure 1].
Figure 1: Design of yogic life style education programme

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Measures

Adolescent Health Questionnaire (AHQ): It consists of 61 items measuring 12 components related to the following domains: Body illness, insomnia, digestive capacity, physical fitness, body image, self-esteem, depression, anxiety, goal clarity, adjustment, empathy, and alienation. The items for evaluating illness were adapted from the Post Graduate Institute Health Questionnaire (Wig & Verma, 1978). These included common physical complaints such as headache, allergy, constipation, diarrhea, absence in school due to illness and limitations in performing daily routine activities. The insomnia subscale was related to difficulty in sleeping. The items related to digestive capacity dealt with the intensity of hunger and appetite. The fitness measured physical stamina, lack of fatigue, and freshness after sleep. The items related to negative body image were adapted from the Body Image Avoidant Questionnaire (Riva & Molinari, 1998). It has items related to concerns for appearance and addictiveness for beauty products. The self-esteem items dealt with self-confidence and enthusiasm in life. The anxiety related items referred to the feelings of embarrassment, irritation, and lack of concentration. The depression related items dealt with loneliness, guilt, and shame. Clarity of life goal was assessed by asking about the extent of identification of ones' life goal. The adjustment related items dealt with familial relationships. The empathy component dealt with ability for identifying others concerns and developing trust in the relationships. Alienation was measured with the help of anxiety scale of MMPI. It dealt with cohesiveness with social group and ability to share own feelings and thoughts.

The respondents were asked to report their functioning and concerns in different areas of self-perceived health by rating every item on a 5-point scale varying from “never,” “rarely,” “sometimes,” “usually,” to “always” based on their experiences. The items of illness, insomnia, negative body image, depression, anxiety, and alienation were negatively scored so as to denote reduction in these measures. The items related to digestion, fitness, self-esteem, clarity of life goal, empathy, and adjustment were scored positively. The internal consistency of the scale was found to be satisfactory computed by Cronbach alpha = 0.89 (N = 100).

Lifestyle Change Inventory: It assessed the compliance for multiple components of YLSEP after three months of the conduct of intervention programme. By using this inventory, respondents were asked to report their adherence regarding persistence in particular lifestyle changes on 7- point scale during usual week.

Procedure

In order to properly assess impact of yogic lifestyle education and persuade adolescents to adopt changes in their lives, first of all, strategies for supporting, incentivizing, and underlying processes and method of delivery of intervention in different phases of YLSEP were properly understood as demonstrated in [Table 1]. For this purpose, insights from research literature were looked for and advice of experts was taken.
Table 1: Details of strategies, activities, processes and goals during the different stages of YLSEP

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Later on, actual study was conducted in three phases. In Phase I, the YLSEP procedures were tried out on a small sample of adolescents (n = 40) in a school. It helped in organizing the sequence and timing of activities included in YLSEP.

In phase II, the main study was conducted. After seeking the formal permission from school authorities, the researcher was introduced to the students during prayer session. This was followed by informal interaction with teachers and students of the school. After a few days of interaction, the students opened up and showed interest in the project. This was followed by classroom interactive discussions on the current trends of yogic lifestyle and their benefits. Later on, they were informed about the acceptance of yoga among celebrities, such as actors, models, players, and by the general public through powerpoint presentation. This was supplemented by a short film on yoga. After this general introduction, the adolescents were asked to indicate their willingness to join the YLSEP.

Those volunteering adolescents who were not participating in any other positive lifestyle activities for last three months and were found fit for participation in yogic activities through a cursory screening procedure by a government registered health care provider were recruited for the study. The intervention group consisted of 50 adolescents (25 boys & 25 girls). A control group matched on age, sex, and grade was also formed (N = 50).

The measures were completed by the adolescents to obtain baseline assessment. The participants were given a self-compliance diary, in which they noted their daily engagements in various activities. The measures of health and well-being were again completed by the participants after the intervention. The compliance for different components of YLSEP was assessed through personal monitoring and attendance in yoga training programme. [Table 2] presents the specific components of YLSEP and mode of checking compliance.
Table 2: Components of YLSEP and mode of ensuring compliance

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YLSEP sessions were run six days in a week over a 2-week period in a hall in the school premises. One session of YLSEP lasted for about one hour. The details of the contents of yoga programme are specifically shown in [Table 3]. The YLSEP was introduced to adolescents through a theoretically guided programme as detailed in [Table 1]. YLSEP group was exposed to yogic lifestyle changes but control group participants were engaged in a dialogue for the same duration. During Phase III, the follow-up was done after three months of the conduct of YLSEP. It (N = 46) involved administration of a checklist of lifestyle change inventory. In addition, five participants were interviewed to explore their in-depth experiences after three months of exposure to YLSEP.
Table 3: Components of yoga training programme

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  Results Top


The data were analyzed by using Statistical Package for the Social Sciences Windows Version 16.0. Chicago, SPSS Inc. to test the efficacy of Yogic Life Style Education Programme in promoting 13 outcome variables of self-reported health, signed change scores (post-test minus baseline) were generated. Further, to examine statistical significance of the effectiveness of YLSEP in promoting different domains of self-perceived health, mean scores for each outcome variable were subjected to separate 2 × 2 between group factorial ANOVA with two levels of type of group and two levels of testing occasions. For want of space, only the significant results are presented here, and complete details may be obtained from the author. [Table 4] displays that YLSEP participants reported more favorable changes in all outcome variables than the control group participants.
Table 4: Means and SDs of scores on the measures of health by type of group, gender and testing occasions

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It suggests that six negative aspects of health (i.e., illness, insomnia, negative body image, depression, anxiety, and alienation) were reduced and 10 positive outcomes of self-reported health (i.e., digestion, fitness, self-esteem, goal clarity, adjustment, and empathy) were promoted in the YLSEP group. Among control group participants, illness, insomnia, and alienation were increased among boys but reduced among girls, negative body image scores were reduced among control group boys and increased among girls, and depression was reduced among all the control group participants. The scores of digestion, fitness, self-esteem, and empathy were increased among control group boys but decreased among control group girls. The scores of goal clarity and adjustment were reduced among all the control group participants.

Subsequently, normality distributions of variables were checked. It was found that the distribution of scores of all outcome variables were normal, with skewness coefficients ranging from 0.48 to −0.78. After that, separate mixed 2 (type of group) × 2 (kind of gender) × 2 (testing occasions) ANOVA tests were conducted on mean scores of different outcomes. The 2 × 2 × 2 analysis partitioned variation due to differences between groups into each pair of independent variables as well as the main effects. All analysis were evaluated at alpha levels of p < 0.05, p < 0.01 and p < 0.001. [Table 5] displays main effects of the type of group, gender and testing occasions for different scales of self-reported health.
Table 5: Summaries of main effects of type of group, gender and testing occasions performed for measures of self-reported health (N=100)

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The ANOVA tests revealed that the intervention group displayed greater mean scores on the measures of self-esteem and empathy than the control group. In regards to gender disparity, it was noted that boys had higher level of illness than girls. The scores for illness, insomnia, negative body image, depression, anxiety, and alienation were significantly higher at the pretest than posttest. The scores for digestion, fitness, self-esteem, goal clarity, adjustment, and empathy were consistently greater at the posttest than pretest.

The results also indicated interactions which qualified relevant main effects. The type of group and testing occasions interaction effects displayed that illness (F(1,96)= 39.62, p < 0.001), insomnia (F(1,96)= 13.51, p < 0.001), fitness (F(1,96)= 9.99, p < 0.01), negative body image (F (1,96)= 25.77, p < 0.001), self-esteem (F(1,96)= 13.62, p < 0.001), anxiety (F(1,96)= 8.65, p < 0.01), goal clarity (F(1,96)= 25.73, p < 0.001), adjustment (F(1,96)= 13.6, p < 0.001), alienation (F(1,96)= 22.49, p < 0.001) and empathy (F(1,96)= 13.87, p < 0.001) were favorably improved more in YLSEP group than control group. It was also found that digestion (F(1,96)= 8.49, p < 0.01), fitness (F(1,96)= 5.02, p < 0.05) were considerably improved more among boys but negative body image (F(1,96)= 4.09, p < 0.05) was reduced more in girls.

Follow-up

Follow-up of the study was undertaken after a period of three months of conducting YLSEP. During this phase, the participants were asked to report the extent to which they were continuing to practice various components of YLSEP. A majority of participants reported continuance with the practice of yogic lifestyle practices (72.7% avoiding water during meals, 100% avoiding fast foods, 93.2% avoiding tea, 78.6% getting up before sunrise, 72.7% sleeping before 10 p.m., 72.7% doing yoga, and 91.9% reciting mantras) for at least once a week.


  Discussion Top


The purpose of the present study was to evaluate the efficacy of YLSEP in promoting the comprehensive set of self-reported outcomes of health among adolescents. The conduct of the study was based on theoretically-oriented and culturally-sensitive YLSEP in which one group was exposed to yogic lifestyle education and another group was engaged in a general dialogue for the same duration. Their scores on different outcomes of health before and after the intervention were analyzed using appropriate statistical techniques. The results suggest astounding effects of YLSEP favorably improving illness, insomnia, negative body image, anxiety, depression, alienation, digestion, physical fitness, self-esteem, clarity of life goal, adjustment, and empathy. The intervention also led to a moderate reduction in depression. The follow-up results indicated that the effect continued and persisted even after three months.

Reported efficacy of YLSEP for promoting self-reported health in adolescents is in line with the findings of previous studies (Aminabhavi, 1996; Abadi, Madgaonkar, & Venkatesam, 2008; Khumar, Kaur, & Kaur, 1993; Palsane, 1998; Priyadarshini, 2001). Previous researches validated the effect of isolated components of lifestyle on particular health-related outcomes. However, the present study extended previous ones by showing usefulness of yogic lifestyle holistically. It has produced evidences to lay notions of health as a “reserve stock,” to be invested in by adopting healthy behaviour or diminished by self-neglect or unhealthy behaviours, and sociological proposition that wellness can be increased by improving lifestyle (Herzlich, 1973). It has affirmed the positivistic view of individuals as having the resources to solve their own problems in a practical and immediate manner and wellness as a way of life toward optimization of health at the physical, mental, and spiritual levels (Myers, Sweeney, & Witmer, 2002). It has also validated the potential role of yogic lifestyle components (i.e., diet, sleep, and religiosity) in improving several related measures of health, which were previously noted merely as correlates of wellness. In sync with some previous studies, the present study has also evinced and extended evidence for the potential impact of yogic lifestyle within a short period of few weeks (Mishra & Sinha, 2001; Rani & Rao, 2005).

There is a need to realize how such a holistic change could have taken place among the adolescents and what could have been the exact psychological procedures adopted for lifestyle changes. While the content of YLSEP was decided on the basis of relevance of particular yogic lifestyle components; methodological conduct of intervention was based on an eclectic and integrated module designed carefully to create awareness about the relevance of lifestyle for health and well-being, introduce positive changes, facilitate voluntary participation, and maintain inculcated changes subsequently. In view of success of a range of theoretical elements used in previous intervention studies, the present study utilized techniques of reinforcements, recognition by teachers, self-monitoring, peer support, and perceptions for positive value of lifestyle behaviors (Ajzen & Fishbein, 1980; Bandura, 1977). During design of effective intervention module, attention was paid to developmental and psychological aspects of adolescent lifestyle. In consonance with previous findings, a web of factors such as group participation, plasticity due to age of participants, self-monitoring perception of health needs could have made successful to the programme (Thirlaway & Upton, 2009).

Although, the effects of separate lifestyle practices and role of lifestyle in cure of disease were not examined in the present study, the study has provided an outstanding evidence for emergence of new field of yogic lifestyle counseling for curative, preventive and protective roles.

A group of four case studies provided deeper revelation about holistic contribution of positive lifestyle change. It was interesting to note that a participant conveyed about improvement in symptoms of a chronic disease, ulcer during introspective observation of video recording session. Although, currently yogic lifestyle interventions are limited to management of cardiovascular diseases and diabetes, this revelation is a marker for immense potential of yogic lifestyle in cure, prevention, protection from illnesses and also improving our wellness. However, the study had some limitations, and therefore, the results need to be interpreted with caution. The participation in the study was voluntary and those who were willing to join were recruited in the intervention group. Also, they apparently got special treatment in the school context. This might have raised their motivation for participation. Moreover, the data were self-reported, behavioural, and observational. Despite this limitation the study points toward the need for school-wide yogic lifestyle education for promoting health of adolescents.

It has demonstrated usefulness and feasibility of YLSEP in the lives of adolescents. It encourages for extension of such intervention on a broader scale with suitable modification as per the requirements of the specific settings. The involvement of peers and teachers in the programme worked as a source of motivation and support. Being a collectivistic culture, the impact of such intervention increases if the changes take place in a group context. However, a close scrutiny of the program revealed that its goals may be attained more effectively if attitudes of parents and teachers for yogic lifestyle are properly addressed. The study brought out that health is a personal as well as a social matter, and bringing out any change and sustaining the same would require yogic lifestyle changes with support from the social context in which adolescents live.


  Conclusion Top


Given the emphasis on alterations in current adolescent lifestyle, YLSEP has the potential to make a unique contribution to enhancement of self-reported health. This can be inculcated through including regular curriculum of yogic lifestyle education. The group-wise intervention seems to be more effective, particularly during adolescence because they are more prone to social influence, peer group pressure, and effects of role models. While the study has focused on school context, the issue of lifestyle requires the involvement of parents. Therefore, it would be pertinent to extend the scope of inquiry to include the parental perspectives on yogic lifestyle. There is need for proper understanding of religio-spiritual activities at home and its relationship with concomitant aspects of well-being. Piecemeal efforts may not prove very effective. Because adolescence is very critical for individual and societal development, the school curriculum needs to have some scope for promoting yogic lifestyle skills. Findings of this study may indeed provide some levers to school counselors, parents, teachers, and several others stakeholders to make informed decisions for promoting self-reported health among school adolescents. [32]

Acknowledgement

Present study has been possible due to enlightening support of Professor Girishwar Misra, Vice-Chancellor, Mahatma Gandhi Antarrashtriya Hindi Vishwavidyalaya, Wardha.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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