Efficacy of Yoga in Tobacco Cessation: A Systematic Review and Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported for the pooled OR; heterogeneity p = .07 (I² = 65%, τ² = 0.7127). Sensitivity analysis (excluding high-risk trials) reduced I² to 16%

• Effect Size: Pooled Odds Ratio (OR) = 1.50, suggesting a 50% higher odds of 7-day abstinence with yoga versus control; however, this did not reach statistical significance

• Primary Outcome: 7-day point prevalence abstinence (7PPA) at end of treatment, pooled from five RCTs

• Nnt Or Sensitivity: NNT cannot be reliably calculated given the non-significant pooled OR with a CI crossing 1.0 and substantial heterogeneity. Secondary outcomes (depression, anxiety, QoL, mood) showed improvements across studies but were not pooled quantitatively in the abstract.

• Confidence Interval: 95% CI: 0.60 to 3.73 — wide interval crossing the null, indicating imprecise and statistically non-significant effect

Clinical Application

Yoga is generally low-cost, low-risk, and widely accessible in community and clinical settings. Active styles (hatha, vinyasa, Iyengar) and pranayama are feasible adjuncts to existing cessation programs. However, standardised yoga protocols for tobacco cessation do not yet exist, and instructor training variability limits implementation fidelity. Adherence and dropout in yoga-based trials can be substantial. In Australia, tobacco cessation is supported by PBS-listed pharmacotherapies (varenicline, nicotine replacement therapy, bupropion) and the Quitline service. The RACGP's 'Supporting Smoking Cessation: A Guide for Health Professionals' (2021) does not currently endorse yoga as an evidence-based cessation strategy. Yoga is widely practised in Australia and is accessible through community centres, private studios, and increasingly via digital platforms. Given the non-significant pooled result and low certainty of evidence, yoga cannot be recommended as a standalone cessation intervention under current TGA or RACGP frameworks. However, it may be offered as a low-risk adjunct to standard care, particularly for patients with psychological comorbidities or those seeking complementary approaches. The growing South Asian diaspora in Australia may find culturally congruent yoga-based programs particularly acceptable. Future Australian RCTs incorporating biochemical verification and longer follow-up would strengthen the evidence base. Adult tobacco users (≥18 years) seeking cessation support, particularly those with comorbid psychological symptoms (depression, anxiety, stress) who may benefit from mind-body interventions as adjuncts to standard pharmacotherapy or behavioural counselling

Abstract

INTRODUCTION: Tobacco consumption is a global epidemic with a high relapse rate. A complementary method like yoga, recognized for addressing psychological and behavioral aspects of addiction, was evaluated in this systematic review and metaanlaysis. METHODS: The objective was to comprehensively summarize the current evidence and evaluate the efficacy of yoga in tobacco cessation. This review was registered with PROSPERO (CRD42025643806). A systematic search across four databases identified randomized controlled trials (RCTs) in English up to September 2024. Eligible studies included adults (≥18 years) using any form of tobacco excluding vaping, randomized to yoga as monotherapy or adjunct therapy. The primary outcome was 7-day point prevalence abstinence (7PPA), while the secondary outcomes included quality of life, depression, anxiety, and mood states. Two reviewers independently extracted data and assessed quality using the Cochrane Risk of Bias (RoB2) tool. A meta-analysis was conducted for outcomes assessed in at least two studies. RESULTS: Seven RCTs were included, with five suitable for meta-analysis. The pooled odds ratio for 7PPA at the end of treatment was 1.50 (95% confidence interval = 0.60 to 3.73), suggesting a positive but inconsistent effect. Considerable heterogeneity was observed (I2 = 65%, p = .07; τ2 = 0.7127), indicating substantial variability across studies. Heterogeneity (I2 = 65%) markedly reduced to 16% when high-risk trials were excluded in sensitivity analysis. Studies reported improvements in depression, anxiety, and quality of life. CONCLUSION: This review consolidates the best available evidence on the effects of yoga interventions for tobacco cessation, showcasing the promising potential of yoga in smoking cessation. IMPLICATIONS: Active yoga styles like hatha, vinyasa, and Iyengar improved 7PPA by reducing stress and depression, while pranayama reduced cravings and negative affect. Future research should explore yoga-based cessation programs in diverse settings, especially low- and middle-income countries, to address unique challenges. Standardizing methodologies across populations will enable a more comprehensive evaluation of yoga's role in tobacco cessation and its potential to enhance global public health outcomes.

References

1. 1.Singh, S., Dhanlika, D., Haldar, P., & Sharma, G. (2026). Efficacy of yoga in tobacco cessation: A systematic review and meta-analysis. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco. Advance online publication. https://doi.org/10.1093/ntr/ntaf236