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Altruism—benefiting fellow group members at a cost to oneself—and parochialism—hostility toward individuals not of one's own ethnic, racial, or other group—are common human behaviors. The intersection of the two—which we term “parochial altruism”—is puzzling from an evolutionary perspective because altruistic or parochial behavior reduces one's payoffs by comparison to what one would gain by eschewing these behaviors. But parochial altruism could have evolved if parochialism promoted intergroup hostilities and the combination of altruism and parochialism contributed to success in these conflicts. Our game-theoretic analysis and agent-based simulations show that under conditions likely to have been experienced by late Pleistocene and early Holocene humans, neither parochialism nor altruism would have been viable singly, but by promoting group conflict, they could have evolved jointly.

As a results of reviews of database for effects of complementary therapies for improvement of Quality of Life on cancer patients, there were 8 mind-body therapies, 2 manual based therapies, 17 biologic based therapies(3 vitamin or minerals, 6 health nutrient products, 8 herbs). There were relative much more proportional studies of mind-body therapies and manual based therapies for quality of life of cancer. It were reported much more positive results in cognitive behavioral therapy, meditation, art therapy, music therapy, yoga included to mind-body therapies also it were reported much more positive result in massage & acupressure included to manual based therapies. And then these findings can be considered to us clinical application of these therapies by additional studies. On the other hand, the amount of study for quality of life of cancer in biologic based therapies was relatively more smaller than mind-body therapies and the results were contrary to each other. The mistletoe, one of the biological therapeutic products, can be considered to relatively useful material as a results of this review and its seems like to have positive value for further study, materials such as honey, ginseng or heat-treated ginseng, AHCCR, selenium. The others of biologic based therapies were inconclusive due to relatively small amounts of studies or revealed negative conclusion or negative tendency by their studies. The high usual rate of complementary therapy in cancer patients in Korea is applying the screw to us study for complementary medicine and is producing needs of complementary closed co-works or cooperation between the citizens, the government, medical doctors for high quality study.

This quasi-experimental study attempted to show that nursing intervention using the DanJeon Breathing Exercise Program (DJBEP) improved the quality of life of recipients after kidney transplantation. DJBEP progressed in three steps. We prospectively included 29 outpatient volunteers: experimental group: n ϭ 15; control group: n ϭ 14. DJBEP derived from the Roy’s adaptation model decreased both the stress and the uncertainty of kidney transplantation recipients. It has also been shown to restore serum cholesterol and serum creatinine levels and enhance strength and flexibility. Simultaneously, self-esteem was enhanced, and eventually adaptation was promoted both physiologically and psychologically. The quality of life of kidney transplantation recipients was enhanced. DJBEP played an effective role as a nursing intervention to promote the quality of life of kidney transplant patients by increasing their physiological and psychological status.

BACKGROUND:Mindfulness-based cognitive therapy (MBCT) has been widely used to treat patients with depressive disorder to prevent relapse. The objective of this study was to examine the effectiveness of newly developed MBCT program as an adjuvant to pharmacotherapy in the treatment of patients with panic disorder or generalized anxiety disorder. METHODS: Forty-six patients with panic disorder or generalized anxiety disorder were assigned to either MBCT or an anxiety disorder education (ADE) program for a period of 8 weeks. The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Symptom Checklist-90-Revised (SCL-90-R) were used to assess the patients at 0 week and after the two programs had been running for 2, 4, and 8 weeks. RESULTS: The MBCT group demonstrated significantly more improvement than the ADE group according to all anxiety (HAM-A, p<0.01; BAI, p<0.01; anxiety subscale of SCL-90-R, p=0.01) and depression (HAM-D, p<0.01; BDI, p<0.01; depression subscale of SCL-90-R, p<0.01) scale scores. The obsessive-compulsive and phobic subscales of the SCL-90-R also showed significantly more improvement in the MBCT group. However, no significant improvement was observed in the MBCT group versus the ADE group in terms of the somatization, interpersonal sensitivity, paranoid ideation, or psychoticism subscale scores of the SCL-90-R. CONCLUSIONS: MBCT may be effective at relieving anxiety and depressive symptoms in patients with panic disorder or generalized anxiety disorder. However, well-designed, randomized controlled trials are needed.

Mindfulness-based cognitive therapy (MBCT) has been studied to treat patients with depressive or anxiety disorders. The aim of this study was to examine whether MBCT is effective as an adjunct to pharmacotherapy in the treatment of patients with panic disorder. Twenty-three patients with panic disorder were included in a MBCT program for a period of 8 weeks. The Hamilton Anxiety Rating Scale (HAM-A), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), and Panic Disorder Severity Scale (PDSS) were used to assess the patients during the MBCT program. Both HAM-A and PDSS scores were significantly decreased at the 2nd, 4th and 8th weeks compared to baseline in the patients with panic disorder (HAM-A, p<0.01; PDSS, p<0.01). Also, BAI, APPQ and ASI-R were improved significantly after MBCT program (BAI, p<0.01; APPQ, p<0.01; ASI-R, p<0.01). In addition, all subscale scores of ASI-R decreased significantly. MBCT could be effective as an adjunct to pharmacotherapy in patients with panic disorder. However, randomized controlled trials are needed.

Background: This study examined the feasibility, safety and efficacy of an 8-week Relaxation Response (RR)-based group. Methods: Twenty-two depressed Chinese American immigrants were recruited. Outcomes measures were response and remission rates, the Hamilton Rating Scale for Depression, Clinical Global Impressions Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and the Multidimensional Scale of Perceived Social Support Scale. Results: Participants (N = 22) were 82% female, mean age was 53 (±12). After intervention, completers (N = 15) showed a 40% response rate and a 27% remission rate, and statistically significant improvement in most outcome measures. Discussion: The RR-based group is feasible and safe in treating Chinese American immigrants with depression.

This study examined the effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. A nonequivalent, control group, pre-posttest design was used. A convenience sample of 41 nursing students were randomly assigned to experimental (n=21) and control groups (n=20). Stress was measured with the PWI-SF (5-point) developed by Chang. Anxiety was measured with Spieberger's state anxiety inventory. Depression was measured with the Beck depression inventory. The experimental group attended 90-min sessions for eight weeks. No intervention was administered to the control group. Nine participants were excluded from the analysis because they did not complete the study due to personal circumstances, resulting in 16 participants in each group for the final analysis. Results for the two groups showed (1) a significant difference in stress scores (F=6.145, p=0.020), (2) a significant difference in anxiety scores (F=6.985, p=0.013), and (3) no significant difference in depression scores (t=1.986, p=0.056). A stress coping program based on mindfulness meditation was an effective intervention for nursing students to decrease their stress and anxiety, and could be used to manage stress in student nurses. In the future, long-term studies should be pursued to standardize and detail the program, with particular emphasis on studies to confirm the effects of the program in patients with diseases, such as cancer.

This study examined the effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. A nonequivalent, control group, pre-posttest design was used. A convenience sample of 41 nursing students were randomly assigned to experimental (n=21) and control groups (n=20). Stress was measured with the PWI-SF (5-point) developed by Chang. Anxiety was measured with Spieberger's state anxiety inventory. Depression was measured with the Beck depression inventory. The experimental group attended 90-min sessions for eight weeks. No intervention was administered to the control group. Nine participants were excluded from the analysis because they did not complete the study due to personal circumstances, resulting in 16 participants in each group for the final analysis. Results for the two groups showed (1) a significant difference in stress scores (F=6.145, p=0.020), (2) a significant difference in anxiety scores (F=6.985, p=0.013), and (3) no significant difference in depression scores (t=1.986, p=0.056). A stress coping program based on mindfulness meditation was an effective intervention for nursing students to decrease their stress and anxiety, and could be used to manage stress in student nurses. In the future, long-term studies should be pursued to standardize and detail the program, with particular emphasis on studies to confirm the effects of the program in patients with diseases, such as cancer.

PurposeThe purpose of this study was to examine a Korean Mindfulness Based Stress Reduction (K-MBSR) program for middle aged women and to verify the program's effectiveness on stress, stress coping style, depression, anger and sleep. Methods Fifty-two women aged from 40 to 59 (26 in the experimental group and 26 in the control group) from G city participated in the study. Data were collected from February 13 to April 3, 2013. The experimental group received 8 sessions, scheduled once a week, with each session lasting two and a half hours. Outcome variables included stress, stress coping style, depression, anger, sleep and a physiological measure (EEG). Results There were significant decreases for stress (t=-2.14, p=.037), depression (t=-2.64, p=.011), state trait anger (t=-3.79, p<.001) in the experimental group compared to the control group. Conclusion The findings in this study indicate that the K-MBSR program is an effective program to decrease stress, depression, and state trait anger in middle aged women.

Purpose] Fragmentary studies on characteristics of respiratory muscles are being done to increase respiratory capacity by classifying exercises into voluntary respiratory exercise which relieves symptoms and prevents COPD and exercise using breathing exercise equipment. But this study found changes on respiratory pattern through changes on the activity pattern of agonist and synergist respiratory muscles and studied what effect they can have on body function improvement. [Subjects and Methods] Fifteen subjects in experimental group I that respiratory exercise of diaphragm and 15 subjects in experimental group II that feedback respiratory exercise were randomly selected among COPD patients to find the effective intervention method for COPD patients. And intervention program was conducted for 5 weeks, three times a week, once a day and 30 minutes a session. They were measured with BODE index using respiratory muscle activity, pulmonary function, the six-minute walking test, dyspnea criteria and BMI Then the results obtained were compared and analyzed. [Results] There was a significant difference in sternocleidomastoid muscle and scalene muscle and in 6-minute walk and BODE index for body function. Thus the group performing feedback respiratory had more effective results for mild COPD patients. [Conclusion] Therefore, the improvement was significant regarding the activity of respiratory muscles synergists when breathing before doing breathing exercise. Although, it is valuable to reduce too much mobilization of respiratory muscles synergists through the proper intervention it is necessary to study body function regarding improvement of respiratory function for patients with COPD.

PurposeThe present study was to examine the effect of a meditation-based exercise program on the motor and non-motor symptoms of Parkinson’s disease (PD). Methods Sixty three PD patients who were recruited from a university hospital were randomly assigned to the experimental group (n = 33) and to the control group (n = 30). Participants completed an 8-week Mindfulness Meditation-based Complex Exercise Program (MMBCEP) that included 6 sessions. Before and after the intervention, the Six-Minute Walk Test (6MWT), elastic band pull, chair stand test, and 2.45-meter walk test were administered for the motor symptoms and the Korean Version of Geriatric Depression Scale, The State-Trait Anxiety Inventory (STAI), the Korean-Montreal Cognitive Assessment, Parkinson’s Disease Sleep Scale (PDSS), Activities of Daily Living (ADL), and the Quality of Life of Patients with Parkinson's Disease (PDQL) were administered for non-motor symptoms. Results Significant improvements in the motor symptoms (i.e., muscle strength (lower and upper extremity), balance, and muscle endurance) and in the non-motor symptoms (i.e., anxiety, depression, cognitive functions, sleep disturbance, quality of life, and activities of daily living) were observed. Conclusions MMBCEP, a complex exercise program-based on mindfulness meditation, is associated with increased motor symptoms, decreased emotional disturbances (anxiety and depression) and sleep disturbance, and improved cognitive functions, quality of life, and activities of daily living. Future research should test the effects of MMBCEP with more representative PD patients.

PurposeThe present study was to examine the effect of a meditation-based exercise program on the motor and non-motor symptoms of Parkinson’s disease (PD). Methods Sixty three PD patients who were recruited from a university hospital were randomly assigned to the experimental group (n = 33) and to the control group (n = 30). Participants completed an 8-week Mindfulness Meditation-based Complex Exercise Program (MMBCEP) that included 6 sessions. Before and after the intervention, the Six-Minute Walk Test (6MWT), elastic band pull, chair stand test, and 2.45-meter walk test were administered for the motor symptoms and the Korean Version of Geriatric Depression Scale, The State-Trait Anxiety Inventory (STAI), the Korean-Montreal Cognitive Assessment, Parkinson’s Disease Sleep Scale (PDSS), Activities of Daily Living (ADL), and the Quality of Life of Patients with Parkinson's Disease (PDQL) were administered for non-motor symptoms. Results Significant improvements in the motor symptoms (i.e., muscle strength (lower and upper extremity), balance, and muscle endurance) and in the non-motor symptoms (i.e., anxiety, depression, cognitive functions, sleep disturbance, quality of life, and activities of daily living) were observed. Conclusions MMBCEP, a complex exercise program-based on mindfulness meditation, is associated with increased motor symptoms, decreased emotional disturbances (anxiety and depression) and sleep disturbance, and improved cognitive functions, quality of life, and activities of daily living. Future research should test the effects of MMBCEP with more representative PD patients.

PurposeAlthough the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for panic disorder (PD) has been studied previously, data on the predictors of treatment outcomes in MBCT for PD are scarce. Materials and Methods Eighty patients with PD were screened to analyze treatment outcomes such as MBCT completion, treatment response, and remission after undergoing MBCT for PD. Sociodemographic characteristics, comorbid personality disorders, and baseline medication doses were examined. The study administered the Panic Disorder Severity Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale and Anxiety Sensitivity Inventory-Revised to patients at baseline and at eight weeks. Results Sixty-five participants were enrolled in the present study. Comorbid personality disorder was significantly associated with MBCT non-completion. We found that anxiety sensitivity (AS) improvement after an eight week MBCT program was a statistically significant factor associated with treatment response. Using logistic regression analysis, AS improvement after MBCT showed significant association with PD remission after MBCT. Conclusion Comorbid personality disorders of participants could be a potential predictor of MBCT non-completion. Furthermore, AS improvement after MBCT may predict treatment response and remission after MBCT for PD. However, better designed studies with a larger number of patients are needed to confirm our findings.

ObjectiveIntolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder. Methods We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI). Results There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001). Conclusion IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.

Areas associated with the default mode network (DMN) are substantially similar to those associated with meditation practice. However, no studies on DMN connectivity during resting states have been conducted on meditation practitioners. It was hypothesized that meditators would show heightened functional connectivity in areas of cortical midline activity. Thirty-five meditation practitioners and 33 healthy controls without meditation experience were included in this study. All subjects received 4.68-min resting state functional scanning runs. The posterior cingulate cortex and medial prefrontal cortex were chosen as seed regions for the DMN map. Meditation practitioners demonstrated greater functional connectivity within the DMN in the medial prefrontal cortex area (x y z = 3 39 −21) than did controls. These results suggest that the long-term practice of meditation may be associated with functional changes in regions related to internalized attention even when meditation is not being practiced.

The purpose of this study was to examine the influence of a professional development (PD) program on teachers' implementation of the Teaching Personal and Social Responsibility (TPSR) model, and to identify the characteristics of PD that influence teaching practice. The participants were six elementary school teachers and 12 students, and the data were collected from interviews with the teachers and students, observations, and teachers' reflective journal entries. The findings revealed that PD enhanced the fidelity of implementation in terms of improving structural adherence, facilitating coherent instructional delivery, and making the students more active and responsible. The PD also helped the teachers to adapt the model by developing cultural differentiation strategies, modifying existing components, and extending the implementation of the TPSR through connection with other subjects or activities. The teachers found that the PD facilitated their implementation of TPSR by giving them common goals, empowering them as creators of knowledge, and providing a continuous and authentic learning experience.

<p>Laboratory researchers in Korea hold a ceremony to honor animals used in experiments over a ten month period. The practice of honoring the passed animals is part of the Buddhist culture and helps ease the scientists minds, although the article mentions that the ceremony is also connected to older shamanic beliefs about animal spirits. (Zach Rowinski 2004-08-03)</p>

BACKGROUND:Caregivers are a vital resource in the care of transplant candidates or recipients. However, few strategies have been tested that attempt to decrease the stress and anxiety they commonly encounter. OBJECTIVE: To test the feasibility of using mindfulness-based stress reduction (MBSR) techniques to decrease stress and anxiety in caregivers of lung transplant candidates/recipients who required admission to an acute care facility. METHODS: 30 caregivers of lung transplant candidates/recipients were recruited during hospitalization of their significant other. Each completed the perceived stress scale (PSS) and state trait anxiety inventory (STAI) before and 4 weeks after receiving a DVD that demonstrated MBSR techniques. Participants were asked to practice MBSR techniques for 5-15 min a day for 4 weeks. RESULTS: The participants had a mean±SD age of 55.6±13.6 years; 77% of participants were female and 93% Caucasian. The mean PSS and STAI (trait and anxiety) scores of caregivers were higher than population norms pre- and post-intervention. Scores for caregivers who stated they watched the entire DVD and practiced MBSR techniques as requested (n=15) decreased significantly from pre- to post-testing for perceived stress (p=0.001), state anxiety (p=0.003) and trait anxiety (p=0.006). Scores for those who watched some or none of the DVD (n=15) did not change significantly. CONCLUSION: Caregivers can benefit from stress reduction techniques using MBSR.

Background: Caregivers are a vital resource in the care of transplant candidates or recipients. However, few strategies have been tested that attempt to decrease the stress and anxiety they commonly encounter.Objective: To test the feasibility of using mindfulness-based stress reduction (MBSR) techniques to decrease stress and anxiety in caregivers of lung transplant candidates/recipients who required admission to an acute care facility. Methods: 30 caregivers of lung transplant candidates/recipients were recruited during hospitalization of their significant other. Each completed the perceived stress scale (PSS) and state trait anxiety inventory (STAI) before and 4 weeks after receiving a DVD that demonstrated MBSR techniques. Participants were asked to practice MBSR techniques for 5–15 min a day for 4 weeks. Results: The participants had a mean±SD age of 55.6±13.6 years; 77% of participants were female and 93% Caucasian. The mean PSS and STAI (trait and anxiety) scores of caregivers were higher than population norms pre- and post-intervention. Scores for caregivers who stated they watched the entire DVD and practiced MBSR techniques as requested (n=15) decreased significantly from pre- to post-testing for perceived stress (p=0.001), state anxiety (p=0.003) and trait anxiety (p=0.006). Scores for those who watched some or none of the DVD (n=15) did not change significantly. Conclusion: Caregivers can benefit from stress reduction techniques using MBSR.

The objective of this study was to examine the usefulness of a mindfulness-based cognitive therapy (MBCT) for treating insomnia symptoms in patients with anxiety disorder. Nineteen patients with anxiety disorder were assigned to an 8-week MBCT clinical trial. Participants showed significant improvement in Pittsburgh Sleep Quality Index (Z = -3.46, p = 0.00), Penn State Worry Questionnaire (Z = -3.83, p = 0.00), Ruminative Response Scale (Z = -3.83, p = 0.00), Hamilton Anxiety Rating Scale (Z = -3.73, p = 0.00), and Hamilton Depression Rating Scale scores (Z = -3.06, p = 0.00) at the end of the 8-week program as compared with baseline. Multiple regression analysis showed that baseline Penn State Worry Questionnaire scores were associated with baseline Pittsburgh Sleep Quality Index scores. These findings suggest that MBCT can be effective at relieving insomnia symptoms by reducing worry associated sleep disturbances in patients with anxiety disorder. However, well-designed, randomized, controlled trials are needed to confirm our findings.

: The objective of this study was to examine the usefulness of a mindfulness-based cognitive therapy (MBCT) for treating insomnia symptoms in patients with anxiety disorder. Nineteen patients with anxiety disorder were assigned to an 8-week MBCT clinical trial. Participants showed significant improvement in Pittsburgh Sleep Quality Index (Z = -3.46, p = 0.00), Penn State WorryQuestionnaire (Z = 3.83, p = 0.00), Ruminative Response Scale (Z = 3.83, p = 0.00), Hamilton Anxiety Rating Scale (Z = 3.73, p = 0.00), and Hamilton Depression Rating Scale scores (Z = 3.06, p = 0.00) at the end of the 8-week program as compared with baseline. Multiple regression analysis showed that baseline Penn State Worry Questionnaire scores were associated with baseline Pittsburgh Sleep Quality Index scores. These findings suggest that MBCT can be effective at relieving insomnia symptoms by reducing worry associated sleep disturbances in patients with anxiety disorder. However, well-designed, randomized, controlled trials are needed to confirm our findings.

BACKGROUND:Anxiety sensitivity (AS) refers to a fear of anxiety-related sensations and is a dispositional variable especially elevated in patients with panic disorder (PD). Although several functional imaging studies of AS in patients with PD have suggested the presence of altered neural activity in paralimbic areas such as the insula, no study has investigated white matter (WM) alterations in patients with PD in relation to AS. The objective of this study was to investigate the WM correlates of AS in patients with PD. METHODS: One-hundred and twelve right-handed patients with PD and 48 healthy control (HC) subjects were enrolled in this study. The Anxiety Sensitivity Inventory-Revised (ASI-R), the Panic Disorder Severity Scale (PDSS), the Albany Panic and Phobia Questionnaire (APPQ), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) were administered. Tract-based spatial statistics were used for diffusion tensor magnetic resonance imaging analysis. RESULTS: Among the patients with PD, the ASI-R total scores were significantly correlated with the fractional anisotropy values of the WM regions near the insula, the splenium of the corpus callosum, the tapetum, the fornix/stria terminalis, the posterior limb of the internal capsule, the retrolenticular part of the internal capsule, the posterior thalamic radiation, the sagittal striatum, and the posterior corona radiata located in temporo-parieto-limbic regions and are involved in interoceptive processing (p<0.01; threshold-free cluster enhancement [TFCE]-corrected). These WM regions were also significantly correlated with the APPQ interoceptive avoidance subscale and BDI scores in patients with PD (p<0.01, TFCE-corrected). Correlation analysis among the HC subjects revealed no significant findings. LIMITATIONS: There has been no comparative study on the structural neural correlates of AS in PD. CONCLUSIONS: The current study suggests that the WM correlates of AS in patients with PD may be associated with the insula and the adjacent temporo-parieto-limbic WM regions, which may play important roles in interoceptive processing in the brain and in depression in PD.

This systematic review aims to evaluate the therapeutic effects of yoga therapy using an evidence-based approach and investigates the relationship between yoga and the meridian energies based on all available clinical studies in Korea. Sixteen electronic databases will be searched from the inception of the study until January 2016. All clinical evidences that evaluate any type of yoga and any type of control in individuals with any type of condition will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool for randomized clinical trials and the Newcastle-Ottawa scale for nonrandomized studies. Two authors will independently assess each study for eligibility and the risk of bias, and then they will extract the data. With its extensive, unbiased search of the Korean literature from various databases without any language restrictions, this systematic review will be useful for both practitioners in the field of yoga research as well as for patients.

Children's participation in yoga activities is receiving increasingly widespread attention as an exercise system that promotes not only physical health benefits but also psychological well-being. The authors of this article introduce how yoga practices can be implemented in an early childhood classroom to enhance children's mind and body harmony, develop their kinesthetic awareness, and provide opportunities for regular exercise. A school-based yoga project such as the one described here can increase children's knowledge of health, while helping them develop skills of balance and control and promoting imagination and collaboration between peers.