The review protocol included only RCTs, the need for comparison groups and trials comparing intervention strategies made a revision process restrictive, but with consistent results and impressions. Few studies have many different strategies of Yoga, with different amounts of sessions, and strategies to measure different domains of impulsivity. So, there is moderate heterogeneity in a few studies to have confidence to say if it is advantageous to improve impulsivity.

Considering Yoga has many applications and varied practices commonly including a lifestyle change. Still, it fills the inclusion criteria since it has respiratory training, postures, and relaxation, it might not be related to changes in daily life since the individuals were evaluated after 10–32 sessions. Findings on impulsivity should be better identified in longer-term studies in which those observed practice yoga and implement lifestyle changes. With few weekly hours of meditation and breath exercises only, the expected effects should be heterogeneous.

Anyway, Yoga as a holistic therapy using varied practices aiming to relax the body, control breath and calm down the mind might result in enhanced health. Yoga as an ability to turn the mind to sustained attention to an object and avoid distractions might be the most interesting to reach good results for impulsivity control. The principles and values might be compatible with an individual's improvement in impulsivity. Yoga as an expression of integrative medicine allows a practice of personalized medicine, a safe environment, a cost-effective treatment, and a non-maleficence practice [23].

It is noteworthy that impulsivity has been prone to confusion and ambiguity in both terminology and conceptual understanding. Impulsivity is not a singular trait but rather a multifaceted characteristic influenced by different psychological and neural mechanisms. Impulsive behavior can be associated with heightened motivation as well as reduced motivation (referred to as 'apathy'). It can reflect inadequate information processing or a failure to regulate responses. The Barratt Impulsiveness Scale 11 (BIS-11) captures this heterogeneity through three different dimensions: motor (action without thinking), cognitive (quick cognitive decision-making), and non-planning (decrease in orientation towards future) [24, 25]. However, only one of the studies selected in our review used BIS-11 as a measurement of impulsivity [21].

The Conners’ CPT II used by Bilderbeck et al. (2013) [21] can provide valuable insights into impulsivity, however, it has some important disadvantages, such as limited assessment scope, lack of contextual factors, reliance on self-report measures, and interpretation challenges. Interpreting the results of the CPT II requires expertise and knowledge of the test's psychometric properties. Misinterpretation of scores or failure to consider individual differences can lead to inaccurate assessments of impulsivity [26, 27].

Butzer et al. (2017) [18] was the only study that used the UPPS-P Impulsive Behavior scale, a 59-item self-report scale which is a revised version of the original UPPS created by Whiteside and Lynam (2001) [28]. It reveals five distinct facets of impulsivity. These facets include sensation seeking, which reflects a tendency to seek novel and thrilling experiences; lack of premeditation, which involves a disregard for the consequences of actions; and lack of perseverance, which relates to difficulty in maintaining focus on long, boring, or challenging tasks. Additionally, the traits of negative urgency entail impulsive actions during intense negative moods, while positive urgency involves impulsive actions during intense positive moods [29, 30].

Jensen and Kenny (2014) [22] used the long version of The Conners’ Parent Rating Scale-Revised (CPRS-R: long), which is the parent form of the Conners’ Rating Scales-Revised (CRS-R) [31]. It is a parent-report measure that assesses children’s problem behaviors, particularly symptoms of ADH) and related disorders (including oppositional defiant disorder and conduct disorder). However, the CPRS-R has some disadvantages when used to assess impulsivity. One of them is that it relies on the parent’s subjective report of their child’s behavior, which may not always be accurate [32]. Another disadvantage is that it does not have formal reliability and validity scales [31]. Instead, the manual recommends that the mental health professional using the CPRS-R examine the protocol for random responding by assessing for an overabundance of one particular answer and zigzag patterns [33].

The Conners' Continuous Performance Test-II [34], used by Kerekes et al. (2017) [20], is a visual assessment tool designed to evaluate attention and measure the response inhibition component of executive control. Its purpose is to provide a reliable and objective measure for the assessment of conditions such as ADHD and other neurological disorders. By utilizing this test, clinicians aim to incorporate standardized and objective evaluations into their diagnostic processes, enhancing the accuracy of assessments for these conditions. It also is a widely used measure of attention and impulsivity. However, only a minimal amount is known about its reliability. Findings indicated that the CCPT-II had strong internal consistency, adequate test–retest reliability for commission errors and response time, poor test–retest reliability for omission errors, and practice effects for omission and commission errors. The CCPT-II was largely unrelated to the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A), Stroop Color and Word Test, and State-Trait Personality Inventory (STPI) [35]. There are many tools to assess impulsivity, but they mean different concepts and domains consisting of weakness in comparison to yoga effects.

Our study has some important limitations. Firstly, the limited number of available studies and the high heterogeneity among them present challenges in drawing definitive conclusions. The diverse strategies of yoga, varying session durations, and different measures of impulsivity across studies contribute to the overall heterogeneity. Consequently, caution is warranted in interpreting the results due to the potential influence of these factors. The evaluation of individuals after a relatively short duration of yoga practice may not capture the full potential effects, and longer-term studies are needed to assess sustained impacts. Moreover, the measurement tools employed in the included studies have their own limitations, such as limited scope, reliance on self-report measures, and challenges in interpretation.