Abstract
Yoga is an ancient mind–body practice that is increasingly recognized to have health benefits in a variety of clinical and non-clinical conditions. This systematic review summarizes the findings of randomized controlled trials examining the effects of yoga on immune system functioning which is imperative to justify its application in the clinic. Fifteen RCTs were eligible for the review. Even though the existing evidence is not entirely consistent, a general pattern emerged suggesting that yoga can downregulate pro-inflammatory markers. In particular, the qualitative evaluation of RCTs revealed decreases in IL-1beta, as well as indications for reductions in IL-6 and TNF-alpha. These results imply that yoga may be implemented as a complementary intervention for populations at risk or already suffering from diseases with an inflammatory component. Beyond this, yoga practice may exert further beneficial effects by enhancing cell-mediated and mucosal immunity. It is hypothesized that longer time spans of yoga practice are required to achieve consistent effects especially on circulating inflammatory markers. Overall, this field of investigation is still young, hence the current body of evidence is small and for most immune parameters, more research is required to draw distinct conclusions.
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References
Abbas, A. K., Lichtman, A. H., & Pillai, S. (2016). Basic immunology: Functions and disorders of the immune system (5th ed.). Missouri: Elsevier.
Agnihotri, S., Kant, S., Kumar, S., Mishra, R. K., & Mishra, S. K. (2014). Impact of yoga on biochemical profile of asthmatics: A randomized controlled study. International Journal of Yoga, 7, 17–21. https://doi.org/10.4103/0973-6131.123473
Ashcroft, G. S., Jeong, M.-J., Ashworth, J. J., Hardman, M., Jin, W., Moutsopoulos, N.,. . . Wahl, S. M. (2012). Tumor necrosis factor-alpha (TNF-α) is a therapeutic target for impaired cutaneous wound healing. Wound Repair and Regeneration: Official Publication of the Wound Healing Society [and] the European Tissue Repair Society, 20(1), 38–49. https://doi.org/10.1111/j.1524-475x.2011.00748.x
Barnes, P. J. (2006). How corticosteroids control inflammation: Quintiles Prize Lecture 2005. British Journal of Pharmacology, 148, 245–254. https://doi.org/10.1038/sj.bjp.0706736
Bayley-Veloso, R., & Salmon, P. G. (2016). Yoga in clinical practice. Mindfulness, 7, 308–319. https://doi.org/10.1007/s12671-015-0449-9
Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: A systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373, 13–24. https://doi.org/10.1111/nyas.12998
Bower, J. E., Greendale, G., Crosswell, A. D., Garet, D., Sternlieb, B., Ganz, P. A., et al. (2014). Yoga reduces inflammatory signaling in fatigued breast cancer survivors: A randomized controlled trial. Psychoneuroendocrinology, 43, 20–29. https://doi.org/10.1016/j.psyneuen.2014.01.019
Bower, J. E., & Irwin, M. R. (2016). Mind-body therapies and control of inflammatory biology: A descriptive review. Brain, Behavior, and Immunity, 51, 1–11. https://doi.org/10.1016/j.bbi.2015.06.012
Buric, I., Farias, M., Jong, J., Mee, C., & Brazil, I. A. (2017). What is the molecular signature of mind-body interventions? A systematic review of gene expression changes induced by meditation and related practices. Frontiers in Immunology, 8, 670. https://doi.org/10.3389/fimmu.2017.00670
Cade, W. T., Reeds, D. N., Mondy, K. E., Overton, E. T., Grassino, J., Tucker, S., et al. (2010). Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors. HIV Medicine, 11, 379–388. https://doi.org/10.1111/j.1468-1293.2009.00801.x
Chen, N., Xia, X., Qin, L., Luo, L., Han, S., Wang, G., et al. (2016). Effects of 8-week Hatha yoga training on metabolic and inflammatory markers in healthy, female chinese subjects: A randomized clinical trial. BioMed Research International, 2016, 5387258. https://doi.org/10.1155/2016/5387258
Chen, P.-J., Yang, L., Chou, C.-C., Li, C.-C., Chang, Y.-C., & Liaw, J.-J. (2017). Effects of prenatal yoga on women’s stress and immune function across pregnancy: A randomized controlled trial. Complementary Therapies in Medicine, 31, 109–117. https://doi.org/10.1016/j.ctim.2017.03.003
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.
Del Vecchio, M., Bajetta, E., Canova, S., Lotze, M. T., Wesa, A., Parmiani, G., et al. (2007). Interleukin-12: Biological properties and clinical application. Clinical Cancer Research: An Official Journal of the American Association for Cancer Research, 13, 4677–4685. https://doi.org/10.1158/1078-0432.CCR-07-0776
Desikachar, K., Bragdon, L., & Bossart, C. (2005). The yoga of healing: Exploring yoga’s holistic model for health and well-being. International Journal of Yoga Therapy, 15, 17–39.
Dinarello, C. A. (2011). Interleukin-1 in the pathogenesis and treatment of inflammatory diseases. Blood, 117, 3720–3732. https://doi.org/10.1182/blood-2010-07-273417
Feuerstein, G. (2011). The parth of yoga: An essential guide to its principles and practices. Boston: Shambala.
Field, T. (2011). Yoga clinical research review. Complementary Therapies in Clinical Practice, 17, 1–8. https://doi.org/10.1016/j.ctcp.2010.09.007
Field, T. (2016). Yoga research review. Complementary Therapies in Clinical Practice, 24, 145–161. https://doi.org/10.1016/j.ctcp.2016.06.005
Gopal, A., Mondal, S., Gandhi, A., Arora, S., & Bhattacharjee, J. (2011). Effect of integrated yoga practices on immune responses in examination stress—A preliminary study. International Journal of Yoga, 4, 26–32. https://doi.org/10.4103/0973-6131.78178
Harkess, K. N., Ryan, J., Delfabbro, P. H., & Cohen-Woods, S. (2016). Preliminary indications of the effect of a brief yoga intervention on markers of inflammation and DNA methylation in chronically stressed women. Translational Psychiatry, 6, e965. https://doi.org/10.1038/tp.2016.234
Higgins, J. P. (2008). Cochrane handbook for systematic reviews of interventions. Cochrane book series. Chichester: Wiley.
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., et al. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical Research Edition), 343, d5928. https://doi.org/10.1136/bmj.d5928
Hunter, C. A., & Jones, S. A. (2015). IL-6 as a keystone cytokine in health and disease. Nature Immunology, 16, 448–457. https://doi.org/10.1038/ni.3153
Irwin, M. R. (2008). Human psychoneuroimmunology: 20 years of discovery. Brain, Behavior, and Immunity, 22, 129–139. https://doi.org/10.1016/j.bbi.2007.07.013
Kiecolt-Glaser, J. K., Bennett, J. M., Andridge, R., Peng, J., Shapiro, C. L., Malarkey, W. B., et al. (2014). Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors: A randomized controlled trial. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 32, 1040–1049. https://doi.org/10.1200/jco.2013.51.8860
Kiecolt-Glaser, J. K., Christian, L., Preston, H., Houts, C. R., Malarkey, W. B., Emery, C. F., et al. (2010). Stress, inflammation, and yoga practice. Psychosomatic Medicine, 72, 113–121. https://doi.org/10.1097/PSY.0b013e3181cb9377
Krishna, B. H., Keerthi, G. S., Kumar, C. K., & Reddy, N. M. (2015). Association of leukocyte telomere length with oxidative stress in yoga practitioners. Journal of Clinical and Diagnostic Research: JCDR, 9, CC01–CC03. https://doi.org/10.7860/jcdr/2015/13076.5729
Kumar, S. B., Yadav, R., Yadav, R. K., Tolahunase, M., & Dada, R. (2015). Telomerase activity and cellular aging might be positively modified by a yoga-based lifestyle intervention. Journal of Alternative and Complementary Medicine (New York, NY), 21, 370–372. https://doi.org/10.1089/acm.2014.0298
Lawrence, T. (2009). The nuclear factor NF-kappaB pathway in inflammation. Cold Spring Harbor Perspectives in Biology, 1, a001651. https://doi.org/10.1101/cshperspect.a001651
Lim, S.-A., & Cheong, K.-J. (2015). Regular yoga practice improves antioxidant status, immune function, and stress hormone releases in young healthy people: A randomized, double-blind, controlled pilot study. Journal of Alternative and Complementary Medicine (New York, NY), 21, 530–538. https://doi.org/10.1089/acm.2014.0044
Lipsey, M. W., & Wilson, D. B. (2015). Practical meta-analysis (Vol. 49). Thousand Oaks: Sage.
Long Parma, D., Hughes, D. C., Ghosh, S., Li, R., Treviño-Whitaker, R. A., Ogden, S. M., et al. (2015). Effects of six months of Yoga on inflammatory serum markers prognostic of recurrence risk in breast cancer survivors. SpringerPlus, 4, 143. https://doi.org/10.1186/s40064-015-0912-z
McGough, J. J., & Faraone, S. V. (2009). Estimating the size of treatment effects: Moving beyond P values. Psychiatry (Edgmont), 6, 21–29. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791668/
Mezentsev, A., Merks, R. M. H., O’Riordan, E., Chen, J., Mendelev, N., Goligorsky, M. S., et al. (2005). Endothelial microparticles affect angiogenesis in vitro: Role of oxidative stress. American Journal of Physiology Heart and Circulatory Physiology, 289, H1106–H1114. https://doi.org/10.1152/ajpheart.00265.2005
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6, e1000097. https://doi.org/10.1371/journal.pmed.1000097
Morgan, N., Irwin, M. R., Chung, M., & Wang, C. (2014). The effects of mind-body therapies on the immune system: Meta-analysis. PLoS ONE, 9, e100903. https://doi.org/10.1371/journal.pone.0100903
Naoroibam, R., Metri, K. G., Bhargav, H., Nagaratna, R., & Nagendra, H. R. (2016). Effect of Integrated Yoga (IY) on psychological states and CD4 counts of HIV-1 infected patients: A randomized controlled pilot study. International Journal of Yoga, 9, 57–61. https://doi.org/10.4103/0973-6131.171723
Pollard, K. M., Cauvi, D. M., Toomey, C. B., Morris, K. V., & Kono, D. H. (2013). Interferon-γ and Systemic Autoimmunity. Discovery medicine, 16(87), 123–131. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934799/
Popa, C., Netea, M. G., van Riel, P. L. C. M., van der Meer, J. W. M., & Stalenhoef, A. F. H. (2007). The role of TNF-alpha in chronic inflammatory conditions, intermediary metabolism, and cardiovascular risk. Journal of Lipid Research, 48, 751–762. https://doi.org/10.1194/jlr.R600021-JLR200
Pullen, P. R. (2009). The benefits of yoga therapy for heart failure patients. (Dissertation). Georgia State University, Georgia. Retrieved from http://scholarworks.gsu.edu/kin_health_diss/2
Pullen, P. R., Nagamia, S. H., Mehta, P. K., Thompson, W. R., Benardot, D., Hammoud, R., et al. (2008). Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. Journal of Cardiac Failure, 14, 407–413. https://doi.org/10.1016/j.cardfail.2007.12.007
Pullen, P. R., Thompson, W. R., Benardot, D., Brandon, L. J., Mehta, P. K., Rifai, L., et al. (2010). Benefits of yoga for African American heart failure patients. Medicine and Science in Sports and Exercise, 42, 651–657. https://doi.org/10.1249/mss.0b013e3181bf24c4
Purdy, J. (2013). Chronic physical illness: A psychophysiological approach for chronic physical illness. The Yale Journal of Biology and Medicine, 86, 15–28.
Qu, S., Olafsrud, S. M., Meza-Zepeda, L. A., & Saatcioglu, F. (2013). Rapid gene expression changes in peripheral blood lymphocytes upon practice of a comprehensive yoga program. PLoS ONE, 8, e61910. https://doi.org/10.1371/journal.pone.0061910
Rajbhoj, P. H., Shete, S. U., Verma, A., & Bhogal, R. S. (2015). Effect of yoga module on pro-inflammatory and anti-inflammatory cytokines in industrial workers of lonavla: A randomized controlled trial. Journal of Clinical and Diagnostic Research: JCDR, 9(2), CC01–CC05. https://doi.org/10.7860/jcdr/2015/11426.5551
Rao, R. M., Nagendra, H. R., Raghuram, N., Vinay, C., Chandrashekara, S., Gopinath, K. S., et al. (2008a). Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery. International Journal of Yoga, 1, 11–20. https://doi.org/10.4103/0973-6131.36789
Rao, R. M., Nagendra, H. R., Raghuram, N., Vinay, C., Chandrashekara, S., Gopinath, K. S., et al. (2008b). Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. International Journal of Yoga, 1, 33–41. https://doi.org/10.4103/0973-6131.36795
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, 379–396. https://doi.org/10.1080/17437199.2014.981778
Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: A review of comparison studies. Journal of Alternative and Complementary Medicine, 16(1), 3–12. https://doi.org/10.1089/acm.2009.0044.
Sauer-Zavala, S. E., Walsh, E. C., Eisenlohr-Moul, T. A., & Lykins, E. L. B. (2013). Comparing mindfulness-based intervention strategies: Differential effects of sitting meditation, body scan, and mindful yoga. Mindfulness, 4, 383–388. https://doi.org/10.1007/s12671-012-0139-9
Schoenborn, J. R., & Wilson, C. B. (2007). Regulation of Interferon-γ During Innate and Adaptive Immune Responses. Advances in Immunology, 96, 41–101. https://doi.org/10.1016/S0065-2776(07)96002-2
Sharma, P., Poojary, G., Dwivedi, S. N., & Deepak, K. K. (2015). Effect of yoga-based intervention in patients with inflammatory bowel disease. International Journal of Yoga Therapy, 25, 101–112. https://doi.org/10.17761/1531-2054-25.1.101
Shrivastava, A. K., Singh, H. V., Raizada, A., & Singh, S. K. (2015). C-reactive protein, inflammation and coronary heart disease. The Egyptian Heart Journal, 67, 89–97. https://doi.org/10.1016/j.ehj.2014.11.005
Slavich, G. M. (2015). Understanding inflammation, its regulation, and relevance for health: A top scientific and public priority. Brain, Behavior, and Immunity, 45, 13–14. https://doi.org/10.1016/j.bbi.2014.10.012
Steptoe, A., Hamer, M., & Chida, Y. (2007). The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain, Behavior, and Immunity, 21, 901–912. https://doi.org/10.1016/j.bbi.2007.03.011
Tolahunase, M., Sagar, R., & Dada, R. (2017). Impact of yoga and meditation on cellular aging in apparently healthy individuals: A prospective, open-label single-arm exploratory study. Oxidative Medicine and Cellular Longevity, 2017, 7928981. https://doi.org/10.1155/2017/7928981
Vijayaraghava, A., Doreswamy, V., Narasipur, O. S., Kunnavil, R., & Srinivasamurthy, N. (2015). Effect of yoga practice on levels of inflammatory markers after moderate and strenuous exercise. Journal of Clinical and Diagnostic Research: JCDR, 9, CC08–CC12. https://doi.org/10.7860/jcdr/2015/12851.6021
Vogler, J., O’Hara, L., Gregg, J., & Burnell, F. (2011). The impact of a short-term iyengar yoga program on the health and well-being of physically inactive older adults. International Journal of Yoga Therapy, 21, 61–72.
Wan, X., Wang, W., Liu, J., & Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology, 14, 135. https://doi.org/10.1186/1471-2288-14-135
Yadav, R. K., Magan, D., Mehta, N., Sharma, R., & Mahapatra, S. C. (2012). Efficacy of a short-term yoga-based lifestyle intervention in reducing stress and inflammation: Preliminary results. Journal of Alternative and Complementary Medicine, 18, 662–667. https://doi.org/10.1089/acm.2011.0265
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Falkenberg, R.I., Eising, C. & Peters, M.L. Yoga and immune system functioning: a systematic review of randomized controlled trials. J Behav Med 41, 467–482 (2018). https://doi.org/10.1007/s10865-018-9914-y
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DOI: https://doi.org/10.1007/s10865-018-9914-y