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01-08-2018

Yoga and immune system functioning: a systematic review of randomized controlled trials

Authors: R. I. Falkenberg, C. Eising, M. L. Peters

Published in: Journal of Behavioral Medicine | Issue 4/2018

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.

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

Bayley-Veloso, R., & Salmon, P. G. (2016). Yoga in clinical practice. Mindfulness, 7, 308–319. https://doi.org/10.1007/s12671-015-0449-9 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 PubMedPubMedCentralCrossRef

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 PubMedPubMedCentralCrossRef

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 CrossRefPubMed

Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.CrossRefPubMed

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

Field, T. (2016). Yoga research review. Complementary Therapies in Clinical Practice, 24, 145–161. https://doi.org/10.1016/j.ctcp.2016.06.005 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

Higgins, J. P. (2008). Cochrane handbook for systematic reviews of interventions. Cochrane book series. Chichester: Wiley.CrossRef

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 PubMedCrossRef

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

Purdy, J. (2013). Chronic physical illness: A psychophysiological approach for chronic physical illness. The Yale Journal of Biology and Medicine, 86, 15–28.PubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

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 CrossRefPubMed

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 CrossRefPubMed

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 PubMedPubMedCentralCrossRef

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 PubMedCrossRef

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

Title: Yoga and immune system functioning: a systematic review of randomized controlled trials
Authors: R. I. Falkenberg
C. Eising
M. L. Peters
Publication date: 01-08-2018
Publisher: Springer US
Published in: Journal of Behavioral Medicine / Issue 4/2018
Print ISSN: 0160-7715
Electronic ISSN: 1573-3521
DOI: https://doi.org/10.1007/s10865-018-9914-y

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