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

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Abbas, A. K., Lichtman, A. H., & Pillai, S. (2016). Basic immunology: Functions and disorders of the immune system (5th ed.). Missouri: Elsevier.

    Google Scholar 

  2. 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

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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

  4. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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

    Article  Google Scholar 

  6. 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

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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

    PubMed  PubMed Central  Article  Google Scholar 

  11. 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

    PubMed  PubMed Central  CAS  Article  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. 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.

    Google Scholar 

  16. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Feuerstein, G. (2011). The parth of yoga: An essential guide to its principles and practices. Boston: Shambala.

    Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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

    Book  Google Scholar 

  23. 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

    Article  Google Scholar 

  24. 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

    Article  PubMed  CAS  Google Scholar 

  25. 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

    Article  PubMed  CAS  Google Scholar 

  26. 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

    Article  Google Scholar 

  27. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. 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

    PubMed  Article  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. 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

    Article  Google Scholar 

  32. Lipsey, M. W., & Wilson, D. B. (2015). Practical meta-analysis (Vol. 49). Thousand Oaks: Sage.

    Google Scholar 

  33. 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

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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/

  35. 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

    Article  PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  PubMed Central  Google Scholar 

  37. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. 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

    Article  PubMed  PubMed Central  Google Scholar 

  39. 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/

  40. 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

    Article  PubMed  CAS  Google Scholar 

  41. 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

  42. 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

    Article  PubMed  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  45. 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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. 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

  47. 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

    Article  PubMed  PubMed Central  Google Scholar 

  48. 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

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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

    Article  PubMed  Google Scholar 

  50. 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.

  51. 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

    Article  Google Scholar 

  52. 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

    Article  PubMed  CAS  Google Scholar 

  53. 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

    Article  PubMed  Google Scholar 

  54. 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

    Article  Google Scholar 

  55. 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

    Article  PubMed  Google Scholar 

  56. 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

    Article  PubMed  CAS  Google Scholar 

  57. 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

    PubMed  PubMed Central  CAS  Article  Google Scholar 

  58. 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

    PubMed  Article  Google Scholar 

  59. 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.

    Google Scholar 

  60. 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

    Article  PubMed  PubMed Central  Google Scholar 

  61. 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

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to R. I. Falkenberg.

Ethics declarations

Conflict of interests

R. I. Falkenberg, C. Eising, and M. L. Peters declare that they have no conflict of interest.

Human and animal rights and Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Yoga
  • Immune
  • Inflammation
  • Systematic review
  • Randomized controlled trials
  • Mind–body-therapy