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

Authors:
Ruth Falkenberg at University of Vienna
Ruth Falkenberg
Carla Maren Eising at University of Zurich
Carla Maren Eising
Madelon L Peters at Maastricht University
Madelon L Peters
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Abstract and Figures

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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Yoga and immune system functioning: a systematic review
of randomized controlled trials
R. I. Falkenberg
1,4
•C. Eising
2
•M. L. Peters
3
Received: September 15, 2017 / Accepted: January 23, 2018 / Published online: February 10, 2018
Springer Science+Business Media, LLC, part of Springer Nature 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 down-
regulate 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 imple-
mented as a complementary intervention for populations at
risk or already suffering from diseases with an inflamma-
tory 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.
Keywords Yoga Immune Inflammation Systematic
review Randomized controlled trials Mind–body-therapy
Introduction
Yoga is an integrated mind–body practice, originating
about 5000 years BC in ancient India. Since then, it has
been employed to promote health and well-being across
various conditions. The word ‘yoga’ is derived from San-
skrit and may be translated as ‘union’ or ‘conjunction’
(Feuerstein, 2011), entailing the idea of uniting body,
mind, and spirit (Feuerstein, 2011). Though yoga is in the
western world predominantly used as a recreational prac-
tice, it is increasingly gaining attention as a clinical inter-
vention. In fact, yoga did not primarily evolve as a system
of physical exercises, but also as a healing system (De-
sikachar et al., 2005). This healing system is based on the
assumptions that a human being is a unique, holistic, and
interconnected entity; that yoga can empower a person to
become active in his or her own healing; and that a per-
son’s state of mind is central to this healing process (De-
sikachar et al., 2005).
This ancient idea that the mind and physiological pro-
cesses, including both healing and disease, are centrally
intertwined has nowadays become scientifically substanti-
ated. It is broadly accepted that psychological stress or
&R. I. Falkenberg
ruth.falkenberg@posteo.de
C. Eising
carla.eising@student.maastrichtuniversity.nl
M. L. Peters
madelon.peters@maastrichtuniversity.nl
1
Albert-Ludwigs-Universita
¨t Freiburg, University College
Freiburg, Bertoldstr. 17, 79089 Freiburg, Germany
2
Faculty of Psychology and Neuroscience, Maastricht
University, Postbus/P.O. Box 616, 6200 MD Maastricht,
Netherlands
3
Department of Clinical Psychological Science, Maastricht
University, Postbus/P.O. Box 616, 6200 MD Maastricht,
Netherlands
4
University of Vienna, Universita
¨tsstraße 7, 1010 Vienna,
Austria
123
J Behav Med (2018) 41:467–482
https://doi.org/10.1007/s10865-018-9914-y
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... One meta-analysis [11] and several systematic reviews [9,12,13] have been undertaken to determine the effect of MBTs such as TC, QG, MED, and YA on inflammation. Morgan et al. [11] summarized the results of 34 studies on MBTs and found a moderate effect size for CRP (K = 9, g = 0.58, I2 = 97%) and a small effect size for IL-6 (K = 10, g = 0.35, I2 = 83%). ...
... The review of available evidence suggests that YA may be more effective in reducing systemic inflammation than other MBTs. Evidence from a systematic review of 15 RCTs supports previous findings on the efficacy of YA in reducing levels of proinflammatory markers including IL-1, IL-6, and TNFα [13]. Another systematic review of 15 studies reported an attenuating effect of YA on inflammatory markers such as CRP, IL-6, and TNF in eleven of the included studies [12]. ...
... To evaluate the effect of YA on inflammatory markers quantitatively, information from 11 relevant studies examined in recent reviews or meta-analyses on MBTs (e.g. [9,[11][12][13] was extracted to derive a combined effect size. The effect size was determined from the standardized mean difference (Hedge's g) in biomarker Journal of Yoga and Physiotherapy levels post-intervention between the YA and control groups. ...
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... This study fills this gap by analysing the adoption of remote yoga among the culturally diverse population of the East and West. There is a growing body of scientific research focusing on the positive outcomes of yoga interventions for a range of health issues (Woodyard, 2011;Cramer et al., 2015;Innes and Selfe, 2016;Hofmann et al., 2016;Saper and Lemaster, 2017;Tolahunase et al., 2017;Bridges and Sharma, 2017;Falkenberg et al., 2018;Cramer et al., 2019;Hsueh et al., 2021;Thimmapuram et al., 2022). However, yoga studies often lack diversity and precise quantitative and qualitative measures, limiting their accuracy and potential for replication. ...
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... In addition, in another study comparing exercise with normal care, it was explained that the exercise group was significantly better than the other group in reducing low back pain [12]. In another study, it was stated that long-term exercise was effective in reducing work injuries [13]. ...
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