Yoga, Meditation, Breathing Exercises, and Inflammatory Biomarkers with Possible Implications in COVID-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
(i) Included different meditations including mini-meditation, loving kindness meditation, and breathing meditations relating to pain supported by psychologists, (ii) In addition participants were encouraged to practice formal mindfulness meditation through the duration of the study
(i) Changes in Cohen’s d of CRP, IL-1ß, TNF-α, IL-6, and IFN-ץ ranged from 0.05 to 0.53 and -0.16 to −0.51 (minimal to medium) (ii) Nonetheless all of these changes were statistically insignificant ()
(i) Statistically insignificant but from small to moderate effects, indicate further study (ii) The combined package of meditations with breathing exercises may be explorative
(i) Mindful awareness practices (MAPs) for 6 weeks including 2 hours group session (ii) Consisting of experiential practice of meditation and gentle movement exercises (e.g., mindful walking) (iii) Psychoeducation (iv) Home practice of mindfulness technique on daily basis beginning with 5 minutes per day increasing to 20 minutes per day
(i) CRP level, IL-6, and sTNFRII, all decreased in intervention groups but were statistically nonsignificant
(i) wait-list control has not controlled for nonspecific effects of the intervention
(i) MBSR (intervention group) consisted of 2.5-hr sessions once per week for 8 weeks with an additional “half-day retreat.“, and practice either formal or informal meditation at home each day, (ii) exercise (control group) consisted a 2.5-hour session once per week for 8 weeks
(i) CRP changed with small (ii) IP-10 changed minimally
(i) Randomizing participants (exercise and meditation) may capture the comparative immunity benefits
(i) Daily group meeting for 60 minutes. (ii) Participants introduced to slow and deep breathing exercise from day 2 (till 21 days). (iii) Every day, 15 minutes relaxation, and 45 minutes meditation was executed
(i) The cortisol level, IL-6, and TNF-α decreased postintervention significantly.
(i) There was no significant difference in the biomarker in intervention and control group and baseline.
(i) The MBSR included weekly 2.5-hour group session and 45 minutes of daily at home practice (ii) The exercise included weekly 2.5-hour group session and 45 minutes of daily at home practice
(i) IgA decreased in the meditation group (ii) Median interferon γ also increased in meditation group (iii) Median Interleukin-10 production showed a overall increase in meditation group
(i) Statistical analysis between group and within group change in biomarkers at baseline and endline is not carried out
(i) Meditation group, was given, weekly twice 1⁄2-hour group sessions and 45 minutes of daily at home practice, focusing on stress manifestations which may lead to a healthier mind-body response. (ii) Exercise group was given, weekly twice a 1⁄2-hour group session of didactic instruction and moderately intensive exercise using stationary bicycles, treadmills, and other equipment, and 45 minutes of daily at home practice of brisk walking or jogging
(i) IL-8 means of meditation and exercise groups were 252 pg/ml and 36 pg/ml higher than that of control group (postintervention).
(i) Two cohort were selected at different time point which might influence the results. (ii) Sample size was marginal for statistical significance
(i) Mindfulness-meditation (MM) included the breath meditation, body-scan meditation, walking meditation, and forgiveness meditation (ii) Sleep health education (SHE) included ways to change daily activities and habits to improve their sleep (iii) Mind-body bridging (MBB) included expanding awareness to face daily life challenges by reducing stress and addressing sleep issues.
(i) Waking cortisol decreased (ns) (ii) MBB slightly outperformed (with producing higher salivary cortisol amount) compared to MM and SHE intervention.
(i) Small sample size with a single day collection and assessment (ii) The difference of changes in the control group and the two intervention groups is very minimal, so providing very weak evidence to conclude
(i) Integrated yoga-based stress reduction program included 60-min two times/week for 12 weeks and consisted of a set of asanas (postures performed with awareness) breathing exercises, pranayama, meditation, and yogic relaxation techniques. (ii) Participants were also asked to practise at home and maintain a diary (iii) Control intervention was given to supportive counselling sessions, including education and reinforcing social support
(i) Significant decrease in the cortisol level in intervention group was observed only at 0600 hr pre post-intervention () (ii) The mean cortisol level decreased in both the intervention and control groups but insignificant
(i) Active control group (ii) The sample for biomarkers were collected at three time point
(i) Health enhancement through mindfulness (HEM) included mindfulness-based stress reduction consisting of mindfulness training through body scan awareness exercise, sitting and walking meditations, mindful eating, mindful stretching, and discussion (ii) Health enhancement through relaxation (HER) included positive treatment expectancies, group support, teacher attention, physical activity, and mental engagement.
(i) Mean raw IL-6 level decreased in the HEM group from baseline to 4 month follow-up, (ii) mean raw IL-6 level increased in the HER group from baseline to 4 month follow-up
(i) Participants’retainment was good (ii) Home practice was not followed and so, not effective
(i) Mindfulness-based stress reduction (MBSR) included 8 weekly sessions of around 2.5 h each for mindfulness exercises, with home mindfulness practice (45 min/day) and intensive mindfulness meditation retreat of 6 hours (ii) Treatment as usual (TAU) included the pharmacological and adjusted to the fibromyalgia (FM) patients’ symptomatic profile and counselling about aerobic exercise
(i) IL-10 decreased postintervention in TAU and increased in MBSR group () with high effect size (ES = −0.72) (ii) IL-6 increased postintervention in both groups (iii) HsCRP, decreased in both groups
(i) 8-week add-on training program consisted of breathing exercises for an average of 30 breaths and strength exercises (e.g., push-ups and yoga balance techniques), gradual cold exposure with immersing whole-body in ice-cold water (0–1°C) for several minutes, and meditation with the eyes closed for 15–20 minutes (ii) During the first 4 weeks, participants had group trainings twice weekly, the second 4 weeks once weekly.
(i) HsCRP progressively decreased and increased in intervention and control group in both endpoints, but remained nonsignificant in both groups ()
(i) Not powered to investigate efficacy (ii) The adherence to the group sessions was reported to be high
(i) Consisted of asana, pranayama, and deep relaxation technique (ii) Included 5 minutes deep relaxation technique practiced in supine position, shavasana (corpse pose) to relax the whole-body completely within a short amount of time (iii) Two sessions in a week each with a duration of 50 minutes for 12 consecutive weeks were conducted
(i) Although negative standardized mean difference (SMD) values were obtained for cortisol and hsCRP, both remained nonsignificant (), respectively
(i) Both the per-protocol and intention to treat analysis was conducted. (ii) Association of stress with cortisol was observed demanding further exploration
(i) Yoga included practice of asanas such as thadasana, trikonasana, vajrasana, konasana, patchimothasana, uttanapadasana, sarvangasana, matchyasana, salabasana, and pranayama including abdomen breathing, nadisudhi, kabalbhati, sitali, and brahmari relaxation technique, for a period of 50 min for 5 days in a week for 3 months. (ii) Exercise (control) group included simple physical exercises for 50 min for 5 days in a week for 3 months.
(i) TBARS, hsCRP reduced while SOD increased in the control arm, whereas IL-6 and TNF-α decreased in the intervention group.
(i) Lack long-term follow- up. May be the first study with a large sample size that nonyoga group in a tertiary care centre for diabetes. (ii) High response rate (75%)
(i) 1 h of yoga was carried out, with various (>20) poses, including warm up, asanas, and pranayama, per day, 6 days a week, divided into three stages, namely, Adaptation stage, advancement in yoga practice, and continuation stage (ii) Pranayama included anulom vilom, bhramari, ujjayi, and kapalabhati
(i) Hs-CRP (p < .01), IL-6 (p < .001), and TNF-a (p < .001) significantly reduced in the YG after 12 weeks of yoga compared to control
(i) The finding cannot be generalized due to selection bias and small sample size
(i) A total of 30 min; 3 times/week for 12-week yoga therapy was carried out in a research centre with warming up yoga exercises, followed by different (7) yogasanas then followed by pranayama and then, dhyana
(i) IL-6 and TNF- α decreased in the control group whereas IL- 1 α, cortisol, IL-6 and TNF- α decreased in the intervention group, both significantly (ii) In between group comparison all biomarkers decreased but insignificantly.
(i) The biomarkers level where comparable at baseline (). (ii) Observation was conducted only at baseline and after 3 months. (iii) Patients with low-to-severe disease activity were included in the study.
(i) Hatha yoga sessions included twice per week over the 8 wks consisting each session of 60 minutes with breathing exercise, loosening exercise, followed by different poses. These poses were followed by relaxation/corpse pose and seated meditation.
(i) TNF-α and IL-6 decreased significantly between and within the group (ii) IL-1β also decreased in the yoga group ()
(i) Study is focused on metabolic syndrome (MetS) among healthy females (ii) Withholds a good retention rate
(i) Yoga group included two 90-minute sessions per week with different poses in different positions, for 24 sessions. (ii) Each session was followed by different four types of breathing practices
(i) All cytokines and TNF-α decreased but remained nonsignificant
(i) The attrition level was low (ii) Between group interpretation was not done
(i) Pranayam plus education group practised the dirgha three-part breath pranayam yoga learning educational materials for one-hour per session (ii) Education (only) group learned of education material for the whole 60 minutes
(i) in the intervention group CIP levels decreased, whereas IL-6 increased (both insignificantly) (ii) The secondary biomarkers (FEV1, IC, RV/TLC, DLCO) levels changed (insignificantly) in the intervention group
(i) Instead of professional yoga instructors, research coordinator provided training (ii) Double blind controlled trial
(i) 12-week iyengar yoga included the yoga focusing on postures, passive inversion (upside-down postures), and passive backbends (supported spinal extensions) for 90 minutes twice a week
(i) sTNF RII level decreased in the intervention group () for both group and time even after controlling the confounders
(i) Inclusion of active control group (ii) Small sample size (iii) In some results, values have not been reported.
(i) Yogic breathing (YB) group was given a combination of 10 min of om chanting (pranava pranayama) followed by 10 min of thirumoolar pranayama (TMP), which includes an inhalation (purakam), breath-holding (kumbakam), and exhalation (Resakam) (ii) Attention control (AC) group performed quiet reading for the same period in independent one-on-one sessions
(i) MCP-1, IL-8, and IL-1β all, were found decreased after the intervention of yogic breathing, IL-8, and MCP-1 were also with time. (ii) There was no significant difference in the salivary levels of IL-1RA, IL-6, IL-10, IL-17, IP-10, MIP-1b, and TNF-α
(i) First to demonstrate feasibility of the salivary cytokines using multiplex assay. (ii) Small sample size (YB = 10; AC = 10)
(i) The yoga consisted of standardized series of 26 hatha yoga postures, two breathing exercises, and two savasanas (i.e., a resting/relaxation posture) in a room heated to 104°F (ii) The yoga sessions were at least two 90 minutes session per week for 8 weeks
(i) Mean cortisol level in both groups decreased (more in yoga group) postintervention.
(i) Two groups were heterogenous (ii) Inferential analysis was not performed
(i) Iyengar yoga was taught which is more physically demanding and has difficult poses. (ii) Props were used to maintain proper alignment and forms during the yoga. (iii) The yoga session was of 90-min twice weekly
(i) The mean salivary cortisol in morning and 5 pm decreased in the intervention group postyoga participation ( and , respectively)
(i) Saliva collection could have been biased. (ii) Out of 18 participants only 14 completed the study
(i) Three 50-min session, 2-3 times/week divided into three parts, namely, Joint mobilization and exercises to promote respiratory body awareness (10 min), standing or sitting practice of āsanas and postures (30 min), and cool down and relaxation (10 min)
(i) Insignificant increase in the salivary cortisol level between the groups. (ii) Increase in IgA level in the intervention and decrease in the control group both insignificantly
(i) The participants were polymedicated and so, may differently influence the effects of the intervention
(i) Yogatherapy (YTP) included a maximum of 1 hour of pranayama, and then gradually moved to asanas, as tolerated on daily basis till discharge (3–4 days of admission) and then continue for 4 weeks at home. (ii) Standard chest physiotherapy (CTP) included percussion, vibration, cough stimulation techniques, and breathing exercises and mobilization
(i) Mean differences of most of the biomarkers on day 1, 2, and 3, and at week 4 remained nonsignificant except IL-4 in day 1, IL-10 in day 3, TNF-α on day 2, and IFN-ץ on day 2. (ii) The intervention was noneffective at 4 week for VT () and FVC/FEV1 (), but was effective for FVC (), FEV1 (), and PEF ()
(i) One of the few studies explaining yogatherapy as an additional rehabilitation strategy in injured patients. (ii) Home practice for 4 weeks may be biased
(i) One-hour yoga session consisting of breathing exercises (pranayama), standing and seated yoga postures, followed by relaxation with meditation, was conducted twice per week, in a quiet room, for a total of 16 supervised sessions during an 8- to 10-wk period. (ii) Standard medical care was provided to control group (CG)
(i) The levels of hsCRP, IL-6 and EC-SOD decreased significantly in the intervention group compared to the control group.
(i) Long-term follow-up of the patients’ adherence to the yoga and walking would be questionable. (ii) Home-based yoga activity track report was difficult to maintain
(i) MBSR included eight weekly classes of 2.5 hour duration, focusing body scan meditation, gentle yoga for body awareness and sitting meditation. (ii) At sixth week an 8-hour silent retreat was conducted and assignments was provided for home practice. (iii) Educational/control group carried out 1.5 hours of group session each week for 8 weeks that covered a variety of educational topics about managing HIV infection
(i) There was a increase in CD4 T cells, decrease in IL-6 levels, increase in hsCRP level, but all were nonsignificant.
(i) Assessed long-term effects of meditation. (ii) Difficult to monitoring the interventions at home
(i) MBSR consist of mindfulness meditation, breathing practices, and gentle yoga. (ii) Consists of eight 2.5-hour weekly sessions and one 6.5-hour retreat
(i) HsCRP decreased consecutively at both endpoints but remained nonsignificant (, adjusted difference)
(ii) A small single center pilot study to assess the feasibility. (ii) To be cautiously generalizable
(i) Online yoga (OLY) intervention included a 60-min/week home-based, online-streamed yoga (online platform for yoga fitness and meditation practice) for 12 weeks, progressively, mild- to moderate-intensity yoga classes based on hatha and vinyasa-style. (ii) Also included the videos for warm-up and cool down, reminders for breathing with the movements/poses, and a closing mindfulness activity and final relaxation
(i) There was a large decrease in TNF-α in OLY participants (−1.3 ± 1.5 pg/ml; ES = −0.87, large effect size). (ii) Change in IL-6 (ES = −0.26) was small
(i) Findings had not a well-defined comparator. (ii) The follow-up of 4 weeks is relatively shorter
(i) Six 70-min yoga sessions per week for 20 weeks, with 10–12 women in each session, which included physical postures/stretching, deep breathing, guided imagery, and deep relaxation
(i) Salivary mean cortisol differences at weeks -16, 20, 24, 28, 32, and 36 were significantly decreased (all ). (ii) Salivary mean IgA differences at weeks -16, 20, 24, 28, 32, and 36 postinterventions in yoga groups were significantly increased (all )
(i) First study showing the change in salivary cortisol and IgA in pregnant women. (ii) The study was powered to measure the change. (iii) Good retention (85%)
(i) MBSR had 14 sessions, 1 hourly spread over 8 weeks (weekly two sessions). (ii) It consisted of sitting meditation, gentle mindful hatha yoga, a body scan meditation, and in the final session, a 6-hour retreat. (iii) Education and support (ESC, control group) group was given educational information and pamphlets about living healthily with HIV/AIDS.
(i) There was a significant increase in the CD4 counts in MBSR group (), 3-months (), 6-month (), and 9 month (), but decreased at 12-month
(i) The CD4+ level at baseline was significantly different in both the groups. (ii) Repeated measures were taken
(i) Each yoga session was conducted for 45 min, six days a week, for 12 weeks, excluding weekly holidays and consisted of 19 different yoga poses, 5 minutes for each, followed by three different breathing exercises and finally, om chanting
(i) The decrease in mean IL-1β levels was significant in the yoga group (). (ii) There was a significant increase in the mean IL-10 in the yoga group ()
(i) The sample size was small. Different types of poses may be difficult to remember to carry on
(i) One and a half hour per day for 7 weeks (i.e. 40 days approximately) excluding Sunday. (ii) Composed of practices (cleansing practices like gayatri mantra (5 min), kunjal (twice/week), jal nethi (thrice/week), ananas (50 min/week), and healthy yoga diet), pranayamas (20 min), and meditation (15 min)
(i) Decrease in the CRP in the YG after 7 weeks of yoga ()
(i) Hatha yoga (intervention group) was carried out at least one group class per week for 10 weeks, and included breathing exercises (pranayama) and seated meditation; warm-ups and half sun salutations; standing postures (asanas); seated postures; an inversion and a twist; and shavasana (relaxation) (80 min). (ii) HLW (healthy living workshop) included at least one HLW class (60 minutes long) per week for 10 weeks, addressing alcohol, nicotine, and caffeine; being a smart patient; brain diseases; cancer prevention; diabetes; nutrition (3 classes); germs, colds, and the flu; physical activity (2 classes); sleep; physical pain, prevalence and causes of depression; and protecting your heart
(i) IL-6 levels reduced significantly in the intervention group compared to control. (ii) TNF-a and CRP did not show evident significant change
(i) Sensitivity analysis of the effect on IL-6 and parameter estimates of growth model have been carried out
(i) Patanjali raj yoga (classical yoga) was taught to the participants for 120 minutes/per day/5 session/8 weeks. (ii) Including a set of different asanas (physical postures), pranayama (breathing practices) and dhyana (meditation)
(i) Between groups the mean reduction in the CRP level, IL- 17A, IL-6, and TNF-α in the yoga group from baseline to 8-week was significant ()
(i) Active control group could have explained the change in biomarker is due to the intervention or otherwise
(i) Taught a set of yoga skills training (YST) by 3 trainers, consisting awareness meditation, movement, and breathing and relaxation. (ii) For home practise an audio recording of YST was provided and asked to practice a 15-minute session (4times/week)
(i) No significant change was observed in the levels of IL-6, IL- 1 ra, TNF- α, and CRP (p>0.05)
(i) Yoga-based lifestyle intervention (YBLI) included Patanjali’s ashtanga yoga, asanas (physical postures), pranayama (breathing techniques), dhyana (meditation), and savasana (relaxation techniques). 120 min per session, 5 days for 8 weeks. (ii) Usual care group (control) were continued with usual medical care and normal routine activity for 8 weeks
(i) Significant decline was noted in the levels of pro-inflammatory cytokines (IL-6, TNF- α, and IL- 17A) in yoga group after 8 weeks
(i) Lacking active control group. (ii) Small sample size and misbalanced male to female ratio, may limit the power of the effects. (iii) Long duration of the intervention
(i) Group 1 met once a week for 60 min and practiced kundalini yoga consisting of various yoga (30 min) movements and positions, breathing techniques, and meditation. (ii) Group 2 were given a doctor’s appointment (20 min), received instructions for two yoga exercises and did the left nostril breathing, followed by spinal flex
(i) The mean change in IL-6 and hsCRP levels in the intervention group were insignificant.
(i) IL-10 was not detectable in a majority of the patients. (ii) The study was carried out in a primary care settings. (iii) The participants were group matched rather than individually. (iv) Track of yoga practise was assessed through self-report
(i) Training for 60 minutes per session three times a week for 8 weeks. (ii) The hatha yoga consisted of 10 minutes of warm-up, followed by seated mountain pose (iii) Seated sun pose, boat pose. (iv) Workout for approximately 40 min
(i) IL-2 increased postintervention significantly in the yoga group () but decreased in the control group, indicating that chronic exercise could delay immunosenescence. (ii) IL-6 increased postintervention in both the groups but remains insignificant ()
(i) Study is related to respiratory system, which may be important for COVID-19. (ii) Increase in IL-6 contradicts with other yoga intervention
(i) Active intervention was carried out for 2 hours a day for 14 days, consisting physical postures, pranayama, interactive lecture, and ending with meditative relaxation, and then followed for next 10 weeks at home. (ii) Dietician provided dietary intervention (DI) for both the groups
(i) IL-6 and TBARS levels significantly decreased in the intervention group at two points of analysis. (ii) TNF- α and SOD levels changed in groups (both within and between), but were insignificant.
(i) Both groups are homogenous. (ii) Intention to treat analysis could not be carried out. (ii) Home-based interventions have been suffered with noncompliance, which was often difficult to assess
(i) An hour class of total 16 classes were offered twice weekly for 8 weeks. (ii) Hatha yoga was taught
(i) A moderate correlation (rho =0 .608, between TNF and IL-6 was observed. (ii) The friedman and mixed between–within subjects ANOVA test represented nonsignificant changes in IL-6 or TNF and hsCRP levels, respectively. (iii) Studied in a nonclinical population
(i) The first study to explore DNA methylation. (ii) A pilot study with small sample size and low power of the test
(i) 1 day a week for 90 minutes, over 12 weeks (ii) yoga consists of (i) Yoga body poses (asanas for 35 min). (ii) Exercises involving awareness and voluntary regulation of breath (pranayamas for 30 min) (iii) Meditational practices (for 25 min). (iii) Participants attended at least 10 of the total 12 weeks and at least three times at home during the experiment period by watching a 40-minute DVD
(i) The serum TBARS, and IL-12, TNF- α, IFN- γ reduced significantly in the intervention group and within group comparison respectively. (ii) The serum SOD levels decreased and cortisol levels increased significantly only in the control group.
(i) Many stress related biomarkers were studied. (ii) The sample size was small, and the findings may not be generalized
(i) 75-min of supervised practices twice a week, for 12 weeks. (ii) Posture included the four typical movement of the vertical column (flexion, extension, lateral bending, and rotation), abdominal fitness practices, and balance exercises.
(i) The salivary cortisol level increased in both the groups, but significant change was observed only in the control group (). (ii) The salivary cortisol level decreased in exercise group
(i) At baseline the cortisol level were different. (ii) Uneven attrition was observed in three groups
M = Meditation, P = Pranayama, Y = Yoga, MP = Meditation and pranayama both, YP = Yoga and pranayama both, YM = Yoga and meditation both, and YMP = Combination of yoga, meditation, and pranayama.
