|
 
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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 3
| Issue : 1 | Page : 1-5 |
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A review of yoga on inflammation and its related diseases
Mooventhan Aruchunan1, L Nivethitha2, R Gowthami1
1 Department of Research, Government Yoga and Naturopathy Medical College and Hospital, Chennai, Tamil Nadu, India
2 Department of Naturopathy, Government Yoga and Naturopathy Medical College and Hospital, Chennai, Tamil Nadu, India
| Date of Submission | 03-Nov-2022 |
| Date of Decision | 12-Dec-2022 |
| Date of Acceptance | 26-Dec-2022 |
| Date of Web Publication | 31-Mar-2023 |
Correspondence Address:
Dr. Mooventhan Aruchunan
Department of Research, Government Yoga and Naturopathy Medical College, Arumbakkam, Chennai - 600 106, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ara.ara_16_22
Inflammation plays a major role in the defense mechanism and becomes an important contributing factor for the progression of various diseases. Research studies suggest that yoga could positively affect inflammation and inflammatory markers in various chronic diseases including arthritis, obesity, cardiovascular diseases (CVD), and cancer. However, there is a lack of a comprehensive review on yoga and its impact on inflammation. We have performed a review in the PubMed/MEDLINE electronic databases. The review suggests that yoga may be beneficial in reducing inflammation in healthy as well as in pathological conditions including arthritis, obesity, CVD, and cancer. However, studies had smaller sample sizes and yoga techniques were varied among the studies, and a possible mechanism for the effect of yoga on inflammation has not been provided in detail. Thus, studies with larger sample sizes and exploring the mechanism behind the yoga effect on inflammation are required for a better understanding and clinical application.
Keywords: Biomarkers, chronic diseases, inflammation, yoga
How to cite this article:
Aruchunan M, Nivethitha L, Gowthami R. A review of yoga on inflammation and its related diseases. Ann Rheumatol Autoimmun 2023;3:1-5 |
| Introduction | |  |
Inflammation plays a major role in the defense mechanism[1] and becomes an important contributing factor for the progression of various diseases including arthritis and its related conditions, obesity, diabetes, hypertension,[2] coronary artery disease (CAD), and predictor of all-cause mortality.[1] Pro-inflammatory markers and anti-inflammatory markers counterbalance each other. It is extremely essential for the body to maintain their balance for a good immune response. This balance is crucial for immediate immune response in acute and chronic conditions.[3] People who are active have lower levels of inflammatory biomarkers than their sedentary counterparts.[4] Regular physical activity decreases pro-inflammatory cytokines and elevates anti-inflammatory cytokines[3] that are associated with several metabolic disorders.[2] Stressors, anxiety, and depression can all raise pro-inflammatory cytokine production. Yoga practices have reported to reduce sympathetic nervous system tone and increase parasympathetic (vagal) activity, both of which have favorable immune and endocrine consequences by reducing stress-related responses.[5] Yoga is a mind–body therapy that has become increasingly popular in Western culture as a form of physical activity.[6] In Western countries, yoga typically refers to postures (asanas), breath control (pranayama), and/or meditation. Yoga is traditionally believed to have beneficial effects on physical and mental health.[7] Research studies suggest that yoga could positively affect inflammation and inflammatory markers in various chronic diseases including arthritis,[8] obesity,[6],[9] metabolic syndrome,[10] heart failure (HF),[11] and chronic inflammatory diseases[9]. However, there is a lack of a comprehensive review on yoga and its impact on inflammation. Thus, this review was performed to provide the effect of yoga on inflammation. In this review, we have provided the evidence-based effect of yoga and inflammation in various conditions as follows:
| Yoga and Rheumatoid Arthritis | | |
Inflammation plays a major role in the pathogenesis of rheumatoid arthritis (RA). Yoga practice showed to improve all parameters of RA including pain intensity, inflammation, stiffness, pulse rate, blood pressure, lymphocyte count, C-reactive protein (CRP), and serum uric acid levels in patients with RA.[12]
| Yoga and Ankylosing Spondylitis | | |
It is a common chronic autoimmune disease that primarily affects the axial skeleton and sacroiliac joints. It leads to stiffness, pain, and reduced flexibility and causes significant disability.[13],[14] A study on the practice of yoga for 60 min a day, 3 days a week for a period of 1 month has reported that yoga was not only feasible, acceptable, and easy to practice by patients with ankylosing spondylitis (AS) but also effective in improving flexibility and in reducing the pain among AS patients. The authors recommend a minimum of 30 min of yoga practice every day under the supervision of a yoga expert to avail the benefits.[14] Likewise, in another study, a residential yoga retreat consisting of yoga practice (sukshma vyayama, breathing practices, asana, meditation, and mediation) for 60 min, 3 times a day, daily along with yogic counseling, vegetarian diet, and bhajan for 2 weeks has been shown to improve spinal flexibility and lung functions, and reduce blood pressure, heart rate (HR), and the use of analgesic medication in patients with AS.[13]
| Yoga and Systemic Lupus Erythematosus | | |
It is an autoimmune disease, in which immune system dysregulation leads to widespread inflammation affecting the skin, joints, kidneys, lungs, nervous system, and other organs of the body. In a study, the participants received yoga (asanas, deep breathing, relaxation, and meditation) for 60 min a day, twice a week for a period of 8 weeks, and were encouraged to do a home practice. The study showed an increase in balance and body awareness and tolerated faster-paced yoga classes. Yoga instructors' recommend to modify yoga based on the patients' energy levels and physical ability of systemic lupus erythematosus patients.[15] Literature suggests that yoga is effective in the management of musculoskeletal disorders as it improves the range of motion and physical functioning and reduces inflammation by downregulating the nuclear factor-kappa β (F-Kβ).[13] Yoga that is commonly employed in rheumatological diseases includes yogic Sukshmavyama, Asanas (Tadasana, Katichakrasana, Virabhadrasana, Gomukhasana, Paschimutaanasana, Shashaankasana, Vakrasana, Ekpada shalabhasana, Bhujangasana, Makarasana, Uttanapadasana, Setubhandhasana, Pavanmuktasana, and Savasana), pranayama (Nadisodhana Pranayama, Kapalbhati, Bhramari, Ujjayi, etc.), relaxation techniques, and meditation.[7],[16]
| Yoga and Inflammation in Healthy Individuals | | |
Yoga is highly beneficial in regulating inflammatory response when it is practiced over a longer duration. Studies have found that people who have practiced yoga for a longer time have decreased amount of serum interleukin (IL)-6 levels, and therefore, a decreased amount of detectable CRP. In contrast, subjects who were new to the practice of yoga or have been practicing yoga for a shorter duration were found to have 41% higher serum IL-6 and therefore, a 4.75 times higher amount of detectable CRP.[4] In addition, more years of yoga practice are found to be associated with lower leptin levels and lower adiponectin-to-leptin ratio. This is not to say that yoga does not have any immediate effects on inflammatory markers.[5] Immediate effects of yoga on inflammatory markers were also studied. It showed that practice of yoga for a duration of 5–20 min and reduced the levels of IL-1 β, IL-8, and monocytic chemotactic protein-1 (MCP-1). The levels of reduction of IL-8 were significant at all-time points tested, whereas IL-1 β showed reduction at 15 and 20 min time points, and MCP-1 level was marginally different at 5–20 min. There was no significant reduction in the levels of IL-1RA, IL-6, IL-10, IL-17, 1P-1O, MIP-1b, and tumor necrosis factor (TNF-α).[17]
A 3-month long yoga retreat has reduced self-reported anxiety and depression in subjects and has increased the level of brain-derived neurotrophic factor, and cortisol awakening response, which is a reflection of increased dynamic physiological arousal and the dual enhancement of pro-and anti-inflammatory cytokine changes to healthy immunologic functioning. Plasma levels of anti-inflammatory cytokines IL-10 were increased and the proinflammatory cytokine IL-12 was reduced. However, plasma levels of other pro-inflammatory cytokines, including interferon-gamma (IFN-γ), TNF-α, IL-1 β, IL-6, and IL-8, were increased after the retreat. This shows that yoga does affect the inflammatory markers of the body.[18]
Yoga has had its differences from other forms of exercise. Strenuous exercises tend to increase the oxidative stress of the body by the accumulation of lactic acid. In contrast, yoga practitioners exhibit reduced inflammatory response as evident from the reduced values of TNF-α and IL-6.[1] Yoga training has also showed a significant reduction in plasma insulin, total cholesterol and low-density lipoprotein (LDL), cholesterol levels, and insulin resistance, but shows no difference in levels of glucose, triglycerides, LDL, high-density lipoprotein, cholesterol, systolic blood pressure (SBP), diastolic blood pressure, body weight, and body mass index (BMI). The intervention showed reduction in the levels of pro-inflammatory cytokines (IL-6, TNF-α, and IL-1β), and inflammatory capacity of inflammatory cells and consequently suppressing the whole body's chronic inflammation.[6]
| Yoga and Inflammation in Women | | |
Women are at a higher risk of contracting chronic diseases due to the differences in the inflammatory states that are brought about the hormonal fluctuations associated with reproductive events. These inflammatory states have been shown to vary by sex. For example, pro-inflammatory cytokines such as IL-8 and IFN-γ are elevated in depressed females along with higher levels of CRP, which positively correlates with the levels of IL-1 β and TNF-α, further predisposing them to many morbid conditions.[19] Yoga intervention has been shown to significantly increase the level of albumin while reducing the levels of vascular inflammation factors such as fibrinogen, hs-CRP, and erythrocyte sedimentation rate.[20] The practice of yoga during pregnancy has been found to lower salivary cortisol levels and significantly increase long-term salivary immunoglobulin A levels. Interestingly, the infants born to women who practiced yoga during their pregnancy weighed more than those born to women who did not practice prenatal yoga. Research findings also suggest a significant reduction in the stress level of pregnant women along with an enhanced immune function after the practice of prenatal yoga.[21]
| Yoga and Inflammation in Industrial Workers | | |
Subjects working in factories manufacturing paint, chemical, and steel for over 3 months, who were at a high risk of occupational hazard showed highly significant changes in cholesterol, high-density lipoprotein, low-density lipoprotein, hs-CRP, IL-6, and TNF-α.[2] Inhaled pollutants such as sulfur oxides, nitrogen oxides, hydrocarbons, carbon monoxide, hydrogen sulfide, ozone (O3), and dust are shown to stimulate alveolar macrophages to produce pro-inflammatory cytokines such as IL-1 β, TNF-α, IL-6, IL-8, and granulocyte-macrophage colony. Twelve weeks of yoga practice has been shown to produce a significant reduction in pro-inflammatory cytokine (IL-1 β) and a significant increase in anti-inflammatory cytokine (IL-10) compared to the control group in industrial workers.[3]
| Yoga and Stress | | |
Yoga reduces inflammatory responses associated with stressful situations. Cross-sectional analysis demonstrated lower DNA methylation of the TNF region as a whole and at specific sites. However, there were no significant changes in the inflammatory biomarkers.[22] Studies have also shown that yoga has demonstrated differential expression of 68 genes including upregulation of genes involved in immunoglobulin-related transcripts and downregulation of transcripts involved in the production of pro-inflammatory cytokines.[23] Overall symptoms of stress improved significantly with a reduction in cortisol levels, which were maintained over the follow-up period.[24]
| Yoga and Obesity | | |
Obesity is the most prevalent nutritional disorder and is an energy imbalance between calories consumed and calories expended. Moderate daily physical activity and healthy eating are modifiable and particularly important for preventing obesity.[25] Obesity is a state of low-grade inflammation. Obesity-related inflammation is associated with adipocytokines produced from the adipose tissue, primarily, leptin and adiponectin. Obesity, especially visceral adiposity found in obesity upregulates various inflammatory cytokines such as IL-6, IL-1 β, IL-10, TNF-α, MCP-1, plasminogen activator inhibitor-1, angiotensinogen-1, endothelin-1, visfatin, resistin, retinol binding protein-4, and serum amyloid A. This state of inflammation can predispose the body to a chronic state of inflammation leading to metabolic dysfunctions, including, increased insulin resistance, and endothelial dysfunction precipitating cardiovascular diseases (CVDs).[26]
Yoga-based intervention administered to people with obesity has shown to significantly reduce weight, BMI, and SBP. A significant reduction was also seen in IL-6 and an increase in adiponectin was observed.[27] These effects were brought out by the administration of a short-term yoga-based lifestyle. The beneficial effects of yoga in the reduction of inflammation appear to be related to the reduction in stress. A plausible reason for stress reduction by yoga is increased mindfulness. Yoga is known to induce relaxation through the lowering of cortisol and increasing the levels of beta-endorphins. This results in lowered levels of cytokines[26] including IL-6 and TNF.[9]
| Yoga and Cancer | | |
Cancer patients practicing yoga showed a continued reduction of Th1 (pro-inflammatory cytokines) over a period of year. The intervention also decreased the SBP and HR.[24] 10–15 min of yoga practice stimulated the levels of deleted in malignant brain tumor 1 (DMBT1), mucin-7, cysteine-rich secretory protein 3, and prolactin inducible protein. Particularly, DMBT1 was elevated by 10 folds and 11 folds.[28] Yoga has both immediate- and long-term effects on fatigue and inflammation that are constantly seen in cancer survivors. Survivors who practiced yoga on a regular basis expressed lower fatigue, increased vitality, and also reduced inflammatory markers such as IL-6, TNF-α, and IL-1 β.[29]
Studies claim that yoga intervention given to fatigued breast cancer survivors reduced the activity of pro-inflammatory transcription factors such as nuclear factor kappa B (NF-κB) and a simultaneous increase in the anti-inflammatory glucocorticoid receptor and reduced activity of cAMP response element-binding protein family transcription factors. No significant changes were found in the CRP, IL-6, or diurnal cortisol levels. In addition to this, there is also downregulation of genes involved in Type I IFN response and reductions in IFN-related transcription factors.[7] Some studies also show significant improvement in decreased % of body fat but not in the cardiorespiratory capacity or in inflammatory serum markers − IL-6, IL-8, TNF-α, and CRP.[30]
| Yoga and Cardiovascular Diseases | | |
Yoga practice has exhibited many cardio and vascular protective effects. The mechanism of which is hypothesized to be the reduction of EMP levels. Studies have shown that yoga reduces CD31+/CD42b − EMPs. Unlike pathological stress, the physiological stress brought about by yoga decreased EMP levels thus exerting protective effects on cardiac and vascular systems.[6] The tone of the vascular system has also shown to improve with yoga practice. There was a significant improvement of 69% in endothelial-dependent vasodilatation in subjects with CAD. This proves that yoga improves endothelial function in subjects with CAD. However, more studies with a larger sample size maybe needed to further solidify these findings.[31] In patients with comorbidities such as hypertension, yoga intervention did not significantly affect the inflammatory biomarkers or the metabolic risk factors associated with CVD.[32] Yoga improved exercise tolerance and positively affected levels of inflammatory markers in patients with HF, and there was also a trend toward improvements in quality of life.[33] Yoga has been shown to improve flexibility, treadmill time, peak oxygen uptake (VO2 peak), and the biomarkers such as CRP and extracellular superoxide dismutase (SOD).[11]
| Yoga and Inflammatory Bowel Disease | | |
Yoga significantly reduced the state and trait anxiety levels and intestinal colic in patients with ulcerative colitis. However, no significant changes were observed in cardiovascular autonomic functions, eosinophil cationic proteins, or IL-2 soluble receptors.[34]
| Yoga and Asthma | | |
The practice of yoga in asthmatic individuals for 6 months showed a significant improvement in the proportion of hemoglobin and antioxidant SOD and a significant decrease was found in total leukocyte count and differential leukocytes count (neutrophils, eosinophils, monocytes, and lymphocytes).[35]
| Conclusion | | |
This literature suggests that yoga may be beneficial in reducing inflammation in healthy as well as in pathological conditions including arthritis, obesity, CVD, and cancer. However, studies had a smaller sample size and different forms of yoga techniques and a possible mechanism for the effect of yoga on inflammation has not been provided in detail. Thus, studies with larger sample sizes and exploring the mechanism behind the yoga effect on inflammation are required for a better understanding and clinical application.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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