Table 2.

Disease or health status, outcome measures and findings of the included studies

First Author	Type of diseases/Subjects involved	Outcome measures	Findings
Agarwal RP et al.	Breast cancer, Colorectal cancer, Leukemia, Lymphoma, Lung cancer, Pediatric cancer (unspecified), Prostate cancer, Hematopoietic stem cell transplant patients.	Telomere length Telomerase activity T-cell subsets Signalling pathways of inflammatory transcription genes Cytokines Nuclear factor kappa B, and cAMP response element binding protein	Yoga when integrated as adjuvant to conventional therapy proves effective
Bhargav H et al.	Cancer	Nuclear factor kappa-B (NFκB)	Brief daily yogic meditation may reverse the pattern of increased NFκB-related transcription of pro-inflammatory cytokines in leukocytes, and thereby reducing the hypoxia-inducible factor-1 (HIF-1), on which cancer stem cells (CSCs) are dependent for survival, growth, and maintenance.
Balasubramanian S et al.	Not mentioned (possibly healthy)	22 salivary proteins associated with immune response, stress and cancer.	Yogic breathing (YB) could alter salivary biomarkers associated with cancer, inflammation, and stress.
Black D S et al.	Family dementia caregivers	Gene Expression Profiling and Analysis	The results portraits that Kirtan Kriya Meditation (KKM) or Relaxing Music (RM) listening KKM treatment found to differentially express. 68 genes (19 up-regulated (immunoglobulin-related transcripts), 49 down-regulated (transcripts included pro-inflammatory cytokines and activation-related immediate-early genes) Promoter-based bioinformatic analysis implicated reduced NF-κB signalling and Increased activity of IRF1 in structuring those effects.
Bower J E et al.	Breast cancer and Heart failure (age=32-88 yrs)	Tissue necrotizing factor (TNF) Soluble IL-2 receptor (sIL-2R) C-reactive protein (CRP) Interleukin-6 (IL-6) Tissue necrotizing factor receptor II (TNFRII) IL-1 receptor antagonist (IL-1Ra)	Alterations in inflammatory gene expression were identified even after relatively short (6 week) interventions Reduced proinflammatory gene expression in the monocyte population. Change in production of proinflammatory cytokines observed as early as 8 weeks after intervention onset. TNFRII − (stable in yoga vs. increase in controls)
Bower JE et al.	stage 0-II breast cancer survivors	Nuclear factor kappa-B (NFκB) Anti-inflammatory glucocorticoid receptor Activity of cAMP response element-binding protein (CREB) sTNF-RII CRP IL-6 Diurnal cortisol	Reduced activity of the pro-inflammatory transcription factor NF-κB Increased activity of the anti-inflammatory glucocorticoid receptor Reduced activity of CREB family transcription factors Plasma levels of sTNF-RII remained stable in the yoga group, whereas levels of this marker increased in the health education group Non-significant trend was observed for the interleukin 1 receptor antagonist No significant changes in CRP, IL-6, or diurnal cortisol measures were observed
Cahn B R et al.	Healthy individuals	Psychometric measures, brain-derived neurotrophic factor (BDNF) Circadian salivary cortisol levels Pro- and anti-inflammatory cytokines.	Positively impact BDNF signaling, CAR, and immunological markers as well as improve subjective well-being. Significant improvements in both HPA axis functioning as exemplified by the CAR as well as neuroimmunologic functioning Increased BDNF levels and Alterations in cytokines were due to the intensive meditation practice involved in this retreat. Plasma level of the anti-inflammatory cytokine Interleukin-10 was increased and the pro-inflammatory cytokine Interleukin-12 was reduced after the retreat. Plasma levels of other pro-inflammatory cytokines, including Interferon Gamma (IFN-γ), Tumor Necrosis Factor (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were increased after the retreat.
Chanta A et al.	Allergic rhinitis (mean age=34.8)	Body weight Body fat BMIResting heart rate BP In addition, pre- and post-study trial rhinitis symptoms, PNIF Nasal blood flow Nasal secretions for cytokine analysis were evaluated	Hatha yoga training had beneficial effects in allergic rhinitis by improved clinical allergic rhinitis and cytokine profiles. The YOG group had increased peak nasal inspiratory flow (PNIF Significantly decreased rhinitis symptoms and nasal blood flow (NBF) compared to pre-test. Significantly higher nasal secretion of interleukin (IL)-2 than the control group.
Chen N et al.	healthy, lean, and female Chinese subjects. (Age=18-45)	Primary outcome measure: plasma insulin level Secondary outcomes (1) other clinical biomarkers (i.e., glucose, TG, HDL-cholesterol, LDL-cholesterol, and total cholesterol); (2) Endothelial microparticles (EMPs); and (3) plasma cytokines and cytokines from culture whole blood ex vivo.	Improvement in markers related to metabolic syndrome, including reduced fasting circulating insulin, cholesterol and LDL-cholesterol levels, and circulating CD31+/CD42b−EMPs Reduced Toll-like receptor 2 (TLR2, a type of EMP) responses from whole blood culture.
Chen P J et al.	Pregnant women of 16-36 weeks of gestation	Salivary cortisol and immunoglobulin A levels	The intervention group had lower salivary cortisol and higher immunoglobulin Prenatal yoga significantly reduced pregnant women’s stress and enhanced their immune function.
Danhauer S C et al.	Cancer	Mobility Flexibility Physical activity Mental, physical Spiritual health	The research has demonstrated that yoga interventions can improve psychological distress, QOL, physical function, and some biological outcomes among adults receiving cancer treatment.
Danhauer SC et al.	Any cancer among adults and children	Anxiety, depression and stress QoL Sleep and fatigue	Improvement in psychological outputs (anxiety, depression, stress) Partial studies suggest improvement in QoL Partial supports that yoga ameliorates sleep and fatigue
Eda N et al.	Elderly individuals aged 60.4±10.4 years	Secretory Immunoglobulin A (SIgA, a mucosal first line immunity) Cortisol Testosterone Profile of Mood States (POMS) score- a measure of stress	The SIgA concentration and secretion rate were significantly higher after yoga. The cortisol concentration and secretion rate both were lower whereas testosterone secretion rate was higher after yoga. Yoga stretching reduces stress and enhances mucosal immune function in elderly women. The participants’ mental state did not change significantly after rest. The POMS significantly lower after yoga stretching than before.
Falkenberg R I et al.	Heart failure patients, Inflammatory bowel disease Risk of chronic inflammation Breast cancer	IL-1- beta, IL-4, IL-6, IL-8, IL-10, IL-12, sIL-2r TNF-alpha and soluble TNF-receptor II (sTNFrII) CRP IFN-gamma Circulating endothelial microparticles (EMPs) NK-kappaB cAMP responsive element binding (CREB)- a nuclear protein Glucocorticoid receptor (GR)	Yoga can downregulate pro-inflammatory parameters. There was significantly higher IgA levels in yoga group compared to controls Decrease in IFN-gamma during examination stress significantly less pronounced in yoga group compared to controls; No significant between group differences immediately postintervention, IgA, IL-4, IL-8, TNF-alpha, and Sil2r Significant increase in CD4+cell count in yoga group compared to controls Significant decrease in IL-1-beta, IL-6, IL-10, IL12, INF-gamma and CRP in yoga group compared to controls
Gallegos A M et al.	Community-dwelling older adults of 50-70 years age group	Interleukin (IL)-6 and IGF-1 Keyhole limpet hemocyanin (KLH) Immunoglobulin (Ig) M and IgG) KLH-specific antibody responses were measured	Yoga Increased IGF-1 and reduced IgG response. Increased IGF-1 Informal meditation-Least evidence for unique effects Body scan-Reduced IgM and IgG response
Gopalan B P et al.	HIV positive patients of 17-78 year age group	Measured in blood plasma Cytokines: TNF-α, IL-6, IFNγ, and IL-10) and Immune activation (sCD163 and sCD14) Plasma lipopolysaccharide (LPS) concentration CD3+, CD8+, CD38 expression; and Gene Expression Profile	Reduction in levels of sCD14, tumor necrosis factor alpha, Interferon gamma, and interleukin-10 was observed among exercisers as compared with non-exercisers at Y2. CD38+expressing CD4+T cells were found to be lower among exercisers at Y2. The differences in levels of interleukin-6, sCD163, lipopolysaccharides, interleukin-2, and brain-derived neurotrophic factor were not significantly different among the 2 groups.
Harkess KN et al.	Adults with clinically confirmed Multiple sclerosis Age group above 65	Cytokines (IL-6 and TNF) High-sensitivity CRP DNA methylation patterns Protein and DNA methylation inflammatory candidate markers Stress measure	The Friedman test indicated that there was no evidence of a longitudinal difference in IL-6 or TNF across the three time points. A non-clinical chronically stressed community population, practicing a minimum of a once-weekly, hour-long yoga class, is associated with differential methylation patterns despite the waitlist control group reporting similar energy expenditure to the yoga group.
Heine M et al.	Fatigue in Multiple Sclerosis Age 8 to 16 years	Primary: [1] Fatigue, mood status, ambulatory functions [2] Berg Balance Scale (BBS) six minute walk test (6MWT), Multiple Sclerosis Impact Scale 29 version 2 (MSIS), and Modified Fatigue Impact Scale (MFIS) and Secondary - MSIS 29v2 psychological component, the Modified Fatigue Impact Scale (MFIS) and the 6-Minute Walk Test (6MWT). [3] Primary-cognitive measures focused on attention. Secondary: [1] Physiologic measures of alertness, Profile of Mood States, State-Trait Anxiety Inventory [2] Multi-Dimensional Fatigue Inventory (MFI), and Short Form (SF)-36 health-related quality of life.	Significant improvement for all 3 interventions for primary outcome. The subjects with MS participating in either a 6-month yoga class or exercise class showed significant improvement in measures of fatigue compared to a waiting-list control group. No relative improvement of cognitive function or mood was observed in either of the intervention groups. No improvement in spasticity after sports climbing and yoga intervention. A 17% increase was observed in selective attention performance after yoga intervention. Sports climbing reduced fatigue while yoga had no effect.
Huberty J et al.	Myeloproliferative neoplasms (MPNs) Age group of 18 years and above	CBC, TNF-a, IL-6) and to provide saliva samples (i.e., salivary cortisol)
Khosravi N et al.		Cytokines	Exercise training reduced pro-inflammatory markers, specifically CRP and TNF. Prostate and breast cancer showed the greatest decrease in pro-inflammatory markers. Combination training was the most effective mode for reducing inflammation Exercise had minimal effects on anti-inflammatory cytokines and immune outcomes.
Kiecolt-Glaser J K et al.	Cancer	Lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale.	The study highlights that immediately post-treatment, fatigue was not lower but vitality was higher in the yoga group compared with the control group. At 3 months of post-treatment, fatigue was lower in the yoga group, vitality was higher, and IL-6, TNF-α, and IL-1β were lower for yoga participants compared with the control group. At 3 months of post-treatment, increasing yoga practice also led to a decrease in IL-6 and IL-1β production but not in TNF-α production.
Lambert B S et al.	Healthy Adults 40±11 yr	VO2, peak VO2 and %VO2 max kcal expenditure Heart rate and respiratory rate upper body range of motion (ROM) Serum cytokine responses to acute exercise.	RER was observed to be reduced during the HY session compared to the RTY session. Significant reductions in carbohydrate oxidation and an increase in fat oxidation was observed during HY compared to RTY. No significant changes were observed for pre-to-post session measures of blood pressure for either the HY or RTY sessions. Pre- and post-exercise Range of Motion measurements show elicited similar acute increases in upper body ROM measures of which were primarily observed in the shoulder. A small increase in elbow extension was observed following the HY but not the RTY condition. For hip ROM, both the HY and RTY conditions yielded increases in ROM for hip flexion and abduction with no change detected in internal or external rotation. HY elicited a significantly greater increase in hip abduction ( Effect Size d=0.8, VL) and trended towards a greater increase in ROM for hip flexion. No post-exercise changes in serum TNF-α or IL-10 were observed under either condition. Serum IL-6 was significantly following HY only compared to the RTY group where no changes were observed.
Lim S A et al.	Healthy Age group of 27-76 yrs	The oxidative stress/antioxidant components, immune-related cytokines, and stress hormones were evaluated in serum or plasma.	The serum levels of nitric oxide, F2-isoprostane, and lipid peroxide were significantly decreased by yoga practice, Serum total glutathione (GSH) contents, activities of GSH-peroxidase, and GSH-s-transferase were remarkably increased in yoga practiced group when compared with the control group. Yoga practice also significantly increased immune-related cytokines, such as interleukin-12, and interferon-γ, in serum and plasma levels of serotonin compared with the control group. Significantly reduced the plasma levels of adrenalin
Morgan N et al.	Age=29-51	CRP, IL-6, TNF-a, CD4 Lymphocytes, Salivary IgA, Total blood count	Stratified by clinical populations, the subgroup meta-analysis showed no significant difference in the pooled effect on IL-6 between studies in healthy people and those in the population with disease conditions. Meta-analysis of 3 studies showed a negligible to small effect on TNF-a. Meta-analysis of 7 studies showed a negligible to small effect on the number of CD4+* T lymphocytes. The study also reported a significant increase in salivary IgA compared to the control, and another study reported no significant difference in salivary IgA between groups, Decrease in neutrophils and increase in lymphocytes compared to the control group.
Nagarathna R et al.	Coronavirus disease	PEFR	There was a significant improvement in their PEFR by >20% within 30 min of the practice with successful relief from the episode. The patients reported reduction in panic and anxiety element, cutting the vicious cycle of aggravating bronchial obstruction.
Naoroibam R et al.	HIV	Anxiety, depression, and CD4 counts	Between-group comparison revealed a significant reduction in depression scores and significant increase in CD4 counts in the yoga group as compared to the control.
Nugent N R et al.	Depression (age up to 60 yrs)	Inflammatory markers (IL-6, CRP, and TNFα), depression	IL-6, an inflammatory marker was observed to decrease over time in persistently depressed participants in the hatha yoga condition relative to health education control participants.
Pallavi P.	depression	Psychometric scores, cytokine and neurotrophin levels	The results support the beneficial effects of the yoga therapy on adolescent depression patients as an adjunct to standard care as reflected in changes in psychometric scores, cytokine and neurotrophin levels.
Viswanathan V et al.	Type 2 Diabetes Mellitus	IL6, HsCRP, Inflammatory cytokine, Adiponectin, leptin levels	There was a marked reduction in leptin and IL-6 levels in the test group Adiponectin levels increased significantly in the test group compared to control. hsCRP levels showed slight reduction in the test group but did not reach statistical significance. Twelve weeks of Yoga practice had a positive impact on inflammatory cytokine response among subjects with T2DM.
Pullen P R et al.	Heart Failure Age group of 13-18 yrs	Peak exertion, flexibility, interleukin-6 (IL-6), C-reactive protein (CRP), and extracellular superoxide dismutase (EC-SOD)	Significant changes were observed in the YG, compared with those in the CG, for flexibility, treadmill time, VO2 peak, and the biomarkers (IL-6; CRP; and EC-SOD). Within the YG, pre-test to post-test scores for the total and physical subscales of the MLwHFQ were improved. Yoga therapy offered additional benefits to the standard medical care of predominantly AA HF patients by improving cardiovascular endurance, QoL, inflammatory markers, and flexibility.
Rajbhoj P H et al.	Industrial workers (Age=30-58 yrs)	Pro-inflammatory cytokine IL-1β and anti-inflammatory cytokine IL-10 were evaluated	The result of within group comparison revealed that the yoga group showed a significant decrease in IL-1 β while significant increase in IL-10 No change was observed in control group. Further, the results between the groups The yoga group had significantly lower level of IL-1 β and increase in IL-10 as compared to control group.
Rao RM et al.	stage II and III breast cancer	Serum immunoglobulins- IgG, IgA and IgM levels (g/L) Depression, anxiety and stress T lymphocyte subsets (CD4%, CD8% and natural killer (NK) cell % counts)	The results suggest possible benefits for yoga in reducing postoperative distress and preventing immune suppression following surgery. The results suggest a significant decrease in the state and trait of anxiety, depression, symptom severity, distress and improvement in quality of life in the yoga group as compared to the controls. There was also a significantly lesser decrease in CD 56% and lower levels of serum IgA in the yoga group as compared to controls following surgery.
Rao R et al.	HIV	Cytokines	The results suggest benefit with yoga in reducing psychological distress and improving quality of life in HIV seropositive patients.
Uebelacker L A et al.	Patients with elevated depression symptoms and on antidepressant medication	Primary outcome was depression symptom at 10 weeks Secondary outcomes included the assessment at 3 and 6 months Of depression symptoms, social and role functioning, general health perceptions, pain, and physical functioning.	At 10 weeks, there was no statistically significant difference between groups in depression symptoms (b = -0.82, s.e. = 0.88, P=0.36) At 6 months, the yoga participants had lower levels of depression than HLW participants (b = -1.38, s.e. = 0.57, P=0.02) After 6 months, 51% of yoga participants demonstrated a response (≥50% reduction in depression symptoms) compared with 31% of HLW participants (odds ratio=2.31; P=0.04) Yoga participants showed significantly better social and role functioning and general health perceptions over time.
Rao R M et al.	Metastatic Breast Cancer Patients (age=49.2±9.6 years)	Diurnal cortisol, and natural killer (NK) cell counts	There was a significant decrease in scales of symptom distress, sleep parameters, and improvement in quality of sleep and Insomnia Rating Scale sleep score following intervention. There was a decrease in morning waking cortisol in yoga group alone following intervention. A significant improvement in NK cell percent following intervention in yoga group compared to control group.
Rathore M et al.	Telomere stability (30-70 yrs)	Most studies measure telomere length in peripheral blood mononuclear cells (PBMCs) by quantitative polymerase chain reaction. In this method, the average telomere length is estimated by comparing the amount of amplification product of telomere repeats (T) to that of a single-copy gene (S).	The results highlight the positive effects of yoga intervention on telomere length
Dada R et al.	fathers of retinoblastoma (RB) affected children	Semen samples were taken, Semen parameters, ROS, DNA extraction, 8OHdG and DFI	Levels of ROS were significantly reduced in tobacco users as well as in alcoholics after intervention. DFI reduced significantly after 6 months of yoga and meditation practice in all groups. The levels of oxidative DNA damage marker 8-OHdG were reduced significantly after 3 months and 6 months of practice. The results suggest that OS and ODD DNA may contribute to the development of childhood cancer. Increased MT DNA mutations and aberrant repair of MT and nuclear DNA due to highly truncated DNA repair mechanisms all contribute to sperm genome hypermutability and persistent oxidative DNA damage.
Santino T A et al.	Adults with Asthma	Primary - Quality of life. Secondary - asthma symptoms, hyperventilation symptoms and some lung function variables.	QoL improved favoring breathing exercise at 3 months and at 6 months, AQLQ showed 0.5 unit improvement with 1.5 OR.
Shete S U et al.	Adults of average health exposed to occupational hazards demonstrated	Serum IL-6, TNF-α, and hs-CRP, erum cholesterol, triglyceride, and HDL, LDL, VLDL	A yoga-based lifestyle intervention seems to be a highly promising as an alternative therapy. The results of within group comparison revealed highly significant changes in cholesterol, high-density lipoprotein, low-density lipoprotein (LDL), hs-CRP, IL-6, and TNF-α in experimental group. Comparison between experimental and control group revealed significant changes in cholesterol, LDL, IL-6, TNF-α, and hs-CRP .
Twal W O et al.	Age=30-58 yrs	Cytokines (IL-1β, IL-1RA, IL-6, IL-8, IL-10, IL-17, IP-10, MCP-1, MIP-1b, and TNF-alpha)	The levels of interleukin (IL)-1β, IL-8, and monocyte chemotactic protein -1 (MCP-1) were significantly reduced in YB group when compared to AC group. The level of reduction of IL-8 was significant at all time points tested, whereas IL-1β showed reduction at 15 and 20 min time points, and MCP-1 level was marginally different at 5-20 min. There were no significant differences between YB and AC groups in the salivary levels of IL-1RA, IL-6, IL-10, IL-17, IP-10, MIP-1b, and TNF-α.
Ye X et al.	Rheumatoid arthritis (RA) Age=18 and above	Pain Physical function, as measured using Health Assessment Questionnaires-Disability Index (HAQ-DI) Disease activity, as measured using Tender joints or Swollen joints count, Disease Activity Score 28 (DAS-28) Inflammatory cytokines, as measured using C-reactive Protein (CRP), Erythrocyte sedimentation rate (ESR), Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α). The minor outcome included: • Grip Strength.	Yoga may be beneficial for improving physical function, disease activity, and grip strength in patients with RA. No significant effect in improving pain, tender joints, swollen joints count, and inflammatory cytokines in patients suffering from RA.
Gunjiganvi M et al.	Chest injury patient	Primary outcomes: pulmonary function tests (PFT) at 4 weeks of discharge Secondary outcomes: changes in quality of life (QoL), respiratory muscle strength and endurance, chest wall mobility, and levels of cytokines at 4 weeks	Significant improvements in PFT in the Yogatherapy group compared with physiotherapy; with an increase in forced vital capacity (P=0.02) and forced expiratory volume (P=0.01) Significant improvement in physical component of QoL, respiratory muscle endurance (P=0.003) and axillary cirtometry (P=0.009) in the Yogatherapy group No statistically significant difference in the trends of cytokine markers
Zhang D et al.	Patients and normal participants with stress Patients with cancer Effects on physical health, e.g., respiratory health (COPD, asthma), Anxiety and depression	Respiratory: FEV1 Cancer: CRF score Stress: effect size (Hedge’s g) on cortisol level Anxiety and depression: effect size, SMD	(FEV1) (3 months: MD=0.1 L, 95% CI: 0.02-0.18; 6 months: MD=0.18 L, 95% CI: 0.1-0.26); Both insignificant; limited effects (needs further investigation) Significant change in CRF score; SMD = -0.51, 95%CI [−0.81-0.20] Stress: Overall effect of cortisol among healthy participants; moderately low (g=0.41; P=0.025) Stress: Overall effect of cortisol among the participants in symptomatic stress: moderate (g=0.42, 95% CI: 0.27-0.57) Anxiety and depression; small to medium effects on both anxiety (SMD=0.39; CI: 0.22, 0.56; PI: 0.07, 0.70; P<0.001, I2=18.90%) and depression (SMD=0.41; CI: 0.19, 0.64; PI: −0.05, 0.88; P<0.001; I2=33.43%)
Jiang T et al.	Peoples living with human immunodeficiency virus (HIV)	CD4-T Cell counts stress, depression, and anxiety symptoms QoL	Improvement of CD4 T-cell counts (Cohen’s d=0.214, P=0.027) and maintained (0.427, P=0.049) Reduction of stress, depression, and anxiety symptoms (0.422, P<0.001; 0.506, P<0.001, and 0.709, P<0.001, respectively) Improved quality of life (0.67, P<0.001)
Yang H J et al.	Experienced meditators vs. novice meditators; PTSD patients, Women reporting psychological distress	Changes in pro-inflammatory gene expressions Changes in epigenetic marks and differentially methylated areas (DMRs)	MBI ( yoga and others e.g., tai chi, qigong, meditation) significantly reduced the CRP level, whereas IL-6 and TNF-alpha levels were not significantly altered It has been reported that yoga and mindfulness practice reduce the expression of pro-inflammatory genes in the blood cells Possibly decrease in methylation of the TNF-alpha gene promoter, an inflammation factor Positive correlation between methylation level of GPR31 and telomere length in meditator Negative correlation between methylation level of SERPINB9 and telomere length in meditator Negative correlation between methylation level of the inter-genic CpG island within the sub-telomeric region of chromosome 4 Short arm and telomere length in meditator No correlation between age and telomere length in meditators