Table 1.

Summary of findings on biomarkers associated with meditation practices

Immunology	Study Design	Biomarker Specimen	Purpose	Intervention	Duration (Weeks)	Population	N	Control Intervention	Outcome Conclusions
Black, 2015	RCT	Blood (PBMCs)	Test effect of mindful meditation or sleep hygiene on sleep quality in older adults	MAPs mindful awareness practices	6	Community adults; 67% female; ages 66.3 ± 7.4 years	49	Sleep hygiene education	Improved insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < 0.05 for all). Differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < 0.05).
Bower, 2015	RCT	Blood (PBMCs, plasma)	To evaluate a brief, mindfulness-based intervention to reduce stress, depression, and inflammatory activity.	MAPs mindful awareness practices	6	Breast cancer patients; 100% female; ages 46.1 (± 28.4–60 range) years	65	Waiting list: Usual care	Significant decline in pro-inflammatory gene expression from baseline to post-intervention (p = 0.009). <NF-B; > IFN-1; < IL-6 (dependent on practice dosage); CRP; sTNF-RII
Cahn, 2017	Open	Blood (PBMCs, plasma); Saliva	To test the positive effects of meditative practices on mental fitness, autonomic homeostasis and inflammatory status.	Yoga Meditation	12	Thirty-eight individuals (mean age: 34.8 years old)	38	None: Pre-post	Decrease in inflammatory processes resulting from the yoga and meditation practices, we found that the plasma level of the anti-inflammatory cytokine Interleukin-10 was increased and the pro-inflammatory cytokine Interleukin-12 was reduced after the retreat. Increases in the plasma levels of BDNF and increases in the magnitude of the cortisol awakening response (CAR) were also observed
Carlson, 2003	Open	Blood (PBMCs, plasma)	This study investigated the relationships between a mindfulness-based stress reduction meditation program for and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production.	MBSR	8	Early stage breast and prostate cancer patients	59	None: Pre-post	Decreased stress symptoms: NK cell production of IL-10 decreased
Carlson, 2007	Open	Blood (PBMCs, plasma)	Investigated the ongoing effects of participation in a mindfulness-based stress reduction (MBSR) program on quality of life (QL), symptoms of stress, mood and endocrine, immune and autonomic parameters	MBSR	8 (one year follow-up)	Early stage breast and prostate cancer patients	59	None: Pre-post	Reduction in Th1 (pro-inflammatory) cytokines. T-cell population of TNF, IFN-γ, and IL-4 decreased
Carlson, 2015	RCT	Whole blood	Test effect of mindful meditation or group therapy/stress management on telomere length i	MBSR	8	Breast cancer survivors	88	Supportive- expressive group therapy; 1-day stress management seminar	> telomere length (trend for attenuated decrease when treatment groups combined vs seminar)
Creswell, 2009	RCT	Blood (plasma)	Test effect of mindful meditation on CD4+ T lymphocyte declines in distressed HIV+ adults	MBSR	8	HIV	48	Education	>CD4+ T lymphocyte count (buffered decline vs controls)
Creswell, 2012	RCT	Blood (PBMCs, plasma)	Test effect of mindful meditation on loneliness in older adults	MBSR	8	Healthy	40	Wait List	IL-6. Decrease in log-transformed CRP between pre- and post-intervention (p = 0.08). <NF-B; < CRP (trend)
Davidson, 2003	RCT	Blood (serum) with influenza vaccine	Test effect of mindful meditation on brain and immune function	Meditation	8	Healthy	41	Wait List	> Influenza antibodies
Eda, 2013	Open	Salivary HBD-2 concentration was measured using an enzyme-linked immunosorbent assay	To determine the effect of yoga stretching on mucosal immune functions, primarily human b-defensin 2 (HBD-2)	Yoga	<1 (2 90 min sessions)	Healthy	15	None: Pre-post	HBD-2 concentration after yoga stretching (165.4 ± 127.1 pg/mL) was significantly higher than that before yoga stretching (84.1 ± 63.4 pg/mL; p \ 0.01). HBD-2 expression rate after yoga stretching (232.8 ± 192.9 pg/min) was significantly higher than that before yoga stretching (110.7 ± 96.8 pg/min; p \ 0.01)
Elsenbruch, 2005	RCT	Blood (EDTA whole stimulated)	Test effect of mindful meditation + multimodality program on neuroendocrine and immune measures in patients with ulcerative colitis	Meditation	10	Ulcerative colitis patients; 50% female; ages 42.9 ± 8.6 years	30	Wait List	Basal levels of TNF-alpha (trend) Significantly greater improvement in the SF-36 scale Mental Health and the Psychological Health Sum score compared with changes observed in the usual-care waiting control group. Patients in the intervention group showed significantly greater improvement on the IBDQ scale Bowel Symptoms compared with the control group.
Gallegos, 2013	RCT	Blood (PBMCs, plasma)	Test effects of (yoga, sitting and informal meditation, body scan) on immune function, circulating insulin-like growth factor (IGF)-1 concentrations, and positive affect	MBSR	8	100 community-dwelling older adults ≥65 years of age and English-speaking	200	Wait List	IGF-1 levels and yoga, and sitting meditation (p < 0.01). Higher post-treatment IGF-1 levels and greater improvement in positive affect from study entry to postintervention (practice effects). Sitting meditation was positively associated with post-treatment IGF-1
Infante, 2014	CT	Blood monoclonal antibodies	To evaluate the immune system in these meditation practitioners, by determining leukocytes and lymphocytes subsets	TM (TM-Sidhi is an advanced meditation technique)	< 1 (40 mins); Ongoing, LTP	Healthy: TM Practitioners	35	Selected: Not previously used any relaxation technique	TM group had higher values than the control group in CD3+CD4−CD8+ lymphocytes (P < 0.05), B lymphocytes (P < 0.01) and natural killer cells (P < 0.01), whereas CD3+CD4+CD8− lymphocytes showed low levels in meditation practitioners (P < 0.001).
Jang, 2017		Blood (PBMCs, plasma)	To assess the effects of MBT on plasma cytokines and their interactions with catecholamines	Mind-body training (MBT)	Ongoing LTP	Healthy: practicing MBT (44 months (range, 3–144 months) recruited; 18 to 36 years (mean±SD, 26±3)	142	Selected: Not previously using MBT	A significant increase in IL-10+IFN-gamma was found in females and a significant increase of IL-10 (anti-inflammatory cytokine); TNF-alpha and IL-6 (pro-inflammatory cytokines) are almost absent (≤1 ng/L) compared with controls. Positive correlations were found between IL-10 and the NE/E ratio and between IL-10 and the DA/E ratio.
Jedel, 2014	RCT	Blood (serum); stool	Test effect of mindful meditation on flare ups and quality of life in ulcerative colitis patients	MBSR	8	Ulcerative colitis patients in remission; 56% female; ages 46.0 ± 12.8 years	53	Mind–body medicine course	< CRP (among non-flared); IL-6; IL-8; > IL-10 (among flared); calprotectin
Lengacher, 2011	RCT	Plasma	Test effect of mindful meditation on immune recovery following breast cancer recovery	MBSR	6	Breast cancer patients; 100% female; ages 58.0 ± 9.0 years	82	Usual care	>T cell activation; > IFN-/IL-4 ratio; > CD4+ /CD8+ ratio (trend); CD3+, CD4+, CD8+; NK cells; B lymphocytes; > telomerase activity; telomere length. reduction in salivary IL-6 in all MBSR participants pre- to post-intervention (p = 0.002)
Li, 2005	CT	Blood (WB neutrophils)	To determine the effect of QG on genomic profile and function of neutrophils	QG: Falun Gong (FLG)	Ongoing, LTP	Healthy: practitioners of QG for 1 year (range, 1–5 years)	12	Normal healthy controls did not perform Qigong, yoga, t’ai chi, or any other type of mind–body practice	Enhanced immunity, downregulation of cellular metabolism, and alteration of apoptotic genes in favor of a rapid resolution of inflammation
Malarkey, 2013	RCT	Blood serum (chemilluminescencand electrochemiluminescence); Saliva (Cortisol)	Test effect of mindful meditation on inflammatory markers in workers with cardiovascular disease risk	Meditation	8	CVD risk	84	Education	A larger MBI-ld effect on CRP (as compared to control) occurred among participants who had a baseline BMI<30 (−2.67 mg/mL) than for those with BMI>30 (−0.18mg/mL)
Manzaneque, 2009	CT	Blood Serum (Cytokines)	To assess the effects of qigong practice on serum cytokines, mood and subjective sleep quality	QG	4	Healthy	16	None	QG enhanced psychological well-being, including sleep duration. The practice of qigong for one month did not alter serum cytokines,
Naoroibam, 2016	CT	Blood serum (flow cytometry	To study the effect of integrated yoga (IY) intervention on anxiety, depression, and CD4 counts	Integrated Yoga	4	HIV	44	Normal care: anti-retroviral therapy (ART)	Between-group comparison revealed a significant reduction in depression scores (F [1, 21] =5.64, P < 0.05) and significant increase in CD4 counts (F [1, 21] =5.35, P < 0.05) in the yoga group
Rosenkranz, 2013	RCT	IL8	Test effect of mindful meditation on physiological stress and neurogenic inflammation responses	QG	8	Healthy	49	Education	< TNF- (dependent on practice dosage)
Vera, 2016	RCT	Blood serum	To assess the acute effects of Taoist qigong practice on immune cell counts	QG	4	Healthy	43	None: Normal Routine	Statistically significant differences were found be- tween the experimental and control groups, with the experi- mental group showing higher values in the number (p = 0.006) and the percentage (p = 0.04) of B lymphocytes, as well as lower values in the percentage of NK cells (p = 0.05), as com- pared to control.
Wang, 2011	RCT	Blood serum	To test the effects of tai chi chuan (TCC) practice on immune function	TC	12	Healthy: female college students (19.3 ± 1.8 years)	144	Education	Significantly higher plasma levels of IgG (P=0.000), IgM (P=0.05) and CD4+ (P=0.032) after practice compared with their respective pre-practice levels.
Witek-Janusek (2008)	CT	Peripheral blood mononuclear cells	To evaluate the effect and feasibility of a mindfulness based stress reduction (MBSR) program on immune function, quality of life (QOL), and coping	MBSR	8	Beast Cancer (recent diagnoisis)	38	N/A	Reduction in IFN- γ production with increased IL-4, IL-6, and IL-10 production between pre- and 1-month post-intervention. In contrast, breast cancer patients in the Non-MBSR group exhibited continued reductions in NKCA and IFN-gamma production with increased IL-4, IL-6, and IL-10 production
Genetics	Study Design	Biomarker	Purpose	Intervention	Duration (weeks)	Population	N	Control Intervention	Outcome Conclusions
Alda, 2016	CT	Genomic DNA: Telomere Length	To determine if the practice of meditation is associated with longer leukocyte telomere length.	Zen	Ongoing: Zen LTP	Healthy: Zen practitioners	40	Selected: not previously meditated	The meditators group had a longer MTL (p = 0.005) and a lower percentage of short telomeres in individual cells (p = 0.007) than those in the comparison group.
Chaix, 2017	CT	DNA methylome from blood cell: Telomees	To examine whether meditation practice influences the epigenetic clock, a strong and reproducible biomarker of biological aging, which is accelerated by cumulative lifetime stress and with age-related chronic diseases	Meditation	Ongoing: LTP	LTP (> 3 years)	38	Selected: not previously meditated	A significant negative correlation between Intrinsic Epigenetic Age Acceleration (IEAA) and the number of years of regular meditation practice
Chaix, 2020	CT	peripheral blood mononuclear cells DNA methylation	To evaluated the impact of a day of intensive meditation practice (t2-t1 = 8 hours) on the methylome of peripheral blood mononuclear cells in experienced meditators	Mindfulness Based	Ongoing: LTP	LTP	34	Selected: not previously meditated	61 differentially methylated sites (DMS) were enriched in genes associated with immune cell metabolism and ageing and in binding sites for several transcription factors involved in immune response and inflammation
Chandran, 2021	RCT	Pro-inflammatory gene expression	The examine the molecular mechanisms underlying the positive impact of meditation on human wellbeing	Yoga and Lifestyle	1 (8 days)	Normal	106	COVID 19 patients and Multiple Sclerosis (MS)	220 genes directly associated with immune response, including 68 genes related to interferon (IFN) signaling were upregulated, with no significant expression changes in the inflammatory genes
Dasanayaka, 2022	CT	Plasma Telomerase Levels	To investigate if continued practice of meditation benefited quality of life, state of mindfulness, and plasma telomerase level in healthy adults	Mindfulness Based	Ongoing Midfulness: LTP	Healthy LTP	60	Selected: not previously meditated	Plasma telomerase levels were observed in skilled meditators compared to non-meditators (p = 0.002). Trait mindfulness level and plasma telomerase level showed a significant relationship with the duration of meditation practice (p = 0.046 and p = 0.011, respectively). Regression analysis indicated that trait mindfulness level (p < 0.001) significantly predicts the plasma telomerase level.
Dutcher, 2022	RCT	Pro-inflammatory gene expression	To study the immunoregulatory impact of Mindfulness meditation training	Smartphone mindfulness meditation: Headspace mindfulness training program or	4	Stressed Adults 18 to 60 (M = 34.03 years, SD = 11.07)	100	Recharge control program	Mindfulness training reduced activity of the pro-inflammatory NF-κB transcription control pathway compared to the active control.
Epel, 2016	RCT	Blood plasma, gene expression and Telomerase activity	To examine improved cellular health due to meditation while controlling for vacation effects	Meditation retreat	< 1 (6 days)	Healthy	102 Average age was 47 (s.d.=8.1, range 31–60 years)	Vacation: relaxing on-site	Regular meditators showed post-intervention differences in a gene network characterized by lower regulation of protein synthesis and viral genome activity. Day-5 follow-up t-tests showed a significant increase in telomerase activity only in the regular meditation group (P=0.004
Harkess, 2016	RCT	DNA methylation and inflammation markers	To evaluate the potential psychological benefits of yoga to a non-clinical population, and address limitations in literature (cross-sectional designs, sample sizes ≤ 20, and limited exploration of community populations) and	Yoga	8	Chronic Stress	116	Wait List	Yoga is only beneficial when practiced regularly, or that 8-weeks is not long enough to cultivate ongoing benefits.
Genetics	Study Design	Biomarker Specimen	Purpose	Intervention	Duration (Weeks)	Population	N	Control Intervention	Outcome Conclusions
Le Nguyen, 2019	RCT	Telomere Length	To probe the distinct effects on telomere length (TL) of mindfulness meditation (MM) and loving-kindness meditation (LKM)	Loving-kindness and Mindfulness meditation	12	Healthy	142	Waiting list: Usual care	The LKM and MM group showed increase in TL that were directional but not significant
Mendioroz, 2020	CT	Telomere Length and DNA methylation (DNA methylation levels, measured by the Infinium HumanMethylation450 BeadChip (Illumina) array	To examine previously described, specific subtelomeric regions in long-term meditators compared to controls		Ongoing Midfulness: LTP	LTP (10 years consistently)	17	Healthy: non-meditators	Specific subtelomeric regions containing GPR31 and SERPINB9 genes were associated with telomere length in long-term meditators with a strong statistical trend when correcting for multiple testing. Notably, age showed no association with telomere length in the group of long-term meditators.
Qu, 2013	RCT	Gene Expression and Peripheral blood mononuclear cells (PBMCs), Lymphocytes	To investigate the mechanisms of how yoga may positively affect the mind-body system	Yoga (gentle yoga postures, breathing exercises, and meditation (Sudarshan Kriya and Related Practices – SK&P)	<1 (4 sessions)	Healthy: attending a one-week yoga retreat	14	Wait list: Nature walk and relaxing music	We show that the SK&P program has a rapid and significantly greater effect on gene expression in PBMCs compared with the control regimen. These data suggest that yoga and related practices result in rapid gene expression alterations which may be the basis for their longer term cell biological and higher level health effects.
Neurology	Study Design	Biomarker	Purpose	Intervention	Duration (weeks)	Population	N	Control Intervention	Outcome Conclusions
Buchwitz, 2021	RCT	Neuropsychological test performance	To evaluate feasibility and effects of a newly developed mindfulness intervention tailored to specific needs of patients with Parkinson’s disease	Mindfulness Training	8	Parkinson’s disease	30	Wait List	Greater performance in sustained attention and language tasks over time. Additional changes included greater mindfulness as well as less sleeping problems and anxiety.
Dissanayaka, 2016	Recruited	Neuropsychological test performance	To effectiveness of a manualized group mindfulness intervention tailored to improving both motor and neuropsychiatric deficits in Parkinson’s disease	Mindfulness Training	8	Parkinson’s disease	4000	None: Pre-post	Increase in PDCRS-Subcortical scores, and an improvement in postural instability, gait, and rigidity motor symptoms
Engel, 2000	Recruited	Electromyography (EMG)	To investigate the psychological and physical effects of training of body awareness and slow stretching on persons with chronic toxic encephalopathy (CTE)	Mind-Body	8	Chronic toxic encephalopathy	8	None: Pre-post	The body–mind training resulted in an improved ability for physical and mental relaxation as indicated from the lower EMG, the higher alpha% and the decrease in state anxiety. The mean alpha% increased 52% during the training period (P,0.01), and the EMG decreased 31% (P, 0.001).
Herzog, 1990	Recruited	positron emission tomography (PET); Regional glucose metabolism	To delineate cerebral metabolic responses to external or mental stimulation. In order to examine possible changes of brain metabolism due to Yoga meditation	Yoga	Ongoing Yoga: LTP	Yoga meditative relaxation (YMR)	8	Normal control state	The ratios of frontal vs occipital rCMRGlc were significantly elevated (p < 0.05) during YMR. These altered ratios were caused by a slight increase of frontal rCMRGlc and a more pronounced reduction in primary and secondary visual centers.
Kosunen, 2016	Open	EEG	To assess the effectiveness of RelaWorld: a neuroadaptive virtual reality meditation system that combines virtual reality with neurofeedback	Virtual Reality Meditation System	Unreported (6 sessions; 2 and 2.5 hours)	Healthy: College students 20 and 48 years (M=28.7)	43		RelaWorld system elicits deeper relaxation, feeling of presence and a deeper level of meditation when compared to a similar setup without head-mounted display or neurofeedback.
Levinson, 2014	RCT	fMRI functional connectivity	To present construct validation of a behavioral measure of mindfulness, breath counting	Mindfulness BCT	4	Normal	400	Normal	Skill in breath counting associated with more meta-awareness, less mind wandering, better mood, and greater non-attachment (ie, less attentional capture by distractors formerly paired with reward).
Lim, 2018	Open	fMRI functional connectivity	To study time-varying connectivity patterns associated with naturally varying and objectively measured trait mindfulness using dynamic functional connectivity (DFC) analysis of resting-state fMRI.	Mindfulness BCT	< 1 (1 session)	Normal, Score selected: High Mindfulnes	39	Normal, Score selected: High vs.Low Mindfulness	DFC analysis of resting state fMRI data revealed that the High Mindfulness group spent significantly more time in a brain state associated with task-readiness - a state characterized by high within-network connectivity and greater anti-correlations between task-positive networks and the default-mode network (DMN).
Neurology	Study Design	Biomarker Specimen	Purpose	Intervention	Duration (Weeks)	Population	N	Control Intervention	Outcome Conclusions
Wang, 2011	Recruited	fMRI, Cerebral Blood Flow	To advance the understanding of the neural pathways of meditation by addressing the cerebral blood flow (CBF) responses associated with meditation	Meditation: “focused-based” practice and “breath-based” practice	< 1 (1 session)	LTP	10	Normal	Strong correlations between depth of meditation and neural activity in the left inferior forebrain areas including the insula, inferior frontal cortex, and temporal pole. There were persistent changes in the left anterior insula and the precentral gyrus even after meditation was stopped.
Steffen, 2015	RCT	Cardiovascular variables	To investigate the effectiveness of brief mindfulness meditation in reducing cardiovascular reactivity and recovery during a laboratory stressor	Mindfulness Training	< 1 (1 session)	Normal: laboratory stressor	62	Wait List: meditation-naïve participants	Mindfulness participants showed lower systolic blood pressure following the mindfulness exercise and decreased systolic and diastolic blood pressure reactivity during a speeded math stressor.
Wong, 2018	Recruited	EEG and psychomotor vigilance task (PVT)	Test the effectiveness of Mindfulness to improve general wellbeing through developing enhanced control over metacognitive processes	Mindfulness Training	8	Nurses, (mean age = 30.3, SD = 8.52	32	None	Following the MBT program, we observed changes in alpha power across all scalp regions during meditation that were correlated with attendance.
Zeidan, 2010	RCT	Neuropsychological test performance	To examine the effects of brief mindfulness meditation training on cognition	Mindfulness Based	4 sessions	Healthy: no prior meditation experience; ave age 20 years	63	Healthy: College Students	Brief mindfulness training significantly improved visuo-spatial processing, working memory, and executive functioning