Invited ReviewMind–body therapies and control of inflammatory biology: A descriptive review
Introduction
Mind–body therapies, or MBTs, have been broadly defined as a group of therapies that emphasize use of the brain in conjunction with the body to assist the healing process (Spencer and Jacobs, 2003). These therapies, the majority of which are based on ancient practices and traditions, are believed to have beneficial effects on mental and physical health and are widely used to manage symptoms and improve well-being. Indeed, in a nationwide survey of community-dwelling adults in the US conducted in 2007, 19% reported that they had used at least one mind–body therapy in the past year, and rates are even higher among clinical populations (Barnes et al., 2008). Over the past two decades, the efficacy of these approaches has been subjected to empirical scrutiny through randomized controlled trials conducted in clinical and non-clinical populations. Meta-analyses of these trials suggest that MBTs are effective in reducing symptoms and improving quality of life and certain functional outcomes (Bussing et al., 2012, Goyal et al., 2014, Wang et al., 2004).
Alterations in inflammatory processes are thought to play a role in many of the symptoms and conditions that are responsive to MBTs, including fatigue, depression, and pain (Irwin and Cole, 2011). Given the importance of inflammation on these patient-reported outcomes, a growing number of trials have evaluated effects of MBTs on markers of inflammation. The goal of this review is to qualitatively evaluate the evidence that MBTs lead to changes in these markers, and to discuss potential mechanisms and issues in this emerging area of research. We include results of randomized controlled trials that assessed inflammatory cytokine activity at multiple levels, including circulating, cellular, and genomic markers of inflammation.
We focus here on four types of MBTs that have received considerable research attention and are widely available to clinical and community populations: Tai Chi, Qigong, yoga, and meditation. Tai Chi and Qigong are practices from traditional Chinese medicine that combine specific movements or postures, coordinated breathing, and mental focus. Yoga has its origins in ancient Indian philosophy; as practiced in the West, it typically includes physical postures, breathing, and meditation or relaxation, though there is considerable variability across different schools of yoga and specific interventions. Meditation refers to a broad range of practices that involve training the mind, typically to focus attention. In particular, mindfulness meditation teaches individuals to bring attention to present moment experiences with openness, curiosity, and non-judgment.
To identify studies for inclusion in this qualitative review, we searched MEDLINE (from 1946), through November 1, 2014. Searches were limited to human studies and the English language. We searched using the following terms: mind–body therapies, tai chi, qigong, meditation, mindfulness, or yoga; and inflammation, cytokines, or proinflammatory. In addition, we screened the reference lists of selected reviews and primary articles for additional publications.
Section snippets
CRP
The most common inflammatory marker assessed in the MBT trials reviewed here is C reactive protein (CRP), a well-established marker of inflammatory activity. We identified 14 RCTs that reported effects of a MBT on CRP, described in Table 1. The majority of these trials evaluated Tai Chi or Qigong (n = 7), with additional studies of yoga (n = 3) and meditation (n = 4). Various control conditions were used including health education, usual care or wait-list, aerobic exercise, and cognitive behavioral
Effects of MBTs on cellular markers of inflammation
Systemic changes in circulating markers of inflammation might be due to effects of MBTs on the release of cytokines such as IL-6 from non-immune sources such as adipose tissue. To evaluate whether mind–body therapies have specific effects on immune cells, which might account for decreases in circulating markers of inflammation, various cellular assays have been used to determine changes in stimulated production of IL-6, TNF, and IL-1 before and after administration of Tai Chi (n = 3), yoga (n = 1),
Effects of MBTs on gene expression inflammatory pathways
As demonstrated in several studies in the growing field of social genomics, significant life adversity is associated with alterations in gene transcriptional programs expressed under basal conditions in circulating immune cells (Cole, 2014). Indeed, genome wide transcriptional profiling of leukocytes from individuals experiencing a range of life adversities (e.g., bereavement, loneliness, low socioeconomic status) has shown a common pattern of increased expression of proinflammatory genes,
Summary of results
Over the past decade investigators have become increasingly interested in the impact of MBTs on markers of inflammation. We reviewed a total of 26 trials that examined effects of Tai Chi, Qigong, meditation, and yoga interventions on inflammatory outcomes. The majority of studies (n = 19) focused on circulating markers, particularly CRP. We found mixed evidence that the MBTs evaluated in these trials led to alterations in circulating concentrations of CRP, with half of the studies showing
Mechanisms
What are the mechanisms through which these diverse approaches might lead to changes in inflammation, particularly changes in cellular and genomic markers? A number of conceptual models have been proposed to explain the effects of MBTs on a broad range of outcomes (Creswell and Lindsay, 2014, Gard et al., 2014, Holzel et al., 2011, Taylor et al., 2010), all of which emphasize the important of self-regulation as a central goal of MBTs. We draw from these models, and from the empirical
Active ingredients
Mind–body treatments include multiple components, including breathing, focused attention, meditation, and physical movements. The different MBTs place different emphasis on these components. For example, mindfulness and other meditative practices focus on conscious and intentional mental activities. Physical movements, if they are included as part of the intervention, are typically performed in the service of cultivating awareness of one’s body and its interaction with the environment. On the
Conclusions
There is a growing literature examining effects of MBTs on inflammatory processes, reflecting increasing use of these approaches and recognition of the importance of inflammation for physical and mental health. Results from this review suggest that effects of these approaches may initially be reflected in alterations in gene expression profiles and indicators of proinflammatory signaling; indeed, alterations in inflammatory gene expression were identified even after relatively short (6 week)
Acknowledgments
Supported in part by R01 CA160427 and funding from the Breast Cancer Research Foundation to JEB; by R01 CA160245, R01 AG034588, R01 AG026364, R01 CA119159, R01 HL095799, R01 DA032922, and P30 AG028748 to MRI; and by UCLA CTSI UL1TR000124, the Cousins Center for Psychoneuroimmunology, and P30-AG028748 UCLA Claude D. Pepper Older Americans Independence Center.
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