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The effects of mind-body therapies on the immune system: meta-analysis

Significance Statement

In this first comprehensive review, we analyzed the beneficial effects of mind-body therapies on the immune system. Classification of the immune outcomes was guided by functional genomics studies with two broad gene expression programs by different types of microbial stimulus, namely inflammation and anti-viral immune responses. Our meta-analysis consisted of 34 randomized trials with a total of 2219 participants, treated for 7 to 16 weeks of mind-body therapies. The results demonstrated that mind-body therapies play a role in regulating the immune system by reducing markers of inflammation and influencing virus-specific cell-mediated immune responses and bolster anti-viral antibodies in response to vaccinations.

The science and clinical applications of this research have far-reaching implications. It is now well-established that immune modulation by psychosocial stressors delay wound healing, lower response to vaccination, increase risk of infection and risk of inflammation-associated disease.

Our results suggest that the multi-dimensional benefits of mind-body therapies buffer these immune alterations through heightened states of relaxation, stress reduction, improved mood, and moderate physical activity. Mind-body therapies such as meditation, Yoga, and Tai Chi not only can have beneficial effects on psychological, behavioral and health functioning symptoms improvements, but also are positively associated with decreased C-reactive protein levels in various patient populations with type 2 diabetes, cancer, heart failure, and the elderly with depression and other cardiovascular disease risk factors. These diseases consist of a complex interplay between biological and psychological aspects that impair anti-viral immune responses and activate innate immunity or markers of inflammation. Indeed, our work is the commencement of the elucidation of a complex and bidirectional interplay between the central nervous system and the immune system.

Activation of inflammatory gene expression programs lead to increases in cellular markers of inflammation such as the pro-inflammatory cytokines IL-6 and C-reactive protein. Evidently, Tai Chi and mindfulness-based meditation can reduce proinflammatory response gene profiles, whereas a yogic meditation appears to decrease NF-kB-related transcription of pro-inflammatory cytokines and decrease IRF1-related transcription of innate antiviral response genes observed in healthy individuals confronting a significant life stressor.
Thus, the immunomodulatory effects of mind-body therapies and clinical implications provide insight into evidence-based molecular mechanistic pathways to understand the mind-body therapies on immunity and they confer. Development of better lifestyle-modifying strategies could slow the progression of disease and its comorbidities, decrease morbidity, and the numerous health benefits. This review supports the therapeutic concept thus establishing a new paradigm for understanding health and treating chronic illness.


Dr. Wang is supported by the National Institutes of Health (K24 AT007323, R01- AT006367, R01-AT005521, R01-AT006367A1 and Tufts CTSI UL1TR025752). Dr. Irwin is supported by the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience, and by the National Institutes of Health (R01-AG034588; R01-AG026364; R01 CA160245-01; R01-CA119159; R01 HL095799; R01 DA032922-01; P30-AG028748; and UCLA CTSI UL1TR000124). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. The investigators are solely responsible for the content of the manuscript and the decision to submit for publication. The funders had no role in study design, data collection and
analysis, decision to publish, or preparation of the manuscript.

Corresponding author:
Chenchen Wang, MD, MSc
Center for Complementary and Integrative Medicine
Division of Rheumatology
Tufts Medical Center, Box 406, Tufts University School of Medicine
Boston, MA 02111
Phone: 617-636-3251
Fax: 617-636-1542
Email: [email protected]


Journal Reference

Morgan N1, Irwin MR2, Chung M3, Wang C1.

PLoS One. 2014 Jul 2;9(7):e100903.

1Center for Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States of America.and

2Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, California, United States of America.and

3Nutrition/Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America.




Psychological and health-restorative benefits of mind-body therapies have been investigated, but their impact on the immune system remain less defined.


To conduct the first comprehensive review of available controlled trial evidence to evaluate the effects of mind-body therapies on theimmune system, focusing on markers of inflammation and anti-viral related immune responses.


Data sources included MEDLINE, CINAHL, SPORTDiscus, and PsycINFO through September 1, 2013. Randomized controlled trials published in English evaluating at least four weeks of Tai Chi, Qi Gong, meditation, or Yoga that reported immune outcome measures were selected. Studies were synthesized separately by inflammatory (n = 18), anti-viral related immunity (n = 7), and enumerative (n = 14) outcomes measures. We performed random-effects meta-analyses using standardized mean difference when appropriate.


Thirty-four studies published in 39 articles (total 2, 219 participants) met inclusion criteria. For inflammatory measures, after 7 to 16 weeks of mind-body intervention, there was a moderate effect on reduction of C-reactive protein (effect size [ES], 0.58; 95% confidence interval [CI], 0.04 to 1.12), a small but not statistically significant reduction of interleukin-6 (ES, 0.35; 95% CI, -0.04 to 0.75), and negligible effect on tumor necrosis factor-{Alpha} (ES, 0.21; 95% CI, -0.15 to 0.58). For anti-viral related immune and enumerative measures, there were negligible effects on CD4 counts (ES, 0.15; 95% CI, -0.04 to 0.34) and natural killer cell counts (ES, 0.12, 95% CI -0.21 to 0.45). Some evidence indicated mind-body therapies increase immune responses to vaccination.


Mind-body therapies reduce markers of inflammation and influence virus-specific immune responses to vaccination despite minimal evidence suggesting effects on resting anti-viral or enumerative measures. These immunomodulatory effects, albeit incomplete, warrant further methodologically rigorous studies to determine the clinical implications of these findings for inflammatory and infectious disease outcomes.

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