impact of yoga and meditation on cellular aging in

Research ArticleImpact of Yoga and Meditation on Cellular Aging inApparently Healthy Individuals A Prospective Open-LabelSingle-Arm Exploratory Study

Madhuri Tolahunase1 Rajesh Sagar2 and Rima Dada1

1Lab for Molecular Reproduction and Genetics Department of Anatomy All India Institute of Medical Sciences (AIIMS)New Delhi India2Department of Psychiatry All India Institute of Medical Sciences (AIIMS) New Delhi India

Correspondence should be addressed to Rima Dada rima dadarediffmailcom

Received 22 September 2016 Revised 17 December 2016 Accepted 22 December 2016 Published 16 January 2017

Academic Editor Delminda Neves

Copyright copy 2017 Madhuri Tolahunase et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

This study was designed to explore the impact of Yoga and Meditation based lifestyle intervention (YMLI) on cellular aging inapparently healthy individuals During this 12-week prospective open-label single arm exploratory study 96 apparently healthyindividuals were enrolled to receive YMLI The primary endpoints were assessment of the change in levels of cardinal biomarkersof cellular aging in blood from baseline to week 12 which included DNA damage marker 8-hydroxy-21015840-deoxyguanosine (8-OH2dG) oxidative stress markers reactive oxygen species (ROS) and total antioxidant capacity (TAC) and telomere attritionmarkers telomere length and telomerase activity The secondary endpoints were assessment of metabotrophic blood biomarkersassociated with cellular aging which included cortisol 120573-endorphin IL-6 BDNF and sirtuin-1 After 12 weeks of YMLI there weresignificant improvements in both the cardinal biomarkers of cellular aging and the metabotrophic biomarkers influencing cellularaging compared to baseline values The mean levels of 8-OH2dG ROS cortisol and IL-6 were significantly lower and mean levelsof TAC telomerase activity 120573-endorphin BDNF and sirtuin-1 were significantly increased (all values 119901 lt 005) post-YMLI Themean level of telomere length was increased but the finding was not significant (119901 = 0069) YMLI significantly reduced the rate ofcellular aging in apparently healthy population

1 Introduction

In the last decade there has been a significant increase incomplex lifestyle diseases like depression diabetes mellitus(DM) cardiovascular diseases (CVD) cancer and infertilityThese diseases are strongly associated with accelerated cellu-lar aging [1 2] and have become the bane of modern society[3ndash5] Within a homogeneous sample of apparently healthyadult population biomarkers have been defined recently [6]to characterize the complex processes of accelerated agingphenomenon Although we do not have any gold standardbiomarker to monitor healthy aging based on the currentknowledge of putative biomarkers the cardinal biomarkersof cellular aging and metabotophic biomarkers which caninfluence them have become the focus of latest translational

research to develop interventions to prevent chronic lifestylediseases

The cardinal biomarkers of cellular aging include DNAdamage telomere length attrition and oxidative stress (OS)[7]DNA damage causes genomic instability which is respon-sible for cellular dysfunctions in the pathogenesis of lifestylediseases [8ndash10] OS is the most important cause for DNAdamage Although many different oxidative DNA damage(ODD) products have been identified 8-OH2dG (8-hydroxy-21015840-deoxyguanosine) a highly mutagenic oxidative DNAadduct has been the subject of intensive study and is a defini-tive biomarker of DNA damage [11] Telomere attrition is dueto altered telomere metabolism involving decrease in telom-erase enzyme activity andOS It contributes to genomic insta-bility and is associated with aging and lifestyle diseases [12]

HindawiOxidative Medicine and Cellular LongevityVolume 2017 Article ID 7928981 9 pageshttpsdoiorg10115520177928981

2 Oxidative Medicine and Cellular Longevity

Oxidative stress an imbalance between the prooxidantsand the antioxidant defense mechanisms becomes patholog-ical at both extremes of the physiological range needed fornormal cellular functions It is involved in the pathogenesisof complex lifestyle and chronic diseases [13] includingdepression [14] obesity [15] and infertility [16 17] theleading public health problems

Several metabotrophic blood biomarkers influencing cel-lular aging include biomarkers of stress and inflamma-tory response neuroplasticity and longevity Sustained stressresponse due to chronic stress stimuli causes constantlyincreased cortisol levels [18] which lead to systemic tissueabnormalities like increased adiposity and neurodegenera-tionThe level of stress responsiveness (cortisol levels) can bea biomarker for predicting susceptibility to lifestyle diseases[19] Accelerated aging is characterized by a chronic low-grade inflammation (ldquoinflammagingrdquo) Inflammaging is ahighly significant risk factor for most of chronic lifestylediseases [20] and is a potential modifiable target [21] IL-6is the most prominent cytokine in inflammaging and is botha marker of inflammatory status and a hallmark of chronicmorbidity [22] Impaired neuroplasticity due to acceleratedaging can have negative influence across the entire lifespan[23] BDNF is amajor regulator of neuroplasticity [24] whichmay be increased in specific regions of the brain by variousinterventions [25] Health span and longevity are influencedby several factors Sirtuin-1 (SIRT1) a histone deacetylase(HDAC) is prominent among them and recently has becomea target for various interventions [26] It systemically influ-ences nutrition and energy metabolism and centrally has arole in circadian rhythm survival against stress [27] andneuronal plasticity [28]

A variety of interventions have been studied [29 30] todetermine their influence on preventing lifestyle diseases andpromoting health and longevityThey include drugs targetingspecific hallmarks of aging namely physical exercise [31]nutrition caloric restriction [32] and antioxidants [33]How-ever no single intervention is shown to be an effective pre-ventive and therapeutic strategy formodern complex lifestylediseases and provide comprehensive benefits for delaying orreversing accelerated aging Therefore further research isneeded to find optimum interventions for population at riskof lifestyle diseases Yoga is an emerging integrative healthdiscipline which can positivelymodulatemind and body [34]and has been shown to improve clinical profile of patientswith various pathologies [35] including depression obesityhypertension asthma type II diabetes and cancer Howeverrecent reviews on Yoga suggest that potential underlyingmechanisms need to be further explored [36] Studies onbiomarkers of disease and health in Yoga based interventionsare limited and they have only highlighted diabetic and lipidprofiles [37 38] stress and inflammatory markers [39 40]andneuroimaging correlates [41] in populationswith specificmedical conditions Evidence is lacking regarding the efficacyof Yoga lasting short duration of 3 to 12 weeks in improvingthe biomarkers of cellular aging in apparently healthy peopleThus the present study was designed to evaluate the impactof Yoga and Meditation based lifestyle intervention (YMLI)on cellular aging and longevity by analyzing cardinal and

metabotrophic biomarkers in the peripheral blood of appar-ently healthy subjects

2 Materials and Methods

21 Study Design and Participants Ninety-six apparentlyhealthy people were enrolled in this 12-week prospectiveopen-label single arm exploratory study from Aug 2015 toMay 2016 designed to explore the impact of YMLI on cellularaging The key inclusion criteria were male or female aged30ndash65 years and leading unhealthy modern lifestyle Thekey exclusion criteria were inability to perform the yogicexercises due to any physical challenges and those with recentchanges in lifestyle during last 3 months The study wasinitiated after ethical clearance (ESCT-37022-07-2015) andthe registration of the trial with Clinical Trial Registry ofIndia (CTRI REF201409007532)

22 Procedure

221 Yoga and Meditation Based Lifestyle Intervention(YMLI) Eligible subjects were enrolled in the study afterscreening and baseline characteristics were recorded Partici-pants underwent 12-week pretested YMLI program compris-ing theory and practice sessions [42 43] YMLI is designedto be an integrative health strategy incorporating the classiccomponents of Yoga including Asanas (physical postures)Pranayama (breathing exercises) and Dhayna (Meditation)which are derived from a mix of Hatha Yoga and Raja YogaThe YMLI for the current study was suitably modified forapparently healthy subjects YMLI program included sessions5 days per week for 12 wks For the first twoweeks the sessionswere held at integrated health clinic (IHC) AIIMS NewDelhi and taught by registered specialized Yoga instructors(educational qualifications include Bachelor of Naturopathyand Yoga Sciences and PG Diploma in Yoga Therapy)Remaining 10 weeks were home based Monitoring of com-pliance of the home based YMLI was through maintenanceof a dairy and telephonic contact The details of the activitiesin a day during YMLI program are given in Table 1 Eachsession in YMLI included a set of Asanas (physical postures)Pranayama (breathing exercises) and Dhayna (Meditation)for approximately 90 minutes This was followed by aninteractive lecture (only during the first two weeks of YMLIat IHC) on lifestyle lifestyle diseases and importance of theirprevention for 30 minutes

222 Laboratory Procedures During this 12-week study theparticipants were evaluated for various biomarkers on day0 and week 12 Fasting venous blood samples (5mL) werecollected and divided into two parts One part was allowed toclot and the serumwas separated within 30min and the otherpart was transferred to heparinizedEDTA vials and wascentrifuged at 2000119892 for 15 minutes at 4∘C Both serum andplasma were stored at minus80∘C until analyzed ROS detectionwas done by chemiluminescence assay (Berthold detectionluminometer USA) Peripheral blood leukocyte telomerelength was measured by qPCRmethod and telomerase activ-ity was determined by using a telomerase assay kit (Roche

Oxidative Medicine and Cellular Longevity 3

Table 1 Details of activities in a day of Yoga and Meditation based Lifestyle Intervention (YMLI) program

S No Practice to be done Duration(1) Session preparation instructions 5min

(2) Prayer 3minLoosening practices (warm-up) 5min

(3) Asanas (Postures)

SupineShavasana 2min

Uttanpadasana 2minPawanmuktasana 2min

ProneMakarasana 2minBhujangasana 2minSalabhasana 2min

SittingVakrasana 2min

Ardha-Matsyendrasana 2minVajrasana 2min

StandingTadasana 2min

Vrikshasana 2minArdhachakrasana 2min

(4) Relaxation Shavasana 5min

(5) Pranayama (Breathing Exercises)

Nadishodhana

20minBhramriShitkariShitali

Brahmamudra(6) Aumkar recitation 3min(7) Dhyana (Meditation) 20min(8) Shanti mantra 5min

(9)Interactive session (first 2 weeks only atIntegrated Health Clinic AIIMS New

Delhi)30min

Total 120min

Switzerland) as per manufacturerrsquos protocol 8-OH2dG wasestimated in white blood cell DNA (Caymanrsquos EIA kit)ELISA kits were used for levels of TAC (Cayman ChemicalAnn Arbor USA) cortisol (DRG Diagnostic Germany)120573-endorphin (Phoenix Pharmaceuticals Inc) IL-6 (Gen-Probe Diaclone Diagnostic France) BDNF (RaybiotechInc) and sirtuin-1 (Quayee Bio-Technology) Quality-controlassays for biomarkers and validation were performed

223 Endpoints The primary endpoint was to assess thechange in levels of cardinal biomarkers of cellular agingfrom baseline to week 12 The biomarkers included thefollowing 8-OH2dG ROS and TAC (markers of OS andODD) and telomere attrition markers telomere length andtelomerase activity The secondary endpoints were assess-ment of metabotrophic blood biomarkers associated withcellular aging which included cortisol 120573-endorphin IL-6BDNF and sirtuin-1 from baseline to week 12

23 Statistical Analysis Data were analyzed using SPSS 20(IBM Corp Armonk NY) Descriptive statistics are reported

as means and standard deviations Changes in outcome vari-ables were analyzed using paired-samples t-test Exploratoryanalysis included comparisons for within gender subgroupsusing paired-sample t-test Significance was accepted at 119901 lt005

3 Results

The flow diagram of participation details is provided inFigure 1 Of 96 subjects 94 subjects were assessed for impactanalysis Two subjects were excluded from analysis due topoor compliance to the program Baseline sociodemographiccharacteristics are shown in Table 2

After 12 weeks of YMLI there was significant improve-ment in both cardinal and metabotrophic biomarkers of cel-lular aging compared to baseline values (Table 3) The meanlevels of 8-OH2dG and ROS were significantly lower andmean levels of TAC and telomerase activity were significantlyincreased (all values 119901 lt 005) The mean level of telomerelength was increased but finding was not significant (119901 =0069)Themean levels of cortisol and IL-6 were significantly


Assessed for eligibility (n = 120)

Excluded (n = 24)

Not meeting inclusion criteria (n = 15)

Declined to participate (n = 9)

Enrolled (n = 96) to receive YLMI for

12 weeks

Analyzed (n = 94)

Dropped out from YMLI (n = 2)

Figure 1 Flow diagram of study participation

Table 2 Sociodemographic characteristics of participants

Variable ValuesAge (years) 4026 (1013)Sex

Female 52 (5532)Male 42 (4468)

Socioeconomic statusKuppuswamy socioeconomic status scaleEducation 482 (124)Occupation 526 (238)Income 860 (274)Total 1868 (734)

BMI (kgm2) 2630 (340)Data were described as frequency () for sex and mean (SD) for others

lower and mean levels of 120573-endorphin BDNF and sirtuin-1were significantly increased (all values 119901 lt 005)

Few differences were noted in the gender subgroupanalysis Only male subgroup showed significant decrease inthe levels of IL-6 and a more marked reduction in cortisollevels (males 119901 = 0001 females 119901 = 0036) After 12 weeks ofYMLI we also noted significantly reduced BMI in the studypopulation (119901 lt 001)

4 Discussion

The results of this study highlight the positive impact ofYMLI on biomarkers of cellular aging and in promotingcellular longevity through changes in both cardinal andmetabotrophic biomarkers The findings suggest that the

impact is mediated through improvement in genomic sta-bility telomere metabolism and balance of cellular oxidativestress well-regulated stress and inflammatory responses andincrease in neuroplasticity and nutrition sensing

Genomic stability is central to cellular longevity anddisease-free youthful healthy life and findings from our studysuggest the reduction of genomic instability (decreased levelsof 8-OH2dG) by YMLI Unhealthy social habits (smokingexcess alcohol intake etc) sedentary lifestyle exposureto environmental pollutants and intake of processed andnutritionally depleted food have taken a toll on human healthwith onset of lifestyle diseases at a much younger age [3ndash5]These environmental and lifestyle factors are responsible forgenomic instability [10] DNA damage to bothmitochondrialand nuclear genome from endogenous as well as exogenousinsults results in accumulation of genetic aberrations andgenome hypermutability [8ndash10]

This is mainly due to aberrant DNA damage response(DDR) pathway which is essential for DNA repair andfor monitoring genomic integrity Deficient DNA repairtriggers systemic effects to promote pathological aging [10]Reduction of DNA damage by YMLI suggests potential ofyoga in activating DDR pathway to repair genomic damageand improve genomic stability and changes inmetabotrophicfactors seen in the study may be associated with thesebenefits

Maintaining telomere length through regulation oftelomere metabolism contributes to genomic stability andreduction in telomere attrition (increase in telomere lengthand telomerase activity levels) shown by our study after YMLIsuggests the potential for yoga in telomere metabolism andcellular longevity Telomeres which serve as a biologicalclock are highly conserved hexameric repeats and main-taining their length is vital for cellular longevity Telomerase


Table 3 Change in outcomes in apparently healthy sedentary subjects participating in a Yoga and Meditation based lifestyle intervention(119899 = 94)

Characteristics Baseline 12 wksChange from baseline to

12wks(diff 95 CI)

Effect sizelowast p value

Primary endpoints cardinal biomarkersof cellular agingOxidative stress

ROS (RLUmin104 neutrophils) 1215069 plusmn 88 102081 plusmn 79 1943 (164 2245) 07 lt00001TAC (mmol Trolox equivL) 594 plusmn 152 74 plusmn 21 minus116 (minus19 minus041) 04 lt0001

DNA damage8OH2dG (pgmL) 102623 plusmn 630 79098 plusmn 400 2353 (7273 3978) 022 lt001

Telomere attritionTelomerase activity (IUcell) 189 plusmn 142 294 plusmn 22 minus105 (minus168 minus041) 03 lt0001Telomere length (IUcell) 236 plusmn 16 244 plusmn 14 minus008 (minus061 045) 002 0069

Secondary endpoints biomarkersassociated with cellular aging

Cortisol (ngmL) 11883plusmn5050 9632 plusmn 386 2251 (76 3742) 03 lt001Interleukin (IL6) (pgmL) 316 plusmn 242 194 plusmn 23 122 (047 197) 03 lt0001120573-Endorphins (ngmL) 62 plusmn 35 82 plusmn 42 minus2 (minus322 minus077) 03 lt0001BDNF (ngmL) 197 plusmn 675 371 plusmn 56 minus174 (minus1948 minus1532) 07 lt00001Sirtuin (ngmL) 2669 plusmn 1042 4064 plusmn 116 minus1395 (minus2341 minus449) 05 lt001

BMI (kgm2) 2630 plusmn 340 2364 plusmn 355 266 (056 312) 04 lt001lowastEffect size was calculated by dividing change by standard deviation at baseline of the specific outcome and interpreted using Cohenrsquos d (small effect 02 to03 medium effect 05 and large effect 08)

is an important regulator of telomere length and accurateregulation of its activity and a correct telomere-telomeraseinteraction is important to precisely safeguard telomerelength and prevent telomere attrition [44]ODD is prominentamong the factors which can adversely affect telomere length[45] Rapid telomere attrition due to ODD is associated withsenescence and related disease conditions [46 47] Improvedtelomere metabolism after YMLI seen in the study maycontribute to genomic stability More research is neededto explore the mechanisms of how yoga and meditationintervention can positively modify telomere metabolism

Our study suggests that improvement in maintenanceof balance in cellular oxidative stress (decrease in ROS andincrease in TAC) by YMLI Supraphysiological ROS levelsare due to endogenous and exogenous factors like smokingexcess alcohol consumption exposure to electromagneticradiation infection xenobiotic exposure and psychologicalstress [48] Even the levels of ROS below physiological limitsare deleterious to normal cellular function and maintainingOS at physiological levels is important for cellular longevityIncreasedOS causes damage to all molecules including dam-age to DNA and telomeres It also affects signal transductionand gene transcription by causing genome wide hypomethy-lation [49] and thus causes changes in the epigenomeRegulation of cellular oxidative stress within physiologicallimits after YMLI suggests the potential of this intervention inprotecting cells fromOS induced DNA damage and telomereattrition and in reversing epigenetic changes which are accu-mulated due to unhealthy lifestyle and adverse environmental

conditions Other studies [50] support these findings andhave shown reduced OS upregulation of telomerase activityand decreased ODD after YMLI To combat OS peopleuse antioxidants without monitoring ROS levels resulting inreductive stress [51] unlike in YMLI which regulates ROSlevels so that no redox sensitive physiological functions areimpaired

Modern lifestyle and associated psychological stress havecomplex interactions with lifestyle habits environmentalconditions and medical interventions to cause acceleratedcellular aging which adversely affect our mental physicaland reproductive fitness [3ndash5] Improved cellular longevityafter YMLI suggests the potential role of Yoga in pro-moting this fitness While psychological stress is a majormanifestation on mind contributing to increased preva-lence of neuropsychiatric disorders including depressionabnormal fat accumulation is a major somatic manifes-tation contributing to increased prevalence of metabolicsyndrome and all the diseases that come under the umbrellaof metabolic syndrome including obesity DM and CVD[52] Other peripheral manifestations of unhealthy modernlifestyle include aging of gonads leading to infertility [53]and recurrent pregnancy loss Previous studies have demon-strated the clinical benefits of Yoga and Meditation in allthese medical conditions [35] Dada et al have shown thatYMLI can reduce testicular aging and result in significantupregulation in telomerase activity and decline in seminalOS and ODD [8] The ongoing studies in our laboratory onthe impact of Yoga and Meditation have provided significant


evidence for the reversal of cellular aging in subjects proneto accelerated aging due to depression Microarray (Agilent8 times 60k Microarray kit) and analysis of gene expression pre-and post-YMLI showed decreased IL6 IL10 and MAP10 andincreased IL2 and IL4 [8 54 55] Improved cellular longevityseen in our study after YMLI suggests that changes in bothcardinal andmetabotrophic biomarkers of cellular agingmaybe amechanism for preventing chronic lifestyle diseases Ourstudy suggests that the changes in metabotrophic factorswhich include increase in levels of 120573-endorphin BDNF andsirtuin-1 and decrease in levels of cortisol and IL-6 and thecellular processes involving them may have important rolesin reversal of cellular aging and improving cellular longevityafter YMLI

Improvement in stress and inflammatory response in ourstudy after YMLI may be mediated by changes in cortisol120573-endorphin IL-6 and other factors with regulation bychanges in brain through hypothalamic-pituitary-adrenal(HPA) axis The response may involve regulation of adaptivepathways including integrated stress response (ISR) [18]which activate the eukaryotic translation initiation factor 2alpha (eIF2120572) that promote cellular recovery driving thesignaling toward cell survival and longevity The responsemay lead to decreased OS and reversal of senescent secretoryphenotype of cells including cells in brain adipose tissueendothelium and gonads Changes in secretory phenotypeinclude decreased IL-6 [56] increased BDNF and sirtuin-1[57] These regulated factors may lead to balance in OS andcellular longevity and contribute to tissue revival throughoutthe body from neuroplasticity in CNS to gonads vessels andmuscles in the periphery Secretory phenotype from somaticcells provides regulatory feedback to brain [58] which com-pletes the vicious cycle of regulation betweenmind and bodyNeurodegeneration is associated with pathogenesis of severalneuropsychiatric conditions and neuroplasticity has a centralrole in their management and for vitality Increased BDNFsirtuin-1 and 120573-endorphin and decreased cortisol whichdecrease cellular aging in brain decrease neurodegenerationand increase neuroplasticity [23] Increased cellular longevityand increased neuroplasticity may be a mechanism for alter-ation of graymatter volume in different regions of the cerebralcortex [59] increased mindfulness [60] and several othercomplex processes [55 61] involved in reduction of stress anddepression after Yoga and Meditation Regulated mind-bodycommunications may lead to minimization of subclinicalinflammation and activation of nutrition and energy sensingpathways promoting longevity where decrease in IL-6 andincrease in sirtuin-1 play a prominent role respectivelyPrevious studies have demonstrated increase in sirtuin-1levels after interventions with caloric restriction [62] Ourstudy is the first to document increase in sirtuin-1 levelsindependent of caloric restriction after practicingYogaTheseimproved processes may result in delaying onset and slowingdown progression of diseases associated with acceleratedcellular aging

The impact of the intervention in both genders wasassessed separately sincemen andwomen respond differentlyto day to day stress [63] Interestingly the gender subgroupanalysis showed that reduction in cortisol and IL6 levels were

more pronounced inmale than in female subjects No signifi-cant gender differences were seen in other biomarkers Phaseof the menstrual cycle should be taken into considerationsince some biomarker levels are known to vary with differentphases of the menstrual cycle [64 65] Our study showedsignificant decrease in BMI in apparently healthy subjectswhich came into normal range (2364 plusmn 355) from baselineoverweight range (2630 plusmn 340) While latest research [66]suggests people with mean BMI of 27 who are overweight bycurrent classification of obesity are likely to survive longestin western population similar data is not available for Indianpopulation Therefore our findings need to be interpretedcautiously

Stratification of cases was not done in this study to dosubgroup analysis due to small sample size

Lifestyle is an integrated entity and an interventionlike YMLI that has overall positive influence on our healthappears most useful versus changing only one aspect at atime as is seen by action of certain drugs Yoga is holisticand amind-bodymedicine and ismore beneficial and advan-tageous than individual interventions like physical exercisecaloric restriction and antioxidantsThe practice of Yoga andphysical exercise are different entities the former results inenergy conservation with economy of energy expenditure formental and physical benefits and the later results in energyexpendituremore for physical exertions andmetabolic needsas is evident from a study which showed exercise causeserratic changes in biomarkers and results in OS [67] whileMeditation brings about uniform biomarker and behavioralchanges and improvement in cognition and decrease OS[68] Therapeutic antioxidants can only decrease ROS ratherthan regulating it and may paradoxically shorten life span[69] due to imbalance in ROS mediated immune response[70] YMLI regulates ROS rather than simply lowering themby balanced stress-related processes and appropriate geneexpressions [71] The only limitation of our study is that itis a single arm proof of concept study and did not includecontrols It is important to adopt a lifestyle which slows thedecline in health by reversing or delaying accelerated agingdue to unhealthy lifestyle The biomarkers of cellular agingcan form the basis for determining the risk of chronic lifestylediseases and the efficacy and usefulness of interventions todecrease disease risk Hence findings from this study aresupportive of YMLI as a significant clinical utility especiallyin prevention of and management of complex multifactorialdiseases and reducing the rate of functional decline withaging

5 Conclusion

Though we cannot change our biology or chronological agewe can definitely reverseslow down the pace at which weage by adopting YMLI This is the first study to demonstrateimprovement in both cardinal and metabotrophic biomark-ers of cellular aging and longevity in apparently healthy popu-lation after Yoga and Meditation based lifestyle interventionSo our health and the rate at which we age entirely dependson our choices Making Yoga andMeditation an integral partof our lifestyle may hold the key to delay aging or aging


gracefully prevent onset of multifactorial complex lifestylediseases promote mental physical and reproductive healthand prolong youthful healthy life

Competing Interests

The authors stated that there is no conflict of interestswhatsoever regarding the publication of this paper

Acknowledgments

The authors are thankful to Amit Tomar and SudhirChoudary for Yoga instructions and all the subjects enrolledin the study

References

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[2] V Boccardi G Paolisso and PMecocci ldquoNutrition and lifestylein healthy aging the telomerase challengerdquo Aging vol 8 no 1pp 12ndash15 2016

[3] J K Chakma and S Gupta ldquoLifestyle and non-communicablediseases a double edged sword for future Indiardquo Indian Journalof Community Health vol 26 no 4 pp 325ndash332 2014

[4] M J Pappachan ldquoIncreasing prevalence of lifestyle diseaseshigh time for actionrdquo The Indian Journal of Medical Researchvol 134 no 2 pp 143ndash145 2011

[5] P Scarborough P Bhatnagar K K Wickramasinghe S Allen-der C Foster andM Rayner ldquohe economic burden of ill healthdue to diet physical inactivity smoking alcohol and obesityin the UK an update to 2006ndash07 NHS costsrdquo Journal of PublicHealth vol 33 no 4 pp 527ndash535 2011

[6] K-H Wagner D Cameron-Smith B Wessner and B FranzkeldquoBiomarkers of aging from function to molecular biologyrdquoNutrients vol 8 no 6 article 338 2016

[7] C Correia-Melo G Hewitt and J F Passos ldquoTelomeresoxidative stress and inflammatory factors partners in cellularsenescencerdquo Longevity amp Healthspan vol 3 no 1 2014

[8] R Dada S B Kumar M Tolahunase M Mishra K Mohantyand TMukesh ldquoYoga andmeditation as a therapeutic interven-tion in oxidative stress and oxidative DNA damage to paternalgenomerdquo Journal of Yoga amp Physical Therapy vol 5 no 4 2015

[9] M B Shamsi S Venkatesh D Pathak D Deka and R DadaldquoSperm DNA damage amp oxidative stress in recurrent sponta-neous abortion (RSA)rdquo Indian Journal of Medical Research vol133 no 5 pp 550ndash551 2011

[10] M-R Pan K Li S-Y Lin and W-C Hung ldquoConnecting thedots from DNA damage and repair to agingrdquo InternationalJournal of Molecular Sciences vol 17 no 5 article 685 2016

[11] M Maes I Mihaylova M Kubera M UytterhoevenN Vrydags and E Bosmans ldquoIncreased 8-hydroxy-deoxyguanosine a marker of oxidative damage to DNAin major depression and myalgic encephalomyelitis chronicfatigue syndromerdquo Neuroendocrinology Letters vol 30 no 6pp 715ndash722 2009

[12] I Chiodi and C Mondello ldquoTelomere and telomerase stabilityin human diseases and cancerrdquo Frontiers in Bioscience vol 21no 1 pp 203ndash224 2016

[13] N Khansari Y Shakiba and M Mahmoudi ldquoChronic inflam-mation and oxidative stress as a major cause of age-relateddiseases and cancerrdquo Recent Patents on Inflammation amp AllergyDrug Discovery vol 3 no 1 pp 73ndash80 2009

[14] C N Black M Bot P G Scheffer P Cuijpers and B W JH Penninx ldquoIs depression associated with increased oxidativestress a systematic review and meta-analysisrdquo Psychoneuroen-docrinology vol 51 pp 164ndash175 2015

[15] A Salmon ldquoBeyond diabetes does obesity-induced oxidativestress drive the aging processrdquoAntioxidants vol 5 no 3 articleno 24 2016

[16] K Verma and G C Baniya ldquoA comparative study of depressionamong infertile and fertile womenrdquo International Journal ofResearch in Medical Sciences vol 4 no 8 pp 3459ndash3465 2016

[17] A Katib ldquoMechanisms linking obesity to male infertilityrdquoCentral European Journal of Urology vol 68 no 1 pp 79ndash852015

[18] K PakosminusZebrucka I Koryga K Mnich M Ljujic A Samaliand A M Gorman ldquoThe integrated stress responserdquo EMBOReports vol 17 no 10 pp 1374ndash1395 2016

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[20] C Franceschi and J Campisi ldquoChronic inflammation (Inflam-maging) and its potential contribution to age-associated dis-easesrdquo Journals of GerontologymdashSeries A Biological Sciences andMedical Sciences vol 69 pp S4ndashS9 2014

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[22] M Maggio J M Guralnik D L Longo and L FerruccildquoInterleukin-6 in aging and chronic disease a magnificentpathwayrdquo Journals of GerontologymdashSeries A Biological Sciencesand Medical Sciences vol 61 no 6 pp 575ndash584 2006

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[28] F Ng L Wijaya and B L Tang ldquoSIRT1 in the brainmdashconnections with aging-associated disorders and lifespanrdquoFrontiers in Cellular Neuroscience vol 9 article no 64 2015

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[32] L Vitetta and B Anton ldquoLifestyle and nutrition caloric restric-tion mitochondrial health and hormones scientific interven-tions for anti-agingrdquo Clinical Interventions in Aging vol 2 no4 pp 537ndash543 2007

[33] V Conti V Izzo G Corbi et al ldquoAntioxidant supplementationin the treatment of aging-associated diseasesrdquo Frontiers inPharmacology vol 7 article 00024 2016

[34] B Patwardhan G Mutalik and G Tillu Integrative ApproachesforHealthmdashBiomedical Research Ayurveda andYoga AcademicPress London UK 1st edition 2015

[35] A Bussing A Michalsen S B S Khalsa S Telles and K JSherman ldquoEffects of yoga on mental and physical health ashort summary of reviewsrdquoEvidence-BasedComplementary andAlternative Medicine vol 2012 Article ID 165410 7 pages 2012

[36] T Field ldquoYoga research reviewrdquo Complementary Therapies inClinical Practice vol 24 pp 145ndash161 2016

[37] M E Papp P Lindfors M Nygren-Bonnier L Gullstrandand P E Wandell ldquoEffects of high-intensity hatha yoga oncardiovascular fitness adipocytokines and apolipoproteins inhealthy students a randomized controlled studyrdquo Journal ofAlternative and Complementary Medicine vol 22 no 1 pp 81ndash87 2016

[38] PM Siu A P Yu I F Benzie and JWoo ldquoEffects of 1-year yogaon cardiovascular risk factors in middle-aged and older adultswith metabolic syndrome a randomized trialrdquoDiabetology andMetabolic Syndrome vol 7 no 1 article no 40 2015

[39] M-S Ha D-Y Kim and Y-H Baek ldquoEffects of Hatha yogaexercise on plasma malondialdehyde concentration and super-oxide dismutase activity in female patients with shoulder painrdquoJournal of Physical Therapy Science vol 27 no 7 pp 2109ndash21122015

[40] BHari Krishna C KiranKumar andNM Reddy ldquoAssociationof leukocyte telomere length with oxidative stress in yogapractitionersrdquo Journal of Clinical and Diagnostic Research vol9 no 3 pp CC01ndashCC03 2015

[41] R Santhakumari I Reddy R Archana and P Rajesh ldquoRoleof yoga in alienating the memory decline and frontal lobemetabolite changes in type 2 diabetesrdquo International Journal ofResearch in Ayurveda amp Pharmacy vol 7 no 1 pp 78ndash81 2016

[42] R L Bijlani R P Vempati R K Yadav et al ldquoA briefbut comprehensive lifestyle education program based on yogareduces risk factors for cardiovascular disease and diabetesmellitusrdquo Journal of Alternative and Complementary Medicinevol 11 no 2 pp 267ndash274 2005

[43] R Vempati R Bijlani and K K Deepak ldquoThe efficacy ofa comprehensive lifestyle modification programme based onyoga in the management of bronchial asthma a randomizedcontrolled trialrdquo BMC Pulmonary Medicine vol 9 article no37 2009

[44] H Oeseburg R A De Boer W H Van Gilst and P Van DerHarst ldquoTelomere biology in healthy aging and diseaserdquo PflugersArchiv European Journal of Physiology vol 459 no 2 pp 259ndash268 2010

[45] S Kawanishi and S Oikawa ldquoMechanism of telomere short-ening by oxidative stressrdquo Annals of the New York Academy ofSciences vol 1019 pp 278ndash284 2004

[46] M A Shammas ldquoTelomeres lifestyle cancer and agingrdquoCurrent Opinion in Clinical Nutrition and Metabolic Care vol14 no 1 pp 28ndash34 2011

[47] J Thilagavathi S Venkatesh and R Dada ldquoTelomere length inreproductionrdquo Andrologia vol 45 no 5 pp 289ndash304 2013

[48] M P Pruchniak M Arazna and U Demkow ldquoBiochemistryof oxidative stressrdquo in Advances in Clinical Science vol 878of Advances in Experimental Medicine and Biology pp 9ndash19Springer 2016

[49] W Wongpaiboonwattana P Tosukhowong T DissayabutraA Mutirangura and C Boonla ldquoOxidative stress induceshypomethylation of LINE-1 and hypermethylation of theRUNX3 promoter in a bladder cancer cell linerdquo Asian PacificJournal of Cancer Prevention vol 14 no 6 pp 3773ndash3778 2013

[50] S B Kumar R Yadav R K Yadav M Tolahunase and R DadaldquoTelomerase activity and cellular aging might be positivelymodified by a yoga-based lifestyle interventionrdquoThe Journal ofAlternative andComplementaryMedicine vol 21 no 6 pp 370ndash372 2015

[51] A Rahal A Kumar V Singh et al ldquoOxidative stress prooxi-dants and antioxidants the interplayrdquo BioMed Research Inter-national vol 2014 Article ID 761264 19 pages 2014

[52] A V W Nunn J D Bell and G W Guy ldquoLifestyle-inducedmetabolic inflexibility and accelerated ageing syndrome insulinresistance friend or foerdquo Nutrition and Metabolism vol 6article no 16 2009

[53] JThilagavathi M Kumar S S Mishra S Venkatesh R Kumarand R Dada ldquoAnalysis of sperm telomere length in men withidiopathic infertilityrdquoArchives of Gynecology andObstetrics vol287 no 4 pp 803ndash807 2013

[54] M R Tolahunase R K Yadav S Khan and R Dada ldquoReversalof aging by yoga and meditationrdquo Journal of InternationalSociety of Antioxidants vol 1 no 1 2015

[55] T Dada M A Faiq K Mohanty et al Eds Effect of Yoga andMeditation Based Intervention on Intraocular Pressure Qualityof Life Oxidative Stress and Gene Expression Pattern in PrimaryOpen Angle Glaucoma A Randomized Controlled Trial ARVOSeattle Wash USA 2016

[56] A H Miller and C L Raison ldquoThe role of inflammation indepression from evolutionary imperative to modern treatmenttargetrdquo Nature Reviews Immunology vol 16 no 1 pp 22ndash342016

[57] S-W Min P D Sohn S-H Cho R A Swanson and L GanldquoSirtuins in neurodegenerative diseases an update on potentialmechanismsrdquo Frontiers in Aging Neuroscience vol 5 article no53 2013

[58] T Tchkonia Y Zhu J Van Deursen J Campisi and J LKirkland ldquoCellular senescence and the senescent secretoryphenotype therapeutic opportunitiesrdquo Journal of Clinical Inves-tigation vol 123 no 3 pp 966ndash972 2013

[59] C Villemure M Ceko V A Cotton and M Catherine Bush-nell ldquoNeuroprotective effects of yoga practice age- experience- and frequency-dependent plasticityrdquo Frontiers in HumanNeuroscience vol 9 article 00281 2015

[60] P L Dobkin and Q Zhao ldquoIncreased mindfulnessmdashthe activecomponent of the mindfulness-based stress reduction pro-gramrdquoComplementaryTherapies in Clinical Practice vol 17 no1 pp 22ndash27 2011

[61] K E Riley and C L Park ldquoHow does yoga reduce stress Asystematic review of mechanisms of change and guide to futureinquiryrdquo Health Psychology Review vol 9 no 3 pp 379ndash3962015


[62] G Lopez-Lluch and P Navas ldquoCalorie restriction as an inter-vention in ageingrdquo Journal of Physiology vol 594 no 8 pp2043ndash2060 2016

[63] B D Darnall M Aickin and H Zwickey ldquoPilot study ofinflammatory responses following a negative imaginal focusin persons with chronic pain analysis by sexgenderrdquo GenderMedicine vol 7 no 3 pp 247ndash260 2010

[64] P A Nepomnaschy R M Altman R Watterson C CoD S McConnell and B G England ldquoIs cortisol excretionindependent of menstrual cycle day A longitudinal evaluationof first morning urinary specimensrdquo PLoS ONE vol 6 no 3Article ID e18242 2011

[65] J Ferrer J Mtnez-Guisasola F Dıaz F Alonso M Guerreroand B Marın ldquoPlasma levels of 120573-endorphin during themenstrual cyclerdquo Gynecological Endocrinology vol 11 no 2 pp75ndash82 1997

[66] S Afzal A Tybjaeligrg-Hansen G B Jensen and B G Nordest-gaard ldquoChange in body mass index associated with lowestmortality in Denmark 1976ndash2013rdquo JAMA vol 315 no 18 pp1989ndash1996 2016

[67] J L Harte G H Eifert and R Smith ldquoThe effects of runningand meditation on beta-endorphin corticotropin-releasinghormone and cortisol in plasma and on moodrdquo BiologicalPsychology vol 40 no 3 pp 251ndash265 1995

[68] T W W Pace L T Negi D D Adame et al ldquoEffect ofcompassion meditation on neuroendocrine innate immuneand behavioral responses to psychosocial stressrdquo Psychoneu-roendocrinology vol 34 no 1 pp 87ndash98 2009

[69] G Bjelakovic D Nikolova L L Gluud R G Simonettiand C Gluud ldquoMortality in randomized trials of antioxidantsupplements for primary and secondary prevention systematicreview and meta-analysisrdquo JAMA vol 297 no 8 pp 842ndash8572007

[70] M Ristow K Zarse A Oberbach et al ldquoAntioxidants preventhealth-promoting effects of physical exercise in humansrdquo Pro-ceedings of the National Academy of Sciences of the United Statesof America vol 106 no 21 pp 8665ndash8670 2009

[71] S Kumar R Yadav and R Dada ldquoYoga as an effective lifestyleintervention for Bhopal methyl isocyanate gas leakage catastro-phe victimsrdquo International Journal of Yoga vol 8 no 2 p 1622015

Submit your manuscripts athttpswwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


Oxidative stress an imbalance between the prooxidantsand the antioxidant defense mechanisms becomes patholog-ical at both extremes of the physiological range needed fornormal cellular functions It is involved in the pathogenesisof complex lifestyle and chronic diseases [13] includingdepression [14] obesity [15] and infertility [16 17] theleading public health problems

Several metabotrophic blood biomarkers influencing cel-lular aging include biomarkers of stress and inflamma-tory response neuroplasticity and longevity Sustained stressresponse due to chronic stress stimuli causes constantlyincreased cortisol levels [18] which lead to systemic tissueabnormalities like increased adiposity and neurodegenera-tionThe level of stress responsiveness (cortisol levels) can bea biomarker for predicting susceptibility to lifestyle diseases[19] Accelerated aging is characterized by a chronic low-grade inflammation (ldquoinflammagingrdquo) Inflammaging is ahighly significant risk factor for most of chronic lifestylediseases [20] and is a potential modifiable target [21] IL-6is the most prominent cytokine in inflammaging and is botha marker of inflammatory status and a hallmark of chronicmorbidity [22] Impaired neuroplasticity due to acceleratedaging can have negative influence across the entire lifespan[23] BDNF is amajor regulator of neuroplasticity [24] whichmay be increased in specific regions of the brain by variousinterventions [25] Health span and longevity are influencedby several factors Sirtuin-1 (SIRT1) a histone deacetylase(HDAC) is prominent among them and recently has becomea target for various interventions [26] It systemically influ-ences nutrition and energy metabolism and centrally has arole in circadian rhythm survival against stress [27] andneuronal plasticity [28]

A variety of interventions have been studied [29 30] todetermine their influence on preventing lifestyle diseases andpromoting health and longevityThey include drugs targetingspecific hallmarks of aging namely physical exercise [31]nutrition caloric restriction [32] and antioxidants [33]How-ever no single intervention is shown to be an effective pre-ventive and therapeutic strategy formodern complex lifestylediseases and provide comprehensive benefits for delaying orreversing accelerated aging Therefore further research isneeded to find optimum interventions for population at riskof lifestyle diseases Yoga is an emerging integrative healthdiscipline which can positivelymodulatemind and body [34]and has been shown to improve clinical profile of patientswith various pathologies [35] including depression obesityhypertension asthma type II diabetes and cancer Howeverrecent reviews on Yoga suggest that potential underlyingmechanisms need to be further explored [36] Studies onbiomarkers of disease and health in Yoga based interventionsare limited and they have only highlighted diabetic and lipidprofiles [37 38] stress and inflammatory markers [39 40]andneuroimaging correlates [41] in populationswith specificmedical conditions Evidence is lacking regarding the efficacyof Yoga lasting short duration of 3 to 12 weeks in improvingthe biomarkers of cellular aging in apparently healthy peopleThus the present study was designed to evaluate the impactof Yoga and Meditation based lifestyle intervention (YMLI)on cellular aging and longevity by analyzing cardinal and

metabotrophic biomarkers in the peripheral blood of appar-ently healthy subjects

2 Materials and Methods

21 Study Design and Participants Ninety-six apparentlyhealthy people were enrolled in this 12-week prospectiveopen-label single arm exploratory study from Aug 2015 toMay 2016 designed to explore the impact of YMLI on cellularaging The key inclusion criteria were male or female aged30ndash65 years and leading unhealthy modern lifestyle Thekey exclusion criteria were inability to perform the yogicexercises due to any physical challenges and those with recentchanges in lifestyle during last 3 months The study wasinitiated after ethical clearance (ESCT-37022-07-2015) andthe registration of the trial with Clinical Trial Registry ofIndia (CTRI REF201409007532)

22 Procedure

221 Yoga and Meditation Based Lifestyle Intervention(YMLI) Eligible subjects were enrolled in the study afterscreening and baseline characteristics were recorded Partici-pants underwent 12-week pretested YMLI program compris-ing theory and practice sessions [42 43] YMLI is designedto be an integrative health strategy incorporating the classiccomponents of Yoga including Asanas (physical postures)Pranayama (breathing exercises) and Dhayna (Meditation)which are derived from a mix of Hatha Yoga and Raja YogaThe YMLI for the current study was suitably modified forapparently healthy subjects YMLI program included sessions5 days per week for 12 wks For the first twoweeks the sessionswere held at integrated health clinic (IHC) AIIMS NewDelhi and taught by registered specialized Yoga instructors(educational qualifications include Bachelor of Naturopathyand Yoga Sciences and PG Diploma in Yoga Therapy)Remaining 10 weeks were home based Monitoring of com-pliance of the home based YMLI was through maintenanceof a dairy and telephonic contact The details of the activitiesin a day during YMLI program are given in Table 1 Eachsession in YMLI included a set of Asanas (physical postures)Pranayama (breathing exercises) and Dhayna (Meditation)for approximately 90 minutes This was followed by aninteractive lecture (only during the first two weeks of YMLIat IHC) on lifestyle lifestyle diseases and importance of theirprevention for 30 minutes

222 Laboratory Procedures During this 12-week study theparticipants were evaluated for various biomarkers on day0 and week 12 Fasting venous blood samples (5mL) werecollected and divided into two parts One part was allowed toclot and the serumwas separated within 30min and the otherpart was transferred to heparinizedEDTA vials and wascentrifuged at 2000119892 for 15 minutes at 4∘C Both serum andplasma were stored at minus80∘C until analyzed ROS detectionwas done by chemiluminescence assay (Berthold detectionluminometer USA) Peripheral blood leukocyte telomerelength was measured by qPCRmethod and telomerase activ-ity was determined by using a telomerase assay kit (Roche















Nadishodhana




Delhi)30min

Total 120min





3 Results





Excluded (n = 24)




12 weeks

Analyzed (n = 94)





Female 52 (5532)Male 42 (4468)





4 Discussion









12wks(diff 95 CI)




















5 Conclusion




Competing Interests


Acknowledgments


References















































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of






























Nadishodhana




Delhi)30min

Total 120min





3 Results





Excluded (n = 24)




12 weeks

Analyzed (n = 94)





Female 52 (5532)Male 42 (4468)





4 Discussion









12wks(diff 95 CI)




















5 Conclusion




Competing Interests


Acknowledgments


References















































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


















Excluded (n = 24)




12 weeks

Analyzed (n = 94)





Female 52 (5532)Male 42 (4468)





4 Discussion









12wks(diff 95 CI)




















5 Conclusion




Competing Interests


Acknowledgments


References















































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















12wks(diff 95 CI)




















5 Conclusion




Competing Interests


Acknowledgments


References















































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of























5 Conclusion




Competing Interests


Acknowledgments


References















































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of


















Competing Interests


Acknowledgments


References















































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















impact of yoga and meditation on cellular aging in

Documents