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Effects of yoga exercise on salivary beta-

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Eur J Appl Physiol (2013) 113:26212627
DOI 10.1007/s00421-013-2703-y
ORIGINAL ARTICLE
Effects of yoga exercise on salivary beta-defensin 2
Nobuhiko Eda Kazuhiro Shimizu Satomi Suzuki
Yoko Tanabe Eunjae Lee Takao Akama
Received: 19 February 2013 / Accepted: 25 July 2013 / Published online: 8 August 2013
Springer-Verlag Berlin Heidelberg 2013
Abstract
Purpose Yoga stretching can be done comfortably and
easily by beginners and older adults to compensate for lack
of exercise or poor health maintenance. The aim of this
study was to determine the effect of yoga stretching on
mucosal immune functions, primarily human b-defensin 2
(HBD-2) in saliva.
Methods Fifteen healthy adults (age, 60.4 8.0 years)
participated in the study. Participants rested for 90 min on
the first day and performed yoga for 90 min on the second
day. Measurements were carried out before and after rest or
yoga. Saliva samples were collected by chewing a sterile
cotton at a frequency of 60 cycles per min. Salivary HBD-2
concentration was measured using an enzyme-linked
immunosorbent assay.
Results 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).
HBD-2 concentration (p \ 0.05) and HBD-2 expression
Communicated by Fabio Fischetti.
N. Eda (&)
Y. Tanabe
E. Lee
Graduate School of Sport Sciences, Waseda University,
2-579-15 Mikajima, Tokorozawa, Saitama 359-1192, Japan
e-mail: e-nobuhiko@asagi.waseda.jp
K. Shimizu
S. Suzuki
Sports Research and Development Core, University of Tsukuba,
1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574, Japan
T. Akama
Faculty of Sport Sciences, Waseda University,
2-579-15 Mikajima, Tokorozawa, Saitama 359-1192, Japan
rate (p \ 0.01) at post on the second day (yoga) was sig-
nificantly higher than that on the first day (rest). POMS
score of anger-hostility was lower after yoga than before.
Conclusions Yoga stretching for 90 min can increase
salivary HBD-2 expression in older adults. Therefore, yoga
stretching might be useful for older adults and athletes to
maintain their health.
Keywords Stretching
Relaxation
Mucosal
immunity
Antimicrobial peptide
Introduction
Respiratory infections such as pneumonia, influenza, and
upper-respiratory tract infections (URTI) are particularly
common and serious illnesses among older adults (Houston
et al. 1997). Previous studies of older adults reported that a
free-living daily physical activity level of approximately
7,000 steps per day and 12 months of moderate exercise
enhances salivary SIgA levels (Akimoto et al. 2003; Shi-
mizu et al. 2007b). It is therefore possible that moderate
physical activity and exercise enhance immune function.
Defensins are antimicrobial peptides that provide a
biochemical barrier by exhibiting anti-pathogenic activity
(Ganz and Lehrer 1994; Lehrer et al. 1993). Defensins
exert antimicrobial effects by breaking the hydrophobic
core of the lipid bilayer on microbes (Oren et al. 1999;
Schaller et al. 2000). Defensins are divided into a-defen-
sins (human neutrophil peptides: HNP-1 to HNP-3), b-
defensins (HBD-1 to HBD-4), and h-defensins (Ganz
2003). HBD-2 is expressed in human epithelial cells of the
oral cavity and respiratory tracts (Ganz 2003). In a previous
study on salivary HBD-2, high-intensity endurance exer-
cise transiently increased HBD-2 expression (Usui et al.
123
2622
2011). However, no study has investigated the effect of
low- or moderate-intensity exercise on salivary HBD-2
expression in humans.
The word yoga comes from Sanskrit Yuj, which means
to yoke or to join together (Iyengar 2001). Various kinds of
yoga have been practiced; for example, Hatha yoga (a
relaxing, restorative form that is sometimes used as an
overarching term for all forms of yoga), Ashtanga (stren-
uous series of poses sometimes referred to as power
yoga), and Iyengar (holding poses longer and some very
strenuous positions) (Field 2011). These kinds of yoga are
mostly difficult for beginners and older adults because of
pranayama (yoga breathing) and meditation. On the other
hand, yoga stretching involves holding relaxed poses with
a natural breathing rhythm without pranayama or medita-
tion. Therefore, yoga stretching may be done comfortably
and easily by beginners and older adults to compensate for
lack of exercise or poor health maintenance (The Ministry
of Health, Labour and Welfare 2006).
Recent studies have reported that yoga decreases psy-
chological stress (Hartfiel et al. 2011), tension (Telles et al.
2009), and depression (Uebelacker et al. 2010), and have
thus demonstrated the effect of relaxation. Additionally, it
has been reported that yoga increases alpha waves while
decreasing serum levels of cortisol, a catabolic glucocor-
ticoid known as the stress hormone (Kamei et al. 2000).
Previous studies have also investigated the suppressive
effect of glucocorticoids on HBD-2 expression (Tomita
et al. 2002; McDermott et al. 2003; Starner et al. 2005) and
the negative correlation between cortisol and HBD-2 levels
in saliva (Usui et al. 2011). Therefore, it is possible that
yoga stretching has a positive effect on relaxation through
enhancing HBD-2 expression, but no study to date has
investigated this speculation.
The aim of this study, therefore, was to determine the
effect of yoga stretching on the antimicrobial peptide sal-
ivary HBD-2. We hypothesized that yoga stretching
increases salivary HBD-2 and thereby enhances immune
function.
Methods
Participants
Fifteen healthy adults (2 males and 13 females; age,
60.4 8.0 years; height, 157.1 6.2 cm; body mass,
55.0 8.0 kg; body mass index, 22.2 2.6 kg/m2; body
fat percentage, 27.4 6.0 %) participated in the study.
Participants rested for 90 min on the first day and per-
formed yoga for 90 min on the second day. Measurements
were carried out before and after rest or yoga. Only mineral
water was permitted for drinking during rest and yoga
123
Eur J Appl Physiol (2013) 113:26212627
periods. Participants were given a detailed explanation of
the risks, stress, and potential benefits of the study before
they signed an informed consent form. All participants had
passed a complete medical examination within the pre-
ceding year. No participants had been treated with any
drugs that were known to affect immune function, and none
reported allergies or recent infections within the prior
3 months. This study was approved by the Ethics Com-
mittee on Human Research of Waseda University, and
experiments were conducted in accordance with the Dec-
laration of Helsinki.
Yoga exercise
Yoga beginners find it too difficult to master advanced
breathing methods (Iyengar 2001). Therefore, participants
carried out yoga stretching, which involves no yoga
breathing, for 90 min (Fig. 1). First, they massaged their
legs and applied pressure to the acupressure points for
20 min. Second, they held various yoga poses, such as the
warrior pose, extended triangle pose, and downward-facing
dog pose, for 65 min. Finally, they lay in the supine
position, known as the corpse pose, for 5 min.
Saliva collection
Saliva samples were collected by the method of a previous
study (Akimoto et al. 2003). Participants sat and rinsed
their mouths with distilled water for 30 s three times and
then rested for 5 min. Saliva production was stimulated by
chewing a sterile cotton (Salivette; Sersted, Vumbrecht,
Germany) at a frequency of 60 cycles per min. Obtained
saliva samples were separated from the cotton by centri-
fugation at 3,500 rpm for 10 min. We measured this saliva
volume secreted by chewing for 1 min and expressed as
saliva flow rate (mL/min). After measurement of the
sample volume, saliva samples were frozen at -50 C and
stored until the end of the study period.
HBD-2 determination
Salivary HBD-2 concentration was measured using an
enzyme-linked immunosorbent assay (ELISA) kit (Phoenix
Pharmaceuticals, Burlingame, CA). A 96-well microtitre
plate was washed with 300 lL of assay buffer and blocked
for 5 min. Saliva samples were thawed and centrifuged at
5,000 rpm for 10 min, and 100 lL of each sample was
added to the mixture which was then incubated for 2 h.
Using HBD-2 standard solutions, known concentrations of
HBD-2 were plated to establish standard values. After the
plate had been washed with assay buffer, biotinylated anti-
human HBD-2 detection antibody, which was diluted
(1:150) with assay buffer, was added to the plate and
Eur J Appl Physiol (2013) 113:26212627
Fig. 1 Protocol of yoga stretching. First, participants massaged their
legs and applied pressure to the acupressure points for 20 min.
Second, they held yoga poses (e.g., warrior pose, extended triangle
incubated for 2 h. After washing, streptavidinhorseradish
peroxidase (SA-HRP) solution, diluted (1:2,000) with
assay buffer, was added to the plate, and the mixture was
incubated for 2 h. After washing again, substrate solution
(TMB) was added, and the color intensity produced after
10 min was measured using a microplate reader (MTP-800;
Corona Electric, Hitachinaka, Japan) at 450 nm. All sam-
ples were assayed in duplicate, and average absorbance
was used as the representative value. Regression analysis
using the relation of standard HBD-2 concentration to
absorbance (nm) was used to interpolate the concentration
of HBD-2 in the samples. HBD-2 expression rate (pg/min)
was calculated by multiplying HBD-2 concentration (pg/mL)
by saliva flow rate (mL/min).
Mental state
Mental state was assessed using the Profile of Mood States
(POMS)Brief Form (Kanekoshobo, Tokyo, Japan) (Yo-
koyama et al. 1990). The POMS questionnaire rated six
mood subscales (TensionAnxiety, TA; Depression, D;
AngerHostility, AH; Vigor, V; Fatigue, F; Confusion, C)
on a 5-point scale and computed standardized points
(t points).
Data analysis and statistics
Data are presented as mean SD values. Analysis of
variance (ANOVA) for 2 (day, Rest and Yoga) 9 2 (time,
pre and post) repeated measures was used to determine the
2623
pose, and downward-facing dog pose) for 65 min. Finally, they lay in
the supine position (corpse pose) for 5 min
effect of yoga stretching. A paired t test was used to assess
differences before and after rest or yoga stretching. For all
analyses, p \ 0.05 was set for statistical significance.
Results
Saliva flow rate was 1.31 0.42 mL/min before rest,
1.29 0.33 mL/min after rest, 1.36 0.51 mL/min before
yoga, and 1.44 0.36 mL/min after yoga. Saliva flow rate
showed no significant change before or after rest and yoga
stretching [statistical power: 0.18 (b = 0.82), Fig. 2].
HBD-2 concentration was 84.7 96.9 pg/mL before
rest, 82.1 109.6 pg/mL after rest, 84.1 63.4 pg/mL
before yoga, and 165.4 127.1 pg/mL after yoga. HBD-2
concentration after yoga stretching was significantly higher
than that before yoga stretching [p \ 0.01; statistical
power: 0.95 (b = 0.05), Fig. 2]. HBD-2 concentration at
post on the second day (Yoga) was significantly higher
than that on the first day (Rest) (p \ 0.05; Fig. 2).
HBD-2 expression rate was 100.6 115.1 pg/min
before rest, 109.0 151.7 pg/min after rest, 110.7 96.8
pg/min before yoga, and 232.8 192.9 pg/min after yoga.
HBD-2 expression rate significantly increased after yoga
stretching [p \ 0.01; statistical power: 0.96 (b = 0.04),
Fig. 2]. HBD-2 expression rate at post on the second day
(yoga) was significantly higher than that on the first day
(rest) (p \ 0.01; Fig. 2).
Mental state showed no significant change before and
after rest. POMS score of depression tended to decrease
123
2624 Eur J Appl Physiol (2013) 113:26212627

Fig. 2 Saliva flow rate (a),

salivary HBD-2 concentration
(b) and HBD-2 expression rate
(c) before and after rest and
yoga stretching. Data are
expressed as mean SD
values. **p \ 0.01 vs. before
yoga (pre), p \ 0.05,
p \ 0.01; rest vs. yoga

after yoga stretching [p = 0.065; statistical power: 0.62
(b = 0.38)], and anger-hostility was significantly lower
after yoga stretching than before [p \ 0.05; statistical
power: 0.90 (b = 0.10), Table 1].
Discussion
This is the first report to examine the effect of yoga
stretching on salivary HBD-2 expression. The major
finding of this study was that yoga stretching for 90 min is
associated with a significant increase in HBD-2 expression.
Yoga and relaxation techniques are known to enhance
innate immune function (Diego et al. 2004; Sakaki 2006;
Field et al. 2007). In a study of ten healthy females who
have done yoga exercise for more than 5 years, yoga
breathing enhanced vagal modulation of the heart rate and
the lymphocytes gradually increased (Sakaki 2006). Pre-
vious studies reported that massage therapy, one of the
relaxation techniques, might enhance vagal activity and

Table 1 POMS scores before and after rest and yoga stretching
POMS scores
TA D AH V F C

Rest
Pre 41.1 6.1 43.3 6.2 41.3 4.2 47.9 9.3 41.4 7.7 45.6 4.8
Post 40.3 5.0 43.7 4.6 42.5 6.9 45.4 9.5 42.3 7.6 47.2 7.0
Yoga
Pre 39.4 6.3 43.0 4.4 40.9 5.4 46.6 10.4 39.5 5.8 44.6 6.4
Post 37.3 3.5 40.7 2.4 37.3 1.3* 47.8 12.6 37.0 2.8 42.8 3.7
Mean SD
TA tension-anxiety, D depression, AH anger-hostility, V vigor, F fatigue, C confusion
* p \ 0.05 vs. yoga (pre)

123
Eur J Appl Physiol (2013) 113:26212627
increase natural killer (NK) cells and natural killer cell
activity (Diego et al. 2004; Field et al. 2007). Therefore,
enhanced vagal activity by yoga might be expected to
activate the innate immune function.
Saliva has a physical cleansing action against various
kinds of microorganisms and serves as a useful indicator
for estimating oral immunity (Mataga 2009; Lamm et al.
1995). Saliva is secreted from the parotid, submandibular,
sublingual, and minor salivary glands, and whole saliva
from these glands can be used to determine composition
of the oral environment (Kuboki and Fujisawa 1986).
However, in the present study, saliva flow rate showed no
significant change before or after rest and yoga stretching.
In this study, participants rested for 90 min on the first
day as a control status. The present study lacked a control
group that was performed to general stretching. General
stretching is known to increase blood flow (Alter 2004)
and may alter saliva flow rate and immune function. It is
necessary to investigate the difference between yoga
stretching and general stretching. More detailed exami-
nation of a control group that is performed general
stretching is required.
Defensins have a broad antibacterial spectrum of
activity against microorganisms such as bacteria, fungi,
and viruses, and play an important role in the innate
immune system (Ganz 1999). Defensins exert antimicro-
bial effects by breaking the hydrophobic core of the lipid
bilayer on microbes (Oren et al. 1999; Schaller et al. 2000).
HBD-2 is expressed in human epithelial cells of the oral
cavity and respiratory tracts (Ganz 2003). A previous study
reported that variation in SIgA secretion, which serves as
an indicator of mucosal immune function in saliva, showed
no significant difference for sex or age (Shimizu et al.
2007a). In addition, there has been no study on the dif-
ferences in HBD-2 expression in relation to sex and age, so
further examination of that is required. In the present study,
we collected whole saliva from both males and females and
found that salivary HBD-2 concentration and expression
rate increased significantly after yoga exercise.
Salivary HBD-2 is known to be responsive to high-
intensity endurance exercise (Usui et al. 2011; Ostrowski
et al. 1999). It was reported that endurance exercise at
75 % VO2max for 60 min transiently increases salivary
HBD-2 concentration (Usui et al. 2011). HBD-2 expression
is induced by stimulation of bacterial bodies such as
staphylococci, Candida, and Pseudomonas aeruginosa
(Dinulos et al. 2003), tumor necrosis factor (TNF)-a, and
interleukin (IL)-1 (Harder et al. 2000). Additionally, pro-
duction of these cytokines is promoted by high-intensity
exercise (Ostrowski et al. 1999). However, the yoga
stretching in the present study was low-intensity exercise
as this intensity is suitable for older adults (Ainsworth et al.
2000). It is therefore suggested that cytokines such as TNF-
2625
a and IL-1 have a non-significant effect on increases in
salivary HBD-2 after yoga.
Recent studies have reported that yoga has a relaxation
effect (Hartfiel et al. 2011; Telles et al. 2009; Kamei et al.
2000). In a study of 48 academic staff in England, 60 min
of yoga per day, once a week for 6 weeks significantly
improved mental scores of the Profile of Mood States
(POMS) Bipolar scale and the Inventory of Positive Psy-
chological Attitudes Scale (Hartfiel et al. 2011). According
to a study carried out with 11 women, yoga for 2 months
significantly decreased depression (Uebelacker et al. 2010).
In the present study, the mood scores of D and A-H were
lower after yoga than before. Consequently, we confirmed
that yoga induces a relaxing effect. However, few previous
studies have reported a relaxation effect of general
stretching. Therefore, it is necessary to compare different
effects on psychological attitudes between general and
yoga stretching in further studies.
HBD-2 expression is known to be responsive to cortisol
(Tomita et al. 2002; McDermott et al. 2003; Starner et al.
2005). Mental and physical stress elicit the release of
cortisol, a catabolic glucocorticoid, from the hypothala-
muspituitaryadrenal (HPA) axis, and cortisol is used
conventionally as a biomarker to measure the effects of
various types of exercise (Greiwe et al. 1999; Kirschbaum
and Hellhammer 1994). Several studies investigated the
suppressive effect of glucocorticoids on the expression of
HBD-2 (Tomita et al. 2002; McDermott et al. 2003; Starner
et al. 2005). Nuclear factor (NF)-jB and activator protein
(AP)-1 transcription factors are essential for HBD-2 gene
expression. Glucocorticoids inhibit both NF-jB and AP-1
transcription factors and decrease HBD-2 gene expression
(Tomita et al. 2002). Therefore, it was suggested that a
decrease in glucocorticoids might increase the expression
of HBD-2. In addition, the previous study reported a larger
increase in salivary cortisol in relation to a smaller increase
in salivary HBD-2 expression after high-intensity exercise,
which demonstrated the negative correlation between cor-
tisol and HBD-2 levels in saliva (Usui et al. 2011). It was
reported that yoga exercise in seven yoga instructors
increased alpha waves and decreased serum cortisol levels
(Kamei et al. 2000). Taken together, the relaxation effect of
yoga stretching likely decrease salivary cortisol concen-
tration, which in turn increase salivary HBD-2 expression.
The primary limitation of this study is that the only
physiologic variable measured was HBD-2 and salivary
cortisol level was not measured. Furthermore, high con-
centrations of salivary HBD-2 can last for up to 180 min
after exercise (Usui et al. 2011). More detailed examination
of the time course of salivary HBD-2 and cortisol after
yoga stretching is thus required. An additional limitation of
this study is the non-randomized order of conditions. All
participants performed the rest condition first and the yoga
123
2626
condition second. The yoga condition was carried out after
14 days of the rest condition. We asked them not to change
their lifestyles such as habits of exercise, diet, and alcohol
drinking. Additionally, there was little change of environ-
mental conditions from the rest day to the yoga day.
Therefore, it was suggested that the non-randomized order
of conditions might not influence to the results of the
present study. However, the randomized study of yoga
stretching is also needed.
Conclusion
Yoga stretching for 90 min can increase salivary HBD-2
expression in older adults. Yoga stretching is a low-inten-
sity exercise aimed at relaxation and can be done com-
fortably and easily by beginners and older adults.
Therefore, yoga stretching might be useful for older adults
and athletes to maintain their health.
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