Evidence Report/Technology Assessment 

Number 155 

Meditation Practices for Health: State of the Research 

Prepared for: 

Agency for Healthcare Research and Quality 

U.S. Department of Health and Human Services 

540 Gaither Road 

Rockville, MD 20850 

www.ahrq.gov 

Contract No. 290-02-0023

Prepared by:

University of Alberta Evidence-based Practice Center 

Edmonton, Alberta, Canada 

Investigators: 

Maria B. Ospina, B.Sc., M.Sc. 

Kenneth Bond, B.Ed., M.A. 

Mohammad Karkhaneh, M.D. 

Lisa Tjosvold, B.A., M.L.I.S. 

Ben Vandermeer, M.Sc. 

Yuanyuan Liang, Ph.D. 

Liza Bialy, B.Sc. 

Nicola Hooton, B.Sc., M.P.H. 

Nina Buscemi, Ph.D. 

Donna M. Dryden, Ph.D. 

Terry P. Klassen, M.D., M.Sc., F.R.C.P.C. 

AHRQ Publication No. 07-E010 

June 2007
This report is based on research conducted by the University of Alberta Evidence-based Practice 

Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), 

Rockville, MD (Contract No. 290-02-0023). The findings and conclusions in this document are 

those of the author(s), who are responsible for its contents, and do not necessarily represent the 

views of AHRQ. No statement in this report should be construed as an official position of AHRQ 

or of the U.S. Department of Health and Human Services. 

The information in this report is intended to help clinicians, employers, policymakers, and others 

make informed decisions about the provision of health care services. This report is intended as a 

reference and not as a substitute for clinical judgment. 

This report may be used, in whole or in part, as the basis for development of clinical practice 

guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage 

policies. AHRQ or U.S. Department of Health and Human Services endorsement of such 

derivative products may not be stated or implied. 
ii

This document is in the public domain and may used and reprinted without permission except 

those copyrighted materials noted for which further reproduction is prohibited without the 

specific permission of copyright holders. 

Suggested Citation: 

Ospina MB, Bond TK, Karkhaneh M, Tjosvold L, Vandermeer B, Liang Y, Bialy L, Hooton N, 

Buscemi N, Dryden DM, Klassen TP. Meditation Practices for Health: State of the Research. 

Evidence Report/Technology Assessment No. 155. (Prepared by the University of Alberta 

Evidence-based Practice Center under Contract No. 290-02-0023.) AHRQ Publication No. 

07-E010. Rockville, MD: Agency for Healthcare Research and Quality. June 2007. 

The investigators have no relevant financial interests in the report. The investigators 

have no employment, consultancies, honoraria, or stock ownership or options, or 

royalties from any organization or entity with a financial interest or financial conflict 

with the subject matter discussed in the report. 
iii

Preface

The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based 

Practice Centers (EPCs), sponsors the development of evidence reports and technology 

assessments to assist public- and private- sector organizations in their efforts to improve the 

quality of healthcare in the United States. This report was requested and funded by the National 

Center for Complementary and Alternative Medicine (NCCAM). The reports and assessments 

provide organizations with comprehensive, science-based information on common, costly 

medical conditions and new healthcare technologies. The EPCs systematically review the 

relevant scientific literature on topics assigned to them by AHRQ and conduct additional 

analyses when appropriate prior to developing their reports and assessments. 

To bring the broadest range of experts into the development of evidence reports and health 

technology assessments, AHRQ encourages the EPCs to form partnerships and enter into 

collaborations with other medical and research organizations. The EPCs work with these partner 

organizations to ensure that the evidence reports and technology assessment they produce will 

become building blocks for healthcare quality improvement projects throughout the Nation. The 

reports undergo peer review prior to their release. 

AHRQ expects that the EPC evidence reports and technology assessments will inform 

individual health plans, providers, and purchasers as well as the healthcare system as a whole by 

providing important information to help improve healthcare quality. 

We welcome comments on this evidence report. They may be sent by mail to the Task Order 

Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, 

Rockville, MD 20850, or by email to epc@ahrq.gov. 

Carolyn M. Clancy, M.D. 

Director 

Agency for Healthcare Research and Quality 

Ruth L. Kirschstein, M.D. 

Acting Director 

National Center for Complementary and 

Alternative Medicine 

National Institutes of Health 

Jean Slutsky, P.A., M.S.P.H. 

Director 

Center for Outcomes and Evidence 

Agency for Healthcare Research and Quality 

Beth A. Collins Sharp, Ph.D.,R.N. 

Director, EPC Program 

Agency for Healthcare Research and Quality 

Margaret Coopey, R.N., M.G.A., M.P.S. 

EPC Program Task Order Officer 

Agency for Healthcare Research and Quality 
iv

Acknowledgments 

We are grateful to members of the technical expert panel for their consultation with and 

advice to the Evidence-based Practice Center during the preparation of this report. The members 

of the panel include John Astin, Ph.D., Ruth Baer, Ph.D., Vernon Barnes, Ph.D., Linda E. 

Carlson, Ph.D., C.Psych., Jeffery Dusek, Ph.D., Thierry Lacaze-Masmonteil, M.D., Ph.D., 

F.R.C.P.C., Badri Rickhi, M.D., Ph.D., and David Shannahoff-Khalsa, B.A. 

We would like to thank the peer reviewers, who provided valuable input into the draft report: 

Dr. Kirk Warren Brown (Virginia Commonwealth University, Richmond, VA), Dr. Bei-Hung 

Chang (Boston University School of Public Health, Boston, MA), Dr. Thawatchai 

Krisanaprakornkit (Khon Kaen University, Khon Kaen, Thailand), Dr. T. M. Srinivasan (The 

International Society for the Study of Subtle Energies and Energy Medicine, Chennai (Madras), 

India), Dr. Harald Walach (The University of Northampton, Northampton, United Kingdom), Dr. 

Ken Walton (Maharishi University of Management, Fairfield, IA), and Dr. Gloria Yeh (Osher 

Institute at Harvard Medical School, Boston, MA). 

We thank Dr. Richard L. Nahin and Dr. Catherine Stoney from the National Center for 

Complementary and Alternative Medicine for their insight, recommendations, and support of this 

work. We are grateful to the Agency for Healthcare Research and Quality for granting the 

contract for this work and the Task Order Officer, Margaret Coopey, for facilitating the 

collaboration of the three organizations. 

We are grateful to Lisa Hartling for her guidance when preparing the Work Plan for this 

report; Amy Couperthwaite, Lisa Malinowsky, and Kenneth Moreau for their assistance with 

article retrieval; Denise Adams, Mauricio Castillo, Carol Spooner, and Kate O’Gorman for their 

assistance with data extraction and quality assessment; and Christine Tyrell and Kelley Bessette 

for their administrative support. 
v

Structured Abstract

Objective: To review and synthesize the state of research on a variety of meditation practices, 

including: the specific meditation practices examined; the research designs employed and the 

conditions and outcomes examined; the efficacy and effectiveness of different meditation 

practices for the three most studied conditions; the role of effect modifiers on outcomes; and the 

effects of meditation on physiological and neuropsychological outcomes. 

Data Sources: Comprehensive searches were conducted in 17 electronic databases of medical 

and psychological literature up to September 2005. Other sources of potentially relevant studies 

included hand searches, reference tracking, contact with experts, and gray literature searches. 

Review Methods: A Delphi method was used to develop a set of parameters to describe 

meditation practices. Included studies were comparative, on any meditation practice, had more 

than 10 adult participants, provided quantitative data on health-related outcomes, and published 

in English. Two independent reviewers assessed study relevance, extracted the data and assessed 

the methodological quality of the studies. 

Results: Five broad categories of meditation practices were identified (Mantra meditation, 

Mindfulness meditation, Yoga, Tai Chi, and Qi Gong). Characterization of the universal or 

supplemental components of meditation practices was precluded by the theoretical and 

terminological heterogeneity among practices. Evidence on the state of research in meditation 

practices was provided in 813 predominantly poor-quality studies. The three most studied 

conditions were hypertension, other cardiovascular diseases, and substance abuse. Sixty-five 

intervention studies examined the therapeutic effect of meditation practices for these conditions. 

Meta-analyses based on low-quality studies and small numbers of hypertensive participants 

showed that TM®, Qi Gong and Zen Buddhist meditation significantly reduced blood pressure. 

Yoga helped reduce stress. Yoga was no better than Mindfulness-based Stress Reduction at 

reducing anxiety in patients with cardiovascular diseases. No results from substance abuse 

studies could be combined. The role of effect modifiers in meditation practices has been 

neglected in the scientific literature. The physiological and neuropsychological effects of 

meditation practices have been evaluated in 312 poor-quality studies. Meta-analyses of results 

from 55 studies indicated that some meditation practices produced significant changes in healthy 

participants. 

Conclusion: Many uncertainties surround the practice of meditation. Scientific research on 

meditation practices does not appear to have a common theoretical perspective and is 

characterized by poor methodological quality. Firm conclusions on the effects of meditation 

practices in healthcare cannot be drawn based on the available evidence. Future research on 

meditation practices must be more rigorous in the design and execution of studies and in the 

analysis and reporting of results.

vii

Contents 

Executive Summary........................................................................................................................ 1 

Evidence Report............................................................................................................................ 7 

Chapter 1. Introduction and Background........................................................................................ 9

Definition and Types of Meditation................................................................................................ 9 

Meditation Practices as a Part of Healing and Healthcare............................................................ 10 

Objectives of the Review.............................................................................................................. 11 

Chapter 2. Methods...................................................................................................................... 13 

Overview....................................................................................................................................... 13 

Key Questions and Analytic Approach......................................................................................... 13 

Topic I. The Practice of Meditation......................................................................................... 13

Topic II. State of Research on the Therapeutic Use of Meditation Practices in Healthcare.... 14 

Topic III. Evidence on the Efficacy and Effectiveness of Meditation Practices ..................... 14 

Topic IV. Evidence on the Role of Effect Modifiers for Meditation Practices ....................... 15 

Topic V. Evidence on the Physiological and Neuropsychological Effects of Meditation 

 Practices ............................................................................................................................ 15 

Literature Review Methods........................................................................................................... 17 

Development of Operational Parameters to Define Meditation Practices................................ 17 

Literature Search and Retrieval ................................................................................................ 17 

Criteria for Selection of Studies................................................................................................ 18 

Study Selection Process ............................................................................................................ 19 

Evaluating the Methodological Quality of Studies................................................................... 20 

Data Collection ......................................................................................................................... 21 

Literature Synthesis ...................................................................................................................... 22 

Data Analysis and Synthesis..................................................................................................... 22 

Peer Review Process..................................................................................................................... 25 

Chapter 3. Results ........................................................................................................................ 27 

Topic I. The Practice of Meditation............................................................................................. 27 

Main Components..................................................................................................................... 27 

Mantra Meditation ........................................................................................................................ 28 

Transcendental Meditation® ..................................................................................................... 29 

Relaxation Response................................................................................................................. 30 

Clinically Standardized Meditation .......................................................................................... 31 

Mindfulness Meditation................................................................................................................ 32 

Vipassana .................................................................................................................................. 32 

Zen Buddhist Meditation .......................................................................................................... 34 

Mindfulness-Based Stress Reduction ....................................................................................... 35 

Mindfulness-Based Cognitive Therapy .................................................................................... 37 

Yoga.............................................................................................................................................. 38 

Tai Chi .......................................................................................................................................... 43 

Qi Gong......................................................................................................................................... 44 
viii

Characteristics of Meditation Practices ........................................................................................ 46 

Main Components..................................................................................................................... 46 

Breathing................................................................................................................................... 47 

Attention and Its Object............................................................................................................ 47 

Spirituality and Belief............................................................................................................... 48 

Training..................................................................................................................................... 49 

Criteria of Successful Meditation Practice ............................................................................... 49 

Search Results for Topics II to V.................................................................................................. 54 

Topic II. State of Research on the Therapeutic Use of Meditation Practices in Healthcare........ 56 

General Characteristics ............................................................................................................. 56 

Methodological Quality ............................................................................................................ 56 

Meditation Practices Examined in Clinical Trials and Observational Studies ......................... 61 

Control Groups Used in Studies on Meditation Practices ........................................................ 69 

Meditation Practices Separated by the Diseases, Conditions, and Populations for Which They 

 Have Been Examined................................................................................................................ 82 

Outcome Measures Used in Studies on Meditation Practices .................................................. 96 

Summary of the Results.......................................................................................................... 105 

Topic III. Evidence on the Efficacy and Effectiveness of Meditation Practices ....................... 107 

Hypertension............................................................................................................................... 107 

Description of the Included Studies........................................................................................ 109 

Methodological Quality of the Included Studies .................................................................... 110 

Results of Direct Comparisons ............................................................................................... 112

Transcendental Meditation® ................................................................................................... 115 

Relaxation Response............................................................................................................... 122 

Qi Gong................................................................................................................................... 123 

Yoga........................................................................................................................................ 124 

Zen Buddhist meditation......................................................................................................... 127 

Mixed Treatment and Indirect Comparisons .......................................................................... 128 

Analysis of Publication Bias................................................................................................... 133 

Cardiovascular Diseases ............................................................................................................. 133 

Description of the Included Studies........................................................................................ 133 

Methodological Quality of Included Studies .......................................................................... 134 

Results of Direct Comparisons ............................................................................................... 137

Indirect Comparisons.............................................................................................................. 141 

Analysis of Publication Bias................................................................................................... 141 

Substance Abuse ......................................................................................................................... 141 

Description of the Included Studies........................................................................................ 141 

Methodological Quality of Included Studies .......................................................................... 142 

Results of Quantitative Analysis............................................................................................. 145 

Analysis of Publication Bias................................................................................................... 145 

Summary of the Results.............................................................................................................. 148 

Hypertension........................................................................................................................... 149 

Cardiovascular Diseases ......................................................................................................... 154 

Substance Abuse ..................................................................................................................... 150 

Topic IV. Evidence on the Role of Effect Modifiers for the Practice of Meditation ................ 152 
ix

Hypertension........................................................................................................................... 152 

Cardiovascular Diseases ......................................................................................................... 154 

Substance Abuse ..................................................................................................................... 155 

Summary of the Results.............................................................................................................. 156 

Topic V. Evidence on the Physiological and Neuropsychological Effects of Meditation 

 Practices .................................................................................................................................. 157 

General Characteristics ........................................................................................................... 157 

Overall Methodological Quality ............................................................................................. 157 

Outcome Measures.................................................................................................................. 159 

Results of Quantitative Analysis............................................................................................. 159 

Methodological Quality of Included Studies .......................................................................... 161 

Transcendental Meditation® ................................................................................................... 165 

Relaxation Response............................................................................................................... 170 

Yoga........................................................................................................................................ 172 

Tai Chi .................................................................................................................................... 183 

Qi Gong................................................................................................................................... 186 

Summary of the Results.............................................................................................................. 187 

Transcendental Meditation® ................................................................................................... 187 

Relaxation Response............................................................................................................... 188 

Yoga........................................................................................................................................ 188 

Tai Chi .................................................................................................................................... 188 

Qi Gong................................................................................................................................... 189 

Chapter 4. Discussion ................................................................................................................. 193 

The Practice of Meditation.......................................................................................................... 193 

Demarcation............................................................................................................................ 193 

Classification........................................................................................................................... 194 

Universal Components of Meditation Practices ..................................................................... 195 

Complexity.............................................................................................................................. 196 

Criteria of Successful Meditation Practice ............................................................................. 196 

Training................................................................................................................................... 197 

State of Research on the Therapeutic Use of Meditation Practices in Healthcare...................... 197 

Quality of the Evidence .......................................................................................................... 198 

Types of Interventions ............................................................................................................ 199 

Types of Control Groups ........................................................................................................ 200 

Types of Study Populations .................................................................................................... 200 

Types of Outcome Measures .................................................................................................. 201 

Evidence on the Efficacy and Effectiveness of Meditation Practices......................................... 201 

Evidence on the Role of Effect Modifiers for the Practice of Meditation.................................. 203 

Evidence on the Physiological and Neuropsychological Effects of Meditation Practices ......... 204 

Strengths and Limitations ........................................................................................................... 205 

Future Research .......................................................................................................................... 208 

Conclusions................................................................................................................................. 209 
x

References and Included Studies ................................................................................................ 211 

 List of Studies Potentially Relevant to the Review ................................................................ 257 

Abbreviations.............................................................................................................................. 259 

Figures 

Figure 1. Analytic framework for evidence report on the state of research on meditation 

 practices in healthcare................................................................................................................16 

Figure 2. Flow-diagram for study retrieval and selection for the review .....................................55 

Figure 3. Meta-analysis of the effect of TM® versus HE on blood pressure (SBP and DBP)....115 

Figure 4. Subgroup analysis by study duration of the effect of TM® versus HE on SBP ..........116 

Figure 5. Subgroup analysis by study duration of the effect of TM® versus HE on DBP..........116 

Figure 6. Meta-analysis of the effect of TM® versus HE on body weight..................................117 

Figure 7. Meta-analysis of the effect of TM® versus HE on heart rate ......................................117 

Figure 8. Meta-analysis of the effect of TM® versus HE on measures of stress ........................118 

Figure 9. Meta-analysis of the effect of TM® versus HE on measures of anger ........................118 

Figure 10. Meta-analysis of the effect of TM® versus HE on measures of self-efficacy ...........119 

Figure 11. Meta-analysis of the effect of TM® versus HE on TC ..............................................119 

Figure 12. Meta-analysis of the effect of TM® versus HE on HDL-C .......................................120 

Figure 13. Meta-analysis of the effect of TM® versus HE on LDL-C........................................120 

Figure 14. Meta-analysis of the effect of TM® versus HE on dietary intake..............................121 

Figure 15. Meta-analysis of the effect of TM® versus HE on physical activity .........................121 

Figure 16. Meta-analysis of the effect of TM® versus PMR on blood pressure 

 (SBP and DBP) ........................................................................................................................122 

Figure 17. Meta-analysis of the effect of RR versus BF on blood pressure (SBP and DBP).....123 

Figure 18. Meta-analysis of the effect of Qi Gong versus WL on blood pressure 

 (SBP and DBP) ........................................................................................................................124 

Figure 19. Meta-analysis of the effect of Yoga versus NT on blood pressure (SBP and DBP).124 

Figure 20. Subgroup analysis by concomitant therapy of Yoga versus NT on SBP ..................125 

Figure 21. Subgroup analysis by concomitant therapy of Yoga versus NT on DBP..................126 

Figure 22. Meta-analysis of the effect of Yoga versus HE on blood pressure (SBP and DBP).127 

Figure 23. Meta-analysis of the effect of Yoga versus HE on stress..........................................127 

Figure 24. Meta-analysis of the effect of Zen Buddhist meditation versus blood pressure 

 checks on blood pressure (SBP and DBP)...............................................................................128 

Figure 25. SBP results (point estimate and 95% credible interval) for all intervention based 

 on mixed treatment comparisons .............................................................................................130 

Figure 26. DBP results (point estimate and 95% credible interval) for all interventions based 

 on mixed treatment comparisons .............................................................................................131 

Figure 27. Meta-analysis of the effect of Yoga versus exercise on body weight .......................139 

Figure 28. Meta-analysis of the effect of TM® versus NT on SBP..............................................166 

Figure 29. Meta-analysis of the effect of TM® versus NT on DBP.............................................167 

Figure 30. Meta-analysis of the effect of TM® versus NT on cholesterol level .........................168 

Figure 31. Meta-analysis of the effect of TM® versus NT on verbal fluency.............................168 

Figure 32. Meta-analysis of the effect of TM® (no control) on blood pressure..........................169 

Figure 33. Meta-analysis of the effect of TM® versus WL on heart rate....................................169 
xi

Figure 34. Meta-analysis of the effect of TM® versus WL on blood pressure ...........................170 

Figure 35. Meta-analysis of the effect of RR versus BF on muscle tension...............................170 

Figure 36. Meta-analysis of the effect of RR versus rest on heart rate.......................................171 

Figure 37. Meta-analysis of the effect of RR versus rest on blood pressure ..............................171 

Figure 38. Meta-analysis of the effect of Yoga (no control) on heart rate .................................172 

Figure 39. Meta-analysis of the effect of Yoga (no control) on heart rate in hypertensive 

 populations...............................................................................................................................173 

Figure 40. Meta-analysis of the effect of Yoga (no control) on blood pressure.........................173 

Figure 41. Meta-analysis of the effect of Yoga (no control) on respiratory rate........................174 

Figure 42. Meta-analysis of the effect of Yoga (no control) on galvanic skin resistance ..........175 

Figure 43. Meta-analysis of the effect of Yoga (no control) on fasting blood glucose 

 (type II DM).............................................................................................................................175 

Figure 44. Meta-analysis of the effect of Yoga (no control) on fasting blood glucose ..............176 

Figure 45. Meta-analysis of the effect of Yoga (no control) on breath holding time after 

 inspiration and expiration ........................................................................................................177 

Figure 46. Meta-analysis of the effect of Yoga (no control) on auditory reaction time .............177 

Figure 47. Meta-analysis of the effect of Yoga (no control) on visual reaction time.................178 

Figure 48. Meta-analysis of the effect of Yoga (no control) on intraocular pressure.................179 

Figure 49. Meta-analysis of the effect of Yoga versus exercise on heart rate ............................179 

Figure 50. Meta-analysis of the effect of Yoga versus exercise on oxygen consumption 

 (VO2 max)................................................................................................................................180 

Figure 51. Meta-analysis of the effect of Yoga (ULNB) versus free breathing on 

 verbal ability ............................................................................................................................181 

Figure 52. Meta-analysis of the effect of Yoga (ULNB and URNB) versus free breathing 

 on spatial ability.......................................................................................................................185 

Figure 53. Meta-analysis of the effect of Yoga (shavasana) versus NT on blood pressure .......182 

Figure 54. Meta-analysis of the effect of Yoga versus medication on fasting blood glucose ....182 

Figure 55. Meta-analysis of the effect of Yoga (ULNB) versus URNB on heart rate ...............183 

Figure 56. Meta-analysis of the effect of Tai Chi versus NT on heart rate ................................183 

Figure 57. Meta-analysis of the effect of Tai Chi versus NT on blood pressure........................184 

Figure 58. Meta-analysis of the effect of Tai Chi versus exercise on blood pressure ................185 

Figure 59. Meta-analysis of the effect of Tai Chi (no control) on heart rate..............................185 

Figure 60. Meta-analysis of the effect of Tai Chi (no control) on blood pressure .....................186 

Figure 61. Meta-analysis of the effect of Qi Gong (no control) on heart rate ............................187 

Tables 

Table 1. Databases searched for relevant studies..........................................................................17 

Table 2. Inclusion criteria for topic I ............................................................................................19 

Table 3. Inclusion criteria for topics II to V .................................................................................19 

Table 4. Characteristics of included meditation practices ............................................................50 

Table 5. Methodological quality of RCTs ....................................................................................57 

Table 6. Methodological quality of NRCTs .................................................................................57 

Table 7. Methodological quality of before-and-after studies........................................................58 

Table 8. Methodological quality of cohort studies (NOS scale)...................................................59 

Table 9. Methodological quality of cross-sectional studies (NOS scale) .....................................61 
xii

Table 10. Meditation practices examined in intervention and observational analytical studies...62 

Table 11. Methodological quality of RCTs by meditation practice..............................................65 

Table 12. Methodological quality of NRCTs by meditation practice...........................................65 

Table 13. Methodological quality of before-and-after studies by meditation practice.................67 

Table 14. Methodological quality of cohort studies by meditation practice.................................67 

Table 15. Methodological quality of cross-sectional studies by meditation practice...................69 

Table 16. Number of control groups by study design...................................................................70 

Table 17. Controlled intervention studies: number of control groups by meditation practice .....70 

Table 18. Observational analytical studies: number of control groups by meditation practice....71 

Table 19. Types of control groups for intervention studies on meditation practices....................77 

Table 20. Types of control groups for observational analytical studies on meditation practices.80 

Table 21. Types of populations and conditions included in studies on meditation ......................82 

Table 22. Intervention studies conducted on meditation practices by populations examined......90 

Table 23. Observational analytical studies conducted on meditation practices by populations 

 examined....................................................................................................................................95 

Table 24. Type of outcome measures examined in studies on meditation practices ....................96 

Table 25. Number of outcome measures examined by meditation practice.................................99 

Table 26. Methodological quality of trials of meditation practices for hypertension.................110 

Table 27. Summary of outcomes by meditation practice and by comparison group included 

 in meta-analyses of the efficacy and effectiveness of meditation practices for hypertension.113 

Table 28. Mixed treatment comparisons on SBP (mm Hg) reductions compared to NT...........129 

Table 29. Mixed treatment comparisons on SBP (mm Hg) reductions compared to NT...........130 

Table 30. Methodological quality of trials of meditation practices for other cardiovascular 

 disorders...................................................................................................................................135 

Table 31. Summary of outcomes by meditation practice and by comparison group included 

 in meta-analyses of the efficacy and effectiveness of meditation practices in cardiovascular 

 diseases ....................................................................................................................................138 

Table 32. Methodological quality of trials of meditation practices for substance abuse............144 

Table 33. Summary of outcomes by meditation practice and by comparison group included 

 in meta-analyses of efficacy and effectiveness........................................................................146 

Table 34. Summary of the meta-analyses of the treatment effects of meditation practices in 

 hypertension and cardiovascular diseases (statistical and clinical significance).....................149 

Table 35. Summary of the analyses of effect modifiers for achieving benefits from 

 meditation practice for hypertension .......................................................................................153 

Table 36. Summary of the analyses of effect modifiers for achieving benefits from meditation 

 practice for cardiovascular diseases.........................................................................................155 

Table 37. Summary of the analysis of effect modifiers for achieving benefits from meditation 

 practice for substance abuse.....................................................................................................156 

Table 38. Methodological quality of RCTs on the physiological and neuropsychological 

 effects of meditation practices .................................................................................................158 

Table 39. Methodological quality of NRCTs on the physiological and neuropsychological 

 effects of meditation practices .................................................................................................158 

Table 40. Methodological quality of before-and-after studies on the physiological and 

 neuropsychological effects of meditation practices.................................................................159 
xiii

Table 41. Summary of outcomes by meditation practice by comparison group by population 

 included in meta-analyses of physiological and neuropsychological effects of meditation 

 practices ...................................................................................................................................160 

Table 42. Methodological quality of RCTs and NRCTs included in meta-analyses for 

 physiological and neuropsychological effects of meditation practices....................................162 

Table 43. Methodological quality of before-and-after studies included in meta-analyses for 

 physiological and neuropsychological effects of meditation practices...................................164 

Table 44. Summary of statistical and clinical significance of physiological outcomes 

 examined in clinical studies on meditation practices...............................................................190

Appendixes 

Appendix A: Technical Experts and Peer Reviewers 

Appendix B: Development of Consensus on a Set of Criteria for an Operational Definition of 

Meditation 

Appendix C: Exact Search Strings 

Appendix D: Review Forms 

Appendix E: Excluded Studies and Non Obtained Studies 

Appendix F: References of Multiple Publications 

Appendix G: Summary Tables for Topic II 

Appendix H: Characteristics of Clinical Trials of Meditation Practices for the Three Most 

 Studied Conditions 

Appendix I: Characteristics of Studies Included in Topic V 

Appendix J: Characteristics of Studies on the Physiological and Neuropsychological Effects 

 of Meditation Practices 

Appendixes and evidence tables cited in this report are provided electronically at 

http://www.ahrq.gov/downloads/pub/evidence/pdf/meditation/medit.pdf

1

Executive Summary 

Introduction 

The University of Alberta Evidence-based Practice Center (UAEPC) reviewed and synthesized 

the published literature on the state of the research of meditation practices for health. The 

research questions were organized under five general topics: 

1. The practice of meditation; 

2. The state of research on the therapeutic use of meditation practices in healthcare; 

3. The evidence on the efficacy and effectiveness of meditation practices; 

4. The evidence on the role of effect modifiers for the practice of meditation; and 

5. The evidence on the physiological and neuropsychological effects of meditation practices. 

Meditation has been a spiritual and healing practice in some parts of the world for more than 

5,000 years. During the last 40 years, the practice of meditation has become increasingly popular 

in Western countries as a complementary mind-body therapeutic strategy for a variety of healthrelated problems. Meditation and its therapeutic effects have been characterized in many ways in 

the scientific literature. The complex nature of meditation and the coexistence of many 

perspectives adopted to describe the characteristics of the practice have contributed to great 

variations in the reports of its therapeutic effects across the studies. There is a need to evaluate 

the evidence that has emerged within the past several decades on the effects of meditation 

practices in healthcare. 

Methodology

The UAEPC established a prospectively designed protocol for this evidence report. A 

Technical Expert Panel (TEP) was invited to provide high-level content and methodological 

expertise in the development of the report. Due to the lack of general consensus on a definition 

of meditation in the scientific literature, a set of parameters to describe meditation practices was 

evaluated by the TEP members using a modified Delphi methodology. 

Literature Sources 

Comprehensive searches were conducted in 17 relevant electronic databases up to September 

2005. Other sources of potentially relevant studies included hand searches, reference tracking, 

contact with experts, and gray literature searches. 

Study Selection 

A set of strict eligibility criteria was used to include potentially relevant studies. They had to 

be comparative, be on any meditation practice, have more than 10 adult participants, provide 

quantitative data on health-related outcomes, and be published in English. The criteria of study 
2

methodology were modified to address each of the research topics of the review. Sources of 

secondary data (e.g., systematic reviews, narrative reviews, and book chapters) were used for 

topic I. Topics II to V included studies with a comparison/control group or control period: 

randomized controlled clinical trials (RCTs), nonrandomized controlled clinical trials (NRCTs) 

(topics III to V), prospective and retrospective observational studies with controls (topic II), 

case-control studies (topic II), uncontrolled before-and-after studies (topics II and V), and crosssectional studies with controls (topic II). 

Data extraction and Assessment of Study Quality 

Trained research assistants extracted the data using a comprehensive and pretested data 

extraction form. One reviewer verified the accuracy and completeness of the data. 

Studies included in the descriptive overview on the practice of meditation (topic I) were not 

assessed for methodological quality. For topics II to V, the methodological quality of RCTs and 

NRCTs was assessed using the criteria for concealment of allocation and the Jadad Scale. The 

quality of observational analytical studies (e.g., prospective and retrospective observational 

studies, case-control studies, and cross-sectional studies with controls) was assessed using the 

Newcastle-Ottawa Scales (NOS). The quality of the before-and-after studies was evaluated 

against four criteria adapted from the NOS. 

Two independent reviewers assessed study relevance, extracted the data and assessed the 

methodological quality of the studies. Disagreements among reviewers were adjudicated by a 

third reviewer. 

Synthesis of the Evidence 

Data for topic I on the practice of meditation were synthesized qualitatively. A combination 

of qualitative and quantitative approaches was used to synthesize the data in Topics II to V. 

Details of individual studies were summarized in evidence tables including information on the 

article source, study design, study population (e.g., sample size, age, and gender), treatment 

groups, and outcomes. Meta-analyses using the standard inverse variance and random effects 

model were planned to derive pooled estimates from individual studies to support inferences 

regarding the magnitude and direction of the effect of meditation practices. Forest plots were 

used to display the individual and pooled results. An analysis of publication bias was also 

planned. 

Results 

Topic I. The Practice of Meditation 

Five broad categories of meditation practices were identified in the included studies: Mantra 

meditation (comprising the Transcendental Meditation® technique [TM®], Relaxation Response 

[RR], and Clinically Standardized Meditation [CSM]), Mindfulness meditation (comprising 

Vipassana, Zen Buddhist meditation, Mindfulness-based Stress Reduction [MBSR], and 

Mindfulness-based Cognitive Therapy [MBCT]), Yoga, Tai Chi, and Qi Gong. Given the variety 

of the practices and the fact that some are single entities (TM®, RR, and CSM, Vipassana, 
3

MBSR, and MBCT) while others are broad categories that encompass a variety of different 

techniques (Yoga, Tai Chi, Qi Gong), it is impossible to select components that might be 

considered universal or supplemental across practices. Though some statement about the use of 

breathing is universal among practices, this is not a reflection of a common approach toward 

breathing. The control of attention is putatively universal; however, there are at least two aspects 

of attention that might be employed and a wide variety of techniques for anchoring the attention. 

The spiritual or belief component of meditation practices is poorly described in the literature and 

it is unclear in what way and to what extent spirituality and belief play a role in the successful 

practice of meditation. The amount of variation in the described frequency and duration of 

practice make it difficult to draw generalizations about the training requirements for meditation 

techniques. The criteria for successful meditation practice have also not been described well in 

the literature. 

Topic II. State of Research on the Therapeutic Use of Meditation 

Practices in Healthcare

Eight hundred and thirteen studies provided evidence regarding the state of research on the 

therapeutic use of meditation practices. The studies were published between 1956 and 2005, with 

half of the studies published after 1994. Most of the studies were published as journal articles. 

Studies were conducted mainly in North America (61 percent). Of the 813 studies included, 67 

percent were intervention studies (286 RCTs, 114 NRCTs and 147 before-and-after studies), and 

33 percent were observational analytical studies (149 cohort and 117 cross-sectional studies). 

Quality of studies. Overall, we found the methodological quality of meditation research to 

be poor, with significant threats to validity in every major category of quality measured, 

regardless of study design. The majority of RCTs did not adequately report the methods of 

randomization, blinding, withdrawals, and concealment of treatment allocation. Observational 

studies were subject to bias arising from uncertain representativeness of the target population, 

inadequate methods for ascertaining exposure and outcome, insufficient followup period, and 

high or inadequately described losses to followup. 

Meditation practices. Mantra meditation practices such as the TM® technique and the RR 

were the most frequently studied meditation practices. Other mantra practices such as CSM, 

Acem meditation, Ananda Marga, concentrative prayer, and Cayce’s meditation have been 

examined less frequently. The second category of meditation practices most frequently examined 

is Yoga. It includes a heterogeneous group of techniques such as Hatha yoga, Kundalini yoga, 

and Sahaja yoga. Mindfulness meditation, which includes MBSR, MBCT, and Zen Buddhist 

meditation, constitutes the third most studied group of meditation practices, Tai Chi the fourth, 

and Qi Gong the fifth. Finally, less than 5 percent of the studies on meditation have failed to 

explicitly describe the meditation practice. 

Control groups. The number of control groups used in the 668 controlled studies ranged 

from one to four. The majority of the studies utilized an active, concurrent control. Among the 

RCTs and NRCTs, the practice of exercise and other physical activities constituted the most 

frequent active comparator followed by conditions involving states of rest and relaxation, health 

education, and progressive muscle relaxation. Almost half of the RCTs and NRCTs included 

comparison groups consisting of participants assigned to waiting lists, or participants that did not 

receive any intervention. The vast majority of observational studies used comparison groups 

consisting of individuals that had not been exposed to any type of meditation practice. 
4

Study population. The majority of studies on meditation practices have been conducted in 

healthy populations. The three most studied clinical conditions are hypertension, other 

cardiovascular diseases, and substance abuse. Other diseases that have been frequently examined 

include anxiety disorders, depression, cancer, asthma, chronic pain, type II diabetes mellitus, and 

fibromyalgia. 

Outcome measures. Physiological functions, particularly cardiovascular outcomes, were the 

most frequently reported outcome of interest in meditation research. Psychosocial outcomes, 

outcomes related to clinical events and health status, cognitive and neuropsychological functions, 

and healthcare utilization outcomes have also been evaluated in studies of meditation practices. 

Topic III. Evidence on the Efficacy and Effectiveness of Meditation 

Practices 

We summarized the evidence from RCTs and NRCTs on the effects of meditation practices 

for the three most studied clinical conditions identified in the scientific literature: hypertension 

(27 trials), other cardiovascular diseases (21 trials), and substance abuse disorders (17 trials). 

A few studies of overall poor methodological quality were available for each comparison in 

the meta-analyses, most of which reported nonsignificant results. TM® had no advantage over 

health education to improve measures of systolic blood pressure and diastolic blood pressure, 

body weight, heart rate, stress, anger, self-efficacy, cholesterol, dietary intake, and level of 

physical activity in hypertensive patients; RR was not superior to biofeedback in reducing blood 

pressure in hypertensive patients; Yoga did not produce clinical or statistically significant effects 

in blood pressure when compared to nontreatment; Zen Buddhist meditation was no better than 

blood pressure checks to reduce systolic blood pressure in hypertensive patients. Yoga was no 

better than physical exercise to reduce body weight in patients with cardiovascular disorders. 

When the relative effectiveness of a variety of meditation practices was assessed using indirect 

meta-analysis, we found that there were no significant differences between MBSR and Yoga to 

control anxiety symptoms in cardiovascular patients. Meta-analysis of the effects of meditation 

practices for substance abuse was not possible due to the diversity of practices, comparison 

groups, and outcome measures reported in each of the studies reviewed. 

The results of the three highest quality trials(Jadad score = 3/5) examining, respectively, 

Mindfulness meditation, RR, and Yoga are inconclusive with respect to the effectiveness of 

meditation pratices. 

The study comparing Mindfulness meditation with usual care (NS) for alcohol and cocaine 

abuse found little indication that Mindfulness meditation enhanced treatment outcomes for 

substance abuse patients. The study comparing RR with PMR and rest groups for alcohol abuse 

found generalized effects for BP, but not for the other outcome measures (anxiety, HR, and 

GSR). The RR and PMR groups did not exhibit increased BP as observed in control subjects. RR 

and PMR produced significant changes in tension. The study comparing Yoga with exercise for 

alcohol abuse found a significantly greater recovery rate for the Yoga group. 

Statistical and clinical heterogeneity among the trials constituted a frequent and considerable 

problem when pooling the results, and in some cases, it precluded summarizing data across the 

studies. The poor methodological quality of the trials limits the strength of inference regarding 

the observed treatment effects reported in this review. The lack of description of the methods of 

allocation concealment, randomization, description of withdrawals and dropouts per treatment 
5

group, the absence of appropriate blinding , and the use of incompatible or inappropriate control 

groups undermine the validity of the results of many clinical studies. 

Topic IV. Evidence on the Role of Effect Modifiers for the Practice of 

Meditation 

The role of patient or meditation characteristics as effect modifiers in the practice of 

meditation is a topic that has so far been neglected in the scientific literature. Few studies have 

systematically examined factors such as dose, duration, or other specific features of meditation 

as moderators of the effects on outcomes. Evidence from RCTs and NRCTs regarding the 

interaction of meditation with other variables in populations of patients with hypertension, 

cardiovascular disorders, or substance abuse is scarce. A few studies conducted exploratory post 

hoc analyses (i.e., a subgroup analysis, multiple regression, or analysis of variance) that were 

intended to be hypothesis generating. No conclusions on the role of effect modifiers can be 

drawn from the analysis of the individual studies. Individual patient data is required to 

appropriately examine this issue. 

TOPIC V. Evidence on the Physiological and Neuropsychological 

Effects of Meditation Practices 

The physiological and neuropsychological effects of meditation practices were evaluated in 

311 studies. The majority of studies have been conducted in healthy participants. Meta-analysis 

revealed that the most consistent and strongest physiological effects of meditation practices in 

healthy populations occur in the reduction of heart rate, blood pressure, and cholesterol. The 

strongest neuropsychological effect is in the increase of verbal creativity. There is also some 

evidence from before-and-after studies to support the hypothesis that certain meditation practices 

decrease visual reaction time, intraocular pressure, and increase breath holding time. As found in 

studies included for topic III, the overall low methodological quality of the studies indicates that 

most of the studies suffered from methodological problems that may result in overestimations of 

the treatment effects or compromise the generalizability of the study results. Particularly, the 

lack of a concurrent control group in the before-and-after studies results in an inability to control 

for temporal trends, regression to the mean, and sensitivity to methodological features. 

Therefore, results from meta-analyses of the physiological and neuropsychological effects of 

meditation practices should be interpreted cautiously. 

The very small number of trials available for each comparison precluded testing for 

publication bias.
6

Future Research 

Future research in meditation has several challenges. There is a need to develop a consensus 

on a working definition of meditation applicable to a heterogeneous group of practices. Another 

area of future inquiry consists of systematically comparing the effects of different meditation 

practices that research shows have promise. Special attention to the appropriate selection of 

controls is also paramount and future research should be directed toward investigating the unique 

challenges that mediation studies present in designing controls. In addition, more research should 

be done on the “dose response” of meditation practices to determine appropriate study durations 

and to help standardize courses of therapeutic meditation. 

Because it is difficult to determine causation using uncontrolled before-and-after designs, it 

is recommended that these study designs be avoided in future research on the effectiveness of 

meditation practices. Researchers should aim to employ designs and analytic strategies that 

optimize the ability to make causal inferences (in some cases this may require the use of 

uncontrolled before-and-after designs). Future studies would benefit from using larger samples 

and employing concurrent controlled designs, using disease-specific measures and providing 

clearer descriptions of intervention components. Finally, the quality of reporting of meditation 

research would be improved by a wider dissemination and stricter enforcement of the 

CONSORT (Consolidated Standards of Reporting Trials) guidelines within the complementary 

and alternative medicine community. 

Conclusions 

The field of research on meditation practices and their therapeutic applications is beset with 

uncertainty. The therapeutic effects of meditation practices cannot be established based on the 

current literature. Further research needs to be directed toward the ways in which meditation may 

be defined, with specific attention paid to the kinds of definitions that are created. A clear 

conceptual definition of meditation is required and operational definitions should be developed. 

The lack of high-quality evidence highlights the need for greater care in choosing and describing 

the interventions, controls, populations, and outcomes under study so that research results may 

be compared and the effects of meditation practices estimated with greater reliability and 

validity. Firm conclusions on the effects of meditation practices in healthcare cannot be drawn 

based on the available evidence. It is imperative that future studies on meditation practices be 

rigorous in the design, execution, analysis, and reporting of the results 
Evidence Report 

9

Chapter 1. Introduction and Background 

Meditation has been a spiritual and healing practice in some parts of the world for more than 

5,000 years.1

 The word “meditation” is derived from the Latin “meditari,” which means “to 

engage in contemplation or reflection.” 

Historically, religious or spiritual aims were intrinsic to any form of meditation. These 

traditional practices held some type of spiritual growth, enlightenment,2

 personal transformation, 

or transcendental experience as their ultimate goal.3 During the last 40 years, the practice of 

meditation has become increasingly popular and has been adapted to the specific interests and 

orientation of Western culture as a complementary therapeutic strategy for a variety of healthrelated problems.2,4 Both secular forms of meditation and forms rooted in religious and spiritual 

systems have increasingly attracted the interest of clinicians, researchers, and the general public, 

and have gained acceptance as important mind-body interventions within integrative medicine 

(the combination of evidence-based conventional and alternative approaches that address the 

biological, psychological, social, and spiritual aspects of health and illness). With an estimated 

10 million practitioners in the United States and hundreds of millions of practitioners 

worldwide,5

 meditation was the first mind-body intervention to be widely adopted by 

mainstream healthcare providers and incorporated into a variety of therapeutic programs in 

hospitals and clinics in the United States and abroad.6,7

Definition and Types of Meditation 

Meditation has been characterized in many ways in the scientific literature and there is no 

consensus definition of meditation. This diversity in definitions reflects the complex nature of 

the practice of meditation and the coexistence of a variety of perspectives that have been adopted 

to describe and explain the characteristics of the practice. Therefore, we recognize that any single 

definition limits the practice artificially and fails to account for important nuances that 

distinguish one type of meditation from another.8

Cardoso et al.9

 developed a detailed operational definition of meditation broad enough to 

include traditional belief-based practices and those that have been developed specifically for use 

in clinical settings. Using a systematic approach based on consensus techniques, they defined 

any practice as meditation if it (1) utilizes a specific and clearly defined technique, (2) involves 

muscle relaxation somewhere during the process, (3) involves logic relaxation (i.e., not “to 

intend” to analyze the possible psychophysical effects, not “to intend” to judge the possible 

results, not “to intend” to create any type of expectation regarding the process), (4) a selfinduced state, and (5) the use of a self-focus skill or “anchor” for attention. From a cognitive and 

psychological perspective, Walsh et al.10 defined meditation as a family of self-regulation 

practices that aim to bring mental processes under voluntary control through focusing attention 

and awareness. Other behavioral descriptions emphasize certain components such as relaxation, 

concentration, an altered state of awareness, suspension of logical thought processes, and 

maintenance of self-observing attitude.11 From a more general perspective, Manocha12 described 

meditation as a discrete and well-defined experience of a state of “thoughtless awareness” or 

mental silence, in which the activity of the mind is minimized without reducing the level of 

alertness. Meditation also has been defined as a self-experience and self-realization exercise.13
10

Despite the lack of consensus in the scientific literature on a definition of meditation, most 

investigators would agree that meditation implies a form of mental training that requires either 

stilling or emptying the mind, and that has as its goal a state of “detached observation” in which 

practitioners are aware of their environment, but do not become involved in thinking about it. All 

types of meditation practices seem to be based on the concept of self-observation of immediate 

psychic activity, training one’s level of awareness, and cultivating an attitude of acceptance of 

process rather than content.3

Meditation is an umbrella term that encompasses a family of practices that share some 

distinctive features, but that vary in important ways in their purpose and practice. This lack of 

specificity of the concept of meditation precludes developing an exhaustive taxonomy of 

meditation practices. However, in order to systematically address the question of the state of 

research of meditation practices in healthcare, we must attempt to identify the components that 

are common to the many practices that are claimed to be meditation or that incorporate a 

meditative component, and also clearly distinguish meditation practices from other therapeutic 

and self-regulation strategies such as self-hypnosis or visualization and from other relaxation 

techniques that do not contain a meditative component. 

Meditation practices may be classified according to certain phenomenological characteristics: 

the primary goal of practice (therapeutic or spiritual), the direction of the attention (mindfulness, 

concentrative, and practices that shift between the field or background perception and experience 

and an object within the field3,14), the kind of anchor employed (a word, breath, sound, object or 

sensation7,15,16), and according to the posture used (motionless sitting or moving).7

 Like other 

complex and multifaceted therapeutic interventions, meditation practices involve a mixture of 

specific and vaguely defined characteristics, and they can be practiced on their own or in 

conjunction with other therapies. As pointed out by many authors, any attempt to create a 

taxonomy of meditation only approximates the multidimensional experience of the practices.17

Meditation Practices as a Part of Healing and Healthcare 

The interest in meditation practices as healing strategies comes with the need to acquire a 

deeper knowledge of the intricate connections between body and mind, and how the mental and 

spiritual state of an individual directly affects psychological and physical well-being. Meditation 

practices have been advocated as mind-body treatments for health-related problems and as 

methods to attain or maintain general wellness. There is a growing body of scientific literature on 

the effects of meditation practices for a variety of psychiatric disorders such as depression,18

anxiety,14,19 panic disorders,20 binge eating disorders,7 and substance abuse21,22 among others. 

Effects of meditation practices have been also documented using measures of emotional 

distress20 and cognitive abilities.23

The effects of meditation practices as complementary treatments for medical conditions other 

than mental illness have been evaluated using a variety of methods and outcomes. These clinical 

conditions include hypertension24 and other cardiovascular disorders,25,26 pain syndromes and 

musculoskeletal diseases,18,27,28 respiratory disorders (e.g., asthma, congestive obstructive 

pulmonary disease),29 dermatological problems (e.g., psoriasis, allergies),30 immunological 

disorders,27 and treatment-related symptoms of breast and prostate cancer.18,31

There is also a considerable interest in understanding the physiological and 

neuropsychological effects of certain meditation practices.3,32,33 Research conducted in this area 
11

has used a variety of methodological approaches and formal evaluations of the methodological 

quality of this body of evidence have not been conducted. 

There is a need to evaluate the evidence that has emerged within the past several decades on 

the effects of meditation practices in healthcare. Reports on the therapeutic effects of a variety of 

meditation practices vary greatly across studies. Numerous authors have claimed that most of the 

studies in this area are methodologically flawed and often have small sample sizes.3,34,35 The 

magnitude and direction of the effect often varies from one type of practice to another; however, 

authors agree that some meditation practices hold some promise of therapeutic benefit for a 

variety of diseases or conditions. Therefore, there is a great need to clarify and address a host of 

clinical and research questions regarding the benefits of these interventions. 

It is also important to systematically evaluate the role that effect modifiers (e.g., age, gender, 

duration of practice, other characteristics of meditators, training conditions) may have in 

influencing the outcomes of the types of meditation. By elucidating important clinical questions 

regarding the therapeutic effects of meditation practices, consensus on standards of practice can 

be reached with a view to integrate mind-body approaches more effectively into conventional 

medical care. 

Objectives of the Review 

• To provide a descriptive overview and synthesis of information on meditation practices in 

terms of the main components of the practice, the role of spirituality, training requirements, 

and criteria for success. 

• To conduct a systematic review and synthesis of the evidence on (1) the state of research on 

the therapeutic use of meditation practices in healthcare, (2) the efficacy and effectiveness of 

meditation practices in healthcare, (3) the role of effect modifiers for the practices, and (4) 

the effects of meditation practices on physiological and neuropsychological outcomes. 

13

Chapter 2. Methods 

Overview 

In this chapter we document a prospectively designed protocol that the University of Alberta 

Evidence-based Practice Center (UAEPC) used to develop this comprehensive evidence report 

on the state of research of meditation practices in healthcare. 

To accomplish the tasks as directed, a core research team at the UAEPC was assembled to 

review and refine the methodology of the task order. All the reviewers at the UAEPC are trained 

and experienced in systematic review methodology and critical analysis of the scientific 

literature. In consultation with the Agency for Healthcare Research and Quality (AHRQ) Task 

Order Officer (TOO) and National Center for Complementary and Alternative Medicine 

(NCCAM) representatives, a Technical Expert Panel (TEP) was invited to provide high-level 

content and methodological expertise in the development of the report. The list of technical 

experts and their curriculum vitae were submitted to the AHRQ TOO for approval (Appendix 

A).*

Throughout the development of the report, the UAEPC project staff worked closely with TEP 

members and AHRQ and NCCAM representatives to refine the research questions. Guidance 

was provided through a series of teleconferences and, when needed, through individual telephone 

calls and e-mail. 

To provide a framework for the report, we first present the key questions of the review and 

our analytic approach to address them. We then describe the literature review methods, including 

a description of how we developed a set of parameters to describe meditation practices. We 

outline our inclusion and exclusion criteria, the search strategy for identifying articles relevant to 

the key questions, and the process for abstracting and synthesizing information from eligible 

studies. We also describe the methods for assessing the methodological quality of individual 

studies and the criteria for evaluating the strength of the evidence as a whole. The methods for 

data analysis and synthesis and the peer review process are described at the end of the chapter. 

Key Questions and Analytic Approach 

The key questions of this review have been organized under five general topics: 

Topic I. The Practice of Meditation 

The following questions pertain to the description of the practice of meditation and 

meditation techniques: 

1. What is known about the practice of meditation? 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
14

a. What are the main components of the various meditation practices (e.g., 

breathing, chanting, mantras, and relaxation)? Which components are universal 

and which ones are supplemental? 

b. How is breathing incorporated in these practices? Are there specific breathing 

patterns that are integral elements of meditation? Is breathing passive or directed? 

c. For each type of meditation practice, where is the attention directed during 

meditation (e.g., mantra, breath, image, nothing)? 

d. To what extent is spirituality a part of meditation? To what extent is belief a part 

of meditation? 

e. What are the training requirements for the various meditation practices (e.g., the 

range of training periods, frequency of training, individual and group approaches) 

f. How is the success of the meditation practice determined (i.e., was it practiced 

properly)? What criteria are used to determine successful meditation practice? 

Topic II. State of Research on the Therapeutic Use of Meditation 

Practices in Healthcare 

The following key questions pertain to the scope of research on meditation in healthcare: 

2. What meditation practices have been examined in clinical trials and observational 

studies? What control groups are used? 

3. Can these practices be separated by the diseases, conditions, and populations for which 

they have been examined? 

4. What outcome measures are used? Are psychosocial outcomes included in these studies? 

If so, what types? 

Topic III. Evidence on the Efficacy and Effectiveness of Meditation 

Practices 

The following key questions pertain to the potential benefits and harms of meditation: 

5. What is the evidence that meditation practices are efficacious for the three most studied 

diseases or conditions identified in question 2 above? 

6. If more than one form of meditation has been studied for a particular disease or condition 

(as identified in question 2 above), does the efficacy of these practices differ? 

7. For specific disease populations, are meditation practices that are used as a complement 

to conventional therapy more effective than either the conventional therapy or meditation 

therapy alone? 
15

Topic IV. Evidence on the Role of Effect Modifiers for Meditation 

Practices 

The following key questions pertain to specific elements of the meditation practice, 

population and practitioner that may influence the outcomes: 

8. What dose of meditation is necessary before successful health outcomes are realized? 

That is, is the duration of meditation important for outcomes? 

9. Does the direction of attention during meditation affect outcomes? 

10. To what extent is a rhythmic aspect (i.e., mantra, controlled breathing, or other ordered, 

recurrent sound or motion) critical to the practice of meditation and to health outcomes? 

Do such approaches to meditation that rely on these rhythmic behaviors demonstrate 

consistent effectiveness versus nonrhythmic approaches to meditation? More broadly, do 

the number and types of components that make up the various meditation practices 

influence the outcomes? 

11. Do individual difference variables (age, gender, race, education, income, other) predict 

success in the process of meditation (i.e., adherence, acceptance), as well as predicting 

health outcomes? 

Topic V. Evidence on the Physiological and Neuropsychological 

Effects of Meditation Practices 

The following key questions pertain to the physiological and neuropsychological effects of 

meditation practices: 

12. What is known regarding cardiopulmonary, endocrine, immunologic, metabolic, and 

autonomic changes seen during meditation practices? 

13. What is known regarding the effects of meditation practices on brain function (e.g., brain 

imaging, electroencephalogram (EEG), neuropsychological and cognitive functions)? 

Figure 1 presents the analytic framework for the review. We used two main methodological 

approaches to address the research topics discussed in this report. 
16

Figure 1. Analytic framework for evidence report on the state of research on meditation practices in 

healthcare 

 Topic I 

 Topic V 

 Topic II 

 Topic IV 

Topic III 

For topic I, the practice of meditation, the steps involved in the development of the 

descriptive overview included: 

• development of an operational definition of meditation 

• literature search 

• study selection 

• data extraction 

• qualitative synthesis of information 

For topic II on the state of research for the therapeutic use of meditation practices, topic III 

on the efficacy and effectiveness of meditation practices, topic IV on the role of effect modifiers 

of meditation practices, and topic V on the physiological and neuropsychological effects of 

meditation practices, a number of steps were involved in conducting the literature review and 

synthesis of the evidence: 

• literature search and retrieval 

• study selection 

• assessment of study quality 

• data extraction 

• data analysis and synthesis 

Population 

(adults) Meditation

Background

Physiological outcomes

Health-related outcomes

Effect modifiers

(dose, duration, direction of 

attention, rhythmic pattern, and 

individual variables) 
17

Literature Review Methods 

Development of Operational Parameters to Define Meditation 

Practices 

There is no consensus on a definition of meditation in the scientific literature. For the 

purposes of this report, a set of parameters to describe meditation practices was developed using 

a modified Delphi methodology.36,37 The systematic process used to reach consensus on the 

operational definition of meditation was documented and is described briefly below (Appendix 

B).1

A first-round questionnaire was distributed to TEP members to solicit their opinion on a set 

of parameters extracted from the scientific literature to describe meditation. Participants 

independently rated the importance of each parameter to characterize a practice as meditation. 

They were also asked to suggest other parameters not included in the questionnaire that they 

considered important. A feedback summary from the first-round responses was sent to TEP 

members along with a second-round questionnaire. In light of round-one group responses, 

participants were asked if they would reconsider their first-round responses. The process stopped 

when consensus among participants was reached. Responses to questions were analyzed and 

categorized by frequency of endorsement. Consensus was defined as agreement on a value or

category by 80 percent of the Delphi participants.37 If consensus was not reached by the Delphi 

technique, the TEP convened and group consensus techniques were used in a teleconference. 

Literature Search and Retrieval 

Databases and search terms. The research librarian worked closely with the TEP to refine 

search strategies for all questions of the review. Comprehensive searches were conducted of the 

electronic databases listed in Table 1 for the time periods specified. The order of the databases in 

Table 1 is the sequence in which the databases were searched (Appendix C).*

Table 1. Databases searched for relevant studies 

Database Date of search Years/issue searched 

Cochrane Central Register of Controlled 

Trials 

August 4, 2005 3rd Quarter 2005 

CSA Neurosciences Abstracts August 4, 2005 1982-2005 

MEDLINE® and PreMedline® September 8, 2005 1966 to August, 2005; Week 5 

Old Medline February 21, 2006 1950-1965 

EMBASE September 8, 2005 1988 to 2005; Week 36 

Cochrane Database of Systematic Reviews September 9, 2005 3rd Quarter 2005 

PsycINFO® September 9, 2005 1872 to August, 2005; Week 4 

Web of Science® September 21, 2005 1900-2005 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
18

Table 1. Databases searched for relevant studies (continued)

Database Date of search Years/issue searched 

OCLC FirstSearch (Articles and 

Proceedings) 

September 22, 2005 1993-2005 

AMED September 30, 2005 1985 to September, 2005 

CINAHL® October 4, 2005 1982 to September Week 5, 

2005 

Cochrane Complementary Medicine 

Trials Register 

October 25, 2005 1943-2003 

CAMPAIN (Complementary and 

Alternative Medicine and Pain 

Database) 

October 25, 2005 1983-2003 

NLM® Gateway October 25, 2005 1950-2005 

Current Controlled Trials - BioMed 

Central 

October 24, 2005 1998-2005 

National Research Register October 24, 2005 2000-2005 

CRISP February 21, 2006 2005-2006 

In addition to the electronic databases, the following journals and collections were hand 

searched: International Journal of Behavioral Medicine (1994–2005), Scientific Research on The 

Transcendental Meditation® Program: Collected Papers (Volumes 1 to 4), Journal of Bodywork 

& Movement Therapies (1996–2005), Journal for Meditation and Meditation Research (2001–

2003), International Journal of Yoga Therapy (1997–2005), and Explore: The Journal of Science 

and Healing (2005). 

The reference lists of relevant studies (e.g., included studies, other systematic or narrative 

reviews) were reviewed to identify potentially relevant studies. Gray literature was searched to 

identify unpublished studies and works in progress. Scientific abstracts from the Society of 

Behavioral Medicine (2005) and the American Psychosomatic Society (1999-2005) annual 

scientific meetings were reviewed. The National Research Register from the National Health 

Service was searched for ongoing trials. Primary authors of potentially eligible ongoing studies 

were contacted if this was necessary to clarify whether those studies did indeed meet the 

inclusion criteria. TEP members were also requested to provide additional information about 

potentially relevant studies. 

Criteria for Selection of Studies 

A set of strict eligibility criteria was used to determine the inclusion and exclusion of studies 

for the report. The inclusion criteria for topic I are documented in Table 2. It is important to 

emphasize that the review on Topic I does not constitute a manual for any meditation practice. A 

more detailed explanation of any specific meditation practice described in this report should be 

sought in specialized texts or from master practitioners. 

Information from primary studies and other original research identified for topics II to V was 

considered for topic I if it provided a detailed description of the meditation practice under study 

according to the parameters defined by the Delphi process. 
19

Table 2. Inclusion criteria for topic I 

Category Criteria 

Source English-language scientific literature 

Population Adults (i.e., individuals aged ≥ 18 years)

Intervention Empirical description of meditation practice according to the parameters 

defined by the TEP in the Delphi process 

Study design Systematic reviews, narrative reviews, book chapters and other sources of 

secondary data 

Outcomes of interest Components of meditation practices (e.g., breathing, chanting, mantras, 

relaxation) 

Role of breathing 

Role of attention 

Role of belief/spirituality 

Training conditions 

Criteria for success 

Our inclusion criteria for topics II to V are documented in Table 3. Some criteria are 

common to all of these topics, but some criteria were specifically developed for inclusion of 

studies in topics III and IV only. We sought to match the type of evidence required to the nature 

of the questions and to identify the highest quality of evidence appropriate to answer each group 

of questions. For topics III and IV on the efficacy and effectiveness of meditation practices, and 

on the role of effect modifiers for meditation practices, we looked for evidence from randomized 

controlled clinical trials (RCTs) and nonrandomized controlled clinical trials (NRCTs). No 

restrictions were applied for setting or geographical location of the studies. Only studies 

published in the English language were eligible according to the scope outlined by NCCAM for 

this review.

Table 3. Inclusion criteria for topics II to V 

Category Criteria 

Source Primary research report published in English 

Population Adults (i.e., individuals aged ≥ 18 years)

Normal (topics II and V only) and clinical populations (topics II to V) 

No previous meditation practice

Intervention Any meditation practice according to the parameters provided by the TEP in 

the Delphi study 

Sample size N greater than 10 

Study design Studies including a comparison/control group or control period in the 

methodological design: RCTs, NRCTs (topics III to V), prospective and 

retrospective observational studies with controls (topic II), case-control 

studies (topic II), uncontrolled before-and-after studies (topics II and V), and 

cross-sectional studies with controls (topics II) 

Outcomes of interest Measurable data for health related outcomes 

Study Selection Process 

Screening of titles and abstracts. We developed a predefined set of broad criteria to apply 

to the results of the literature searches to ensure that potentially relevant articles were not 
20

excluded early in the selection process (Appendix D).2

 Four independent reviewers evaluated the 

title and abstract of each study to select references potentially relevant to the topics of the report. 

The full-text of studies meeting the criteria was retrieved as was the full-text of those that 

reported insufficient information to determine eligibility. 

Identification of studies eligible for the review. Two independent reviewers appraised the fulltext of potentially relevant articles using a standard form that outlined the inclusion and 

exclusion criteria for each research topic (Appendix D).*

 Decisions regarding inclusion and 

exclusion and the reasons for exclusion were documented. 

The level of agreement among reviewers at all stages of the selection process was evaluated 

using the Kappa (κ) statistic.38 A κ score in the range from 0.0 to 0.40 was considered poor 

agreement; 0.41 to 0.60 moderate agreement; and 0.61 to 0.80 substantial agreement.39

Disagreements about the inclusion or exclusion of studies were resolved by consensus. When 

consensus was not reached, a decision was made in consultation with the TEP. 

Evaluating the Methodological Quality of Studies 

Rating the quality of individual articles. Studies included in the descriptive overview on 

the practice of meditation (topic I) were not assessed for methodological quality; therefore, the 

following methods for quality assessment apply to studies meeting eligibility criteria for topics II 

to V only. 

Quality of intervention studies (RCTs, NRCTs, and before-and-after studies). The 

methodological quality of RCTs was assessed using the criteria for concealment of allocation40,41

and the Jadad scale.42 The former is based on the evidence of a strong relationship between the 

potential for bias in the results and allocation concealment: failure to conceal the process of 

treatment allocation can undermine randomization and, consequently, a selection bias may 

occur.40 The Jadad scale is a validated scale that includes questions related to bias reduction: 

randomization, double-blinding and description of dropouts and withdrawals. This tool scores 

quality from 0 to 5. Studies scoring less than 3 points are usually considered to be of low 

quality.42 The psychometric properties of the Jadad scale have been thoroughly tested, providing 

rigorous evidence to support its use.42,43 We used individual components of the Jadad scale to 

create a 3-point scale based on blinding and participant attrition to assess the methodological 

quality of NRCTs. 

No completely or partially validated instruments are available to assess the methodological 

quality of uncontrolled before-and-after studies. Quality of reporting of uncontrolled before-andafter studies included in topics II and V was evaluated with four questions assessing whether the 

study participants were representative of the target population, the method of outcome 

assessment was the same for the pre- and postintervention periods for all participants, outcome 

assessors were blind to the intervention and the purpose of study, and the number of and reasons 

for study withdrawals were reported. 

Quality of observational analytical studies. The methodological quality of observational 

analytical studies (i.e., prospective and retrospective observational studies, case-control studies, 

and cross-sectional studies with controls) was assessed using the Newcastle-Ottawa Scales 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm 
21

(NOS).44 These are eight-item instruments that use a star system to assess methodological quality 

across three categories: the methods of selecting the study groups, their comparability, and the 

ascertainment of the outcome of interest. Scores range from 0 to 9 stars. The NOS scales have 

been recommended by the Cochrane Nonrandomized Studies Methods Working Group, and 

studies on their psychometric properties are in progress.44

The assessment of quality of observational studies is more difficult than the assessment of 

RCTs and NRCTs. Empirical research has shown that numeric scores based on arbitrary weights 

given to each item in a scale are unreliable and difficult to interpret.45 Therefore, we decided to 

describe the methodological quality of observational analytical studies using the individual 

components of the NOS scales. 

Finally, information regarding the source of funding was collected for all the included 

studies.46

Two reviewers assessed the methodological quality of studies independently. Disagreements 

were resolved by consensus or, when no consensus could be reached, a senior methods expert 

adjudicated (Appendix D).*

Data Collection 

For topic I on the practice of meditation, a single reviewer extracted information that was 

organized according to narrative categories (e.g., components of the meditation practices, role of 

breathing and spirituality, training requirements, and criteria for success) to allow for a 

systematic description of the meditation practices considered in this report. 

For topics II to V, trained research staff at the UAEPC extracted the information. A 

comprehensive and pretested data extraction form and guidelines explaining the extraction 

criteria were developed (Appendix D)*. Information regarding the study design and methods, the 

characteristics of participants, interventions, comparison groups, and outcomes of interest were 

extracted. Data collection on study design and methods included information on the country and 

year of publication, type of publication, objective of the study, study design, duration, number of 

centers, and source of funding. Data on characteristics of the participants included setting of the 

study, type of primary health problem or health condition of study participants, and diagnostic 

criteria (as reported by the authors of the studies). Data on characteristics of the intervention (i.e., 

meditation practices) included a description of the practice in terms of components, content and 

format, frequency, and intensity. Likewise, data on the characteristics of the control group 

included a description of the components, content, and format. Finally, information was 

extracted on the type of outcomes and on the units or instruments of measurement for each 

outcome. A single reviewer extracted the data from the primary studies and another independent 

reviewer verified the accuracy and completeness of the data. Any discrepancies in data extraction 

were solved by consensus between the data extractor and the data verifier. During this process, 

the reviewers consulted with TEP members both for content and methodological advice as 

needed. 

Study selection, methodological quality assessment, and data extraction were managed with 

the Systematic Review SoftwareTM (SRS), version 3.0 (TrialStat!; Ottawa, ON). Graph extraction 

was performed using Corel Draw®, version 9.0 (Vector Capital, San Francisco, CA). Extracted 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm 
22

data were exported into Microsoft ExcelTM (Microsoft Corporation, Redmond, WA) 

spreadsheets. 

Literature Synthesis 

Data Analysis and Synthesis 

Classification of the meditation practices. The first step in synthesizing the data for topics I 

to V was to create categories of analysis for the meditation practices described in the scientific 

literature. Based on data from the Delphi study, input from the TEP members, and a review of 

the literature, a set of seven categories was constructed to classify the meditation practices. Two 

independent researchers coded each study according to this classification scheme. Coding was 

discussed between researchers on a study-by-study basis. Coding discrepancies were resolved by 

consulting the original research study. 

The following seven categories were used for data synthesis for topics II to V: 

Mantra meditation. This category comprises meditation practices in which a main element of 

practice is mantra: the Relaxation Response technique (Relaxation Response or RR), the 

Transcendental Meditation® technique (hereafter, simply “Transcendental Meditation®” or 

“TM®”), Clinically Standardized Meditation (CSM), Acem meditation, Ananda Marga, and other 

concentrative practices that involve the use of a mantra such as Rosary prayer, and the Cayce 

method. 

Mindfulness meditation. Though described slightly differently by Eastern and Western 

interpreters, this category refers generally to meditation practices that cultivate awareness, 

acceptance, nonjudgment, and require paying attention to the present moment.47-49 This category 

includes Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy 

(MBCT), Vipassana meditation, Zen Buddhist meditation, and other mindfulness meditation 

practices not further described. 

Qi Gong. This category refers to an ancient practice from traditional Chinese medicine that 

combines the coordination of different breathing patterns with various physical postures, bodily 

movements, and meditation. External Qi Gong, in which a trained practitioner directs his or her 

own qi outward, with the intention of helping patients clear blockages, remove negative qi and 

balance the flow of qi in the body, to help the body rid itself of certain diseases is not a form of 

meditation according to the working definition developed for this report. 

Tai Chi. This category describes a Chinese martial art characterized by soft, slow, flowing 

movements that emphasize force and complete relaxation. It has been also called “meditation in 

motion.” 

Yoga. This category includes a broad group of techniques rooted in yogic tradition that 

incorporate postures, breath control, and meditation. It includes practices such as Hatha yoga, 

Kundalini yoga, and individual components of Yoga such as pranayama (breath control 

exercises). 

Miscellaneous meditation practices. This category describes techniques that combine 

different approaches to meditation in a single intervention, without giving prominence to one. It 

includes combined practices such as Yoga plus RR, TM® and Buddhist Meditation, and RR plus 
23

Mindfulness meditation. The category was also used to describe meditation practices that do not 

fall within any of the other categories (e.g., coloring mandalas). 

Meditation practices (not described). This category refers to meditation practices that were 

not described in sufficient detail to allow them to be assigned to a more specific category, 

including techniques that were described by vague terminology such as “meditation,” 

“movement meditation,” and “concentrative meditation.” 

Topic I. Data for topic I on the practice of meditation were synthesized qualitatively. 

Information was presented in a structured format, with narrative categories of interest for the 

different practices of meditation identified in the scientific literature. Once categorized, the 

similarities and differences among the various meditation practices could be appraised. 

Categories of analysis include the main components of the meditation practices, the role of 

breathing, attention, and spirituality, the training requirements, and the criteria of success for the 

various meditation practices. 

Topic II. Data collected for topic II on the state of research for the therapeutic use of 

meditation practices were summarized using descriptive statistics (e.g., proportions and 

percentages for categorical data, means with standard deviations [SD], or medians with 

interquartile ranges [IQR], for continuous data). Evidence and summary tables were constructed 

to summarize relevant characteristics of the included studies. Data from the included studies 

were synthesized qualitatively. We used the systematic approach of the Cochrane Collaboration 

for the synthesis of the evidence.50 The basic conceptual framework of the qualitative synthesis 

for topic II focused on the types of meditation practices that have been examined in intervention 

studies (RCTs, NRCTs, and uncontrolled before-and-after studies) and observational analytical 

studies (cohort studies, case-control studies, and cross-sectional studies), the types of control 

groups, the populations, and the types of outcome measures that have been examined in the 

included studies. 

Topics III and IV. Based on the results of topic II describing the populations that have been 

examined, RCTs and NRCTs assessing the effects of meditation practices for the three most 

studied clinical conditions were included in the analyses of efficacy and effectiveness of 

meditation practices (topic III) and the role of effect modifiers for meditation practices (topic 

IV). The first step in synthesizing the data for topics III and IV was to construct evidence tables 

that included information on each article’s source, study design, study population (e.g., sample 

size, age, and gender), treatment groups, and outcomes. The evidence tables also included 

summaries of study quality and comments to help interpret the outcomes. 

Meta-analyses were planned as part of the data analysis to derive pooled estimates from 

individual studies to support inferences regarding the magnitude and direction of the effect of the 

meditation practices. If studies evaluating specific meditation practices were sufficiently similar, 

effect sizes were combined and weighted using the standard inverse variance method51 to 

produce an overall effect size for a given outcome. Meta-analyses used a random effects model. 

In this method, study means are averaged, weighting by a combination of inverse variance 

augmented by heterogeneity. 

The types of summary statistics considered were risk ratios (RR) or odds ratios (OR) with 95 

percent confidence intervals (95% CI) for dichotomous outcomes and weighted or standardized 

mean differences (WMD and SMD, respectively) with 95% CI for continuous outcomes.52 WMD 

was chosen as the default method, with SMD being used only when units for the outcome were 

different among the studies being compared (i.e., stress measured on different scales).50,53

Hedges adjusted g was used as the SD estimate when the SMD was used.54 If the means were not 
24

reported, they were either imputed from medians or discarded from meta-analysis if neither mean 

nor median was available. Occasionally studies did not report SDs of their estimates. In these 

cases, we determined the SD exactly from confidence intervals or exact p-values; estimated the 

SD from upper-bound p-values, interquartile ranges, ranges, or exact nonparametric p-values; or 

imputed from other studies reporting similar outcomes in a similar population. All the metaanalyses used endpoint data or change from baseline to endpoint data instead of using the 

average of separate mean changes calculated at different intervals of time. Forest plots were used 

to display the individual and pooled results. 

Since some common outcomes were reported for many interventions, indirect comparisons55

were made of these active interventions. This type of comparison involves taking the differences 

between the differences derived from separate meta-analyses. For example, by taking the 

difference between the derived meta-analysis of A versus B, and the derived meta-analysis of A 

versus C an estimate of the comparison of B versus C can be obtained. For some outcomes, when 

more than four interventions could be compared indirectly, a mixed treatment comparison was 

conducted. Indirect comparisons are a valid approach to meta-analysis when there is insufficient 

direct evidence from randomized trials reporting head-to-head comparisons between 

interventions.55,56

In this method, a Bayesian formulation of the data is employed. The differences between 

each intervention and a baseline intervention (in this case, “no treatment” was chosen as the 

baseline) are modeled by choosing a prior distribution for the effect and combining this prior 

value with the data from the studies to arrive at a posterior estimate and 95% credible interval. 

Such an estimate was obtained for all pairwise comparisons of interventions as well as the 

comparisons to the baseline intervention. Since the resulting posterior distributions are too 

complex for direct computation, a Markov Chain Monte Carlo simulation57 was used to obtain 

the posterior estimates. This procedure involved simulating the unconditional, unknown posterior 

distribution by sampling many times from the conditional distribution and averaging the results. 

We used a sample of 20,000 burn-in iterations followed by 200,000 samples and noninformative 

normal (point estimate) and uniform (variance estimate) priors to obtain the distributions. We 

also computed a statistic to estimate the probability that each intervention was the best (e.g., 

lowered blood pressure the most) by recording the best intervention at each iteration. This 

simulation was performed using the WinBUGS software, version 1.4 (MRC Biostatistics Unit, 

Cambridge, United Kingdom). 

We tested for statistical heterogeneity using the chi-square test51 and quantified it using the I2

statistic.58 When there was evidence of clinical or statistical heterogeneity among studies, effect 

size estimates with corresponding 95% CI were presented separately for each study.59,60 Sources 

of heterogeneity were explored qualitatively. They may be methodological (differences in design 

or quality), or clinical (differences in key characteristics of participants, interventions, or 

outcome measures).61 Where appropriate, subgroup analysis based on patient, intervention, and 

study characteristics were conducted and sensitivity analysis based on study quality (Jadad score 

of greater than and equal to 3 points or less than 3 points) were conducted to assess the effect of 

quality on precision of the pooled estimates if the number of studies per comparison allowed it.62

Two analytic strategies were considered for topic IV on the effect modifiers of meditation 

practices. First, a meta-regression analysis using RCT-level covariates was planned to explore 

whether certain characteristics of the participants (e.g., age, gender, ethnicity, education, and 

income) or the interventions (e.g., dose, frequency, and duration) were associated with increased 

benefits of meditation practices. The outcome (or dependent) variable in the meta-regression 
25

analyses would be the pooled effect size (log OR for binary outcomes, or WMD or SMD for 

continuous outcomes). If a meta-regression was not feasible due to a small number of trials, or 

limited data from primary studies, subgroup analyses would be conducted based on participant or 

intervention characteristics. 

Topic V. Based on the types of outcomes identified in topic II, RCTs, NRCTs, and 

uncontrolled before-and-after studies (i.e., without a parallel control group) were included in the 

analysis of the physiological and cognitive/neuropsychological effects of meditation practices. 

Evidence tables were constructed to summarize each article’s source, study design, study 

population (e.g., setting, sample size, age, and gender), treatment groups, and outcomes. The 

evidence tables also included summaries of the strength of the evidence, study quality, and 

comments to help interpret the outcomes. 

Meta-analyses of RCTs and NRCTs using the methods described above for topic III were 

also planned for topic V. For studies with pre- and post-measures, data on change from baseline 

were used if available; otherwise, endpoint data were used. If meta-analytic methods were not 

feasible, effect size estimates with corresponding 95% CIs were presented separately for each 

study.59,60 Data from uncontrolled before-and-after studies were analyzed separately, and, if 

appropriate, the individual estimates of the treatment effect were pooled using the generic 

inverse variance method. Sensitivity analyses were conducted to assess the robustness of the 

findings when necessary. Data were displayed using forest plots. 

Publication bias. Publication bias, or the selective publication of research depending on the 

results, was assessed using funnel plots, and the trim and fill method63 if enough data were 

available from the meta-analyses. Funnel plots of effect sizes (axis X) against the SD (axis Y) for 

each meta-analysis were examined to identify gaps suggesting publication bias. Finally, the trim 

and fill method provided estimates of the number of studies potentially missing from a metaanalysis and the effect these omissions might have had on its outcome. 

All analyses were performed using SAS/STAT® software version 9.1 (SAS Institute Inc., 

Cary, NC), Statistical Package for the Social Sciences® for Windows® (SPSS® version 14.1, 

SPSS Inc., Chicago, IL), and RevMan version 4.1 (Cochrane Collaboration, Oxford, UK). 

Potential limitations, conclusions, and implications for future practice and research were 

discussed. The results were interpreted in light of the heterogeneity of the individual studies 

(e.g., differences in design, study populations, interventions or exposures, and outcome 

measures) and any evidence of publication bias, if present. Recommendations for practitioners 

and researchers were based solely on the evidence available. 

Peer Review Process 

During the course of the study, the UAEPC created a list of 18 potential peer reviewers and sent 

it to the AHRQ TOO and NCCAM representatives for approval. In May and June 2006, the 

individuals on the list were approached by the UAEPC and asked if they would act as peer 

reviewers for this evidence report. Seven experts agreed to act as peer reviewers (Appendix A)*

and were sent a copy of the draft report and guidelines for review (Appendix D6).* Reviewers 

had one month in which to provide critical feedback. Replies were requested in a word 

processing document, though comments were also accepted by email and telephone. The 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm 
26

reviewers’ comments were placed in a table and common criticisms were identified by the 

authors. All comments and authors’ replies were submitted to the AHRQ for assessment and 

approval. As appropriate, the draft report was amended based on reviewer comments and a final 

report was produced. 
27

Chapter 3. Results 

In this chapter, the main results of the systematic review are presented according to the 

five topics that were addressed. The results for topic II, the state of research for the 

therapeutic use of meditation practices, contain all eligible studies. Studies were then selected 

from this larger set to address topics III to V (see chapter two on Methods).

Topic I. The Practice of Meditation 

Main Components 

The main components of any meditation practice or technique refer to its most general 

features. These may include specific postures (including the position of the eyes and tongue), 

the use of a mantra, breathing, a focus of attention, and an accompanying belief system. 

Posture refers to the position of the body assumed for the purpose of meditation. Though 

traditional meditation practices prescribe particular postures (e.g., the lotus position), postures 

vary between practices with the only limitation being that the posture does not encourage 

sleep.64 Because accounts of most meditation practices describe explicitly the use and role of 

breathing, mantra, attention, spirituality and belief, training, and criteria for successful 

meditation practice, these topics are described individually. 

Breathing. Breathing in meditation can be incorporated passively or actively. In passive 

breathing, no conscious control is exerted over inhalation and exhalation and breathing is 

“natural.” In contrast, active breathing involves the conscious control over inhalation and 

exhalation. This may involve controlling the way in which air is drawn in (e.g., through the 

mouth or nostrils), the rate (e.g., drawn in quickly or over a specified length of time), the 

depth (e.g., shallow or deep), and the control of other body parts (e.g., relaxation of the 

abdomen). 

Mantra. A distinctive feature of some meditation practices is the use of a mantra. A 

mantra is a sound, word, or phrase that is recited repetitively, usually in an unvarying tone, 

and used as an object of concentration. The mantra may be chanted aloud, or recited silently. 

Mantras can be associated with particular historical or archetypal figures from spiritual or 

religious systems, or they may have no such associations.65

Relaxation. Relaxation is often considered to be one of the defining characteristics of 

meditation practices and meditation itself is often considered to be a relaxation technique.66-68

Indeed, it has been suggested that the popularity of meditation practices in the West is due, at 

least in part, to the widely accepted plausibility of their alleged effects with respect to arousal 

reduction.69 Some researchers have attempted to draw a distinction between relaxation and 

meditation practices on the basis of intention.70

Attention and its object. The intentional self-regulation of attention is considered crucial 

to the practice of meditation, as is the development of an awareness in which thoughts do not 

necessarily disappear, but are simply not encouraged by dwelling on them, a state of so-called 

“thoughtless awareness.”71,72 Some meditation practices focus attention on a singular external 
28

object (e.g., mandala, candle, flame), sound (e.g., breath), word or phrase (i.e., mantra), or 

body part (e.g., the tip of the nose, the space between the eyebrows).71 In contrast, 

“mindfulness” meditation techniques aim to cultivate an objective openness to whatever 

comes into awareness (e.g., by paying attention to simple and repetitive activities or to the 

sensations of the body). In doing so, the breath may be used as an anchor (but not a focal 

point) to keep the meditator engaged with the present moment.65,73 Each of these techniques 

serves, in a different way, to discourage logical and conceptual thinking.65

Spirituality and belief. This component refers to the extent to which spirituality and 

belief systems are a part of meditation practices. Spirituality and belief systems are composed 

of metaphysical concepts and the rules or guidelines for behavior (e.g., devotional practices or 

interpersonal relations) that are based on these concepts. 

Training. Training refers to the recommended frequency and duration of periods of 

practice, and how long a practitioner is expected to train before being considered proficient in 

a given technique. 

Criteria of successful meditation practice. The criteria of successful meditation practice 

are understood both in terms of the successful practice of a specific technique (i.e., is the 

technique being practiced properly) and in terms of achieving the aim of the meditation 

practice (e.g., has practice led to reduced stress, calmness of mind, or spiritual enlightenment). 

Five broad categories of meditation practices were identified in the scientific literature: 

mantra meditation (comprising Transcendental Meditation® [TM®], Relaxation Response 

[RR], and Clinically Stadardized Meditation [CSM]), mindfulness meditation (comprising 

Vipassana, Zen Buddhist meditation, Mindfulness-based Stress Reduction [MBSR], and 

Mindfulness-based Cognitive Therapy [MBCT]), Yoga, Tai Chi, and Qi Gong. These broad 

categories were used for descriptive purposes throughout the report to address the key 

research questions. 

Mantra Meditation 

The distinctive characteristic of the meditation practices included in this category is the 

use of a mantra. A mantra is a word or phrase repeated aloud or silently and used to focus 

attention. A mantra often has a smooth sound, for example, the mantras “Om” or “Mu.”74 It is 

thought that these sounds produce vibrations that have different effects on people, and these 

vibrations can be described qualitatively or quantitatively.62,75 The three mantra meditation 

practices described below consist of standardized techniques; that is, the techniques have been 

described systematically in manuals and are relatively invariant wherever, whenever, and by 

whomever they are taught.23
29

Transcendental Meditation®

TM® is a technique derived from the Vedic tradition of India by Maharishi Mahesh 

Yogi.76 In TM®, a meditative state is purportedly achieved in which the repetition of the 

mantra no longer consciously occurs and instead the mind is quiet and without thought.77

During the practice of TM®, the ordinary thinking process is said to be “transcended” (or gone 

beyond) as the awareness gradually settles down and is eventually freed of all mental content, 

remaining silently awake within itself, and producing a psychophysiological state of “restful 

alertness.”78,79 These periods, referred to as pure consciousness or transcendental 

consciousness, are said to be characterized by the experience of perfect stillness, rest, 

stability, order, and by a complete absence of mental boundaries.80

Main components. In the TM® technique, the meditation state is achieved by the 

repetition of a mantra. The mantra is a meaningless sound from the ancient Vedic tradition 

and is given to the meditator by an instructor in the TM® technique.81,82 TM® practitioners sit 

in a comfortable posture, with eyes closed, and silently repeat the mantra.83 Though there are 

reports of the components of the mantras and how they are assigned, it is difficult to confirm 

these reports as many of the details of practice, including mantras, are revealed only to those 

who have formal instruction in TM®. Instruction in the TM® technique is a systematic, but 

individualized process. It is believed that keeping the techniques confidential prevents 

students from having preconceptions about the technique (making the learning process 

simpler) and that it maintains the integrity of the technique across generations. 

Breathing. TM® involves passive breathing; no breath control procedures are employed 

and no specific pattern is prescribed.80

Attention and its object. TM® is described as not requiring any strenuous effort, 

concentration, or contemplation.80,84 However, meditators are instructed to direct their 

attention to the mantra.83

Spirituality and belief. The TM® technique has a theoretical framework that is described 

in Maharishi Mahesh Yogi’s writings on the nature of transcendental consciousness and the 

principles underlying the TM® technique.81 However, it is unclear to what extent this 

theoretical framework, including any of its implications for spirituality, is a part of the 

practice. Sources that discuss this issue contend that the practice of the technique requires no 

changes in beliefs, philosophy, religion, or lifestyle,78,80,85 implying that the theoretical 

framework plays no role in its practice. 

Training. TM® is usually taught in a course comprising five to six hours of instruction 

over four days.84 General information about the technique and its effects is presented in a 1.5-

hour lecture. More specific information is given in a second 1-hour lecture. Those interested 

in learning the technique meet with the teacher for a 5- to 10-minute interview. The 

participant learns the technique on a separate day in a 1- to 1.5-hour session, following a short 

ceremony in which the mantra is given to the prospective practitioner. The next three sessions 

consist of 1.5-hour meetings held in the 3 days following, in which further aspects of the 

technique are explained. The teacher explains the practice of the technique in more detail, 

corrects practice if necessary, and explains practical arrangements (e.g., when to practice), the 

benefits of practice, and personal development through the technique. In addition, the 

technique is regularly checked by the teacher in the first months of practice to ensure correct 

practice, and the student is advised to continue with periodic checks thereafter.86,87
30

Clinical reports indicate that this technique can be learned easily by individuals of any 

age, level of education, occupation, or cultural background.78,80,85 The technique requires 

systematic instruction by a qualified teacher to ensure effortless and correct practice.78,84,86

The technique is practiced twice daily for 15 to 20 minutes, usually once in the morning 

(before breakfast) and once in the afternoon (before dinner).78,85,88

Criteria of successful meditation practice. The successful practice of the TM®

technique is determined by a qualified teacher. As many details of the TM® technique are 

restricted to those who receive instruction, a description of the criteria used by the instructor 

for the assessment of the technique is not available in the scientific literature. 

Relaxation Response 

The “relaxation response” is a term coined by Harvard cardiologist Herbert Benson in the 

early 1970s to refer to the self-induced reduction in the activity of the sympathetic nervous 

system,68,89 the opposite of the hyperactivity of the nervous system associated with the fightor-flight response. Benson believed that this response was not unique to TM® and that all 

ancient meditation practices involved common components that together are capable of 

producing such a response.68 Basing his belief on his scientific research on hypertension and 

TM®, he integrated these common factors into a single technique (RR) and found that it 

promoted a decrease in sympathetic nervous system similar to TM®.

90 Many techniques for 

eliciting the relaxation response have been presented in a religious context in Judaism, 

Christianity, or Islamic mysticism (Sufism). These techniques employ both mental and 

physical methods, including the repetition of a word, sound, or phrase (often in the form of a 

prayer); and the adoption of a passive attitude.91 Benson emphasized that the relaxation 

response is not simply a state of relaxation (and should not be confused with it) or a sleep-like 

state, but a unique state brought about by adherence to specific instructions.89

Main components. The individual is instructed to assume a comfortable posture (usually 

sitting, but kneeling or squatting may also be used), the eyes are closed, and the muscles are 

relaxed, beginning at the feet and progressing upward to the face. Once the practitioner is 

relaxed, the eyes may be open or remain closed. Then, breathing through the nose and 

focusing on the breath, the practitioner inhales and exhales, silently saying the word “one” 

with each exhalation.89,90,92 Like TM®, the repetition of a sound, word, or phrase is considered 

essential to the technique.89 Benson recommends "one" as a neutral, one-syllable word.93

When the practice is completed, the meditator sits quietly for several minutes with eyes closed 

and then with eyes open.89

More recent versions of the technique include a body scan (similar to that employed in 

MBSR, described below) in which practitioners are asked to move their attention slowly over 

the body focusing on relaxing different regions, and information sessions on the stress 

response and its effects on health.94

Breathing. Breathing is active. Practitioners breathe through the nose, cultivating an easy, 

natural rhythm.89

Attention and its object. Attention is focused on the breath. In addition, should 

distracting thoughts occur, an attempt should be made to ignore them and focus on the 

mantra.92 The mantra is therefore “linked” with the breath.68 It has been claimed that Benson's 

RR demands a greater degree of concentration than either TM® or CSM (described below).64
31

Spirituality and belief. Because it is believed that RR incorporates the essential 

components of a wide variety of meditation practices, it is conceptualized as a secular 

technique89,95 and does not require adopting a specific spiritual orientation or belief system. 

Training. RR is learned in approximately five minutes. Patients are typically instructed to 

elicit the relaxation response twice daily, for 15 to 20 minutes, but not within two hours after 

any meal, as the digestive processes may interfere with the subjective changes induced by the 

technique.89,90,96

Criteria of successful meditation practice. Instructions for this technique are available 

in books and articles and there is no explicit recommendation that an experienced practitioner 

teach the technique or that individualized instruction is necessary. The criteria for successful 

meditation practice rest with the subjective evaluation of the meditator; the results of practice 

judged against the reported effects of RR. Instructions for this technique include the 

injunction not to worry about whether one is successful in achieving a deep level of 

relaxation, and instead to maintain a positive attitude and let relaxation occur at its own 

pace.89

Clinically Standardized Meditation 

CSM was developed by Patricia Carrington while she was conducting studies on 

meditation at Princeton University in the early-to-mid 1970s. Believing that TM® was not 

flexible enough to be suitable for all clinical purposes and that the cost of its instruction put it 

beyond the reach of most individuals and institutions, Carrington modified a classical Indian 

form of mantra meditation and produced what she called CSM.64

Main components. Trainees are instructed to choose a mantra from a list of 16 Sanskrit 

mantras, or choose their own. In choosing their own mantra, practitioners are told to select a 

word that has a “pleasant ringing sound” and to avoid using words that are emotionally 

loaded. The word should help imbue the practitioner with a sense of serenity.64 In its original 

formulation, CSM used a secular ritual for transferring the mantra. CSM is practiced while 

sitting comfortably, with eyes open and focused on a pleasant object of some kind. The 

mantra is repeated aloud, slowly and rhythmically, at ever decreasing volume, until it is a 

whisper, at which point the mantra is no longer said aloud, but instead is only thought. The 

eyes are then closed as the meditator continues repeating the mantra in thought. Meditators 

allow the mantra to proceed at its own pace, getting faster or slower, louder or softer “as it 

wants.”64,97

Breathing. Breathing is passive, proceeding at its own pace and is unconnected to the 

repetition of the mantra. 

Attention and its object. Like TM® and RR, CSM is a passive technique that requires 

little concentration or discipline. In contrast to RR, CSM instructs practitioners to flow with 

their thoughts rather than ignore them, returning periodically to the mantra.64

Spirituality and belief. CSM is designed as a secular, clinical form of meditation 

practice, so no specific system of spirituality or belief is required. 

Training. CSM is taught in two lessons: a 1-hour individual lesson and a group meeting. 

CSM is practiced twice daily for 20 minutes.64 As with RR, the contemporary version of CSM 

differs slightly from its original form, with perhaps the most important difference being that 
32

trainees are given a manual and an audio recording of instructions rather than individual 

instruction.64

Criteria of successful meditation practice. The criteria for successful meditation 

practice rest with the subjective evaluation of the meditator, the results of practice judged 

against the reported effects of CSM. Books and audiotapes for self-instruction in CSM are 

readily available, and there is no explicit statement that an experienced practitioner teach the 

technique or that individualized instruction is necessary. 

Mindfulness Meditation 

Mindfulness has been described as a process of bringing a certain quality of attention to 

moment-by-moment experience and as a combination of the self-regulation of attention with 

an attitude of curiosity, openness, and acceptance toward one's experiences.98 Mindfulness 

meditation, the core practice of Vipassana meditation, has been incorporated into several 

clinically-based meditation therapies.76 The capacity to evoke mindfulness is developed using 

various meditation techniques that originated in Buddhist spiritual practices;99 however, 

general descriptions of mindfulness vary from investigator to investigator and there is no 

consensus on the defining components or processes.98

Mindfulness approaches are not considered relaxation or mood management techniques,98

and once learned, may be cultivated during many kinds of activities. Mindfulness increases 

the chances that any activity one is engaged in will result in an expanded perspective and 

understanding of oneself.76 In a state of mindfulness, thoughts and feelings are observed on 

par with objects of sensory awareness, and without reacting to them in an automatic, habitual 

way.98,99 Thus, mindfulness allows a person to respond to situations reflectively rather than 

impulsively.98 Mindfulness meditation practices include the traditional Vipassana, and Zen 

meditation and the clinically-based techniques MBSR and MBCT. Of the four practices 

described below, the last two, MBSR and MBCT have standardized techniques (i.e., the 

techniques have been described systematically in manuals and are relatively invariant 

wherever, whenever, and by whomever they are taught). 

Vipassana

Considered by some to be the form of meditation practiced by Gautama the Buddha more 

than 2,500 years ago,100 Vipassana, or insight meditation, is practiced primarily in south and 

southeast Asia but is also a popular form of meditation in Western countries. Vipassana is the 

oldest of the Buddhist meditation techniques that include Zen (Soto and Rinzai schools) and 

Tibetan Tantra.47,99 The Pali term “Vipassana”, though not directly translatable to English 

roughly means “looking into something with clarity and precision, seeing each component as 

distinct, and piercing all the way through so as to perceive the most fundamental reality of 

that thing.”47 The goal of Vipassana is the understanding of the 3 characteristics of nature 

which are impermanence (anicca), sufferings (dhuka), and non-existence (anatta). Vipassana 

meditation helps practitioners to become more highly attuned to their emotional states.47

Through the technique, meditators are trained to notice more and more of their flowing life 

experience, becoming sensitive and more receptive to their perceptions and thoughts without 

becoming caught up in them. Vipassana meditation teaches people how to scrutinize their 
33

perceptual processes, to watch thoughts arise, and to react with calm detachment and clarity, 

reducing compulsive reaction, and allowing one to act in a more deliberate way.47

Main components. Vipassana meditation requires the cultivation of a particular attitude 

or approach: (1) don't expect anything, (2) don't strain; (3) don't rush, (4) observe experience 

mindfully, that is, don't cling to or reject anything, (5) loosen up and relax, (6) accept all 

experiences that you have, (7) be gentle with yourself and accept who you are, (8) question 

everything, (9) view all problems as challenges, (10) avoid deliberation, and (11) focus on 

similarities rather than differences.47

Vipassana meditation is practiced in a seated position when focusing on the breath; 

otherwise, no posture is prescribed and the meditator may sit, stand, walk, or lie down. 

Traditionally, if a static position has been taken, it is not to be changed until the meditation 

session has ended. However, many Western teachers allow students to move, though 

mindfully, to avoid persistent pain caused by being in the same position for too long.47 The 

time devoted to seated meditation should be no longer than one can sit without excruciating 

pain. The eyes should be closed.47

Breathing. Air is inhaled and exhaled freely through the nose. There is a natural, brief 

pause after inhaling and again after exhaling.47

Attention and its object. The focus of attention or awareness in Vipassana can be 

categorized into 4 groups: body, emotions and feelings, thoughts, and mental processes.101 In 

focusing attention on the breath, novice Vipassana meditators attain a degree of “shallow 

concentration.”47 This is not the deep absorption or pure concentration of the mantra 

meditation techniques. Gradually, the focus of attention is shifted to the rims of the nostrils, to 

the feeling of the breath going in and out. When attention wanders from the breath, the 

meditator brings it back and anchors it there.47,100 To help concentrate on the breath, a novice 

meditator may silently count breaths or count between breaths.47 The meditator notices the 

feeling of inhaling and exhaling and ignores the details of the experience. The movement of 

the abdominal wall while inhaling and exhaling may also be used as a focus of attention.47

The primary technique for focusing on bodily sensations is the body scan.102 Beginning 

with the top of the head, the practitioner observes the sensations as if for the first time, and 

then scans the scalp, the back of the head, and the face. When visualizations of the body 

distract the meditator, the thoughts are simply directed back to the sensations. The focus of 

attention is moved continuously over the body, moving down the neck, to the shoulders, arms, 

hands, trunk, legs and feet. Throughout the entire scan, an attitude of nonanticipation and 

acceptance is maintained.102

Mindfulness can be practiced during any activity and practitioners are encouraged to 

practice being mindful and fully aware during other activities such as walking, stretching, and 

eating.100

Spirituality and belief. Though often described as a profound religious practice, no 

particular spiritual or philosophical system is required to practice Vipassana meditation.47

Training. Vipassana should be practiced twice daily, morning and evening, for about 5 to 

10 minutes.100 Western interpreters of Vipassana have recommended that novice meditators 

should be instructed to sit motionless for no longer than 20 minutes.47 Ideally, a meditator 

works up to at least two 1-hour sessions per day, and does at least one 10-day retreat per 

year.102 Longer meditation sessions allow for deeper periods of meditation.102 The length of 

time required to become proficient in Vipassana meditation varies by individual, some 

students progress rapidly, others slowly. 
34

Criteria of successful meditation practice. As instructions for this technique are 

available in books and articles and there is no explicit instruction in the literature that an 

experienced practitioner teach the technique or that individualized instruction is necessary, it 

is presumed that the criteria for successful meditation practice rests with the subjective 

evaluation of the meditator. However, instruction may be given and, if this is the case, 

presumably successful practice is judged by an experienced meditator. 

Zen Buddhist Meditation 

Zen Buddhist meditation, or Zazen, perhaps one of the most well-known forms of 

meditation, is a school of Mahayana Buddhism103 that employs meditation techniques that 

originated in India several thousand years ago and were introduced to Japan from China in 

1191 A.D.104 Zen Buddhist meditation is typically divided into the Rinzai and Soto schools. 

Main components. The harmony of the body, the breath, and the mind is considered 

essential to the practice of Zen. In the traditional forms of Zen meditation, physical 

preparation involves eating nutritious food in modest amounts.104

Posture is of great importance in Zen meditation. In traditional forms, Zen meditation is 

performed while seated on a cushion in either the full-lotus or half-lotus position; however, 

many Western practitioners practice in a variety of ways from chair sitting to full lotus.104 In 

the full-lotus position, the legs are crossed and the feet rest on top of the thighs. In the halflotus position, only one foot is brought to rest on top of the thigh, the other remaining on the 

ground as in the regular cross-legged position.104,105 The hands are held in one of two 

prescribed ways, either with the left hand placed palm up on the palm of the right hand with 

the tips of the thumbs touching, or with the right hand closed in a loose fist and enclosed in 

the left hand, the left thumb between the web of the thumb and the index finger of the right 

hand.104 The spine is held straight and with the top of the head thrust upward, with the chin 

drawn in and the shoulders and abdomen remain relaxed. The body should be perpendicular 

and the ears, shoulders, nose, and navel should be in line. The tongue should touch the upper 

jaw and the molars should be in gentle contact with one another. The eyes should be half 

closed and the gaze focused on a point on the floor approximately 3 feet in front.104,105

Breathing. Breathing in Zen meditation is active and many breathing patterns are used. 

One deep breathing pattern begins with exhaling completely through an open mouth and 

letting the lower abdomen relax. Air is then inhaled through the nose and allowed to fill the 

chest and then the abdomen. This breathing pattern is repeated 4 to 10 times. The mouth is 

then closed, and air is inhaled and exhaled through the nose only. By the use of abdominal 

and diaphragmatic pressures, air is drawn in and pushed out. Both inhalation and exhalation 

should be smooth, with long breaths.104 After practitioners have learned to focus on their 

breath by counting, counting is omitted and meditators practice “shikantaza,” which means 

“nothing but precisely sitting.”106 Shikantaza is the most advanced form of Zen meditation.106

With practice, the frequency of breathing becomes about three to six breaths per minute.104

Attention and its object. Attention is focused on counting breaths or on a koan, a specific 

riddle that is unsolvable by logical analysis.106 The frequency of breathing is silently counted 

in one of three ways: counting the cycles of inhalation and exhalation, counting inhalations 

only, or counting exhalations only.104 Though some koans have become famous in the West 

(e.g., what is the sound of one hand clapping?), in practice, beginners often silently repeat the 
35

sound “mu” while counting. As a student advances, there are many koans that may be worked 

on over a period of years.47 This silent repetition allows the meditator to become fully 

absorbed in the koan. In both counting of breaths and focusing on a koan, it is essential that 

the concentration of the mind is on the counting or on the koan and not on respiration as 

such.104 No attempt is made to focus the mind on a single idea or experience; the meditator 

sits, aware only of the present moment.49

Spirituality and belief. It is generally accepted that Buddhist metaphysical beliefs are not 

essential to the practice of Zen. At a spiritual level, Zen is considered a recognition of or, 

more accurately, the constant participation of all beings in the reality of each being.49 Sitting 

should be based on the compassionate desire to save all sentient beings by means of calming 

the mind; however, this belief is not essential to practice. Only the wish to save all sentient 

beings and the strength to be disciplined in practice is necessary.104

Training. Depending on the purpose, Zen meditation may be practiced for a few minutes 

or for many hours.103

Criteria of successful meditation practice. Successful meditation practice is judged in 

terms of the internal changes that are brought about by cultivating awareness. The practice of 

Zen meditation should not be done with the aim of accomplishing some purpose or acquiring 

something.104 Examples of incorrect aims or approaches include (1) sitting in order to 

tranquilize the mind, (2) sitting to be empty in one's mind, (3) attempting to solve a koan as if 

playing a guessing game, and (4) being motivated by a wish to escape from everyday 

conflicts.104 Some Zen masters believe that it is acceptable for prospective students to be 

motivated by desires for good health, composure, iron nerves, etc., because in time their 

attachment to these less important purposes will be recognized.104 The successful practice of 

Zen meditation is often described in terms of an awareness of the “true nature” of reality, of 

discovering the extent to which ordinary experience is constructed and manipulated by our 

interests, fears, and purposes. Thus, successful practice results in the realization that a 

dreamlike absorption in personal intentions is actually the principal content of daily mental 

life,49 freeing the practitioner from circumstance and emotion.104

Mindfulness-Based Stress Reduction 

The MBSR program emerged in 1979 as a way to integrate Buddhist mindfulness 

meditation into mainstream clinical medicine and psychology.107 Originally designed by Dr. 

Jon Kabat-Zinn at the University of Massachusetts Medical Center, the MBSR program was a 

group-based program designed to treat patients with chronic pain. Since then, MBSR has also 

been used to reduce morbidities associated with chronic illnesses such as cancer and acquired 

immunodeficiency syndrome and to treat emotional and behavioral disorders.98

Main components. The mindfulness component of the program incorporates three 

different practices: a sitting meditation, a body scan, and Hatha yoga. In addition to the 

mindfulness meditation practice that forms the basis of the intervention, patients are taught 

diaphragmatic breathing, coping strategies, assertiveness, and receive educational material 

about stress.96 The foundation for the practice of MBSR is the cultivation of seven attitudes: 

1. nonjudgment, becoming an impartial witness to your own experience; 

2. patience, allowing your experiences to unfold in their own time; 
36

3. beginner's mind, a willingness to see everything as if for the first time; 

4. trust, in your own intuition and authority and being yourself; 

5. nonstriving, having no goal other than meditation itself; 

6. acceptance, of things as they actually are in the present moment; and 

7. not censoring one’s thoughts and allowing them to come and go.48

In addition to these attitudes, a strong motivation and perseverance are considered 

essential to developing a strong meditation practice and a high degree of mindfulness.48 These 

attitudes are cultivated consciously during each meditation session.48 As with other 

mindfulness practices, posture and breathing are essential.48 The practitioner sits upright, 

either on a chair or cross-legged on the floor, and attempts to focus attention on a particular 

object, most commonly on the sensations of his or her own breath as it passes the opening of 

the nostrils or on the rising and falling of the abdomen or chest.48 Whenever attention wanders 

from the breath, the practitioner will simply notice the distracting thought and then let it go as 

attention is returned to the breath. This process is repeated each time that attention wanders 

from the breath. The MBSR program incorporates formal meditation (i.e., seated, walking, 

Yoga) and informal meditation (i.e., the application of mindfulness to the activities of daily 

life). In informal practice, practitioners are reminded to become mindful of their breath to 

help induce a state of physical relaxation, emotional calm, and insight.48

The seated meditation is done either on the floor or on a straight-backed chair.48 When 

sitting on the floor, a cushion approximately 6 inches thick should be placed beneath the 

buttocks. The practitioner may use the “Burmese” posture in which one heel is drawn in close 

to the body and the other leg is draped in front, or a kneeling posture, placing the cushion 

between the feet.48 The sincerity of effort matters more than how one is sitting.48 Posture 

should be erect with the head, neck, and back aligned. The shoulders should be relaxed and 

the hands are usually rested on the knees or on the lap with the fingers of the left hand above 

the fingers of the right and the tips of the thumbs just touching each other.48

The body scan is the first formal mindfulness technique that meditators do for a prolonged 

period and is practiced intensively for the first 4 weeks of the program. Body scanning 

involves lying on your back and moving the mind through the different regions of the body, 

starting with the toes of the left foot and moving slowly upwards to the top of the head. 

Scanning is done in silence and stillness. 

The third formal meditation technique used in the MBSR program is mindful Hatha yoga. 

It consists of slow and gentle stretching and strengthening exercises along with mindfulness 

of breathing and of the sensations that arise as the practitioner assumes various postures48

Breathing. Breathing is passive and without any specific pattern.48

Attention and its object. During sitting meditation, the attention is focused on the 

inhalation and exhalation of the breath or on the rising and falling of the abdomen. When the 

mind becomes distracted with other thoughts, the attention is gently, but firmly returned to the 

breath or abdomen. During the body scan, attention is focused on the bodily sensations. When 

the mind wanders, attention is brought back to the part of the body that was the focus of 

awareness.48 In contrast to other Yoga practices, mindful Hatha yoga is focused less on what 

the body is doing and more on maintaining moment-to-moment awareness. As in the seated 

meditation and body scan, the attention is focused on the breath and on the sensations that 

arise as the various postures are assumed. 
37

Spirituality and belief. MBSR was designed as a secular, clinical practice and its practice 

does not require adopting any specific spiritual orientation or belief. 

Training. The program consists of an 8-week intervention with weekly classes that last 2 

to 3 hours. There is a day-long intensive meditation session between the sixth and seventh 

sessions.48,96 Participants also complete 45-minute sessions at home, at least 6 days a week for 

8 weeks.48 During the 2-hour weekly sessions, participants are instructed in the informal and 

formal practice of mindfulness meditation. Participants must commit to a daily, 45-minute 

home practice of the skills taught during the weekly meetings.48 The components of practice 

change as participants become more adept in sitting meditation, body scan, and Yoga. Body 

scan is initially practiced at least once per day for 45 minutes for about 4 weeks. It is then 

practiced every other day, alternating with Yoga.48

Criteria of successful meditation practice. The proper practice is determined by an 

experienced teacher. In the absence of any religious or spiritual component, the measure of 

success is the achievement of successful outcomes, whether subjective (reduced perceived 

stress, reduced anxiety, etc.) or objective (reduced blood pressure, reduction in medication 

usage, etc.). 

Mindfulness-Based Cognitive Therapy 

Developed by Zindel Segal, Mark Williams, and John Teasdale in the 1990s as a method 

for preventing relapse in patients with clinical depression, MBCT combines the principles of 

cognitive therapy with a framework of mindfulness to improve emotional well-being and 

mental health.98,108 Based on the MBSR program developed by Jon Kabat-Zinn, the original 

aim of the MBCT program was to help individuals alter their relationship with the thoughts, 

feelings, and bodily sensations that contribute to depressive relapse, and to do so through 

changes in understanding at a deep level.108

Main components. Like MBSR, the MBCT program incorporates seated meditation and 

body scan. The practice teaches patients decentering (the ability to distance oneself from one's 

mental contents), how to recognize when their mood is deteriorating, and techniques to help 

reduce the information channels available for sustained ruminative thought-affect cycles and 

negative reactions to emotions and bodily sensations.108 The core skill that the MBCT 

program aims to teach is the ability, at times of potential relapse, to recognize and disengage 

from mind states characterized by self-perpetuating patterns of ruminative, negative thought. 

Breathing. Breathing is passive and without any specific pattern.108

Attention and its object. During seated meditation, the attention is focused on the 

inhalation and exhalation of the breath or on the rising and falling of the abdomen. When the 

mind becomes distracted, the attention is gently, but firmly, returned to the breath or 

abdomen. During the body scan, attention is focused on the bodily. When the mind wanders, 

attention is brought back to the part of the body that was the focus of attention. 

Spirituality and belief. Like MBSR, MBCT was developed as a secular, clinical 

intervention and does not require adopting any specific spiritual orientation or belief system. 

Training. The program consists of an 8-week program, with one 2-hour session per week. 

Classes contain approximately 12 students. The program is divided into two main 

components: in sessions one to four, participants are taught to become aware of the constant 

shifting of the mind and how to bring the mind to a single focus using a body scan technique 
38

and breathing. Participants also learn how the wandering mind can give rise to negative 

thoughts and feelings. In sessions five to eight, participants learn how to handle mood shifts, 

either immediately or at a future time. 

Like the MBSR program, participants must continue the sessions at home for 6 or 7 days 

and complete various homework exercises that teach and reinforce mindfulness skills and 

help participants to reflect on their mindfulness practice.108

Criteria of successful meditation practice. The presence of an instructor who is adept in 

the practice of mindfulness is crucial to the success of the program. It is generally believed 

that if instructors are not mindful as they teach, the extent to which class members can learn 

mindfulness will be limited.108 The proper technique is determined by an experienced 

practitioner. The measure of success is the achievement of successful prevention of relapse 

based on clinical criteria. 

Yoga 

The philosophy and practice of Yoga date back to ancient times, originating perhaps as 

early as 5,000 to 8,000 years ago.1,109,110 It has been argued that the rules or precepts set down 

in the first systematic work on Yoga, Patanjali’s Yoga Sutras, do not set forth a philosophy, 

but are practical instructions for attaining certain psychological states.111,112 It is important to 

acknowledge the diversity of techniques subsumed under the term “Yoga.” Over many 

millenia, different yogic meditative techniques had been developed and used to restore and 

maintain health, and to elevate self-awareness and to also transcend ordinary states of 

consciousness, and ultimately to attain states of enlightenment.110

Yogic meditative techniques have been transmitted through Kundalini yoga, Sahaja yoga, 

Hatha yoga and other yogic lineages.113 Though there are numerous styles of Yoga;114 the 

styles vary according to the emphasis and combination of four primary components: asanas, 

pranayamas, mantras, and the various meditation techniques.115 In Kundalini yoga, there are 

thousands of different postures, some dynamic and some static, and also thousands of 

different meditation techniques, many of which are disorder specific.116,117 Kundalini yoga 

meditation techniques are usually practiced while maintaining a straight spine, and employ a 

large number of specific, and highly structured breathing patterns, various eye and hand 

postures, and a wide variety of mantras. All of these techniques supposedly have different 

effects and benefits in their respective combinations. 

Within Hatha yoga, many “schools” have developed, each differing slightly in its 

emphasis on the use of breathing and postures: in Bikram Yoga, practitioners perform the 

same sequence of 26 asanas in each session; in Vini Yoga, emphasis on the breath makes for a 

slower-paced practice. Iyengar Yoga is distinguished from other styles by its emphasis on 

precise structural alignment, the use of props, and sequencing of poses.118,119 There are also 

two Tibetan yogic practices, Tsa Lung and Trul Khor, that incorporate controlled breathing, 

visualization, mindfulness techniques, and postures.120 In Yoga, it is also believed that the 

practice of meditation techniques can be enhanced by the proper cleansing and conditioning 

of the body through the asanas and breathing exercises, or pranayama techniques121 (though 

pranayama places particular emphasis on techniques of breathing, some pranayama also 

employ physical movements).122

In addition to the schools of Yoga described above, TM® and the secular meditation 

techniques RR and CSM are derived from classical yogic techniques.123 It is important to note 
39

that the techniques in any given school or type of Yoga represent distinct interventions, in 

much the same way that psychodynamic, cognitive-behavioral, and interpersonal therapies 

each involve different approaches to psychotherapy.124

The purpose of asanas, pranayams, and pratyahar (emancipation of the mind from the 

domination of the senses) is to help rid the practitioner of the distractions of body, breath, and 

sensory activity and to prepare the body and mind for meditation and spiritual 

development.114 The use of mantras is said to help cleanse and restructure the subconscious 

mind, and to help prepare the conscious mind to experience the various states of 

superconsciousness. The more advanced Yoga practices lie in dharana (concentration), 

dhyana (yogic meditation) and samadhi (absorption). Concentration involves attention to a 

single object or place, external or internal (e.g., the space between the eyebrows, the tip of the 

nose, the breath, a mantra [chanted loudly, softly, or silently] or attention to all of these 

elements simultaneously). When the mind flows toward the object of concentration 

uninterruptedly and effortlessly, it is meditation. When it happens for a prolonged period of 

time it leads to samadhi, the comprehension of the true nature of reality that ultimately leads 

to enlightenment and emancipates the practitioner from the bonds of time and space.123,125

Main components. Classical Yoga is an all-encompassing lifestyle incorporating moral 

and ethical observances (yamas and niyamas), physical postures (asanas), breathing 

techniques (pranayams), and four increasingly more demanding levels of meditation 

(pratyahar, dharana, dhyana, and samadhi).126,127 Due to the incredible diversity of techniques 

in yogic meditation practice, it is impossible to describe them in adequate detail here. Instead, 

we have attempted to provide the reader with a very general description of the main 

components of many yogic meditation techniques. The reader is directed to the reference list 

for more detailed information on specific Yoga styles or techniques.110,116,117,119,128,129

The most common translation of “asana” is “posture” or “pose” and it refers to both 

specific postures for gaining greater strength and flexibility and those used specifically to help 

achieve proper concentration for meditation. Asanas are practiced either standing, sitting, 

supine, or prone.130 The postures for strength and flexibility take each joint in the body 

through its full range of motion, stretching, strengthening, and balancing each body part.114

Depending on the particular yogic technique one follows and the individual level of practice, 

each asana is held anywhere from a few breath cycles (as long as 2 minutes) to as long as 10 

minutes or, in the case of some advanced practices, even 2.5 hours. 

In most schools, during each posture attention is directed to the breath—to the deep, inout, rhythmic sensation—and awareness is brought to the area of the body that is being 

stretched or strengthened.130 Though poses may be held for a few seconds to a few minutes, 

the body can also be in constant dynamic motion. Muscles relax and loosen, changing the 

shape of the pose, and the in and out breath moves in rhythm with the body. The practitioner 

simply observes the physical or psychical sensations and emotions arising while suspending 

judgment. The asanas are interspersed with brief moments of relaxation during which the 

practitioner attempts to redirect or maintain an inward focus.130

In postures used specifically for meditation, for example in Kundalini yoga, the spine is 

kept straight and the practitioner can be seated in a chair with the feet flat on the floor or 

seated in a cross-legged posture, and specific directions are given regarding the positioning of 

the arms, hands, and eyes, (e.g., the palms of the hands can be pressed together with the 

fingers together pointing up at a 60-degree angle, and the sides of the thumbs rest on the 

sternum in what is called “prayer pose,”129 and the eyes are closed as if looking at a central 
40

point on the horizon, the “third eye,” or the notch region between the eyes). A mantra (again 

technique specific) may also be chanted, and/or a simple or complex breathing pattern may be 

employed.129 Alternately, the eyes might be kept open and focused on the tip of the nose or 

closed and focused on the tip of the chin or top of the head, again in conjunction with any 

number of a wide variety of breathing patterns, and/or mantras.129 In Sahaja yoga, 

practitioners sit in a relaxed posture with hands in front, palms upward. Attention is directed 

to a picture placed in front with a candle lit before it. Gradually when thoughts recede, 

meditators close their eyes and direct their attention to the “sahasrara chakra” or top of the 

head. The individual sits in meditation for about 10 to 15 minutes.131 The amount to which the 

eyes are open or closed also varies; eyes may be fully open, fully closed, or half-closed. 

Breathing. A central focus for most yogic meditation techniques is the breathing 

pattern.119 Pranayams, or breathing exercises, involve the conscious regulation of rhythmic 

breathing patterns, where some or all of the inspiration, breath retention, expiration, and 

breath out phases are regulated according to specific ratios or times. The inspiration and 

expiration phases can also be regulated by breaking each breath of the inspiration and 

expiration into 4 parts, 8 parts, or 16 parts or only the inspiration may be broken while the 

expiration remains unbroken.132 In addition, a breath pattern may be employed selectively 

through either the left or right nostril (or a sequential combination of both), or specific 

combinations of the nose and mouth. A wide variety of broken breath patterns have been 

discovered that have varying effects. Some techniques may also require holding attention on 

the imagined flow of energy along the spinal column collaterally with the breathing rhythm, 

on the sensation of inhaled air touching and passing through the nasal passage, on other parts 

of the body, or on a mantra.129,133

In Hatha yoga, various patterns of respiration are closely coordinated with the body in 

either a static posture or with movement.134 There are many pranayama techniques described 

in Hatha yoga texts; however, the practice of pranayama in this tradition has four primary 

objectives: (1) a stepwise reduction in breathing frequency, (2) attainment of a 1:2 ratio for 

the duration of inspiration and expiration respectively, (3) holding the breath for a period at 

the end of inspiration that lasts twice the length of expiration, i.e., a 1:4 ratio between 

inhalation and retention, and (4) mental concentration on breathing.121,135 The four objectives 

are united in the achievement of a single purpose, namely, the slowing down of respiration to 

achieve an immediate intensification of consciousness through the elimination of external 

stimuli.136 

Practices such as Sudarshan Kriya Yoga involve rhythmic breathing at different rates 

following ujjayi pranayama (long and deep breaths with constriction at the base of throat) and 

bhastrika (fast and forceful breaths through the nose along with arm movements).137,138 Other 

practices, such as Iyengar Yoga, instruct the practitioner to breath through the nostrils only 

while performing the asanas.139 Some varieties of pranayama require the practitioner to inhale 

and exhale through one nostril selectively, a practice called unilateral forced nostril 

breathing.119,140 These breathing exercises are often practiced in combination with different 

postural locks (bandhas). Bandhas are restrictive positions or muscle maneuvres that exercise 

certain parts of the body. The most common of these are the abdominal lift (uddiyana 

bandha), the root lock (mula bandha), and the chin lock (jalandhara bandha).123

In Kundalini yoga, there are hundreds of different breathing patterns, each having unique 

and specific benefits and effects. In “Sodarshan Chakra Kriya,” considered one of the most 

powerful pranayama meditation techniques in Kundalini yoga, a unilateral forced nostril 
41

breathing pattern is employed selectively with inspiration through the left nostril, with breath 

retention, and with selective expiration through the right nostril. During the breath retention 

phase the abdomen is pumped in and out 48 times and a three-part mantra is mentally 

repeated 16 times in phase with the abdominal pumping (one repetition of the three-part 

mantra with three pumps), and the eyes are open and focused on the tip of the nose. As the 

technique is mastered, the rate of respiration is eventually reduced to less than one breath per 

minute and practiced for a maximum of 2 hours and 31 minutes.129

Attention and its object. Inherent in the practice of Yoga is an effortful progression 

toward increased concentration, or, more precisely, toward entering a state in which the mind 

is highly stable and still, consciously and purposely focused, and ordinary thoughts are 

suspended, and the meditator is more aware of the present moment (samadhi).

141,142 This state 

has been described as the complete merging of the subjective consciousness and the object of 

focus.130 Hatha yoga has been defined as gentle stretching and strengthening exercises with 

constant awareness of breathing and of the sensations that arise as the meditator assumes 

various postures.76,128 By manipulating the body and making minute, detailed adjustments to 

perfect each posture, a person develops “one-pointed” concentration and ceases to become 

distracted by extraneous thoughts.130

One Hatha yoga technique, Shavasana, or corpse pose, involves lying on the back, with 

legs resting on the floor slightly apart, arms at the sides, palms facing up, and eyes closed. 

This seemingly simple pose is actually one of the most demanding to perfect because of the 

practitioner's need to achieve absolute stillness and total concentration as well as control over 

the breath.119 If drowsiness occurs, practitioners are told to increase the depth of their 

breathing. If the mind is restless, attention to the breathing cycle or other bodily sensations is 

encouraged. The goal is to rest in a state of relaxation, yet be aware of raw, sensory 

information and to let go of any reactions or judgments.121

In Kundalini yoga, one complex meditation technique called “Gan Puttee Kriya”, with 

multiple aspects of focus, is said to help eliminate negative thoughts, “psychic scarring,” and 

acute stress.116 The practitioner sits with a straight spine, either on the floor or in a chair. The 

backs of the hands are resting on the knees with the palms facing upward. The eyes are open 

only one-tenth of the way, but looking straight ahead into the darkness, not the light below. 

The practitioner chants consciously from the heart center in a natural, relaxed manner at a rate 

of one sound per second. The practitioner begins by chanting “SA” (the A sounding like 

“ah”), and touching the thumbtips and index fingertips together quickly and simultaneously 

then chanting “TA” and touching the thumbtips to the middle fingertips, then chanting “NA” 

and touching the thumbtips to the ring fingertips, then chanting “MA” and touching the 

thumbtips to the little fingertips, then chanting “RA” and touching the thumbtips and index 

fingertips, then chanting “MA” and touching the thumbtips to the middle fingertips, then 

chanting “DA” and touching the thumbtips to the ring fingertips, then chanting “SA” and 

touching the thumbtips to the little fingertips, then chanting “SA” and touching the thumbtips 

and index fingertips, then chanting “SAY” (like the word “say”) and touching the thumbtips 

to the middle fingertips, then chanting “SO” and touching the thumbtips to the ring fingertips, 

then chanting “HUNG” and touching the thumbtips to the little fingertips. The thumbtips and 

fingers touch with about 2 to 3 pounds of pressure with each connection which supposedly 

helps to consolidate a circuit created by each thumb-finger link. The techniques can be 

practiced for 11 minutes (or less) to a maximum of 31 minutes. When finished, the 

practitioner remains in the sitting posture and inhales and holds the breath for 20 to 30 
42

seconds while shaking and moving every part of the body vigorously, with the hands and 

fingers moving very loosely, then exhaling and repeating this two additional times, 

immediately followed by opening the eyes and focusing them on the tip of the nose and 

breathing slowly through the nose for one minute. 

Spirituality and belief. Yoga is a science and philosophy of the human mind and body; it 

is a way of life, moral as well as practical.143 Yoga predates all formal religions,1,129 and, 

perhaps for this reason, the practice of Yoga does not presuppose an individual’s commitment 

to a particular philosophical or religious system.144,145

Training. The ethical principles of Yoga describe the essential attitudes and values that 

are needed to undertake the safe practice of Yoga. The physical practice of Yoga focuses on 

the development of the strength, flexibility, and endurance of the body, strengthening of the 

respiratory and nervous systems, development of the glandular system, and increasing the 

ability to concentrate. In its complete form, Yoga combines rigorous physical training with 

meditation practices, breathing, and sound/mantra techniques that lead to a mastery of the 

body, mind, and consciousness. Both ancient commentaries on Yoga and more modern books 

of instruction stress the importance of learning under the guidance of an experienced teacher, 

Guru or Master.110,121,139 However, some Yoga techniques, especially asanas, pranayams, and 

meditation techniques, have been described and illustrated in books and videos produced for 

the purpose of self-study.139 In terms of specific training requirements, it is recommended that 

Yoga exercises be practiced daily, preferably in the morning, and on an empty stomach.139

Exercises can last from 15 minutes to several hours and it can take several years of consistent 

practice before a practitioner is able to practice properly the more demanding asanas and 

meditation techniques.121

Criteria of successful meditation practice. The ideal instruction in and assessment of 

Yoga techniques comes from a Guru or Master. Nevertheless, as books and video instruction 

are available, it can be assumed that the practitioner is able, to varying degrees, to assess the 

correctness of at least some asanas, pranayams, and a wide variety of meditation techniques. 

Yoga is ultimately a tradition of spiritual self-discipline and practice for the pursuit of 

enlightenment.136 Like Vipassana and Zen Buddhism, the success of meditation practice is 

judged on the basis of the practitioner achieving this state of enlightenment or other 

intermediate psychological or spiritual states. For example, the central experience achieved 

through Sahaja yoga meditation is a state called “thoughtless awareness” or “mental silence” 

in which the meditator is alert and aware but is free of any unnecessary mental activity.12 The 

state of thoughtless awareness is usually accompanied by emotionally positive experiences of 

bliss. In general, the outcome of the meditative process is associated with a sense of relaxation 

and positive mood and a feeling of benevolence toward oneself and others.146

As Yoga also involves exercises to strengthen the body and voluntarily control different 

aspects of breathing, success in these techniques can be evaluated against the standards for 

practice (e.g., achieving a 1:4:2 ratio in inhalation, retention, and exhalation), or developing 

the ability to reduce the rate of respiration to one breath per minute for 1 or 2 hours. 

Successful practice can also be determined by a subjective and objective evaluation of the 

achievement of some of the reported health benefits. 
43

Tai Chi 

Tai Chi (also romanized as Tai Chi Ch’uan, T'ai Chi Ch'uan, Taijiquan, Taiji, or T'ai Chi) 

has a history stretching back to the 13th century A.D. to the Sung dynasty.147 There are five 

main schools, or styles, of Tai Chi, each named for the style's founding family: Yang, Chen, 

Sun, Wu (Jian Qian), and Wu (He Qin).148 Each style has a characteristic technique that 

differs from other styles in the postures or forms included, the order in which the forms 

appear, the pace at which movements are executed, and the level of difficulty of the 

technique.148 Though differing in focus on posture and the position of the center of gravity, all 

styles emphasize relaxation, mental concentration, and movement coordination.147 Tai Chi 

practice usually involves the need to memorize the names associated with each posture and 

the sequence of postures.148

Main components. The practice of Tai Chi encompasses exercises that promote posture, 

flexibility, relaxation, well-being, and mental concentration.148,149 It is characterized by 

extreme slowness of movement, absolute continuity without break or pause, and a total 

focusing of awareness on the moment.150 Unlike most exercises that are characterized by 

muscular force and exertion, the movements of Tai Chi are slow, gentle and light. The active 

concentration of the mind is instrumental in guiding the flow of the body’s movements.151

Thus, Tai Chi is not only a physical exercise, but also involves training the mind, and this has 

prompted some to consider the practice “moving meditation.”148-150 Although Tai Chi follows 

the principles of other types of martial arts that focus on self-defense, its primary objective is 

to promote health and peace of mind. In contrast to other martial arts, Tai Chi is performed 

slowly, with deep and consistent breathing.151 The movements should be performed in a quiet 

place that will help the practitioner to achieve a relaxed state. The muscles and joints are 

relaxed and the body is able to move easily from one position to another. The spine is in a 

natural erect position, and the head, torso, arms, and legs should be able to move freely and 

gently. The upper body is straight, never bending forward or backward, or leaning left or 

right.152

Breathing. Several different breathing techniques are employed in Tai Chi; however, the 

principal breathing technique, called “natural breathing,” is the foundation for all other 

breathing techniques. In natural breathing, the practitioner takes a slow, deep (but not 

strained) breath, inhaling and exhaling through the nose. The mouth is closed, but the teeth 

are not clenched. The tip of the tongue is held lightly against the roof of the mouth. As the air 

is taken in, the lower abdomen expands. Once the lungs are adequately filled with air, the 

person exhales and the lower abdomen contracts. The breath is never held. The eyes should be 

lightly closed.152

The movements of Tai Chi are coordinated with the breath, and the pattern of breathing 

follows the succession of opposing movements of the arms: inhalation takes place when the 

arms are extended outward or upward, exhalation occurs as arms are contracted or brought 

downward. Breathing eventually becomes an unconscious part of the exercise; however, its 

importance in the practice never diminishes.150

Attention and its object. Throughout the practice, the mind remains alert but tranquil, 

directing the smooth series of movements and focusing on one's internal energy. This active 

concentration is integral to the practice.149,151 It has been argued that if Tai Chi movements are 

performed without concentration, Tai Chi is no different from other forms of exercise. The 
44

variety and distinctiveness of the movements ensure that one concentrates on the execution of 

the movements.151

Spirituality and belief. Tai Chi derives its philosophical orientation from the opposing 

elements of yang (activity) and yin (inactivity) and from qi (breath energy).147 In accordance 

with the symbols of yin and yang, Tai Chi movements are circular. The movements are 

designed to balance the qi, or vital energy, in the meridians of the body, and strengthen the qi, 

thus preventing illness.153 Like Yoga, the practice of Tai Chi does not require adopting a 

specific spiritual or belief system and has been used clinically as a therapeutic intervention. 

Training. The exercise routines of the different forms of Tai Chi vary in the number of 

postures and in the time required to complete the routine,147 with some Tai Chi programs 

being modified to suit the abilities of practitioners with declining physical and mental 

function.148 Classical Yang Tai Chi includes 108 postures with some repeated sequences. 

Each training session includes a 20-minute warm-up, 24 minutes of Tai Chi practice, and a 

10-minute cooldown. The warm-up consists of 10 movements with 10 to 20 repetitions. 

However, the exercise intensity depends on training style, posture, and duration.154

When practiced solely as an exercise form, sessions should occur twice a day and last 

about 15 minutes, 4 or more days per week.147 Practitioners are not required to continue 

training permanently with a Tai Chi teacher, and can continue practice as a form of selftherapy.152 When used as a system of self-defense, Tai Chi must be practiced with a Master 

and long enough to develop a deep understanding and “body memory” of the movements.155

However, as a healing practice, years of study are not required and the typical practitioner 

may be able to learn the fundamental movements within a week.155

Criteria of successful meditation practice. The overall aim is not to “master” the 

movements, but to appreciate a developing sense of inner and outer harmony as the 

movements become more fluid, yet controlled, and the mind more alert, yet peaceful.149 To 

learn and practice Tai Chi successfully, practitioners must adopt and practice specific 

traditional principles of posture and movement such as holding the head in vertical alignment, 

relaxing the chest and straightening the back, using mental focus instead of physical force, 

and seeking calmness of mind in movement.148

Qi Gong 

Qi Gong is classified as one of the practices known as “energy healing,” a category that 

includes Reiki, therapeutic touch,156 and the Korean practice of Chundosunbup. Dating back 

more than 3,000 years to the Shang Dynasty (1600 to 1100 B.C.), Qi Gong is believed to be 

the basis for traditional Chinese medicine.157 Qi Gong is intimately connected with the 

practice of Tai Chi in that both exercises utilize proper body positioning, efficient movement, 

and deep breathing. A quiet focused mind is also essential to both. The main difference 

between Qi Gong and Tai Chi is that Tai Chi is a martial art. Usually practiced slowly, Tai 

Chi movements can be sped up to provide a form of self-defense, whereas this is not the case 

with the forms of Qi Gong. As a result, the visualization that accompanies a particular form is 

different: for a movement in Tai Chi that might involve visualizing the external consequences 

of a motion (e.g., disabling one’s adversary), the same movement in Qi Gong would involve 

the visualization of an internal consequence of qi flow (e.g., qi flowing down your arm, 

healing your arthritis).155 There are two forms of Qi Gong practice: internal (nei qi), 

consisting of individual practice, and external (wai qi), whereby a Qi Gong practitioner 
45

“emits” qi for the purpose of healing another person.156,158 External Qi Gong is not a 

meditative practice according to the working definition developed for this report. Specifically, 

is not a self-applied practice, and there is a relationship of dependency between the 

practitioner and the person being treated. For this reason, this review is restricted to studies 

using internal Qi Gong. 

Qi Gong is said to have several thousand forms. There are five main schools or styles of 

Qi Gong, each emphasizing a different purpose for practice157 and incorporating different 

exercises: Taoist, Buddhist, Confucian, Medical, and Martial.155 It is believed that every Qi 

Gong style has its own special training methods, objectives, and compatibility with an 

individual's constitution and physique.159 Despite this variation in technique, the main 

function of Qi Gong is to regulate the mind.160

Main components. Qi Gong, literally “breathless exercise,” consists primarily of 

meditation, physical movements, and breathing exercises. The main components of Qi Gong 

vary, but most emphasize correct posture and body alignment, regulation of respiration, 

posture, and mind, as well as self-massage and movement of the limbs.155,160 In general, Qi 

Gong consists of two aspects: (1) dynamic or active Qi Gong, which involves visible 

movement of the body, typically through a set of slowly enacted exercises, usually performed 

in a relaxed stationary position;155 and (2) meditative or passive Qi Gong, which comprises 

still positions with inner movement of the diaphragm.156 In some concentration practices, the 

eyes are closed and the tip of the tongue touches the front of the upper palate.160 Essential to 

both aspects of practice are alert concentration, precise control of abdominal breathing, and a 

mental concentration on qi flow.156

Qi Gong, as a practice of self-regulation, includes regulation of the body (e.g., relaxation 

and posture), breath (to breathe deeply and slowly), and mind (thinking and emotion). 

Methods for the regulation of the mind vary. Some forms of Qi Gong stress thinking, e.g., 

focusing on a specific object or visualization. Other forms emphasize regulation of the 

emotions (e.g., a peaceful and calm mood), but let thinking go or remain "no-thought." 

Accordingly, Qi Gong techniques may be classified as one of two forms: concentrative Qi 

Gong and nonconcentrative Qi Gong.161 Self-practice of Qi Gong consists of three major 

forms: guided movement (dynamic form), pile standing, and static meditation.162 Whether 

with motion or without, the aim of Qi Gong is to remove all thoughts and focus on a region of 

the body known as “dantian” (the elixir field). As the body relaxes, the mind concentrates on 

the elixir field and all other thoughts are erased, while respiration becomes deeper and 

gradually decreases in frequency. When the respiration rate is decreased to four or five times 

per minute, the subject falls into the so-called Qi Gong state.161 It is recommended that a 

student practice only one type of Qi Gong before learning another as not all techniques are 

congruent.155

Breathing. Qi Gong breathing is characterized by a concentration of attention on dantian 

in concert with inhalation, exhalation, and holding of breath in order to stimulate qi and 

blood, and to strengthen the body.159 There are many ways to regulate the breath in Qi Gong 

including natural breathing, chest breathing, abdominal and reverse-abdominal breathing, 

holding the breath, and one-sided nostril and alternating nostril techniques.160

Attention and its object. A main tenet of Qi Gong is that intention can direct the qi 

within the body; the mind leads the qi, and qi leads the blood.158 To exert this control over qi, 

the practitioner must calm the mind and clear it of thoughts. A person's success Qi Gong is 

directly related to the ability to concentrate in this way. This is done by focusing the mind and 
46

body on correct breathing, and the visualization of qi as a substance moving through the 

body.160

Spirituality and belief. Qi Gong posits the existence of a subtle energy (qi) that circulates 

throughout the entire human body. Pain and disease are considered to be the result of qi 

blockage or imbalance; strengthening and balancing qi flow can improve health and ward off 

disease.159,162 Taoism, an ancient spiritual tradition in East Asia, is a philosophical perspective 

underlying the practice of Qi Gong. The Tao is the indefinable ultimate reality—the process 

involving every aspect in nature and in the entire universe. Similar to the worldviews of 

Buddhism and Hinduism, Taoism emphasizes harmony with nature. The universe is viewed in 

a dynamically continuous flow and constant change.163

Basic concepts considered essential to the understanding of Qi Gong include qi, vital 

energy, and gong, the skill, control, training, cultivation and practice of adjusting physical, 

mental and spiritual phenomena. Yin and yang, two other crucial concepts, are 

complementary opposites: yin signifies decrease, stillness, darkness, the six solid organs 

(lungs, spleen, heart, kidneys, pericardium, and liver), and bodily substances; yang signifies 

increase, activity, lightness, the upper and exterior parts of the body, the six hollow organs 

(large intestine, stomach, small intestine, urinary bladder, gallbladder, san jiao [not an organ, 

but the sum of the functions of transformation and interpenetration of various densities and 

qualities of substance within the organism]), and bodily functions.160

Training. Because of the possibility of Qi Gong-induced disorders from improper 

practice, or from the combination of incongruent forms, proper coaching is considered 

mandatory for safe Qi Gong practice.159 Qi Gong should be practiced twice daily for 20 to 30 

minutes160,164 with no single session exceeding 3 hours.159

Criteria of successful meditation practice. Correctness of technique is judged by a Qi 

Gong Master. No statement of the criteria for evaluating successful outcomes was available in 

the literature. 

Characteristics of Meditation Practices 

Main Components 

What are the main components of the various meditation practices? Which components are 

universal and which ones are supplemental?. 

The variety of meditation practices is an indication of the diversity of the combination of 

main components and the way in which a given component may be emphasized in a practice. 

Given the multitude of practices and the many variations or techniques within these practices, 

it is impossible to select components that might be considered universal or supplemental 

across practices. Some practices prescribe specific postures (e.g., Zen Buddhist meditation, 

Tai Chi, Yoga) while others are less concerned with the exact position of the body (e.g., TM®, 

RR, CSM). Some practices (e.g., Vipassana, Zen Buddhist meditation, Yoga, Tai Chi, and Qi 

Gong) incorporate moving meditation, while others are strictly seated meditations (e.g., 

TM®, RR, and CSM). Some clinically-based practices (e.g., MBSR, MBCT), though guided 

by the underlying practice of mindfulness, combine several techniques. In this, however, they 

are not substantially different from older multifaceted meditation practices such as Yoga. 
47

More detailed summaries addressing the main components used to describe individual 

practices are described below and summarized in Table 4. However, it is worth noting here 

some general conclusions that can be drawn from them. Though some statement about the use 

of breathing is universal across the practices, this seems more indicative of the ubiquitousness 

of breathing in humans rather than a universal feature of meditation practices per se. The 

control of attention is putatively universal; however, as noted below, there are at least two 

aspects of attention that might be employed and a wide variety of techniques for anchoring the 

attention, no one of which is universal. In terms of the spiritual or belief component of 

meditation, no meditation practice required the adoption of a specific religious framework. 

However, if Taoist metaphysical assumptions of Qi Gong are crucial to correctly 

understanding, visualizing, and guiding qi flow, then at least this practice would seem to 

require the adoption of a particular belief system. Nevertheless, this aspect of all meditation 

practices is poorly described, and it is unclear in what way and to what extent spirituality and 

belief play a role in the successful practice of meditation at all levels. The amount of variation 

in the described frequency and duration of practice make it difficult to draw generalizations 

about the training requirements for meditation techniques. Lastly, the criteria for successful 

meditation, for both the correct practice of the technique and the achievement of successful 

outcomes, have not been described well in the literature. 

Breathing 

How is breathing incorporated in these practices? Are there specific breathing patterns that 

are integral elements of meditation? Is breathing passive or directed?

The use of the breath is ubiquitous in all practices; however, the importance and attention 

given to it vary from practice to practice. Each meditation practice and technique has a 

breathing pattern or element that can be considered integral to that technique, whether the 

breath is actively controlled in terms of its timing and depth (e.g., Zen Buddhist meditation, 

Yoga, Tai Chi), or passive and “natural” (e.g., TM®, RR, CSM, Vipassana, MBCT). The 

practice of Yoga, which covers thousands of techniques, uses both active and passive 

breathing. Though the direction for active breathing may be relatively uniform across the 

techniques in a given practice (e.g., Zen Buddhist meditation), other practices use a wide 

array of breathing techniques that change according to the outcome desired (e.g., Kundalini 

yoga). For those practices that utilize passive breathing, there is no consistent pattern or 

rhythm as “breathing naturally” will vary from practitioner to practitioner.

Attention and Its Object 

For each type of meditation practice, where is the attention directed during meditation (e.g., 

mantra, breath, image, nothing)? 

The purposeful focusing of attention is considered crucial in all meditation practices. 

However, like breathing, the techniques for anchoring attention vary and there is no single 

method shared by all practices. For those practices that use a mantra (e.g., TM®, RR, CSM), 
48

in some the mantra may be repeated silently, and in some aloud. The factors surrounding the 

choice of the mantra vary and the nature of the mantra chosen will influence the number of 

associations brought forth by the word and the vibrations caused by the vocalization of the 

mantra. Some mantras will have no meaning to Western practitioners unfamiliar with Sanskrit 

(e.g., TM®, CSM, Yoga), while others will (e.g., RR). 

Other forms of meditation practice focus attention on bodily sensations (e.g., Vipassana, 

MBSR, MBCT) or a body part (e.g., Tai Chi) to the exclusion of other thoughts. The so-called 

mindfulness techniques focus on the breath and cultivate an objective openness to whatever 

comes into awareness.72 Though this may be interpreted as not focusing attention, or, as it is 

sometimes paradoxically phrased, as focusing on nothing, the attention is controlled and 

directed with the aim of achieving a distance from one’s emotional and cognitive responses to 

the objects in the field of attention. The difference between mindfulness meditation and other 

practices lies in the acceptance of these other thoughts into the field of awareness. 

Though the distinction between concentrative and mindfulness meditation has prima facie 

validity, the reality is somewhat more complicated because some practices, such as Zen and 

Vipassana, have phases where concentration is used, and for which certain techniques such as 

counting or concentrating on a mantra are employed, while at other stages broad spaced 

mindful attention is encouraged. 

Spirituality and Belief 

To what extent is spirituality a part of meditation? To what extent is belief a part of 

meditation? 

The one common feature of all meditation practices examined in this review is the 

apparent ability to practice meditation without adopting a specific system of spiritual or 

religious belief. However, the extent to which spirituality and belief are part of any given 

meditation practice is poorly described. Furthermore, if the Taoist metaphysical assumptions 

of Qi Gong are crucial to successfully understand, visualize, and guide qi, then at least this 

practice requires adoping a specific belief system. 

The extent to which spirituality or belief play a role in any meditation practice appears to 

depend in large part on the individual practitioner. Though the traditional practices were 

developed within specific spiritual or religious contexts (Vipassana, Zen Buddhist meditation, 

Yoga, Tai Chi, Qi Gong), and therefore have spiritual or religious aspects, this does not mean 

that a practitioner must adopt the belief systems upon which they were based. In addition, 

some practices developed for purposes other than spiritual enlightenment; for example, Tai 

Chi and Qi Gong were developed within a system martial exercise and Traditional Chinese 

Medicine, respectively. Though Yoga, too, has spiritual and religious components, it is often 

considered more properly a system of metaphysics and psychology, especially when the 

ethical instructions are ignored. In summary, it appears that all meditation practices can be 

performed, to some degree, without adopting a specific system of spirituality or belief.
49

Training 

What are the training requirements for the various meditation practices (e.g., the range of 

training periods, frequency of training, individual and group approaches)? 

Training refers to the specific periods of practice, the frequency and duration of practice, 

and how long a practitioner is expected to train before becoming proficient in a given 

technique. The training for meditation varies with periods of practice, ranging from 5 minutes 

(RR, Vipassana) to several hours (Yoga). The frequency of practice ranges from daily 

(MBSR, MBCT, Tai Chi, Vipassana, Yoga) to twice daily (TM®, RR, CSM, Qi Gong). Zen 

meditation does not specify a frequency of practice. Few practices give a required duration of 

practice; however, some (Yoga, Zen Buddhist meditation) give an indication of the time 

required to master a given technique.

Criteria of Successful Meditation Practice 

How is the success of the meditation practice determined (i.e., was it practiced properly)? 

What criteria are used to determine successful meditation practice? 

The criteria of successful meditation practice is understood both in terms of the successful 

practice of a specific technique (i.e., the technique is practiced properly) and in terms of 

achieving the aim of the meditation practice (e.g., leading to reduced stress, calmness of mind, 

or spiritual enlightenment).

The successful practice of a specific technique is sometimes judged by an experienced or 

master practitioner (TM®, MBSR, Yoga, Tai Chi, Qi Gong), and in some cases it can be 

judged by the individual (RR, CSM). However, the proliferation of self-instruction books and 

videos for some of the practices that also recommend an experienced teacher implies that 

individuals may judge, to some degree, the success of a practice. 
50

Table 4. Characteristics of included meditation practices 

Meditation 

practice Main components Breathing Attention Spirituality/belief Training 

Mantra meditation TM® Sitting (no prescribed 

posture) 

Personalized Sanskrit 

mantra 

Eyes closed 

Passive, 

unconnected to repetition of mantra 

No description of 

breathing 

Attention directed to 

prescribed mantra 

Mantra repeated 

silently 

No specific spiritual 

or religious beliefs required 

Taught in 4 

consecutive days (preceded by two 1-hour lectures and a 5-10 minute interview) in a 1-hour training session and three 1.5 hour group sessions. 

Individual instruction Practiced twice daily, 

15-20 min/session 

Instruction by 

qualified TM®

teacher 

Relaxation 

Response 

Comfortable posture 

(sitting, kneeling, squatting) 

Eyes open or closed Can also include body 

scan and information sessions 

Passive, but mantra 

is “linked” to exhalation 

Nasal 

Attention focused on 

the breath 

Mantra repeated 

silently 

Thoughts are 

ignored 

No specific spiritual 

or religious beliefs required 

Taught in 5-min 

training session 

Individual instruction Practiced twice daily, 

15-20 min/session and not before 2hrs after a meal 

Clinically 

Standardized Meditation 

Comfortable seated 

posture 

Sanskrit mantra or individually chosen 

mantra 

Eyes open initially and 

focused on pleasant object, then closed for repetition of mantra 

Passive, 

unconnected to repetition of mantra 

Attention directed to 

individually chosen mantra (1 of 16) 

Mantra repeated 

aloud and then at decreasing volume until it is repeated silently 

Thoughts 

recognized, but not focused on 

No specific spiritual 

or religious beliefs required 

Taught in 2 1-hr 

lessons 

Individual instruction 

or training manual and audio tapes 

Practiced twice daily 

for 20 min/session 
51

Table 4. Characteristics of included meditation practices (continued)

Meditation 

practice Main components Breathing Attention Spirituality/belief Training 

Mindfulness meditation Vipassana Cultivation of a 

“mindful” attitude 

Seated posture 

Passive Nasal 

Attention is focused 

on the breath (first on the inhalation and exhalation, then shifted to rims of the nostrils) or on bodily sensations 

No specific spiritual or 

religious beliefs required 

No specific training 

period given 

Session should 

last no longer than one can comfortably sit 

Novice meditators 

no longer than 20 min 

Zen Specific seated 

postures (lotus or half-lotus), positioning of hands, mouth and tongue 

Eyes half closed and 

focused on point on floor 

Active Inhale through nose, 

exhale through mouth and nasal only 

Many breathing 

patterns 

Attention focused on 

counting of breath, on a koan or “just sitting.” 

Breath counted by 1 

of 3 methods 

No attempt to focus 

on single idea or experience 

No specific spiritual or 

religious beliefs required; however, attitude of nonpurposefulness is essential 

No specific training 

period given 

Sessions may last 

from several minutes to several hours 

MBSR Cultivation of a 

“mindful” attitude 

Prescribed postures Seated meditation Body scan (supine 

posture) 

Hatha yoga postures 

Active 

(diaphragmatic breathing) and passive 

Seated meditation: 

attention focused on breath as it passes edge of nostrils or on rising and falling of abdomen 

Body scan: attention 

focused on somatic sensations in the part of the body being “scanned.” 

Hatha yoga: 

attention focused on breath and the sensations that arise as different postures are assumed 

No specific spiritual or 

religious beliefs required; however, strong commitment and self-discipline are essential 

Taught in an 8-

week course involving weekly 2-3 hr classes and 45-min sessions at home 6 days a week with homework exercises 

After course, 

practiced daily for 45 min 

Group instruction 

by an experienced MBSR practitioner 
52

Table 4. Characteristics of included meditation practices (continued) 

Meditation 

practice Main components Breathing Attention Spirituality/belief Training 

Mindfulness meditation (continued)MBCT Based on MBSR 

program 

Cultivation of 

“decentered” or “mindful” perspective 

Seated meditation Body scan 

Passive Seated meditation: 

attention focused on breath as it passes edge of nostrils or on rising and falling of abdomen 

Body scan: attention 

focused on somatic sensations in the part of the body being “scanned 

No specific spiritual 

or religious beliefs required 

Taught in an 8-week 

course involving weekly 2-hr classes and 45-min sessions at home 6 days a week with homework exercises 

Program taught in 2 

main components: (1) teaching of mindfulness, (2) learning to handle mood shifts 

Group instruction by 

an experienced practitioner of mindfulness meditation 

Yoga Kundalini 

yoga, Sahaja yoga, and Hatha yoga (many styles) 

Emphasis of 

components vary among “schools” but can include 

ethical observances, physical postures, breathing techniques, concentrative and 

mindfulness meditation 

Active and passive Techniques vary 

Awareness for all 

techniques is centered on the breath 

Some techniques 

also focus on posture 

No specific spiritual 

or religious beliefs required unless the ethical component is included 

Regular daily 

practice from 15 min to several hours; instruction by an experienced Yogi or Guru; may take several years or longer to properly execute asanas and pranayama 
53

Table 4. Characteristics of included meditation practices (continued) 

Meditation 

practice Main components Breathing Attention Spirituality/belief Training 

Tai Chi Yang, Chen, 

Sun, Wu (Jian Qian), and Wu (He Qin) styles 

A routine of slow, 

deliberate movements (movements and postures vary among schools) 

Body relaxed, upper 

body erect, not bending 

Mouth closed, teeth 

not clenched 

Active Nasal 

Attention is focused 

on movement and on one’s internal energy (qi) 

No specific spiritual 

or religious beliefs required 

Routines vary in 

number of postures and duration Classical Yang-style Tai Chi includes 108 postures and takes approximately 20-25 min to complete; practice also includes a 20-min warm-up and 10-min cooldown 

Should practice 

everyday 

Qi Gong Many 

techniques 

Meditation Prescribed posture for 

seated meditation 

Movements practiced 

in a relaxed stationary position 

Breathing exercises 

Active Techniques vary 

 Attention is focused 

on the “elixir field” and on the inhalation and exhalation of the breath 

No specific spiritual 

or religious beliefs required 

Practiced twice daily 

for 20-30 min with no single session exceeding 3 hr 
54

Search Results for Topics II to V 

The combined search strategies identified 11,030 citations. After screening titles and 

abstracts, 2,366 references were selected for further examination. The manuscripts of 81 articles 

were not retrieved (Appendix E).* The majority of the unretrieved studies were abstracts from 

conference proceedings and articles from nonindexed journals and were requested through our 

interlibrary loan service, but did not arrive within the 9-month cutoff that we established for 

article retrieval. Therefore, the full text of 2,285 potentially relevant articles was retrieved and 

evaluated for inclusion in the review. The application of the selection criteria to the 2,285 articles 

resulted in 911 articles being included and 1,374 excluded. Figure 2 outlines study retrieval and 

selection for the review. 

The primary reasons for excluding studies were as follows: (1) the study was not primary 

research on meditation practices (n= 909), (2) the study did not have a control group (n= 280), 

(3) the study did not report adequately on measurable data for health-related outcomes relevant 

to the review (n= 170), (4) the study did not examine an adult population (n= 9), and (5) the 

study sample included less than 10 participants (n= 6) (Appendix E)*. The level of agreement 

between reviewers for inclusion and exclusion of studies was substantial (kappa = 0.84, 95% CI, 

0.80 to 0.87). 

From 911 included articles, 108 were identified as multiple publications;165 that is, cases in 

which the same study was published more than once, or part of data from an original report was 

republished.166 The multiple publications were not considered to be unique studies and any 

information that they provided was included with the data reported in the main study (Appendix 

F).* The report that was published first wasregarded as the main study. In total, 803 articles 

were included in this report 10 of which each reported on two studies. Therefore, this report 

included 813 unique studies reported in 803 articles.

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm 
55

Figure 2. Flow-diagram for study retrieval and selection for the review 

Total number of citations retrieved from electronic and gray 

literature searches 

N = 11,030

Citations selected for further examination of titles and 

abstracts 

N = 2,366

Not retrieved 

N = 81 

Articles retrieved and evaluated in full for inclusion 

N = 2,285

Articles included 

N = 911

Excluded 

N = 1,374 

Reasons for exclusions 

- Not primary research on meditation 

(909) 

- No control group (280) 

- No measurable data for healthrelated outcomes relevant to the 

review (170) 

- No adults (9) Multiple publications - Sample size < 10 (6) N = 108 

Number of unique articles included 

N = 803 

- 793 articles each reporting one unique study 

- 10 articles each reporting two studies 

Unique studies 

included in 

Topic II 

N = 813 

Unique studies included in 

Topic III and IV 

N = 65 

Unique studies 

included in Topic V 

N = 311 
56

Topic II. State of Research on the Therapeutic Use of 

Meditation Practices in Healthcare 

General Characteristics 

Eight hundred and thirteen studies provided evidence regarding the state of research on the 

therapeutic use of meditation. Tables G1 to G3 of Appendix G*

 summarize the key 

characteristics of studies included in topic II. 

The studies were published between 1956 and 2005, with 51 percent of the studies (n = 417) 

published after 1994. Most of the studies (86 percent, n = 701) were published as journal articles. 

Seventy-nine (10 percent) were theses or dissertations, 25 (3 percent) were abstracts from 

scientific conferences, and 5 (0.5 percent) were book chapters or letters. Three unpublished 

studies (0.5 percent) were identified by contacting investigators. Studies were conducted in 

North America (61 percent), Asia (24 percent), Europe (11 percent), Australasia (3 percent) and 

other regions (1 percent). 

Of the 813 studies included, 67 percent (n = 547) were intervention studies (286 RCTs, 114 

NRCTs and 147 before-and-after studies), and 33 percent (n = 266) were observational analytical 

studies (149 cohort and 117 cross-sectional studies). 

Methodological Quality 

Intervention studies. Overall, the methodological quality of the 286 RCTs was poor 

(median Jadad score = 2/5; IQR, 1 to 2). Only 14 percent (n = 40) of the RCTs were considered 

of high quality (i.e., Jadad scores greater than or equal to 3 points). Three studies167-169 obtained 

4 points on the Jadad scale, and none obtained a perfect score (5 points). The remaining 246 

RCTs had a high risk of bias. 

The methodological quality of the RCTs was analyzed by the individual components of the 

Jadad scale. We found that 21 percent (n = 60) described how the randomization was carried out. 

Among these 60 trials, 75 percent (n = 45) reported adequate methods to randomize study 

participants to treatment groups, whereas 25 percent (n = 15) used inappropriate and unreliable 

methods (i.e., alternation or methods based on patient characteristics) that might have introduced 

imbalances and jeopardized the estimates of the overall treatment effect. 

The vast majority of RCTs (97 percent, n = 278) did not use double blinding to hide the 

identity of the assigned interventions from the participant and assessor, or hide the hypothesis 

from the instructor and participant or participant and assessor. One of them170 described an 

inadequate method of double blinding while the others did not provide any description about the 

double-blinding procedures. Finally, 51 percent (n = 145) of the RCTs provided a description of 

withdrawals and dropouts from the study. 

Concealment of treatment allocation (separating the process of randomization from the 

recruitment of participants) was adequately reported in 12 (4 percent) RCTs and was inadequate 

in 2 (1 percent) RCTs. The majority of RCTs (272, 95 percent) failed to describe how they 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
57

concealed the allocation to the interventions under study. Finally, funding source was disclosed 

in 41 percent (n = 118) of the RCTs. A summary of the methodological quality of RCTs is 

presented in Table 5. 

Table 5. Methodological quality of RCTs 

Quality components N studies (%) 

Randomization 286 (100) 

Double blinding 8 (2.8) 

Appropriate randomization 45 (15.6) 

Appropriate double blinding ... 

Inappropriate randomization 15 (5.2) 

Inappropriate double blinding 1 (0.3) 

Description withdrawals 145 (50.7) 

Total Jadad score (max 5); median (IQR) 2 (1, 2) 

Number of high quality RCTs (Jadad score ≥3) 40 (13.9) 

Appropriate concealment of allocation 12 (4.1) 

Funding reported 118 (41.3) 

IQR = interquartile range; RCT = randomized controlled trial 

Overall, the quality of the 114 NRCTs was low (median modified Jadad score: 0/3; IQR, 0 to 

1). Forty-six percent (n = 52) of the NRCTs obtained only 1 point out of 3 for the individual 

components of the Jadad scale, most frequently for the description of withdrawals and dropouts. 

The remaining 54 percent (n = 62) of the NRCTs did not score any points. Finally, the source of 

funding was cited in 26 percent (n = 30) of the NRCTs. A summary of the methodological 

quality of NRCTs is presented in Table 6. 

Table 6. Methodological quality of NRCTs 

Quality components N studies (%)

Double blinding ... 

Appropriate double blinding ... 

Inappropriate double blinding ... 

Description withdrawals 52 (45.6) 

Total modified Jadad score (max 3), median (IQR) 0 (0, 1) 

Funding reported 30 (26.3) 

NRCT = nonrandomized controlled trials 

The quality of the 147 before-and-after studies was poor. Only 16 percent (n = 23) of the 

before-and-after studies included representative samples of the target population. Descriptions of 

the number of study withdrawals (31 percent, n = 45), reasons for study withdrawals (14 percent, 

n = 20), and blinding of outcome assessors to intervention and assessment periods (2 percent, n = 

3) were also infrequent. Better quality results were obtained for the homogeneity in the methods 

for outcome assessment for the pre- and postintervention periods for all participants. Finally, 

funding source was disclosed in 28 percent (n = 41) of the before-and-after studies. A summary 

of the methodological quality of the before-and-after studies is presented in Table 7. Studies that 
58

were included in the analysis of the methodological quality of RCTs, NRCTs, and before-andafter studies are summarized in Table G4 in Appendix G.*

Table 7. Methodological quality of before-and-after studies 

Quality components N studies (%)

Study population representative of the target population 23 (15.6) 

The method of outcome assessment was the same for the pre and post intervention periods for 

all participants 

140 (95.2) 

Outcome assessors were blind to intervention and assessment period 3 (2) 

Description of the number of study withdrawals 45 (30.6) 

Description of the reasons for study withdrawal 20 (13.6) 

Funding reported 41 (27.9) 

Observational analytical studies. The quality of reporting of cohort studies was evaluated 

with the individual components of the NOS scale regarding the selection and comparability of 

the cohorts, and outcome assessment. Overall, the methodological quality of the 149 cohort 

studies was poor (median NOS score = 3/9 stars; IQR; 2 to 4), suggesting a high risk of bias in 

these studies. Table 8 displays the methodological quality of the cohort studies assessed with the 

NOS scale. 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
59

Table 8. Methodological quality of cohort studies (NOS scale) 

Quality components N studies (%) 

Representativeness of the exposed cohort

Truly representative of the average group in the community* 12 (8.1) 

Somewhat representative of the average group in the community* 43 (28.9) 

Selected group of participants 88 (59.1) 

No description of the derivation of the cohort 6 (4.0) 

Selection of the nonexposed cohort

Drawn from the same community as the exposed cohort* 56 (37.6) 

Drawn from a different source 79 (53.0) 

No description of the derivation of the nonexposed cohort 14 (9.4) 

Ascertainment of exposure

Secure record* 10 (6.7) 

Structured interview 4 (2.7) 

Written self-report 21 (14.1) 

No description of exposure ascertainment 114 (76.5) 

Ascertainment of outcome

Selection of the cohorts

Demonstration that the outcome(s) of interest was not present at the start 

of the study* 

10 (6.7) 

Study controls for two or more important confounding factors* 48 (32.2) 

Study controls for at least one important confounding factor* 51 (34.2) 

Comparability of 

the cohorts 

No adjustment for important confounding factors in the design or analysis 

of the study 

50 (33.6) 

* Positive responses earn stars for the final score. 

IQR = interquartile range; NOS = Newcastle-Ottawa Scale 
60

Table 8. Methodological quality of cohort studies (NOS scale) (continued) 

Quality components N studies (%) 

Assessment of outcome

Independent blind assessment* 24 (16.1) 

Record linkage* 85 (57.0) 

Self-report 38 (25.5) 

No description of outcomes assessment 2 (1.3) 

Length of followup

Followup long enough for outcomes to occur* 44 (29.5) 

Adequacy of followup of cohorts

Complete followup (all subjects accounted for)* 17 (11.4) 

Subjects lost to followup unlikely to introduce bias* 12 (8.1) 

Lost to followup likely to introduce bias 8 (5.4) 

Outcome assessment 

No description of losses to followup 112 (75.2) 

NOS total score (max 9); median (IQR) 3 (2, 4) 

In general, the cohort studies failed to protect against selection bias when assembling the 

exposed and nonexposed cohorts. Participants in 60 percent (n = 94) of the studies were not 

representative of the target population about which conclusions were to be drawn. The selection 

of the nonexposed cohort was equally compromised (62 percent, n = 93). 

Detection bias affecting the ascertainment of both exposure and outcome was introduced in 

139 (93 percent) studies. These studies did not use reliable methods to ensure that no differences 

in accuracy of exposure data between the cohorts existed. A similar proportion was found for 

studies that failed to demonstrate that the outcomes of interest were not present at the start of the 

study. Similarly, 105 (71 percent) cohort studies did not provide enough information to assess 

whether the length of the followup period was sufficient for outcomes to occur. 

Attrition bias was substantial; only 20 percent (n = 29) of the studies reported followup rates 

unlikely to introduce differences between the comparison groups. The only methodological 

component that did not appear to be severely jeopardized was the control of confounders in the 

design or analysis. Sixty-six percent (n = 99) of the cohort studies adjusted for potential 

confounders either in the design or analysis. Finally, 28 percent (n = 41) of the cohort studies 

reported the source of funding. 

The methodological quality of the cross-sectional studies was poor (median NOS total score 

= 2/6 stars; IQR, 1 to 3). The methodological characteristics of cross-sectional studies are 

summarized in Table 9. The cross-sectional studies had less prominent methodological 

weaknesses than the cohort studies. 

Over half of the cross-sectional studies (53 percent, n = 62) chose study groups that were at 

least somewhat representative of the target population. However, only 21 percent of the studies 

(n = 24) drew the comparison groups from the same population as the study group. None of the 

studies used secure methods for ascertainment of exposure. Half of the cross-sectional studies 

(54 percent, n = 63) adjusted for potential confounders either in the design or analysis and used 

relatively reliable methods for assessing the outcomes (53 percent, n = 62). Finally, only 27 (23 

percent) cross-sectional studies disclosed their source of funding. 

Studies that were included in the analysis of the methodological quality of cohort and crosssectional studies are summarized in Table G5 in Appendix G.*

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
61

Table 9. Methodological quality of cross-sectional studies (NOS scale)

Quality components N studies (%) 

Representativeness of the study group

Truly representative of the average group in the community* 1 (0.9) 

Somewhat representative of the average group in the community* 61 (52.1) 

Selected group of participants 12 (10.3) 

No description of the derivation of the study group 43 (36.8) 

Selection of the comparison group

Drawn from the same community as the study group* 24 (20.5) 

Drawn from a different source 56 (47.9) 

No description of the derivation of the comparison group 37 (31.6) 

Ascertainment of exposure

Secure record* ... 

Structured interview ... 

Written self-report 2 (1.7) 

Selection of the comparison groups

No description of exposure ascertainment 115 (98.3) 

Study controls for two or more important confounding factors* 49 (41.8) 

Study controls for at least one important confounding factor* 14 (12) 

Comparability of 

the comparison 

groups 

No adjustment for important confounding factors in the design or analysis of the 

study 

54 (46.2) 

Assessment of outcome

Independent blind assessment* ... 

Record linkage* 62 (53.0) 

Self-report 52 (44.4) 

Outcome 

assessment 

No description of outcomes assessment 3 (2.6) 

NOS total score (max 9); median (IQR) 2 (1, 3) 

* Positive responses earn stars for the final score. 

IQR = interquartile range; NOS = Newcastle-Ottawa Scale 

Meditation Practices Examined in Clinical Trials and Observational 

Studies 

Eight hundred and thirteen studies described meditation practices examined in intervention 

studies (RCTs, NRCTs, and before-and-after studies) and observational analytical studies (cohort 

and cross-sectional studies with control groups). 

Overall, 86 percent (n = 698) of the studies reported on single interventions, whereas 14 

percent (n = 115) reported on composite interventions. The composite interventions included 

either meditation practices combined with each other, or with other therapeutic strategies within 

holistic treatment programs. Table 10 reports the type of meditation practices that have been 

examined in intervention studies and observational analytical studies. Table G6 in Appendix G*

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
62

provides the references of studies included for this question along with their distribution by 

meditation practice and study design. 

Table 10. Meditation practices examined in intervention and observational analytical studies 

Intervention studies (n) Observational analytical 

studies (n) Meditation practice 

RCT NRCT Before-andafter Cohort Crosssectional 

Total 

(n)

Mantra meditation 111 30 31 105 60 337 

Mindfulness meditation 50 25 28 12 12 127 

Meditation (ND) 11 6 2 1 1 21 

Miscellaneous meditation 

practices 

3 ... 3 2 3 11 

Qi Gong 13 ... 9 7 8 37 

Tai Chi 29 17 20 4 18 88 

Yoga 69 36 54 18 15 192 

Total 286 114 147 149 117 813 

ND = not described; NRCT = nonrandomized controlled trials; RCT = randomized controlled trials 

Mantra meditation. Forty-one percent (n = 337) of the included studies reported on 

interventions involving the use of a mantra as a pivotal component for the practice of meditation. 

The studies were published from 1972 to 2005, with 1986 the median year of publication (IQR, 

1978 to 1991). Study sample sizes ranged from 10 to 602,000 participants with a median of 40 

participants per study (IQR, 24 to 68). 

A variety of mantra meditation techniques were assessed in the studies. The majority of the 

studies (68 percent, n = 230) focused on TM® or the TM®-Sidhi program. Fifteen percent (n 

= 51) reported on Benson’s RR, and nine percent (n = 31) assessed practices in which words or 

phrases (mantra) were chanted aloud or silently and used as objects of attention. Mantra 

meditation techniques such as CSM, and SRELAX that are similar to TM®, but developed 

specifically for clinical purposes, were assessed in four percent (n = 12) of the studies”. Acem 

meditation, an amalgam of traditional meditation techniques and Western psychological theory 

and practices, was evaluated in two percent (n = 7) of the studies. Finally, three percent of the 

studies focused on other mantra techniques such as Ananda Marga (n = 3), concentrative prayer 

(n = 2), and Cayce’s meditation (n = 1). 

Design and methodology. Thirty-three percent (n = 111) of the studies on mantra meditation 

were RCTs, 31 percent (n = 105) were cohort studies, 18 percent (n = 60) cross-sectional studies, 

and 9 percent for each of before-and-after studies (n = 31) and NRCTs (n = 30). The 

methodological quality of intervention studies on mantra meditation was poor: The median Jadad 

score for RCTs was 1/5 (IQR, 1 to 2). Only 13 out of 111 RCTs (12 percent) scored 3 points or 

more on the Jadad scale and thus could be considered high quality. The median modified Jadad 

score for NRCTs was 0.5/3 (IQR, 0 to 1). The quality of before-and-after studies was poor. The 

methodological quality of observational studies was also low, with a median NOS total score for 

cohort studies of 3/9 stars (IQR, 2 to 4) and a median NOS total score for cross-sectional studies 

of 2/6 stars (IQR, 1 to 3). There were major deficiencies in the selection and comparability of the 

study groups. 

Mindfulness meditation. Sixteen percent of the studies (n = 127) described the use of 

mindfulness meditation techniques, such as MBSR (n = 49), mindfulness meditation techniques 

not further described (n = 37), Zen Buddhist meditation (n = 28), MBCT (n = 7), and Vipassana 
63

meditation (n = 6). The studies were published from 1964 to 2005, with a median year of 

publication of 2001 (IQR, 1992 to 2003). Study sample sizes ranged from 10 to 719 with a 

median number of 39 participants per study (IQR, 23 to 73). 

Design and methodology. Thirty-nine percent (n = 50) of the studies on mindfulness 

meditation were RCTs, 22 percent (n = 28) were before-and-after studies, 20 percent (n = 25) 

NRCTs, and 9 percent for each of cohort (n = 12) and cross-sectional studies (n = 12). The 

methodological quality of intervention studies on mindfulness meditation was low (RCTs 

median Jadad score = 2/5; IQR, 1 to 2; NRCTs median modified Jadad score: 0.5/3; IQR, 0 to 1). 

The quality of before-and-after studies was poor. Only 7 of 50 RCTs (14 percent) scored 3 or 

more points in the Jadad scale and were thus considered high quality. The observational studies 

also exhibited major methodological shortcomings (cohort studies median NOS total score: = 3/9 

stars; IQR, 2 to 4; cross-sectional studies median NOS total score: 3/6; IQR, 1 to 3), particularly 

in the areas of selection and comparability of the study groups. 

Meditation practices not described. Three percent of the included studies (n = 21) reported 

on meditation practices that were not described. The studies were published from 1974 to 2004, 

with a median year of publication of 1998 (IQR, 1990 to 2002). Study sample sizes ranged from 

10 to 230 with a median number of 46 participants per study (IQR, 27 to 97). 

Design and methodology. Almost half (n = 11) of the studies were RCTs, six were NRCTs, 

two before-and-after studies, one cohort and one cross-sectional study. The methodological 

quality of the intervention studies was low (RCTs median Jadad score = 1.5/5; IQR, 1 to 2; 

NRCTs median modified Jadad score = 0/3; IQR, 0 to 0). Only 1 out of 11 RCTs scored 3 or 

more points on the Jadad scale and thus was considered high quality. The quality of before-andafter studies was poor. The cohort and cross-sectional studies obtained three and two stars on the 

NOS scales, respectively. Both studies failed to select unbiased study samples, thus 

compromising the comparability of the groups. 

Miscellaneous meditation practices. One percent of the included studies (n = 11) reported 

on interventions that combined different meditation techniques in a single intervention. The 

studies were published from 1980 to 2005, with a median year of publication of 1985 (IQR, 1981 

to 1993). Sample sizes ranged from 11 to 340 with a median number of participants per study of 

84 (IQR, 20 to 181). 

Design and methodology. Three out of 11 studies were RCTs, 3 were before-and-after 

studies, 2 were cohort studies, and 3 were cross-sectional studies. The methodological quality of 

studies on miscellaneous meditation practices showed important flaws. All RCTs scored 2 points 

on the Jadad scale and were considered low quality. The quality of before-and-after studies was 

also poor. The observational studies exhibited the same methodological flaws as the studies of 

other interventions described above (cohort studies median NOS total score = 3/9 stars; IQR, 1 to 

3; cross-sectional studies median NOS total score = 2/6; IQR, 2 to 3). 

Qi Gong. Five percent of the included studies (n = 37) reported on Qi Gong interventions. 

The studies were published between 1956 and 2005, with a median year of publication of 2000 

(IQR, 1996 to 2004). Study sample sizes varied from 10 to 254 with a median number of 36 

participants per study (IQR, 22 to 73). 

Design and methodology. Thirty-five percent (n = 13) of the studies on Qi Gong were RCTs, 

24 percent (n = 9) were before-and-after studies, 19 percent cohort (n = 7), and 22 percent crosssectional studies (n = 8). The methodological quality of studies on Qi Gong was poor (RCTs 

median Jadad score = 1/5; IQR, 1 to 2), all scoring less than 3 points on the Jadad scale. The 

quality of before-and-after studies was also poor. The quality of observational studies was low 
64

(cohort studies median NOS total score = 2/9 stars; IQR, 2 to 4; cross-sectional studies median 

NOS total score = 2.5/6; IQR, 2 to 3). Major deficiencies were found in the selection and 

comparability of the study groups. 

Tai Chi. Eleven percent of the included studies (n = 88) reported on Tai Chi interventions. 

The studies were published from 1977 to 2005, with a median year of publication of 2002 (IQR, 

1998 to 2004). Study sample sizes ranged from 10 to 311 with a median number of participants 

per study of 39 (IQR, 25 to 65). 

Design and methodology. Thirty-three percent (n = 29) of the studies on Tai Chi were RCTs, 

23 percent (n = 20) were before-and-after studies, 19 percent (n = 17) NRCTs, 20 percent (n 

= 18) cross-sectional studies, and 4.5 percent (n = 4) were cohort studies. The methodological 

quality of studies on Tai Chi was poor (RCTs median Jadad score = 2/5; IQR, 1 to 3; NRCTs 

median modified Jadad score = 1/3; IQR, 0 to 1). Nine out of 29 RCTs scored 3 or more points 

on the Jadad scale and thus were considered high quality. The quality of before-and-after studies 

was also low. The observational studies exhibited major flaws and were likely to be affected by 

bias (cohort studies median NOS total score = 2/9 stars; IQR, 2 to 4; cross-sectional studies 

median NOS total score = 2/6; IQR, 2 to 4). 

Yoga. Twenty-four percent of the included studies (n = 192) reported on interventions 

involving Yoga practices. The studies were published between 1968 and 2005, with a median 

year of publication of 1998 (IQR, 1991 to 2002). Study sample sizes ranged from 10 to 335 with 

a median of 40 participants (IQR, 23 to 70). 

Design and methodology. Thirty-six percent (n = 69) of the studies on Yoga interventions 

were RCTs, 28 percent (n = 54) were before-and-after studies, 19 percent (n = 36) NRCTs, 9 

percent (n = 18) cohort studies, and 8 percent (n = 15) were cross-sectional studies. The 

methodological quality of studies on Yoga was low (RCTs median Jadad score = 1/5; IQR, 1 to 

2; NRCTs median modified Jadad score = 0/3; IQR, 0 to 1). Fourteen percent (n = 10) of the 

RCTs on Yoga scored 3 points or more on the Jadad scale and were considered high quality. The 

quality of before-and-after studies was also poor. The methodological quality of observational 

studies was low (cohort studies median NOS total score: = 3.5/9 stars; IQR, 2.5 to 5; crosssectional studies median NOS total score = 3/6; IQR, 1 to 3). 

Tables 11 to 15 provide a comparative summary of the methodological quality of the studies 

classified according to the seven categories of meditation practices described in this report. 
65

Table 11. Methodological quality of RCTs by meditation practice* 

Quality criteria 

Mantra 

meditation 

(n = 111) 

Mindfulness 

meditation 

(n = 50) 

Meditation 

practices (ND) 

(n = 11) 

Miscellaneous 

meditation 

practices 

(n = 3) 

Qi Gong 

(n = 13) 

Tai Chi 

(n = 29) 

Yoga 

(n = 69) 

Randomization; n (%) All All All All All All All 

Double blinding; n (%) 2 (1.2) 1 (2.0) ... ... ... 1 (3.4) 4 (5.8) 

Appropriate 

randomization; n (%) 

15 (13.3) 8 (16.0) 2 ... ... 9 (31.0) 11 (15.9) 

Appropriate double 

blinding; n (%) 

... ... ... ... ... ... ... 

Inappropriate 

randomization; n (%) 

3 (2.7) 1 (2.0) 1 ... 2 1 (3.4) 7 (10.1) 

Inappropriate double 

blinding; n (%) 

... ... ... ... ... ... 1 (1.4) 

Description withdrawals; 

n (%) 

50 (45.0) 27 (54.0) 5 3 8 19 (65.5) 33 (47.8) 

Total Jadad score (max 

5); Median (IQR) 

1 (1, 2) 2 (1, 2) 1 (1, 2) 2 (2, 2) 1 (1, 2) 2 (1, 3) 1 (1, 2) 

Number of high quality 

RCTs (Jadad scores 

≥3); n (%) 

13 (11.6) 7 (14.0) 1 ... ... 9 (31) 10 (14.4) 

Appropriate concealment 

of allocation; n (%) 

3 (2.7) 1 (2.0) ... ... ... 3 (10.3) 5 (7.2) 

Funding reported; n (%) 49 (44.1) 20 (40.0) 3 ... 7 10 (34.4) 28 (40.6) 

* Percentages are reported for N ≥ 20 only 

IQR = interquartile range; ND = not described 

Table 12. Methodological quality of NRCTs by meditation practice* 

Quality criteria 

Mantra 

meditation 

(n = 30) 

Mindfulness 

meditation 

(n = 25) 

Meditation 

practices 

(ND) 

(n = 6) 

Tai Chi 

(n = 17) 

Yoga 

(n = 36) 

Double blinding; n (%) ... ... ... ... ... 

Appropriate double blinding; n 

(%) 

... ... ... ... ... 

Inappropriate double blinding; n 

(%) 

... ... ... ... ... 

Description withdrawals; n (%) 15 (50.0) 14 (56.0) - 9 (52.9) 14 (38.9) 

Total modified Jadad score, (max 

3); Median (IQR) 

0.5 (0, 1) 1 (0, 1) 0 (0, 0) 1 (0, 1) 0 (0, 1) 

Funding reported; n (%) 5 (16.7) 7 (28.0) 2 7 (41.2) 9 (25) 

*Percentages are reported for N ≥ 20 only 

IQR = interquartile range; ND = not described 
66

Table 13. Methodological quality of before-and-after studies by meditation practice* 

Quality criteria 

Mantra meditation 

(n = 31) 

Mindfulness 

meditation 

(n = 28) 

Meditation 

practices (ND) 

(n = 2) 

Miscellaneous 

meditation 

practices 

(n = 3) 

Qi Gong 

(n = 9) 

Tai Chi 

(n = 20) 

Yoga 

(n = 54) 

Study population 

representative of the target 

population; n (%)

1 (3.2) 11 (39.3) 1 2 1 4 (20) 3 (5.5) 

The method of outcome 

assessment was the same 

for the pre and 

postintervention periods for 

all participants; n (%) 

29 (93.5) 25 (89.3) 2 3 8 20 (100) 53 

(98.1) 

Outcome assessors were 

blind to intervention and 

assessment period; n (%) 

2 (6.4) ... ... ... ... 1 (5) - 

Description of the number of 

study withdrawals; n (%) 

12 (38.7) 15 (53.6) ... 3 1 6 (30) 8 (14.8) 

Description of the reasons for 

study withdrawal; n (%) 

4 (12.9) 5 (17.8) ... 2 1 4 (20) 4 (2.1) 

Funding reported; n (%) 4 (12.9) 7 (25) ... 2 5 3 (15) 20 (37) 

* Percentages are reported for N ≥ 20 only 

ND = not described 
67

Table 14. Methodological quality of cohort studies by meditation practice* 

Quality criteria 

Mantra 

meditation 

(n = 105) 

Mindfulness 

meditation 

(n = 12) 

Meditation 

practices (ND) 

(n = 1) 

Miscellaneous 

meditation 

practices 

(n = 2) 

Qi Gong 

(n = 7) 

Tai Chi 

(n = 4) 

Yoga 

(n = 18) 

Truly representative of the 

community; n (%) 

10 (9.5) 2 ... ... ... ... ... 

Somewhat representative of the 

community; n (%) 

29 (27.6) 4 ... 1 1 2 6 

Selected group of participants; n (%) 62 (59.0) 6 1 1 5 2 11 

No description of the derivation of the 

cohort; n (%) 

4 (3.8) ... ... ... 1 ... 1 

Drawn from the same community as 

the exposed cohort; n (%) 

38 (36.2) 5 ... 1 3 3 6 

Drawn from a different source; n (%) 56 (53.3) 7 ... 1 4 1 10 

No description of the derivation of the 

nonexposed cohort 

11 (10.5) ... 1 ... ... ... 2 

Secure record; n (%) 7 (6.7) 1 ... ... ... ... 2 

Structured interview; n (%) ... 2 ... ... ... 1 1 

Written self-report; n (%) 11 (10.5) 6 ... ... 1 2 1 

No description of exposure 

ascertainment; n (%) 

87 (82.9) 3 1 2 6 1 14 

Selection of the cohorts 

Demonstration that the outcome(s) of 

interest was not present at the start 

of the study; n (%) 

7 (6.7) 1 1 ... ... ... 1 

Study controls for two or more 

confounding factors; n (%) 

32 (30.5) 3 ... 1 1 2 9 

Study controls for at least one 

confounding factor; n (%) 

39 (37.1) 2 ... ... 3 1 6 

Comparability 

No adjustment for confounding 

factors in the design or analysis of 

the study; n (%) 

34 (32.4) 7 1 1 3 1 3 

Independent blind assessment; n (%) 16 (15.2) 1 ... ... 2 1 4 

Record linkage; n (%) 64 (61.0) 5 ... 1 4 3 8 

Self-report; n (%) 23 (21.9) 6 1 1 1 - 6 

No description of outcomes 

assessment; n (%) 

2 (1.9) ... ... ... ... ... ... 

Followup enough for outcomes 

to occur; n (%) 

27 (25.7) 5 1 ... 1 2 8 

Complete followup (all subjects 

accounted for); n (%) 

7 (6.7) 2 1 ... 1 1 5 

Outcome assessment 

Subjects lost to followup unlikely 

to introduce bias; n (%) 

9 (8.6) 2 ... ... ... 1 ... 

*Percentages are reported for N ≥ 20 only 

ND = not described; NOS = Newcastle-Ottawa Scale
68

Table 14. Methodological quality of cohort studies by meditation practice (continued) 

Quality criteria 

Mantra 

meditation 

(n = 105) 

Mindfulness 

meditation 

(n = 12) 

Meditation 

practices (ND) 

(n = 1) 

Miscellaneous 

meditation 

practices 

(n = 2) 

Qi Gong 

(n = 7) 

Tai Chi 

(n = 4) 

Yoga 

(n = 18) 

Lost to followup likely to 

introduce bias; n (%) 

6 (5.7) 1 ... ... ... ... 1 

Outcome assessment 

(continued) 

No description of losses to 

followup; n (%) 

83 (79.0) 6 ... 2 6 2 12 

NOS total score (max 9); Median (IQR) 3 (2,4) 3 (2,4) 3 3 (1,3) 2 (2,4) 2 (2,4) 3.5 (2.5,5) 

Funding reported; n (%) 22 (21.0) 4 ... 1 4 3 7 

Table 15. Methodological quality of cross-sectional studies by meditation practice* 

Quality criteria 

Mantra meditation 

(n = 60) 

Mindfulness 

meditation 

(n = 12) 

Meditation 

practices (ND) 

(n = 1) 

Miscellaneous 

meditation 

practices 

(n = 3)

Qi Gong 

(n = 8) 

Tai Chi 

(n = 18) 

Yoga 

(n = 15) 

Truly representative of the 

community; n (%) 

1 (1.7) ... ... ... ... ... ... 

Somewhat representative of the 

community; n (%) 

27 (45.0) 6* 1 3 6 13 5 

Selected group of participants; n 

(%) 

6 (10.0) 2 ... ... 2 2 2 

No description of the derivation of 

the study group; n (%) 

26 (46.3) 4 ... ... ... 3 8 

Drawn from the same community 

as the study group; n (%) 

14 (23.3) 2 1 2 1 2 2 

Drawn from a different source; n 

(%) 

25 (41.7) 6 ... 1 6 13 5 

No description of the derivation of 

the comparison group; n (%) 

21 (35.0) 4 ... ... 1 3 8 

Secure record; n (%) ... ... ... ... ... ... ... 

Structured interview; n (%) ... ... ... ... ... ... ... 

Written self-report; n (%) 1 (1.7) 1 ... ... ... ... ... 

Selection of the comparison groups 

No description of exposure 

ascertainment; n (%) 

59 (98.3) 11 1 3 8 18 15 

* Percentages are reported for N ≥ 20 only 

ND = not described; NOS = Newcastle-Ottawa Scale
69

Table 15. Methodological quality of cross-sectional studies by meditation practice (continued) 

Quality criteria 

Mantra meditation 

(n = 60) 

Mindfulness 

meditation 

(n = 12) 

Meditation 

practices (ND) 

(n = 1) 

Miscellaneous 

meditation 

practices 

(n = 3)

Qi Gong 

(n = 8) 

Tai Chi 

(n = 18) 

Yoga 

(n = 15) 

Study controls for two or more 

confounding factors; n (%) 

23 (38.3) 6 ... 2 3 8 8 

Study controls for at least one 

confounding factor; n (%) 

7 (11.7) 2 ... ... 3 1 1 

Comparability 

No adjustment for confounding 

factors in the design or analysis 

of the study; n (%) 

30 (50) 4 1 1 2 9 6 

Independent blind assessment; n (%) ... ... ... ... ... ... ... 

Record linkage; n (%) 28 (46.7) 6 ... ... 4 16 8 

Self-report; n (%) 29 (48.3) 6 1 3 4 2 7 

Outcome assessment 

No description of outcomes 

assessment; n (%) 

3 (5.0) ... ... ... ... ... ... 

NOS total score (max 9); Median (IQR) 2 (1,3) 3 (1,3) 2 2 (2,3) 2.5 (2,3) 2 (2,4) 3 (1,3) 

Funding reported; n (%) 6 (10) 3 ... 3 4 11 3 

Control Groups Used in Studies on Meditation Practices 

Six hundred and sixty-eight studies contributed data for this question (402 intervention 

studies [RCTs and NRCTs] and 266 observational analytical studies [cohort studies and crosssectional studies with control groups]). One hundred and forty-five studies were excluded from 

this analysis because they were uncontrolled before-and-after studies. Only two before-and-after 

studies171,172 had controlled comparisons and were considered for the analysis of the type of 

control groups used in studies on meditation practices. 

Overall, the number of control groups per study ranged from one to four. The median number 

of control groups per study was one (IQR, 1 to 2). Table 16 shows the distribution of the number 

of control groups by study design. The majority of studies (72 percent, n = 482) included one 

control group per study, 21 percent (n = 139) used two control groups, 5 percent (n = 33) used 

three control groups, and, 2 percent (n = 14) used four control groups. 
70

Table 16. Number of control groups by study design 

Number of controls 

Study design 1 

N (%) 

2 

N (%) 

3 

N (%) 

4 

N (%) 

Total 

RCTs 185 (64.7) 76 (26.4) 19 (6.6) 6 (2.0) 286 

NRCTs 88 (77.2) 20 (17.5) 1 (0.9) 5 (4.4) 114 

Intervention 

studies 

Controlled before-and-after 2 (100) ... ... ... 2 

Cohort studies (concurrent 

controls) 

110 (81.5) 19 (14.1) 4 (3.0) 2 (1.5) 135 

Cohort studies (historical 

controls) 

13 (92.9) ... 1 (7.1) ... 14 

Observational 

analytical 

studies 

Cross-sectional studies 84 (71.8) 24 (20.5) 8 (6.8) 1 (0.9) 117 

Total 482 (72.2) 139 (20.7) 33 (4.9) 14 (2.0) 668 

NRCT = nonrandomized controlled trials; RCT = randomized controlled trials. 

The majority of intervention studies and observational analytical studies considered in this 

review used single control groups (n = 482, 72 percent) as compared to the number of studies 

that used multiple control groups (n = 186, 28 percent). Tables 17 and 18 display the distribution 

of the number of control groups used in the intervention and observational analytical studies for 

each meditation practice. 

Table 17. Controlled intervention studies: number of control groups by meditation practice* 

Number of controls 

Meditation practice 1 

N (%) 

2 

N (%) 

3 

N (%) 

4 

N (%) 

Total 

Mantra meditation 77 (54.2) 48 (33.5) 12 (8.3) 5 (3.4) 142 

Mindfulness meditation 55 (73.3) 16 (21.3) 3 (4.0) 1 (1.3) 75 

Meditation practice (ND) 10 5 1 1 17 

Miscellaneous meditation practices 1 2 ... ... 3 

Qi Gong 12 1 ... ... 13 

Tai Chi 40 (87) 5 (10.9) 1 (2.2) ... 46 

Yoga 80 (75.5) 19 (17.9) 3 (2.8) 4 (3.8) 106 

Total 275 96 20 11 402 

* Percentages are reported for N ≥ 20 only 

ND = not described 
71

Table 18. Observational analytical studies: number of control groups by meditation practice 

Number of controls 

Meditation practice 1 

N (%) 

2 

N (%) 

3 

N (%) 

4 

N (%) 

Total 

Mantra meditation 136 (82.4) 23 (13.9) 5 (3.0) 1 (0.6) 165 

Mindfulness meditation 17* 5 2 ... 24 

Meditation practice (ND) 1 ... 1 ... 2 

Miscellaneous meditation practices 3 ... 1 1 5 

Qi Gong 8 2 4 1 15 

Tai Chi 16 6 ... ... 22 

Yoga 26 (15.8) 7 (4.2) ... ... 33 

Total 207 43 13 3 266 

* Percentages are reported for N ≥ 20 only 

ND = not described 

Control groups from intervention studies (RCTs, NRCTs, and controlled before-and-after 

studies) were grouped into six categories according to the type of control group.173 As some 

studies used more than one control group as a comparator, the number of intervention studies 

reported below does not match the number of control groups. Tables 19 and 20 describe the 

types of control groups for intervention and observational studies along with their distribution by 

meditation practice. Table G7 in Appendix G*

 lists the references for studies included in the 

description of the type of control groups for intervention studies along with their distribution by 

meditation practice. 

Sham meditation or placebo concurrent controls. Eighteen of 402 intervention studies 

(four percent) compared meditation practices with elaborately designed and executed sham 

procedures such as sitting in a comfortable position without being instructed in the use of any 

sound or in directing the attention in certain way. Half of the studies (n = 9) using sham 

meditation or placebo control groups were conducted on mantra meditation (three on TM®, three 

on mantra techniques not specified, two on RR, and one on SRELAX, a technique adapted from 

TM®). Evaluation of other practices that used sham meditation or placebo groups included three 

studies on meditation practices not further described, two studies on Qi Gong, two on Yoga, one 

study on mindfulness meditation (Zen meditation), and one on Tai Chi. 

No-treatment concurrent controls. Two types of no-treatment conditions were included in 

the studies: no intervention and waiting lists (WL). 

No intervention controls. One hundred and twenty-four out of 402 studies (31 percent) used 

control groups that received no intervention of any kind. Thirty-five percent (43/123) of these 

studies were conducted on mantra meditation (25 studies on TM®, 8 on mantra techniques not 

specified, 6 on RR, 1 on Acem meditation, 1 on Cayce’s meditation). There were 30 intervention 

studies on Yoga that used a no-intervention condition as comparator. There were 22 studies nointervention studies on mindfulness meditation (9 studies on MBSR, 7 on mindfulness 

meditation practices not further specified, 5 on Zen Buddhist meditation, and 1 study on MBCT), 

19 on Tai Chi, 6 on meditation practices not further described, 2 on Qi Gong, and 1 on a 

miscellaneous technique called “coloring mandalas.” 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
72

Waiting list controls. Sixty-two (15 percent) of the intervention studies utilized a WL control 

group. Twenty-four were conducted on mantra meditation (10 studies on TM®, 5 on CSM, 5 on 

RR, 3 on mantra techniques not specified, and 1 on SRELAX, a technique modeled after TM®); 

21 on mindfulness meditation (11 studies on MBSR, 6 on mindfulness meditation practices not 

further specified, 2 on MBCT, and 2 on Zen Buddhist meditation); 10 on Yoga, 3 on meditation 

practices not further described, 2 on Qi Gong, and 2 on Tai Chi. 

Active (positive) concurrent controls: interventions other than meditation. Active 

concurrent controls, as opposed to placebo or no treatment concurrent controls (i.e., no 

intervention, and waiting list conditions) were used as comparisons in 306 intervention studies 

(90 percent). A wide variety of active comparison groups were employed. 

Exercise and other physical activities. The practice of exercise and other physical activities 

constituted the most frequently used comparator (45 studies). Physical activities included, but 

were not limited to, aerobics, running, swimming, fencing, and stretching. Eighteen studies using 

exercise and other physical activities as controls were conducted on Yoga, 14 on Tai Chi, and 10 

on mantra meditation (3 on mantra techniques not specified, 3 on RR, 2 on TM®, 1 on Acem 

meditation, 1 on CSM). One study was conducted on MBSR, one on meditation practices not 

specified, and one on Qi Gong. 

Rest and states of relaxation. Conditions involving states of rest and relaxation were used as 

controls in 45 studies. There were 28 studies on mantra meditation (14 on RR, 9 on TM®, 3 on 

mantra techniques not specified, and 2 on CSM), 9 on Yoga, 6 on mindfulness meditation (3 on 

Zen Buddhist meditation, 2 on mindfulness meditation techniques not further specified, and 1 on 

MBSR), and 2 on other meditation practices not further described. 

Educational activities. Forty-four studies used educational activities such as lectures and 

courses on stress management, nutrition, health, and wellness as comparators. Seventeen of these 

studies were conducted on mantra meditation (9 on TM®, 5 on RR, 2 on mantra techniques not 

specified, and 1 on CSM), 10 studies on mindfulness meditation (5 studies on MBSR, 3 on Zen 

Buddhist meditation, and 2 on mindfulness meditation techniques not further specified), 8 on 

Yoga, 6 on Tai Chi, 2 on meditation practices not further described, and 2 on miscellaneous 

meditation techniques. 

Progressive muscle relaxation. The practice of progressive muscle relaxation (PMR) was 

chosen as a control group in 39 intervention studies. The majority of studies (n = 27) using PMR 

as a control were conducted on mantra meditation (10 on TM®, 8 on RR, 5 on mantra techniques 

not specified, 3 on CSM, and 1 on Acem meditation). There were also six studies on Yoga, five 

on mindfulness meditation (two on MBSR, two on mindfulness meditation techniques not further 

specified, and one on Zen Buddhist meditation), and one study on a meditation practice not 

further described. 

Cognitive behavioral techniques. Twenty studies employed cognitive behavioral 

interventions as comparison groups. Nine of these studies were conducted on mantra meditation 

(three on TM®, three on RR, two on CSM, and one on mantra techniques not specified). There 

were seven intervention studies on mindfulness meditation (four on mindfulness meditation 

techniques not further specified, and three on MBSR). There were two studies on meditation 

practices not further described, and two studies on Yoga. 

Pharmacological interventions. Eight studies used comparators involving pharmacological 

interventions such as antihypertensive medication, lipid-lowering medication, antidepressants, 

and other medications that were not described. There were six studies on Yoga, and two on Qi 

Gong that used a pharmacological intervention as a control. 
73

Miscellaneous active controls. Nineteen studies reported on the use of control groups that 

involved a heterogeneous collection of active interventions, such as charting, creativity 

techniques, herbal therapy, visualization and other imagery, and cognitive tasks. Six of these 

studies were conducted on mantra meditation (three on RR, two on mantra techniques not 

specified, and one on TM®). There were also six studies on Yoga, four studies on mindfulness 

meditation (two on MBSR, one on Zen Buddhist meditation, and one on mindfulness meditation 

techniques not further specified), two on miscellaneous meditation practices, one on Tai Chi, and 

one on a meditation practice not further described. 

Group therapy and psychotherapy. Sixteen studies used psychotherapeutic interventions such 

as group therapy (13 studies) and individual psychotherapy (3 studies) as comparison groups. 

Among the 13 studies that used group therapy as a control, 6 were on mantra meditation (3 on 

RR, 2 on TM®, and 1 on Acem meditation), 3 on mindfulness meditation (2 on mindfulness 

meditation techniques not further specified, and one on MBSR). There were also three studies on 

Tai Chi and two on Yoga that used group therapy as a comparator. Generally, group therapy was 

delivered as a form of group counseling and psychosocial support. Individual psychotherapeutic 

approaches were used as control groups in one study on mantra meditation (TM®), one study on 

MBSR, and one study on Yoga. 

Biofeedback techniques. The practice of biofeedback (BF) techniques such as 

electromyographic (EMG) BF, and blood pressure BF was used as comparators in 12 

intervention studies. The majority of the studies (n = 11) were conducted on mantra meditation 

(six on RR, three on mantra techniques not specified, and two on TM®) and one was conducted 

on Yoga. 

Reading. Activities involving reading were utilized as controls in eight studies. There were 

six studies on mantra meditation (four on RR, and two on TM®), one on Tai Chi, and one on 

Yoga. 

Hypnosis. Hypnosis was selected as a control group in four intervention studies: two on 

mantra meditation (TM®) and two on meditation practices not further described. 

Therapeutic massage and acupuncture. Three studies used complementary interventions such 

as massage (two studies; one on RR, and another on MBSR) and acupuncture (one on Tai Chi) as 

comparison groups. 

Usual care. Thirty-seven intervention studies included a group of usual care in their 

comparisons. Nine of these studies were conducted on mindfulness meditation (3 on MBCT, 2 

on mindfulness meditation techniques not further specified, 2 on MBSR, and 1 on Zen Buddhist 

meditation), 3 on Qi Gong, 3 on mantra meditation (2 on TM® and 1 on RR), 4 on Tai Chi, 16 on 

Yoga, and one on meditation practices not further described 

Other control groups. Six studies reported on the comparison groups in terms of controls 

without providing further comprehensive details. Two of these studies were conducted on mantra 

meditation (one on RR and one on TM®), two on Qi Gong, one on mindfulness meditation not 

further specified, and one on Tai Chi. 

Active (positive) concurrent controls: meditation practices as comparison groups. Fortythree studies used meditation practices as control groups. Fourteen of these studies compared two 

different meditation practices against each other. Twenty-nine studies compared two versions of 

the same meditation practice but varied certain components of the practice, e.g., method of 

delivery, intensity, and length of session, of the comparison group. The former category of 

studies is described first and the latter is described under the category of “different dose or 

response concurrent control groups.” 
74

Yoga practices. Four studies (three on TM® and one on mantra techniques not specified) 

compared mantra meditation techniques versus Yoga techniques such as Savasana. One study 

compared Hatha yoga versus a meditation practice not further described. 

Mantra meditation. Three studies on Yoga (Kundalini, Sahaja, and Hatha yoga) used a 

mantra meditation technique for their comparison groups; two of them used RR169,174 the third 175

used a mantra technique not further described. 

Mindfulness meditation. Two studies on mantra meditation (TM® and a mantra technique not 

further described) used interventions described as “mindfulness training” as comparison groups. 

Another study on a meditation practice not further described used mindfulness meditation as the 

comparison group. 

Meditation practices not described. Two studies on mantra meditation (one on RR, and the 

other on TM®) failed to describe the type of meditation practice chosen for the comparison 

group. 

Tai Chi: One study on mantra meditation (RR) used a Tai Chi-based intervention for the 

comparison group. 

Different dose or regimen: concurrent control groups. Twenty-nine studies compared 

similar meditation practices but modified certain components of the practices to create the 

comparison groups. 

Yoga practices. Fourteen studies compared different types of Yoga practices with each other. 

Nine studies140,176-183 compared different patterns of yogic nostril breathing techniques (e.g., 

unilateral versus bilateral nostril breathing, left versus right forced unilateral nostril breathing), 

whereas five studies compared different modalities of yoga practice such as Hatha versus 

Astanga,127 different formats for practice (e.g., full Sudarshan Kriya versus partial Sudarshan 

Kriya),184 or combinations with other therapeutic strategies.111,175,185

Mantra meditation. Nine studies on mantra meditation compared different formats for the 

delivery of practice. Three studies186-188 on TM® examined either short- versus long-term or 

regular versus irregular practice. Two other studies on TM®189,190 included RR as one of the 

comparators. There were two studies on RR that used TM®191 or modifications of the RR 

technique192 as comparison groups. One study on CSM193 used a RR control group. The 

remaining study on mantra meditation194 did not describe the practices being compared. 

Mindfulness meditation. Four studies on mindfulness meditation used other mindfulness 

meditation techniques as control groups. There were two studies on MBSR,195,196 one on Zen 

Buddhist meditation,197 and one197 that did not describe the mindfulness techniques being 

compared. 

Meditation practice not described. Two studies198,199 failed to provide a clear description of 

the meditation practices being compared. 

Multiple control groups. As was shown in Table 16, 275 out of 402 intervention studies 

used a single control group, whereas 127 used more than one kind of control (e.g., used one 

active and one inactive control). Sixty-five of the intervention studies with multiple controls 

were conducted on mantra meditation (25 on TM®, 22 on RR, 12 on mantra techniques not 

further described, 4 on CSM, 1 on Acem meditation, and 1 on SRELAX). There were 26 studies 

with multiple controls conducted on Yoga, 20 studies on mindfulness meditation (8 on MBSR, 6 

on mindfulness meditation techniques not further specified, and 6 on Zen Buddhist meditation), 

7 studies on meditation practices not further described, 6 on Tai Chi, 2 on miscellaneous 

meditation practices, and 1 on Qi Gong. 
75

Control groups from observational analytical studies (cohort and cross-sectional studies) 

were also classified according to the type of comparison used.173 As some studies used more than 

one control group as a comparator, the number of observational analytical studies reported below 

is less than the number of control groups. Table G8 in Appendix G provides the references for 

studies included in the description of the type of control groups in observational analytical 

studies along with their distribution by meditation practice.*

Unexposed controls. The vast majority of observational analytical studies (92 percent, 

244/266) used comparison groups consisting of individuals that were not been exposed to any 

type of meditation practice. Sixty-three percent (153/244) of these studies examined mantra 

meditation (140 studies on TM®, 6 on mantra techniques not specified, 4 on Acem meditation, 

and 3 on Ananda Marga meditation). There were 29 observational analytical studies on Yoga 

that used a group of unexposed individuals as a comparator, 21 studies where the exposed group 

practiced mindfulness meditation (12 on Zen Buddhist meditation, 6 on mindfulness meditation 

techniques not further specified, and 3 studies on Vipassana meditation), 21 on Tai Chi, 13 on Qi 

Gong, 5 on miscellaneous practices combining different meditation practices, and 2 on 

meditation practices not further described. 

Active (positive) controls using interventions other than meditation practice. Thirtyseven observational analytical studies utilized control groups consisting of practitioners of 

techniques other than meditation. 

Exercise and other physical activities. Practitioners of exercise and other physical activities 

constituted the most frequent active comparator (14 studies). Four studies examined Tai Chi 

practitioners, four studies examined Yoga practitioners, and two studies examined subjects 

practicing a miscellaneous group of meditation techniques. Two studies examined TM®

practitioners, one examined practitioners of meditation techniques not specified, and one 

examined Qi Gong practitioners. The type of physical activities practiced by the control groups 

included aerobic and anaerobic exercises, swimming, running, and golfing. 

Miscellaneous active controls. Five studies used control groups consisting of practitioners of 

martial arts, concentration, and creativity techniques. Three of these studies used practitioners of 

mantra meditation, specifically TM®, as exposed groups. One study examined practitioners of 

Tai Chi and one practitioners of miscellaneous meditation techniques. 

Other comparison groups consisted of individuals exposed to a variety of practices not 

considered meditation. Four studies on TM® used a group of practitioners of PMR as a control 

group. Three studies on TM® included participants that underwent hypnosis therapy. Three 

studies on TM® used groups of participants exposed to conditions of rest and relaxation for their 

comparisons. One study on Qi Gong and one on Yoga included participants in educational 

activities. Group therapy participants were included for comparison in one study on TM® and in 

one on Yoga. Individuals involved in reading activities were used as controls in one study of Zen 

Buddhist meditation, and in one study of Yoga. Finally, practitioners of BF and cognitive 

behavioral techniques such as sensitivity training acted as controls in, respectively, one study of 

RR and one study of TM®. 

Active (positive) controls exposed to other meditation practices. Forty-seven studies used 

active control groups of practitioners of a variety of meditation techniques. Eleven of these 

studies compared groups of practitioners of different meditation techniques against each other. 

Thirty-six observational analytical studies compared groups of practitioners of the same 

meditation technique but with different lengths of practice. The former group of studies is 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
76

described immediately below and the latter is described under “Concurrent control groups 

exposed to different dose or regimen of the same meditation practice.” 

Practitioners of mantra meditation (TM® and a mantra technique not specified) were used as 

the comparison group in two observational studies on mindfulness meditation (one on Zen 

Buddhist meditation and the other on a mantra technique not further described). 

There were two studies (one on TM® and the other on a mantra technique not further 

described) that used mindfulness meditation practitioners as control groups. Two other studies 

(one on Yoga, and the other on a meditation practice not described) failed to describe the type of 

meditation technique practiced by the comparison group. One study on Qi Gong used Tai Chi 

practitioners for comparisons, and Yoga practitioners were used as control groups in two studies 

on TM®, one on Zen Buddhist meditation, and one on Qi Gong. 

Concurrent control groups exposed to different dose or regimen of the same meditation 

practice. Thirty-six studies made comparisons between groups of practitioners of the same 

meditation practice but using different lengths of practice (e.g., short-term versus long-term). 

Twenty of these studies were on mantra meditation (17 on TM®, 2 on Ananda Marga, and 1 on a 

mantra technique not further described), 6 on mindfulness meditation (4 on Zen Buddhist 

meditation, 1 on Vipassana meditation, and 1 on a Mindfulness meditation technique not further 

specified), 6 on Qi Gong, 3 on Yoga, and 1 on Tai Chi. 

Historical controls. Fourteen out of 266 observational analytical studies used historical 

controls consisting of groups of participants external to the study or of the same single group of 

participants with data collected at an earlier period of time. Eleven of these studies compared 

mantra meditation (nine on TM® and one on Ananda Marga) to data from nonmeditators 

collected earlier for other purposes. Three studies on Qi Gong also used nonconcurrent data from 

nonpractitioners,200,201 Yoga practitioners,202 groups of athletes and participants in educational 

lectures.202

Multiple control groups. As shown earlier in Table 16, 207 out of 266 observational 

analytical studies used a single control group, whereas 59 used more than one kind of control per 

study (e.g., use of either active controls or inactive interventions). 

Twenty-nine of the observational analytical studies with multiple controls were conducted on 

mantra meditation (25 on TM®, 2 on Ananda Marga, and 2 on mantra techniques not further 

described). There were seven studies with multiple controls conducted on mindfulness 

meditation (five on Zen Buddhist meditation, one on mindfulness meditation techniques not 

further described, and one on Vipassana meditation), seven on Yoga, seven on Qi Gong, six on 

Tai Chi, two on miscellaneous interventions, and one on meditation practices not further 

described. 
77

Table 19. Types of control groups for intervention studies on meditation practices 

Type of control group N 

groups 

N 

studies Meditation practice (no. studies) 

Placebo/sham 18 18 Mantra meditation (9 groups, 9 studies) 

TM®

 (3), Mantra (NS) (3), RR (2), SRELAX (1), 

Meditation practices (ND) (3 groups, 3 studies) 

Yoga (2 groups, 2 studies) 

Mindfulness meditation (1 group, 1 study) 

Zen Buddhist meditation (1)

Qi Gong (2 groups, 2 studies) 

Tai Chi (1 group, 1 study) 

No-treatment concurrent controls 

NT 126 123 Mantra meditation (44 groups, 43 studies) 

TM®

 (25), Mantra (NS) (8); RR (6), CSM (2), Acem meditation 

(1), Cayce’s meditation (1) 

Yoga (31 groups, 30 studies)

Mindfulness meditation (23 groups, 22 studies) 

MBSR (9), MM (NS) (7), Zen Buddhist meditation (5), 

MBCT (1)

Tai Chi (19 groups, 19 studies)

Meditation practices (ND) (6 groups, 6 studies)

Qi Gong (2 groups, 2 studies)

Miscellaneous meditation practices (1 group, 1 study) 

WL 62 62 Mantra meditation (24 groups, 24 studies) 

TM®

 (10), CSM (5), RR (5), Mantra (NS) (3), SRELAX (1) 

Mindfulness meditation (21 groups, 21 studies) 

MBSR (11), MM (NS) (6),MBCT (2), 

Zen Buddhist meditation (2) 

Yoga (10 groups, 10 studies) 

Meditation practices (ND) (3 groups, 3 studies) 

Qi Gong (2 groups, 2 studies) 

Tai Chi (2 groups, 2 studies) 

Active (positive) concurrent controls—interventions other than meditation practices 

Exercise/physical 

activity 

52 45 Yoga (23 groups, 18 studies)

Tai Chi (14 groups, 14 studies)

Mantra meditation (13 groups, 10 studies) 

Mantra (NS) (3), RR (3), TM®

 (2), Acem meditation (1), 

CSM (1) 

Mindfulness meditation (1 group, 1 study) 

MBSR (1) 

Meditation practices (ND) (1 group, 1 study)

Qi Gong (1 group, 1 study) 

Rest and states of 

relaxation 

47 45 Mantra meditation (30 groups, 28 studies) 

RR (14), TM®

 (9), Mantra (NS) (3), CSM (2) 

Yoga (9 groups, 9 studies) 

Mindfulness meditation (6 groups, 6 studies) 

Zen Buddhist meditation (3), MM (NS) (2), MBSR (1)

Meditation practices (ND) (2 groups, 2 studies) 

BF = biofeedback; CSM = Clinically Standardized Meditation; MBCT = mindfulness-based cognitive therapy; MBSR = 

Mindfulness-based stress reduction; MM = mindfulness meditation; = ND = not described; NS = not specified; NT = no 

treatment; PMR = progressive muscle relaxation; RR = Relaxation Response; TM® = Transcendental Meditation®; WL = 

waiting list 
78

Table 19. Types of control groups for intervention studies on meditation practices (continued) 

Type of control group N 

groups 

N 

studies Meditation practice (no. studies) 

Active (positive) concurrent controls—interventions other than meditation practices (continued) 

Education 46 44 Mantra meditation (19 groups, 17 studies) 

TM®

 (9), RR (5), Mantra (NS) (2), CSM (1) 

Mindfulness meditation (10 groups, 10 studies) 

MBSR (5), Zen Buddhist meditation (3), MM (NS) (2) 

Yoga (8 groups, 8 studies) 

Tai Chi (6 groups, 6 studies) 

Meditation practices (ND) (2 groups, 2 studies) 

Miscellaneous meditation practices (1 groups, 1 study) 

PMR 39 39 Mantra meditation (27 groups, 27 studies) 

TM®

 (10), RR (8), Mantra (NS) (5), CSM (3), Acem 

meditation (1) 

Yoga (6 groups, 6 studies) 

Mindfulness meditation (5 groups, 5 studies) 

MBSR (2), MM (NS) (2), Zen Buddhist meditation (1) 

Meditation practices (ND) (1 group, 1 study) 

Cognitive behavioral 

techniques 

22 20 Mantra meditation (9 groups, 9 studies) 

TM®

 (3), CSM (2), Mantra (NS) (1)

Mindfulness meditation (7 groups, 7 studies) 

MM (NS) (4), MBSR (3)

Meditation practices (ND) (3 groups, 2 studies) 

Yoga (3 groups, 2 studies) 

Miscellaneous active 

controls 

23 19 Yoga (7 groups, 6 studies)

Mantra meditation (6 groups, 6 studies) 

RR (3), Mantra (NS) (2), TM®

 (1)

Mindfulness meditation (6 groups, 4 studies) 

MBSR (2), Zen Buddhist meditation (1), MM (NS) (1)

Miscellaneous meditation practices (2 groups, 1 study)

Meditation practices (ND) (1 group, 1 study)

Tai Chi (1 group, 1 study) 

Group therapy 14 13 Mantra meditation (6 groups, 6 studies) 

RR (3), TM®

 (2), Acem meditation (1) 

Mindfulness meditation (3 groups, 3 studies) 

MBSR (1), MM (NS) (2) 

Tai Chi (3 groups, 2 studies) 

Yoga (2 groups, 2 studies) 

Psychotherapy 3 3 Mantra meditation (1 group, 1 study) 

TM®

 (1)

Mindfulness meditation (1 group, 1 study) 

MBSR (1) 

Yoga (1 group, 1 study) 

BF 13 12 Mantra meditation (12 groups, 11 studies) 

RR (6), Mantra (NS) (3), TM®

 (2), 

Yoga (1 group, 1 study) 

Reading 8 8 Mantra meditation (6 groups, 6 studies) 

RR (4), TM®

 (2) 

Tai Chi (1 group, 1 study)

Yoga (1 group, 1 study) 

Pharmacological 

interventions 

8 8 Yoga (6 groups, 6 studies)

Qi Gong (2 groups, 2 studies) 

Hypnosis 4 4 Mantra meditation (2 groups, 2 studies) 

TM®

 (2) 

Meditation practices (ND) (2 groups, 2 studies) 
79

Table 19. Types of control groups for intervention studies on meditation practices (continued)

Type of control group N 

groups 

N 

studies Meditation practice (no. studies) 

Active (positive) concurrent controls—interventions other than meditation practices (continued) 

Massage 3 2 Mantra meditation (2 groups, 1 study) 

RR (1)

Mindfulness meditation (1 group, 1 study) 

MBSR (1) 

Acupuncture 1 1 Tai Chi (1 group, 1 study) 

Active (positive) concurrent controls—meditation practices as comparison groups

Yoga 5 5 Mantra meditation (4 groups, 4 studies) 

TM®

 (3), Mantra (NS) (1)

Meditation practices (ND) (1 group, 1 study) 

Mantra meditation 3 3 Yoga (3 groups, 3 studies) 

Mindfulness meditation 3 3 Mantra meditation (2 groups, 2 studies) 

TM®

 (1), Mantra (NS) (1)

Meditation practices (ND) (1 group, 1 study) 

Meditation practices 

(ND) 

2 2 Mantra meditation (2 groups, 2 studies) 

RR (1), TM®

 (1) 

Tai Chi 1 1 Mantra meditation (1 group, 1 study) RR (1) 

Different dose or regimen of meditation practices—concurrent control groups 

Yoga 15 14 Yoga (15 groups, 14 studies) 

Mantra meditation 9 9 Mantra meditation (9 groups, 9 studies) 

TM®

 (5), RR (2), CSM (1), Mantra (NS) (1) 

Mindfulness meditation 5 4 Mindfulness meditation (5 groups, 4 studies) 

MBSR (2), Zen Buddhist meditation (1), MM (NS) (1) 

Meditation practices 

(ND) 

2 2 Meditation practices (ND) (2 groups, 2 studies) 

Usual care 37 37 Mindfulness meditation (9 groups, 9 studies) 

MM (NS) (2), MBSR (3), MBCT (3), Zen Buddhist (1) 

Qi Gong (3 groups, 3 studies)

Mantra meditation (2 groups, 2 studies) 

RR (1), TM®

 (2)

Tai Chi (4 groups, 4 studies)

Yoga (16 groups, 16 studies) 

Meditation practices (ND) (1 group, 1 study)

Miscellaneous meditation practices (1 group, 1 study) 

Control groups (ND) 6 6 Mantra meditation (2 groups, 2 studies) 

RR (1), TM®

 (1)

Qi Gong (2 groups, 2 studies)

MM (NS) (1) 

Tai Chi (1 groups, 1 studies) 

Number of controls per study 

Single control 275 275 Yoga (80 groups, 80 studies) 

Mantra meditation (77 groups, 77 studies) 

TM®

 (34), RR (23), Mantra (NS) (9), CSM (6), Acem 

meditation (2), Cayce’s meditation (1) 

Mindfulness meditation (55 groups, 55 studies) 

MBSR (25), MM (NS) (18), MBCT (6), Zen Buddhist 

meditation (6), 

Tai Chi (40 groups, 40 studies) 

Qi Gong (12 groups, 12 studies)

Meditation practices (ND) (10 groups, 10 studies)

Miscellaneous meditation practices (1 group, 1 study) 
80

Table 19. Types of control groups for intervention studies on meditation practices (continued) 

Type of control group N 

groups 

N 

studies Meditation practice (no. studies) 

Number of controls per study (continued) 

Multiple controls 296 127 Mantra meditation (152 groups, 65 studies) 

TM®

 (25), RR (22), Mantra (NS) (11), Acem meditation (1), 

SRELAX (1)

Yoga (63 groups, 26 studies) 

Mindfulness meditation (45 groups, 20 studies) 

MBSR (8), MM (NS) (6), Zen Buddhist meditation (6) 

Meditation practices (ND) (17 groups, 7 studies)

Tai Chi (13 groups, 6 studies)

Miscellaneous meditation practices (4 groups, 2 studies) 

Qi Gong (2 groups, 1 study)

Table 20. Types of control groups for observational analytical studies on meditation practices 

Type of control group N 

groups 

N 

studies Meditation practice (no. studies) 

Nonexposed 

cohorts/comparison 

groups 

247 244 Mantra meditation (155 groups, 153 studies) 

TM®

 (140), Mantra (NS) (6), Acem meditation (4), 

Ananda marga (3) 

Yoga (29 groups, 29 studies) 

Mindfulness meditation (21 groups, 21 studies) 

Zen Buddhist meditation (12), MM (NS) (6), Vipassana (3)

Tai Chi (22 groups, 21 studies)

Qi Gong (13 groups, 13 studies)

Miscellaneous meditation practices (5 groups, 5 studies) 

Meditation practices (ND) (2 groups, 2 studies) 

Active (positive) concurrent controls exposed to interventions other than meditation practices 

Exercise/physical 

activity 

16 14 Tai Chi (4 groups, 4 studies)

Yoga (4 groups, 4 studies) 

Miscellaneous meditation practices (4 groups, 2 studies) 

Mantra meditation (2 groups, 2 studies) 

TM®

 (2) 

Meditation practices (ND) (1 group, 1 study)

Qi Gong (1 group, 1 study) 

Miscellaneous active 

controls 

7 5 Mantra meditation (5 groups, 3 studies) 

TM®

 (3) 

Miscellaneous meditation practices (1 group, 1 study) 

Tai Chi (1 group, 1 study) 

Progressive muscle 

relaxation 

5 4 Mantra meditation (5 groups, 4 studies) 

TM®

 (4) 

Hypnosis 3 3 Mantra meditation (3 groups, 3 studies) 

TM®

 (3) 

Rest and states of 

relaxation 

3 3 Mantra meditation (3 groups, 3 studies) 

TM®

 (3) 

Education 2 2 Qi Gong (1 group, 1 study)

Yoga (1 group, 1 study) 

MM = mindfulness meditation; ND = not described; NS = not specified; RR = Relaxation Response; TM® = Transcendental 

Meditation®
81

Table 20. Types of control groups for observational analytical studies on meditation practices (continued) 

Type of control group N 

groups 

N 

studies Meditation practice (no. studies) 

Active (positive) concurrent controls exposed to interventions other than meditation practices 

Group therapy 2 2 Mantra meditation (1 group, 1 study) 

TM®

 (1) 

Yoga (1 group, 1 study) 

Reading 2 2 Mindfulness meditation (1 group, 1 study) 

Zen Buddhist meditation (1) 

Yoga (1 group, 1 study) 

Biofeedback 1 1 Mantra meditation (1 group, 1 study) 

RR (1) 

Cognitive behavioral 

techniques 

1 1 Mantra meditation (1 group, 1 study) 

TM®

 (1) 

Active (positive) concurrent controls exposed to meditation practices 

Mantra meditation 2 2 Mindfulness meditation (2 groups, 2 studies) 

Zen Buddhist meditation (1), MM (NS) (1)

Mindfulness meditation 2 2 Mantra meditation (2 groups, 2 studies) 

TM®

 (1), Mantra (NS) (1) 

Meditation practices 

(ND) 

2 2 Yoga (1 group, 1 study) 

Meditation practices (ND) (1 group, 1 study) 

Tai Chi 1 1 Qi Gong (1 group, 1 study) 

Yoga 4 4 Mantra meditation (2 groups, 2 studies) 

TM®

 (2) 

Mindfulness meditation (1 group, 1 study) 

Zen Buddhist meditation (1) 

Qi Gong (1 group, 1 study) 

Concurrent control groups exposed to different dose or regimen of the same meditation practice 

Mantra meditation 21 20 Mantra meditation (21 groups, 20 studies) 

TM®

 (17), Ananda marga (2), Mantra (NS) (1) 

Mindfulness meditation 8 6 Mindfulness meditation (8 groups, 6 studies) 

Zen Buddhist meditation (4), Vipassana (1), MM (NS) (1) 

Qi Gong 11 6 Qi Gong (11 groups, 6 studies) 

Yoga 3 3 Yoga (3 groups, 3 studies) 

Tai Chi 1 1 Tai Chi (1 group, 1 study) 

Historical controls 14 14 Mantra meditation (11 groups, 11 studies) 

TM®

 (10), Ananda marga (1) 

Qi Gong (3 groups, 3 studies) 
82

Table 20. Types of control groups for observational analytical studies on meditation practices (continued) 

Type of control group N 

groups 

N 

studies Meditation practice (no. studies) 

Number of controls per study 

Single control 207 207 Mantra meditation (136 groups, 136 studies) 

TM®

 (126), Acem meditation (4), Mantra (NS) (4), Ananda 

marga (1), RR (1) 

Yoga (26 groups, 26 studies) 

Mindfulness meditation (17 groups, 17 studies) 

Zen Buddhist meditation (8), MM (NS) (6), Vipassana (3) 

Tai Chi (16 groups, 16 studies) 

Qi Gong (8 groups, 8 studies) 

Miscellaneous meditation practices (3 groups, 3 studies) 

Meditation practices (ND) (1 group, 1 study) 

Multiple controls 137 59 Mantra meditation (65 groups, 29 studies) 

TM®

 (25), Ananda marga (2), Mantra (NS) (2) 

Mindfulness meditation (16 groups, 7 studies) 

Zen Buddhist meditation (5), MM (NS) (1), Vipassana (1) 

Yoga (14 groups, 7 studies) 

Qi Gong (20 groups, 7 studies)

Tai Chi (12 groups, 6 studies) 

Miscellaneous meditation practices (7 groups, 2 studies) 

Meditation practices (ND) (3 groups, 1 study) 

Meditation Practices Separated by the Diseases, Conditions, and 

Populations for Which They Have Been Examined 

Eight hundred and thirteen studies contributed to the description of the diseases, conditions, 

and populations for which meditation practices have been examined. 

Overall, 69 percent (n = 564) of the studies included healthy participants only, whereas 30 

percent (n = 244) reported on clinical populations. Five studies (0.6 percent) included both 

healthy and clinical participants in the study populations. Overall, the median number of 

participants per study was 40 (IQR, 23 to 71), with a median age of 37 years (IQR, 26 to 50; n = 

536). Both male and females were equally represented in the studies (median number of males 

per study, 19; IQR, 10 to 36; median number of females per study, 19; IQR, 7 to 39). 

Table 21 displays the diseases, conditions, and populations that have been examined in 

intervention and observational analytical studies on meditation practices. 

Table 21. Types of populations and conditions included in studies on meditation 

Category of 

interest Study condition Intervention studies 

Observational 

analytical 

studies 

Total Total studies 

per category 

Circulatory and Hypertension 35 2 37 

cardiovascular Other cardiovascular diseases 24 ... 24 

61 

COPD = chronic obstructive pulmonary disease; HIV = human immunodeficiency virus; NS = not specified 
83

Table 21. Types of populations and conditions included in studies on meditation (continued) 

Category of 

interest Study condition Intervention studies 

Observational 

analytical 

studies 

Total Total studies 

per category 

Dental Dental problems (NS) 1 ... 1 2 

 Periodontitis ... 1 1 

Dermatology Psoriasis 3 ... 3 3 

Endocrine Obesity 1 ... 1 

Type II diabetes mellitus 10 ... 10 

11 

Gastrointestinal Gastrointestinal disorders 1 ... 1 

Irritable bowel syndrome 2 ... 2 

3 

Infertility 1 ... 1 

Menopause 2 ... 2 

Postmenopause 1 3 4 

Pregnancy 1 1 2 

Gynecology 

Premenstrual syndrome 1 ... 1 

10 

College and university students 123 65 189 

Elderly 34 26 60 

Healthy volunteers 90 160 250 

Army and military 8 ... 8 

Prison inmates 7 3 10 

Workers 25 3 28 

Athletes 6 ... 6 

Healthy 

Smokers 3 ... 3 

553 

Immunologic HIV 3 ... 3 3 

Sleep disorders Insomnia 2 ... 2 

Chronic insomnia 3 ... 3 

5 

Anger management 1 ... 1 

Anxiety disorders 14 ... 14 

Binge eating disorder 3 ... 3 

Burnout 1 ... 1 

Depression 11 ... 11 

Miscellaneous psychiatric 

conditions 

6 1 7 

Mood disorders 3 ... 3 

Neurosis 1 ... 1 

Obsessive-compulsive disorder 1 ... 1 

Parents of children with behavior 

problems 

1 ... 1 

Personality disorders 1 ... 1 

Postraumatic stress disorders 1 ... 1 

Mental health 

disorders 

Psychosis 1 ... 1 

66 
84

Table 21. Type of populations and conditions included in studies on meditation (continued) 

Category of 

interest Study condition Intervention studies 

Observational 

analytical 

studies 

Total Total studies 

per category 

Schizophrenia 1 ... 1 

Schizophrenia AND antisocial 

personality disorders 

1 ... 1 

Mental health 

disorders 

(continued) 

Substance abuse 18 ... 18 

Miscellaneous Heterogeneous patient population 10 ... 10 

medical 

conditions Chronic fatigue 1 ... 1 

11 

Balance disorders 1 ... 1 

Carpal tunnel syndrome 1 ... 1 

Multiple sclerosis 2 ... 2 

Muscular dystrophy 1 ... 1 

Chronic pain 10 1 11 

Chronic rheumatic diseases 1 ... 1 

Fibromyalgia 10 ... 10 

Regional pain syndrome 1 ... 1 

Rheumatoid arthritis 6 ... 6 

Hyperkyphosis 1 ... 1 

Osteoarthritis 4 ... 4 

Osteoporosis 1 ... 1 

Postpolio syndrome 1 ... 1 

Musculoskeletal 

Total hip and knee replacement 1 ... 1 

42 

Developmental disabilities 1 ... 1 

Epilepsy 2 ... 2 

Migraine and tension headaches 3 ... 3 

Stroke 2 ... 2 

Neurological 

Traumatic brain injuries 2 ... 2 

10 

Oncology Cancer 12 ... 12 12 

Organ transplant Organ transplantation 1 ... 1 1 

Renal End-stage renal disease 1 ... 1 1 

Asthma 11 ... 11 

COPD 1 ... 1 

Chronic airways obstruction 1 ... 1 

Chronic bronchitis 1 ... 1 

Pleural effusion 1 ... 1 

Respiratory and 

pulmonary 

Pulmonary tuberculosis 1 ... 1 

16 

Vestibular Tinnitus 2 ... 2 3 
85

Table 21. Type of populations and conditions included in studies on meditation (continued) 

Category of 

interest Study condition Intervention studies 

Observational 

analytical 

studies 

Total Total studies 

per category 

 Vestibulopathy 1 ... 1 

Total 547 266 813 813 

In general, the majority of studies (68 percent) on meditation practices have been conducted 

in healthy populations such as college and university students, healthy elderly participants from 

the community, army and military personnel, prison inmates, workers, athletes, and smokers 

(553 studies comprising 196 intervention studies and 257 observational analytical studies). 

Individuals with mental health disorders constituted the second most studied population (and the 

most frequently studied category of clinical conditions) examined in studies on meditation 

practices (66 studies: 65 intervention studies, and 1 observational analytical study). Mental 

health conditions included substance abuse, anxiety disorders, depression, and binge eating 

disorders, among others. 

People with cardiovascular and circulatory conditions were the third most studied population 

and the second most frequently studied clinical condition (61 studies comprising 59 intervention 

studies and 2 observational analytical studies). There were 37 studies on hypertensive 

participants (35 intervention studies and 2 observational analytical studies). Cardiovascular 

conditions (24 intervention studies) included hypertension and a group of heterogeneous 

cardiovascular diseases (diseases of the circulatory system—the heart, the blood vessels of the 

heart, and the veins and arteries throughout the body and within the brain) such as coronary 

artery disease, chronic heart failure, ischemic heart disease, and myocardial infarction. 

Forty-two studies on meditation practices (41 intervention studies and 1 observational 

analytical study) have been conducted in musculoskeletal conditions including chronic pain, 

fibromyalgia, rheumatoid arthritis, and osteoarthritis. Respiratory conditions (e.g., asthma and 

chronic obstructive pulmonary disease) have been examined in 16 intervention studies. Twelve 

intervention studies in oncology have been conducted using different types of cancer 

populations, such as breast, prostate, skin and lymphoma. Endocrine diseases such as type II 

diabetes mellitus (DM) and obesity conditions have been examined in 11 intervention studies on 

meditation practices. Heterogeneous patient populations with a variety of medical conditions not 

specified have been examined in 11 intervention studies. 

Gynecological conditions such as postmenopause, menopause, premenstrual syndrome, 

pregnancy, and infertility have been examined in 10 intervention studies. Populations with 

gastrointestinal disorders have been examined in three intervention studies. Three intervention 

studies have examined the effect of meditation practices in dermatological disorders, such as 

psoriasis, and on vestibular problems, such as tinnitus. Finally, patients with dental problems 

(one intervention study, one observational study), end-stage renal disease (one intervention 

study), and organ transplants (one intervention study) have been used as study populations for 

studies on meditation practices. 
86

After excluding healthy populations, the distribution of conditions or disorders for which 

meditation practices have been examined was 

1. hypertension (35 intervention studies and 2 observational analytical studies); 

2. other cardiovascular diseases (24 intervention studies); 

3. substance abuse disorders (18 intervention studies); 

4. anxiety disorders (14 intervention studies); 

5. cancer (12 intervention studies); 

6. asthma (11 intervention studies); 

7. chronic pain (10 intervention studies and 1 observational analytical study); 

8. type II DM (10 intervention studies); 

9. fibromyalgia (10 intervention studies); and 

10. miscellaneous psychiatric conditions (six intervention studies and one observational 

analytical study). 

Table G9 in Appendix G*

 provides a comparative summary of the number and study 

references by meditation practice, separated by the conditions and populations for which they 

have been examined. 

Mantra meditation. Among the intervention studies on TM®, the majority (72 percent, 

57/80) have been conducted in healthy populations (college and university students [24 studies], 

healthy volunteers from the community [19 studies], prison inmates [4 studies], elderly [3 

studies], smokers [2 studies], and athletes [1 study]). The second largest group of TM® studies 

examined its effects on mental health disorders (nine studies) such as substance abuse (five 

studies), anxiety disorders (two studies), posttraumatic stress disorder (one study), and other 

miscellaneous psychiatric conditions (one study). Participants with circulatory or cardiovascular 

diseases such as hypertension (9 studies) and coronary artery disease (1 study) have been 

included in 10 studies on TM®. Other conditions such as asthma (two studies), chronic insomnia 

(one study), and a miscellaneous group of cancer patients (one study) have also been included in 

intervention studies on TM®. 

The vast majority of observational analytical studies on TM® (98 percent, 148/151) have 

been conducted in healthy populations (healthy volunteers from the community [91 studies], 

college and university students [48 studies], prison inmates [3 studies], and workers [1 study]). 

Conditions such as pregnancy (one study), postmenopause (one study), and dental problems 

(e.g., periodontitis, one study) have been also examined. 

Intervention studies on RR have included mainly healthy populations (31 studies), in addition 

to circulatory and cardiovascular conditions (hypertension [4 studies], other cardiovascular 

conditions [5 studies] including chronic heart failure, congestive heart failure, ischemic heart 

disease, premature ventricular contractions, and peripheral vascular disease), mental health 

disorders (substance abuse [2 studies], anxiety disorders [1 study], schizophrenia or antisocial 

personality disorders [1 study]), gynecological conditions (menopause [1 study], premenstrual 

syndrome [1 study]), and other clinical conditions such as irritable bowel syndrome (1 study), 

total knee replacement (1 study), skin cancer (1 study), and a group of patients with 

heterogeneous clinical conditions (1 study). The only observational analytical study on RR has 

been conducted in a population of hypertensive patients. 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
87

Nineteen intervention studies on mantra meditation techniques not further described have 

been conducted with healthy populations. Other populations included people with mental health 

disorders (anxiety disorders [three studies], substance abuse [two studies], miscellaneous 

psychiatric conditions [one study]), hypertension (one study), and epilepsy (one study). The six 

observational analytical studies conducted on mantra techniques not further described have 

included healthy volunteers from the community. 

Seven intervention studies on CSM have been conducted on healthy populations, three on 

mental disorders such as anxiety disorders (one study), schizophrenia (one study), and substance 

abuse (one study), and another study on chronic insomnia. 

All the intervention and observational analytical studies on Acem meditation, Ananda Marga, 

Cayce’s meditation, and Rosary prayer have been conducted with healthy populations. 

Yoga. Among the intervention studies on Yoga, more than half (80/158) have been 

conducted with healthy populations (healthy volunteers from the community [34 studies], college 

and university students [26 studies], army and military personnel [7 studies], workers [5 studies], 

prison inmates [4 studies], and athletes [1 study]). The second largest group of conditions studied 

is constituted by circulatory and cardiovascular diseases (21 studies) such as hypertension (13 

studies), and other cardiovascular conditions (8 studies). Studies on Yoga have also included 

participants with mental health disorders (16 studies) such as depression (7 studies), anxiety 

disorders (3 studies), substance abuse (3 studies), other miscellaneous psychiatric conditions (2 

studies), and obsessive-compulsive disorders (1 study). Respiratory and pulmonary conditions 

such as asthma (nine studies), chronic airways obstruction, chronic bronchitis, pleural effusion, 

and pulmonary tuberculosis (one study each) have been also examined. Participants with 

musculoskeletal conditions such as chronic pain, rheumatoid arthritis (two studies each), carpal 

tunnel syndrome, chronic rheumatic diseases, fibromyalgia, hyperkyphosis, multiple sclerosis, 

osteoarthritis, and postpolio syndrome (one study each) have been included in intervention 

studies on Yoga. Other conditions examined in Yoga studies were gastrointestinal disorders (two 

studies), epilepsy, migraine, pregnancy, human immunodeficiency virus (HIV), lymphoma, 

chronic insomnia, tinnitus, and heterogeneous patient populations (one study each). All the 

observational analytic studies on Yoga (33 studies) have been conducted with healthy 

populations. 

Mindfulness meditation. Among the 49 intervention studies on MBSR, 12 were conducted 

with healthy populations and 12 with populations with mental health disorders. Mental health 

disorders included anxiety disorders (three studies), mood disorders (two studies), substance 

abuse (two studies), binge eating disorders, burnout, personality disorders, miscellaneous 

psychiatric conditions, and stress-related conditions of parents of children with behavioral 

problems (one study each). 

Participants with musculoskeletal conditions such as chronic pain (four studies) and 

fibromyalgia (two studies) have been also included. Cancer patients have been included in four 

intervention studies on MBSR. Other conditions such as psoriasis (two studies), cardiovascular 

diseases (two studies), traumatic brain injuries (two studies), obesity, HIV, and organ 

transplantation (one study each) have also been included. No observational analytic studies on 

MBSR were identified. 

Eleven intervention studies on mindfulness meditation not further specified have been 

conducted in healthy populations. Other populations included mental health disorders (binge 

eating disorders [two studies], anxiety disorders, psychosis, substance abuse [one study each]). 
88

Musculoskeletal conditions such as fibromyalgia (three studies) and chronic pain (two 

studies), cardiovascular diseases, cancer (three studies each), psoriasis, infertility, and 

heterogeneous patient populations (one study each) have been included also. The majority of 

observational analytical studies on mindfulness meditation techniques not further specified (six 

studies) have been conducted in healthy populations, with only one observational study 

conducted in a clinical population (individuals with chronic pain). 

The majority of intervention studies (73 percent) on Zen Buddhist meditation have been 

conducted on healthy participants (11 studies). Clinical conditions that have been studied in 

intervention studies include hypertension (two studies), coronary artery disease, and insomnia 

(one study each). All the observational analytical studies conducted on Zen Buddhist meditation 

(13 studies) have included healthy volunteers. 

Three intervention studies on MBCT have included patients with a depressive disorder. Other 

populations that have been examined are individuals with fibromyalgia, stroke, tinnitus, and 

healthy workers (one study each). No observational studies on MBCT were identified. 

Intervention studies on Vipassana meditation have involved healthy populations from the 

community and patients with migraine or tension headaches (one study each). The observational 

analytical studies conducted on Vipassana meditation (four studies) have employed healthy 

populations from the community (two studies), college and university students, and elderly 

individuals (one study each). 

Tai Chi. Intervention studies on Tai Chi have mainly assessed healthy populations (38 

studies), particularly the elderly (25 studies). Clinical conditions examined in intervention 

studies of Tai Chi include musculoskeletal conditions such as rheumatoid arthritis (four studies), 

osteoarthritis (three studies), chronic pain (two studies), balance disorders, fibromyalgia, 

multiple sclerosis, and osteoporosis (one study each). Circulatory and cardiovascular conditions 

have been examined in four studies. Other populations examined in studies on Tai Chi are 

menopause, postmenopause, depression, miscellaneous psychiatric conditions, developmental 

disabilities, stroke, type II DM, HIV, breast cancer, end-stage renal disease, and vestibulopathy 

(one study each). The majority (91 percent, 20/22) of the observational analytical studies 

conducted in Tai Chi have examined groups of healthy, elderly individuals or other healthy 

individuals from the community. Two observational studies have been conducted in groups of 

postmenopausal women. 

Qi Gong. Intervention studies on Qi Gong have examined populations of healthy participants 

(seven studies), patients with circulatory and cardiovascular disorders (hypertension [four 

studies], coronary artery disease [one study]), musculoskeletal conditions (fibromyalgia [two 

studies], muscular dystrophy and regional pain syndrome [one study each]), type II DM, 

substance abuse, miscellaneous medical conditions, migraine, and chronic obstructive pulmonary 

disease (COPD) (one study each). Almost all the observational analytical Qi Gong studies 

(14/15) were conducted with healthy populations; one was conducted with hypertensives. 

Meditation practices (ND). Among the 19 intervention studies that failed to describe the 

meditation practice under study, 12 examined healthy college and university students (nine 

studies), workers (2 studies), and healthy volunteers from the community (one study). 

Intervention studies on clinical conditions included patients with hypertension, dental problems, 

and insomnia (one study each). Two observational studies included respectively, healthy college 

and university students and individuals with miscellaneous psychiatric conditions. 
89

Miscellaneous meditation practices. Five of the six intervention studies that combined 

different meditation practices were conducted in healthy populations (three studies), 

miscellaneous psychiatric conditions, and heterogeneous populations of patients (one study 

each). One intervention study was conducted in patients with breast cancer. All five 

observational studies on miscellaneous meditation practices examined healthy populations. 

Tables 22 and 23 summarize the diseases, conditions, and populations for which meditation 

practices have been studied in intervention and observational analytical studies. 
90

Table 22. Intervention studies conducted on meditation practices by populations examined* 

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practices 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi 

Gong 

(N) 

Tai Chi 

(N) 

Y

Circulatory and Hypertension 14* 2 1 ... 4 1 

cardiovascular Other 

cardiovascular diseases 

6 6 ... ... 1 3 

Dental Dental problems 

(NS) 

... ... 1 ... ... ... 

Dermatology Psoriasis ... 3 ... ... ... ... Endocrine Obesity ... 1 ... ... ... ... 

Type II diabetes 

mellitus 

... ... ... ... 2 1 

Gastrointestinal 

disorders 

Gastrointestinal ... ... ... ... ... ... 

Irritable bowel 

syndrome 

1 ... ... ... ... ... 

Infertility ... 1 ... ... ... ... Menopause 1 ... ... ... ... 1 Postmenopause ... ... ... ... ... 1 Pregnancy ... ... ... ... ... ... 

Gynecology 

Premenstrual 

syndrome 

1 ... ... ... ... ... 

College and 

university students 

56 23 9 2 2 4 

Elderly 3 ... ... ... 1 25 Healthy 

volunteers 

36 6 1 1 4 8 

Healthy 

Army and military 1 ... ... ... ... ... 

*Only conditions for which studies were available COPD = chronic obstructive pulmonary disease; HIV = human immunodeficiency virus; ND = not described; NS = not specified 
91

Table 22. Intervention studies conducted on meditation practices by populations examined (continued) 

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practices 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi 

Gong 

(N) 

Tai Chi 

(N) 

Prison inmates 5 ... ... ... ... ... Workers 12 5 2 ... ... 1 Athletes 4 1 ... ... ... ... 

Healthy 

(continued) 

Smokers 2 1 ... ... ... ... 

Immunologic HIV ... 1 ... ... ... 1 Sleep disorders Insomnia ... 1 1 ... ... ... 

Chronic insomnia 2 ... ... ... ... ... 

Anger 

management 

... ... 1 ... ... ... 

Anxiety disorders 7 4 ... ... ... ... Binge eating 

disorder 

... 3 ... ... ... ... 

Burnout ... 1 ... ... ... ... Depression ... 3 ... ... ... 1 Miscellaneous 

psychiatric conditions 

2 1 ... 1 ... 1 

Mood disorders ... 2 1 ... ... ... Neurosis ... ... ... ... ... ... Obsessivecompulsive 

disorder 

... ... ... ... ... ... 

Parents of children 

with behavior problems 

... 1 ... ... ... ... 

Mental health 

disorders 

Personality 

disorders 

... 1 ... ... ... ... 
92

Table 22. Intervention studies conducted on meditation practices by populations examined (continued)

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practices 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi 

Gong 

(N) 

Tai Chi 

(N) 

Yoga 

(N) 

Postraumatic 

stress disorders 

1 ... ... ... ... ... ... 

Psychosis ... 1 ... ... ... ... ... Schizophrenia 1 ... ... ... ... ... ... Schizophrenia 

and antisocial personality disorders 

1 ... ... ... ... ... ... 

Mental health 

disorders (continued) 

Substance abuse 9 3 2 ... 1 ... 3 Heterogeneous 

patient population 

Miscellaneous 1 6 ... 1 1 ... 1 

medical conditions 

Chronic fatigue ... 1 ... ... ... ... ... Balance 

disorders 

... ... ... ... ... 1 ... 

Carpal tunnel 

syndrome 

... ... ... ... ... 1 

Multiple sclerosis ... ... ... ... ... 1 1 Muscular 

dystrophy 

... ... ... ... 1 ... ... 

Chronic pain ... 6 ... ... 2 2 10 Chronic 

rheumatic diseases 

... ... ... ... ... ... 1 

Fibromyalgia ... 6 ... ... 2 1 1 Regional pain 

syndrome 

... ... ... ... 1 ... ... 

Musculoskeletal 

Rheumatoid 

arthritis 

... ... ... ... ... 4 2 
93

Table 22. Intervention studies conducted on meditation practices by populations examined (continued)

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practices 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi 

Gong 

(N) 

Tai Chi 

(N) 

Yoga 

(N) 

Hyperkyphosis ... ... ... ... ... - 1 Osteoarthritis ... ... ... ... ... 3 1 Osteoporosis ... ... ... ... ... 1 ... Postpolio 

syndrome 

... ... ... ... ... ... 1 

Musculoskeletal 

(continued) 

Total hip and 

knee replacement 

1 ... ... ... ... ... ... 

Developmental 

disabilities 

... ... ... ... ... 1 ... 

Epilepsy 1 ... ... ... ... ... 1 Migraine and 

tension headaches 

... 1 ... ... 1 ... 1 

Stroke ... 1 ... ... ... 1 ... 

Neurological 

Traumatic brain 

injuries 

... 2 ... ... ... ... ... 

Oncology Cancer 2 7 ... 1 ... 1 1 Organ 

transplant 

Organ 

transplantation 

... 1 ... ... ... ... ... 

Renal End-stage renal 

disease 

... ... ... ... ... 1 ... 

Asthma 2 ... ... ... ... ... 9 COPD ... ... ... ... 1 ... ... Chronic airways 

obstruction 

... ... ... ... ... ... 1 

Chronic 

bronchitis 

... ... ... ... ... ... 1 

Respiratory 

and pulmonary 

Pleural effusion ... ... ... ... ... ... 1 
94

Table 22. Intervention studies conducted on meditation practices by populations examined (continued)

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practices 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi 

Gong 

(N) 

Tai Chi 

(N) 

Yoga 

(N) 

Respiratory 

and pulmonary (continued) 

Pulmonary 

tuberculosis 

... ... ... ... ... ... 1 

Vestibular Tinnitus ... 1 ... ... ... ... 1 

Vestibulopathy ... ... ... ... ... 1 ... 

Total 172 103 19 6 22 66 159 
95

Table 23. Observational analytical studies conducted on meditation practices by populations examined* 

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practices 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi Gong 

(N) 

Tai Chi 

(N) 

Circulatory 

and cardiovascu-lar 

Hypertension 1 ... ... ... 1 ... 

Dental Periodontitis 1 ... ... ... ... ... Gynecology Postmenopause 1 ... ... ... ... 2 

Pregnancy 1 ... ... ... ... ... College and 

university students 

48 6 1 1 2 ... 

Elderly 5 1 ... ... 1 18 Healthy 

volunteers 

104 16 ... 4 11 2 

Prison inmates 3 ... ... ... ... ... 

Healthy 

Workers 1 ... ... ... ... ... 

Mental health 

disorders 

Miscellaneous 

psychiatric conditions 

... ... 1 ... ... ... 

Musculoskeletal Chronic pain ... 1 ... ... ... ... Total 165 24 2 5 15 22 *Only conditions for which studies were available ND = not described; NS = not specified 
96

Outcome Measures Used in Studies on Meditation Practices 

In total, 3,665 outcome measures were reported in 813 studies on meditation practices. The 

median number of outcomes reported per study was four (IQR, 2 to 6). Table 24 displays the 

type of outcome measures that have been examined in studies on meditation practices. 

Table 24. Type of outcome measures examined in studies on meditation practices 

Domain Outcomes No. measures (%) No. per domain 

Cardiovascular 496 (13.51) 

Pulmonary and respiratory 251 (6.85) 

Nutritional biochemistry and metabolism 235 (6.41) 

Endocrine and hormonal 125 (3.41) 

Brain and nervous system 112 (3.06) 

Electrodermal responses 72 (1.96) 

Muscular 46 (1.26) 

Lymphatic and immunological 45 (1.23) 

Blood 28 (0.76) 

Thermoregulatory 22 (0.60) 

Skeletal 14 (0.38) 

Ocular 13 (0.35) 

Sensory 8 (0.22) 

Renal and excretory 7 (0.19) 

Physiological 

Gastric 1 (0.03) 

1,474 

Psychiatric and psychological symptoms 645 (15.6) 

Personality 313 (8.54) 

Positive psychology outcomes 108 (2.95) 

Social and interpersonal relationships 50 (1.36) 

Health-related quality of life 42 (1.15) 

Activities of daily living and events impact 26 (0.71) 

Psychosocial 

Other behavioral 20 (0.55) 

1,204 

Physical functionality 252 (6.88) 

Clinical events and symptoms 

improvement 

154 (4.20) 

Nutritional status, body composition or 

weight 

74 (2.02) 

Health status or well-being 70 (1.91) 

Sleep 55 (1.50) 

Pain and pain-related behavior 54 (1.47) 

Falls occurrence and related behaviors 17 (0.46) 

Adherence 12 (0.33) 

Mortality 8 (0.22) 

Clinical 

Longevity 2 (0.05) 

698 
97

Table 24. Type of outcome measures examined in studies on meditation practices (continued) 

Domain Outcomes No. measures (%) No. per domain 

Sensory perceptual and motor functions 103 (2.81) 

Reasoning and executive functions 40 (1.09) 

General functions 37 (1.01) 

Memory 24 (0.65) 

Attention 22 (0.60) 

Cognitive and neuropsychological 

Language 13 (0.35) 

239 

Healthcare Medication use 30 (0.82) 

utilization Healthcare utilization and economic 

outcomes 

20 (0.55) 

50 

Total 3,665 3,665 

The most frequently studied outcomes were those of physiological functions (1,474 

measures), followed by psychosocial outcomes (1,204 measures), outcomes related to clinical 

events and health status (698 measures), cognitive and neuropsychological functions (239 

measures), and healthcare utilization (50 outcomes). 

Studies on mantra meditation techniques reported the largest number of outcome measures 

(1,306 measures), followed by studies on Yoga (989 measures), mindfulness meditation 

techniques (567 measures), Tai Chi (489 measures), and Qi Gong (197 measures). Studies that 

did not describe the meditation practice under study reported 76 measures and studies that 

combined practices reported 41 measures. 

Table 25 provides a summary of the type and number of outcome measures examined by 

meditation practice. 

Physiological outcomes. Cardiovascular measures (495 measures) were the most frequently 

examined variables among the physiological outcomes. They included variables such as changes 

in systolic and diastolic blood pressure, heart rate, oxygen consumption, and electrocardiogram 

patterns. Other physiological measures frequently reported included pulmonary and respiratory

outcomes (251 measures) such as respiratory rate, lung function testing measures (e.g., forced 

expiratory volume [FEV1], forced vital capacity [FVC], peak expiratory flow rate [PEFR]), and 

carbon monoxide levels). Nutritional biochemistry and metabolism outcomes (235 measures) 

included biochemical and metabolic processes measures that act as markers of certain diseases or 

conditions. These measures included serum levels of cholesterol, tryglicerides, glucose, lactate, 

potassium, calcium, sodium, and lipid profile. 

Endocrine and hormonal outcomes (125 measures) described changes in substances secreted 

by the endocrine system to regulate the activity of the organs. They included measures of cortisol 

levels, neurohormones, catecholamines, endorphines, adrenaline, and aldosterone. Brain and 

nervous system measures (112 measures) included electroencephalogram (EEG) profile, P300 

latencies, and neurotransmitter levels. Electrodermal responses, also known as galvanic skin 

responses, skin conductance, and skin resistance (72 measures), included measures of the ability 

of the skin to conduct an electrical current as a sympathetic reaction to emotional arousal and 

stress. Muscular physiology (46 measures), as a proxy for emotional arousal, was examined for 

variables such as muscle tension and relaxation, frontal electromyographic activity, muscle 

voltage, and reflex function, among others. Outcomes related to the physiological functioning of 

the immune system (45 measures) included immunoglobulin (IgA, IgG, and IgM) concentrations, 

leukocytes, lymphocytes, monocytes, and neutrophil levels in general, natural killer cell activity, 

white blood cell count, and number of monoclonal antibodies. There were 28 outcomes related to 
98

blood products and hemodynamic parameters, 22 on thermoregulatory functions such as skin or 

body temperature, and 14 measures related to the skeletal system, for example, bone mineral 

density. Other physiological outcomes less frequently reported included ocular (e.g., intraocular 

pressure, pupillary dilatation) (13 measures), sensory, for example, auditory thresholds (8 

measures), renal function tests (7 measures), and gastric measures, for example, gastric motility 

(1 measure). 
99

Table 25. Number of outcome measures examined by meditation practice 

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practice 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi Gong 

(N) 

Tai Chi 

(N) 

Cardiovascular 196 25 9 ... 27 87 Pulmonary and 

respiratory 

83 14 1 ... 14 33 

Nutritional biochemistry 

and metabolism 

76 3 2 2 22 20 

Endocrine and 

hormonal 

49 10 2 ... 15 7 

Brain and nervous 

system 

73 13 ... ... 7 ... 

Electrodermal 

responses 

53 8 1 ... ... ... 

Muscular 30 2 2 ... ... 6 Lymphatic and 

immunological 

5 9 ... ... 29 1 

Blood 12 1 1 ... 3 1 Thermoregulatory 10 1 1 ... 1 2 Skeletal ... ... ... ... ... 12 Ocular 6 ... ... ... ... ... Sensory 3 ... ... ... ... ... Renal and excretory ... ... 2 ... 3 1 

Physiological

Gastric ... ... ... ... ... ... 

ND = not described 
100

Table 25. Number of outcome measures examined by meditation practice (continued) 

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practice 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi Gong 

(N) 

Tai Chi 

(N) 

Psychiatric and 

psychological symptoms 

231 183 20 13 25 33 

Personality 146 66 12 6 8 14 Positive psychology 

outcomes 

37 37 4 5 ... 4 

Social and interpersonal 

relationships 

26 14 ... ... ... 3 

Health-related quality of 

life 

3 12 2 1 4 10 

Activities of daily living 

and events impact 

8 8 ... 1 1 5 

Psychosocial 

Other behavioral 7 3 1 3 ... 1 Physical functionality 12 7 1 1 8 165 Clinical events and 

symptoms improvement 

33 31 1 3 8 17 

Nutritional status, body 

composition and weight 

22 10 ... ... 7 8 

Health status and wellbeing 11 23 1 2 3 13 Sleep 25 14 2 ... 1 2 Pain and pain-related 

behavior 

6 20 ... ... 6 11 

Falls occurrence and 

related behavior 

... ... ... ... 1 16 

Adherence 4 3 ... ... ... 3 Mortality 5 ... ... ... 2 ... 

Clinical

Longevity 2 ... ... ... ... ... 
101

Table 25. Number of outcome measures examined by meditation practice (continued)

Category Population 

Mantra 

meditation 

(N) 

Mindfulness 

meditation 

(N) 

Meditation 

practice 

(ND) 

(N) 

Miscellaneous 

meditation 

practices 

(N) 

Qi Gong 

(N) 

Tai Chi 

(N) 

Sensory perceptual and 

motor functions 

48 18 3 2 ... 8 

Reasoning and 

executive functions 

21 11 5 1 ... ... 

General functions 17 5 1 1 ... 4 Memory 14 3 2 ... ... ... 

Cognitive and Attention 10 5 ... ... ... ... 

neuropsychological

Language 5 1 ... ... ... ... 

Healthcare Medication use 4 3 ... ... 2 2 

utilization

Healthcare utilization 

and economic outcomes 

13 4 ... ... ... ... 

Total 1321 567 76 41 197 489 
102

Psychosocial outcomes. The most studied psychosocial outcomes were those measuring 

psychiatric and psychological symptoms (645 measures) of anxiety, depression, stress, mood 

states, irritability and anger expression, and abuse of psychoactive or other substances causing 

psychological dependence. Measures of personality (both normal and abnormal) were reported 

for 313 outcomes. These studies reported data on either general characteristics of the personality 

(e.g., personality and psychological profiles, ego strength, and coping styles) or particular traits 

or characteristics of the individual psychological functioning (e.g., locus of control, neuroticism, 

psychoticism, extraversion, self-actualization, self-esteem, and hostility traits). Positive 

psychology outcomes (measures of processes that contribute to flourishing or optimal functioning 

of individuals (e.g., empathy, assertive behavior, happiness, spirituality, autonomy) were 

reported in 108 outcomes). Outcomes related to social and interpersonal relationships such as 

marital adjustment, level of interpersonal conflicts, social adjustment, and social functioning, 

were examined in 50 measures. Health-related quality of life measures were reported for 42 

outcomes. Other psychosocial outcomes included activities of daily living (26 measures), and 

other miscellaneous and nonspecific behavioral measures not further classified, such as “level of 

relaxation” and “hypnotic response.” 

Clinical outcomes. Measures examining physical functions such as balance, strength, 

flexibility, mobility, and postural stability were the most frequently reported types of clinical 

outcomes (252 measures). They were followed by measures of discrete clinical events, or 

indicators of symptom improvement that were particular to the conditions under study, such as 

change in fibromyalgia symptoms, number of asthma episodes, and angina pectoris symptoms 

(154 measures). Outcomes related to the nutritional status or body composition of individuals 

(74 measures) included body weight, body mass index, and diet and nutritional patterns. There 

were 70 outcomes related to general health status and well-being, 55 outcomes for sleep

characteristics, and 54 for pain-related symptoms. Seventeen outcomes reported on the frequency 

of falls or falls-related behaviors. Other clinical measures included adherence (12 measures), 

mortality (8 measures), and longevity (2 measures). 

Cognitive and neuropsychological measures. Measures related to sensory perception and 

motor functions (103 measures) were the most frequently examined cognitive and 

neuropsychological outcomes. These measures included psychomotor performance, perceptual 

motor skills, field independence, absorption, autonomic arousal, and visual-spatial ability. Other 

cognitive and neuropsychological measures less frequently examined included reasoning and 

executive functions (40 measures) (e.g., cognitive flexibility, logical reasoning, thought 

categorization, and associate learning). General cognitive outcomes (37 measures) included 

global measures of intelligence, cognitive status, and neuropsychological functioning. Memory

functions (e.g., short- and long-term, verbal and visual, declarative and procedural) were 

reported by 24 measures. Finally, language (e.g., verbal fluency, vocabulary, language 

comprehension, reading skills) and attention functions (e.g., concentration, sustained focusing 

capacity) were each reported by seven measures. 

Healthcare utilization: A number of outcomes addressed factors related to the use of 

healthcare resources, such as medication use (30 measures), length of hospital stay, medical 

utilization rates, number of sick leaves, and payments to the healthcare system (20 measures). 

When the outcome measures were analyzed by the type of meditation practice under study, 

we found that the 10 most frequently reported outcome measures in mantra meditation studies 

were 
103

1. psychiatric and psychological symptoms (231 measures); 

2. physiological cardiovascular outcomes (196 measures); 

3. personality outcomes (146 measures); 

4. physiological pulmonary and respiratory outcomes (83 measures); 

5. physiological nutrition, biochemical and metabolic outcomes (76 measures); 

6. physiological brain and nervous system outcomes (73 measures); 

7. physiological electrodermal responses (53 measures); 

8. physiological endocrine and hormonal outcomes (49 measures); 

9. sensory perceptual and motor neuropsychological functions (48 measures); and 

10. positive psychology outcomes (37 measures). 

There are no studies on mantra meditation practices that have reported skeletal, renal and 

excretory, or gastric physiology outcomes or the occurrence of falls or fall-related behaviors. 

The 10 most frequently reported outcome measures in studies on Yoga were 

1. physiological cardiovascular outcomes (151 measures); 

2. psychiatric and psychological symptoms (140 measures); 

3. physiological nutrition, biochemical and metabolic outcomes (110 measures); 

4. physiological pulmonary and respiratory outcomes (106 measures); 

5. personality outcomes (61 measures); 

6. clinical events and symptom improvement (61 measures); 

7. physical functionality outcomes (58 measures); 

8. physiological endocrine and hormonal outcomes (42 measures); 

9. outcomes of nutritional status and body composition (27 measures); and 

10. sensory perceptual and motor neuropsychological functions (24 measures). 

No studies on Yoga reported on the occurrence of falls or fall-related behaviors, or on 

longevity of study participants. 

The 10 most frequently reported outcome measures in studies on Tai Chi were 

1. physical functionality (165 measures); 

2. physiological cardiovascular outcomes (87 measures); 

3. physiological pulmonary and respiratory outcomes (33 measures); 

4. psychiatric and psychological symptoms (33 measures); 

5. physiological nutrition, biochemical and metabolic outcomes (20 measures); 

6. clinical events and symptom improvement (17 measures); 

7. falls and fall-related behavior (16 measures); 

8. personality measures (14 measures); 

9. measures of health status and well-being (13 measures); and 

10. physiological skeletal outcomes (12 measures). 

There are no studies on Tai Chi that reported physiological outcomes related to the brain and 

central nervous system, ocular, sensory, or gastrointestinal systems, or electrodermal response. 

Studies on Tai Chi have not examined outcomes related to mortality, longevity, healthcare 

utilization, or cognitive and neuropsychological functions such as reasoning, memory, attention, 

and language. 
104

The 10 most frequently outcome measures in studies on mindfulness meditation practices 

were 

1. psychiatric and psychological symptoms (183 measures); 

2. personality measures (66 measures); 

3. positive psychology outcomes (37 measures); 

4. clinical events and symptom improvement (31 measures); 

5. physiological cardiovascular outcomes (25 measures); 

6. measures of health status and well-being (23 measures); 

7. measures of pain and pain-related behavior (20 measures); 

8. sensory perceptual and motor neuropsychological functions (18 measures); 

9. physiological pulmonary and respiratory outcomes (14 measures); and 

10. social and interpersonal relationships measures (14 measures). 

No studies on mindfulness meditation practices have reported outcomes of longevity, 

physiology of ocular, sensory, gastric, skeletal or renal systems, mortality, or the incidence of 

falls. 

The 10 most frequently reported outcome measures in studies on Qi Gong were 

1. physiological lymphatic and immunological outcomes (29 measures); 

2. physiological cardiovascular outcomes (27 measures); 

3. psychiatric and psychological symptoms (25 measures); 

4. physiological nutrition, biochemical and metabolic outcomes (22 measures); 

5. physiological endocrine and hormonal outcomes (15 measures); 

6. physiological pulmonary and respiratory outcomes (14 measures); 

7. personality measures (8 measures); 

8. clinical events and symptom improvement (8 measures); 

9. physical function (8 measures); and 

10. physiological brain and nervous system outcomes (8 measures). 

There are no studies on Qi Gong that reported physiological outcomes related to the 

muscular, skeletal, ocular, sensory, and gastric systems or on electrodermal response. Other 

outcomes that have not been examined in studies on Qi Gong include positive psychology, 

interpersonal and social relationships, and cognitive functions such as memory, attention, 

language, and reasoning and executive functions. 

The 10 most studied outcome measures examined in studies that did not describe the 

meditation practice under study were 

1. psychiatric and psychological symptoms (20 measures); 

2. personality measures (20 measures); 

3. physiological cardiovascular outcomes (9 measures); 

4. reasoning and executive neuropsychological functions (5 measures); 

5. positive psychology outcomes (4 measures); 

6. sensory perceptual and motor neuropsychological functions (3 measures); 

7. memory (3 measures); 

8. muscular physiology (2 measures); 
105

9. physiological nutrition, biochemical and metabolic outcomes (2 measures); and 

10. physiological endocrine and hormonal outcomes (2 measures). 

Finally, the most studied outcome measures in studies that combined miscellaneous 

approaches to the meditation practice were 

1. psychiatric and psychological symptoms (13 measures); 

2. personality measures (6 measures); and 

3. positive psychology outcomes (5 measures). 

Summary of the Results 

General remarks. Evidence regarding the state of research on the therapeutic use of 

meditation was provided in 813 studies. Half of the studies on meditation practices were 

published after 1994. Most of the studies have been published as journal articles, and have been 

conducted in North America. More than half of the studies have examined meditation practices 

in intervention studies. The majority of the intervention studies on meditation practices are 

RCTs, followed by before-and-after studies, and NRCTs. A lesser proportion of studies have 

used observational analytical designs, the majority being cohort studies, and compared groups of 

meditators versus nonmeditators or compared different groups of meditators. 

Methodological quality of the included studies. Overall, the methodological quality of both 

intervention and observational analytical studies on meditation practices is poor. A small 

proportion of RCTs reported adequately on the methods of randomization, blinding, description 

of withdrawals, and concealment of the sequence of allocation to treatment. Half of the RCTs 

explicitly reported the source of funding, as did a smaller proportion of NRCTs and before-andafter studies. The observational analytical studies that have been conducted on meditation 

practices are prone to biases affecting the representativeness of the study and comparison groups, 

the ascertainment of both exposure and outcome and, in the case of longitudinal studies (i.e., 

cohort studies), the integrity of the followup period. Compared to the cohort studies, the crosssectional studies have less prominent methodological weaknesses. The only methodological 

aspect that did not appear to be severely jeopardized in the observational studies was the 

methods used to control for confounders in the design or analysis. More than half of 

observational studies have attempted to control for confounding either in the design or the 

analysis of the results. 

Meditation practices examined in intervention and observational analytical studies. The 

category of meditation practices that has been most frequently studied in the scientific literature 

is mantra meditation. This category includes a group of meditation techniques that, despite 

differences in principles of practice and theoretical grounds, all have a mantra as an important 

component of their practice. Both intervention and observational analytical studies on TM®

dominate the literature on mantra meditation techniques, followed by studies on RR. Other 

mantra techniques such as CSM, Acem meditation, Ananda Marga, concentrative prayer, and 

Cayce’s meditation have been examined less frequently. 

The second category of meditation practices most frequently examined is Yoga. This 

category includes a heterogeneous group of practices rooted in yogic traditions such as Hatha, 

Kundalini, and Sahaja yoga. Mindfulness meditation is the third most studied group of practices. 
106

Within this category, MBSR and Zen Buddhist meditation have been most frequently examined. 

The practice of Tai Chi is the fourth most frequently examined practice, followed by Qi Gong. 

Finally, less than five percent of the studies on meditation practices did not explicitly describe 

the practice under study or have combined different approaches to meditation in a single 

intervention without describing the individual components of the intervention. 

Control groups. The number of control groups per study ranged from one to four. Among 

the six hundred and sixty-eight studies that used control groups, the majority of them utilized an 

active concurrent control for their comparisons. Among the RCTs and NRCTs, the practice of 

exercise and other physical activities constituted the most frequent active comparator followed 

by conditions involving states of rest and relaxation, educational activities, and PMR. Other 

active control groups included cognitive behavioral techniques, pharmacological interventions, 

psychotherapy, BF techniques, reading, hypnosis, therapeutic massage, and acupuncture. Almost 

half of the RCTs and NRCTs included comparison groups consisting of participants assigned to 

waiting lists or participants that did not receive any intervention. A lower proportion of RCTs 

and NRCTs compared different meditation practices against each other, different doses of the 

practice, or modified formats of similar techniques. 

The vast majority of observational analytical studies used comparison groups consisting of 

individuals that had not been exposed to any type of meditation practice. A smaller proportion of 

observational analytical studies compared groups of individuals that have been actively exposed 

to different meditation practices. 

Diseases, conditions, and populations examined in studies on meditation practices. The 

vast majority of studies on meditation practices have been conducted in healthy populations. The 

three most studied clinical conditions are hypertension, other cardiovascular diseases, and 

substance abuse. Other diseases that have been frequently examined include anxiety disorders, 

cancer, asthma, chronic pain, type II DM, fibromyalgia, and a variety of psychiatric conditions 

studied altogether. Studies on hypertension have been conducted mainly on mantra meditation 

and Yoga. Studies on other cardiovascular diseases have been conducted using Yoga, 

mindfulness meditation techniques, and mantra meditation. Studies on substance abuse have 

been conducted mainly on mantra meditation. 

Outcome measures examined in studies on meditation practices. Studies on meditation 

practices tend to report a median number of four outcomes per study. The most frequently 

studied outcomes were those of physiological functions, followed by psychosocial outcomes, 

outcomes related to clinical events and health status, cognitive and neuropsychological functions, 

and healthcare utilization outcomes. Cardiovascular measures were the most frequently 

examined variables among the physiological outcomes. The most studied psychosocial outcomes 

were measures of psychiatric and psychological symptoms (e.g., anxiety and depression). Other 

psychosocial outcomes frequently reported include personality measures, positive psychology 

outcomes, and others related to social relationships, quality of life, and activities of daily living. 

Outcomes related to clinical events focused on measures of physical functionality, and the 

incidence of discrete clinical events. Among the cognitive and neuropsychological outcomes, 

measures of sensory perceptual and motor functions, and reasoning and executive functions were 

frequently examined. Finally, measures reporting healthcare utilization were uncommon. 
107

Topic III. Evidence on the Efficacy and Effectiveness of 

Meditation Practices 

The three most studied diseases identified in topic II were hypertension, cardiovascular 

diseases, and substance abuse disorders. Sixty-five RCTs and NRCTs (27 on hypertension, 21 on 

cardiovascular diseases, and 17 on substance abuse disorders) were included in the review on the 

efficacy and effectiveness of meditation practices. All qualifying studies are presented in 

summary tables in the appropriate sections. Details regarding these studies are available in 

Appendix H.*

Hypertension 

Description of the Included Studies 

Twenty-seven trials (24 RCTs185,203-225 and 3 NRCTs226-228) were identified that evaluated the 

effects of meditation practices in hypertensive individuals (see Appendix H*). The included trials 

evaluated eight meditation practices aimed to ameliorate a variety of outcomes associated with 

hypertension. The group of studies comprised eight trials on yoga,185,204,212,,216,,217,,219,,224,226 five 

trials on TM®,

205,206,210,220,221,222 four trials on RR,208,209,218,228 four trials on Qi Gong,207,211,213,214

two trials on Zen Buddhist meditation,225,227 one trial on a technique modeled after TM®,

222 one 

trial on Tai Chi,223 one trial on a mantra technique not further described,203 and one trial on a 

meditation practice that did not specify the technique.215

The trials were published between 1975 and 2005 (median year of publication, 1995; IQR, 

1982 to 2003). Twenty-four of these trials have been published in journals185,203,204,206-209,211-

214,216-228 while three205,210,215 were identified from the gray literature. Nine trials205,206,208-

210,220,221,227,228 were conducted in the United States, four204,212,217,226 in India, three185,218,219 in the 

United Kingdom, two211,225 in China, two213,214 in South Korea, and one each in Germany,215

Hong Kong,207 The Netherlands,224 New Zealand,222 Russia,203 Taiwan,223 and Thailand.216 The 

trials contained a total of 1,940 participants. The median sample size was 65 participants per 

study (IQR, 23 to 392; data from 19 trials). Seven203,205,206,218,220,221,225 out of 19 trials had study 

sample sizes greater than 100 participants. The mean age of participants was 50.7 ± 9.6 years 

(range, 28 to 68 years; data from 20 trials). Two trials203,227 were conducted in samples with an 

average age between 20 and 40 years. Sixteen trials185,205-208,210,213,214,216,219,220,222-226 were 

conducted in samples with mean ages ranging from 41 to 60 years. Two trials221,228 included 

study populations with mean ages of 61 years and above. Seven trials204,209,211,212,215,217,218 did not 

report the age of participants.

When the trials that reported the gender of participants were combined (n = 23), 54 percent 

of the participants were male and 46 percent were female. Samples in four trials203,204,211,226 were 

entirely male while none of the trials included entirely female samples. Four trials185,209,212,217

failed to report the gender of participants. Six trials explicitly indicated the ethnicity of their 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
108

samples. Five of them205,206,210,220,221 were conducted in African-American samples, whereas one 

trial227 stated that only white participants took part in the study.

All the trials were conducted in patients with a diagnosis of essential hypertension. All trials 

except five185,204,208,212,217 provided a definition of hypertension in their selection criteria. Half of 

the trials (n = 14)203,207,209,210,213-216,218,220,221,225,226,228 included participants diagnosed with Stage 

1 hypertension (mean systolic blood pressure [SBP] between 140 and 159 mm Hg and/or mean 

diastolic blood pressure [DBP] between 90 and 99 mm Hg) and with Stage 2 hypertension (mean 

SBP 160 mm Hg and above and/or mean DBP 100 mm Hg and above). One study206 included 

participants with prehypertension (mean SBP between 120 and 139 mm Hg, and/or DBP 

between 80 and 89 mm Hg), Stage 1, and Stage 2 hypertension. Another study205 was conducted 

in patients with prehypertension or with Stage 1 hypertension. Five trials211,219,222,224,227 included 

only participants with Stage 2 hypertension, whereas one trial223 included only participants with 

Stage 1 hypertension. 

All 27 trials employed a parallel study design. The length of the trials varied from 8 days204

to 1 year.203,210,211,221,224 The median duration of the trials was 3 months (IQR, 2 to 6). Twelve 

studies204,208,209,213-217,219,225,226,228 were short-term trials (less than 3 months), nine 

trials185,205,207,212,218,220,222,223,227 had a duration from 3 to 6 months, and six trials203,206,210,211,221,224

lasted longer than 6 months 

The 27 trials comprised six comparisons between meditation practices and no 

intervention,185,203,204,215,217,225 four comparisons between meditation practices and waiting 

list,208,213,214,222 and one comparison222 between meditation practices and placebo. There were 29 

comparisons between meditation practices and active therapies other than no intervention, WL, 

or placebo. Because some trials had more than one comparison arm, the total number of 

comparisons exceeded the number of trials. Of the 29 active comparisons, the comparative 

treatments were health education (HE),205,206,210,212,216,218,220,221,225 BF,208,209,228 PMR,204,220,221 rest 

or relaxation,204,219,223 antihypertensive medication,211,217 blood pressure checks,225,227 exercise,207

orthostatic tilt,226 and meditation practice plus BF.185 The median number of comparisons per 

study was one (IQR, 1 to 2). 

Methodological Quality of the Included Studies 

A summary of the methodological quality of the included trials is provided in Table 26. As a 

measure of methodological quality for included trials, the overall median Jadad score was 2/5 

(IQR, 1 to 2). Only two trials220,221 obtained 3 points and were considered of high quality. 

Twelve trials185,203,206,207,210,214,216,218,219,222-224 obtained 2 points, nine 

trials204,205,208,209,211,213,215,217,225 obtained 1 point, and four trials212,226-228 did not obtain any 

points. All the trials except three226-228 were described as randomized; however, the details of the 

description of randomization varied. The majority of trials (n = 19)185,203-205,207-211,214-219,222-225 did 

not describe how the randomization was performed. Three trials206,220,221 described an 

appropriate method to generate the sequence of randomization, whereas two trials212,213 reported 

the use of inadequate approaches to sequence generation. None of the trials were described as 

double-blind. The adequacy of allocation concealment was unclear in all trials. 

An intention-to-treat statistical analysis was specified in five trials.203,206,207,220,221 Nineteen 

trials185,203,205-207,209,210,212-214,216,218-225 reported the number of dropouts for the total study sample 

(mean dropout rate: 21 percent; range 3 to 57 percent). Seven trials205,206,209,212,213,220,225 had a 
109

dropout rate of more than 20 percent. Withdrawals and dropouts per treatment group were 

clearly described in 14 trials.185,203,207,210,213,214,216,218-224 On average, 14 percent of participants 

(range 0 to 26 percent) dropped out of the meditation groups. The mean dropout rate for the 

control groups was also 14 percent (range 4 to 25 percent; 16 control groups). 

Fifteen trials185,205-209,218-222,224,225,227,228 disclosed their source of funding. Nine trials 

205,206,209,218-220,225,227,228 received funding from government sources, six studies185,207,208,221,222,224

received funding from a private donor or foundation, and one214 received internal funding. 
110

Table 26. Methodological quality of trials of meditation practices for hypertension 

Randomization Double blinding 

Study, year Meditation practice 

Stated Method described Stated Method described 

Description of 

withdrawals 

/dropouts 

Overall 

Jadad 

score 

Allo

conc

Aivazyan TA, 

1988203

Mantra meditation 

(NS) + relaxation techniques 

Yes Unclear No NA Yes 2 Un

Broota A, 

1995204 Yoga Yes Unclear No NA No 1 Un

Calderon R Jr, 

2000205

TM® Yes Unclear No NA No 1 Un

CastilloRichmond A, 

200079,206

TM® Yes Adequate No NA No 2 Un

Cheung BMY, 

2005207 Qi Gong Yes Unclear No NA Yes 2 Un

Cohen J, 

1983208

RR Yes Unclear No NA No 1 Un

Hafner RJ, 

1982185 Yoga + BF Yes Unclear No NA Yes 2 Un

Hager JL, 

1978209

RR Yes Unclear No NA No 1 Un

Kondwani KA, 

1998210,229

TM® Yes Unclear No NA Yes 2 Un

Kuang AK, 

1987211 Qi Gong + AHM Yes Unclear No NA No 1 Un

Latha DR, 

1991212 Yoga + BF (thermal) Yes Inadequate No NA No 0 Un

Lee MS, 

2003214,230 Qi Gong Yes Unclear No NA Yes 2 Un

Lee MS, 

2004213,231 Qi Gong Yes Inadequate No NA Yes 1 Un

Manikonda P, 

2005215

CMBT Yes Unclear No NA No 1 Un

AHM = antihypertensive medication; AT = autogenic training; BE = breathing exercises; BF = biofeedback; CMBT = contemplative meditation and bapplicable; NS = not specified; PMR = progressive muscle relaxation; RR = Relaxation Response; TM® = Transcendental Meditation®
111

Table 26. Methodological quality of trials of meditation practices for hypertension (continued) 

Randomization Double blinding 

Study, year Meditation practice 

Stated Method described Stated Method described 

Description of 

withdrawals 

/dropouts 

Overall 

Jadad 

score 

Allo

conc

McCaffrey R, 

2005216 Yoga Yes Unclear No NA Yes 2 Un

Murugesan R, 

2000217 Yoga Yes Unclear No NA No 1 Un

Patel CH, 

1985218

RR + BE + PMR Yes Unclear No NA Yes 2 Un

Patel CH, 

1975219 Yoga + BF Yes Unclear No NA Yes 2 Un

Schneider RH, 

199579,221,232

TM® Yes Adequate No NA Yes 3 Un

Schneider RH, 

2005220

TM® Yes Adequate No NA Yes 3 Un

Seer P, 1980222 SRELAX (technique 

modeled after TM®) 

Yes Unclear No NA Yes 2 Un

Selvamurthy W, 

1998226 Yoga No NA No NA No 0 Un

Stone RA, 

1976227

Zen Buddhist 

meditation 

No NA No NA No 0 Un

Surwit RS, 

1978228

RR No NA No NA No 0 Un

Tsai JC, 2003223 Tai Chi Yes Unclear No NA Yes 2 Unvan Montfrans 

GA, 1990224 Yoga + RR + PMR + AT Yes Unclear No NA Yes 2 Un

Yen LL, 1996225 Zen Buddhist 

meditation + PMR 

Yes Unclear No NA No 1 Un
112

Results of Direct Comparisons 

Table 27 summarizes the meditation practices, comparison groups, and outcomes that were 

available for direct meta-analyses on the efficacy and effectiveness of meditation practices to 

treat hypertension. Direct meta-analyses were conducted when two or more studies assessed the 

same meditation practice, used similar comparison groups, and had usable data for common 

outcomes of interest. No single diagnostic criterion was chosen for categorizing study 

populations as hypertensive; rather, we included all studies conducted in hypertensive patients, 

as defined by the authors of the primary studies. Fifteen comparisons (14 studies) were not 

suitable for direct meta-analyses because no more than one study was available for statistical 

pooling: SRELAX (technique modeled after TM®) versus waiting list (WL),222 SRELAX versus 

placebo,222 RR versus HE,218 RR versus WL,208 Qi Gong versus antihypertensive medication 

(AHM),211 Qi Gong versus exercise,207 Tai Chi versus rest,223 Yoga versus AHM,217 Yoga versus 

orthostatic tilt,226 Yoga versus progressive muscle relaxation (PMR),204 Yoga versus 

relaxation,224 Yoga versus Yoga plus BF,185 Zen Buddhist meditation versus NT,225 mantra 

meditation not specified versus NT,203 and meditation practice not further specified versus NT.215

Data from 16 studies were available for direct meta-analyses that involved eight comparisons: 

TM® versus HE, TM® versus PMR, RR versus BF, Qi Gong versus WL, Yoga versus NT, Yoga 

versus HE, Yoga versus rest, and Zen Buddhist meditation versus blood pressure checks. 

Outcomes of interest and comparisons for which data could be combined into a direct metaanalysis were 

1. blood pressure: TM® versus HE, TM® versus PMR, RR versus BF, Qi Gong versus WL, 

Yoga versus NT, Yoga versus HE, Zen Buddhist meditation versus blood pressure checks; 

2. body weight: TM® versus HE; 

3. heart rate: TM® versus HE; 

4. stress: TM® versus HE, Yoga versus HE; 

5. anger: TM® versus HE; 

6. self-efficacy: TM® versus HE; 

7. total cholesterol (TC): TM® versus HE; 

8. high-density lipoprotein cholesterol (HDL-C): TM® versus HE; 

9. low-density lipoprotein cholesterol (LDL-C): TM® versus HE; 

10. dietary intake (caloric intake, total fat intake, and sodium intake): TM® versus HE; and 

11. physical activity: TM® versus HE. 

Results from individual studies not included in a meta-analysis of clinical trials of meditation 

practices in hypertension are summarized in Table H1 in Appendix H.*

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
113

Table 27. Summary of outcomes by meditation practice and by comparison group included in meta-analyses of the efficacy anpractices for hypertension 

Intervention Comparator Outcome No. studies Meta- analysis 

HE TC, TG, LDL-C, HDL-C, BP changes, anger, stress, personal efficacy, 

diet, physical activity, pulse rate205

cIMT, BP changes, weight, PR, TC, HDL-C, LDL-C, pulse pressure, 

smoking, exercise206

LVMI, BP changes (DBP, SBP), weight, PR, PWT, LVIDD, LVIDS, IVST, 

E/A ratio, energy, stress impact, sleep, positive affect, sleep pattern, anxiety, depression, anger, self-efficacy, locus of control, diet, activity level, compliance210

BP changes (DBP, SBP)221

BP changes (DBP, SBP), change in AHM220

5 Yes 

PMR BP changes (DBP, SBP), compliance221

BP changes (DBP, SBP), change in AHM220 2 Yes 

TM®

PLB BP changes (DBP, SBP)222 1 No 

SRELAX 

(technique modeled after TM®) 

WL BP changes (DBP, SBP)222 1 No HE BP changes (DBP, SBP), TC, smoking, morbidity, mortality218 1 No BFB Attention (field independence, attention deployment, absorption), BP 

changes (DBP, SBP)208

BP changes (DBP, SBP)209

BP changes (DBP, SBP)228

3 Yes 

RR 

WL Attention (field independence, attention deployment, absorption), BP208 1 No 

AHM = antihypertensive medication; AI = alpha index; APO-A1 = apolipoprotein A1; BF = biofeedback; BMI = body mass index; BP = blood pressure

thickness; CO = cardiac output; CPR = cold pressor response; Cr = creatinine; DBH = dopamine beta hydroxylase; DBP = diastolic blood pressure; E/atrial constriction; EEG = electroencephalogram; EMG = electromyography; EPI = epinephrine; FEV1 forced expiratory volume in 1 second; FVC = galvanic skin response; HDL-C = high density lipoprotein cholesterol; HE = health education; HR = heart rate; HRQL = health-related quality of life; 

thickness; K = potassium; LDL-C = low density lipoprotein cholesterol; LVIDD = left ventricular internal dimension at diastole; LVDIS = left ventric

LVMI = left ventricular mass index; NA = not applicable; Na = sodium; NE = norepinephrine; NS = not specified; NT = no treatment; PLB = placebo

relaxation; PRA = plasma renin activity; PR = pulse rate; PWT = posterior wall thickness; RPP = rate pressure product; RR = Relaxation Response; SBtotal cholesterol; TG = triglycerides; TM® = Transcendental Meditation®; WL = waiting list 
114

Table 27. Summary of outcomes by meditation practice and by comparison group included in meta-analyses of the efficacy anpractices for hypertension (continued) 

Intervention Comparator Outcome No. studies Meta-analysi

AHM Plasma 18-OH-DOC levels, BP changes(DBP, SBP)211 1 No Exercise BP, health status, anxiety, depression, HR, weight, BMI, body fat, 

waist/hip circumference, renin excretion, urinary albumin excretion, Na, K, urea, Cr, TC, HDL-C, LDL-C, TG, aldosterone, urine cortisol, urine Cr, urine Na, urine protein, LVMI, ejection fraction207

1 No 

Qi Gong 

WL BP changes (DBP, SBP, RPP), HR, PR, EPI, NE, FVC, FEV1, cortisol214

BP changes (DBP, SBP), APO-A1, TC, HDL-C, TG, self-efficacy213 2 Yes 

Tai Chi Rest BP changes (DBP, SBP), HR, TC, HDL-C, LDL-C, TG, BMI, anxiety223 1 No 

AHM Stress, BP changes (DBP, SBP), PR, weight217 1 No NT BP changes (DBP, SBP), anxiety, GSR204

BP changes (DBP, SBP), hostility, assertive behavior, psychological 

symptoms185

Stress, BP changes (DBP, SBP), PR, weight217

3 Yes 

HE BP changes (DBP, SBP), AHM intake, stress control, negative responses 

to stress, coping behavior, somatic symptoms, symptom severity212

Stress, BP changes (DBP, SBP), BMI, HR216

2 Yes 

Orthostatic 

tilt 

BP changes (DBP, SBP), AI-EEG, CO, HR, NE, EPI, PRA, urine K, urine 

Na, CPR226

1 No 

PMR BP changes (DBP, SBP), anxiety, GSR204 1 No Rest BP changes (DBP, SBP), anxiety, GSR204

BP changes (DBP, SBP)219 2 Yes 

Relaxation BP changes (DBP, SBP), body weight, urine Na, TC224 1 No 

Yoga 

Yoga + BF BP changes (DBP, SBP), hostility, assertive behavior, anxiety, 

depression185

1 No 

Blood 

pressure checks 

BP changes (DBP, SBP), changes in plasma DBH, plasma volume, 

PRA227

BP changes (DBP, SBP)225

2 Yes 

Zen Buddhist 

meditation 

NT BP changes (DBP, SBP)225 1 No 

Mantra (NS) NT BP changes (DBP, SBP); time of BP restoration, HRQL, emotional stress, 

number of sick leaves203

1 No 

Meditation 

practices (NS) 

NT BP changes (DBP, SBP)215 1 No 
115

Transcendental Meditation®

Five RCTs assessing the effects of TM® in hypertensive patients were identified. Five 

trials205,206,210,220,221 compared TM® versus HE, and two trials220,221 compared TM® versus PMR. 

Meta-analyses were conducted for the comparisons TM® versus HE, and TM® versus PMR. 

TM® versus HE 

Blood pressure. Five trials205,206,210,220,221 totaling 337 participants (TM® = 175, HE = 162) 

provided data on the effects of TM® versus HE on SBP and DBP (Figure 3). The combined 

estimate of changes in SBP (mm Hg) indicated a small, nonsignificant improvement (reduction) 

in favor of TM® (WMD = -1.10; 95% CI, -5.24 to 3.04). There was evidence of heterogeneity 

among the studies regarding the mean change in SBP (p = 0.05; I2 = 56.9 percent).

Figure 3. Meta-analysis of the effect of TM® versus HE on blood pressure (SBP and DBP) 

Possible causes of heterogeneity in the outcome of SBP were explored. The five trials were 

similar in terms of the type of participants, severity of hypertension, characteristics of the 

interventions, and methodological quality. There were differences, however, in the duration of 

the trials and followup period. All but one study221 were medium- or long-term trials (more than 

3 months). The study with the shortest duration221 (3 months) was the only trial that reported 

statistically significant changes in SBP favoring TM®. The medium- or long-term trials did not 

find statistically significant differences between TM® and HE for changes in SBP. A subgroup 

analysis based on the duration of the studies (Figure 4) showed that greater homogeneity 

(p = 0.64, I2 = 0 percent) was observed for the studies that assessed the medium- and long-term 

effects of TM® and HE on SBP. After excluding the short-term study,221 the direction of the 

effect changed to a small, nonsignificant reduction of SBP in favor of HE (WMD = 0.70; 95% 

CI, -2.29 to 3.68). 
116

Figure 4. Subgroup analysis by study duration of the effect of TM® versus HE on SBP 

The combined estimate of changes in DBP (mm Hg) indicated a small, nonsignificant 

improvement (reduction) in favor of TM® (WMD = -0.58; 95% CI, -4.22 to 3.06). We found 

significant heterogeneity (p = 0.003; I2 = 74.8 percent) among the studies for this outcome, 

which may be attributed to variations in the duration of the studies. The study with the shortest 

duration221 (3 months) was the only trial that reported statistically significant changes in DBP 

favoring TM®. The other medium- or long-term trials did not find statistically significant 

differences between TM® and HE for changes in DBP. A subgroup analysis based on the 

duration of the studies (Figure 5) showed that greater homogeneity (p = 0.26, I2 = 25.2 percent) 

was observed for the studies assessing the medium- and long-term effects of TM® and HE on 

DBP. After excluding the short-term study,221 the magnitude of the effect estimate changed to a 

small, nonsignificant reduction of DBP in favor of HE (WMD = 1.02; 95% CI, -1.41 to 3.44). 

Figure 5. Subgroup analysis by study duration of the effect of TM® versus HE on DBP 
117

Body weight. Three trials205,206,210 totaling 166 participants (TM® = 86, HE = 80) provided 

data on the effects of TM® versus HE on changes in body weight (lbs) (Figure 6). The results of 

the trials for changes in body weight were homogeneous (p = 0.96; I2 = 0 percent), and the 

combined WMD of 1.72 (95% CI, -2.29 to 5.74) showed a greater nonsignificant improvement 

(reduction) in body weight in favor of HE. 

Figure 6. Meta-analysis of the effect of TM® versus HE on body weight 

Heart rate. Three trials205,206,210 totaling 165 participants (TM® = 85, HE = 80) provided data 

on the effects of TM® versus HE on heart rate (bpm) (Figure 7). The results were statistically 

homogeneous (p = 0.34; I2 = 8.3 percent). The combined WMD of -0.43 (95% CI, -4.17 to 3.31) 

indicated a small, nonsignificant reduction in pulse rate with TM®. 

Figure 7. Meta-analysis of the effect of TM® versus HE on heart rate 

Stress. Two trials205,210 totaling 105 participants (TM® = 54, HE = 51) contributed data on the 

effects of TM® versus HE on measures of stress (Figure 8). The combined estimate (SMD = 

0.12; 95% CI, -0.27 to 0.50) indicated a small, nonsignificant reduction in stress scores with HE. 

There was evidence of homogeneity between the studies regarding the outcome of stress (p = 

0.38; I2 = 0 percent). 
118

Figure 8. Meta-analysis of the effect of TM® versus HE on measures of stress 

Anger. Two trials205,210 totaling 105 participants (TM® = 54, HE = 51) examined the effects 

of TM® versus HE on measures of anger (Figure 9). The results of the trials for changes in 

measures of anger were homogeneous (p = 0.64; I2

 = 0 percent), and the combined SMD of -0.06 

(95% CI, -0.45 to 0.32) showed a small and nonsignificant reduction in scores of anger with 

TM®. 

Figure 9. Meta-analysis of the effect of TM® versus HE on measures of anger 

Self-efficacy. Data on changes in measures of self-efficacy were available from two 

trials205,210 with a total of 105 participants (TM® = 54, HE = 51) (Figure 10). The combined SMD 

in measures of self-efficacy for trials of TM® compared with HE was -0.36 (95% CI, -0.92 to 

0.19), and showed a nonsignificant improvement in self-efficacy in favor of TM®. The results of 

the trials for changes in self-efficacy were moderately heterogeneous (p = 0.18; I2

 = 44.8 

percent). 
119

Figure 10. Meta-analysis of the effect of TM® versus HE on measures of self-efficacy 

Total cholesterol (TC). Information on TC changes (mg/dL) was available from two 

trials205,206 with a total of 126 participants (TM® = 65, HE = 61) (Figure 11). The combined 

effect estimate showed no differences between TM® and HE in TC changes (WMD = -0.94; 95% 

CI, -11.49 to 9.62). The results of the trials were homogeneous (p = 0.80; I2 = 0 percent). 

Figure 11. Meta-analysis of the effect of TM® versus HE on TC 

High-density lipoprotein cholesterol (HDL-C). Two trials205,206 totaling 126 participants 

(TM® = 65, HE = 61) provided data on the effects of TM® versus HE on changes in HDL-C 

(mg/dL) (Figure 12). The results of the trials were homogeneous (p = 0.35; I2

 = 0 percent), and 

the combined WMD of -2.58 (95% CI, -6.12 to 0.96) showed a nonsignificant benefit (increase) 

with HE for HDL-C. 
120

Figure 12. Meta-analysis of the effect of TM® versus HE on HDL-C 

Low-density lipoprotein cholesterol (LDL-C). Two trials205,206 totaling 126 participants (TM®

= 65, HE = 61) contributed data on the effects of TM® versus HE on changes in LDL-C (mg/dL) 

(Figure 13). The pooled results of the trials were homogeneous (p = 0.90; I2

 = 0 percent), and the 

combined WMD of 1.08 (95% CI, -8.65 to 10.81) showed a nonsignificant benefit (reduction) 

with HE for LDL-C. 

Figure 13. Meta-analysis of the effect of TM® versus HE on LDL-C 

Dietary intake. Two trials205,210 totaling 49 participants (TM® = 30, HE = 19) provided data 

on the effects of TM® versus HE on dietary intake, expressed as caloric intake, total fat intake, 

and sodium intake (Figure 14). The results of the trials for caloric intake were homogeneous (p = 

0.97; I2

 = 0 percent), and the combined SMD of 0.28 (95% CI, -0.30 to 0.86) showed a 

nonsignificant reduction in caloric intake in the HE group. The results of the trials for total fat 

intake were homogeneous (p = 0.23; I2 = 30.7 percent), and the combined SMD of 0.50 (95% CI, 

-0.21 to 1.21) showed a nonsignificant reduction in fat intake in the HE group. The results of the 

trials for sodium intake were homogeneous (p = 0.64; I2 = 0 percent), and the combined SMD of 

0.14 (95% CI, -0.44 to 0.72) showed a nonsignificant reduction in sodium intake in the HE 

group. 
121

Figure 14. Meta-analysis of the effect of TM® versus HE on dietary intake 

Physical activity. Three trials205,206,210 totaling 138 participants (TM® = 68, HE = 70) 

provided data on the effects of TM® versus HE on changes in physical activity (Figure 15). The 

combined results showed a nonsignificant reduction in changes in favor of the HE group (SMD = 

-0.20; 95% CI, -0.14 to 0.53). The results of the trials for changes in physical activity were 

homogeneous (p = 0.57; I2 = 0 percent). 

Figure 15. Meta-analysis of the effect of TM® versus HE on physical activity 

TM® versus PMR 

Blood pressure. Two trials220,221 totaling 179 participants (TM® = 90, PMR = 89) provided 

data on the effects of TM® versus PMR on SBP and DBP (Figure 16). The combined estimate of 

changes in SBP (mm Hg) indicated a significant improvement (reduction) in favor of TM®

(WMD = -4.30; 95% CI, -8.02 to -0.57). The results of the trials for changes in SBP were 

homogeneous (p = 0.25; I2

 = 25.6 percent).
122

The combined estimate of changes in DBP (mm Hg) indicated a significant improvement 

(reduction) in favor of TM® (WMD = -3.11; 95% CI, -5.00 to -1.22). The results of the trials for 

changes in DBP were homogeneous (p = 0.67; I2 = 0 percent). 

Figure 16. Meta-analysis of the effect of TM® versus PMR on blood pressure (SBP and DBP) 

Relaxation Response 

Five trials assessing the effects of RR in hypertensive patients were identified. Three 

trials208,209,228 compared RR versus BF, one trial compared RR versus HE,218 and one trial 

compared RR versus WL.208 A meta-analysis was conducted for the comparison between RR and 

BF. 

RR versus BF 

Blood pressure. Three trials208,209,228 totaling 53 participants (RR = 28, BF = 25) provided 

data for a meta-analysis of the effects of RR versus BF on SBP and DBP (Figure 17). The 

combined estimate of changes in SBP (mm Hg) showed that BF produced a greater but 

nonsignificant reduction in SBP when compared to RR (WMD = 2.39; 95% CI, -5.13 to 9.91). 

The results were homogeneous across the trials (p = 0.55; I2

 = 0 percent). Likewise, the 

combined estimate of changes in DBP (mm Hg) indicated a small, nonsignificant improvement 

(reduction) in favor of BF (WMD = 4.44; 95% CI, -4.00 to 12.88). The results of the trials for 

changes in DBP were homogeneous (p = 0.42; I2

 = 0 percent).
123

Figure 17. Meta-analysis of the effect of RR versus BF on blood pressure (SBP and DBP) 

Qi Gong 

Four trials assessing the effects of Qi Gong in hypertensive patients were identified. Two 

trials213,214 compared Qi Gong versus WL, one trial compared Qi Gong versus AHM,211 and 

another trial207 compared Qi Gong versus exercise. A meta-analysis was conducted for the 

comparison between Qi Gong and WL. 

Qi Gong versus WL 

Blood pressure. Two trials213,214 totaling 94 participants (Qi Gong = 46, WL = 48) provided 

data for a meta-analysis of the effects of Qi Gong versus WL on SBP and DBP (Figure 18). The 

combined estimate of changes in SBP (mm Hg) indicated a significant improvement (reduction) 

in favor of Qi Gong (WMD = -17.78; 95% CI, -22.03 to -13.54). The results were homogeneous 

across the trials (p = 0.57; I2

 = 0 percent).

Likewise, the combined estimate of changes in DBP (mm Hg) indicated a significant 

improvement (reduction) of DBP in favor of Qi Gong (WMD = -12.06; 95% CI, -21.62 to -2.49). 

There was evidence of substantial heterogeneity among the studies in DBP (p <0.00001; I2 

= 

93.5 percent). Possible causes of heterogeneity were explored. The two trials were similar in 

terms of the type of participants, severity of hypertension, characteristics of the interventions, 

study duration, and methodological quality. Therefore, it is unknown whether clinical 

heterogeneity produced statistical heterogeneity between the trials for the outcome of DBP. 

Although each trial showed the same direction of effect, the wide confidence intervals indicate 

that the estimates of effect are unreliable and consistent with a broad range of possible effect 

sizes. Therefore, heterogeneity obscures the clinical applicability of the WMD in the analysis.
124

Figure 18. Meta-analysis of the effect of Qi Gong versus WL on blood pressure (SBP and DBP) 

Yoga 

Eight trials185,204,212,216,217,219,224,226 assessing the effects of Yoga in hypertensive patients were 

identified. Three trials185,204,217 compared Yoga versus NT, two trials212,216 compared Yoga 

versus HE, two trials204,219 compared Yoga versus rest, one trial217 compared Yoga versus AHM, 

one trial226 compared Yoga versus orthostatic tilt, one trial204 compared Yoga versus PMR, one 

trial224 compared Yoga versus relaxation, and one trial185 compared Yoga versus a combination 

of Yoga and BF. Meta-analyses were conducted for the comparisons of Yoga versus NT, Yoga 

versus HE, and Yoga versus rest. 

Yoga versus NT 

Blood pressure. Three trials185,204,217 totaling 57 participants (Yoga = 28, NT = 29) provided 

data for a meta-analysis of the effects of Yoga versus NT on SBP and DBP (Figure 19). The 

combined estimate of changes in SBP (mm Hg) indicated a small, nonsignificant improvement 

(reduction) in favor of Yoga (WMD = -15.39; 95% CI, -31.97 to 1.19). There was evidence of 

significant (p = 0.006) and substantial (I2 = 80.2 percent) heterogeneity among the studies 

regarding the mean change in SBP.

Figure 19. Meta-analysis of the effect of Yoga versus NT on blood pressure (SBP and DBP) 
125

Possible causes of heterogeneity in the outcome of SBP were explored. The three trials were 

similar in duration and methodological quality. The studies failed to appropriately report some 

important characteristics that would have been useful for appraising the potential sources of 

heterogeneity in the trials. Age of participants was similar in two studies,204,217 while the 

remaining study185 failed to provide this information. The distribution of males and females for 

the total study population was also unknown in two185,217 of the three trials. None of the studies 

provided a critical value for the presence or severity of hypertension. Treatment in the Broota 

study204 consisted of practicing Shavasana consecutively for 8 days, with each session lasting 20 

minutes. The intervention group in the trial of Hafner185 practiced Yoga for eight 1-hour sessions 

at weekly intervals. Finally, participants in the Yoga group in the study of Murugesan217 engaged 

in a variety of yogic practices (i.e., asanas, Om recitation, and meditation) twice a day for 1 hour, 

6 days a week. 

The most obvious difference among the three studies was that control participants in the 

Broota204 and Hafner185 trials were assigned to a NT condition in which existing medical 

treatment was not interrupted, whereas controls in the trial of Murugesan217 did not receive any 

therapy. Therefore, it is likely that the conditions of NT in the Murugesan217 study were 

systematically different from the other two studies. Yoga was used as an adjuvant therapy in the 

studies of Broota204 and Hafner185 whereas in the Murugesan trial217 it was not. Murugesan217

was the only study to report statistically significant results in favor of Yoga for changes in SBP 

and DBP. 

A subgroup analysis by concomitant treatment (Figure 20) showed that greater homogeneity 

(p = 0.86, I2 = 0 percent) was observed for the studies that continued medical therapy in the NT 

condition. After excluding the study that did not provide any therapy,217 the direction of the 

effect did not change, and a nonsignificant improvement (reduction) in favor of Yoga was found 

for SBP (WMD = -7.15; 95% CI, -17.70 to 3.39). 

Figure 20. Subgroup analysis by concomitant therapy of Yoga versus NT on SBP 

As depicted in Figure 19, the combined estimate of changes in DBP (mm Hg) indicated a 

significant improvement (reduction) in favor of Yoga (WMD = -13.95; 95% CI, -27.24 to -.0.66) 

There was evidence of significant heterogeneity (p = 0.01; I2

 = 76.5 percent) among the studies 

for this outcome, which may be accounted for by the use of concomitant therapy in the NT 

condition. A subgroup analysis based on the presence of concomitant treatment (Figure 21) 
126

showed that homogeneity (p = 0.44, I2 = 0 percent) was observed for the studies that did not 

interrupt existing medical therapy for the NT condition. After excluding the study that did not 

provide any concomitant therapy,217 the results remained similar, and a nonsignificant 

improvement (reduction) in favor of Yoga was found for DBP (WMD = -6.82; 95% CI, -15.51 to 

1.87). 

Figure 21. Subgroup analysis by concomitant therapy of Yoga versus NT on DBP 

Yoga versus HE 

Blood pressure. Two trials208,212,216 totaling 68 participants (Yoga = 34, HE = 34) provided 

data on the effects of Yoga versus HE on SBP and DBP (Figure 22). The combined estimate of 

changes in SBP (mm Hg) indicated a small, nonsignificant improvement (reduction) in favor of 

Yoga (WMD = -15.32; 95% CI, -38.77 to 8.14). There was evidence of heterogeneity between 

the studies regarding the mean change in SBP (p = 0.001; I2 = 90.3 percent). Possible causes of 

heterogeneity in the outcome of SBP were explored. The studies failed to report appropriately 

some important characteristics that would have been useful for appraising the potential sources 

of heterogeneity. The two trials were similar in terms of the type of participants, and 

methodological quality. There were differences in the duration of trials that may explain the 

differences in the results from the individual studies, and the heterogeneity in the pooling of the 

results. The Latha212study was a medium-term trial lasting 6 months, whereas the McCaffrey216

study was a short-term trial of 11 weeks. The short-term trial reported statistically significant 

changes in SBP for Yoga as compared to HE, whereas the effects seem to disappear at medium 

term, as reported by the statistically nonsignificant results of the McCaffrey216 trial.

The combined estimate of changes in DBP (mm Hg) indicated a nonsignificant improvement 

(reduction) in favor of Yoga (WMD = -11.35; 95% CI, -30.17 to 7.47). There was evidence of 

significant heterogeneity (p = 0.01; I2

 = 84.0 percent) between the studies for this outcome, 

which may be primarily accounted for by the duration of the trials. The difference in the 

significance of the individual study results may be a function of the duration of the trials, with 

the short-term trial212showing statistically significant changes in DBP, and the medium term trial 

reporting nonstatistically significant results. 
127

Figure 22. Meta-analysis of the effect of Yoga versus HE on blood pressure (SBP and DBP) 

Stress. Two trials208,216 totaling 68 participants (Yoga = 34, HE = 34) examined the effects of 

Yoga versus HE on measures of stress (Figure 23). The results of the trials for changes in 

measures of stress were homogeneous (p = 0.59; I2 = 0 percent), and the combined SMD of -1.10 

(95% CI, -1.61 to -0.58) showed a statistically significant reduction in scores of stress with 

Yoga. 

Figure 23. Meta-analysis of the effect of Yoga versus HE on stress 

Zen Buddhist meditation 

Two trials225,227 assessing the effects of Zen Buddhist meditation in hypertensive patients were 

identified. The two trials were included in a meta-analysis comparing Zen Buddhist meditation 

versus blood pressure checks. 

Zen Buddhist meditation versus blood pressure checks 

Blood pressure. Two trials225,227 totaling 250 participants (Zen Buddhist meditation = 134, 

blood pressure checks = 116) provided data for a meta-analysis of the effects of Zen Buddhist 

meditation versus blood pressure checks on SBP and DBP (Figure 24). The combined estimate 
128

of changes in SBP (mm Hg) indicated a nonsignificant improvement (reduction) in favor of Zen 

Buddhist meditation (WMD = -3.67; 95% CI, -9.04 to 1.70). The results were homogeneous (p = 

0.34; I2 = 0 percent). The combined estimate of changes in DBP (mm Hg) indicated a significant 

improvement (reduction) in favor of Zen Buddhist meditation (WMD = -6.08; 95% CI, -11.68 to 

-0.48). The results of the trials for changes in DBP were moderately homogeneous (p = 0.15; I2 = 

52.4 percent).

Figure 24. Meta-analysis of the effect of Zen Buddhist meditation versus blood pressure checks on blood 

pressure (SBP and DBP) 

Mixed Treatment and Indirect Comparisons 

Blood pressure. Since many of the studies of meditation practices in hypertensive patients 

reported data on SBP and DBP, we were able to do a mixed treatment analysis56 which allowed 

us to compare all interventions to one another.

SBP. Table 28 and Figure 25 show the results of the mixed treatment comparisons for SBP, 

ordered by the point estimate of difference from NT. The interventions ranged from reducing 

SBP from an average of 0.3 to 21.9 mm Hg. Tai Chi, Yoga plus BF, and Qi Gong seem to be 

more effective than the other interventions in terms of point estimates and likelihood of being the 

best intervention. However, we cannot make strong inferences on which is the best intervention 

due to a lack of statistical power.

Tai Chi, Yoga plus BF, and Yoga alone all reduced SBP significantly compared to NT. 

Yoga, Tai Chi, and Yoga plus BF were also found to be significantly superior to HE, while Qi 

Gong was significantly superior to a WL control (not shown). No other pair-wise comparisons 

were statistically significant. 
129

Table 28. Mixed treatment comparisons on SBP (mm Hg) reductions compared to NT 

Intervention Point estimate 95% credible interval Probability of being 

“best” intervention (%) 

Tai Chi -21.9 -37.9, -5.7 32.0 

Yoga + BF -20.1 -36.7, -3.1 23.8 

Qi Gong -18.4 -47.4, 10.7 27.2 

CMBT -14.9 -30.6, 0.9 8.1 

Biofeedback -13.2 -35.9, 9.4 5.1 

Yoga -13.1 -21.7, -4.4 0.6 

RR -10.8 -30.5, 8.9 0.9 

Zen Buddhist meditation -7.3 -22.1, 7.6 0.9 

Rest/Relaxation -5.9 -22.4, 11.0 0.3 

Mantra meditation (NS) -5.6 -21.8, 10.5 1.0 

TM® -2.5 -14.0, 8.7 0.0 

PMR -2.4 -15.0, 9.6 0.0 

HE -0.5 -11.8, 10.6 0.0 

WL -0.3 -26.9, 26.3 0.0 

NT 0.0 NA 0.0 

BF = biofeedback; CMBT = contemplative meditation plus breathing techniques; HE = health education; NA = not applicable; 

NS = not specified; NT = no treatment; PMR = progressive muscle relaxation; RR = Relaxation Response; SBP = systolic 

blood pressure; TM® = Transcendental Meditation®; WL = waiting list 
130

Figure 25. SBP results (point estimate and 95% credible interval) for all intervention based on mixed 

treatment comparisons 

CMBT = contemplative meditation and breathing techniques; PMR = progressive muscle relaxation 

DBP. Table 29 and Figure 26 show the results of the mixed treatment comparisons for DBP, 

ordered by the point estimate of difference from NT. Note that the study215 that reported on the 

CMBT intervention did not report DBP and was excluded from this analysis, giving us one less 

intervention than the SBP analysis. The interventions ranged from reducing DBP from an 

average of 1.0 to 17.1 mm Hg. Yoga plus BF and Qi Gong were slightly above the other 

interventions in terms of point estimates and likelihood of being the best intervention, although 

the differences between interventions were even less than for SBP. 

Yoga alone and Yoga plus BF were the only interventions that reduced DBP significantly 

compared to NT. The only other pair-wise comparisons (not shown) that were statistically 

significant were Yoga compared to HE and Qi Gong compared to WL. 
131

Table 29. Mixed treatment comparisons on SBP (mm Hg) reductions compared to NT 

Intervention Point Estimate 95% Credible Interval Probability of “best” (%) 

Yoga + Biofeedback -17.1 -30.9, -3.0 34.0 

Qi Gong -15.2 -40.4, 9.3 30.6 

Tai Chi -12.1 -25.8, 1.5 12.5 

Zen Buddhist meditation -12.0 -24.4, 0.2 9.1 

Yoga -11.8 -19.1, -4.6 1.8 

BF -11.4 -32.1, 8.5 9.2 

Rest/Relaxation -8.5 -22.0, 5.0 1.3 

RR -7.4 -24.2, 8.6 0.8 

TM® -3.4 -13.3, 5.9 0.1 

WL -3.3 -26.4, 19.3 0.0 

PMR -2.2 -12.8, 7.7 0.1 

HE -1.9 -11.8, 7.3 0.0 

Mantra meditation (NS) -1.0 -14.4, 12.4 0.6 

NT 0.0 NA 0.0 

BF = biofeedback; DBP = diastolic blood pressure; HE = health education; NA = not applicable; NS = not specified; NT = no 

treatment; PMR = progressive muscle relaxation; RR = Relaxation Response; TM® = Transcendental Meditation®; WL = 

waiting list 
132

Figure 26. DBP results (point estimate and 95% credible interval) for all interventions based on mixed 

treatment comparisons 

PMR = progressive muscle relaxation 

Other indirect comparisons. We were able to make indirect comparisons between TM® and 

Yoga via HE for body mass index (BMI), heart rate, and stress. Yoga was nonsignificantly 

superior to TM® in reducing BMI (MD: -0.69; 95% CI, -2.53 to 1.15) and significantly superior 

in reducing both heart rate (MD: -15.6 bpm; 95% CI, -21.7 to -9.6) and stress (MD: -0.95; 95% 

CI, -1.76 to -0.14). 

We were also able to make an indirect comparison of TM® versus RR in reducing cigarette 

smoking via direct comparisons with HE. RR was found to significantly reduce smoking 

compared to TM® (MD: -2.8; 95% CI, 0.3 to 5.4). 
133

Analysis of Publication Bias 

Because of the very small number of trials available for each comparison, the statistical tests 

lacked the power to detect publication bias. Therefore the analysis of the effect of publication 

bias on the meta-analyses presented above was not conducted. 

Cardiovascular Diseases 

Description of the Included Studies 

Twenty-one trials (15 RCTs91,233-246 and 6 NRCTs247-252) that evaluated the effects of 

meditation practices in individuals with cardiovascular diseases were identified. They included 

seven trials on Yoga,233,238-240,247,250,251 three on Tai Chi,235,246,248 three on RR,91,234,236 three on 

mindfulness meditation (not specified),241,242,249 two on MBSR,244,245 one on Qi Gong,243 one on 

TM®,

252 and one on Zen Buddhist meditation.237

The trials were published between 1988 and 2005 (median year of publication: 2002; IQR, 

1998 to 2004). Fifteen of these trials have been published in journals233-236,238-240,243,244,246,248-252

while six91,237,241,242,245,247 were identified from the gray literature. Eleven 

trials91,233,234,237,241,242,244-246,251,252 were conducted in the United States, three239,240,250 in India, 

one236 in Brazil, one249 in China, one247 in Germany, one243 in Sweden, one248 in Taiwan, and 

one238 in Thailand. Characteristics of the trials are summarized in Table H2 in Appendix H.*

A 

total of 1,358 individuals were assigned to meditation practices or control groups. The median 

sample size based on data from 20 trials was 48 participants per study (IQR, 31 to 106). 

Five235,242,243,249,250 of 20 trials that provided data on sample size had more than 100 participants 

assigned to the study groups. The mean age of participants based on data from 17 trials was 63 ± 

7 years (range: 52 to 77 years). Eight trials91,235,238,240,241,244,248,252 were conducted in samples with 

mean ages ranging from 41 to 60 years. Nine trials233,234,236,237,243,246,247,249,251 included study 

populations with ages above 61 years. Four trials239,242,245,250 did not report on the age of 

participants. 

Across all the trials that reported the gender of participants (n = 17), 70 percent were males 

and 30 percent were females. The samples in three trials240,248,252 were entirely male while 

samples in two trials233,244 were entirely female. Four trials239,242,245,250 did not report the gender 

of participants. Five trials91,234,241,244,246 explicitly indicated the race or ethnicity of their samples. 

Around 80 percent of their samples consisted of Caucasian participants, except for one trial249

that involved Asian subjects only. 

Twelve studies237-241,243-245,247,249,250,252 were conducted in patients with coronary artery 

disease (CAD), as described by the primary study authors. Clinical conditions included history of 

myocardial infarction (MI), chronic stable angina, valve diseases, and arrhythmias. CAD 

diagnoses were confirmed either by angiography,237,238,240,252 clinical history,241,243,244,249 or 

combining both clinical history and electrocardiogram.239 Three studies245,247,250 failed to provide 

a description of the diagnosis criteria for inclusion in the trials. Three studies 233,242,251 were 

conducted in patients with coronary heart disease. 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
134

Three studies246,234,236 were conducted in patients with chronic hearth failure (CHF). Patients 

from one of the studies246 on CHF met the functional capacity criteria for New York Heart 

Association (NYHA) classification I-IV. Patients in another study on CHF234 met the criteria for 

NYHA functional class II-III. The remaining study on CHF236 included patients that met both the 

Vasan and Lecy criteria for CHF, and the criteria for NYHA functional class I-II. Other 

cardiovascular conditions that were studied included acute myocardial infarction (AMI),235 and 

peripheral vascular occlusive disease.91 Finally, one study248 was conducted in patients that 

underwent coronary artery bypass surgery 

All 21 trials employed a parallel study design. The length of the trials varied from 90 

minutes237 to 1 year.240,248-250 The median duration of the trials was 3 months (IQR, 2 to 9; data 

from 20 trials). Six studies235,237,241,244,251,252 were short-term trials (less than 3 months in 

duration), nine trials233,234,236,238,239,243,245-247 were between 3 and 6 months, and five 

trials240,242,248-250 were longer than 6 months. 

The 21 trials comprised 5 comparisons between meditation practices and no 

intervention,235,244,245,247,251 and one comparison between meditation and WL.252 There were 20 

comparisons between meditation and active therapies other than no intervention or WL. As some 

trials had more than one comparison arm, the total number of comparisons exceeds the number 

of trials. The 20 active comparisons comprise exercise,233,235,239,240,248 HE,234,237,243 usual 

care,234,242,246,249 group therapy,236,241 pharmacological interventions,238,246,250 rest,91 listening to 

music,91 and cognitive restructuring training.241 Four studies were three-arm trials91,234,235,241

while the remaining 17 were two-arm trials. 

Methodological Quality of Included Studies 

The methodological quality of the included trials as measured by the overall median Jadad 

score was 1/5 (IQR, 1 to 2). Two trials91,234 obtained 3 points and were considered of high 

quality (i.e., Jadad scores greater than or equal to 3 points). Seven trials235,236,238,241,243,244,246

obtained 2 points, 11 trials233,237,239,240,242,245,248-252 obtained 1 point, and one trial247 did not obtain 

any points. All the trials except six247-252 were described as randomized; however, the description 

of randomization varied. The majority of trials (n = 13)235-246,253 did not provide a description on 

how the randomization was performed. Two trials91,234 described appropriate methods of 

generating the sequence of randomization. None of the trials were described as double-blind. The 

adequacy of allocation concealment was unclear in all the trials except one.246

An intention-to-treat analysis was specified in two trials only.234,246 Sixteen trials91,233-

238,241,243,244,246,248-252 reported dropout information for the total study sample (mean dropout rate, 

17 percent; range, 0 to 32 percent). Six trials236,241,248,249,251,252 had a dropout rate of more than 20 

percent. Withdrawals and dropouts per treatment group were clearly described in 14 trials91,234-

236,238,241,243,244,246,248-252 On average, 20 percent of participants (range, 0 to 39 percent) dropped 

out from the meditation groups in the 14 studies that reported dropouts. The mean dropout rate 

for the control groups was slightly lower (16 percent; range, 0 to 33 percent). 

Eight trials233,234,239,240,243,246,248,249 disclosed their source of funding. Seven 

trials233,234,239,240,243,246,249 received funding from government sources; two243,246 received funds 

from a private donor/foundation; and one248 received internal funds. A comparative summary of 

the methodological quality of the included trials is provided in Table 30. 
135

Table 30. Methodological quality of trials of meditation practices for other cardiovascular disorders 

Randomization Double blinding 

Study name Meditation practice Stated Method 

described 

Stated Method 

described 

Description of 

withdrawals 

/dropouts 

Jadad 

score 

Al

con

Ades PA, 

2005233,253 Yoga + BE Yes Unclear No NA No 1 U

Chang BH, 

2005234 RR Yes Adequate No NA Yes 3 U

Channer KS, 

1996235

Tai Chi Yes Unclear No NA Yes 2 U

Curiati JA, 

2005236

RR + BE Yes Unclear No NA Yes 2 U

Friedman NL, 

2002237

Zen Buddhist 

meditation 

Yes Unclear No NA No 1 U

Hipp A, 1998247 Yoga No NA No NA No 0 UJatuporn S, 

2003238 Yoga + intensive 

lifestyle modification 

Yes Unclear No NA Yes 2 U

Lan C, 1999248 Tai Chi No NA No NA Yes 1 UMahajan AS, 

1999239 Yoga + diet changes Yes Unclear No NA No 1 U

Manchanda SC, 

2000240 Yoga + diet + Aerobic 

exercise 

Yes Unclear No NA No 1 U

Mandle CL, 

198891,254 RR Yes Adequate No NA Yes 3 U

Pool JI, 1995241 Mindfulness 

meditation (NS) 

Yes Unclear No NA Yes 2 U

Quillian-Wolever 

RE, 2005242

Mindfulness 

meditation (NS) + HE + health coaching 

Yes Unclear No NA No 1 U

BE = breathing exercises; HE = health education; MBSR = mindfulness-based stress reduction; NA = not applicable; NS = not specified; PMR = prog

RR = Relaxation Response; TM® = Transcendental Meditation®
136

Table 30. Methodological quality of trials of meditation practices for other cardiovascular disorders (continued) 

Randomization Double blinding 

Study name Meditation practice Stated Method 

described 

Stated Method 

described 

Description of 

withdrawals 

/dropouts 

Jadad 

score 

Al

con

Stenlund T, 

2005243 Qi Gong Yes Unclear No NA Yes 2 U

Tacon AM, 

2003244,255

MBSR Yes Unclear No NA Yes 2 U

Tsai SL, 2004249 Mindfulness 

meditation + BE + PMR + imagery 

No NA No NA Yes 1 U

Williams KA, 

2001245

MBSR Yes Unclear No NA No 1 U

Yeh GY, 

2004246,256 Tai Chi Yes Unclear No NA Yes 2 A

Yogendra J, 

2004250 Yoga + risk factors 

control + diet + stress management 

No NA No NA Yes 1 U

Young JW, 

2001251 Yoga No NA No NA Yes 1 U

Zamarra JW, 

1996252,257

TM® No NA No NA Yes 1 U
137

Results of Direct Comparisons 

Table 31 summarizes the type of meditation practice, comparison group, and outcomes that 

were available for direct meta-analyses on the efficacy and effectiveness of meditation practices 

to treat cardiovascular diseases. No single diagnostic criterion was chosen for categorizing study 

populations; rather, we included all studies conducted in patients with cardiovascular disorders, 

as defined by the authors of the primary studies. Direct meta-analyses were conducted when two 

or more studies assessed the same type of meditation practice, used similar comparison groups, 

and had usable data for common outcomes of interest. Briefly, the majority of the comparisons 

from 14 studies (16 out of 18 comparisons) were not suitable for direct meta-analyses. Common 

clinical outcomes were absent for the following comparisons: MBSR versus NT,244,245

mindfulness techniques not specified versus usual care,242,249 Yoga versus exercise,233,239,240 and 

Yoga versus NT.247,251 No more than one study was available for statistical pooling of the results 

for mindfulness techniques not specified versus cognitive restructuring training,241 mindfulness 

techniques not specified versus group therapy,241 Qi Gong versus HE,243 RR versus HE,234 RR 

versus group therapy,236 RR versus music,91 RR versus usual care,234 RR versus rest,91 Tai Chi 

versus HE,235 Tai Chi versus usual care,246 and Zen Buddhist meditation versus HE.237

Data from six studies were available for direct meta-analyses to compare Tai Chi versus 

exercise, Yoga versus medication, and Yoga versus exercise. Outcomes of interest for which data 

could be combined into a direct meta-analysis were 

1. heart rate; Tai Chi versus exercise; 

2. total cholesterol (TC); Yoga versus medication; 

3. low-density lipoprotein cholesterol (LDL-C); Yoga versus medication; and 

4. body weight; Yoga versus exercise 

Results from individual studies that were not included in a direct meta-analysis of clinical 

trials of meditation practices in cardiovascular are summarized in Table H2 in Appendix H.*

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
138

Table 31. Summary of outcomes by meditation practice and by comparison group included in meta-analyses of the efficacy anmeditation practices in cardiovascular diseases 

Intervention Comparator Outcome No. 

studies 

Metaanalysis 

MBSR NT Anxiety, coping styles, emotional control, health locus of control, cortisol, 

breathing frequency, total catecholamines, BP changes (DBP, SBP), HRQL, perceived physical well-being244

Depression, anxiety, anger, hostility, vitality, mental health, general health245

2 No 

CRT BP changes (DBP, SBP), HR, anxiety, depression, psychological distress, 

irritability, hostility241

1 No 

UC (NS) Coronary heart disease risk at 10 yr.242

Anxiety, sleep, relaxation level249

2 No 

Mindfulness 

(NS) 

Group therapy BP changes (DBP, SBP), HR, anxiety, depression, psychological distress, 

irritability, hostility241

1 No 

Qi Gong HE Level of physical activity, balance, coordination, fear of falling243 1 No 

HE HRQL, VO2 max234 1 No Group therapy NE, HRQL, VE/VCO2 slope, VO2, LVEF, LVDDi236 1 No Music tape Anxiety, pain, medication use, HR, BP changes (DBP, SBP), PR91 1 No UC (NS) HRQL, VO2 max234 1 No 

RR 

Rest Anxiety, pain, medication use, HR, BP changes (DBP, SBP), PR91 1 No Exercise BP changes (DBP, SBP), secondary: HR235

Peak VO2, peak WR, HR248

2 Yes 

HE BP changes (DBP, SBP), secondary: HR235 1 No 

Tai Chi 

UC HRQL, exercise capacity, BNP, VO2 max, plasma catecholamines246 1 No 

TM WL Exercise tolerance, maximal workload, ST depression onset, rate-pressure 

product252

1 No 

Yoga Exercise TEE, body strength, body weight, BMI, fat-free mass, left ventricular 

function, VO2 max, depression233

Body weight, lipid profile (TC, HDL-C, LDL-C)239

Depression, anger, anxiety, hostility, vitality, mental health240

3 Yes 

BNP = B-type natriuretic peptide; BMI = body mass index; BP = blood pressure; CRT = cognitive restructuring training; DBP = diastolic blood pressu

HDL-C = high density lipoprotein cholesterol; HE = health education; HRQL = health-related quality of life; HRV = heart rate variability; LDL-C = 

cholesterol; LLM = lipid lowering medication; LVEF = left ventricular ejection fraction; LVDDi = left ventricular end diastolic volume index; MBS

stress reduction; NA = not applicable; NE = norepinephrine; NT = no treatment; P-MDA = plasma malondialdehyde; PMR = progressive muscle re

SBP = systolic blood pressure; TC = total cholesterol; TEE = total energy expenditure; TG = triglycerides; TM® = Transcendental Meditation®; UC 

very low density lipoprotein cholesterol; VE/VCO2 = rate of increase of ventilation per unit of increase of carbon dioxide production; VO2 max = ma

WR = work rate
139

Table 31. Summary of outcomes by meditation practice and by comparison group included in meta-analyses of the efficacy anmeditation practices in cardiovascular diseases (continued) 

Intervention Comparator Outcome No. studies Meta- analysis 

NT TC, HDL-C, LDL C, VLDL-C, TG 247

Anxiety, somatization, tension, depression, global status, mood 

disturbances251

Yoga 2 No 

(continued) 

LLM Total antioxidant status, vitamin C, vitamin E, TG, TC, HDL-C, LDL-C, 

P-MDA, erythrocyte GSH, BMI238

TC, LDL-C, clinical improvement, caloric intake, regression of disease, 

anxiety, depression, myocardial perfusion250

2 Yes 

Zen Buddhist 

meditation 

HE HRV237 1 No 
140

Tai Chi versus exercise 

Heart rate. Two trials235,248 totaling 99 participants (Tai Chi = 47, exercise = 52) provided 

data on the effects of Tai Chi versus exercise on heart rate (HR). After analyzing the substantial 

heterogeneity of the studies (I2

 = 70 percent), it was considered inappropriate to combine the 

study results into a single effect estimate. There were substantial differences between the two 

studies regarding the characteristics of participants in the studies, the methods to evaluate HR, 

study design, and the duration of the followup period. The study by Channer235 was an 8-week 

RCT conducted in patients who had suffered acute MI within 3 weeks prior to enrolling in the 

trial. Measures of HR were taken at rest. Individual study results showed a significant benefit 

(reduction) in resting heart rate that favored Tai Chi over exercise. The study of Lan248 was a 1-

year NRCT conducted in patients that underwent coronary artery bypass surgery. Measures of 

HR were taken during exercise. Individual study results showed a nonsignificant improvement 

(increase) in HR during exercise as compared to Tai Chi.

Yoga versus lipid lowering medication (LLM) 

Total cholesterol (TC). Two trials238,250 totaling 157 participants (Yoga = 93, LLM = 64) 

provided data on the effects of Yoga versus LLM on TC. After analyzing the substantial 

heterogeneity of the studies (I2 = 97.4 percent), it was considered inappropriate to combine the 

study results into a single effect estimate. There were substantial differences between the two 

studies regarding the characteristics of participants in the studies, study design, and the duration 

of the followup period. The study of Jatuporn238 was a 4-month RCT conducted in patients with 

coronary artery disease that compared the practice of Yoga and the administration of LLM. 

Individual study results showed a significant benefit (reduction) over the short-term in TC that 

favored LLM over Yoga. The study of Yogendra250 was a 1-year NRCT conducted in patients 

with coronary artery disease that compared Yoga versus LLT. Individual study results showed a 

nonsignificant improvement (reduction) over the long-term in TC that favored Yoga over LLM.

Low-density lipoprotein cholesterol (LDL-C). Two trials238,250 totaling 157 participants (Yoga 

= 93, LLM = 64) provided data on the effects of Yoga versus LLM on TC. As mentioned before, 

there was considerable clinical heterogeneity between the studies (I2 = 97.3 percent) that 

precluded the pooling of the results. The short-term RCT of Jatuporn238 reported a significant 

reduction in LDL-C with LLM. The long-term NRCT of Yogendra250 showed a nonsignificant 

decrease in LDL-C that favored Yoga over LLM.

Yoga versus exercise 

Body weight. Two trials233,239 totaling 95 participants (Yoga = 51, exercise = 44) provided 

data on the effects of Yoga versus exercise on body weight changes (Figure 27). The combined 

estimate of changes in body weight (kg) indicated a nonsignificant improvement (reduction) in 

favor of Yoga (WMD = -2.14; 95% CI, -7.30 to 3.02). The results were statistically 

homogeneous (p = 0.61; I2 = 0 percent).
141

Figure 27. Meta-analysis of the effect of Yoga versus exercise on body weight 

Indirect Comparisons 

We were able to indirectly compare changes in measures of anxiety in Yoga versus MBSR 

(i.e., each was compared to NT in separate studies). There was no significant difference between 

the two interventions in terms of measures of anxiety (SMD = 0.03; 95% CI, -1.16 to 1.22). 

Analysis of Publication Bias 

Because of the very small number of trials available for each comparison, the statistical tests 

lacked the power to detect publication bias. Therefore the analysis of the effect of publication 

bias on the meta-analyses presented above was not conducted. 

Substance Abuse 

Description of the Included Studies 

Seventeen trials (13 RCTs258-270 and 4 NRCTs271-274) that evaluated the effects of meditation 

practices in individuals with substance abuse disorders were identified. They included five trials 

on TM®,

259,261,267,270,271 three on Yoga,266,269,273 two on MBSR,263,272 two on RR,265,268 one on 

CMS,264 one on a medical meditation practice involving the use of mantra and breathing 

techniques,260 one on Qi Gong,262 one on mindfulness meditation not further specified,258 and 

one on a meditation practice not further described.274

The trials were published between 1956 and 2004 (median year of publication: 1986; IQR, 

1979 to 1999). All the trials were published in journals, except for two,260,263 which were 

identified from the gray literature. The majority of trials (n = 13) 258-260,263-265,267-272,274 were 

conducted in the United States; two studies were conducted in India,266,273 one study was 

conducted in China,262 and one in Sweden.261 Characteristics of the trials are summarized in 

Table H3 in Appendix H.*

A total of 825 individuals were assigned to meditation practices or control groups. The 

median sample size based on data from 16 trials was 45 participants per study (IQR, 30 to 77). 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
142

Two273,274 of the 16 trials had more than 100 participants assigned to the study groups. The mean 

age of participants based on data from 13 trials was 33 ± 7 years (range: 21 to 45 years). All the 

trials except two265,270 were conducted in samples with mean ages ranging from 20 to 40 years. 

Four trials259-261,273 did not report the age of participants. 

Across all the trials that reported the gender of participants (n = 16), 87 percent were males 

and 13 percent were females. Samples in nine trials262-266,268,270,273,274 were entirely male; none of 

the trials included entirely female samples. One trial259 failed to report the gender of participants. 

The race of ethnicity of samples was reported in five trials.258,263,269,270,274 African American 

participants constituted more than 60 percent of the study population in three trials,258,263,270

whereas Caucasian participants constituted more than 80 percent of the study population in two 

trials.269,274

All the trials except five217,258,266,268,269 attempted to use formal criteria or validated 

instruments to select participants in their studies. Two studies used the Addiction Severity 

Index,258,269 one study266 used the DSM-III criteria for alcohol dependence, and another used the 

Drinking Practices Questionnaire. The remaining 13 trials selected the study participants based 

on their reported history of substance abuse. 

Participants in the studies were recruited in addiction treatment centers,258,261,262,265,269-272,274

prisons,259,263,267 psychiatric wards,266 universities264,268 or from Alcoholics Anonymous.260,273

Abused substances included alcohol,258,260,261,263-266,268,270-273 cocaine,258,263,272 heroin,258,262,269,272

marijuana,261,272 inhalants,272 hashish,261 amphetamines,261 and lysergic acid diethylamide 

(LSD).261 Three studies did not provide details about the type of substances abused. 

All 17 trials employed a parallel study design. The length of the trials varied from 1 day260 to 

18 months.270 The median duration of the trials based on data from 16 trials was 4 months (IQR, 

1 to 6). Seven studies259,260,262-265,272 were short-term trials (less than 3 months), seven 

trials258,261,266,268,269,271,274 had a duration between 3 and 6 months, and two trials270,273 lasted 

longer than 6 months. 

The 17 trials comprised four comparisons between meditation practices and no 

intervention,259,262,264,272 and two comparisons between meditation practices and WL.259,271 There 

were 20 comparisons between meditation practices and active therapies other than no 

intervention or WL. As some trials had more than one comparison arm, the total number of 

comparisons exceeds the number of trials. Of the 20 active comparisons, the comparative 

treatments were BF,270,273 exercise,264,266 group therapy,261,269 PMR,263,265 rest,260,265

counseling,270 psychotherapy,273 relaxation,274 neurotherapy,270 stereotaxic surgery,273 low 

frequency pulsed magnetic field therapy,273 and pharmacotherapy.262 Two studies267,268 failed to 

provide a description of the control group, and one study258 reported the comparison group as 

“usual care” without providing further details. The median number of comparisons per study was 

one (IQR, 1 to 2). 

Methodological Quality of Included Studies 

As a measure of methodological quality for included trials, the overall median Jadad score 

was 1 (IQR, 1 to 2). Three trials258,265,266 obtained 3 points and were considered high quality (i.e., 

Jadad scores of 3 points or more). Three trials260,263,264 obtained 2 points, seven trials259,261,267-271

obtained 1 point, and four trials262,272-274 did not obtain any points.. All the trials except four271-274

were described as randomized; however, the description of randomization varied. The majority 
143

of trials (8 out of 13259,261,263,264,267-270 did not provide a description on how the randomization 

was performed. Four trials258,260,265,266 described an appropriate method of generating the 

sequence of randomization, whereas one trial262 reported an inadequate method of sequence 

generation. None of the trials were described as double-blind. The adequacy of allocation 

concealment was unclear in all included trials. 

None of the studies reported the use of intention-to-treat analysis. Eight trials258,263-268,271

reported dropout information for the total study sample (mean dropout rate: 34 percent; range: 0 

to 87 percent). Four trials263,264,266,271 had a dropout rate of more than 20 percent. Withdrawals 

and dropouts per treatment group were clearly described in six trials.258,263-266,271 Among the six 

studies that reported dropouts per treatment group, 24 percent of participants (range: 0 to 48 

percent) dropped out from the meditation groups. The mean dropout rate for the control groups 

was similar (21 percent; range: 0 to 44 percent; eight control groups). 

Seven trials264,268-270,272-274 reported their source of funding. Five trials268-270,273,274 received 

government funding and two264,272 received internal funding. A comparative summary of the 

methodological quality of the included trials is provided in Table 32. 
144

Table 32. Methodological quality of trials of meditation practices for substance abuse 

Randomization Double blinding 

Study Meditation practice Stated Method 

described 

Stated Method 

described 

Withdrawals 

/dropouts 

described 

Jadad 

score 

Al

con

Alterman AI, 2004258 Mindfulness 

meditation 

Yes Adequate No NA Yes 3 U

Ballou D, 1977259 TM® Yes Unclear No NA No 1 UBarton MJ, 2004260 Medical 

meditation (mantra + BE) 

Yes Adequate No NA No 2 U

Brautigam E, 1977261 TM® Yes Unclear No NA No 1 UKline KS, 1982271 TM® No NA No NA Yes 1 ULi M, 1956262 Qi Gong Yes Inadequate No NA No 0 UMarcus MT, 

2001272,275

MBSR No NA No NA No 0 U

Murphy R, 1995263 MBSR Yes Unclear No NA Yes 2 UMurphy TJ, 1986264 CSM Yes Unclear No NA Yes 2 UParker JC, 

1978265,276,277 RR Yes Adequate No NA Yes 3 U

Raina N, 2001266 Yoga Yes Adequate No NA Yes 3 URamirez J, 1990267 TM® Yes Unclear No NA No 1 URohsenow DJ, 

1985268

RR + PMR + 

CRT 

Yes Unclear No NA No 1 U

Shaffer HJ, 1997269 Yoga + 

methadone 

Yes Unclear No NA No 1 U

Subrahmanyam S, 

1986273 Yoga No NA No NA No 0 U

Taub E, 1994270 TM® Yes Unclear No NA No 1 UWong MR, 1981274 Meditation 

practice (NS) 

No NA No NA No 0 U

BE = breathing exercises; CRT = cognitive restructuring training; CSM = clinically standardized meditation; MBSR = mindfulness-based stress reducNS = not specified; PMR = progressive muscle relaxation; RR = Relaxation Response; TM® = Transcendental Meditation®
145

Results of Quantitative Analysis 

Table 33 summarizes the type of meditation practice, comparison group, and outcomes that 

were available for meta-analysis. No single diagnostic criterion was chosen for categorizing 

study populations. Rather, we included all studies conducted in patients with substance abuse, as 

defined by the authors of the primary studies. Studies were too dissimilar in type of meditation 

practice, comparison group, and data for common outcomes of interest to allow direct or indirect 

comparisons of the effectiveness of meditation practices for substance abuse. No more than one 

study was available for statistical pooling of any of the 23 comparisons. 

Results from individual clinical trials of meditation practices in substance abuse are 

summarized in Table H3 in Appendix H.*

Analysis of Publication Bias 

The lack of trials available for a meta-analysis on the effects of meditation practices in 

substance abuse precluded an assessment of publication bias. 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
146

Table 33. Summary of outcomes by meditation practice and by comparison group included in meta-analyses of efficacy and ef

Intervention Comparator Outcome No. studies Meta- analysis 

NT Anxiety, behavioral changes, inmate infractions259 1 No WL Anxiety, behavioral changes, inmate infractions259

Personality profile, self-actualization271

2 No 

Group therapy Frequency of drug use, leisure activity, self-confidence, anxiety, 

psychomotor retardation261

1 No 

Control (NS) Self-concept, emotional stability, maturity, hostility, overconcern with 

physical symptoms267

1 No 

BF Drinking days, complete abstinence, mood states270 1 No Neurotherapy Drinking days, complete abstinence, mood states270 1 No 

TM®

Counseling Drinking days, complete abstinence, mood states270 1 No Exercise Alcohol consumption, VO2 max264 CSM 1 No NT Alcohol consumption, VO2 max264 1 No NT Coping styles, psychopathology symptoms272 MBSR 1 No PMR Egocentrism, anger, impulsivity, cortisol levels263 1 No 

Medical 

meditation (mantra + BE) 

Rest BP changes (DBP, SBP), PR, GSR, spirituality260 1 No Methadone Withdrawal symptoms, anxiety, urine morphine262 Qi Gong 1 No NT Withdrawal symptoms, anxiety, urine morphine262 1 No PMR Anxiety, BP changes (DBP, SBP), HR, GSR, tension265 1 No Rest Anxiety, BP changes (DBP, SBP), HR, GSR, tension265 1 No 

RR 

Control (NS) Anxiety, anger, depression, alcohol consumption, locus of control, 

irrational beliefs268

1 No 

Exercise Recovery rate266 1 No Group therapy Addiction severity, psychological symptoms269 1 No 

Yoga 

Psychotherapy Clinical status, psychological status, WBC count, ESR, blood glucose, TC, 

cortisol, lactic acid, PBI, 5-HIAA, Hb, catecholamines, S-Ca, S-Mg, VMA; HVA; 17-KS, PT, MHPG, cholinesterase273

1 No 

5-HIAA = 5-hydroxyindole acetic acid; 17-KS = 17-ketosteroids; BE = breathing exercises; BF = biofeedback; BP = blood pressure; CSM = clinically 

DBP = diastolic blood pressure; ESR = erythrocyte sedimentation rate; GSR = galvanic skin response; Hb = hemoglobin; HR = heart rate; HVA = hlow frequency pulsed magnetic field; MHPG = 3-methoxy-4-hydroxyphenylglycol; MBSR = mindfulness-based stress reduction; NA = not applicabno treatment; PBI = protein bound iodine; PMR = progressive muscle relaxation; PR = pulse rate; RR = Relaxation Response; SBP = systolic blood 

calcium; S-Mg = serum magnesium; TC = total cholesterol; TM® = Transcendental Meditation®; VMA = vanillylmandelic acid; WL = waiting list; 
147

Table 33. Summary of outcomes by meditation practice and by comparison group included in meta-analyses of efficacy and ef

Intervention Comparator Outcome No. studies Meta- analysis 

Stereotaxic 

surgery 

Clinical status, psychological status, WBC count, ESR, blood glucose, TC, 

cortisol, lactic acid, PBI, 5-HIAA, Hb, catecholamines, S-Ca, S-Mg, 

VMA; HVA; 17-KS, PT, MHPG, cholinesterase273

1 No 

BF Clinical status, psychological status, WBC count, ESR, blood glucose, TC, 

cortisol, lactic acid, PBI, 5-HIAA, Hb, catecholamines, S-Ca, S-Mg, VMA; HVA; 17-KS, PT, MHPG, cholinesterase273

1 No 

Yoga 

(continued) 

LFPMF Clinical status, psychological status, WBC count, ESR, blood glucose, TC, 

cortisol, lactic acid, PBI, 5-HIAA, Hb, catecholamines, S-Ca, S-Mg, VMA; HVA; 17-KS, PT, MHPG, cholinesterase273

1 No 
148

Summary of the Results 

Table 34 summarizes the results of the meta-analyses of the treatment effects (statistical and 

clinical significance) of meditation practices in hypertension and cardiovascular diseases. 

Hypertension 

Twenty-seven trials (24 RCTs, and 3 NRCTs) have evaluated the effects of meditation 

practices in hypertension. The majority of trials on hypertension have been conducted in Yoga 

(eight studies). The trials have been predominantly conducted in the United States in participants 

with a mean age of 51 years (range: 41 to 60 years). All studies were conducted in patients with a 

diagnosis of essential hypertension and used a parallel-group design. The majority of the trials 

were short- and medium-term. Comparison groups included HE, NT, WL, BF, PMR, and rest. 

The methodological quality of trials was low with only two trials considered high quality. 

Data from 16 studies were available for direct meta-analyses. Outcomes suitable for metaanalysis included blood pressure, body weight, heart rate, total cholesterol, HDL-C, LDL-C, 

dietary intake, physical activity, and psychological measures such as stress, anger, and selfefficacy. 

Direct meta-analyses showed that compared to HE, TM® did not produce significantly 

greater benefits on blood pressure (SBP and DBP), heart rate, TC, HDL-C, LDL-C, body weight, 

dietary intake, physical activity, measures of stress, anger, and self-efficacy. A subgroup analysis 

by study duration showed short-term significant improvement in SBP with TM®, but not over the 

long-term. When compared to PMR, TM® produced significantly greater benefits in SBP and 

DBP. When RR was compared to BF, RR did not produce significantly greater benefits on blood 

pressure (SBP and DBP). Qi Gong was significantly more effective than a WL in reducing SBP. 

Compared to NT, Yoga produced significant reductions in DBP, but not in SBP. As the results 

among trials were heterogeneous, a subgroup analysis showed that the effect of Yoga on SBP 

was significantly greater when compared to a control group without an adjuvant treatment. The 

same subgroup analysis was conducted for the outcome of DBP and the magnitude of the effect 

changed from significant to nonsignificant when Yoga was compared to a control group with an 

adjuvant treatment. When compared to HE, Yoga did not produce significantly greater benefits 

on SBP and DBP. Heterogeneity in this outcome suggested that short-term trials showed 

statistically significant benefits in blood pressure, whereas the effects decreased over time. 

Compared to HE, Yoga produced significant benefits in controlling stress. When compared with 

blood pressure checks, Zen Buddhist meditation did not produce significantly greater reduction 

in SBP, but did produce a significant reduction in DBP. 

When Tai Chi, Yoga plus BF, and Yoga were indirectly compared with NT, they 

significantly reduced SBP. These three interventions were also better than HE to reduce SBP. 

For the outcome of DBP, Yoga plus BF and Yoga alone were the only interventions that 

significantly reduced DBP when compared to NT. Yoga was also better than HE. Yoga was 

nonsignificantly superior to TM® for the outcomes of body weight, heart rate and stress. 

Compared to TM®, RR significantly helped to reduce smoking. 
149

Cardiovascular Diseases

Twenty-one trials (15 RCTs and 6 NRCTs) have evaluated the effects of meditation practices 

in cardiovascular diseases. The majority of trials have been conducted in Yoga (seven studies). 

The trials have been predominantly conducted in the United States in participants with a mean 

age of 63 years (range: 52 to 77 years). Clinical conditions of study populations included MI, 

coronary artery disease, angina, arrhythmias, peripheral occlusive disease, and congestive heart 

failure. All studies used a parallel-group design. The majority of the trials were medium-term. 

Comparison groups included exercise, no intervention group, pharmacological interventions, HE, 

usual care not specified, group therapy, WL, listening to music, cognitive restructuring training. 

The methodological quality of trials was low with only two trials considered high quality. 

Data from six studies were available for direct meta-analyses. Outcomes suitable for metaanalysis included TC, LDL-C, and body weight; however, only the results from the two trials 

comparing the use of Yoga with exercise for the reduction of body weight could be combined. 

This direct meta-analysis showed that Yoga was no better than exercise at producing changes in 

body weight. Indirect comparisons showed that there were no significant differences in measures 

of anxiety between Yoga and MBSR. 

Table 34. Summary of the meta-analyses of the treatment effects of meditation practices in hypertension and 

cardiovascular diseases (statistical and clinical significance) 

Hypertension 

Comparison Outcome Statistical significance Clinical 

significance 

SBP Medium and Long-term 

WMD = 0.70 mm Hg (95% CI, -2.29 to 3.68) 

TM®

 no better than HE 

No 

DBP WMD = 1.02 mm Hg (95% CI, -1.41 to 3.44) 

TM® no better than HE

No 

Body weight WMD = 1.72 lbs (95% CI, -2.29 to 5.74) 

TM®

 no better than HE

No 

Heart rate WMD = -0.43 bpm (95% CI, -4.17 to 3.31) 

TM® no better than HE

No 

Stress SMD = 0.12 (95% CI, -0.27 to 0.50) 

TM®

 no better than HE`

No 

Anger SMD = 0.06 (95% CI, -0.45 to 0.32) 

TM®

 no better than HE

No 

Self-efficacy SMD = -0.36 (95% CI, -0.92 to 0.19) 

TM®

 no better than HE

No 

TC WMD = -0.94 mg/dL (95% CI, -11.49 to 9.62) 

TM®

 no better than HE

No 

HDL-C WMD of -2.58 mg/dL (95% CI, -6.12 to 0.96) 

TM®

 no better than HE

No 

LDL-C WMD of 1.08 mg/dL (95% CI, -8.65 to 10.81) 

TM®

 no better than HE

No 

TM® versus HE 

Dietary intake Fat intake: SMD = 0.50 (95% CI, -0.21 to 1.21) 

Sodium intake: SMD = 0.14 (95% CI, -0.44 to 0.72) 

TM®

 no better than HE

No 

BF = biofeedback; DBP = diastolic blood pressure; HDL-C = high-density lipoprotein cholesterol; HE = health education; LDLC = low-density lipoprotein cholesterol; MBSR = mindfulness-based stress reduction; RR = Relaxation Response; SBP = 

systolic blood pressure; SMD = standardized mean difference
150

Table 34. Summary of the meta-analyses of the treatment effects of meditation practices in hypertension and 

cardiovascular diseases (statistical and clinical significance) (continued) 

Hypertension (continued) 

Comparison Outcome Statistical significance Clinical 

significance 

TM® versus HE 

(continued) 

Physical 

activity 

SMD = -0.20 (95% CI, -0.14 to 0.53) 

TM®

 no better than HE

No 

SBP WMD = -4.30 mm Hg (95% CI, -8.02 to -0.57) 

TM®

 better than PMR

TM Yes ® versus PMR 

DBP WMD = -3.11 mm Hg (95% CI, -5.00 to -1.22) 

TM®

 better than HE

Borderline 

SBP WMD = 2.39 mm Hg (95% CI, -5.13 to 9.91) 

RR no better than BF 

RR versus BF No 

DBP WMD = 4.44 mm Hg (95% CI, -4.00 to 12.88) 

RR no better than BF

No 

SBP WMD = -17.78 mm Hg (95% CI, -22.03 to -13.54) 

Qi Gong better than WL

Qi Gong versus Questionable 

WL 

DBP WMD = -12.06 mm Hg (95% CI, -21.62 to -2.49) 

Qi Gong better than WL

Questionable 

SBP With concomitant therapy: WMD = -7.15 mm Hg (95% 

CI, -17.70 to 3.39) 

Yoga no better than NT 

Yoga versus NT No 

DBP With concomitant therapy: WMD = -6.82 mm Hg (95% 

CI, -15.51 to 1.87) 

Yoga no better than NT

No 

Yoga versus HE Stress SMD = -1.10 (95% CI, -1.61 to -0.58) 

Yoga better than HE

No 

SBP WMD = -3.67 mm Hg (95% CI, -9.04 to 1.70) 

Zen Buddhist meditation no better than blood 

pressure checks 

Zen Buddhist No 

meditation 

versus blood 

pressure checks DBP WMD = -6.08 mm Hg (95% CI, -11.68 to -0.48) 

Zen Buddhist meditation better than blood 

pressure checks

Yes 

Cardiovascular diseases 

Comparison Outcome Statistical significance Clinical 

significance 

Yoga versus 

exercise 

Body weight WMD = -2.14 (95% CI, -7.30 to 3.02 

Yoga no better than exercise

No 

MBSR versus 

Yoga (indirect 

comparison) 

Anxiety No; SMD: 0.03; 95% CI, -1.16 to 1.22 

MBSR no better than yoga 

No 

Substance Abuse 

Seventeen trials (13 RCTs and 4 NRCTs) have evaluated the effects of meditation practices in 

substance abuse. The majority of trials have been conducted on TM® (five studies). The trials 

have been predominantly conducted in the United States in participants with a mean age of 33 

years (range: 21 to 45 years). All studies used a parallel-group design. The majority of the trials 

were short- and medium- term. Control groups included BF, exercise, group therapy, PMR, rest, 

counseling, psychotherapy, relaxation, neurotherapy, stereotaxic surgery, low frequency pulsed 

magnetic field therapy, and pharmacotherapy. The methodological quality of trials was low with 

only three trials considered high quality. Study results were not combined because the trials were 
151

too dissimilar in meditation practice, comparison group, and data for common outcomes of 

interest. In addition, the results of the three highest quality trials258,265,266 (Jadad score = 3/5) 

examining, respectively, Mindfulness meditation, RR, and Yoga are inconclusive with respect to 

the effectiveness of meditation pratices. 

The study comparing Mindfulness meditation with usual care (NS) 258 for alcohol and 

cocaine abuse found little indication that Mindfulness meditation enhanced treatment outcomes 

for substance abuse patients. The study comparing RR with PMR and rest groups265 for alcohol 

abuse found generalized effects for BP, but not for the other outcome measures (anxiety, HR, 

and GSR). The RR and PMR groups did not exhibit increased BP as observed in control subjects. 

RR and PMR produced significant changes in tension. The study comparing Yoga with 

exercise266 for alcohol abuse found a significantly greater recovery rate for the Yoga group. 

Table 32 provides a summary of the meta-analyses of the treatment effects of meditation 

practices in hypertension and cardiovascular diseases in terms of the statistical and clinical 

significance of the findings. Overall, we found that TM® had no advantages over HE to improve 

measures of SBP, DBP, body weight, heart rate, stress, anger, self-efficacy, cholesterol, dietary 

intake, and level of physical activity in hypertensive patients. Compared to PMR, TM® produced 

clinically and statistically significant benefits to reduce SBP. The results for DBP were of 

borderline clinical significance. Caution should be exerted when interpreting these results. Metaanalyses were derived from only two open label trials; therefore, performance bias and detection 

bias may have contributed to an overestimate of the treatment effect. RR was not shown to be 

superior to BF at reducing blood pressure in hypertension. 

Qi Gong was superior to WL to reduce blood pressure in subjects with essential 

hypertension; however, the clinical significance of this finding is questionable, as the effect 

estimate is quite imprecise (i.e., wide confidence interval), the comparison is based on a few 

low-quality studies, and the appropriateness of a WL comparison group is questionable. Yoga 

did not produce clinically or statistically significant effects in blood pressure when compared to 

NT. Compared to HE, Yoga produced statistically significant changes in measures of stress. The 

clinical value of this change, however, is questionable (approximately a one-point reduction in 

measures of stress). Results were obtained from only two open label trials and this could have 

affected the subjective determination of outcomes. Finally, Zen Buddhist meditation was not 

better than blood pressure checks to reduce SBP. Although the result for DBP was clinically and 

statistically significant, caution should be exerted as there was some heterogeneity among the 

studies that contributed data for this outcome. 

Yoga was no better than physical exercises to reduce body weight in patients with 

cardiovascular disorders. When the relative effectiveness of a variety of meditation practices was 

assessed using indirect meta-analysis, we found that there were no significant differences 

between MBSR and Yoga to control anxiety symptoms in cardiovascular patients. 
152

Topic IV. Evidence on the Role of Effect Modifiers for the 

Practice of Meditation 

We aimed to identify the role of effect modifiers (e.g., patient and meditation characteristics) 

as moderators of the treatment effect measured in clinical trials of meditation practices in 

hypertension, other cardiovascular diseases, and substance abuse. The small number of trials per 

comparison and the limited data from primary studies precluded meta-regression analyses using 

RCT-level covariates to assess the role of specific effect modifiers for the practice of meditation. 

We were also unable to conduct subgroup analyses to explore differences among subgroups of 

patients as the trials failed to report results by the effect modifiers being considered (i.e., 

characteristics of the practice or patients). Therefore, we will describe the findings from the 

individual studies that reported data on the role of effect modifiers.

Hypertension 

Of 27 trials that examined the effect of meditation practices for hypertension, only seven 

trials203,205,206,209,220-222 conducted a subgroup analysis or a multiple regression analysis to explore 

the role of a variety of effect modifiers. A summary of the analysis is provided in Table 35. 

Four studies205,206,220,221 conducted an analysis of the role of effect modifiers on health 

outcomes resulting from the practice of TM®. They used multiple regression models205,206,221 or 

subgroup analyses220,222 by a variety of effect modifiers such as age,205,206,206 gender, 

antihypertensive medication use,206,220,222 income,205 education,205 and smoking206 One study209

conducted a subgroup analysis by age, gender, severity of hypertension, duration of disease, and 

medication use for the effects of RR. Another study203 conducted a subgroup analysis by severity 

of hypertension and duration of the disease on the effects of mantra meditation and relaxation 

techniques. Finally, one study on a technique modeled after TM® conducted subgroup analyses 

of medication use,222 and marital status.222

All the trials were likely to have conducted post hoc analyses as the analyses were not 

reported as part of the plan of analysis in the Methods sections of the studies. It is unknown 

whether authors of the trials decided to selectively report on the variables that showed a 

statistically significant positive effect. 

None of the trials that provided data on effect modifiers of meditation practices for 

hypertension analyzed the effect of the dose of practice necessary to achieve health outcomes. 

Neither the role of the direction of attention during meditation nor the rhythmic aspects of the 

practice were explored in the studies. The trials did not provide data on how ethnicity predicts 

health outcomes resulting from the practice of meditation. The role of individual variables to 

predict success in the process of meditation (expressed as adherence or acceptance) was not 

explored in the trials of meditation practice and hypertension. 
153

Table 35. Summary of the analyses of effect modifiers for achieving benefits from meditation practice for 

hypertension 

Study, year, 

country

Study 

design, 

duration, 

followup, 

ITT

Intervention Comparison 

groups Type of analysis Authors’ conclusions

Aivazyan TA, 

1988203

Russia 

RCT parallel 

2 arms 

Duration: 12 

mo. 

ITT: Yes 

Mantra 

meditation 

+ 

relaxation 

techniques

NT Subgroup analysis 

by severity and 

duration of 

disease (post 

hoc) 

The responders had 

higher BP and 

shorter 

hypertension 

duration than did 

the nonresponders 

Calderon R 

Jr, 2000205

United States 

RCT parallel 

2 arms 

Duration: 6 

mo. 

ITT: NR 

TM®

 HE Multiple regression 

analysis 

controlling by 

age, income, 

education. 

Subgroup analysis 

by education 

(post hoc) 

Subjects with high 

school education 

differed 

significantly in 

magnitude of 

reduction in TC and 

LDL-C compared to 

those with college 

education 

Education/SES may 

interact with lipid 

response to the 

practice of TM®

CastilloRichmond 

A, 2000206

United States 

RCT parallel 

2 arms 

Duration: 9 

mo. 

ITT: Yes 

TM® HE Multiple regression 

analysis 

controlling by 

age, AHM use, 

and smoking 

(post hoc) 

No significant 

differences in SBP 

and DBP were 

observed after 

controlling for age, 

AHM use, and 

smoking 

Hager JL, 

1978209

United States 

RCT parallel 

2 arms 

Duration: 4 

wk. 

ITT: No 

RR BF (BP) Subgroup analysis 

by age, sex, 

severity and 

duration of 

disease, and 

medication use 

(post hoc) 

There were no 

significant effects 

of age, sex, 

severity and 

duration of disease, 

and medication use 

on BP mean 

changes 

Schneider RH, PMR 

199579,221,232

United States 

RCT parallel 

3 arms 

Duration: 3 

mo. 

ITT: Yes 

TM®

HE 

Multiple regression 

analysis 

controlling by 

age, sex, risk 

level 

Both SBP and DBP 

significantly 

improved for both 

sexes and for highand low-risk levels 

AHM = antihypertensive medication; AT = autogenic training; BE = breathing exercises; BF = biofeedback; BHT = borderline 

hypertension; BP = blood pressure; CMBT = contemplative meditation with breathing techniques; DBP = diastolic blood 

pressure; HE = health education; HT = hypertension; ITT = intention-to-treat;; LDL-C = low-density lipoprotein cholesterol; 

mo. = months; NR = not reported; NRCT = nonrandomized clinical trial; NS = not specified; NT = no treatment; PLB = 

placebo; PMR = progressive muscle relaxation; RR = relaxation response; SBP = systolic blood pressure; TM® = 

Transcendental Meditation®; UC = usual care; wk = weeks; WL = waiting list; yr = year 
154

Table 35. Summary of the analysis of effect modifiers for achieving benefits from meditation practice for 

hypertension (continued) 

Study, year, 

country

Study 

design, 

duration, 

followup, 

ITT

Intervention Comparison 

groups Type of analysis Authors’ conclusions

Schneider PMR 

RH, 2005220

United States 

RCT parallel 

3 arms 

Duration: 1 

yr. 

ITT: Yes 

TM®

HE 

Subgroup analysis 

by sex (post hoc) 

The change of SBP in 

women was not 

significantly greater 

than in men 

There was no 

significant overall 

difference in DBP. 

Compared to the 

other groups, 

women in the TM®

group decreased 

more on both SBP 

and DBP 

Seer P, PLB 

1980222

New Zealand 

RCT parallel 

3 arms 

Duration: 3 

mo. 

ITT: NR 

SRELAX 

(technique 

modeled 

after TM®

) 

WL 

Subgroup analysis 

by sex, marital 

status, use of 

AHM in the past, 

duration of 

disease (post 

hoc) 

Responders had a 

significantly longer 

hypertension 

history 

Sex, marital status, 

and use of 

hypertensive 

medication in the 

past did not affect 

outcomes 

Cardiovascular Diseases 

Of 21 trials on the effects of meditation practice on cardiovascular (CV) diseases, only two 

trials234,239 conducted subgroup or multiple regression analyses to explore the role of effect 

modifiers on achieving potential benefits of meditation practice. A summary of the analysis is 

provided in Table 36. 

Using a multiple regression model, one trial234 explored whether age, education, medication 

use, and diet restrictions were predictors of the effectiveness of RR in patients with CV diseases. 

Another trial239 conducted a subgroup analysis by type of condition, (i.e., patients with angina 

versus patients with risk factors) of the effect of an intervention that combined Yoga and dietary 

changes. Both trials likely conducted post hoc analyses as they were not reported as part of a 

plan of analysis in the Methods sections of the studies. It is unknown whether there is an 

outcome selection bias in the reporting of variables that were included in the analysis. None of 

the trials explored the effect of the dose practice necessary to achieve health outcomes, the role 

of direction of attention during meditation, or the rhythmic aspects of the practice. The trials did 

not provide data on whether ethnicity or other individual variables affect associated health 

outcomes or whether these variables can be used to predict the successful practice of meditation. 
155

Table 36. Summary of the analyses of effect modifiers for achieving benefits from meditation practice for 

cardiovascular diseases 

Study, year, 

country 

Study 

design, 

duration, 

followup, 

ITT 

Intervention Comparison 

groups Type of analysis Authors’ conclusions 

Chang BH, HE 

2005234

United States 

RCT parallel 

3 arms 

Duration: 19 

wk. 

ITT: Yes 

RR 

UC (NS) 

Multiple regression 

analysis 

controlling by 

age, education, 

medication use, 

and diet 

restrictions (post 

hoc) 

No significant differences were 

observed in the adjusted 

change values of VO2 max, 

total exercise time, and 

exercise capacity 

Mahajan AS, 

1999239

India 

RCT parallel 

2 arms 

Duration: 14 

wk. 

ITT: NR 

Yoga + diet 

changes 

Exercise + diet 

changes 

Subgroup analysis 

by condition (risk 

factor group, 

angina group) 

Subjects with coronary risk 

factors had significant 

decreases in body weight, 

TC, LDL-C, and increase in 

HDL-C 

Subjects with angina had a 

decrease in body weight, TG 

and HDL-C increased 

Changes in agina patients 

were acute (4 wk.) while 

those in subjects with 

subject factors lasted 10 wk. 

CAD = coronary artery disease; HDL-C = high-density lipoprotein cholesterol; HE = health education; ITT = intention-to-treat; 

LDL-C = low-density lipoprotein cholesterol; NS = not specified; TC = total cholesterol; TG = triglycerides; VO2 max = 

maximum oxygen consumption; UC = usual care; wk. = weeks 

Substance Abuse 

Of 17 trials investigating the effect of meditation practices on substance abuse disorders, only 

4 trials264,267,268,274 conducted subgroup or multiple regression analyses to explore the role of a 

variety of effect modifiers on achieving potential benefits of meditation practices. A summary of 

the analysis of effect modifiers is provided in Table 37. 

The trials did not report on effect of variables such as age, gender, or ethnicity. One trial on 

the effect of RR that incorporated PMR and cognitive restructuring268 conducted a subgroup 

analysis by level of drinking and level of social support received. The effect of other patient 

characteristics on the outcomes achieved after practicing meditation were not reported in the 

studies. One study267 conducted a subgroup analysis by regularity of practice of TM®. A third 

trial, on a meditation practice not further specified,274 conducted a subgroup analysis by 

participation in Alcoholic Anonymous groups. All the trials seemed to use exploratory post hoc 

analyses that were intended to be hypothesis generating. It is unknown whether authors of the 

trials selectively reported the variables that showed a statistically significant positive effect. The 

fourth trial264 conducted a subgroup analysis on differences in outcomes between high compliers 

and noncompliers. 

None of the trials that provided data on effect modifiers of meditation practices for substance 

abuse analyzed the effect of the dose of practice necessary to achieve health outcomes, the role 

of direction of attention during meditation, or the rhythmic aspects of the practice. 
156

Table 37. Summary of the analysis of effect modifiers for achieving benefits from meditation practice for 

substance abuse 

Study, year, 

country

Study 

design, 

duration, 

followup, 

ITT

Intervention Comparison 

groups 

Type of 

analysis 

Authors’ conclusions

Murphy TJ, Exercise 

1986264

United States 

RCT parallel 

3 arms 

Duration: 8 

wk. 

ITT: NR 

CSM 

NT 

Subgroup 

analysis by 

compliance 

(post hoc) 

Statistically significant 

differences between 

high compliers and 

noncompliers in 

ethanol consumption 

and in VO2 gains 

among meditators 

Ramirez J, 

1990267

United States 

RCT parallel 

2 arms 

Duration: NR 

ITT: NR 

TM®

 Control (NS) Subgroup 

analysis by 

regularity of 

practice 

(post hoc) 

Regular TM®

practitioners showed 

a significantly greater 

increase in a 

measure of selfconcept 

No differences between 

regular versus 

irregular TM®

practitioners were 

found for measures of 

internality-externality 

Rohsenow 

DJ, 1985268

United States 

RCT parallel 

2 arms 

Duration: 6 

mo. 

ITT: NR 

RR + PMR + 

cognitive 

restructuring 

Control (NS) Subgroup 

analysis by 

level of 

drinking and 

social 

support 

(post hoc) 

Participants with 

heavier drinking 

behavior and greater 

social support at 

baseline obtained 

significantly greater 

decreases in alcohol 

consumption 

Wong MR, 

1981274

United States 

NRCT 

parallel 

2 arms 

Duration: 6 

mo. 

ITT: NR 

Meditation 

practice 

(NS) 

Relaxation Subgroup 

analysis by 

participation 

in AA (post 

hoc) 

Participants in the 

meditation group that 

took part in AA 

showed greater 

improvements in 

measures of 

impulsivity 

AA = Alcoholics Anonymous; CSM = clinically standardized meditation; ITT = intention-to-treat; mo = months; NRCT = 

nonrandomized controlled trial; NR = not reported; NS = not specified; PMR = progressive muscle relaxation; RR = relaxation 

response; TM® = Transcendental Meditation®; VO2 = oxygen consumption; wk = weeks 

Summary of the Results 

The role of effect modifiers such as characteristics of the practice or patient characteristics 

has so far been neglected in primary research on the effects of meditation practices. Therefore, 

we were unable to use a linear meta-regression procedure to explore any interactions between 

patient characteristics or characteristics of the practice and the magnitude of the overall effect of 

meditation practices for hypertension, cardiovascular diseases, and substance abuse. Individual 

studies (seven trials on hypertension, two on cardiovascular diseases, and four on substance 

abuse) conducted subgroup or multiple regression analysis; however, no analyses were reported 

a priori in the “Methods” sections of the studies. No conclusions on the role of effect modifiers 
157

can be drawn from the analysis of the individual studies. Individual patient data are required to 

appropriately examine this issue. 

Topic V. Evidence on the Physiological and 

Neuropsychological Effects of Meditation Practices 

Three hundred and eleven intervention studies provided evidence on 1,323 measures of the 

physiological and neuropsychological effects of meditation practices. Physiological outcomes 

only were reported in 253 studies, cognitive and neuropsychological outcomes only in 34 

studies, and both physiological and neuropsychological outcomes were reported in 24 studies. 

The main characteristics and methodological quality of the studies included in topic V are 

summarized in Tables I1 to I3 in Appendix I.*

General Characteristics 

Of the 311 studies providing data for this topic, 54 percent (n = 167) were RCTs, 21 percent 

(n = 65) were NRCTs, and 25 percent (n = 79) used a before-and-after design. The studies that 

examined the physiological and neuropsychological effects of meditation practices were 

composed of 110 trials on Yoga, 47 on TM®, 38 on Tai Chi, 34 on RR, 17 on mantra meditation 

not further described, 15 on Qi Gong, 12 on MBSR, 10 on Zen Buddhist meditation, 9 on 

meditation practices not further described, 8 on MM, 4 on CSM, 3 on Acem meditation, and 2 

each on MBCT and Vipassana meditation. The studies were published between 1956 and 2005 

(median year of publication, 1995; IQR, 1986 to 2002). Most of the studies (88 percent, n = 274) 

were published as journal articles. Seven percent (n = 22) were theses or dissertations, four 

percent (n = 13) were abstracts, and one percent (n = 2) were published as research letters. Fifty 

percent of the studies were conducted in North America (n = 155), followed by Asia (34 percent, 

n = 106), Europe (11 percent, n = 35), Australasia (three percent, n = 10), and other regions (two 

percent, n = 5). 

Overall Methodological Quality 

Randomized controlled trials. The methodological quality of the RCTs was analyzed by the 

individual components of the Jadad scale. Overall, the methodological quality of the 167 RCTs 

was poor (median Jadad score 2/5; IQR, 1 to 2). Thirteen percent (n = 21) of the RCTs were 

considered high quality (i.e., Jadad score of 3 or more). Only one study168 obtained a score of 4 

and no study obtained a perfect score of 5. The remaining 146 RCTs had a high risk of bias. 

We found that only 32 (19 percent) of the studies described the randomization procedure. Of 

these 32 studies, 24 described an adequate procedure to randomize study participants to 

treatment groups, and 8 described inadequate or unreliable methods of randomization that might 

have introduced imbalances between group characteristics and jeopardized the estimates of the 

overall treatment effect. 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
158

The majority of RCTs (97 percent, n = 162) did not use double blinding to conceal the 

identity of the interventions. Four studies (two percent) were reported as double-blind trials. 

Finally, 52 percent (n = 86) of the RCTs provided a description of withdrawals and dropouts 

from the study. 

Adequate concealment of treatment allocation was reported in five percent (n = 8) of the 

RCTs and was reported but considered inadequate in one percent (n = 2). The remaining RCTs 

(94 percent, n = 157) failed to describe how they concealed the allocation of subjects to the 

interventions under study. Finally, the source of funding was disclosed in 46 percent (n = 76) of 

the RCTs. A summary of the methodological quality of RCTs is presented in Table 38.

Table 38. Methodological quality of RCTs on the physiological and neuropsychological effects of meditation 

practices 

Quality components N studies (%) 

Randomization 167 (100) 

Double blinding 4 (2.4) 

Appropriate randomization 24 (14.3) 

Appropriate double blinding 0 (0) 

Description withdrawals 86 (51.5) 

Total Jadad score (max 5); Median (IQR) 2 (1,2) 

Number of high quality RCTs (Jadad scores ≥3) 22 (13.1) 

Appropriate concealment of allocation 8 (4.8) 

Funding reported 76 (45.5) 

IQR = interquartile range; RCT = randomized controlled trial 

Nonrandomized controlled trials. Overall, the quality of the 65 NRCTs was low (median 

modified-Jadad score 0/3; IQR, 0 to 1). Thirty-seven percent of the studies (n = 24) received one 

point out of three for the individual components of the Jadad scale, in all cases for a description 

of withdrawals or dropouts. The remaining 63 percent did not receive any points. No studies 

described themselves as double blind. Finally, the source of funding was reported in 32 percent 

(n = 21) of the NRCTs. A summary of the methodological quality of NRCTs is presented in 

Table 39. 

Table 39. Methodological quality of NRCTs on the physiological and neuropsychological effects of 

meditation practices 

Quality components N studies (%)

Double blinding ... 

Appropriate double blinding ... 

Description withdrawals 24 (36.9) 

Funding reported 21 (32.3) 

NRCT = nonrandomized controlled trials 

Before-and-after studies. The quality of the 79 before-and-after studies was low. Only four 

percent (n = 3) of studies contained a sample population that could be considered representative 

of the target population. The blinding of outcome assessors to the intervention and assessment 

was described in 3 percent (n = 2) of studies, the number of study withdrawals in 15 percent 

(n = 12) and reasons for study withdrawals in 8 percent (n = 6). However, 94 percent of studies 
159

(n = 74) reported using the same method of outcome assessment for the pre- and postintervention periods. Funding source was disclosed in 32 percent (n = 25) of studies. A summary 

of the methodological quality of before-and-after studies is provided in Table 40. 

Table 40. Methodological quality of before-and-after studies on the physiological and neuropsychological 

effects of meditation practices 

Quality components N studies (%)

Study population representative of the target population 3 (3.8) 

Method of outcome assessment is the same for pre- and post- intervention periods 74 (93.7) 

Outcome assessors were blind to intervention and assessment period 2 (2.5) 

Description of the number of study withdrawals 12 (15.2) 

Description of the reasons for study withdrawal 6 (7.6) 

Funding reported 25 (31.6) 

Outcome Measures 

The ten most commonly reported physiological outcome measures were (1) cardiovascular 

functioning such as heart rate or blood pressure (169 studies), (2) pulmonary functioning FEV1

and FVC (67 studies), (3) periferal nerve tests such as skin conductance (40 studies), (4) 

adrenocortical functioning such as cortisol and adrenaline levels (26 studies), (5) lipoprotein 

levels (25 studies), (6) EMG (23 studies), (7) carbohydrate metabolism such as glucose and 

insulin levels (18 studies), (8) brain electrophysiology such as EEG patterns (17 studies), (9) 

metabolic product levels such as lactic acid level (16 studies), and (10) CNS hormone and blood 

composition (11 studies each).

 

The ten most commonly reported cognitive/neuropsychological outcomes were measures of 

(1) attention (19 studies), (2) memory (12 studies), (3) perception (12 studies), (4) other 

cognitive measures such as overall cognitive functioning (11 studies), (5) reasoning (10 studies), 

(6) sensorimotor functioning (10 studies), (7) language (7 studies), (8) creativity (4 studies), (9) 

intelligence (4 studies), and (10) spatial ability (4 studies). Table I6 in Appendix I contains the 

complete list of reported outcome measures and their associated studies.*

Results of Quantitative Analysis 

To summarize the results of the physiological and neuropsychological effects of meditation 

practices, we combined study results when two or more studies agreed on the type of meditation 

practice, comparison group, outcomes assessed, and had usable outcome data. Table 41 

summarizes the type of meditation practice, comparison group, and outcomes that were available 

for direct meta-analyses. Meta-analyses of physiological and neuropsychological outcomes on 

populations with hypertension, cardiovascular diseases or substance abuse have been reported in 

topic III. 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
160

Outcomes on the physiological and neuropsychological effects of meditation practices for 

which data could be combined into a direct meta-analysis were provided by 53 unique studies for 

a total of 15 comparisons examining five meditation techniques: TM®, RR, Yoga, Tai Chi, and 

Qi Gong. The remaining 258 studies were not suitable for direct meta-analysis because no more 

than one study was available for pooling. Yoga interventions provided the most studies for 

comparison (28 studies), followed by TM® (10 studies), Tai Chi (7 studies), RR (6 studies), and 

Qi Gong (2 studies). The trials were published between 1974 and 2005 (median year of 

publication, 1993; IQR, 1989 to 2001). 

Of the 53 intervention studies included for meta-analysis, 20 used an RCT design, 8 used an 

NRCT design, and 25 were before-and-after studies. The majority of studies (n = 43) examined 

outcomes in healthy populations (athletes, college and university students, workers, military, 

prisoners, and elderly). The remaining studies examined individuals with hypertension (6 

studies) and type II DM (4 studies). The main characteristics and conclusions of the individual 

studies included in the meta-analyses are provided in Appendix J.*

Table 41. Summary of outcomes by meditation practice by comparison group by population included in 

meta-analyses of physiological and neuropsychological effects of meditation practices 

Intervention Comparator Population Outcome No. of 

studies 

No control Healthy BP change (SBP) 2 

Healthy BP change (DBP) 2 

Healthy BP change (SBP) 3 

Healthy BP change (DBP) 3 

Healthy Cholesterol level 3 

NT 

Healthy Verbal fluency 2 

Healthy HR 2 

Healthy BP change (SBP) 2 

TM®

WL 

Healthy BP change (DBP) 2 

BF Healthy Muscle tension 2 

Healthy HR 3 

Healthy BP change (SBP) 2 

RR 

Rest 

Healthy BP change (DBP) 2 

Exercise Healthy BP change (DBP) 2 

Healthy HR 2 

Free breathing Healthy Verbal ability 2 

Healthy Spatial ability 2 

Medication Healthy VO2 2 

Type II DM Fasting blood glucose 2 

Healthy HR 7 

Hypertension HR 2 

Healthy BP change (SBP) 5 

Healthy BP change (DBP) 5 

Healthy Respiratory rate 3 

Healthy Galvanic skin resistance 2 

Yoga 

No control 

Type II DM Fasting glucose 2 

 

*

Appendixes and evidence tables cited in this report are provided electronically at http://www.ahrq.gov/clinic/tp/medittp.htm
161

BF = biofeedback; BP = blood pressure; DBP = diastolic blood pressure, DM = diabetes mellitus; HE = health education; HR = 

heart rate; NT = no treatment; RR = Relaxation Response; SBP = systolic blood pressure, ULNB = unilateral left nostril 

breathing; URNB = unilateral right nostril breathing; WL = wait list 

Table 41. Summary of outcomes by meditation practice by comparison group by population included in 

meta-analyses of physiological and neuropsychological effects of meditation practices (continued) 

Intervention Comparator Population Outcome No. of 

studies 

Healthy Fasting glucose 2 

Healthy Total cholesterol 2 

Healthy Breath holding time (inspiration) 3 

Healthy Breath holding time (expiration) 4 

Healthy Auditory reaction time 2 

Healthy Visual reaction time 2 

No control 

(continued) 

Healthy Intraocular pressure 2 

NT Healthy BP change (SBP) 2 

Yoga (continued) 

URNB Healthy HR 2 

Exercise Healthy BP change (SBP) 2 

Healthy BP change (DBP) 2 

Healthy HR 2 

Healthy BP change (SBP) 2 

No control 

Healthy BP change (DBP) 2 

Healthy HR 2 

Healthy BP change (SBP) 3 

Tai Chi 

NT 

Healthy BP change (DBP) 3 

Qi Gong No control Healthy HR 2 

Methodological Quality of Included Studies 

Intervention studies. The median Jadad score for the 20 RCTs was 2/5 (IQR, 1 to 2) (Table 

40). No trials were described as double blind and no studies were considered to have employed 

adequate concealment of treatment allocation. A description of withdrawals and dropouts was 

provided in 10 of the trials.278-287 Only five RCTs reported the source of funding.281,282,285,286,288

The median Jadad score for the eight NRCTs was 1/3 (IQR, 0 to 1). No NRCTs described 

themselves as double blind (blinding of participant and outcome assessor). Five trials provided a 

description of withdrawals and dropouts.289-293 Three NRCTs reported the source of 

funding180,181,293 (Table 42). 

Before-and-after studies. The overall methodological quality of the 25 included before-andafter studies was low (Table 43). Only one study294 was considered to have a study population 

representative of the population of interest. Twenty-five studies employed the same method of 

outcome assessment for pre and post periods; no studies reported blinding of outcome assessors. 

Two studies295,296 provided a description of withdrawals or dropouts; no studies provided reasons 

for withdrawals. Nine studies reported their source of funding.294,296-303
162

Table 42. Methodological quality of RCTs and NRCTs included in meta-analyses for physiological and neuropsychological effe

practices 

Randomization Double blinding 

Study Meditation practice Stated Method 

described 

Stated Method 

described 

Description of 

withdrawals and 

dropouts 

Overall 

Jadad 

score 

Allo

conc

Abrams AI, 

1978289

TM® No NA No NA Yes 1 Un

Agrawal RP, 

2003278 Yoga Yes Unclear No NA Yes 2 Inad

Alexander CN, 

1991279

TM® Yes Unclear No NA Yes 2 Inad

Bahrke MS, 

1978304 RR Yes Unclear No NA No 1 Inad

Block RA, 1989177 Yoga (UNB) Yes Unclear No NA No 1 InadBlumenthal JA, 

1991280 Yoga Yes Unclear No NA Yes 2 Inad

Bose S, 1987305 Yoga (Shavasana) Yes Unclear No NA No 1 InadBowman AJ, 

1997281 Yoga Yes Unclear No NA Yes 2 Inad

Broota A, 1995204 Yoga (Shavasana) Yes Unclear No NA No 1 InadChen WW, 

1997290

Tai Chi No NA No NA Yes 1 Un

Cooper MJ, 

1990291

TM® No NA No NA Yes 1 Un

Cuthbert B, 

1981306b 

RR No NA No NA No 0 Un

De Armond DL, 

1996292

TM® No NA No NA Yes 1 Un

Fields JZ, 2002282 TM® + herbal food 

supplements + diet + Yoga asanas 

Yes Adequate No NA Yes 3 Inad

Hoffman JW, 

1982283 RR Yes Unclear No NA Yes 2 Inad

Jin P, 1992307 Tai Chi Yes Unclear No NA No 1 InadNA = not applicable; RR = Relaxation Response; TM® = Transcendental Meditation®; UNB = unilateral nostril breathing
163

Table 42. Methodological quality of RCTs and NRCTs included in meta-analyses for physiological and neuropsychological effe

practices (continued) 

Randomization Double blinding 

Study Meditation practice 

Stated Method described Stated Method described 

Description of 

withdrawals and 

dropouts 

Overall 

Jadad 

score 

Allo

conc

Mohan SM, 

2002180 Yoga (UNB) No NA No NA No 0 Un

Monro R, 1992308 Yoga Yes Adequate No NA No 2 InadPeters RK, 

1977284 RR Yes Adequate No NA Yes 3 Inad

Pollak MH, 

1979288 RR Yes Unclear No NA No 1 Inad

Reddy KM, 

1990309

TM® Yes Unclear No NA No 1 Inad

Sanders B, 

1994181 Yoga (UNB) No NA No NA No 0 Un

Sun WY, 1996285 Tai Chi Yes Unclear No NA Yes 2 InadTelles S, 1994140 Yoga (UNB) Yes Unclear No NA No 1 InadThornton EW, 

2004286 Tai Chi Yes Unclear No NA Yes 2 Inad

Travis FT, 

1990293

TM® No NA No NA Yes 1 Un

Young DR, 

1999287 Tai Chi Yes Unclear No NA Yes 3 Inad

Zaichkowsky LD, 

1978191 RR Yes Adequate No NA No 1 Inad
164

Table 43. Methodological quality of before-and-after studies included in meta-analyses for physiological and neuropsychologipractices 

Study Meditation practice 

Study 

population 

representative 

Outcome method 

same for pre and 

post periods 

Blinding of 

outcome 

assessors 

Description of 

withdrawals/ 

dropouts 

R

Agarwal BL, 1990295

TM® No Yes No Yes 

Anantharaman 

RN, 1984310 Yoga (asanas + pranayama) No Yes No No 

Benson H, 1974311

TM® No Unsure No No 

Bhargava R 1988312 Yoga (pranayamas) No Yes No No Chen JC, 2004297 Yoga (UNB) No Yes No No Damodaran A, 2002294 Yoga (asanas + pranayamas) Yes Yes No No Jain SC, 1993298 Yoga No Yes No No Jones AY, 2005296

Tai Chi No Yes No Yes 

Jones BM, 2001299 Qi Gong No No No No Joseph S, 1981313 Yoga (prayer + asanas + pranayama + 

meditation) 

No Yes No No 

Joshi LN, 1992314 Yoga (pranayamas) No Yes No No Kocer I, 2002315 Yoga (UNB) No Yes No No Lim YA, 1993316 Qi Gong No Yes No No Liu S, 1996317

Tai Chi No Yes No No 

Madanmohan, 1992300 Yoga No Yes No No RR = Relaxation Response; TM® = Transcendental Meditation®; UNB = unilateral nostril breathing 
165

Table 43. Methodological quality of before-and-after studies included in meta-analysis for physiological and neuropsychologicpractices (continued) 

Study Meditation practice 

Study 

population 

representative 

Outcome method 

same for pre and 

post periods 

Blinding of 

outcome 

assessors 

Description of 

withdrawals/ 

dropouts 

Re

w

Malathi A, 1989318 Yoga (asanas + pranayamas) No Yes No No Manjunatha S, 2005301 Yoga No Yes No No Pollack AA, 1977319

TM® No Yes No No 

Raju PS, 1986320 Yoga (asanas + pranayamas) No Yes No No Schmidt TFH, 1994302 Yoga + meditation + vegetarian diet No Yes No No Singh S, 2004321 Yoga (asanas + pranayamas) No Yes No No Sung BH, 2002322 Yoga No Yes No No Telles S, 1993323 Yoga (asanas + pranayama + mantra 

meditation + lectures) 

No Yes No No 

Telles S, 199383 Raja Yoga No Yes No No Vijayalakshmi P, 2004303 Yoga (asanas + pranayamas) No Yes No No 
166

Transcendental Meditation® 

Ten studies assessing the physiological and neuropsychological effects of TM® were 

identified for meta-analysis: three RCTs,279,282,324 four NRCTs,289,291-293 and three before-andafter studies.295,311,319 Among the controlled studies, five studies compared TM® versus 

NT,279,282,291-293 and two compared TM® versus WL.289,309

TM® versus NT 

Blood pressure. Three studies282,291,292 totaling 132 participants (TM® = 67, NT = 65) 

provided data for a meta-analysis on the effects of TM® on blood pressure in healthy populations 

(Figure 28). The combined estimate of changes in SBP (mm Hg) showed a small, but 

nonsignificant improvement (reduction) in favor of NT (WMD = 0.93; 95% CI, -9.53 to 11.39). 

There was evidence of high heterogeneity among the studies regarding the mean change in SBP 

(p = 0.04, I2 = 69.7 percent). The studies differed in duration with two studies being longterm282,291 (10 and 12 months, respectively) and the remaining study292 being short-term (3 

months). A subgroup analysis indicated that for the long-term studies there was a nonsignificant 

improvement (reduction) in SBP favoring TM® (WMD = -5.24, 95% CI, -12.85, 2.37); for the 

short-term study, there was a statistically significant improvement favoring NT (Figure 28).

Figure 28. Meta-analysis of the effect of TM® versus NT on SBP 

The combined estimate of changes in DBP (mm Hg) indicated a small, but nonsignificant 

improvement (reduction) in favor of TM® (WMD = -1.63, 95% CI, -8.01 to 4.75) (Figure 29). 

There was evidence of high heterogeneity among the studies regarding the mean change in DBP 

(p = 0.04, I2 = 68.8 percent). As noted above, the studies differed in duration. A subgroup 
167

analysis indicated a statistically and clinically significant reduction in DBP in favor of TM® 

(WMD = -5.19, 95% CI, -10.24 to -0.13) in the long-term studies (Figure 29). 

Figure 29. Meta-analysis of the effect of TM® versus NT on DBP 

Cholesterol level. Three studies282,291,292 totaling 132 participants (TM® = 67, Nt = 65) 

provided data on the effects of TM® on LDL-C levels in healthy populations. The combined 

estimate of changes in LDL-C level (mg/dL) indicated a small, nonsignificant improvement 

(reduction) in favor of TM® (WMD = -15.08; 95% CI, -29.03 to -1.14). The results for the trials 

were homogeneous (p = 0.44, I2

 = 0 percent). However, because of the difference in duration of 

the studies noted above (two were long-term282,291 and one was short-term292), we conducted a 

subgroup analysis by duration of study (Figure 30). The long-term studies indicated a statistically 

significant improvement (reduction) in favor of TM® (WMD = -23.94; 95% CI, -43.87 to -4.00). 
168

Figure 30. Meta-analysis of the effect of TM® versus NT on cholesterol level 

Verbal fluency. Two studies279,293 totaling 117 participants (TM® = 66, NT = 51) provided 

data on the effects of TM® on verbal creativity in healthy populations (Figure 31). The combined 

estimate of changes in measures of verbal fluency showed a large, significant improvement 

(increase) in favor of TM® (SMD = -0.74; 95% CI, -1.12 to -0.36). The results of the combined 

studies were homogeneous (p = 0.73, I2 = 0 percent). 

Figure 31. Meta-analysis of the effect of TM® versus NT on verbal fluency 

TM® (no control) 

Blood pressure. Three before-and-after studies295,311,319 totaling 58 participants provided data 

on the effect of TM® on blood pressure (mm Hg) in hypertensive populations (Figure 32). The 

combined estimate of changes in SBP indicated a statistically and clinically significant 

improvement (reduction) favoring TM® (change from baseline = -10.95; 95% CI, -17.52 to -

4.39). There was substantial heterogeneity in the study results (p = 0.16; I2

 = 64.1 percent).

The combined estimate of changes in DBP also indicated a statistically and clinically 

significant improvement (reduction) favoring TM® (change from baseline = -6.86; 95% CI, -
169

10.54 to -3.19). There was moderate heterogeneity in the study results for DBP (p = 0.16; I2

 = 

46.3 percent). 

All three studies were of low methodological quality; moreover, the potential biases inherent 

in the before-and-after design may be responsible for the variability of results. Similar 

interventions, durations (not reported by Benson311), and study populations were used in the 

three studies. Though all three studies examined hypertensive patients, the baseline measures 

suggest that the DBP of participants in the Benson311 study (mean DBP 94 ± 9 mm Hg) was 

lower upon entrance to the trial than the other two studies (minimum 90 mm Hg). 

Figure 32. Meta-analysis of the effect of TM® (no control) on blood pressure 

TM® versus WL 

Heart rate. Two studies289,309 totaling 70 participants (TM® = 41, WL = 29) provided data on 

the effects of TM® on heart rate (bpm) in healthy populations (Figure 33). The combined 

estimate of changes in heart rate showed small, significant improvement (reduction) favoring 

TM® (WMD = -5.94; 95% CI, -11.54 to -0.35). The trial results were homogeneous (p = 0.73, I2

= 0 percent).

Figure 33. Meta-analysis of the effect of TM® versus WL on heart rate 

Blood pressure. The same two studies289,309 provided data on the effects of TM® on blood 

pressure in healthy populations (Figure 34). The combined estimate of changes in SBP (mm Hg) 

showed a small, significant improvement (reduction) favoring TM® (WMD = -8.74; 95% CI, -
170

17.47 to -0.02). There was moderate heterogeneity in the study results (p = 0.15; I2

 = 52.6 

percent). It is unclear what clinical differences among the study participants are responsible for 

the heterogeneity of this outcome. 

The combined estimate of changes in DBP (mm Hg) also showed a small, significant 

improvement (reduction) favoring TM® (WMD = -3.61; 95% CI, -6.62 to -0.59). There was little 

heterogeneity in the study results (p = 0.31; I2 = 4.6 percent). 

Figure 34. Meta-analysis of the effect of TM® versus WL on blood pressure 

Relaxation Response 

Six studies191,283,284,288,304,306b assessing the effect of RR on physiological and 

neuropsychological outcomes were identified for meta-analysis: five RCTs191,283,284,288,304 and 

one NRCT.306b Two studies compared RR versus BF191,306b and four compared RR versus 

rest.283,284,288,304

RR versus BF 

Muscle tension. Two studies306b,191 totaling 48 participants (RR = 24, BF = 24) provided data 

on the effect of RR on muscle tension (Figure 35). The combined results of changes in muscle 

tension (microvolts) indicated a small, nonsignificant change favoring RR (WMD = -1.28; 95% 

CI, -3.23 to 0.68). There was little heterogeneity in the study results (p = 0.29; I2 = 11.7 percent).

Figure 35. Meta-analysis of the effect of RR versus BF on muscle tension 
171

RR versus rest 

Heart rate. Three trials283,288,304 totaling 99 participants (RR = 45, rest = 44) provided data on 

the effect of RR on heart rate in healthy populations (Figure 36). The combined estimate of 

changes in heart rate (bpm) showed a significant improvement (reduction) favoring rest (WMD = 

2.56; 95% CI, 1.32 to 3.80). The study results were homogeneous (p = 0.70, I2

 = 0 percent).

Figure 36. Meta-analysis of the effect of RR versus rest on heart rate 

Blood pressure. Two studies283,284 totaling 109 participants (RR = 45, rest = 44) provided 

data on the effect of RR on blood pressure in healthy populations (Figure 37). The combined 

estimate of changes in SBP (mm Hg) indicated a small, nonsignificant improvement (reduction) 

favoring RR (WMD = -5.67; 95% CI, -12.76 to 1.42). There was evidence of moderate 

heterogeneity between the study results (p = 0.23; I2 = 31.6 percent). The combined estimates for 

DBP showed a small, nonsignificant improvement favoring RR (WMD = -6.98; 95% CI, -16.05 

to 2.09). There was evidence of considerable heterogeneity between the study results (p = 0.11; 

I

2

 = 60.5 percent). Both studies were short-term and similar in participant characteristics 

(proportion of males to females, healthy) and intervention. The most likely source of 

heterogeneity is study design (RCT284 versus NRCT283). 

Figure 37. Meta-analysis of the effect of RR versus rest on blood pressure 
172

Yoga 

Twenty-eight studies assessing the physiological and neuropsychological effect of Yoga were 

identified for meta-analysis: 8 RCTs,140,177,204,278,280,281,305,308 2 NRCTs,180,181 and 18 before-andafter studies.83,294,297,298,300-303,310,312-315,318,320-323 Four trials168,204,305,325 compared Yoga versus NT, 

two trials280,281 compared Yoga versus exercise, two177,181 compared Yoga versus free breathing 

(FB), two278,308 compared Yoga versus medication, and two140,180 compared Yoga (unilateral left 

nostril breathing [ULNB]) versus another Yoga intervention (unilateral right nostril breathing 

[URNB]). 

Yoga (no control) 

Heart rate. Seven before-and-after studies83,302,310,313,320,322,323 (17, 10, 12, 50, 25, 40, and 18 

participants, respectively) provided data on the effect of Yoga (no control) on heart rate (bpm) in 

healthy populations (Figure 38). The substantial heterogeneity among the study results (p < 

0.00001; I2

 = 95.9 percent) precluded reporting a combined estimate. Four of the seven studies 

indicated significant improvements (reduction) after practicing Yoga,302,310,313,323 whereas three 

did not favor the intervention.83,320,322

Figure 38. Meta-analysis of the effect of Yoga (no control) on heart rate 

Possible sources for the observed heterogeneity were explored. Two studies were very shortterm and reported study duration in number of sessions (one to six).83,322 The remaining five 

studies had a 3-month study period.302,310,313,320,323 The studies also differed in the frequency and 

length of intervention sessions: two studies reported sessions of less than 1 hour,83,322 two studies 

reported 1-hour sessions,313,320 two studies reported sessions of 4 hours,302,323 and one study310

did not report session length. Five studies were considered to have used composite 

interventions302,310,313,320,323 composed of some combination of postures, breathing techniques, 

cleansing practices, meditation, and lectures. Two studies were considered to have used single 

interventions; however, the two studies employed different techniques (breathing exercises322

and Raja meditation83). 

The age range of participants also varied, with the mean ages ranging from 25313 to 35 

years.322 Three studies included only men,83,313,323 one study included only women,310 two studies 
173

included both men and women in almost equal proportion,302,320 and one study failed to report 

the gender of participants.322

Two studies294,303 totaling 33 participants provided data on the effect of Yoga on heart rate in 

hypertensive populations (Figure 39). The combined estimate of changes in heart rate (bpm) 

showed a small, significant improvement (reduction) favoring Yoga (change from baseline = -

6.79; 95% CI, -9.97 to -3.60). There was evidence of moderate heterogeneity among the study 

results (p = 0.21, I2 = 35.6 percent). The possible sources of heterogeneity were explored. While 

the subjects in both studies were similar in mean age, the Vijayalakshmi study303 did not include 

women, whereas Damodaran294 had a male to female ratio of 1:4. The two studies also differed 

in quality with Damodaran294 having a study population considered representative of the 

population of interest, while Vijayalakshmi303 had a nonrepresentative study population. 

Figure 39. Meta-analysis of the effect of Yoga (no control) on heart rate in hypertensive populations 

Blood pressure. Five studies302,310,313,322,323 totaling 201 participants provided data on the 

effect of Yoga on blood pressure in healthy populations (Figure 40). The combined estimate of 

changes in SBP (mm Hg) indicated a small, significant improvement (reduction) favoring Yoga 

(change from baseline = -8.05; 95% CI, -14.01 to -2.09). There was evidence of substantial 

heterogeneity among the study results (p = 0.00001; I2

 = 89.1 percent). 

The combined estimate of changes in DBP (mm Hg) also indicated a small, significant 

improvement (reduction) favoring Yoga (change from baseline = -6.22; 95% CI, -7.73 to -4.70). 

The study results were homogeneous (p = 0.52; I2

 = 0 percent). 

The discrepancy between the measures of heterogeneity found for SBP and DBP is possibly 

accounted for by the difference in baseline measures. The participants in the Schmidt302 study 

had a combined SBP baseline noticeably higher (9 mm Hg from the next highest) than the those 

of the other studies, and it is unclear what clinical differences may be responsible for this 

difference in baseline measures. Other than baseline measures, the studies were comparable in 

study design, duration, and other participant characteristics. The baseline measures of DBP were 

similar across all groups. 
174

Figure 40. Meta-analysis of the effect of Yoga (no control) on blood pressure 

Respiratory rate. Three studies83,310,323 with 17, 40, and 18 participants respectively provided 

data on the effect of Yoga on respiratory rate in healthy populations (Figure 41). The 

heterogeneity among study results was substantial (p = 0.0001; I2 = 85.5 percent) and precluded 

combining the studies. The Telles study83 differed from the other two studies in duration and the 

type of yogic practice used. Anantharaman323 and Telles323 were short-term (3-month) studies 

using postures and breathing exercises. In contrast, Telles83 employed Raja yoga meditation 

(seated meditation with a fixed gaze) that lasted three sessions (approximately 1 week). 

Figure 41. Meta-analysis of the effect of Yoga (no control) on respiratory rate 

Galvanic skin resistance. Two studies83,323 totaling 58 participants provided data on the effect 

of Yoga on galvanic skin resistance in healthy populations (Figure 42). The combined estimate 

of changes in skin resistance (kilohms) indicated a nonsignificant difference favoring the “before 

Yoga” period (change from baseline = 3.12, 95% CI, -12.15 to 18.40). There was evidence of 

moderate heterogeneity between the study results (p = 0.24, I2

 = 27.2 percent). 
175

Figure 42. Meta-analysis of the effect of Yoga (no control) on galvanic skin resistance 

The possible sources of heterogeneity in the outcome of galvanic skin resistance were 

differences in the intervention, comparison period, and duration of study. One study323 used a 

multicomponent intervention that consisted of yogic postures, breathing exercises, meditation, 

cleansing exercises, and lectures. The comparison period preceded the learning of any yogic 

techniques, but was not fully described. The outcome measurements were taken at the end of a 3-

month period. The second study83 used a seated meditation technique in which participants fixed 

their gaze on a light and thought positive thoughts about a universal force. The nonmeditation 

period involved sitting quietly without targeted thinking; the outcome measures were assessed 

the day after the baseline measures. 

Fasting blood glucose (type II DM). Two studies,298,321 with 149 and 24 participants 

respectively, provided data on the effect of Yoga on levels of fasting blood glucose in 

populations with type II DM (Figure 43). The heterogeneity of the combined study results was 

too high (p = 0.001; I2 = 90.6 percent) to report an overall estimate. While both studies employed 

Yoga postures and breathing techniques, Jain298 employed two breathing techniques called 

“kapalbhati” (also described as a cleansing practice and a milder form of bhastrika119) and 

“ujjayi,” and a variety of postures and cleansing practices. Singh321 employed “bhastrika 

pranayama”(a breathing exercise) and postures, and did not use cleansing practices. In addition, 

while the Singh study used sessions of about 30 minutes duration, the daily sessions in the Jain 

study lasted 2.5 hours (1.5 hours in the morning and 1 hour in the evening). 

Figure 43. Meta-analysis of the effect of Yoga (no control) on fasting blood glucose (type II DM) 

Fasting blood glucose (healthy). Two studies301,313 totaling 30 participants provided data on 

the effect of Yoga on levels of fasting blood glucose in healthy populations (Figure 44). The 

study of Manjunatha301 provided data on the effect of four different sets of two asana techniques. 

For each of the sets, we pooled the results with the results from the Joseph313 study. Each of the 

combined estimates of change in blood glucose level (mg/dL) showed a small, nonsignificant 
176

improvement (reduction) favoring Yoga (change from baseline ranged from -3.64 [95% CI, -7.92 

to 0.64] to -3.81 [95% CI, -7.97 to 0.35]). There was no evidence of heterogeneity for any of the 

pooled results (p-values range from 0.37 to 0.47; I2

 = 0 percent). 

Figure 44. Meta-analysis of the effect of Yoga (no control) on fasting blood glucose 

Breath holding time. Four studies300,312,314,323 provided data on the effect of Yoga on breath 

holding time (seconds) in healthy populations. Three studies300,312,314 totaling 112 participants 

examined breath holding time after inspiration The combined results of changes indicated a large 

improvement (increase) after practicing Yoga (change from baseline = -18.85; 95% CI, -22.64 to 

-15.05). The study results were homogeneous (p = 0.49; I2

 = 0 percent). 

Four studies300,312,314,323 totaling 152 participants examined breath holding after exhalation. 

The combined results of changes indicated a large improvement (increase) after practicing Yoga 

(change from baseline = -14.53; 95% CI, -16.82 to -12.24). The study results were homogeneous 

(p = 0.87, I2

 = 0 percent) (Figure 45). 
177

Figure 45. Meta-analysis of the effect of Yoga (no control) on breath holding time after inspiration and 

expiration 

Auditory reaction time. Two trials,300,318 with 27 and 41 participants respectively, provided 

data on the effect of Yoga on auditory reaction time (milliseconds) (Figure 46). Though both 

studies found statistically significant results favoring Yoga, the results of the studies were too 

heterogeneous to report as a combined estimate (p = 0.0001; I2 = 94.1 percent). Possible sources 

of heterogeneity include characteristics of study participants and duration of the intervention. 

Madanmohan300 included men only with an age range from 18 to 21 years. Malathi318 included 

men only with an age range from 30 to 45 years. Both studies were short-term; however, the 

Madanmohan300 study had a duration of 12 weeks compared to six weeks for the Malathi 

study.318 Finally, participants in the Madanmohan300 study practiced Yoga for 30 minutes per 

day; those in the Malathi318 study practiced 1 hour per day. 

Figure 46. Meta-analysis of the effect of Yoga (no control) on auditory reaction time 

Visual reaction time. Two studies300,318 totaling 110 participants provided data on the effect 

of Yoga on visual reaction time (Figure 47). The combined estimate of change in visual reaction 

time (milliseconds) indicated a small, significant improvement (reduction) favoring Yoga 

(change from baseline = -36.06; 95% CI, -53.65 to -18.57). There was evidence of substantial 

heterogeneity between the study results (p = 0.03, I2

 = 79.4 percent). As noted in the previous 
178

section, the observed heterogeneity is possibly accounted for by differences in participant 

characteristics, study duration, and duration of practice. 

Figure 47. Meta-analysis of the effect of Yoga (no control) on visual reaction time 

Intraocular pressure. Two studies297,315 totaling 67 participants provided data on the effect of 

Yoga (unilateral nostril breathing [UNB]) on intraocular pressure in healthy populations (Figure 

48). The two studies assessed ipsi- and contralateral eye and nostril combinations. We did not 

pool the results of the studies because the outcomes were measured under different conditions, 

which may have resulted in the observed heterogeneity. Chen297 took before and after measures 

while the study participants were at rest. Kocer315 took baseline measures while participants were 

resting; the “after” measures were taken during exercise. Kocer315 reported a statistically 

significant change favoring UNB for all eye/nostril combinations. In contrast, Chen297 reported a 

nonsignificant change favoring no UNB for left nostril breathing. For right nostril breathing, the 

results favored UNB; however, only the right nostril/right eye combination was statistically 

significant. 
179

Figure 48. Meta-analysis of the effect of Yoga (no control) on intraocular pressure 

Yoga versus exercise. 

Heart rate. Two trials280,281 totaling 91 participants provided data on the effect of Yoga on 

heart rate in healthy populations (Figure 49). The combined estimate of changes in heart rate 

(bpm) indicated a small, nonsignificant improvement (reduction) favoring Yoga (WMD = -1.39; 

95% CI, -8.24, 5.47). There was evidence of high heterogeneity between the study results (p = 

0.10, I2

 = 62.6%). The heterogeneity is possibly accounted for by the difference in study 

duration. Blumenthal280 was a short-term study (6 weeks) that found statistically nonsignificant 

results favoring exercise and Bowman281 was a long-term study (14 months) that found 

statistically nonsignificant results favoring Yoga.

Figure 49. Meta-analysis of the effect of Yoga versus exercise on heart rate 

Oxygen consumption. Two studies280,281 totaling 91 patients provided data on the effect of 

Yoga on oxygen consumption in healthy populations (Figure 50). The combined estimate of 

changes in VO2 max (ml/kg/min) indicated a small, nonsignificant improvement (increase) 

favoring exercise (WMD = 1.91; 95% CI, -0.48 to 4.31). The study results were homogeneous (p 

= 0.81, I2 = 0%). 
180

Figure 50. Meta-analysis of the effect of Yoga versus exercise on oxygen consumption (VO2 max) 

Yoga versus free breathing. 

Verbal ability. Two studies177,181 totaling 104 participants (Yoga = 52, free breathing = 52) 

provided data on the effect of Yoga, specifically, unilateral left and right nostril breathing 

(ULNB, URNB), on verbal ability based on a consonant-vowel matching task (Figure 51). For 

ULNB, the combined estimate of changes in verbal ability (score) indicated a small, 

nonsignificant improvement (increase) favoring free breathing (WMD = 0.26; 95% CI, -1.96 to 

2.47). There was evidence of moderate heterogeneity between the study results (p = 0.18; I2 = 

44.8 percent).

For URNB, the combined estimate of changes in verbal ability (score) indicated a small, 

nonsignificant improvement (increase) favoring free breathing (WMD = 1.50; 95% CI, -1.37 to 

4.37). There was evidence of substantial heterogeneity between the study results (p = 0.10; I2 = 

62.2 percent). A possible source of heterogeneity may be study design. Block177 used an RCT 

design while Sanders181 employed an NRCT design and found statistically nonsignificant results 

favoring Yoga. Both studies were of low methodological quality. Lack of reporting prevented 

further exploration of sources of heterogeneity related to participant characteristics, and study 

duration. 

Figure 51. Meta-analysis of the effect of Yoga (ULNB) versus free breathing on verbal ability 
181

Spatial ability. Two studies177,181 totaling 104 participants (Yoga = 52, free breathing = 52) 

provided data on the effect of Yoga, specifically (ULNB and URNB) on measures of spatial 

ability (Figure 52). For ULNB, the combined measures of spatial ability (score) indicated a 

nonsignificant improvement (increase) favoring free breathing (SMD = 0.05; 95% CI, -0.34 to 

0.43). The study results were homogeneous (p = 0.95; I2

 = 0 percent). 

For URNB, the combined estimate of change in measures of spatial ability indicated a 

nonsignificant improvement (increase) favoring free breathing (SMD = 0.24; 95% CI, -

0.15 to 0.63). The study results were homogeneous (p = 0.53; I2

 = 0 percent). 

Figure 52. Meta-analysis of the effect of Yoga (ULNB and URNB) versus free breathing on spatial ability 

Yoga versus NT 

Blood pressure. Two studies204,305 totaling 79 participants (Yoga = 40, NT = 39) provided 

data on the effect of Yoga (Shavasana) on blood pressure in healthy populations (Figure 53). The 

combined estimate of change in SBP (mm Hg) indicated a small, nonsignificant improvement 

(reduction) favoring Yoga (WMD = -8.10; 95% CI, -16.94 to 0.74). The study results were 

homogeneous (p = 0.88; I2

 = 0 percent).

The combined estimate of changes in DBP (mm Hg) also indicated a small, nonsignificant 

improvement (reduction) favoring Yoga (WMD = -6.09; 95% CI, -16.83 to 4.64). The study 

results were homogeneous (p = 0.98; I2

 = 0 percent). 
182

Figure 53. Meta-analysis of the effect of Yoga (shavasana) versus NT on blood pressure 

Yoga versus medication 

Fasting blood glucose. Two studies,278,308 with 154 (Yoga = 82, medication = 72) and 21 

(Yoga = 11, medication = 10) participants respectively, provided data on the effect of Yoga on 

fasting blood glucose in populations with type II DM (Figure 54). The heterogeneity between the 

results was too high to report a combined result (p < 0.00001; I2 = 96.2 percent). The results of 

Agrawal278 indicated a large, significant improvement (reduction) favoring Yoga (mean 

difference = -32.07; 95% CI, -43.57 to -20.57). The results of Monro308 showed a smaller, but 

still significant improvement (reduction) favoring Yoga (mean difference = -1.80; 95% CI, -3.26 

to -0.34).

Possible sources of heterogeneity are differences in the proportion of males and females 

included in the studies and the complexity of the interventions. Agrawal278 had a proportion of 

males to females of approximately 1:1 and Monro308 had a proportion of approximately 2:1. In 

addition, the Agrawal study278 used a complex intervention consisting of Yoga asanas, diet 

modification, aerobic exercise, and HE, whereas the Monro study308 used a standard set of 

postural, breathing, and relaxation exercises. 

Figure 54. Meta-analysis of the effect of Yoga versus medication on fasting blood glucose 

Yoga (ULNB) versus Yoga (URNB). 

Heart rate. Two studies140,180 totaling 74 participants (ULNB = 37, URNB = 37) provided 

data on the effect of Yoga (ULNB) on heart rate in healthy populations (Figure 55). The 

combined estimate of changes in heart rate (bpm) showed a small, nonsignificant improvement 

(reduction) favoring ULNB (WMD = -2.12; 95% CI, -4.41, 0.17). The study results were 

homogeneous (p = 0.43; I2

 = 0 percent)
183

Figure 55. Meta-analysis of the effect of Yoga (ULNB) versus URNB on heart rate 

Tai Chi 

Seven studies assessing the physiological and neuropsychological effect of Tai Chi were 

identified for meta-analysis: four RCTs,285-287,307 one NRCT,290 and two before-and-after 

studies.296,317 Four studies compared Tai Chi to NT,285,286,290,326 and two compared Tai Chi versus 

exercise.287,307

Tai Chi versus NT 

Heart rate. Two studies,285,290 with 28 (Tai Chi = 18, NT = 10) and 20 (Tai Chi = 10, NT = 

10) participants respectively, provided data on the effect of Tai Chi on resting heart rate in 

healthy, elderly populations (Figure 56). The heterogeneity in the study results was too high to 

report a combined result (p = 0.002; I2 = 89.2 percent). The results of Chen290 indicated a small, 

nonsignificant change favoring Tai Chi (mean difference 

= -0.70; 95% CI, -1.50 to 0.09). In contrast, Sun285 showed a larger, significant improvement 

(reduction) favoring NT (mean difference = 1.26; 95% CI, 0.28 to 2.24).

The opposite direction of effect between the two studies is possibly a result of the study 

design, frequency of practice, or complexity of the intervention. Chen290 used an NRCT design, 

while Sun285 conducted an RCT. In addition, the participants in the Chen study practiced a Tai 

Chi program of 24 forms for 1 hour twice weekly. The participants in the Sun study285 practiced 

2 hours once a week and incorporated HE and stress management techniques in addition to a Tai 

Chi program. 

Figure 56. Meta-analysis of the effect of Tai Chi versus NT on heart rate 

Blood pressure. Three studies285,286,290 with 28 (Tai Chi = 18, NT = 10), 20 (Tai Chi = 10, NT 

= 10), and 34 (Tai Chi = 17, NT = 17) participants respectively provided data on the effect of Tai 

Chi on blood pressure in healthy populations (Figure 57). The results were too heterogeneous to 

report as a combined estimate (p = 0.001, I2

 = 94.5%). The results of the Chen290 study showed a 
184

small, nonsignificant improvement (reduction) favoring Tai Chi (mean difference = -0.69; 95% 

CI, -11.72 to 10.34). Sun285 indicated a moderate, significant improvement (reduction) favoring 

NT (mean difference = 5.20; 95% CI, 3.73 to 6.67), and the results of Thornton286 showed a 

moderate, significant improvement (reduction) favoring Tai Chi (mean difference = -7.70; 95% 

CI, -11.65 to 

-3.75). 

The heterogeneity in results for changes in DBP (mm Hg) also precluded reporting a 

combined estimate (p = 0.00001; I2 = 98%). Chen290 reported a small, nonsignificant 

improvement (reduction) favoring Tai Chi (mean difference = 0.44; 95% CI, -5.03 to 5.91). 

Sun285 reported a moderate, significant improvement (reduction) favoring NT (mean difference = 

5.20; 95% CI, 4.23 to 6.17), and the results of Thornton286 showed a moderate, significant 

improvement (reduction) favoring Tai Chi (mean difference 

= -8.50; 95% CI, -11.00 to -6.00). 

The possible sources of heterogeneity are the age of the study participants and the frequency 

of practice. While Thornton286 used healthy volunteers between the ages of 33 to 55 years (mean 

age 48 years), Sun285 employed healthy elderly participants over 60 years of age. The Chen290

study used participants between the ages of 50 and 74 years. The Sun285 and Thornton286 studies 

used a similar frequency and form of Tai Chi intervention (two to three times per week, 108 

forms), while the Chen290 study employed only one Tai Chi session per week and did not 

describe the number of forms or Tai Chi style used. 

Figure 57. Meta-analysis of the effect of Tai Chi versus NT on blood pressure 

Tai Chi versus exercise 

Blood pressure. Two RCTs287,307 totaling 110 participants (Tai Chi = 55, exercise 

= 55) provided data on the effect of Tai Chi on blood pressure in healthy populations (Figure 58). 

The combined estimate of changes in SBP (mm Hg) showed a moderate, nonsignificant 

improvement (reduction) favoring exercise (WMD = 1.79; 95% CI, -0.82 to 4.41). There was 

evidence of low heterogeneity between the studies regarding the mean change in SBP (p = 0.28; 

I

2

 = 14.7 percent).

The combined estimate of changes in DBP (mm Hg) showed a small, significant 

improvement (reduction) favoring exercise (WMD = 0.83; 95% CI, 0.18 to 1.48). There was 

evidence of low heterogeneity between the studies regarding the mean change in DBP (p = 0.32; 

I

2

 = 0.8 percent). The heterogeneity is possibly accounted for by the difference in the ages of the 

participants, and the frequency and duration of the intervention. Jin307 used healthy volunteers 

with a mean age of 36 years; Young287 used healthy elderly participants with a mean age of 67 

years. The Jin study employed two 
185

1-hour Tai Chi sessions, whereas the Young study lasted 12 weeks and had four 

30-minute sessions of Tai Chi per week. 

Figure 58. Meta-analysis of the effect of Tai Chi versus exercise on blood pressure 

Tai Chi (no control) 

Heart rate. Two studies296,317 totaling 74 participants provided data on the effect of Tai Chi 

on heart rate in healthy populations (Figure 59). The combined estimate of changes in heart rate 

(bpm) indicated a small, nonsignificant improvement (reduction) favoring Tai Chi (change from 

baseline = -2.34; 95% CI, -5.29 to 0.60). There was evidence of heterogeneity between the 

studies (p = 0.09, I2

 = 65 percent). A possible source of heterogeneity is the difference in the age 

of study participants. The mean age of participants in Jones296 was 53 ± 10 years; the mean age 

of participants in Liu317 was 22 ± 3 years. Liu317 did not report the frequency or complexity of 

the intervention used, so the studies could not be compared for these variables.

Figure 59. Meta-analysis of the effect of Tai Chi (no control) on heart rate 

Blood pressure. Two studies296,317 totaling 74 participants provided data on the effect of Tai 

Chi on blood pressure in healthy populations (Figure 60). The combined estimate of changes in 

SBP (mm Hg) indicated a small, nonsignificant improvement (reduction) favoring Tai Chi 

(change from baseline = -3.35; 95% CI, -7.55 to 0.85). There was evidence of heterogeneity 

between the studies regarding change from baseline (p = 0.12; I2

 = 57.7 percent). 
186

The combined estimate of changes in DBP (mm Hg) also showed a small, nonsignificant 

improvement (reduction) favoring Tai Chi (change from baseline = -0.93; 95% CI, -3.31 to 

1.44). The study results were homogeneous (p = 0.41, I2

 = 0 percent). Though there were 

differences between the studies regarding the age of participants (mean ages respectively 53 ± 10 

years and 22 ± 3 years) and proportion of males to females (1:5 and 1:1), it is unlikely that these 

are the sources of the discrepancy in the measures of heterogeneity for SBP and DBP results. As 

a result, it is unclear what clinical differences may be responsible for the discrepancy. 

Figure 60. Meta-analysis of the effect of Tai Chi (no control) on blood pressure 

Qi Gong 

Two before-and-after studies that assessed the effect of Qi Gong on physiological outcomes 

were identified.191,299

Qi Gong (no control) 

Heart rate. Two studies191,299 totaling 29 participants assessed the effect of Qi Gong on heart 

rate in healthy populations (Figure 61). The combined estimate in changes in heart rate (bpm) 

indicated a small, nonsignificant improvement (reduction) after practicing Qi Gong (change from 

baseline = -1.21; 95% CI, -6.18 to 3.76). The study results were homogeneous (p = 0.79, I2

 = 0 

percent).
187

Figure 61. Meta-analysis of the effect of Qi Gong (no control) on heart rate 

Summary of the Results 

Overall, 311 studies evaluated the physiological and neuropsychological effects of 

meditation practices. The majority of studies used an RCT design (54 percent) and Yoga was the 

most common intervention (35 percent) that was studied. The overall methodological quality of 

all studies was low with only one study168 considered high quality. The majority of studies were 

of short and medium duration. 

Data from 53 studies (20 RCTs, 8 NRCTs, 25 before-and-after) were considered for direct 

meta-analysis to provide an evaluation of the effects of TM®, RR, Yoga, Tai Chi, and Qi Gong. 

The intervention groups were compared variously against BF, exercise, free breathing, 

medication, NT, WL, and UNB. Outcomes suitable for meta-analysis included blood pressure 

(SBP and DBP), heart rate, total cholesterol, respiratory rate, fasting blood glucose, and galvanic 

skin resistance. The majority of studies used healthy participants (45 studies) as the comparison 

group; people with type II DM and with essential hypertension comprised the only other study 

populations (six studies and four studies, respectively). All results below apply to healthy 

populations unless otherwise indicated. 

Transcendental Meditation®

Direct meta-analysis showed that compared to NT, TM® did not produce significantly greater 

benefits on blood pressure (SBP and DBP). However, there was significant improvement in 

LDL-C levels and verbal creativity with TM®. When compared to WL, TM® produced 

significantly greater reduction in SBP and DBP. Before-and-after studies on TM® for patients 

with essential hypertension indicated a statistically significant reduction in SBP and DBP after 

practicing TM®. The heterogeneity present for the comparisons evaluating blood pressure 

changes and cortisol levels suggests that there were important clinical differences among the 

studies; however, the small number of studies precluded subgroup analyses.
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Relaxation Response 

The results of meta-analysis showed that compared to BF, RR did not produce significantly 

greater reduction in muscle tension. When RR was compared to a condition of rest, the rest 

group showed a significantly greater reduction in heart rate. 

Yoga 

When compared to NT, Yoga did not show a significantly greater benefit in lowering SBP or 

DBP. When compared to exercise, Yoga did not significantly lower heart rate or increase oxygen 

consumption. Compared to URNB, ULNB showed no significantly greater benefit in reducing 

heart rate. 

When compared to free breathing, Yoga (UNB) showed no statistically or clinically 

significant benefit in improving verbal or spatial ability test scores. Finally, when examined 

using a before-and-after design, practicing Yoga did not demonstrate a significant benefit 

decreasing heart rate. There was also no significant benefit for Yoga in increasing galvanic skin 

resistance, reduction of intraocular pressure, and reduction of fasting blood glucose in healthy 

populations. There was varied heterogeneity among studies combined for heart rate, respiratory 

rate, galvanic skin resistance, and intraocular pressure, suggesting important clinical differences 

among the studies. 

Before-and-after studies showed a significantly greater benefit after practicing Yoga in 

reducing heart rate in hypertensive populations. In healthy populations, practicing Yoga 

demonstrated a significant benefit in reducing DBP. There was also indication that Yoga has 

significantly greater benefit in increasing breath holding time after inspiration and expiration, in 

decreasing visual reaction time, and in the reduction of intraocular pressure (two of four 

outcomes). There was varied heterogeneity between studies combined for heart rate in 

hypertensive patients, SBP, and fasting blood glucose in patients with type II DM, suggesting 

important clinical differences between the studies. The heterogeneity present in the results 

examining respiratory rate, auditory reaction time, intraocular pressure (two of four outcomes), 

and fasting blood glucose prevented calculating an overall estimate of effect and suggested 

important clinical differences between the studies. 

Tai Chi 

The results of studies that compared Tai Chi to NT were too heterogeneous to provide 

combined estimates for the effect of Tai Chi on heart rate and blood pressure. In addition, the 

small number of studies precluded a subgroup analysis. 

When compared to exercise, Tai Chi showed no significantly greater reduction in SBP, but 

did indicate a significant benefit in the reduction of DBP. In before-and-after studies, there was 

no significantr reduction in heart rate, SBP and DBP after practicing Tai Chi than before. 

Substantial heterogeneity was also present in this comparison and, as with NT, a lack of studies 

prevented a subgroup analysis. 
189

Qi Gong 

Qi Gong did not significantly reduce heart rate in elderly populations, nor did it significantly 

reduce SBP and DBP in healthy populations. 

There were 22 outcome measures on the physiological and neuropsychological effects of 

meditation practices for which a combined estimate could be produced with little or no statistical 

heterogeneity. The comparisons, overall effect estimate, and statistical and clinical significance 

of each is outcome is summarized in Table 44. 

Statistically and clinically significant changes in healthy participants were produced by TM® 

for heart rate, DBP, and LDL-C (TM® versus NT), and for SBP and DBP (TM® versus WL). The 

increase in verbal creativity (SMD = 0.74; TM® versus WL) is also statistically significant, but it 

is unlikely that this change would be clinically meaningful. In contrast, the change in SBP (TM®

versus NT) was not statistically significant; however, the effect estimate suggests a clinically 

meaningful reduction of 5.24 mm Hg. When compared to rest, RR was more effective at 

reducing heart rate. However, though statistically significant, the change suggested by the overall 

effect estimate is unlikely to be clinically meaningful. 

Statistically and clinically meaningful changes were produced in healthy participants by the 

practice of Yoga for breath holding (18 and 14 breaths/minute) and DBP 

(-6.22 mm Hg). There was a significant reduction in heart rate in hypertensive patients 

(-7 bpm); however, the clinical significance of this change depends on the baseline measures of 

the population for which the intervention is being considered. All the changes described above 

were observed in studies using a before-and-after design, a design that is unable to control for a 

host of extraneous variables that may bias the study results (e.g., temporal trends, regression to 

the mean, and sensitivity to design parameters) and potentially overestimate the effect of the 

intervention. Therefore, any causal claim about the effect of the intervention should be 

considered in light of these methodological shortcomings and caution should be exercised when 

interpreting these results. 

The overall effects of Yoga based on RCTs and NRCTs indicate that this practice does not 

produce significant changes in healthy populations in oxygen consumption, spatial ability, SBP, 

DBP, or fasting glucose. 

When Tai Chi was compared to exercise, there was a statistically significant reduction in 

DBP; however, the change was not clinically significant (0.83 mm Hg). No significant change 

was observed in SBP. Before-and-after studies on Tai Chi did not indicate a clinically significant 

change in either SDP or DBP; however, these results should be interpreted in light of the 

stronger evidence available from the two combined RCTs. Likewise, no statistically or clinically 

significant changes in heart rate were produced by the practice of Qi Gong. Nevertheless, this 

result is based on before-and-after studies and the result should be considered carefully in light 

of the methodological difficulties described previously. 

Finally, the low methodological quality of all the studies included in the meta-analysis is an 

additional cause for interpreting all the results described here with caution. 
190

Table 44. Summary of statistical and clinical significance of physiological outcomes examined in clinical 

studies on meditation practices 

Comparison Outcome Statistical significance Clinical significance 

SBP Medium and long term 

WMD = -5.24; 95% CI, -12.85 to 2.37 

TM®

 no better than NT

Yes 

DBP Medium and long term 

WMD = -5.19; 95% CI, -10.24 to -0.13 

TM®

 better than NT

Yes 

LDL-C levels Long term 

WMD = -23.94; 95% CI, -43.87 to -4.00 

TM®

 better than NT

Potentially, 

depending on initial 

LDL level and risk 

factors 

TM® versus NT 

Verbal creativity SMD = -0.74; 95% CI, -1.12 to -0.36 

TM® better than NT

No 

Heart rate WMD = -5.94; 95% CI, -11.54 to -0.35 

TM®

 better than WL 

TM Potentially ® versus WL 

DBP WMD = -3.61; 95% CI, -6.62 to -0.59 

TM®

 better than WL

No 

DBP = diastolic blood pressure; LDL-C = low-density lipoprotein cholesterol; NT = no treatment; RR = Relaxation Response; 

SBP = systolic blood pressure; SMD = standardized mean difference; TM® = Transcendental Meditation®; ULNB = unilateral 

left nostril breathing; URNB = unilateral right nostril breathing; WL = waiting list; WMD = weighted mean difference 
191

Table 44. Summary of statistical and clinical significance of physiological outcomes examined in clinical 

studies on meditation practices (continued) 

Comparison Outcome Statistical significance Clinical significance 

RR versus rest Heart rate WMD = 2.56; 95% CI, 1.32 to 3.80 

RR not as good as rest No 

Yoga versus 

exercise 

Oxygen 

consumption 

WMD = 1.91; 95% CI, -0.48 to 4.31 

Yoga no better than exercise 

No 

Yoga versus Free 

breathing 

Spatial ability Left nostril: SMD = 0.24; 95% CI, -0.34 to 0.43 

Right nostril: SMD = 0.05; 95% CI, -0.34 to 0.43 

Yoga no better than free breathing 

No 

Yoga versus NT SBP WMD = -8.10; 95% CI, -16.94 to 0.74 

Yoga no better than NT 

Yes 

 DBP WMD = -6.09; 95% CI, -16.83 to 4.64 

Yoga no better than NT 

Yes 

Yoga (ULNB) 

versus URNB 

Heart rate WMD = -2.12; 95% CI, -4.41 to 0.17 

Yoga (ULNB) no better than URNB 

No 

Breath holding 

time after 

inspiration 

Change from baseline = -18.85; 95% CI, -22.64 to –

15.05 

Significant change after practicing Yoga 

Potentially 

Breath holding 

time after 

expiration 

Change from baseline = -14.53; 95% CI, -16.82 to -

12.24 

Significant change after practicing Yoga 

Potentially 

Yoga (no control) 

Heart rate 

(hypertensives) 

Change from baseline = -6.79; 95% CI, -9.97 to -3.60 

Significant change after practicing Yoga 

No 

Fasting blood 

glucose 

(healthy) 

I: Change from baseline = -3.71; 95% CI, -7.52 to 

0.11 

II: Change from baseline = -3.77; 95% CI, -7.80 to 

0.27 

III: Change from baseline = -3.64; 95% CI, -7.92 to -

0.64 

IV: Change from baseline = -3.81; 95% CI, -7.97 to -

0.35 

No significant change after practicing Yoga 

No 

DBP Change from baseline = -6.22; 95% CI, -7.73 to -

4.70 

Significant change after practicing Yoga 

Yes 

SBP (WMD = 1.79; 95% CI, -0.82, 4.41 

Tai Chi no better than exercise 

Tai Chi versus No 

exercise 

DBP (WMD = 0.83; 95% CI, 0.18 to 1.48) 

Tai Chi better than exercise 

No 

SBP Change from baseline = -3.35; 95% CI, -7.55 to 

0.85) 

No significant change after practicing Tai Chi 

Tai Chi (no control) No 

DBP (Change from baseline = -0.93; 95% CI, -3.31 to 

1.44) 

No significant change after practicing Tai Chi 

No 

Qi Gong (no control) Heart rate Change from baseline = -1.21; 95% CI, -6.18 to 3.76 

No significant change after practicing Qi Gong 

No 
193

Chapter 4. Discussion 

The Practice of Meditation 

Five broad categories of meditation practices were identified in the included studies: Mantra 

meditation (comprising TM®, RR, and CSM), Mindfulness meditation (comprising Vipassana, 

Zen Buddhist meditation, MBSR, and MBCT), Yoga, Tai Chi, and Qi Gong. One of the 

objectives of this review was to provide a descriptive overview and synthesis of information on 

meditation practices in terms of their main components, the role of spirituality, training 

requirements, and criteria for success. It is important to emphasize that the review on Topic I 

does not constitute a manual for any meditation practice. A more detailed explanation of any 

specific meditation practice described in this report should be sought in specialized texts or from 

master practitioners. 

Given the variety of the practices and the fact that some are single entities (TM®, RR, and 

CSM, Vipassana) while others are broad categories that encompass a variety of different 

techniques or combination of practices (Yoga, Tai Chi, Qi Gong, MBSR, and MBCT), it is 

impossible to select components that might be considered universal or supplemental across 

practices. Though some statement about the use of breathing is universal among practices, this is 

not a reflection of a common approach toward breathing. The control of attention is putatively 

universal; however, there are at least two aspects of attention that might be employed and a wide 

variety of techniques for anchoring attention. The spiritual or belief component of meditation 

practices is poorly described in the literature and it is unclear in what way and to what extent 

spirituality and belief play a role in successful practice. The amount of variation in the described 

frequency and duration of practice make it difficult to draw generalizations about the training 

requirements for meditation practices. The criteria for successful meditation have also not been 

described well in the literature, though this may reflect the attitude that meditation is successful 

if one simply does it. At a clinical level, it might be argued that meditation is successful if it 

produces positive outcomes. 

Demarcation 

Providing a comprehensive review and summary of the scientific research on meditation 

practices requires the development of appropriate criteria by which to distinguish meditation 

practices from nonmeditation practices (what Ross327 has called a “demarcation criterion”). The 

development of such criteria is one of the most difficult yet important components of research on 

meditation practices,12 yet there is currently no consensus on a definition of meditation12

 or on a 

way to classify the variety of meditation practices.12,37 Researchers have attempted to identify the 

components essential to the practice of meditation and to classify meditation practices in various 

ways: 

• any procedure that uses: (1) a specific, clearly defined technique, i.e., a “recipe” for 

meditation; (2) muscle relaxation in some moment of the process; (3) “logic relaxation”; (4) a 

self-induced state; and (5) a “self-focus” skill, or anchor;9
194

• a discrete and well defined experience of “thoughtless awareness.12,125 Techniques that fail to 

provide the key experience of mental silence or thoughtless awareness, including techniques 

that use constant repetition of syllables, visualizations, or other thought forms are considered 

“quasi-meditation;12

• techniques that seem to restrict awareness to a single, unchanging source of stimulation for a 

definite period of time;328

• an exercise in which the individual turns attention or awareness to dwell upon a single object, 

concept, sound, image, or experience, with the intention of gaining greater spiritual or 

experiential and existential insight, or of achieving improved psychological well-being;34 and 

• a family of self-regulation practices that focus on training attention and awareness in order to 

bring mental processes under greater voluntary control and thereby foster general mental 

well-being and development and/or specific capacities such as calm, clarity, and 

concentration.10

Even if most investigators would agree that meditation implies a form of mental training that 

requires either stilling or emptying the mind to achieve a state of “detached observation,” few 

seem to consider this a sufficient demarcation criterion. Also, the general definitions offered 

above appear to be too narrow, excluding awareness-based forms of meditation such as 

Vipassana, MBSR, MBCT, and Zen Buddhist meditation. 

Definitions usually focus on the phenomenological aspects of meditation practice and, with 

the exception of Cardoso et al.,9

 rarely describe the necessary practical and physical components 

in sufficient detail to be translated into an operational definition of meditation. Further, though 

some investigators believe that research has shown meditation to be clearly distinguished from 

relaxation,3 as Manocha12 notes, there is sufficient evidence to show that “quasi-meditation,” 

techniques that do not cultivate a state of mental silence, do not differ from rest in terms of their 

physiological effects. Such results, if valid, make the development of clear demarcation even 

more important. This review has not evaluated whether meditation is indeed different from 

relaxation. 

Whether defining meditation by one criterion or more, most investigators have looked for 

necessary and sufficient conditions with which to demarcate meditation practices from 

nonmeditation practices. Surprisingly, despite a persistent lack of consensus and the fact that 

demarcation criteria need not be bound by this approach,327 no author has examined alternative 

approaches to defining meditation despite some well-known developments in methods of 

demarcation in the philosophy of language329 and cognitive psychology,330 and more recent 

developments in ethics331 and evolutionary biology.332,333 Applying some of these techniques to 

meditation may prove fruitful. 

Classification 

To our knowledge, this is the first systematic examination of the components of and 

training for individual meditation practices.125 Classification of meditation practices is frequently 

based on the direction of attention,334 e.g., “opening up” versus “turning off,”328 positive versus 

negative,9

 mindful versus concentrative,3 directive versus nondirective,335 etc. However, it has 

been suggested that the concentrative forms should not be viewed as opposites to the mindful or 

negative forms, but as the first step toward a progressive refinement of attention and 
195

concentration.335 Several practices in Yoga and Qi Gong will fall into both categories. 

Meditation practices may also be classified according to their historical origins with Indian and 

Chinese forms constituting two groups and clinically-based practices another.334

We employed consensus techniques to develop an extensive, though not exhaustive, list of 32 

common meditation practices. The categories of meditation practices we have employed reflect 

only those practices identified in the English-language scientific literature and that satisfied the 

inclusion criteria for this review. There is a noticeable gap in the research that has been 

conducted on meditation practices—of the 32 practices identified in the Delphi process, only the 

10 described here (TM®, RR, CSM, Vipassana, Zen Buddhist meditation, MBSR, MBCT, Yoga, 

Tai Chi, and Qi Gong) have been assessed in trials or using a before-and-after design. It is 

unlikely that our literature search failed to uncover a broad category of practices, though we may 

have missed certain practices, for example, techniques purportedly used by indigenous peoples 

of North America.34 However, given the comprehensiveness of our literature search strategy, it is 

unlikely that such practices, if subjected to scientific inquiry, would have been missed. 

The categories are only meant to be descriptive and conclusions have not been made on the 

basis of the broad categories, but at the level of individual practices. Despite this, it may be that 

we have not sufficiently distinguished between schools of Tai Chi and style of Yoga and that 

distinct techniques have been subsumed under one category or class of practice. This lack of 

specificity will have affected the results of our analysis in cases where, for example, two styles 

of Tai Chi (e.g., Wu and Chang) have been combined. However, this potential limitation should 

serve to highlight the need for more explicit descriptions of techniques and the need for studies 

on a wide range of techniques for similar health conditions.336

The broad categories we have employed can be criticized as being simplistic and as ignoring 

subtle differences among practices. However, the categorization of practices is a product of the 

typological divisions one makes. For example, we have chosen to class together TM® and RR, 

even though some may argue that there are sufficient differences between these two mantra 

meditation techniques to keep them separate. In addition, though Benson’s68 original formulation 

of RR clearly falls within the category of mantra meditation, contemporary formulations of the 

technique are multifaceted and incorporate a body scan, which is a mindfulness meditation 

technique (Dr. Jeffrey Dusek, personal communication, December 2006). Some may contend 

that RR and TM® should not be classed together because during TM® one does not try to 

associate the mantra with the breath, or dissociate the breath from the mantra, but rather the 

mantra is favored. There may be other subtle differences between practices grouped together in 

the broad categories. The difficulty in categorizing practices and the dearth of detailed 

descriptions in the literature reinforce the need for detailed descriptions of all components of the 

interventions employed in efficacy and effectiveness studies. 

Universal Components of Meditation Practices 

The results of this review are similar to those of a study by Koshikawa et al.334 that examined 

the physical components of 12 different types of meditation practices (excluding Tai Chi and 

including Christian meditation practices, early Buddhist meditation, Ajikan meditation, and 

Hotei meditation) in order to determine what similarities, if any, existed among the practices. 

Using a survey methodology, the investigators questioned 12 experts (one for each type of 

meditation practice) regarding the environmental conditions required for practice, method of 
196

breathing, postures, body movement, use of mantra, object of attention, diet, and training 

requirements for mastery of the technique. Their results indicate that, though some meditation 

practices may share some features in common, no two practices are alike in all features and no 

features of practice are universal to them. 

Complexity 

The complexity of meditation practices makes dissecting components difficult and 

questionable; components may be synergistic and imperfectly understood if artificially separated 

from the whole discipline within which they take place.328 For example, though we have noted 

that no practice of a meditative technique requires the adoption of a particular belief system, 

West34 has questioned the reliance of researchers on clinically standardized forms of meditation 

practice rather than examining meditation as a practice that may be inextricably bound up with 

belief systems and expectations and ignoring the use of meditation as a central component of the 

belief system and of the day-to-day life of the practitioner. Other researchers have noted that the 

specific components adopted in a given meditation practice depend on the desired 

outcome,116,128,129,334 a fact which may make finding the common components across several 

practices undesirable unless the same outcome can be achieved. In addition, different techniques 

are reported to have different effects, so even if subjective descriptions of two or more 

techniques make them appear similar, their similarity must still be rigorously assessed. 

In addition, for some of the practices that involve movement (Tai Chi and some yogic and Qi 

Gong techniques), researchers face additional challenges in designing studies that can separate 

the effects of exercise from the effects of the meditation practice. As physical activity has been 

shown to produce beneficial effects in those same physiological and neuropsychological 

outcomes of interest in trials on meditation practices (e.g., blood pressure, mood, etc.), this type 

of research is particularly important if the benefits of meditation practices are to be accurately 

assessed. 

Criteria of Successful Meditation Practice 

No descriptions of meditation practices provided an explicit statement of the criteria for 

successful meditation practice beyond reference to the internal states of the practitioner. The 

criteria have generally been inferred from descriptions of the practice. For example, in TM® the 

practitioner attends a series of checkup meetings in which their technique is examined, implying 

that the adequacy of the technique is judged by an experienced practitioner. However, there is no 

statement that individual practitioners cannot assess the correctness of their technique themselves 

and no list of the components that an experienced teacher may be attending to in assessing the 

practice. The same is true of Zen Buddhist meditation. Because of this method, there may be 

some inconsistencies in the criteria for successful practice. However, this does not change the 

fact that there is a dearth of information on the determination of successful meditation practice 

and that this is an area in which future studies may improve. 
197

Training 

Some overviews of meditation practices328 have provided descriptions of the training 

requirements for meditation. However, these descriptions have focused mainly on TM®, Zen 

Buddhist meditation, and some yogic practices, and they fail to capture the wide range of 

training practices suggested by our literature review. In addition, poor descriptions of the 

physical aspects of the meditation techniques and the requisite training hinder identifying the 

components that may be similar across practices and limit the proper construction of and 

comparison between studies on the effectiveness of specific meditation practices. Without a 

detailed knowledge of, for example, an adequate training period for a particular Hatha yoga 

technique versus that for a Tai Chi technique, such studies are already confounded by factors 

pertaining to the learning of a technique and not the effects of the technique per se. In addition, 

some investigators334 have found that if, as Naranjo335 has observed, the development of the 

attitude specific to meditation is essential and the hardest part of meditation to attain and this can 

only be realized through practice, then proper instruction seems paramount and a description of 

the proper duration and frequency of any given technique is crucial to designing and appraising 

such studies. 

State of Research on the Therapeutic Use of Meditation 

Practices in Healthcare 

We have summarized a vast body of evidence regarding a broad group of practices 

categorized under the umbrella term “meditation”. Some may argue that addressing a research 

question regarding the effects of “meditation on healthcare” would be as challenging as reporting 

on the effects of “medication on healthcare” (Personal communication, David Shannahoff 

Khalsa, May 2007). There were substantial variations among the studies in the description of the 

practices of meditation, the type of controls, the type of populations, and the outcomes reported. 

The field of scientific research on meditation practices does not appear to be organized under 

a shared theoretical framework, but instead consists of distinct groups of investigators working 

within different approaches of treatment theory (e.g., physiological, cognitive, behavioral, and 

cognitive-behavioral) that fail to engage each other meaningfully.

The majority of studies on meditation practices identified in this review have been conducted 

in Western countries and published as journal articles within the past 15 years. The majority of 

research in meditation practices has been conducted as intervention studies (67 percent), with 49 

percent being RCTs or NRCTs. A similar bibliometric analysis on the clinical application of 

Yoga has revealed an increase in publication frequency over the past three decades with a 

substantial and growing use of RCTs.337

We identified and excluded from the review a considerable number of multiple publications 

(n = 108). In some instances, the same study was published in two separate journal articles 

without full cross reference, a practice of redundant publication that has been considered 

scientific misconduct.338-340 Including redundant publications in systematic reviews and metaanalyses increases the risk of overestimating the effect size. The problem of redundant 

publications has not yet been sufficiently explored in the scientific literature; therefore, it is 

unknown how the proportion of redundant publications in meditation research compares to other 
198

areas of scientific inquiry. Authors of future studies on meditation should avoid redundant 

publications and must adhere to guidelines for good publication practices.340

Quality of the Evidence 

Overall, we found the methodological quality of meditation research to be poor, with 

significant threats to validity in every major category of quality regardless of study design. 

Observational studies accounted for 33 percent of all the studies in the review. This type of study 

is open to several forms of systematic error such as selection bias, detection bias, and attrition 

bias. Intervention studies that used designs with pre-post treatment comparisons within the same 

group (known as single group before-and-after studies or uncontrolled trials) are not as rigorous 

as designs that use between-group comparisons because they do not allow investigators to 

determine whether the results are due to the meditation practice or to other factors. Studies with 

stronger designs such as RCTs and NRCTs allow a greater sense of confidence in study results; 

however, we found the quality of reporting to be poor for most of the intervention studies 

included in the review. This finding is not unique to the area of meditation research, and quality 

of reporting is a frequent problem in other areas of complementary and alternative medicine 

(CAM) research.341

The publication of the Consolidated Standards of Reporting Trials (CONSORT)342 statement 

in 1996 was aimed at the improvement of the quality of research reports of RCTs. It is unknown 

how the quality of reporting of RCTs of meditation practices has changed after the dissemination 

of CONSORT in the CAM community, but it is noteworthy that only 20 percent of the RCTs 

identified in the review described how the randomization was carried out, 8 percent were 

described as double-blind, and 4 percent described how they concealed the allocation. 

The lack of double-blind RCTs has been a controversial topic not only in meditation 

research, but also in other areas of CAM,343 surgical interventions,344 and behavioral 

treatments.345 Some authors have called for a “paradigm shift,” suggesting that the quality of 

CAM research should be evaluated by other methodological standards. Some commentators have 

argued that the placebo-controlled trial is not a valid or fair method for evaluating CAM 

treatments.346-348 Specifically, it is claimed that the scientific techniques oftreatment protocols, 

randomization, double-blind conditions, and use of placebo controls distort the "holistic" 

therapeutic milieu of CAM. However, the notion of “holistic” interventions as opposed to 

“conventional medicine” may be an artificial misconception. Just as CAM does, traditional 

interventions provide treatments within a symbolic healing context by using "nonspecific" 

therapeutic attention and expectations.349

There is little argument against the idea that RCTs provide the least biased method for 

finding a reliable answer on the effectiveness of any therapeutic intervention, including CAM 

practices such as meditation. Based on empirical evidence and theoretical considerations, there 

are some basic characteristics that should always be considered when evaluating the quality of an 

RCT: randomization, blinding, handling of patient attrition in the analysis, and allocation 

concealment.40,42,350,351

Some authors have supported the idea that “those who insist that the evidence to support 

complementary and alternative medicine can legitimately be softer than in mainstream medicine 

will have to reconsidertheir position. Double standards in medicine existed for many years; 

undoubtedly they still exist today, but hopefully their days are numbered.”352
199

Double-blinding of the instructor and participant to treatment in meditation studies is often 

infeasible, a consequence of the fact that instructors must apply a specially learned skill in a 

particular therapeutic context (e.g., with clinically depressed patients). However, double blinding 

is still possible because the difficulties in blinding the experimenter can be circumvented by 

blinding the participants using a sham procedure such as similar attention control intervention or 

a placebo with a different mode of administration (as it has been done in psychotherapy research) 

and by blinding them to the hypothesis, and by blinding the outcome assessors to the nature of 

the intervention and the hypothesis. In cases where the comparison is an active treatment and 

blinding of participants to the treatment is impossible, it may still be possible to blind 

participants to the research hypothesis to minimize expectancy bias. Therefore, research on CAM 

should adhere to the same methodological requirements for all clinical research, and randomized, 

placebo-controlled clinical trials should be used for assessing the efficacy of CAM treatments 

whenever feasible and ethically justifiable.353

When double blinding was assessed using an individual components approach, we found 

that, although the vast majority did not use double blinding to hide the identity of the assigned 

interventions (97 percent), a small but promising percentage reported the use of double-blind 

procedures. The idea that it is possible to design high-quality trials in meditation and implement 

double-blind procedures by selecting appropriate control groups is gaining support in meditation 

research. We agree with other researchers that the implementation of these trials in any area of 

CAM research, including meditation, require much more preparation than trials of 

pharmacological interventions, and components such as blinding procedures, selection of 

credible placebos, and consistency of inherently individualized interventions are challenging 

issues that need extensive evaluation.343

Our conclusion here is that the idea that “due to the nature of meditation, it is impossible to 

double blind meditation practices” has been used as an excuse to justify the overall low quality 

of research that characterizes this body of evidence. However, the over emphasis of the “doubleblinding” issue does not hide the fact that 95 percent of the studies failed to describe how they 

concealed the allocation to the interventions under study or the fact that overall, only 20 percent 

of the trials described the procedures of randomization, and that only half described study 

dropouts. 

Therefore, syntheses of the results from studies included in this review should be interpreted 

with caution due to the serious threats to theinternal validity of the included studies. 

Types of Interventions 

Although a relatively small group of meditation practices have been studied in the scientific 

literature, they vary in many respects. There was a remarkable heterogeneity across the studies 

regarding the description of the characteristics and implementation of the practice even within 

the same type of meditation. Differences in theoretical assumptions underlying the practices of 

meditation may explain why studies conducted on similar meditation practices often differed in 

the potential benefits that were assessed. Some authors have declared that meditation poses a 

considerable challenge for the principles of evidence-based medicine.17 Meditation is a complex 

and multifaceted intervention, difficult to standardize, and for which specific effects are hard to 

distinguish.17 It is important, therefore, that investigators make an effort to avoid the excessive 
200

heterogeneity that characterizes this field, by clearly defining and reporting the intervention 

procedures of the meditation practice under scrutiny. 

Types of Control Groups 

Control groups are essential for the valid evaluation of the effects of meditation practices; 

however, the problem of the inadequacy of control groups in meditation research is not new.354

Almost half of the RCTs and NRCTs have used WL or no treatment approaches for the control 

group rather than a comparator that would more fully control for the variety of influences that 

may bias the results including expectancy effects, social interactions, attention given by 

instructors, and time spent in the practice. Some authors have argued that the use of WL as a 

control group is clearly inappropriate as no one expects to improve while they are waiting to 

begin treatment. This situation may create a negative expectation of improvement that may 

spuriously amplify the difference in treatment effect between the intervention and the control.345

Therefore, caution should be exercised when interpreting studies comparing the effectiveness of 

meditation practices to no treatment or WL.

A wide array of active control groups were used in the intervention studies on meditation 

practices. Active controls included exercise and other physical activities, states of rest and 

relaxation, educational activities, PMR, cognitive behavioral techniques, pharmacological 

interventions, psychotherapy, biofeedback techniques, reading, hypnosis, therapeutic massage, 

acupuncture, and other meditation techniques. 

The results of this review show that the control groups employed in meditation research are 

many and various, and it is unknown how comparable they are across studies. Meditation 

practices are disparate with regard to specific components, and there is the potential for welldesigned studies to employ disparate control groups. Authors of future studies need to design 

control groups with a clear vision of the research question and the hypothesized mechanism and 

full consideration of how threats to validity may be best addressed for a given meditation 

practice. 

Types of Study Populations 

The vast majority of studies on the effects of meditation practices have been conducted in 

healthy populations as compared to clinical populations. It can be argued that studies of healthy 

individuals are useful to assess how meditation practices prevent certain clinical conditions and 

enhance wellness and well-being. However, studying the therapeutic effects of meditation 

practices in a healthy population does not provide a clear picture of their effectiveness as 

therapeutic interventions in healthcare. Clinical studies of meditation practices have addressed 

conditions with high mortality and morbidity rates, or burden of disease including hypertension, 

cardiovascular disorders, substance abuse, anxiety disorders, cancer, asthma, chronic pain, type 

II DM, and fibromyalgia. The first three conditions were among the six leading sources of 

premature death and disability in the United States in the mid-1900s and are projected to 

continue to be so to the year 2020, as measured by disability-adjusted life years (DALYs).355,356
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Types of Outcome Measures 

Studies varied widely in their use of outcome measures. Outcomes of physiological 

functions, particularly cardiovascular measures, were the most frequently studied. Psychosocial 

outcomes (i.e., psychiatric and psychological symptoms, measures of personality and positive 

outcomes) and outcomes related with clinical events were also frequently assessed. Compared to 

physiological and psychosocial outcomes, little has been explored on cognitive and 

neuropsychological functions. Some authors have argued that relatively gross outcomes such as 

physiological measures have taken prominence in meditation research.354 However, considering 

that the close interdependence of the mind and body should be taken into account when 

evaluating the responses to meditation practices, more subjective and experiential variables354 are 

paramount to evaluate the effects of these mind-body techniques. 

Evidence on the Efficacy and Effectiveness of Meditation 

Practices 

We have summarized the evidence regarding the efficacy and effectiveness of meditation 

practices for the three most studied conditions in the scientific literature: hypertension, 

cardiovascular diseases, and substance abuse. 

We conducted a series of direct and indirect meta-analyses comparing a variety of meditation 

practices versus a comparison group in hypertensive patients. We provided pooled estimates for 

the following comparisons: TM® versus HE, TM® versus PMR, RR versus BF, Qi Gong versus 

WL, Yoga versus NT, Yoga versus HE, and Zen Buddhist meditation versus blood pressure 

checks. 

A few studies of poor methodological quality were available for each comparison, mostly 

reporting nonsignificant results (TM® had no advantages over HE to improve measures of SBP, 

DBP, body weight, heart rate, stress, anger, self-efficacy, cholesterol, dietary intake, and level of 

physical activity in hypertensive patients; RR was not shown to be superior to BF in reducing 

blood pressure in hypertensive patients; Yoga did not produce clinical or statistically significant 

effects in blood pressure when compared to NT; Zen Buddhist meditation was not better than 

blood pressure checks to reduce SBP in hypertensive patients; Yoga was not better than physical 

exercise to reduce body weight in patients with cardiovascular disorder. When indirect metaanalysis was used, we did not find differences between MBSR and Yoga to control anxiety 

symptoms in cardiovascular patients. It is unknown whether these are truly “negative findings” 

(i.e., one cannot say that there is evidence of no effect) or if there is a lack of power to detect a 

statistically significant result due to the low number of studies included in the meta-analyses 

(i.e., we can say that there is no evidence of effect). 

A few statistically significant results favoring meditation practices were found: both TM®

versus PMR, and Qi Gong versus WL for DBP and SBP, Zen Buddhist meditation versus blood 

pressure checks for DBP, and Yoga versus HE to reduce stress. The positive results from these 

meta-analyses need to be interpreted with caution, as biases, such as expectancy bias, cannot be 

excluded. 

For the majority of the comparisons, meta-analyses were derived from only two open-label 

trials; therefore, performance bias and detection bias may have contributed to an overestimate of 
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the treatment effect. In some instances, the appropriateness of the comparison group was 

questionable (e.g., Qi Gong versus WL) 

Other reviews have summarized the evidence on the effects of Tai Chi in hypertension, and 

on TM® for hypertension, cardiovascular diseases, and substance abuse. Differences in selection 

criteria and review methods preclude a direct comparison of the results among the reviews. 

Wang et al.29 assessed the evidence on the effects of Tai Chi in hypertension and concluded 

that Tai Chi produces benefits in cardiovascular function. The review included evidence from 

two studies published in the non-English literature, and another study in a population of normal 

elderly, not individuals diagnosed with hypertension. Differences in the selection criteria of 

study participants and language of publication may explain the differences in the findings 

between Wang et al.29 and our review. 

Walton et al.357 reviewed the literature on the effectiveness of TM® in the treatment or 

prevention of cardiovascular diseases and concluded that TM® produced reductions in blood 

pressure, carotid artery intima-media thickness, myocardial ischemia, left ventricular 

hypertrophy, mortality, and other relevant outcomes. The authors adopted a qualitative approach 

for the synthesis of the evidence. The Walton review357 did not report on the use of systematic 

literature searches or on the assessment of the methodological quality of the evidence, but 

adopted a methodological approach where significant findings were emphasized within studies. 

Differences between Walton's conclusions and the results reported in our review may be due to 

differences in the methodological approaches to synthesize the evidence. We conducted 

comprehensive searches of the scientific literature and assessed the methodological quality of the 

trials. Our synthesis of the evidence combined a qualitative approach with quantitative metaanalytic methods that assessed mean treatment effects in relation to the between-study variability 

of treatment effects. Furthermore, differences in the selection criteria (i.e., type of participants, 

diagnostic criteria, publication year) for the inclusion of studies may also explain differences in 

the conclusions of the reviews. 

Canter et al.25 conducted a systematic review on the effects of TM® for blood pressure. Six 

trials were identified but only one evaluated the effect of TM® in hypertensive individuals, 

whereas the others were conducted in adults with normal blood pressure and adolescent 

populations. The authors concluded that there was insufficient good quality evidence to conclude 

whether or not TM® has a positive effect on blood pressure. 

Evidence on the effects of TM® on substance abuse has been summarized in two 

reviews.22,358 Alexander et al.358 conducted a meta-analysis of 19 studies to provide a single 

estimate of treatment effect. The review included a variety of study designs such as crosssectional studies, “retrospective studies,” “longitudinal studies,” and “experiments with random 

assignment.”358 Effect sizes across studies were provided for categories of study designs (“welldesigned” studies, cross sectional studies, and general population studies). Gelderloos et al.22

conducted a review of 24 studies of TM® for preventing and treating substance abuse. The 

authors concluded that “taken together”, the studies demonstrate an improvement in psychosocial 

outcomes. The review did not use a systematic approach to select and appraise the literature and 

made no distinctions among the variety of study designs that were considered. 

Other systematic reviews have synthesized the evidence on the efficacy and effectiveness of 

meditation practices for conditions other than hypertension, cardiovascular diseases, and 

substance abuse. However, it was beyond the scope of this report to examine conditions other 

than hypertension, cardiovascular diseases and substance abuse. Other systematic reviews have 

examined the effects of Tai Chi for a variety of medical diseases,359 chronic conditions,29
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rheumatoid arthritis,360 improvement of aerobic capacity,361 and elderly populations.362 Studies 

on the effects of Yoga in depression145 and anxiety,363and MBSR on health status measures18 and 

a variety of medical conditions7 have been also reviewed. Finally, other reviews have assessed 

the effects of a variety of meditation practices such as Qi Gong in Chinese cancer patients,364 RR 

in adult patients,365 meditation therapy programs for anxiety disorders,19 and the effects of TM®

on cognitive function23 and psychological health.366

It is expected that systematic reviews have heterogeneity in their results when they bring 

together studies that are both clinically and methodologically diverse.367 Statistical and clinical 

heterogeneity constituted a frequent and considerable problem when pooling the results, and, in 

some cases, it precluded an effort to summarize data across the studies. Clinical heterogeneity 

was due to differences across the trials in the characteristics of study populations, the 

implementation of the meditation practice, outcome measurement, and followup period. Clinical 

heterogeneity may have explained why trials with different types of participants, interventions, 

or outcomes showed different effects. When statistical heterogeneity exists, pooled results are 

uncertain or conditional.368

The poor methodological quality of the trials limits the strength of inference regarding the 

observed treatment effects reported in this review and constitutes a possible shortcoming of the 

meta-analysis.367 The lack of description of the methods of allocation concealment, 

randomization, description of withdrawals and dropouts per treatment group, the absence of 

double blinding the interventions, and the use of incompatible or inappropriate control groups 

undermine the results of many clinical studies. Therefore, researchers are advised against making 

firm statements regarding treatment effects based on the quantitative summaries reported in this 

review. 

Some factors have impeded the scientific progress regarding the efficacy and effectiveness of 

meditation practices in healthcare. Few studies have described the meditation practices or control 

procedures in sufficient detail, which prevents a sensible analysis of the observed differences in 

treatment effects for some classes of meditation practices. Other limitations include insufficient 

information regarding the characteristics of the trainer’s competence and experience, the lack of 

an accurate assessment of participants’ expectancy, compliance and motivation, and the paucity 

of descriptions of the statistical power of the intervention effect. 

Evidence on the Role of Effect Modifiers for the Practice of 

Meditation 

The role of effect modifiers in the practice of meditation is a topic that has so far been 

neglected in the scientific literature. Evidence from RCTs and NRCTs regarding the interaction 

of meditation practices with other variables in populations of patients with hypertension, 

cardiovascular disorders, or substance abuse is scarce. A few studies conducted exploratory post 

hoc analyses (i.e., a subgroup analysis, multiple regression, or analysis of variance) that were 

intended to be hypothesis generating. Due to the small sample sizes in the studies, there were 

small numbers of subjects in each of the variable subgroups, lowering the power to detect any 

relationship with the outcomes produced by the practice of meditation. The lack of evidence on 

the role of effect modifiers has been pointed out by other authors.17,354 Variables that may be 

important for the therapeutic effect of meditation practices include individual characteristics of 
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the meditator, characteristics and training experience of the instructor, and the role of motivation 

and expectancy.17,354

Evidence on the Physiological and Neuropsychological 

Effects of Meditation Practices 

We have summarized the evidence from RCTs, NRCTs and before-and-after studies 

regarding the physiological and neuropsychological effects of meditation practices. Our metaanalysis revealed that the most consistent and strongest physiological effects of meditation 

practices in healthy populations occur in the reduction of heart rate, blood pressure, and LDL-C. 

The strongest neuropsychological effect is in the increase of verbal creativity. There is also some 

evidence from before-and-after studies to support the hypothesis that certain meditation 

techniques decrease visual reaction time, intraocular pressure, and increase breath holding time. 

Though over half of the combined effect estimates are not statistically significant, the potential 

clinical significance of these estimates must be carefully considered. However, all of the studies 

included in the meta-analyses were of low methodological quality and, for this reason, the results 

should be interpreted cautiously. 

Of the 311 studies reporting physiological and neuropsychological outcomes, only 53 (17 

percent) were eligible for meta-analysis. Though small, this proportion is even smaller when one 

considers the 813 studies pertaining to research on the therapeutic use of meditation practices 

included in topic II. Some investigators have claimed that there are many empirical studies that 

have shown that meditation practices are effective at treating stress-related states,4

 including 

reducing heart rate, breathing, and blood pressure. In addition, previous literature reviews have 

noted the seemingly large number of research papers that purport to show the therapeutic benefit 

of meditation practices.25,113,157,359,369 This review has shown that there are startlingly few 

scientific studies that could be statistically combined to provide evidence on the physiological 

and neuropsychological effects of meditation practices. While other investigators have noted the 

need for rigorous meta-analyses of the therapeutic use of meditation practices,3,369 to our 

knowledge there are only two previous English-language meta-analyses361,369 that examine the 

physiological effects of meditation practices and none examining the cognitive or 

neuropsychological effects. However, the two meta-analyses cover neither the range of 

meditation practices examined here nor the breadth of outcomes. 

The clinical and methodological diversity of the studies make estimating the effects of 

meditation practices difficult. This difficulty is reinforced when one considers that 25 of the 44 

(57 percent) outcome measures examined in the analyses had levels of heterogeneity that suggest 

important clinical differences between the studies. In addition, 8 of these 25 (32 percent) had 

heterogeneity measures greater than 80 percent, making overall effect estimates unwise because 

the implied clinical among study populations would render the overall estimates spurious. 

The overall low methodological quality of the studies indicates that most suffered from 

methodological problems that may produce overestimations of the treatment effects or 

compromise the generalizability of the study results. Empirical evidence has demonstrated that 

trials “that were not double blinded yielded larger estimates of treatment effects compared with 

trials in which authors reported double blinding (odds ratios exaggerated, on average, by 17 

percent)”.40,370 Though difficult to do in studies on meditation practices, appropriate blinding is a 
205

special source of concern where an expectation of the efficacy of the practice under study on the 

part of the subject and assessor may bias outcome measures. 

The low rate of reporting of withdrawals and dropouts and the reasons for dropping out are 

also of concern because this makes the assessment of the comparability between the intervention 

and control groups difficult. An additional concern is that patients who drop out may differ in 

important ways from those who complete the meditation regimen (e.g., being favorably 

predisposed to meditation practice), but, without adequate reporting, these differences remain 

hidden and their effects on outcomes remain unknown. 

Regarding the predominant use of healthy subjects in the included studies, though of benefit 

for ascertaining the physiological and neuropsychological effects of meditation practices in this 

group, the use of healthy subjects limits the generalizability of the findings and provides 

information that is unlikely to be of use to clinicians who normally treat patients with specific 

health conditions. 

Finally, the results of this meta-analysis indicate that research on the effects of meditation 

practices has been hindered by the use of weak study designs, specifically before-and-after 

studies (also known as single group pretest-postest designs and uncontrolled trials). Although the 

before-and-after study is simple and practical, it has been argued that results from such study 

designs be considered circumstantial evidence,371 that is, hypothesis generating for further 

research using more rigorous study designs. The lack of a concurrent control group and the 

resulting inability to control for temporal trends, regression to the mean, and sensitivity to 

methodological features make it difficult to ascertain the true causal effect of a meditation 

practice. Clinical outcomes—whether good or bad—may be a result of factors other than the 

practice of meditation. For this reason, the estimates of the physiological and neuropsychological 

effects of meditation practices that are made on the basis of single-group studies should be 

considered carefully. 

Strengths and Limitations 

This evidence report is a systematic and comprehensive review of the indexed scientific 

literature available on the effectiveness of meditation practices supplemented by a search for 

relevant gray literature, abstracts from scientific meetings, dissertations and theses, reference 

lists, and trial registries. As noted previously, the need for rigorous meta-analyses of the 

therapeutic use of meditation practices has been recognized by other researchers.3,369 To our 

knowledge, there has been no other meta-analysis of the effectiveness of meditation practices 

that covers the range of meditation techniques examined here or the breadth of health outcomes. 

In addition, the relatively large number of included studies reported in dissertations (10 percent 

of all studies) may have reduced the potential effects of publication bias (i.e., the tendency for 

studies with positive outcomes to be published more frequently). We were also able to identify 

and exclude from the review a significant number of multiple publications that may have also 

affected the results of our meta-analyses and their conclusions. 

The assessment of the methodological quality for all study designs is also a strength of this 

review. Methodological quality may be defined in various ways.372 Our approach to the 

methodological quality of the studies on meditation practices focused on an assessment of the 

internal validity of the studies, as recommended by several researchers.42,373-375 Various criteria 

to assess methodological quality of studies are available in the scientific literature,376 and there is 
206

no consensus on which quality assessment tool can be recommended without reservation.50 For 

the assessment of the methodological quality of RCTs, we have chosen two assessment tools that 

have well-established face validity, and for which a relationship with bias has been proven in 

empirical studies.40,350 The selection of the Jadad scale has relative merit since it uses a simple 

and easy to understand approach that incorporates the most important individual components of 

internal validity: randomization, blinding, and handling of patient attrition. Based on empirical 

evidence and theoretical considerations, these aspects should always be assessed when 

evaluating the quality of an RCT.350

The most important dimension of methodological quality is internal validity, defined as the 

confidence that the design, performance, and report of a trial prevent or reduce bias in the 

outcomes.372 We have not addressed in our approach other important aspects of good research 

practice—those contributing to studies’ external validity and adherence to ethical procedures. 

Although such factors are important and help to put study findings in context, they may not be 

directly related to internal validity, but may contribute indirectly to it. It is unknown how factors 

related with external validity may bias study results, and, therefore, research syntheses’ findings. 

Certainly, the external validity of a trial is a very important concept that it is worthy of 

consideration in future reviews; however, it was not covered in our methodological assessment. 

We have adopted a model for quality assessment of research on meditation based on stringent 

criteria of research methodology. Evaluation of CAM treatments, including meditation, requires 

a stringent and systematic approach.352,377 The Jadad scale is the most commonly used quality 

scale for RCTs in pharmacological and nonpharmacological reviews.378 The decision to use both 

the Jadad scale and the concealment of allocation approach reflects our emphasis on using the 

same methodological standards to assess the quality of research in meditation as applied to other 

areas of CAM research. 

We did not make any decisions in terms of inclusion or exclusion of studies in the review or 

in the meta-analyses based on the overall Jadad score. We also analyzed the methodological 

quality of the RCTs by the individual components of the scale (i.e., percentage of studies that 

satisfied the Jadad criteria). 

Though no reliable and valid instruments have been developed for the assessment of 

observational studies and before-and-after studies, the instruments used here serve to indicate 

important potential methodological weaknesses, tempering the conclusions that may be drawn, 

and highlighting areas in which future research might improve. 

Despite its strength, the use of nonstandardized quality assessment instruments may be 

questioned. However, the assessment criteria were not used to produce an overall quality score or 

to exclude studies from the review, but only to draw out commonalities in potential 

methodological problems. Because of the potential methodological weaknesses of the studies and 

the use of weak study designs, the question of how meditation achieves its effects remains almost 

as open to debate as it did over 25 years ago.379

It is unlikely that all of the meditation research meeting our inclusion criteria has been 

identified and acquired. In particular, a number of Indian journals have not been indexed and are 

difficult to acquire, particularly Yoga specialty journals. We did not contact either any 

religious/spiritual organization to acquire information regarding unpublished studies. 

Nevertheless, it is likely that the vast majority of publications that satisfy our inclusion criteria 

have been examined and that the general trends reported in this review are sufficiently 

representative of the research on meditation practices.337 
207

Peer reviewers have provided references to potentially relevant studies that were not 

identified during the development of this report. To increase the transparency of this report, we 

have collated the references of these studies following the “References and Included Studies” 

section. Despite the comprehensiveness of our search strategies for the literature search, there are 

inevitable gaps in literature retrieval, especially with respect to gray literature when conducting 

systematic reviews. The impact of the potentially relevant studies identified by the peer 

reviewers should be weighed against the number of studies that were actually retrieved and 

included. 

The restriction of included studies to English-language publications is of special concern in 

this topic because of the origin of many of these techniques in non-English speaking countries. In 

light of a recent bibliometric study on Yoga that reported that there is a large amount of research 

by Indian researchers,337it is possible that there is a substantial evidence base on Yoga that 

remains untapped. In addition, it is likely that a significant amount of the research on Tai Chi29

and Qi Gong has been published in the Chinese language. However, despite this potential 

weakness, some research has shown that compared to language inclusive meta-analyses, 

language restricted meta-analyses did not differ with respect to the estimate of benefit of the 

effectiveness of an intervention, and there is no evidence that language restricted meta-analyses 

lead to biased estimates of intervention effectiveness.380

This review may be also be criticized for ignoring important differences between meditation 

practices and techniques by using categories for studies using “single entity” practices, e.g., 

TM®, RR, and CSM, and for those practices that are made up of a broad array of techniques, e.g., 

Yoga, Tai Chi, and Qi Gong. Thus while the meta-analytic techniques used here may be 

appropriate for standardized “single entity” practices, such an approach, when used to combine 

complex interventions, may produce spurious or misleading results. For example, one of the 

problems of combining the results of studies that use different yogic techniques is that “fine 

grained” descriptions of many of these techniques are not reported. This lack of reporting 

increases the possibility of pooling the results for yogic practices that were putatively designed to 

have different effects. 

To address this potential problem, we have used measures of heterogeneity to help identify 

those groups of studies that may differ in important clinical characteristics as well as examining 

the descriptions of the techniques employed in the studies. The combining of results was based 

on these “fine grained” descriptions; however, poor reporting of meditation practices employed 

in studies leaves open the possibility that such combinations may have occurred. In addition, 

caution should be taken in concluding that the effects of complex or composite interventions are 

due to the practice of meditation rather than to other main components of the treatment such as 

physical exercise. 

The approach adopted here of combining the results of only two studies may be considered 

inappropriate by some researchers because it is unlikely that only two studies provide strong 

evidence with respect to the general direction or effect size of the intervention. Also, if the 

results of two studies differ in direction of effect, at least one more study is needed to help 

strengthen the evidence regarding the true direction of the effect. However, it must be 

remembered that one of the principal reasons for conducting a meta-analysis is not only for 

summarizing the discrepant results of a large number of studies but also for overcoming the 

imprecision resulting from small sample sizes. By combining several studies with small samples, 

the overall estimate provides a more precise estimate of effect than either of the studies on their 
208

own. Thus, combining only two studies can provide an informative picture of the likely effect of 

an intervention. 

Finally, a main weakness of this report is the lack of assessment of the appropriateness of 

controls. The need for appropriate controls, described by some researchers as the most difficult 

conundrum for designing research trials in meditation,381 is closely related to the difficulties in 

designing rigorous double-blind meditation trials. Though some controls may be adequate to 

compare the relative effectiveness of two different interventions (e.g., rest meditation versus 

quiet rest), such controls may not be adequate placebo controls needed to assess the effects of 

meditation interventions.381 Though we are unaware of assessment tools developed to 

specifically address this issue as it pertains to meditation practices, the comprehensive 

categorization given in this report of the kinds of controls used in meditation research provides 

future researchers with a starting point for examining the appropriateness of controls for various 

therapeutic meditation practices. 

Future Research 

Future research in practices of meditation has several challenges. First, there is a need to 

develop a consensus on a working definition of meditation applicable to a heterogeneous group 

of practices. The application of consensus techniques, such as the Delphi method used in this 

report, is one approach to refine operational criteria and to standardize terms with the goal of 

achieving consistency among the characterizations of meditation practices. The validity and 

reliability of any operational definition applied to diverse meditation practices should be 

thoroughly investigated. Another area of future inquiry consists of systematically comparing the 

effects of different meditation practices that research shows have promise. 

We have assessed the quality of meditation research from studies that have been published 

between 1956 and 2005. Half of them have been published after 1994. We did not set any 

restrictions in terms of the year of publication of the included studies, and it is possible that the 

standard for a rigorous study in the earlier years of research might be different before 1994 than 

that of the past 15 years. Future reviews should examine how the quality of studies on meditation 

practices has evolved over time and particularly whether guidelines such as CONSORT have 

improved the reporting of RCTs. 

We have analyzed the evidence of the therapeutic effects of meditation practices for the three 

most studied conditions identified in the scientific literature. Evidence of the effects of 

meditation practices for other conditions frequently reported in the scientific literature (i.e., a 

variety of mental health problems such as anxiety disorders and depression, and musculoskeletal 

conditions such as fibromyalgia and chronic pain)) should be evaluated in systematic reviews in 

the near future. Further reviews should address the effects of meditation practices as strategies to 

enhance wellness and well-being in healthy population. 

In light of the few intervention studies that provided direct comparisons of meditation 

practices or that used similar control groups, special attention should be paid to developing 

studies that provide a more accurate assessment of the efficacy and effectiveness of meditation 

practices, both against standard therapies and against each other. The appropriate selection of 

controls is also paramount if progress is to be made with respect to determining the effects of 

meditation practices. Future research should be directed toward investigating the unique 

challenges that the studies on meditation practices present in designing appropriate controls. In 
209

addition, more research should be done on the “dose response” of meditation practices to 

determine what may be effective study durations and to help standardize courses of therapeutic 

meditation. 

As noted earlier, blinded allocation to meditation treatments may be difficult, but it is not 

impossible. There are many ways in which to circumvent the difficulties in blinding the 

experimenter many of which rely on “creative” (i.e., nonstandard methods). These suggestions 

follow other proposed modifications of the traditional double-blind methodology such as the 

“dual-blinding” approach (a methodology where the subject and an external evaluator, but not 

the practitioner, are blind to treatment) 382 Given the strength of the RCTdesign in providing 

estimates of effectiveness, it appearsimportant to develop research in this domain instead of 

trying to change the instruments with which the quality of research is assessed. 

NCCAM is striving to elevate CAM research to a higher standard, and we think that creative 

solutions to the difficulties of conducting randomized, double-blind controlled trials should be 

applied to meditation research. 

Key methodological issues in the study of meditation using an evidence-based approach 

should be further explored through the analysis of important factors such as the impact of 

publication bias in meditation research (e.g., positive outcome bias, time to publication bias, 

empirical evidence of relationships between study quality and effect estimates in meditation 

research, the impact of language bias in systematic reviews of meditation practices, the impact of 

year of publication of primary studies on pooled estimates in meditation research, trends of 

quality of primary studies and systematic reviews in meditation, and use of quality assessment 

tools in meditation research). The effect of report of funding and disclosure of conflict of interest 

and positive outcomes also merits formal evaluation. 

Because of the difficulty of determining causation using uncontrolled before-and-after 

designs, it is recommended that these study designs be avoided in future research on the 

effectiveness of meditation practices . Researchers should aim to employ designs and analytic 

strategies that optimize the ability to make causal inferences (in some cases this may require the 

use of uncontrolled before-and-after designs). Although it is important to suggest conducting 

more high quality studies based on the standards for RCTs, it is also important to develop 

alternative study designs and analytic tools that can incorporate the special features of meditation 

practices to fully investigate the possible effects of these practices. As well, future studies would 

benefit from having larger samples with concurrent controlled designs, using disease-specific 

measures and providing clearer descriptions of intervention components. The quality of reporting 

of meditation research would be improved by a wider dissemination and stricter enforcement of 

the CONSORT guidelines within the CAM community. 

Conclusions 

The field of research on meditation techniques and their therapeutic applications has been 

clouded by confusion over what constitutes meditation and by a lack of methodological rigor in 

much of the research. Further research needs to be directed toward distinguishing the effects and 

characteristics of the many different techniques falling under the rubric “meditation.” The single 

and multimodality meditation practices included in this report were categorized for pragmatic 

reasons, but specific attention must be paid to developing definitions for these techniques that are 

both conceptually and operationally useful. Such definitions are a prerequisite for scientific 
210

research of the highest quality. Research of higher quality is vital to respond appropriately to the 

many persistent questions in this area. The dearth of high-quality evidence highlights the need 

for greater care in defining and choosing the interventions and in choosing controls, populations, 

and outcomes that permit comparison of studies across techniques regarding their therapeutic 

effects. More care in these choices will allow effects to be estimated with greater reliability and 

validity. More randomized trials that draw on the experience of investigators or consultants with 

a strong background in clinical and basic research should be conducted. As a whole, firm 

conclusions on the effects of meditation practices in healthcare cannot be drawn based on the 

available evidence. However, the results analyzed from methodologically stronger research 

include findings sufficiently favorable to emphasize the value of further research in this field. It 

is imperative that future studies on meditation practices be more rigorous in design, execution, 

and analysis, and in the reporting of the results. Greater importance should be placed on the 

reporting of study methods and providing detailed descriptions of the training of the participants, 

qualifications of meditation instructors, and on reporting the criteria and methods used to 

determine a successful meditation practice. 
211

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 1013. Detsky AS, Naylor CD, O'Rourke K, et al. 

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 1015. Paul GL, Trimble RW. Recorded vs "live" 

relaxation training and hypnotic suggestion: 

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physiological arousal and inhibiting stress 

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meditation on self-actualization, locus of control, 

and trait anxiety [abstract]. Diss Abstr Int 

1980;40(7B):3419. 

 1017. Smith JC. Psychotherapeutic effects of 

Transcendental Meditation with controls for 

expectation of relief and daily sitting. J Consult 

Clin Psychol 1976;44(4):630-7. 

 1018. Bevan AJW. Endocrine changes in 

Transcendental Meditation. Clin Exp Pharmacol 

Physiol 1980;7(1):75-6. 

 1019. Werner OR, Wallace RK, Charles BM, et al. 

Long-term endocrinologic changes in subjects 

practicing the Transcendental Meditation and 

TM-sidhi program. Psychosom Med 1986;48(1-

2):59-66. 

 1020. Jevning RA , Wells I, Wilson AF. Plasma thyroid 

hormones, thyroid stimulating hormone, and 

insulin during acute hypometabolic states in man. 

Physiol Behav 1987;40(5):603-6. 

 1021. Tooley GA, Armstrong SM, Norman TR, et al. 

Acute increases in night-time plasma melatonin 

levels following a period of meditation. Biol 

Psychol 2000;53(1):69-78. 

 1022. Jevning RA , Wilson AF, Pirkle HC. Modulation 

of red cell metabolism by states of decreased 

activation: comparison between states. Physiol 

Behav 1985;35(5):679-82. 

 1023. Murphy MB. Theta bursts and rhythmical theta 

trains in the Transcendental Meditation technique 

and TM-Sidhi program: a qualitative and 

quantitative analysis of EEG theta activity 

[dissertation]. Melbourne, FL: Florida Institute of 

Technology; 1984. 

 1024. Pelletier KR. Influence of Transcendental 

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257

List of Studies Potentially Relevant to the Review

The following studies were not retrieved through the formal literature search and were 

identified by peer reviewers as potentially relevant to this review. (n = 17). 

More detailed examination of these studies is required to determine which, if any, of the 

research topics they may help to address. 

Alexander CN, Swanson GC, Rainforth M, et al. The 

Transcendental Meditation program and business: a 

prospective study. In: Wallace RK, Orme-Johnson DW, 

Dillbeck MC, eds. Scientific research on Maharishi’s 

Transcendental Meditation and TM-Sidhi program : 

collected papers. Vol. 5. Fairfield, IA: Maharishi 

International University Press; 1990. p.3141-9. 

Backon J, Matamoros, Ramirez M, et al. A functional 

vagotomy induced by unilateral forced right nostril 

breathing decreases intraocular pressure in open and closed 

angle glaucoma. Br J Ophthalmol 1990; 74:607-9. 

Bassette, JE, Blanchard EB. Effects of instructionalexpectancy sets on relaxation training with prisoners. J 

Community Psychol 1977;5(2):166-70. 

Cranson R. Increased general intelligence through the 

Transcendental Meditation and TM-Sidhi program. In: 

Wallace RK, Orme-Johnson DW, Dillbeck MC, eds. 

Scientific research on Maharishi’s Transcendental 

Meditation and TM-Sidhi program : collected papers. Vol. 

5. Fairfield, IA: Maharishi International University Press; 

1990. p.3078. 

Fergusson LF, Bonshek AJ, Le Masson, G. Vedic Science 

based education and nonverbal intelligence: a preliminary 

longitudinal study in Cambodia. Higher Education 

Research and Development 1995;15: 73-82. 

Garnier D, Cazabat A, Thebault P; et al. An experimental 

study: pulmonary ventilation during the Transcendental 

Meditation technique—applications in preventive 

medicine. Est-Médicine 1984;4(76): 867–70. 

Gelderloos P. Psychological health and development of 

students at Maharishi International University: a controlled 

longitudinal study. In: Wallace RK, Orme-Johnson DW, 

Dillbeck MC, eds. Scientific research on Maharishi’s 

Transcendental Meditation and TM-Sidhi Program : 

collected papers. Vol. 5. Fairfield, IA: Maharishi 

International University Press; 1990. p.3097-3106. 

Haratani T, Hemmi T. Effects of Transcendental 

Meditation on the mental health of industrial workers. 

Japanese Journal of Industrial Health 1990;32(7): 656. 

Hill DA, Wallace RD, Walton KG, Meyerson LR. Acute 

decreased platelet serotonin and attenuation of autonomic 

activity in the Transcendental Meditation program (TM) 

[abstract]. Soc Neurosci 1989;15:1281. 

Jevning R, Wilson AF, Pirkle H, et al. Modulation of red 

cell metabolism by states of decreased activation: 

comparison between states. In: Wallace RK, Orme-Johnson 

DW, Dillbeck MC, eds. Scientific research on Maharishi’s 

Transcendental Meditation and TM-Sidhi Program : 

collected papers. Vol. 5. Fairfield, IA: Maharishi 

International University Press; 1990. p.2988-92. 

Jevning R, Wells I, Wilson AF, Guich S. Plasma thyroid 

hormones, thyroid stimulating hormone, and insulin during 

acute hypometabolic states in man. In: Wallace RK, OrmeJohnson DW, Dillbeck MC, eds. Scientific research on 

Maharishi’s Transcendental Meditation and TM-Sidhi 

program : collected papers. Vol. 5. Fairfield, IA: Maharishi 

International University Press; 1990. p.2999-3002. 

Luparello TJ, Leist N, Lourie CH, Sweet P. The interaction 

of psychologic stimuli and pharmacologic agents on airway 

reactivity in asthmatic subjects. Psychosom Med 

1970;32(5):509-13. 

MacLean C, Schneider R, Wenneberg S, Levitsky D, 

Walton K.. Reactivity of plasma serotonin to psychological 

stress. Trans Amer Soc Neurochem 1992;23:223. 

Schneider RH, Mills PJ, Schramm W, et al. Luteinizing 

hormone: a marker for type A behavior and its modification 

by the Transcendental Meditation program? In: Wallace 

RK, Orme-Johnson DW, Dillbeck MC, eds. Scientific 

research on Maharishi’s Transcendental Meditation and 

TM-Sidhi Program : collected papers. Vol. 5. Fairfield, IA: 

Maharishi International University Press; 1990. p. 3011. 

Tjoa A. Some evidence that the Transcendental Meditation 

program increases intelligence and reduces neuroticism as 

measured by psychological tests. In: Orme-Johnson DW, 

Farrow JT, eds. Scientific Research on Maharishi’s 

Transcendental Meditation and TM-Sidhi program: 

collected papers. Vol.1. Switzerland: Maharishi European 

Research University – MVU Press; 1977. p.363-7. 

Travis F. Development along an integration scale: 

longitudinal transformation in brain dynamics with regular 

Transcendental Meditation practice. Psychophysiology 

2002;39: S81 

Walton KG, Gelderloos P, Pugh NDC, Macrae P, Goddard 

P, MacLean C, Levitsky D. Stress as the cause of 

serotonergic dysfunction in mental disorders: support from 

correlates of serotonin turnover in normal subjects 

[abstract]. Soc. Neurosci. 1989;15:1282.

259

Abbreviations 

Abbreviation Description 

 

AA Alcoholics Anonymous 

ACF adrenocortical functioning 

Ach acetylcholine 

AEI artery elasticity index 

AHM antihypertensive medication 

AHRQ Agency for Healthcare Research and Quality 

AI alpha index 

AMI acute myocardial infarction 

APO-A1 apolipoprotein A1 

AT autogenic training 

ATN attention 

BC blood composition 

BDT bone density test 

BE breathing exercises 

BF biofeedback 

BGM blood gass measurement 

BHT borderline hypertension 

BHt breath holding time 

BL blood lactate 

BM blood measurement 

BMI body mass index 

BNP B-type natriuretic peptide 

BP blood pressure 

BR breathing rate 

bpm beats per minute 

BS blood sugar 

Ca calcium 

CABS coronary artery bypass surgery 

cAMP cyclic adenosine monophosphate 

CF cognitive function 

CHD chronic heart disease 

ChE cholinesterase 

cIMT carotid intima media thickness 

CM carbohydrate metabolism 

CMBT contemplative meditation with breathing techniques 

CNS-H central nervous system hormone 

CO cardiac output 

COG/N cognitive/neuropsychological 

COPD chronic obstructive pulmonary disease 

CPR cold pressor response 

Cr creatinine 
260

CRT cognitive restructuring training 

CSM Clinically Standardized Meditation 

CTY creativity 

CV cardiovascular 

CVF cardiovascular functioning 

d day(s) 

DBH dopamine beta hydroxylase 

DBP diastolic blood pressure 

DHEAS dehydroepiandrosterone 

DIG digestive 

DM diabetes mellitus 

DPV digital pulse volume 

E/A ratio early filling divided by atrial constriction 

ECG electrocardiography 

EEG electroencephalogram 

EMG electromyography 

EPC Evidence-based Practice Center 

EPI epinephrine 

ESR erythrocyte sedimentation rate 

FBS fasting blood sugar 

FEV1 forced expiratory volume in one second 

FPA finger plethysmogram amplitude 

FVC forced vital capacity 

GH growth hormone 

Glc glucose 

GLH glycosylated hemoglobine 

GSH glutathione 

GSR galvanic skin response 

Hb hemoglobin 

Hb-A1c hemoglobin A1c 

HDL-C high-density lipoprotein cholesterol 

HE health education 

HI humoral immunity 

HIV human immunodeficiency virus 

HR heart rate 

HRQL health-related quality of life 

HRV heart rate variability 

HT hypertension 

HVA homovanillic acid 

IQR interquartile range 

ITT intention-to-treat 

IVST intraventricular septal thickness 

JNC 7 Joint National Committee 7 

K potassium 

LDL-C low-density lipoprotein cholesterol 

LDH lactate dehydrogenase 
261

LFPMF low frequency pulsed magnetic field 

LIP lipoproteins 

LLM lowering lipid medication 

LSD lysergic acid diethylamide 

Lt left 

LVDIS left ventricular internal dimension at systole 

LVDDi left ventricular end diastolic volume index 

LVEF left ventricular ejection fraction 

LVIDD left ventricular internal dimension at diastole 

LVMI left ventricular mass index 

MBCT mindfulness-based cognitive therapy 

MBSR mindfulness-based stress reduction 

MEM memory 

MEP maximum expiratory volume 

Mg magnesium 

MHPG 3-methoxy-4-hydroxyphenylglycol 

MI myocardial infarction 

MIP maximum inspiratory pressure 

MM 

mo. 

mindfulness meditation 

month(s) 

MSK musculoskeletal 

MVV maximal voluntary ventilation 

Na sodium 

NA not applicable 

NCCAM National Center for Complementary and Alternative Medicine 

ND not described 

NE norepinephrine 

NER nervous 

NHS National Health System 

NIDDM noninsulin dependent diabetes mellitus 

N/M nutrition/metabolism 

NOS Newcastle-Ottawa Scales 

NR not reported 

NRCT nonrandomized controlled clinical trial 

NS not specified 

NT no treatment 

NYHA New York Heart Association 

OGTT oral glucose tolerance test 

OH-DOC hydroxydeoxycorticosterone 

OR odds ratio 

PAA peak aortic acceleration 

PaO2 pressure of oxygen 

PBI protein bound iodine 

PEF (25-75) peak expiratory flow at piddle portion of expiration 

PEFR peak expiratory flow rate 

PER perception 
262

PFT pulmonary function test 

PIFR peak inspiratory flow rate 

PLB placebo 

P-MDA plasma malondialdehyde 

PMR progressive muscle relaxation 

PO2 pressure of oxygen 

PP pulse pressure 

PPT physical performance test 

PRA plasma renin activity 

PR pulse rate 

PWT posterior wall thickness 

RA renin activity 

RCT randomized controlled clinical trial 

RER respiratory exchange ratio 

RES respiratory 

Res-v respiratory variability 

RFT renal function test 

RPP rate pressure product 

RR relaxation Response 

RSG reasoning 

RT reaction time 

Rt right 

SA spatial ability 

SAO2 saturated oxygen 

SBP systolic blood pressure 

S-Ca serum calcium 

SCL skin conductance level 

SD standard deviation 

se session 

SEN sensory 

SI serum insulin 

SMD standardized mean difference 

S-Mg serum magnesium 

SMF sensory motor function 

SPSS Statistical Package for the Social Sciences 

SRL skin resistance level 

SRS Systematic Review Software 

SVR systemic vascular resistance 

TC total cholesterol 

TEE total energy expenditure 

TG triglycerides 

TEP technical expert panel 

THR thermoregulatory 

TM® Transcendental Meditation®

TOO Task Order Officer 

TSH thyroid stimulating hormone 
263

TV tidal volume 

UAEPC University of Alberta Evidence-based Practice Center 

UC usual care 

UE urinary/excretory 

UFNB unilateral forced nostril breathing 

UL urine lactate 

ULNB unilateral left nostril breathing 

UNB unilateral nostril breathing 

URNB unilateral right nostril breathing 

VA verbal ability 

VCO2 carbon dioxide production 

Ve minute ventilation 

VE/VCO2 rate of increase of ventilation per unit of increase of carbon 

dioxide production 

VLDL-C very low density lipoprotein cholesterol 

VMA vanillylmandelic acid 

VO2 oxygen consumption 

VO2 max maximum oxygen consumption 

WBC white blood cell 

wk week(s) 

WL waiting list 

WR work rate 

WMD weighted mean difference 

yr year(s) 

Zn zinc 

5-HIAA 5-hydroxyindole acetic acid 

17-KS 17-ketosteroids 

95% CI 95% confidence interval 
A-1

Appendix A. Technical Experts and Peer Reviewers 

Technical Expert Panel 

In designing the study questions and methodology at the outset of this report, the EPC 

consulted several technical and content experts. Broad expertise and perspectives are sought. 

Divergent and conflicted opinions are common and perceived as health scientific discourse that 

results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design 

and/or methodologic approaches do not necessarily represent the views of individual technical 

and content experts. 

Name Institution 

John Astin, Ph.D. California Pacific Medical Center, San Francisco, CA, United 

States 

Ruth Baer, Ph.D. University of Kentucky, Lexington, KT, United States 

Vernon Barnes, Ph.D. Medical College of Georgia, Augusta, GA, United States 

Linda Carlson, Ph.D, C.Psych. University of Calgary, Calgary, AB, Canada 

Jeffery Dusek, Ph.D. Harvard Medical School, Boston, MA, United States 

Thierry Lacaze-Masmonteil, M.D., Ph.D., 

F.R.C.P.C. 

University of Alberta, Edmonton, AB, Canada 

Badri Rickhi, M.D., Ph.D. Canadian Institute of Natural and Integrative Medicine (CINIM), 

Calgary, AB, Canada 

David Shannahoff-Khalsa, B.A. University of California at San Diego, San Diego, CA, United 

States 

Peer Reviewers 

Peer reviewer comments on a preliminary draft of this report were considered by the EPC in 

preparation of this final report. Synthesis of the scientific literature presented here does not 

necessarily represent the views of individual reviewers. 

Name Institution 

Kirk Warren Brown, Ph.D. Virginia Commonwealth University, Richmond, VA, United States 

Bei-Hung Chang, Sc.D. Boston University School of Public Health, Boston, MA, United 

States 

Thawatchai Krisanaprakornkit, M.D. Khon Kaen University, Khon Kaen, Thailand 

T. M. Srinivasan, Ph.D. The International Society for the Study of Subtle Energies and 

Energy Medicine, Madras (Chennai), India 

Harald Walach, Ph.D. The University of Northampton, Northampton, United Kingdom 

Ken Walton, Ph.D. Maharishi University of Management, Fairfield, IA, United States 

Gloria Yeh, M.D., M.P.H. Osher Institute at Harvard Medical School, Boston, MA, United 

States 
B-1 

Appendix B. Development of Consensus on a Set of 

Criteria for an Operational Definition of Meditation 

A consensus definition of meditation has not been established. The rationale for developing a 

consensus definition for meditation was to guide an unbiased selection of studies to be included 

in the review. We sought to develop consensus among a panel of experts on a set of criteria for a 

working definition of meditation; the relative importance of these criteria in defining a practice 

as meditation; and on a classification of practices as meditation or not meditation. 

Methods 

Study Design 

A five-round modified Delphi study was conducted from August to December 2006. The 

Delphi technique is a research tool designed to address complex problems with a high level of 

uncertainty that are not suited to statistical methods or open deliberation.36,37 Its goal is to obtain 

the most reliable consensus among a group of experts on a particular topic.36 The technique 

involves recruiting a group of experts to participate in an iterative process of answering 

questionnaire, receiving feedback regarding group responses, and revising their opinions in light 

of this feedback.37 The distinguishing characteristics of the Delphi technique are anonymity, 

iteration (processes occur in rounds), controlled feedback, (showing the distribution of the 

group’s response) and statistical group response (expressing judgment using summary measures 

of the full group response). This method was chosen over other consensus techniques due to its 

ability to allow all group members equal participation and influence, even when separated 

geographically.383

Study Participants 

Participants were seven individuals who acted as members of the Technical Expert Panel 

(TEP) for a report on the state of the research of meditation practices in healthcare. Each member 

lived in the United States or Canada and had expertise and training in meditation practices. 

Development of Questionnaires 

An initial list of potential criteria for an operational definition of meditation was generated 

from a preliminary list of key articles.9,98 Similarly, a list of potential meditation practices was 

developed based on an initial review of the literature.. The items were refined through an 

iterative review process, until a set of nine criteria to define meditation was found. The firstround questionnaire consisted of two parts. In the first part of the survey, participants were asked 

to rate the importance of the nine criteria as “not important at all,” “important but not essential,” 

or “essential. They were also asked to suggest any other criteria that they felt were essential for a 

working definition of meditation. In the second part of the questionnaire, participants were given 

a list of 41 interventions and were asked to indicate which interventions qualified as meditation 

practices based on the essential criteria rated in the first part of the questionnaire. The 
B-2 

participants were also asked to indicate any other intervention that they believed involved 

meditation but that was not represented in the list. 

In round two, feedback was provided on the group responses from round one. The 

participants were asked to reflect on their responses from the first round in light of the peer 

responses and to either confirm or change their responses accordingly. Based on round one 

comments, the wording of some criteria was modified, and three practices were added to the list 

of interventions. The second-round process was repeated until consensus was reached in round 

five. Round three helped to establish consensus on items for which disagreement persisted. 

Round four aimed to determine if the criteria considered “essential” to meditation in previous 

rounds were, in fact, a necessary part of the practices. Participants were asked to indicate which 

of the “essential” and “important but not essential” criteria applied to each potential intervention. 

The list of potential meditation practices was refined until consensus was reached. 

Study Procedures

The TEP members received a personalized letter describing the Delphi process, and the 

expectations regarding their participation. The questionnaires were sent electronically. 

Participants were given up to 1 week to respond to each questionnaire, and nonresponders were 

sent one reminder. Although participants were aware of the identity of other responders, they 

were blind to individual responses, ensuring anonymity throughout the process. 

Data Analysis 

Data from electronic questionnaires were exported into Microsoft ExcelTM (Microsoft 

Corporation, Redmond, WA) spreadsheets and analyzed with Statistical Package for the Social 

Sciences for Windows (SPSSTM version 14.1, SPSS, Inc., Chicago, IL). Categorical data were 

collected from each survey round and expressed as frequencies. The frequency of endorsement 

was tabulated for each criteria and practice. A priori, it was established that a frequency of 

endorsement of five out of seven would be considered consensus. 

Results 

The response rate in all rounds of the survey was 100 percent. Table B1 shows the experts’ 

final-round responses regarding the importance of various criteria for a working definition of 

meditation. Participants in the Delphi study agreed that a meditation practice (1) uses a defined 

technique, (2) involves logic relaxation, and (3) involves a self-induced state/mode. These 

criteria were considered essential. Participants also agreed that a meditation practice may (1) 

involve a state of psychophysical relaxation somewhere in the process; (2) use a self-focus skill 

or anchor; (3) involve an altered state/mode of consciousness, mystic experience, enlightenment 

or suspension of logical thought processes; (4) be embedded in a religious/spiritual/philosophical 

context; or (5) involve an experience of mental silence. After round four, participants did not 

reach consensus on whether bringing about mental calmness and physical relaxation by 

suspending the stream of thoughts would be essential or important to define an intervention as 

meditation. 
B-3 

Table B1. Final responses for the importance of various criteria for an operational definition of meditation 

Criteria 

Not important at all 

Important but not 

essential 

Essential 

Don’t know 

1. It uses a defined technique 0 0 7 0 

2. It involves logic relaxation: not “to intend” to analyze the possible 

psychophysical effects, not “to intend” to judge the possible results, not “to 

intend” to create any type of expectation regarding the process 

0 0 7 0 

3. It involves a state of psychophysical relaxation installed somewhere during 

the process 

1 5 1 0 

4. It involves a self-induced state/mode. It refers to a therapeutic method that 

can be taught by an instructor, but self-applied by the individual 

him/herself. It must, for instance, be feasible to be done at home, without 

the presence of the instructor. There must not be any relationship of 

dependence 

0 1 6 0 

5. It uses a self-focus skill or “anchor. A concentration (“positive anchor”) or a 

turning off (“negative anchor”) focus is used, in order to avoid sequels of 

undesirable thinking, torpor, sleep 

0 5 2 0 

6. It involves altered states/modes of consciousness, mystic experiences, 

“enlightenment” or suspension of logical thought processes 

1 5 1 0 

7. It is embedded in a religious/ spiritual/philosophical context 0 7 0 0 

8. It involves an experience of mental silence 0 5 1 1 

9. It involves a self-paced systematic desensitization 6 1 0 0 

10. It brings about mental calmness and physical relaxation by suspending the 

stream of thoughts that normally occupy the mind 

0 3 4 0 

Table B2 shows the experts’ final responses regarding the interventions that can be 

considered as meditation practices or practices involving a meditative component. The experts 

agreed that 32 out of 41 potential interventions were meditation or involved a meditative 

component in the practice; therefore, these 32 practices were considered for inclusion in the 

review. 

Table B2. Final responses for interventions considered meditation practices or practices involving a 

meditative component 

Intervention Yes No Don’t know 

1. Vipassana 7 0 0 

2. Dhyana 7 0 0 

3. Zen Budhhist meditation (Zazen) 7 0 0 

4. Kinemantra meditation (KM) 7 0 0 

5. Anapana sati 6 1 0 

6. Mindfulness-based stress reduction (MBSR) 7 0 0 

7. Mindfulness-based cognitive therapy (MBCT) 7 0 0 

8. Transcendental Meditation® technique (TM®) 7 0 0 

9. Mindfulness meditation (MM) 7 0 0 

10. Relaxation response (RR) 7 0 0 

11. Progressive muscle relaxation (PMR) 0 7 0 
B-4 

Table B2. Final responses for interventions considered as meditation practices or practices involving a 

meditative component (continued)

Intervention Yes No Do not know 

12. Unilateral forced nostril breathing 6 1 0 

13. Yoga (any) 6 1 0 

14. Kundalini yoga 7 0 0 

15. Raja yoga 7 0 0 

16. Hatha yoga 5 2 0 

17. Sudarshan kriya yoga 6 1 0 

18. Yogic breathing 6 1 0 

19. Pranayama 6 1 0 

20. Kapalabhati 6 1 0 

21. Centering prayer 6 1 0 

22. Qigong 5 1 1 

23. Tai chi 5 2 0 

24. Samadhi 7 0 0 

25. Visual imagery 0 7 0 

26. Guided imagery 1 5 1 

27. Guided visualization 1 6 0 

28. Creative visualization 1 6 0 

29. Mantra 7 0 0 

30. Pratyahara 6 1 0 

31. Dharana 7 0 0 

32. Tae eul ju 5 1 1 

33. Hesychasm 5 2 0 

34. Lectio divina 2 5 0 

35. Silva method 1 6 0 

36. Naam 5 2 0 

37. Dialectical behavior therapy 1 6 0 

38. Autogenic training 0 7 0 

39. Clinically standardized meditation 5 2 0 

40. Sound chanting 5 2 0 

41. Sufic practices 7 0 0 

This study was undertaken to develop a working definition of meditation that could be used 

to clearly differentiate meditation practices from those that are not meditation. These criteria 

formed part of a multicomponent approach to study selection in the report on the state of 

research of meditation practices for healthcare. The results of this study provide valuable insight 

into the problem of defining meditation and pcontribute with a preliminary set of criteria with 

which to judge potential meditation practices. 
C-1 

Appendix C. Exact Search Strings 

Table C1. MEDLINE®—Ovid version 

Years/issue searched: 1966 to August 2005, week 5 

Search date: September 8, 2005

1. exp meditation/ 

2. exp yoga/ 

3. meditat$.mp. 

4. cogitat$.ti,ab. 

5. Pranayam$.mp. 

6. kapalabhati.ti,ab. 

7. (yoga or yogic$).mp. 

8. mindful$.mp. 

9. zen.ti,ab,sh. 

10. transcendental.ti,ab. 

11. TM-Sidhi.mp. 

12. mahayana.ti,ab. 

13. hiniyana.ti,ab. 

14. theravada$.ti,ab. 

15. vajrayana.ti,ab. 

16. (vipissana or vipashyana).ti,ab. 

17. (dhyana or dyana).ti,ab. 

18. dharana.ti,ab. 

19. zazen.ti,ab. 

20. (kinemantra or KM).ti,ab. 

21. (mantra or mantras).mp. 

22. (samadhi or samatha).ti,ab. 

23. pratyahara.ti,ab. 

24. purusha.ti,ab. 

25. prakruti.ti,ab. 

26. ((Visual or guided) adj5 imagery).mp. 

27. ((guided or creative or vivid) adj 

visualization).ti,ab. 

28. pray$.mp. 

29. Hesychasm.ti,ab. 

30. "lectio divina".ti,ab. 

31. bonadona.ti,ab. 

32. (qigong or qi gong).mp. 

33. ch'i kung.ti,ab. 

34. "Tae Eul Ju".ti,ab. 

35. "mind-body and relaxation techniques"/ or "mindbody relations (metaphysics)"/ 

36. tai ji/ 

37. (tai chi or tai ji).mp. 

38. Taijiquan.ti,ab. 

39. "open awareness".mp. 

40. "focused awareness".mp. 

41. "relaxation response".mp. 

42. "progressive muscle relaxation".ti,ab. 

43. progressive relaxation.ti,ab. 

44. "forced nostril breathing".ti,ab. 

45. "Uninostril breathing".ti,ab. 

46. "unilateral breathing".ti,ab. 

47. (Khundalini or Kundalini).mp. 

48. raja.ti,ab. 

49. hatha.ti,ab. 

50. "sudarshan kriya".ti,ab. 

51. RRMM.ti,ab. 

52. MBSR.ti,ab. 

53. MBCT.ti,ab. 

54. "Wide-angle lens attention".ti,ab. 

55. ("Anapana Sati" or anapanasati).mp. 

56. kabat-zinn.ab. 

57. or/1-56 

58. RANDOMIZED CONTROLLED TRIAL.pt. 

59. CONTROLLED CLINICAL TRIAL.pt. 

60. RANDOMIZED CONTROLLED TRIALS 

61. RANDOM ALLOCATION/ 

62. DOUBLE BLIND METHOD/ 

63. SINGLE-BLIND METHOD/ 

64. or/58-63 

65. ANIMAL/ not HUMAN/ 

66. 64 not 65 

67. CLINICAL TRIAL.pt. 

68. exp CLINICAL TRIALS/ 

69. (clin$ adj25 (trial$ or study or studies or 

design)).ti,ab. 

70. ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ 

or mask$)).ti,ab. 

71. PLACEBOS/ 

72. placebo$.ti,ab. 

73. random$.ti,ab. 

74. RESEARCH DESIGN/ 

75. or/67-74 

76. 75 not 65 

77. 76 not 66 

78. COMPARATIVE STUDY/ 

79. exp EVALUATION STUDIES/ 

80. FOLLOW UP STUDIES/ 

81. (Follow up adj5 (study or studies or design)).ti,ab. 

82. PROSPECTIVE STUDIES/ 

83. exp COHORT STUDIES/ 

84. CROSS-SECTIONAL STUDIES/ 

85. exp CASE-CONTROL STUDIES/ 

86. Epidemiologic studies/ 

87. Epidemiological factors/ 

88. exp Causality/ 

89. Age factors/ 

90. Comorbidity/ 

91. Odds ratio/ 

92. exp Risk/ 

93. Probability/ 

94. ((Allocat$ or control$ or assign$ or treatment or 

compar$ or interven$ or experiment$) and (group 

or groups)).mp. 

95. (group or groups).ti,ab. 

96. (control$ or prospectiv$ or retrospectiv$ or 

volunteer$ or participant$ or compar$).mp. and 

(trial$ or study or studies or design).ti,ab,sh. 

97. cohort$.ti,ab. 

98. case-control$.ti,ab. 

99. Cross sectional.ti,ab. 
C-2 

Table C1. MEDLINE®—Ovid version (continued) 

100. (observational adj5 (study or studies or 

design)).ti,ab. 

101. Longitudinal.mp. 

102. Retrospective.ti,ab. 

103. Relative risk.ti,ab. 

104. Odds ratio.ti,ab. 

105. (case adj (comparison or referent)).ti,ab. 

106. (Causation or causal$).ti,ab. 

107. (Analytic adj (study or studies)).ti,ab. 

108. or/78-107 

109. 108 not 65 

110. 109 not (66 or 77) 

111. 66 or 77 or 109 

112. 57 and 111 

113. limit 112 to (humans and english language) 

114. limit 113 to "all adult (19 plus years)" 

115. 113 not 114 

116. limit 115 to "all child (0 to 18 years)" 

117. 115 not 116 

118. 114 or 117 

119. remove duplicates from 118 

120. systematic review$.mp. 

121. systematic literature review$.mp. 

122. meta-analysis.sh. 

123. (meta-analys?s or metaanalys?s).ti. 

124. evidence-based medicine.mp. 

125. quantitative review$.ti,ab. 

126. quantitative overview$.ti,ab. 

127. quantitative synthes?s.ti. 

128. quantitative analys?s.ti,ab. 

129. (evidence-based adj (guideline$ or 

recommendation$)).mp. 

130. health planning guideline$.mp. 

131. cochrane database of systematic reviews.mp. 

132. cdsr.mp. 

133. acp journal club.mp. 

134. (health tech$ assess$ or hta).mp. 

135. technolog$ assess$.mp. 

136. evidence based nursing.mp. 

137. evidence based mental health.mp. 

138. clinical evidence.mp. 

139. biomedical technology assessment.sh. 

140. evidence report$.mp. 

141. or/120-140 

142. systematic$.mp. 

143. critical.mp. 

144. (study and selection).ti,ab. 

145. ((predetermined or inclusion) and criteri$).mp. 

146. exclusion criteri$.mp. 

147. main outcome measure$.mp. 

148. "standard$ of care".mp. 

149. or/142-148 

150. (survey$ or overview$ or review or reviews or 

search$ or handsearch$).mp. 

151. (analys?s or critique or appraisal).mp. 

152. (reduction and risk and (death or 

occurrence)).mp. 

153. or/150-152 

154. (literature or article$ or publication$ or 

bibliograph$ or published or unpublished or 

ciation$ or database$ or internet or reference$ 

or textbook$ or trial$).mp. 

155. meta-analysis.sh. 

156. (medline or medlars or pubmed or embase 

or index medicus or cochrane or scisearch or 

web of science or psychinfo or psychlit or cinahl 

or experta medica or science citation index or 

sciences citation index or biological 

abstracts).mp. 

157. (clinical and studies).mp. 

158. (treatment outcome or combine$ or combining or 

peto or der simonian or dersimonian or fixed 

effect$ or pooled or pooling or mantel 

haenszel).mp. 

159. or/154-157 

160. 149 and 153 and 159 

161. 141 or 160 

162. case report.ti,sh. 

163. editorial.ti,pt. 

164. letter.pt. 

165. note.pt. 

166. or/162-165 

167. 161 not 166 

168. 167 and 57 

169. 168 not 119 

170. meta-analysis.pt. 

171. (meta-anal$ or metaanal$).mp. 

172. (((quantitativ$ adj3 review$1) or quantitativ$) 

adj3 overview$).mp. 

173. (((systematic adj3 review$1) or systematic) adj3 

overview$1).mp. 

174. (((methodologic adj3 review$1) or methodologic) 

adj3 overview$).mp. 

175. (integrat$ adj5 research).mp. 

176. (quantitativ$ adj3 synthes$).mp. 

177. or/170-176 

178. review.pt. or (review$ or overview$).mp. 

179. (medline or medlars or pubmed or index medicus 

or embase or cochrane).mp. 

180. (scisearch or web of science or psycinfo or 

psychinfo or cinahl or cinhal).mp. 

181. (excerpta medica or psychlit or psyclit or current 

contents or science citation index or sciences 

citation index).mp. 

182. (hand search$ or manual search$).mp. 

183. ((((electronic adj3 database$) or bibliographic) 

adj3 database$) or periodical index$).mp. 

184. (pooling or pooled or mantel haenszel).mp. 

185. (peto or der simonian or dersimonian or fixed 

effect$).mp. 

186. ((combine$ or combining) adj5 (data or trial or 

trials or studies or study or result or 

results)).mp. 

187. or/179-186 

188. 178 and 187 

189. 177 or 188 
C-3 

Table C1. MEDLINE®—Ovid version (continued)

190. (hta$ or health technology assessment$ or biomedical technology assessment$).mp. 

191. technology assessment, biomedical/ or biomedical technology assessment/ 

192. 190 or 191 

193. 189 or 192 

194. 119 and 193 

195. 57 and 193 

196. 119 or 195 
C-4 

Table C2. EMBASE—Ovid version 

Years/issue searched: 1988 to 2005, week 36 

Search date: September 8, 2005

1. exp meditation/ 

2. Transcendental meditation/ 

3. exp yoga/ 

4. meditat$.mp. 

5. cogitat$.ti,ab. 

6. Pranayam$.mp. 

7. kapalabhati.ti,ab. 

8. (yoga or yogic$).mp. 

9. mindful$.mp. 

10. zen.ti,ab,sh. 

11. transcendental.ti,ab. 

12. TM-Sidhi.mp. 

13. mahayana.ti,ab. 

14. hiniyana.ti,ab. 

15. theravada$.ti,ab. 

16. vajrayana.ti,ab. 

17. (vipissana or vipashyana).ti,ab. 

18. (dhyana or dyana).ti,ab. 

19. dharana.ti,ab. 

20. zazen.ti,ab. 

21. (kinemantra or KM).ti,ab. 

22. (mantra or mantras).mp. 

23. (samadhi or samatha).ti,ab. 

24. pratyahara.ti,ab. 

25. purusha.ti,ab. 

26. prakruti.ti,ab. 

27. ((Visual or guided) adj5 imagery).mp. 

28. ((guided or creative or vivid) adj 

visualization).ti,ab. 

29. pray$.mp. 

30. Hesychasm.ti,ab. 

31. lectio divina.ti,ab. 

32. bonadona.ti,ab. 

33. (qigong or qi gong).mp. 

34. ch'i kung.ti,ab. 

35. "Tae Eul Ju".ti,ab. 

36. relaxation training/ and (Psychophysiology/ or 

Breathing Exercise/) 

37. "Mental Concentration"/ and (Breathing Exercise/ 

or relaxation training/) 

38. (mind adj body).ti,ab. 

39. brain mind relationship/ 

40. exp Tai Chi/ 

41. (tai chi or tai ji).mp. 

42. Taijiquan.ti,ab. 

43. "open awareness".mp. 

44. "focused awareness".mp. 

45. "relaxation response".mp. 

46. "progressive muscle relaxation".ti,ab. 

47. progressive relaxation.ti,ab. 

48. "forced nostril breathing".ti,ab. 

49. "Uninostril breathing".ti,ab. 

50. "unilateral breathing".ti,ab. 

51. (Khundalini or Kundalini).mp. 

52. raja.ti,ab. 

53. hatha.ti,ab. 

54. "sudarshan kriya".ti,ab. 

55. RRMM.ti,ab. 

56. MBSR.ti,ab. 

57. MBCT.ti,ab. 

58. "zoom lens attention".ti,ab. 

59. "Wide-angle lens attention".ti,ab. 

60. ("Anapana Sati" or anapanasati).mp. 

61. kabat-zinn.ab. 

62. or/1-61 

63. Randomized Controlled Trial/ 

64. exp Randomization/ 

65. Double Blind Procedure/ 

66. Single Blind Procedure/ 

67. or/63-66 

68. Clinical Trial/ 

69. (clin$ adj25 (trial$ or study or studies or 

design)).mp. 

70. ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ 

or mask$)).mp. 

71. exp Placebo/ 

72. (placebo$ or random$).mp. 

73. exp Methodology/ 

74. exp Comparative Study/ 

75. exp Evaluation/ 

76. exp Follow Up/ 

77. exp Prospective Study/ 

78. clinical study/ 

79. case control study/ 

80. family study/ 

81. longitudinal study/ 

82. retrospective study/ 

83. cohort analysis/ 

84. exp Risk/ 

85. ((allocat$ or compar$ or assign$ or treatment or 

control$ or interven$ or experiment$) and (group 

or groups)).mp. 

86. (group or groups).ti,ab. 

87. ((control$ or prospectiv$ or retrospectiv$ or 

volunteer$ or participant$ or compar$) and (trial$ 

or study or studies or design)).ti,ab,sh. 

88. cohort$.ti,ab. 

89. "case-control".ti,ab. 

90. "Cross sectional".ti,ab. 

91. (observational adj5 (study or studies or 

design)).ti,ab. 

92. Longitudinal.mp. 

93. Retrospective.ti,ab. 

94. "Relative risk".ti,ab. 

95. "Odds ratio".ti,ab. 

96. (Follow up adj5 (study or studies or 

design)).ti,ab. 

97. (case adj (comparison or referent)).ti,ab. 

98. (Causation or causal$).ti,ab. 

99. (Analytic adj (study or studies)).ti,ab. 

100. (epidemiologic$ adj (study or studies)).ti,ab. 

101. or/68-99 

102. 67 or 101 
C-5 

Table C2. EMBASE—Ovid version (continued) 

103. limit 102 to human 

104. Nonhuman/ 

105. 103 not 104 

106. 62 and 105 

107. limit 106 to english language 

108. limit 107 to (adult <18 to 64 years> or aged <65+ 

years>) 

109. 107 not 108 

110. limit 109 to (embryo or infant or child or 

preschool child <1 to 6 years> or school child <7 to 12 

years>) 

111. 109 not 110 

112. 108 or 111 

113. remove duplicates from 112 

114. systematic review$.mp. 

115. systematic literature review$.mp. 

116. meta-analysis.sh. 

117. (meta-analys?s or metaanalys?s).ti. 

118. evidence-based medicine.mp. 

119. quantitative review$.ti,ab. 

120. quantitative overview$.ti,ab. 

121. quantitative synthes?s.ti. 

122. quantitative analys?s.ti,ab. 

123. (evidence-based adj (guideline$ or 

recommendation$)).mp. 

124. health planning guideline$.mp. 

125. cochrane database of systematic reviews.mp. 

126. cdsr.mp. 

127. acp journal club.mp. 

128. (health tech$ assess$ or hta).mp. 

129. technolog$ assess$.mp. 

130. evidence based nursing.mp. 

131. evidence based mental health.mp. 

132. clinical evidence.mp. 

133. biomedical technology assessment.sh. 

134. evidence report$.mp. 

135. or/114-134 

136. systematic$.mp. 

137. critical.mp. 

138. (study and selection).ti,ab. 

139. ((predetermined or inclusion) and criteri$).mp. 

140. exclusion criteri$.mp. 

141. main outcome measure$.mp. 

142. "standard$ of care".mp. 

143. or/136-142 

144. (survey$ or overview$ or review or reviews or 

search$ or handsearch$).mp. 

145. (analys?s or critique or appraisal).mp. 

146. (reduction and risk and (death or 

occurrence)).mp. 

147. or/144-146 

148. (literature or article$ or publication$ or 

bibliograph$ or published or unpublished or ciation$ 

or database$ or internet or reference$ or textbook$ or 

trial$).mp. 

149. meta-analysis.sh. 

150. (medline or medlars or pubmed or embase or 

index medicus or cochrane or scisearch or web of 

science or psychinfo or psychlit or cinahl or experta 

medica or science citation index or sciences citation 

index or biological abstracts).mp. 

151. (clinical and studies).mp. 

152. (treatment outcome or combine$ or combining 

or peto or der simonian or dersimonian or fixed 

effect$ or pooled or pooling or mantel haenszel).mp. 

153. or/148-151 

154. 143 and 147 and 153 

155. 135 or 154 

156. case report.ti,sh. 

157. editorial.ti,pt. 

158. letter.pt. 

159. note.pt. 

160. or/156-159 

161. 155 not 160 

162. meta-analysis.pt. 

163. (meta-anal$ or metaanal$).mp. 

164. (((quantitativ$ adj3 review$1) or quantitativ$) 

adj3 overview$).mp. 

165. (((systematic adj3 review$1) or systematic) adj3 

overview$1).mp. 

166. (((methodologic adj3 review$1) or methodologic) 

adj3 overview$).mp. 

167. (integrat$ adj5 research).mp. 

168. (quantitativ$ adj3 synthes$).mp. 

169. or/162-168 

170. review.pt. or (review$ or overview$).mp. 

171. (medline or medlars or pubmed or index medicus 

or embase or cochrane).mp. 

172. (scisearch or web of science or psycinfo or 

psychinfo or cinahl or cinhal).mp. 

173. (excerpta medica or psychlit or psyclit or current 

contents or science citation index or sciences citation 

index).mp. 

174. (hand search$ or manual search$).mp. 

175. ((((electronic adj3 database$) or bibliographic) 

adj3 database$) or periodical index$).mp. 

176. (pooling or pooled or mantel haenszel).mp. 

177. (peto or der simonian or dersimonian or fixed 

effect$).mp. 

178. ((combine$ or combining) adj5 (data or trial or 

trials or studies or study or result or results)).mp. 

179. or/171-178 

180. 170 and 179 

181. 169 or 180 

182. (hta$ or health technology assessment$ or 

biomedical technology assessment$).mp. 

183. technology assessment, biomedical/ or 

biomedical technology asssessment/ 

184. 182 or 183 

185. 181 or 184 

186. 161 or 185 

187. 186 and 62 

188. limit 187 to (human and english language) 

189. limit 188 to (adult <18 to 64 years> or aged <65+ 

years>) 

190. 188 not 189 

191. limit 190 to (embryo or infant or child or 

preschool child <1 to 6 years> or school child <7 to 12 

years> or adolescent <13 to 17 years>) 

192. 190 not 191 

193. 189 or 192 

194. remove duplicates from 193 
C-6 

Table C2. EMBASE—Ovid version (continued)

195. 113 or 194 
C-7 

Table C3. Central (EBM Reviews–Cochrane Central Register of Controlled Trials)—Ovid version 

Years/issue searched: 3rd Quarter 2005 

Search date: August 4, 2005

1. exp meditation/ 

2. exp yoga/ 

3. meditat$.mp. 

4. cogitat$.ti,ab. 

5. Pranayam$.mp. 

6. kapalabhati.ti,ab. 

7. (yoga or yogic$).mp. 

8. mindful$.mp. 

9. zen.ti,ab,sh. 

10. transcendental.ti,ab. 

11. TM-Sidhi.mp. 

12. mahayana.ti,ab. 

13. hiniyana.ti,ab. 

14. theravada$.ti,ab. 

15. vajrayana.ti,ab. 

16. (vipissana or vipashyana).ti,ab. 

17. (dhyana or dyana).ti,ab. 

18. dharana.ti,ab. 

19. zazen.ti,ab. 

20. (kinemantra or KM).ti,ab. 

21. (mantra or mantras).mp. 

22. (samadhi or samatha).ti,ab. 

23. pratyahara.ti,ab. 

24. purusha.ti,ab. 

25. prakruti.ti,ab. 

26. ((Visual or guided) adj5 imagery).mp. 

27. ((guided or creative or vivid) adj 

visualization).ti,ab. 

28. pray$.mp. 

29. Hesychasm.ti,ab. 

30. "lectio divina".ti,ab. 

31. bonadona.ti,ab. 

32. (qigong or qi gong).mp. 

33. ch'i kung.ti,ab. 

34. "Tae Eul Ju".ti,ab. 

35. "mind-body and relaxation techniques"/ or "mindbody relations (metaphysics)"/ 

36. tai ji/ 

37. (tai chi or tai ji).mp. 

38. Taijiquan.ti,ab. 

39. "open awareness".mp. 

40. "focused awareness".mp. 

41. "relaxation response".mp. 

42. "progressive muscle relaxation".ti,ab. 

43. progressive relaxation.ti,ab. 

44. "forced nostril breathing".ti,ab. 

45. "Uninostril breathing".ti,ab. 

46. "unilateral breathing".ti,ab. 

47. (Khundalini or Kundalini).mp. 

48. raja.ti,ab. 

49. hatha.ti,ab. 

50. "sudarshan kriya".ti,ab. 

51. RRMM.ti,ab. 

52. MBSR.ti,ab. 

53. MBCT.ti,ab. 

54. "zoom lens attention".ti,ab. 

55. "Wide-angle lens attention".ti,ab. 

56. ("Anapana Sati" or anapanasati).mp. 

57. kabat-zinn.ab. 

58. or/1-57 

59. adult.mp. 

60. elderly.mp. 

61. middle-age$.mp. 

62. aged.hw. or aged.kw. or aged.sh. or "aged 80 

and over".sh. 

63. or/59-62 

64. 58 and 63 

65. 58 not 64 

66. child$.hw. 

67. adolescen$.hw. 

68. infan$.hw. 

69. minors.hw. 

70. neonat$.hw. 

71. pediatric$.hw. 

72. (nurseries or nursery).hw. 

73. or/66-72 

74. child$.mp. 

75. paediatric$.mp. 

76. pediatric$.mp. 

77. (neonat$ or perinat$).mp. 

78. newborn$.mp. 

79. infan$.mp. 

80. preemie$.mp. 

81. (baby or babies).mp. 

82. (nursery or nurseries).mp. 

83. toddler$.mp. 

84. boy$.mp. 

85. girl$.mp. 

86. (schoolage$ or (school adj1 age$)).mp. 

87. (preschool$ or (pre adj1 school$)).mp. 

88. nursery school$.mp. 

89. kindergar?en$.mp. 

90. (schoolchild$ or (school adj1 child$)).mp. 

91. primary school$.mp. 

92. elementary school$.mp. 

93. (prepubescen$ or postpubescen$ or (pre adj1 

pubescen$) or (post adj1 pubescen$)).mp. 

94. secondary school$.mp. 

95. (pubescen$ or pubert$).mp. 

96. adolescen$.mp. 

97. juvenil$.mp. 

98. underage$.mp. 

99. (teen or teens).mp. 

100. teenage$.mp. 

101. (youth or youths).mp. 

102. (highschool$ or (high adj1 school$)).mp. 

103. kid$1.mp. 

104. offspring.mp. 

105. or/74-104 

106. infan$.jw. 

107. (neonat$ or perinat$).jw. 

108. child$.jw. 

109. pediatric$.jw. 
C-8 

Table C3. Central (EBM Reviews–Cochrane Central Register of Controlled Trials)—Ovid version (continued) 

110. paediatric$.jw. 

111. adolescen$.jw. 

112. youth$.jw. 

113. school$.jw. 

114. or/106-113 

115. or/105,114 

116. 65 and 115 

117. 65 not 116 

118. 65 not 115 

119. 118 or 64 

120. exp meditation/ 

121. Transcendental meditation/ 

122. exp yoga/ 

123. meditat$.mp. 

124. cogitat$.ti,ab. 

125. Pranayam$.mp. 

126. kapalabhati.ti,ab. 

127. (yoga or yogic$).mp. 

128. mindful$.mp. 

129. zen.ti,ab,sh. 

130. transcendental.ti,ab. 

131. TM-Sidhi.mp. 

132. mahayana.ti,ab. 

133. hiniyana.ti,ab. 

134. theravada$.ti,ab. 

135. vajrayana.ti,ab. 

136. (vipissana or vipashyana).ti,ab. 

137. (dhyana or dyana).ti,ab. 

138. dharana.ti,ab. 

139. zazen.ti,ab. 

140. (kinemantra or KM).ti,ab. 

141. (mantra or mantras).mp. 

142. (samadhi or samatha).ti,ab. 

143. pratyahara.ti,ab. 

144. purusha.ti,ab. 

145. prakruti.ti,ab. 

146. ((Visual or guided) adj5 imagery).mp. 

147. ((guided or creative or vivid) adj 

visualization).ti,ab. 

148. pray$.mp. 

149. Hesychasm.ti,ab. 

150. lectio divina.ti,ab. 

151. bonadona.ti,ab. 

152. (qigong or qi gong).mp. 

153. ch'i kung.ti,ab. 

154. "Tae Eul Ju".ti,ab. 

155. relaxation training/ and (Psychophysiology/ or 

Breathing Exercise/) 

156. "Mental Concentration"/ and (Breathing Exercise/ 

or relaxation training/) 

157. (mind adj body).ti,ab. 

158. brain mind relationship/ 

159. exp Tai Chi/ 

160. (tai chi or tai ji).mp. 

161. Taijiquan.ti,ab. 

162. "open awareness".mp. 

163. "focused awareness".mp. 

164. "relaxation response".mp. 

165. "progressive muscle relaxation".ti,ab. 

166. progressive relaxation.ti,ab. 

167. "forced nostril breathing".ti,ab. 

168. "Uninostril breathing".ti,ab. 

169. "unilateral breathing".ti,ab. 

170. (Khundalini or Kundalini).mp. 

171. raja.ti,ab. 

172. hatha.ti,ab. 

173. "sudarshan kriya".ti,ab. 

174. RRMM.ti,ab. 

175. MBSR.ti,ab. 

176. MBCT.ti,ab. 

177. "zoom lens attention".ti,ab. 

178. "Wide-angle lens attention".ti,ab. 

179. ("Anapana Sati" or anapanasati).mp. 

180. kabat-zinn.ab. 

181. or/120-180 

182. 181 or 58 

183. 182 not 58 

184. 119 or 183 
C-9 

Table C4. PsycINFO®—Ovid version 

Years/issue searched: 1872 to August 2005, week 4 

Search date: September 9, 2005 

1. exp meditation/ 

2. exp yoga/ 

3. exp Guided Imagery/ 

4. exp Prayer/ 

5. Autogenic Training/ 

6. meditat$.mp. 

7. cogitat$.ti,ab. 

8. Pranayam$.mp. 

9. kapalabhati.ti,ab. 

10. (yoga or yogic$).mp. 

11. mindful$.mp. 

12. zen.ti,ab,sh. 

13. transcendental.ti,ab. 

14. TM-Sidhi.mp. 

15. mahayana.ti,ab. 

16. hiniyana.ti,ab. 

17. theravada$.ti,ab. 

18. vajrayana.ti,ab. 

19. (vipissana or vipashyana).ti,ab. 

20. (dhyana or dyana).ti,ab. 

21. dharana.ti,ab. 

22. zazen.ti,ab. 

23. (kinemantra or KM).ti,ab. 

24. (mantra or mantras).mp. 

25. (samadhi or samatha).ti,ab. 

26. pratyahara.ti,ab. 

27. purusha.ti,ab. 

28. prakruti.ti,ab. 

29. (((Visual or guided) adj3 imagery) and (therap$ or 

treat$ or interven$)).mp. 

30. imagery/ and relaxation therapy/ 

31. ((guided or creative or vivid) adj 

visualization).ti,ab. 

32. pray$.mp. 

33. Hesychasm.ti,ab. 

34. lectio divina.ti,ab. 

35. bonadona.ti,ab. 

36. (qigong or qi gong).mp. 

37. ch'i kung.ti,ab. 

38. "Tae Eul Ju".ti,ab. 

39. relaxation therapy/ and mind.ti,ab. 

40. Progressive relaxation therapy/ 

41. ((mind adj body) and (therap$ or treat$ or 

interven$ or aware$ or breath$ or relax$ or 

conscious$)).ti,ab. 

42. (tai chi or tai ji).mp. 

43. Taijiquan.ti,ab. 

44. "open awareness".mp. 

45. "focused awareness".mp. 

46. "relaxation response".mp. 

47. "progressive muscle relaxation".ti,ab. 

48. progressive relaxation.ti,ab. 

49. "forced nostril breathing".ti,ab. 

50. "Uninostril breathing".ti,ab. 

51. "unilateral breathing".ti,ab. 

52. (Khundalini or Kundalini).mp. 

53. raja.ti,ab. 

54. hatha.ti,ab. 

55. "sudarshan kriya".ti,ab. 

56. RRMM.ti,ab. 

57. MBSR.ti,ab. 

58. MBCT.ti,ab. 

59. "zoom lens attention".ti,ab. 

60. "Wide-angle lens attention".ti,ab. 

61. ("Anapana Sati" or anapanasati).mp. 

62. kabat-zinn.ab. 

63. or/1-61 

64. exp CLINICAL TRIALS/ 

65. control group/ 

66. random$.mp. 

67. "sampling (experimental)"/ or Biased Sampling/ or 

Random Sampling/ 

68. ((singl$ or doubl$ or tripl$ or trebl$) adj10 (blind$ or 

mask$)).mp. 

69. (cross?over or placebo$ or control$ or factorial or 

sham$).mp. 

70. double dummy.mp. 

71. ((clin$ or intervention$ or compar$ or experiment$ or 

preventive or therap$) adj10 (trial$ or study or 

studies)).mp. 

72. Experimental Subjects/ or Experiment volunteers/ or 

Experiment controls/ or Experimental Replication/ 

73. clinical research.mp. or exp Treatment Effectiveness 

Evaluation/ 

74. Treatment Outcomes/ or Psychotherapeutic outcomes/ 

75. (outcome$ adj assessment).mp. 

76. (longitudinal study or meta analysis or program 

evaluation or prospective study or retrospective study 

or treatment outcome study or empirical study or 

experimental replication or followup study).fc. 

77. clinical case report.fc. 

78. (clin$ adj25 (trial$ or study or studies or design)).ti,ab. 

79. ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or 

mask$)).ti,ab. 

80. (efficacy or effective$ or findings or results).mp. 

81. RESEARCH DESIGN/ 

82. FOLLOW-UP STUDIES/ 

83. (Follow up adj5 (study or studies or design)).ti,ab. 

84. PROSPECTIVE STUDIES/ 

85. LONGITUDINAL STUDIES/ 

86. Comorbidity/ 

87. exp Probability/ 

88. ((Allocat$ or control$ or assign$ or treatment or 

compar$ or interven$ or experiment$) and (group or 

groups)).mp. 

89. (group or groups).ti,ab. 

90. ((control$ or multicenter or prospectiv$ or retrospectiv$ 

or evaluation or outcome$ or volunteer$ or subjects or 

participant$ or compar$) and (trial$ or study or 

studies or design)).mp. 

91. Ss.ab. 

92. cohort$.ti,ab. 

93. case-control$.ti,ab. 
C-10

Table C4. PsycINFO® – Ovid Version (continued) 

94. Cross sectional.ti,ab. 

95. (observational adj5 (study or studies or 

design)).ti,ab. 

96. Longitudinal.mp. 

97. Retrospective.ti,ab. 

98. risk.ti,ab. 

99. Odds ratio.ti,ab. 

100. (case adj (comparison or referent)).ti,ab. 

101. (Causation or causal$).ti,ab. 

102. (Analytic adj (study or studies)).ti,ab. 

103. exp Placebo/ 

104. exp Empirical Methods/ 

105. Repeated Measures/ 

106. Between Groups Design/ 

107. exp Evaluation/ 

108. cohort analysis/ 

109. or/64-108 

110. 63 and 109 

111. limit 110 to (human and english language) 

112. limit 111 to adulthood <18+ years> 

113. 111 not 112 

114. limit 113 to (childhood or adolescence <13 to 17 

years>) 

115. 113 not 114 

116. 112 or 115 

117. limit 116 to (chapter or journal or peer reviewed 

journal or dissertation abstract or report or 

"review") 

118. remove duplicates from 117 

119. meta analysis/ or statistical analysis/ or 

"literature review"/ 

120. systematic review$.mp. 

121. systematic literature review$.mp. 

122. meta-analysis.sh. 

123. (meta-analys?s or metaanalys?s).ti. 

124. evidence-based medicine.mp. 

125. quantitative review$.ti,ab. 

126. quantitative overview$.ti,ab. 

127. quantitative synthes?s.ti. 

128. quantitative analys?s.ti,ab. 

129. (evidence-based adj (guideline$ or 

recommendation$)).mp. 

130. health planning guideline$.mp. 

131. cochrane database of systematic reviews.mp. 

132. cdsr.mp. 

133. acp journal club.mp. 

134. (health tech$ assess$ or hta).mp. 

135. technolog$ assess$.mp. 

136. evidence based nursing.mp. 

137. evidence based mental health.mp. 

138. clinical evidence.mp. 

139. biomedical technology assessment.sh. 

140. evidence report$.mp. 

141. or/120-140 

142. systematic$.mp. 

143. critical.mp. 

144. (study and selection).ti,ab. 

145. ((predetermined or inclusion) and criteri$).mp. 

146. exclusion criteri$.mp. 

147. main outcome measure$.mp. 

148. "standard$ of care".mp. 

149. or/142-148 

150. (survey$ or overview$ or review or reviews or 

search$ or handsearch$).mp. 

151. (analys?s or critique or appraisal).mp. 

152. (reduction and risk and (death or 

occurrence)).mp. 

153. or/150-152 

154. (literature or article$ or publication$ or 

bibliograph$ or published or unpublished or 

ciation$ or database$ or internet or reference$ 

or textbook$ or trial$).mp. 

155. meta-analysis.sh. 

156. (medline or medlars or pubmed or embase or 

index medicus or cochrane or scisearch or web 

of science or psychinfo or psychlit or cinahl or 

experta medica or science citation index or 

sciences citation index or biological 

abstracts).mp. 

157. (clinical and studies).mp. 

158. (treatment outcome or combine$ or combining or 

peto or der simonian or dersimonian or fixed 

effect$ or pooled or pooling or mantel 

haenszel).mp. 

159. or/154-157 

160. 149 and 153 and 159 

161. 141 or 160 

162. case report.ti,sh. 

163. editorial.ti,pt. 

164. letter.pt. 

165. note.pt. 

166. or/162-165 

167. 161 not 166 

168. systematic review$.mp. 

169. systematic literature review$.mp. 

170. meta-analysis.pt. 

171. (meta-analys?s or metaanalys?s).ti. 

172. evidence-based medicine.mp. 

173. quantitative review$.ti,ab. 

174. quantitative overview$.ti,ab. 

175. quantitative synthes?s.ti. 

176. quantitative analys?s.ti,ab. 

177. (evidence-based adj (guideline$ or 

recommendation$)).mp. 

178. consensus development conference.pt. 

179. health planning guideline$.mp. 

180. guideline.pt. 

181. cochrane database of systematic reviews.mp. 

182. cdsr.mp. 

183. acp journal club.mp. 

184. health tech$ assess$.mp. 

185. hta.mp. 

186. evidence based nursing.mp. 

187. evidence based mental health.mp. 

188. clinical evidence.mp. 

189. technolog$ assess$.mp. 

190. evidence report$.mp. 

191. or/168-190 

192. systematic$.mp. 

193. critical.mp. 

194. (study and selection).ti,ab. 

195. ((predetermined or inclusion) and criteri$).mp.
C-11

Table C4. PsycINFO® – Ovid Version (continued) 

196. exclusion criteri$.mp. 

197. main outcome measure$.mp. 

198. "standard$ of care".mp. 

199. or/192-198 

200. (survey$ or overview$ or review or reviews or 

search$ or handsearch$).mp. 

201. (analys?s or critique or appraisal).mp. 

202. (reduction and risk and (death or 

occurrence)).mp. 

203. or/200-202 

204. (literature or article$ or publication$ or 

bibliograph$ or published or unpublished or 

ciation$ or database$ or internet or reference$ 

or textbook$ or trial$).mp. 

205. meta-analysis.sh. 

206. (medline or medlars or pubmed or embase or 

index medicus or cochrane or scisearch or web 

of science or psychinfo or psychlit or cinahl or 

experta medica or science citation index or 

sciences citation index or biological 

abstracts).mp. 

207. (clinical and studies).mp. 

208. (treatment outcome or combine$ or combining or 

peto or der simonian or dersimonian or fixed 

effect$ or pooled or pooling or mantel 

haenszel).mp. 

209. or/204-207 

210. 199 and 203 and 209 

211. 191 or 210 

212. case report.ti,sh. 

213. editorial.ti,pt. 

214. letter.pt. 

215. newspaper article.pt. 

216. comment.pt. 

217. or/212-216 

218. 211 not 217 

219. meta-analysis.pt. 

220. (meta-anal$ or metaanal$).mp. 

221. (((quantitativ$ adj3 review$1) or quantitativ$) 

adj3 overview$).mp. 

222. (((systematic adj3 review$1) or systematic) adj3 

overview$1).mp. 

223. (((methodologic adj3 review$1) or methodologic) 

adj3 overview$).mp. 

224. (integrat$ adj5 research).mp. 

225. (quantitativ$ adj3 synthes$).mp. 

226. or/219-225 

227. review.pt. or (review$ or overview$).mp. 

228. (medline or medlars or pubmed or index medicus 

or embase or cochrane).mp. 

229. (scisearch or web of science or psycinfo or 

psychinfo or cinahl or cinhal).mp. 

230. (excerpta medica or psychlit or psyclit or current 

contents or science citation index or sciences 

citation index).mp. 

231. (hand search$ or manual search$).mp. 

232. ((((electronic adj3 database$) or bibliographic) 

adj3 database$) or periodical index$).mp. 

233. (pooling or pooled or mantel haenszel).mp. 

234. (peto or der simonian or dersimonian or fixed 

effect$).mp. 

235. ((combine$ or combining) adj5 (data or trial or 

trials or studies or study or result or 

results)).mp. 

236. or/228-235 

237. 227 and 236 

238. 226 or 237 

239. (hta$ or health technology assessment$ or 

biomedical technology assessment$).mp. 

240. technology assessment, biomedical/ or 

biomedical technology asssessment/ 

241. 239 or 240 

242. 238 or 241 

243. 63 and (119 or 167 or 218 or 242) 

244. 243 not 118 

245. limit 244 to (100 childhood or 200 adolescence ) 

246. 244 not 245 

247. limit 246 to (human and english language) 

248. remove duplicates from 247 

249. 118 or 248
C-12

Table C5. AMED (Allied and Complementary Medicine)—Ovid version 

Years/issue searched: 1985 to September 2005 

Search date: September 30, 2005 

1. exp meditation/ 

2. exp yoga/ 

3. meditat$.mp. 

4. cogitat$.ti,ab. 

5. Pranayam$.mp. 

6. kapalabhati.ti,ab. 

7. (yoga or yogic$).mp. 

8. mindful$.mp. 

9. zen.ti,ab,sh. 

10. transcendental.ti,ab. 

11. TM-Sidhi.mp. 

12. mahayana.ti,ab. 

13. hiniyana.ti,ab. 

14. theravada$.ti,ab. 

15. vajrayana.ti,ab. 

16. (vipissana or vipashyana).ti,ab. 

17. (dhyana or dyana).ti,ab. 

18. dharana.ti,ab. 

19. zazen.ti,ab. 

20. (kinemantra or KM).ti,ab. 

21. (mantra or mantras).mp. 

22. (samadhi or samatha).ti,ab. 

23. pratyahara.ti,ab. 

24. purusha.ti,ab. 

25. prakruti.ti,ab. 

26. visualization/ 

27. ((Visual or guided) adj5 imagery).mp. 

28. ((guided or creative or vivid) adj 

visualization).ti,ab. 

29. pray$.mp. 

30. Hesychasm.ti,ab. 

31. "lectio divina".ti,ab. 

32. bonadona.ti,ab. 

33. (qigong or qi gong).mp. 

34. ch'i kung.ti,ab. 

35. "Tae Eul Ju".ti,ab. 

36. "mind body medicine"/ 

37. tai chi/ 

38. (tai chi or tai ji).mp. 

39. Taijiquan.ti,ab. 

40. "open awareness".mp. 

41. "focused awareness".mp. 

42. relaxation/ 

43. "relaxation response".mp. 

44. "progressive muscle relaxation".ti,ab. 

45. progressive relaxation.ti,ab. 

46. breathing therapies/ 

47. "forced nostril breathing".ti,ab. 

48. "Uninostril breathing".ti,ab. 

49. "unilateral breathing".ti,ab. 

50. (Khundalini or Kundalini).mp. 

51. raja.ti,ab. 

52. hatha.ti,ab. 

53. "sudarshan kriya".ti,ab. 

54. RRMM.ti,ab. 

55. MBSR.ti,ab. 

56. MBCT.ti,ab. 

57. "Wide-angle lens attention".ti,ab. 

58. ("Anapana Sati" or anapanasati).mp. 

59. or/1-58 

60. limit 59 to english 

61. ((singl$ or doubl$ or trebl$ or tripl$) and (blind$ 

or mask$)).mp. 

62. PLACEBOS/ or placebo$.mp. 

63. random$.mp. 

64. RESEARCH DESIGN/ 

65. (control$ or prospectiv$ or volunteer$).ti,ab. 

66. "control (research)".mp. 

67. (cross?over or factorial or sham$).mp. 

68. (meta?analy$ or systematic review$).mp. 

69. exp research/ 

70. exp CLINICAL TRIALS/ 

71. (cross?over or placebo$ or control$ or factorial 

or sham$).mp. 

72. double dummy.mp. 

73. ((clin$ or intervention$ or compar$ or 

experiment$ or preventive or therap$) adj10 

(trial$ or study or studies)).mp. 

74. (outcome$ adj assessment).mp. 

75. (efficacy or effective$ or findings or results).mp. 

76. RESEARCH DESIGN/ 

77. FOLLOW-UP STUDIES/ 

78. (Follow up adj5 (study or studies or 

design)).ti,ab. 

79. PROSPECTIVE STUDIES/ 

80. LONGITUDINAL STUDIES/ 

81. Comorbidity/ 

82. exp Probability/ 

83. ((Allocat$ or control$ or assign$ or treatment or 

compar$ or interven$ or experiment$) and 

(group or groups)).mp. 

84. (group or groups).ti,ab. 

85. ((control$ or multicenter or prospectiv$ or 

retrospectiv$ or evaluation or outcome$ or 

volunteer$ or subjects or participant$ or 

compar$) and (trial$ or study or studies or 

design)).mp. 

86. Ss.ab. 

87. cohort$.ti,ab. 

88. case-control$.ti,ab. 

89. Cross sectional.ti,ab. 

90. (observational adj5 (study or studies or 

design)).ti,ab. 

91. Longitudinal.mp. 

92. Retrospective.ti,ab. 

93. risk.ti,ab. 

94. Odds ratio.ti,ab. 

95. (case adj (comparison or referent)).ti,ab. 

96. (Causation or causal$).ti,ab. 

97. (Analytic adj (study or studies)).ti,ab. 

98. RANDOMIZED CONTROLLED TRIAL.pt. 

99. CONTROLLED CLINICAL TRIAL.pt. 

100. RANDOMIZED CONTROLLED TRIALS/ 

101. RANDOM ALLOCATION/ 
C-13

Table C5. AMED (Allied and Complementary Medicine)—Ovid version (continued) 

102. DOUBLE BLIND METHOD/ 

103. SINGLE-BLIND METHOD/ 

104. CLINICAL TRIAL.pt. 

105. COMPARATIVE STUDY/ 

106. exp COHORT STUDIES/ 

107. Age factors/ 

108. Comorbidity/ 

109. exp Risk/ 

110. (therapy or treat$).mp. 

111. (epidemiologic$ adj (study or studies)).ti,ab. 

112. clinical research.mp. 

113. or/61-112 

114. 113 and 60 

115. meta-analysis.pt. 

116. (meta-anal$ or metaanal$).mp. 

117. (((quantitativ$ adj3 review$1) or quantitativ$) 

adj3 overview$).mp. 

118. (((systematic adj3 review$1) or systematic) adj3 

overview$1).mp. 

119. (((methodologic adj3 review$1) or 

methodologic) adj3 overview$).mp. 

120. (integrat$ adj5 research).mp. 

121. (quantitativ$ adj3 synthes$).mp. 

122. or/115-121 

123. review.pt. or (review$ or overview$).mp. 

124. (medline or medlars or pubmed or index 

medicus or embase or cochrane).mp. 

125. (scisearch or web of science or psycinfo or 

psychinfo or cinahl or cinhal).mp. 

126. (excerpta medica or psychlit or psyclit or current 

contents or science citation index or sciences 

citation index).mp. 

127. (hand search$ or manual search$).mp. 

128. ((((electronic adj3 database$) or bibliographic) 

adj3 database$) or periodical index$).mp. 

129. (pooling or pooled or mantel haenszel).mp. 

130. (peto or der simonian or dersimonian or fixed 

effect$).mp. 

131. ((combine$ or combining) adj5 (data or trial or 

trials or studies or study or result or 

results)).mp. 

132. or/124-131 

133. 123 and 132 

134. 122 or 133 

135. (hta$ or health technology assessment$ or 

biomedical technology assessment$).mp. 

136. technology assessment, biomedical/ or 

biomedical technology asssessment/ 

137. 135 or 136 

138. 134 or 137 

139. 60 and 138 

140. 114 or 139 
C-14

Table C6. CINAHL® (Cumulative Index to Nursing and Allied Health Literature)—Ovid Version 

Years/issue searched: 1982 to September 2005, week 5 

Search date: October 4, 2005 

1. exp "MEDITATION (IOWA NIC)"/ or exp 

MEDITATION/ 

2. yoga/ or mind body techniques/ 

3. exp Guided Imagery/ 

4. exp Prayer/ 

5. exp Tai Chi/ 

6. exp Relaxation Techniques/ 

7. exp "progressive muscle relaxation (iowa nic)"/ 

8. exp "AUTOGENIC TRAINING (IOWA NIC)"/ 

9. meditat$.mp. 

10. cogitat$.ti,ab. 

11. Pranayam$.mp. 

12. kapalabhati.ti,ab. 

13. (yoga or yogic$).mp. 

14. mindful$.mp. 

15. zen.ti,ab,sh. 

16. transcendental.ti,ab. 

17. TM-Sidhi.mp. 

18. mahayana.ti,ab. 

19. hiniyana.ti,ab. 

20. theravada$.ti,ab. 

21. vajrayana.ti,ab. 

22. (vipissana or vipashyana).ti,ab. 

23. (dhyana or dyana).ti,ab. 

24. dharana.ti,ab. 

25. zazen.ti,ab. 

26. (kinemantra or KM).ti,ab. 

27. (mantra or mantras).mp. 

28. (samadhi or samatha).ti,ab. 

29. pratyahara.ti,ab. 

30. purusha.ti,ab. 

31. prakruti.ti,ab. 

32. ((Visual or guided) adj5 imagery).mp. 

33. ((guided or creative or vivid) adj 

visualization).ti,ab. 

34. pray$.mp. 

35. Hesychasm.ti,ab. 

36. "lectio divina".ti,ab. 

37. bonadona.ti,ab. 

38. (qigong or qi gong).mp. 

39. ch'i kung.ti,ab. 

40. "Tae Eul Ju".ti,ab. 

41. (tai chi or tai ji).mp. 

42. Taijiquan.ti,ab. 

43. "open awareness".mp. 

44. "focused awareness".mp. 

45. "relaxation response".mp. 

46. "progressive muscle relaxation".ti,ab. 

47. progressive relaxation.ti,ab. 

48. "forced nostril breathing".ti,ab. 

49. "Uninostril breathing".ti,ab. 

50. "unilateral breathing".ti,ab. 

51. (Khundalini or Kundalini).mp. [mp=title, subject 

heading word, abstract, instrumentation] 

52. raja.ti,ab. 

53. hatha.ti,ab. 

54. "sudarshan kriya".ti,ab. 

55. RRMM.ti,ab. 

56. MBSR.ti,ab. 

57. MBCT.ti,ab. 

58. "Wide-angle lens attention".ti,ab. 

59. ("Anapana Sati" or anapanasati).mp. [mp=title, 

subject heading word, abstract, instrumentation] 

60. or/1-59 

61. random assignment/ 

62. exp random sample/ 

63. crossover design/ 

64. exp clinical trials/ 

65. exp comparative studies/ 

66. "control (research)".mp. 

67. control group/ 

68. factorial design/ 

69. quasi-experimental studies/ 

70. nonrandomized trials/ 

71. placebos/ 

72. meta analysis/ 

73. clinical nursing research.mp. or clinical research/ 

74. community trials/ or experimental studies/ or oneshot case study/ or pretest-posttest design/ or 

solomon four-group design/ or static group 

comparison/ or study design/ 

75. (clinical trial or systematic review).pt. 

76. random$.mp. 

77. ((singl$ or doubl$ or tripl$ or trebl$) adj25 (blind$ 

or mask$ or dummy)).mp. 

78. (cross?over or placebo$ or control$ or factorial or 

sham$).mp. 

79. ((clin$ or intervention$ or compar$ or experiment$ 

or preventive or therapeutic) adj10 trial$).mp. 

80. (meta?analy$ or systematic review$).mp. 

81. convenience sample/ or sample size/ 

82. exp research, allied health/ or research, medical/ 

or research, nursing/ 

83. research question/ 

84. nursing practice, research-based/ 

85. exp research methodology/ 

86. exp evaluation research/ 

87. concurrent prospective studies/ or prospective 

studies/ 

88. (nursing interventions or research or review or 

proceedings or "tables/charts" or protocol).pt. 

89. (Follow up adj5 (study or studies or design)).ti,ab. 

90. exp COHORT STUDIES/ 

91. exp CROSS SECTIONAL STUDIES/ 

92. exp CASE CONTROL STUDIES/ 

93. Epidemiologic research/ 

94. Seroprevalence studies/ 

95. exp Causal Attribution/ 

96. Reproducibility of results/ 

97. Correlational Study/ 
C-15

Table C6. CINAHL® (Cumulative Index to Nursing and Allied Health Literature)—Ovid version (continued)

98. Age factors/ 

99. Comorbidity/ 

100. Odds ratio/ 

101. Relative Risk/ or Risk Assessment/ 

102. Probability/ 

103. Patient Selection/ 

104. ((Allocat$ or control$ or assign$ or treatment or 

compar$ or interven$ or experiment$) and 

(group or groups)).mp. [mp=title, subject 

heading word, abstract, instrumentation] 

105. (group or groups).ti,ab. 

106. (control$ or prospectiv$ or retrospectiv$ or 

volunteer$ or participant$ or compar$).mp. and 

(trial$ or study or studies or design).ti,ab,sh. 

[mp=title, subject heading word, abstract, 

instrumentation] 

107. cohort$.ti,ab. 

108. case-control$.ti,ab. 

109. Cross sectional.ti,ab. 

110. (observational adj5 (study or studies or 

design)).ti,ab. 

111. Longitudinal.mp. 

112. Retrospective.ti,ab. 

113. Relative risk.ti,ab. 

114. Odds ratio.ti,ab. 

115. (case adj (comparison or referent)).ti,ab. 

116. (Causation or causal$).ti,ab. 

117. (Analytic adj (study or studies)).ti,ab. 

118. or/61-117 

119. 60 and 118 

120. limit 119 to english 

121. limit 120 to (adult <19 to 44 years> or middle age 

<45 to 64 years> or aged <65 to 79 years> or 

"aged <80 and over>") 

122. 120 not 121 

123. limit 122 to (fetus or newborn infant or infant <1 

to 23 months> or preschool child <2 to 5 years> 

or child <6 to 12 years> or adolescence <13 to 18 

years>) 

124. 122 not 123 

125. 121 or 124 

126. meta-analysis.pt. 

127. (meta-anal$ or metaanal$).mp. 

128. (((quantitativ$ adj3 review$1) or quantitativ$) 

adj3 overview$).mp. 

129. (((systematic adj3 review$1) or systematic) adj3 

overview$1).mp. 

130. (((methodologic adj3 review$1) or methodologic) 

adj3 overview$).mp. 

131. (integrat$ adj5 research).mp. 

132. (quantitativ$ adj3 synthes$).mp. 

133. or/126-132 

134. review.pt. or (review$ or overview$).mp. 

135. (medline or medlars or pubmed or index medicus 

or embase or cochrane).mp. 

136. (scisearch or web of science or psycinfo or 

psychinfo or cinahl or cinhal).mp. 

137. (excerpta medica or psychlit or psyclit or current 

contents or science citation index or sciences 

citation index).mp. 

138. (hand search$ or manual search$).mp. 

139. ((((electronic adj3 database$) or bibliographic) 

adj3 database$) or periodical index$).mp. 

140. (pooling or pooled or mantel haenszel).mp. 

141. (peto or der simonian or dersimonian or fixed 

effect$).mp. 

142. ((combine$ or combining) adj5 (data or trial or 

trials or studies or study or result or 

results)).mp. 

143. or/135-142 

144. 134 and 143 

145. 133 or 144 

146. (hta$ or health technology assessment$ or 

biomedical technology assessment$).mp. 

147. technology assessment, biomedical/ or 

biomedical technology asssessment/ 

148. 146 or 147 

149. 145 or 148 

150. 60 and 149 

151. limit 150 to english 

152. limit 151 to (adult <19 to 44 years> or middle age 

<45 to 64 years> or aged <65 to 79 years> or 

"aged <80 and over>") 

153. 151 not 152 

154. limit 153 to (fetus or newborn infant or infant <1 

to 23 months> or preschool child <2 to 5 years> 

or child <6 to 12 years> or adolescence <13 to 18 

years>) 

155. 153 not 154 

156. 152 or 155 

157. 125 or 156
C-16

Table C7. Web of Science®–Institute for Scientific Information—The Thomson Corporation 

Years/issue searched: 1900 to 2005 

Search date: September 21, 2005 

#1 TS=meditat* OR TS=yoga OR TS=yogic OR TS=(tai chi) OR TS=(tai ji) OR TS=(qi gong) OR TS=qigong OR 

TS=pray* OR TS=mantra* OR TS=(progressive muscle relaxation) OR TS=(relaxation response) OR TS=unilateral 

W/1 breath* OR TS=(guided imagery) OR TS=transcendental OR TS=zen OR TS=rrmm OR TS=mbsr OR TS=mbct 

OR TS=(unilateral forced) OR TS=(forced nostril) OR TS=(progressive relaxation) OR TS=mindful* 

#2 TS=psychotherap* OR TS=sympt* OR TS=clinic* OR TS=illness* OR TS=rehab* OR TS=heal OR TS=healing OR 

TS=health OR TS=medicin* OR TS=medical* OR TS=therap* OR TS=counsel* OR TS=interven* OR TS=physiol* 

OR TS=heart* OR TS=cardiac OR TS=stress* OR TS=analges* OR TS=anxiety OR TS=stress* OR TS=cancer* OR 

TS=psychol* OR TS=metabol* OR TS=respirat* OR TS=neuro* OR TS=participants OR TS=patients OR TS=(control 

group*) 

#3 SO=psychotherap* OR SO=sympt* OR SO=clinic* OR SO=illness* OR SO=rehab* OR SO=heal OR SO=healing 

OR SO=health OR SO=medicin* OR SO=medical* OR SO=therap* OR SO=counsel* OR SO=interven* OR 

SO=physiol* OR SO=heart* OR SO=cardiac OR SO=stress* OR SO=analges* OR SO=anxiety OR SO=stress* OR 

SO=cancer* OR SO=psychol* OR SO=metabol* OR SO=respirat* OR SO=neuro* 

#4 #2 OR #3 

#5 #1 AND #4 

#6 #5 

DocType=All document types; Language=English; Databases=SCI-EXPANDED, SSCI, A&HCI; Timespan=1900-

2005 

#7 #5 

DocType=Art Exhibit Review OR Biographical-Item OR Book Review OR Dance Performance Review OR Database 

Review OR Fiction, Creative Prose OR Film Review OR Hardware Review OR Music Performance Review OR Music 

Score OR Music Score Review OR News Item OR Poetry OR Script OR Software Review OR TV Review, Radio 

Review OR Theater Review; Language=All languages; Databases=SCI-EXPANDED, SSCI, A&HCI; Timespan=1900-

2005 

#8 #6 NOT #7 
C-17

Table C8. CSA Neurosciences Abstracts—CSA Illumina 

Years/issue searched: 1982 to 2005 

Search date: August 4, 2005 

 (((meditat* or yoga or yogic) or ((tai chi) or (tai ji) or (qi gong)) or (qigong or pray* or mantra*) or ((progressive muscle 

relaxation) or (relaxation response) or (unilateral breath*)) or ((guided imagery) or transcendental or zen) or 

AB=(rrmm or mbsr or mbct) or ((forced nostril breath*) or (progressive relaxation) or mindful*) or AB=(pmr or 

cogitat*)) and (PT=bibliography or PT=(book monograph) or PT=conference or PT=dissertation or PT=(journal article) 

or PT=report or PT=review or PT=(training manual))) not ((rat or rats or mantis* or pigeon*) or ((mice or mouse) or 

sheep or pig or pigs)) 

Table C9. Cochrane Complementary Medicine Trials Register and CAMPAIN (Complementary and Alternative 

Medicine and Pain Database)

Years/issue searched: 1983 to 2003 

Search date: October 25, 2005 

Meditation or meditate or meditating or mindful or mindfulness or qigong or qi gong or tai chi or taiji or yoga or yogic 

or relaxation response or autogenic or kundalini or pranayama or pranayam or samahdi or imagery or visualization or 

mantra or cogitation or mbsr or kinemantra or dyana or dhyana or naam or anapanasati or mbct or hatha or raja or 

vipashyana or vipassana 
C-18

Table C10. CDSR- (EBM Reviews–Cochrane Database of Systematic Reviews)—Ovid version 

Years/issue searched: 3rd Quarter 2005 

Search date: September 9, 2005

1. exp meditation/ 

2. exp yoga/ 

3. meditat$.mp. 

4. cogitat$.ti,ab. 

5. Pranayam$.mp. 

6. kapalabhati.ti,ab. 

7. (yoga or yogic$).mp. 

8. mindful$.mp. 

9. zen.ti,ab,sh. 

10. transcendental.ti,ab. 

11. TM-Sidhi.mp. 

12. mahayana.ti,ab. 

13. hiniyana.ti,ab. 

14. theravada$.ti,ab. 

15. vajrayana.ti,ab. 

16. (vipissana or vipashyana).ti,ab. 

17. (dhyana or dyana).ti,ab. 

18. dharana.ti,ab. 

19. zazen.ti,ab. 

20. (kinemantra or KM).ti,ab. 

21. (mantra or mantras).mp. 

22. (samadhi or samatha).ti,ab. 

23. pratyahara.ti,ab. 

24. purusha.ti,ab. 

25. prakruti.ti,ab. 

26. ((Visual or guided) adj5 imagery).mp. 

27. ((guided or creative or vivid) adj 

visualization).ti,ab. 

28. pray$.mp. 

29. Hesychasm.ti,ab. 

30. "lectio divina".ti,ab. 

31. bonadona.ti,ab. 

32. (qigong or qi gong).mp. 

33. ch'i kung.ti,ab. 

34. "Tae Eul Ju".ti,ab. 

35. "mind-body and relaxation techniques"/ or "mindbody relations (metaphysics)"/ 

36. tai ji/ 

37. (tai chi or tai ji).mp. 

38. Taijiquan.ti,ab. 

39. "open awareness".mp. 

40. "focused awareness".mp. 

41. "relaxation response".mp. 

42. "progressive muscle relaxation".ti,ab. 

43. progressive relaxation.ti,ab. 

44. "forced nostril breathing".ti,ab. 

45. "Uninostril breathing".ti,ab. 

46. "unilateral breathing".ti,ab. 

47. (Khundalini or Kundalini).mp. 

48. raja.ti,ab. 

49. hatha.ti,ab. 

50. "sudarshan kriya".ti,ab. 

51. RRMM.ti,ab. 

52. MBSR.ti,ab. 

53. MBCT.ti,ab. 

54. "zoom lens attention".ti,ab. 

55. "Wide-angle lens attention".ti,ab. 

56. ("Anapana Sati" or anapanasati).mp. 

57. kabat-zinn.ab. 

58. or/1-57 
C-19

Table C11. OCLC Article First and OCLC Proceedings First—OCLC First Search 

Years/issue searched: 1993 to 2005 

Search date: September 22, 2005 

(kw: meditat* OR kw: yoga OR kw: yogic OR (kw: tai and kw: chi) OR (kw: tai and kw: ji) OR (kw: qi and kw: gong) 

OR kw: qigong OR kw: pray* OR kw: mantra* OR (kw: progressive and kw: muscle and kw: relaxation) OR (kw: 

relaxation and kw: response) OR ((kw: unilateral and kw: W/1 and kw: breath*) OR (kw: guided and kw: imagery)) OR 

kw: transcendental OR kw: zen OR kw: rrmm OR kw: mbsr OR kw: mbct OR (kw: unilateral and kw: forced) OR (kw: 

forced and kw: nostril) OR (kw: progressive and kw: relaxation) OR kw: mindful*) and ((kw: psychotherap* OR kw: 

sympt* OR kw: clinic* OR kw: illness* OR kw: rehab* OR kw: heal OR kw: healing) or (kw: health OR kw: medicin* 

OR kw: medical* OR kw: therap* OR kw: counsel* OR kw: interven* OR kw: physiol*) or (kw: heart* OR kw: cardiac 

OR kw: stress* OR kw: analges* OR kw: anxiety OR kw: stress* OR kw: cancer* OR kw: psychol*) or (kw: metabol* 

OR kw: respirat*) or (kw: neurosci* OR kw: neurol* OR kw: neuron+) or (kw: participant+ OR kw: patient+ OR kw: 

control w group*)).

Table C12. NLM Gateway–National Library of Medicine 

Years/issue searched: 1950 to 2005 

Search date: October 25, 2005 

meditation or yoga or tai chi or qigong 
C-20

Table C13. Current Clinical Trials—Biomed Central 

Years/issue searched: 1998 to 2005 

Search date: October 24, 2005 

imagery OR mindful* OR "tai chi" OR qigong OR yoga OR 'qi gong’ OR meditation

Table C14. National Research Register 

Years/issue searched: 2000 to 2005 

Search date: October 24, 2005 

imagery OR mindful* OR "tai chi" OR qigong OR yoga OR 'qi gong’ OR meditation 

Table C15. CRISP (Computer Retrieval of Information on Scientific Projects) 

Years/issue searched: 2005 to 2006 

Search date: February 21, 2006 

$(meditate | meditation | meditating | mindful | mindfulness | yoga | qigong 
D-1 

Appendix D. Review Forms 

D1. Title and abstract screening form 

For screening, the criteria will be suitably broad to exclude only those articles that are obviously irrelevant to the 

descriptive overview (topic I); the review of evidence on the state of the research literature (topic II); and the effects, 

efficacy and effectiveness of meditation (topics III to V). 

For each title/abstract, go through the five rejection criteria R1 to R5, in any order. Any article must clearly satisfy one 

of the criteria below in order to be considered clearly irrelevant. Stop at the first "Yes" and classify the study as “Do 

not retrieve article”. Otherwise, classify it as “Retrieve article”. If it is unclear whether an article meets any of the 

criteria below, the article will be considered eligible for retrieval and further review. 

Reference ID #: Reviewer ID #: 

Author(s): Year of Publication: 

Criteria of Irrelevance: 

Yes No Unsure 

R1: Non-English study 

R2: Study participants clearly < 18 years old 

R3: Clearly not on meditation 

R4: Case report/case series/editorial/letter/lay press 

R5: Total study population clearly < 10 

Decisions: 

 Retrieve article 

Do not retrieve article 

Specific instructions: 

R2: Primary studies that clearly indicate that only pediatric populations (< 18 years) were studied will be considered 

irrelevant. 

R3: An article will be considered irrelevant if: 1) the main topic of the article does not include the word meditation or a 

synonym, 2) the article does not include any of the specific terms listed in the list of potentially relevant techniques, or 

3) it is clear that the topic is not related to meditation or any of the meditation practices. 
D-2 

D2. Inclusion and exclusion form 

Reference ID #: Reviewer ID #: 

Author(s): Year of Publication: 

1. TOPIC/INTERVENTION

a. Primary research evaluating the effects of meditation Yes No Unsure 

b. Secondary research on practice of meditation Yes No Unsure 

c. Do the authors of the study explicitly describe the intervention as 

meditation or as involving a meditative component? Yes No Unsure 

d. Does the TEP consider the intervention as a meditation practice or 

involving a meditative component? Yes No Unsure 

e. Does the intervention satisfy the operational criteria developed by 

consensus? Yes No Unsure 

2. DESIGN 

Does the study satisfy any of the following designs? Yes No Unsure 

a. Narrative/systematic review Yes No Unsure 

b. RCT/NRCT Yes No Unsure 

c. Prospective cohort study with concurrent control group Yes No Unsure 

d. Prospective cohort study with historical control group Yes No Unsure 

e. Retrospective cohort study with control group (any type) Yes No Unsure 

f. Case-control study Yes No Unsure 

g. Cross-sectional study with controls Yes No Unsure 

h. Before-and-after study Yes No Unsure 

3. CONTROLS

a. Does the study provide a comparison or control condition population with 

which to compare the intervention group? Yes No Unsure 

4. PARTICIPANTS

a. Does the study population consist of adults (i.e.., individuals who are ≥

18 years of age), or 

Does the study population include a subgroup of adults for which separate 

data can be analyzed?

Yes No Unsure 

b. Study population is ≥10? Yes No Unsure 

5. OUTCOMES

a. Study reports numeric data on at least one health-related outcome? Yes No Unsure 

REVIEWER’S DECISION: 

TO INCLUDE IN Q1 To INCLUDE IN Q2

• Meets 1b • Meets 1a 

• Meets at least two of 1c, 1d, or 1e • Meets at least two of 1c, 1d, or 1e

• Meets any from 2b to 2h • Meets 2a • Meets all from 3 to 5 

INCLUDE Q1 Yes No Unsure INCLUDE Q2 Yes No Unsure 

TEP TO VERIFY INTERVENTION Useful background information (TO FLAG): 
D-3 

D3. Methodological quality assessment forms 

Intervention Studies 

Jadad scale—RCTs 

ITEMS YES NO 

1. Was the study described as randomized (this includes the use of words such as 

randomly, random and randomization)? 

1 0 

2. Was the study described as double-blind? 1 0 

3. Was there a description of withdrawals and drop-outs? 1 0 

4. Method to generate the sequence of randomization was described and was appropriate 

(e.g. table of random numbers, computer generated, coin tossing, etc.) 

1 0 

5. Method of double-blinding described and appropriate (identical placebo, active placebo, 

or dummy)? 

1 0 

6. Method of randomization described and it was inappropriate (allocated alternately, 

according to date of birth, hospital number, etc.)? 

-1 0 

7. Method of double-blinding described but it was inappropriate (comparison of tablet vs. 

injection with no double dummy)? 

-1 0 

OVERALL SCORE (Maximum 5)

Schultz concealment of treatment allocation—RCTs 

Concealment of treatment allocation 

 Adequate 

 Inadequate 

 Unclear 

Adequate: Central randomization; numbered/coded containers; drugs prepared by pharmacy; 

serially numbered, opaque, sealed envelopes 

Inadequate: Alternation, use of case record numbers, dates of birth or day of week; open lists 

Unclear: Allocation concealment approach not reported or fits neither above category 

Jadad Scale (modified)—NRCTs

ITEMS YES NO 

2. Was the study described as double-blind? 1 0 

3. Was there a description of withdrawals and drop-outs? 1 0 

5. Method of double-blinding described and appropriate (identical placebo, active placebo, 

dummy)? 

1 0 

6. Method of randomization described and it was inappropriate (allocated alternately, 

according to date of birth, hospital number, etc.)? 

-1 0 

7. Method of double-blinding described but it was inappropriate (comparison of tablet vs. 

injection with no double dummy)? 

-1 0 

OVERALL SCORE (Maximum 3)

Questions for quality assessment for before-and-after studies 

1. Was the study population representative of the target population? YES NO 

2. Was the method of outcome assessment the same for the pre- and post- intervention periods for 

all participants? YES NO 

3. Were outcome assessors blind to intervention and assessment period? YES NO 

4. Did the study report the number of and reasons for study withdrawals? YES NO 
D-4 

D3. Methodological quality assessment forms (continued) 

Observational Analytical Studies 

Newcastle-Ottawa Scale for case-control studies 

Note: A study can be awarded a maximum of one star for each numbered item within the Selection and Exposure 

categories. A maximum of two stars can be given for Comparability. 

Selection 

1) Is the case definition adequate? 

a) Yes, with independent validation * (1) 

b) Yes, e.g. record linkage or based on self reports (0) 

c) No description (0) 

2) Representativeness of the cases 

a) Consecutive or obviously representative series of cases * (1) 

b) Potential for selection biases or not stated (0) 

3) Selection of Controls 

a) Community controls * (1) 

b) Hospital controls (0) 

c) No description (0) 

4) Definition of Controls 

a) No history of disease (endpoint) * (1) 

b) No description of source (0) 

Comparability 

1) Comparability of cases and controls on the basis of the design or analysis 

a) Study controls for _______________ (select the most important factor.) * (1) 

b) Study controls for any additional factor * (this criteria could be modified to indicate specific control for a 

second important factor.) (1) 

Exposure 

1) Ascertainment of exposure 

a) Secure record (e.g. surgical records) * (1) 

b) Structured interview where blind to case/control status * (1) 

c) Interview not blinded to case/control status (0) 

d) Written self report or medical record only (0) 

e) No description (0) 

2) Same method of ascertainment for cases and controls 

a) Yes * (1) 

b) No (0) 

3) Nonresponse rate 

a) Same rate for both groups * (1) 

b) Non respondents described (0) 

c) Rate different and no designation (0) 
D-5 

D3. Methodological quality assessment forms (continued) 

Newcastle-Ottawa Scale for cohort studies 

Note: A study can be awarded a maximum of one star for each numbered item within the Selection and Outcome 

categories. A maximum of two stars can be given for Comparability 

Selection 

1) Representativeness of the exposed cohort 

a) Truly representative of the average _______________ (describe) in the community * (1) 

b) Somewhat representative of the average ______________ in the community * (1) 

c) Selected group of users e.g. nurses, volunteers 

d) No description of the derivation of the cohort 

2) Selection of the non exposed cohort 

a) Drawn from the same community as the exposed cohort * (1) 

b) Drawn from a different source 

c) No description of the derivation of the non exposed cohort 

3) Ascertainment of exposure 

a) Secure record (e.g. surgical records) * (1) 

b) Structured interview 

c) Written self report 

d) No description 

4) Demonstration that outcome of interest was not present at start of study 

a) Yes * (1) 

b) No 

Comparability 

5) Comparability of cohorts on the basis of the design or analysis 

a) Study controls for _____________ (select the most important factor) * (1) 

b) Study controls for any additional factor * (this criteria could be modified to indicate specific control for a 

second important factor) (1) 

Outcome 

6) Assessment of outcome 

a) Independent blind assessment * (1) 

b) Record linkage * (1) 

c) Self report 

d) No description 

7) Was follow-up long enough for outcomes to occur 

a) Yes (select an adequate follow up period for outcome of interest) * (1) 

b) No 

8) Adequacy of followup of cohorts 

a) Complete follow up - all subjects accounted for * (1) 

b) Subjects lost to follow up unlikely to introduce bias - small number lost - > ____ % (select an adequate 

%) follow up, or description provided of those lost) * (1) 

c) Follow up rate < ____% (select an adequate %) and no description of those lost 

d) No statement 
D-6 

D3. Methodological quality assessment forms (continued) 

Newcastle-Ottawa Scale (modified) for cross-sectional studies 

Note: A study can be awarded a maximum of one star for each numbered item within the Selection and Outcome 

categories. A maximum of two stars can be given for Comparability 

Selection 

1) Representativeness of the study group 

a) Truly representative of the average _______________ (describe) in the community * (1) 

b) Somewhat representative of the average ______________ in the community * (1) 

c) Selected group of users e.g. nurses, volunteers 

d) No description of the derivation of the cohort 

2) Selection of the comparison group 

a) Drawn from the same community as the study group * (1) 

b) Drawn from a different source 

c) No description of the derivation of the comparison group 

3) Ascertainment of exposure 

a) Secure record (e.g., surgical records) * (1) 

b) Structured interview 

c) Written self report 

d) No description 

Comparability 

5) Comparability of cohorts on the basis of the design or analysis 

a) Study controls for _____________ (select the most important factor) * (1) 

b) Study controls for any additional factor * (this criteria could be modified to indicate specific control for a 

second important factor) (1) 

Outcome 

6) Assessment of outcome 

a) Independent blind assessment * (1) 

b) Record linkage * (1) 

c) Self report 

d) No description 
D-7 

D4. Data extraction form 

1. GENERAL INFORMATION

Reference ID: Reviewer ID Verifier ID 

First author Year 

Country Publication type 

Specify source of funding: (Check all that apply) 

Pharmaceutical industry Industry, other than 

pharmaceutical 

Government 

agency Foundation/charity 

Internal funds Professional 

organizations Other Specify: 

2. SPECIFIC INFORMATION

Study characteristics

Study Setting 

Acute care hospital Community Complementary Medicine practice 

University Primary care/outpatient service Extended care facility 

Other Specify: 

Study design 

RCT NRCT Cross-sectional Cohort Case-control Before-and-after 

Aim(s) of the study: 

Population characteristics:

Target population 

Type of primary health 

problem/condition/population 

(describe) 

Clinical population only Normals only Both normal and clinical 

If health problem, specify body system/problem involved (Check all that apply) Selection criteria for participation in 

study

 Circulatory/Cardio-vascular Musculoskeletal Inclusion Exclusion

 Dermatological Neuropsychiatric (addictions, 

stress, depression, etc) 

 

 Endocrine Oncology 

 Gastrointestinal Respiratory/Pulmonary 

 Genitourinary Rheumatologic 

 Gynecological Other 

 Head/eyes/ears/nose/throat 

 Hematological 

Specify: 

 
D-8 

D4. Data extraction form (continued) 

Number of patients recruited: 

Note: Add as many columns as study groups

Group 1: Total enrolled (or randomized, if applicable): Group 2: 

Group 1 Total analyzed: Group 2 

Losses to follow up: Group 1 

Group 2 

Characteristics of participants: Note: Add as many columns as study groups

GROUP 1 (n = ) GROUP 2 (n = ) TOTAL (N = ) 

Gender Female n = Male n = Female n = Male n = Female n = Male n = 

Age Mean = SD = Mean = SD = Mean = SD = 

Ethnicity (n) 

Education (n) 

Principal health problem, 

condition or diagnosis (n) 

 

Stage/severity of 

problem/illness (n) 

 

Duration of disease 

described (time) 

 

Comorbidities/other health 

problem/s (if relevant) 

(specify) (n) 

 

Other relevant 

social/demographic info 

 

Cointerventions 

Intervention characteristics: Note: Add as many columns as study groups

Intervention (Group 1) Control (Group 2) 

Name 

Description of intervention 

Frequency (how many times per week/day?) 

Duration (total time = # sessions x length of time in 

min) 

 

Intensity (time per session) 

Details of the trainers (a) Who delivered the 

intervention?; b) number of providers; c) training of 

providers

 

Details of the trainees 

Co-interventions (list) 
D-9 

D4. Data extraction form (continued) 

Outcomes

Outcome characteristics 

Timing of outcome assessment Outcome Instrument/units 

< 3 months 3 to 6 months > 6 months 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

Results

For continuous outcomes 

Note: Add as many columns as study groups

Intervention (Group 1) Control (Group 2) 

Outcome Baseline Final Baseline Final 

Mean SD Mean SD Mean SD Mean SD 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 
D-10

D4. Data extraction form (continued) 

For categorical outcomes 

Note: Add as many columns as study groups 

Intervention (Group 1) Control (Group 2) 

Outcome Final Final 

n N n N 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

n = # events; N = total # subjects per group 
D-11

D5. Guidelines for data extraction 

GENERAL GUIDELINES:

• Please, do not leave empty spaces. Enter either NA (not applicable) or NR (not reported), as required. 

• Double check with a senior member of the research team if you have any doubts about the correct data that 

should be extracted. 

1. GENERAL INFORMATION

# 1. Data extracted by:

• Choose your name from the available list. 

# 2. Data verified by:

• Complete this field ONLY if you are doing data verification. You do not have to answer this question if you 

are doing data extraction. 

• Choose your name from the available list. 

# 3. Country: 

• Enter country where the study took place.

• If not reported, enter NR (not reported). 

Note: If the article does not specify in the background/method sections where the study took place, enter the 

corresponding author’s country (and specify this in brackets: “CAC”). 

# 4. Study source: 

• Abstract: The study is reported only in abstract form. 

• Journal article: The study is published as full text in a journal. 

• Conference proceeding: The study comes from a conference book. 

• Other, specify: Click here if the study is reported in any other form. Describe the source (book chapter, 

web-info). 

# 5. Source of funding: 

• Check all that apply if more than one option is applicable. Check “None reported” if no source of funding is 

reported. 

• If the source of funding is “academic/from university”, report it under “Other” and specify as “Academic”. 

2. SPECIFIC INFORMATION

Study characteristics

# 6. Population source:

• It refers to where the study population comes from. 

• Check all that applies if more than one population source is cited in the study (i.e. cases from hospitals, 

controls from community). 

# 7. Number of centres:

• Single centre: If study was conducted in ONE centre. 

• Multicentre: If the study was conducted in MORE THAN ONE centre. 

• Unclear/not reported: If no information is provided regarding the number of centres, or if it is hard to identify 

how many centres participated in the study. 

• For studies other than RCTs and NRCTs, a multicenter study is a study where more than one source of 

population is used: For example: cases come from more than one facility/hospital, and controls come from 

more than one community. Therefore, a single center study collects cases from ONE hospital/facility, and 

controls from ONE community. 
D-12

D5. Guidelines for data extraction (continued) 

# 8. Study design:

• RCT: A planned experiment or research study in which subjects are allocated to intervention or control 

groups using a random method, and between-group comparisons are made for the outcomes of interest. 

• NRCT: Subjects are allocated to intervention or control groups using a quasi-random or nonrandom method 

and the outcomes are compared. 

• Prospective cohort study with concurrent control group: A type of analytical observational study where 

a group of subjects with a specific characteristic or exposure (e.g., being meditators) are followed over a 

period of time to assess outcomes. Comparisons are made with a concurrent control group. No interventions 

are normally applied to the participants. It is important to note that: 1) They are longitudinal and go forward 

over time, 2) Compare exposed vs. nonexposed persons, 3) Start with a defined group of people (defined by 

exposure). 4) Participants are followed through time for occurrence of disease/outcome of interest. 

• Prospective cohort study with historical control group: A type of analytical observational study where a 

group of subjects with a specific characteristic or exposure (e.g., being meditators) are followed over a 

period of time to assess outcomes. Comparisons are made with a historical control group (e.g. 

nonmeditators). Retrospective cohort study with control group (any type): A type of observational 

investigation in which medical/other records of groups of individuals who are alike in many ways but differ by 

a certain characteristic (for example, exposure status to meditation) are compared for a particular outcome. 

Also called a historic cohort study. 

• Case-control study: A case-control study is an observational investigation in which people with a condition 

("cases") are identified, suitable comparison subjects ("controls") are identified, and the two groups are 

compared with respect to prior exposure to certain factors (e.g. meditation). Thus, subjects are sampled by 

disease status. It is important to note that: 1) They are generally retrospective. 2) Start with disease of 

interest (cases), 3) Compare people with a condition to people without the the condition, 4) Compare 

frequency of the exposure of interest between cases and controls. 

• Cross-sectional study with controls: A study where a group of individuals defined by a certain 

characteristic of interest (e.g. being meditators) are compared at a single point in time cross-sectionally with 

a control group without that characteristic (nonmeditators) on certain characteristics/outcomes of interest. 

• Before-and-after study: A nonexperimental study design where data are collected before and after the 

intervention is implemented. Participants act as their own controls based on previous baseline data. 

# 9. Design source:

• Reported by authors: The authors clearly report the type of study design (and the designation is correct). 

Use this category when you agree with what the author’s report. 

• Classified by reviewer: The reviewer used the criteria in #8 to classify the study design. Use this category 

when you disagree with the author’s design classification, or when the authors failed to provide a clear 

statement regarding the study design. 

• Unclear: It is hard to identify the study design. 

# 10. Aims of study:

• Enter as reported in the study. 

• Enter either NA (not applicable) or NR (not reported), as required. 

Population characteristics

# 11. Target population: Clinical population only: The study population consists ENTIRELY of participants with a 

clinical condition/disorder. 

• Normal population only: The study population consists ENTIRELY of “healthy”/normal participants (e.g. 

students, community members, and/or people without clinical conditions/disorders). 

• Both normal and clinical population: The study combines both participants with a clinical condition/disorder 

and “healthy”/normal participants. 

• Not reported: The study does not provide a description of the participants in terms of the type of population. 

# 12. Type of primary health problem/condition/population: 

• Enter the type of health problem/condition/population as reported in the study. 

• If the study participants are normals, enter the specific type of population, if available (e.g., university 

students, workers, etc). 

• Enter either NA (not applicable) or NR (not reported), if required. 

D5. Guidelines for data extraction (continued) 
D-13

# 13. If health problem, specify body system involved:

• Choose the corresponding category of response according to the health problems of the study population. 

• Check all that apply if more than one health problem/condition/population is relevant. 

• If health problem is “None” (e.g. normals), enter this information in the OTHER category and specify 

“None”. 

# 14. Are the inclusion/exclusion criteria for participation in the study specified?

• Yes: The study provides data on the set of inclusion and/or exclusion criteria. 

• No: The study does not FORMALLY provide data on the set of inclusion and/or exclusion criteria. 

• Don’t make assumptions regarding I/E based on the description of characteristics of participants. The study 

authors must provide a description of the inclusion/exclusion criteria. 

# 15. Specify INCLUSION criteria and 

# 16. Specify EXCLUSION criteria: 

• Enter as reported in the study. 

• Enter either NA (not applicable) or NR (not reported), if required. 

Characteristics of participants 

General remarks: This section should be adapted according to the design of the study (e.g. cohort, case-control, 

cross sectional). 

• If it is an RCT/NRCT, Group 1 refers to the group receiving the active intervention of interest in the study. 

Group 2 and the others, refer to the comparators. If it is not clearly stated what intervention is the main 

intervention of interest in the study, it does not matter what you choose to be Group 1 or Group 2, but it is 

important to be consistent with reporting throughout the form. 

• For all other designs, the groups with the exposure of interest (e.g., being meditators) are Group 1, and the 

comparators are Group 2, 3 etc. 

Specify 'N' values for each group

• Complete for all comparison/intervention groups. 

• Ideally, the population characteristics refer to those participants who entered the study (not only completers). 

Otherwise, enter as reported in the study. 

• If it is a before-and-after study (within-subject design), enter data only for Group 1. 

• For RCTs/NRCTs: The INTERVENTION group (Group 1) comprises individuals receiving the treatment that 

the study is aimed to evaluate. 

# 17. Total N: 

• Enter the total number of study participants in each group (raw numbers). 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 18. Female N: 

• Enter the number of females in each group (raw numbers). 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 19. Male N: 

• Enter the number of males in each group (raw numbers). 

• Enter either NA (not applicable) or NR (not reported), as required. 

Specify age variables 

• If reported by gender, enter: M = xxxx; F = xxxxx; T = xxxxx 

# 20. Age range:

• Enter the age range of study participants in years (per group and total), when reported. Ex: 18 – 65 years. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 21. Mean age:

• Enter the mean age of study participants in years (per group and total), when reported. Ex: 26.3 years. 

• Enter either NA (not applicable) or NR (not reported), as required. 
D-14

D5. Guidelines for data extraction (continued) 

# 22. Median age:

• Enter the median age of study participants in years (per group and total), when reported. Ex: 26.3 years. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 23. Standard deviation:

• Enter the standard deviation of mean age of study participants (per group and total), when reported. Ex: SD 

= 3. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 24. Standard error of the mean:

• Enter the standard error of the mean age of study participants (per group and total), when reported. Ex: 

SEM = 3. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 25. Age groups (%) as reported:

• If the ages of study participants are reported according to age groups, describe the distribution of 

percentages across these age groups (n and % per group and total). Ex: 18 – 35 years: 20% (20/100); 36 – 

50: 25% (25/100), and so on. 

• Enter either NA (not applicable) or NR (not reported), as required. 

Other Characteristics of Participants:

• When reported, enter the distribution of study participants (n and % per group and total) according to other 

characteristics as described below: 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 26. Ethnicity:

• Enter the distribution of study participants (n and % per group and total) according to ethnicity, if reported. 

• Ex: White: 20% (20/100); Black: 25% (25/100), etc. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 27. Education:

• Enter as reported in the study 

• Enter the distribution of study participants (n and % per group and total) according to education level, if 

reported. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 28. Principal health problem, condition or diagnosis:

• Enter as reported in the study. 

• Enter the distribution of study participants (n and % per group and total) according to the principal health 

problem, condition or diagnosis (if more than one). 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 29. Stage/severity of problem/illness:

• Enter as reported in the study 

• Enter the distribution of study participants (n and % per group and total) according to stage/severity of the 

problem, if reported. 

• The stage/severity of problem can be also reported as a mean score on a certain scale. In that case, specify 

measure used to grade the level of severity, if available. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 30. Duration of disease:

• Enter as reported in the study (in years or months) 

• Enter the distribution of study participants (n and % per group and total) according to duration of the 

problem, if reported. 

• The duration of the problem/disease can be also reported as a mean value (years or months). 

• Enter either NA (not applicable) or NR (not reported), as required.
D-15

D5. Guidelines for data extraction (continued) 

# 31. Comorbidities/other health problems 

• Enter as reported in the study. 

• Enter the distribution of study participants (n and % per group and total) according to the presence of any 

co-morbidities or health problems other than the main condition of interest. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 32. Other social/demographic details (eg. literacy or reading level, income, employment status, marital status):

• Enter as reported in the study. 

• Specify the social/demographic variable. Enter the distribution of study participants (n and % per group and 

total) according to this variable. 

• Enter either NA (not applicable) or NR (not reported), as required. 

Intervention characteristics:

# 33. Specify the type of intervention: 

• Single intervention: When meditation comprises a single set of techniques. 

• Composite intervention: When a meditation practice is combined with other techniques (they can be other 

meditation techniques or other interventions). 

# 34. Is meditation used as a control group for a nonmeditation intervention under study?

• This mainly applies when meditation is not the main focus of the study. 

• YES: Meditation is used only as a control group for other “active” intervention (other than meditation), or 

intervention of interest under study. 

• If the study compares two different meditation techniques, enter NO. 

# 35. Sample size:

• Enter the number of participants (per group and total) that were enrolled in the study, and that completed the 

study. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 36. Name of the intervention(s)/control: 

• Enter the name of the intervention(s)/control as reported in the study. 

• If the study is other than RCT/NRCT, describe the intervention that was used to classify participants into 

Group 1. 

# 37. Description of interventions/control: 

• Enter as described in the study protocol/description of procedures. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 38. Frequency: 

• Enter how many times per week/day the intervention was practiced. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 39. Duration: 

• Enter the total time = #sessions x length of time in minutes 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 40. Intensity (Time per session):

• Enter the duration of each session in minutes, if available. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 41. Trainer details (who delivered intervention; number of providers; training of providers for delivery of 

intervention):

• Enter as reported in the study. 

• Enter either NA (not applicable) or NR (not reported), as required. 
D-16

D5. Guidelines for data extraction (continued)

# 42. Trainee details:

• Enter as reported in the study. 

• Enter either NA (not applicable) or NR (not reported), as required. 

# 43. Cointerventions:

• List any intervention that was co-administered for any of the groups. 

• Enter “None” if no interventions were co-administered. 

• Enter either NA (not applicable) or NR (not reported), as required. 

Outcome characteristics (#44 and others)

The following information should be completed for each reported outcome. Enter either NA (not applicable) or NR

(not reported), as required. 

• NAME: Name of the outcome, as reported in the study. 

• CATEGORY OF OUTCOME: Classify according to: 

1 = Physiological markers (e.g., cardiovascular, respiratory, brain, immune, etc).

2 = Disease/functional outcomes (any outcome reporting either the incidence of discrete events or scores on 

questionnaires/ tests other than physiological). 

3 = Health care utilization (e.g., frequency and type of healthcare visits, use of medication, costeffectiveness data). 

4 = Other outcomes (e.g., outcomes difficult to classify in any of the categories above). 

• MEASUREMENT TOOL/UNITS: 

Enter the name of the assessment tool (if scales or questionnaires) that was used to evaluate the outcome. 

Report the measure units, if applicable. 

• METHODS OF ASSESSING OUTCOME MEASURES: Enter 

P = Patient (if the measure is self-rated), 

A = assessor (if the measure is assessed by a second person: clinician, family), 

L = laboratory rated (if the measure is assessed using instruments/lab equipment), 

NR = Not reported. 

• VALIDITY and/or RELIABILITY: (Applicable for scales and questionnaires) 

Yes: Validity and/or reliability of measurement tool known or described. 

No: Validity and/or reliability of measurement tool unknown. 

NA = Not applicable. 

NR = Not reported. 

Note: The important issue here is whether the scale properties have been published, not the quality of reporting of 

these characteristics. If the study reports that a “checklist” was developed for the study purposes, it is likely that the 

instrument has not been validated. In that case, enter “No”. On the other hand, if the study uses for example, a scale 

that it is likely to have reliability and/or validity data available from other sources (e.g. Beck questionnaire for 

depression), but the study does not mention this, enter “NR”. What is important is to know whether the scale 

properties have been published, or are known, not the reporting of specific details on validity and reliability. 

• TIMING OF OUTCOME ASSESSMENT/FOLLOWUP MEASURES: Enter 

1 = Short term: outcome is assessed in the period less or equal to 3 months. 

2 = Medium term: outcome is assessed in the period greater than three but equal to 6 months. 

3 = Long-term: outcome is assessed for more than 6 months. 

4 = If timing of outcome assessment is not reported. 

Note: Baseline measures are not included for timing of outcome assessment. 
D-17

D6. Structured format for peer reviewer comments

Thank you for agreeing to review the draft of this evidence-based report. We are relying on your expertise to 

address the questions below and provide insight that will assist us in improving the content and format of the report. 

This is still in the draft stages and a thorough copy edit will take place before the publication of the final report. Please 

remember that the information in this manuscript is confidential. 

When assessing the report, please consider the following points: 

Problem Formulation 

• Are the review questions well formulated with specified key components? 

Study Identification 

• Is there a comprehensive search for relevant data using appropriate resources? 

• Are there unbiased explicit searching strategies that are appropriately matched to the research question? 

Study Selection 

• Are appropriate inclusion and exclusion criteria used to select articles? 

• Are selection criteria applied in a manner that limits bias? 

• Are efforts made to identify unpublished data, if this is appropriate? 

• Are major changes in selection criteria avoided during the review process? 

• Are reasons for excluding studies from the report stated? 

Appraisal of Studies 

• Is the validity of individual studies addressed in a reliable manner? 

• Are important parameters (e.g., setting, study population, study design) that could affect study results 

systematically addressed? 

Data Collection 

• Is there a minimal amount of missing information regarding outcomes and other variables considered key to 

interpretation of results? 

• Are efforts made to reduce bias in the data collection process? 

Data Synthesis 

• Are important parameters, such as study designs, considered in the synthesis? 

• Are reasonable decisions made concerning whether and how to combine the data? 

• Are results sensitive to changes in the way the analysis was done? 

• Is precision of results reported? 

Discussion 

• Are the discussion and conclusions well balanced and adequately supported by the data? 

• Are limitations and inconsistencies of studies stated? 

• Are limitations of the review process stated? 

• Are review finding integrated within the context of relevant indirect evidence? 

• Are implications for research discussed 

• Are implications for practice discussed? 

Conclusions 

• Are conclusions supported by the data reviewed? 

• Are plausible competing explanations of observed effects addressed? 

• Is evidence appropriately interpreted as inconclusive (no evidence of effect) or as showing a particular 

strategy did not work (evidence of no effect)? 
D-18

• Are important considerations for decision makers identified, including values and contextual factors that 

might influence decisions? 

• Is a summary of pertinent findings provided? 

• Is the writing acceptable? 

Please make your review as constructive and detailed as possible in your comments so that we have the 

opportunity to overcome any serious deficiencies that you find and please also divide your comments into the 

following categories: 

Discretionary Revisions. Recommendations for improvement but which the author can choose to ignore. 

Minor Essential Revisions. E.g., missing labels on figures, or the wrong use of a term, which the author can be 

trusted to correct. 

Major Compulsory Revisions. Revisions that the author must respond to before a decision on publication can be 

reached. 
E-1 

Appendix E. Excluded Studies and Nonobtained 

Studies 

For the questions on the state of research on the therapeutic use of meditation in healthcare 

(topic II), 1,374 studies were excluded. The reasons for exclusion are as follows: (1) the study 

was not primary research on meditation (n= 909), (2) the study did not have a control group (n= 

280), (3) the study did not report adequately on any measurable data for health related outcomes 

relevant to the review (n= 170), (4) the study did not examine an adult population (n= 9), and (5) 

the study sample included less than 10 participants (n= 6).

Excluded: Not Primary Research on Meditation (N = 909) 

The following studies were excluded because they were not relevant to the review topic. 

1. Abbey SE. Mindfulness based stress reduction 

for oncology patients. Psychooncology 1999;8(6 

Suppl):53. 

2. Abbot NC. Yoga-based intervention for carpal 

tunnel syndrome. Focus Altern Complement Ther 

1999;4(2):81-2. 

3. Abdullah S. Use of biofeedback in meditation 

technique: innovative combination in 

psychotherapy. J Contemp Psychother 

1973;5(2):101-6. 

4. Abdullah S, Schucman H. Cerebral lateralization, 

bimodal consciousness, and related developments 

in psychiatry. Res Commun Psychol Psychiatr 

Behav 1976;1(5-6):671-9. 

5. Achterberg J, Kenner C, Lawlis GF. Severe burn 

injury: a comparison of relaxation, imagery and 

biofeedback for pain management. J Ment 

Imagery 1988;12(1):71-87. 

6. Adair L, Jean F. Structural integration and 

change in body experience [abstract]. Diss Abstr 

Int 1981;41(7B):2741. 

7. Ader R. Much ado about nothing. Adv Mind 

Body Med 2001;17(4):293-5. 

8. Ades PA, Wu G. Benefits of tai chi in chronic 

heart failure: body or mind? Am J Med 

2004;117(8):611-2. 

9. Adler SS. Seeking stillness in motion: an 

introduction to tai chi for seniors. Activ Adapt 

Aging 1983;3(4):1-14. 

10. Aerthayil J. Jesus prayer and stillness of heart. J 

Dharma 2003;28(4):529-42. 

11. Ai AL. Assessing mental health in clinical study 

on qigong: between scientific investigation and 

holistic perspectives. Semin Integrative Med 

2003;1(2):112-21. 

12. Ai AL, Bolling SF, Peterson C. The use of prayer 

by coronary artery bypass patients. Int J Psychol 

Relig 2000;10(4):205-20. 

13. Ai AL, Dunkle RE, Peterson C, et al. The role of 

private prayer in psychological recovery among 

midlife and aged patients following cardiac 

surgery. Gerontologist 1998;38(5):591-601. 

14. Ai AL, Dunkle RE, Peterson C, et al. Spiritual 

well-being, private prayer, and adjustment of 

older cardiac patients. In: Thorson JA, ed. 

Perspectives on spiritual well-being and aging. 

Springfield (IL): Thomas; 2000. p. 98-119. 

15. Ai AL, Peterson C, Bolling SF. Psychological 

recovery from coronary artery bypass graft 

surgery: the use of complementary therapies. J 

Altern Complement Med 1997;3(4):343-53. 

16. Ai AL, Peterson C, Gillespie B, et al. Designing 

clinical trials on energy healing: ancient art 

encounters medical science. Altern Ther Health 

Med 2001;7(4):83-90. 

17. Alexander CN, Alexander VK, Boyer RW, et al. 

The subjective experience of higher states of 

consciousness and the Maharashi technology of 

the unified field: personality, cognitive, 

perceptual, and physiological correlates of 

growth to enlightenment. In: Chalmers RA, 

Clements G, Schenkluhn H, et al., eds. Sci Res 

Maharishi's Transcendental Meditation TM-Sidhi 

Programme: collected papers. Vol. 4. 

Switzerland: Maharishi European Research 

University - MVU Press; 1991. p. 2423-42. 
E-2 

18. Alexander CN, Heaton DP, Chandler HM. 

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19. Alexander CN, Rainforth MV, Gelderloos P. 

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20. Alexander CN, Robinson P, Orme-Johnson DW,

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21. Alexander CN, Robinson P, Rainforth M. 

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22. Alpher VS, Blanton RL. Motivational processes 

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25. Anderson EZ. Energy therapies for physical and 

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F-1 

Appendix F. References of Multiple Publications 

(Topics II to V) 

From 911 included articles, 108 were identified as multiple publications, that is, cases in 

which the same study was published more than once, available in another format, or part of data 

from an original report was republished. The multiple publications were not considered to be 

unique studies and any information that they provided was included with the data reported in the 

main study. The report that was published first wasregarded as the main study. 

1.Ades PA, Savage PD, Cress ME, et al. Resistance 

training on physical performance in disabled older 

female cardiac patients. Med Sci Sports 

2003;35(8):1265-70. Associated publication of 233

2.Alexander CN, Langer EJ, Newman RI, et al. 

Transcendental Meditation, mindfulness, and 

longevity: an experimental study with the elderly. J 

Pers Soc Psychol 1989 ;57(6):950-64. Associated 

publication of 279

3.Alexander CN, Schneider RH, Staggers F, et al. Trial 

of stress reduction for hypertension in older African 

Americans II: sex and risk subgroup analysis. 

Hypertension 1996;28(2):228-37. Associated 

publication of 221

4.Anderson VL. The effects of meditation on teacher 

perceived occupational stress and trait anxiety 

[dissertation]. Indiana, PA: Indiana University of 

Pennsylvania; 1996. Associated publication of 384

5.Barnes VA, Treiber FA, Turner JR, et al. Acute effects 

of Transcendental Meditation on hemodynamic 

functioning in middle aged adults [abstract]. In: 57th 

Annual Scientific Conference of the American 

Psychosomatic Society; Vancouver, BC; 1999. No. 

1209. Associated publication of 385

6.Blumenthal JA, Emery CF, Madden DJ, et al. Effects 

of exercise training on cardiorespiratory function in 

men and women older than 60 years of age. Am J 

Cardiol 1991;67(7):633-9. Associated publication of 

280

7.Blumenthal JA, Emery CF, Madden DJ, et al. 

Cardiovascular and behavioral effects of aerobic 

exercise training in healthy older men and women. J 

Gerontol 1989;44(5):147-57. Associated publication 

of 280

8.Blumenthal JA, Emery CF, Madden DJ, et al. Effects 

of exercise training on bone density in older men and 

women. J Am Geriatr Soc 1991;39(11):1065-70. 

Associated publication of 280

9.Bowman AJ. Effects of aerobic exercise training and 

yoga on cardiac and lymphocyte beta-adrenergic 

responses in sedentary elderly subjects. J Am Geriatr 

Soc 1995;43(9):SA78. Associated publication of 281

10. Carlson LE, Speca M, Patel KD, et al. Mindfulnessbased stress reduction in relation to quality of life, 

mood, symptoms of stress and levels of cortisol, 

dehydroepiandrosterone sulfate (DHEAS) and 

melatonin in breast and prostate cancer outpatients. 

Psychoneuroendocrinology 2004;29(4):448-74. 

Associated publication of 386

11. Carlson LE, Speca M, Patel KD, et al. Mindfulnessbased stress reduction in relation to quality of life, 

mood, symptoms of stress, and immune parameters 

in breast and prostate cancer outpatients. 

Psychosom Med 2003;65(4):571-81. Associated 

publication of 386

12. Carlson LE, Ursuliak Z, Goodey E, et al. The 

effects of a mindfulness meditation-based stress 

reduction program on mood and symptoms of stress 

in cancer outpatients: 6-month follow-up. Support 

Care Cancer 2001;9(2):112-23. Associated 

publication of 386

13. Chang JC, Chiung W. Effect of meditation on music 

performance anxiety [dissertation]. New York: 

Columbia University; 2001. Associated 

publication of 387

14. Chen KM, Snyder M, Krichbaum K. Tai chi and 

well-being of Taiwanese commmunity-dwelling 

elders. Clin Gerontol 2001;24(3-4):137-56. 

Associated publication of 388

15. Cohen L, Thornton B, Chanmdwani K. A 

randomized trial of a Tibetan yoga intervention for 

breast cancer patients [abstract]. In: 63rd Annual 

Scientific Conference of the American 

Psychosomatic Society; Vancouver, BC; 2005. No. 

1607. Associated publication of 120
F-2 

16. Cooper MJ, Aygen MM. A relaxation technique in 

the management of hypercholesterolemia. J Hum 

Stress 1979;5(4):24-7. Associated publication of 

291

17. Cusumano JA. The short-term psychophysiological 

effects of hatha yoga and progressive relaxation on 

female Japanese students [dissertation]. Tempe, 

AZ: Arizona State University; 1991. Associated 

publication of 389

18. Daubenmier JJ. The relationship of yoga, body 

awareness, and body responsiveness to self 

objectification and disordered eating. Psychol 

Women Q 2005;29(2):207-19. Associated 

publication of 390

19. Davis PG, Mustian KM, Katula JA, et al. Tai chi 

chuan and insulin-like growth factor-I (Igf-I) in 

breast cancer survivors. Med Sci Sports Exerc 

2004;36(5 Suppl):S97-8. Associated publication 

of 391

20. Delmonte MM. Effects of expectancy on 

physiological responsivity in novice meditators. 

Biol Psychol 1985;21(2):107-21. Associated 

publication of 392

21. Delmonte MM. Expectancy and response to 

meditation. Int J Psychosom 1986;33(2):28-34. 

Associated publication of 393

22. Delmonte MM. Expectation and meditation. 

Psychol Rep 1981;49(3):699-709. Associated 

publication of 393

23. Delmonte MM. Response to meditation in terms of 

physiological, behavioral and self-report measures. 

Int J Psychosom 1984;31(2):3-17. Associated 

publication of 392

24. Emery CF, Blumenthal JA. Perceived change 

among participants in an exercise program for older 

adults. Gerontologist 1990;30(4):516-21. 

Associated publication of 280

25. Friedman E, Berger BG. Influence of gender, 

masculinity, and femininity on the effectiveness of 

three stress reduction techniques: jogging, 

relaxation response, and group interaction. J Appl 

Sport Psychol 1991;3(1):61-86. Associated 

publication of 394

26. Gaston L, Crombez JC, Joly J, et al. Efficacy of 

imagery and meditation techniques in treating 

psoriasis. Imagination Cogn Pers 1988-

1989;8(1):25-38. Associated publication of 395

27. Gilbert GS, Parker JC, Claiborn CD. Differential 

mood changes in alcoholics as a function of anxiety 

management strategies. J Clin Psychol 

1978;34(1):229-32. Associated publication of 265

28. Goodale IL. The effects of the relaxation response 

on premenstrual syndrome [abstract]. Diss Abstr Int 

1990;50(8B):3731. Associated publication of 396

29. Hass CJ, Gregor RJ, Waddell DE, et al. The 

influence of tai chi training on the center of 

pressure trajectory during gait initiation in older 

adults. Arch Phys Med Rehabil 2004;85(10):1593-

8. Associated publication of 397

30. Irwin MR, Pike JL, Cole JC, et al. Effects of a 

behavioral intervention, tai chi chih, on varicellazoster virus. Specific immunity and health 

functioning in older adults. Psychosom Med 

2003;65:824-30. Associated publication of 398

31. Jevning RA, Wells I, Wilson AF. Plasma thyroid 

hormones, thyroid stimulating hormone, and insulin 

during acute hypometabolic states in man. Physiol 

Behav 1987;40(5):603-6. Associated publication 

of 399

32. Jevning RA, Wilson AF. Acute decline in 

adrenocortical activity during Transcendental 

Meditation. In: Chalmers RA, Clements G, 

Schenkluhn H, et al., eds. Scientific research on 

Maharishi's Transcendental Meditation and TMSidhi programme: collected papers. Vol. 2. 

Switzerland: Maharishi European Research 

University - MVU Press; 1990. p. 811. Associated 

publication of 400

33. Jevning RA, Wilson AF, Davidson JM. 

Adrenocortical activity during meditation. Horm 

Behav 1978;10(1):54-60. Associated publication 

of 400

34. Jevning RA, Wilson AF, Pirkle HC. Modulation of 

red cell metabolism by states of decreased 

activation: comparison between states. Physiol 

Behav 1985;35(5):679-82. Associated publication 

of 399

35. Jevning RA, Wilson AF, Smith WR. Redistribution 

of blood flow in Transcendental Meditation. In: 

Chalmers RA, Clements G, Schenkluhn H, et al., 

eds. Scientific research on Maharishi's 

Transcendental Meditation and TM-Sidhi 

programme: collected papers. Vol. 2. Switzerland: 

Maharishi European Research University - MVU 

Press; 1990. p. 787. Associated publication of 401
F-3 

36. Kabat-Zinn J, Wheeler E, Light T, et al. Influence 

of a mindfulness meditation-based stress reduction 

intervention on rates of skin clearing in patients 

with moderate to severe psoriasis undergoing 

phototherapy (UVB) and photochemotherapy 

(PUVA). Psychosom Med 1998;60(5):625-32. 

Associated publication of 195

37. Kondwani K, Schneider RH, Alexander CN, et al. 

Left ventricular mass regression with the 

Transcendental Meditation technique and a health 

education program in hypertensive African 

Americans. J Soc Behav Pers 2005;17(1):181-200. 

Associated publication of 210

38. Kreitzer MJ, Gross CR, Ye X. Longitudinal impact 

of mindfulness meditation on illness burden in 

solid-organ transplant recipients. Prog Transplant 

2005;15(2):166-72. Associated publication of 402

39. Kristeller JL, Quillian-Wolever RE, Sheets V. 

Mindfulness meditation in treating binge eating 

disorder: a randomized clinical trial. Int J Eat 

Disord 2004;35(4):453. Associated publication of 

403

40. Kutner NG, Barnhart HX, Wolf SL. Self-report 

benefits of tai chi practice by older adults. J 

Gerontol B Psychol Sci Soc Sci 1997;52(5):242-6. 

Associated publication of 397

41. Lan C, Lai JS, Chen SY. Tai chi chuan to improve 

muscular strength and endurance in elderly 

individuals: a pilot study. Arch Phys Med Rehabil 

2000;81(5):604-7. Associated publication of 326

42. Latha DR, Kaliappan KV. The efficacy of yoga 

therapy in the treatment of migraine and tension 

headaches. J Indian Acad Appl Psychol 

1987;13(2):95-100. Associated publication of 404

43. Lee MS, Kang CW, Lim HJ. Effects of qi-training 

on anxiety and plasma concentrations of cortisol, 

acth, and aldosterone: a randomized placebocontrolled pilot dtudy. Stress Health 

2004;20(5):243-8. Associated publication of 405

44. Lee MS, Kang CW, Ryu H. Acute effect of qitraining on natural killer cell subsets and cytotoxic 

activity. Int J Neurosci 2005;115(2):285-97. 

Associated publication of 405

45. Lee MS, Kang CW, Ryu H. Endocrine and immune 

effects of qi-training. Int J Neurosci 

2004;114(4):529-37. Associated publication of 

405

46. Lee MS, Lee MS, Choi ES. Effects of qigong on 

blood pressure, blood pressure determinants and 

ventilatory function in middle-aged patients with 

essential hypertension. Am J Chin Med 

2003;31(3):489-97. Associated publication of 214

47. Lee MS, Lim HJ, Lee MS. Impact of qigong 

exercise on self-efficacy and other cognitive 

perceptual variables in patients with essential 

hypertension. J Altern Complement Med 

2004;10(4):675-80. Associated publication of 213

48. Lee SW, Charlson ME, Mancuso CA. Practice of 

energy-yoga is associated with improvements in 

health-related quality of life. J Gen Intern Med 

2003;18(1 Suppl):267-8. Associated publication 

of 406

49. Levitsky DK. Effects of the "Transcendental 

Meditation" (TM®) program on neuroendocrine 

indicators of chronic stress [dissertation]. Fairfield, 

IA: Maharishi International University; 1998. 

Associated publication of 407

50. Li F, Fisher KJ, Harmer P. Delineating the impact 

of tai chi training on physical function among the 

elderly. Am J Prev Med 2002;23(2 Suppl):92-7. 

Associated publication of 408

51. Li F, Fisher KJ, Harmer P. Falls self-efficacy as a 

mediator of fear of falling in an exercise 

intervention for older adults. J Gerontol B Psychol 

Sci Soc Sci 2005;60(1):34-40. Associated 

publication of 409

52. Li F, Harmer P, Fisher KJ. Tai chi: improving 

functional balance and predicting subsequent falls 

in older persons. Med Sci Sports 

2004;36(12):2046-52. Associated publication of 

409

53. Li F, Harmer P, Mcauley E. An evaluation of the 

effects of tai chi exercise on physical function 

among older persons: a randomized contolled trial. 

Ann Behav Med 2001;23(2):139-46. Associated 

publication of 408

54. Li F, Harmer P, Mcauley E. Tai chi, self-efficacy, 

and physical function in the elderly. Prev Sci 

2001;2(4):229-39. Associated publication of 408

55. Li F, Mcauley E, Harmer P. Tai chi enhances selfefficacy and exercise behavior in older adults. J 

Aging Phys Act 2001;9(2):161-71. Associated 

publication of 408

56. Lukoff DG. Comparison of a holistic and a social 

skills training program for schizophrenics 

[dissertation]. Chicago: Loyola University; 1980. 

Associated publication of 410
F-4 

57. MacLean CR, Walton KG, Wenneberg SR. Altered 

responses of cortisol, GH, TSH and testosterone to 

acute stress after four months' practice of 

Transcendental Meditation (TM). Ann N Y Acad 

Sci 1994;746:381-4. Associated publication of 

407

58. Madden DJ, Blumenthal JA, Allen PA. Improving 

aerobic capacity in healthy older adults does not 

necessarily lead to improved cognitive 

performance. Psychol Aging 1989;4(3):307-20. 

Associated publication of 280

59. Malathi A, Damodaran A, Shah N. Effect of yogic 

practices on subjective well being. Indian J Physiol 

Pharmacol 2000;44(2):202-6. Associated 

publication of 411

60. Malhotra V, Singh S, Singh KP. Study of yoga 

asanas in assessment of pulmonary function in 

NIDDM patients. Indian J Physiol Pharmacol 

2002;46(3):313-20. Associated publication of 321

61. Mandle CL, Domar AD, Harrington DP. Relaxation 

response in femoral angiography. Radiology 

1990;174(3 Pt 1):737-9. Associated publication of 

91

62. Marcus MT, Fine PM, Moeller FG. Change in stress 

levels following mindfulness-based stress reduction 

in a therapeutic community. Addict Disord Their 

Treat 2003;2(3):63-8. Associated publication of 

272

63. Mason LI, Alexander CN, Travis FT. 

Electrophysiological correlates of higher states of 

consciousness during sleep in long-term 

practitioners of the Transcendental Meditation 

program. Sleep 1997;20(2):102-10. Associated 

publication of 412

64. McComb JJR, Tacon AM, Randolph PD. A pilot 

study to examine the effects of a mindfulness-based 

stress-reduction and relaxation program on levels of 

stress hormones, physical functioning, and 

submaximal exercise responses. J Altern 

Complement Med 2004;10(5):819-27. Associated 

publication of 244

65. McGibbon CA, Krebs DE, Wolf SL. Tai chi and 

vestibular rehabilitation effects on gaze and wholebody stability. J Vestib Res 2004;14(6):467-78. 

Associated publication of 413

66. Mustian KM, Katula JA, Gill DL. Tai chi chuan, 

health-related quality of life and self-esteem: a 

randomized trial with breast cancer survivors. 

Support Care Cancer 2004;12(12):871-6. 

Associated publication of 391

67. Mustian KM, Katula JA, Roscoe JA. The influence 

of tai chi (Tc) and support therapy (St) on fatigue 

and quality of life (Qol) in women with breast 

cancer (Bc). Am J Clin Oncol 2004;22(14 

Suppl):764S. Associated publication of 391

68. Nakao M, Fricchione GL, Myers P. Anxiety is a 

good indicator for somatic symptom reduction 

through behavioral medicine intervention in a 

mind/body medicine clinic. Psychother Psychosom 

2001;70(1):50-7. Associated publication of 414

69. Narendran S, Nagarathna R, Gunasheela S. Efficacy 

of yoga in pregnant women with abnormal doppler 

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Med Assoc 2005;103(1):12-4. Associated 

publication of 415

70. O'Halloran JP, Jevning RA, Wilson AF. 

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vasopressin. In: Chalmers RA, Clements G, 

Schenkluhn H, et al., eds. Scientific research on 

Maharishi's Transcendental Meditation and TMSidhi programme: collected papers. Vol. 3. 

Switzerland: Maharishi European Research 

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Associated publication of 416

71. Orme-Johnson DW, Kiehlbauch J, Moore RG. 

Personality and autonomic changes in prisoners 

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Associated publication of 188

72. Panjwani U, Gupta HL, Singh SH. Effect of sahaja 

yoga practice on stress management in patients of 

epilepsy. Indian J Physiol Pharmacol 

1995;39(2):111-6. Associated publication of 417

73. Panjwani U, Selvamurthy W, Singh SH. Effect of 

sahaja yoga practice on seizure control and EEG 

changes in patients of epilepsy. Indian J Med Res 

1996;103:165-72. Associated publication of 417

74. Parker JC, Gilbert GS, Thoreson RW. Reduction of 

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relaxation and meditation techniques. J Consult 

Clin Psychol 1978;46(5):879-86. Associated 

publication of 265

75. Patel CH. Yoga and biofeedback in the management 

of 'stress' in hypertensive patients. Clin Sci Mol 

Med Suppl 1975;2:171-4. Associated publication 

of 219
F-5 

76. Pelletier KR. Influence of Transcendental 

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Mot Skills 1974;39(3):1031-4. Associated 

publication of 418

77. Peters RK, Benson H, Peters JM. Daily relaxation 

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on blood pressure. Am J Pub Health 

1977;67(10):954-9. Associated publication of 284

78. Rani NJ, Rao PVK. Self-ideal disparity and yoga 

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Associated publication of 172

79. Reddy MK, Ath D, Bai AJL. The effects of the 

Transcendental Meditation program on athletic 

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eds. Scientific research on the Transcendental 

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Associated publication of 309

80. Robinson FP. Psycho-endocrine-immune response 

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University; 2002. Associated publication of 419

81. Sagula DA. Varying treatment duration in a 

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Associated publication of 420

82. Schneider RH, Castillo-Richmond A, Alexander 

CN. Behavioral treatment of hypertensive heart 

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83. Sephton SE, Lynch G, Weissbecker I. Effects of a 

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84. Shafii M, Lavely R, Jaffe R. Meditation and 

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423

86. Smith JC. Psychotherapeutic effects of 

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Clin Psychol 1976;44(4):630-7. Associated 

publication of 424

87. Taggart HM. Tai chi, balance, functional mobility, 

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88. Takahashi T, Murata T, Hamada T. Changes in 

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89. Teasdale JD, Moore RG, Hayhurst H. 

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90. Tebecis AK. Eye movements during Transcendental 

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91. Throll DA. Transcendental Meditation and 

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92. Tiefenthaler U, Grossman P. Buddhist psychology's 

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93. Travis FT. The Transcendental Meditation 

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431

96. Wang JS, Lan C, Wong MK. Tai chi chuan training 

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432
F-6 

97. Weissbecker I, Salmon PG, Studts JL, et al. 

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98. Wenneberg SR. The effects of Transcendental 

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99. Wenneberg SR, Schneider RH, Walton KG, et al. A 

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102.Wolf SL, Barnhart HX, Ellison GL, et al. The effect 

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103.Wolf SL, Barnhart HX, Kutner NG, et al. Reducing 

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397

104.Wolf SL, Barnhart HX, Kutner NG, et al. Selected 

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397

105.Wolf SL, Sattin RW, Kutner M, et al. Intense tai chi 

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106.Yan JH. Tai chi practice reduces movement force 

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Sci 1999;54(12):M629-34. Associated publication 

of 435

107.Yeh GY, Eisenberg DM, Wood MJ, et al. Tai chi as 

an adjunctive intervention for patients with heart 

failure: a pilot study. J Gen Intern Med 2003;18(1 

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Zamarra JW, Besseghini I, Wittenberg S. The effects of 

the Transcendental Meditation program on the exercise 

performance of patients with angina pectoris. In: OrmeJohnson DW, Farrow JT, eds. Scientific research on the 

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G-1

Appendix G. Summary Tables for Topic II Table G1. Country of study

Country N References 

United States 462 111,120,126,152,175,177,193,205,206,208,233,234,258-260,279,280,289,290,304,311,384,385,387,394,436-494a494b

508a306b192,509b509a80,94,134,186,187,237,282,292,324,390,510-547a547b548-552a552b209,396,402,553-571

624a624b70,75,78,91,92,105,118,141,168,174,181,188,190,191,196,198,202,220,221,227,228,241,242,244-246,25270,272,274,284,285,287,288,293,309,316,317,319,322,325,391,397,406-410,412,414,416,418-425,433-435,625-76

North 

America 

Canada 32 97,182,189,194,296,386,395,413,770-793 India 115 83,133,137,138,140,142,170,172,184,204,212,217,226,239,240,250,266,273,278,294,295,298,300,301,303,305,310,31

314,318,320,321,323,404,411,415,417,794-870 

China 19 161,211,225,249,262,871-884 South Korea 15 200,201,213,214,405,885-894 Hong Kong 13 207,286,299,895-904 Taiwan 12 223,248,326,388,432,905-911 Japan 10 389,426,912-919 Thailand 5 106,216,238,920,921 

Asia 

Malaysia 2 179,180 

United Kingdom 31 122,167,185,218,219,235,281,283,308,427,431,922-941 Germany 12 215,247,942-950a950b Sweden 9 951a951b243,261,302,952-955 Norway 7 956-962 Ireland 5 392,393,963-965 Italy 4 966-969 Switzerland 4 199,970-972 Netherlands 4 973a973b224,974 Spain 3 975-977 Austria 2 430,978 Czech Republic 2 183,979 France 2 980,981 Russia 2 146,203 

Europe 

Turkey 2 315,982 
G-2

Table G1. Country of study (continued)

Country N References 

Denmark 1 983 Poland 1 984 

Europe 

(continued) 

Belgium 1 985 

Australia 20 169,297,307,428,986-1001 Australasia New Zealand 6 222,429,1002-1005 Israel 4 176,291,1006,1007 South Africa 3 86,1008,1009 Brazil 2 236,1010 Argentina 1 1011 

Other 

Netherlands 

Antilles 

1 974 
G-3

Table G2. Study design 

Study design N References 

RCTs 286 86,111,120,176,177,189,193,203-208,233-235,258-261,278-281,304,305,384,387,394,437,444,445,447,448,455,460,467,472,474-478,480,483

485,490,493,494,796,871,885,895b127,194,236,306,389,503,504,507a70,75,78,91,92,94,97,118,134,138,140,167-170,174,182,184-186,19270,282-288,307-309,325,386,391,392,395-398,403-405,407-409,413,417,418,421,423,424,427,431,433,434,512,514,515,519,521,528,530558,562,567,569,572,573,575,579,584,589,592,594,597,603,610,615,616,618,625-627,631,637,651,658,665,666,674,676,677,680,683,687,702,706,710,711,714,719,726,736,738,746,751,754-756,759,761,764,765,767-769,774,775,777,782,783,791,793,805,811,819,823,825,829,832,836-839,841,844,852,858,868,882,894,900,910,919,920,926,929,930,932,934,940,943,945,946,953,954,956,959,961,965,971,977,984,987,988

NRCTs 114 126,175,289,290,440,461-463,482,489,494,794,799a197,291,306,500b106,122,137,178-181,183,187,188,198,199,226-228,247-252,271-

274,292,293,326,415,419,420,429,430,435,518,523,532,538,553,566,577,587,593,595,596,602,617,629,639,642,645,650,656,659,662,673

730,752,758,762,773,787,789,804,806,809,816,818,824,826,834,846,854,860,864,866,878,904,915,925,938,955,974,981,986,1001,1007 

Intervention studies Before-and-after 147 Controlled (2) 171,172 

Uncontrolled (145) 83,133,152,294-303,310- 324,393,402,406,411,414,425,426,442,457,459,464,468,471,488,491,502,505,510,516,517,524,525,533,559,561,564,578,580,588,590,604

654,657,682,684,690,692,697,707,709,715,716,724,725,727,733,739,747,750,753,766,770,780,784,797,800-802,808,810,812-815,821,822,827,830,831,840,843,845,847,848,850,851,856,862,863,867,870,872,875,883,889,891,897,906,913,914,916,922,931,942,944

Cohort studies with 

controls 

149 400,422,439,450,452,453,487,492,600,601,624,669,771,776,873,949,970a624b80,105,141,142,161,200-

202,385,399,401,416,428,436,449,456,458,466,469,479,486,498,499,501,508,520,522,526,527,540,548,550,555,563,574,576,581,583,585

643,644,647,655,663,668,670,672,675,685,686,688,693,695,699,700,703,708,712,720,721,723,772,779,781,788,790,803,807,817,820,833912,917,921,923,927,928,935,948,950,952,958,960,964,967,969,972,983,985,989,994,995,997,1008,1009a950b731,734,936,973a973b741

Observational 

analytical studies Cross-sectional studies with controls 117 412,509,529,546,582,591,704,732,740,748,786b571b441,534,535,551,646,649,701,722,737,743,744,859,937,941,951,957,975,976a951b552a

,570,571,640,660,661,694,717,978,980,993,1004a509,560,638,648,671,718,1000a146,388,390,432,443,454,465,470,473,481,495- 497,506,511,565,628,632,636,641,664,667,729,735,742,778,785,798,842,849,865,869,876,879-881,884,887,888,890,892,893,896,898,899903,905,908,911,918,924,933,968,990,1010 
G-4

Table G3. Publication type

Type of 

publication N References 

Journal article 701 120,146,176,177,189,193,203,204,206-208,233-235,258,259,261,278-281,289,290,295,297,304,305,310-312,384,385,387,394,436-440,445-452

486,488,489,491-494,770,771,794-802,871,885,895,922,952,966,978,980,1010a494b127,171,194,236,291,306,389,495,498-503,505,507,508,1008a306b192,294,509,982b509a80,187,282,324,392,393,395,510-513,515,516,518-531,533-540,542-547,772,803-808,92965,967,986,987,1009a547b185,209,396,402,548-551,553-555,557-566,568,570,571,774,775,809-811,924,988b571a138,178,195,211,212,2

315,326,398-401,404,572-580,582,583,585,586,588,590,592,594,595,597-599,601,603-613,615-624,776,777,812-821,873,874,886,896,905-928,945,946,970,975,976,989,1006a624b92,97,161,168,172,179-182,184,188,190,198,200-202,213,214,216-222,226,239,240,262,264-269,2

320,405-411,413-420,422,426,625-629,631-634,636-655,657-663,665,666,668-678,680-686,688-694,697-699,701,702,704-706,778-782,785

899,909,917,929-932,947-949,953,956,972,974,977,979,991-995,1002,1007,174,707,708,709,710,711,845,137,846,847,712,996,714,715,918,716,997,321,848,789,717,424,718,719,957,958,959,960,96

,933,983,227,722,850,273,106,723,285,851,934,228,935,724,244,425,725,998,852,726,270,427,428,853,83,854,133,855,856,857,858,140,8a,950b,293,731,732,733,734,223,249,910,900,901,878,879,880,902,735,936,862,863,962,170,937,973a,973b,224,864,325,865,303,866,981745,746,432,747,748,749,750,751,752,753,754,954,755,938,939,955,1000,940,756,118,1003,1004,757,941,758,759,760,761,434,397,792,901,870,768,435,246,225,904,250,287,251,793,191,252,199,884,1005,984,769 

Thesis/Dissertation 79 951a951b86,111,126,134,152,175,197,205,237,260,292,388,390,442-

444,453,455,469,474,482,487,490,496,497,504,506,514,517,532,541,552,773,920a552b75,78,91,105,141,196,210,241,263,391,412,421,423

630,635,656,664,667,679,687,695,696,703,727,736-738,762,784,882,971,990 

Abstract 25 94,215,242,245,247,317,322,403,430,467,556,587,596,600,700,713,720,730,872,875,883,943,944,999,1011 Unpublished 3 167,169,783 Research letter 3 919,925,968 Book chapter 2 186,441 
G-5

Table G4. Methodological quality—intervention studies 

RCTs that obtained Jadad scores lower than 3 (n = 246) 111,176,177,203,204,233,259-261,278-281,304,305,384,394,437,444,445,447,448,4

186,189,192-194,205-208,235,236,306,387,389,392,483-485,490,493,494,503,507,512,514,515,519,805,871,895,920,965,987 94,134,185,209,237,395,396,528,530,531558,562,567,569,572,573,575,774,775,811,943,988,1006,1011 138,195,210-214,238,262,283,307,403-405,408,584,594,597,603,610,615,616,618,625-627,777,819,926,219,239,240,263,264,308,407,410,413,417,433,637,651,658,665,666,674,676,782,823,825,829,929,930,953,956,977 70,78,118,140,170,182,184,190,191,196,222-225,2270,285,286,288,309,325,397,418,423,427,431,434,677,680,683,687,702,706,710,711,714,719,726,736,746,751,754,756,759,761,764,765,767-769,791,793,832,836-838,841,844,852,858,868,882,900,910,919,932,934,940,954,959,961,984,998,1005 RCTs that obtained Jadad scores greater than 3 (n = 40) 75,86,91,120,127,167- 169,174,220,221,234,258,265,266,282,284,391,398,409,421,504,521,541,542,544,579,589,592,631,783,839,885,991 287,386,424,738,894,999RCTs describing the methods of randomization (n = 60) Appropriate (n = 45) 86,120,127,167,206,234,258,260,282,398,448,504,521,541,542,544,569,573,579,589,592,631,811,885 91,265,266,284,308,391,409,421,7

75,168,174,220,221,287,386,738,839,894,910 

Inappropriate (n = 15) 134,212,213,262,404,408,478,484,545,584,761,841,868,920,971RCTs described as double-blind (n = 8) 167-170,424,782,991,999

RCTs—Jadad scale 

RCTs describing withdrawals/dropouts (n = 145) 86,111,120,189,193,203,207,234,258,278-281,394,444,455,467,478,480,484,485,494,885,895b

169,174,185,196,210,213,214,216,218-224,236,238,241,243,244,246,263-266,282-287,325,386,391,395,398,408-410,421,423,434,503,504,507,514,515,521,528,536,537,541,542,544,556,557,562,575,579,584,589,592,603,610,616,618,626,627,631,637,651,666,683,702,710,711769,777,783,791,793,829,839,841,852,868,882,894,920,926,929,930,940,945,946,953,954,971,977,984,991,998,999

RCTs with adequate report of methods for concealment of allocation (n = 12) 168,169,246,418,476,521,544,589,631,894,926,991RCTs with inadequate report of methods for concealment of allocation (n = 2) 545,868

RCTs—

Concealment of treatment allocation 

RCTs that failed to describe the methods for concealment of allocation (n = 272) 86,111,176,177,203,204,233,258-261,278- 281,304,305,384,394,437,444,445,447,448,455,460,467,472,474,475,477,478,796 120,189,193,205-208,234,235,387,480,483-

485,490,493,494,871,885,895b127,194,236,306,389,503,504,507a192,512,514,515,805 94,134,185,186,237,282,392,395,396,519,528,530,531,536,537,539,541-543558,562,774,775,920,943,965,987,988,1011 138,167,195,209-211,238,283,307,398,403,567,569,572,573,575,579,584,592,594,597,603,610,615,616,618,777,811,81216,239,240,262,308,404,405,407-410,413,421,433,625-627,637,782,783,823,825,929,930,953,977 97,190,217-219,241,242,263-267,284,288,309,391,417,651,658,839,956 75,174,182,184,220-222,243,244,268-270,285,386,423,424,687,702,706,710,711,714,719,726,791,841,844,852,932,934,959,961,998 70,78,118,140,170,19225,245,286,287,325,397,427,431,434,736,738,746,751,754,756,759,761,764,765,767-769,793,858,882,900,910,919,940,954,984,999,1005

RCTs - Funding Funding reported (n = (118) 120,189,193,205-208,233,234,279,280,394,444,448,460,474,475,478,480,485,494,871,895b194,306,503,507a94,97,118,167,168,174,185,192,195,209,214,218-222,224

270,282,284,288,386,395,397,398,403,405,407-410,413,421,423,427,433,512,521,536,537,544,545,557,562,573,575,579,592,610,618,625,626,631,637,651,665,683769,774,777,783,793,825,839,852,868,894,900,930,934,940,953,954,961,991,999 

NRCTs—Jadad 

scale 

NRCTs describing withdrawals/dropouts (n = 52) 126,175,289,290,440,461,462,482,494a197,291,292,518,532,553,577,593,773,809,925 122,228

252,271,293,326,419,420,435,602,617,642,645,650,679,681,691,728,762,787,816,846,866,878,904,938,955,1007

NRCT = nonrandomized controlled trials; RCT = randomized controlled trials
G-6

Table G4. Methodological quality—intervention studies (continued) 

Before-and-after studies with study population representative of the target population (n = 23) 294,414,425,464,502,564,590

623,682,692,697,716,724,808,810,847,962

Before-and-after studies in which the method of outcome assessment was the same for the pre- and post-interven

participants (n = 140) 83,133,152,171,172,294-298,300-303,310,312- 324,393,402,406,411,414,425,426,442,459,464,468,471,488,491,502,505,510,516,517,524,525,533,559,561,564,578,580,588,590,604,606,608,609,613,620-623,634

654,657,682,684,690,692,707,709,715,716,724,725,727,733,739,747,750,753,766,770,780,784,797,800-802,808,810,812-815,821,822,827,830,831,840,843,845,847,848,850,851,856,862,863,867,870,872,875,883,889,891,897,906,913,914,922,931,942,944,947,962,963,979,982,992,996

Before-and-after studies in which outcome assessors were blind to intervention and assessment period (n = 3) 654,Before-and-after studies that reported the number of study withdrawals (n = 45) 295,296,402,406,411,414,425,442,457,471,488,502,525,533,559,561,564,604,609,611,613,620-623,635,684,690,709,716,725,727,733,739,753,770,784,797,801,814Before-and-after studies that reported the reasons for study withdrawal (n = 20) 411,442,471,502,525,559,561,564,609,613,623,63

Before-and-after studies 

Before-and-after studies that reported source of funding (n = 41) 133,294,296-303,402,406,411,459,488,502,516,533,559,606,613,621,623,634,684,697,753,766,770,800,822,830,831,843,848,850,862,863,883,889,944 
G-7

Table G5. Methodological quality—observational analytical studies 

Cohort studies describing representative samples of the target population (n = 55) 80,439,449,453,456,466,469,479,487,492,501,520,522,548,550,555,563,605,607,612,619,624,776,803,874,921,970a624b142,161,422,428,655,669,675,695,708,835,855

a950b973a741,755,760,792Cohort studies describing nonexposed cohorts drawn from the same community as the exposed cohort (n = 56) 80,400,401,436,439,449,453,458,466,486,520,522,527,540,548,563,599,605,614,624,772,807,873,874,907,912,921a624b142,416,663,668,670,685,693,695,699,703

969a950b973a741,749,755,757,1003

Cohort studies that reported reliable methods for ascertainment of exposure (n = 10) 141,439,456,458,668,776,835,949,969,973Cohort studies that reported reliable methods for ascertainment of outcome (n = 10) 80,453,466,469,605,619,630,695,958,1009Cohort studies that adjusted for important confounding factors in the design or analysis (n = 99) 105,142,200,201,385,399- 401,422,449,466,486,492,501,522,555,574,583,585,598,599,607,612,668,669,672,675,685,693,703,723,772,779,803,833,853,873,909,923,949,950,964,972,983,997

8,520,526,563,576,581,644,647,695,700,712,720,731,734,741,745,749,755,757,763,776,792,807,817,835,855,857,861,874,877,886,907,921,939,948,958,960,967,96

Cohort studies that reported reliable methods for outcome assessment (n = 109) 80,161,200-202,385,399- 401,416,428,439,449,450,452,456,458,466,479,486,498,499,501,508,520,526,540,555,576,581,585,586,598-

601,612,619,633,643,644,647,655,668,669,672,675,685,686,693,699,700,703,712,720,721,723,731,734,741,745,749,755,757,760,763,771,772,776,779,781,792,803907,909,912,917,923,927,928,939,948,949,952,958,960,964,967,969,970,972,983,985,989,995,997,1003,1008,1009

Cohort studies reporting length of followup enough for outcomes to occur (n = 44) 439,453,456,469,487,492,501,522,548,563,574,583,599,605,614,619,624,776,820,873,874a624b105,141,142,422,630,663,669,670,688,695,708,833,855,861,877,94Cohort studies reporting adequate followup of cohorts (n = 29) 141,439,469,487,501,522,548,599,605,614,619,630,669,670,708,855,857,861,873,874,877,921,949,950,969,994a950b936,973a

Cohort studies—NOS scale 

Cohort studies that reported source of funding (n = 41) 161,200,201,385,399,416,422,439,453,456,486,492,498,555,585,605,607,644,734,745,755,757,760,776,788,792,807,833,874,877,886,909,912,949,960,967,989,997,10

Cross sectional studies describing representative samples of the target population (n = 62) 951a951b388,441,443,446,454,4

497,506,529,534,535,551,552,978a552b432,560,565,568,570,582,591,628,632,646,648,649,660,661,701,717,729,740,744,748,778,865,869,876,879,880,887,888,891,976,990

Cross sectional studies describing that comparison groups were drawn from the same community as the study gro

951a951b388,390,441,446,454,481,497,570,582,591,628,646,648,660,701,722,737,740,778,849,899,924

Cross sectional studies that reported reliable methods for ascertainment of exposure (n = 0) Cross sectional studies that adjusted for important confounding factors in the design or analysis (n = 63) 146,951a951

497,506,511,529,546,551,552,795,798,980a552b412,560,568,570,591,638,640,641,646,661,664,667,701,717,722,732,735,740,743,744,748,778,849,865,876,880,883,976,990

Cross sectional studies that reported reliable methods for outcome assessment (n = 62) 146,451,465,509,798,978,980,1010a513,551,552a552b432,565,632,636,640,641,646,648,664,667,694,701,717,718,729,732,735,737,740,743,744,842,859,869,876,8

903,905,908,911,918,937,941,957,968,975,976,990,1000,1004

Cross sectional 

studies—NOS scale 

Cross sectional studies that reported source of funding (n = 27) 388,432,438,473,511,632,636,641,646,649,704,744,778,798,876,879,880,888,893,896,901-903,905,908,957,1010 

NOS = Newcastle-Ottawa scales
G-8

Table G6. Studies on meditation practices examined in clinical trials and observational studies 

Category of 

meditation 

practice 

Meditation 

practice N Study design and associated references 

ACEM 

meditation 

7 RCT (3);956,959,961 Cohort (3);720,958,960 Cross sectional (1)957

Ananda marga 3 Cohort (2);498,526 Cross sectional (1)786Cayce’s 

meditation 

1 RCT (1) 680

CSM 11 RCT (11) 97,193,264,384,410,536,537,627,658,676,702SRELAX 

(technique modeled after TM®

1 RCT (1) 222

Concentrative/ 

rosary prayer 

2 Before-and-after (1); 966 Cohort (1) 969

Mantra 

meditation 

31 RCT (17);194,203,260,434,472,483,503,531,597,626,706,719,736,761,777,805,965 NRCT (3);494,577,650a Before-an

Cohort (1);853 Cross sectional (4); 591,828,859,937

RR 51 RCT (40);208,234,236,304,306,394,460,475- 477,480,504a75,91,92,94,191,192,209,218,265,268,283,284,288,396,515,521,530,558,567,569,572,592,594,610,616,625,637,988 

Before-and-after (5);414,459,524,525,753 Cohort (1)492

Mantra 

meditation 

(337) 

TM® 230 RCT (38);86,186,189,190,205,206,210,220,221,259,261,267,279,282,309,392,407,418,433,478,519,528,545,557,674,677,683,782

NRCT (22); 187,188,271,289,291,292,429,440,463,518,538,587,659,662,705,787,816,974,986,293,758,252 Before-and

171,295,311,319,324,471,505,533,561,709,733,750,780,814,815,850,942,996,1002 Cohort (97); 80,385,399- 401,436,439,449,450,452,453,458,466,469,487,499,501,508,520,522,540,548,555,563,576,581,583,585,586,598-

601,607,612,619,624,771,772,776,817,923,927,928,952,964,970,1008a624b416,422,428,633,643,644,647,655,663,668-670,672,675,685,686,688,693,695,700,703,712,721,723,779,781,790,835,950,972,983,994,997a950b731,734,936,973a973b741,74

sectional (54) 951a951b438,441,446,451,509,795,978,980a509b513,529,534,535,546,547a547b551,552a552b560,568,570,571a571b412,582,63

4,717,718,722,732,737,740,743,744,748,941,975,976,993,1000,1004

Mindfulness 

meditation 

(127) 

MBSR 49 RCT (22);167,195,196,244,245,263,421,423,485,493,512,556,575,579,589,687,710,711,754,756,930,934; NRCT (11) 272,4

Before-and-after (16) 402,457,488,517,606,609,620,622,635,682,684,692,697,724,770,947

CSM = Clinically Standardized Meditation; MBCT = mindfulness-based cognitive therapy; MM = mindfulness meditation; ND = not described; NS = 

Relaxation Response; TM® = Transcendental Meditation®
G-9

Table G6. Studies on on meditation practices examined in clinical trials and observational studies (continued)

Category of 

meditation 

practice 

Meditation 

practice N Study design and associated references 

MM (NS) 37 RCT (16);241,242,258,386,395,403,444,447,448,474,490,738,751,775,932,1011 NRCT (8);106,249,430,523,532,696,728

(6);442,464,604,716,727,922 Cohort (4);479,486,605,614 Cross sectional (3)497,511,641

Zen Buddhist meditation 

28 RCT (7); 70,225,237,554,765,774,920 NRCT (5);197,227,500,629,639 Cohort (6);105,456,550,886,917,995 Cross 

(7);443,495,636,729,742,918,924 Before-and-after (3) 426,913,916 

MBCT 7 RCT (5);427,455,929,940,984 NRCT (1);553 Before-and-after (1)784 

Mindfulness 

meditation (continued) 

Vipassana 6 Before-and-after (2) 847,848; Cohort (2) 708,921; Cross sectional (2) 664,990 

Meditation practices (ND) 21 RCT (11);387,484,494b215,431,514,539,651,783,910,987 NRCT (6);198,199,274,656,730,915 Before-and-after 

sectional (1)481

Miscellaneous meditation practices 

11 RCT (3);507,726,791 Before-and-after (3);621,623,801 Cohort (2);935,967 Cross sectional (3)454,628

Qi Gong 37 RCT (13);207,211,213,214,243,262,405,767,900,919,953,954,977 Before-and-after (9);299,316,502,634,875,889,89

202,873,907,912 Cross sectional (8);632,778,884,887,888,890,892,893

Tai Chi 88 RCT (29);235,285,286,307,391,398,408,409,413,437,467,541,573,603,631,665,871,885,894,895,1006,223,999,746,397,882,7

NRCT(17);248,290,326,435,489,566,595,596,617,645,698,713,789,878,904,955,1001 Before-and-after 

(20);152,296,317,425,564,588,590,608,657,690,715,725,747,766,872,883,897,906,931,962 Cohort (4);699,874,877,909 

388,432,470,565,735,876,879-881,896,898,899,901-903,905,908,911

Yoga 192 RCT (69);111,118,120,127,134,138,140,168-170,174,176,177,182,184,185,204,212,216,217,219,224,233,238- 240,266,269,278,280,281,305,308,325,389,404,417,445,542-544,549,562,584,615,618,666,764,811,819,823,825,829,832,836-

839,841,844,852,858,868,926,943,946,971,991,998 NRCT (36);122,126,137,175,178- 181,183,226,247,250,251,273,415,461,462,642,679,794,799,804,806,809,818,824,826,834,846,854,860,864,866,925,981,1007 

(54);83,133,172,294,297,298,300-303,310,312-315,318,320- 323,406,411,468,491,510,516,559,578,611,613,707,739,797,800,802,810,812,813,821,822,827,830,831,840,843,845,851,862,8

(18);141,142,527,574,755,788,803,807,820,833,855,857,861,948,949,985,989,1009 Cross-sectional (15) 146,390,465,473,496,506,667,785,798,842,849,865,869,968,1010
G-10

Table G7. Type of control groups for intervention studies on meditation practices 

Type of 

control group 

N 

groups 

N 

studies References 

Placebo/sham 18 18 Mantra meditation (9 groups, 9 studies) 

TM

® (3);433 793,1005 Mantra (NS) (3);434,472,531 RR (2);477,678 SRELAX (1)222

Meditation practices (ND) (3 groups, 3 studies) 484,651,987

Yoga (2 groups, 2 studies) 170,846

Mindfulness meditation (1 group, 1 study) Zen Buddhist meditation (1) 554 

Qi Gong (2 groups, 2 studies) 405,767

Tai Chi (1 group, 1 study) 999

NT 126 123 Mantra meditation (44 groups, 43 studies) 

TM

® (25);86,171,187,188,190,259,279,282,291-293,440,463,518,538,662,674,705,758,769,793,945,974,986,1005 Mantra (NS) (8)

(6);92,192,284,394,480,673 CSM (2);264,676 ACEM meditation (1);959 Cayce's meditation (1)680

Yoga (31 groups, 30 studies) 111,126,137,168,172,175,185,204,217,247,251,305,325,417,445,542,679,799,804,806,819,823,826

Mindfulness meditation (23 groups, 22 studies) MBSR (9);167,244,245,272,419,575,593,691,930 MM (NS) (7);106,395,474,523,728,762,1011 Zen Buddhist meditation Tai Chi (19 groups, 19 studies) 223,285,286,290,326,437,467,489,541,595,596,617,645,698,882,885,894,895,955 Meditation practices (ND) (6 groups, 6 studies) 215,431,656,730,915,987 Qi Gong (2 groups, 2 studies) 262,954 Miscellaneous meditation practices (1 group, 1 study) 791

No-treatment concurrent controls WL 62 62 Mantra meditation (24 groups, 24 studies) TM

® (10); 86,252,259,271,289,309,418,528,557,677 CSM (5);193,384,536,537,658 RR (5); 75,208,476,515,610 Mantra (NS

Mindfulness meditation (21 groups, 21 studies) MBSR (11);420,421,485,493,512,589,602,681,710,711 196 MM (NS) (6);386,395,403,430,447,532 MBCT (2); 553,984 Zen 

Yoga (10 groups, 10 studies) 120,169,175,280,584,666,764,825,946,971

Meditation practices (ND) (3 groups, 3 studies) 387,730,783

Qi Gong (2 groups, 2 studies) 213,214

Tai Chi (2 groups, 2 studies) 398,408

BF = Biofeedback; CSM = Clinically Standardized Meditation; MBCT = mindfulness-based cognitive therapy; MBSR = Mindfulness-based stress red

meditation; = ND = not described; NS = not specified; NT = no treatment; PMR = progressive muscle relaxation; RR = Relaxation Response; TM® 

Meditation®; WL = waiting list 
G-11

Table G7. Type of control groups for intervention studies on meditation practices (continued) 

Type of control group N groups N studies References 

Exercise/physical 

activity 

52 45 Yoga (23 groups, 18 studies) 233,266,280,281,415,417,461,462,618,666,811,834,836

Tai Chi (14 groups, 14 studies) 235,248,287,307,409,413,435,541,603,631,665,713,7Mantra meditation (13 groups, 10 studies) Mantra (NS) (3); 483,706,777 RR (3); 304,394,480 TM

® (2); 78,282 ACEM me

Mindfulness meditation (1 group, 1 study) MBSR (1) 930

Meditation practices (ND) (1 group, 1 study) 514 

Qi Gong (1 group, 1 study) 207

Rest and states 

of relaxation 

47 45 Mantra meditation (30 groups, 28 studies) 

RR (14); 304,306,475,504b91,265,283,284,288,396,558,594,625,938 TM

® (9); 186,279,392

(3); 260,503,965 CSM (2) 537,627

Yoga (9 groups, 9 studies) 134,177,181,204,219,224,615,858,868

Mindfulness meditation (6 groups, 6 studies) Zen Buddhist meditation (3); 70,500,639 MM (NS) (2); 728,932 MBSR (1) 

Meditation practices (ND) (2 groups, 2 studies) 274,539,915

Education 46 44 Mantra meditation (19 groups, 17 studies) 

TM

® (9); 205,206,210,220,221,407,659,714,787 RR (5); 94,192,218,234,476 Mantra (N

Mindfulness meditation (10 groups, 10 studies) MBSR (5); 423,575,579,689,756 Zen Buddhist meditation (3); 197,225,237 MM 

Yoga (8 groups, 8 studies) 118,212,216,461,462,562,926,1007

Tai Chi (6 groups, 6 studies) 235,307,397,665,746,878

Meditation practices (ND) (2 groups, 2 studies) 656,910

Miscellaneous meditation practices (1 groups, 1 study) 791

Active (positive) concurrent controls—interventions other than meditation practices PMR 39 39 Mantra meditation (27 groups, 27 studies) TM

® (10); 86,220,221,429,528,545,769,945,986,1005 RR (8); 191,265,288,475,477,569,616

472,531,577,626,736 CSM (3); 97,193,627 ACEM meditation (1) 961

Yoga (6 groups, 6 studies) 122,204,389,549,615,991

Mindfulness meditation (5 groups, 5 studies) MBSR (2); 196,263 MM (NS) (2); 696,751 Zen Buddhist meditation (1) 765

Meditation practices (ND) (1 group, 1 study) 494b
G-12

 Table G7. Type of control groups for intervention studies on meditation practices (continued)

Type of control group N groups N studies References 

Cognitive behavioral 

techniques 

22 20 Mantra meditation (9 groups, 9 studies) 

TM

® (3); 545,674,677; RR (3) 476,616,637 CSM (2); 410,702 Mantra (NS) (1) 483 

Mindfulness meditation (7 groups, 7 studies) MM (NS) (4); 241,444,474,775 MBSR (3) 482,579,687 Meditation practices (ND) (3 groups, 2 studies) 656,987

Yoga (3 groups, 2 studies) 120 946

Miscellaneous active 

controls 

23 19 Yoga (7 groups, 6 studies) 138,226,273,679,825,943 

Mantra meditation (6 groups, 6 studies) RR (3);396,558,592 Mantra (NS) (2);494a719 TM

® (1) 270 

Mindfulness meditation (6 groups, 4 studies) MBSR (2);195,754 Zen Buddhist meditation (1);225 MM (NS) (1) 490 Miscellaneous meditation practices (2 groups, 1 study) 507 Meditation practices (ND) (1 group, 1 study) 198 Tai Chi (1 group, 1 study) 1001

Group therapy 14 13 Mantra meditation (6 groups, 6 studies) 

RR (3);236,394,637 TM

® (2);261,816 ACEM meditation (1) 961

Mindfulness meditation (3 groups, 3 studies) MBSR (1); 482 MM (NS) (2) 241,738

Tai Chi (3 groups, 2 studies) : 391,768

Yoga (2 groups, 2 studies) 269,618

Psychotherapy 3 3 Mantra meditation (1 group, 1 study) TM

® (1) 478 

Mindfulness meditation (1 group, 1 study) MBSR (1) 752

Yoga (1 group, 1 study) 273

Active (positive) concurrent controls—interventions other than meditation 

practices 

BF 13 12 Mantra meditation (12 groups, 11 studies) 

RR (6);208,306b306a191,209,228 Mantra (NS) (3);194,503,531 TM

® (2); 270,683

Yoga (1 group, 1 study) 273
G-13

Table G7. Type of control groups for intervention studies on meditation practices (continued)

Type of control group N groups N studies References 

Reading 8 8 Mantra meditation (6 groups, 6 studies) 

RR (4); 521,567,572,592 TM

® (2) 587,759

Tai Chi (1 group, 1 study) 307 

Yoga (1 group, 1 study) 615

Pharmacological 

interventions 

8 8 Yoga (6 groups, 6 studies) 138,217,806,809,818,841 

Qi Gong (2 groups, 2 studies) 211,262

Hypnosis 4 4 Mantra meditation (2 groups, 2 studies) TM

® (2) 75,460

Meditation practices (ND) (2 groups, 2 studies) 494b198

Massage 3 2 Mantra meditation (2 groups, 1 study) RR (1) 558 

Mindfulness meditation (1 group, 1 study) MBSR (1) 556

Active (positive) concurrent 

controls—interventions other 

than meditation practices 

Acupuncture 1 1 Tai Chi (1 group, 1 study) 1001Yoga 5 5 Mantra meditation (4 groups, 4 studies) 

TM

® (3); 793,796,816 Mantra (NS) (1) 597 

Meditation practices (ND) (1 group, 1 study) 656

Mantra meditation 3 3 Yoga (3 groups, 3 studies) 169,174,175Mindfulness 

meditation 

3 3 Mantra meditation (2 groups, 2 studies) 

TM

® (1); 279 Mantra (NS) (1) 494a 

Meditation practices (ND) (1 group, 1 study) 783

Meditation 

practices (ND) 

2 2 Mantra meditation (2 groups, 2 studies) 

RR (1); 530 TM

® (1) 1005

Active (positive) 

concurrent controls—

meditation practices as 

comparison groups

Tai Chi 1 1 Mantra meditation (1 group, 1 study) RR (1) 480Yoga 15 14 Yoga (15 groups, 14 studies) 111,127,140,175-185Mantra meditation 9 9 Mantra meditation (9 groups, 9 studies) 

TM

® (5); 186-190 RR (2); 191,192 CSM (1); 193 Mantra (NS) (1) 194

Mindfulness 

meditation 

5 4 Mindfulness meditation (5 groups, 4 studies) 

MBSR (2); 195,196 Zen Buddhist meditation (1); 197 MM (NS) (1) 395

Different dose or regimen of 

meditation practices—concurrent 

control groups 

Meditation 

practices (ND) 

2 2 Meditation practices (ND) (2 groups, 2 studies) 198,199
G-14

Table G7. Type of control groups for intervention studies on meditation practices (continued) 

Type of control group N groups N studies References 

Usual care 37 37 Mindfulness meditation (9 groups, 9 studies) 

MM (NS) (2); 249,258; MBSR (2) 556,773,934MBCT (3); 929 427,940 Zen Buddhist (1) 227

Qi Gong (3 groups, 3 studies) 243,900,919 

Mantra meditation (2 groups, 2 studies) RR (1)268 TM

® (2) 78,270 

Tai Chi (4 groups, 4 studies) 246,566,573,904 Yoga (16 groups, 16 studies) 238-240,250,278,308,404,543,544,642,794,824,829,832,852,866 Meditation practices (ND) (1 group, 1 study) 274 Miscellaneous meditation practices (1 group, 1 study)726

Control groups (ND) 6 6 Mantra meditation (2 groups, 2 studies) 

RR (1); 234 TM

® (1) 267 

Qi Gong (2 groups, 2 studies) 953,977 MM (NS) (1); 242

Tai Chi (1 groups, 1 studies) 871

Number of 

controls per study 

Single control 275 275 Yoga (80 groups, 80 studies) 118,120,126,127,134,137,168,170,172,174,176,178-18

240,247,250,251,266,269,278,281,308,325,389,404,415,445,542-544,549,562,584,642,764,794,799,804,809,811,818,819,823,824,826,829,832,834,836-839,841,844,846,852,854,858,860,864,866,868,925,926,971,981,991,998 

Mantra meditation (77 groups, 77 studies) TM

® (34); 171,189,205,206,210,252,261,267,271,289,291- 293,309,392,407,418,424,429,433,440,463,478,518,519,538,557,587,662,705,714,758,759,782

236,306,460,504a92,94,209,218,268,283,515,521,530,567,569,572,594,610,625,673,678,938,9203,260,577,650,706,736,761,805,965 CSM (6); 97,384,410,536,658,676 ACEM med

meditation (1) 680

Mindfulness meditation (55 groups, 55 studies) MBSR (25) 167,244,245,263,272,419-421,423,485,493,512,589,593,602,681,687,689,691,71

(18) 106,242,249,258,386,430,444,447,448,523,532,696,738,751,762,775,932,1011; MBC

Buddhist meditation (6); 227,237,500,639,774,920

Tai Chi (40 groups, 40 studies) 223,246,248,285- 287,290,326,391,397,398,408,409,413,435,437,467,489,566,573,595,596,603,617,631,645,698

4,955,999,1006

Qi Gong (12 groups, 12 studies) 207,211,213,214,243,405,767,900,919,953,954,97

Meditation practices (ND) (10 groups, 10 studies) 199,215,274,387,431,484Miscellaneous meditation practices (1 group, 1 study) 726
G-15

Table G7. Type of control groups for intervention studies on meditation practices (continued) 

Type of control group N groups N studies References 

Number of controls per study (continued) 

Multiple controls 296 127 Mantra meditation (152 groups, 65 studies) 

TM

® (25); 78,86,186-188,190,220,221,259,270,279,282,528,545,659,674,677,683,769,793,796

208,234,304,306,394,475-477,480b75,91,191,192,228,265,284,288,396,558,592,616,637 Man

472,483,494a194,434,503,531,597,626,719,777; CSM (5) 193,264,537,627,702 

ACEM meditation (1); 961 SRELAX (1) 222,

Yoga (63 groups, 26 studies) 111,122,138,140,169,175,177,181,185,204,217,273,280,305,417,461,462,615,618,666,679,806

Mindfulness meditation (45 groups, 20 studies) MBSR (8); 195,196,482,556,575,579,754,930 MM (NS) (6); 241,395,403,474,490,728 Z

70,197,225,554,629,765

Meditation practices (ND) (17 groups, 7 studies) 494b198,656,730,783,915,

Tai Chi (13 groups, 6 studies) 235,307,541,665,768,1001 Miscellaneous meditation practices (4 groups, 2 studies) 507,791

Qi Gong (2 groups, 1 study) 262
G-16

Table G8. Type of control groups for observational analytical studies on meditation practices 

Type of control group N groups N studies References 

Nonexposed cohorts/comparison 

groups 

247 244 Mantra meditation (155 groups, 153 studies) 

TM® (140); 509,994a638,740,748,951a951b80,438,441,446,449- 453,458,466,487,499,508,513,520,522,534,535,540,547,771,772,795,923,964,978,980,1008a547

0,401,576,581,585,600,601,612,619,624,776,817,927,928,970,975,976a624b422,428,633,640,643672,685,686,688,693-695,703,712,717,718,721,723,779,781,790,835,950,972,983,993,997a950b385,436,469,501,509,792,936,941,1000,1003,1004b546,555,571b399,412,416,598,599,607,647,675,701,732,973b743,74591,828,853,859,937,969 ACEM meditation (4); 720,957,958,960 Ananda marg

Yoga (29 groups, 29 studies) 141,142,146,390,465,473,496,506,527,574,667,785,798,803,807,820,833,842,849,855,857,861,86

Mindfulness meditation (21 groups, 21 studies) Zen Buddhist meditation (12); 105,443,456,495,636,729,742,886,917,918,924,995 MM 

479,486,497,511,605,641 Vipassana (3) 664,921,990 

Tai Chi (22 groups, 21 studies) 388,432,470,565,735,874,876,877,879-881,896,898,89Qi Gong (13 groups, 13 studies) 161,200,201,632,778,884,887,888,890,892,893,907,Miscellaneous meditation practices (5 groups, 5 studies) 454,628,933,935Meditation practices (ND) (2 groups, 2 studies) 481,630

Exercise/physical 

activity 

16 14 Tai Chi (4 groups, 4 studies) 470,565,879,903 

Yoga (4 groups, 4 studies) 390,755,842,989Miscellaneous meditation practices (4 groups, 2 studies) 933,935

Mantra meditation (2 groups, 2 studies) TM® (2) 529,704

Meditation practices (ND) (1 group, 1 study) 481 Qi Gong (1 group, 1 study) 202

Miscellaneous 

active controls 

7 5 Mantra meditation (5 groups, 3 studies) TM® (3) 439,522,939

Miscellaneous meditation practices (1 group, 1 study) 935

Tai Chi (1 group, 1 study) 699

Progressive 

muscle relaxation 

5 4 Mantra meditation (5 groups, 4 studies) TM® (4) 509a509b508,749

Hypnosis 3 3 Mantra meditation (3 groups, 3 studies) TM® (3) 655,741,952Rest and states 

of relaxation 

3 3 Mantra meditation (3 groups, 3 studies) TM® (3) 453,586,939

Active (positive) 

concurrent controls exposed to interventions other than meditation practices 

Education 2 2 Qi Gong (1 group, 1 study) 202 

Yoga (1 group, 1 study) 755

MM = mindfulness meditation; ND = not described; NS = not specified; RR = Relaxation Response; TM® = Transcendental Meditation®
G-17

Table G8. Type of control groups for observational analytical studies on meditation practices (continued) 

Type of control group N groups N studies References 

Group therapy 2 2 Mantra meditation (1 group, 1 study) TM® (1) 439

Yoga (1 group, 1 study) 527

Reading 2 2 Mindfulness meditation (1 group, 1 study) Zen Buddhist meditation 

Yoga (1 group, 1 study) 948

Biofeedback 1 1 Mantra meditation (1 group, 1 study) RR (1) 492

Active (positive) 

concurrent controls exposed to interventions other than meditation practices 

Cognitive 

behavioral techniques 

1 1 Mantra meditation (1 group, 1 study) TM® (1) 583

Mantra 

meditation 

2 2 Mindfulness meditation (2 groups, 2 studies) 

Zen Buddhist meditation (1); 456 MM (NS) (1) 614 

Mindfulness 

meditation 

2 2 Mantra meditation (2 groups, 2 studies) 

TM® (1); 453 Mantra (NS) (1) 937

Meditation 

practices (ND) 

2 2 Yoga (1 group, 1 study) 141

Meditation practices (ND) (1 group, 1 study) 481

Tai Chi 1 1 Qi Gong (1 group, 1 study) 907

Active (positive) 

concurrent controls exposed to meditation practices 

Yoga 4 4 Mantra meditation (2 groups, 2 studies) TM® (2) 509a817

Mindfulness meditation (1 group, 1 study) Zen Buddhist meditation 

Qi Gong (1 group, 1 study) 202

Mantra 

meditation 

21 20 Mantra meditation (21 groups, 20 studies) 

TM® (17); 436,509b522,546,548,571b412,582,586,607,655,675,722,732,740,748,994 Anan

(NS) (1) 591

Mindfulness 

meditation 

8 6 Mindfulness meditation (8 groups, 6 studies) 

Zen Buddhist meditation (4); 729,742,917,924 Vipassana (1); 708 MM (NS

Qi Gong 11 6 Qi Gong (11 groups, 6 studies) 161,873,884,888,890,892Yoga 3 3 Yoga (3 groups, 3 studies) 788,820,869

Concurrent 

control groups exposed to different dose or regimen of the same meditation practice 

Tai Chi 1 1 Tai Chi (1 group, 1 study) 911
G-18

Table G8. Type of control groups for observational analytical studies on meditation practices (continued) 

Type of control group N groups N studies References 

Historical controls 14 14 Mantra meditation (11 groups, 11 studies) 

TM

® (10); 400,450,452,600,601,624,771,970a624b688 Ananda marga (1) 720

Qi Gong (3 groups, 3 studies) 200-202

Number of 

controls per study 

Single control 207 207 Mantra meditation (136 groups, 136 studies) 

TM

® (126); 951a951b80,385,438,446,449- 452,458,466,469,487,499,501,513,520,529,534,535,540,547,771,772,795,923,952,964,978,980

,568,570,571a399-401,576,581-583,585,598-601,612,619,624,776,927,928,970,975,976a624b4649,661,663,668-672,685,686,688,693-695,700,701,703,704,712,717,718,721,723,779,781,790,835,950,972,983,993,997a950b731,73745,757,760,763,792,941,1000,1003,1004

 ACEM meditation (4); 720,957,958,960 Mantra (NS) (4); 828,853,859,969 Ana

Yoga (26 groups, 26 studies) 142,146,465,473,496,506,574,667,785,788,798,803,807,833,849,855,857,861,865,948,949,968

Mindfulness meditation (17 groups, 17 studies) Zen Buddhist meditation (8); 105,443,495,550,636,886,918,995 MM (NS) (6); 

(3) 664,921,990

Tai Chi (16 groups, 16 studies) 388,699,735,874,876,877,880,881,896,898,899,901

Qi Gong (8 groups, 8 studies) 200,201,632,778,873,887,893,912

Miscellaneous meditation practices (3 groups, 3 studies) 454,628,967

Meditation practices (ND) (1 group, 1 study) 630

Multiple controls 137 59 Mantra meditation (65 groups, 29 studies) 

TM

® (25); 436,439,441,453,508,509a509b522,546,571b412,586,607,655,660,675,722,732,740

marga (2); 498,786 Mantra (NS) (2) 591,937

Mindfulness meditation (16 groups, 7 studies) Zen Buddhist meditation (5); 456,729,742,917,924 MM (NS) (1); 511 Vipas

Yoga (14 groups, 7 studies) 141,390,527,755,820,842,869

Qi Gong (20 groups, 7 studies) 161,202,884,888,890,892,907

Tai Chi (12 groups, 6 studies) 432,470,565,879,903,911

Miscellaneous meditation practices (7 groups, 2 studies): 933,935

Meditation practices (ND) (3 groups, 1 study) 481
G-19

Table G9. Meditation practices separated by the diseases, conditions, and populations for which they have been examined 

Category of 

meditation 

practices 

Meditation 

practice N Study populations/conditions and associated references 

Mantra 

meditation 

(337) 

TM®® 231 Intervention studies (80) 

Healthy populations (57) College/university students (24); 186,187,189,293,424,429,433,463,518,519,538,545,659,662,705,750,758,769,782,793,796,945,986,1005 Healthy volunteer

171,190,291,324,392,407,418,471,505,528,533,561,677,709,733,815,942,996,1002; Prison inmates (4); 188,289,557,974 

Elderly (3); 78,279,282 Smokers (2); 674,787 Athletes (1) 309

Mental health disorders (9) Substance abuse (5); 259,261,267,270,271 Anxiety disorders (2);683,814 

conditions (1); 850 Posttraumatic stress disorder (1) 478

Circulatory/cardiovascular (10) Coronary artery disease (1);252 Hypertension (9) 205,206,210,220-

Respiratory/Pulmonary (2) Asthma (2) 587,759

Sleep disorders (1) Chronic insomnia (1) 780

Oncology (1) Cancer (miscellaneous) (1) 816Observational analytical (151) Healthy populations (148) Healthy volunteers from the community (91); 951a951b385,446,449- 452,499,508,509,771,795,952,978,980,1008a509b80,513,522,529,546,551,555,560,563,571,923,964a571b399,400,576,581,583,585

601,607,612,624,776,928,970,975,976a624b412,416,422,428,633,638,640,643,644,646,647,649,655,669,675,686,695,700,703,704,77b973a745,748,749,760,792,939,941,1004 College/university students (48); 436,458,466,487,501,520,534,535,540,547,772a547b401,548,568,570,582,648,660,661,663,668,671,672,685,688,693,694,712,718,7

37,741,744,757,763,936,1000,1003 Elderly (5);453,552a552b701,740 Prison inmates (3); 438,439,441 Workers (

Gynecology (2) Pregnancy (1); 469 Postmenopause (1) 743 

Dental (1) Periodontitis (1) 619

 RR 51 Intervention studies (50) 

Healthy populations (31) College/university students (19); 306,394,475-477b306a75,191,515,524,530,558,56

volunteers from the community (8); 94,283,284,288,304,480,525,594 Prison inmates (1); 92 Workers 

Circulatory/cardiovascular (9) Other cardiovascular diseases (5); 91,234,236,459,753 Hypertensio

Mental health disorders (4) Substance abuse (2); 265,268 Anxiety disorders (1); 460 Schizophre

disorders (1) 678

Gynecology (2) Menopause (1) 592; Premenstrual syndrome (1) 396Gastrointestinal (1) Irritable bowel syndrome (1) 610

Miscellaneous medical conditions (1) Heterogeneous patient population (1) 414

Musculoskeletal (1) Total knee replacement (1) 192

Oncology (1) Skin cancer (1) 521

Observational analytical (1) Circulatory/cardiovascular: Hypertension (1) 492. 

COPD = chronic obstructive pulmonary disease; CSM = clinically standardized meditation; DM = diabetes mellitus; HIV = human immunodeficiency 

mindfulness-based cognitive therapy; MBSR = mindfulness-based stress reduction; MM = mindfulness meditation; ND = not described; NS = not s

Response; TM® = Transcendental Meditation®
G-20

Table G9. Meditation practices separated by the diseases, conditions, and populations for which they have been examined (co

Category of 

meditation 

practices 

Meditation 

practice N Study populations/conditions and associated references 

Mantra 

meditation (ND) 

32 Intervention studies (26) 

Healthy populations (19) College/university students (10); 472,494a531,597,650,653,654,706,719,965 Hea

community (6); 393,434,503,652,777,856 Workers (2); 483,761 Army/military (1) 194

Mental health disorders (5) Anxiety disorders (3);577,626,736 Substance abuse (1);260 Miscellan

(1) 963

Circulatory/cardiovascular (1) Hypertension (1) 203

Neurological (1) Epilepsy (1) 805

Observational analytical (6) Healthy populations (6) Healthy volunteers from the community (6) 591,828,853,859,937,969

CSM 11 Intervention studies (11) 

Healthy populations (7) College/university students (3); 537,658,676 Workers (3); 193,384,536 Healt

community (1) 627 

Mental health disorders (3) Anxiety disorders (1); 97 Schizophrenia (1); 410 Substance abuse 

Sleep disorders (1) Chronic insomnia (1) 702

ACEM 

meditation 

7 Intervention studies (3) 

Healthy populations (3) Athletes (3) 956,959,961Observational analytical (4) Healthy populations (4) Healthy volunteers from the community (4) 720,957,958,960

Ananda marga 3 Observational analytical (3) 

Healthy populations (3) Healthy volunteers from the community (3) 498,526,786

Cayce’s 

meditation 

1 Intervention studies (1) 

Healthy populations (1) Healthy volunteers from the community (1) 680

Mantra 

meditation (continued) 

Concentrative/ 

rosary prayer 

1 Intervention studies (1) 

Healthy populations (1) Healthy volunteers from the community (1) 966

Yoga 191 Intervention studies (158) 

Healthy populations (80) Healthy volunteers from the community (34); 83,111,122,126,133,140,180,183,301,302,310,312,318,320,322,323,406,411,491,578,707,739,799,821,822,826,858,860,863,864,867

students (26); 127,134,172,177-179,181,182,297,300,305,314,315,389,462,468,615,800,802,823,838,840,854,862,971,982 A

137,313,811,836,837,839,844 Elderly (5); 280,281,445,562,825 Workers (5) 169,176,549,679,1007 Prison inmate

Circulatory/cardiovascular (21) Hypertension (13); 185,204,212,216,217,219,224,226,294,303,510,831,851 Ca

233,238-240,247,250,251,611; 

Mental health disorders (16) Depression (7);138,184,618,764,806,819,830 Anxiety disorders (3); 810,84

266,269,273 Obsessive-compulsive disorder (1);174 Miscellaneous psychiatric conditions (1); 1
G-21

Table G9. Meditation practices separated by the diseases, conditions, and populations for which they have been examined (co

Category of 

meditation 

practices 

Meditation 

practice N Study populations/conditions and associated references 

Yoga (continued) 192 Respiratory/Pulmonary (13) Asthma (9); 168,325,813,818,829,843,866,943,991 Chronic airways obstruc

(1); 797 Pleural effusion (1); 832 Pulmonary tuberculosis (1) 868

Muscoloskeletal (11) Chronic pain (2); 118,542 Rheumathoid arthritis (2); 804,925 Carpal tunnel 

rheumatic diseases (1); 845 Fibromyalgia (1); 584 Hyperkyphosis (1); 559 Multiple sclerosis 

Post-polio syndrome (1) 516

Endocrine (7) Type 2 DM (7) 278,298,308,321,794,824,926Gastrointestinal (2) Irritable bowel syndrome (1); 852 Miscellaneous gastrointestinal disorder

Neurological (2) Epilepsy (1); 417 Migraine/tension headaches (1) 404

Gynecology (1) Pregnancy (1) 415

Immunologic (1) HIV (1) 642 Miscellaneous medical conditions (1) Heterogeneous patient population (1) 870

Oncology (1) Lymphoma (1) 120

Sleep disorders (1) Chronic insomnia (1) 613Vestibular (1) Tinnitus (1) 946 

Observational analytical (33) Healthy populations (33) Healthy volunteers from the community (23); 141,146,390,465,473,506,527,574,667,798,803,820,833,842,855,861,865,948,949,968,985,989,1009 College/university st

142,755,785,788,807,857,869 Workers (2); 496,849 Elderly (1) 1010

Mindfulness 

meditation (127) 

MBSR 49 Intervention studies (49) 

Healthy populations (12) College/university students (6); 457,488,517,689,711,754 Healthy voluntee

485,602,756 Workers (3) 512,593,710

Mental health disorders (12) Anxiety disorders (3); 196,589,606 Mood disorders (2); 681,752 Subs

eating disorder (1); 620 Burnout (1); 493 Miscellaneous psychiatric conditions (1); 622 Perso

Parents of children with behavioral problems (1) 687

Miscellaneous medical conditions (6) Heterogeneous patient population (5); 579,684,691,692,947 

Musculoskeletal (6) Chronic pain (4); 420,482,556,682 Fibromyalgia (2) 421,609

Oncology (4) Breast cancer (3); 423,575,724 Prostate cancer (1) 697

Dermatology (2) Psoriasis (2) 167,195

Circulatory/Cardiovascular (2) Cardiovascular diseases (2) 244,245 

Neurological (2) Traumatic brain injuries (2) 770,930Endocrine (1) Obesity (1) 635

Immunologic (1)HIV (1) 419

Organ transplantation (1) Kidney, lung, pancreas (1) 402
G-22

Table G9. Meditation practices separated by the diseases, conditions, and populations for which they have been examined (co

Category of 

meditation 

practices 

Meditation 

practice N Study populations/conditions and associated references 

Mindfulness 

meditation (127) (continued) 

MM (NS) 37 Intervention studies (30) 

Healthy populations (11) College/university students (7); 106,447,490,523,696,728,775 Athletes (1); 7

community (1); 532 Smokers (1); 444 Workers (1) 932

Mental health disorders (5) Binge eating disorders (2); 403,474 Anxiety disorders (1); 751 Psyc

(1) 258

Musculoskeletal (5) Fibromyalgia (3); 430,448,716 chronic pain (2) 464,604Circulatory/Cardiovascular (3) Cardiovascular diseases (3) 241,242,249

Oncology (3) Cancer (miscellaneous) (3) 386,442,738

Dermatology (1) Psoriasis (1) 395

Gynecology (1) Infertility (1) 1011

Miscellaneous medical conditions (1) Heterogeneous patient population (1) 727 

Observational analytical (7) Healthy populations (6) College/university students (4); 497,511,614,641 Healthy volunteers from 

Musculoskeletal (1) Chronic pain (1) 605

Zen Buddhist 

meditation 

28 Intervention studies (15) 

Healthy populations (11) College/university students (10); 70,426,500,554,629,639,774,913,916,920 Hea

community (1) 197 

Circulatory/Cardiovascular: Cardiovascular diseases (1); 237 Hypertension (2) 225,227

Sleep disorders (1) Insomnia (1) 765 

Observational analytical (13) Healthy populations (13) Healthy volunteers from the community (12); 105,443,456,495,550,636,729,

College/university students (1) 918

MBCT 7 Intervention studies (7) 

Mental health disorders (3) Depression (3) 427,929,940

Healthy populations (1) Workers (1) 984

Musculoskeletal (1) Fibromyalgia 553

Neurological (1) Stroke (1) 784

Vestibular (1) Tinnitus (1) 455

Vipassana 

meditation 

6 Intervention studies (2) 

Healthy populations: Healthy volunteers from the community (1) 848Neurological (1) Migraine/Tension headaches (1) 847Observational analytical (4) Healthy populations (4) Healthy volunteers from the community (2); 708,990 College/university 

664
G-23

Table G9. Meditation practices separated by the diseases, conditions, and populations for which they have been examined (co

Category of 

meditation 

practices 

Meditation 

practice N Study populations/conditions and associated references 

Tai Chi 88 Intervention studies (66) 

Healthy populations (38) Elderly (25); 285,287,290,326,397,398,408,409,425,435,489,566,588,603,631,645,657,665,6

volunteers from the community (8); 152,286,296,307,595,596,766,906 College/university students (4)

Musculoskeletal (13) Rheumatoid arthritis (4); 617,746,883,962 Osteoarthritis (3); 573,894,904 Chron

disorders (1); 564 Fibromyalgia (1); 725 Multiple sclerosis (1); 590 Osteoporosis (1) 713

Circulatory/Cardiovascular (4) Cardiovascular diseases (3); 235,246,248 Hypertension (1) 223

Gynecology (2) Menopause (1); 1001 Postmenopause (1) 895

Mental health disorders (2) Depression (1); 871 Miscellaneous psychiatric conditions (1) 768

Neurological (2) Developmental disabilities (1); 608 Stroke (1) 1006

Endocrine (1) Type 2 DM (1) 999

Immunologic (1) HIV (1) 541

Oncology (1) Breast cancer (1) 391

Renal (1) : End-stage renal disease (1) 897 Vestibular (1) Vestibulopathy (1) 413

Observational analytical (22) Healthy populations (20 ) Elderly (18); 388,432,565,735,874,876,879-881,896,898,901-903,905,908,909,911 Healt

community (2) 470,699

Gynecology (2)Postmenopause (2) 877,899

Qi Gong 37 Intervention studies (22) 

Healthy populations (7) Healthy volunteers from the community (4); 299,405,634,891 College/univ

Elderly (1) 889 

Circulatory/cardiovascular (5) Hypertension (4); 207,211,213,214 Cardiovascular diseases (1); 243

Musculoskeletal (4) Fibromyalgia (2); 502,953 Muscular dystrophy (1); 954 Regional pain syndro

Endocrine (2) Type 2 DM (2) 914,919

Mental health disorders (1) Substance abuse (1) 262Miscellaneous medical conditions (1) Heterogeneous patient population (1) 900

Neurological (1) Migraine/Tension headaches (1) 944

Respiratory/Pulmonary (1) COPD (1) 875

Observational analytical (15) Healthy populations (14) Healthy volunteers from the community (11); 161,200,201,632,778,884,887,8

students (2); 202,912 Elderly (1) 907

Circulatory/Cardiovascular (1) Hypertension (1) 873
G-24

Table G9. Meditation practices separated by the diseases, conditions, and populations for which they have been examined (co

Category of 

meditation 

practices 

Meditation 

practice N Study populations/conditions and associated references 

Meditation practices (ND) 21 Intervention studies (19) 

Healthy populations (12) College/university students (9); 387,494b199,431,539,580,656,730,915 Workers 

from the community (1) 651 

Mental health disorders (4) Substance abuse; (2) 274,808 Anger management problems (1); 98Circulatory/cardiovascular (1) Hypertension (1) 215

Dental problems (1) Dental problems (1) 198

Sleep disorders (1) Insomnia (1) 484 

Observational analytical (2) Healthy populations (1) College/university students (1) 481

Mental health disorders (1) Miscellaneous psychiatric conditions (1) 630

Miscellaneous meditation 

practices 

11 Intervention studies (6) 

Healthy populations (3) College/university students (2); 507,791 Healthy volunteers from the co

Mental health disorders (1) Miscellaneous psychiatric conditions (1) 621

Miscellaneous medical conditions (1) Heterogeneous patient population (1) 801

Oncology (1) Breast cancer (1) 726

Observational analytical (5) Healthy populations (5) Healthy volunteers from the community (4); 454,628,933,967 College/univ
H-1

Appendix H. Characteristics of Clinical Trials of Meditation Prathe Three Most Studied Conditions Table H1. Characteristics of clinical trials of meditation practices in hypertension 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Aivazyan, 

TA 1988203 

Russia 

RCT 

parallel 2 arms 

Duration: 

12 mo 

ITT: yes 

35.7 yr F = 0 M = 117 Mild HT (DBP 90-

105 mm Hg) 

R: 146 C: 117 W: 29 

Composite Mantra 

meditation + relaxation techniques

R: 90 C: 70 W: 20 

NT R: 56 

C: 47 W: 9 

Primary: BP changes 

(SBP, DBP) 

Secondary: time of BP 

restoration, HRQL, emotional stress, number of sick leaves 

AHM = anti-hypertensive medication; AI = alpha index; APO-A1 = apolipoprotein A1; AT = autogenic training; BE = breathing exercises; BF = biofe

hypertension; BMI = body mass index; BP = blood pressure; C = number completed; cIMT = carotid intima media thickness; CMBT = contempl

breathing techniques; CO = cardiac output; CPR = cold pressor response; Cr = creatinine; d = day(s); DBH = dopamine beta hydroxylase; DBP = number enrolled (for NRCTs); E/A ratio = early filling divided by atrial constriction; EEG = electroencephalogram; EMG = electromyography; E

forced expiratory volume in 1 second; FVC = forced vital capacity; GSR = galvanic skin response; HDL-C = high density lipoprotein cholesterol

= heart rate; HRQL = health-related quality of life; HT = hypertension; IHD = ischemic heart disease; ITT = intention to treat; IVST = intraventri

= Joint National Committee 7; K = potassium; LDL-C = low density lipoprotein cholesterol; LVIDD = left ventricular internal dimension at diast

internal dimension at systole; LVMI = left ventricular mass index; MI = myocardial infarction; mo = month(s); Na = sodium; NA = not applicabl= not reported; NRCT = nonrandomized controlled trial; NS = not specified; NT = no treatment; PLB = placebo; PMR = progressive muscle relaxactivity; pR = Pulse rate; PWT = posterior wall thickness; R = number randomized (for RCTs); RPP = rate pressure product; RR = Relaxation Re

pressure; TC = total cholesterol; TG = triglycerides; TM® = Transcendental Meditation®; wk = week(s); UC = usual care; W = number withdraw

waiting list; yr = year(s); 18-OH-OHDOC = hydroxydeoxycorticosterone 
H-2

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued) 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Broota R: NR 

C: 10 W: NR 

PMR R: NR 

C: 10 W: NR 

Broota A, 

1995204

India 

RCT 

parallel 4 arms 

Duration: 

8 d 

ITT: No 

35-59 yr F = 0 M = 40 Essential HT 

(NR) 

R: NR C: 40 W: NR 

Single Yoga 

R: NR C: 10 W: NR 

NT R: NR 

C: 10 W: NR 

Primary: BP change

(SBP, DBP) 

Secondary: anxiety

GSR 

Calderon R 

Jr, 2000205

United 

States 

RCT 

parallel 2 arms 

Duration: 

6 mo 

ITT: NR 

53.9 yr F = 48 M = 24 Mild HT (SBP 

130-140 mm Hg and DBP 85-89 mm Hg or SBP 140-150 mm Hg and DBP 90-99 mm Hg) 

R: 146 C: 72 W: 74 

Single TM®

R: NR C: 36 W: NR 

HE R: NR 

C: 36 W: NR 

Primary: TC, TG. 

LDL-C, HDL-C 

Secondary: BP 

changes, PR, anger, personal efficacy, diet, stress, physical activity 
H-3

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued) 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

CastilloRichmond 

A, 2000206

United States 

RCT parallel 

2 arms 

Duration: 9 

mo 

ITT: Yes 

53.8 yr F = 41 M = 19 Mild to 

moderate HT 

(SBP 130-

139 mm Hg and DBP 80-85 mm Hg [high normal]; SBP 140-159 mm Hg and DBP 90-99 mm Hg [stage I]; SBP 160-179 mm Hg and DBP 100-109 mm Hg [stage 2]) 

R: 138 C: 60 W: 78 

Single TM®

R: NR C: 31 W: NR 

HE R: NR 

C: 29 W: NR 

Primary: cIMT Secondary: BP 

changes, weightpulse pressure, THDL-C, LDL-C, smoking, exercis
H-4

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued) 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Cheung BMY, 

2005207

Hong Kong 

RCT parallel 

2 arms 

Duration: 

16 wk 

ITT: Yes 

54.4 yr F = 51 M = 37 Mild HT (SBP 140-

170 mm Hg and/or DBP 90-105 mm Hg) 

R: 91 C: 88 W: 3 

Single Qi Gong 

R: 47 C: 47 W: 0 

Exercise R: 44 

C: 44 W: 3 

Primary: BP, health 

status, anxiety, depression 

Secondary: HR, we

BMI, body fat, waist/hip circumference, reexcretion, urinary albumin excretioNa, K, urea, Cr, HDL-C, LDL-C, Taldosterone, urincortisolurine, Cr, Na, urine proteinLVMI, ejection fraction 

BF R: NR 

C: 10 W: NR 

Cohen J, 

1983208

United States 

RCT parallel 

3 arms 

Duration: 

10 wk 

ITT: NR 

44.5 yr F = 17 M = 13 Essential 

HT 

(NR) 

R: NR C: 30 W: NR 

Single RR 

R: NR C: 10 W: NR 

WL R: NR 

C: 10 W: NR 

Primary: attention (

independence, attention deploymabsorption) 

Secondary: BP cha

(SBP, DBP) 
H-5

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued) 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age 

(mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Yoga R: 8 

C: 7 W: 1 

Hafner RJ, 

1982185

United 

Kingdom 

RCT 

parallel 3 arms 

Duration: 

3 mo 

ITT: NR 

48.9 yr F = NR M = NR Essential 

HT 

(NR) 

R: 24 C: 22 W: 2 

Composite Yoga + BF 

R: 8 C: 7 W: 1 

NT R: 8 

C: 8 W: 0 

Primary: BP chang

(SBP, DBP) 

Secondary: hostilit

assertive behavpsychological symptoms 

Hager JL, 

1978209

United States 

RCT 

parallel 2 arms 

Duration: 

4 wk 

ITT: No 

Age NR F = NR M = NR BHT (SBP >145 

mm Hg and/or DBP >95 mm Hg) 

R: 30 C: 17 W: 13 

Single RR 

R: NR C: 10 W: NR 

BF (BP) R: NR 

C: 7 W: NR 

Primary: BP chang

(SBP, DBP) 

Kondwani 

KA, 1998210,229

United States 

RCT 

parallel 2 arms 

Duration: 

1 yr 

ITT: NR 

50.7 yr F = 19 M = 15 Mild HT (DBP 90-

104 mm Hg) 

R: 42 C: 34 W: 8 

Single TM®

R: 22 C: 19 W: 3 

HE R: 20 

C: 15 W: 5 

Primary: LVMI Secondary: BP cha

(SBP, DBP), weHR, PWT, LVIDLVIDS, IVST, E/ratio, energy, slepositive affect, spattern, anxiety, depression, angself-efficacy, loccontrol, diet, actlevel, complianc
H-6

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued) 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age 

(mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Kuang AK, 

1987211

China 

RCT 

parallel 2 arms 

Duration: 

1 yr 

ITT: NR 

40-60 yr F = 0 M = 46 Essential HT (DBP 100-

120 mm Hg) 

R: NR C: 46 W: NR 

CompositeQi Gong + 

AHM 

R: NR C: 23 W: NR 

AHM R: NR 

C: 23 W: NR 

Primary: plasma 

OH-DOC level

Secondary: BP 

changes (SBPDBP) 

Latha DR, 

1991212

India 

RCT 

parallel 2 arms 

Duration: 

6 mo 

ITT: NR 

45-70 yr F = NR M = NR Essential HT (NR) 

R: 23 C: 14 W: 9 

CompositeYoga + BF 

(thermal) 

R: NR C: 7 W: NR 

HE R: NR 

C: 7 W: NR 

Primary: BP 

changes (SBPDBP) 

Secondary: AHM 

intake, stress control, negatiresponses to stress, coping havior, somatisymptoms, symtom severity 
H-7

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued) 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age 

(mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Lee MS, 

2003214,230

South Korea 

RCT 

parallel 2 arms 

Duration: 

10 wk 

ITT: NR 

56.2 yr F = 35 M = 23 Essential HT (SBP 140-180 

mm Hg and DBP 90-100 mm Hg) 

R: 65 C: 58 W: 7 

Single Qi Gong 

R: 33 C: 29 W: 4 

WL R: 32 

C: 29 W: 3 

Primary: BP 

changes (SBPDBP, RPP) 

Secondary: HR, 

EPI, NE, FVC,230FEV1,2

cortisol, stress level 

Lee MS, 

2004213,231

South Korea 

RCT 

parallel 2 arms 

Duration: 

8 wk 

ITT: NR 

53.4 yr F = 22 M = 14 Essential HT (SBP 140-180 

mm Hg and DBP 90-105 mm Hg) 

R: 47 C: 36 W: 11 

Single Qi Gong 

R: 23 C: 17 W: 6 

WL R: 24 

C: 19 W: 5 

Primary: BP 

changes (SBPDBP) 

Secondary: APO

A1, TC, HDL-CTG, selfefficacy231
H-8

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued) 

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age 

(mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Manikonda P, 

2005215

Germany 

RCT 

parallel 2 arms 

Duration: 

8 wk 

ITT: NR 

30-70 yr F = 18 M = 34 Mild to 

moderate HT 

(JNC7 

criteria) 

R: NR C: 52 W: NR 

Single CMBT 

R: NR C: 26 W: NR 

NT R: NR 

C: 26 W: NR 

Primary: BP 

changes 

McCaffrey R, 

2005216

Thailand 

RCT 

parallel 2 arms 

Duration: 

8 wk 

ITT: NR 

56.4 yr F = 35 M = 19 Mild to 

moderate HT 

(BP>140/90 

mm Hg) 

R: 61 C: 54 W: 7 

Single Yoga 

R: 32 C: 27 W: 5 

HE R: 29 

C: 27 W: 2 

Primary: stress, 

changes (SBPDBP) 

Secondary: BMI, 

AHM R: NR 

C: 11 W: NR 

Murugesan R, 

2000217

India 

RCT 

parallel 3 arms 

Duration: 

11 wk 

ITT: NR 

35-65 yr F = NR M = NR Essential HT (NR) 

R: NR C: 33 W: NR 

Single Yoga 

R: NR C: 11 W: NR 

NT R: NR 

C: 11 W: NR 

Primary: stress, 

changes (SBPDBP) 

Secondary: PR, 

weight 
H-9

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Patel CH, 

1985218

United 

Kingdom 

RCT parallel 

2 arms 

Duration: 

8 wk8 mo4 yr 

ITT: NR 

35-64 yr F = 74 M = 118 Mild HT (BP>140/90 

mm Hg) 

R: 204 C: 192 W: 12 

CompositeRR + BE + 

PMR 

R: 107 C: 99 W: 8 

HE R: 97 

C: 93 W: 4 

Primary: BP chang

(SBP, DBP), TC 

Secondary: smoki

morbidity, morta

Patel CH, 

1975219

United 

Kingdom 

RCT parallel 

2 arms 

Duration: 

6 wk 

ITT: NR 

59 yr F = 21 M = 13 Essential HT (DBP ≥110 

mm Hg) 

R: 36 C: 34 W: 2 

CompositeYoga + BF

R: 18 C: 17 W: 1 

Rest R: 18 

C: 17 W: 1 

Primary: BP chang

(SBP, DBP) 
H-10

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

PMR R: 42 

C: 37 W: 5 

Schneider 

RH, 199579,221,232

United States 

RCT parallel 

3 arms 

Duration: 

3 mo 

ITT: yes 

66.8 yr F = 64 M = 47 Mild HT (SBP ≤ 189 mm 

Hg and DBP 90-109 mm Hg) 

R: 127 C: 111 W: 16 

Single TM®

R: 40 C: 36 W: 4 

HE R: 45 

C: 38 W: 7 

Primary: BP 

changes (SBDBP) 

Secondary: 

compliance 

PMR R: 68 

C: 52 W: 16 

Schneider 

RH, 2005220

United States 

RCT parallel 

3 arms 

Duration: 

1 yr 

ITT: yes 

48.5 yr F = 79 M = 71 Mild to moderate 

HT 

(SBP 140-179 or 

DBP 90-109 mm Hg) 

R: 197 C: 150 W: 47 

Single TM®

R: 65 C: 54 W: 11 

HE R: 64 

C: 44 W: 20 

Primary: BP 

changes (SBDBP) 

Secondary: ch

in AHM 

PLB R: 14 

C: 11 W: 3 

Seer P, 

1980222

New Zealand 

RCT parallel 

3 arms 

Duration: 

3 mo 

ITT: NR 

43.3 yr F = 18 M = 23 Essential HT (DBP ≥ 100 mm 

Hg) 

R: 41 C: 36 W: 5 

Single SRELAX 

(technique modeled after TM®) 

R: 14 C: 12 W: 2 

WL R: 13 

C: 13 W: 0 

Primary: BP 

changes (SBDBP) 
H-11

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Selvamurthy 

W, 1998226

India 

NRCT 

parallel 2 arms 

Duration: 

3 wk 

ITT: NR 

41.7 yr F = 0 M = 20 Essential HT (SBP>140 mm Hg 

and DBP >90 mm Hg)

E: NR C: 20 W: NR 

Single Yoga 

E: NR C: 10 W: NR 

Orthostatic 

tilt 

E: NR C: 10 W: NR 

Primary: BP 

changes (SBP, DBP) 

Secondary: AIEEG, CO, HR, 

NE, EPI, PRA, urine K, urine Na, CPR 

Stone RA, 

1976227

United States 

NRCT 

parallel 2 arms 

Duration: 

6 mo 

ITT: NR 

28 yr F = 2 M = 17 Mild to moderate 

HT 

(DBP > 105 mm 

Hg) 

E: NR C: 19 W: NR 

Single Zen 

Buddhist meditation

E: NR C: 14 W: NR 

BP 

checks 

E: NR C: 5 W: NR 

Primary: BP 

changes (SBP, DBP) 

Secondary: 

changes in plasma DBH, plasma volumePRA 

BF (EMG) 

E: NR C: 8 W: NR 

Surwit RS, 

1978228

United States 

NRCT 

parallel 3 arms 

Duration: 

6 wk 

ITT: NR 

46.4 yr F = 5 M = 19 BHT (SBP ≥ 140 mm 

Hg or DBP ≥ 90 

mm Hg) 

E: NR C: 24 W: NR 

Single RR 

R: NR C: 8 W: NR 

BF (BP) E: NR 

C: 8 W: NR 

Primary: BP 

changes (SBP, DBP) 
H-12

Table H1. Characteristics of clinical trials of meditation practices in hypertension (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Tsai JC, 

2003223

Taiwan 

RCT parallel 

2 arms 

Duration: 

12 wk 

ITT: NR 

52 yr F = 38 M = 38 Borderline and 

Mild HT 

(SBP 130-159 

mm Hg or DBP 85 -99 mm Hg) 

R: 88 C: 76 W: 12 

Single Tai Chi 

R: 44 C: 37 W: 7 

NT R: 44 

C: 39 W: 5 

Primary: BP 

changes (SBP, DBP) 

Secondary: HR, 

TC, HDL-C, LDC, TG, BMI, anxiety 

van Montfrans 

GA, 1990224

Netherlands 

RCT parallel 

2 arms 

Duration: 

1 yr 

ITT: NR 

41.4 yr F = 17 M = 18 Mild HT (SBP 160-200 

mm Hg and/or DBP 95-119 mm Hg) 

R: 42 C: 35 W: 7 

Compo

site 

Yoga + 

RR + PMR + AT 

R: 23 C: 18 W: 5 

Rest R: 19 

C: 17 W: 2 

Primary: BP 

changes (SBP, DBP) 

Secondary: body 

weight, urine NTC 

BP 

checks 

R: NR C: 64 W: NR 

HE R: NR 

C: 69 W: NR 

Yen LL, 

1996225

China 

RCT parallel 

4 arms 

Duration: 

2 mo 

ITT: NR 

54.5 yr F = 107 M = 192 Mild to moderate 

HT 

(SBP ≥ 140 mm 

Hg or DBP ≥ 90 mm Hg) 

R: 392 C:299 W: 93 

Compo

site 

Zen 

Buddhist meditation + PMR

R: NR C: 56 W: NR 

NT R: NR 

C: 110 W: NR 

Primary: BP 

changes (SBP, DBP) 
H-13

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases 

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Ades PA, 

2005233,253 

United States 

RCT 2 arms Duration: 6 

mo 

ITT: NR 

72.7 yr F = 42 M = 0 CHD 

R: 51 C: 42 W: 9 

Composite Yoga + BE 

R: NR C: 21 W: NR 

Resistance 

training 

R: NR C: 21 W: NR 

Primary: TEE Secondary: body 

strength, body weight, BMI, fat free mass, left ventricular function, VO2

max, depression 

AMI = acute myocardial infarction; BE = breathing exercises; BNP = B-type natriuretic peptide; BMI = body mass index; BP = blood pressure; C = 

= coronary artery bypass surgery; CAD = coronary artery disease; CHD = coronary heart disease; CHF = chronic heart failure; CRT = cognitive rday(s); DBP = diastolic blood pressure; E = number enrolled (for NRCTs) GSH = glutathione; HDL-C = high-density lipoprotein cholesterol; HE = health-related quality of life; HRV = heart rate variability; ITT = intention to treat; LDL-C = low density lipoprotein cholesterol; LLM = lowerleft ventricular ejection fraction; LVDDi = left ventricular end diastolic volume index; min = minute(s); mo = month(s); NRCTs = nonrandomize

mindfulness-based stress reduction; NA = not applicable; NE = norepinephrine; NR = not reported; NS = not specified; NT = no treatment; NYH

Association; P-MDA = plasma malondialdehyde; PMR = Progressive muscle relaxation; PVD= peripheral vascular disease; PR = pulse rate; R = RCTs) SBP = systolic blood pressure; TC = total cholesterol; TEE = total energy expenditure; TG = triglycerides; TM® = Transcendental Medita

increase of ventilation per unit of increase of carbon dioxide production; VO2 max = maximum oxygen consumption; UC = usual care; VLDL

lipoprotein cholesterol; W = number withdrawals/losses to followup; wk = week(s); WL = waiting list; WR = work rate; yr = year(s)
H-14

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

HE R: 32 

C: 24 W: 8 

Chang BH, 

2005234 

United States 

RCT parallel 

3 arms 

Duration: 

19 wk 

ITT: yes 

69.2 yr. F = 1 M = 94 CHF 

R: 95 C: 83 W: 12 

Single RR 

R: 34 C: 31 W: 3 

UC (NS) R: 29 

C: 28 W: 1 

Primary: HRQL Secondary: VO2

max

Exercise R: 41 

C: 30 W: 11 

Channer KS, 

1996235 

United 

Kingdom 

RCT parallel 

3 arms 

Duration: 

8 wk 

ITT: NR 

56 yr F = 36 M = 90 AMI 

R: 126 C: 104 W: 22 

Single Tai Chi 

R: 38 C: 31 W: 7 

HE R: 47 

C: 43 W: 4 

Primary: BP 

changes (DBP, SBP) 

Secondary: HR 

Curiati JA, 

2005236 

Brazil 

RCT parallel 

2 arms 

Duration: 

12 wk 

ITT: NR 

74.7 yr F = 14 M = 5 CHF 

R: 19 C: 15 W: 4 

Composite RR + BE 

R: 10 C: 8 W: 2 

Group 

therapy 

R: 9 C: 7 W: 2 

Primary: NE

Secondary: 

HRQL, VE/VCO2 slope, 

VO2, LVEF, 

LVDDi
H-15

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Friedman NL, 

2002237 

United States 

RCT parallel 

2 arms 

Duration: 

90 min 

ITT: NR 

63 yr F = 9 M = 47 CAD 

R: 67 C: 56 W: 11 

Single Zen 

Buddhist meditation 

R: NR C: 28 W: NR 

HE R: NR 

C: 28 W: NR 

Primary: HRV 

Hipp A, 

1998247 

Germany 

NRCT 

parallel 2 arms 

Duration: 

6 mo 

ITT: NR 

64 yr F = 7 M = 19 CAD 

E: NR C: 26 W: NR 

Single Yoga 

E: NR C: 20 W: NR 

NT E: NR 

C: 6 W: NR 

Primary: TC Secondary: HDLC, LDL-C, 

VLDL-C, TG

Jatuporn S, 

2003238 

Thailand 

RCT parallel 

2 arms 

Duration: 

4 mo 

ITT: NR 

59 yr F = 9 M = 35 CAD 

R: 44 C: 44 W: 0 

Composite Yoga + 

intensive lifestyle modification program 

R: 22 C: 22 W: 0 

LLM R: 22 

C: 22 W: 0 

Primary: total antioxidant status, 

vitamin C, vitamin E 

Secondary: TG, 

TC, HDL-C, LDL-C, P-MDA, erythrocyte GSH, BMI 
H-16

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Lan C, 

1999248 

Taiwan 

NRCT 

parallel 2 arms 

Duration: 

1 yr 

ITT: NR 

56.5 yr F = 0 M = 27 CABS 

E: 27 C: 20 W: 7 

Single Tai Chi 

E: 12 C: 9 W: 3 

Exercise E: 15 

C: 11 W: 4 

Primary: peak VO

Secondary: peak 

HR 

Mahajan AS, 

1999239 

India 

RCT parallel 

2 arms 

Duration: 

14 wk 

ITT: NR 

56-59 yr F = 0 M = 93 CAD 

R: 93 C: NR W: NR 

Composite Yoga + diet 

changes 

R: 52 C: NR W: NR 

Exercise + 

Diet changes 

R: 41 C: NR W: NR 

Primary: body we

lipid profile (TCC, LDL-C) 

Manchanda 

SC, 2000240 

India 

RCT parallel 

2 arms 

Duration: 

1 yr 

ITT: NR 

51.5 yr F = 0 M = 42 CAD 

R: 42 C: NR W: NR 

Composite Yoga + diet 

+ aerobic exercise 

R: 21 C: NR W: NR 

Exercise + 

diet changes 

R: 21 C: NR W: NR 

Primary: number 

gina episodes/lesion severityfunctional clas

Secondary: exerc

capacity, body weight, TC, HDLDL-C, TG 
H-17

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Rest (1) 

Listening music 

R: 14 C: 14 W: 0 

Mandle CL, 

198891,254

United States 

RCT 

parallel 3 arms 

Duration: 

NR 

ITT: NR 

59.8 yr F = 28 M = 17 PVD 

R: 45 C: 45 W: 0 

Single RR 

R: 15 C: 15 W: 0 

Rest (2) 

Listening blank tapes 

R: 16 C: 16 W:0 

Primary: anxiety, pSecondary: 

medication useBP changes (DSBP), PR 

CRT R: 13 

C: 9 W: 4 11 

Pool JI, 

1995241 

United States 

RCT 

parallel 3 arms 

Duration: 

9 wk 

ITT: NR 

59.2 yr F = 36 M = 16 CHD 

R: 50 C: 35 W: 15 

Single Mindfulness 

meditation (NS) 

R: 16 C: 10 W: 6 

Group 

therapy 

R: 21 C: 16 W: 5 

Primary: BP chang

(DBP, SBP) 

Secondary: HR, 

anxiety, deprespsychological distress, irritabihostility 

QuillianWolever 

RE, 2005242 

United States 

RCT 

parallel 2 arms 

Duration: 

10 mo 

ITT: NR 

Age NR F = NR M = NR CHD 

R: 154 C: NR W: NR 

Composite Mindfulness 

meditation (NS) + HE + health coaching 

R: NR C: NR W:NR 

UC (NS) R: NR 

C: NR W:NR 

Primary: coronary 

heart disease ri10 years 
H-18

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Stenlund T, 

2005243 

Sweden 

RCT 

parallel 2 arms 

Duration: 

3 mo 

ITT: NR 

77.4 yr F = 29 M = 66 CAD 

R: 109 C: 95 W: 14 

Composite Qi Gong + 

discussions 

R: 56 C: 48 W: 8 

HE R: 53 

C: 47 W: 6 

Primary: level of 

physical activit

Secondary: balan

coordination, fefalling 

Tacon AM, 

2003244,255 

United States 

RCT 

parallel 2 arms 

Duration: 

8 wk 

ITT: NR 

60.3 yr F = 18 M = 0 CAD 

R: 20 C: 18 W: 2 

Single MBSR 

R: 10 C: 9 W: 1 

WL R: 10 

C: 9 W: 1 

Primary: anxiety Secondary: copin

styles, emotioncontrol, health of control, cort

breathing frequency,255 

catecholamin

BP changes (DSBP), HRQL 
H-19

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Tsai SL, 

2004249

China 

NRCT 

parallel 2 arms 

Duration: 

1 yr 

ITT: NR 

63.2 yr F = 13 M = 87 CAD 

E: 146 C: 100 W: 46 

Composite Mindfulness 

meditation (NS) + BE + PMR + imagery 

E: 67 C: 41 W: 26 

UC (NS) E: 79 

C: 59 W: 20 

Primary: anxiety Secondary: sleep, 

relaxation level 

Williams KA, 

2001245 

United States 

RCT parallel 

2 arms 

Duration: 

12 wk 

ITT: NR 

Age NR F = NR M = NR CAD 

R: 35 C: NR W: NR 

Single MBSR 

R: 11 C: NR W: NR 

NT R: 24 

C: NR W: NR 

Primary: depression Secondary: anger, 

anxiety, hostility, vitality, mental he

Yeh GY, 

2004246,256 

United States 

RCT parallel 

2 arms 

Duration: 

12 wk 

ITT: Yes 

64 yr F = 11 M = 19 CHF 

R: 30 C: 26 W: 4 

Single Tai Chi 

R: 15 C: 15 W: 0 

Medication 

(NS) 

R: 15 C: 12 W: 3 

Primary: HRQL, 

exercise capacity 

Secondary: BNP, 

plasma catecholamines, V

max 
H-20

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Yogendra J, 

2004250

India 

NRCT 

parallel 2 arms 

Duration: 

1 yr 

ITT: NR 

Age NR F = NR M = NR CAD 

E: 140 C: 113 W: 27 

Composite Yoga + risk 

factors control + diet + stress management 

E: 80 C: 71 W: 9 

Medication 

(NS) 

E: 60 C: 42 W: 18 

Primary: TC, LDL-C Secondary: clinical im

provement, caloric intake, regression disease, anxiety, dpression, myocardperfusion 

Young JW, 

2001251 

United States 

NRCT 

parallel 2 arms 

Duration: 

6 wk 

ITT: NR 

63 yr F = 13 M = 21 CHD 

E: 44 C: 34 W: 10 

Single Yoga 

E: 27 C: 17 W: 10 

NT E: 17 

C: 17 W: 0 

Primary: anxiety Secondary: somatiza

tion, tension, depression, global status, mood disturbances 
H-21

Table H2. Characteristics of clinical trials of meditation practices in cardiovascular diseases (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcome

Zamarra 

JW1996252,257

United States 

NRCT 

parallel 2 arms 

Duration: 

8 mo 

ITT: NR 

55 yr F = 0 M = 21 CAD 

E: 21 C: 16 W: 5 

Single TM®

E: 12 C: 10 W: 2 

WL E: 9 

C: 6 W: 3 

Primary: Exerci

tolerance 

Secondary: Max

workloadST dpression onsepressure prod
H-22

Table H3: Characteristics of clinical trials of meditation practices in substance abuse

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcome

Alterman AI, 

2004258 

United States 

RCT parallel 

2 arms 

Duration: 

5 mo 

ITT: NR 

36.5 yr F = 17 M = 14 Alcohol and drug 

abuse (cocaineheroin) 

R: 31 C: 25 W: 6 

Single Mindfulness 

meditation (NS) 

R: 18 C: 15 W:3 

UC (NS) R: 13 

C: 10 W:3 

Primary: addict

severity 

Secondary: me

problems, pomood, positivhealth, persomeaning, optimismpessimism, spirituality 

WL R: 20 

C: NR W: NR 

Ballou D, 

1977259 

United States 

RCT parallel 

3 arms 

Duration: 

11 wk 

ITT: NR 

Age NR F = 0 M = 66 Drug dependency 

R: 66 C: NR W: NR 

Single TM®

R: 30 C: NR W: NR 

NT R: 16 

C: NR W: NR 

Primary: anxietSecondary: 

behavioral changes, inminfractions 

5-HIAA = 5-hydroxyindole acetic acid; 17-KS = 17-ketosteroids; BE = breathing exercises; BF = biofeedback; BP = blood pressure; C = number com

restructuring training; CSM = clinically standardized meditation; d = day(s); DBP = diastolic blood pressure; E = number enrolled (for NRCTs); 

ESR = erythrocyte sedimentation rate; GSR = galvanic skin response; Hb = hemoglobin; HR = heart rate; HVA = homovanillic acid; ITT = inten

frequency pulsed magnetic field; LSD = lysergic acid diethylamide; MBSR = mindfulness-based stress reduction; MHPG = 3-methoxy-4-hydrox

month(s); NRCT = nonrandomized controlled trial; NR = not reported; NS = not specified; PBI = protein bound iodine; PMR = progressive muscrate; PT = prothrombine time; R = number randomized (for RCTs); RR = Relaxation Response; SBP = systolic blood pressure; S-Ca = serum calmagnesium; TM® = Transcendental Meditation®; VO2 max = maximum oxygen consumption; UC = usual care; VMA = vanillylmandelic acid; W 

withdrawals/losses to followup;WBC = white blood cell; wk = week(s); yr = year(s) 
H-23

Table H3: Characteristics of clinical trials of meditation practices in substance abuse (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcome

Barton MJ, 

2004260 

United 

States 

RCT parallel 2 

arms 

Duration: 1 d ITT: NR 

Age NR F = 4 M = 6 Alcohol abuse 

R: 10 C: NR W:NR 

Single Medical 

meditation (mantra + BE) 

R: 5 C: NR W: NR 

Rest 

(music) 

R: 5 C: NR W: NR 

Primary: BP 

changes (DSBP) 

Secondary: P

GSR, spirituality 

Brautigam 

E, 1977261

Sweden 

RCT parallel 2 

arms 

Duration: 6 

mo 

ITT: NR 

17-24 yr F = 6 M = 14 Alcohol and drug 

abuse (marijuana, hashish, LSD, amphetamines) 

R: 20 C: NR W: NR 

Single TM®

R: 10 C: NR W: NR 

Group 

therapy 

R: 10 C: NR W: NR 

Primary: 

frequency odrug use 

Secondary: le

sure activityself-confideanxiety, psychomotor retardation 

Kline KS, 

1982271 

United 

States 

NRCT parallel 

2 arms 

Duration: 12 

wk 

ITT: NR 

34.7 yr F = 9 M = 14 Alcohol abuse 

E: 23 C: 8 W: 15 

Single TM®

E: 11 C: 7 W: 4 

WL E: 12 

C: 8 W: 4 

Primary: 

personality profile 

Secondary: s

actualizatio

Lofexidine R: 26 

C: NR W: NR 

Li M, 

1956262 

China 

RCT parallel 3 

arms 

Duration: 10 

days 

ITT: NR 

32.3 yr F = 0 M = 86 Drug abuse 

(heroin) 

R: 86 C: NR W: NR 

Single Qi Gong 

R: 34 C: NR W: NR 

NT R: 26 

C: NR W: NR 

Primary: withdrawal 

symptoms 

Secondary: 

anxiety, urimorphine 
H-24

Table H3: Characteristics of clinical trials of meditation practices in substance abuse (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Marcus MT, 

2001272,275 

United States 

NRCT 

parallel 2 arms 

Duration: 

8 wk 

ITT: NR 

34 yr F = 2 M = 34 Alcohol and drug 

abuse 

E: 36 C: NR W: NR 

Single MBSR 

E: 18 C: NR W: NR 

NT E: 18 

C: NR W: NR 

Primary: 

coping styles 

Secondary: 

psychopathology symptoms 

Murphy R, 

1995263 

United States 

RCT parallel 

2 arms 

Duration: 

1 month 

ITT: NR 

32.7 yr F = 0 M = 31 Alcohol and drug 

abuse 

R: 31 C: 27 W: 4 

Single MBSR 

R: 15 C: 13 W: 2 

PMR R: 16 

C: 14 W: 2 

Primary: egocentrism Secondary: 

anger, impulsivity, cortisol levels 

Exercise R: 20 

C: 13 W: 7 

Murphy TJ, 

1986264 

United States 

RCT parallel 

3 arms 

Duration: 

8 wk 

ITT: NR 

24.7 yr F = 0 M = 43 Alcohol abuse 

R: 60 C: 43 W: 17 

Single CSM 

R: 20 C: 14 W: 6 

NT R: 20 

C: 16 W: 4 

Primary: 

alcohol consumption 

Secondary: 

VO2 max 
H-25

Table H3: Characteristics of clinical trials of meditation practices in substance abuse (continued)

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcome

PMR R: 10 

C: 10 W: 0 

Parker JC, 

1978265,276,277 

United States 

RCT parallel 

3 arms 

Duration: 

3 wk 

ITT: NR 

45.1 yr F = 0 M = 30 Alcohol abuse 

R: 30 C: 30 W: 0 

Single RR 

R: 10 C: 10 W: 0 

Rest R: 10 

C: 10 W: 0 

Primary: 

anxiety 

Secondary: 

BP changes (DBP, SBP), HRGSR, tension 

Raina N, 

2001266 

India 

RCT parallel 

2 arms 

Duration: 

24 wk 

ITT: NR 

34.9 yr F = 0 M = 50 Alcohol abuse 

R: 50 C: 27 W: 23 

Single Yoga 

R: 25 C: 13 W: 12 

Exercise R: 25 

C: 14 W: 11 

Primary: 

recovery rate 

Ramirez J, 

1990267 

United States 

RCT parallel 

2 arms 

Duration: NR ITT: NR 

23.3 yr F = 40 M = 40 Drug abuse 

R: 80 C: 68 W: 12 

Single TM®

R: 40 C: NR W: NR 

Control 

(NS) 

R: 40 C: NR W: NR 

Primary: se

concept 

Secondary: 

emotionastability, maturity, hostility, overconcern with physcal symp toms 
H-26

Table H3: Characteristics of clinical trials of meditation practices in substance abuse (continued)

Characteristics of 

study population Intervention Comparison groups 

Study, country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Rohsenow DJ, 

1985268 

United States 

RCT 

parallel 2 arms 

Duration: 

6 mo 

ITT: NR 

21.3 yr F = 0 M = 36 Heavy 

social drinkers 

R: 40 C: 36 W: 5 

Composite RR + PMR + 

CRT 

R: NR C: 15 W: NR 

Control 

(NS) 

R: NR C: 21 W: NR 

Primary: anxiety Secondary: anger

depression, alcohol consumtion, locus of control, irrationabeliefs 

Shaffer HJ, 

1997269 

United States 

RCT 

parallel 2 arms 

Duration: 

6 mo 

ITT: NR 

35.9 yr F = 24 M = 35 Drug 

abuse 

R: 59 C: NR W: NR 

Composite Yoga + 

methadone

R: 29 C: NR W: NR 

Group 

therapy + methadone 

R: 30 C: NR W: NR 

Primary: addiction 

severity 

Secondary: 

psychological symptoms 
H-27

Table H3: Characteristics of clinical trials of meditation practices in substance abuse (continued)

Characteristics of 

study population Intervention Comparison groups 

Study, country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Psychotherapy E: 20 C: NR 

W: NR 

Stereotaxic 

surgery 

E: 20 C: NR W: NR 

BF E: 20 

C: NR W: NR 

Subrahmanyam 

S, 1986273

India 

NRCT 

parallel 5 arms 

Duration: 

1 yr 

ITT: NR 

20-45 yr F = 0 M = 100 Alcohol 

abuse 

E: 100 C: NR W: NR 

Single Yoga 

E: 20 C: NR W: NR 

LFPMF E: 20 

C: NR W: NR 

Primary: clinical 

status 

Secondary: 

psychological status, WBC count, ESR, bglucose, TC, cortisol, lactic acid, PBI, 5-HHb, catecholamineS-Ca, S-Mg, VMA, HVA, 17KS, PT, MHPGcholinesterase 
H-28

Table H3: Characteristics of clinical trials of meditation practices in substance abuse (continued)

Characteristics of 

study population Intervention Comparison groups 

Study, country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

BF (EMG) R: NR 

C: 13 W: NR 

Neurotherapy R: NR C: 18 

W: NR 

Taub E, 1994270United States 

RCT 

parallel 3 arms 

Duration: 

18 mo 

ITT: NR 

44.3 yr F = 0 M = 67 Alcohol 

abuse 

R: NR C: 67 W: NR 

Single TM®

R: NR C: 18 W: NR 

Counselling R: NR 

C: 18 W: NR 

Primary: drinking 

days 

Secondary: 

complete abstinence, mstates 
H-29

Table H3: Characteristics of clinical trials of meditation practices in substance abuse (continued)

Characteristics of 

study population Intervention Comparison groups 

Study, country 

Study 

design, 

followup 

duration, 

ITT 

Age (mean/range), 

gender, diagnosis 

N participants 

Type/name 

N participants 

Type/name 

N participants Outcomes 

Wong MR, 

1981274

United States 

NRCT 

parallel 2 arms 

Duration: 

6 mo 

ITT: NR 

28.9 yr F = 0 M = 103 Drug 

abuse 

E: 103 C: 91 W: 12 

Composite Meditation 

practice (NS) 

E: NR C: 52 W: NR 

Relaxation E: NR 

C: 39 W: NR 

Primary: physica

tension 

Secondary: anxi

personality changes 
I-1

Appendix I. Characteristics of Studies Included in Topic V Table I1. Country of study 

Country N References 

United States 146 126,177,205,206,208,233,234,260,279,280,289,290,304,311,387,440,442,459,460,463,468,475,477,478,480,483,489,491,494b127,197,306,500,503a30

210,220,221,227,228,237,241,244,263-265,272,282,284,285,288,292,293,309,316,317,319,322,325,391,396,398,407,409,418,419,433,510,512,517-,544,545,554,558,559,562,567,577,594,596,602,603,608,615,616,618,625-627,634,639,642,651-654,665,666,677,678,681,683,696,697,706,713,714,246 ,252,274,287,397,435,759,764,766 

North 

America 

Canada 9 97,182,194,296,386,413,777,782,793 India 71 83,133,137,140,204,212,217,226,239,240,250,273,278,294,295,298,300,301,303,305,310,312-314,318,320,321,323,417,794,796,797,799,801,802,805,8

815,818,822,824,829,831,832,834,836-839,841,843,844,847,848,850-852,856,858,860,862-864,866-868,870 

China 8 211,225,262,872,875,878,882,883 South Korea 6 213,214,405,889,891,894 Hong Kong 5 207,286,299,895,897 Taiwan 4 223,248,326,906 Japan 7 389,426,913-916,919 Thailand 3 106,216,238 

Asia 

Malaysia 2 179,180 United 

Kingdom 

14 185,218,219,235,281,283,308,427,431,926,930,932,938,940 

Germany 4 215,247,943,946 Sweden 2 302,955 Norway 3 956,959,961 Ireland 2 392,965 Italy 1 966 Switzerland 1 199 Netherlands 1 224 Spain 1 977 Austria 1 430 Czech 

Republic 

1 183 

France 1 981 

Europe 

Russia 1 203 

Table I1. Country of study (continued) 
I-2

Country N References 

Europe 

(continued) Turkey 2 315,982 

Australia 7 297,307,991,992,998,999,1001 

Australasia New Zealand 3 222,429,1002 

Israel 2 176,291 South Africa 1 86 Brazil 1 236 

Other 

Netherlands 

Antilles 

1 974 
I-3

Table I2. Study design 

Study design N References 

RCT 167 86,91,94,97,127,134,140,168,176,177,182,185,190,194,203-224,233-241,244,260,262-265,278-286,288,304,305,307-

309,325,386,387,389,391,392,396,398,405,407,409,413,417,418,427,431,433,460,475,477,478,480,483,503,512,519,521,528,530,531,536,539,541,18,625-627,651,665,666,677,683,706,714,746,751,754,777,782,796,805,811,829,832,836-839,841,844,852,858,868,894,895,919,926,930,932,943,978,191,225,246,287,397,759,764,793,882,940 

NRCT 65 126,289,290,440,463,489,494,794,799b 197,291,306,500a 306b 106,137,178-181,183,188,198,199,226-228,247,248,250,252,272-

274,292,293,326,419,429,430,435,518,577,596,602,639,642,678,681,696,713,806,818,824,834,860,864,866,878,915,938,955,974,981,1001 

Before-and-after 79 83,133,294-303,310-323,426,442,459,468,491,510,517,524,525,559,608,634,652-654,697,733,750,753,766,797,801,802,812-

815,822,831,843,847,848,850,851,856,862,863,867,870,872,875,883,889,891,897,906,913,914,916,966,982,992,1002 

NRCT = nonrandomized controlled trials; RCT = randomized controlled trials 
I-4

Table I3. Type of publication 

Type of publication N References 

Journal article 274 176,177,203,204,206-208,233-235,278-281,289,290,295,297,304,305,310-312,387,440,459,460,463,468,475,477,478,480,483,489,491,494,794,796,797

127,194,236,291,306,389,500,503a 306b 83,97,106,133,137,140,168,178-183,185,188,190,198,209,211-214,216-224,226-228,238-240,244,248,262286,288,293,294,296,298-303,307-309,313-316,318-321,323,325,326,386,392,396,398,405,407,409,413,417-419,426,427,429,431,510,512,518,519,521,524,525,528,530,531,536,539,544,545,554,558,559,562,577,594,603,608,615,616,618,625-627,634,639,654,665,666,677,678,681,683,697,706,714,733,750,751,753,754,777,782,805,806,811-815,818,822,824,829,831,832,834,836-839,841,843,844,847,868,878,889,891,894,897,906,913-916,926,930,932,946,956,959,961,965,974,977,981,982,991,992,998,1002a 754b 191,199,225,246,250,252,274,287,397,435,759,764,766,793,870,938,940,955,1001 

Thesis/Dissertation 22 78,86,91,126,134,197,205,210,237,241,260,263,292,391,433,442,517,541,567,602,696,882 Abstract 13 94,215,247,317,322,430,596,713,872,875,883,943,999 Research letter 2 746,919 
I-5

Table I4 Methodological quality—intervention studies 

RCTs that obtained Jadad scores lower than 3 (n=145) 94,97,134,140,176,177,182,185,190,194,203-219,222-224,233,235-2

281,283,285,286,288,304,305,307-309,325,387,389,392,396,405,407,413,417,418,427,431,433,460,475,477,478,480,483,503,512,519,528,530,531,536,539,545,554,558,562,567,594,603627,651,665,666,677,683,706,714,746,751,754,777,782,796,805,811,829,832,836-838,841,844,852,858,868,895,919,926,930,932,943,946,956,959,961

78,191,225,246,397,759,764,793,882,940

RCTs that obtained Jadad scores of 3 or greater (n=22) 86,91,127,168,220,221,234,265,282,284,287,386,391,398,409,521,5RCTs describing the methods of randomization (n=32) Appropriate (n=24) 86,91,127,168,206,220,221,234,260,265,282,284,287,308,386,391,398,409,521,541,544,811,839,894 Inappropriate (n=8) 134,212,213,262,478,545,841,868RCTs described as double-blind (n=5) 168,424,782,991,999

RCTs—Jadad scale 

RCTs describing withdrawals/dropouts (n=86) 86,91,94,97,127,168,185,203,207,210,213,214,216,218-224,234-236,238,241,244,2

286,325,386,391,398,409,478,480,503,521,528,536,541,544,562,603,616,618,626,627,651,666,683,714,754,777,829,839,841,852,868,894,895,926,754b78,246,287,759,764,793,882,940

RCTs with adequate report of methods for concealment of allocation (n=8) 168,246,418,521,544,894,926,991RCTs with inadequate report of methods for concealment of allocation (n=2) 545,868

RCTs—concealment of 

treatment allocation 

RCTs that failed to describe the methods for concealment of allocation (n=157) 86,91,94,97,127,134,140,176,177

241,244,260,262-265,278-286,288,304,305,307-309,325,386,387,389,391,392,396,398,405,407,409,413,417,427,431,433,460,475,477,478,480,483,503,512,519,528,530,531,536,539,541,554,558,627,651,665,666,677,683,706,714,746,751,754,777,782,796,805,811,829,832,836-839,841,844,852,858,895,919,930,932,943,946,956,959,961,965,78,191,225,287,397,759,764,793,882,940

Before-and-after studies with study population representative of the target population (n=3) 294,697,847Before-and-after studies in which the method of outcome assessment was the same for the pre- and p

all participants (n=74) 83,133,294-298,300-303,310,312-323,426,442,459,468,491,510,517,524,525,559,608,634,652-654,733,750,753,76

815,822,831,843,847,848,850,851,856,862,863,867,870,872,875,883,889,891,897,906,913,914,982,992,1002

Before-and-after studies in which outcome assessors were blind to intervention and assessment period Before-and-after studies that reported the number of study withdrawals (n=12) 295,296,442,525,559,733,753,797,

Before-and-after studies 

Before-and-after studies that reported the reasons for study withdrawal (n=6) 442,525,559,733,801,897
I-6

Table I5. Clinical trials and before-and-after studies on physiological and neuropsychological effects of meditation practicesCategory of meditation practices 

Meditation practice N Associated references 

ACEM 

meditation 

3 956,959,961 

CSM 4 97,264,536,627 Mantra 

meditation 

17 203,260,483,494,706b194,503,531,577,626,652-654,777,805,856,965 

RR 34 208,234,236,304,306,459,460,475,477,480a 306b 91,94,191,209,218,228,265,283,284,288,396,521,524,525,530,558,567,594,616,625

Mantra 

meditation 

(105) 

TM® 47 78,86,188,190,205,206,210,220-222,252,279,282,289,291-

293,295,309,311,319,392,407,418,429,433,440,463,478,518,519,528,545,677,683,714,733,750,759,782,793,796,814,815,850,974,

MBSR 12 244,263,272,419,512,517,602,681,697,754,930a 754b MM (NS) 8 106,241,386,430,442,696,751,932 Zen Buddhist 

meditation 

10 197,225,227,237,426,500,554,639,913,916 

MBCT 2 427,940 

Mindfulness 

meditation 

(44) 

Vipassana 2 847,848

Meditation practices (ND) 9 198,199,215,274,387,431,539,651,915 Qigong 15 207,211,213,214,262,299,316,405,634,875,889,891,914,919,977 Tai Chi 38 223,235,246,248,285-287,290,296,307,317,326,391,397,398,409,413,435,489,541,596,603,608,665,713,746,766,872,878,882,883,894Yoga 110 83,126,127,133,134,137,140,168,176-183,185,204,212,216,217,219,224,226,233,238-240,247,250,273,278,280,281,294,297,298,300-

323,325,389,417,468,491,510,544,559,562,615,618,642,666,764,794,797,799,801,802,806,811-813,818,822,824,829,831,832,834864,866-868,870,926,943,946,966,981,982,991,992,998 

CSM = clinically standardized meditation; MBCT = mindfulness-based cognitive therapy; MBSR = mindfulness-based stress reduction; MM = mindf

described; NS = not specified; RR = Relaxation Response; TM® = Transcendental Meditation ®
I-7

Table I6. Studies reporting outcome measures on the physiological and neuropsychological effects of meditation practices 

Domain Category Subcategory N Studies reporting outcome measure 

Blood 

composition 

11 213,273,302,309,320,746,794,843,919,926,977 Blood 

system (15) Blood enzyme 4 273,313,862,863 

Blood gas 

measurement 

8 233,296,320,524,813,839,891,998 

Cardiovascular 

functioning 

169 213,246,250,296,297,321,426,811,906 

83,106,140,185,190,199,206,208,214,217,218,221,223,224,226,235,248,252,264,280-

283,286,294,299,306,307,316,323,326,326,392,396,429,480,521,525,536,562,651,733,753,777,796,813,822,834,83

966,9821306286,91,94,97,126,127,134,180,194,197,203-205,207,209-212,215,216,219,220,222,225,227,228,234,236,237,241,244,260,265,278,279,284,285,287-292,295,302-305,309-313,317,319,320,322,387,389,391,433,435,442,459,460,475,483,491,510,517,524,528,530,531,539,541,577,608,61872,883,897,915,926,932,956,998,1002 

Energy 

expenditure 

2 233,491 

Cardiovasc

ular system (186)

Physical 

performance 

7 240,246,391,397,409,666,813 

Gastric 

function 

1 852 Digestive 

system (26) Lipoproteins 25 205-207,213,218,223,238-240,247,250,273,278,280,282,291,292,302,313,317,794,801,850,926,1002 

Adrenocortical 

functioning 

26 106,207,214,226,236,244,246,263,272,273,283,299,307,313,386,405,407,417,419,433,651,764,806,850,862,955 

Carbohydrate 

metabolism 

18 273,278,282,298,301,308,313,317,321,391,405,794,801,850,862,914,961,999 

CNS hormone 11 211,246,313,386,405,407,433,806,811,889,956 Genital gland 

secretion 

1 433 

Parathyroid 

function 

4 273,407,713,889 

Endocrine 

system (62)

Thyroid 

function 

2 836,889 

Cellular 

immunity 

7 386,405,419,642,843,959,977 

Physiological 

Immune 

system (14) Humoral 

immunity 

7 299,386,398,512,558,697,977 

CNS = central nervous system; EMG = electromyography 
I-8

Table I6. Studies reporting outcome measures on the physiological and neuropsychological effects of meditation practices (co

Domain Category Subcategory N Studies reporting outcome meas

 Body index 2 391,559 Musculos

keletal system (35)

Bone density 

test 

6 280,596,713,872,895,1001 

EMG 23 190,199,306,392,766,837a 306b 290,503,531,577,626,627,683,847,965 

191,228,274,477,639,844,882 

Isometric contraction 3 413,489,872 Reflex test 1 750 

Autonomic 

functioning 

1 852 

Brain 

electrophysiology 

17 133,226,417,426,512,519,545,594,627,634,706,733,805,814,815,913,916 

Neuroendocrin

e measurement 

7 227,273,407,433,806,850,863 

Nervous 

system (63)

Peripheral 

nerve test 

40 754a 83,140,190,199,226,294,306,323,392,417,544,545,733,777,796,824,856,858,981a 306b 

188,204,260,265,288,312,440,463,477,478,483,531,577,627,652,844,847,848,938 

Antioxidants 3 137,238,799 Cell 

metabolism 

1 281 

Metabolic 

product 

16 137,262,273,313,320,417,653,713,746,799,806,834,838,844,862,870 

Salivary test 2 198,654 

Nutrition/ metabolis

m (32)

Serum protein 6 106,227,273,313,850,862 

Ocular 

system (4) 

Ophthalmologi

c test 

4 176,297,315,625 

Physio-  logical 

Respirato

ry system (68) 

Pulmonary 

function test 

68 83,106,140,168,190,199,214,248,280,294,296,300,306,314,316,321,323,325,326,429,468,521,733,797,802,811,813,82

306b 86,94,183,236,244,288,309,310,312,313,320,442,510,524,530,531,577,608,652,759,818,839,844,862,866,875
I-9

Table I6. Studies reporting outcome measures on the physiological and neuropsychological effects of meditation practices (co

Domain Category Subcategory N Studies reporting outcome measure 

Sensory 

system (3) 

Auditory test 3 300,946,981 

Thermoreg

ulatory system (10) 

Body 

temperature 

10 134,199,313,392,503,531,608,696,838,844 

Renal function 7 207,226,227,273,278,319,407,1012 

Physio-  logical

Urinary/excr

etory system (9) 

Salivary test 2 198,654 Attention 19 754a 754b 78,182,208,280,294,387,577,602,666,678,751,793,838,841,848,930,974 Creativity 4 293,500,615,915 Intelligence 4 78,309,793,863 Language 7 754a 78,177,178,181,279,793 Memory 12 280,294,494b 78,310,431,793,815,863,867,930,940 Other cognitive 

functions 

11 273,279,280,310,618,665,681,863,930,974,999 

Perception 12 417,494,860b 78,208,418,518,554,616,654,915,974 Reasoning 10 78,178,279,427,518,567,681,782,915,930 Sensory motor 

functions 

10 106,263,280,300,309,318,539,812,848,878 

Cognitive/ 

neuropsychological

Cognitive/n

europsychological (93) 

Spatial ability 4 78,177,178,181 
J-1

Appendix J. Characteristics of Studies on the Physiological and Neuropsychological Effects of Meditation Practices Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation prac

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome 

examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome ca

(measu

Agrawal RP, 2003278 India 

Type 2 DM Physiological Cardiovascular, 

digestive, endocrine, urinary/excretory 

3 mo No 

51.6 yr F = 46 M = 108 

R: 200 C: 154 W: 46 

Single Yoga 

R: 100 C: 72 W: 28 

Exercise R: 100 

C: 82 W: 18 

CVF (BP), DIG 

HDL, VLDL, TG), END (CHb-A1c]), U[urea, Cr, microalbumi

5-HIAA = 5-hyroxyindol acetic acid; ACF = adrenocortical functioning; ATN = attention; BDT = bone density test; BF = biofeedback; BP = blood pr

measurement; C = number completed; Ca = calcium; cAMP = cyclic adenosine monophosphate; CF = cognitive function; CHD = chronic heart dise

media thickness; CM = carbohydrate; metabolism; CNS-H = central nervous system hormone; COG/N = cognitive/neuropsychological; Cr = creatin

functioning; d = day(s); DIG = digestive; DHEAS = dehydroepiandrosterone; DPV = digital pulse volume; ECG = electrocardiography; EMG = ele

endocrine; EPI = epinephrine; FBS = fasting blood sugar; GH = growth hormone; GSR = galvanic skin response; Hb = hemoglobin; Hb- A1c = hemdensity lipoprotein; HE = health education; HR = heart rate; K = potassium; LDL = low density lipoprotein; LIP = lipoproteins; Lt = left; MEM = m

mo = month(s); MSK = musculoskeletal; Na = sodium; NE = norepinephrine; NER = nervous; NIDDM = non-insulin-dependent diabetes mellitus; 

treatment; OGTT = oral glucose tolerance test; PAA = peak aortic acceleration; PFT = pulmonary function test; PMR = progressive muscle relaxati

(for RCTs); RES = respiratory; RFT = renal function test; RR = Relaxation Response; RSG = reasoning; Rt = right; SA = spatial ability; SBP = syst

skin conductance level; se = session(s); TC = total cholesterol; TG = triglyceride; TM® = Transcendental Meditation®; TSH = thyroid stimulating h

excretory; UFNB = unilateral forced nostril breathing; VA = verbal ability; VLDL = very low density lipoprotein; VO2 = oxygen consumption; VO2 

consumption; W = number withdrawals/losses to followup; wk = week(s); WL = waiting list; yr = year(s); Zn = zinc
J-2

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation pr

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome ca

(measu

MM R: 23 

C: 21 W: 2 

Rest R: 22 

C: 21 W: 1 

Alexander 

CN, 

1991279United States 

Elderly Physiological, neuropsychological Cardiovascular, 

cognitive/neuropsychological 

18 mo No 

80.7 yr F = 60 M = 13 

R: 73 C: 73 W: 0 

Single TM

®

R: 21 C: 20 W: 1 

NT R: 7 

C: 11 W: NA 

CVF (BP), CO

(CF, RSG, V

Exercise R: 25 

C: 25 W: 0 

Rest R: 25 

C: 25 W: 0 

Bahrke MS, 1978304United States 

Healthy volunteers Physiological Cardiovascular 

1 se NR 

51.9 yr F = 0 M = 75 

R: 75 C: 75 W: 0 

Single RR 

R: 25 C: 25 W: 0 

CVF (HR, BGM 
J-3

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation pr

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome ca

(measu

Yoga R: 20 

C: 20 W: 0 

Block RA, 1989177 United 

States 

College/university 

students 

Neuropsychological Cognitive/neuropsychological 

1 se NR 

Age 

NR 

F = 30 M = 30 

R: 60 C: 60 W: 0 

Single UFNB 

(Lt) 

R: 20 C: 20 W: 0 

Rest R: 20 

C: 20 W: 0 

COG/N (SA, V

Exercise R: 34 

C: 34 W: 0 

Blumenthal 

JA, 

1991280United States 

Elderly Physiological, neuropsychological Cardiovascular, 

cognitive/neuropsychological, digestive, musculoskeletal 

14 mo Yes 

67 yr F = 51 M = 50 

R: 101 C: 97 W: 4 

Single Yoga 

R: 33 C: 31 W: 2 

WL R: 34 

C: 32 W: 2 

CVF (HR, BGM 

V

O2 max], E

COG/N (MECF), DIG (LHDL, TC, TG(BDT) 
J-4

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation pr

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome ca

(measu

NT R: 29 

C: 29 W: 0 

Bose S, 1987305 India 

College/university 

students 

Physiological Cardiovascular 

3 mo NR 

17-23 yrF = 0 M = 200

R: 200 C: 200 W: 0 

Single Shavasana 

R: 30 C: 30 W: 0 

NT R: 141 

C: 141 W: 0 

CVF (BP) 

Bowman AJ, 1997281United 

Kingdom 

Elderly Physiological Cardiovascular 

1.5 mo No 

67 yr F = 17 M = 23 

R: 40 C: 26 W: 14 

Single Yoga 

R: 20 C: 14 W: 6 

Exercise R: 20 

C: 12 W: 8 

CVF (BP, HR, 

[V

O2 max], H

variability, bsensitivity, Maortic velocicAMP) 
J-5

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation pr

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome ca

(measu

PMR R: 10 

C: 10 W: 0 

Rest R: 10 

C: 10 W: 0 

Broota A, 1995204 India 

Hypertension Physiological Cardiovascular, 

nervous 

8 se NR 

NR F = 0 M = 40 

R: 40 C: 40 W: 0 

Single Shavasana 

R: 10 C: 10 W: 0 

NT R: 10 

C: 10 W: 0 

CVF (BP), NE

Exercise R: 9 

C: 5 W: 4 

Fields JZ, 2002282United States 

Elderly Physiological Cardiovascular, 

digestive, endocrine 

12 mo Yes 

74.2 yr F = 16 M = 27 

R: 57 C: 43 W: 14 

Composite TM

® + 

herbal food + diet + Yoga asanas 

R: 14 C: 8 W: 6 

NT R: 20 

C: 16 W: 4 

CVF (BP, cIMT

(LIP, LDL, HTG), END ( [FBS, OGTTHb, fasting 

Hoffman JW, 1982283United 

Kingdom 

Healthy volunteers Physiological Cardiovascular, 

endocrine 

1 mo No 

25.4 yr F = 8 M = 11 

R: 30 C: 19 W: 11 

Single RR 

R: 15 C: 10 W: 5 

Rest R: 15 

C: 9 W: 6 

CVF (BP, HR)

(ACF [NE]) 
J-6

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation pr

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome 

(meas

Exercise R: 24 

C: 24 W: 0 

HE R: 24 

C: 24 W: 0 

Jin P, 1992307Australia 

Healthy volunteers Physiological Cardiovascular, 

endocrine 

2 d NR 

36.2 yr F = 48 M = 48 

R: 96 C: 96 W: 0 

Single Tai Chi 

R: 24 C: 24 W: 0 

Reading R: 24 

C: 24 W: 0 

CVF (BP, HR

(ACF [corsalivary Eand dopam
J-7

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation prac

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome 

(meas

Monro R, 1992308United 

Kingdom 

Type 2 DM Physiological Endocrine 

12 wk NR 

54.9 yr F = 11 M = 11 

R: 21 C: 21 W: 0 

Single Yoga 

R: 11 C: 11 W: 0 

Medication R: 10 C: 10 

W: 0 

END (CM [F

A1c]) 

Rest R: 39 

C: 36 W: 3 

NT R: 39 

C: 36 W: 3 

Peters RK, 1977284United States 

Healthy volunteers Physiological Cardiovascular 

12 wk Yes 

33.4 yr F = 96 M = 82 

R: 190 C: 178 W: 12 

Single RR 

R: 58 C: 54 W: 4 

NT R: 54 

C: 52 W: 2 

CVF (BP) 

PMR R: NR 

C: 10 W: NR 

Pollak MH, 1979288United States 

Healthy volunteers Physiological Cardiovascular, 

nervous, respiratory 

1 se No 

NR F = 15 M = 15 

R: 41 C: 30 W: 11 

Single RR 

R: 0 C: 10 W: 0 

Rest R: NR 

C: 10 W: NR 

CVF (HR, D

(SCL), RE(respirato
J-8

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation prac

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome categ

(measure) 

Reddy KM, 1990309United States 

Athletes Physiologicalneuropsychological 

Blood, 

cardiovascular, cognitive/neuropsychological, respiratory 

6 wk NR 

19.8 yr F = 7 M = 23 

R: 30 C: 30 W: 0 

Single TM® 

R: 15 C: 15 W: 0 

WL R: 15 

C: 15 W: 0 

BC (Hb), CVF (H

BP), COG/N (CRES (PFT [VT

Sun WY, 1996285United States 

Elderly Physiological Cardiovascular 

12 wk Yes 

>60 yr F = 13 M = 7 

R: 20 C: 20 W: 0 

Single Tai Chi 

R: 10 C: 10 W: 0 

NT R: 10 

C: 10 W: 0 

CVF (BP, HR) 

Yoga R: 12 

C: 12 W: 0 

Telles S, 1994140India 

Healthy volunteers Physiological Cardiovascular, 

nervous, respiratory 

1 mo NR 

34 yr F = 0 M = 48 

R: 48 C: 48 W: 0 

Single UFNB 

(Rt) 

R: 12 C: 12 W: 0 

Yoga R: 24 

C: 24 W: 0 

CVF (HR, BGM 

[VO2]), NER (G

RES (respiratorate) 
J-9

Table J1. Characteristics of randomized controlled trials on the physiological and neuropsychological effects of meditation prac

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants 

Intervention type 

Meditation practice

N participants 

Control

N participants Outcome cate

(measure

Thornton 

EW, 

2004286Hong Kong 

Healthy volunteers Physiological Cardiovascular 

3 mo No 

47.8 yr F = 40 M = 0 

R: 40 C: 34 W: 6 

Single Tai Chi 

R: 20 C: 17 W: 3 

NT R: 20 

C: 17 W: 3 

CVF (BP) 

Young DR, 1999287United States 

Elderly Physiological Cardiovascular 

12 wk No 

66.7 yr F = 49 M = 13 

R: 62 C: 62 W: 0 

Single Tai Chi 

R: 31 C: 31 W: 0 

Exercise R: 31 

C: 31 W: 0 

CVF (BP, BGM [

max]) 

TM® R: 7 

C: 7 W: 0 

BF R: 14 

C: 14 W: 0 

Zaichkowsky 

LD, 

1978191 United States 

College/university 

students 

Physiological Musculoskeletal 

12 wk NR 

NR F = 0 M = 0 

R: 48 C: 48 W: 0 

Single RR 

R: 14 C: 14 W: 0 

PMR R: 13 

C: 13 W: 0 

MSK (EMG front
J-10

Table J2. Characteristics of nonrandomized controlled trials on the physiological and neuropsychological effects of meditation p

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome 

examined 

System 

evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants

Intervention type 

Meditation practice

N participants

Control

N participantsOutcom

(me

Abrams AI, 1978289 United States 

Prison inmates Physiological Cardiovascular 

14 wk No 

Age NR F = 0 M = 89 

E: 115 C: 89 W: 26 

Single TM®

E: 60 C: 49 W: 11 

WL E: 55 

C: 40 W: 15 

CVF (BP, 

Chen WW, 1997290 United States 

Elderly Physiological Cardiovascular, 

musculoskeletal 

16 wk No 

50-74 yr F = NR M = NR 

E: 36 C: 28 W: 8 

Single Tai Chi 

E: 23 C: 18 W: 5 

NT E: 13 

C: 10 W: 3 

CVF (BP, 

(EMG) 

Cooper MJ, 1990291 Israel 

Healthy 

volunteers 

Physiological Cardiovascular, 

digestive 

10 mo No 

43 yr F = 19 M = 25 

E: 55 C: 44 W: 11 

Single TM®

E: 34 C: 23 W: 11 

NT E: 21 

C: 21 W: 0 

CVF (BP)

BF = biofeedback; BP = blood pressure; C = number completed; COG/N = cognitive/neuropsychological; CTY = creativity; CVF = cardiovascular fun

E = number enrolled; EMG = electromyography; HR = heart rate; Lt = left; MSK = musculoskeletal; mo = month(s); NER = nervous; NR = not repPR = pulse rate; RES = respiratory; Res-v = respiratory variability; RR = Relaxation Response; SA = spatial ability; SRL = skin resistance level; TC 

Transcendental Meditation®; UFNB = unilateral forced nostril breathing; VA = verbal ability; W = number withdrawals/losses to followup; wk = w
J-11

Table J2. Characteristics of nonrandomized controlled trials on the physiological and neuropsychological effects of meditat

Characteristics of 

study population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome 

examined 

System 

evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants

Intervention type 

Meditation practice

N participants

Control

N participantsOutcome 

(mea

BF E: 20 

C: 20 W: 0 

Cuthbert B, 1981306b

United States 

College/university students Physiological Cardiovascular, 

musculoskeletal, nervous, respiratory 

3 se NR 

Age 

NR 

F= 0 M=60 

E: 60 C: 60 W: 0 

Single RR 

E: 20 C: 20 W: 0 

Rest E: 20 

C: 20 W: 20 

CVF (HR), M

(EMG), NRES (Res

De Armond 

DL, 

1996292United States 

Workers 

(Technology) 

Physiological Cardiovascular, 

digestive 

3 mo NR 

43 yr F= 17 M=58 

E: 76 C: 75 W: 1 

Single TM®

E: 38 C: 38 W: 0 

NT E: 38 

C: 37 W: 1 

CVF (BP), D

Mohan SM, 2002180 Malaysia 

Healthy 

volunteers 

Physiological, cardiovascular 

1 se No 

19-24 

yr 

F= NR M=NR 

E: 58 C: NR W: NR 

Single UFNB 

(Lt) 

E: NR C: NR W: NR 

Yoga E: NR 

C: NR W: NR 

CVF (PR) 
J-12

Table J2. Characteristics of nonrandomized controlled trials on the physiological and neuropsychological effects of meditatio

Characteristics of study 

population Intervention Comparison groups 

Study, 

country 

Condition 

Outcome 

examined 

System 

evaluated 

Duration/followup, 

ITT 

Age (mean/range) 

Gender 

N participants

Intervention type 

Meditation practice

N participants

Control

N participantsOutcome 

(meas

Yoga E: 32 

C: 32 W: 0 

Sanders B, 1994181United States 

College/university students Neuropsychological Cognitive/neuropsychological 

NR NR 

NR F = 48 M = 48 

E: 96 C: 96 W: 0 

Single UFNB 

(Lt) 

E: 32 C: 32 W: 0 

Rest E: 32 

C: 32 W: 0 

COG/N (SA, 

Travis FT, 1990293 United States 

College/university students Neuropsychological Cognitive/ Neuropsychological 

5 mo No 

NR F = 37 M = 34 

E: 96 C: 71 W: 25 

Single TM

®

E: 46 C: 35 W: 11 

NT E: 40 

C: 36 W: 4 

COG/N (CTY
J-13

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Comparison groups O

Agarwal BL, 1990295 India 

Hypertension Physiological Cardiovascular 

6 mo 49.9 yr 

F= 4 M=12 

E: 24 C: 16 W: 8 

Single TM®

CVF (BP) TM® m

treahyp

Anantharaman 

RN, 

1984310 India 

Healthy volunteers Physiological, 

neuropsychological 

Cardiovascular, 

cognitive/neuropsychological, respiratory 

3 mo 34.2 yr 

F= 20 M=0 

E: 20 C: 17 W: 3 

Composite Yoga (asanas + 

pranayama) 

CVF (BP, HR), 

COG/N (CF, MEM), RES (BR) 

Yoga 

decvarsomvar

ACF = adrenocortical functioning; AEI = artery elasticity index; ATN = attention; BC = blood composition; BGM = blood gas measurement; BHT = b

blood lactate; BM = blood measurement; BP = blood pressure; BR = breathing rate; BS = blood sugar; C = number completed; CF = cognitive funcCM = carbohydrate; metabolism; COG/N = cognitive/neuropsychological; CV = cardiovascular; CVF = cardiovascular functioning; d = day(s); DIG 

mellitus; E = number enrolled; ECG = electrocardiography; END = endocrine; FBS = fasting blood sugar; FEV1 = forced expiratory volume in first 

acid; FPA = finger plethysmogram amplitude; FVC = forced vital capacity; Glc = glucose; GLH = glycosylated hemoglobin; GSR = galvanic skin r

lipoprotein; HI = humoral immunity; HR = heart rate; IMS = immune system; LDH = lactate dehydrogenase; LDL = low density lipoprotein; LIP = 

= memory; MEP = maximum expiratory pressure; MIP = maximum inspiratory pressure; mo = month(s); MVV = maximal voluntary ventilation; Ndependent diabetes mellitus; NER = nervous; N/M = nutrition/metabolism; NR = not reported; OCL = ocular; OGTT = oral glucose tolerance test; Pexpiratory flow at middle portion of expiration; PEFR = peak expiratory flow rate; PER = perception; PFT = pulmonary function test; PIFR = peak 

pressure of oxygen; PP = pulse pressure; PPT = physical performance test; RA = renin activity; RER = respiratory exchange ratio; RES = respiratorright; SaO2 = saturated oxygen; SBPse = session(s); SEN = sensory; SI = serum insulin; SMF = sensory motor function; SVR = systemic vascular r

cholesterol; TG = triglyceride; THR = thermo-regulatory; TM® = Transcendental Meditation®; TP = total protein; TV = tidal volume; UE = urinary 

unilateral forced nostril breathing; UL = urine lactate; VCO2 = carbon dioxide production; Ve = minute ventilation; VLDL = very low density lipop

consumption; VO2 max = maximum oxygen consumption; yr = year(s); W = number withdrawals/losses to followup; wk = week(s)
J-14

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Outcome category (measure) Au

Benson H, 1974311United States 

Hypertension Physiological Cardiovascular 

NR Age NR 

F= NR M=NR 

E: 22 C: 22 W: 0 

Single TM®

CVF (BP) TM® r

sys

Bhargava R, 1988312 India 

Healthy volunteers Physiological Cardiovascular, 

nervous, respiratory 

4 wk 19-28 yr 

F = 0 M = 10 

E: 10 C: 10 W: 0 

Single Pranayama 

CVF (BP, HR), NER 

(GSR), RES (BHT) 

Prana

exeautBH tonsym

Chen JC, 2004297Australia 

College/university 

students 

Physiological Cardiovascular, ocular 

1 se 21.8 yr 

F = NR M = NR 

E: 17 C: 17 W: 0 

Single UFNB 

CVF (BP, HR), OCL 

(ophthalmologic test) 

UFNB 

intrhad accwith act
J-15

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Outcome category (measure) Au

Damodaran 

A, 

2002294 India 

Hypertension Physiological, neuropsychological Cardiovascular, 

cognitive/neuropsychological, nervous, respiratory 

3 mo 45.8 yr 

F = 4 M = 16 

E: 20 C: 20 W: 0 

Composite Yoga (asanas 

+ pranayama) 

CVF (BP, HR), 

COG/N (ATN, MEM, PER, SMF), NER (steadiness, coordination, choice RT, GSR, grip) RES (BR) 

Yoga 

role CV mo

Jain SC, 1993298India 

Type II DM Physiological Endocrine 

40 d 45.9 yr 

F = 30 M =119 

E: 149 C: 149 W: 0 

Single Yoga 

CM (FBS, OGTT) Yoga 

a bme(NI

Jones AY, 2005296Canada 

Healthy volunteers Physiological Cardiovascular, 

respiratory 

12 wk 52.6 yr 

F = 50 M = 10 

E: 60 C: 51 W: 9 

Single Tai Chi 

CVF (BGM [SaO2, 

VCO2 ], BP, HR), 

RES (PFT [FEV1, FVC, PIFR, PEFR, PEF 

25-50]) 

A com

probencomrepexptria
J-16

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Outcome category (measure) Au

Jones BM, 2001299 Hong Kong 

Healthy volunteers Physiological Cardiovascular, 

endocrine, immune 

14 wk 43.9 yr 

F = 11 M = 8 

E: 19 C: 10 W: 9 

Single Qi Gong 

CVF (BP, HR), END 

(ACF [cortisol], IMS (HI [cytokines]) 

Cortis

shoQig

Conco

numsecobs

Joseph S, 1981313 India 

Army/militar Physiological Blood, cardiovascular, 

digestive, endocrine, nervous, nutrition/metabolism, respiratory, thermoregulatory 

3 mo 24.9 yr 

F = 0 M = 10 

E: 10 C: 10 W: 0 

Composite Yoga (prayer + 

asanas + pranayama + meditation) 

BM (ChE, LDH), CVF 

(BP, HR, BGM [VO2 ]), DIG (TC, 

FFA, LIP) NER (CNS-H [dopamine-B hydroxylase]), END (CM [FBS]), N/M (MP [MAO], TP), RES (BR), THR (skin temperature) 

A 3-m

resof ttowpardom

Joshi LN, 1992314 India 

College/university 

students 

Physiological Respiratory 

6 wk 18.5 yr 

F = 42 M = 33 

E: 75 C: 75 W: 0 

Single Pranayama 

RES (PFT [FEV1, 

FVC, BHt, MVV, PEFR, BR]) 

Regu

brepul(FVincrCO
J-17

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Outcome category (measure) Au

Kocer I, 2002315Turkey 

College/university 

students 

Physiological Ocular 

3 se 20.6 yr 

F = 26 M = 24 

E: 50 C: 50 W: 0 

Single UFNB 

OCL (Intraocular 

pressure [Rt eye/Rt nostril, Rt eye/Lt nostril, Lt eye/Rt nostril, Lt eye/Lt nostril]) 

UFNB 

premeincrner

Lim YA, 1993316United States 

College/university 

students 

Physiological Cardiovascular, 

respiratory 

1 se 20.5 yr 

F = 5 M = 5 

E: 10 C: 10 W: 0 

Single Qi Gong 

CVF (HR, BGM [V

O2, 

VCO2 ]), RES (PFT 

[TV, Ve, RER, BR]) 

Qigon

ven

upt

pro

Liu S, 1996317United States 

College/university 

students 

Physiological Cardiovascular, 

digestive, endocrine 

8 wk 22.1 yr 

F = 8 M = 6 

E: 14 C: 14 W: 0 

Single Tai Chi 

CVF (BP, HR, PPT), 

DIG (TC), CM (BS) 

An 8-

can balstre

No ef

choleve

Madanmohan, 1992300India 

College/university 

students 

Physiological Cognitive/neuropsychological, 

respiratory, sensory 

12 wk 18-21 yr 

F = 0 M = 27 

E: 27 C: 27 W: 0 

Single Yoga 

COG/N (ATN), RES 

(MEP, MIP, BHT), SEN (auditory test) 

A 12-

resredaud

Yoga 

pregrip 
J-18

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Outcome category (measure) Au

Malathi A, 1989318India 

Healthy volunteers Neuropsychological Cognitive/neuropsychological 

6 wk 30-45 yr 

F = 83 M = 0 

E: 83 C: 83 W: 0 

Composite Yoga (asanas 

+ pranayama) 

COG/N (SMF) Either 

asaredaud

Manjunatha 

S, 

2005301 India 

Healthy volunteers Physiological Endocrine 

4 wk 23.8 yr 

F = 3 M = 17 

E: 20 C: 20 W: 0 

Single Yoga (asanas) 

END (CM [SI, OGTT, 

FBS, insulin sensitivity, postprandial glucose test]) 

Asana

incrpanglu

Pollack AA, 1977319United States 

Hypertension Physiological Cardiovascular, 

urinary/excretory 

6 mo 40.5 yr 

F = 10 M = 10 

E: 20 C: 20 W: 0 

Single TM®

CVF (BP, HR), UE 

(RA) 

It is u

contowBP 

The p

expfee

Raju PS, 1986320India 

Healthy volunteers Physiological Cardiovascular, 

nutrition/metabolism, respiratory 

3 mo 23.7 yr 

F = 6 M = 6 

E: 12 C: 12 W: 0 

Composite Yoga (asanas 

+ pranayama) 

CVF (HR, BGM [PO2, 

SaO2, VO2 max]), 

N/M (BL, UL, blood pyruvate), RES (Ve) 

After 

incr

Signif

and 

I an

Fema

loapha
J-19

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Outcome category (measure) Au

Schmidt TFH, 1994302Sweden 

Healthy volunteers Physiological Blood, cardiovascular, 

digestive 

3 mo 29.7 yr 

F = 48 M = 58 

E: 150 C: 106 W: 44 

Composite Yoga + 

meditation + vegetarian diet 

BC (fibrinogen), CVF 

(BP, HR), DIG (LDL,VLDL, HDL, TG) 

Yoga 

with vegcessubcarhea

Singh S, 2004321India 

Type II DM Physiological Cardiovascular, 

endocrine, respiratory 

40 d 30-60 yr 

F = NR M = NR 

E: 24 C: 24 W: 0 

Composite Yoga (asanas 

+ pranayama) 

CVF (BP, HR, ECG), 

BGM [CM (FBS, OGTT, GLH]), RES (PFT [FEV1, FVC, 

PEFR, MVV]) 

Yoga 

prabetand fun

Sung BH, 2002322United States 

Healthy volunteers Physiological Cardiovascular 

1 se 35 yr 

F = NR M = NR 

E: 25 C: 25 W: 0 

Single Yoga breathing 

CVF (HR, BP, stroke 

volume, SVR, AEI [large/small]) 

Yoga 

favarteres

Telles S, 1993323 India 

Healthy volunteers Physiological Cardiovascular, 

nervous, respiratory 

3 mo 34.7 yr 

F = 0 M = 40 

E: 40 C: 40 W: 0 

Composite Yoga (asanas 

+ pranayama + mantra meditation + lectures) 

CVF (BP, HR), NER 

(GSR), RES (PFT [BR, FEV1, FVC, PEFR, BHT]) 

3 mo 

signgenredlun
J-20

Table J3. Characteristics of before-and-after studies on the physiological and neuropsychological effects of meditation prac

Characteristics of study 

population Intervention 

Study, 

country 

Condition 

Outcome examined 

System evaluated 

Duration/followup 

Age (mean/range) 

Gender

N participants

Intervention type 

Meditation practice Outcome category (measure) Aut

Telles S, 199383 India 

Healthy volunteers Physiological Cardiovascular, 

nervous, respiratory 

6 se 34.1 yr 

F = 0 M = 18 

E: 18 C: 18 W: 0 

Single Yoga (Brahmakumaris 

Raja) 

CVF (HR, FPA), 

NER (GSR), RES (BR) 

There 

symdesceffetech

Vijayalakshmi 

P, 

2004303India 

Hypertension Physiological Cardiovascular 

4 wk 50 yr 

F = 0 M = 13 

E: 13 C: 13 W: 0 

Composite Yoga (asanas 

+ pranayama) 

CVF (BP, HR, PP) Yoga o

symstre

Yoga r

reguhype