An add-on training program involving breathing exercises, cold exposure, and meditation attenuates inflammation and disease activity in axial spondyloarthritis – A proof of concept trial

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Citation

Buijze GA, De Jong HMY, Kox M, van de Sande MG, Van Schaardenburg D, Van Vugt RM, Popa CD, Pickkers P, Baeten DLP. An add-on training program involving breathing exercises, cold exposure, and meditation attenuates inflammation and disease activity in axial spondyloarthritis - A proof of concept trial. PLoS One. 2019 Dec 2;14(12):e0225749. doi: 10.1371/journal.pone.0225749. PMID: 31790484; PMCID: PMC6886760.

4 FUNDAMENTALS

 

1. Essential Background Material

 

The landmark PNAS study of Wim Hof’s method showed that it could reduce inflammation associated with an endotoxin injection.  Although groundbreaking, it was unclear if long-term practice could reduce chronic inflammation, which would be valuable in autoimmune diseases.

 

This study aimed to fill that gap.  They implemented Wim’s method (WHM) in a group of people with axial spondyloarthritis (axSpA), a type of arthritis involving chronic inflammation of the spine and the joints at the bottom of the spine.

 

This disease is a good first test case because people with it have an altered immune response, are generally younger, have fewer comorbidities, and the condition can remain somewhat stable for many years.

 

Let’s see what they did.

 

 

2. What Did this Research Do?

 

Twenty-four patients with axSpA were selected for this study.  They were randomized into early intervention (n=13) and late intervention groups (n=11).  The early group trained in the WHM for 8 weeks.  The late group started WHM training when the early group finished.  Thus, the 8-week waiting period for the late group served as the control period to compare the intervention against.

 

The WHM Training

 

The WHM group trained with Wim and four instructors for 8 weeks.  The core training included the 3 pillars of Wim’s method: breathing, cold, and meditation.  (They also did exercises such as push-ups, yoga poses, horse stance, etc.)

 

  • The breathing consisted of the two exercises described in the 2014 PNAS study. See that Science 411 for the full description.

 

  • Cold exposure was achieved through cold showers at home.  On group training days, participants were exposed to ice-cold water for several minutes (up to 5 min max).

 

  • The meditation involved 15-20 minutes of visualization, typically used at the end of the training session.

 

During the first 4 weeks, there was group training twice a week; it was reduced to once a week for the second four weeks.  They were also expected to perform the method at home daily.

Measurements

 

The study's primary outcome was safety: They simply wanted to test if the WHM was safe in autoimmune patients. 

 

However, they also measured a host of blood and quality-of-life markers, which are probably most interesting to us breathing nerds:

 

 

They assessed how these measurements changed from baseline to the 8-week mark when the training was completed.  (The 24-week assessment shown in the graphic above was to determine longer-term safety.)

 

 

3. What Were the Major Findings?

  • No serious adverse events occurred during the training period, meaning it “passed” the primary objective of the study (listen to the audio version of this 411 for more on this).

  • ESR significantly declined during the intervention but not during the control period.

  • Calprotectin and CRP both decreased, but the changes did not reach statistical significance.

  • The two global measures of axSpA disease activity, ASDAS-CRP and BASDAI, decreased significantly.

  • Quality of life improved following the intervention.

 

 

4. Why Do These Results Matter?

 

This study shows for the first time that voluntary activation of the immune system using the WHM is not only effective in short-term inflammation, but also in chronic inflammation associated with autoimmune disease.

 

And it’s more than just inflammation.  The WHM also improved quality of life and two overall markers of disease activity in axSpA.  These would be significant results for any intervention, much less a free mind-body one. 

 

1 BIG TAKEAWAY

 

This study showed that the daily practice of Wim Hof’s method can help people with autoimmune disease reduce chronic inflammation, improve markers of disease status, and improve overall quality of life.

 

 

 

1 PRACTICAL APPLICATION

 

NOTE: To use the method, it’s critical that you work with a certified Wim Hof instructor to ensure you perform it safely (as was done in this study). 

 

If you have an autoimmune disease, these results suggest that daily practice of Wim’s method is generally safe and might reduce inflammation associated with the overactivation of the innate immune response.  Moreover (and maybe more importantly), it may also improve your quality of life with the disease.

 

If you’re a regular WHM practitioner, these results can simply motivate you to continue your practice.

 

Lastly, remember that all three pillars were used.  So, we must assume that all three are needed to get these positive outcomes.