The Effects of Cold Exposure Training and a Breathing Exercise on the Inflammatory Response in Humans: A Pilot Study

Abstract

ObjectiveWe previously showed that a training intervention comprising a combination of meditation, exposure to cold, and breathing exercises enables voluntary activation of the sympathetic nervous system, reflected by profoundly increased plasma epinephrine levels, and subsequent attenuation of the lipopolysaccharide (LPS)-induced inflammatory response. Several elements of the intervention may contribute to these effects, namely, two different breathing exercises (either with or without prolonged breath retention) and exposure to cold. We determined the contribution of these different elements to the observed effects.MethodsForty healthy male volunteers were randomized to either a short or an extensive training in both breathing exercises by either the creator of the training intervention or an independent trainer. The primary outcome was plasma epinephrine levels. In a subsequent study, 48 healthy male volunteers were randomized to cold exposure training, training in the established optimal breathing exercise, a combination of both, or no training. These 48 participants were subsequently intravenously challenged with 2 ng/kg LPS. The primary outcome was plasma cytokine levels.ResultsBoth breathing exercises were associated with an increase in plasma epinephrine levels, which did not vary as a function of length of training or the trainer (F(4,152) = 0.53, p = .71, and F(4,152) = 0.92, p = .46, respectively). In the second study, the breathing exercise also resulted in increased plasma epinephrine levels. Cold exposure training alone did not relevantly modulate the LPS-induced inflammatory response (F(8,37) = 0.60, p = .77), whereas the breathing exercise led to significantly enhanced anti-inflammatory and attenuated proinflammatory cytokine levels (F(8,37) = 3.80, p = .002). Cold exposure training significantly enhanced the immunomodulatory effects of the breathing exercise (F(8,37) = 2.57, p = .02).ConclusionsThe combination of cold exposure training and a breathing exercise most potently attenuates the in vivo inflammatory response in healthy young males. Our study demonstrates that the immunomodulatory effects of the intervention can be reproduced in a standardized manner, thereby paving the way for clinical trials.Trial Registration:ClinicalTrials.gov identifiers: NCT02417155 and NCT03240497.

The positive effects of combined breathing techniques and cold exposure on perceived stress: a randomised trial

“…Studies have found anti-inflammatory impacts (Buijze et al, 2019 ; Zwaag et al, 2020 ), control over autonomic parts of the nervous system (Kox et al, 2012 , 2014 ; Muzik et al, 2018 ), resistance to endotoxins (van Middendorp et al, 2016 ), and accelerated acclimatization to high altitudes (Buijze & Hopman, 2014 ). Consistent with the WHM’s notion of three integrated pillars, empirical evidence shows that the main techniques of breathing exercises and cold exposure may yield unique physiological effects (Zwaag et al, 2022 ). Hence, it may be expected that their combined application leads to an interaction and thus, greater effects than a total of the two isolated techniques would suggest.…”

“…Research has examined the potential of mindfulness-related techniques such as yoga, particularly the influence of yogic breathing, i.e., pranayama (Cowen, 2010 ; Kanchibhotla et al, 2021 ; Lei Chui et al, 2021 ). Extant findings show that these exercises can improve markers that are symptomatic for perceived stress, such as inflammatory mediators (Kox et al, 2014 ; Zwaag et al, 2022 ). An important concept in research on physiological stress countermeasures, explaining their mechanisms of action, is that of hormesis.…”

“…Recent findings, however, suggest that the sympathetic nervous system might also be activated using techniques such as the breathing technique from the WHM (Kox et al, 2014 ; Muzik et al, 2018 ; Zwaag et al, 2020 ) or yogic breathing, i.e., pranayama (Jerath et al, 2006 ; Shapiro et al, 2007 ; Telles et al, 1994 ). Here, it is interesting to note that the breathing technique of the WHM is similar to pranayama (Agarwal et al, 2020 ; Kiecolt-Glaser et al, 2010 ), and both appear to yield congruent effects: the activation of the sympathetic nervous system leads to increased levels of epinephrine and a diminished innate immune response, which is expected to attenuate inflammation as is the case with autoimmune diseases (Kox et al, 2014 ; Zwaag et al, 2020 , 2022 ). Indeed, early empirical evidence suggests an alleviating influence on inflammation in the case of arthritis (Buijze et al, 2019 ).…”

“…For the treatment, three groups were distinguished: one group only performed daily breathing exercises (group ‘breathing technique’), another conducted cold exposure in terms of having a cold shower every morning (group ‘cold exposure’), and the third treatment group undertook both (group ‘combined’). Morning sessions were defined as the creator of the WHM himself suggests exercising on an empty stomach before breakfast (Innerfire, 2021 ), and extant research identified significant differences between morning and afternoon sessions regarding blood parameters (Zwaag et al, 2022 ).…”

“…In line with the extant literature, participants were instructed by trainers of the WHM (Buijze et al, 2019 ; Kox et al, 2014 ). Recent research has shown that the exercises can be learned in a short time frame and are performed adequately (Zwaag et al, 2022 ). The individuals were assessed for health issues and demanded to seek medical advice before participation.…”