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

PainSci » bibliography » Zwaag et al 2022
updated
Tags: inflam-sys, yoga, ice heat, exercise, self-treatment, treatment, rehab, injury, pain problems

Three articles on PainSci cite Zwaag 2022: 1. The Art of Bioenergetic Breathing2. Chronic, Subtle, Systemic Inflammation3. A Rational Guide to Fibromyalgia

PainSci commentary on Zwaag 2022: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is just a pilot study, but it is complex, dramatic, and persuasive despite its limitations.

The researchers were hunting for the “active ingredients” in a messy cocktail of meditation, breathing, and cold exposure exercises that they had studied previously. This time, Zwaag et al. observed a clear anti-inflammatory effect from hyperventilatory breathing exercises both alone and when combined with cold exposure. Cold exposure alone had no effect, but it did seem to enhance the effect of the breathing exercises.

This experiment was impressively gruelling for the participants: Zwaag et al. put a few dozen healthy young men through several days of intense breathing and/or cold exposure training, for hours at a time, and then artificially cranked up their systemic inflammation with injections of bacterial lipopolysaccharides. Serious business! Lots of care and ethical oversight required to do a study like this safely.

The breathing exercises mainly consisted of extensive hyperventilation. Most people would find the full protocol prohibitively challenging and exhausting. Happily, the researchers also tested easier methods… and were convinced by their data that a much tamer and simpler protocol had the same effect. Yahtzee.

The cold exposure protocol was even more intense, and impractical for most people to even attempt.

All of the hyperventilating certainly seemed to reduce objective signs of endotoxemia (assuming no statistical jiggery-pokery, which is always possible of course).

The simplest practical implication is that hyperventilation exercises alone might reduce some systemic inflammation in ways that could be helpful for some kinds of chronic pain … and that breathing probably works better with a bunch of added cold exposure. There’s plenty of uncertainty here, and in particular the required dosage might just be too much for a lot of people, but the data clearly shows that there is potential in principle. The word “promising” gets overused in this business, but I think it might actually be applicable in this case.

For additional perspective on this paper, see the blog post “Anti-inflammatory hyperventilation: I’ll huff and I’ll puff and I’ll blow my pain away.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: We 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.

METHODS: Forty 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.

RESULTS: Both 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).

CONCLUSIONS: The 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.

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