Increasing Plasma Adrenaline Levels Through Breathing Techniques - an Explorative Study
Condition: Autoimmune Diseases
MeSH terms: Autoimmune Diseases
Study type: Interventional

Summary: 
      Inflammatory cytokines play a pivotal role in rheumatoid arthritis (RA) and innovative
      non-pharmacological therapies aimed at limiting cytokine production are highly warranted.
      Adrenaline, a neurotransmitter of the autonomic sympathetic nervous system, attenuates
      cytokine production. Along these lines, endogenous modulation of sympathetic activity could
      limit inflammation and therefore represent a treatment modality that would empower RA
      patients to exert self-control over disease activity. However, both the autonomic nervous
      system and the inflammatory response are regarded as systems that cannot be voluntarily
      influenced. Nevertheless, results from two recent studies demonstrate that this is possible
      through techniques developed by 'iceman' Wim Hof, namely meditation, exposure to cold, and
      breathing exercises. Hof himself and healthy volunteers trained by him were able to
      voluntarily activate the sympathetic nervous system, resulting in adrenaline release and
      subsequent suppression of the inflammatory response during experimental human endotoxemia (a
      model of systemic inflammation elicited by administration of lipopolysaccharide [LPS] in
      healthy volunteers). Interestingly, while having been taught all three techniques, during the
      endotoxemia experiment the trained subjects (like Hof himself) predominantly practiced the
      breathing exercises consisting of two different techniques. A 'hyper/hypoventilation'
      technique, characterized by cycles of hyperventilation followed by breath retention and a
      'strength ventilation' technique consisting of deep inhalations and exhalations followed by
      breath holding. These techniques resulted in intermittent hypoxia and cyclic shifts in
      acid-base balance. Based on these observations and previous studies, the investigators
      hypothesize that these breathing techniques account for the increased production of
      adrenaline and thus for the suppressed inflammatory response but it is unclear which of these
      two techniques is most important.
    

Detailed description: 
      The main objective of the study is to compare the increase in plasma adrenaline levels during
      the two different breathing techniques in a group of healthy volunteers trained by Hof. Also,
      the investigators investigate whether it is necessary to be trained by Hof and if a
      relatively short instruction instead of the extensive training is sufficient. Additionally,
      the investigators want to evaluate the influence of the training and breathing techniques on
      pain thresholds.
    

Intervention name(s): Hyper/hypoventilation; Strength ventilation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Subjects are asked to hyperventilate for an average of 30 breaths. Subsequently, the subjects exhaled and hold their breath for approximately 2 minutes ("retention phase"). The duration of breath retention will be entirely at the discretion of the subject himself. Breath retention is followed by a deep inhalation breath, that will be held for 10 s. Subsequently a new cycle of hyper/hypoventilation begins.; This exercise consists of deep inhalations and exhalations in which every inhalation and exhalation is followed by breath holding for 10 s, during which the subject tightens all his body muscles.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Autonomic Nerve System; Epinephrin; Hyperventilation; Hypoventilation