The Effectiveness of the Wim Hof Method in People With Spinal Cord Injury

Study Overview
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Brief Summary
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People with a spinal cord injury (SCI) often experience secondary medical complications. One of the methods that may help to prevent or deal with secondary complications in people with SCI is the Wim Hof Method (WHM). The WHM is based on three elements: 1) breathing exercises, 2) gradual cold exposure (cold showers, or cold water immersion), and 3) mindset. The primary objective of this randomized controlled trial is to assess the effects of WHM, involving breathing exercises, mindset (and cold exposure), on health-related quality of life in people with SCI. The secondary objectives are to assess the effects of WHM, involving breathing exercises, mindset (and cold exposure) in people with SCI on: inflammation markers, metabolic health, pulmonary function, body composition, sleep quality, spasticity, stress, and on chronic pain.

Detailed Description
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A spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Long-term, secondary medical complications are common and play an important role in the continuum of care for people with SCI. Complications are a frequent cause of morbidity and mortality and lead to increased rates of rehospitalisation, loss of employability and decreased quality of life. During multidisciplinary SCI rehabilitation, the treatment is focussed on working with the patient physically and psychologically to maximize their neurological recovery and general health but also to prevent or deal with the secondary complications. One of the methods that may help to prevent or deal with secondary complications in people with SCI is the Wim Hof Method (WHM). The WHM is based on three elements: 1) breathing exercises, 2) gradual cold exposure (cold showers, or cold water immersion), and 3) mindset. Previous studies showed a positive effect of the WHM on health-related quality of life and the inflammatory profile of healthy individuals as well as patients with active axial spondyloarthritis. Furthermore, a pilot study in people with SCI showed that the WHM (only breathing exercises and mindset) led to positive changes in respiratory function, mental health index, hyperventilation and a trend was visible regarding the hindrance due to spasticity. Some of the participants mentioned that they experienced positive effects on coughing, energy level, mood or used less spasticity medication after the WHM intervention. These positive findings in the pilot study warrant a full-scale randomised-controlled trial (RCT) of this novel therapeutic approach in people with SCI. The primary objective of this randomized controlled trial is to assess the effects of WHM, involving breathing exercises, mindset (and cold exposure), on health-related quality of life in people with SCI. The secondary objectives are to assess the effects of WHM, involving breathing exercises, mindset (and cold exposure) in people with SCI on: inflammation markers, metabolic health, pulmonary function, body composition, sleep quality, spasticity, stress, and on chronic pain.

Official Title
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The Effectiveness of the Wim Hof Method on Physical and Mental Health of People With a Spinal Cord Injury

Conditions
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Spinal Cord Injuries

Intervention / Treatment
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* Other: Wim Hof Methode


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals (Male/Female) with either a complete or incomplete chronic SCI. In this study, a chronic SCI is defined as a time since injury ≥ 1 year. Participants have to be between 18 and 75 years old. Exclusion Criteria: Cardiac arrhythmias or cardiac disease; A history of severe autonomic dysreflexia assessed with the 'Autonomic standards assessment'; Severe pulmonary disease (such as COPD) based on a pulmonary history; Insufficient mastery of the Dutch language (speaking and reading); Severe cognitive or communicative disorders; Progressive disease; Being or becoming pregnant during the study period; Severe psychiatric illness or disorders (at the discretion of the treating rehabilitation physician); Involved in another intervention study which may have an effect on the outcome measures of the present study; Experience with (parts of) the Wim Hof Method. Negative advice from physician to participate in the Wim Hof Method intervention based on the medical screening.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized controlled trial.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual care group<br>The control group will not receive any intervention, they will receive usual care and only participate in the pre and post tests. | |
| Experimental: Wim Hof Method - breathing and mindset exercise<br>The first intervention group will practice the breathing and mindset exercise. | Other: Wim Hof Methode<br>* The intervention groups will follow a 7-weeks intervention, with one practice session per week at the rehabilitation center led by Wim Hof or one of his instructors. Besides these joint weekly sessions, the intervention groups have to practice daily at home with the Wim Hof Method app.<br>|
| Experimental: Wim Hof Method - breathing and mindset exercise and cold exposure<br>The second intervention group will also practice the cold exposure (i.e, breathing, mindset and cold exposure) | Other: Wim Hof Methode<br>* The intervention groups will follow a 7-weeks intervention, with one practice session per week at the rehabilitation center led by Wim Hof or one of his instructors. Besides these joint weekly sessions, the intervention groups have to practice daily at home with the Wim Hof Method app.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in mental health | Mental Health Index - 5 (MHI-5), a subscale of the SF-36. The MHI-5 has a score of 0 to 100, where a score of 100 represents optimal mental health. | Assessed before and after the 7-weeks WHM intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in health-related quality of life | The SF-36 measures measures eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Each scale is scored on a 0 to 100 range, a higher score defines a more favorable health state. | Assessed before and after the 7-weeks WHM intervention | 
| Change in mindful attention awareness | The Mindful Attention Awareness Scale is a 15-item scale designed to assess a core characteristic of mindfulness. Each item can be scored from 1 (almost always) to 6 (almost never). The overall outcome is the average of the 15 items, with a higher score indicating being more mindful. | Assessed before and after the 7-weeks WHM intervention | 
| Change in hyperventilation | The Nijmegen Hyperventilation Syndrome Questionnaire has 16 items (related to symptoms of hyperventilation syndrome) to be answered on a 5-point scale ranging from 'never' (0) to 'very often' (4). A total score of more than 23 out of 64 points suggests significant hyperventilation. | Assessed before and after the 7-weeks WHM intervention | 
| Change in pain and pain interference | Four questions of the International Spinal Cord Injury Pain basic data set will be used to assess (the interference of) pain on a 0 (no pain or no interference) to 10 (extreme pain or extreme interference) range. | Assessed before and after the 7-weeks WHM intervention | 
| Change in sleep quality | Pittsburgh Sleep Quality Index (PSQI) is a self-rating questionnaire resulting in a global score between 0 and 21, which consists of seven subscores. Higher scores indicate worse sleep quality. | Assessed before and after the 7-weeks WHM intervention | 
| Change in hindrance due to spasticity | Hindrance due to spasticity will be assessed with a subjective rating scale for each of the following activities: (1) sleeping; (2) making transfers; (3) washing and clothing; (4) wheelchair driving; (5) 'others'. The scale ranges from 0 to 2 (0: no hindrance due to spasticity; 1: little hindrance due to spasticity; 2: a lot of hindrance due to spasticity). A sum score for hindrance during all activities will be calculated. It ranges from 0 (no hindrance) to 10 (a lot of hindrance during all activities). | Assessed before and after the 7-weeks WHM intervention | 
| Change in CRP | Concentration CRP (mg/L) in blood | Assessed before and after the 7-weeks WHM intervention | 
| Change in IL-6 | Concentration IL-6 (pg/ml) in blood | Assessed before and after the 7-weeks WHM intervention | 
| Change in fasted glucose | Concentration of fasted glucose (mmol/l) in blood | Assessed before and after the 7-weeks WHM intervention | 
| Change in triglycerides | Concentration of triglycerides (mmol/l) in blood | Assessed before and after the 7-weeks WHM intervention | 
| Change in high-density lipoprotein | Concentration of high-density lipoprotein (mmol/l) in blood | Assessed before and after the 7-weeks WHM intervention | 
| Change in low-density lipoprotein | Concentration of low-density lipoprotein (mmol/l) in blood | Assessed before and after the 7-weeks WHM intervention | 
| Change in total cholesterol | Concentration of total cholesterol (mmol/l) in blood | Assessed before and after the 7-weeks WHM intervention | 
| Change in blood pressure | Systolic and diastolic blood pressure (mm Hg) | Assessed before and after the 7-weeks WHM intervention | 
| Change in forced vital capacity | Forced vital capacity (FVC, liter) measured by spirometry | Assessed before and after the 7-weeks WHM intervention | 
| Change in forced expiratory volume | Forced expiratory volume in 1 sec (FEV1, liter) measured by spirometry | Assessed before and after the 7-weeks WHM intervention | 
| Change in forced inspiratory volume | Forced inspiratory volume in 1 sec (FIV1, liter) measured by spirometry | Assessed before and after the 7-weeks WHM intervention | 
| Change in peak expiratory flow | Peak expiratory flow (PEF, liter/s) measured by spirometry | Assessed before and after the 7-weeks WHM intervention | 
| Change in peak inspiratory flow | Peak inspiratory flow (PIF, liter/s) measured by spirometry | Assessed before and after the 7-weeks WHM intervention | 
| Change in body mass | Body mass (kg) measured on a (wheelchair) weighing scale | Assessed before and after the 7-weeks WHM intervention | 
| Change in fat and fat free mass | Fat mass and fat free mass (both in kg) measured by bio-impedance analysis: | Assessed before and after the 7-weeks WHM intervention | 
| Participant compliance and experiences | Diary and exit interview | Assessed before and after the 7-weeks WHM intervention |