Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Dec 2;14(12):e0225749.
doi: 10.1371/journal.pone.0225749. eCollection 2019.

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

G A Buijze  1 , H M Y De Jong  2 , M Kox  3 , M G van de Sande  2 , D Van Schaardenburg  2   4 , R M Van Vugt  5 , C D Popa  6   7 , P Pickkers  3 , D L P Baeten  2
Affiliations
Randomized Controlled Trial

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

G A Buijze et al. PLoS One. .

Abstract

Objectives: The primary objective of this trial was to assess safety and anti-inflammatory effects of an add-on training program involving breathing exercises, cold exposure, and meditation in patients with axial spondyloarthritis.

Methods: This study was an open-label, randomised, one-way crossover clinical proof-of-concept trial. Twenty-four patients with moderately active axial spondyloarthritis(ASDAS >2.1) and hs-CRP ≥5mg/L were included and randomised to an intervention (n = 13) and control group (n = 11) group that additionally received the intervention after the control period. The intervention period lasted for 8 weeks. The primary endpoint was safety, secondary endpoints were change in hs-CRP, serum calprotectin levels and ESR over the 8-week period. Exploratory endpoints included disease activity measured by ASDAS-CRP and BASDAI, quality of life (SF-36, EQ-5D, EQ-5D VAS), and hospital anxiety and depression (HADS).

Results: We found no significant differences in adverse events between groups, with one serious adverse event occurring 8 weeks after end of the intervention and judged 'unrelated'. During the 8-week intervention period, there was a significant decline of ESR from (median [interquartile range] to 16 [9-26.5] to 9 [5-23] mm/hr, p = 0.040, whereas no effect was found in the control group (from 14 [8.3-27.3] to 16 [5-37] m/hr, p = 0.406). ASDAS-CRP declined from 3.1 [2.5-3.6] to 2.3 [1.9-3.2] in the intervention group (p = 0.044). A similar trend was observed for serum calprotectin (p = 0.064 in the intervention group versus p = 0.182 in the control group), but not for hs-CRP.

Conclusions: This proof-of-concept study in axial spondyloarthritis met its primary endpoint with no safety signals during the intervention. There was a significant decrease in ESR levels and ASDAS-CRP upon the add-on training program in the intervention group. These findings warrant full-scale randomised controlled trials of this novel therapeutic approach in patients with inflammatory conditions.

Trial registration: ClinicalTrials.gov; NCT02744014.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow-chart and patients disposition.
See this image and copyright information in PMC

References

    1. Kox M, Stoffels M, Smeekens SP, van Alfen N, Gomes M, Eijsvogels TMH, et al. The influence of concentration/meditation on autonomic nervous system activity and the innate immune response: a case study. Psychosom Med. 2012;74(5):489–94. 10.1097/PSY.0b013e3182583c6d - DOI - PubMed
    1. Kox M, van Eijk LT, Zwaag J, van den Wildenberg J, Sweep FCGJ, van der Hoeven JG, et al. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proc Natl Acad Sci U S A. 2014;111(20):7379–84. 10.1073/pnas.1322174111 - DOI - PMC - PubMed
    1. Dougados M, Baeten D. Spondyloarthritis. Lancet. 2011;377(9783):2127–37. 10.1016/S0140-6736(11)60071-8 - DOI - PubMed
    1. Ambarus C, Yeremenko N, Tak PP, Baeten D. Pathogenesis of spondyloarthritis. Curr Opin Rheumatol. 2012;24(4):351–8. 10.1097/BOR.0b013e3283534df4 - DOI - PubMed
    1. van Tok MN, Satumtira N, Dorris M, Pots D, Slobodin G, van de Sande MG, et al. Innate immune activation can trigger experimental spondyloarthritis in HLA-B27/Huβ2m Transgenic Rats. Front Immunol. 2017;8(AUG):1–12. - PMC - PubMed

Publication types

Associated data

LinkOut - more resources