Autoimmune DiseasesINADRINCT02417155
Increasing Plasma Adrenaline Levels Through Breathing Techniques - an Explorative Study
A study testing Hyper/hypoventilation and Strength ventilation in people with Autoimmune Diseases, run by Radboud University Medical Center at 1 site in Netherlands.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 to 35 years, men onlyHealthy volunteers can take part
- Conditions the study is for
- Autoimmune Diseases
- What is being tested?
- Hyper/hypoventilation and Strength ventilation
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 40 participants
- Where
- 1 siteNetherlands
- Study dates
- Nov 2014to Oct 2015
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 35 years
- Men only
- Healthy volunteers accepted
- Adult
Who may be able to join
- Age ≥18 and ≤35 yrs
- Male
- Healthy
Who cannot join
- Experience with the methods of Wim Hof or other breathing techniques
- Use of any medication
- Smoking
- Use of recreational drugs within 21 days prior to the experiment day
- Use of caffeine or alcohol within 1 day prior to the experimental day.
- Surgery or trauma with significant blood loss or blood donation within 3 months prior to the experimental day.
Show all 14Show fewer
- Participation in another clinical trial within 3 months prior to the experimental day.
- History, signs, or symptoms of cardiovascular disease
- History of atrial or ventricular arrhythmia
- Hypertension (RR systolic >160 or RR diastolic >90)
- Hypotension (RR systolic <100 or RR diastolic <50)
- Conduction abnormalities on the ECG consisting of a 1st degree atrioventricular block or a complex bundle branch block
- History of asthma, or any other pulmonary disease
- C reactive protein (CRP) > 20 mg/L, White blood count (WBC) > 12x109/L, or clinically significant acute illness, including infections, within 4 weeks before the experimental day.
Trial locations and contacts
1 site in 1 country.
Netherlands1 site
Intensive Care Medicine, Radboud University Nijmegen Medical Centre
Nijmegen, Gelderland, 6500 HB
About this study
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.
Read the 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.
- Conditions
- Autoimmune Diseases
- Being tested
- Hyper/hypoventilation, Strength ventilation
- Keywords
- Autonomic Nerve System, Epinephrin, Hyperventilation, Hypoventilation
- Medical subject headings
- Autoimmune Diseases, Hyperventilation, Hypoventilation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Hyper/hypoventilationBehavioural
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.
Strength ventilationBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| HTR | Experimental | The 'Hoftraining' group (HTR): a group of subjects (n=10) that will be trained extensively by mr. Hof and his team in both hyper/hypoventilation and strength ventilation breathing techniques. Total time training is 8 days. Receives: Behavioral: Hyper/hypoventilation; Behavioral: Strength ventilation |
| EIN | Active comparator | The 'extensive instruction' group (EIN): a group of subjects (n=10) that will receive an extensive instruction course supervised by the research team (in absence of Mr. Hof) in both hyper/hypoventilation and strength ventilation breathing techniques. Receives: Behavioral: Hyper/hypoventilation; Behavioral: Strength ventilation |
| STR | Active comparator | The 'short training' group (STR): a group of subjects (n=10) that will receive only a short training of 1 hour (immediately prior to the study) by Mr. Hof and his team in both hyper/hypoventilation and strength ventilation breathing techniques. Receives: Behavioral: Hyper/hypoventilation; Behavioral: Strength ventilation |
| SIN | Active comparator | The 'short instruction' group (SIN): a group of subjects (n=10) that will receive no training, but only an short instruction course of 1 hour (immediately prior to the study) supervised by the research team (in absence of Mr. Hof) in both hyper/hypoventilation and strength ventilation breathing techniques. Receives: Behavioral: Hyper/hypoventilation; Behavioral: Strength ventilation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Concentration of plasma adrenaline within arm 1
Our primary endpoint is the difference between plasma adrenaline levels during the hyper/hypoventilation technique and the strength ventilation technique within the HTR group.
Measured: 1 day
Secondary outcomes (11)
Concentration of plasma adrenaline within arms 2, 3, 4
Blood will be collected into chilled lithium-heparin tubes and will immediately be placed on ice and centrifuged at 2.000 x g for 10 min at 4 degrees celsius after which plasma will be stored at -80 degrees celsius until analysis. Plasma adrenaline is measured using High Performance Liquid Chromatography (HPLC) with fluorometric detection. The investigators will compare levels during the hyper/hypoventilation technique and plasma adrenaline levels during the strength ventilation technique within the EIN, STR and SIN groups.
Measured: 1 day
concentration of plasma adrenaline between arms 1, 2, 3, 4
Blood will be collected into chilled lithium-heparin tubes and will immediately be placed on ice and centrifuged at 2.000 x g for 10 min at 4 degrees celsius after which plasma will be stored at -80 degrees celsius until analysis. Plasma adrenaline is measured using HPLCy with fluorometric detection. The investigators will compare differences in plasma adrenaline levels during hyper/hypoventilation or strength ventilation between HTR, EIN, STR and SIN groups.
Measured: 1 day
Plasma interleukine 10 concentration
EDTA (ethylenediaminetetraacetic acid) anticoagulated blood will centrifuged immediately at 2.000 x g for 10 min at 4 degrees calcium after which plasma will be stored at -80 degrees until analysis. Concentration of [cytokine] will be measured using a simultaneous Luminex assay according to the manufacturer's instructions (Milliplex; Millipore). The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Body temperature
Body temperature will be measured using an infrared tympanic thermometer (FirstTemp Genius 2; Sherwood Medical). The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Heart rate, blood pressure
Heart rate will be recorded with a three-lead electrocardiogram on a Philips MP50 patient monitor. The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Blood pressure
Blood pressure will be measured on a Philips MP50 patient monitor through a 20-gauge arterial catheter. The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Leukocyte counts and differentiation
Analysis of leukocyte counts and differentiation will be performed in EDTA anticoagulated blood using routine analysis methods also used for patient samples (flow cytometric analysis on a Sysmex XE-5000). The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Cortisol (plasma)
Blood will be collected in serum-separating tubes and allowed to clot at room temperature for a minimum of 30 min. Subsequently, samples are centrifuged at 2,000 × g for 10 min at 4 °C, after which serum is stored at -80 °C until analysis. Cortisol levels will be determined using a routine analysis method also used for patient samples (electrochemiluminescent immunoassay on a Modular Analytics E170 (Roche Diagnostics). The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Noradrenaline
Blood will be collected into chilled lithium-heparin tubes and will immediately be placed on ice and centrifuged at 2.000 x g for 10 min at 4 degrees celsius after which plasma will be stored at -80 degrees celsius until analysis. Plasma noradrenaline is measured using HPLCy with fluorometric detection. The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Blood gas parameters
Blood gas parameters are analyzed in lithium heparin anticoagulated arterial blood using CG4+ cartridges and a point-of-care i-STAT blood gas analyzer (Abbott). The investigators will compare differences between hyper/hypoventilation and strength ventilation within HTR, EIN, STR and SIN groups as well as differences during hyper/hypoventilation or strength ventilation between HTR, EIN, and SIN groups.
Measured: 1 day
Pain threshold
Pain thresholds before start training/instruction, during each of the breathing techniques, and at the end of the experimental day, objectified with Quantitive Sensory Testing by a dedicated, trained member of the studyteam.
Measured: 1 day
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Apr 2015 (estimated)
- Study startNov 2014
- Primary completionJul 2015
- Study completionOct 2015
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Autoimmune DiseasesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 40 participants (actual)
Sponsor and investigators
- Lead sponsor
- Radboud University Medical Center
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Matthijs Kox, PhD, Principal investigator, Radboud University Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02417155
- Sponsor's protocol ID
- INADRI
- Acronym
- INADRI
- Status last verified
- Nov 2015
- First submitted
- 2 Dec 2014
- Last updated
- 10 Nov 2015
- Results posted
- No
- Data monitoring committee
- No
Publications
Kox M, van Eijk LT, Zwaag J, van den Wildenberg J, Sweep FC, van der Hoeven JG, Pickkers P. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proc Natl Acad Sci U S A. 2014 May 20;111(20):7379-84. doi: 10.1073/pnas.1322174111. Epub 2014 May 5.
PubMed 24799686Kox M, Stoffels M, Smeekens SP, van Alfen N, Gomes M, Eijsvogels TM, Hopman MT, van der Hoeven JG, Netea MG, Pickkers P. The influence of concentration/meditation on autonomic nervous system activity and the innate immune response: a case study. Psychosom Med. 2012 Jun;74(5):489-94. doi: 10.1097/PSY.0b013e3182583c6d.
PubMed 22685240Zwaag J, Naaktgeboren R, van Herwaarden AE, Pickkers P, Kox M. The Effects of Cold Exposure Training and a Breathing Exercise on the Inflammatory Response in Humans: A Pilot Study. Psychosom Med. 2022 May 1;84(4):457-467. doi: 10.1097/PSY.0000000000001065. Epub 2022 Feb 23.
PubMed 35213875
Study at a glance
From the registry record, last updated by the sponsor on 10 Nov 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Increasing Plasma Adrenaline Levels Through Breathing Techniques - an Explorative Study
- ClinicalTrials.gov ID
- NCT02417155
- Acronym / sponsor ID
- INADRI / INADRI
- Conditions
- Autoimmune Diseases
- Keywords
- Autonomic Nerve System, Epinephrin, Hyperventilation, Hypoventilation
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 40 participants (actual)
- Lead sponsor
- Radboud University Medical CenterUniversity, hospital or other
- Study start
- Nov 2014
- Primary completion
- Jul 2015 (actual)
- Study completion
- Oct 2015 (actual)
- First posted
- 15 Apr 2015 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| HTR | Experimental | Behavioral: Hyper/hypoventilation, Behavioral: Strength ventilationThe 'Hoftraining' group (HTR): a group of subjects (n=10) that will be trained extensively by mr. Hof and his team in both hyper/hypoventilation and strength ventilation breathing techniques. Total time training is 8 days. |
| EIN | Active comparator | Behavioral: Hyper/hypoventilation, Behavioral: Strength ventilationThe 'extensive instruction' group (EIN): a group of subjects (n=10) that will receive an extensive instruction course supervised by the research team (in absence of Mr. Hof) in both hyper/hypoventilation and strength ventilation breathing techniques. |
| STR | Active comparator | Behavioral: Hyper/hypoventilation, Behavioral: Strength ventilationThe 'short training' group (STR): a group of subjects (n=10) that will receive only a short training of 1 hour (immediately prior to the study) by Mr. Hof and his team in both hyper/hypoventilation and strength ventilation breathing techniques. |
| SIN | Active comparator | Behavioral: Hyper/hypoventilation, Behavioral: Strength ventilationThe 'short instruction' group (SIN): a group of subjects (n=10) that will receive no training, but only an short instruction course of 1 hour (immediately prior to the study) supervised by the research team (in absence of Mr. Hof) in both hyper/hypoventilation and strength ventilation breathing techniques. |
Who may qualify
- Ages
- 18 to 35 years
- Sex
- Male only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Age ≥18 and ≤35 yrs
- Male
- Healthy
Key exclusion criteria (14 listed)
- Experience with the methods of Wim Hof or other breathing techniques
- Use of any medication
- Smoking
- Use of recreational drugs within 21 days prior to the experiment day
- Use of caffeine or alcohol within 1 day prior to the experimental day.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Hyper/hypoventilationSubjects 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. | Behavioural | EIN, HTR, SIN, STR |
| Strength ventilationThis 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. | Behavioural | EIN, HTR, SIN, STR |
Primary outcome
Concentration of plasma adrenaline within arm 1
Time frame: 1 day
Our primary endpoint is the difference between plasma adrenaline levels during the hyper/hypoventilation technique and the strength ventilation technique within the HTR group.
11 secondary outcomes
Concentration of plasma adrenaline within arms 2, 3, 4
Time frame: 1 day
concentration of plasma adrenaline between arms 1, 2, 3, 4
Time frame: 1 day
Plasma interleukine 10 concentration
Time frame: 1 day
Body temperature
Time frame: 1 day
Heart rate, blood pressure
Time frame: 1 day
Blood pressure
Time frame: 1 day
Leukocyte counts and differentiation
Time frame: 1 day
Cortisol (plasma)
Time frame: 1 day
Noradrenaline
Time frame: 1 day
Blood gas parameters
Time frame: 1 day
Pain threshold
Time frame: 1 day
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Nov 2015.
- Background: PubMed 24799686Kox M, van Eijk LT, Zwaag J, van den Wildenberg J, Sweep FC, van der Hoeven JG, Pickkers P. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proc Natl Acad Sci U S A. 2014 May 20;111(20):7379-84. doi: 10.1073/pnas.1322174111. Epub 2014 May 5.
- Background: PubMed 22685240Kox M, Stoffels M, Smeekens SP, van Alfen N, Gomes M, Eijsvogels TM, Hopman MT, van der Hoeven JG, Netea MG, Pickkers P. The influence of concentration/meditation on autonomic nervous system activity and the innate immune response: a case study. Psychosom Med. 2012 Jun;74(5):489-94. doi: 10.1097/PSY.0b013e3182583c6d.
- Derived from this study: PubMed 35213875Zwaag J, Naaktgeboren R, van Herwaarden AE, Pickkers P, Kox M. The Effects of Cold Exposure Training and a Breathing Exercise on the Inflammatory Response in Humans: A Pilot Study. Psychosom Med. 2022 May 1;84(4):457-467. doi: 10.1097/PSY.0000000000001065. Epub 2022 Feb 23.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Matthijs Kox, PhD principal investigator
Radboud University Medical Center
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Hyper/hypoventilation and Strength ventilation in people with Autoimmune Diseases, run by Radboud University Medical Center at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 10 Nov 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Concentration of plasma adrenaline within arm 1 (time frame: 1 day). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02417155, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Nov 2015.