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P128 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
  1. H De Jong1,
  2. G Buijze1,
  3. M Kox2,
  4. M van de Sande1,
  5. DJ van Schaardenburg1,3,
  6. R van Vugt1,
  7. C Popa2,4,
  8. P Picckers2,
  9. D Baeten1
  1. 1Amsterdam UMC, Amsterdam
  2. 2Radboud UMC, Nijmegen
  3. 3Reade, Amsterdam
  4. 4Bernhoven, Uden, Netherlands


Career situation of first and presenting author Student for a master or a PhD.

Introduction Previous research in healthy individuals showed that the innate immune response can be voluntarily modulated by a training program involving breathing exercises, exposure to cold and meditation1. It is unknown whether the same intervention could potentially lead to suppression of inflammation and whether it can safely be applied in patients with chronic inflammatory diseases.

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

Methods This was an open-label randomised one-way crossover proof-of-concept trial. Participants were randomised to either the early or late intervention group. The intervention consisted of an 8 weeks training program comprising cold exposure, meditation and breathing exercises.

Results There was no significant difference in adverse events between groups, with one serious adverse event occurring 8 weeks after end of the intervention and judged ‘unrelated’. After 8 weeks there was a significant decline of the hs-CRP in the intervention group (median [interquartile range] from 10.2 [6.5–17.1] to 6.0 [3.9–15.6] mg/L; p=0.02), but not in the control group (from 8.7 [5.2–17.2] to 13.2 [7.9–20.1] mg/L; p=0.70). A similar trend was seen for serum calprotectin (p=0.07 in intervention versus p=0.31 in control), but not for ESR. In addition, ASDAS-CRP (p=0.02), BASDAI (p=0.04), SF-36 physical component score (p=0.01), EQ-5D (p=0.049), and EQ-5D VAS (p=0.02) decreased significantly in the intervention group, but not the control group.

Conclusions In the present trial we show that the add-on training program involving breathing exercises, cold exposure, and meditation can safely be applied in patients with axial spondyloarthritis, a prototype chronic inflammatory disease. Furthermore, it attenuated inflammation and improved disease activity, function, and quality of life.


  1. 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 USA 2014 May 20;111(20):7379–84.

Acknowledgements Professor Piet van Riel, Lisa van Maanen, Sanne Pons, Wim Hof, Isa Hof, Henk van den Berg, Marianne Peper, Linda Hochstenbach, and Iris Premssler.

Disclosure of Interest None declared.

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