The effect of breathing exercises and mindset with or without cold exposure on mental and physical health in persons with a spinal cord injury—Results of a randomized controlled trial

Objective: To examine the effects of the Wim Hof Method (WHM), with cold exposure (WHM-C) and without (WHM-NC), on mental and physical health in individuals with chronic spinal cord injury (SCI). Design: Randomized-controlled trial. Setting: Rehabilitation center. Participants: Sixty-two adults with chronic SCI (37% tetraplegia, 41% motor complete) were randomized into three groups: WHM-C, WHM-NC, and usual care (UC). Intervention: The intervention groups participated in a 7-week program involving weekly supervised sessions and daily home practice. WHM-NC included breathing exercises and mindset training, while WHM-C also incorporated cold exposure. UC participants received no intervention. Main measures: The primary outcome was the Mental Health Inventory (MHI-5) score. Secondary outcomes included inflammatory and metabolic markers, pulmonary function, body composition, sleep quality, spasticity, chronic pain, and psychological stress. Results: WHM-NC had eight dropouts, mostly due to motivation or unrelated medical issues, while WHM-C and UC had one dropout each. No significant differences in MHI-5 scores were observed between groups. However, WHM-C participants reported reduced pain interference in daily activities compared to UC (p=0.027). WHM-C also showed improvements in inspiratory parameters FIV1 (+27%, p=0.02) and PIF (+23%, p=0.02) and a significant reduction in fasting glucose concentration (-6%, p=0.006) compared to UC. Conclusions: While 44% of WHM-NC dropped out, WHM-C appears to be a feasible, effective intervention for improving aspects of physical health and pain perception in a broad group of individuals with chronic SCI, although no significant mental health benefits were observed.