The effect of breathing exercises and mindset with or without cold exposure on mental and physical health in persons with a spinal cord injury-a protocol for a three-arm randomised-controlled trial.

STUDY DESIGN: A three-arm randomized controlled trial. OBJECTIVES: To investigate the effects of the Wim Hof Method (WHM), with (WHM-C) and without cold exposure (WHM-NC), on mental and physical health in persons with chronic spinal cord injury (SCI). SETTING: Rehabilitation centre (assessments and once-weekly intervention sessions) and home-based (daily intervention sessions). METHODS: Sixty adults with chronic SCI will be randomised (1:1:1) to one of three groups: participants in the intervention groups (i.e., WHM-C and WHM-NC) will engage in a 7-week intervention, with one weekly practice session at the rehabilitation centre and a daily WHM session at home. WHM-NC will consist of breathing exercises and mindset, while participants in WHM-C will partake in breathing exercises, mindset and cold exposure. Participants allocated to usual care (UC) will not receive the WHM intervention. The primary outcome is mental health reported via the Mental Health Inventory (MHI)-5, while secondary outcomes include circulating inflammatory and metabolic marker concentration, pulmonary function, body composition, sleep quality, spasticity, chronic pain and psychological stress. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the medical ethics committee of the Máxima Medical Centre (Veldhoven, the Netherlands; identifier: w22.069). If shown efficacious in improving mental health, as well as physical health, in persons with chronic SCI, the low cost and accessibility of the WHM allows it to be directly implemented in SCI rehabilitation. TRIAL REGISTRATION NUMBER: NCT05704322.

The Effect of Mindset and Breathing Exercises on Physical and Mental Health in Persons with Spinal Cord Injury-A Pilot Feasibility Study.

This study investigated the feasibility and efficacy of mindset and breathing exercises (Wim Hof Method (WHM)) on physical and mental health in persons with spinal cord injury (SCI). Ten individuals with SCI participated in this pilot study. These ten participants followed a 4-week WHM intervention, with one weekly group session in the rehabilitation center and daily practice at home using the WHM app. An in-person exit-interview was conducted post-intervention to collect qualitative information on participants' experiences, regarding the feasibility and effects of the intervention. Furthermore, tests and questionnaires were administered pre- and post-intervention to assess physical and mental health outcomes. Adherence to the weekly in-person meetings was excellent and no adverse events occurred. Physical and mental health outcomes in this small sample size showed some pre-post differences. This pilot feasibility study provides preliminary evidence supporting the feasibility and efficacy of the WHM, including mindset and breathing exercises, on physical and mental health of people with SCI. These results warrant a randomized-controlled trial, including cold exposure, of this novel intervention in people with SCI.

Predicting resting energy expenditure in people with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: The aims of this study were (1) to validate the two recently developed SCI-specific REE equations; (2) to develop new prediction equations to predict REE in a general population with SCI. SETTING: University, the Netherlands. METHODS: Forty-eight community-dwelling men and women with SCI were recruited (age: 18-75 years, time since injury: ≥12 months). Body composition was measured by dual-energy X-ray absorptiometry (DXA), single-frequency bioelectrical impedance analysis (SF-BIA) and skinfold thickness. REE was measured by indirect calorimetry. Personal and lesion characteristics were collected. SCI-specific REE equations by Chun et al. [1] and by Nightingale and Gorgey [2] were validated. New equations for predicting REE were developed using multivariate regression analysis. RESULTS: Prediction equations by Chun et al. [1] and by Nightingale and Gorgey [2] significantly underestimated REE (Chun et al.: -11%; Nightingale and Gorgey: -11%). New equations were developed for predicting REE in the general population of people with SCI using FFM measured by SF-BIA and Goosey-Tolfrey et al. skinfold equation (R2 = 0.45-0.47; SEE = 200 kcal/day). The new equations showed proportional bias (p < 0.001) and wide limits of agreement (LoA, ±23%). CONCLUSIONS: Prediction equations by Chun et al. [1] and by Nightingale and Gorgey [2] significantly underestimated REE and showed large individual variations in a general population with SCI. The newly developed REE equations showed proportional bias and a wide LoA (±23%) which limit the predictive power and accuracy to predict REE in the general population with SCI. Alternative methods for measuring REE need to be investigated.

Accuracy of bioelectrical impedance analysis and skinfold thickness in the assessment of body composition in people with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: This study: (1) investigated the accuracy of bioelectrical impedance analysis (BIA) and skinfold thickness relative to dual-energy X-ray absorptiometry (DXA) in the assessment of body composition in people with spinal cord injury (SCI), and whether sex and lesion characteristics affect the accuracy, (2) developed new prediction equations to estimate fat free mass (FFM) and percentage fat mass (FM%) in a general SCI population using BIA and skinfolds outcomes. SETTING: University, the Netherlands. METHODS: Fifty participants with SCI (19 females; median time since injury: 15 years) were tested by DXA, single-frequency BIA (SF-BIA), segmental multi-frequency BIA (segmental MF-BIA), and anthropometry (height, body mass, calf circumference, and skinfold thickness) during a visit. Personal and lesion characteristics were registered. RESULTS: Compared to DXA, SF-BIA showed the smallest mean difference in estimating FM%, but with large limits of agreement (mean difference = -2.2%; limits of agreement: -12.8 to 8.3%). BIA and skinfold thickness tended to show a better estimation of FM% in females, participants with tetraplegia, or with motor incomplete injury. New equations for predicting FFM and FM% were developed with good explained variances (FFM: R2 = 0.94; FM%: R2 = 0.66). CONCLUSIONS: None of the measurement techniques accurately estimated FM% because of the wide individual variation and, therefore, should be used with caution. The accuracy of the techniques differed in different subgroups. The newly developed equations for predicting FFM and FM% should be cross-validated in future studies.

Changes in body composition during and after inpatient rehabilitation in people with recent spinal cord injury.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To investigate changes in body composition parameters in people with recent spinal cord injury (SCI) during their first inpatient rehabilitation and up to 1 year after discharge and whether those potential changes over time varied between different personal and lesion characteristics groups. SETTING: Rehabilitation center, the Netherlands. METHODS: People with recent SCI (≥18 years; n = 53) were tested around admission (T0) and discharge (T1) of inpatient rehabilitation. A sub-group (n = 19) was measured 1 year after discharge (T2). Personal and lesion characteristics were registered at T0. Anthropometry (height, body mass, body mass index, and waist circumference) was performed at T0, T1, and T2. Bioelectrical impedance analysis (BIA) was measured at T0 and T1. RESULTS: During inpatient rehabilitation, no significant changes in all body composition parameters were found. During the first year after discharge, body mass index (26.8 kg/m2) significantly increased compared with the level at both admission (25.4 kg/m2; p = 0.01, 95% CI: 0.32-2.52) and discharge (25.1 kg/m2; p = 0.02, 95% CI: 0.26-3.00). People with paraplegia showed an increase in absolute waist circumference (6.5%) compared with people with tetraplegia who showed a net decrease (-5.5%) in the year after discharge (p = 0.047, 95% CI: 0.27-33.62). CONCLUSIONS: A stable body composition during inpatient rehabilitation is followed by an increased BMI in the year after discharge in people with recent SCI. People with paraplegia showed an increase in absolute waist circumference compared with people with tetraplegia who showed a net decrease in the year after discharge.