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.

The sample size was small, particularly in the breathing-only group where many participants dropped out, reducing statistical power. Participants who dropped out declined posttreatment assessments, preventing a true intention-to-treat analysis for those individuals. The cold showers were home-based and averaged 14.6°C, which may be less standardized or intense than laboratory conditions. Multiple statistical comparisons were made without correction, increasing the risk that some significant findings occurred by chance. The study lacked long-term follow-up to determine if the physical benefits were sustained after the 7-week intervention ended.

The study was funded by specific foundations (Vaals Fonds, Stichting Wijnand Carnoy Fonds, and Stichting Sante Postma Fonds). The authors disclosed no conflicts of interest.

Do not recommend this intervention for mental health benefits based on this trial, as the primary outcome was null. The observed improvements in lung function and glucose were specific to the group that received cold exposure, suggesting the breathing exercises alone were insufficient to produce these physical changes.