Comparative Effects of Wim Hoff Method and Box Breathing Method in Mild COPD

Comparative Effects of Wim Hoff Method and Box Breathing on Anxiety, Dyspnea and Peak Expiratory Flow Rate in Mild Copd

The goal of this clinical trial is to support the role of effective, non-pharmacological interventions in the management of the symptoms of mild Chronic Obstructive Pulmonary Disease (COPD) or the anxiety, dyspnea, and peak expiratory flow rate decline. The main questions it aims to answer are

• There are no significant effects of wim hoff breathing and box breathing technique on dyspnea, anxiety, and PEFR in mild COPD patients.
• There are significant effects of wim hoff breathing and box breathing technique on dyspnea, anxiety, and PEFR in mild COPD patients.

There 2 study groups, group A received box breathing technique and Group B of mild COPD patients received wim hoff breathing technique.

Study Overview

• Status: Completed
• Conditions: COPD
• Intervention / Treatment: Other: Box Breathing; Other: Wim Hoff Breathing Technique

Detailed Description

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition that causes airflow limitation, leading to symptoms such as dyspnea, chronic cough, and anxiety. COPD significantly affects patients' quality of life, with anxiety and breathlessness often exacerbating the disease's impact. Traditional treatments primarily focus on medication, but non-pharmacological interventions like controlled breathing techniques have gained attention for their potential benefits in symptom management.

The objective is to determine the effects of the Wim Hof Method and Box Breathing on anxiety, dyspnea, and pulmonary function (PEFR and FEV1) in patients with mild COPD, assessing which method offers greater benefits in managing these symptoms. It is a randomized clinical trial was conducted with 60 participants diagnosed with mild COPD. Participants were assigned to either the Wim Hof Method group or the Box Breathing group by simple randomization technique of computer-generated random number table. Over 8 weeks, both groups practiced their respective breathing techniques, and assessments of anxiety (State-Trait Anxiety Inventory), dyspnea (Borg Dyspnea Scale), and pulmonary function (PEFR and FEV1) were performed pre- and post-treatment. Statistical analysis included Mann-Whitney U tests and Wilcoxon signed-rank tests.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Chak Four Hundred Fifty-four, Punjab Province, Pakistan, 63100
      • Bahawal Victoria Hospital BVH Bahawalpur

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Male and female patients
• Age 35 and 50 years
• Patients diagnosed with mild COPD with and FEV1 80%-85% of predicted.
• Participants should have physical and cognitive ability to perform and understand exercises.
• Participants who quit smoking over 6 months

Exclusion Criteria:

• History of other respiratory conditions (asthma, interstitial lung disease, cystic fibrosis) excluded.
• Patients of cardiovascular conditions were not included.
• Neurological or psychiatric and cognitive disorders excluded.
• Recent history of COPD hospitalization.
• Participants formally engage in pulmonary rehabilitation programs in last 6 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Box Breathing; Using Box Breathing as primary intervention in addition to baseline COPD therapy	Other: Box Breathing; The protocol for box breathing, which is a powerful technique for stress management and relaxation, guided patients through a structured breathing exercise. The box breathing exercise consisted of the following steps: Inhaled Deeply: Patients breathed in slowly through their nose, counting to 4, allowing their lungs to fill fully and gradually.; Held the Breath: They held their breath for a count of 4, maintaining a sense of calm as they allowed the air to settle.; Exhaled Slowly: They released the breath through their mouth over a count of 4, focusing on the slow, controlled release of air.; Paused Again: After exhaling, they held the breath out for a final count of 4, embracing the brief stillness before the next cycle.
Experimental: Wim Hoff breathing technique; Using Wim Hoff breathing technique as primary intervention in addition to baseline COPD therapy	Other: Wim Hoff Breathing Technique; The Wim Hof Breathing Technique was introduced as a powerful method to improve physical and mental resilience, boost energy, and enhance control over the nervous and immune systems. The protocol for the Wim Hof Breathing Technique included the following steps: Preparation: Participants began by sitting or lying down in a comfortable position in a safe, quiet environment where they could practice without disturbances. Step 1: 30-40 Deep, Rhythmic Breaths Step 2: Hold Your Breath (Retention Phase) Step 3: Recovery Breath Step 4: Repeat the Cycle Duration of Practice: Each full session of the Wim Hof Breathing Technique, including all breathing cycles, took around 15-20 minutes. These treatment sessions continued for 8 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PEFR	Peak Forced Expiratory Rate (PFER) is a vital measure in pulmonary health, assessing the maximum speed of exhalation to gauge lung function, particularly in asthma and COPD patients. It is measured in liters per minute using a peak flow meter, providing instant feedback on airway health. Patients monitor PFER to track airway constriction, adjusting medication as needed. The zone system include Green Zone (80-100%) indicates stable control, Yellow Zone,(50-79%) signals caution, Red Zone (below 50%) requires urgent attention.	8 weeks
FEV1	Forced Expiratory Volume in 1 Second (FEV1) measures the air exhaled in one second after a deep breath, serving as a critical indicator of lung function and a key diagnostic tool for obstructive lung diseases like asthma and COPD. Measured via spirometry, FEV1 is compared to predicted values and paired with Forced Vital Capacity (FVC) to calculate the FEV1/FVC ratio, differentiating obstructive from restrictive diseases. In COPD classification, FEV1 aids in determining severity: Mild (≥80% of predicted), Moderate (50-79%), Severe (30-49%), and Very Severe (<30%). Tracking FEV1 over time helps clinicians assess progression, adjust treatments, and manage respiratory health effectively .	8 weeks
STAI for anxiety	The State-Trait Anxiety Inventory (STAI) is a psychological tool that assesses anxiety through two scales: State Anxiety (temporary anxiety linked to specific situations) and Trait Anxiety (a general, long-term tendency toward anxiety). With 40 self-report items, it measures how individuals feel at the moment (state) and their baseline anxiety levels over time (trait). Used widely in clinical and research settings, the STAI helps in diagnosing anxiety, tracking treatment progress, and providing insights into situational versus personality-based anxiety. Its dual approach enables a deeper understanding of anxiety, supporting personalized interventions and research into anxiety patterns across populations.	8 weeks
Borg Dyspnea scale	The Borg Dyspnea Scale is a subjective tool for rating breathlessness, commonly used in assessing respiratory conditions like COPD, asthma, and heart failure. It ranges from 0 (no breathlessness) to 10 (maximum breathlessness), with descriptive terms for each level to help individuals rate their symptoms accurately. Widely applied in clinical, exercise, and rehabilitation settings, the scale enables healthcare providers to gauge a patient's perceived breathlessness, adjust treatment, and monitor symptom changes over time.	8 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Qurat ul Ain, MS, Riphah International University

Publications and helpful links

Helpful Links

• The diagnosis and treatment of COPD and its comorbidities
• COPD. Do the right thing
• The impact of age on prevalence of anxiety, depression and stress in patients with chronic obstructive pulmonary disease.
• How to use peak expiratory flow rate.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2025
• Primary Completion (Actual): October 1, 2025
• Study Completion (Actual): October 1, 2025

Study Registration Dates

• First Submitted: March 16, 2026
• First Submitted That Met QC Criteria: March 27, 2026
• First Posted (Actual): April 1, 2026

Study Record Updates

• Last Update Posted (Actual): April 1, 2026
• Last Update Submitted That Met QC Criteria: March 27, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: COPD; comparison; Breathing techniques; Box Breathing; Wim Hoff; Mild COPD
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pathological Conditions, Signs and Symptoms; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: REC/RCR & AHS/24/0378 Muntaha

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No