Take A Breather –Physiological Correlates Of A Conscious Connected Breathing Session In A Trained Group Of Breast Cancer Patients

Take A Breather –Physiological Correlates Of A Conscious Connected Breathing Session In A Trained Group Of Breast Cancer Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Take A Breather –Physiological Correlates Of A Conscious Connected Breathing Session In A Trained Group Of Breast Cancer Patients Alicja Heyda, Agnieszka Gdowicz-Kłosok, Magdalena Bugowska, Marcela Krzempek, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6626599/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Stress and negative emotions have been demonstrated to exert a substantial impact on cancer patients, affecting their ability to adapt to therapy and the treatment's overall effectiveness. Elevated cortisol levels, a stress-induced hormone, have been shown to suppress immune system function, potentially reducing the body's capacity to combat cancer cells. Conversely, prolactin, a hormone that stimulates the immune system, has demonstrated potential in this context but requires further study. Goal The objective of this study was to investigate the physiological changes that occur during the Conscious Connected Breathing (CCB) session, as part of a larger study. The main objective was to create a new form of integrative psychosomatic intervention, called Integrative Breathwork Psychotherapy (IBP), suitable for cancer patients that would improve both their psychosomatic and immune status. Method Of all eligible consecutive breast cancer patients hospitalised for post-operative radiotherapy who were invited to participate in the study, 77 patients took part in the study (experimental group – 48 pts, controls – 29 pts, response rate: 62%). IBP had a small open group setting (up to six participants). It included ten sessions in a small open group setting, three meetings a week. Each meeting consisted of a 45-minute breathwork session (CCB – rhythmic circular breathing through the nose, deeper than usual, without breath holding) in the state of acceptance followed by free emotional expression. Patients were encouraged to exercise 15 minutes daily on the other days of the week and after the programme was completed. The factors analysed were white blood cells, lymphocyte counts, IgA, serum prolactin and cortisol concentration, arterialised capillary blood gasometry. IgA, hormone and gasometry measures were taken before the 10th session and after 30 min (2/3 of the session) when the patients gained experience and practised correctly. Results During the CCB session, the gasometry showed significant change indicating slight overbreathing pattern, including decreases in pCO 2 (P=0.003), pO 2 (P<0.001), CH + (P<0.001), ctO 2 (P<0.001), COHb (P=0.03), and HHb (P=0.004) alongside an increase in pH (P<0.001). Additionally, prolactin level increased (P<0.001), while cortisol (P<0.001) and IgA (P<0.001) decreased. Conclusion This study is the first to analyze changes in capillary blood gas levels and hormonal balance during Conscious Connected Breathing sessions, revealing its immunostimulatory effects. The observed improvements in endocrine, immune, and respiratory-circulatory functions suggest breathwork could be a valuable complementary therapy for cancer patients. Further research is needed to explore the mechanisms involved and assess long-term psychological and immunological impacts. Biological sciences/Cancer Biological sciences/Immunology Biological sciences/Psychology Health sciences/Oncology breast cancer Integrative Breathwork Psychotherapy Conscious Connected Breathing immunostimulation cortisol prolactin Figures Figure 1 Figure 2 Figure 3 1. Introduction High stress level and negative emotions negatively impact treatment of patients with malignant tumor. Effective psychosomatic interventions has proven to prevent depression, reduce therapy related pain and fatigue, and boost patients' psychological resilience. Patients who adopt these techniques often feel more in control of their health and experience significant improvements in mental well-being. This holistic approach, combining psychological and physiological elements, highlights the interconnected nature of these dimensions, where progress in one area fosters positive changes in others. Breathing is an activity that we often do without consciously thinking about it. Techniques that encourage mindful breathing are available to everyone, regardless of age, gender or state of health. They require no special equipment or environment, making them easy to learn and very practical in use. These methods have significant therapeutic potential and are recommended for inclusion in clinical practice. Our research emphasizes the need to raise public awareness of the benefits of psychotherapeutic methods such as conscious breathing. The effectiveness beyond placebo effects and their role as a valuable adjunct to cancer treatment should be stressed. A number of studies have been conducted on the stress-reducing effect of rhythmic breathing. These findings suggest a beneficial effect on the endocrine, immune, and nervous systems. It has been established that voluntary regulation of breathing impacts interoceptive communication and emotion regulation (Boiten et al., 1994 ; Homma & Masaoka, 2008 ). There is a reciprocal relationship between breathing patterns and emotions, with intense emotions disrupting regular breathing and, in some cases, leading to apnea. Slow, deep breathing has been shown to synchronize with limbic system activity during memory recall (Masaoka et al., 2012 ). The practice of breathing exercises has been demonstrated to modify body-to-nervous system signals, thereby impacting emotional processing, social interaction, decision-making, and cognitive functions (Gerbarg&Brown, 2024 ). Autonomic nervous system dysfunction has been associated with a range of psychiatric disorders, including anxiety, depression, PTSD, and more. Regulated breathing practices have been shown to improve symptoms of these conditions by influencing the 10th cranial nerve, which connects to all organs and glands (Gerbarg&Brown, 2016 ). Breathwork helps to balance the parasympathetic and sympathetic branches, enhancing stress resilience and reducing psychological and physical symptoms (Gerbarg&Brown, 2024 ). While slow breathing practices have been extensively researched, intense deep breathwork, despite its historical use in Yoga, Taoism, Buddhism, and modern wellness, remains less studied. These practices, renowned for their swift effects and potential health benefits, have yet to be extensively studied scientifically (Zaccaro et al., 2018 ; Shao et al., 2024 ). A growing body of research has demonstrated the efficacy of methods incorporating deep connected (circular) breathwork, such as Conscious Connected Breathing (CCB) and Sudarshan Kriya Yoga (SKY), in promoting beneficial emotional, immunomodulatory, and anti-inflammatory effects. Specifically, CCB training has been associated with enhanced self-esteem, improved mood, and augmented internal locus of control (Rubin, 1983 ). Additionally, a reduction in depression and anxiety (Heyda, 2003 ), an increase in joy and satisfaction, a significant decrease in anger, and a comprehensive reduction in anxiety across all domains, including motoric, physiological, and cognitive aspects has been observed. Furthermore, the studies noted a 70% reduction in alcohol relapse rates (Rajski, 2002, Tabugan et al. 2025 ), enhanced outcomes in eating disorders (Reggios, 1985 ), and the induction of a blissful and altered state, accompanied by positive psychedelic experiences and altered brain waves (Bahi et al., 2024 ). The practice of Sudarshan Kriya Yoga has been shown to reduce symptoms of PTSD (Vasudev et al., 2020), pain, and cortisol, which is a common stress marker (Kumar et al., 2013 ). It has also been associated with a reduction in anxiety and depression (Sharma et al., 2015). The practice has also been shown to positively affect cardiac autonomic tone (Kharya et al. 2014), brain waves (Chandra et al., 2017), immunity by increasing the number of natural killer cells (Kochupillai et al., 2005 ), antioxidant status, and gene expression (Sharma et al., 2003 ; Sharma et al, 2008 ). There is only limited research on the subject of what exactly is happening during a breathwork session that includes deep circular breathing. The first known study of CCB session physiology by Rubin (1985) showed several physiological effects of a 35-minute session in two subjects who were instructed to breathe fully and deeply, one breath after another. Three measurements of physiological functions were taken: before, during and after the CCB session. Total exhalation volume, end-tidal O 2 , end-tidal CO 2 , pulse volume, pulse propagation time, interbeat interval (HRV), skin potential and electromyogram (EMG) were measured every 5 minutes. In both cases, the volume of air and the end-tidal volume of CO 2 increased significantly during the session. During rest after the breathing session, the results did not show an increase in the volume of air inhaled. The percentage of oxygen and carbon dioxide during and after the session showed that CCB, in addition to breathing more air, also changes its processing. The changes in end-tidal CO₂ (etCO 2 ) and etO 2 were significant, but differed in two subjects. The less experienced person showed a pattern of hyperventilation, while the other with more experience retained more CO 2 . Two subjects examined experienced an increase in pulse volume during breathwork, which was indicated by the extension of the blood vessels. The author stated that the changes in the interval between beats were slight or flat, indicating that the increase in blood volume is not attributable to a faster heartbeat. The heartbeat had slightly accelerated or remained at the pretreatment level, suggesting that increased blood flow could not be attributed to the accelerated heartbeat. The author suggests that the heart worked more efficiently at the end of the session and during the rest period. Other physiological measurements showed significant changes. In both cases, the SPR (Skin Potential Response) reached its highest point at the end of the session. The EMG showed increased muscle tension during the CCB session and a significant decrease in muscle tension during rest afterward and to the pre-session level. A comprehensive study involving 61 practitioners showed that active breathing techniques significantly reduced end-tidal CO 2 (etCO 2 ) levels in people who breathed vs. people who breathed passively. The study monitored both holotropic breathwork and consciously connected breathwork sessions and observed a trend of decreasing CO 2 levels during the initial part of the session. The study showed that the lowered etCO₂ levels played a key role in facilitating the participants' altered states of consciousness, which were analogous to those induced by moderate doses of psychedelics. The depth of the experience remained elevated even after the CO₂ levels returned to normal. Furthermore, the study showed a significant improvement in the participants' mood and a reduction in depressive symptoms after the sessions, as well as a reduction in sympathetic nervous system activity. These findings indicate that both Holotropic Breathwork® and Consciously-Connected breathwork elicit comparable physiological and psychological outcomes, thus highlighting the potential therapeutic applications of breath as a non-pharmacological intervention in mental health treatment (Havenith et al. 2024 preprint). Studies by Sharma et al. ( 2003 ), Vedamurthachar et al. ( 2006 ), Kamei et al. ( 2001 ) and Kochupillai et al. ( 2005 ) of yogic deep breathing showed important and promising changes in physiological correlates of stress, oxidative and endocrine status, and immunomodulation. Sharma et al. ( 2003 ) subjected 24 police officers to regular Sudarshan Kriya Yoga training, of similar age and socioeconomic status, who were randomly assigned to two groups. The experimental group practiced SKY regularly for five months. Before starting practicing, physiological correlates of stress were measured in both groups: blood lactic acid levels (the higher the exertion and stress) and levels of antiradical enzymes: glutathione (GSH), catalase, and superoxide dismutase (SOD). After five months, all these parameters were measured again, and the experimental group was tested during a breathing session. and the control group at the same time during a rest period. The results showed significantly lower levels of lactic acid in the blood of SKY exercisers, before, during, and after the session, and similarly: statistically higher levels of SOD, glutathione, and catalase. Chronic stress triggers cortisol release, weakening the immune system and leading to persistent inflammation. Since 1863, researchers have linked inflammation to cancer progression, as tumor cells secrete cytokines and chemokines like TNF, IL-1, and IL-6, which promote growth. Breaking this cycle could be key to mitigating its harmful effects (Balkwill et al. 2001,Koong et al. 2000 ). A therapeutic intervention reduces cortisol levels while stimulating prolactin production has the potential to not only mitigate stress and enhance well-being but also fortify the immune system's capacity to combat cancer cells. 2. Materials and methods 2.1 Clinical Materials The research material consisted of blood samples. from patients treated with adjuvant post-operative radiotherapy because of stage I-III breast cancer at the Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice between 2006 and 2008. Additionally 73% of them received chemotherapy and 65% received hormonal therapy. Participation in the study was offered to all patients admitted to the unit who met the eligibility criteria (Table 1). Patient eligibility criteria for the study Breast cancer patients who met the following inclusion criteria, eligible for retrospective analysis: 1. Histopathologically confirmed breast cancer. 2. Status after previous surgical treatment. 3. No prior treatment for another malignancy. 4. No concurrent malignancies diagnosed at the same time as breast cancer and during the patient's follow-up. 5. Patient performance status 0-1 on the ZUBROD scale. 6. Patients over 18 years of age. Criteria for exclusion of patients from the study 1. Failure to meet any of the eligibility criteria. 2. Pregnancy. 3. Metastatic breast cancer. 4. Comorbidities that may interfere with the evaluation of study parameters, i.e. chronic obstructive pulmonary disease, ischemic heart disease, renal disease, alcohol and drug addiction, anorexia and bulimia, schizophrenia, Parkinson's disease, Alzheimer's disease, disability, dementia, advanced atherosclerosis, organic and post-traumatic brain damage. 5. Age > 70 years> do tabeli Fifty six patients (60%) out of 93 agreed to participate in the study (60%). Cases excluded from the analysis included: metastases detected during treatment (two patients in the experimental group), - cases in which the number of NK cells could not be counted, or patients who did not appear at the last examination at the last visit (five patients in the experimental group). - the patients who withdrew during the study (two cases in the experimental group). A total of 48 patients were included in the analysis. The characteristics of the study group are shown in Table 1. Characteristic Patients (n=48) Age – mean (range) 53 (38–68) Education n(%) Primary Vocational Secondary Higher 9 (19) 9 (19) 19 (39) 11 (23) Social status n(%) Married Divorced Widowed Single 34 (71) 1 (2) 9 (19) 4 (8) Smoking status n(%) Yes No 9 (19) 39 (81) Type of treatment Surgical treatment n(%) Mastectomy 25 (52) Conservative Surgery 23 (48) Chemiotherapy n(%) Adjuvant 19 (40) Neoadjuvant 16 (33) Hormonal therapy n(%) 31 (65) Area of radiotherapy n(%) Breast or chest wall with scar 25 (52) Breast/chest + axilla 3 (6) Breast/chest + axilla + supraclavicular 20 (42) Radiation dose n(%) 45 Gy/18 fx 9 (19) 50 Gy/25 fx 39 (81) Additional boost to the surgical bed (10 Gy) 15 (31) Receptors status ER status n(%) Negative 1 + 2 ++ 3 +++ No data 15 (31) 9 (19) 14 (29) 9 (19) 1 (2) PR status n(%) Negative 1 + 2 ++ 3 +++ No data 17 (35) 9 (19) 11 (23) 9 (19) 2 (4) HER status n(%) Negative 1 + 2 ++ 3 +++ No data 18 (38) 14 (29) 4 (8) 3 (6) 9 (19) Abbreviations: ER – Estrogen receptor, PR – Progesterone receptor, HER – Human epidermal growth factor receptor 2 (HER2). The designation +++; ++; + – is the level of receptor expression, which indicates the hormone-dependence of the tumor. Table 1. Characteristics of the study group. 2.2 Procedure The study was carried out after receiving approval from the bioethics committee. Informed consent was obtained from all participants. Integrative Breathwork Psychotherapy (IBP) consisted of 10 sessions three times a week. The CCB breathwork session lasted 45 minutes, followed by 15 minutes of free emotional expression. On other days, patients practiced CCB for 15 minutes with the psychotherapist or by themselv alone. Classes were held in small groups (up to six people) see: Figure 1. IBP combines intensive breathwork training and the state of mindfulness followed by free emotional expression. Breathwork session is followed by verbal process-based expression. Patients communicate their feelings and give them their own meaning. Patients are supported to maintain non-judgemental mindfulness during any kind of experience while breathing. Conscious Connected Breathing (CCB) includes taking moderately deep breaths, deeper than usual; one after another, without pausing, rhythmically, drawing air into the upper lungs. The exhalation is completely relaxed, the air leaves the lungs without any effort: pushing, dividing the exhalation into parts, or holding back. Breathing was performed through the nasal respiratory passage. Before starting IBP, patients received information on the experience of the specifics of the breathwork session, including possible temporary tingling, slight sleepiness, and emotional experiences. Integrative Breathwork Psychotherapy session: After an approximately 3-minute process of calming the breath and relaxing the muscles, the practitioner begins to breathe rhythmically CCB described above. Proper breathing during subsequent breathwork sessions was guided by an experienced breathworker and certified psychotherapist. The therapist helped reach an elemental mindfulness state during the breathwork session, focus, and allow emotions and thoughts to flow freely without attaching or pushing them away. No specific suggestions were made about the origins of session sensations. The patients received emotional support to allow them to open to new experiences and feel safe. Data Collection: Patients in the experimental group participated in an intensive cycle of IBP as a part of a larger study. The first measurement was taken at rest before the start of session no. 10. The second measurement was taken only at the 30th minute of the breathing session in the experimental group. All blood samples were taken at the same hour due to fluctuations in diurnal cortisol. The second measurement was taken at the 30th minute of the breathing session. The blood collected was transferred to the laboratory immediately after sampling. Measurement no. (time) Physiological variables I (at rest, 15 min before session no. 10) Arterialised capillary blood gasometry: pO 2 , pCO 2 , pH, cH + , cHCO 3 , BE, BB, sO 2 , ctO 2 , MetHb, COHb, O 2 Hb, HHb Cortisol and prolactin concentrations IgA II (at 30 minutes into session no. 10) Same as above Table 2. Table including measuring biological variables in the experimental group. 2.3 Analytical methods The concentration of IgA, prolactin, and cortisol was determined in blood serum. Blood was obtained in standard conditions, patients in fasting state, between 7.00 – 9.00 o’clock, using a vacuum Becton–Dickinson system, to sample tubes without anticoagulant. Samples obtained after centrifugation at 3000 rotations/min for 10 min. at the temperature. 4 0 C were analyzed on the same day. IgA concentration was determined by nephelometric immunoassay, using the Atelica analyzer and commercial kit analyzer from Siemens Healthcare. The concentration of cortisol was determined by means of chemiluminescent immunoassay (CLIA)) using the reagent kits Siemens Healthcare and Immulite 2000 i reagent kits. The concentration of prolactin was determined by chemiluminescent microparticle immunoassay (CMIA), using an Atelica analyzer and commercial kit analyzer from Abbott Laboratories. CBC analysis was performed using a Sysmex XN-2000 hematology analyzer. Sysmex XN-2000 is a multiparameter blood cell counter. To count blood cells, the auto-machine uses an impedance principle. The impedance principle uses a constant electric current that is passed through a blood sample and a reagent solution to determine the changes in electrical resistance that occur when blood cells pass through the detection aperture. To keep the quality of the CBC analyzer in the commercially prepared known blood samples (normal, low and high), background checks and machine maintenance were performed according to the manufacturer’s instructions and as per the clinical laboratory institute. This study aimed to qualify blood gas parameters (pH, pCO 2 , pO 2 ), electrolytes (Na + , K + ), ionized calcium (Ca 2+ ), metabolites (glucose, lactate), and oximetry parameters (tHb, O 2 Hb, COHb, MetHb). Using the Cobas b221 analyzer, pH, pCO 2 , Na + , K + , Ca 2+ are measured using potentiometry methods, pO 2 , glucose and lactate using amperomerty method. tHb, O 2 Hb, COHb, MetHb are measured by spectrophotometry in capillary blood. 2.4 Statistical analysis Continuous variables are presented as means with standard deviation, with normality assessed using the Shapiro–Wilk test. Prior to analysis, data were log-transformed to approximate normal distribution and stabilize variance, except for variables already expressed as logarithms (e.g., pH) and percentages. To compare pre- and post-IBP session measurements, paired t -tests were conducted. The magnitude of the differences observed between time points was quantified using Cohen’s d for effect size. For multiple comparisons, the False Discovery Rate (FDR) correction was applied using the Benjamini–Hochberg method to control for Type I error. All statistical analyses were performed using R software (version 4.4.1; R Foundation for Statistical Computing, "http://www.r-project.org/"). A two-sided P≤0.05 was considered statistically significant.. A two-sided P≤0.05 was considered statistically significant. 3. Results Table 3 presents the results of the assessed parameters, grouped into two categories: hormonal and immune markers (cortisol, prolactin, and IgA), and gasometric parameters (pH, pCO₂, pO₂, base excess, and other oxygen-related variables). Boxplots in Figure 2 illustrates the changes in these parameters, highlighting individual data points before and after the IBP sessions, along with the direction of change for each patient. Measure I (n=48) Measure II (n=48) Mean ± SD Mean ± SD P value adjusted Effect size (95%CI) Effect size interpretation Direction change Hormonal and Immune Markers Cortisol 9.6 ± 3.2 8.4 ± 3.5 <0.001 -0.59 (-1 to -0.29) medium ↓ Prolactin 9.3 ± 5.1 11.5 ± 6.4 <0.001 0.54 (0.33 to 0.76) medium ↑ IgA 2.6 ± 1.2 2.51 ± 1.2 <0.001 -0.56 (-0.88 to -0.32) medium ↓ Gasometry pH 7.4 ± 0 7.5 ± 0 <0.001 0.64 (0.39 to 0.91) medium ↑ pO 2 74.1 ± 6.2 69.4 ± 7.6 <0.001 -0.57 (-0.89 to -0.31) medium ↓ pCO 2 37.7 ± 3.8 35.9 ± 4.6 0.003 -0.45 (-0.72 to -0.19) small ↓ BB 48 ± 1.8 48.2 ± 1.6 0.058 0.28 (-0.03 to 0.6) small ↔ BE 0.6± 1.7 1.1 ± 1.5 <0.001 0.51 (0.25 to 0.84) medium ↑ sO 2 95.6 ± 1.9 94.9 ± 2.5 0.088 -0.25 (-0.64 to -0.01) small ↔ cH + 36.9 ± 2 35 ± 3 <0.001 -0.66 (-0.94 to -0.42) medium ↓ ctO 2 17.7 ± 1.4 16.9 ± 1.4 <0.001 -0.6 (-0.9 to -0.31) medium ↓ cHCO 3 24.6 ± 2.1 24.6 ± 1.9 0.984 0 (-0.28 to 0.3) negligible ↔ ctHb 13.4 ± 1 12.9 ± 1 0.001 -0.5 (-0.85 to -0.24) medium ↓ HHb 4.1 ± 1 5 ± 2.5 0.004 0.44 (0.16 to 0.8) small ↑ O 2 Hb 93.6 ± 1.4 92.7 ± 2.7 0.011 -0.38 (-0.75 to -0.19) small ↓ MetHb 0.5 ± 0.2 0.5 ± 0.2 0.195 0.19 (-0.1 to 0.5) small ↔ COHb 1.8 ± 0.7 1.7 ± 0.7 0.03 -0.32 (-0.68 to -0.03) small ↓ Effect size interpretation in accordance with Rules of thumb on magnitudes of effect sizes. Retrieved March 12, 2025, from https://imaging.mrc-cbu.cam.ac.uk/statswiki/FAQ/effectSize Abbreviations: SD – standard deviation Table 3. Characteristics of parameters before and after IBP intervention. 3.1. Hormonal and Immune Markers Cortisol level was significantly reduced after the IBP sessions (P<0.001; d =-0.59; 95% CI: -1 to -0.29), whereas prolactin level demonstrated a notable increase (P<0.001; d =0.54; 95% CI: 0.33 to 0.76). A significant decrease in IgA levels was also observed (P<0.001; d =-0.56; 95% CI: -0.88 to -0.32). These findings are presented in Figure 2A. 3.2. Gasometry Subsequent to the conclusion (?) of the IBP session, substantial alterations were detected in multiple blood gas parameters. A statistically significant increase was observed in blood pH (P<0.001; d=0.64; 95%CI: 0.39 to 0.91), base excess (BE, P<0.001; d=0.51; 95%CI: 0.25 to 0.84), and deoxygenated hemoglobin concentration (HHb, P=0.004; d=0.44; 95%CI: 0.16 to 0.8). Concurrently, a substantial decline in the partial pressure of oxygen (pO2, P<0.001; d=-0.57; 95%CI: -0.89 to -0.31) and the partial pressure of carbon dioxide (pCO2, P=0.003; d=-0.45; 95%CI: -0.72 to -0.19), hydrogen ion concentration (cH+, P<0.001; d=-0.66; 95%CI: -0.94 to -0.42), and total blood oxygen content (ctO2, P<0.001; d=-0.6; 95%CI: -0.9 to -0.31), total hemoglobin content (ctHb, P=0.001; d=-0.5; 95%CI: -0.85 to -0.24), and hemoglobin oxygen saturation (O2Hb, P=0.011; d=-0.38; 95%CI: The obtained results suggest that IBP sessions have a significant impact on acid-base balance and blood gas exchange, which may indicate adaptive changes in the physiology of the body in response to the intervention used. The interpretation of these changes necessitates further research to ascertain their potential mechanisms and consequences for bodily function. No significant changes were observed in BB, sO 2 , cHCO 3 and MetHb. These results are illustrated in Figure 2B 4. Discussion The utilization of breathing techniques as a therapeutic modality is of paramount importance for individuals diagnosed with cancer. The research approach employed by our group is distinctive in its unique focus on the physiological significance of breathing therapy. The accessibility and simplicity of conscious breathing techniques have been demonstrated to reduce stress, fatigue, and treatment-related pain. Furthermore, it has been demonstrated to enhance psychological well-being, thereby reinforcing patients' sense of autonomy in managing their health. We posit that these techniques serve as a valuable complement to oncological therapy by integrating the psychological and physiological dimensions, thus improving the overall quality of life of patients undergoing treatment. One of the most important factors that contribute to poorer treatment outcomes in cancer patients is chronic stress and the subsequent stress caused by cancer diagnosis and the therapy used (Lutgendorf and Andersen, 2015). Chronic stress activates the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is one of the main adaptive mechanisms in response to stress. When cortisol levels increase, it acts on the hypothalamus and pituitary in a feedback mechanism that prevents excessive activation of the HPA axis. Chronic stress has been shown to disrupt this system, resulting in its hyperactivation or dysregulation. The secretion of stress hormones, including catecholamines (noradrenaline and epinephrine) and cortisol, has been shown to modulate the immune response at both the level of immune cells, such as T lymphocytes and macrophages, and within tumor cells (Armaiz-Pena et al., 2013; Colon-Echevarria et al., 2019). In mouse models of ovarian cancer, chronic stress has been shown to lead to tumor-associated inflammatory processes and disease progression (Armaiz-Pena et al., 2015; Colon-Echevarria et al., 2020). In cancer patients, behavioral disorders such as stress, depression, and anxiety have been demonstrated to induce systemic, tumor-related immunosuppression (Andersen et al., 1998; Blomberg et al., 2009; Thornton et al., 2007). For example, elevated levels of perceived stress have been associated with decreased cytokine production by Th1/Th2 lymphocytes, decreased T cell proliferation, and diminished activity of tumor-infiltrating lymphocytes (Andersen et al., 1998; Blomberg et al., 2009; Lutgendorf et al., 2008; Thornton et al., 2007). Stress has long been established to be a contributing factor to the development of inflammation. The release of cortisol, which is triggered by stress, acts as an inhibitor of the immune system. Chronic stress results in the generation of chronic inflammation within the body. As early as 1863, Rudolf Virchow posited that the presence of leukocytes in tumor tissue is associated with chronic inflammation and promotes cancer progression (Balkwill et al. 2001). Cancer cells secrete inflammatory cytokines and chemokines that can directly contribute to tumor progression. Examples of such secreted factors include tumor necrosis factor (TNF), IL-1 and IL-6, and chemokines (Koong et al. 2000). It would be beneficial to ascertain whether it is possible to disrupt this closed circle. Chronic inflammation is a consequence of stress and there is evidence to suggest that inflammation may promote cancer progression Avoiding immune surveillance is a hallmark of cancer progression, but the role of the cortisol-pituitary hormone feedback loop in this process is still poorly understood. Cortisol, the primary endogenous glucocorticoid in humans, is secreted by the adrenal cortex in response to stress. Furthermore, cortisol and its inactive metabolite cortisone can undergo interconversion to further modulate the tissue-dependent effects of glucocorticoids (Schwarzlmuller et al. 2025). In recent years, evidence has emerged that the production of glucocorticoids by tumors, both by immune cells in the microenvironment and by tumor cells, supports immune evasion. This is achieved by activating immune checkpoints to promote autotolerance and prevent autoimmunity (Grywalska et al., 2019). Incorporation of checkpoint blockade has had a significant influence on treatment outcomes of patients with multiple solid malignancies, including lung cancer and melanoma (Sharma et al., 2021). At the opposite end of the scale is prolactin (PRL), a 23 kDa polypeptide hormone secreted primarily by pituitary gland lactotroph cells, which performs several functions, and its role in the regulation of immune and autoimmune responses remains not fully explained. The expression of PRL is not limited to the pituitary gland, but is present in various extrapituitary sites, including the ovary, placenta, mammary epithelium, endothelium, neurons, skin cells, spleen, bone marrow, adipose tissue, and prostate, each with a different molecular weight and biological activity (Borba et al. 2019, Buckley 2021, Angum et al. 2020). Secretion of PRL is primarily governed by hypothalamic inhibitory dopamine, with regulation occurring through negative feedback loops. In particular, PRL itself functions as an inhibitory signal, thereby contributing to a short-loop feedback mechanism. A significant function of PRL in the immune system is to stimulate the proliferation and differentiation of immune cells. PRL has been shown to promote the growth and activation of T lymphocytes, which are key components of the adaptive immune response (Alemán-Garca et al. 2021). Furthermore, PRL has been shown to support the maturation and functioning of B cells, increasing the production of immunoglobulins (Igs) (Borba et al. 2018, Alemán-Garca, R.M et al. 2021). The specific network of dependencies between prolactin and cortisol is shown in Figure 3. In the present study, it was shown that IBP therapy instigates substantial alterations in biochemical levels within the body. A notable decline in cortisol levels was observed, indicative of a concomitant reduction in stress levels (P<0.001; d =-0.59). A statistically significant increase in prolactin levels was recorded, potentially reflecting a positive effect of therapy on the endocrine system (P<0.001; d =0.54). Furthermore, a moderate significant decrease in IgA was detected, which may indicate an impact on the immune system or a temporary response to changes in the respiratory system due to intense breathwork (P<0.001; d =-0.56). These results confirm the effectiveness of IBP therapy in modulating selected stress response markers and potential therapeutic benefits, although further research is needed to better understand its impact. The findings of this study indicate that respiratory therapies play a pivotal role in stress reduction, given their ability to regulate the nervous, immune, and endocrine systems, thereby facilitating the restoration of emotional balance. Kamei et al. (2001) conducted a study on eight yoga instructors while they performed three types of exercises: asanas (physical exercises), pranayama (breathing exercises) and meditation. During the exercises, the researchers measured brain activity (EEG) and Natural Killer (NK) activity, the main cells that destroy cancer cells. It was observed that during all exercises, alpha activity corresponding to relaxation was present, and this is often induced in biofeedback exercises to promote wound healing, pain management, and relaxation. In particular, NK cell activity exhibited a significant increase exclusively during the pranayama phase of breathing exercises, which are frequently used in biofeedback practices to facilitate wound healing, manage pain, and promote relaxation. The authors of this study hypothesize that the effect of increased Natural Killer cell count is related to alpha activity, which often occurs in relaxation and meditation. A strong correlation between increased NK activity and alpha activity was found (P<0.2, r=0.83). Furthermore, cancer patients who had undergone standard treatment and had completed the Sudarshan Kriya yoga training exhibited a significant increase in their NK cell count (P<0.001) within 12 to 24 weeks of treatment compared to their baseline levels. The increase in NK cell count after 24 weeks was significant (P<0.05) when compared to the control group. No significant impact on T lymphocyte subgroups was observed in either the test or control group. Furthermore, incorporation of respiratory practices alongside tobacco use exhibited a 21% success rate in terms of achieving control over a period of up to six months of observation. (Kochupillai et al., 2005) The World Health Organization (WHO) has identified stress as a contributing factor to many diseases that can be classified as "diseases of civilization" (Prüss-Ustün et al., WHO 2016). Considering the current global mental health crisis and the numerous obstacles that make it difficult to access psychotherapy, there is an urgent need for easily accessible and implementable methods such as breath work. The provision of breathwork exercises can be performed in a straightforward manner, either as a standalone activity or as part of a group session. One of the effects of chronic stress is a significant increase in the level of cortisol in the blood. Cortisol, commonly referred to as the stress hormone, functions as an immune system inhibitor (Mavoungou et al. 2004). The endocrine system plays a key role in regulating the components of the immune system. Natural Killer cells represent a pivotal component of the anticancer immune response. The capacity of these cells to induce a cytotoxic response against neoplastic cells depends on the level of expression of surface activating receptors such as NKp46 and NKp30. Research has shown that the expression of these receptors is modulated by hormonal factors, with prolactin increasing and cortisol decreasing their expression. The activation or inhibition of the surface expression of the natural cytotoxicity receptor (NCR) by prolactin and cortisol, respectively, reflects gene regulation at the transcriptional level (Mavoungou et al., 2004). Consequently, there is an urgent need to identify the fundamental mechanisms that promote tumor-associated inflammation, which may contribute to an inadequate response to checkpoint blockade and subsequent resistance. Recent findings have revealed a novel aspect of tumor immune suppression, namely local steroid production and metabolism, which may offer novel therapeutic interventions. Strategic targeting of steroid hormones to enhance anticancer therapies holds promise for increasing their efficacy. Alterations in blood gas parameters, such as those analyzed in this study, can be significant in the context of tumors, particularly with regard to the metabolism of tumor cells and their microenvironment. In the present analysis, increases in blood pH, BE, and HHb were observed. An elevated blood pH suggests an improvement in acid-base balance, indicating lower blood acidity. During the IBP session BE (Base Excess) exhibited an increase, suggesting a potential decline in blood acidity. Additionally, reductions in pCO 2 (partial pressure of carbon dioxide) and cH+ (concentration of hydrogen ions) also point to this shift. In the context of cancer, this phenomenon is particularly significant, as cancer cells frequently exhibit an altered metabolism (Warburg effect), resulting in acidification of the microenvironment. Changes in the microenvironment have the potential to affect the proliferation of cancer cells, their capacity for invasion, and their response to therapy. The increase in deoxygenated hemoglobin (HHb) may be attributable to the adaptation of the circulatory system to fluctuating respiratory conditions. On the contrary, a decrease in O 2 Hb (oxygenated hemoglobin) and COHb (carboxyhemoglobin) suggests alterations in oxygenation and respiratory gas metabolism. Furthermore, reductions in pO 2 (partial oxygen pressure) and ctO 2 (total oxygen content) may indicate a lower oxygen level in the bloodstream. BB (buffer base), sO 2 (oxygen saturation), cHCO3 (bicarbonate), and MetHb (methemoglobin) parameters did not show significant alterations, suggesting stability despite respiratory intervention. This stability may imply that the regulatory mechanisms maintain an internal balance, a finding that could be advantageous in the treatment of cancer patients. A comprehensive study revealed that active breathing techniques significantly lowered etCO 2 levels, with participants showing an average of 22.4 ± 0.8 mmHg compared to 36.7 ± 1.5 mmHg in subjects who breathed passively. Researchers observed both Holotropic Breathwork and Conscious Connected Breathing sessions, noting that CO 2 levels typically decreased during the early portion of each session, reaching as low as 16.6 ± 0.8 mmHg in active breathers while passive breathers maintained levels of 33.6 ± 1.5 mmHg. The research demonstrated that this reduction in etCO 2 was crucial for inducing altered consciousness states similar to those experienced with moderate psychedelic doses. Notably, participants continued to experience elevated states even after CO 2 levels normalized. The sessions also produced significant mood improvements, reduced depressive symptoms, and decreased sympathetic nervous system activity. These outcomes suggest that both Holotropic Breathwork® and Consciously Connected Breathwork produce similar physiological and psychological benefits, highlighting breathing's potential as a non-drug therapeutic approach for mental health treatment (Havenith et al. preprint 2024). Our analysis demonstrates that IBP therapy reduces the level of immunosuppressive cortisol (reducing stress) and increases the level of prolactin, which supports the endocrine and immune systems, stimulates the proliferation and activation of immune cells, increases antibody production, and acts in opposition to cortisol. Regular breathwork exercises have been shown to enhance NK cell activity (Kamei et al, 2001, Kochupillai, 2005), thus bolstering the immune system's anticancer response. Furthermore, alterations in the tumor microenvironment, such as elevated blood pH and reduced acidity, can impede tumor cell proliferation and enhance response to therapy. Simple stress management techniques, such as conscious breathing exercises, are essential for a wide range of cancer patients, especially during periods of mental health crisis. The presented study demonstrate that the implementation of diverse therapeutic approaches can facilitate stress reduction, exert an immunostimulatory effect, and modify the tumor microenvironment, thereby impacting the overall balance and the effectiveness of treatment. 5. Conclusion The present study constitutes a pioneering analysis of alterations in capillary blood gas levels and hormonal changes during Conscious Connected Breathing sessions. This study offers novel insights, demonstrating for the first time alterations in hormonal equilibrium that are associated with the immunostimulatory effects of deep breathing. The significant positive changes in the functioning of the endocrine, immune, and respiratory-circulatory systems that our group observed in such a brief period during breathwork suggest that this type of therapy has a substantial impact when used as a complementary therapy in cancer patients. To further elucidate the therapeutic mechanisms underlying these observations, additional research is necessary, including the enrollment of larger patient cohorts and the analysis of the long-term impact of breathing therapy on psychological and immunological responses Declarations Acknowledgment: The work of M.B. was funded by Medical Research Agency (grant no. 2023/ABM/02/00011). Acknowledgments: We would like to express our gratitude to Dr. Tomasz Rutkowski for his expert support. Conflicts of Interest: The authors declare no conflict of interest. Ethical Declaration: The authors declare that the use of samples from breast cancer patients CONFIRMS that all experiments were conducted in accordance with the relevant guidelines and regulations. The authors confirm that all methods were performed in accordance with the relevant guidelines and regulations. The authors confirm that all experimental protocols were approved by the Bioethics Committee of the M. Skłodowska-Curie Institute of Oncology, Gliwice Branch, on September 1, 2005 (A scanned copy of the consent form has been sent to the editorial office) Final remarks: Alldata (anonymized) is available from the authors and can be shared with anyone who's interested. To access the data, please send your request to dr Alicja Heyda at [email protected] . References Boiten, F. A., Frijda, N. H. & Wientjes, C. J. Emotions and respiratory patterns: review and critical analysis. Int J Psychophysiol. ;17(2):103 – 28. (1994). 10.1016/0167-8760(94)90027-2 . PMID: 7995774. Homma, I. & Masaoka, Y. Breathing rhythms and emotions. Exp. Physiol. 93 (9), 1011–1021. 10.1113/expphysiol.2008.042424 (2008). Epub 2008 May 16. PMID: 18487316. Masaoka, Y., Sugiyama, H., Katayama, A., Kashiwagi, M. & Homma, I. Remembering the past with slow breathing associated with activity in the parahippocampus and amygdala. Neurosci. Lett. 521 (2), 98–103. 10.1016/j.neulet.2012.05.047 (2012). Epub 2012 Jun 2. PMID: 22668857. Gerbarg, P. L. & Brown, R. P. Breath-Focused Mind-Body Therapy for Global Mental Health: War and Other Mass Disasters. Academia Mental Health and Well-Being, 1 , 1, Acad. edu Journals , doi: 10.20935/MHealthWellB6198 . (2024). Gerbarg, P. L. & Brown, R. P. Neurobiology and neurophysiology of breath practices in psychiatric care. Psychiatric Times, 2016, 3.11: 22. (2016). Zaccaro, A. et al. How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Front. Hum. Neurosci. 12 , 353. 10.3389/fnhum.2018.00353 (2018). PMID: 30245619; PMCID: PMC6137615. Shao, R., Man, I. S. C. & Lee, T. M. C. The Effect of Slow-Paced Breathing on Cardiovascular and Emotion Functions: Meta-analysis and systematic review. Mindfulness 15 , 1–18. https://doi.org/10.1007/s12671-023-02294-2 (2024). Rubin, B. K. Cognitive, Affective, Affective, and Physiological Outcomes of the Rebirthing, part of doctoral dissertation, Washington, DC, American University. (1983). Heyda An Impact of Conscious Connected Breathing Training on Emotional States, The Healing Breath Journal – a. J. Breathwork Pract. Spiritual. Psychother. 5 (2), 9–18 (2003). Rajski, P., Alcoholism & Rebirthing Int. J. Advancement Counselling 24 , 123–136, https://doi.org/10.1023/A:1020963817447 (2002). Tabugan, D. C. et al. Novel Insights into Addiction Management: A Meta-Analysis on Intervention for Relapse Prevention. Medicina 61 (4), 619. https://doi.org/10.3390/medicina61040619 (2025). Reggios, F. -6, Des mots pour un corps, un corps pour des mots. Bull. de Psychologie Sep-Oct . 39 (16–18)[377]), 891–899 (1985). Bahi, C. et al. Effects of conscious connected breathing on cortical brain activity, mood,mood, and state of consciousness in healthy adults. Curr. Psychol. 43 , 10578–10589. https://doi.org/10.1007/s12144-023-05119-6 (2024). Vasudev, K. et al. Sudarshan Kriya Yoga Program in Posttraumatic Stress Disorder: A Feasibility Study. Int. J. Yoga . 13 (3), 239–246. 10.4103/ijoy.IJOY_16_20 (2020 Sep-Dec). Epub 2020 Sep 13. PMID: 33343155; PMCID: PMC7735495. Kumar, N. et al. Surajpal. Randomized Controlled Trial in Advance Stage Breast Cancer Patients for the Effectiveness on Stress Marker and Pain through Sudarshan Kriya and Pranayam. Indian J. Palliat. Care . 19 (3), 180–185. 10.4103/0973-1075.121537 (2013). PMID: 24347909; PMCID: PMC3853397. Sharma, P. et al. Rhythmic breathing: immunological, biochemical, and physiological effects on health. Adv. Mind Body Med. 29 (1), 18–25 (2015 Winter). PMID: 25607119. Kharya, C. et al. Effect of controlled breathing exercises on the psychological status and the cardiac autonomic tone: Sudarshan Kriya and Prana-Yoga. Indian J. Physiol. Pharmacol. 58 (3), 211–221 (2014 Jul-Sep). PMID: 25906603. Chandra, S., Jaiswal, A. K., Singh, R., Jha, D. & Mittal, A. P. Mental Stress: Neurophysiology and Its Regulation by Sudarshan Kriya Yoga. Int. J. Yoga . 10 (2), 67–72. 10.4103/0973-6131.205508 (2017 May-Aug). PMID: 28546676; PMCID: PMC5433115. Kochupillai, V. et al. Effect of rhythmic breathing (Sudarshan Kriya and Pranayam) on immune functions and tobacco addiction. Ann N Y Acad Sci. ;1056:242 – 52. (2005). 10.1196/annals.1352.039 . PMID: 16387692. Sharma, H. et al. Sudarshan Kriya practitioners exhibit better antioxidant status and lower blood lactate levels. Biol Psychol. ;63(3):281 – 91. (2003). 10.1016/s0301-0511(03)00071-1 . PMID: 12853172. Sharma, H. et al. Gene expression profiling in practitioners of Sudarshan Kriya. J Psychosom Res. ;64(2):213-8. (2008). 10.1016/j.jpsychores.2007.07.003 . PMID: 18222135. Havenith, M. et al. CO2 saturation during circular breathwork supports emergence of altered states of consciousness February 2024 10.21203/rs.3.rs-3976380/v1https://doi.org/10.21203/rs.3.rs-3976380/v1 Vedamurthachar, A. et al. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. J Affect Disord. ;94(1–3):249 – 53. (2006). 10.1016/j.jad.2006.04.025 . Epub 2006 Jun 5. PMID: 16740317. Kamei, T., Toriumi, Y., Kimura, H. & Kimura, K. Correlation between alpha rhythms and natural killer cell activity during yogic respiratory exercise. Stress Health: J. Int. Soc. Invest. Stress . 17 (3), 141–145 (2001). Balkwill, F. & Mantovani, A. Inflammation and cancer: back to Virchow? Lancet. ;357(9255):539 – 45. (2001). 10.1016/S0140-6736(00)04046-0 . PMID: 11229684. Koong, A. C. et al. Candidate genes for the hypoxic tumor phenotype. Cancer Res. 60 (4), 883–887 (2000). PMID: 10706099. Lutgendorf, S. K. & Andersen, B. L. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. Am Psychol. (2015). Feb-Mar;70(2):186 – 97 10.1037/a0035730 . PMID: 25730724; PMCID: PMC4347942. Armaiz-Pena, G. N., Cole, S. W., Lutgendorf, S. K. & Sood, A. K. Neuroendocrine influences on cancer progression. Brain Behav. Immun. 30 (Suppl(Suppl), S19–25. 10.1016/j.bbi.2012.06.005 (2013). Epub 2012 Jun 21. PMID: 22728325; PMCID: PMC3467346. Colon-Echevarria, C. B., Lamboy-Caraballo, R., Aquino-Acevedo, A. N. & Armaiz-Pena, G. N. Neuroendocrine Regulation of Tumor-Associated Immune Cells. Front. Oncol. 9 , 1077. 10.3389/fonc.2019.01077 (2019). PMID: 31737559; PMCID: PMC6828842. Armaiz-Pena, G. N. et al. Adrenergic regulation of monocyte chemotactic protein 1 leads to enhanced macrophage recruitment and ovarian carcinoma growth. Oncotarget 6 (6), 4266–4273. 10.18632/oncotarget.2887 (2015). PMID: 25738355; PMCID: PMC4414188. Colon-Echevarria, C. B. et al. Zoledronic Acid Abrogates Restraint Stress-Induced Macrophage Infiltration, PDGF-AA Expression, and Ovarian Cancer Growth. Cancers (Basel) . 12 (9), 2671. 10.3390/cancers12092671 (2020). PMID: 32962103; PMCID: PMC7563308. Andersen, B. L. et al. Stress and immune responses after surgical treatment for regional breast cancer. J. Natl. Cancer Inst. 90 (1), 30–36. 10.1093/jnci/90.1.30 (1998). PMID: 9428780; PMCID: PMC2743254. Blomberg, B. B. et al. Psychosocial adaptation and cellular immunity in breast cancer patients in the weeks after surgery: An exploratory study. J. Psychosom. Res. 67 (5), 369–376. 10.1016/j.jpsychores.2009.05.016 (2009). Epub 2009 Sep 24. PMID: 19837199; PMCID: PMC2764537. Thornton, L. M., Andersen, B. L., Crespin, T. R. & Carson, W. E. Individual trajectories in stress covary with immunity during recovery from cancer diagnosis and treatments. Brain Behav. Immun. 21 (2), 185–194. 10.1016/j.bbi.2006.06.007 (2007). Epub 2006 Sep 5. PMID: 16908118; PMCID: PMC2151213. Schwarzlmueller, P. et al. Steroid hormones as modulators of anti-tumoural immunity. Nat Rev Endocrinol. 2025 Mar 24. 10.1038/s41574-025-01102-2 . Epub ahead of print. PMID: 40128599. Grywalska, E., Sobstyl, M., Putowski, L. & Roliński, J. Current Possibilities of Gynecologic Cancer Treatment with the Use of Immune Checkpoint Inhibitors. Int. J. Mol. Sci. 20 (19), 4705. 10.3390/ijms20194705 (2019). PMID: 31547532; PMCID: PMC6801535. Sharma, A. & Gupta, P. Emotional intelligence, mindfulness and subjective well-being: A mediational analysis. Int. J. Indian Psychol. 9 , 1100–1107 (2021). Borba, V. V., Zandman-Goddard, G. & Shoenfeld, Y. Prolactin and autoimmunity: The hormone as an inflammatory cytokine. Best Pract Res Clin Endocrinol Metab. ;33(6):101324. (2019). 10.1016/j.beem.2019.101324 . Epub 2019 Sep 11. PMID: 31564625. Orbach, H. & Shoenfeld, Y. Hyperprolactinemia and autoimmune diseases. Autoimmun. rev. 6 (8), 537–542 (2007). Buckley, A. R. Prolactin, a lymphocyte growth and survival factor. Lupus. ;10(10):684 – 90. (2001). 10.1191/096120301717164912 . PMID: 11721694. Angum, F., Khan, T., Kaler, J., Siddiqui, L. & Hussain, A. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. Cureus 12 (5), e8094. 10.7759/cureus.8094 (2020). PMID: 32542149; PMCID: PMC7292717. 5. Borba, V. V., Zandman-Goddard, G., Shoenfeld, Y. & Prolactin Autoimmun. Front. Immunol. ; 9 :73. doi: 10.3389/fimmu.2018.00073 . (2018). PMID: 29483903; PMCID: PMC5816039. Alemán-García, Y. P. et al. Prolactin Increases the Frequency of Follicular T Helper Cells with Enhanced IL21 Secretion and OX40 Expression in Lupus-Prone MRL/lpr Mice. J. Immunol. Res. 2021 , 6630715. 10.1155/2021/6630715 (2021). PMID: 33763492; PMCID: PMC7963914. Prüss-Ustün et al. Preventing Disease through Healthy Environments, a global assessment of the burden of disease from environmental risks. WHO (2016). https://www.who.int/publications/i/item/9789241565196 Mavoungou, E., Bouyou-Akotet, M. K. & Kremsner, P. G. Effects of prolactin and cortisol on natural killer (NK) cell surface expression and function of human natural cytotoxicity receptors (NKp46, NKp44 and NKp30). Clin. Exp. Immunol. 139 (2), 287–296. 10.1111/j.1365-2249.2004.02686.x (2005). PMID: 15654827; PMCID: PMC1809301. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6626599","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":466270073,"identity":"14687c5c-2ee2-4faa-93f7-4ff1b0fcc9b6","order_by":0,"name":"Alicja Heyda","email":"","orcid":"","institution":"The Maria Sklodowska-Curie National Research Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Alicja","middleName":"","lastName":"Heyda","suffix":""},{"id":466270074,"identity":"9e537ae1-9762-4237-ae84-385581cc6bca","order_by":1,"name":"Agnieszka Gdowicz-Kłosok","email":"data:image/png;base64,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","orcid":"","institution":"The Maria Sklodowska-Curie National Research Institute of Oncology","correspondingAuthor":true,"prefix":"","firstName":"Agnieszka","middleName":"","lastName":"Gdowicz-Kłosok","suffix":""},{"id":466270076,"identity":"3b6466a6-8221-4417-928e-4e3f118fe080","order_by":2,"name":"Magdalena Bugowska","email":"","orcid":"","institution":"The Maria Sklodowska-Curie National Research Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Bugowska","suffix":""},{"id":466270077,"identity":"84d6d1e0-2a5f-4ece-86df-08d1fb6021e3","order_by":3,"name":"Marcela Krzempek","email":"","orcid":"","institution":"The Maria Sklodowska-Curie National Research Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Marcela","middleName":"","lastName":"Krzempek","suffix":""},{"id":466270079,"identity":"a5d91336-d3ce-4bb6-b247-9bbddb099eeb","order_by":4,"name":"Kinga Dębiec","email":"","orcid":"","institution":"The Maria Sklodowska-Curie National Research Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Kinga","middleName":"","lastName":"Dębiec","suffix":""},{"id":466270081,"identity":"14790a7e-a7e5-4074-bfe6-3b473618fc73","order_by":5,"name":"Jolanta Mrochem-Kwarciak","email":"","orcid":"","institution":"The Maria Sklodowska-Curie National Research Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Jolanta","middleName":"","lastName":"Mrochem-Kwarciak","suffix":""},{"id":466270084,"identity":"80c17b77-f890-4651-909d-96428025ac88","order_by":6,"name":"Krzysztof Składowski","email":"","orcid":"","institution":"The Maria Sklodowska-Curie National Research Institute of Oncology","correspondingAuthor":false,"prefix":"","firstName":"Krzysztof","middleName":"","lastName":"Składowski","suffix":""}],"badges":[],"createdAt":"2025-05-09 08:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6626599/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6626599/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84199379,"identity":"ec6854d6-bc49-497b-b673-ab64ee8e9e03","added_by":"auto","created_at":"2025-06-09 08:15:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139542,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6626599/v1/2e1b10c44323e87474e09caa.jpg"},{"id":84199378,"identity":"2d81c738-e593-480c-a872-71146fe93e32","added_by":"auto","created_at":"2025-06-09 08:15:36","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":419886,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in parameters before and after IBP.\u003cstrong\u003e \u003c/strong\u003eBoxplots illustrate changes between measure at rest 15 min before session 10 (measure I, before) and at 30 minutes into the session (measure II, after) for two main categories: (A) hormonal and immune markers and (B) gasometric parameters. The median is represented by a horizontal line within each box, and individual observations are connected by lines to indicate direction of change. Observations with an increased value are connected by light blue lines, whereas those with a decrease are connected by dark blue lines. Statistically significant differences are marked with an asterisk in the following convention for symbols: * - P\u0026lt;=0.05, ** - P \u0026lt;=0.01, *** - P\u0026lt;=0.001, **** - P\u0026lt;=0.0001.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6626599/v1/ea7022370d46a9d684293796.jpg"},{"id":84199382,"identity":"af9abd3d-9f88-4577-8f2a-19b4e1185509","added_by":"auto","created_at":"2025-06-09 08:15:36","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":106891,"visible":true,"origin":"","legend":"\u003cp\u003eCooperation of the hypothalamus-pituitary-adrenal axis and the sympathetic nervous system in the stimulation of the carcinogenesis process under the influence of stress. Own illustration created with BioRender.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6626599/v1/a079db69749e31b87f5e2bdb.jpg"},{"id":85573396,"identity":"4266009a-062b-4709-b781-c95100fdce92","added_by":"auto","created_at":"2025-06-27 17:16:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1689134,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6626599/v1/b8621c13-dc01-4d13-bca3-c5c661842fef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Take A Breather –Physiological Correlates Of A Conscious Connected Breathing Session In A Trained Group Of Breast Cancer Patients","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHigh stress level and negative emotions negatively impact treatment of patients with malignant tumor. Effective psychosomatic interventions has proven to prevent depression, reduce therapy related pain and fatigue, and boost patients' psychological resilience. Patients who adopt these techniques often feel more in control of their health and experience significant improvements in mental well-being. This holistic approach, combining psychological and physiological elements, highlights the interconnected nature of these dimensions, where progress in one area fosters positive changes in others.\u003c/p\u003e \u003cp\u003eBreathing is an activity that we often do without consciously thinking about it. Techniques that encourage mindful breathing are available to everyone, regardless of age, gender or state of health. They require no special equipment or environment, making them easy to learn and very practical in use. These methods have significant therapeutic potential and are recommended for inclusion in clinical practice. Our research emphasizes the need to raise public awareness of the benefits of psychotherapeutic methods such as conscious breathing. The effectiveness beyond placebo effects and their role as a valuable adjunct to cancer treatment should be stressed. A number of studies have been conducted on the stress-reducing effect of rhythmic breathing. These findings suggest a beneficial effect on the endocrine, immune, and nervous systems.\u003c/p\u003e \u003cp\u003eIt has been established that voluntary regulation of breathing impacts interoceptive communication and emotion regulation (Boiten et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1994\u003c/span\u003e; Homma \u0026amp; Masaoka, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). There is a reciprocal relationship between breathing patterns and emotions, with intense emotions disrupting regular breathing and, in some cases, leading to apnea. Slow, deep breathing has been shown to synchronize with limbic system activity during memory recall (Masaoka et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The practice of breathing exercises has been demonstrated to modify body-to-nervous system signals, thereby impacting emotional processing, social interaction, decision-making, and cognitive functions (Gerbarg\u0026amp;Brown, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Autonomic nervous system dysfunction has been associated with a range of psychiatric disorders, including anxiety, depression, PTSD, and more. Regulated breathing practices have been shown to improve symptoms of these conditions by influencing the 10th cranial nerve, which connects to all organs and glands (Gerbarg\u0026amp;Brown, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Breathwork helps to balance the parasympathetic and sympathetic branches, enhancing stress resilience and reducing psychological and physical symptoms (Gerbarg\u0026amp;Brown, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). While slow breathing practices have been extensively researched, intense deep breathwork, despite its historical use in Yoga, Taoism, Buddhism, and modern wellness, remains less studied. These practices, renowned for their swift effects and potential health benefits, have yet to be extensively studied scientifically (Zaccaro et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Shao et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). A growing body of research has demonstrated the efficacy of methods incorporating deep connected (circular) breathwork, such as Conscious Connected Breathing (CCB) and Sudarshan Kriya Yoga (SKY), in promoting beneficial emotional, immunomodulatory, and anti-inflammatory effects. Specifically, CCB training has been associated with enhanced self-esteem, improved mood, and augmented internal locus of control (Rubin, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e1983\u003c/span\u003e). Additionally, a reduction in depression and anxiety (Heyda, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), an increase in joy and satisfaction, a significant decrease in anger, and a comprehensive reduction in anxiety across all domains, including motoric, physiological, and cognitive aspects has been observed. Furthermore, the studies noted a 70% reduction in alcohol relapse rates (Rajski, 2002, Tabugan et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), enhanced outcomes in eating disorders (Reggios, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1985\u003c/span\u003e), and the induction of a blissful and altered state, accompanied by positive psychedelic experiences and altered brain waves (Bahi et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The practice of Sudarshan Kriya Yoga has been shown to reduce symptoms of PTSD (Vasudev et al., 2020), pain, and cortisol, which is a common stress marker (Kumar et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). It has also been associated with a reduction in anxiety and depression (Sharma et al., 2015). The practice has also been shown to positively affect cardiac autonomic tone (Kharya et al. 2014), brain waves (Chandra et al., 2017), immunity by increasing the number of natural killer cells (Kochupillai et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2005\u003c/span\u003e), antioxidant status, and gene expression (Sharma et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Sharma et al, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is only limited research on the subject of what exactly is happening during a breathwork session that includes deep circular breathing. The first known study of CCB session physiology by Rubin (1985) showed several physiological effects of a 35-minute session in two subjects who were instructed to breathe fully and deeply, one breath after another. Three measurements of physiological functions were taken: before, during and after the CCB session. Total exhalation volume, end-tidal O\u003csub\u003e2\u003c/sub\u003e, end-tidal CO\u003csub\u003e2\u003c/sub\u003e, pulse volume, pulse propagation time, interbeat interval (HRV), skin potential and electromyogram (EMG) were measured every 5 minutes. In both cases, the volume of air and the end-tidal volume of CO\u003csub\u003e2\u003c/sub\u003e increased significantly during the session. During rest after the breathing session, the results did not show an increase in the volume of air inhaled. The percentage of oxygen and carbon dioxide during and after the session showed that CCB, in addition to breathing more air, also changes its processing. The changes in end-tidal CO₂ (etCO\u003csub\u003e2\u003c/sub\u003e) and etO\u003csub\u003e2\u003c/sub\u003e were significant, but differed in two subjects. The less experienced person showed a pattern of hyperventilation, while the other with more experience retained more CO\u003csub\u003e2\u003c/sub\u003e. Two subjects examined experienced an increase in pulse volume during breathwork, which was indicated by the extension of the blood vessels. The author stated that the changes in the interval between beats were slight or flat, indicating that the increase in blood volume is not attributable to a faster heartbeat. The heartbeat had slightly accelerated or remained at the pretreatment level, suggesting that increased blood flow could not be attributed to the accelerated heartbeat. The author suggests that the heart worked more efficiently at the end of the session and during the rest period. Other physiological measurements showed significant changes. In both cases, the SPR (Skin Potential Response) reached its highest point at the end of the session. The EMG showed increased muscle tension during the CCB session and a significant decrease in muscle tension during rest afterward and to the pre-session level.\u003c/p\u003e \u003cp\u003eA comprehensive study involving 61 practitioners showed that active breathing techniques significantly reduced end-tidal CO\u003csub\u003e2\u003c/sub\u003e (etCO\u003csub\u003e2\u003c/sub\u003e) levels in people who breathed vs. people who breathed passively. The study monitored both holotropic breathwork and consciously connected breathwork sessions and observed a trend of decreasing CO\u003csub\u003e2\u003c/sub\u003e levels during the initial part of the session. The study showed that the lowered etCO₂ levels played a key role in facilitating the participants' altered states of consciousness, which were analogous to those induced by moderate doses of psychedelics. The depth of the experience remained elevated even after the CO₂ levels returned to normal. Furthermore, the study showed a significant improvement in the participants' mood and a reduction in depressive symptoms after the sessions, as well as a reduction in sympathetic nervous system activity. These findings indicate that both Holotropic Breathwork\u0026reg; and Consciously-Connected breathwork elicit comparable physiological and psychological outcomes, thus highlighting the potential therapeutic applications of breath as a non-pharmacological intervention in mental health treatment (Havenith et al. 2024 preprint).\u003c/p\u003e \u003cp\u003eStudies by Sharma et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), Vedamurthachar et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), Kamei et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) and Kochupillai et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) of yogic deep breathing showed important and promising changes in physiological correlates of stress, oxidative and endocrine status, and immunomodulation. Sharma et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) subjected 24 police officers to regular Sudarshan Kriya Yoga training, of similar age and socioeconomic status, who were randomly assigned to two groups. The experimental group practiced SKY regularly for five months. Before starting practicing, physiological correlates of stress were measured in both groups: blood lactic acid levels (the higher the exertion and stress) and levels of antiradical enzymes: glutathione (GSH), catalase, and superoxide dismutase (SOD). After five months, all these parameters were measured again, and the experimental group was tested during a breathing session. and the control group at the same time during a rest period. The results showed significantly lower levels of lactic acid in the blood of SKY exercisers, before, during, and after the session, and similarly: statistically higher levels of SOD, glutathione, and catalase.\u003c/p\u003e \u003cp\u003eChronic stress triggers cortisol release, weakening the immune system and leading to persistent inflammation. Since 1863, researchers have linked inflammation to cancer progression, as tumor cells secrete cytokines and chemokines like TNF, IL-1, and IL-6, which promote growth. Breaking this cycle could be key to mitigating its harmful effects (Balkwill et al. 2001,Koong et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA therapeutic intervention reduces cortisol levels while stimulating prolactin production has the potential to not only mitigate stress and enhance well-being but also fortify the immune system's capacity to combat cancer cells.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Clinical Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research material consisted of blood samples. from patients treated with adjuvant post-operative radiotherapy because of stage I-III breast cancer at the Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice between 2006 and 2008. Additionally 73% of them received chemotherapy and 65% received hormonal therapy. Participation in the study was offered to all patients admitted to the unit who met the eligibility criteria (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient eligibility criteria for the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBreast cancer patients who met the following inclusion criteria, eligible for retrospective analysis:\u003c/p\u003e\n\u003cp\u003e1. Histopathologically confirmed breast cancer.\u003c/p\u003e\n\u003cp\u003e2. Status after previous surgical treatment.\u003c/p\u003e\n\u003cp\u003e3. No prior treatment for another malignancy.\u003c/p\u003e\n\u003cp\u003e4. No concurrent malignancies diagnosed at the same time as breast cancer and during the patient\u0026apos;s follow-up.\u003c/p\u003e\n\u003cp\u003e5. Patient performance status 0-1 on the ZUBROD scale.\u003c/p\u003e\n\u003cp\u003e6. Patients over 18 years of age.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCriteria for exclusion of patients from the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Failure to meet any of the eligibility criteria.\u003c/p\u003e\n\u003cp\u003e2. Pregnancy.\u003c/p\u003e\n\u003cp\u003e3. Metastatic breast cancer.\u003c/p\u003e\n\u003cp\u003e4. Comorbidities that may interfere with the evaluation of study parameters, i.e. chronic obstructive pulmonary disease, ischemic heart disease, renal disease, alcohol and drug addiction, anorexia and bulimia, schizophrenia, Parkinson\u0026apos;s disease, Alzheimer\u0026apos;s disease, disability, dementia, advanced atherosclerosis, organic and post-traumatic brain damage.\u003c/p\u003e\n\u003cp\u003e5. Age \u0026gt; 70 years\u0026gt; do tabeli\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Fifty six patients (60%) out of 93 agreed to participate in the study (60%).\u003c/p\u003e\n\u003cp\u003eCases excluded from the analysis included:\u003c/p\u003e\n\u003cp\u003emetastases detected during treatment (two patients in the experimental group),\u003c/p\u003e\n\u003cp\u003e- cases in which the number of NK cells could not be counted, or patients who did not appear at the last examination at the last visit (five patients in the experimental group).\u003c/p\u003e\n\u003cp\u003e- the patients who withdrew during the study (two cases in the experimental group). A total of 48 patients were included in the analysis. The characteristics of the study group are shown in Table 1.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cem\u003eCharacteristic\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cem\u003ePatients (n=48)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge \u0026ndash; mean (range)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e53 (38\u0026ndash;68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eVocational\u003cbr\u003e\u0026nbsp;Secondary\u003cbr\u003e\u0026nbsp;Higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003cp\u003e19 (39)\u003c/p\u003e\n \u003cp\u003e11 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial status n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e34 (71)\u003c/p\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003cp\u003e4 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003cp\u003e39 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 365px;\"\u003e\n \u003cp\u003e\u003cem\u003eType of treatment\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical treatment n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eMastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e25 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eConservative Surgery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e23 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChemiotherapy n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eAdjuvant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e19 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eNeoadjuvant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e16 (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHormonal therapy n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e31 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArea of radiotherapy n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eBreast or chest wall with scar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e25 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eBreast/chest + axilla\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eBreast/chest + axilla + supraclavicular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e20 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiation dose n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e45 Gy/18 fx\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e50 Gy/25 fx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e39 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eAdditional boost to the surgical bed (10 Gy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e15 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 365px;\"\u003e\n \u003cp\u003e\u003cem\u003eReceptors status\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eER status n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 +\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 ++\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 +++\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e15 (31)\u003c/p\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003cp\u003e14 (29)\u003c/p\u003e\n \u003cp\u003e9 (19)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePR status n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003e1 +\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 ++\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 +++\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e17 (35)\u003c/p\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003cp\u003e11 (23)\u003c/p\u003e\n \u003cp\u003e9 (19)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHER status n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 268px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003e1 +\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 ++\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 +++\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 97px;\"\u003e\n \u003cp\u003e18 (38)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (29)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (8)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (6)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: ER \u0026ndash; Estrogen receptor, PR \u0026ndash; Progesterone receptor, HER \u0026ndash; Human epidermal growth factor receptor 2 (HER2). The designation +++; \u0026nbsp;++; \u0026nbsp;+ \u0026ndash; is the level of receptor expression, which indicates the hormone-dependence of the tumor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Characteristics of the study group.\u003c/p\u003e\n\u003ch1\u003e2.2 Procedure\u003c/h1\u003e\n\u003cp\u003eThe study was carried out after receiving approval from the bioethics committee. Informed consent was obtained from all participants.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIntegrative Breathwork Psychotherapy (IBP) consisted of 10 sessions three times a week. The CCB breathwork session lasted 45 minutes, followed by 15 minutes of free emotional expression. On other days, patients practiced CCB for 15 minutes with the psychotherapist or by themselv alone. Classes were held in small groups (up to six people) see: Figure 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIBP\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ecombines intensive breathwork training and the state of mindfulness followed by free emotional expression. Breathwork session is followed by verbal process-based expression. Patients communicate their feelings and give them their own meaning. Patients are supported to maintain non-judgemental mindfulness during any kind of experience while breathing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConscious Connected Breathing (CCB) includes taking moderately deep breaths, deeper than usual; one after another, without pausing, rhythmically, drawing air into the upper lungs. The exhalation is completely relaxed, the air leaves the lungs without any effort: pushing, dividing the exhalation into parts, or holding back. Breathing was performed through the nasal respiratory passage. Before starting IBP, patients received information on the experience of the specifics of the breathwork session, including possible temporary tingling, slight sleepiness, and emotional experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntegrative Breathwork Psychotherapy session:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter an approximately 3-minute process of calming the breath and relaxing the muscles, the practitioner begins to breathe rhythmically CCB described above. Proper breathing during subsequent breathwork sessions was guided by an experienced breathworker and certified psychotherapist. The therapist helped reach an elemental mindfulness state during the breathwork session, focus, and allow emotions and thoughts to flow freely without attaching or pushing them away. No specific suggestions were made about the origins of session sensations. The patients received emotional support to allow them to open to new experiences and feel safe.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients in the experimental group participated in an intensive cycle of IBP as a part of a larger study. The first measurement was taken at rest before the start of session no. 10. The second measurement was taken only at the 30th minute of the breathing session in the experimental group.\u003c/p\u003e\n\u003cp\u003eAll blood samples were taken at the same hour due to fluctuations in diurnal cortisol. The second measurement was taken at the 30th minute of the breathing session. The blood collected was transferred to the laboratory immediately after sampling.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeasurement no. (time)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 427px;\"\u003e\n \u003cp\u003e\u003cem\u003ePhysiological variables\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u0026nbsp;\u003c/strong\u003e(at rest, 15 min before session no. 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 427px;\"\u003e\n \u003cp\u003eArterialised capillary blood gasometry:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003epO\u003csub\u003e2\u003c/sub\u003e, pCO\u003csub\u003e2\u003c/sub\u003e, pH, cH\u003csup\u003e+\u003c/sup\u003e, cHCO\u003csub\u003e3\u003c/sub\u003e, BE, BB, sO\u003csub\u003e2\u003c/sub\u003e, ctO\u003csub\u003e2\u003c/sub\u003e, MetHb, COHb, O\u003csub\u003e2\u003c/sub\u003eHb, HHb\u003c/p\u003e\n \u003cp\u003eCortisol and prolactin concentrations\u003c/p\u003e\n \u003cp\u003eIgA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eII\u0026nbsp;\u003c/strong\u003e(at 30 minutes into\u0026nbsp;\u003c/p\u003e\n \u003cp\u003esession no. 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 427px;\"\u003e\n \u003cp\u003eSame as above\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Table including measuring biological variables in the experimental group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Analytical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe concentration of IgA, prolactin, and cortisol was determined in blood serum. Blood was obtained in standard conditions, patients in fasting state, between 7.00 \u0026ndash; 9.00 o\u0026rsquo;clock, using a vacuum Becton\u0026ndash;Dickinson system, to sample tubes without anticoagulant. Samples obtained after centrifugation at 3000 rotations/min for 10 min. at the temperature. 4\u003csup\u003e0\u003c/sup\u003e C were analyzed on the same day. IgA concentration was determined by nephelometric immunoassay, using the Atelica analyzer and commercial kit analyzer from Siemens Healthcare. The concentration of cortisol was determined by means of chemiluminescent immunoassay (CLIA)) using the reagent kits Siemens Healthcare and Immulite 2000\u003cem\u003ei\u003c/em\u003e reagent kits. The concentration of prolactin was determined by chemiluminescent microparticle immunoassay (CMIA), using an Atelica analyzer and commercial kit analyzer from Abbott Laboratories.\u003c/p\u003e\n\u003cp\u003eCBC analysis was performed using a Sysmex XN-2000 hematology analyzer. Sysmex XN-2000 is a multiparameter blood cell counter. To count blood cells, the auto-machine uses an impedance principle. The impedance principle uses a constant electric current that is passed through a blood sample and a reagent solution to determine the changes in electrical resistance that occur when blood cells pass through the detection aperture. To keep the quality of the CBC analyzer in the commercially prepared known blood samples (normal, low and high), background checks and machine maintenance were performed according to the manufacturer\u0026rsquo;s instructions and as per the clinical laboratory institute.\u003c/p\u003e\n\u003cp\u003eThis study aimed to qualify blood gas parameters (pH, pCO\u003csub\u003e2\u003c/sub\u003e, pO\u003csub\u003e2\u003c/sub\u003e), electrolytes (Na\u003csup\u003e+\u003c/sup\u003e, K\u003csup\u003e+\u003c/sup\u003e), ionized calcium (Ca\u003csup\u003e2+\u003c/sup\u003e), metabolites (glucose, lactate), and oximetry parameters (tHb, O\u003csub\u003e2\u003c/sub\u003eHb, COHb, MetHb). Using the Cobas b221 analyzer, pH, pCO\u003csub\u003e2\u003c/sub\u003e, Na\u003csup\u003e+\u003c/sup\u003e, K\u003csup\u003e+\u003c/sup\u003e, Ca\u003csup\u003e2+\u003c/sup\u003e are measured using potentiometry methods, pO\u003csub\u003e2\u003c/sub\u003e, glucose and lactate using amperomerty method. tHb, O\u003csub\u003e2\u003c/sub\u003eHb, COHb, MetHb are measured by spectrophotometry in capillary blood.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables are presented as means with standard deviation, with normality assessed using the Shapiro\u0026ndash;Wilk test. Prior to analysis, data were log-transformed to approximate normal distribution and stabilize variance, except for variables already expressed as logarithms (e.g., pH) and percentages. To compare pre- and post-IBP session measurements, paired \u003cem\u003et\u003c/em\u003e-tests were conducted. The magnitude of the differences observed between time points was quantified using Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e for effect size. For multiple comparisons, the False Discovery Rate (FDR) correction was applied using the Benjamini\u0026ndash;Hochberg method to control for Type I error. All statistical analyses were performed using R software (version 4.4.1; R Foundation for Statistical Computing, \u0026quot;http://www.r-project.org/\u0026quot;). A two-sided P\u0026le;0.05 was considered statistically significant.. A two-sided P\u0026le;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable 3 presents the results of the assessed parameters, grouped into two categories: hormonal and immune markers (cortisol, prolactin, and IgA), and gasometric parameters (pH, pCO₂, pO₂, base excess, and other oxygen-related variables). Boxplots in Figure 2 illustrates the changes in these parameters, highlighting individual data points before and after the IBP sessions, along with the direction of change for each patient.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasure I (n=48)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasure II (n=48)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean \u0026plusmn; SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean \u0026plusmn; SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003eP value adjusted\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cem\u003eEffect size (95%CI)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cem\u003eEffect size interpretation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003eDirection change\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 612px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHormonal and Immune Markers\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCortisol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.6 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8.4 \u0026plusmn; 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.59 (-1 to -0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlactin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.3 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e11.5 \u0026plusmn; 6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.54 (0.33 to 0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026uarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIgA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.6 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.51 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.56 (-0.88 to -0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 612px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGasometry\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7.4 \u0026plusmn; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7.5 \u0026plusmn; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.64 (0.39 to 0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026uarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epO\u003csub\u003e2\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e74.1 \u0026plusmn; 6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e69.4 \u0026plusmn; 7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.57 (-0.89 to -0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epCO\u003csub\u003e2\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e37.7 \u0026plusmn; 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e35.9 \u0026plusmn; 4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.45 (-0.72 to -0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e48 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e48.2 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.28 (-0.03 to 0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026harr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.6\u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.51 (0.25 to 0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026uarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esO\u003csub\u003e2\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e95.6 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e94.9 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.25 (-0.64 to -0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026harr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecH\u003csup\u003e+\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e36.9 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e35 \u0026plusmn; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.66 (-0.94 to -0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ectO\u003csub\u003e2\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17.7 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16.9 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.6 (-0.9 to -0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecHCO\u003csub\u003e3\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e24.6 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e24.6 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0 (-0.28 to 0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003enegligible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026harr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ectHb\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e13.4 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e12.9 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.5 (-0.85 to -0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHHb\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.1 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.44 (0.16 to 0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026uarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eO\u003csub\u003e2\u003c/sub\u003eHb\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e93.6 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e92.7 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.38 (-0.75 to -0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetHb\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.5 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.5 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.19 (-0.1 to 0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026harr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOHb\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.8 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.7 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-0.32 (-0.68 to -0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026darr;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEffect size interpretation in accordance with Rules of thumb on magnitudes of effect sizes. Retrieved March 12, 2025, from https://imaging.mrc-cbu.cam.ac.uk/statswiki/FAQ/effectSize Abbreviations: SD \u0026ndash; standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Characteristics of parameters before and after IBP intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1. Hormonal and Immune Markers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCortisol level was \u0026nbsp;significantly reduced \u0026nbsp;after the IBP sessions (P\u0026lt;0.001; \u003cem\u003ed\u003c/em\u003e=-0.59; 95% CI: -1 to -0.29), whereas prolactin level demonstrated a notable increase (P\u0026lt;0.001; \u003cem\u003ed\u003c/em\u003e=0.54; 95% CI: 0.33 to 0.76). A significant decrease in IgA levels was also observed (P\u0026lt;0.001; \u003cem\u003ed\u003c/em\u003e=-0.56; 95% CI: -0.88 to -0.32). These findings are presented in Figure 2A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Gasometry\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubsequent to the conclusion (?) of the IBP session, substantial alterations were detected in multiple blood gas parameters. A statistically significant increase was observed in blood pH (P\u0026lt;0.001; d=0.64; 95%CI: 0.39 to 0.91), base excess (BE, P\u0026lt;0.001; d=0.51; 95%CI: 0.25 to 0.84), and deoxygenated hemoglobin concentration (HHb, P=0.004; d=0.44; 95%CI: 0.16 to 0.8).\u003c/p\u003e\n\u003cp\u003eConcurrently, a substantial decline in the partial pressure of oxygen (pO2, P\u0026lt;0.001; d=-0.57; 95%CI: -0.89 to -0.31) and the partial pressure of carbon dioxide (pCO2, P=0.003; d=-0.45; 95%CI: -0.72 to -0.19), hydrogen ion concentration (cH+, P\u0026lt;0.001; d=-0.66; 95%CI: -0.94 to -0.42), and total blood oxygen content (ctO2, P\u0026lt;0.001; d=-0.6; 95%CI: -0.9 to -0.31), total hemoglobin content (ctHb, P=0.001; d=-0.5; 95%CI: -0.85 to -0.24), and hemoglobin oxygen saturation (O2Hb, P=0.011; d=-0.38; 95%CI:\u003c/p\u003e\n\u003cp\u003eThe obtained results suggest that IBP sessions have a significant impact on acid-base balance and blood gas exchange, which may indicate adaptive changes in the physiology of the body in response to the intervention used. The interpretation of these changes necessitates further research to ascertain their potential mechanisms and consequences for bodily function. No significant changes were observed in BB, sO\u003csub\u003e2\u003c/sub\u003e, cHCO\u003csub\u003e3\u0026nbsp;\u003c/sub\u003eand MetHb. These results are illustrated in Figure 2B\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe utilization of breathing techniques as a therapeutic modality is of paramount importance for individuals diagnosed with cancer. The research approach employed by our group is distinctive in its unique focus on the physiological significance of breathing therapy. The accessibility and simplicity of conscious breathing techniques have been demonstrated to reduce stress, fatigue, and treatment-related pain. Furthermore, it has been demonstrated to enhance psychological well-being, thereby reinforcing patients\u0026apos; sense of autonomy in managing their health. We posit that these techniques serve as a valuable complement to oncological therapy by integrating the psychological and physiological dimensions, thus improving the overall quality of life of patients undergoing treatment.\u003c/p\u003e\n\u003cp\u003eOne of the most important factors that contribute to poorer treatment outcomes in cancer patients is chronic stress and the subsequent stress caused by cancer diagnosis and the therapy used (Lutgendorf and Andersen, 2015). Chronic stress activates the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is one of the main adaptive mechanisms in response to stress. When cortisol levels increase, it acts on the hypothalamus and pituitary in a feedback mechanism that prevents excessive activation of the HPA axis. Chronic stress has been shown to disrupt this system, resulting in its hyperactivation or dysregulation. The secretion of stress hormones, including catecholamines (noradrenaline and epinephrine) and cortisol, has been shown to modulate the immune response at both the level of immune cells, such as T lymphocytes and macrophages, and within tumor cells (Armaiz-Pena et al., 2013; Colon-Echevarria et al., 2019). In mouse models of ovarian cancer, chronic stress has been shown to lead to tumor-associated inflammatory processes and disease progression (Armaiz-Pena et al., 2015; Colon-Echevarria et al., 2020). In cancer patients, behavioral disorders such as stress, depression, and anxiety have been demonstrated to induce systemic, tumor-related immunosuppression (Andersen et al., 1998; Blomberg et al., 2009; Thornton et al., 2007). For example, elevated levels of perceived stress have been associated with decreased cytokine production by Th1/Th2 lymphocytes, decreased T cell proliferation, and diminished activity of tumor-infiltrating lymphocytes (Andersen et al., 1998; Blomberg et al., 2009; Lutgendorf et al., 2008; Thornton et al., 2007).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStress has long been established to be a contributing factor to the development of inflammation. The release of cortisol, which is triggered by stress, acts as an inhibitor of the immune system. Chronic stress results in the generation of chronic inflammation within the body. As early as 1863, Rudolf Virchow posited that the presence of leukocytes in tumor tissue is associated with chronic inflammation and promotes cancer progression (Balkwill et al. 2001). Cancer cells secrete inflammatory cytokines and chemokines that can directly contribute to tumor progression. Examples of such secreted factors include tumor necrosis factor (TNF), IL-1 and IL-6, and chemokines (Koong et al. 2000). It would be beneficial to ascertain whether it is possible to disrupt this closed circle. Chronic inflammation is a consequence of stress and there is evidence to suggest that inflammation may promote cancer progression\u003c/p\u003e\n\u003cp\u003eAvoiding immune surveillance is a hallmark of cancer progression, but the role of the cortisol-pituitary hormone feedback loop in this process is still poorly understood. Cortisol, the primary endogenous glucocorticoid in humans, is secreted by the adrenal cortex in response to stress. Furthermore, cortisol and its inactive metabolite cortisone can undergo interconversion to further modulate the tissue-dependent effects of glucocorticoids (Schwarzlmuller et al. 2025). In recent years, evidence has emerged that the production of glucocorticoids by tumors, both by immune cells in the microenvironment and by tumor cells, supports immune evasion. This is achieved by activating immune checkpoints to promote autotolerance and prevent autoimmunity (Grywalska et al., 2019). Incorporation of checkpoint blockade has had a significant influence on treatment outcomes of patients with multiple solid malignancies, including lung cancer and melanoma (Sharma et al., 2021).\u003c/p\u003e\n\u003cp\u003eAt the opposite end of the scale is prolactin (PRL), a 23 kDa polypeptide hormone secreted primarily by pituitary gland lactotroph cells, which performs several functions, and its role in the regulation of immune and autoimmune responses remains not fully explained. The expression of PRL is not limited to the pituitary gland, but is present in various extrapituitary sites, including the ovary, placenta, mammary epithelium, endothelium, neurons, skin cells, spleen, bone marrow, adipose tissue, and prostate, each with a different molecular weight and biological activity (Borba et al. 2019, Buckley 2021, Angum et al. 2020). Secretion of PRL is primarily governed by hypothalamic inhibitory dopamine, with regulation occurring through negative feedback loops. In particular, PRL itself functions as an inhibitory signal, thereby contributing to a short-loop feedback mechanism. A significant function of PRL in the immune system is to stimulate the proliferation and differentiation of immune cells. PRL has been shown to promote the growth and activation of T lymphocytes, which are key components of the adaptive immune response (Alem\u0026aacute;n-Garca\u0026nbsp;et al. 2021). Furthermore, PRL has been shown to support the maturation and functioning of B cells, increasing the production of immunoglobulins (Igs) (Borba et al. 2018,\u0026nbsp;Alem\u0026aacute;n-Garca, R.M et al. 2021).\u0026nbsp;The specific network of dependencies between prolactin and cortisol is shown in Figure 3.\u003c/p\u003e\n\u003cp\u003eIn the present study, it was shown that IBP therapy instigates substantial alterations in biochemical levels within the body. A notable decline in cortisol levels was observed, indicative of a concomitant reduction in stress levels (P\u0026lt;0.001; \u003cem\u003ed\u003c/em\u003e=-0.59). A statistically significant increase in prolactin levels was recorded, potentially reflecting a positive effect of therapy on the endocrine system (P\u0026lt;0.001; \u003cem\u003ed\u003c/em\u003e=0.54). Furthermore, a moderate significant decrease in IgA was detected, which may indicate an impact on the immune system or a temporary response to changes in the respiratory system due to intense breathwork (P\u0026lt;0.001; \u003cem\u003ed\u003c/em\u003e=-0.56). These results confirm the effectiveness of IBP therapy in modulating selected stress response markers and potential therapeutic benefits, although further research is needed to better understand its impact. The findings of this study indicate that respiratory therapies play a pivotal role in stress reduction, given their ability to regulate the nervous, immune, and endocrine systems, thereby facilitating the restoration of emotional balance.\u003c/p\u003e\n\u003cp\u003eKamei et al. (2001) conducted a study on eight yoga instructors while they performed three types of exercises: asanas (physical exercises), pranayama (breathing exercises) and meditation. During the exercises, the researchers measured brain activity (EEG) and Natural Killer (NK) activity, the main cells that destroy cancer cells. It was observed that during all exercises, alpha activity corresponding to relaxation was present, and this is often induced in biofeedback exercises to promote wound healing, pain management, and relaxation. In particular, NK cell activity exhibited a significant increase exclusively during the pranayama phase of breathing exercises, which are frequently used in biofeedback practices to facilitate wound healing, manage pain, and promote relaxation. The authors of this study hypothesize that the effect of increased Natural Killer cell count is related to alpha activity, which often occurs in relaxation and meditation. A strong correlation between increased NK activity and alpha activity was found (P\u0026lt;0.2, r=0.83).\u003c/p\u003e\n\u003cp\u003eFurthermore, cancer patients who had undergone standard treatment and had completed the Sudarshan Kriya yoga training exhibited a significant increase in their NK cell count (P\u0026lt;0.001) within 12 to 24 weeks of treatment compared to their baseline levels. The increase in NK cell count after 24 weeks was significant (P\u0026lt;0.05) when compared to the control group. No significant impact on T lymphocyte subgroups was observed in either the test or control group. Furthermore, incorporation of respiratory practices alongside tobacco use exhibited a 21% success rate in terms of achieving control over a period of up to six months of observation. (Kochupillai et al., 2005)\u003c/p\u003e\n\u003cp\u003eThe World Health Organization (WHO) has identified stress as a contributing factor to many diseases that can be classified as \u0026quot;diseases of civilization\u0026quot; (Pr\u0026uuml;ss-Ust\u0026uuml;n et al., WHO 2016). Considering the current global mental health crisis and the numerous obstacles that make it difficult to access psychotherapy, there is an urgent need for easily accessible and implementable methods such as breath work. The provision of breathwork exercises can be performed in a straightforward manner, either as a standalone activity or as part of a group session. One of the effects of chronic stress is a significant increase in the level of cortisol in the blood. Cortisol, commonly referred to as the stress hormone, functions as an immune system inhibitor (Mavoungou et al. 2004).\u003c/p\u003e\n\u003cp\u003eThe endocrine system plays a key role in regulating the components of the immune system. Natural Killer cells represent a pivotal component of the anticancer immune response. The capacity of these cells to induce a cytotoxic response against neoplastic cells depends on the level of expression of surface activating receptors such as NKp46 and NKp30. Research has shown that the expression of these receptors is modulated by hormonal factors, with prolactin increasing and cortisol decreasing their expression. The activation or inhibition of the surface expression of the natural cytotoxicity receptor (NCR) by prolactin and cortisol, respectively, reflects gene regulation at the transcriptional level (Mavoungou et al., 2004). Consequently, there is an urgent need to identify the fundamental mechanisms that promote tumor-associated inflammation, which may contribute to an inadequate response to checkpoint blockade and subsequent resistance.\u003c/p\u003e\n\u003cp\u003eRecent findings have revealed a novel aspect of tumor immune suppression, namely local steroid production and metabolism, which may offer novel therapeutic interventions. Strategic targeting of steroid hormones to enhance anticancer therapies holds promise for increasing their efficacy.\u003c/p\u003e\n\u003cp\u003eAlterations in blood gas parameters, such as those analyzed in this study, can be significant in the context of tumors, particularly with regard to the metabolism of tumor cells and their microenvironment. In the present analysis, increases in blood pH, BE, and HHb were observed. An elevated blood pH suggests an improvement in acid-base balance, indicating lower blood acidity. During the IBP session BE (Base Excess) exhibited an increase, suggesting a potential decline in blood acidity. Additionally, reductions in pCO\u003csub\u003e2\u003c/sub\u003e (partial pressure of carbon dioxide) and cH+ (concentration of hydrogen ions) also point to this shift. In the context of cancer, this phenomenon is particularly significant, as cancer cells frequently exhibit an altered metabolism (Warburg effect), resulting in acidification of the microenvironment.\u003c/p\u003e\n\u003cp\u003eChanges in the microenvironment have the potential to affect the proliferation of cancer cells, their capacity for invasion, and their response to therapy. The increase in deoxygenated hemoglobin (HHb) may be attributable to the adaptation of the circulatory system to fluctuating respiratory conditions. On the contrary, a decrease in O\u003csub\u003e2\u003c/sub\u003eHb (oxygenated hemoglobin) and COHb (carboxyhemoglobin) suggests alterations in oxygenation and respiratory gas metabolism. Furthermore, reductions in pO\u003csub\u003e2\u003c/sub\u003e (partial oxygen pressure) and ctO\u003csub\u003e2\u003c/sub\u003e (total oxygen content) may indicate a lower oxygen level in the bloodstream.\u003c/p\u003e\n\u003cp\u003eBB (buffer base), sO\u003csub\u003e2\u003c/sub\u003e (oxygen saturation), cHCO3 (bicarbonate), and MetHb (methemoglobin) parameters did not show significant alterations, suggesting stability despite respiratory intervention. This stability may imply that the regulatory mechanisms maintain an internal balance, a finding that could be advantageous in the treatment of cancer patients.\u003c/p\u003e\n\u003cp\u003eA comprehensive study revealed that active breathing techniques significantly lowered etCO\u003csub\u003e2\u003c/sub\u003e levels, with participants showing an average of 22.4 \u0026plusmn; 0.8 mmHg compared to 36.7 \u0026plusmn; 1.5 mmHg in subjects who breathed passively. Researchers observed both Holotropic Breathwork and Conscious Connected Breathing sessions, noting that CO\u003csub\u003e2\u003c/sub\u003e levels typically decreased during the early portion of each session, reaching as low as 16.6 \u0026plusmn; 0.8 mmHg in active breathers while passive breathers maintained levels of 33.6 \u0026plusmn; 1.5 mmHg. The research demonstrated that this reduction in etCO\u003csub\u003e2\u003c/sub\u003e was crucial for inducing altered consciousness states similar to those experienced with moderate psychedelic doses. Notably, participants continued to experience elevated states even after CO\u003csub\u003e2\u003c/sub\u003e levels normalized. The sessions also produced significant mood improvements, reduced depressive symptoms, and decreased sympathetic nervous system activity. These outcomes suggest that both Holotropic Breathwork\u0026reg; and Consciously Connected Breathwork produce similar physiological and psychological benefits, highlighting breathing\u0026apos;s potential as a non-drug therapeutic approach for mental health treatment (Havenith et al. preprint 2024).\u003c/p\u003e\n\u003cp\u003eOur analysis demonstrates that IBP therapy reduces the level of immunosuppressive cortisol (reducing stress) and increases the level of prolactin, which supports the endocrine and immune systems, stimulates the proliferation and activation of immune cells, increases antibody production, and acts in opposition to cortisol. Regular breathwork exercises have been shown to enhance NK cell activity (Kamei et al, 2001, Kochupillai, 2005), thus bolstering the immune system\u0026apos;s anticancer response. Furthermore, alterations in the tumor microenvironment, such as elevated blood pH and reduced acidity, can impede tumor cell proliferation and enhance response to therapy. Simple stress management techniques, such as conscious breathing exercises, are essential for a wide range of cancer patients, especially during periods of mental health crisis. The presented study demonstrate that the implementation of diverse therapeutic approaches can facilitate stress reduction, exert an immunostimulatory effect, and modify the tumor microenvironment, thereby impacting the overall balance and the effectiveness of treatment.\u0026nbsp;\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe present study constitutes a pioneering analysis of alterations in capillary blood gas levels and hormonal changes during Conscious Connected Breathing sessions. This study offers novel insights, demonstrating for the first time alterations in hormonal equilibrium that are associated with the immunostimulatory effects of deep breathing. The significant positive changes in the functioning of the endocrine, immune, and respiratory-circulatory systems that our group observed in such a brief period during breathwork suggest that this type of therapy has a substantial impact when used as a complementary therapy in cancer patients. To further elucidate the therapeutic mechanisms underlying these observations, additional research is necessary, including the enrollment of larger patient cohorts and the analysis of the long-term impact of breathing therapy on psychological and immunological responses\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe work of M.B. was funded by Medical Research Agency (grant no. 2023/ABM/02/00011).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e We would like to express our gratitude to Dr. Tomasz Rutkowski for his expert support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Declaration:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe authors declare that the use of samples from breast cancer patients CONFIRMS that all experiments were conducted in accordance with the relevant guidelines and regulations.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe authors confirm that all methods were performed in accordance with the relevant guidelines and regulations.\u003c/li\u003e\n \u003cli\u003eThe authors confirm that all experimental protocols were approved by the Bioethics Committee of the M. Skłodowska-Curie Institute of Oncology, Gliwice Branch, on September 1, 2005 (A scanned copy of the consent form has been sent to the editorial office)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFinal remarks:\u0026nbsp;\u003c/strong\u003eAlldata (anonymized) is available from the authors and can be shared with anyone who's interested. To access the data, please send your request to dr Alicja Heyda at \u003cstrong\[email protected].\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoiten, F. A., Frijda, N. H. \u0026amp; Wientjes, C. J. Emotions and respiratory patterns: review and critical analysis. Int J Psychophysiol. ;17(2):103\u0026thinsp;\u0026ndash;\u0026thinsp;28. (1994). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0167-8760(94)90027-2\u003c/span\u003e\u003cspan address=\"10.1016/0167-8760(94)90027-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 7995774.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHomma, I. \u0026amp; Masaoka, Y. Breathing rhythms and emotions. \u003cem\u003eExp. Physiol.\u003c/em\u003e \u003cb\u003e93\u003c/b\u003e (9), 1011\u0026ndash;1021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1113/expphysiol.2008.042424\u003c/span\u003e\u003cspan address=\"10.1113/expphysiol.2008.042424\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2008). Epub 2008 May 16. PMID: 18487316.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasaoka, Y., Sugiyama, H., Katayama, A., Kashiwagi, M. \u0026amp; Homma, I. Remembering the past with slow breathing associated with activity in the parahippocampus and amygdala. \u003cem\u003eNeurosci. Lett.\u003c/em\u003e \u003cb\u003e521\u003c/b\u003e (2), 98\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.neulet.2012.05.047\u003c/span\u003e\u003cspan address=\"10.1016/j.neulet.2012.05.047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2012). Epub 2012 Jun 2. PMID: 22668857.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerbarg, P. L. \u0026amp; Brown, R. P. Breath-Focused Mind-Body Therapy for Global Mental Health: War and Other Mass Disasters. Academia Mental Health and Well-Being, \u003cb\u003e1\u003c/b\u003e, 1, \u003cem\u003eAcad. edu Journals\u003c/em\u003e, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.20935/MHealthWellB6198\u003c/span\u003e\u003cspan address=\"10.20935/MHealthWellB6198\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerbarg, P. L. \u0026amp; Brown, R. P. Neurobiology and neurophysiology of breath practices in psychiatric care. Psychiatric Times, 2016, 3.11: 22. (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZaccaro, A. et al. How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. \u003cem\u003eFront. Hum. Neurosci.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e, 353. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnhum.2018.00353\u003c/span\u003e\u003cspan address=\"10.3389/fnhum.2018.00353\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018). PMID: 30245619; PMCID: PMC6137615.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShao, R., Man, I. S. C. \u0026amp; Lee, T. M. C. The Effect of Slow-Paced Breathing on Cardiovascular and Emotion Functions: Meta-analysis and systematic review. \u003cem\u003eMindfulness\u003c/em\u003e \u003cb\u003e15\u003c/b\u003e, 1\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12671-023-02294-2\u003c/span\u003e\u003cspan address=\"10.1007/s12671-023-02294-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubin, B. K. Cognitive, Affective, Affective, and Physiological Outcomes of the Rebirthing, part of doctoral dissertation, Washington, DC, American University. (1983).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeyda An Impact of Conscious Connected Breathing Training on Emotional States, The Healing Breath Journal \u0026ndash; a. \u003cem\u003eJ. Breathwork Pract. Spiritual. Psychother.\u003c/em\u003e \u003cb\u003e5\u003c/b\u003e (2), 9\u0026ndash;18 (2003).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajski, P., Alcoholism \u0026amp; Rebirthing \u003cem\u003eInt. J. Advancement Counselling\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e, 123\u0026ndash;136, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1023/A:1020963817447\u003c/span\u003e\u003cspan address=\"10.1023/A:1020963817447\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabugan, D. C. et al. Novel Insights into Addiction Management: A Meta-Analysis on Intervention for Relapse Prevention. \u003cem\u003eMedicina\u003c/em\u003e \u003cb\u003e61\u003c/b\u003e (4), 619. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/medicina61040619\u003c/span\u003e\u003cspan address=\"10.3390/medicina61040619\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReggios, F. -6, Des mots pour un corps, un corps pour des mots. \u003cem\u003eBull. de Psychologie Sep-Oct\u003c/em\u003e. \u003cb\u003e39\u003c/b\u003e (16\u0026ndash;18)[377]), 891\u0026ndash;899 (1985).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahi, C. et al. Effects of conscious connected breathing on cortical brain activity, mood,mood, and state of consciousness in healthy adults. \u003cem\u003eCurr. Psychol.\u003c/em\u003e \u003cb\u003e43\u003c/b\u003e, 10578\u0026ndash;10589. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12144-023-05119-6\u003c/span\u003e\u003cspan address=\"10.1007/s12144-023-05119-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVasudev, K. et al. Sudarshan Kriya Yoga Program in Posttraumatic Stress Disorder: A Feasibility Study. \u003cem\u003eInt. J. Yoga\u003c/em\u003e. \u003cb\u003e13\u003c/b\u003e (3), 239\u0026ndash;246. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijoy.IJOY_16_20\u003c/span\u003e\u003cspan address=\"10.4103/ijoy.IJOY_16_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020 Sep-Dec). Epub 2020 Sep 13. PMID: 33343155; PMCID: PMC7735495.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar, N. et al. Surajpal. Randomized Controlled Trial in Advance Stage Breast Cancer Patients for the Effectiveness on Stress Marker and Pain through Sudarshan Kriya and Pranayam. \u003cem\u003eIndian J. Palliat. Care\u003c/em\u003e. \u003cb\u003e19\u003c/b\u003e (3), 180\u0026ndash;185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0973-1075.121537\u003c/span\u003e\u003cspan address=\"10.4103/0973-1075.121537\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013). PMID: 24347909; PMCID: PMC3853397.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma, P. et al. Rhythmic breathing: immunological, biochemical, and physiological effects on health. \u003cem\u003eAdv. Mind Body Med.\u003c/em\u003e \u003cb\u003e29\u003c/b\u003e (1), 18\u0026ndash;25 (2015 Winter). PMID: 25607119.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKharya, C. et al. Effect of controlled breathing exercises on the psychological status and the cardiac autonomic tone: Sudarshan Kriya and Prana-Yoga. \u003cem\u003eIndian J. Physiol. Pharmacol.\u003c/em\u003e \u003cb\u003e58\u003c/b\u003e (3), 211\u0026ndash;221 (2014 Jul-Sep). PMID: 25906603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra, S., Jaiswal, A. K., Singh, R., Jha, D. \u0026amp; Mittal, A. P. Mental Stress: Neurophysiology and Its Regulation by Sudarshan Kriya Yoga. \u003cem\u003eInt. J. Yoga\u003c/em\u003e. \u003cb\u003e10\u003c/b\u003e (2), 67\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0973-6131.205508\u003c/span\u003e\u003cspan address=\"10.4103/0973-6131.205508\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017 May-Aug). PMID: 28546676; PMCID: PMC5433115.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKochupillai, V. et al. Effect of rhythmic breathing (Sudarshan Kriya and Pranayam) on immune functions and tobacco addiction. Ann N Y Acad Sci. ;1056:242\u0026thinsp;\u0026ndash;\u0026thinsp;52. (2005). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1196/annals.1352.039\u003c/span\u003e\u003cspan address=\"10.1196/annals.1352.039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 16387692.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma, H. et al. Sudarshan Kriya practitioners exhibit better antioxidant status and lower blood lactate levels. Biol Psychol. ;63(3):281\u0026thinsp;\u0026ndash;\u0026thinsp;91. (2003). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0301-0511(03)00071-1\u003c/span\u003e\u003cspan address=\"10.1016/s0301-0511(03)00071-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 12853172.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma, H. et al. Gene expression profiling in practitioners of Sudarshan Kriya. J Psychosom Res. ;64(2):213-8. (2008). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpsychores.2007.07.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychores.2007.07.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 18222135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHavenith, M. et al. CO2 saturation during circular breathwork supports emergence of altered states of consciousness February 2024 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21203/rs.3.rs-3976380/v1https://doi.org/10.21203/rs.3.rs-3976380/v1\u003c/span\u003e\u003cspan address=\"10.21203/rs.3.rs-3976380/v110.21203/rs.3.rs-3976380/v1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVedamurthachar, A. et al. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. J Affect Disord. ;94(1\u0026ndash;3):249\u0026thinsp;\u0026ndash;\u0026thinsp;53. (2006). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jad.2006.04.025\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2006.04.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2006 Jun 5. PMID: 16740317.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamei, T., Toriumi, Y., Kimura, H. \u0026amp; Kimura, K. Correlation between alpha rhythms and natural killer cell activity during yogic respiratory exercise. \u003cem\u003eStress Health: J. Int. Soc. Invest. Stress\u003c/em\u003e. \u003cb\u003e17\u003c/b\u003e (3), 141\u0026ndash;145 (2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalkwill, F. \u0026amp; Mantovani, A. Inflammation and cancer: back to Virchow? Lancet. ;357(9255):539\u0026thinsp;\u0026ndash;\u0026thinsp;45. (2001). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(00)04046-0\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(00)04046-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 11229684.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoong, A. C. et al. Candidate genes for the hypoxic tumor phenotype. \u003cem\u003eCancer Res.\u003c/em\u003e \u003cb\u003e60\u003c/b\u003e (4), 883\u0026ndash;887 (2000). PMID: 10706099.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLutgendorf, S. K. \u0026amp; Andersen, B. L. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. Am Psychol. (2015). Feb-Mar;70(2):186\u0026thinsp;\u0026ndash;\u0026thinsp;97 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/a0035730\u003c/span\u003e\u003cspan address=\"10.1037/a0035730\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 25730724; PMCID: PMC4347942.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmaiz-Pena, G. N., Cole, S. W., Lutgendorf, S. K. \u0026amp; Sood, A. K. Neuroendocrine influences on cancer progression. \u003cem\u003eBrain Behav. Immun.\u003c/em\u003e \u003cb\u003e30\u003c/b\u003e (Suppl(Suppl), S19\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bbi.2012.06.005\u003c/span\u003e\u003cspan address=\"10.1016/j.bbi.2012.06.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013). Epub 2012 Jun 21. PMID: 22728325; PMCID: PMC3467346.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColon-Echevarria, C. B., Lamboy-Caraballo, R., Aquino-Acevedo, A. N. \u0026amp; Armaiz-Pena, G. N. Neuroendocrine Regulation of Tumor-Associated Immune Cells. \u003cem\u003eFront. Oncol.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e, 1077. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2019.01077\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2019.01077\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019). PMID: 31737559; PMCID: PMC6828842.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmaiz-Pena, G. N. et al. Adrenergic regulation of monocyte chemotactic protein 1 leads to enhanced macrophage recruitment and ovarian carcinoma growth. \u003cem\u003eOncotarget\u003c/em\u003e \u003cb\u003e6\u003c/b\u003e (6), 4266\u0026ndash;4273. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18632/oncotarget.2887\u003c/span\u003e\u003cspan address=\"10.18632/oncotarget.2887\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015). PMID: 25738355; PMCID: PMC4414188.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColon-Echevarria, C. B. et al. Zoledronic Acid Abrogates Restraint Stress-Induced Macrophage Infiltration, PDGF-AA Expression, and Ovarian Cancer Growth. \u003cem\u003eCancers (Basel)\u003c/em\u003e. \u003cb\u003e12\u003c/b\u003e (9), 2671. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/cancers12092671\u003c/span\u003e\u003cspan address=\"10.3390/cancers12092671\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020). PMID: 32962103; PMCID: PMC7563308.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndersen, B. L. et al. Stress and immune responses after surgical treatment for regional breast cancer. \u003cem\u003eJ. Natl. Cancer Inst.\u003c/em\u003e \u003cb\u003e90\u003c/b\u003e (1), 30\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jnci/90.1.30\u003c/span\u003e\u003cspan address=\"10.1093/jnci/90.1.30\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1998). PMID: 9428780; PMCID: PMC2743254.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlomberg, B. B. et al. Psychosocial adaptation and cellular immunity in breast cancer patients in the weeks after surgery: An exploratory study. \u003cem\u003eJ. Psychosom. Res.\u003c/em\u003e \u003cb\u003e67\u003c/b\u003e (5), 369\u0026ndash;376. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpsychores.2009.05.016\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychores.2009.05.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2009). Epub 2009 Sep 24. PMID: 19837199; PMCID: PMC2764537.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThornton, L. M., Andersen, B. L., Crespin, T. R. \u0026amp; Carson, W. E. Individual trajectories in stress covary with immunity during recovery from cancer diagnosis and treatments. \u003cem\u003eBrain Behav. Immun.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e (2), 185\u0026ndash;194. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bbi.2006.06.007\u003c/span\u003e\u003cspan address=\"10.1016/j.bbi.2006.06.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007). Epub 2006 Sep 5. PMID: 16908118; PMCID: PMC2151213.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwarzlmueller, P. et al. Steroid hormones as modulators of anti-tumoural immunity. Nat Rev Endocrinol. 2025 Mar 24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41574-025-01102-2\u003c/span\u003e\u003cspan address=\"10.1038/s41574-025-01102-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub ahead of print. PMID: 40128599.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrywalska, E., Sobstyl, M., Putowski, L. \u0026amp; Roliński, J. Current Possibilities of Gynecologic Cancer Treatment with the Use of Immune Checkpoint Inhibitors. \u003cem\u003eInt. J. Mol. Sci.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e (19), 4705. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijms20194705\u003c/span\u003e\u003cspan address=\"10.3390/ijms20194705\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019). PMID: 31547532; PMCID: PMC6801535.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma, A. \u0026amp; Gupta, P. Emotional intelligence, mindfulness and subjective well-being: A mediational analysis. \u003cem\u003eInt. J. Indian Psychol.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e, 1100\u0026ndash;1107 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorba, V. V., Zandman-Goddard, G. \u0026amp; Shoenfeld, Y. Prolactin and autoimmunity: The hormone as an inflammatory cytokine. Best Pract Res Clin Endocrinol Metab. ;33(6):101324. (2019). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.beem.2019.101324\u003c/span\u003e\u003cspan address=\"10.1016/j.beem.2019.101324\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2019 Sep 11. PMID: 31564625.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrbach, H. \u0026amp; Shoenfeld, Y. Hyperprolactinemia and autoimmune diseases. \u003cem\u003eAutoimmun. rev.\u003c/em\u003e \u003cb\u003e6\u003c/b\u003e (8), 537\u0026ndash;542 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuckley, A. R. Prolactin, a lymphocyte growth and survival factor. Lupus. ;10(10):684\u0026thinsp;\u0026ndash;\u0026thinsp;90. (2001). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1191/096120301717164912\u003c/span\u003e\u003cspan address=\"10.1191/096120301717164912\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 11721694.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAngum, F., Khan, T., Kaler, J., Siddiqui, L. \u0026amp; Hussain, A. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. \u003cem\u003eCureus\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (5), e8094. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.8094\u003c/span\u003e\u003cspan address=\"10.7759/cureus.8094\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020). PMID: 32542149; PMCID: PMC7292717. 5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorba, V. V., Zandman-Goddard, G., Shoenfeld, Y. \u0026amp; Prolactin \u003cem\u003eAutoimmun. Front. Immunol.\u003c/em\u003e ;\u003cb\u003e9\u003c/b\u003e:73. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fimmu.2018.00073\u003c/span\u003e\u003cspan address=\"10.3389/fimmu.2018.00073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (2018). PMID: 29483903; PMCID: PMC5816039.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlem\u0026aacute;n-Garc\u0026iacute;a, Y. P. et al. Prolactin Increases the Frequency of Follicular T Helper Cells with Enhanced IL21 Secretion and OX40 Expression in Lupus-Prone MRL/lpr Mice. \u003cem\u003eJ. Immunol. Res.\u003c/em\u003e \u003cb\u003e2021\u003c/b\u003e, 6630715. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2021/6630715\u003c/span\u003e\u003cspan address=\"10.1155/2021/6630715\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021). PMID: 33763492; PMCID: PMC7963914.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePr\u0026uuml;ss-Ust\u0026uuml;n et al. Preventing Disease through Healthy Environments, a global assessment of the burden of disease from environmental risks. WHO (2016). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241565196\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241565196\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMavoungou, E., Bouyou-Akotet, M. K. \u0026amp; Kremsner, P. G. Effects of prolactin and cortisol on natural killer (NK) cell surface expression and function of human natural cytotoxicity receptors (NKp46, NKp44 and NKp30). \u003cem\u003eClin. Exp. Immunol.\u003c/em\u003e \u003cb\u003e139\u003c/b\u003e (2), 287\u0026ndash;296. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1365-2249.2004.02686.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2249.2004.02686.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2005). PMID: 15654827; PMCID: PMC1809301.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, Integrative Breathwork Psychotherapy, Conscious Connected Breathing, immunostimulation, cortisol, prolactin","lastPublishedDoi":"10.21203/rs.3.rs-6626599/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6626599/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStress and negative emotions have been demonstrated to exert a substantial impact on cancer patients, affecting their ability to adapt to therapy and the treatment's overall effectiveness. Elevated cortisol levels, a stress-induced hormone, have been shown to suppress immune system function, potentially reducing the body's capacity to combat cancer cells. Conversely, prolactin, a hormone that stimulates the immune system, has demonstrated potential in this context but requires further study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGoal\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe objective of this study was to investigate the physiological changes that occur during the Conscious Connected Breathing (CCB) session, as part of a larger study. The main objective was to create a new form of integrative psychosomatic intervention, called Integrative Breathwork Psychotherapy (IBP), suitable for cancer patients that would improve both their psychosomatic and immune status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf all eligible consecutive breast cancer patients hospitalised for post-operative radiotherapy who were invited to participate in the study, 77 patients took part in the study (experimental group – 48 pts, controls – 29 pts, response rate: 62%). IBP had a small open group setting (up to six participants). It included ten sessions in a small open group setting, three meetings a week. Each meeting consisted of a 45-minute breathwork session (CCB – rhythmic circular breathing through the nose, deeper than usual, without breath holding) in the state of acceptance followed by free emotional expression. Patients were encouraged to exercise 15 minutes daily on the other days of the week and after the programme was completed.\u003c/p\u003e\n\u003cp\u003eThe factors analysed were white blood cells, lymphocyte counts, IgA, serum prolactin and cortisol concentration, arterialised capillary blood gasometry. IgA, hormone and gasometry measures were taken before the 10th session and after 30 min (2/3 of the session) when the patients gained experience and practised correctly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the CCB session, the gasometry showed significant change indicating slight overbreathing pattern, including decreases in pCO\u003csub\u003e2\u003c/sub\u003e (P=0.003), pO\u003csub\u003e2\u003c/sub\u003e (P\u0026lt;0.001), CH\u003csup\u003e+\u003c/sup\u003e (P\u0026lt;0.001), ctO\u003csub\u003e2\u003c/sub\u003e (P\u0026lt;0.001), COHb (P=0.03), and HHb (P=0.004) alongside an increase in pH (P\u0026lt;0.001). Additionally, prolactin level increased (P\u0026lt;0.001), while cortisol (P\u0026lt;0.001) and IgA (P\u0026lt;0.001) decreased.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is the first to analyze changes in capillary blood gas levels and hormonal balance during Conscious Connected Breathing sessions, revealing its immunostimulatory effects. The observed improvements in endocrine, immune, and respiratory-circulatory functions suggest breathwork could be a valuable complementary therapy for cancer patients. Further research is needed to explore the mechanisms involved and assess long-term psychological and immunological impacts.\u003c/p\u003e","manuscriptTitle":"Take A Breather –Physiological Correlates Of A Conscious Connected Breathing Session In A Trained Group Of Breast Cancer Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 08:15:31","doi":"10.21203/rs.3.rs-6626599/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a64a52c2-010d-41c8-86df-6286bef957b0","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":49500083,"name":"Biological sciences/Cancer"},{"id":49500084,"name":"Biological sciences/Immunology"},{"id":49500085,"name":"Biological sciences/Psychology"},{"id":49500086,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2025-06-27T17:08:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 08:15:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6626599","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6626599","identity":"rs-6626599","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}