Online breathing, wellness program improves health-related quality of life after COVID-19

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Disclosures: Elkin and Philip have not released any relevant financial information. Please see the study for relevant financial statements from all other authors.


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An online respiration and wellness program has improved health-related quality of life and sustained respiration in people with persistent symptoms after COVID-19, the researchers reported. Lancet Respiratory Medicine.

“We need more evidence-based treatment and interventions for people with long-term COVID, which currently affects around 1 in 50 people in the UK.” Keir EJ Philip, MRCP, Members of the National Institute of Heart and Lung and clinical research at the NIHR Imperial Biomedical Research Center said in a related press release. “Our research suggests that art health interventions can be effective tools for carefully selected participants, especially when successfully integrated with clinical services.”

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Philip and colleagues conducted a parallel, single-blind, randomized controlled trial that enrolled 150 adults from one of the 51 long UK-based COVID clinics. All patients were recovering from COVID-19 with continuous breathing, with or without anxiety, for at least 4 weeks after the onset of symptoms. Patients had access to the Internet with appropriate devices and were randomly assigned to participate in the English National Opera (ENO) Breathe program (n = 74; mean age 49 years; 78% women) or regular care (n = 76; mean age). 50 years; 83% women).

The ENO Breathe program team participated in a 6-week network breathing and wellness program focused on recycling breathing techniques using singing techniques.

The main result was a change in the quality of life associated with health. Secondary outcomes were the COPD assessment test score, visual analog scales for respiratory and dyspnea-12, 7-item General Anxiety Disorder scale, and SF-6D scores. The trial took place from April to May 2021.

ENO Breathe team members improved their mental health scores (P = .047) but not compound physical health scores (P = .54) compared with regular care, according to the results. Intervention was also associated with better visual analog scale of respiration (P = .0026).

The researchers found that there were no significant differences between the two groups in other secondary outcomes.

The health improvements observed in this study were further explored through focus groups and questionnaires. Studies showed that people who participated in the ENO Breathe program showed a greater improvement in their symptoms, that the program complemented the attention they were receiving, and that the use of singing techniques and music suited their needs. Additional analyzes aimed at participants who completed all sessions highlighted improvements in broader respiratory symptoms, anxiety, and a greater improvement in quality of life. For example, 40% of the ENO Breathe group had a five-point improvement in the mental component of quality of life, compared to 17% in the regular care group, according to a press release.

A participant in the ENO Breathe program group reported feeling dizzy using the computer for a long time. No other adverse events were reported.

“As we continue to recover from the impact of the pandemic, it is essential to find ways to help people with long-term COVID-19 who recover from COVID-19 infection and suffer from debilitating symptoms for a long time.” Sarah Elkin, MD, The director of the ENO Breathe program and the respiratory counselor at the Imperial College Heart and Lung National Institute of the NHS in Trout, London, said in a statement. “It’s very important to build an evidence base for programs like ENO Breathe so that we can continue to better understand how to help people with long-term COVID and make improvements that can lead to better results.”

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