Change in RAND SF-36 scores from baseline to week 6 of follow-up. (A) Change in RAND SF-36 MHC score. (B) Change in RAND SF-36 PHC score. Boxes indicate 25th to 75th percentiles, center line is the median, whiskers are adjacent upper and lower values, outliers are values beyond the adjacent upper and lower values. ENO=English National Opera. MHC = Mental Health Composite. PHC=physical health composite. SF-36=36-item short-form survey instrument. Credit: The Lancet Respiratory Medicine (2022). DOI: 10.1016/S2213-2600(22)00125-4
An online breathing and wellness program helps improve quality of life and breathlessness for people recovering from COVID-19, according to a new study.
This is one of the first clinical trials to report an effective intervention for people with post-COVID syndrome, also known as prolonged COVID. The study is published in The Lancet Respiratory Medicine.
The “ENO Breathe” program has been developed by the English National Opera (ENO) and respiratory clinicians from Imperial College Healthcare NHS Trust. He uses singing techniques to improve the well-being of patients with persistent dyspnea due to COVID-19. The social prescription program has been supporting people in London and across England since September 2020 and is run by ENO Engage, ENO’s learning and engagement department.
Patients are referred to ENO Breathe through specialist NHS Post-COVID Assessment Services following a review of their medical condition and treatments. 70 services now refer to ENO Breathe in London and England. This includes areas that the Arts Council England and the Department for Culture, Media and Sport have identified as Leveling up for Culture locations such as Blackpool, Peterborough, North Somerset and Stoke on Trent. The six-week program is delivered online, starting with an individual session, group sessions once a week, and a variety of online resources throughout the program. To date, more than 1,000 participants have accessed the free program.
Researchers from Imperial College London together with the program team at Imperial College Healthcare. The study found that ENO Breathe participants experienced a 10.48 point reduction (out of 100) in shortness of breath while running, compared to people who only continued usual care. They also experienced a 2.42 point improvement in the mental component of quality of life, as measured by a validated online questionnaire.
These health improvements were further explained through focus groups and questionnaires, which showed that ENO Breathe participants reported experiencing improvements in their symptoms, felt that the program complemented other care they were receiving, and that the use of chanting techniques and music suited his needs. Further analyzes focusing on participants who attended all sessions found improvements in a broader range of respiratory symptoms, anxiety, and improvements in quality of life. For example, 40 percent of ENO Breathe participants experienced a five-point improvement in the mental component of quality of life, compared to 17 percent in the usual care group. This suggests that the participants who were most committed to the program benefited the most. Although the physical component of the quality of life did not improve more in any of the groups.
ENO Breathe uses weekly online group sessions and digital resources, developed with the support of healthcare professionals, to empower participants with tools and techniques to improve how they breathe and how they engage with their breath. The program is led by professional ENO singers and focuses on respiratory recycling through singing techniques, using lullabies as a musical starting point. No experience or interest in singing is required.
Dyspnea is one of the most common symptoms in people with long-standing COVID. Many factors can contribute, including damage to the lungs and supporting tissues, shock to the nervous system, and other ongoing symptoms such as fatigue and cough. Anxiety around breathing can exacerbate shortness of breath, and all of these factors can influence how people breathe after COVID-19 infection, potentially worsening their quality of life. As of January 2022, an estimated 1.5 million people in the UK may be experiencing prolonged symptoms of COVID.
Lead study author Dr Keir Phillip, Clinical Research Fellow at the National Heart and Lung Institute at Imperial College London, said:
“We urgently need evidence-based treatments and interventions for people with prolonged COVID, which currently affects around 1 in 50 people in the UK. Our study suggests that arts-in-health interventions can be effective tools for carefully selected participants, especially when successfully integrated with clinical services.”
“Our study suggests that improvements in symptoms experienced by participants were the result of learned practical breathing techniques, but also the creative, humane and positive way in which the program was delivered.”
Lead author Dr Sarah Elkin, Lead Program Consultant and Respiratory Consultant at Imperial College Healthcare NHS Trust, said:
“As we continue to re-protect ourselves from the impact of the pandemic, it is vital that we find ways to help people with prolonged COVID who experience debilitating symptoms long after they recover from their initial COVID-19 infection. It is extremely important to build an evidence base for programs like ENO Breathe, so that we can continue to understand how best to support people with prolonged COVID and make improvements that can lead to better outcomes.”
Professor Nicholas Hopkinson, co-lead author and Professor of Respiratory Medicine at Imperial College London, said:
“Shortness of breath is one of the most common symptoms experienced by people with long-standing COVID. The ENO Breathe program is designed to help people with this condition learn to better control their breathing. Our research shows that it is effective, and the program has already benefited over 1,000 people recruited from post-COVID clinics across the UK.”
Dr Harry Brunjes, President of the English National Opera, said:
“We are extremely proud that ENO Breathe has been shown to aid the recovery of people with long-standing COVID. It has been designed to help. Research like this demonstrates the enormous benefit that the arts can have when applied in a medical context. We are enormously grateful to our partners at Imperial College Healthcare NHS Trust for their dedicated work developing this program with us, and to the phenomenal team at Imperial College for their meticulous research.”
James Sanderson, Executive Director of The National Academy of Social Prescription (NASP), said:
“At NASP we believe that social prescribing can transform people’s health, so it’s exciting to see published clinical evidence demonstrating the effectiveness of a social prescribing program. We are delighted to be able to support ENO’s “Breathe” classes that are improving the lives of hundreds of people living with prolonged COVID.”
All trial participants were recovering from COVID-19 with ongoing breathlessness, either with or without associated anxiety, and had been referred from post-COVID assessment clinics after appropriate investigations and treatment. The majority of participants (81 percent) were women, which is broadly representative of the broader population of long-term COVID patients.
The participants were divided into two groups. One group (74 people) participated in the six-week ENO Breathe program and a control group (76 people) continued their usual care as directed by their post-COVID evaluation clinic. Both groups were evaluated after six weeks, when the control group was also offered the opportunity to participate in the program.
The researchers collected information about the participants’ health and well-being through online questionnaires and used focus groups and feedback questions to gauge the participants’ experience. They measured the mental and physical components of a validated “Health-Related Quality of Life” tool that assesses key indicators of quality of life, including difficulties arising from health problems, social impacts, pain, and impact in daily activities. The researchers also looked at other impacts of the disease, including shortness of breath, anxiety, and a range of other symptoms.
There were also three common qualitative themes regarding the participants’ experience: an improvement in symptoms, a feeling that the program complemented the care they received. receiving, and that the singing and breathing were adapted to their needs.
explore more
Fatigue and shortness of breath improve after six weeks of virtual exercise sessions: recovery program for patients with COVID-19 More information: Keir EJ Philip et al, An online breathing and wellness program (ENO Breathe) for people with persistent symptoms after COVID-19: a parallel group, single-blind, randomized controlled trial, The Lancet Respiratory Medicine (2022). DOI: 10.1016/S2213-2600(22)00125-4 Magazine information: Lancet Respiratory Medicine
Provided by Imperial College London Date: Singing wellness program can improve quality of life and breathlessness after COVID-19 (April 28, 2022) Retrieved Aug 29, 2022 from https://medicalxpress.com/news/2022-04- well-being-quality-life-breathlessness-covid-.html This document is subject to copyright. Other than any fair dealing for private study or research purposes, no part may be reproduced without written permission. The content is provided for informational purposes only.