Impact of an online breathing and wellbeing programme (ENO Breathe) in people with persistent symptoms following COVID-19: a randomised controlled trial
Background Evidence-based interventions for Long COVID are lacking, however holistic approaches supporting recovery are advocated. We assessed whether an online breathing and wellbeing programme (ENO Breathe) improves health related quality-of-life (HRQoL) in people with persisting breathlessness following COVID-19. Methods We conducted a parallel-group, single-blind, randomised-controlled trial, involving 51 UK-based Long COVID clinics. Following clinical assessment, potential participants were given a unique online portal code. Those used were randomly allocated to immediate, or deferred (controls), ENO Breathe participation - a 6-week online breathing and wellbeing programme, developed for people with Long COVID, focusing on breathing re-training utilising singing techniques. Findings There were 150 participants (mean(SD) 49(12)years, 81% female, 320(127) days since symptom onset; ENO Breathe (n=74), Control (n=76). The primary outcome was change in Health-Related Quality of Life (HRQoL) from baseline to end of the 6-week course, assessed using the RAND SF-36 Mental (MHC) and Physical (PHC) Health Composite Scores. Compared to controls, ENO Breathe was associated with an improvement in MHC of 2·42 points (95%CI 0·03 to 4·80, p=0·047), but not PHC 0·6 (-1·33 to 2·52 points, p=0·54). The secondary outcome measure Visual Analogue Scale (VAS) for breathlessness (running) also favoured ENO Breathe participation -10·48, (-17·23 to -3·73, p=0·003). No other statistically significant between group differences in secondary outcomes were observed. Thematic analysis of ENO Breathe participant experience, using focus groups and free-text responses identified three key themes: 1) improvements in symptoms; 2) feeling that the programme was complementary to standard care; 3) the particular suitability of singing and music to address their needs. Interpretation An online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind-body and music-based approaches, including practical, enjoyable symptom-management techniques may have a role supporting recovery
