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Study finds ENO Breathe programme improves aspects of mental wellbeing and breathlessness in long COVID

ENO Breathe, developed by the English National Opera, improved mental health wellbeing and aspects of breathlessness in long COVID patients

Use of the ENO Breathe programme by patients experiencing long COVID symptoms has been shown to improve mental health scores and breathlessness during running in comparison to usual care. This was the conclusion from the first randomised trial to evaluate interventions for patients with long COVID by a UK team of researchers from London.

One of the recognised consequences of an acute infection with COVID-19 for some people is long COVID, defined as new or ongoing symptoms 4 weeks or more after the start of the acute infection. Although a wide range of symptoms have been reported by individuals with the condition, the most frequent include breathing problems, fatigue, muscle weakness or joint stiffness, sleep disturbances, problems with mental abilities, and mood changes such as anxiety or depression. Furthermore, in a review of studies, it has been found both acute and long COVID exert a substantial impact on health-related quality of life (HRQoL). One intervention which positively impacts upon HRQoL is music interventions, with a systematic review, finding that such musical interventions were associated with clinically meaningful improvements.

The English National Opera created the ENO Breathe programme, to help patients recovering from the effects of COVID-19 and for the present study, the UK researchers set out to determine whether the programme could improve both mental and physical aspects of health-related quality of life, as well as the level of breathlessness, in patients with long COVID. They undertook a parallel-group, single-blinded, randomised trial to compare the ENO programme with usual care. Eligible patients were adults (> 18 years of age) and who were recovering from COVID-19 with ongoing breathlessness with or without anxiety for at least 4 weeks after their acute onset of symptoms. Individuals were randomised 1:1 to the ENO Breathe programme or usual care. The programme was individualised and designed to support people with breathlessness and/or anxiety by focusing on breathing, retraining through singing techniques and delivered online. Starting with an introductory session, the programme was followed by a total of 6 sessions held every week.

The researchers set the primary outcome of interest as a change in health-related quality of life (HRQoL) from baseline to the end of the 6-week programme and which was assessed using the RAND 36-item short form survey instrument and in particular two summary measures, the mental health (MHC) and physical health components (PHC). A number of secondary outcomes were used including a visual analogue scale (VAS) for breathlessness on rest, walking, climbing stairs and running.

ENO Breathe programme and HRQoL

A total of 150 participants with a mean age of 49 (81% female) were randomised to either the ENO programme or usual care. Across the two groups, there was a mean of 320 days since the onset of their initial COVID-19 symptoms.

Compared to usual care, those allocated to the ENO Breathe programme had a greater improvement in the MHC (regression coefficient = 2.42, 95% CI 0.03 – 4.80, p = 0.047). However, there was no significant difference between groups for the PHC component (p = 0.54).

With respect to breathlessness, the only self-reported measure to significantly reduce was based on running (p = 0.0026).

The authors concluded that the ENO Breathe intervention could improve mental health wellbeing and one aspect of breathlessness and suggested that the programme might have a role in supporting patients with persisting long COVID symptoms.

Philip KEJ et al. An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19: a parallel-group, single-blind, randomised controlled trial Lancet Respir Med 2022

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