ENO Breathe Announces Results of Randomised Controlled Trial

28th April 2022 in News Press

Online health and wellbeing programme using singing techniques (ENO Breathe) can improve quality of life and breathlessness after COVID-19.

We are incredibly proud to announce the results of a Randomised Controlled Trial (RCT) that was conducted on the ENO Breathe programme last summer. This study is hugely important for ENO Breathe in proving the efficacy of the programme, but also in the much wider context of evidencing effective interventions for supporting people with post-COVID syndrome, or long COVID, as this is possibly the first RCT for people diagnosed with this condition.

The study is published in The Lancet Respiratory Medicine, the world’s top-ranking respiratory medicine journal, and can be read in full here.

Summary of Results:

  • The study found that ENO Breathe participants experienced a 10.48 point (out of 100) reduction in breathlessness while running, compared to people who just continued with usual care alone.
  • 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 explained in more detail using focus groups and questionnaires, which showed that ENO Breathe participants:

  • reported experiencing improvements in their symptoms
  • found the programme complemented other care they were receiving
  • felt that using singing techniques and music suited their needs

Additional analyses focusing on participants that went to all the sessions, found improvements in a wider range of respiratory symptoms, anxiety, and had larger quality of life improvements. For example 40 per cent of ENO Breathe participants experienced a five-point improvement in the mental component of quality of life, compared with 17 per cent in the usual care group. This suggests the participants who engaged most with the programme got the biggest benefit.

Details of the clinical trial:

The clinical trial involved 150 participants. It was conducted by researchers at Imperial College London alongside the programme team at Imperial College Healthcare.

Participants were split into two groups. One group (74 people) took part in the six-week ENO Breathe programme and a control group (76 people) continued with their usual care as directed by their post-COVID assessment clinic. Both groups were assessed after six weeks, when the control group were then also offered the opportunity to take part in the programme.

The researchers collected information about participants’ health and wellbeing via online questionnaires and used focus groups and feedback questions to assess participant experience. They measured mental and physical components of a validated ‘Health-Related Quality of Life’ tool that assesses key indicators of quality of life, including difficulties resulting from health problems, social impacts, pain and impact on daily activities. The researchers also assessed other disease impacts including breathlessness, anxiety, and a range of other symptoms.

Lead author of the study, Dr Keir Philip, 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 long COVID, which currently affects approximately 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 the improvements in symptoms experienced by participants, resulted from both practical breathing techniques learnt, but also the creative, humane, and positive way the programme is delivered.”

Senior author, Dr Sarah Elkin, consultant lead for the programme and a respiratory consultant at Imperial College Healthcare NHS Trust said:

“As we continue to recover from the impact of the pandemic, it’s vital we find ways to support people with long COVID who are experiencing debilitating symptoms long after recovering from their initial COVID-19 infection. It is extremely important to build an evidence base for programmes such as ENO Breathe, so we can continue to understand how best to support people with long COVID and make improvements that can lead to better outcomes.”

Dr Harry Brunjes, Chair, the English National Opera said:

“We are extremely proud that ENO Breathe has been evidenced to aid the recovery of the people with long-covid it has been designed to help. Research like this demonstrates the enormous benefit the arts can have when applied in a medical context. We’re enormously grateful to our partners at Imperial College Healthcare NHS Trust for their dedicated work in developing this programme with us, and to Imperial College’s phenomenal team for their painstaking research.”


To find out more about the ENO Breathe programme, please visit the ENO Breathe home page

For any general enquiries, please contact [email protected]

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