Opera techniques support COVID-19 recovery

Following the success of an initial six-week pilot, English National Opera (ENO) announces that ENO Breathe, a programme that prescribes singing, breathing and wellbeing to provide support to people recovering from COVID-19, is to be rolled out across King’s Health Partners.

According to research from King’s College London, some patients who survive COVID-19 can experience the effects of the disease for months after initial recovery – known as ‘long COVID’ – including symptoms such as fatigue and lack of breath.

The ENO programme seeks to address the increasing need for support for those experiencing ‘long-COVID’ symptoms, by bringing together musical and medical expertise and creating an integrated social prescribing programme of singing, breathing and wellbeing for patients. Building on techniques used by singers, the holistic online programme offers self-management tools for patients experiencing breathlessness, and the anxiety that this can produce.

Following an initial six-week trial with 12 participants from September - November 2020, the programme will now be rolled out to up to 1,000 patients by participating healthcare networks, including Guy’s and St Thomas and King’s College Hospital NHS Foundation Trusts.

The initial six-week pilot proved to be successful following independent evaluation, with the participants reporting definite improvements in symptoms and wellbeing, indicating that ENO Breathe has had positive impacts for them both emotionally and physically.

Patients for the six-week pilot were referred onto the programme by Imperial College Healthcare. They all had ongoing symptoms of breathlessness and anxiety eight to twelve weeks after initial infection with COVID-19. Participants’ ages ranged from early 30s to late 70s, 41% were from a Black, Asian and minority ethnic background (25% Black/Black British and 8% Asian/Asian British), and 25% had English as a second language. There was a high participant retention rate - only one from the original 13 participants had to withdraw (for health reasons).

The ENO commissioned an independent evaluation to assess the efficacy and impact of the programme for participants. The evaluation methodology included participant focus groups and patient self-assessments pre- and post-programme, using validated metrics including RAND-36 General Wellbeing index, a health-related quality of life survey instrument, Generalised Anxiety Disorder Assessment (GAD-7) and breathlessness scores.

Led by Baylis, ENO’s learning and participation programme, ENO Breathe uses weekly group online sessions and digital resources to empower participants with tools and techniques to help them focus constructively on their breathing. The programme focuses on breathing retraining through singing, using lullabies as its musical starting point.

Led by professional singing specialists, participants learn breathing and singing exercises [pictured above, patients engaging in opera techniques], using an approach that mirrors techniques employed by opera singers who achieve the physical coordination required for singing via emotional connection and imagery, rather than by giving their bodies explicit physiological instructions. Participants are then equipped with exercises to practice these techniques in their own time, aided by online resources specifically designed to support their progress.

By the end of the pilot programme, participants reported definite improvements in symptoms and wellbeing. 90% reported positive improvement in their breathlessness and 91% of participants felt their levels of anxiety had dropped. Prior to the programme, the group’s mean Generalised Anxiety Disorder Assessment score was 6.7. By the end of the six weeks, this had dropped to 3.2. Notable improvements were also seen in areas such as fatigue.

Jenny Mollica, Director of ENO Baylis, said:

The ENO are committed to making a difference to the lives of people and communities recovering from COVID-19, using our unique skills and resources in ways that are relevant and useful – and that matter to people. Following our successful pilot programme, we are hugely proud to be able to roll out ENO Breathe nationally, enabling us to support many more patients in their recovery from COVID and journey back to wellness.

Dr Irem Patel, respiratory consultant at King’s College Hospital NHS Foundation Trust, who is also Respiratory Clinical Director for London and Joint Director of Clinical Strategy at King's Health Partners, said: 

I am delighted Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts are participating in this programme as part of post-COVID clinics. It is really great that patients across south east London will have access to this programme, as the benefits to helping patients recover from COVID-19 and breathlessness are very clear.