E3 PreliminaryPreliminaryPEM not requiredObservationalPeer-reviewedMachine draft
SingStrong-A singing and breathing retraining intervention for respiratory and other common symptoms of long COVID: A pilot study.
Cahalan, Roisin M, Meade, Ciara, Mockler, Sarah · Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2022 · DOI
Quick Summary
Researchers tested a 10-week online program called SingStrong that combines breathing exercises, singing, and mindfulness to help people with long COVID. The 21 participants who completed the program reported significant improvements in breathlessness, fatigue, pain, voice quality, and ability to do daily activities. Qualitative feedback was overwhelmingly positive, with participants reporting better breathing and overall wellbeing.
Why It Matters
Many long COVID patients experience severe breathlessness and fatigue with limited treatment options. This study provides preliminary evidence that a non-pharmacological, accessible online intervention may address multiple common symptoms simultaneously, offering hope for a relatively low-burden therapeutic approach that could be widely implemented.
Observed Findings
- Significant improvements in breathlessness at rest (p<0.001), breathlessness with dressing (p=0.01), and breathlessness with stairs (p<0.001).
- Significant improvements in fatigue (p=0.03), usual activities (p=0.04), and pain/disability (p=0.03).
- Significant improvements in voice quality (p=0.01) and communication/cognition (p=0.04).
- Nine fewer participants met ME/CFS diagnostic criteria post-intervention (14.3% reduction).
- Qualitative feedback from all eight focus group participants was overwhelmingly positive regarding breathing and wellbeing improvements.
Inferred Conclusions
- The SingStrong programme shows promise as a viable, accessible treatment option for addressing multiple common long COVID symptoms.
- A multimodal approach combining breathing retraining, singing, and mindfulness may be more effective than single-component interventions for long COVID.
- Non-pharmacological interventions warrant further investigation as part of the long COVID management toolkit.
Remaining Questions
- What is the durability of improvements—do benefits persist after the program ends or require ongoing practice?
- Which specific components (breathing, singing, mindfulness, social support) are most responsible for symptom improvements?
What This Study Does Not Prove
This pilot study does not establish that SingStrong is definitively effective because it lacked a control group or blinded design—improvements could partly reflect placebo effect, natural recovery, or simply benefit from group support. The small sample size and high dropout rate (22% of enrolled participants) limit generalizability. The study cannot determine which components of the intervention (breathing, singing, mindfulness, or group effects) drove the observed improvements.
Tags
Symptom:Cognitive DysfunctionPainFatigue
Phenotype:Long COVID Overlap
Method Flag:Weak Case DefinitionNo ControlsSmall SampleExploratory OnlyMixed Cohort
Metadata
- DOI
- 10.29390/cjrt-2021-074
- PMID
- 35359819
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 10 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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