A23-14 REducing STress (REST) in COPD: A Pilot Study of a Brief Pranayama Intervention

Abstract Rationale Stress in COPD is associated with increased symptoms and exacerbations. Through a theory driven, patient-informed intervention mapping process, we designed a stress reduction intervention (REST) based on Pranayama, a set of Indian-origin yoga breathing techniques. In this randomized pilot trial, we aimed to determine if a single session of the breathing intervention led to improvements in vital signs, lung function, dyspnea, and psychological symptoms scores. Methods Twenty adults with spirometry-confirmed COPD and high levels of stress were recruited from an academic pulmonary clinic for a pilot, two-arm study of a controlled breathing intervention (REST trial). Participants were randomized to either the REST protocol or usual-breathing control condition. The REST protocol comprised three pranayama-based techniques (three-part dirgha breath, alternate nostril breathing, and 2:1 breathing) taught during an initial session and practiced for one week for 15 minutes daily. Physiologic (vital signs, EKG, spirometry) and self-report measures (perceived stress, relaxation, and anxiety via visual analog scale, and dyspnea via modified Borg scale) were collected immediately pre- and post- 15 minute breathing intervention (or usual breathing) after 1 week of daily practice of pranayama exercises. Exploratory analyses compared pre- to post-change within and between groups using descriptive statistics. Difference-of-differences estimates to characterize the magnitude and direction of intervention effects. Standard errors were calculated using a linear mixed effect model. Results Twenty participants enrolled in the study (11 in treatment, 9 in control; 50% female). Study completion rate was 100% for the total sample (n = 20) and self-reported adherence rate was 100% for the treatment group. Compared to the control group, the intervention group had improvements in systolic (DoD(SE) -5.0 (2.9) mmHg) and diastolic (DoD(SE) -4.9 (2.6) mmHg) blood pressure and heart rate (DoD(SE) -3.3(3.2) beats per minute). Oxygen saturation had a minimal improvement (DoD(SE) 0.72% (0.5)) (Figure 1). There was no change in lung function after a single session. The Borg dyspnea scale (range 1-10 {max dyspnea]) improved in the intervention group (DoD -1.54). Stress and anxiety decreased in both groups; however, relaxation improved only in the intervention group. Conclusion Preliminary data from a pilot study of a brief 15-minute Pranayama-based stress reduction intervention in patients living with COPD support the conduct of a clinical trial testing the efficacy of a breathing intervention on acute changes in blood pressure, dyspnea, and psychological symptom outcomes. This abstract is funded by: NHLBI