Table_3_Slow-Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot.docx

PurposeNearly one in three US adolescents meet the criteria for anxiety, an issue that has worsened with the COVID-19 pandemic. We developed a video-based slow diaphragmatic breathing stress-reduction curriculum for high school students and evaluated its feasibility, tolerability, and preliminary effectiveness.
MethodsThis cluster-randomized feasibility pilot compared 5-min slow diaphragmatic breathing for 5 weeks with treatment-as-usual control among four 12th-grade public high school classes. Students individually participated after school during COVID-19-related hybrid teaching, with slow diaphragmatic breathing three times/week and breath science education once/week. Feasibility was based on completion of breathing exercises, breath science education, and preliminary effectiveness assessments, and ease/tolerability was based on qualitative assessments. Preliminary effectiveness was measured with the State-Trait Anxiety Inventory (STAI) and a timed-exhale carbon dioxide tolerance test (CO2TT) of physiological stress response. Descriptive statistics and repeated analysis of variance were performed to quantify and compare outcomes between time periods. Human subjects research approval was granted through Western IRB–Copernicus Group (WCG IRB) [ClinicalTrials.gov, Identifier: NCT05266833.]
ResultsForty-three students consented to participate. Breath practice compliance ranged from 29 to 83% across classes and weeks, and decreased on average over the 5 weeks. Compliance with the breath science videos ranged from 43 to 86%, and that with the weekly STAI-State and CO2TT measures varied from 36 to 86%. Compliance with ease/tolerability assessments ranged from 0 to 60%. Preliminary effectiveness assessments' compliance varied across classes from 83 to 89% during baseline, and 29 to 72% at follow-up. The curriculum was rated as somewhat-to-definitely useful/beneficial, and definitely-to-very easy/tolerable. Students reported enjoying the diaphragmatic breathing, CO2TT, and breath science education; some found the extended exhales challenging and the curriculum and assessments time-consuming. Preliminary effectiveness analyses indicated no significant changes in STAI or CO2TT from baseline to followup or from before to after breathing exercises (p > 0.05 for all).
ConclusionsImplementation of this 5-week slow breathing curriculum was feasible and tolerable to this cohort. Compliance, tolerability, and effectiveness may be improved with in-class participation. Future research on simple and accessible slow-breathing exercises is warranted to address today's adolescent stress-management crisis.
Trial RegistrationClinicalTrials.gov, Identifier: NCT05266833

目的
近三分之一的美国青少年符合焦虑症诊断标准，这一问题在新冠疫情期间进一步恶化。我们开发了一套面向高中生的视频版缓慢腹式呼吸（slow diaphragmatic breathing）减压课程，并对其可行性、可耐受性及初步疗效进行了评估。
方法
本研究采用整群随机可行性预试验设计，将4个公立高中12年级班级分为两组，分别接受为期5周、每次5分钟的缓慢腹式呼吸干预，以及常规治疗（treatment-as-usual）对照。在新冠疫情相关的混合教学模式下，学生于课后自主参与干预：每周进行3次缓慢腹式呼吸练习，同时每周接受1次呼吸科学教育。可行性通过呼吸练习完成情况、呼吸科学教育完成情况及初步疗效评估情况进行判定；可耐受性通过质性评估进行判定。初步疗效采用状态-特质焦虑量表（State-Trait Anxiety Inventory, STAI）与计时呼气二氧化碳耐受试验（timed-exhale carbon dioxide tolerance test, CO2TT）来量化生理应激反应。本研究采用描述性统计与重复测量方差分析，对不同时间节点的研究结局进行量化与组间比较。本人体受试者研究已通过西部伦理审查委员会-哥白尼集团（Western IRB–Copernicus Group, WCG IRB）批准，临床试验注册号为ClinicalTrials.gov，标识符：NCT05266833。
结果
本研究共招募43名签署知情同意书的学生。各班各周的呼吸练习依从率介于29%至83%之间，且在5周试验周期内整体呈下降趋势。呼吸科学视频课程的依从率介于43%至86%之间，每周进行的STAI-状态版与CO2TT检测依从率介于36%至86%之间。可耐受性与简易性评估的依从率介于0%至60%之间。初步疗效评估的依从率在基线时介于83%至89%之间，随访阶段则介于29%至72%之间。受试者评价该课程具有一定至极高的有用性/获益性，且难度极低至完全可耐受。学生反馈表示喜爱腹式呼吸练习、CO2TT检测与呼吸科学教育；部分学生认为延长呼气过程存在难度，且课程与评估耗时较长。初步疗效分析显示，从基线至随访阶段，或在呼吸练习前后，STAI评分与CO2TT结果均无显著变化（所有比较p>0.05）。
结论
本研究队列可顺利实施为期5周的缓慢呼吸减压课程，且该课程具备可耐受性。通过课堂参与的形式，或可提升依从性、可耐受性与疗效。针对简易且易获取的缓慢呼吸练习开展后续研究，以应对当前青少年应激管理危机，具有重要意义。
试验注册
ClinicalTrials.gov，标识符：NCT05266833