Table_6_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

研究目的
近三分之一的美国青少年符合焦虑症诊断标准，且这一问题在新冠疫情期间进一步恶化。本研究针对高中生开发了一套基于视频的缓慢腹式呼吸（slow diaphragmatic breathing）减压课程，并对其可行性、可接受性及初步疗效进行了评估。

研究方法
本研究采用整群随机可行性预试验设计，将4个公立高中十二年级班级分为两组，分别接受为期5周、每次5分钟的缓慢腹式呼吸干预，以及常规治疗对照。在新冠疫情相关的混合教学模式期间，学生于课后单独参与干预：每周进行3次缓慢腹式呼吸练习，同时辅以每周1次的呼吸科学知识教育。可行性通过呼吸练习、呼吸科学知识教育及初步疗效评估的完成情况进行衡量；可接受性基于定性评估结果进行判断。初步疗效采用状态-特质焦虑量表（State-Trait Anxiety Inventory, STAI）与呼气时长控制二氧化碳耐受试验（timed-exhale carbon dioxide tolerance test, CO2TT）——用于评估生理应激反应——进行测量。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。本研究已通过西方伦理审查委员会-哥白尼集团（Western IRB–Copernicus Group, WCG IRB）的人体受试者研究伦理审批，试验注册信息：美国临床试验数据库（ClinicalTrials.gov）编号NCT05266833。

研究结果
共有43名学生签署知情同意书并参与研究。各班级及各周的呼吸练习依从性为29%~83%，整体依从性在5周试验期间呈平均下降趋势。呼吸科学知识视频的依从性为43%~86%，每周状态-特质焦虑量表（STAI-状态版）与CO2TT检测的依从性为36%~86%。可接受性与易用性评估的依从性为0~60%。初步疗效评估的依从性在基线时各班级为83%~89%，随访阶段为29%~72%。受试学生认为该课程"略有用途至非常有用"，且"非常容易接受且耐受性良好"。学生反馈表示喜欢腹式呼吸练习、CO2TT检测及呼吸科学知识教育；部分学生认为延长呼气时长存在难度，且课程与评估耗时较长。初步疗效分析结果显示，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（所有比较的p值均大于0.05）。

研究结论
本5周缓慢呼吸减压课程在该受试队列中具备可行性与良好耐受性。通过课堂内参与的方式，或可提升依从性、可接受性与疗效。针对简便易行的缓慢呼吸练习的后续研究，有助于应对当前青少年压力管理危机。

试验注册
美国临床试验数据库（ClinicalTrials.gov），编号：NCT05266833