Mobile app for breathing meditation may reduce sarcoidosis fatigue
Trial results show it might also lower patients' stress, improve quality of life
Written by |
A mobile health app designed to guide breathing awareness meditation (BAM) sessions may effectively reduce fatigue and stress and improve the quality of life for people with sarcoidosis.
That’s according to results from a pilot clinical trial (NCT05230693) that assessed the feasibility and efficacy of the Sarcoidosis Patient Resource Companion (SPARC) app in about four dozen sarcoidosis patients.
BAM refers to meditation involving diaphragmatic breathing, a type of deep breathing that focuses on movements of the diaphragm, the primary muscle used for breathing.
“While adherence rates were lower than expected, usability was acceptable, and user feedback was generally positive and informative to guide future studies evaluating the use of mHealth [mobile Health] in sarcoidosis,” the researchers wrote.
The trial findings were described in the study, “A mHealth app for sarcoidosis-associated fatigue: a feasibility randomized control trial,” which was published in Respiratory Medicine by a team of researchers at the Medical University of South Carolina (MUSC).
Fatigue reported by up to 90% of sarcoidosis patients
Although symptoms of sarcoidosis vary depending on the organs affected, fatigue is reported by up to 90% of patients. Sarcoidosis-associated fatigue has been linked to higher stress levels, depression, and poor quality of life.
Limited evidence to date suggests that mindfulness-based programs and BAM can reduce fatigue and improve well-being in people with sarcoidosis.
“Importantly, BAM can also be easily incorporated for use via mHealth platforms, with the potential to overcome barriers commonly faced by underserved and rural populations,” the researchers wrote.
With this in mind, the researchers developed SPARC, an app that includes educational modules on sarcoidosis and the impact of fatigue on quality of life, as well as a voice-guided BAM module. This module prompts patients to perform BAM daily, and is accompanied by inspirational messages to encourage adherence.
In the pilot study, the team assessed the feasibility and preliminary efficacy of the SPARC app at easing sarcoidosis-associated fatigue and improving quality of life in 49 adults with sarcoidosis. All had significant fatigue, defined as a score of 22 or higher on the Fatigue Assessment Scale (FAS).
Fitbits used to monitor participation in meditation breathing
Recruited at MUSC, participants were randomly assigned to either use the SPARC app to perform at least one 10-minute BAM session per day (25 individuals) or to receive standard care to manage fatigue (24 individuals).
All participants were equipped with Fitbit fitness trackers, which were used primarily to objectively measure whether patients in the app group were performing BAM as instructed, based on a reduction in heart rate that is expected during sessions.
Participants (mostly women and in their 50s) underwent evaluations at the study’s start and after one, three, and six months. Overall, six participants in the app group and five in the control group did not complete their three-month surveys and were considered dropouts.
Although scores of the app’s engagement, functionality, aesthetics, and information were generally favorable, with an overall median score of 3.6 on a five-point scale, only 44% of the app group participants were considered adherent, meaning they completed more than 70% of the 90 possible BAM sessions.
The median score for app usability was 55.8, which is considered below average. Still, the 17 people who used the app and participated in three-month follow-up interviews generally reported that the app was “pretty straightforward and simple,” easy to use, and facilitated the meditation practice, which was “very pleasant.”
App users also found the educational videos to be helpful, particularly the personalized encouragement and education provided by their sarcoidosis specialist.
Despite low adherence, the SPARC group showed greater reductions in fatigue over the three-month intervention period relative to the control group, as evidenced by a drop of 5.9 vs. 1.1 points in the FAS score, which persisted through month six.
Barriers to full adherence included a lack of time
Quality of life and stress were also assessed using validated measures. Those using the app experienced greater improvements in quality of life (a score increase of 9.2 points vs. 2.3 points) after three months and greater reductions in stress (a decrease in score of 4.2 points vs. 0.6 points) after six months.
At the three-month interviews, more than half of the 17 participants (58.8%) considered the app helpful in easing their fatigue, while most (82.4%) reported that it helped reduce their overall stress levels.
This highlights the need to adapt the functionality of the device to people’s real-life demands … and continuing to build flexibility in the app to allow [patients] to implement this practice into their daily routine.
The researchers also explored potential reasons for low levels of adherence to the app. Although there were no significant differences between adherent and non-adherent participants, non-adherence tended to be higher in younger patients, Black individuals, those with lower levels of education, and those earning less than $30,000 a year.
Barriers to full adherence reported by patients included a lack of time and difficulty in fitting the sessions into their daily routine.
“This highlights the need to adapt the functionality of the device to people’s real-life demands … and continuing to build flexibility in the app to allow [patients] to implement this practice into their daily routine,” the researchers wrote. “Our hope is that our future work and that of others with [larger-scale] trials will result in the development and dissemination of mHealth self-management tools that will lead to meaningful and sustainable improvements in [quality of life] in [people with sarcoidosis].”
