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Singing-based respiratory training in people with post-COVID syndrome: a bicentric randomized feasibility study - 11/12/25

Doi : 10.1016/j.rehab.2025.102073 
Prof. Dr. med. Anke Steinmetz 1, 10, , Dr. rer. hum. Alexander Hönning 2 , Dr. rer. nat. Wiebke Käckenmester 2 , Prof. Dr. med. Ingo Schmehl 3 , Prof. Marc Secara 4 , Dr. med. dent. Sigrid Biffar 5 , Ina Kim 3 , Katja Bahcesular 7 , Dr. med. Bernhard Lehnert 6 , Dr. med. Kristin Lehnert 7, 10 , Prof. Dr. med. Marcus Dörr 7, 8, 10 , Dr. med. Kristina Zappel 2, 9
1 Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany 
2 Centre for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany 
3 Clinic for Neurology with Stroke Unit and Early Rehabilitation, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany 
4 Berlin School of Popular Arts, Potsdamerstraße 188, 10783 Berlin, Germany 
5 Physical and Rehabilitation Medicine, Department of Orthopaedics, Trauma, and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany 
6 Department of Otorhinolaryngology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany 
7 Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany 
8 Institute of Community Medicine, Study of Health in Pommerania, University Medicine Greifswald, Walter Rathenau Str. 48, 17475 Greifswald, Germany 
9 Central Ethics Committee for Stem Cell Research, Robert Koch Institute, 13353 Berlin, Germany 
10 DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Fleischmannstraße 42-44, 17475 Greifswald, Germany 

Correspondence to Anke Steinmetz.

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In corso di stampa. Manoscritto Accettato. Disponibile online dal Thursday 11 December 2025
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Highlights

Singing-based respiratory training (SBRT) can treat post-COVID syndrome
SBRT is well accepted by participants and has a high level of treatment adherence
Health-related quality of life is a useful primary outcome for a confirmatory study

Il testo completo di questo articolo è disponibile in PDF.

Abstract

Background

People with post-COVID syndrome (PCS) often suffer from long-term pulmonary consequences. Singing-based respiratory training (SBRT) has proven to be a valuable rehabilitative therapy for people with chronic lung diseases.

Objectives

The aim of this study was to investigate the feasibility of SBRT in people with PCS breathing disorders, their compliance and adherence, and to obtain detailed findings on the effect of this training on people with PCS respiratory symptoms.

Methods

A randomized controlled, single-blind, bicentric study was conducted with 23 outpatient and 24 inpatient participants undergoing rehabilitation for PCS. Participants either received singing-based respiratory training with the intention of reducing breathing rate or training without the aim of influencing breathing rate. The main outcomes were patient compliance, determination of target parameters for a future efficacy study, and assessment of outcome differences between treatment groups.

Results

The 45 study participants were predominantly female (81%) with a mean age of 51.5 (SD 10.44) years. There was a high level of compliance with SBRT, with 96% of participants completing all training sessions led by vocal coaches. The overall comparison between baseline and follow-up assessments yielded improvements corresponding to medium effects in the physical component score of the Veterans RAND 12-Item Health Survey (VR-12) with a Cohen’s d of 0.52 (95% Confidence Interval, CI 0.05, 0.99]), in the Generalized Anxiety Disorder Scale-7 (GAD-7) with a Cohen’s d of 0.55 (95% CI 0.11, 0.9) and in the Patient Health Questionnaire-9 (PHQ-9) with a Cohen’s d of 0.50 (95% CI 0.06, 0.93).

Conclusion

SBRT was well-tolerated, with high adherence and compliance among participants in our study. Questionnaires assessing health-related quality of life and mental health may be suitable as primary outcomes for a future confirmatory study. The data suggest that SBRT aimed at reducing the respiratory rate does not have a positive effect compared to regular SBRT.

Trial registration

German Register of Clinical Trials (DRKS ID DRKS00028275).

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Post-COVID syndrome, singing-based respiratory training, breathing disorders, pulmonary rehabilitation, health-related quality of life

Abbreviations : COPD, Dyspnea 10a, DLCO, FEV1/FVC, FVC, GAD-7, GEE, HRV, I_IND, I_RRR, PCR, PCS, PHQ-9, pNN50, POTS, RMSSD, RRMean, RRSD, RSA, RV, SBRT, SLH, TLC, VR-12, 6MWT, WHO


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