Living, breathing, learning: a community approach to lung health in Wales
We know that pulmonary rehabilitation is the most effective way to manage breathlessness in COPD and stay fit and well, but could singing or community exercise help? Joseph Carter, our Head of Devolved Nations, looks at the evaluation of the Helping You Help Yourself and Singing for Lung Health projects.
Helping You Help Yourself
Helping You Help Yourself was a National Lottery Community Fund Wales funded project managed by the British Lung Foundation (BLF). The project delivered self-management and exercise workshops, and provided support to people across Aneurin Bevan, Cwm Taf and Swansea Bay University Health Boards. It was aimed at those who had recently been diagnosed with, or who had, mild COPD, with a Medical Research Council (MRC) score of 1 or 2, (a patient-described experience of breathlessness used to gauge the severity of symptoms).
The project consisted of a six-week exercise and education programme delivered by a BLF Programme Coordinator with a Level 4 chronic respiratory disease qualification, a healthcare professional and a volunteer living with COPD.
The project ran from January 2018 until March 2020, delivering a total of 52 programmes to over 300 participants. Thirteen programmes scheduled for March–June 2020 were cancelled due to the COVID-19 pandemic.
So, what were the results?
Symptoms - We tested participants symptoms of COPD before the programme using the COPD Assessment Test (CAT), a patient-completed instrument that can quantify the impact of COPD on the patient’s health. CAT scores were measured at the start and at six and twelve months afterwards, scoring each symptom between 0 and 5.
All symptoms, including breathlessness, cough and confidence all showed significant improvements as a result of the programme with an average improvement of 35% after 6 months.
Understanding - Participants demonstrated an increased understanding of their condition as a result of the programme. At the start of the programme, 67% of respondents felt that they had a good understanding of their lung condition and 53% felt they knew what to do when having an exacerbation. After the programme, both these figures increased to 96%.
Healthy choices - Participants demonstrated that they were making healthier lifestyle choices as a result of the programme. The percentage of participants who told us they did not smoke increased from 82% to 92% at completion of the programme and this was sustained at six and twelve months afterwards. 97% reported eating healthily after the programme, and 83% told us they took regular exercise, results which were sustained six and twelve months after the programme.
Reducing social isolation - Evidence of social isolation was reduced in participants who had taken part in the programme. 87% were happier with their social life after the programme, 81% more participants had network of friends & social contacts to go to for support at completion of the programme, and 80% more people attended groups and activities of interest.
Increased strength and mobility - Participants demonstrated increased strength and mobility as a result of the programme. We tested how far participants were able to walk in six minutes before and at completion of the programme, and on average, 89% of participants were able to walk on average 51m further, an improvement of 16%.
Singing for Lung Health
Singing has been shown to be exercise for the lungs and can help people manage their breathlessness, while building friendships and social support networks. We began our work in this field in 2014 and have since built up a network of over 100 singing groups across the UK.
The Welsh project started in 2018 training 18 singing leaders, setting up 21 new groups and supporting over 200 people.
What were the results?
Improved symptoms - Singing group members demonstrated improved symptoms as a result of their singing. We tested participants symptoms of COPD before they joined their singing group using the CAT, scoring each symptom between 0 and 5.
When asked again at three, six and twelve months afterwards, we saw that on average, their symptoms improved consistently over time, falling from an average of 2.4 to 1.9. Participants in singing groups also demonstrated decreased inhaler use. At six months, only 70% of participants used their inhalers on a daily basis, compared with 84% at the start of the project.
Reduced social Isolation - We also found that singing group members experienced reduced feelings of loneliness and social isolation as a result of joined their group. We measured their perception of their own nervousness, worry, anxiety, tension, fear and general mental health using the General Anxiety Disorder 7 (GAD7) questionnaire at the start of the project, and at three, six and twelve months. Participants feel less nervous, worried, tense and anxious after a year of being in a Singing for Lung Health group.
Through these two projects we have shown that providing exercise and self-management to people with mild COPD is cost effective and can improve people’s lives. We are therefore calling on political parties to make pulmonary rehabilitation available to not just the current moderate to severe COPD group, but also those with mild COPD. We are also calling on the next Welsh Government to fund singing for lung health in every health board.
Read the full report here: