Long-term usage of the gamified breathing training Breeze and its effect on momentary relaxation in people with cancer: A cohort study

Abstract

Background: People with cancer often experience stress. Digital health interventions (DHIs) can help individuals increase momentary relaxation. Breeze is a gamified breathing training that can be embedded into DHIs. Its effectiveness in controlled cross-sectional studies was shown. However, adherence to Breeze and its effect on momentary relaxation in longitudinal interventional studies has yet to be investigated. Objective: This work aims to assess the use of Breeze and its effect on momentary relaxation in people with cancer. Methods: Breeze was one of seven relaxation techniques included in the CanRelax 2.0 app, designed specifically for individuals diagnosed with cancer. Participants could select any of the seven techniques to promote momentary relaxation. The intervention was designed to last 10 weeks. However, participants were allowed to use the CanRelax 2.0 app after that period. Participants were adults diagnosed with cancer in the last five years recruited across Switzerland, Germany, and Austria. Momentary relaxation was measured pre- and post-exercise using an 11-point visual analog scale, while Breeze was assessed through objective usage metrics. Statistical analyses included linear mixed-effects models and effect size calculations. Results: Out of 352 participants, 118 (33.5%) used Breeze at least once. The 118 participants engaged in 754 breathing sessions with Breeze. Momentary relaxation was assessed and calculated for 249 (33.0%) Breeze sessions. The use of Breeze remained stable even after the formal intervention period. Participants also followed the pre-defined breathing rates of Breeze. On average, a small effect on momentary relaxation was observed for 2-minute breathing sessions (d = .20), while a large effect (d = .74) resulted from breathing sessions >=4 minutes. Conclusions: This study shows the potential of Breeze to reduce acute stress in individuals with a chronic condition, such as cancer. By combining gamification with evidence-based breathing techniques, Breeze fosters sustained user engagement and momentary relaxation. Future research aims to assess the impact of Breeze on other populations and chronic conditions. Clinical Trial: German Clinical Trials Register DRKS00027546; registered on 23 February 2022