Web-Based Isha Kriya Meditation and Breathwork in Long COVID: Mixed Methods Randomized Controlled Pilot Study

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Abstract
Background: Long COVID affects millions of adults, causing fatigue, dyspnea, cognitive symptoms, and mood disturbances. Effective treatments are limited, and many patients cannot access multidisciplinary rehabilitation because of symptom fluctuation, distance, or specialist shortages. Web-based mind-body interventions may offer accessible, scalable support alongside existing care. Objective: We assessed the feasibility and efficacy of a 3-week web-based yogic breathing and meditation program for long COVID symptoms. Methods: In this completed, parallel-group, 6-week waitlist-controlled, mixed methods randomized trial, adults aged 18‐70 years with physician-confirmed long COVID were recruited from US clinics and self-referral and randomized 1:1 to immediate intervention or waitlist control, crossing over at week 3. The program included live webinars and video guides for daily self-practice. The primary outcome was adherence, defined as practicing at least 1 of 3 techniques on ≥4 days/week across all 3 active-intervention weeks. Secondary outcomes included perceived stressmood, quality of life, dyspnea, and somatic symptom burden, assessed at baseline, 3 weeks, and 6 weeks. Quantitative outcomes were analyzed using linear mixed-effects models. Semistructured interviews and focus groups underwent conventional content analysis and were integrated with quantitative findings via joint display. Results: Of 189 randomized participants, 1 was excluded post-randomization for a protocol deviation; 188 (96 intervention, 92 waitlist) began the study. Of these, 124 reached the active intervention period. Among 58 with complete adherence data, 55% met the adherence threshold (60% intervention, 50% waitlist). Secondary analyses included 185 participants with ≥1 assessment. No adverse events were reported. Compared with waitlist control, the intervention group showed greater reductions in total mood disturbance (MD=−10; 95% CI −19 to −1.6; P=.02), negative mood (MD=−7.5; 95% CI −15 to −0.44; P=.04), fatigue (MD=−2.9; 95% CI −4.6 to −1.2; P=.001), MDP immediate perception (MD=−5.5; 95% CI −9.4 to −1.6; P=.007), MDP sensory dimension (MD=−5.1; 95% CI −8.5 to −1.7; P=.003), and somatic symptom burden (MD=−2.0; 95% CI −3.6 to −0.38; P=.02), and greater increases in positive mood (MD=2.9; 95% CI 0.66 to 5.1; P=.01) and vigor (MD=1.7; 95% CI 0.18 to 3.2; P=.03). Stress and quality of life did not differ significantly. Qualitative findings identified medical-system struggles, digital delivery, online support, and practices’ effects on resilience and identity. Integration showed convergence for dyspnea and mood, divergence for stress and quality of life, and expansion through themes of medical-system experience, identity, and social connection. Conclusions: This web-based yogic breathing and meditation program appears feasible and accessible for people with long COVID. By combining 3 practices in a brief protocol and integrating quantitative and qualitative evidence, this study provides novel insight into both symptom outcomes and dimensions of recovery not captured by standardized measures. Further evaluation should assess longer-term effects and integration into scalable telehealth and virtual rehabilitation pathways.

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