Long-Term Usage of Breeze, a Gamified Breathing Training App, and Its Effect on Momentary Relaxation in People With Cancer: Cohort Study.
Anja Yvonne Bischof, Tobias Budig, Sonja Schläpfer, Yanick Xavier Lukic, Fabian Schneider, Prabhakaran Santhanam, Jürgen Barth, Claudia M Witt, Tobias Kowatsch
JMIR serious games December 16, 2025 DOI: 10.2196/70297 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Longitudinal interventional study (secondary analysis of app usage data from the CanRelax 2.0 trial) Cross-sectional Peer reviewed |
|---|---|
| Sample size | 279 |
| Population | Adults diagnosed with cancer within the last 5 years, recruited in Switzerland, Germany, and Austria |
| Duration | 10-week intervention, with app use permitted afterward |
| Measures | 11-point visual analog scale (momentary relaxation), Pearson correlation coefficient (adherence to breathing pattern) |
| Topics | Meditation |
| Keywords | Breathing Self-care Stress management Digital health Gamification Self-guided People with cancer Momentary relaxation |
| Key findings | Breeze use declined initially but remained stable through and after the 10-week intervention, and participants adhered closely to its guided breathing rates (r=0.9). Momentary relaxation improved by a small average effect (d=0.19); 2-minute sessions showed a small effect (d=0.13), while sessions of 4 minutes or longer showed a large effect (d=0.74). The authors argue longer breathing sessions are considerably more effective than short ones. |
Abstract
Background: People with cancer often experience stress. Digital health interventions can help individuals increase momentary relaxation. Breeze is a gamified breathing training that can be embedded into digital health interventions. Its effectiveness in controlled cross-sectional studies has been demonstrated. However, adherence to Breeze and its effect on momentary relaxation in longitudinal interventional studies has yet to be investigated.
Objective: This study aimed to assess Breeze across 3 key dimensions: (1) its usage over time compared to other intervention components; (2) the accuracy with which users adhered to the guiding breathing pattern provided by Breeze; and (3) its effect on momentary relaxation, including the impact of the duration of the breathing session delivered by Breeze.
Methods: Breeze was 1 of 7 relaxation techniques included in the CanRelax 2.0 app, designed specifically for individuals diagnosed with cancer. Participants could select any of the 7 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 5 years recruited across Switzerland, Germany, and Austria. Adherence to the intended breathing pattern was measured using a Pearson correlation coefficient. Momentary relaxation was measured pre- and post-exercise using an 11-point visual analog scale. Statistical analyses included linear mixed effects models and calculations of effect sizes. We further analyzed the relationship between session duration and the magnitude of momentary relaxation and compared Breeze's efficacy and time efficiency to the other available techniques.
Results: Of 279 participants, 118 (42.3%) 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 declined initially but remained stable even after 10 weeks. Participants followed the predefined breathing rates of Breeze (r=0.9). On average, a small effect (-0.42; P<.001; d=0.19) on momentary relaxation was observed, with 2-minute breathing sessions (-0.30; P=.02; d=0.13) showing a small effect, whereas a large effect (-1.53; P=.03; d=0.74) was observed for breathing sessions of 4 minutes or longer.
Conclusions: This study demonstrates the potential of Breeze to alleviate acute stress in individuals with chronic conditions, such as cancer. By combining gamification with evidence-based breathing techniques, Breeze fosters sustained user engagement and momentary relaxation. Participants adhered well to the guided breathing. While even short breathing sessions of 2 minutes provided modest momentary relaxation, longer durations (≥4 min) were considerably more effective. Future research aims to assess the impact of Breeze on other populations and chronic conditions.
Comparable studies
Other non-randomized and open-label trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Mindfulness-Based Stress Reduction in Relation to Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients Early-stage breast and prostate cancer patients | 2003 | Pre-post intervention study | n = 59 |
| Exploring self‐compassion and empathy in the context of mindfulness‐based stress reduction (MBSR) Community sample | 2010 | Pre-post intervention study | |
| Mindfulness-Based Stress Reduction Lowers Psychological Distress In Medical Students Second-year medical students | 2003 | Prospective nonrandomized cohort-controlled study | n = 302 |
| Intensive meditation training, immune cell telomerase activity, and psychological mediators. Retreat participants and matched controls | 2011 | Controlled trial with wait-list control group | n = 60 |
| The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents Children aged 8-12 with ADHD and their parents | 2011 | Within-group waitlist controlled trial | n = 22 |
Citations in the library
Cites 5
- Brief structured respiration practices enhance mood and reduce physiological arousal Cell Reports Medicine 2023
- Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory Annual Review of Psychology September 14, 2022
- Different Effects of Four Yogic Breathing Techniques on Mindfulness, Stress, and Well-being OBM Integrative and Complementary Medicine September 18, 2021
- The Integration of Meditation and Positive Psychology Practices to Relieve Stress in Women Workers (Flourish): Effects in Two Pilot Studies. Behavioral Sciences March 26, 2021
- The Gamification of Meditation: A Randomized-Controlled Study of a Prescribed Mobile Mindfulness Meditation Application in Reducing College Students’ Depression Simulation & Gaming June 4, 2019