Use of Singing for Lung Health as an alternative training modality within pulmonary rehabilitation for COPD: a randomised controlled trial

Mette Kaasgaard, Daniel Bech Rasmussen, Karen Hjerrild Andreasson, Ole Hilberg, Anders Løkke, Peter Vuust, Uffe Bodtger, Mette Kaasgaard, Daniel Bech Rasmussen, Karen Hjerrild Andreasson, Ole Hilberg, Anders Løkke, Peter Vuust, Uffe Bodtger

Abstract

Background: Pulmonary rehabilitation (PR) is a cornerstone in chronic obstructive pulmonary disease (COPD) management. However, PR adherence is generally low, and barriers include availability, economic issues, motivation and an inability to attend or perform physical training. Therefore, alternative, evidence-based PR activities are required. Singing may have benefits for quality of life (QoL), respiratory control and well-being in COPD, but the impact on the PR key outcome, physical exercise capacity, is uncertain.

Methods: In this randomised controlled trial (NCT03280355), we investigated the effectiveness of 10 weeks of PR, including either "Singing for Lung Health" (SLH) training or standard physical exercise training (PExT). The primary outcome was a change in exercise capacity (6-min walk distance (6MWD)) from baseline to post-PR. Secondary outcomes were changes in QoL (St George's Respiratory Questionnaire (SGRQ)), Hospital Anxiety and Depression Score (HADS), lung function, dyspnoea and adherence.

Results: We included 270 COPD patients, and 195 completed the study. Demographics across groups were comparable, and both groups improved significantly in 6MWD and SGRQ score. SLH was non-inferior to PExT in improving 6MWD (mean±sd 13.1±36.3 m versus 14.1±32.3 m, p=0.81; difference 1.0 m, 95% CI -7.3-9.3 m) with 21.8% and 25.0%, respectively (p=0.57), reaching the 6MWD minimal important difference of 30 m. We found no significant between-group differences concerning SGRQ, HADS, lung function, dyspnoea or adherence.

Conclusion: Our study suggests that SLH is non-inferior to PExT in improving 6MWD during a 10-week PR programme. Future studies addressing reproducibility, long-term effects and health economics are needed.

Conflict of interest statement

Conflict of interest: M. Kaasgaard holds a diploma graduate degree from the Royal Danish Academy of Music in Voice and Voice Pedagogy. Conflict of interest: D.B. Rasmussen has nothing to disclose. Conflict of interest: K.H. Andreasson has nothing to disclose. Conflict of interest: O. Hilberg has nothing to disclose. Conflict of interest: A. Løkke has nothing to disclose. Conflict of interest: P. Vuust is leader of the research centre, Center for Music in the Brain. Conflict of interest: U. Bodtger has nothing to disclose.

Copyright ©The authors 2022.

Figures

FIGURE 1
FIGURE 1
CONSORT flow diagram. COPD: chronic obstructive pulmonary disease; PR: pulmonary rehabilitation; 6MWD: 6-min walk distance.
FIGURE 2
FIGURE 2
Change in 6-min walk distance (6MWD). SLH: Singing for Lung Health; PExT: physical exercise training.
FIGURE 3
FIGURE 3
Change in St George's Respiratory Questionnaire (SGRQ) scores. SLH: Singing for Lung Health; PExT: physical exercise training.

References

    1. Gibson GJ, Loddenkemper R, Sibille Y, et al. , eds. European Lung White Book. Sheffield, European Respiratory Society, 2013.
    1. McKeough Z. Community-based pulmonary rehabilitation is effective for people with chronic obstructive pulmonary disease (COPD). Aust J Physiother 2009; 55: 287. doi:10.1016/S0004-9514(09)70013-3
    1. Rochester CL, Vogiatzis I, Holland AE, et al. . An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med 2015; 192: 1373–1386. doi:10.1164/rccm.201510-1966ST
    1. Oates GR, Niranjan SJ, Ott C, et al. . Adherence to pulmonary rehabilitation in COPD: a qualitative exploration of patient perspectives on barriers and facilitators. J Cardiopulm Rehabil Prev 2019; 39: 344–349. doi:10.1097/HCR.0000000000000436
    1. Peixoto Boaventura RD, Meira L, Santos V, et al. . Factors influencing pulmonary rehabilitation adherence – surely is not simple. Rehabil Chronic Care 2016; 48: PA694. doi:10.1183/13993003.congress-2016.PA694
    1. Almadana Pacheco V, Pavón Masa M, Gómez-Bastero Fernández AP, et al. . Patient profile of drop-outs from a pulmonary rehabilitation program. Arch Bronconeumol 2017; 53: 257–262. doi:10.1016/j.arbr.2017.03.003
    1. Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis 2011; 8: 89–99. doi:10.1177/1479972310393756
    1. McNamara RJ, Dale M, McKeough ZJ. Innovative strategies to improve the reach and engagement in pulmonary rehabilitation. J Thorac Dis 2019; 11: S2192–S2199. doi:10.21037/jtd.2019.10.29
    1. Lewis A, Cave P, Stern M, et al. . Singing for Lung Health—a systematic review of the literature and consensus statement. NPJ Prim Care Resp Med 2016; 26: 16080. doi:10.1038/npjpcrm.2016.80
    1. Bonilha, AG, Onofre F, Vieira ML, et al. . Effects of singing classes on pulmonary function and quality of life of COPD patients. Int J Chronic Obstructive Pulm Dis 2008; 4: 1–8. doi:10.2147/COPD.S4077
    1. Panigrahi A, Sohani S, Amadi C, et al. . Role of music in the management of chronic obstructive pulmonary disease (COPD): a literature review. Technol Health Care 2014; 22: 53–61. doi:10.3233/THC-130773
    1. Canga B, Azoulay R, Raskin J, et al. . AIR: Advances in Respiration – music therapy in the treatment of chronic pulmonary disease. Respir Med 2015; 109: 1532–1539. doi:10.1016/j.rmed.2015.10.001
    1. McNamara RJ, Epsley C, Coren E, et al. . Singing for adults with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 12: cd012296.
    1. Gick ML, Nicol JJ. Singing for respiratory health: theory, evidence and challenges. Health Promot Int . 2016; 31: 725–734. doi:10.1093/heapro/dav013
    1. Gebauer L, Vuust P. Music Interventions in Health Care. White Paper. Kongens Lyngby, Danish Sound Innovation Network, 2014.
    1. Stewart NAJ, Lonsdale AJ. It's better together: the psychological benefits of singing in a choir. Psychology of Music 2016; 44: 1240–1254. doi:10.1177/0305735615624976
    1. Pentikäinen E, Pitkäniemi A, Siponkoski S-T, et al. . Beneficial effects of choir singing on cognition and well-being of older adults: Evidence from a cross-sectional study. PLoS One 2021; 16: e0245666. doi:10.1371/journal.pone.0245666
    1. Lord VM, Cave P, Hume VJ, et al. . Singing teaching as a therapy for chronic respiratory disease—a randomised controlled trial and qualitative evaluation. BMC Pulm Med 2010; 10: 41. doi:10.1186/1471-2466-10-41
    1. Liu H, Song M, Zhai Z-H, et al. . Group singing improves depression and life quality in patients with stable COPD: a randomized community-based trial in China. Qual Life Res 2019; 28: 725–735. doi:10.1007/s11136-018-2063-5
    1. Salomoni S, van den Hoorn W, Hodges P. Breathing and singing: objective characterization of breathing patterns in classical singers. PLoS One 2016; 11: e0155084.
    1. Leanderson R, Sundberg J, von Euler C. Role of diaphragmatic activity during singing: a study of transdiaphragmatic pressures. J Appl Physiol (1985) 1987; 62: 259–270. doi:10.1152/jappl.1987.62.1.259
    1. Tamplin J, Baker FA, Grocke D, et al. . Effect of singing on respiratory function, voice, and mood after quadriplegia: a randomized controlled trial. Arch Phys Med Rehabil 2013; 94: 426–434. doi:10.1016/j.apmr.2012.10.006
    1. Heydon R, Fancourt D, Cohen J. The Routledge Companion to Interdisciplinary Studies in Singing. Volume III: Wellbeing. Part I Singing and Health. Chapter 7. 1st edition. Abingdon-on-Thames, Routledge, 2020; pp. 86–97.
    1. Fancourt D, Finn S. What is the Evidence on the Role of the Arts in Improving Health and Well-being? A Scoping Review. Health Evidence Network (HEN) synthesis report 67. Copenhagen, WHO Regional Office for Europe, 2019.
    1. Holland AE, Hill CJ, Jones AY, et al. . Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; 10: CD008250.
    1. Lewis A, Cave P, Hopkinson N. Singing for Lung Health: service evaluation of the British Lung Foundation programme. Perspect Public Health 2018; 138: 215–222. doi:10.1177/1757913918774079
    1. Lewis A, Cave P, Hopkinson NS. Singing for Lung Health: a qualitative assessment of a British Lung Foundation programme for group leaders. BMJ Open Respir Res 2017; 4: e000216. doi:10.1136/bmjresp-2017-000216
    1. Goldenberg RB. Singing lessons for respiratory health: a literature review. J Voice 2017; 32: 85–94. doi:10.1016/j.jvoice.2017.03.021
    1. Kaasgaard M, Andersen IC, Rasmussen DB, et al. . Heterogeneity in Danish lung choirs and their singing leaders: delivery, approach, and experiences: a survey-based study. BMJ Open 2020; 10: e041700. doi:10.1136/bmjopen-2020-041700
    1. Godtfredsen NS, Sørensen TB, Lavesen M, et al. . Effects of community-based pulmonary rehabilitation in 33 municipalities in Denmark—results from the KOALA project. COPD 2018; 14: 93–100. doi:10.2147/COPD.S190423
    1. Holland AE, Nici L. The return of the minimum clinically important difference for 6-minute-walk distance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187: 335–336. doi:10.1164/rccm.201212-2191ED
    1. Slade SC, Dionne CE, Underwood M, et al. . Consensus on Exercise Reporting Template (CERT): modified Delphi study. Phys Ther 2016; 96: 1514–1524. doi:10.2522/ptj.20150668
    1. Danish Health Authority . Sundhedsstyrelsen. National Klinisk Retningslinje for Rehabilitering af Patienter Med KOL [National Clinical Practice Guideline on Rehabilitation for Chronic Obstructive Pulmonary Disease]. Copenhagen, Danish Health Authority, 2014.
    1. Spruit MA, Gosselink R, Troosters T, et al. . Resistance versus endurance training in patients with COPD and peripheral muscle weakness. Eur Respir J 2002; 19: 1072–1078. doi:10.1183/09031936.02.00287102
    1. Bernard S, Whittom F, LeBLANC P, et al. . Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159: 896–901. doi:10.1164/ajrccm.159.3.9807034
    1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. . Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195: 557–582. doi:10.1164/rccm.201701-0218PP
    1. Zeng Y, Jiang F, Chen Y, et al. . Exercise assessments and trainings of pulmonary rehabilitation in COPD: a literature review. COPD 2018; 13: 2013–2023. doi:10.2147/COPD.S167098
    1. Bottle A, Aylin O. Statistical Methods for Healthcare Performance Monitoring. Boca Raton, CRC Press, 2017.
    1. Järvinen TLN, Sihvonen R, Bhandari M, et al. . Blinded interpretation of study results can feasibly and effectively diminish interpretation bias. J Clin Epidemiol 2014; 67: 769–772. doi:10.1016/j.jclinepi.2013.11.011
    1. Lord VM, Hume VJ, Kelly JL, et al. . Singing classes for chronic obstructive pulmonary disease: a randomized controlled trial. BMC Pulm Med 2012; 12: 69. doi:10.1186/1471-2466-12-69
    1. Steiner M, McMillan V, Lowe D, et al. . Pulmonary Rehabilitation: an Exercise in Improvement. London, Royal College of Physicians, 2018.
    1. McCarthy B, Casey D, Devane D, et al. . Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015; 2: CD003793. doi: 10.1002/14651858.CD003793.pub3
    1. Neves LF, dos Reis MH, Gonçalves TR. Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Cad Saude Publica 2016; 32: S0102-311X2016000602001.
    1. van Wetering CR, Hoogendoorn M, Mol SJM, et al. . Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial. Thorax 2010; 65: 7–13. doi:10.1136/thx.2009.118620
    1. Marotta N, Demeco A, Moggio L, et al. . Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease. Complement Ther Clin Pract 2020; 41: 101260. doi:10.1016/j.ctcp.2020.101260
    1. Kjærgaard J, Juhl CB, Lange P, et al. . Adherence to early pulmonary rehabilitation after COPD exacerbation and risk of hospital readmission: a secondary analysis of the COPD-EXA-REHAB study. BMJ Open Respir Res 2020; 7: e000582. doi:10.1136/bmjresp-2020-000582

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