Singing has become a popular arts-in-therapy activity used by physiotherapists as part of
their clinical treatment. For example, Singing for Lung Health (SLH) programmes are used in
the management of long-term respiratory conditions. These programmes involve group-based
singing activities with a focus on breathing control and posture. There are indications that
SLH is effective at alleviating symptoms of respiratory disease, likely due to a combination
of physical, psychological and social mechanisms.
One main factor that could directly impact on breathing are affective and attentional
changes. Reduced anxiety and depression through singing therapy has been suggested to improve
breathing control and functioning in those with chronic respiratory conditions. Qualitative
surveys have reported that participants find singing to be an "uplifting" activity and that
singing with a group of peers may also help to combat isolation.
These changes may be accompanied by changes in allocation of attention. I.e., it is thought
that anxiety leads to heightened vigilant monitoring of breathing, and that this
hypervigilance leads to a switch in control of breathing from automatic to consciously
processed, resulting in breathing dysfunction and breathlessness. Notably, normalisation of
such excessive anxiety related vigilance may underpin the improvements that patients report
after singing therapy, in terms of control of breathing and breathlessness during
exacerbations. Singing therapy may therefore improve breathing control through reducing
anxiety as well as associated attention to breathing. One aim of this study is to test this
idea further, and to determine if singing impacts on breathing vigilance.
An additional potentially very important effect of singing interventions is that people may
improve their balance control as well, both directly and indirectly. Breathing and postural
control are tightly linked. We continuously need to make postural adjustment in response to
disturbances due to (changes in) breathing - and especially so when breathing is effortful
and accelerated. Several studies of SLH in patients with COPD report participants perceive
singing had a positive impact on their posture. Also, recent studies suggest that expert
singers have better postural control compared to novices. Better control over breathing thus
may also improve postural control.
Indirectly, and similar to breathing vigilance, singing interventions may also help normalise
individual's attention toward posture and balance. Fear of falling is common in people with
respiratory conditions such as COPD. Typically, such fear / anxiety will lead to a strong,
potentially excessive, increase in attention to balance. As with breathing, this
"hypervigilance" can itself lead to distorted perception of unsteadiness. Singing therapy may
therefore improve balance control through reducing anxiety and associated attention to
movement.
Therefore, this study will also explore the effects of singing on balance control and
associated changes in balance-related hypervigilance.
To investigate these questions, investigators planned a scoping study in which they:
Aim to investigate the effects of singing on breathing control (e.g., breathing rate,
breathing pattern assessment; see all outcomes below)
Immediate: Effects of singing (varying demands) vs no-singing condition
Long-term: differences between people with and without regular singing experience in
terms of breathing control during no-singing vs singing conditions.
Aim to investigate the effects of singing on breathing-related anxiety & vigilance
(state anxiety, breathing vigilance; self-reported)
Immediate effects (balance vs. balance + singing) & long-term effects (differences
between groups with and without singing experience)
Aim to investigate the effects of singing on balance control (sway, sway frequency)
Immediate effects (balance vs. balance + singing) & long-term effects (differences
between groups with and without singing experience)
Aim to investigate the effects of singing on balance-related anxiety and vigilance
(state anxiety, balance hypervigilance, conscious processing of balance; all
self-reported)
Again, immediate effects (balance vs. balance + singing) & long-term effects
(differences between groups with and without singing experience)