In many cultures, singing has been considered a powerful healing tool since ancient times, especially chanting, but only recently have scientists begun to study the potential health benefits of this popular art form.
What they're finding is that singing has a variety of benefits for both the body and mind, and may be a useful 'therapy' for a number of chronic conditions.
Benefits for everyone
Studies suggest that both old and young people can benefit from singing-particularly as part of a group. In a survey of a university-
based choral society, 87 per cent said they had benefited socially from their involvement in the choir, while 75 per cent benefited emotionally and 49 per cent spiritually. Moreover, 58 per cent agreed that they had also gained in some physical way, with improvements that included better lung function and breathing, less stress and more positive mood (J R Soc Promot Health, 2001; 121: 248-56).
In older people, group singing has been found to have a range of physical and psychological benefits. In one study, 31 care-home residents were assigned to four hour-long singing sessions over four weeks, while 30 other institutionalized residents had no such intervention. The researchers reported that the singing group showed significant improvements in measured anxiety and depression over the course of the study compared with the non-intervention control group (BMC Public Health, 2011; 11: 142).
Another trial, which ran for 12 months, assessed 166 healthy people aged 65 and older who participated in either a weekly chorale or the usual activity (for comparison). Based on questionnaires and self-reports, a number of positive effects were found with participating in the singing group, including a higher rating of physical health, fewer doctor visits, fewer falls, less medication use and better mental health (Gerontologist, 2006; 46: 726-34).
Although some may argue that the benefits of group singing are more to do with the social aspects than the singing itself (indeed, WDDTY has previously reported on the importance of social connectedness for health; see vol 21 no 10), the evidence suggests that the act of producing musical sounds with the voice has direct physiological effects.
Singing involves relatively strong and fast inspirations, followed by extended, regulated expirations, and can therefore improve respiratory muscle strength. What's more, when practised intensively, singing can lead to long-lasting cardiovascular changes. A study comparing professional and amateur singers assessed heart-rate variability before and after singing lessons (the more the heart is able to vary its rate, the better 'trained' it is). Across the two time points (before
and after the lessons), heart-rate varia-bility increased significantly in the professionals, but not in the amateur group, suggesting that professional singers have better cardiophysiol-ogical fitness (Music Percept, 2010; 27: 287-95).
Singing also involves the brain, and its long-term practice has been associated with structural differ-ences in the part of the brain that connects the auditory with motor regions (Ibid).
Singing as therapy
These physiological effects have led to singing being used as a therapy for a range of common health problems. Parkinson's disease patients, for example, may benefit from singing, according
to certain evidence. More than 80 per cent of these patients develop voice and speech problems at some point, which can severely affect their quality of life, so singing has been proposed
to improve their speech intelligibility as well as oral-communication skills.
In a small study of four Parkinson's patients, University of Kansas researcher Dr Eri Haneishi inves-tigated the effects of a music-based protocol consisting of vocalized warm-ups and singing exercises. After 12-14 sessions, patients showed significant increases in speech intelligibility and vocal intensity (Music Ther, 2001; 38: 273-90).
More recently, 20 Parkinson's patients took part in a voice rehabili-tation programme that involved speech therapy and choral singing. After a total of 20 hours of speech therapy and 26 hours of singing, the patients showed significant improve-ments in vowel phonation and reading out loud (Eur J Phys Rehabil Med, 2009; 45: 13-9).
Stroke patients may also gain from singing, studies suggest. A technique called Melodic Intonation Therapy (MIT), which involves making patients sing words and phrases, has helped patients with aphasia-a common complication of stroke and other brain injuries resulting in the loss of ability to produce and/or comprehend language.
In a study of two patients with similar stroke-induced impairment, Harvard researchers compared the effects of MIT with a control intervention (speech repetition) on picture-naming performance and measures of propositional speech. After 40 daily sessions, both tech-niques resulted in improvement in all outcomes, although the extent of improvement was far greater for the MIT patient compared with the control (Music Percept, 2008; 25: 315-23).
A large-scale randomized controlled trial (RCT) to assess the efficacy of MIT for aphasia is currently underway (Music Percept, 2010; 27: 287-95).
Respiratory problems could also be helped through singing. In an RCT of 43 patients with chronic obstructive pulmonary disease (COPD), weekly singing classes were found to improve pulmonary function and quality of life (Int J Chron Obstruct Pulmon Dis, 2009; 4: 1-8). Another RCT assessing the value of singing classes in COPD patients reported that twice-weekly sessions can significantly improve anxiety as well as several physical measures compared with controls (BMC Pulm Med, 2010; 10: 41).
In one case report, preoperative hypertension (high blood pressure prior to surgery) was reduced by singing in a 76-year-old woman who failed to respond to aggressive drug treatment. However, her blood pressure dropped dramatically after singing several religious songs, making it possible for surgery to proceed (Arthritis Care Res [Hoboken], 2011; 63: 630-2). Nevertheless, whether regular singing has long-term effects on blood pressure remains to be seen.
Chronic pain sufferers may also benefit from singing, according to one study. Chronic-pain patients attending a pain clinic were assigned to nine 30-minute sessions of either small-group singing or a comparison group that listened to music while exercising. Both groups showed marked improvements in mood, coping and measures of perceived pain (VJ Music ther, 2004; 41: 241-58).
However, although singing had no significant effects over the music-listening-and-exercise group in the above study, both music therapy and exercise are interventions that have shown success in treating pain (Ky Nurse, 2007; 55: 10; Eur J Phys Rehabil Med, 2011 May 23; Epub ahead of print). For this reason, a more passive comparative intervention might have been more appropriate.
Snoring is another condition that may be helped by singing. In a study comparing semi-professional choir singers with non-singers, the singers had significantly lower snoring scores. "Singing practice may have a role in the treatment of snoring," the researchers said (Sleep Breath, 2008; 12: 265-8).
Sing the doctor away
Although better-quality studies are needed in this field-particularly those using large sample sizes and randomized controlled designs-the findings so far are promising, suggesting that singing has benefits beyond just making us feel good. With more research underway, perhaps the future will see a daily power ballad as the new 'apple a day'.
WDDTY VOL. 22 NO. 4