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Prescription 2015: Group Singing

October 19, 2015 Written by JP       [Font too small?]

Miguel de Cervantes Saavedra, the famed Spanish author of “Don Quixote”, once proclaimed, “He who sings scares away his woes!”. However, there is a mistaken or, at least, incomplete perception of singing in the modern era. It’s true that many associate singing with happiness and health. But, it is often assumed that those who are happy and feel good sing as a consequence of their positive lot in life. What science is beginning to discover is that singing itself can actually promote a more positive mental state and well-being in general – even in those who lack one or both of these attributes.

Numerous studies now show that singing as part of a choir or group decreases levels of anxiety and depression. It, likewise, promotes feelings of connectedness and resilience. These findings have been largely reported in seniors, some of whom live in nursing homes or rehabilitation centers. Additionally, singing tends to benefit attention, episodic memory, executive function and overall cognition in those with dementia. And, that’s far from all singing does. Participating in group vocalizations benefits a wide variety of health conditions, including COPD (chronic obstructive pulmonary disease), lung cancer and stroke recovery, and it even improves muscle strength, respiratory function and speech intensity in quadriplegics.

If this all seems too good to be true, bear the following in mind. The short answer as to why group singing aids wellness is twofold. The social aspect of creatively engaging with other like-minded people is certainly part of the equation. Then there’s the physical component. Much like laughter, singing requires a certain level of physicality. Norman Cousins, the late laughter proponent, used to state that, “Laughter is inner jogging”. In a 2012 column in the Daily Telegraph, Dr. James de Fanu defined the health effects of singing thusly, “Singing involves virtually every muscle group, vibrating the whole system like a tonic massage. It increases lung capacity, improves posture, clears the sinuses and boosts mental alertness by increasing the amount of oxygen in the blood. And, for good measure, it exercises the facial muscles – helping to maintain youthful good looks.” Who couldn’t use more of that?

Perhaps, the last piece of the puzzle is getting those who don’t sing to participate. For starters, don’t let any perceived (or real) lack of skill dissuade you. After all, you’re not trying out for American Idol. This is for you and your good health. Other reasons to consider singing is that it may be a viable hobby for those who: a) already exercise and/or practice forms of mind-body activities but, want some added physical or psychological support; b) cannot engage in regular exercise; c) are depressed and for whom medication or other conventional therapies are contraindicated or not available. Finally, what if you just don’t like to sing? Some non-singers find that they develop a love for song over time. So, why not start right now? A one, a two, a one, two, three, four!

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Effectiveness and Cost-Effectiveness of Community Singing on (link)

Study 2 - Evaluating the Potential of Group Singing to Enhance the Well- … (link)

Study 3 – Effects of Community Singing Program on Mental Health Outcomes(link)

Study 4 - The Contribution of Community Singing Groups to the Well-Being (link)

Study 5 - The Singing-Group: A New Therapic Rehabilitation for Mood (link)

Study 6 - Cognitive Improvements with Active Singing in Dementia (link)

Study 7 - ‘Singing for the Brain’: A Qualitative Study Exploring the Health (link)

Study 8 - Alzheimer’s Society: What Is ‘Singing for the Brain’? (link)

Study 9 - Learning Sung Lyrics Aids Retention in Normal Aging and (link)

Study 10 - Possible Benefits of Singing to the Mental and Physical (link)

Study 11 - Cognitive, Emotional, and Social Benefits of Regular Musical (link)

Study 12 - Singing Classes for Chronic Obstructive Pulmonary Disease (link)

Study 13 - Pilot Investigation of Quality of Life and Lung Function Following (link)

Study 14 - ‘Stroke a Chord’: Effect of Singing in a Community Choir on Mood (link)

Study 15 - Effect of Singing on Respiratory Function, Voice, and Mood After (link)

Study 16 - Doctor’s Diary: Why Singing is Good for Your Health (link)

Group Singing Lowers Stress Hormones

Source: Front Psychol. 2015; 6: 1242. (link)

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10 Comments & Updates to “Prescription 2015: Group Singing”

  1. JP Says:

    Updated 10/19/15:

    http://www.jvoice.org/article/S0892-1997%2815%2900187-3/abstract

    J Voice. 2015 Sep 14. pii: S0892-1997(15)00187-3.

    Aerobic Exercise as a Warm-Up for Singing: Aerodynamic Changes.

    OBJECTIVES: This study was designed to determine the impact of aerobic exercise on vocal warm-up.

    STUDY DESIGN: This is a cohort experimental study.

    METHODS: Sixteen graduate and six undergraduate students in an academic vocal performance program participated. They completed a 30-minute treadmill workout in their target aerobic heart range. Aerodynamic data during singing were acquired before and after the treadmill workout. In full voice, participants sang the first seven notes of the Star Spangled Banner on “pah,” repeating the seventh note seven times, at 1.5 syllables/s after an inhalation. The key was determined by voice type, with the target note within the range of passaggio for men, and in head voice for women.

    RESULTS: Paired t tests were performed on the data from 17 singers who maintained or increased sound pressure level (SPL) after exercise. Significant pre- to post-exercise increases were found for mean SPL and mean airflow during voicing, although increased estimated subglottal pressure approached significance. These measures were essentially unchanged in individuals who decreased SPL after exercise. There was no significant difference in vocal efficiency after the aerobic exercise, primarily due to large standard deviations within the pre- and post-exercise conditions.

    CONCLUSIONS: Most participants demonstrated favorable aerodynamic changes during singing after aerobic exercise. It is possible that in certain situations, a general aerobic warm-up could set the stage for a less-demanding vocal-specific warm-up, especially for a high voice performing early in the morning.

    Be well!

    JP

  2. JP Says:

    Updated 10/19/15:

    https://www.thieme-connect.com/DOI/DOI?10.1055/s-0035-1555941

    Exp Clin Endocrinol Diabetes. 2015 Aug 4.

    Group Singing as a Therapy during Diabetes Training – A Randomized Controlled Pilot Study.

    Comprehensive diabetes treatment has been shown to reduce quality of life in diabetic patients. However, there is evidence to suggest that group singing can have positive effects on quality of life in various clinical settings. In this randomized controlled pilot study, the effect of singing as a therapy to reduce stress and improve quality of life was investigated in insulin-dependent diabetic patients, undergoing a lifestyle intervention program. Patients from the singing group felt less discontented following treatment. This effect, however, was lost after 3 months. No effect on serum cortisol and plasma adrenocorticotropic hormone (ACTH) levels could be seen when comparing the singing group with the control group, although reduced levels of ACTH and cortisol 3 days after treatment could be found and were still present after 3 months within the group of patients who undertook singing as a therapy. Singing led to an increase in bodyweight, which interestingly had no effect on glucose control or methylglyoxal levels. Therefore, singing during a lifestyle intervention program for insulin-dependent diabetic patients had a short lasting and weak effect on patients’ mood without affecting glucose control, but no significant effect on stress related hormones.

    Be well!

    JP

  3. JP Says:

    Updated 10/19/15:

    http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1068875

    Disabil Rehabil. 2015 Jul 25:1-11.

    Choral singing therapy following stroke or Parkinson’s disease: an exploration of participants’ experiences.

    PURPOSE: People with stroke or Parkinson’s disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others.

    METHOD: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23).

    RESULTS: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice.

    CONCLUSIONS: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. Implications for Rehabilitation Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

    Be well!

    JP

  4. Gladys S. Says:

    Hi JP: I know your dad from OLLI. I am a health nut, so do enjoy your info. Proper BREATHING, sleeping, eating, exercises all play a large part in staying YOUNG in OLD AGE.

    I ADVOCATE proper NUTRITION in supplements as well as in FOOD.

    Do email me with more info. Thanks, Gladys S.

  5. JP Says:

    Hi, Gladys!

    Thank you for your kind comments! I agree 100% with your philosophy!

    I love that my dad and mom are involved in OLLI and other positive social activities. I believe that staying active in the community is an important component of optimal health as well.

    Please continue to visit my site. And, feel free to contact me if you have any questions or if I can be of assistance in any way.

    Be well!

    JP

  6. JP Says:

    Updated 1/31/16:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608626/

    Dement Geriatr Cogn Dis Extra. 2015 Sep 4;5(3):296-308.

    Music Therapy Using Singing Training Improves Psychomotor Speed in Patients with Alzheimer’s Disease: A Neuropsychological and fMRI Study.

    BACKGROUND/AIMS: To investigate the effect of singing training on the cognitive function in Alzheimer’s disease (AD) patients.

    METHODS: Ten AD patients (mean age 78.1 years) participated in music therapy using singing training once a week for 6 months (music therapy group). Each session was performed with professional musicians using karaoke and a unique voice training method (the YUBA Method). Before and after the intervention period, each patient was assessed by neuropsychological batteries, and functional magnetic resonance imaging (fMRI) was performed while the patients sang familiar songs with a karaoke device. As the control group, another 10 AD patients were recruited (mean age 77.0 years), and neuropsychological assessments were performed twice with an interval of 6 months.

    RESULTS: In the music therapy group, the time for completion of the Japanese Raven’s Colored Progressive Matrices was significantly reduced (p = 0.026), and the results obtained from interviewing the patients’ caregivers revealed a significant decrease in the Neuropsychiatric Inventory score (p = 0.042) and a prolongation of the patients’ sleep time (p = 0.039). The fMRI study revealed increased activity in the right angular gyrus and the left lingual gyrus in the before-minus-after subtraction analysis of the music therapy intervention.

    CONCLUSION: Music therapy intervention using singing training may be useful for dementia patients by improving the neural efficacy of cognitive processing.

    Be well!

    JP

  7. JP Says:

    Updated 04/04/16:

    http://ecancer.org/journal/10/full/631-singing-modulates-mood-stress-cortisol-cytokine-and-neuropeptide-activity-in-cancer-patients-and-carers.php

    ecancer 10 631

    Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers

    Daisy Fancourt, Aaron Williamon, Livia A Carvalho, Andrew Steptoe, Rosie Dow and Ian Lewis

    There is growing evidence that psychosocial interventions can have psychological benefits for people affected by cancer, including improved symptoms of mental health and wellbeing and optimised immune responses. However, despite growing numbers of music interventions, particularly singing, in cancer care, there is less research into their impact. We carried out a multicentre single-arm preliminary study to assess the impact of singing on mood, stress and immune response in three populations affected by cancer: carers (n = 72), bereaved carers (n = 66) and patients (n = 55). Participants were excluded if pregnant or if they were currently being treated with chemotherapy, radiotherapy or oral immunosuppressive drugs. Participants were regular participants in five choirs across South Wales and took part in one hour of group singing. Before and after singing, visual analogue mood scales, stress scales and saliva samples testing for cortisol, beta-endorphin, oxytocin and ten cytokines were taken. Across all five centres and in all four participant groups, singing was associated with significant reductions in negative affect and increases in positive affect (p < .01) alongside significant increases in cytokines including GM-CSF, IL17, IL2, IL4 and sIL-2rα (all p < .01). In addition, singing was associated with reductions in cortisol, beta-endorphin and oxytocin levels. This study provides preliminary evidence that singing improves mood state and modulates components of the immune system. Further work is needed to ascertain how this differs for more specific patient groups and whether repeat exposure could lead to meaningful, longitudinal effects.

    Be well!

    JP

  8. JP Says:

    Updated 07/20/16:

    http://ahp.sagepub.com/content/30/4/259.abstract

    Am J Health Promot. 2016 Mar;30(4):259-63.

    Effects of Community Singing Program on Mental Health Outcomes of Australian Aboriginal and Torres Strait Islander People: A Meditative Approach.

    PURPOSE: To evaluate the impact of a meditative singing program on the health outcomes of Aboriginal and Torres Strait Islander people.

    DESIGN: The study used a prospective intervention design.

    SETTING: The study took place in six Aboriginal and Torres Strait Islander communities and Community Controlled Health Services in Queensland, Australia.

    SUBJECTS: Study participants were 210 Australian Aboriginal and Torres Strait Islander adults aged 18 to 71 years, of which 108 were in a singing intervention group and 102 in a comparison group.

    INTERVENTION: A participative community-based community singing program involving weekly singing rehearsals was conducted over an 18-month period.

    MEASURES: Standardized measures in depression, resilience, sense of connectedness, social support, and singing related quality of life were used.

    ANALYSIS: The general linear model was used to compare differences pre- and postintervention on outcome variables, and structural equation modeling was used to examine the pathway of the intervention effect.

    RESULTS: Results revealed a significant reduction in the proportion of adults in the singing group classified as depressed and a concomitant significant increase in resilience levels, quality of life, sense of connectedness, and social support among this group. There were no significant changes for these variables in the comparison group.

    CONCLUSIONS: The participatory community singing approach linked to preventative health services was associated with improved health, resilience, sense of connectedness, social support, and mental health status among Aboriginal and Torres Strait Islander adults.

    Be well!

    JP

  9. JP Says:

    Updated 09/21/16:

    http://onlinelibrary.wiley.com/wol1/doi/10.1111/ecc.12568/abstract

    Eur J Cancer Care (Engl). 2016 Sep 20.

    Choir singing and health status in people affected by cancer.

    Cancer survival rates have improved dramatically over recent years, however, health-related quality of life (HRQoL) for many patients, survivors and their families remains low even after successful treatment. This mixed-methods observational study explored the effects of participation in community choirs on HRQoL in individuals who have had cancer (patients) or have been affected by cancer (non-patients). This included a longitudinal analysis of choristers commencing the Tenovus Cancer Care “Sing with Us” choirs across Wales and a series of semi-structured interviews and focus groups. Participants completed the Short-form 36 and the Hospital Anxiety and Depression Scale on commencement of the choir and 3 and 6 months later. On joining the choir, several domains of the SF36 were lower, indicating worse HRQoL and greater depression in patients than non-patients (p < .05). In patients, choir participation improved vitality, overall mental health and anxiety. In non-patients, choir participation improved anxiety (p < .05). Participants experienced the choirs as both an uplifting musical activity and a supportive community group. The results support the provision of a spectrum of support options to meet the different needs and preferences of people affected by cancer.

    Be well!

    JP

  10. JP Says:

    Updated 01/30/17:

    http://bmjopen.bmj.com/content/7/1/e014151.long

    BMJ Open. 2017 Jan 24;7(1):e014151.

    Sing Your Lungs Out-a community singing group for chronic obstructive pulmonary disease: a 1-year pilot study.

    OBJECTIVE: Singing group participation may benefit patients with chronic obstructive pulmonary disease (COPD). Previous studies are limited by small numbers of participants and short duration of generally hospital-based singing group intervention. This study examines the feasibility of long-term participation in a community singing group for patients with COPD who had completed pulmonary rehabilitation (PR).

    METHODS: This was a feasibility cohort study. Patients with COPD who had completed PR and were enrolled in a weekly community exercise group were recruited to a new community-based singing group which met weekly for over 1 year. Measurements at baseline, 4 months and 1 year comprised comprehensive pulmonary function tests including lung volumes, 6 min walk test (6MWT), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and hospital admission days for acute exacerbation of COPD (AECOPD) for 1 year before and after the first singing group session.

    FINDINGS: There were 28 participants with chronic lung disease recruited from 140 people approached. Five withdrew in the first month. 21 participants meeting Global Initiative for Chronic Obstructive Lung Disease criteria for COPD completed 4-month and 18 completed 1-year assessments. The mean attendance was 85%. For the prespecified primary outcome measure, total HADS score, difference between baseline and 12 months was -0.9, 95% CI -3.0 to 1.2, p=0.37. Of the secondary measures, a significant reduction was observed for HADS anxiety score after 1 year of -0.9 (95% CI -1.8 to -0.1) points, p=0.038 and an increase in the 6MWT at 1 year, of 65 (95% CI 35 to 99) m compared with baseline p<0.001.

    CONCLUSIONS: Our findings support the feasibility of long-term participation in a community singing group for adults with COPD who have completed PR and are enrolled in a weekly community exercise group and provide evidence of improved exercise capacity and a reduction in anxiety.

    Be well!

    JP

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