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ChiesiPro | Kongress | European Respiratory Society | Let the music play – music therapy as an adjunct to clinical care

Let the music play – music therapy as an adjunct to clinical care

Music therapy options, including music listening and singing may address breathlessness, anxiety and depression to boost psychological well-being and motivation to exercise in people with chronic respiratory disease.

ChiesiPro | Kongress | European Respiratory Society | Let the music play – music therapy as an adjunct to clinical care

How music therapy interventions could facilitate self management

What is the rationale and the evidence for including singing or listening to music in self-management and behavioral change? A symposium at the ERS Vienna aimed to provide some answers.

Listening

– not as passive as you’d think

Music listening at rest or during exercise is considered as a passive form of intervention, but it triggers psychological, psychophysiological and physiological activity.1,2,3  Music exerts its effects through neuroactivation as well as hormonal and metabolic responses. At rest, it can reduce vital signs while during exercise it can enhance exercise performance. From a psychological perspective music can provoke different memories or emotions and have a positive impact on mood and provoke relaxation or enjoyment of an activity. Listening to music can help shifting away focus from the symptoms such as dyspnea and fatigue.  

Chill out music  

A number of studies have focused on music listening at rest, typically in people with COPD1,4. In these studies, music was applied from a single session to 5 times a week for 8 months. The music was a mix of lyrical and non-lyrical and either in an unspecified or in slow tempo (60-80 bpm). Results showed a positive effect in terms of lowering anxiety and the magnitude was stronger when applied for longer duration of time. No effect on depression, QoL or dyspnea was observed. For those with anxiety, listening to music at rest may be another tool in the self-management tool kit.

Workout music and playlist

Studies where music was applied during exercise, mixed effect on psychological symptoms such as anxiety has been shown. Music in these studies was derived from the participants or the clinician’s collection and lead to improvement of physical capacity and a positive trend in QoL. In home-based walking, high adherence (92%) was seen when the cadence of music was synchronized with the gait speed. Music can provide a positive distraction from breathlessness and fatigue during 6 minute walk test, while also improving mood and relaxation10. In conclusion, application of music during exercise can add some form of distraction from symptoms and promote control of symptoms. Being able to choose your own music is important, according to the music therapy literature, as this may promote empowerment 5,6,7,8,9. 

Singing 

Singing is an active form of music therapy. It requires active inspiration/expiration for phrase length and sound volume. Singing is thought to help control expiratory flow, which in people with lung disease can make breathing feel more comfortable. It may also help reduce dynamic hyperinflation and improve muscle length tension relationships. It builds inspiratory muscle strength and may make the active phases of respiration easier. Singing can, when combined with e.g. postural exercises or breathing exercises, serve as an appropriate physical form of activity for some patients11.  

Singing together

Group singing options seem to include many layers, which have recently been explored: relaxation, postural and breathing exercises and, on top of that, the vocalization and singing. Sensory and affective dimensions of dyspnea can be targeted with singing, using breathing to a more positive activity, and thus decrease fear and anxiety. The social aspect of singing can help reduce isolation and loneliness, common among people with lung diseases 12,13,14.  

Structured musical pulmonary rehabilitation

Various group-singing programs for people with impaired lungs have emerged during the recent years (Sing Strong, Sing for Better Breathing, Sing for Lung Health). Most of these offer short or medium duration group singing (6-24 weeks) and the songs were facilitator selected 15,16,17,18. When explored, findings showed a small increase in respiratory muscle strength and some transient reduction of hyperinflation. Improvement in the physical part of QoL was found, but not in the mental part 15,16,17,18.  

Keeping it up

A longer, one-year study in 28 people with COPD 13 offered weekly group-singing. Here, participants were able to influence the selection of songs. After 4 months there was a reduction in the static lung volumes and after 12 months, there both exercise capacity and anxiety was improved. Adherence after 12 months was relatively high (85%), which suggested that this is an acceptable intervention and gave a hint of other patient perceived benefits. The benefits include e.g. increasing awareness of breathing control, ease of dyspnea, improved coping with lung condition, change in attitude and improved self efficacy, enhanced social connection and reduced isolation, sense of achievement and shared purpose (individual and group), distraction and respite from lung condition, motivation to re-engage pulmonary rehabilitation of exercise and improved exercise tolerance 16,18,19,20,21. 

Findings and impact on COPD care

Listening to music – Perhaps not every one is a ”responder” to music therapy, but for those who enjoy it it can boost self management. When using music to relax or to boost exercise, chances of success are probably higher if the person enjoy listening to music and if the music selection reflects the person’s taste in music. As music listening may reduce symptom intensity and improve exercise performance, it could help support behavioral change 22. 

Photo by freepik.com

Singing – Similarly, the success for a singing activity depends on willingness to participate and having influence on song selection. It may not be realistic to manage singing sessions for patients 1-2 times per week, so providing singing resources for home use could be a way forward. Singing in groups offers benefits beyond improved breathing control: sharing positive experiences, achieving music together, it provides psychosocial support for coping and reduces loneliness and therefore could be an effective self-management strategy 23.  

Pekka Ojasala
Medical Advisor, Chiesi Nordic

Replay of seminar is available until 30 Dec 2024 for those with access to ERS online platform: https://live.ersnet.org/programme/session/92674

References

  1. Singh VP, Rao V, V P, R C S, K KP. Comparison of the effectiveness of music and progressive muscle relaxation for anxiety in COPD–A randomized controlled pilot study. Chron Respir Dis. 2009;6(4):209-16. doi: 10.1177/1479972309346754. PMID: 19858350. 
  2. Ballmann CG. The Influence of Music Preference on Exercise Responses and Performance: A Review. J Funct Morphol Kinesiol. 2021 Apr 8;6(2):33. doi: 10.3390/jfmk6020033. PMID: 33917781; PMCID: PMC8167645. 
  3. Karageorghis CI, Priest DL. Music in the exercise domain: a review and synthesis (Part I). Int Rev Sport Exerc Psychol. 2012 Mar;5(1):44-66. doi: 10.1080/1750984X.2011.631026. Epub 2011 Dec 7. PMID: 22577472; PMCID: PMC3339578. 
  4. Huang J, Yuan X, Zhang N, Qiu H, Chen X. Music Therapy in Adults With COPD. Respir Care. 2021 Mar;66(3):501-509. doi: 10.4187/respcare.07489. Epub 2020 Nov 3. PMID: 33144384. 
  5. Frank, Hannah E.; Munro, Prue E.; Clark, Imogen; Lee, Annemarie L. The Effect of Music Listening During Pulmonary or Cardiac Rehabilitation on Clinical Outcomes: A Systematic Review and Meta-analysis. Cardiopulmonary Physical Therapy Journal. 34(1):13-29, January 2023. DOI: 10.1097/CPT.0000000000000204 
  6.  Reychler G, Mottart F, Boland M, Wasterlain E, Pieters T, Caty G, Liistro G. Influence of ambient music on perceived exertion during a pulmonary rehabilitation session: a randomized crossover study. Respir Care. 2015 May;60(5):711-7. doi: 10.4187/respcare.03671. Epub 2015 Jan 13. PMID: 25587172. 
  7. Bauldoff GS, Hoffman LA, Zullo TG, Sciurba FC. Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli. Chest. 2002 Sep;122(3):948-54. doi: 10.1378/chest.122.3.948. PMID: 12226037. 
  8. Liu WT, Wang CH, Lin HC, Lin SM, Lee KY, Lo YL, Hung SH, Chang YM, Chung KF, Kuo HP. Efficacy of a cell phone-based exercise programme for COPD. Eur Respir J. 2008 Sep;32(3):651-9. doi: 10.1183/09031936.00104407. Epub 2008 May 28. PMID: 18508824. 
  9. A. Norweg 2, F. Haas 2, J.H. Whiteson 2, D. Veltri 2, E.G. Collins 4, J.A. Krishnan 3, G. Sweeney 2, V.H. Raveis. Respiratory Patient Perspectives on Exercising with Music: A Qualitative Study.  American Journal of Respiratory and Critical Care Medicine 2019;199:A3738. https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A3738 
  10. Clark IN, Baker FA, Taylor NF. Older Adults’ Music Listening Preferences to Support Physical Activity Following Cardiac Rehabilitation. J Music Ther. 2016 Winter;53(4):364-397. doi: 10.1093/jmt/thw011. Epub 2016 Sep 3. PMID: 27591761. 
  11. Lewis A, Philip KEJ, Lound A, Cave P, Russell J, Hopkinson NS. The physiology of singing and implications for ’Singing for Lung Health’ as a therapy for individuals with chronic obstructive pulmonary disease. BMJ Open Respir Res. 2021 Nov;8(1):e000996. doi: 10.1136/bmjresp-2021-000996. PMID: 34764199; PMCID: PMC8587358. 
  12. Kim SJ, Yeo MS, Kim SY. Singing Interventions in Pulmonary Rehabilitation: A Scoping Review. Int J Environ Res Public Health. 2023 Jan 12;20(2):1383. doi: 10.3390/ijerph20021383. PMID: 36674142; PMCID: PMC9858886. 
  13. McNaughton A, Weatherall M, Williams M, McNaughton H, Aldington S, Williams G, Beasley R. Sing Your Lungs Out-a community singing group for chronic obstructive pulmonary disease: a 1-year pilot study. BMJ Open. 2017 Jan 24;7(1):e014151. doi: 10.1136/bmjopen-2016-014151. PMID: 28119393; PMCID: PMC5294022. 
  14. Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev. 2023 Mar 22;32(167):220170. doi: 10.1183/16000617.0170-2022. PMID: 36948501; PMCID: PMC10032611. 
  15. Fang X, Qiao Z, Yu X, Tian R, Liu K, Han W. Effect of Singing on Symptoms in Stable COPD: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis. 2022 Nov 14;17:2893-2904. doi: 10.2147/COPD.S382037. PMID: 36407671; PMCID: PMC9673938. 
  16. Lord VM, Cave P, Hume VJ, Flude EJ, Evans A, Kelly JL, Polkey MI, Hopkinson NS. Singing teaching as a therapy for chronic respiratory disease–a randomised controlled trial and qualitative evaluation. BMC Pulm Med. 2010 Aug 3;10:41. doi: 10.1186/1471-2466-10-41. PMID: 20682030; PMCID: PMC2920262. 
  17. Bonilha AG, Onofre F, Vieira ML, Prado MY, Martinez JA. Effects of singing classes on pulmonary function and quality of life of COPD patients. Int J Chron Obstruct Pulmon Dis. 2009;4:1-8. Epub 2009 Apr 15. PMID: 19436683; PMCID: PMC2672787. 
  18. Lord VM, Hume VJ, Kelly JL, Cave P, Silver J, Waldman M, White C, Smith C, Tanner R, Sanchez M, Man WD, Polkey MI, Hopkinson NS. Singing classes for chronic obstructive pulmonary disease: a randomized controlled trial. BMC Pulm Med. 2012 Nov 13;12:69. doi: 10.1186/1471-2466-12-69. Erratum in: BMC Pulm Med. 2014;14:181. PMID: 23145504; PMCID: PMC3515466. 
  19. Skingley, A., Page, S., Clift, S., Morrison, I., Coulton, S., Treadwell, P., … Shipton, M. (2013). “Singing for Breathing”: Participants’ perceptions of a group singing programme for people with COPD. Arts & Health, 6(1), 59–74. https://doi.org/10.1080/17533015.2013.840853 
  20. McNaughton A, Aldington S, Williams G, Levack WM. Sing Your Lungs Out: a qualitative study of a community singing group for people with chronic obstructive pulmonary disease (COPD). BMJ Open. 2016 Sep 20;6(9):e012521. doi: 10.1136/bmjopen-2016-012521. PMID: 27650768; PMCID: PMC5051388. 
  21. Cahalan R, Green J, Meade C, Griffin A. ”SingStrong”: Singing for better lung health in COPD – A pilot study. Physiother Theory Pract. 2022 Dec;38(12):1978-1986. doi: 10.1080/09593985.2021.1907825. Epub 2021 Mar 31. PMID: 33787452. 
  22. Karageorghis CI, Priest DL. Music in the exercise domain: a review and synthesis (Part II). Int Rev Sport Exerc Psychol. 2012 Mar;5(1):67-84. doi: 10.1080/1750984X.2011.631027. Epub 2011 Dec 7. PMID: 22577473; PMCID: PMC3339577. 
  23. Price, S. and Skingley, A. Singing and COPD: development, implementation and evaluation of a resource to support home practice and disease self-management. Journal of Music, Health and Wellbeing May 2022: 1-18. 

ID 10113-19.09.2024

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