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Shop Talk: Singing as Therapy for Long-COVID

March 4, 2021 • Health Care News • Sheila Schindler-Ivens

Shop Talk is a newsletter published by The Evidence Workshop, LLC.  
It helps clinicians integrate the best, available research evidence into front-line practice. 

Last month marked the 1st anniversary of Shop Talk, and we are delighted to bring you an inspiring story from London where the English National Opera is hosting a breathing and wellbeing program for people recovering from COVID-19. That’s right; singing is no longer just a nemesis when it comes to COVID. If you want to revisit that nightmare, read the CDC’s report from May of 2020 describing a choir-related super spreader event. If you prefer to hum a happier tune, check out ENO Breathe where you’ll learn about an interdisciplinary team of artists, clinicians, and researchers who are using lullabies as a form of exercise for COVID long haulers. I’m reluctant to say that the pandemic has been anything but downbeat, but ENO Breathe is another example of the extraordinary innovation and compassion that many have harnessed in the past year.

This story left us wondering what the literature has to say about the usefulness of singing for people with SARS-CoV-2 and other conditions that affect breathing. As you might expect, it’s too soon to understand the effects of singing on acute and chronic symptoms of COVID-19. (See only 3 COVID-related articles in our bibliography.) But the practice of singing for lung health is well described in the literature. Of the 41 articles we retrieved in PubMed, 11 examined singing in people with chronic obstructive pulmonary disease (COPD). While initially elated that 1 of those articles was a systematic review from the Cochrane Collaboration, we switched to a minor key when we learned that there is weak evidence at best for the effectiveness of singing for people with COPD. The Cochrane group reported no improvement in health‐related quality of life or dyspnea as compared control interventions consisting of film workshops, handcraft work, or no intervention. They found only low-quality evidence supporting improvements in physical health.

We also found a Cochrane review on cystic fibrosis (CF) that examined one small study on singing. Here again, there were no significant differences between groups (singing vs. video games or movies) in quality of life or respiratory muscle strength in hospitalized children with CF.

What’s the upshot?

Kudos to the group in England for their innovation! The music industry has been hard hit by physical distancing, and the English National Opera found a way to adapt their score in service to their community. They also had the insight to partner with a research fellow, presumably to evaluate outcomes associated with their initiative. Maybe ENO Breathe works; maybe it doesn’t. I hope to find out some day, and I’ll accept the outcome either way. Meanwhile, here at the Shop, we’re singing the praises of a group that recognized an opportunity to lead, serve, and explore.

Thanks for reading. As always, you can find search details and articles below. We also post at https://www.buymeacoffee.com/ptworkshop/posts. If you like what we’re doing, post an anniversary message. Take care, and regardless of the evidence, don’t stop singing in the shower.

Further Reading

· This is the search we used at www.pubmed.gov –
(“COVID-19″[Mesh] OR “SARS-CoV-2” [Mesh] OR “SARS Virus” [Mesh] OR “Lung Diseases”[Mesh] OR “Respiration Disorders”[Mesh] ) AND (“singing” [Mesh])

· Learn more about the Cochrane Collaboration at https://www.cochrane.org/about-us.

· This is the full list of 41 hits arrange by topic –

COVID-19 Related

  1. Can occupational therapy manpower be replaced with social robots in a singing group during COVID-19? Liao YH, Lin TY, Wu CC, Shih YN. Work. 2021;68(1):21-26. doi: 10.3233/WOR-205096. PMID: 33459684

  2. COVID-19 and spontaneous singing to decrease loneliness, improve cohesion, and mental well-being: An Italian experience. Corvo E, De Caro W. Psychol Trauma. 2020 Aug;12(S1):S247-S248. doi: 10.1037/tra0000838. Epub 2020 Jun 25. PMID: 32584108

  3. Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial. Philip KE, Lewis A, Jeffery E, Buttery S, Cave P, Cristiano D, Lound A, Taylor K, Man WD, Fancourt D, Polkey MI, Hopkinson NS.BMJ Open Respir Res. 2020 Nov;7(1):e000737. doi: 10.1136/bmjresp-2020-000737. PMID: 33239406 Free PMC article. Clinical Trial.

Chronic Obstructive Pulmonary Disease (COPD)

  1. Singing and Dancing as Modalities for Exercise Training in COPD. Lewis A, Philip KE. COPD. 2020 Feb;17(1):120. doi: 10.1080/15412555.2019.1702011. Epub 2019 Dec 13. PMID: 31833425 No abstract available.

  2. Sing Your Lungs Out-a community singing group for chronic obstructive pulmonary disease: a 1-year pilot study. McNaughton A, Weatherall M, Williams M, McNaughton H, Aldington S, Williams G, Beasley R.BMJ Open. 2017 Jan 24;7(1):e014151. doi: 10.1136/bmjopen-2016-014151. PMID: 28119393 Free PMC article.

  3. Community singing groups for people with chronic obstructive pulmonary disease: participant perspectives. Skingley A, Clift S, Hurley S, Price S, Stephens L. Perspect Public Health. 2018 Jan;138(1):66-75. doi: 10.1177/1757913917740930. Epub 2017 Nov 21. PMID: 29160737

  4. Group singing improves depression and life quality in patients with stable COPD: a randomized community-based trial in China. Liu H, Song M, Zhai ZH, Shi RJ, Zhou XL. Qual Life Res. 2019 Mar;28(3):725-735. doi: 10.1007/s11136-018-2063-5. Epub 2019 Jan 5. PMID: 30612266 Free PMC article. Clinical Trial.

  5. HOOTENANNY. Singing away the blues, COPD. Robeznieks A. Hosp Health Netw. 2016 Mar;90(3):16. PMID: 27180394 No abstract available.

  6. Non-pharmacological management of chronic breathlessness in stable chronic obstructive pulmonary disease. Watson JS. Br J Community Nurs. 2018 Aug 2;23(8):376-381. doi: 10.12968/bjcn.2018.23.8.376. PMID: 30063393 Review.

  7. Pulmonary Rehabilitation: The Lead Singer of COPD Therapy but Not a “One-Man Band”. Evans RA, Steiner MC. Chest. 2017 Dec;152(6):1103-1105. doi: 10.1016/j.chest.2017.06.040. PMID: 29223257 No abstract available.

  8. Sing Your Lungs Out: a qualitative study of a community singing group for people with chronic obstructive pulmonary disease (COPD). McNaughton A, Aldington S, Williams G, Levack WM. BMJ Open. 2016 Sep 20;6(9):e012521. doi: 10.1136/bmjopen-2016-012521. PMID: 27650768 Free PMC article.

  9. Singing classes for chronic obstructive pulmonary disease: a randomized controlled trial. 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. BMC Pulm Med. 2012 Nov 13;12:69. doi: 10.1186/1471-2466-12-69.PMID: 23145504 Free PMC article. Clinical Trial.

  10. Singing for adults with chronic obstructive pulmonary disease (COPD). McNamara RJ, Epsley C, Coren E, McKeough ZJ. Cochrane Database Syst Rev. 2017 Dec 19;12(12):CD012296. doi: 10.1002/14651858.CD012296.pub2. PMID: 29253921 Free PMC article. Review.

  11. Singing in chronic obstructive pulmonary disease patients: A pilot study in Portugal. Pacheco C, Costa A, Amado J, Almeida P. Rev Port Pneumol. 2014 Jul-Aug;20(4):225-8. doi: 10.1016/j.rppneu.2014.02.009. Epub 2014 Apr 30. PMID: 24793633 No abstract available.

The Bad News – singing as a vector for virus transmission

  1. High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice – Skagit County, Washington, March 2020. Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, Lynn J, Ball A, Narwal S, Russell S, Patrick D, Leibrand H. MMWR Morb Mortal Wkly Rep. 2020 May 15;69(19):606-610. doi: 10.15585/mmwr.mm6919e6. PMID: 32407303

  2. Impulse Dispersion of Aerosols during Singing and Speaking: A Potential COVID-19 Transmission Pathway. Echternach M, Gantner S, Peters G, Westphalen C, Benthaus T, Jakubaß B, Kuranova L, Döllinger M, Kniesburges S. Am J Respir Crit Care Med. 2020 Dec 1;202(11):1584-1587. doi: 10.1164/rccm.202009-3438LE.PMID: 33064957 Free PMC article. No abstract available.

Asthma and Cystic Fibrosis

  1. Asthma Evaluation of a Choir as a Non-Medical Intervention for Children with Asthma: BreathStars. Bowden L, Long T, Henry H. Compr Child Adolesc Nurs. 2020 Jun;43(2):128-141. doi: 10.1080/24694193.2019.1607629. Epub 2019 Jun 13. PMID: 31192700

  2. CF Singing as an adjunct therapy for children and adults with cystic fibrosis: A Cochrane review summary. Whitehead L, Arabiat RND, Foster M. Int J Nurs Stud. 2018 Jun;82:163-164. doi: 10.1016/j.ijnurstu.2017.09.007. Epub 2017 Sep 15. PMID: 29055499 Review. No abstract available.

Miscellaneous

  1. Will we be singing a different tune on combined post- and pre-capillary pulmonary hypertension? Hsu S, Tedford RJ.Eur Respir J. 2018 Feb 7;51(2):1702589. doi: 10.1183/13993003.02589-2017. Print 2018 Feb. PMID: 29437950 Free article. No abstract available.

  2. The clinical characteristics of situational syncope in children and adults undergoing head-up tilt testing. Zou R, Wang S, Lin P, Hu C, Wang Y, Li F, Xu Y, Wang C. Am J Emerg Med. 2020 Jul;38(7):1419-1423. doi: 10.1016/j.ajem.2019.11.042. Epub 2019 Nov 29. PMID: 31843331

  3. “Attacks” or “Whistling”: Impact of Questionnaire Wording on Wheeze Prevalence Estimates. Pescatore AM, Spycher BD, Beardsmore CS, Kuehni CE.PLoS One. 2015 Jun 26;10(6):e0131618. doi: 10.1371/journal.pone.0131618. eCollection 2015. PMID: 26114296 Free PMC article.

  4. “Screaming your Lungs Out!” A Case of Boy Band-Induced Pneumothorax, Pneumomediastinum, and Pneumoretropharyngeum. Slaughter JM Jr, Roppolo L. J Emerg Med. 2017 Nov;53(5):762-764. doi: 10.1016/j.jemermed.2017.08.006. Epub 2017 Oct 4.PMID: 28987299 No abstract available.

  5. Contemporary Commercial Music Singing Students-Voice Quality and Vocal Function at the Beginning of Singing Training. Sielska-Badurek EM, Sobol M, Olszowska K, Niemczyk K. J Voice. 2018 Nov;32(6):668-672. doi: 10.1016/j.jvoice.2017.08.027. Epub 2017 Oct 3. PMID: 28986153

  6. Contribution of Glottic Insufficiency to Perceived Breathiness in Classically Trained Singers. Graham E, Angadi V, Sloggy J, Stemple J. Med Probl Perform Art. 2016 Sep;31(3):179-84. doi: 10.21091/mppa.2016.3032. PMID: 27575295

  7. How the power of singing is helping patients to breathe again. Tanday S. Lancet Respir Med. 2016 Feb;4(2):101. doi: 10.1016/S2213-2600(16)00002-3. Epub 2016 Jan 8. PMID: 26774706 No abstract available.

  8. Laryngeal hereditary hemorrhagic telangiectasia. Lechien JR, Finck C. Ear Nose Throat J. 2018 Dec;97(12):388. doi: 10.1177/014556131809701203.PMID: 30540884 No abstract available.

  9. Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument. Lechien JR, Schindler A, Robotti C, Lejeune L, Finck C. Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun;136(3S):S39-S43. doi: 10.1016/j.anorl.2018.08.008. Epub 2018 Aug 27. PMID: 30166226 Review.

  10. Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Filippa M, Devouche E, Arioni C, Imberty M, Gratier M. Acta Paediatr. 2013 Oct;102(10):1017-20. doi: 10.1111/apa.12356. Epub 2013 Aug 8. PMID: 23848529 Clinical Trial.

  11. NICU music therapy: song of kin as critical lullaby in research and practice. Loewy J. Ann N Y Acad Sci. 2015 Mar;1337:178-85. doi: 10.1111/nyas.12648.PMID: 25773633

  12. Non-pharmacological management of chronic breathlessness in stable chronic obstructive pulmonary disease. Watson JS. Br J Community Nurs. 2018 Aug 2;23(8):376-381. doi: 10.12968/bjcn.2018.23.8.376. PMID: 30063393 Review.

  13. Reflux symptoms in professional opera soloists. Lenti MV, Cammarota G, Vidali F, Masala G, Bendinelli B, Gasbarrini G, Corazza GR, Di Sabatino A. Dig Liver Dis. 2019 Jun;51(6):798-803. doi: 10.1016/j.dld.2018.11.026. Epub 2018 Dec 4. PMID: 30578108

  14. REPEATED ASSESSMENT OF AIRWAY RESISTANCE BY WHISTLING PATIENTS. DEBONO E. Lancet. 1965 Apr 17;1(7390):866-7. doi: 10.1016/s0140-6736(65)91401-7.PMID: 14263555 No abstract available.

  15. Singing for respiratory health: theory, evidence and challenges. Gick ML, Nicol JJ. Health Promot Int. 2016 Sep;31(3):725-34. doi: 10.1093/heapro/dav013. Epub 2015 Mar 16. PMID: 25784304 Review.

  16. Syncope in children and adults undergoing head-up tilt testing. Zou R, Wang S, Lin P, Hu C, Wang Y, Li F, Xu Y, Wang C. Am J Emerg Med. 2020 Jul;38(7):1419-1423. doi: 10.1016/j.ajem.2019.11.042. Epub 2019 Nov 29. PMID: 31843331

  17. The Illness and Death of Enrico Caruso (1873-1921): A Medical Chorus Out of Tune? Cascella M.J Relig Health. 2016 Feb;55(1):217-225. doi: 10.1007/s10943-015-0054-1.PMID: 25877665

  18. The meaning of the name of ‘pulmonary rehabilitation’ and its influence on engagement with individuals with chronic lung disease. Oxley R, Harrison SL, Rose A, Macnaughton J. Chron Respir Dis. 2019 Jan-Dec;16:1479973119847659. doi: 10.1177/1479973119847659. PMID: 31137961 Free PMC article.

  19. Voice work. Frisch S. Minn Med. 2015 Jul;98(7):12-3.PMID: 26267914 No abstract available.

  20. Whistling Cough. Sharma SC, Sakthivel P. N Engl J Med. 2018 Aug 9;379(6):e10. doi: 10.1056/NEJMicm1716704. PMID: 30089074 No abstract available.

For those who can read Russian, French, or German

  1. [Health state in Tyva guttural singers]. Saryglar SY, Nesina IA, Liutkevich AA. Med Tr Prom Ekol. 2015;(6):23-7. PMID: 26369243 Russian.

  2. [Outcomes of a pulmonary rehabilitation program including singing training]. Herer B.Rev Mal Respir. 2013 Mar;30(3):194-202. doi: 10.1016/j.rmr.2012.10.602. Epub 2012 Dec 13.PMID: 23497929 Clinical Trial. French.

  3. Die Spielzeugpfeife funktioniert auch im Segmentbronchus. Holzgreve H. MMW Fortschr Med. 2018 Nov;160(20):40. doi: 10.1007/s15006-018-1173-x. PMID: 30478560 German. No abstract available.

Sheila Schindler-Ivens

Dr. Sheila Schindler-Ivens is a licensed physical therapist who earned her PhD in Rehabilitation Science from the University of Iowa and completed a postdoctoral fellowship at the Feinberg School of Medicine at Northwestern University. Dr. Schindler-Ivens joined the faculty in the Dept. of Physical Therapy at Marquette University in 2005. She directs an independent research...

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