Singing and Health

Original Editor - Wendy Walker Top Contributors - Wendy Walker, Kim Jackson and Lucinda hampton

Introduction[edit | edit source]

Choir singing at the 2000 Sydney Paralympic Games Opening Ceremony.

Singing is found in all human cultures around the world; it often occurs in social settings such as religious ceremonies and even some sporting events such as football matches, and of course there are many dedicated communal singing groups/choirs in many countries. Parents sing to their babies, people sing birthday greetings, the new year is often welcomed with a communal song, so there is no doubt that singing and music is embedded within all societies.

We know that music-making developed approx 40,000 years ago in the upper Paleolithic period of the stone age due to an exciting archelogical find in Germany, near the Danube[1]: several flutes made from the radius bone of vultures, with finger holes precisely incised and a notch at one end where they were blown. Radiocarbon dating indicates they come from the Upper Paleolithic period; this was a creative period and we have evidence of many cave paintings, carvings and engravings dating from this time.

Singing facilitates the active use of diaphragmatic breathing, which can help to promote deep breaths and a slower rate of respiratioin. This diaphragmatic breathing has an influence on a number of important physiological functions, such as the cardiovascular system and the autonomic nervous system. In addition, singing with a group of people often leads to social cohesion and increased emotional support.

Physical/Physiological Effects of Singing[edit | edit source]

Brain Function[edit | edit source]

In the brain, music making (both singing and playing musical instruments) results in multiple motor, sensory, cognitive, emotional and social processes all interacting, employing both cortical and subcortical regions of the brain[2][3][4]. One enterprising study utilised fMRI and demonstrated that "rhythm and tonality in music recruit limbic regions as well as cognitive and somatomotor areas"[3]. Another study reports that "reward value for music can be coded by activity levels in the nucleus accumbens, whose functional connectivity with auditory and frontal areas increases as a function of increasing musical reward. We propose that pleasure in music arises from interactions between cortical loops that enable predictions and expectancies to emerge from sound patterns and subcortical systems responsible for reward and valuation"[5].

Respiratory Function[edit | edit source]

Intuitively it is easy to assume that singing, involving as it does the whole respiratory system, is likely to be an effective way to improve respiratory function in people with conditions such as COPD[6], asthma[7], emphysema[8], bronchiectasis[9], cystic fibrosis[10] etc. Yet, many studies conducted to date do not show statistically signifiant changes in lung function, such as Peak Flow, FEV1 or FVC. One recent meta-study concludes: "Singing for respiratory health remains promising but inconclusive at this stage"[11]. However, self reported measures of quality of life, general health and anxiety levels in people with respiratory diseases show benefits from choral singing[12][6][13].

A 2016 report Singing for Lung Health - a systematic review of the literature and consensus statement[14] concludes:

"Quantitative data suggest that singing has the potential to improve health-related quality of life, particularly related to physical health, and levels of anxiety without causing significant side effects. There is a significant risk of bias in many of the existing studies with small numbers of subjects overall. Little comparison can be made between studies owing to their heterogeneity in design. Qualitative data indicate that singing is an enjoyable experience for patients, who consistently report that it helps them to cope with their condition better. Larger and longer-term trials are needed."

Cardiac Function and Heart Rate Variability[edit | edit source]

Heart rate variability (HRV) is the measurement of the beat-to-beat changes in heart rate, and is known to be an indicator of autonomic nervous system (ANS) function[15][16][17][18].

Studies have found that heart rate variability [HRV] is affected by singing, such that variability is increased during singing activities, and that singing produces slow, regular and deep respiration[19]. Coupling of heart rate variability (HRV) to respiration, known as Respiratory Sinus Arrhythmia [RSA], is known be beneficial for cardiovascular function, and to have a subjective as well as a biologically soothing effect, which can result in lowering of blood pressure[20][21].

Immunological Effects[edit | edit source]

A number of studies have investigated the effects of singing on the immune system, and report that after singing the levels of salivary immunoglobulin A are increased[22][23]. From these studies we see that choir singing has a positive influence on immune competence.

Psychobiological Effects of Singing[edit | edit source]

Effects on Quality of Life and Mental Health[edit | edit source]

There are a large number of studies[24][25][26] from various countries which all demonstrate that communal singing is beneficial for mental health, improves quality of life (on self-reported scales) and improves self-reported well being.

One Canadian study[27] examined choral singing and psychological well-being, and concluded: "Results suggest that a single rehearsal of choral singing is associated with significant increases in positive affect, personal growth, and vitality".

Some choirs have been formed with specifically therapeutic intentions for people with chronic mental health problems or disabilities, demonstrating that this cohort are able to gain "important social and health benefits from choir singing"[28].

Self Confidence and Self Esteem[edit | edit source]

Many studies report improved self confidence and self worth in members of choirs[25][4][24][29]. Self-reported measures suggest that singing in a group enables people with low self esteem to establish friendships, and that these in turn can impact positively on their work and social lives[24][30][28]. It is often reported by the participants that becoming a member of a group with a focus on making music together has a significant benefit to their social relationships; friendships formed within the choir can become a source of support. One study reports, "the regular experience of helpful accepting relationships within the choir provided confidence for choir members to increase their social interactions outside of choir times. For people with chronic mental health problems and/or disabilities, this accumulation of positive social experiences can be seen as an important step in the process of achieving broader outcomes such as entering paid employment and maintaining stable housing, which rely on interpersonal skill and confidence."[28]

Singing as we Age[edit | edit source]

There is evidence that communal singing in older adults is linked to higher verbal flexibility and that regular choir activity is associated with better social engagement[4][31].

We know that despite age-related changes, the brain remains plastic throughout life, and that it can make some structural adaptations as well as amend its function in order to compensate for lost volume and functioning of specific areas. There is a wealth of evidence that physical exercise can decrease the risk of cognitive decline and dementia, and that it can slow down age-related neural changes; see the Physical Activity in Older Adults page for details. There are now a number of studies investigating the effects of cultural activities and the arts, including music and participatory singing activities[30][32][31].

One small study enrolled 49 older adults (mean age 83.6 years) to sing in a choir for 75 minute long rehearsal each week for a total of 12 weeks. From this relatively short intervention, the participants achieved improved scores in Verbal Fluency testing[33].

Groups of elderly people with specific conditions, including stroke, Parkinson's and dementia have been shown to benefit from communal singing[34][35] in terms of communication, sociability, reduction in aggression and improved mood.

References[edit | edit source]

  1. Conard N J; Malina M; Munzel SC. (2009). New flutes document the earlist musical tradition in southwestern Germany". Nature 460 (7256): 737-40.
  2. Zatorre R.J., & Salimpoor V.N. (2013). From perception to pleasure: Music and its neural substrates. Proceedings of the National Academy of Sciences of the United States of America, 110, 10430–10437. pmid:23754373
  3. 3.0 3.1 Alluri V., Toiviainen P., Jääskeläinen I. P., Glerean E., Sams M., & Brattico E. (2012). Large-scale brain networks emerge from dynamic processing of musical timbre, key and rhythm. NeuroImage, 59, 3677–3689. pmid:22116038
  4. 4.0 4.1 4.2 Pentikäinen E, Pitkäniemi A, Siponkoski S-T, Jansson M, Louhivuori J, Johnson JK, et al. (2021) Beneficial effects of choir singing on cognition and well-being of older adults: Evidence from a cross-sectional study. PLoS ONE 16(2): e0245666.
  5. Zatorre RJ, Salimpoor VN. From perception to pleasure: music and its neural substrates. Proc Natl Acad Sci U S A. 2013 Jun 18;110 Suppl 2(Suppl 2):10430-7. doi: 10.1073/pnas.1301228110. Epub 2013 Jun 10. PMID: 23754373; PMCID: PMC3690607.
  6. 6.0 6.1 I Morrison, SM Clift, A UK feasibility study on the value of singing for people with Chronic Obstructive Pulmonary Disease (COPD) September 2011 to June 2012: Ian Morrison,  European Journal of Public Health, Volume 23, Issue suppl_1, October 2013, ckt123.059,
  7. Wade, Leanne M. January 2002 A Comparison of the Effects of Vocal Exercises/Singing Versus Music-Assisted Relaxation on Peak Expiratory Flow Rates of Children with Asthma. Music Therapy Perspectives 20(1):31-37 DOI:10.1093/mtp/20.1.31<footer></footer>
  8. Engen R. L. (2005). The singer's breath: implications for treatment of persons with emphysema. Journal of music therapy42(1), 20–48.
  9. Irons  JY, Kenny  DT, Chang  AB. 2010 Singing for children and adults with bronchiectasis. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD007729. DOI: 10.1002/14651858.CD007729.pub2. Accessed 11 April 2021.
  10. Irons, J. Y., Petocz, P., Kenny, D. T., & Chang, A. B. (2019). Singing as an adjunct therapy for children and adults with cystic fibrosis.  The Cochrane database of systematic reviews7(7), CD008036. Advance online publication.
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  13. Skingley, A., Page, S., Clift, S., Morrison, I., Coulton, S., Treadwell, P., Vella-Burrows, T., Salisbury, I. and Shipton, M., 2014. “Singing for Breathing”: Participants' perceptions of a group singing programme for people with COPD. Arts & Health6(1), pp.59-74.
  14. Lewis, A., Cave, P., Stern, M., Welch, L., Taylor, K., Russell, J., Doyle, A. M., Russell, A. M., McKee, H., Clift, S., Bott, J., & Hopkinson, N. S. (2016). Singing for Lung Health-a systematic review of the literature and consensus statement.  NPJ primary care respiratory medicine26, 16080.
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  18. McCraty, R. & Zayas, M. Cardiac coherence, self-regulation, autonomic stability, and psychosocial well-being. Frontiers in psychology 5, 1–13, (2014)
  19. Cardiac and respiratory patterns synchronize between persons during choir singing. Müller V, Lindenberger U PLoS One. 2011; 6(9):e24893.
  20. The effects of specific respiratory rates on heart rate and heart rate variability. Song HS, Lehrer PM Appl Psychophysiol Biofeedback. 2003 Mar; 28(1):13-23.
  21. RESPeRATE: nonpharmacological treatment of hypertension. Sharma M, Frishman WH, Gandhi K Cardiol Rev. 2011 Mar-Apr; 19(2):47-51.
  22. Beck, R. (2000). Choral Singing, Performance Perception, and Immune System Changes in Salivary Immunoglobulin A and Cortisol. UC Irvine: Center for Learning in the Arts, Sciences and Sustainability. Retrieved from
  23. Kreutz, G., Bongard, S., Rohrmann, S. et al. Effects of Choir Singing or Listening on Secretory Immunoglobulin A, Cortisol, and Emotional State. J Behav Med 27, 623–635 (2004).
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  25. 25.0 25.1 Jacob, C., C. Guptill and T. Sumsion, 2009. Motivation for continuing involvement in a leisure-based choir: the lived experiences of university choir members. Journal of Occupational Science, 2009. 16(3): p. 187-93
  26. Johnson, J. K., Louhivuori, J., & Siljander, E. (2017). Comparison of Well-being of Older Adult Choir Singers and the General Population in Finland: A Case-Control Study. Musicae scientiae : the journal of the European Society for the Cognitive Sciences of Music21(2), 178–194.
  27. Busch, Sally L.; Gick, Mary A Quantitative Study of Choral Singing and Psychological Well-Being. Source: Canadian Journal of Music Therapy . 2012, Vol. 18 Issue 1, p45-61.
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  29. Coulton, S., Clift, S., Skingley, A., & Rodriguez, J. (2015). Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: Randomised controlled trial. British Journal of Psychiatry, 207(3), 250-255. doi:10.1192/bjp.bp.113.129908
  30. 30.0 30.1 Fancourt, D., & Finn, S. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. WHO Health Evidence Network Synthesis Reports. Copenhagen: WHO Regional Office for Europe.
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  34. Särkämö T, et al., Cognitive, Emotional, and Social Benefits of Regular Musical Activities in Early Dementia: Randomized Controlled Study. Gerontologist, 2013 Sep 5
  35. Myska, A. and P.G. Nord, ‘The day the music died’: a pilot study on music and depression in a nursing home. Nordic Journal of Music Therapy, 2008. 17(1): p. 30-40