COPD: Singing training as effective as physical rehabilitation

Singing is as effective as classical pulmonary rehabilitation in COPD patients as a means of improving physical performance.

Danish study examines alternative options

Singing is as effective as classical pulmonary rehabilitation in COPD patients as a means of improving physical performance.1

"As you all know, pulmonary rehabilitation is a cornerstone in COPD care and has an immense impact on the subjective and objective aspects of living with COPD," said Prof. Uffe Bødtger from Nætved Hospital, Denmark. Unfortunately, adherence to pulmonary rehabilitation can be quite a problem, so there is a need for alternative options.

Physical effects have not yet been studied

"Over the last 20 years, “lung choirs” or singing training for patients with respiratory diseases including COPD have shown that it can improve respiratory control, dyspnoea levels and self-perception of physical health, but the effects on physical performance are still unknown," said Prof. Bødtger explaining the motivation for this multicentre randomized study. Therefore, the primary endpoint of this study, which compared song training with physical training, was non-inferiority in the improvement of physical performance, which was demonstrated by a change in the 6-minute walk test (6MWT). Secondary endpoints included quality of life, lung function (FEV1), general disease-specific health (St George's Respiratory Questionnaire, SGRQ), and adherence.

270 rehabilitation patients in two years

The study randomized 270 subjects who had a prescription for pulmonary rehabilitation from August 2017 to August 2019, 195 of whom completed their rehabilitation after 10 weeks. The initial parameters between the groups were comparable. The patients had a mean age of 69 years and a mean FEV1 of 51%. About 2/3 of them were female and about 73% were undergoing double or triple inhalation treatment.

No significant differences found

The results show: There were no differences in 6MWT (P=0.81) between vocal training and standard physical training. However, for some of the secondary endpoints, patients with vocal training showed more significant differences in intra-group changes: e.g. SGRQ (vocal training group vs. physical training group: P<0.001 vs P=0.08), predicted FEV1 (P=0.04 vs 0.35). Nevertheless, no differences in training adherence, dyspnea, anxiety, and depression were observed between the different rehabilitation measures. Adverse events were not reported.

"In summary, it can be said that singing training in COPD patients undergoing rehabilitation could be as effective as physical training in improving physical performance. However, there is still a long way to go before the optimal content of vocal training is researched and standardized," said Prof. Bødtger.

1. Kaasgaard M, et al Sing-a-Lung: Group singing as a training modality in pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD): A multicentre, cluster-randomized, non-inferiority controlled study. Poster 4663, ERS International Virtual Congress 2020, 7-9 Sept.