Singing for health

Humans have a profound connection with music, but is it possible to harness that to improve the lives of people with long-term conditions? Vita FitzSimons reports

RCN members Trish Vella-Burrows and Ann Skingley have been involved in a series of pioneering research projects to ascertain the effects of singing on health in older people, and those with dementia, mental health problems, lung disease and Parkinson’s.

A nurse and singer by background, Trish is the musical director of community singing groups being studied by the Sidney De Haan Research Centre for Arts and Health at Canterbury Christ Church University, and Ann is a nurse and senior researcher who carried out the first ever randomised controlled trial of the health benefits of a participatory singing programme for older people.

The centre’s latest project has been a feasibility pilot measuring lung function and health-related quality of life in people with chronic obstructive pulmonary disease (COPD) participating in a 10-month weekly singing programme.

The results have been overwhelmingly positive. Chronic obstructive pulmonary disease (COPD) is a debilitating, irreversible condition - the second most common cause of UK emergency hospital admissions and one of the most expensive conditions that the NHS treats. Following diagnosis, patients can get caught in a spiral of decline as they reduce their physical activity. As a result, they often experience knock-on effects such as social isolation, loss of confidence, and depression.

Participants in the COPD 10-month weekly singing programme reported social, psychological and physical health benefits from taking part in the groups. “We weren’t surprised as we’d been watching individuals become more alert and alive,” says Trish. “Many were able to place their breath much further down, relaxing the upper thoracic regions. During sessions they were able to sing longer phrases and lower notes. As nurses it was wonderful to see the scientific evidence backing up our experience.”

Measures of lung function and health-related quality of life showed significant improvement by the end of the singing programme. “You would normally expect to see deterioration in lung function over time,” says Ann, “but instead, their lung function either improved slightly or stayed the same. That in itself is a remarkable thing.”

A running theme Ann identifies in all the groups, for whichever health condition, is the participants’ desire to continue past the end of the studies. Ann is currently analysing comments from individuals who participated in the COPD groups and her initial findings confirm the value that they placed on their weekly time together. “The research shows that the sessions give people a positive identity as a part of a choir,” says Ann. “Meeting people who are going through similar experiences provides a valuable peer group and social support. It also offers participants something to look forward to, giving a structure to the week.”

Tapping into the emotions

Researchers at the centre believe nursing staff are well placed to advocate the value of singing for health, either referring patients to existing groups – for example as a follow-up to a pulmonary rehabilitation programme – or by starting groups where none exist.

“It’s a sort of utopian care-giving,” says Trish. “It’s not just about the singing; it’s about tapping into the emotions and expressions of feelings and the reality of experiencing illness for people and their carers. It’s a very fulfilling experience as a nurse. There are times when I’m moved to tears, sharing an emotion that is borne out of a sense of being able to achieve something together. In my dementia groups, someone can appear not to have any interaction with people, and then there’s a little spark and suddenly they’ll start singing along with the group. I understand this to be an innate connection to music. We use simple western musical scales and pentatonics (five-note scales) – it’s very pure music. There’s something about those sounds and the intervals between the notes that people can connect with.”

Trish is interested in how nursing staff perceive singing in the workplace. She explored perceived barriers to using music as part of a nursing role for her PhD. “What strikes me is that staff often perceive music as tangential to their role, while using it in their private lives to support themselves,” she says. “Music reaches people on a deep level. Using music as a health care intervention can target the psychotherapeutic dimensions of health giving and health care, as well as supporting nurses’ own sense of wellbeing.”

Taking singing seriously

The team has produced a set of downloadable resources to enable people to set up, run and evaluate their own groups, providing theoretical background, practical advice and case studies. They also run training programmes designed for non-musicians who want to use music with their clients.

They are keen for commissioners and health professionals to take singing for health groups seriously as a cost-effective option for people with a range of conditions. All their participants fill in questionnaires, placing a value on their health which is then converted into quality-adjusted life years (QALYs). This can be taken into account when costing interventions.  “When you look at the cost of setting up singing groups, it’s really peanuts,” says Ann, “The evidence points to it being a cost-effective intervention for a range of health issues.”

Contact isobel.salisbury@canterbury.ac.uk to gain access to the resources referred to in this feature.

Write to bulletin@rcn.org.uk to share your stories of pioneering treatment methods.