Use of Singing for Lung Health as an alternative training modality within pulmonary rehabilitation for COPD: an RCT

Background Pulmonary rehabilitation (PR) is a cornerstone in Chronic Obstructive Pulmonary Disease (COPD) management. However, PR adherence is generally low, and barriers include availability, economic issues, motivation, and inability to attend or perform physical training. Therefore, alternative, evidence-based PR activities are required. Singing may have benefits within quality of life (QoL), respiratory control, and wellbeing in COPD, but impact on PR key outcome, physical exercise capacity, is uncertain.

Methods In this RCT (NCT03280355), we investigated effectiveness of 10-weeks of PR, including either “Singing for Lung Health” (SLH)-training or standard physical exercise training (PExT). Primary outcome: Change in exercise capacity (6-Minute Walk Test, distance (6 MWD)) from baseline to post-PR. Secondary outcomes: Changes in QoL (St George's Respiratory Questionnaire (SGRQ)), Hospital anxiety and depression score (HADS), lung function, dyspnoea, and adherence.

Results We included 270 COPD patients, and 195 completed the study. Demographics across groups were comparable, and both groups improved significantly in 6 MWD and SGRQ. SLH was non-inferior to PExT in 6 MWD (13.1 m±36.3/14.1 m±32.3; p=0.81 [95%CI=−7.28;9.30]) with 21.8% respectively 25.0% (p=0.57) reaching 6 MWD Minimal Important Difference of 30 m. We found no significant between-group differences concerning SGRQ, HADS, lung function, dyspnoea, or adherence.

Conclusions Our study suggests that SLH is non-inferior to PExT in improving 6 MWD during a 10-weeks PR programme. Future studies addressing reproducibility, long-term effects and health-economics are needed.