Singing for better breathing: findings from the Lambeth & Southwark singing and COPD project.

Research report


Clift, S., Skingley, A., Price, S., Stephens, L., Hurley, S., Dickinson, J., Meadows, S., Levai, I., Jackson, A., Sullivan, R., Wren, N., McDaid, D., Park, A., Saleem, A., Baxter, N., Rosenthuler, G. and Shah, S. 2017. Singing for better breathing: findings from the Lambeth & Southwark singing and COPD project. Canterbury Canterbury Christ Church University.
AuthorsClift, S., Skingley, A., Price, S., Stephens, L., Hurley, S., Dickinson, J., Meadows, S., Levai, I., Jackson, A., Sullivan, R., Wren, N., McDaid, D., Park, A., Saleem, A., Baxter, N., Rosenthuler, G. and Shah, S.
TypeResearch report
Abstract

Introduction
Over the last eight years there has been a growth of interest in the potential value of participation in singing groups for people with chronic obstructive pulmonary disease (CODP) and other respiratory illnesses. This is shown by the increasing number of singing for breathing groups established across the UK over this period. The British Lung Foundation have taken a leading role in promoting this activity through their ‘Singing for Lung Health’ programme.

A limited number of small-scale research studies have assessed the benefits of singing for people with COPD and other lung conditions. These include three randomised controlled trials, one in Brazil, and two conducted at the Royal Brompton Hospital in London. Further studies have been carried out in Canada, New Zealand, the UK and the USA. There is limited evidence that singing improves lung function and exercise capacity, but qualitative feedback from participants has been highly positive. Testimonies point to singing having substantial subjective benefits for physical, psychological and social wellbeing, and in enabling people with COPD to better manage their lung condition.

The current study in Lambeth and Southwark, South London, was based on earlier research conducted in East Kent, UK. Morrison et al. (2013) established and evaluated a network of six community singing groups for people with COPD which ran over the course of ten months. Seventy-two people with COPD were followed up
over this time and assessed using validated questionnaires, with St. George’s Respiratory Questionnaire (SGRQ) as the primary outcome measure. Spirometry was also used to assess lung function. Significant improvements were found on the total and impact scores from the SGRQ, and participants also improved in their lung function.

Project and evaluation.
The aim of the current study was to further test the feasibility of setting up a network of community singing groups for people with COPD to run over the course of ten months from end of September 2015 to end of July 2016. Recruitment took place over the period April-September 2015. The study involved two cohorts, assessed
in September 2015 and January 2016. The two groups were comparable on all baseline measures, and were combined for the purpose of the evaluation. A total of 60 participants with breathing difficulties were recruited into the study.

Assessment included a battery of validated questionnaires, with the SGRQ as the primary outcome measure. Questions were also included on use of health and social care services and medication, including the use of inhalers. Participants underwent a comprehensive assessment to measure lung function. The principal measures were the amount of air expelled forcibly from the lungs in one second (FEV1); the total volume of air forcibly expelled from the lungs (FVC), and distance walked in six minutes – the Six-Minute Walk Test (6MWT).

Singing groups met weekly over the course of the project in four venues, led by two experienced and skilled facilitators. Three groups started in late September/early October 2015 and ran for 38-40 sessions and a fourth group, commenced in January 2016, and ran for 25 sessions.

At follow-up, 44 participants completed the questionnaires again and 42 completed the lung and exercise assessments (attrition rate 27-30% due to health issues and family commitments). In addition, 37 participants took part in a structured interview in April/May 2016 to gather feedback on their experiences of the singing groups and their perceptions of any benefits gained. Average level of attendance was 26 sessions, with approximately 82% participants attending at least 20 sessions. Filming and photography was also used throughout to provide a documentary record of the project, and the final film giving an account of the whole project is included with this report.

Sidney De Haan Research Centre for Arts and Health
Findings from the Lambeth and Southwark Singing and COPD Project 3

Among the participants followed-up, 31 were shown to have COPD from the lung function tests at baseline (FEV1/ FVC <0.7) - six mild, 15 moderate, nine severe, and one very severe. Findings for the total sample and for those with COPD are presented, but particular attention is given to the changes seen for participants with COPD.

Findings
The principal quantitative findings for the COPD group were as follows:
• A significant improvement on the SGRQ symptom scale
• Participants with COPD reported ‘fewer bad days’ and ‘more good days’
• No change on FEV1
• A small but statistically significant decline in FVC
• A small but statistically significant increase in FEV1/FVC
• No change in distance walked on the 6MWT
• No change in breathlessness after the 6MWT
• No change in reported health service use

The accounts provided in the interviews were consistently and highly positive. Participants claimed that regular singing helped them in managing their respiratory symptoms, and reported improvements in mental wellbeing, attributing this to the singing group. Social benefits were also described, extending to participants meeting outside of the singing sessions, and group members providing each other with support and advice.

Reflections
Our study shows that COPD patients who took part in singing groups experienced a reduction in symptoms, as measured by the St. George’s Respiratory Questionnaire. Detailed structured interviews also revealed a wide range of physical, psychological and social benefits, which together substantially improved the wellbeing of participants. In addition, lung function and functional exercise capacity was maintained throughout the course of the 6 – 10 month singing intervention.

The findings add to the previous body of research in supporting the value of regular singing for people with COPD, and other respiratory conditions. We agree with the conclusions reached in a recent systematic review (Lewis, et al., 2016) that further, larger-scale controlled trials are needed to establish benefits and address a range of outstanding questions on effective delivery.

Confounding factors of weather and background air pollution may have had some impact on the participants in this study. Such factors can only be controlled for through multi-centre trials in which an intervention is run over a wide geographical area including inner-city and rural locations.

Our experience of difficulties with recruitment indicates the need for greater resources, time and effort to ensure sufficient numbers for any future studies on singing for people with lung disease.

Year2017
PublisherCanterbury Christ Church University
Place of publicationCanterbury
Official URLhttp://www.canterbury.ac.uk/health-and-wellbeing/sidney-de-haan-research-centre/sidney-de-haan-research-centre.aspx
Output statusUnpublished
Publication process dates
Deposited16 Mar 2018
CompletedJun 2017
FunderGuy's and St Thomas' Charity
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Clift, S. and Page, S. 1994. Travel, lifestyles and health. Tourism Management. 15 (1), pp. 69-70. https://doi.org/10.1016/0261-5177(94)90030-2
Formative evaluation of the Silver Song Club project
Skingley, A., Bungay, H., Clift, S. and Hancox, G. 2008. Formative evaluation of the Silver Song Club project.
Health and the older traveller: issues for health promotion
Clift, S. and Morrissey, M. 2001. Health and the older traveller: issues for health promotion. in: Chiva, A. and Stears, D. (ed.) Promoting the Health of Older People: The Next Step in Health Generation Buckingham Open University Press. pp. 132-143
Tourist health: the precautions, behaviour and health problems of British tourists in Malta
Clift, S. 1994. Tourist health: the precautions, behaviour and health problems of British tourists in Malta. in: Page, S. and Clark, N. (ed.) Tourism: the state of the art Chichester John Wiley & Sons. pp. 799-817
Health, sex and drugs education - rhetoric and reality
Stears, D., Clift, S. and Blackman, S. 1995. Health, sex and drugs education - rhetoric and reality. in: Ahier, J. and Ross, A. (ed.) Social Subjects within the Curriculum: Children's Social Learning in the National Curriculum Falmer Press.
AIDS: the secondary scene - a guide to issues, approaches and resources
Clift, S. and Stears, D. 1992. AIDS: the secondary scene - a guide to issues, approaches and resources. Horsham AVERT.
Travel, sexual behaviour and gay men
Clift, S. and Wilkins, J. 1995. Travel, sexual behaviour and gay men. in: Aggleton, P., Davies, P. and Hart, G. (ed.) Aids Safety, Sexuality and Risk London Taylor & Francis. pp. 35-54
Impulsiveness, venture-some-ness and sexual risk-taking among heterosexual GUM clinic attenders
Clift, S., Wilkins, J. and Davidson, E. 1993. Impulsiveness, venture-some-ness and sexual risk-taking among heterosexual GUM clinic attenders. Personality and Individual Differences. 15 (4), pp. 403-410. https://doi.org/10.1016/0191-8869(93)90068-E
Assessing pupils' games performance in the secondary school: an exploration using repertory grid techniques
Balsdon, A. and Clift, S. 1992. Assessing pupils' games performance in the secondary school: an exploration using repertory grid techniques. in: Almond, L., Williams, T. and Sparkes, A. (ed.) Sport and Physical Activity London Spon Press.
Assessing gymnastic performance
Balsdon, A. and Clift, S. 1990. Assessing gymnastic performance. Physical Education Review. 13 (1), pp. 48-59.
AIDS education in secondary schools
Clift, S. and Stears, D. 1991. AIDS education in secondary schools. Education and Health. 9 (2), pp. 23-26.
A guide to using the booklet: sexual feelings and relationships
Clift, S., Kanabus, A., Callister, C. and Forrester, S. 1996. A guide to using the booklet: sexual feelings and relationships. AVERT.
Sexual feelings and relationships: a booklet for young people
Clift, S., Kanabus, A., Callister, C. and Forrester, S. 1996. Sexual feelings and relationships: a booklet for young people. AVERT.
Merton, Sutton and Wandsworth female sex workers outreach project report
Clift, S. 1995. Merton, Sutton and Wandsworth female sex workers outreach project report. Merton, Sutton and Wandsworth Health.
Europe against AIDS summer campaign 1995 schools resource pack
Clift, S. and Thomas, L. 1995. Europe against AIDS summer campaign 1995 schools resource pack. Canterbury Christ Church University.
Sexual behaviour abroad: a study of genito-urinary clinic attenders
Black, P., Clift, S. and Wijesurendna, C. 1995. Sexual behaviour abroad: a study of genito-urinary clinic attenders. Travel Medicine International. 13 (6), pp. 66-69.
Part V: Psychology - Coach and players' assessment of coach effectiveness in an elite men's hockey team
Balsdon, A., Clift, S., Underwood, G. and Stephenson, G. 2001. Part V: Psychology - Coach and players' assessment of coach effectiveness in an elite men's hockey team. Journal of Sports Sciences. 16 (1), pp. 71-72. https://doi.org/10.1080/026404198366966
Gay tourist space and sexual risk behaviour
Forrest, S. and Clift, S. 1998. Gay tourist space and sexual risk behaviour. in: Aitchison, C. and Jordan, F. (ed.) Gender, Space and Identity Eastbourne Leisure Studies Association. pp. 163-176
An exploration of players' and coach's assessment of player performance in an elite men’s hockey team
Balsdon, A., Clift, S., Bird, S. and Stephenson, G. 2001. An exploration of players' and coach's assessment of player performance in an elite men’s hockey team. Journal of Sports Sciences. 19 (1), p. 16. https://doi.org/10.1080/026404101750070166
The effectiveness and cost-effectiveness of a participative community singing programme as a health promotion initiative for older people: protocol for a randomised controlled trial
Skingley, A., Clift, S., Coulton, S. and Rodriguez, J. 2011. The effectiveness and cost-effectiveness of a participative community singing programme as a health promotion initiative for older people: protocol for a randomised controlled trial. BMC Public Health. 11 (1), p. 142. https://doi.org/10.1186/1471-2458-11-142
Romance and sex on holidays abroad: a study of magazine representations
Clift, S. 1994. Romance and sex on holidays abroad: a study of magazine representations. Canterbury Canterbury Christ Church College.
Constructing at home: understanding the experience of the amateur maker
Jackson, A. 2010. Constructing at home: understanding the experience of the amateur maker. Design and Culture. 2 (1), pp. 5-26. https://doi.org/10.2752/175470710X12593419555081
Men who make: the "flow" of the amateur designer/maker
Jackson, A. 2011. Men who make: the "flow" of the amateur designer/maker. in: Buszek, M. (ed.) Extra/Ordinary: Craft and Contemporary Art Duke University Press. pp. 260-275
The use of singing-in-a-group as a response to adverse life events
Von Lob, G., Camic, P. and Clift, S. 2010. The use of singing-in-a-group as a response to adverse life events. International Journal of Mental Health Promotion. 12 (3), pp. 45-53. https://doi.org/10.1080/14623730.2010.9721818
Therapeutic effects of music and singing for older people
Skingley, A. and Vella-Burrows, T. 2010. Therapeutic effects of music and singing for older people. Nursing Standard. 24 (19), pp. 35-41.
Shall we dance? An exploration of the perceived benefits of dancing on well-being
Quiroga Murcia, C., Kreutz, G., Clift, S. and Bongard, S. 2010. Shall we dance? An exploration of the perceived benefits of dancing on well-being. Arts & Health. 2 (2), pp. 149-163. https://doi.org/10.1080/17533010903488582
The significance of choral singing for sustaining psychological wellbeing: findings from a survey of choristers in England, Australia and Germany
Clift, S. and Hancox, G. 2010. The significance of choral singing for sustaining psychological wellbeing: findings from a survey of choristers in England, Australia and Germany. Music Performance Research. 3 (1), pp. 79-96.
The arts and global health inequities
Clift, S., Camic, P. and Daykin, N. 2010. The arts and global health inequities. Arts & Health. 2 (1), pp. 3-7. https://doi.org/10.1080/17533010903421476
Singing for health: a musical remedy
Clift, S. 2010. Singing for health: a musical remedy. British Journal of Wellbeing. 1 (6), pp. 19-21.
Let the music play
Clift, S. 2010. Let the music play. British Journal of Wellbeing. 1 (1), pp. 15-17.
The Silver Song Club Project: A sense of well-being through participatory singing
Bungay, H., Clift, S. and Skingley, A. 2010. The Silver Song Club Project: A sense of well-being through participatory singing. Journal of Applied Arts and Health. 1 (2), pp. 165-178. https://doi.org/10.1386/jaah.1.2.165_1
Arts on prescription: A review of practice in the UK
Bungay, H. and Clift, S. 2010. Arts on prescription: A review of practice in the UK. Perspectives in Public Health. 130 (6), pp. 277-281. https://doi.org/10.1177/1757913910384050
The Silver Song Club Project: singing to promote the health of older people.
Skingley, A. and Bungay, H. 2010. The Silver Song Club Project: singing to promote the health of older people. British Journal of Community Nursing. 15 (3), pp. 135-140.
The Silver Song Club Project: A formative evaluation
Bungay, H. and Skingley, A. 2008. The Silver Song Club Project: A formative evaluation. Canterbury Canterbury Christ Church University.
Supported further education provision for people with long-term mental health needs: Findings from a survey of further education colleges and primary care trusts across the south east of England
Morrison, I., Clift, S. and Stosz, L. 2010. Supported further education provision for people with long-term mental health needs: Findings from a survey of further education colleges and primary care trusts across the south east of England. Perspectives in Public Health. 130 (2), pp. 78-85. https://doi.org/10.1177/1757913909360454
Australian data from the "cross-national research on the effects of choral singing" project
Stewart, D., Sun, J., Clift, S., Hancox, G., Morrison, I., Hess, B. and Kreutz, G. 2008. Australian data from the "cross-national research on the effects of choral singing" project.
Stress and Antonovsky's Resistance Resources: A practical example
Morrison, I. and Clift, S. 2007. Stress and Antonovsky's Resistance Resources: A practical example. Stress News. 19 (2), pp. 4-5.
Mental health needs in the workplace
Morrison, I. and Clift, S. 2005. Mental health needs in the workplace. The Institution of Electrical Enginners Engineering Management. 15 (2), pp. 36-37.
The Open Door programme: student journeys to employment and university
Morrison, I. and Clift, S. 2005. The Open Door programme: student journeys to employment and university. A Life in the Day. 9 (2), pp. 23-26. https://doi.org/10.1108/13666282200500016
A survey of supported education for people with long-term mental health needs in Further Education colleges in the South East of England
Morrison, I. and Clift, S. 2006. A survey of supported education for people with long-term mental health needs in Further Education colleges in the South East of England. Canterbury Canterbury Christ Church University.
Arts and healthy communities in the South East
Clift, S. and Vella-Burrows, T. 2003. Arts and healthy communities in the South East. Canterbury Canterbury Christ Church University.
The MusicStart Project: evaluation of an early years music initiative
Clift, S., MacKenzie, K. and Bushell, F. 2006. The MusicStart Project: evaluation of an early years music initiative. Canterbury Canterbury Christ Church University.
Choral singing, wellbeing and health: findings from a cross-national survey
Clift, S., Hancox, G., Morrison, I., Hess, B., Stewart, D. and Kreutz, G. 2008. Choral singing, wellbeing and health: findings from a cross-national survey. Canterbury Canterbury Christ Church University.
Choral singing and psychological wellbeing: quantitative and qualitative findings from English choirs in a cross-national survey
Clift, S., Hancox, G., Morrison, I., Hess, B., Kreutz, G. and Stewart, D. 2010. Choral singing and psychological wellbeing: quantitative and qualitative findings from English choirs in a cross-national survey. Journal of Applied Arts and Health. 1 (1), pp. 19-34. https://doi.org/10.1386/jaah.1.1.19/1
Singing and health: a systematic mapping and review of non-clinical research
Clift, S., Hancox, G., Staricoff, R. and Whitmore, C. 2008. Singing and health: a systematic mapping and review of non-clinical research. Canterbury Canterbury Christ Church University.
Evaluation of the 'Sound Start' project - singing to babies before and after birth
Clift, S. 2002. Evaluation of the 'Sound Start' project - singing to babies before and after birth. Canterbury Canterbury Christ Church University College.
Southampton Silver Song Club: reflections on music making with elderly people facilitated by student volunteers
Bamford, A. and Clift, S. 2007. Southampton Silver Song Club: reflections on music making with elderly people facilitated by student volunteers. Canterbury Canterbury Christ Church University.
Music into Upton: reflections on an initiative to bring live music into a hospital setting
Bamford, A. and Clift, S. 2007. Music into Upton: reflections on an initiative to bring live music into a hospital setting. Canterbury Canterbury Christ Church University.
Making singing for health happen: reflections on a 'Singing for the Brain' training course
Bamford, A. and Clift, S. 2007. Making singing for health happen: reflections on a 'Singing for the Brain' training course. Canterbury Canterbury Christ Church University.
An evidence base for mental health promotion through supported education: a practical application of Antonovsky's salutogenic model of health
Morrison, I., Stosz, L. and Clift, S. 2008. An evidence base for mental health promotion through supported education: a practical application of Antonovsky's salutogenic model of health. International Journal of Health Promotion and Education. 46 (1), pp. 11-20.
The MusicStart Project: an evaluation of the impact of a training programme to enhance the role of music and singing in educational settings for children aged three to five years
MacKenzie, K. and Clift, S. 2008. The MusicStart Project: an evaluation of the impact of a training programme to enhance the role of music and singing in educational settings for children aged three to five years. International Journal of Music Education. 26 (3), pp. 229-242. https://doi.org/10.1177/0255761408092524
Choral singing and psychological wellbeing: findings from English choirs in a cross-national survey using the WHOQOL-BREF
Clift, S., Hancox, G., Morrison, I., Hess, B., Kreutz, G. and Stewart, D. 2007. Choral singing and psychological wellbeing: findings from English choirs in a cross-national survey using the WHOQOL-BREF. in: Williamon, A. and Coimbra, D. (ed.) Proceedings of the International Symposium on Performance Science Association Européenne des Conservatoires, Académies de Musique et Musikhochschulen. pp. 201-207
Tourism and the sexual ecology of gay men
Clift, S. and Forrest, S. 2000. Tourism and the sexual ecology of gay men. in: Clift, S. and Carter, S. (ed.) Tourism and Sex: Culture, Commerce and Coercion Leicester Pinter.
Gay tourism, sex and sexual health promotion
Clift, S. and Forrest, S. 2000. Gay tourism, sex and sexual health promotion. in: Horne, J. and Fleming, S. (ed.) Masculinities: Leisure Culture, Identities and Consumption Eastbourne Leisure Studies Association.
Factors associated with the sexual behaviour and risk of gay men on holiday
Clift, S. and Forrest, S. 1999. Factors associated with the sexual behaviour and risk of gay men on holiday. AIDS Care. 11 (3), pp. 281-295.
Sex and international travel: behaviour, health and human rights
Clift, S. 2003. Sex and international travel: behaviour, health and human rights. in: Bor, R. (ed.) Passenger Behaviour London Ashgate.
Tourism and health: present issues and future concerns
Clift, S. 2000. Tourism and health: present issues and future concerns. Tourism Recreation Research. 25 (3), pp. 55-61.
The health promoting school: a resource for developing indicators
Barnekov, V., Buijs, G., Clift, S., Jensen, B., Paulus, P., Rivett, D. and Young, I. 2006. The health promoting school: a resource for developing indicators. Copenhagen International Planning Committee of the European Network of Health Promoting Schools Task Force.
Cognitive predictors of adherence to malaria prophylaxis regimens on return from a malarious region: a prospective study
Abraham, C., Clift, S. and Grabowski, P. 1999. Cognitive predictors of adherence to malaria prophylaxis regimens on return from a malarious region: a prospective study. Social Science and Medicine. 48, pp. 1641-1654.
Coming of age for arts and health: what we hope to achieve
Camic, P., Clift, S. and Daykin, N. 2009. Coming of age for arts and health: what we hope to achieve. Arts & Health. 1 (1), pp. 3-5. https://doi.org/10.1080/17533010802614627
Incidence and location of diabetic foot ulcer recurrence
Galea, A., Springett, K., Clift, S., Bungay, H., Fava, S. and Cachia, M. 2009. Incidence and location of diabetic foot ulcer recurrence. The Diabetic Foot Journal. 12 (4), pp. 181-186.
The state of arts and health in England
Clift, S., Camic, P., Chapman, B., Clayton, G., Daykin, N., Eades, G., Parkinson, C., Secker, J., Stickley, T. and White, M. 2009. The state of arts and health in England. Arts & Health. 1 (1), pp. 6-35. https://doi.org/10.1080/17533010802528017
Antonovsky revisited: implications for mental health promotion practice
Morrison, I. and Clift, S. 2007. Antonovsky revisited: implications for mental health promotion practice. International Journal of Mental Health Promotion. 9 (2), pp. 36-46. https://doi.org/10.1080/14623730.2007.9721837
Mental health promotion through supported further education: The value of Antonovsky's salutogenic model of health
Morrison, I. and Clift, S. 2006. Mental health promotion through supported further education: The value of Antonovsky's salutogenic model of health. Health Education. 106 (5), pp. 365-380. https://doi.org/10.1108/09654280610685956
Music and well-being
Clift, S. and Hancox, G. 2006. Music and well-being. in: Greenstreet, W. (ed.) Integrating Spirituality in Health and Social Care: Perspectives and Practical Approaches Oxford Radcliffe Publishing. pp. 151-165
The perceived benefits of singing: findings from preliminary surveys of a university college choral society
Clift, S. and Hancox, G. 2001. The perceived benefits of singing: findings from preliminary surveys of a university college choral society. The Journal of the Royal Society for the Promotion of Health. 121 (4), pp. 248-256. https://doi.org/10.1177/146642400112100409
Malaria prophylaxis and the media
Clift, S. and Grabowski, P. 1996. Malaria prophylaxis and the media. The Lancet. 348 (9023), pp. 344-344. https://doi.org/10.1016/S0140-6736(05)64522-9
Factors associated with gay men's sexual behaviours and risk on holiday
Clift, S. and Forrest, S. 1999. Factors associated with gay men's sexual behaviours and risk on holiday. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV. 11 (3), pp. 281-295. https://doi.org/10.1080/09540129947929
Supporting practice teachers to identify failing students
Skingley, A., Arnott, J., Greaves, J. and Nabb, J. 2007. Supporting practice teachers to identify failing students. British Journal of Community Nursing. 12 (1), pp. 28-32. https://doi.org/10.12968/bjcn.2007.12.1.22689
Guest Editorial
Clift, S. 2005. Guest Editorial. Health Education. 105 (5), pp. 328-331. https://doi.org/10.1108/09654280510617150
Dimensions of holiday experience and their implications for health: a study of British tourists in Malta
Clift, S. and Clark, N. 1995. Dimensions of holiday experience and their implications for health: a study of British tourists in Malta. Canterbury Christ Church University.