Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 150 No. 3738 (2020)

Choir singing improves respiratory muscle strength and quality of life in patients with structural heart disease – HeartChoir: a randomised clinical trial

DOI
https://doi.org/10.4414/smw.2020.20346
Cite this as:
Swiss Med Wkly. 2020;150:w20346
Published
16.09.2020

Summary

AIMS OF THE STUDY

Most patients with reduced exercise capacity and acquired or congenital structural heart disease also have a reduced respiratory muscle strength. The aim of this pilot study was to investigate whether choir singing in combination with respiratory muscle training positively influences respiratory muscle strength, exercise capacity and quality of life in this population.

METHODS

In this single-centre, randomised and open-label interventional study we compared respiratory muscle strength, exercise capacity and quality of life in patients with acquired or congenital structural heart disease who received either standard of care and a 12-week intervention (weekly choir rehearsal and daily breathing exercises) or standard of care alone. The primary endpoint was the difference in change in maximum inspiratory pressure (∆MIP%predicted). Secondary endpoints included the difference in change in maximum expiratory pressure (∆MEP%predicted), exercise capacity quantified as maximal oxygen uptake during exercise (∆MVO2%predicted) and quality of life quantified by the Minnesota living with heart failure questionnaire (∆MLHFQ score).

RESULTS

Overall 24 patients (mean age 65, standard deviation [SD] 19 years, 46% male) were randomised after exclusion. ∆MIP%predicted was significantly higher in the intervention group (∆MIP%predicted +14, SD 21% vs −14, SD 23%; p = 0.008) and quality of life improved significantly (∆MLHFQ score −5, SD 6 vs 3, SD 5; p = 0.006) after 12 weeks. ∆MEP%predicted and ∆MVO2%predicted did not differ between both groups (∆MEP%predicted −3, SD 26% vs −3, SD 16%; p = 1.0 and ∆MVO2%predicted 18, SD 12% vs 10, SD 15%; p = 0.2).

CONCLUSIONS

Choir singing in combination with respiratory muscle training improved respiratory muscle strength and quality of life in patients with structural heart disease and may therefore be valuable supplements in cardiac rehabilitation. (Clinical trial registration number: NCT03297918)

References

  1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. doi:.https://doi.org/10.1093/eurheartj/ehw128
  2. Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, et al.; American Heart Association Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, and Council on Cardiovascular Radiology and Imaging. Chronic Heart Failure in Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation. 2016;133(8):770–801. doi:.https://doi.org/10.1161/CIR.0000000000000352
  3. Diller GP, Dimopoulos K, Okonko D, Li W, Babu-Narayan SV, Broberg CS, et al. Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic implication. Circulation. 2005;112(6):828–35. doi:.https://doi.org/10.1161/CIRCULATIONAHA.104.529800
  4. Clark AL, Poole-Wilson PA, Coats AJ. Exercise limitation in chronic heart failure: central role of the periphery. J Am Coll Cardiol. 1996;28(5):1092–102. doi:.https://doi.org/10.1016/S0735-1097(96)00323-3
  5. Mancini DM, Henson D, LaManca J, Levine S. Evidence of reduced respiratory muscle endurance in patients with heart failure. J Am Coll Cardiol. 1994;24(4):972–81. doi:.https://doi.org/10.1016/0735-1097(94)90858-3
  6. Hammond MD, Bauer KA, Sharp JT, Rocha RD. Respiratory muscle strength in congestive heart failure. Chest. 1990;98(5):1091–4. doi:.https://doi.org/10.1378/chest.98.5.1091
  7. Meyer FJ, Borst MM, Zugck C, Kirschke A, Schellberg D, Kübler W, et al. Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance. Circulation. 2001;103(17):2153–8. doi:.https://doi.org/10.1161/01.CIR.103.17.2153
  8. Mancini DM, Henson D, La Manca J, Donchez L, Levine S. Benefit of selective respiratory muscle training on exercise capacity in patients with chronic congestive heart failure. Circulation. 1995;91(2):320–9. doi:.https://doi.org/10.1161/01.CIR.91.2.320
  9. Greutmann M, Le TL, Tobler D, Biaggi P, Oechslin EN, Silversides CK, et al. Generalised muscle weakness in young adults with congenital heart disease. Heart. 2011;97(14):1164–8. doi:.https://doi.org/10.1136/hrt.2010.213579
  10. Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. J Am Coll Cardiol. 1993;22(3):678–83. doi:.https://doi.org/10.1016/0735-1097(93)90176-2
  11. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016;67(1):1–12. doi:.https://doi.org/10.1016/j.jacc.2015.10.044
  12. Slimani M, Ramirez-Campillo R, Paravlic A, Hayes LD, Bragazzi NL, Sellami M. The Effects of Physical Training on Quality of Life, Aerobic Capacity, and Cardiac Function in Older Patients With Heart Failure: A Meta-Analysis. Front Physiol. 2018;9:1564. doi:.https://doi.org/10.3389/fphys.2018.01564
  13. Piepoli MF, Davos C, Francis DP, Coats AJ ; ExTraMATCH Collaborative. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ. 2004;328(7433):189. doi:.https://doi.org/10.1136/bmj.37938.645220.EE
  14. Dall’Ago P, Chiappa GR, Guths H, Stein R, Ribeiro JP. Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiol. 2006;47(4):757–63. doi:.https://doi.org/10.1016/j.jacc.2005.09.052
  15. Schulz KF, Altman DG, Moher D ; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152(11):726–32. doi:.https://doi.org/10.7326/0003-4819-152-11-201006010-00232
  16. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care. 2009;54(10):1348–59.
  17. Ross RM. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(10):1451, author reply 1451. doi:.https://doi.org/10.1164/ajrccm.167.10.950
  18. Rector TS, Cohn JN ; Pimobendan Multicenter Research Group. Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Am Heart J. 1992;124(4):1017–25. doi:.https://doi.org/10.1016/0002-8703(92)90986-6
  19. Morcillo C, Aguado O, Delás J, Rosell F. Utilidad del Minnesota Living With Heart Failure Questionnaire en la evaluación de la calidad de vida en enfermos con insuficiencia cardiac[Utility of the Minnesota Living With Heart Failure Questionnaire for assessing quality of life in heart failure patients]. Rev Esp Cardiol. Article in Spanish. 2007;60(10):1093–6. doi:.https://doi.org/10.1157/13111242
  20. Behlouli H, Feldman DE, Ducharme A, Frenette M, Giannetti N, Grondin F, et al. Identifying relative cut-off scores with neural networks for interpretation of the Minnesota Living with Heart Failure questionnaire. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:6242–6. doi:.https://doi.org/10.1109/IEMBS.2009.5334659
  21. Winkelmann ER, Chiappa GR, Lima CO, Viecili PR, Stein R, Ribeiro JP. Addition of inspiratory muscle training to aerobic training improves cardiorespiratory responses to exercise in patients with heart failure and inspiratory muscle weakness. Am Heart J. 2009;158(5):768.e1–7. doi:.https://doi.org/10.1016/j.ahj.2009.09.005
  22. Pullen PR, Nagamia SH, Mehta PK, Thompson WR, Benardot D, Hammoud R, et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail. 2008;14(5):407–13. doi:.https://doi.org/10.1016/j.cardfail.2007.12.007
  23. Pullen PR, Thompson WR, Benardot D, Brandon LJ, Mehta PK, Rifai L, et al. Benefits of yoga for African American heart failure patients. Med Sci Sports Exerc. 2010;42(4):651–7. doi:.https://doi.org/10.1249/MSS.0b013e3181bf24c4
  24. Kang J, Scholp A, Jiang JJ. A Review of the Physiological Effects and Mechanisms of Singing. J Voice. 2018;32(4):390–5. doi:.https://doi.org/10.1016/j.jvoice.2017.07.008
  25. Fu MC, Belza B, Nguyen H, Logsdon R, Demorest S. Impact of group-singing on older adult health in senior living communities: A pilot study. Arch Gerontol Geriatr. 2018;76:138–46. doi:.https://doi.org/10.1016/j.archger.2018.02.012
  26. Herer B. Éducation respiratoire par le chant au cours d’un programme de réhabilitation respiratoire [Outcomes of a pulmonary rehabilitation program including singing training]. Rev Mal Respir. 2013;30(3):194–202. Article in French. doi:.https://doi.org/10.1016/j.rmr.2012.10.602
  27. Irons JY, Petocz P, Kenny DT, Chang AB. Singing as an adjunct therapy for children and adults with cystic fibrosis. Cochrane Database Syst Rev. 2016;9:CD008036. doi:.https://doi.org/10.1002/14651858.CD008036.pub4

Most read articles by the same author(s)

1 2 > >>