Features

A postive note

06 June 2019

Research is now exploring the link beween singing and better health more rigorously, says journalist Rima Evans. 

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The past decade or so has seen an explosion in choirs across the country and there’s little sign of it mellowing. Singing movement
Voices Now revealed that in 2017 the UK had at least 40,000 choirs, representing around 2.14 million people singing regularly. The real numbers are likely to be much higher, it says, but capturing the data is tricky.

What’s been fuelling this ever-expanding number is media coverage and television programmes such as Gareth Malone’s The Choir. On the back of that, however, there has been a well-publicised debate in both academia and the mainstream media about singing having significant mental and physical health benefits, which is adding further to people’s interest. 

Individuals have long had anecdotal evidence to support the link between wellbeing and singing (see case study, page 42). But what’s shifted recently is the scientific backing for that – the past 10 years or so has seen a huge swell in academic research that can offer a more rigorous explanation of why singing has become such a passion for so many. The Sidney De Haan Research Centre for Arts and Health (SDHRCAH), part of Canterbury Christ Church University and set up in 2005, exists specifically to research the potential value of music, and other arts activities, in the health and wellbeing of individuals and communities. It’s one of the leading centres in this field. 

Back in 2008 it published a review of research, Singing and health: a systematic mapping and review of non-clinical research (SDHRCAH, 2008). This highlighted that ‘singing could contribute to quality of life, wellbeing and even health’ but pointed out there was still too little research exploring the subject.

Co-author of that report, Professor Stephen Clift, director of the Sidney De Haan Centre, says there has been an ‘exponential growth in published research since then’. Significantly, the evidence base is also now more clinically focused, addressing benefits it can have for people with specific health problems – from postnatal depression (group singing with babies can help women with PND recover more quickly (Fancourt and Perkins, 2018) to improved wellbeing during cancer treatment (Fancourt et al, 2016) – and focusing on clinical outcomes.

‘Our [past and present] work [at the Sidney De Haan Centre] has focused on people with dementia, Parkinson’s disease, long-term mental health conditions and lung disease, particularly COPD,’ Stephen says. ‘However, singing can be used in any setting or to benefit individuals with any health condition because it’s so holistic: people are using their own voice and body as a musical instrument.’

Super choirs

Mental health and wellbeing

Studies have shown that singing in choirs enhances positive mental wellbeing because it addresses cognitive, social and emotional needs, Stephen reveals (for instance, Shakespeare and Whieldon, 2018). 

‘People develop a sense of achievement because they are learning a new skill. There’s also a social element: people make friends and it can be a bonding experience. And then there’s the emotional factor. It’s fun, there can be a lot of humour involved and the songs can be varied but are often upbeat. Belonging to a choir can also help people find the emotional support they need. On a number of different levels, people gain.’

COPD

The latest research shows very real physical benefits, too, for people with long-term conditions. For COPD patients, singing can aid their breathing, says Stephen (Skingley et al, 2017). 

‘We believe it trains people with COPD to be more aware of how they are breathing and to breathe more effectively. This is intrinsic to the process of singing, because when you sing you take a rapid inbreath, then control an extended outbreath.’ He further explains: ‘Very quickly, people discover they can extend their breaths through a variety of exercises. This can be self-monitored by counting on the outbreath. So, a person may be able to count up to eight at the start of a session. Over a period of weeks, however, they may find they can count to 20. We have lots of feedback from people who say they learn how to breathe more effectively – it’s very powerful.’

Future research, it is hoped, will look more closely at patterns of breathing and how they change over time when people participate in structured singing programmes, Stephen adds.

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Wellbeing for cancer

Tenovus Cancer Care, based in Wales, has a Sing with Us choir programme open to anyone affected by cancer, whether a patient, survivor, or carer. There are now 18 choirs mainly in Wales (two are in London), with 1683 people a week attending sessions, says Sing with Us lead, Paul Rothwell.

‘They are designed for people from all walks of musical life and are particularly good for those who haven’t sung in a choir before. People don’t need to read music, and no experience is necessary to join. 

Neither do people need to think they are great singers, which can be a barrier for people getting involved,’ he explains.

‘The first half hour of our sessions are always for just chatting and having a cup of tea, to build in social time. That’s important, since we get a lot of people who feel quite socially isolated.’ 

Paul adds: ‘Choirs enjoyed a resurgence around 10 years ago – they became fashionable for a while, but then people started to see the benefits and enjoy them. Surprisingly, though, there wasn’t that much research backing up those benefits.’

In response, Tenovus worked with Cardiff University between 2012 and 2015 to collect quantitative and qualitative data from choir members. One study found that on joining the choir, cancer patients had worse health-related quality of life and greater depression than non-patients. However, after three months in the choir, patients’ vitality, overall mental health and anxiety had improved. For non-cancer patients, participation improved anxiety. These positive changes were sustained after six months (Tenovus Cancer Care).

The charity also worked with the Royal College of Music to find out the biology behind those findings. 

Saliva samples were taken from 193 choir members before and after a one-hour rehearsal. 

The results of the research have been startling. 

It found that the choirs reduced anxiety and depression, improved mood and had a positive impact on biological markers related to stress, immune function and inflammatory response (Fancourt et al,2016).

‘Results showed that singing for just an hour a week put cancer patients in the best possible position to receive their treatment,’ says Paul. Further research is being conducted to establish if there is a more long-term improvement, testing over six months.

Singing for dementia

The power of singing is proving valuable for people with dementia, too.

Singing for the Brain is an initiative organised by the Alzheimer’s Society, bringing dementia patients and carers together in regular singing groups. There are now 200 groups across England, Wales and Northern Ireland.

Tim McLachlan, operations director – local and national services, at the Alzheimer’s Society says singing sessions engage more than just the brain and the area related to singing. ‘With so much of the brain being stimulated, individuals exercise more mind power than usual. 

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‘From our experience of Singing for the Brain and seeing the impact of personal music for people with dementia, when used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function and help coordinate motor movements. This is because music requires little to no mental processing, so singing does not require the cognitive function that would otherwise be needed,’ says Tim.

This May saw Scotland launch its own dementia-friendly choir network for people with dementia and carers. The initiative is funded by charities the Life Changes Trust and The Baring Foundation, but will be overseen by creative organisation Luminate and supported by other leading agencies. 

‘The singing is important but there’s another side that’s relevant for people with dementia,’ says Anna Buchanan, CEO of the Life Changes Trust.

‘There are some people with dementia who are non-verbal and just want to hum along. Others who haven’t spoken for months may suddenly sing all the words to a particular song. Also, for those who feel a sense of isolation, being a part of something bigger is crucial. It’s equally as important as the singing. Those with dementia also have the right to be kept included in community cultural activities.’

Singing for you

As Professor Stephen Clift says, pretty much any group could benefit from community singing – and that extends to community practitioners themselves.

Paul says that quite a few members of the Sing with Us programme are healthcare professionals. ‘They gain not only because it enhances their own wellbeing but also because it means they get to see clients doing well, too.

‘Also, if CPs are involved and can experience the benefits themselves, they can help spread the word. People are more likely to take a first-hand recommendation more seriously, and be encouraged to take that first step.’ 


‘It’s given me a goal that’s not cancer-related’

Ramola Manocha decided to join the Soul of the City choir in her home town of Brighton for creative release.

‘Going to the theatre or watching singing performances makes you feel alive – that’s instinctive. After I was diagnosed with breast cancer, it seemed a natural step to take to get involved with singing – it was something I loved doing at school,’ she says.

‘I went along with my partner with no expectations, really. We both underestimated how much we would enjoy it and how much it would benefit our health.

‘It’s given me a goal that’s not cancer-related and helped me cope with my diagnosis. I am also recovering from a collapsed lung, so the breathing control that comes with singing has been helpful. It’s just about being in a room with other people and singing – there are no complications,’ she adds.


Resources


 

References

Fancourt D and Perkins R. (2018) Effect of singing interventions on symptoms of postnatal depression: three-arm randomised controlled trial. See: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/effect-of-singing-interventions-on-symptoms-of-postnatal-depression-threearm-randomised-controlled-trial/534122E539704BAEAC0824F9FCACC5A8 (accessed May 23 2019).

Fancourt D et al. (2016) Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers. See https://ecancer.org/journal/10/631.php (accessed May 23 2019).

Shakespeare T, Whieldon A. (2018) Sing Your Heart Out: community singing as part of mental health recovery. See: https://mh.bmj.com/content/44/3/153 (accessed 23 May 2019).

Sidney De Haan Research Centre for Arts and Health. (2008) Singing and Health: A Systematic Mapping and Review of Non-Clinical Research. See https://www.canterbury.ac.uk/health-and-wellbeing/sidney-de-haan-research-centre/documents/singing-and-health.pdf (accessed May 23 2019).

Skingley A, Clift S, Hurley S, Price S, and Stephens L. (2017)  Community singing groups for people with chronic obstructive pulmonary disease: participant perspectives. See: https://journals.sagepub.com/doi/abs/10.1177/1757913917740930# (accessed May 23 2019).

Tenouvous Cancer Care. How we know Sing with Us helps See: https://tenovuscancercare.org.uk/research/more-than-singing/how-we-know-sing-with-us-helps/ (accessed May 23 2019).

Voices Now. (2017) The Big Choral Census. See: https://voicesnow.org.uk/wp-content/uploads/2018/03/FINAL-Voicesnowreport-July-2017.pdf (accessed 23 May 2019).

 

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