Amateur singing has undergone something of a renaissance in recent years, with a vast surge in the number of people regularly singing in choirs, thanks in part to the popularity of several singing-themed television programmes. In parallel with this have been numerous features in the media hailing singing for newly-discovered powers of health and healing. Sadly, media coverage of original research has bordered on the sensationalist, and it remains unclear whether laboratory findings translate into clinical benefit for singers. Examining the evidence behind several alleged benefits of singing suggests that while it is indisputably “good for you”, there are more reliable keys to longevity.
The one area in which media claims for singing are well supported by research is in its benefits to mental health. A 2010 review of scientific literature found good evidence for improved psychosocial well-being as well as some benefits for patients suffering from chronic diseases and pain (1). There is also evidence that group singing has cognitive, emotional and social benefits for dementia sufferers (2), and music appreciation is known to be relatively well preserved despite advancement of the disease. As violinist and academic Professor Paul Robertson puts it, “We tend to remain contactable as musical beings on some level right up to the very end of life” (3).
Evidence for the physical benefit of singing, however, is far less convincing, despite media coverage loaded with hyperbole. A strong example of this was seen last year. A study by Vickhoff et al in Gothenburg concluded that “Heart rate variability profiles tend to conform between singers” (4). This led The Telegraph to report that “Choir practice is healthier than yoga” (5), and the Daily Mail and BBC to state that singers’ heart beats become synchronised (6, 7). The reason for the findings is an effect called respiratory sinus arrhythmia (RSA), a phenomenon easily demonstrable on oneself: during inhalation and exhalation, pulse rates generally show a subtle increase and decrease respectively. RSA is more commonly seen in the young and athletic, and profound RSA has a loose connection with good cardiovascular health. It is heightened by controlled breathing exercises such as yoga, and so it follows that when singing (and therefore breathing) as a group, the same should happen collectively. This explains the Gothenburg findings, but the media suggestions that singing improves cardiovascular health and is as beneficial as yoga are simply not supported by the original research. NHS Choices has a good article explaining this further (8).
In a similar way, a 2011 Telegraph headline called for “Singing on Prescription”, citing an improvement in breathing in patients suffering from chronic obstructive pulmonary disease (COPD) when they sing regularly (9). By the author’s own admission, the evidence for this is almost entirely anecdotal. A recent study from Canterbury Christ Church University found more concrete evidence for a small improvement in some aspects of breathing, as well as reporting some psychosocial benefits (10), and though certainly promising, a good deal of further work is required before singing can be endorsed as a frontline therapy for breathing disorders.
Further misreporting came about from a Cardiff University study examining the effects of singing on lung cancer survivors and carers of patients with lung cancer, which reported a trend towards improved expiratory pressure, in addition to marked improvements in mental health (11). The authors admit that the improvement in lung function was not statistically significant, and it is not even clear whether the improvement was seen in the cancer survivors or the carers. Despite this, the Telegraph article above (5) simply reports that “lung cancer patients who sang in a choir had a greater expiratory capacity than those who didn’t”, which is simply not what the Cardiff authors claims. Rather than singing being a particularly potent medicine, these findings, like those of the Gothenburg study, are easily explained by the controlled, deep breathing necessitated by singing, and so it follows that activities such as yoga and meditation may have similar effects.
There have been numerous claims that singing boosts the immune system (12), chiefly based on two studies which examined the effects of singing Beethoven’s Missa Solemnis (13) and Mozart’s Requiem (14) on parts of the immune system. Both papers report an increase in IgA antibodies, which protect the gut and respiratory tracts from infection, after singing. Cortisol, an important stress hormone, was shown to decrease significantly when singing the Beethoven in rehearsal, signifying relaxation, but to increase when performing, implying that the stress of performance has a tangible effect on the body’s chemistry. However, neither paper reports the permanence of the biochemical changes, nor the general health of choristers, and so it is impossible to draw conclusions about whether the findings translate into an actual clinical effect on the immune system. Indeed, one could argue that a large group of people singing in an unheated room in winter is a significant infection risk as people breathe and cough over each other!
Finally, one of the most eye-catching claims made for choral singing is that it actually increases life expectancy. A joint Yale and Harvard study from 2008 is widely quoted across the internet, claiming that singers in New Haven, Connecticut, live longer than non-singers (15). Oddly, I have been unable to find the original paper, despite extensive searching, but would be very interested to hear of further details.
It is clear that singing has strong benefits for psychological well-being as well as short term mood, and going out to choir rehearsal is certainly physically better for you than watching a TV singing contest. There may even be some coincidental benefits to your physical health as a bonus. Media overstatement of the physical benefits of singing, though, is unhelpful, and encouraging people to take up singing so that they live longer, healthier lives is dangerously misleading. Equally, it does the arts of singing and music a great disservice. Do we really need an antibody boost to enjoy and be deeply moved by Beethoven’s Missa Solemnis?
1. Clift S, Nicol J, Raisbeck M, Whitmore C, Morrison I. Group singing, wellbeing and health: A systematic mapping of research evidence. The University of Melbourne Refereed eJournal [Internet]. 2010 [cited 2014 Mar 1];2(2). Available from: http://web.education.unimelb.edu.au/UNESCO/pdfs/ejournals/clift-paper.pdf
2. Särkämö T, Tervaniemi M, Laitinen S, Numminen A, Kurki M, Johnson JK, et al. Cognitive, Emotional, and Social Benefits of Regular Musical Activities in Early Dementia: Randomized Controlled Study. The Gerontologist [Internet]. 2013 Sep 5 [cited 2014 Feb 25]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/24009169
3. AgeUK. Dementia and music [Internet]. ageuk.org.uk. [cited 2014 Mar 2]. Available from: http://www.ageuk.org.uk/health-wellbeing/conditions-illnesses/dementia-and-music/
4. Vickhoff B, Malmgren H, Aström R, Nyberg G, Ekström S-R, Engwall M, et al. Music structure determines heart rate variability of singers. Frontiers in psychology [Internet]. 2013 Jan [cited 2014 Feb 27];4:334. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3705176&tool=pmcentrez&rendertype=abstract
5. Rainey S. All together now: singing is good for your body and soul. The Telegraph [Internet]. London; 2013 Jul 10 [cited 2014 Feb 27]; Available from: http://www.telegraph.co.uk/health/10168914/All-together-now-singing-is-good-for-your-body-and-soul.html
6. McDermott N. Choir singing is “as good for you as yoga” because it helps synchronise heart beats with others. Daily Mail [Internet]. 2013 Jul 9 [cited 2014 Feb 27]; Available from: http://www.dailymail.co.uk/health/article-2358589/Choir-singing-good-yoga-helps-synchronise-heart-beats-others.html
7. Morelle R. Choir singers “synchronise their heartbeats”. BBC News [Internet]. 2013 Jul 9 [cited 2014 Feb 27]; Available from: http://www.bbc.com/news/science-environment-23230411
8. NHSChoices. No proof that singing in a choir is good for heart - Health News - NHS Choices [Internet]. Behind the Headlines. Department of Health; 2013 [cited 2014 Mar 1]. Available from: http://www.nhs.uk/news/2013/07July/Pages/No-proof-that-singing-in-a-choir-is-good-for-heart.aspx
9. Carlowe J. Health choirs: let’s have singing on prescription. The Telegraph [Internet]. London; 2011 Sep 12 [cited 2014 Mar 1]; Available from: http://www.telegraph.co.uk/health/healthnews/8752955/Health-choirs-lets-have-singing-on-prescription.html
10. Clift S, Morrison I, Skingley A, Page S, Coulton S, Treadwell P, et al. An evaluation of community singing for people with COPD [Internet]. Canterbury; 2013. Available from: http://www.canterbury.ac.uk/Research/Documents/COPDSummaryReport.pdf
11. Gale N, Enright S, Reagon C, Lewis I, Van Deursen R. A pilot investigation of quality of life and lung function following choral singing in cancer survivors and their carers. Ecancermedicalscience [Internet]. 2012 Jan [cited 2014 Feb 6];6:261. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3404598&tool=pmcentrez&rendertype=abstract
12. ABC-News. Scientists say singing boosts immune system. ABC News [Internet]. Australia; 2004 Jan 18 [cited 2014 Mar 1]; Available from: http://www.abc.net.au/news/2004-01-19/scientists-say-singing-boosts-immune-system/121668
13. Beck RJ, Cesario TC, Yousefi A, Enamoto H. Choral Singing, Performance Perception, and Immune System Changes in Salivary Immunoglobulin A and Cortisol. Music Perception: An Interdisciplinary Journal [Internet]. 2000 [cited 2014 Feb 27];18(1):87–106. Available from: http://www.jstor.org/stable/pdfplus/40285902.pdf?acceptTC=true&acceptTC=true&jpdConfirm=true
14. Kreutz G, Bongard S, Rohrmann S, Hodapp V, Grebe D. Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state. Journal of behavioral medicine [Internet]. 2004 Dec [cited 2014 Jan 30];27(6):623–35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15669447
15. HeartResearchUK. Singing is good for you [Internet]. heartresearch.org.uk. [cited 2014 Mar 1]. Available from: http://heartresearch.org.uk/fundraising/singing-good-you