Music listening at rest or during exercise is considered as a passive form of intervention, but it triggers psychological, psychophysiological and physiological activity.^1,2,3  Music exerts its effects through neuroactivation as well as hormonal and metabolic responses. At rest, it can reduce vital signs while during exercise it can enhance exercise performance. From a psychological perspective music can provoke different memories or emotions and have a positive impact on mood and provoke relaxation or enjoyment of an activity. Listening to music can help shifting away focus from the symptoms such as dyspnea and fatigue.  

Chill out music  

A number of studies have focused on music listening at rest, typically in people with COPD^1,4. In these studies, music was applied from a single session to 5 times a week for 8 months. The music was a mix of lyrical and non-lyrical and either in an unspecified or in slow tempo (60-80 bpm). Results showed a positive effect in terms of lowering anxiety and the magnitude was stronger when applied for longer duration of time. No effect on depression, QoL or dyspnea was observed. For those with anxiety, listening to music at rest may be another tool in the self-management tool kit.

Workout music and playlist

Studies where music was applied during exercise, mixed effect on psychological symptoms such as anxiety has been shown. Music in these studies was derived from the participants or the clinician’s collection and lead to improvement of physical capacity and a positive trend in QoL. In home-based walking, high adherence (92%) was seen when the cadence of music was synchronized with the gait speed. Music can provide a positive distraction from breathlessness and fatigue during 6 minute walk test, while also improving mood and relaxation¹⁰. In conclusion, application of music during exercise can add some form of distraction from symptoms and promote control of symptoms. Being able to choose your own music is important, according to the music therapy literature, as this may promote empowerment ^5,6,7,8,9. 

Singing 

Singing is an active form of music therapy. It requires active inspiration/expiration for phrase length and sound volume. Singing is thought to help control expiratory flow, which in people with lung disease can make breathing feel more comfortable. It may also help reduce dynamic hyperinflation and improve muscle length tension relationships. It builds inspiratory muscle strength and may make the active phases of respiration easier. Singing can, when combined with e.g. postural exercises or breathing exercises, serve as an appropriate physical form of activity for some patients¹¹.  

Singing together

Group singing options seem to include many layers, which have recently been explored: relaxation, postural and breathing exercises and, on top of that, the vocalization and singing. Sensory and affective dimensions of dyspnea can be targeted with singing, using breathing to a more positive activity, and thus decrease fear and anxiety. The social aspect of singing can help reduce isolation and loneliness, common among people with lung diseases ^12,13,14.  

Structured musical pulmonary rehabilitation

Various group-singing programs for people with impaired lungs have emerged during the recent years (Sing Strong, Sing for Better Breathing, Sing for Lung Health). Most of these offer short or medium duration group singing (6-24 weeks) and the songs were facilitator selected ^15,16,17,18. When explored, findings showed a small increase in respiratory muscle strength and some transient reduction of hyperinflation. Improvement in the physical part of QoL was found, but not in the mental part ^15,16,17,18.  

Keeping it up

A longer, one-year study in 28 people with COPD ¹³ offered weekly group-singing. Here, participants were able to influence the selection of songs. After 4 months there was a reduction in the static lung volumes and after 12 months, there both exercise capacity and anxiety was improved. Adherence after 12 months was relatively high (85%), which suggested that this is an acceptable intervention and gave a hint of other patient perceived benefits. The benefits include e.g. increasing awareness of breathing control, ease of dyspnea, improved coping with lung condition, change in attitude and improved self efficacy, enhanced social connection and reduced isolation, sense of achievement and shared purpose (individual and group), distraction and respite from lung condition, motivation to re-engage pulmonary rehabilitation of exercise and improved exercise tolerance ^{16,18,19,20,21}. 

Findings and impact on COPD care

Listening to music – Perhaps not every one is a ”responder” to music therapy, but for those who enjoy it it can boost self management. When using music to relax or to boost exercise, chances of success are probably higher if the person enjoy listening to music and if the music selection reflects the person’s taste in music. As music listening may reduce symptom intensity and improve exercise performance, it could help support behavioral change ²².