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Singing training effective as physical rehabilitation in COPD

Presented By
Prof. Uffe Bødtger, Nætved Hospital, Denmark
ERS 2020


Comparing classic pulmonary rehabilitation with a singing-based training, a Danish study found non-inferiority of the singing method to improve physical capacity in COPD patients [1].

“As you all know, pulmonary rehabilitation is a cornerstone in COPD care and has an immense impact on subjective and objective aspects of living with COPD,” said Prof. Uffe Bødtger (Nætved Hospital, Denmark). Unfortunately, adherence to pulmonary rehabilitation can be quite a problem, which is why there is a need for alternative options [2,3].

“Within the last 20 years or so, lung choirs or singing training for patients with respiratory diseases including COPD has shown to improve respiratory control, dyspnoea levels, and self-perceived physical health, but the impact on physical capacity is unknown,” Prof. Bødtger explained the motivation for this multicentre, randomised-controlled trial [1]. As such, the primary endpoint of this investigation comparing singing training with physical training was non-inferiority in improvement of physical capacity demonstrated by change in 6-minute walking test (6MWT). Secondary endpoints included quality of life, lung function (FEV1), overall disease-specific health (St. George’s Respiratory Questionnaire, SGRQ), and adherence.

The study randomised 270 patients who had a prescription for pulmonary rehabilitation from August 2017 to August 2019, of whom 195 completed their rehabilitation over 10 weeks. Baseline parameters between groups were comparable. The patients had a mean age of 69 years and a mean FEV1 of 51%. About two-thirds were female and around 73% were on double or triple inhalation treatment.

The result showed no difference in the magnitude of difference in the 6MWT between singing training and standard physical training (P=0.81). However, in some of the secondary endpoints, patients with singing training demonstrated more significant disparities in the within-group changes: e.g. SGRQ (singing training group vs physical training group: P<0.001 vs P=0.08), predicted FEV1 (P=0.04 vs P=0.35). Nevertheless, no differences in training adherence, nor in dyspnoea, anxiety, and depression were observed between the different rehabilitation regimens. Adverse events were not reported.

“In conclusion, it appears that singing training could be as effective as physical training in improving physical capacity in COPD patients attending rehabilitation. However, there is a long way in exploring and standardising the optimal content of singing training,” said Prof. Bødtger.


    1. Kaasgaard M, et al. Sing-a-Lung: Group singing as training modality in pulmonary rehabilitation for patients with Chronic Obstructive Pulmonary Disease (COPD): A multicenter, cluster-randomised, non-inferiority controlled trial. Abstract 4663, ERS International Virtual Congress 2020, 7-9 Sept.
    2. Jones SE, et al. Thorax. 2014;69(2):181-182.
    3. Hayton C, et al. Respir Med. 2013;107:401-407.


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