Exploratory Study on the Impact on Emotional Health Derived from Participation in an Inclusive Choir.

Participation in group activities such as choirs has been shown to have positive effects on emotional health and overall well-being. Inclusive choirs, which integrate individuals of various abilities and diverse backgrounds, provide a unique space for social interaction, emotional expression, and inclusion. This study aims to explore the impact of participation in an inclusive choir on the emotional health of its members, identifying both positive and negative emotional impacts as well as personal experiences derived from their participation. This longitudinal exploratory study combines participant observation, field notes, focus groups, and questionnaires to gain a deep understanding of the participant's emotional experiences through their narratives. The study was conducted in an inclusive choir located in a medium-sized city in Spain, which brings together people of various ages, genders, abilities, and cultural backgrounds. The results indicated that most participants experienced significant improvements in their emotional well-being, including increased self-esteem, a greater sense of belonging, and reduced symptoms of anxiety and depression. Participants also reported that the choir provided a safe space for emotional expression and the building of meaningful relationships. Participation in an inclusive choir can have a considerable positive impact on the emotional health of its members.

Dedalo Vola project: The effect of choral singing on physiological and psychosocial measures. An Italian pilot study.

Several studies have been conducted that show the crucial role of active participation in music in health promotion (e.g. Dingle et al., 2021; Sheppard & Broughton, 2020); however, little research has focused on the biopsychosocial effects of choral singing. The present study aims to evaluate the effectiveness, in terms of improving physiological and psychosocial factors, of a choral program for middle-aged and older individuals. We integrated our study with qualitative observations of the atmosphere and flow state experienced by the choristers. The data were collected before and after 12 weeks of training, with 23 participants took part in the study. They experienced significant improvements in weight, oxygen saturation, heart rate, and satisfaction of psychological needs. A beneficial trend, although not statistically significant, were observed for blood pressure, cholesterol, triglycerides, stress, psychological needs, and mental health. The observations progressively revealed a more cohesive and focused group. Our findings support the potential for cross-disciplinary collaboration between healthcare and arts policy to promote and enhance health and well-being throughout the lifespan.

Effects of Participation in a Structured Choral Program on the Voice of Older Adults.

OBJECTIVES: To examine the effects of short-term and long-term engagement with structured choral singing on vocal function and quality of life outcomes in older adults. METHODS: Two groups of older adult singers over 55 years, one with fewer than 4 semesters and one with 4 or more semesters singing in a chorale, were assessed at 3 time points: baseline, after 1 semester of singing, and either after 1 semester of rest or after 1 semester of rest and 1 semester more of singing. Acoustic and aerodynamic measures, voice-related quality of life ratings, and measures of singing accuracy were obtained. Percent change between time points were calculated to determine three outcomes: improvement, lack of change, or worsening of measures across time. RESULTS: Long-term average spectrum (LTAS), difference in first and second harmonics and estimated subglottic pressure were significantly more likely to improve after a semester of singing with less experience singers, and LTAS continued to improve after a semester of rest. Flow was significantly more likely to improve with more singing experience after a semester of singing. Aerodynamic variables consistently changed in more experienced singers and improvement was maintained over the three visits. No significant changes occurred over time for singing accuracy for any singer type. Self-perception of singing voice continued to improve with more singing experience. CONCLUSIONS: This study demonstrated that for older adults in good health, regular singing provided a mechanism for maintaining speaking voice over time.

Impact of Daily Choral Singing and Creative Writing Activities on the Cognitive Development of Second-, Third-, and Fourth-Grade French Children from Low Socioeconomic Backgrounds.

In France, around one-fifth of children have reading difficulties, and school results are highly dependent on their socio-economic status. In this context, the need for alternative and innovative teaching techniques holds importance, and more artistic approaches are promising. The aim of this study was to assess the impact of a daily choral singing or creative writing practice on the cognitive and linguistic development of French children from disadvantaged backgrounds. Eighty children participated in this longitudinal study, for whom we measured several cognitive and linguistic skills at the beginning (pre-test) and end (post-test) of the school year. The results showed that children in "singing" classes improved both their reading skills and processing speed, while those in "writing" classes improved their reading skills and vocabulary. These results open up new avenues of learning support, specifically for children with difficulties.

Intergenerational choral singing to improve communication outcomes in Parkinson's disease: Development of a theoretical framework and an integrated measurement tool.

Purpose: This study presented an initial step towards developing the evidence base for intergenerational choral singing as a communication-focussed rehabilitative approach for Parkinson's disease (PD).Method: A theoretical framework was established to conceptualise the rehabilitative effect of intergenerational choral singing on four domains of communication impairments - motor drive, timing mechanism, sensorimotor integration, higher-level cognitive and affective functions - as well as activity/participation, and quality of life. A computer-assisted multidimensional acoustic analysis was developed to objectively assess the targeted domains of communication impairments. Voice Handicap Index and the World Health Organization's Quality of Life assessment-abbreviated version were used to obtain patient-reported outcomes at the activity/participation and quality of life levels. As a proof of concept, a single subject with PD was recruited to participate in 9 weekly 1-h intergenerational choir rehearsals. The subject was assessed before, 1 week post, and 8 weeks post-choir.Result: Notable trends of improvement were observed in multiple domains of communication impairments at 1 week post-choir. Some improvements were maintained at 8 weeks post-choir. Patient-reported outcomes exhibited limited pre-post changes.Conclusion: This study provided the theoretical groundwork and an empirical measurement tool for future validation of intergenerational choral singing as a novel rehabilitation for PD.

Self-Perception of Inclusion in an Inclusive Choir: An Analysis Using the Scale for the Assessment of Inclusion (SAI).

Inclusion promotes equal opportunities, and aims to eliminate discrimination, by ensuring full access, participation, and representation for all individuals in society, with music playing a crucial role in addressing this global challenge, and fostering positive and inclusive change. The aim of this study is to identify perceptions of inclusive culture, policies, values, and practices in one specific inclusive choir in Spain. The sample consisted of 135 members, ranging from 18 to 79 years of age, of which 22.2% have recognised disabilities. All of them filled in the adapted Scale for the Assessment of Inclusion (SAI) form. The results show that, regardless of gender, age, and length of participation in the choir, their members share positive perceptions of the inclusiveness of its values, policies, practices, and culture. However, perceptions vary across the groups surveyed, and are generally more favourable among participants with a disability, those without a university education, or those aged 26 or over. It is found that people who participate in an inclusive choir, in which music is the mediating resource, perceive a high level of inclusion that allows them to feel they belong to a group where diversity, equality, and the promotion of people are respected. The findings are analysed, considering the importance of conducting multidimensional evaluations that include all members of an organisation.

"When I Sing, I Feel Peaceful": Experiences of Older Choral Singers From North Korea.

North Korean (NK) defectors fled their homeland and traveled thousands of miles in search of a better life. This qualitative study explored the experiences of older NK defectors who were part of a serious leisure choral group. In-depth interviews were conducted with eight NK defector members of a South Korean choir group, from which four central themes emerged: (a) conquering adversity and promoting health; (b) making good friends and having great adventures; (c) providing an arena to develop a new identity; and (d) developing proficiency through vigorous efforts. Involvement in choral singing as a serious leisure activity assisted the members in overcoming the various adversities they were facing, promoted their physical and mental health, and helped them develop comradery and new social identities.

The Effect of Different Preparatory Conducting Gestures on Breathing Behavior and Voice Quality of Choral Singers.

OBJECTIVE: The breathing technique is a determining factor for the singer's sound quality and consequently crucial for the choral sound. However, very little is known about possible influences of the conductor's preparatory gesture on the way choral singers inhale before the beginning of a piece (respectively every subsequent phrase). The conducting literature does not discriminate between out- and inward preparatory gestures and even describes them as equivalent, but previous studies suggest that singers assign different types of inhalation to different preparatory gestures. It may therefore be assumed that the type of preparatory gesture has a direct influence on the singer's inhalation and tone production, and the aim of this study is hence to examine possible effects of two contrasting preparatory gestures on the singer's inhalation type and the resulting tone quality. METHODS: In our within-subjects study design, 18 healthy choral singers (9 male/ 9 female) were recruited to participate in a laboratory experiment. The participants were asked to sing a tone suitable for their voice register in response to different video stimuli. These consisted of two conducting-videos, each showing a different preparatory gesture, and two control conditions with an animated bar and an arrow indicating the desired breathing type. The singers reacted to 10 sets of videos, each set consisting of the four stimuli in randomized order. For evaluation of the breathing behavior and vocal output during the different experimental conditions, chest wall kinematics of upper rib cage, abdominal rib cage and abdomen were measured via 3D motion capture and voice samples were recorded. The obtained data were filtered and compared using the repeated measures analysis of variance and post hoc Tukey test for significant results. The level of significance was set at P < 0.05. RESULTS: The results of the study show significant differences in volume of the abdomen between the two different gestures (F1,17 = 24.04, η2 = 0.59, P = 0.0001), which can be validated by the two control measurements (F1,17 = 21.12, η2 = 0.55, P = 0.0002). An outward preparatory gesture evoked an abdominal breathing type while an inward-upward movement led to an inhalation with a higher portion of clavicular breathing. Furthermore, significant differences in timbre and loudness of the produced tone could be observed. The maximum sound pressure level of the outward preparatory gesture was significantly higher than in case of the inward-upward movement (F1,17 = 20.4, η2 = 0.56, P = 0.0004). CONCLUSIONS: In contrast to the existing conducting literature, which does not discriminate between out- and inward preparatory gestures, the results of this study show that the conductor's choice of trajectory direction and form of the preparatory gestures elicit spontaneous, gesture-specific reactions in singers' breathing behavior as well as the corresponding loudness and sound quality.

The Psychological and Biological Impact of "In-Person" vs. "Virtual" Choir Singing in Children and Adolescents: A Pilot Study Before and After the Acute Phase of the COVID-19 Outbreak in Austria.

Psychobiological responses to music have been examined previously in various naturalistic settings in adults. Choir singing seems to be associated with positive psychobiological outcomes in adults. However, evidence on the effectiveness of singing in children and adolescents is sparse. The COVID-19 outbreak is significantly affecting society now and in the future, including how individuals engage with music. The COVID-19 pandemic is occurring at a time when virtual participation in musical experiences such as singing in a virtual choir has become more prevalent. However, it remains unclear whether virtual singing leads to different responses in comparison with in-person singing. We evaluated the psychobiological effects of in-person choral singing (7 weeks, from January to March 2020, before the COVID-19 outbreak) in comparison with the effects of virtual choral singing (7 weeks, from May to July 2020, after schools partly re-opened in Austria) in a naturalistic pilot within-subject study. A group of children and young adolescents (N = 5, age range 10-13, female = 2) from a school in Salzburg, Austria were recruited to take part in the study. Subjective measures (momentary mood, stress) were taken pre- and post-singing sessions once a week. Additionally, salivary biomarkers (cortisol and alpha-amylase) and quantity of social contacts were assessed pre- and post-singing sessions every second week. Psychological stability, self-esteem, emotional competences, and chronic stress levels were measured at the beginning of in-person singing as well as at the beginning and the end of the virtual singing. We observed a positive impact on mood after both in-person and virtual singing. Over time, in-person singing showed a pre-post decrease in salivary cortisol, while virtual singing showed a moderate increase. Moreover, a greater reduction in stress, positive change in calmness, and higher values of social contacts could be observed for the in-person setting compared to the virtual one. In addition, we observed positive changes in psychological stability, maladaptive emotional competences, chronic stress levels, hair cortisol, self-contingency and quality of life. Our preliminary findings suggest that group singing may provide benefits for children and adolescents. In-person singing in particular seems to have a stronger psychobiological effect.

Breathing with the Conductor? A Prospective, Quasi-Experimental Exploration of Breathing Habits in Choral Singers.

OBJECTIVE: The breathing technique is a determining factor for the sound quality of the singers' vocal production and thus crucial for the choral sound. The aim of this study was to examine choral singers' awareness of breathing techniques and habits while singing and to identify potential correlations between the breathing technique and the preparatory gestures of the conductor. METHODS: In our prospective, quasi-experimental study, 720 choral singers answered a 25-item anonymous online survey which focused on demographic information, musical and choral experience, information on choir (size, type, repertoire) and conductor (age, gender, level of expertise). As the central issue we examined the subjects' general knowledge of breathing techniques and habits and their own use thereof in choral practice. Finally, subjects were asked to watch videos showing two different preparatory conducting gestures and to assess the meaning of these gestures. RESULTS: The results of the study show that the majority of choral singers (68.1%) inhale not before and not after, but during the conductor's preparatory gesture. The most well-known (94.7%) and allegedly most frequently (81.8%) used type of inhalation is abdominal breathing. Six times more singers associate abdominal breathing with an outward gesture rather than with the more frequently occurring inward-upward gesture. CONCLUSION: The conducting literature does not discriminate between out- and inward preparatory gestures and describe them as equivalent. However, according to our data, a vast majority of singers assign these gestures to different types of inhalation which influences singing technique and sound quality. This might lead to ambiguous action-reaction expectations from singers and conductors in rehearsals and concerts.

Effects of choral singing versus health education on cognitive decline and aging: a randomized controlled trial.

We conducted a randomized controlled trial to examine choral singing's effect on cognitive decline in aging. Older Singaporeans who were at high risk of future dementia were recruited: 47 were assigned to choral singing intervention (CSI) and 46 were assigned to health education program (HEP). Participants attended weekly one-hour choral singing or weekly one-hour health education for two years. Change in cognitive function was measured by a composite cognitive test score (CCTS) derived from raw scores of neuropsychological tests; biomarkers included brain magnetic resonance imaging, oxidative damage and immunosenescence. The average age of the participants were 70 years and 73/93 (78.5%) were female. The change of CCTS from baseline to 24 months was 0.05 among participants in the CSI group and -0.1 among participants in the HEP group. The between-group difference (0.15, p=0.042) became smaller (0.12, p=0.09) after adjusting for baseline CCTS. No between-group differences on biomarkers were observed. Our data support the role of choral singing in improving cognitive health in aging. The beneficial effect is at least comparable than that of health education in preventing cognitive decline in a community of elderly people. Biological mechanisms underlying the observed efficacy should be further studied.

Exploring the perceived health benefits of singing in a choir: an international cross-sectional mixed-methods study.

AIM: This mixed-methods exploratory study investigates the perceived health benefits of singing in a choir from an international sample of choristers. METHOD: An online questionnaire including demographic information, 28 quantitative statements and two qualitative questions relating to the perceived health benefits of singing in a choir was distributed via email and social media over a period of 4 months to a sample of 1,779 choristers. Basic descriptives and comparisons between subgroups of the sample are presented along with thematic analysis of qualitative comments. RESULTS: Basic descriptives suggest an overwhelmingly positive response. Females scored significantly higher than males on physical benefits, social benefits and emotional benefits. Professional singers reported significantly more physical, social and spiritual benefits than amateur singers. Bias may be present in these findings as the results were entirely self-reported by people who already sing in choirs. Qualitative thematic analysis identified six key themes which may counter this bias by providing deeper understanding of the perceived benefits for choir singers. These include social connection, physical and physiological benefits (specifically respiratory health), cognitive stimulation, mental health, enjoyment and transcendence. CONCLUSION: Choral singing elicits a positive response in the chorister across a plethora of domains. This research confirms previous findings on the health benefits of singing but offers evidence from the largest sample of singers to date. However, results are based on self-perceptions of choristers, and findings are, therefore, limited. Results may be used as a base on which to develop further research in this area. It also provides confirmatory evidence to support choral singing as a means of improving wellbeing in many populations, including but not limited to workplaces, schools, nursing homes, communities and churches.

Psychobiological Effects of Choral Singing on Affective State, Social Connectedness, and Stress: Influences of Singing Activity and Time Course.

Previous studies have suggested that there are complex psychobiological effects of amateur choral singing on well-being. Here, we investigate the influences of singing vs. non-singing on psychological and biological measurements, reflecting current positive and negative affect, perceived social connectedness, and physiological stress. We hypothesized that active singing leads to significant increases in these measurements compared to participating without singing. Amateur choristers (Exp. 1: N = 54, age range 18-85 years and Exp. 2: N = 49, age range 18-85 years) were tested in two experiments in which approximately half of the group was asked not to sing over periods of 30 (Exp. 1) and 60 min (Exp. 2), while the other half of the group sang. Dependent measures included scales for positive and negative affect and perceived social connectedness. In addition, saliva samples were collected to assess cortisol and alpha-amylase. The results revealed that singing activity had positive influences on affect measurements. However, significant increases in perceived social connectedness for singing were found only in Exp. 2. Biomarker changes were not significant across the experiments. Together, our findings suggest that both singing activity and duration of singing modulate psychological effects, with perceived social connectedness evolving over larger time spans than 30 min. Findings support the notion of beneficial psychological effects also for individuals, who report lower levels of general social support. The unexpected absence of biological effects warrants further investigation.

Factors associated with singers' perceptions of choral singing well-being.

OBJECTIVES: Choral singing is a popular vocational pastime across cultures. The potential health benefits associated with choral singing, including positive effect on well-being, are a topic of interest in health research. However, anecdotal reports from voice professionals suggest that the unique demands of choral singing may enforce unhealthy singing habits. This study explores suboptimal vocal behaviors that are sometimes associated with choral singing, which include singing outside comfortable pitch range, singing too loudly, and singing too softly for blend. METHOD: The relationships between suboptimal choral singing habits, vocal warm-ups (WUs), vocal fatigue, and singing-related well-being were assessed via a 14-item Likert-based response format questionnaire. Participants consisted of 196 attendees of the international World Choir Games. The final study group consisted of 53 male and 143 female international amateur singers aged 10-70. RESULTS: Results indicated a positive correlation between vocal fatigue and suboptimal singing behaviors (r = 0.34, P < 0.0001). Participants who did not engage in suboptimal singing behavior experienced increased singing-related well-being (r = -0.32, P < 0.0001, N = 141). Vocal WUs were not related to vocal fatigue or singing well-being. Substantially, more participants from this demographic preferred choir over solo singing (X²[1, N = 196] = 22.93, P < 0.0001). CONCLUSION: Suboptimal choral singing behaviors may result in vocal fatigue and reduction of choral singing well-being and should therefore be considered when examining the effect of choral singing on singing-related well-being and health. Future research will compare the amateurs' perceptions of choral singing with perceptions from professional singers and will look at determinants of choral singing well-being.

Music structure determines heart rate variability of singers.

Choir singing is known to promote wellbeing. One reason for this may be that singing demands a slower than normal respiration, which may in turn affect heart activity. Coupling of heart rate variability (HRV) to respiration is called Respiratory sinus arrhythmia (RSA). This coupling has a subjective as well as a biologically soothing effect, and it is beneficial for cardiovascular function. RSA is seen to be more marked during slow-paced breathing and at lower respiration rates (0.1 Hz and below). In this study, we investigate how singing, which is a form of guided breathing, affects HRV and RSA. The study comprises a group of healthy 18 year olds of mixed gender. The subjects are asked to; (1) hum a single tone and breathe whenever they need to; (2) sing a hymn with free, unguided breathing; and (3) sing a slow mantra and breathe solely between phrases. Heart rate (HR) is measured continuously during the study. The study design makes it possible to compare above three levels of song structure. In a separate case study, we examine five individuals performing singing tasks (1-3). We collect data with more advanced equipment, simultaneously recording HR, respiration, skin conductance and finger temperature. We show how song structure, respiration and HR are connected. Unison singing of regular song structures makes the hearts of the singers accelerate and decelerate simultaneously. Implications concerning the effect on wellbeing and health are discussed as well as the question how this inner entrainment may affect perception and behavior.

Erratum: Music structure determines heart rate variability of singers.

[This corrects the article on p. 334 in vol. 4, PMID: 23847555.].