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

Background: Pulmonary rehabilitation (PR) is a cornerstone in COPD care. Physical training (PT) is a key component of PR programmes. However, PR adherence is suboptimal, and barriers include inability to perform PT. There is an emerging need for alternative, evidence-based PR programmes. Lung choirs or singing training (ST) has potential benefits concerning improved respiratory control and wellbeing but impact on physical capacity is unknown.

Methods: We investigated the effects of ST compared to PT in a 10 weeks’ PR program in a randomised controlled trial (NCT03280355). Primary outcome was change in physical capacity (6-Minutes Walk Test, 6MWT) from baseline to post-PR, and secondary outcomes were changes in Quality of Life (QoL; St. George’s Respiratory Questionnaire, SGRQ), depression or anxiety (HADS), dyspnea (mMRC), lung function (FEV1%predicted), and overall PR adherence.

Results: We included 270 patients with COPD and 195 completed the study. Study arms were comparable, and both study arms benefitted significantly in 6MWT and SGRQ. ST was non-inferior to PT in 6MWT (p=0.94), though superior in SGRQ Impact improvement (p<0.01). No significant inter-group differences were seen in depression or anxiety, dyspnoea, lung function, or adherence.

Conclusions: ST appears to be as efficacious as PT in improving physical capacity and superior concerning QoL. The long-term effects and impact of COPD exacerbation rate is unknown. There is a need to explore and standardise the optimal content of ST to provide evidence-based and personalized medicine to COPD patients needing PR.