Singing in Pulmonary Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease

Research output: ThesisPh.D. thesis


Chronic Obstructive Pulmonary Disease (COPD) is a common disease characterised by chronic inflammation and airflow limitation. Predominant symptoms comprise dyspnoea, cough, and sputum. Furthermore, COPD is associated with decreased physical activity, social isolation, psychological distress, and impaired quality of life (QoL).

Pulmonary rehabilitation (PR) is a key component in COPD care and improves e.g. physical capacity and QoL. Physical Exercise Training (PExT) is the gold standard activity in PR. However, challenges in PR are ability to perform PExT, high drop-out rates, and lack of maintenance. Therefore, alternative evidence-based activities have been requested to supplement an increasingly personalised PR offer. Several novel activities and approaches have been suggested, but evidence remain scarce.

Singing has been suggested as a novel approach, potentially relevant for people with COPD. Singing has become increasingly popular as a leisure time activity in COPD and may be relevant as a novel PR intervention as singing is both a physiologically-oriented activity, focusing on e.g. respiratory muscles, and a social activity associated with joy and cohesion.

My PhD dissertation focuses on singing training in PR for COPD and include three main topics:

1: What is a lung choir and how are lung choirs currently delivered in Denmark? Delivery of lung choirs is unknown and there are no guidelines or common training on preferred approach available. Study 1 was based on an online survey among 20 lung choir leaders and used both quantitative and qualitative research approaches. The study showed that setting and delivery of lung choirs were heterogeneous and without standardised, disease-specific methodology. The new task of leading a lung choir was perceived as highly meaningful and beneficial but also associated with insecurities.

2: Does singing in COPD work? Effects of singing in key outcomes in PR for CODP are unknown. Study 2 was based on a multicentre, randomised controlled trial (RCT) of PR with either a disease-specific methodological approach, Singing for Lung Health (SLH) (intervention), or conventional PExT (comparator). A total of 270 COPD patients and 11 municipalities participated. The study demonstrated that singing provided meaningful changes in key PR outcomes and was non-inferior to PExT.

3: When singing in COPD works, how does it work? Study 2 showed that SLH is effective in improving walking distance and QoL. However, it is unknown which physiological factors are related to SLH and whether there is an association between achieving clinically significant improvement in walking distance and/or QoL. Study 3 was based on post-hoc analyses of the RCT per-protocol data, specifically in the SLH group. A total of 108 participants were included. The study found that SLH may provide meaningful physiological changes. Achieving improvement in both walking distance and/or QoL was not closely correlated.

To conclude, singing appears to be relevant and beneficial in COPD in both objective and subjective parameters. Thus, singing represents more than a pleasant leisure time activity that may be relevant to include as part of a diverse, personalised offer in PR to supplement PExT. Furthermore, singing is a cheap and easily implementable activity.

The PhD project represents an important contribution to the current body-of-evidence within singing for COPD. Further studies are needed to define and develop preferred, standardised, homogenous delivery of singing in COPD. Moreover, further high-quality studies are needed to confirm effects in both objective and subjective parameters, to assess long-term effects and maintenance, and to evaluate health-economic aspects.
Original languageEnglish
Awarding Institution
  • Aarhus University
  • Vuust, Peter, Principal supervisor, External person
  • Bødtger, Uffe, Co-supervisor
  • Hilberg, Ole, Co-supervisor
  • Ottesen, Anders Løkke, Co-supervisor
Publication statusPublished - 10. Jun 2022
Externally publishedYes


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