Singing Has Some Benefits for Covid Long Haulers
A Complementary Therapy for Improving Quality of Life
An online singing program conducted by the English National Orchestra (ENO) and the Imperial College of London Medical School showed some benefits in reducing symptoms of breathlessness and improving overall quality of life in people with Long Covid.
“An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19: a parallel-group, single-blind, randomised controlled trial.” Lancet Respiratory Medicine, 27 April 2022. PMID 35489367.
Difficulty breathing (dyspnea) is one of the most common symptoms in Long Covid - in many surveys; it is second only to fatigue. The sense of being breathless can also contribute to fatigue, it encourages people to limit themselves, and fitness declines over time. A number of studies have looked at various forms of breathing exercises to improve patient status, and most have shown some positive results. 1 2
Breathing exercises conducted under the guise of ‘respiratory therapy’ also work - but blowing into a tube can be boring and many people drift away from that sort of exercise after a while. Singing has the built-in advantage of being more pleasurable for many people. Participants in the ENO program were also linked up over the internet, and they had social support to keep going… the participants were even sent mugs, tea and biscuits (“cookies” in the U.S.) to create an online social experience. The program focused on lullabies - a type of singing that is less strenuous.
In terms of the numbers, “there was a significant difference in the improvement in VAS breathlessness (running) score between the groups, favouring the ENO Breathe group. Although most other secondary outcome measures were numerically better in the ENO Breathe group, differences were not statistically significant.”
So the results point to a modest improvement in breathing. In a broader measure of physical health (the PHC index), no differences were seen between those who sang and those who did not. A broad measure of mental health (the MHC index) showed clear improvements in the people who took part in the ENO Breathe program.
The study involved people singing at home, linked up by the internet. Singing together in groups still represents a high risk of spreading Covid if any of the singers has an active infection. When singing with volume or force, a large number of saliva micro-droplets go into the air. Studies have shown that church choirs and karaoke both represent excellent ways to spread SARS2/Covid-19. 3 4
The Bottom Line
A singing program can offer some benefits for those who are willing to take part. The improvements seen were real and positive, but far short of remission. This type of activity complements other forms of treatment or therapy, and is worth considering.
“SingStrong-A singing and breathing retraining intervention for respiratory and other common symptoms of long COVID: A pilot study.” Canadian Journal of Respiratory Therapy, 9 Mar 2022, PMID 35359819.
“Cardiopulmonary Rehabilitation in Long-COVID-19 Patients with Persistent Breathlessness and Fatigue: The COVID-Rehab Study.” International Journal of Environmental Research and Public Health, 31 Mar 2022, PMID 35409815.
“Singing Is a Risk Factor for Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Case-Control Study of Karaoke-Related Coronavirus Disease 2019 Outbreaks in 2 Cities in Hokkaido, Japan, Linked by Whole Genome Analysis.” Open Forum on Infectious Diseases, 23 Mar 2022, PMID 35531379.
“Transmission of SARS-CoV-2 in the Karaoke Room: An Outbreak of COVID-19 in Guangzhou, China, 2020.” Journal of Epidemiology and Global Health, Mar 2021, PMID 33095983.