The development of singing therapy protocol and its evaluation on lung function and chest expansion: comparison between singing and no singing / Norhuda Sulaiman

Currently, singing famed as an adjunct therapy has excited numerous research
interests since it is said to contribute to various health benefits. Previous qualitative
data studies reported that singing had improved patients’ psychological, social, stress
and physical levels. In terms of corporeal progress, patients enlightened that singing
improved their breathing as well as their physical well-being. However, studies on the
effects of singing therapy on respiratory measure are inconclusive. Dosage and
singing protocol are cited as the contributing factors related to the insignificant results.
Hence, the objective of this study is to develop a Singing Therapy Protocol (STP) and
to evaluate its effect on lung function and chest expansion. Gaps of the literature
substantiated by reviews of experts engaged by this study were carried out to
formulate the STP. Thirty physiotherapy students from the Universiti Teknologi
MARA form the participants of this study. They were divided equally into the STP
group and the No Singing (NS) group. The STP group practiced the STP for two
sessions per day, five days per week and consecutively for 4 weeks. The NS group
continued their daily routines without additional physical activity. The outcome
measures used are lung Function (FEV1 and FVC parameters) and chest expansion
measurements (Upper and lower thoracic). Measurements were taken pre and post the
4 weeks. Data were analysed using the IBM SPSS version 23 software to determine
the Within Group and the Between Group changes for all the outcomes of lung
function and chest expansion. Results show significant differences between time and
group where FEV1 F (1, 28) =0.069, p=0.005, and FVC F (1, 28) =15.603, p=0.000,
but with both effect size being small. No significant difference was found for both the

upper and the lower thoracic expansion. For the Between Group analysis, Kruskall-
Wallis test was used and it showed a significant difference between the STP group

(mean rank=20.80) and the NS group (mean rank=10.20) where H=10.993, p=0.001,
Cohen’s ƒ=0.781 for FEV1 mean differences and for FVC mean differences for the
STP group (mean rank=22.47) and the NS group (mean rank=8.53) group, H=18.943,
p=0.000, Cohen’s ƒ = 1.372 respectively. However, there was no significant
difference between both groups for chest expansion outcome. This study concludes
that practicing the Adopted STP for twice daily, five days per week and continuous
routines for 4 weeks improves the lung volumes among the participants. Therefore,
the STP has demonstrated itself as a comprehensive exercise for respiratory purposes
which comprises of a combination of diaphragmatic breathing and pursed-lip
breathing routines. In fact, these facilitated the preparedness of the respiratory muscles
before the practice. Hence, this protocol enhanced the thoracic cage movements and
improved lung volumes. Indeed, the STP developed by this study could be exploited
as an adjunct therapy in clinical practice for patients with respiratory disorders
especially those suffering from COPD and the like.