Choir singing improves respiratory muscle strength and quality of life in patients with structural heart disease - HeartChoir: a randomised clinical trial.

AIMS OF THE STUDY: Most patients with reduced exercise capacity and acquired or congenital structural heart disease also have a reduced respiratory muscle strength. The aim of this pilot study was to investigate whether choir singing in combination with respiratory muscle training positively influences respiratory muscle strength, exercise capacity and quality of life in this population. METHODS: In this single-centre, randomised and open-label interventional study we compared respiratory muscle strength, exercise capacity and quality of life in patients with acquired or congenital structural heart disease who received either standard of care and a 12-week intervention (weekly choir rehearsal and daily breathing exercises) or standard of care alone. The primary endpoint was the difference in change in maximum inspiratory pressure (Delta MIP%predicted). Secondary endpoints included the difference in change in maximum expiratory pressure (Delta MEP%predicted), exercise capacity quantified as maximal oxygen uptake during exercise (Delta MVO2%predicted) and quality of life quantified by the Minnesota living with heart failure questionnaire (Delta MLHFQ score). RESULTS: Overall 24 patients (mean age 65, standard deviation [SD] 19 years, 46% male) were randomised after exclusion. Delta MIP%predicted was significantly higher in the intervention group (Delta MIP%predicted +14, SD 21% vs -14, SD 23%; p = 0.008) and quality of life improved significantly (Delta MLHFQ score -5, SD 6 vs 3, SD 5; p = 0.006) after 12 weeks. Delta MEP%predicted and Delta MVO2%predicted did not differ between both groups (Delta MEP%predicted -3, SD 26% vs -3, SD 16%; p = 1.0 and MVO2%predicted 18, SD 12% vs 10, SD 15%; p = 0.2). CONCLUSIONS: Choir singing in combination with respiratory muscle training improved respiratory muscle strength and quality of life in patients with structural heart disease and may therefore be valuable supplements in cardiac rehabilitation.