Choir singing improves lung function and mental wellbeing in children

Singing in a choir strengthens breathing capacity, decreases depression and anxiety, and improves perceived school functioning in children born with a single heart ventricle, according to a feasibility study from Ann & Robert H. Lurie Children's Hospital of Chicago published in Pediatric Cardiology. This intervention, including in-person and online singing and breathing instruction, was developed and trialed in collaboration with Northwestern University Bienen School of Music.

Children born with a single ventricle face physical and psychosocial challenges related to the three surgeries they undergo, ending with the Fontan procedure when they are around 3-4 years old. Over the course of these three surgeries, surgeons reroute oxygen-poor blood from the upper and lower body and connect it directly into the pulmonary artery, bypassing the heart completely. This allows blood to flow passively to the lungs, driven by normal breathing and pressure changes rather than a heart pump.

While lifesaving, the surgeries may result in weaker lungs. Affected children often have decreased exercise tolerance, tiring easily with activity. Over time, the passive blood flow to the lungs can contribute to heart failure and may lead to the need for a heart transplant. Many of these children have neurocognitive differences, such as ADHD, also as a consequence of their single ventricle heart disease.

We offered our Fontan patients participation in the choir in hopes to provide a fun way to support their lungs and psychosocial development. We found that the kids really enjoyed it. Many expressed that the choir gave them a sense of camaraderie and helped them feel less alone. I underappreciated to what extent these kids felt different from their peers."

Kendra Ward, MD, MSCI, lead author, Director of Cardiopulmonary Exercise Lab and Cardiac Rehabilitation Program, Lurie Children's, and Professor of Pediatrics, Northwestern University Feinberg School of Medicine

The choir included 14 patients, aged 8-16 years, who participated in the program for eight weeks. The study provided 30 minutes of private voice instruction and 60 minutes of group instruction a week. Participants also had access to an online program of singing and breathing exercises.

Post-intervention assessments demonstrated improvements in some breathing measures, and higher scores on self-reports of depression and wellbeing, as well as parent reports of school function, depression and anxiety.

"We hope to launch a larger, multicenter study of the choir intervention in 2027," said Dr. Ward. "We also are starting a non-study choir this fall, since the kids and families wanted to keep it going. In the future, we'd like to branch out and include children with congenital heart disease who have other diagnoses. We are excited to benefit more children with this novel program that does not require significant resources and could be replicated anywhere."