A physician with a background in musical theatre, Derek Corpus, MD, MBBS, has often wondered about the link between exercises used in pulmonary rehabilitation and singing. “The breathing techniques for trained singers and the level of engagement that’s involved are very robust,” explained Corpus, pediatric pulmonologist at Cedars-Sinai Guerin Children’s Health Sciences University, Los Angeles. “You have to sustain notes when singing. You’re changing the pressures in your airway and the musculature of the thoracic cage. You’re moving air through.”

Music’s role in medicine dates back centuries, including that neurologists used tunes during psychotherapy, according to the American Music Therapy Association. Music as homeopathy was explored by ancient Greek philosophers, and singing has been shown to reduce levels of cortisol and other stress hormones.

While interest in the concept of “singing for lung health” has grown in recent years, related studies have been challenged as having significant biases and small subject numbers, rendering a lack of well-documented results.

“I don’t know that this is something that’s being looked at very much, and there’s definitely not much looked at in kids,” said Corpus. Still, Corpus and other physicians are encouraged about recent evidence that finds singing can have benefits on quality of life (QOL) among patients diagnosed with lung disease, potentially marking the potential of integrating programs into practice as an adjunct to pulmonary rehab.

Singing and Stated QOL Improvements

According to a phase 2/3 randomized controlled trial presented at the European Respiratory Society Congress in Amsterdam in September, patients who participated in a group singing program reported statistically higher QOL based on surveys that measured pain, social function, fatigue, and perception of general health. Reportedly the first research of its kind to evaluate patients involved in a group singing initiative held entirely online, the SINFONIA study examined participants with a median age of 69.6 years during weekly 90-minute sessions for 12 weeks.

In addition to singing a selection of songs, the program included warmups, breathing exercises, and social check-ins intended to foster group connection. Among the 101 participants, 50 were allocated to the singing sessions, whereas 51 were provided typical care, such as smoking cessation, respiratory vaccination, inhaler therapy, self-management education, and antifibrotic medication. Song lists were tailored to participant preference to ensure enjoyment and engagement.

Upon program completion, patients answered the Health Survey Short Form-36 questionnaire, with the singing group recording scores 7.4 points higher than the control group. The results indicated the possible benefit of a singing program, said lead researcher Natasha Smallwood, professor at Monash University in Melbourne, Australia.

Adding to the Tools for ILD

“Our study adds new knowledge on people with interstitial lung disease, as most previous trials have primarily included people with chronic obstructive pulmonary disease (COPD),” said Smallwood. “The way in which group singing improves quality of life remains unclear and may vary for different participants. But it could be due to better control of breathing, social connection, or mood improvements.”

The SINFONIA study also found the greatest improvements in QOL among women, individuals with anxiety or depression, and those who had not previously participated in pulmonary rehab, although Smallwood said reasoning is not clear. “It may relate to how different groups of people engage with the activity of group singing,” she said. “It may be the case that people who had not previously completed pulmonary rehabilitation had greater benefits due to having received no prior intervention.”

Smallwood said her team is planning further research to better understand who may benefit from group singing and to offer suggestions for how group singing could be implemented more broadly.

Perception of Symptoms Matter

Corpus believes there is real-world impact that justifies considering similar approaches with his pediatric patients. “Apparently, patients are saying they felt better, so from a quality perspective the singing was helpful per their perception,” Corpus explained. “Technically, we do not get objective evidence of how people’s lung function changed, and there wasn’t a huge sample size. But sometimes you see things that happen, or people perceive something even though the science part of it doesn’t correlate directly. How is it for us to say then that our current pulmonary function testing is enough to really get a full picture of how people actually are functioning?”

Samuel Cohen, MD, the director of pulmonary physiology and blood gas laboratories at Cedars-Sinai, has similar sentiments for his adult patients. “Perceived symptoms are a big part of living with lung disease,” said Cohen, whose most common referrals include patients diagnosed with COPD, asthma, bronchiectasis, and those experiencing lung nodules and/or exercise intolerance — many of whom are musicians and singers who might have had their hobbies or careers affected by lung disease.

“Quality of life is an important metric. Finding ways to cope with the challenges and the discomfort that comes with it, to feel better, and be able to be more functional in daily activities is also important, even if it doesn’t specifically show an improvement in lung function itself,” said Cohen.

“As these programs develop, if it could be incorporated into a pulmonary rehab program where they’re already learning different breathing techniques and ways to exercise within the context of their lung disease,” Cohen added. “This could potentially be a nice adjunct for the right subpopulations for those who enjoy music and are musically inclined.”

A 2025 randomized controlled trial also piqued the interest of Corpus: The study investigated the effect of karaoke with telerehabilitation-based exercise training on health-related outcomes for children with asthma. The primary outcome was pulmonary function, and secondary outcomes included perception of dyspnea and fatigue, thoracic expansion, respiratory and peripheral muscle function, functional capacity, asthma control, and QOL. “At the very least, there is no harm to the singing,” Corpus said. “I wouldn’t worry about any vocal cord strain because you’re not going to have kids shouting at the top of their lungs every day. It’s more about doing something that people enjoy, something that they will stick with. Habit formation is extremely difficult.”

Establishing Musical and Singing Interventions

At Temple Lung Center, Philadelphia, Jamie L. Garfield, MD, professor of thoracic medicine and surgery, is piloting a qualitative music therapy research program focused on wellness in partnership with Temple School of Music, Philadelphia. Trained music therapists are mentoring medical students on how to strategize and choose musical instruments for each patient to play therapeutically.

“We will be piloting the program in individual rooms, in shared spaces like dialysis or surgical waiting areas, and in public spaces like the lobby of the main hospital,” said Garfield, general pulmonologist who works in both inpatient and outpatient departments and specializes in lung cancer. “There’s so much that music therapy can do, and it achieves different things in different locations and to different audiences, depending on what you’re looking for. Essentially, this argument is about understanding what it is about pulmonary rehab that could be replicated by a singing program, or is it just rolling singing into traditional pulmonary rehab regimens and therapy programs?”

Garfield encourages those who are interested in introducing any type of program into their practice to consult with those who have professional training. “Music training is a discipline,” she explained. “Partnering with people who have training in music therapy is important because regardless of how well it is utilized to train the diaphragm, there’s still things about the music that you select and the way in which the music is played. There’s data to support a certain way of initiating music therapy for therapeutic benefits,” said Garfield.

“It is very reasonable to make the assumption that, although the research is modest to prove this thus far, singing also improves diaphragm muscle strength. If in singing you are able to train the diaphragm to be more effective in its control, contraction, and function, you will glean the benefits that we see from diaphragm muscle training in the context of pulmonary rehab,” Garfield explained.

Smallwood said this approach was also taken during SINFONIA. “To make sure that the songs were approachable for people with lung conditions who had not necessarily done a lot of singing prior to our trial, our music therapist-selected songs with short-to-medium phrase lengths and small-to-medium pitch ranges,” she said.

Assuming that he will eventually take next steps, Corpus believes he has identified his target cohort. “The lowest hanging fruit for me is probably utilizing this in the asthma population,” he said. “It’s a diagnosis that is scary, and the biggest question I always get is ‘Will I grow out of it?’ But rather than framing it as it possibly going away, maybe it should be more of how to deal with it at its current state and how to empower patients to do things because they are capable. Singing and music are inherent or intrinsic to human nature. Breathing is life, and singing is part of breathing.”

Cohen said he also intends to keep the possibility open. “I do think more robust evidence would be helpful to implement these types of programs, because it would require significant interdisciplinary team collaboration,” he said. “It’s an interesting idea that has a growing body of literature. If it’s something that could be incorporated as an adjunct to multi-modality therapy, that would be fantastic. I’m interested to see what comes out of the ongoing research.”

Cohen, Corpus, and Garfield reported having no relevant financial disclosures. Smallwood led the SINFONIA study.