Singing in a choir strengthens lung capacity, decreases depression and anxiety, and improves perceived school functioning in children born with a single heart ventricle.
RT’s Three Key Takeaways:
- Breathing and Psychosocial Gains: An eight-week choir intervention improved respiratory measures, lowered depression and anxiety, and bolstered school functioning in children who had undergone reconstructive surgery for single-ventricle heart disease, according to a feasibility study.
- Physiological Support for Fontan Circulation: Because post-surgical single-ventricle circulation relies on respiratory mechanics and thoracic pressure changes rather than a muscular ventricular pump to drive blood flow through the lungs, respiratory muscle training offers vital physiological support.
- Accessible Clinical Replication: Investigators plan to launch a multicenter study in 2027 to assess how this low-resource, adaptable singing and breathing model can benefit broader pediatric healthcare populations.
Singing in a choir strengthens lung capacity, decreases depression and anxiety, and improves perceived school functioning in children born with a single heart ventricle, according to a feasibility study published in Pediatric Cardiology.
The intervention combined in-person and online singing and breathing instruction, and was developed in collaboration between Ann & Robert H Lurie Children’s Hospital of Chicago and the Northwestern University Bienen School of Music.
Children born with a single ventricle typically undergo three staged surgical procedures, concluding with the Fontan procedure when they are around 3 to 4 years of age. During these surgeries, surgeons redirect oxygen-poor systemic blood flow directly into the pulmonary artery, bypassing the heart entirely.
This surgical circuit causes blood to flow passively to the pulmonary bed, propelled by natural respiratory effort and intrathoracic pressure shifts instead of a mechanical pump. Although the procedure is lifesaving, patients can develop weakened lungs, lower exercise tolerance, and progressive fatigue during physical activity. Over time, passive pulmonary blood flow can contribute to heart failure and eventual heart transplantation, while neurocognitive diagnoses, including attention-deficit/hyperactivity disorder (ADHD), are also common in this clinical cohort.
“We offered our Fontan patients participation in the choir in hopes to provide a fun way to support their lungs and psychosocial development,” said Kendra Ward, MD, MSCI, director of cardiopulmonary exercise lab and cardiac rehabilitation program at Lurie Children’s, and professor of pediatrics at Northwestern University Feinberg School of Medicine. “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.”
Measurable Gains in Respiratory Function and Wellbeing
The pilot study enrolled 14 pediatric patients between 8 and 16 years of age who took part in the intervention for eight weeks, according to the study release. The protocol delivered 30 minutes of individual voice instruction and 60 minutes of weekly group rehearsals, paired with continuous access to a digital platform featuring guided breathing and singing exercises.
Following the eight-week program, clinical evaluations revealed measurable improvements in select breathing parameters, according to the authors. Participants also recorded better scores on self-reported measures of wellbeing and depression, while parent reports reflected meaningful gains in school functioning and reductions in child anxiety and depression.
“We hope to launch a larger, multicenter study of the choir intervention in 2027,” said 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.”
