Let’s Get Physical: Singing and Disease-Specific Therapy

Every morning Rene Marcus and her husband rose early and did yoga stretches to get the stiffness out of their necks and backs. From there, Rene proceeded into a daily routine that included two hours of exercise—a combination of swimming, weight lifting, jogging, and hiking. 

At 67, Marcus was active, positive—the picture of healthy aging. Then, during one of her exercise periods, she noticed a nagging inner tremor in her muscles. Her doctor recommended she see a neurologist, and Marcus went dutifully, completely unprepared for what the specialist would tell her.

“Mrs. Marcus, I believe you have Parkinson’s disease.”

“That was a week before Christmas in 2009,” Marcus recalled, “and the beginning of a very challenging time in my life. I took my health very seriously and always felt that you didn’t have anything if you didn’t have your health. Now my health was being jeopardized. I wondered if this would be something that would ruin my life.” 

At first she told no one about the diagnosis, not even her family. Instead she scoured the books in the lending library of the Parkinson’s Association in San Diego. She learned that Parkinson’s was a disabling condition of the brain characterized by slowness of movement, shaking, stiffness, and in the later stages, loss of balance. Many of these symptoms are due to the loss of certain nerves in the brain, which results in the lack of a chemical called dopamine. Medication can treat the movement-related symptoms of Parkinson’s, but there is no known cure for the disease.

Still reeling from the news, Marcus joined a support group for other Parkinson’s patients. It was in that circle of new friends that she heard about an intervention that was showing promise in lessening the symptoms of the disease—singing. Karen Hesley, a speech therapist and skilled choral conductor, was leading a choir for people with Parkinson’s disease and their family and caregivers. 

The group was called, appropriately, the Tremble Clefs, one of about a dozen such choirs in the U.S. “I have always belonged to singing groups,” Marcus said, “so I decided to give it a try. I didn’t want to be in a group where folks were just spending time. Karen is a serious musician, knows her music, and we were not singing a bunch of lightweight songs. I wanted a challenge. That’s my nature."

Addressing Symptoms—and More

At least 75 percent of Parkinson’s patients have voice and speech abnormalities related to their disease. Common symptoms are a soft, breathy voice, slurring, and monotone. New studies show that participating in a choir improves these symptoms.

Rene Marcus

At Tremble Clefs rehearsals, Hesley leads choristers through breathing, stretching, and posture activities, and vocal, rhythm and movement exercises, all designed to address Parkinson’s symptoms. Though Marcus has not yet developed vocal symptoms of Parkinson’s, Hesley encouraged her to stretch beyond her usual alto to sing soprano. “I had always wanted to sing soprano,” Marcus said. Soon, she was recruited to sing the soprano part on the rehearsal tapes given to choristers to learn their music. And she also joined the Tremble Toes, a dance troupe that often performs with the Tremble Clefs.

Other members of the chorus have reported improvements in their symptoms, but uniformly they say that the sense of camaraderie and community is the healing factor for them. “I have attended some other Parkinson’s support groups where people discussed their woes,” said Don Murdock, who was diagnosed with the disease in 1998. “I found that to be depressing. Tremble Clefs was different. Here were people looking the disease in the face and saying I can sing and I can dance. There is so much positive energy and love in the air. We are a family of caring people.”

“The purpose is therapeutic,” Hesley said, “but there are other things that have come out of this. One is the social benefits. The joy of singing together develops community very quickly. This is an organization in which people have something in common. It is a safe zone. Spouses, children, and caregivers can come. Many say it is the highlight of their week.” 

The Singing Treatment

Patients suffering from chronic pain who participated in a singing group showed marked improvements in their mood, active coping, and perceived pain.

Parkinson’s disease is not the only ailment for which singing has been found to be a potentially potent treatment. Adults with Chronic Obstructive Pulmonary Disease (COPD) have also improved their symptoms through singing lessons and singing in a group as have children with cystic fibrosis, another disease of the lungs.

John Townsend, confined to a wheelchair because of his severe COPD, was skeptical about the "Singing for Breathing" sessions at the Royal Brompton Hospital in the UK. “I just thought it was silly and I think a lot of the doctors did, too,” he told Tessa Thomas, a reporter for The Independent newspaper, in 2010. “But I quickly learned it wasn't silly at all." After a few months of twice-weekly vocal exercise and song sessions led by a professional singing teacher, Townsend, a former smoker in his 70s, was not only free of the chest infections he had suffered from for years, but was walking regularly without help and was "breathing more deeply than I could remember."

The impact of singing for people with other kinds of diseases and health problems are less direct but no less significant. Patients suffering from chronic pain who participated in a singing group showed marked improvements in their mood, active coping, and perceived pain. Patients struggling with aphasia—a deficit in language that results from a stroke on the left side of the brain—saw dramatic improvements when they learned to sing useful phrases such as “I am hungry” while tapping a rhythm with their left hands.

Finding the Part of the Brain Where the Music Lives 

Some of the more remarkable stories about the impact of music making are told about patients suffering from dementia or Alzheimer’s disease. While group singing has not been shown to slow the progression of these diseases, it does seem to help patients access a part of the brain where the preserved memory for song and music lives. 

“People who have constant memory problems are so undermined by this, but somehow the memory for singing is preserved forever in the brain and it gives people a lift when they can remember things," said Chreanne Montgomery-Smith of the Alzheimer's Society in the UK. She founded Singing for the Brain, a choral group for people with dementia, memory problems, or Alzheimer's disease. 

Participants in the group and their caregivers report that singing together helps them express themselves and come out of the shell of anxiety and depression that is often associated with the loss of memory. “I feel free,” one of the participants said in a video about the program. “I do the things as the others around me are doing it.”

“It’s not just the singing, it is all the attributes of singing,” said group leader Sue Shapland on the same video. “It’s the breathing, the relaxation, the articulation. We always have a welcome song and call out to each person by name. I have had caregivers come and tell me that conversations have started again at home because they [the Alzheimer’s patients] got used to using their voice again.”

Opening a Pathway

"He can’t read a newspaper. He can’t read a book. But when words are placed along a music staff, he can read the lyrics to a song. Music opens a pathway into my father’s brain.” - Mary Ellen Geist

Music making was a life-giving companion for Woody Geist as Alzheimer’s disease snatched away his thoughts and memories. ”Music and the sphere of comfort it creates seem to envelop the heart and soul and brain of my father and make Alzheimer’s go away for just a little while,” his daughter Mary Ellen Geist wrote in her book Measure of the Heart, published before her father’s death in 2011.“It provides a way for him to tell us that he is still inside, even when he’s in a deep sleep. He can’t read a newspaper. He can’t read a book. But when words are placed along a music staff, he can read the lyrics to a song. Music opens a pathway into my father’s brain.” 

Mary Ellen Geist told the story of her father performing a holiday concert with his singing group, the Grunyons, at the Fox Theater in Detroit. “As the men filed onto the huge, lighted stage, there was Dad, looking the way he always did when he sang with his group: confident, smiling,” she wrote. “I watched him throughout the performance and he seemed to know his part and all the words. They sounded great, especially on ‘Have Yourself a Merry Little Christmas,’ one of his favorites, which he often whistles and sings in any season.”

Afterward, Geist and her mother told Woody what a wonderful show it was—how great he sounded, how good he looked.

“What did I do?” he asked. 

“I don’t know if he remembered being on the stage,” Geist wrote, “but I am quite sure, from the look on his face, that he knew something wonderful had happened. He seemed to stand up straighter than he had before. A smile seemed to come more easily to his lips. He said, “Aren’t those great guys?” 

And then he said, “Aren’t we lucky?”