Singing and Cardiovascular Health in Older Adults

Study Overview
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Brief Summary
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Cardiovascular disease (CVD) claims more lives each year than cancer and chronic respiratory disease combined. Participation in cardiac rehabilitation (CR) reduces mortality and risk of a major cardiovascular event in secondary prevention populations, including older adults. Older adults are less likely to participate in CR, as comorbidities in this population, including arthritis and chronic obstructive pulmonary disease, make participation difficult. Singing is a physical activity that involves components of the vagal nerves manifested as changes in cardiac autonomic regulation. Unlike physical exercise, the effects of singing on cardiovascular health has not been well-studied. The hypothesis for this project is that older patients with CVD will have favorable improvement in cardiovascular biomarkers, including, endothelial function and heart rate variability (HRV), after 30 minutes of singing.

Detailed Description
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This proposal seeks to create, optimize and test two different singing interventions in older patients with CVD. The study will consist of three arms, according to a randomized, single-blind, crossover, sham procedure-controlled design. Sixty-five total participants will each have three visits on three different occasions for the following interventions: a 30-minute period of guided singing from an in-person music therapist a 30-minute period of singing along to an instructional video including a professor of voice and inexperienced, older singing student a 30-minute sham intervention (subjects will undergo a hearing test) The goal will be to determine which singing intervention, if any, is superior to the other - as this would be important to guide longer and larger clinical trials in the field. Knowledge gained from this proposal will improve understanding of biologic mechanisms of singing behaviors, as it relates to CVD.

Official Title
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Evaluating the Impact of Singing Interventions on Markers of Cardiovascular Health in Older Patients With Cardiovascular Disease

Conditions
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Cardiovascular Diseases, Cardiovascular Risk Factor, Cardiovascular Health

Intervention / Treatment
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* Other: Singing with Music Therapist
* Other: Singing with Guided Video
* Other: Control Arm


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: English Speaking Have a history of coronary artery disease (defined as history of myocardial infarction, coronary stenosis >50%, percutaneous coronary intervention with stent placement, balloon angioplasty, or coronary arterial bypass grafting) Exclusion Criteria: Subjects with a permanent pacemaker or implantable cardioverter defibrillator (ICD) implanted Patients with a history of atrial fibrillation, flutter or atrial tachycardia Parkinson's disease or a tremor Amputated upper extremity or presence of upper-arm (dialysis) fistula Fingernail onychomycosis (fungal infections resulting in thickening of the nails) Pregnancy Current illicit drug use (marijuana, tobacco, cocaine, amphetamines, etc.) Current excessive alcohol use (defined as more than 14 drinks/week for women, more than 28 drinks/week for men) Unstable coronary heart disease (active symptoms of chest discomfort) History of a Stroke or TIA or peripheral arterial disease Known history of cognitive impairment or inability to follow study procedures Cancer requiring systemic treatment within five years of enrollment. Subjects requiring supplemental oxygen use Non-English speaking subjects (video with lyrics are taped in English)

Ages Eligible for Study
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Minimum Age: 55 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Singing intervention 1<br>Instructional sing-a-long video. A video series will be created and recorded for the purposes of the study. Flow Mediated dilation (FMD) and EndoPAT will be measured before and after singing. | Other: Singing with Guided Video<br>* The videos will include a vocal warm-up (10 minutes long). The subject will then have the option to select and sing two songs (10 minutes each), with offerings in four music genres including Folk, Pop, Country, and a Hymn. Each piece will vary in tempo, melodic contour, and rhythm. The total duration of singing via this format will be 30 minutes.<br>|
| Active Comparator: Singing intervention 2<br>In-person music therapy session. The music therapist will continue to coach throughout the 30-minute session. Flow Mediated dilation (FMD) and EndoPAT will be measured before and after singing. | Other: Singing with Music Therapist<br>* Music therapy sessions will begin with vocal and breathing warm-up exercises for about 10 minutes. The Music Therapist will play the songs (chosen from a list by the subject) to sing along to and will alter the characteristics of the music (volume, tempo, level of support) to ensure a successful experience for subjects and motivate them to put forth more effort into singing the song. The music therapist will continue to coach throughout the 30-minute session, reminding subjects of strategies practiced and how to implement those strategies while singing. Music therapy sessions will be led by Erica Flores, MT-BC, WMTR, Owner of Healing Harmonies Music Therapy, or a member of her team. Erica and her team of MTs were trained in Neurological Music Therapy.<br>|
| Sham Comparator: Control/sham intervention<br>Subjects will have a 30-minute period of rest sitting upright (as they would be positioned for the singing interventions). This arm is meant to isolate the specific effects of the treatment rather than the potential incidental effects related to the research setting and measurements. During this time, subjects will undergo hearing testing. Flow Mediated dilation (FMD) and EndoPAT will be measured before and after the 30 minute rest. | Other: Control Arm<br>* 30 minute rest period, no singing will take place during this arm. During this rest period a member of the study team will assist the subject in a hearing test using headphones, a tablet, and a trumpet app. This is done to asses the current hearing level of the subject.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in vascular (endothelial) function | Measure endothelial function and brachial artery flow-mediated dilation | At baseline and after 30-minute singing and sham intervention(s) | 
| change in vascular (endothelial) function | Measure endothelial function (reactive hyperemia index, and PAT ratio) through finger plethysmography using EndoPAT | At baseline and after 30-minute singing and sham intervention(s) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| level of exertion achieved during singing | BORG Rating of Perceived Exertion | after 30-minute singing (and sham) interventions | 
| level of exertion achieved during singing | percent of maximum predicted heart rate achieved | after 30-minute singing (and sham) interventions | 
| cardiac hemodynamics | heart rate variability will be measured before, during and post singing | at baseline and after 30-minute singing and sham intervention(s) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Singing