Post-COVID syndrome relief may just be a song away

A study conducted in Germany demonstrates the feasibility of singing-based respiratory training (SBRT) among individuals with post-COVID syndrome (PCS) with respiratory disorders.

Fifty-five PCS patients were eligible for enrolment. Eligibility criteria included a history of PCR*-confirmed COVID-19 at least 4–6 weeks prior to study inclusion, with respiratory dysfunction (eg, dyspnoea, increased respiratory rate). Participants were randomized to one of two groups: those aimed at reducing their respiratory rate to 6 breaths per min (group 1) and those with individual respiratory rates (group 2). Of the 47 patients evaluated (mean age 51.5 years, 81 percent women), 24 were inpatients, and 23 were outpatients. [Ann Phys Rehabil Med 2026;doi:10.1016/j.rehab.2025.102073]

Adherence to SBRT was high across study groups and patient settings. All but one participant in each inpatient and outpatient group completed all training sessions.

Compliance was similar between groups 1 and 2, with a low dropout rate (15 percent) and a high amount of time spent on self-training. Inpatients practiced independently with the aid of an exercise diary for a mean of 835 mins; outpatients did so for a mean of 1,262 mins. Sessions were approximately 40 mins each.

The overall comparison between baseline and follow-up assessments yielded improvements corresponding to medium effects in the physical component score of the Veterans RAND 12-Item Health Survey (Cohen’s d, 0.52), Generalized Anxiety Disorder Scale-7 (Cohen’s d, 0.55), and Patient Health Questionnaire-9 (Cohen’s d, 0.50).

The improvements in lung function parameters were relatively small between baseline and follow-up, the researchers noted. “The rather low therapy frequency of four to six sessions might not have been enough for lung function to improve significantly.”

SBRT

In individuals with chronic lung diseases, singing positively affects physical well-being, mental health, and physiological parameters and breath control. [BMC Pulm Med 2012;12:69; BMJ Open Respir Res 2021;8:e000996; Health Promot Int 2016;31:725-734] Evidence has shown the efficacy of concurrent training and a respiratory exercise programme for improving dyspnoea, fatigue, and quality of life in individuals with PCS. [J Appl Physiol 2023;134:95-104]

SBRT, developed by study co-author Prof Marc Secara in collaboration with the other investigators, is based on the principles of Estill Voice Training^® and respiratory therapy. It includes physical and stretching exercises, as well as phonation and articulation exercises from vocal pedagogy.

“Physical and stretching exercises include relaxation and mobilization of postural muscles, and mild muscle training using a Theraband to mobilize the secondary respiratory muscles,” explained Secara and colleagues. “Vocalization exercises were performed using Lax Vox^®, a silicone tube developed for specific respiratory muscle training.”

In this study, SBRT was conducted by two professionally trained vocal pedagogues and was added to the participants’ outpatient or inpatient treatments. Participants chose from three songs: ‘Happy Birthday’, ‘My Bonnie is Over the Ocean’, and ‘All My Little Ducklings’. Five different playbacks were made for each song.

In group 1, the objective was to sing the chosen song with six breaths per min and to breathe at the specified points in the song. During a regular training session, participants practiced a full run-through and sang along to the five audio samples. Not all participants achieved the goal. “[In group 2,] participants sang short-phrased vocal passages without speed control,” they said.

“In summary, our results underpin the feasibility of SBRT for individuals with PCS … We suggest conducting a confirmatory randomized controlled trial investigating SBRT vs standard of care (eg, standard breathing therapy), including a follow-up period of 6 months,” the investigators concluded.