August 2017 - a great summary of research - An Evidence Review of the Impact of Participatory Arts on Older People

July 2017

Here's the new Government all-party inquiry report on the importance of the arts to our keeping and staying well.

In summary, it explains that GPs prescribing arts activities to some patients could lead to a dramatic fall in hospital admissions and thus save the NHS money.The report, published July 2017, includes hundreds of interviews and dozens of case studies showing how powerfully the arts can promote health and wellbeing.

Co-chaired by former arts ministers Alan Howarth and Ed Vaizey, the all-party inquiry contends that the arts can keep people well, aid recovery from illness, help people live longer, better lives and save money in health and social services. 

Lord Howarth said it was a comprehensive review of evidence that had never been produced before. “Sceptics say where is the evidence of the efficacy of the arts in health? Where is the evidence of the value for money it can provide? We show it in this report.

“The arts can help people take responsibility for their own health and wellbeing in ways that will be crucial to the health of the nation.”

And as Grayson Perry says in the report:

“Making and consuming art lifts our spirits and keeps us sane. Art, like science and religion, helps us make meaning from our lives, and to make meaning is to make us feel better.”

Here's summary of the full report…/Creative_Health_

Report by Music In Our Bones bringing together national and local research into the health benefits of group singing to launch  HeartSong July 2011 

There are now more choirs than fish and chip shops in the UK and a spate of TV shows, The Choir that Rocks, The Last Choir Standing and Gareth Malone’s award-winning series, suggest that at last it is being recognised that something special happens when we have the chance to sing with others. The following is a summary of some of the main strands of both national and locally collated research into what the benefits of singing with others might be. 

Singing is an ancient art form. People living in less technological societies than our own in many parts of the globe still sing as a central way of being together. There are no distinctions between audience and performers, no-one watches on passively. It is assumed we are all artists, and dancers, and singers. 
As a favourite Zimbabwean proverb says, 

‘If you can walk you can dance, if you can talk you can sing.’ 

Looking back to the not too distant past, we have always used singing as a way of marking community life. We have sung to celebrate births, to grieve together at deaths, we‘ve sung whilst working, and as a way of celebrating being together.Like a heart beat, singing connects us. Yet in an increasingly consumer-orientated world, we are now encouraged to believe only the best singer should sing, reduced to being passive listeners rather than full-blooded singers. It is only those of us who either attend church, or football matches, who are still regularly in touch with the power and bond which singing with others engenders. Most of us feel we ‘can’t’ sing, most of us don’t think our voices are ‘good enough’, most of us have stopped believing we have a right to raise our voices with others.

Music in our Bones believes very strongly in giving people back that belief. We hope to restore people’s confidence that it is our birthright to sing, that each of us has a unique voice to develop, and that we CAN, together with others, do it!  

Research into the health benefits of singing 

Due to advances in neurological science, we now have a growing body of scientific evidence explaining what community singers have always known, that singing’s good for us!The Sidney de Haan Centre for Research, which is part of Canterbury University, has been researching into the health benefits of singing for more than a decade. They are interested in the World Health Organization’s definition of health (WHO, 1946) as 

 ‘a state of complete physical, mental and social wellbeing and not merely an absence of illness or infirmity.’ 

Professor Clift from the Institute writes that, 

 “Just as walking is now prescribed, the benefits of singing for health are slowly being rediscovered by health practitioners.” 

Clift, S. and Hancox, G. (2001) The Perceived benefits of singing: findings from preliminary surveys with a university college choral society.  Journal of the Royal Society for the Promotion of Health 

In Kent there has been significant interest and PCT funding both for this research and in consequence, their ‘singing on prescription’ and silver song choirs for older people.  
In an economic climate intent on saving money, investing in community singing also makes sound economic sense, as the larger the group often, the more positive the experience for all involved, something which is rarely true for therapeutic interventions. 

Physical benefits 
Physical benefits include: 
  • Improved breathing 
The Royal Brompton hospital now offers ‘singing for breathing’ sessions for patients with emphysema and pulmonary problems. This month, the hospital, so impressed with the efficacy of these sessions is introducing it for children with cystic fibrosis and people suffering with severe asthma.( Breathe-Easy Singing Club for people with COPD:Royal Brompton and Harefield NHS Foundation Trust press release August 17th 2010) 
  • Improved speech and posture 
The Hereford PCT runs singing sessions for people with Parkinsons who have problems with speech called ‘Quivers and Quavers.’ (The choral cure’ - Features, Health & Families  The Independent 12 Jan 2010) One asthma sufferer who attended with her husband who has Parkinsons has found she now needs to use her inhaler less and reported that: 
“he now stoops and stutters less, I breathe more easily and we both have better posture. None of the group are much good at singing by the way.” 

A member of one of our groups, Lifting Spirits, who has cerebral palsy,  mentioned the importance of singing in their ability to speak with confidence saying, 
“Singing lubricates and exercises the voice box – if you live alone and don’t often speak to anyone, you can start to feel unconfident about your voice ‘working’ properly, singing helps with this.” 
  • Improved circulation and an accessible way of taking exercise 
In an article, ‘The Choral Cure’ in the Independent 12th January 2010, Robert Wyatt, the sixties musician who following an accident is a wheelchair user said: 

“ Singing is the best free drug going! It does what exercise does and more!” 

Several people who have sung with us with Inside Out, have spoken of how they do not feel motivated to exercise, often due to debilitating and painful conditions such as arthritis, sometimes due to having a poor body image and sometimes due to the effects of the medication they are taking. Participants have told us though that they do experience singing workshops as a real physical workout which they enjoy.
Professor Graham Welch, Chair of Music Education at the Institute of Education, University of London, who has studied developmental and medical aspects of singing for 30 years points out that,

 “The health benefits of singing are both physical and psychological. Singing has physical benefits because it is an aerobic activity that increases oxygenation in the blood stream and exercises major muscle groups in the upper body, even when sitting.” 

  • Reduced pain levels whilst singing 
  • An increased sense of well-being 
A recent study at the University of Stockholm ( as reported in ‘the Choral Cure’) showed that men and women get an oxytocin high when they sing. As this is released during pregnancy and lactation and sex, it’s unsurprising that so many singers speak of a huge sense of well-being they experience during a singing session! 

  • Improved immunity levels 
Research by Dr Kreutze at Frankfurt University’s Music Department 2002 sampling singer’s saliva before and after singing  proved that our secretion of antibodies is increased too when we sing, so our immunity is boosted too! This, interestingly did not happen when singers listened to the same music. We have to actively participate in singing to reap its physical benefits. 

Professor Graham Welch, the professor of music education at the Institute of Education, spokesperson for the National singing programme for school children, Sing Up, also commented, 

 “Singing has psychological benefits because of its normally positive effect in reducing stress levels through the action of the endocrine system which is linked to our sense of emotional well-being. Psychological benefits are also evident when people sing together as well as alone because of the increased sense of community, belonging and shared endeavour.” 

New research from Wales-based cancer charity Tenovus shows that singing has resulted in marked improvements to cancer patients’ mental health, vitality, social function and pain. The charity has been running a Tenovus Sing for Life Choir as part of a research study into the effects of singing on cancer sufferers. There were also indications anxiety and depression was relieved in those members who reported symptoms before the choir started.Dr Ian Lewis, head of research for Tenovus, said: “Tenovus’ motivation for the choir was to give those who have been affected by cancer a space to come together in a fun, positive and energetic way and focus on something other than their cancer.” 

Who are Music in Our Bones? 

As practitioners we have run singing workshops over the last four years with people locally:
  • Family Carers many of whom are managing stressful and unremitting caring roles: people who’s caring role has ended, managing grief and the need to create a new life: their husbands, wives, mothers and fathers, who are perhaps  living with conditions such as early Alzheimers, Parkinsons, Stroke, MS  or cancer: 
  • people living on the acute wards at St Clements: 
  • people in living in the community, attending Inside Out’s community Arts programme;
  • people who simply find that singing helps increase their sense of well-being with Music In Mind and 
  • Lifting Spirits a women’s singing project which attracts people from across these groups, includes people with physical disabilities and as in all communities, women struggling to manage periods of acute anxiety, depression and grief.  
We have observed the clearly visible signs of the physical benefits of singing (people moving from stiffer, more defensive body postures towards being more relaxed and open, standing taller, connecting with others through laughter and song)and been given a huge amount of feedback from people that singing relaxes them and reduces the tension they were holding. Feedback tells us how helpful it is for people to be taken away from their negative thoughts and to feel a new connection with their bodies, their tension reduced. 
"Singing makes my mind stop churning, I leave here on a natural high." 
What is almost more interesting however, are the subtle things people say about their improved mental attitude and sense of community. 

Psychological benefits of singing 

A Sidney de Han research project reports that singing in harmony with others:

“engenders happiness and raised spirits which counteracts feelings of sadness and depression” 
(Clift, S., Hancox, G., Morrison, I., Hess, B., Stewart, D. and Kreutz, G. (2008) Choral Singing, Wellbeing and Health: Summary of Findings from a Cross-national Survey.) 

Singers with Inside Out have said: 
  • It helps my mental health, it’s a calming influence
  • It lifts my mood and keeps me well
  • It keeps me out of hospital
  • It takes me out of myself 
  • It works by helping focus people on the communal goal of making a piece of music together 
  • You forget problems and get absorbed in the music, it absorbs all our attention there’s no room for distractions
  • Stops you thinking negative thoughts 
Choice of songs can be very important as songs can bring with them a rich heritage of resilience and protest in the face of difficulty.
  • It lets you express your feelingsIt’s grounding.
‘Changing Tunes’ an innovative participatory music project in prisons point out that:

Music can connect with people at a profound level; time and again we see it has the ability to tap into deeply held feelings and hopes. Doing this enables people to meet, and to start to deal with, their frustrations, as well as to express their dreams. It allows the darkest despair to be acknowledged as well as the most uplifting optimism.We have often experienced moments when singing’s power to move us has been tangible. Sometimes these moments are times of realisation, as our emotional life is acknowledged.  

  •  Singing helped me find something I’d been searching for within myself for a long time 
and many people, struggling with the effects of medication changes, have spoken of the relief of being able to think more clearly after singing. 

Cognitive benefits 

This was one of the findings of the Kent project that singing because it
“ involves education and learning, keeps the mind active, gives a sense of achievement and counteracts the decline of cognitive functions.” 
(Clift, S., Hancox, G., Morrison, I., Hess, B., Stewart, D. and Kreutz, G. (2008) Choral Singing, Wellbeing and Health: Summary of Findings from a Cross-national Survey.) 

One of Inside Out participants described it this way;
  • You can think clearer – it helps make rational thoughts and ‘unwinds’ your mind 
The hugely successful ‘  Singing for the Brain’ groups for people with dementia and their partners prove the value of providing activities which reconnect people to parts of themselves which they associate with positive memories and in which they still are still confident.
Bamford, A. (2006) Making Singing for Health Happen: Reflections on a ‘Singing for the Brain’ Training Course. Canterbury: Canterbury Christ Church University. 

Social benefits 

Heart Research UK ‘s  Sing For Your Heart programme has produced studies showing that singing in a group helps to reduce stress and depression, improve memory and reduce anxiety. Several reasons have been advanced for the beneficial effects of group singing.
1. Memorizing the words to songs improves brain function, including the ability to store and retrieve memory.
2. The exercises associated with group singing improve deep breathing and that has the added benefit of adding to relaxation and stress reduction.
3. Performing in front of an audience and as part of a group inspires self confidence and self esteem.
4. Group interaction in a singing group ends social isolation and fosters relationships of all kinds.
5. Group participation is fun and allows people to get away from daily stresses and worries                                                             Allan Schwartz, LCSW, Ph.D  

Another vital aspect of the Sidney de Haan’s findings is that“singing offers social support and friendship which ameliorates feelings of isolation and loneliness, and provides a sense of community and social inclusion.”(Clift, S., Hancox, G., Morrison, I., Hess, B., Stewart, D. and Kreutz, G. (2008) Choral Singing, Wellbeing and Health: Summary of Findings from a Cross-national Survey.) 
Dr Sarah Montgomery, a member of the Sidney De Haan’s advisory group and a GP said:  
Many of the health problems we see as doctors arise against a backdrop of social isolation, relationship breakdown and low self esteem.  Good medicine can be just as much about helping people to find meaning and purpose in their lives as it is about treating physical and psychological illness.  Drugs cannot address these important issues, but there is growing evidence arts can.  
Singing can help build a sense of Community 
This community building aspect is central to our work with Family Carers and their families. Singing is especially helpful as it moves people from being alone, towards a sense of community through the process of music making. No conversation is required, you do not have to be able or up to ‘being a good communicator,’ something that is so hard to offer when you are feeling depressed and unlovable, the sessions themselves bring us together and this is very strongly felt by participants.
Singers with Inside Out told us: 
You can be in a group of people and still feel lonely; singing brings you together
It gives me a sense of community that’s lacking in society
It’s good to feel part of something – connected by the singingYou make new friends
There’s a sense of camaraderie getting over feeling embarrassed
I feel alone when I walk through the door. When I walk out I have sung with everyone. I feel together! 

We’re also hoping that the monthly nature of our HeartSong project (or even fortnightly for those able to attend both Bury and Claydon sessions) will help in that community building, motivating people regularly to move away from feeling isolated to experience the positive qualities singing with others engenders. Time with others before, during and after sessions is visibly valued as much sharing of both emotional and practical issues occurs naturally as groups settle into feeling secure with each other group members. 
 ‘it helps me get through difficult times’
 ‘I enjoy the warm up, body and voice. It has made me more aware of my body and I have done more exercise at home.’
‘It lifts me, helps me relax and makes me aware of a full range of emotions.’ 

As Professor Clift points out in ‘Music and Well-being. Integrating Spirituality in Health and Social Care’,  
‘it provides us with a wonderful resource in promoting health in a holistic sense, embracing not just the balanced functioning of the body, but our social and mental well-being, and the life of the spirit – our purposes, aspirations and hopes for a fuller life.’ 

Music in our Bones hopes that staff and volunteers in the voluntary and Health sectors will really encourage people to try HeartSong to find out if it might be useful to them. Everyone will need initially to overcome the fears and insecurities we all experience when faced with such a prospect. We are relying on your understanding and willingness to be alongside people in the process and hope that you will find yourself enjoying with them becoming part of this new community singing project. We would like to work with you all to make sure its impact is as wide-reaching as we can together make it. We hope as many of you as possible might become part of its development.

Please contact us to plan a free taster singer with the group of people you work with. or or 

Bibliography – a starting point ! 
M. Besson et al Singing in the BrainPsychological Science, Vol 9 1998C. Clift and G.Hancock The Perceived benefits of SingingCentre for Health and Education Research, Canterbury Christ Church University College.Singing and Health:Summary of a systematic Mapping and Review of Non-Clinical Research 2008Choral Singing, Wellbeing and Health: A cross-national survey (2008)Formative Evaluation of the Silver Song Club Project (2008)Evaluation of the ‘Singing for the Brain’ Training Course (2006)Clift, S., Hancox, G., Morrison, I., Hess, B., Stewart, D. and Kreutz, G. (2008) Choral Singing, Wellbeing and Health: Summary of Findings from a Cross-national Survey. 
Current research projects include :Singing and mental health see BBC feature, Raising Voices, Raising Spirits 19/01/10 and COPD ( see article on breathe – easy singing clubs) and dementia projects 
C.Grape et al Does Singing Promote Well-being? (using 5 visual analogue scales)Integrative Physiological and Behavioural Science, 2003 
G Kreutz et al Does singing provide Health Benefits? ( interest in emotional effects of singing and immunoglobulin released )Hanover University of Music and Drama, Germany 2003  
R.Stacey et al Singing for Health: an exploration of the issues( a review of the way music and singing have related to health and healing historically and cross-culturally.)Health Education, Vol 102. 2002  
M.M.Unwin D.T.Kenny, P.J.Davis  The Effects of Group Singing on Mood (using profile of mood states questionnaire)National Voice Centre, University of Sidney 2006 
A.Wignall Keeping Body and Soul in TuneReport in the Guardian 2008. Professor G Welch, Chairman of music education at UCL and Professor Hancox co-director of Sidney de Haan Research Centre for Arts and Health. 
Other accessible singing projects 
LocalChris Rowbury’s ‘singing safaris’ 6 week sessions culminating in a performance for confident singers and the OK Chorale Woodbridge
Co-op community choirs
Funky Voices open access choir Northgate Arts Centre, Ipswich
Keep on Rocking – Town and Bridge Community singers meet Cumberland Towers, Ipswich Different Directions – new group run by Suffolk Music Therapy weekly in Stoke area of Ipswich on Friday afternoons hoping to attract people with physical and learning difficulties.
Music in Mind –run by Music In Our Bones Monday afternoons fortnightly in Ipswich Library
New Voices choral singing for less experienced singers Ipswich
Newmarket Community Choir - Wendy Fletcher Phone: 01638 663396 
Orwell Connection - Community Choir Felixstowe
Shared Voices – monthly workshops at Stutton
Singing for fun – Bury Ipswich and Cambridge Call 01284 700 286 or email
Sing Your Heart Out - Sing Your Heart Out is a series of singing workshops in Norfolk, designed to get people together to enjoy themselves, and to gain the known benefits to mental health from singing.
Stowmarket Chorale
Viva Voices – Bury
Vocal-Ease therapeutic singing, dance and music making opps in Ipswich
YoxVox fortnightly singing workshops in Yoxford run by Bridget Cousins and Helen Rolfe 

Changing Tunes - Innovatory participatory music project in 
Quivers and Quavers – singing group for people with Parkinsons - Hereford PCT also Robert Wyatt in ‘The choral cure’ - Features, Health & Families  The Independent 12 Jan 2010 
Breathe-Easy Singing Club for people with COPD:                  Royal Brompton and Harefield NHS Foundation Trust press release August                  2010 
Tenovus Singing for people with cancer                 Cardiff University News 22 Jan 2009 
Sing for your Heart  Heart UK 
Sing Up –  National Singing project to encourage more singing back into schools    
  The Sage Gateshead 
Singing for the brain Alzheimers Society

Useful Health and Well-being Websites

Music in Our Bones July 2011
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Music In Our Bones - singing to lift our spirits
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