An eight-week choir intervention successfully strengthened lung capacity, lowered depression and anxiety, and bolstered school functioning in children born with a single heart ventricle, according to a feasibility study published in Pediatric Cardiology and reported by Respiratory Therapy.
Children born with a single ventricle undergo three staged surgical procedures, ending with the Fontan procedure around age 3 or 4. Surgeons redirect oxygen-poor systemic blood flow directly into the pulmonary artery, bypassing the heart entirely. This physiological setup means blood flows passively to the lungs, propelled by natural respiratory effort and intrathoracic pressure shifts rather than a mechanical ventricular pump.
While lifesaving, this univentricular circulation can lead to weakened lungs, reduced exercise tolerance, and progressive fatigue during physical activity. Over time, passive pulmonary blood flow contributes to heart failure and potential heart transplantation, while neurocognitive diagnoses like attention-deficit/hyperactivity disorder frequently affect this clinical cohort.
To counteract these challenges, investigators developed a targeted program combining in-person and online singing and breathing instruction. The protocol was created through a collaboration between the Ann & Robert H. Lurie Children’s Hospital of Chicago and the Northwestern University Bienen School of Music.
“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 the 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.”
In Plain English: The Clinical Takeaway
- Respiratory Support via Vocal Mechanics: Controlled breathing and vocalization act as targeted respiratory muscle training, helping drive blood flow through the lungs in patients who lack a traditional heart pump.
- Psychosocial Benefits: Group singing fosters social connection, effectively easing symptoms of anxiety and depression while boosting self-reported wellbeing and school functioning in pediatric heart patients.
- Low-Resource Scalability: Because the intervention relies on accessible singing and breathing exercises, researchers can easily adapt and replicate the model across diverse healthcare settings without heavy financial barriers.
Pilot Study Improves Breathing and Wellbeing in Pediatric Patients
The pilot study enrolled 14 pediatric patients between 8 and 16 years of age who participated in the intervention for eight weeks. The clinical protocol delivered 30 minutes of individual voice instruction and 60 minutes of weekly group rehearsals. Participants also received 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. Participants recorded better scores on self-reported measures of wellbeing and depression, while parent reports reflected meaningful gains in school functioning along with reductions in child anxiety and depression.
| Study Parameter | Intervention Details | Observed Outcomes |
|---|---|---|
| Cohort Demographics | 14 pediatric patients (ages 8–16) with single-ventricle heart disease | Completed an 8-week structured singing and breathing protocol |
| Intervention Design | 30 mins individual voice instruction, 60 mins weekly group rehearsal, digital platform access | Improved respiratory function parameters and positive psychosocial scoring |
| Reported Metrics | Self-reported wellbeing and parent-reported school functioning | Decreased anxiety and depression, enhanced peer camaraderie |
Future Multi-Center Expansion Plans
Buoyed by the success of the initial pilot, the clinical team is already looking toward broader implementation. “We hope to launch a larger, multicenter study of the choir intervention in 2027,” said Ward. Investigators aim to assess how this low-resource, adaptable singing and breathing model can benefit pediatric healthcare populations beyond the initial cohort.
“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. This new program requires few resources and can be used in other locations to help more children.”
References
- Ann & Robert H. Lurie Children’s Hospital of Chicago & Northwestern University Feinberg School of Medicine clinical research briefings
- Respiratory Therapy: Clinical reporting on pediatric cardiopulmonary rehabilitation models
