Participant-selected music in pulmonary rehab didn't result in reduced dyspnea or leg fatigue compared to standard care, though both groups saw some overall symptom improvement.
By
Lana Pine
| Published on October 9, 2024
5 min read
Participant-selected music listening during pulmonary rehabilitation (PR) for individuals with chronic obstructive pulmonary disease (COPD) did not show additional benefits in reducing symptoms of dyspnea (shortness of breath) or exertion compared to usual care. While both groups experienced significant improvements following PR, no significant between-group differences were observed.
“International guidelines for managing COPD includes PR,” wrote a group of investigators led by Annemarie Lee, PhD, associate professor of Physiotherapy at Monash University, Australia. “This recommendation is supported by compelling evidence that PR improves exercise capacity and reduces dyspnea, fatigue and anxiety, all of which enhance health-related quality of life (HRQoL). However, not all people with COPD accrue symptom improvement from PR, with 46% classed as non-responders.”
Some experts theorize that listening to music during exercise can help desensitize patients with COPD to dyspnea and fatigue as it alters the perception of symptoms and switches focus from the symptoms to the music. During paced-walking interventions, patients who listened to music reported improvements in exercise capacity and reductions in physical symptoms.
To understand the impact of participant-selected music listening on symptoms, exercise tolerance and HRQoL, investigators conducted a multicenter, prospective, randomized controlled trial. Eligible patients were recruited from three sites and had a COPD diagnosis, a smoking history of >10 pack years and were clinically stable.
Primary outcomes included functional exercise capacity, as measured using two six-minute walk tests (6MWT), dyspnea and leg fatigue. Other areas of interest included the enjoyment of physical activity, changes in anxiety and depression and general fatigue.
Participants underwent an eight-week PR outpatient program, attending two supervised exercise sessions per week. Patients were required to attend at least 70% of the sessions and were also prescribed an unsupervised home exercise routine, aiming for two to three additional sessions weekly.
Those placed in the intervention group completed a music preference questionnaire, which was used by a music therapist to create personalized exercise playlists with music at a tempo of at least 90 beats per minute, designed to enhance exercise motivation and performance. Participants used these playlists during PR sessions and home exercises, as well as after the program for six months.
The control group received usual care, which involved conversations, no music or clinician-selected background music during sessions. Monitoring was conducted to ensure compliance with the respective conditions for both groups and both groups attended the program concurrently.
A total of 58 patients were initially randomized to receive either the intervention (28 participants) or standard care (30 participants) between August 2016 and March 2020.
Unfortunately, due to the global COVID-19 pandemic, recruitment and delivery of the in-person PR program were halted for two years beginning on March 16, 2020. This disruption led to the recruitment being stopped at 58 participants, which was fewer than the planned sample size. As a result, the study couldn’t fully achieve its primary and secondary goals, and data collection for certain outcomes, including the 6MWT, was incomplete.
Strategies were put in place to retain participants, reduce missing data, and continue the trial safely. However, issues with obtaining physical activity monitors in Australia meant that data on this outcome was only collected at Canadian sites, and because of the small sample size, this data wasn’t reported.
Both groups were comparable regarding lung function, quality of life, 6-minute walk distance (6MWD) and symptom scores at baseline.
No differences were observed in end-6MWT symptoms, immediate discomfort, emotional response and the Multidimensional Dyspnea Profile (MDP) sensory quality following PR. However, both groups had significant improvements in MDP sensory quality and emotional response. There was a significant reduction in immediate breathing discomfort in the intervention group.
At the six-month follow-up, no differences in the end-6MWT symptom scores or MDP dimensions were observed between groups. However, a significant reduction in dyspnea scores was seen in the control group and both groups had significant improvements in sensory quality and emotional response from baseline. Additionally, no differences in anxiety and depression were reported between groups both immediately following PR or at six months.
“The study was limited by COVID-19 interruptions which inhibited the ability to reach an adequate sample size,” investigators wrote. “Therefore, the potential role of participant-selected music listening as an adjunct to PR remains to be clarified.”