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. 2017 Dec 18;2017(12):CD012296. doi: 10.1002/14651858.CD012296.pub2

Bonilha 2009.

Methods Study design: randomised controlled trial
Participants Participants: n = 43
Included: COPD (according to GOLD criteria); stable for 2 months; ex‐smoker
Excluded: severe comorbidities; oxygen therapy; smoker
Baseline characteristics:
Intervention group — singing (n = 15)

  1. Gender, male: n = 12

  2. Age, years: mean (SD) 70 (7)

  3. FEV1, L: 1.11 (0.47)

  4. FEV1, % predicted: 49 (21)

  5. FEV1/FVC, %: 46 (18)


Control group — handcraft (n = 15)

  1. Gender, male: n = 12

  2. Age, years: 74 (8)

  3. FEV1, L: 1.18 (0.47)

  4. FEV1, % predicted: 53 (20)

  5. FEV1/FVC, %: 43 (11)
Interventions Intervention characteristics:
Intervention group — singing

  1. Duration (session): 1 hour

  2. Frequency: 1/week

  3. Length (programme): 24 weeks

  4. Professional/s: physiotherapist + singing teacher

  5. Location: not reported

  6. Session details: (1) relaxation exercises of neck and upper limb muscles, conducted by a physiotherapist (5 minutes); (2) singing‐related respiratory exercises conducted by a singing teacher (10 minutes) — these exercises are part of regular singing teaching, and consisted of: performing fast, deep inspirations, followed by slow, full or interrupted expirations; performing fast and deep respiratory incursions, paying attention to the upper abdominal movements; generating breathing movements against, or with the help, of pressures generated by a hand placed on the upper abdominal region; (3) vocalisation exercises, lead by the singing teacher, as a preparation for singing (15 minutes) — participants loudly pronounced vowels such as “le”, “la”, “mi”, “mu”, and also sang the melody of a familiar song using such vowels instead of actually singing the lyrics; (iv) singing training of Brazilian folk songs, conducted by the singer teacher (30 minutes)

  7. Additional information: participants were also instructed to practice the folk songs at home for half an hour on at least two more days during the week


Control group — handcraft

  1. Duration (session): 55 minutes

  2. Frequency: 1/week

  3. Length (programme): 24 weeks

  4. Professional/s: physiotherapist + handcraft work teacher

  5. Session details: (I) relaxation exercises of neck and upper limb muscles, conducted by a physiotherapist (5 minutes); (ii) execution of handcraft artwork such as paper folding, drawing, and collages (50 minutes)

  6. Additional information: participants were also routinely instructed to include some incomplete artwork or beginning a new one at home
Outcomes Health‐related quality of life — St George's Respiratory Questionnaire, total score

  1. Outcome type: continuous outcome

  2. Range: 0‐100

  3. Unit of measure: percent, %

  4. Direction: lower is better

  5. Data value: change from baseline


Dyspnoea — Basal Dyspnoea Index (BDI), score

  1. Outcome type: continuous outcome

  2. Range: 0‐12

  3. Unit of measure: score

  4. Direction: higher is better

  5. Data value: change from baseline


Respiratory muscle strength — PImax, cmH2O

  1. Outcome type: continuous outcome

  2. Unit of measure: cmH2O

  3. Direction: higher is better

  4. Data value: change from baseline


Respiratory muscle strength — PEmax, cmH2O

  1. Outcome type: continuous outcome

  2. Unit of measure: cmH2O

  3. Direction: higher is better

  4. Data value: change from baseline


Lung function — FVC, L

  1. Outcome type: continuous outcome

  2. Unit of measure: litre, L

  3. Direction: higher is better

  4. Data value: change from baseline


Lung function — FEV1, L

  1. Outcome type: continuous outcome

  2. Unit of measure: litre, L

  3. Direction: higher is better

  4. Data value: change from baseline


Lung function — FEV1/FVC, %

  1. Outcome type: continuous outcome

  2. Unit of measure: percent, %

  3. Direction: higher is better

  4. Data value: change from baseline


Lung function — ERV, L

  1. Outcome type: continuous outcome

  2. Unit of measure: L

  3. Direction: higher is better

  4. Data value: change from baseline


Lung function — IC, L

  1. Outcome type: continuous outcome

  2. Unit of measure: litre, L

  3. Direction: higher is better

  4. Data value: change from baseline
Identification Country: Brazil
Setting: hospital
Authors name: Amanda Gimenes Bonilha
Institution: University of Sao Paulo
Email: jabmarti@fmrp.usp.br
Address: Internal Medicine Department, Avenida Bandeirantes 3900, CEP: 14048‐800, Ribeirao Preto, Sao Paulo, Brazil
Notes Authors were contacted for further information, with no response.
 Sponsorship source: Not stated
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Not specified
Allocation concealment (selection bias) Unclear risk Not specified
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Not specified, but due to the physical nature of the intervention it is unlikely the participants were able to be blinded
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Not specified
Incomplete outcome data (attrition bias) 
 All outcomes High risk Outcomes measured reported for all participants completing post intervention assessment
High dropout rate from singing group (35%)
Selective reporting (reporting bias) Low risk All outcome measures listed in methods were reported
Other bias Low risk Study appears to be free of other sources of bias