Fit to Perform: A Profile of Higher Education Music Students' Physical Fitness

'I Have Had to Stop Singing Because I Can't Take the Pain': Experiences of Voice, Ability, and Loss in Singers With Hypermobility Spectrum Disorders

OBJECTIVE

This study explored the voice experience, singing ability, and wellbeing of singers diagnosed with Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos Syndrome (h-EDS).

STUDY DESIGN

This was a mixed-method study. A purposive sampling strategy was used. Data were collected via an online survey, using written closed and open-ended questions.

METHODS

276 adults completed the survey. This study focuses on a subset of professionally-trained singers (n=71). Responses elicited information about participants' voice health and function, symptoms of hypermobility, singing experiences and training. Data were analysed using template analysis.

RESULTS

Many participants reported wide vocal ranges and enjoyment of singing but 74.6% of participants across all age groups (18-60 years) experienced voice difficulties. Three common themes were identified: (1) 'My unreliable voice': The ups and downs; (2) Wider effects of HSD/h-EDS on singers, and (3) Need for acknowledgment and support.

CONCLUSIONS

Voice difficulties and hypermobility-related health conditions affected the participants' abilities to sing and perform; this impacted their professional and personal opportunities, communication, relationships, and wellbeing. Our results indicate that symptoms of voice disorder worsen over time. We suggest practical strategies that singers and training providers could implement to support hypermobile singers. More research is needed to fully understand voice difficulties in singers with HSD/H-EDS and to inform tuition and support.

The Influence of Age, Gender, Health-Related Behaviors, and Other Factors on Occupationally Relevant Health Complaints of Singers

OBJECTIVES

Professional singers' careers are usually associated with health-relevant factors that they themselves may or may not be able to influence. We have therefore investigated the effect of modifiable health-related behaviors and non-modifiable factors on singers' occupational health.

METHODS

In an explorative, questionnaire-based study, self-reported, occupationally relevant health complaints and behaviors, along with singer-specific characteristics, were surveyed from 349 professional singers and voice teachers (116 men, 233 women; age 18-73 years) and the influence of age, gender, duration of daily and lifelong singing, voice category, and health-related behaviors (smoking, alcohol consumption, physical activity) on occupationally relevant health complaints were analyzed using bi- and multivariate statistical methods.

RESULTS

Singers reported less risky alcohol consumption (5.4% versus ≈15%) and smoking (15.5% versus 29.7%) than the general population, and too little physical activity was described in two thirds of both populations. After controlling for multiple testing, no effect was found for these behaviors, the time spent singing daily, gender, or voice categories on singers' complaints. Health complaints were significantly fewer for males (P < .001) and older women and were reported more frequently for higher-pitched male voices, a trend not found in females.

CONCLUSION

Singers seem to smoke and drink less than members of the general population. These factors did not affect their complaints. Female singers described more work-related health complaints than males, a finding that corresponds to women in the general population. Older singers reported fewer complaints than younger singers, possibly because of selection effects or older singers acquiring strategies to avoid health-damaging behavior.

Modelling arts professionals' wellbeing and career intentions within the context of COVID-19

The COVID-19 pandemic had a substantial effect on the creative and cultural industries in the United Kingdom (UK), as seen in our first snapshot of the HEartS Professional Survey (April-June 2020, Phase 1, N = 358). By analysing data collected one year later (April-May 2021, Phase 2, N = 685), the aims of the current study are to trace the contributors to (1) arts professionals' mental and social wellbeing and (2) their expectations of staying in the arts. Findings show that artists continued to experience challenges in terms of finances, and mental and social wellbeing. Over half of the respondents reported financial hardship (59%), and over two thirds reported being lonelier (64%) and having increased anxiety (71%) than before the pandemic. Hierarchical multiple linear regression models, using the Mental Health Continuum-Short Form, Center for Epidemiologic Studies Depression Scale, Social Connectedness Scale, and Three-Item Loneliness Scale as outcome variables, indicate that perceived financial hardship continued to be associated with higher depression and loneliness scores. As in our first study, more physical activity before lockdown was associated with higher wellbeing and social connectedness scores, and higher self-rated health scores were associated with higher wellbeing and lower depression scores. Similarly, increases in physical activity during lockdown, as well as older age, were still associated with higher wellbeing and social connectedness scores and with lower depression and loneliness scores. An ordinal logistic regression model indicated three contributors to artists' professional expectations of remaining in the arts: greater proportion of income from the arts pre-pandemic, continued maintenance of skills, and greater proportion of freelance work. The results suggest that the wellbeing patterns observed at the start of the pandemic remained consistent a year on. They point to possible strategies to support wellbeing and underline the importance of finances for expectations of remaining in arts professions.

Norwegian music students' perceptions and experiences of challenges and resources for health

Introduction

Music students in higher education experience health-related challenges linked to practice and performance, while an understanding of these challenges and access to resources to deal with them are required to promote the students´ health. Health literacy and health education are integral parts of health promotion and resources for health, which encompasses health-related knowledge and competence aiming to improve health. The aim of this study was to explore Norwegian music students' perceptions and experiences of resources and challenges for health and address the following research question: What health-related challenges do music students in higher music education meet, and what health promoting resources do they need and use to deal with these challenges and promote their health?

Methods

We conducted a qualitative study including three focus group interviews with 13 music students aged between 19 and 31 years studying classical, folk, jazz or rhythmic genres from five different music departments in Norwegian universities. The Salutogenic model of health was used as theoretical framework and a few questions regarding the concept of health literacy were included in the interviews. We used thematic network analysis to analyze the data.

Results

Main health challenges were related to performance pressure and difficulties implementing good health habits in the students` daily lives. Furthermore, the findings revealed several resources that promoted the students' health: (1) Personal resources included situational understanding, using adequate coping strategies, high motivation and participating in regular physical activity. (2) Social resources involved an understanding of the importance of social support from peers and teachers and synergy created between themselves and the audience through sharing of music. (3) Environmental resources were linked to access to good rehearsal rooms. The music students expressed a need for increased competence in health promoting routines during practice and performance and suggested that health-related topics should be an integrated part of education.

Comparative characteristics of the functional state of future art teachers and other pedagogical specialties students

Purpose: to reveal the autonomic regulation peculiarities of the functional state based on indicators of the nervous and cardiovascular systems work of future fine arts and music teachers for the development of recommendations for the use of physical exercises. Material and methods 812 students of pedagogical institutions of higher education of Ukraine took part in the study. During psychophysiological testing, the following indicators were determined for each test: reaction time, number of errors. The shorter the reaction time, the higher the mobility of nervous processes. The lower the number of errors in the reaction test of choosing two elements out of three, the higher the stability of nervous processes. Orthostatic reactions were determined by the results of heart rate in the lying position and in the standing position. Parametric processing methods (Student's method for comparing average values) and hierarchical cluster analysis were used. Results Two groups of students - future teachers were identified: with a predominance of the sympathetic department of the autonomic nervous system and with a predominance of the parasympathetic department of the autonomic nervous system. The largest number of students with predominance of the parasympathetic department of the autonomic nervous system was found among students – future teachers of creative specialties (faculty of arts). Students of the Faculty of Arts have significantly longer latency time of visual-motor reaction compared to representatives of other faculties. This indicates a lower mobility of nervous processes of students of the Faculty of Arts in comparison with students of other faculties. Along with this, future art teachers have significantly fewer errors in the test for choosing 2 elements out of 3. This indicates greater stability of nervous processes in future teachers – representatives of art compared to other future teachers. Conclusions Students – future teachers of creative specialties (faculty of arts) have the more stability and less mobility nervous system in combination with the autonomic nervous system parasympathetic department predominance. That is why endurance exercises that do not require frequent switching of attention are suitable for them. Such exercises include walking, slow running, swimming et. all. Exercises should be performed for at least one hour. They will also be suitable for exercises with the activation of visual perception.

Assessing Performing Artists in Medical and Health Practice - The Dancers, Instrumentalists, Vocalists, and Actors Screening Protocol

ABSTRACT

Training in the performing arts exposes individuals to often extreme physical and psychological demands, which are linked to high occupational injury rates. The intense demands of performing artists have been likened to those of sport athletes. However, distinct differences in these demands necessitate specialized approaches to the health care of performing artists. Through the Athletes and the Arts collaboration, the American College of Sports Medicine and Performing Arts Medicine Association identified that the creation of a specialized preparticipation screening tool for performing artists would likely enhance health care for performing artists significantly. Based on a thorough review of established assessments and an extensive consultation process with domain experts, a consensus best-practice screening tool was developed: the Dancer, Instrumentalist, Vocalist, Actor (DIVA) Preparticipation Screening. This screening tool is modeled on the athletic preparticipation examination (PPE) in its structure and 30-min target duration. However, DIVA diverges considerably from the PPE in its content to address the specific risks and needs of performing artists. In particular, screening questions and physical examination procedures focus strongly on musculoskeletal injuries and mental health conditions, in response to the preponderance and interactions of these conditions appearing in performing artists. The DIVA tool presented is intended as a "living tool," which can be modified in the future to include new effective assessment techniques as appropriate. Training in the DIVA preparticipation physical examination is included as a core component of the essentials of performing arts medicine continuing education course described in detail in a companion manuscript in this issue.

The structure of occupational diseases in first-third-year piano students

BACKGROUND

The aim is to analyze the structure of occupational diseases in first-third year piano students studying.

METHODS

A total sample of 300 individuals participating in the research process underwent a complete medical examination at the end of each academic year.

RESULTS

Among piano students, number of those distributed to special medical groups for health reasons grew from 14 to 38% (p ≤ 0.02). The incidence of diseases of the muscular system increased from 58 to 71% (p ≤ 0.05), with the sharpest rise during the transition from the second to the third year of study. Similar tendencies were obtained for the incidence of hand-related diseases-their overall frequency advanced from 17 to 23% (p ≤ 0.05). The surge of morbidity in the transition from the second to the third year of study can be attributed to the increased educational load experienced by students during this period, as they begin to practice music intensively after theoretical classes. Сorresponding measures directed at preventing occupational diseases, bettering physical education, expanding the rest intervals between piano lessons are to be taken.

CONCLUSIONS

The research results indicate that the main occupational diseases of piano students are those related to hands and muscular system.

IMPACT

The obtained data suggest that the range of diseases is likely to progress throughout the musical training. The main diseases of piano students are those related to hands and muscular system. The sharpest rise was during the transition from the 2nd to the 3rd year of study.

Multiple Factors Influencing Healthy Performance for Pre-professional and Professional Classical Violinists: An Exploratory Study Focusing on Physical Health

Musculoskeletal complaints are common in pre-professional and professional classical violinists and these complaints can affect violinists' performance. Therefore, it is important to identify the factors that contribute to healthy performance in this population. Qualitative studies with a variety of stakeholders are able to provide insights from different perspectives into factors influencing healthy performance for the pre-professional and professional classical violinist. In the current small-scale, exploratory study, semi-structured interviews were conducted with various stakeholders; two classical violin students, one classical violin teacher, a physiotherapist, a professional classical violinist, who is also a performance coach, and a health specialist who also graduated as a professional classical violist. Thematic analysis was conducted using Atlas.ti 9. We identified six themes that were indicated as important by the participants in terms of ensuring healthy performance for the pre-professional and professional classical violinist. The themes were: (1) physical aspects (involved in playing the violin); (2) practice routine and techniques; (3) interaction between physical and mental aspects; (4) culture; (5) role of the main subject teacher; and (6) preventive measures. Furthermore, when asked specifically about the development of a physical screening tool, the participants indicated that such a tool should include multiple factors covering various regions of the body, the inclusion of a questionnaire on risk-factors, and follow-up measurements. Also, collaborations between health professionals and main subject teachers were recommended as part of the screening tool to increase commitment of participating students. The results of the current study are based on the opinions, attitudes, and ideas of a small, selected group of participants only and cannot be generalized to a wider group of violinists. More research is needed regarding factors influencing healthy performance, before conservatoires and professional orchestras can develop programs for a healthy playing environment for pre-professional and professional violinists.

The Time Course of Event-Related Brain Potentials in Athletes' Mental Rotation With Different Spatial Transformations

Studies have found that athletes outperformed non-athletes in mental rotation tasks with both object-based and egocentric transformations (ET), but the effect of sport expertise on the processing stages (i.e., perceptual stage, rotation stage, and decision stage) remains conflicted. Bearing the view that the stages occur sequentially and the high temporal resolution of event-related brain potentials, this study focused on brain processing during mental rotation and was designed to determine the time course of electrophysiological changes in athletes and non-athletes. A total of 42 divers and non-athletes were recruited for the study. A mental body rotation task with object-based and egocentric transformation conditions was conducted, and the reaction time (RT), accuracy, performance stages, N2 latency, amplitude, and the amplitude of rotation-related negativity (RRN) were recorded. Behavioral results demonstrated higher accuracy for athletes at 120° and 180°. Moreover, as compared to non-athletes, the enlarged amplitude of N2 and RRN were confirmed in both transformations for athletes and were correlated with the performance stages and athletes' professional training years. The present study provided a deeper insight into the relationship between sports training, behavior performance, and brain activity.

The Motor Impact of the Static Balance in the Up Plank Position on Three Different Balls in Physical Activities of Physical Education Students

The present study aimed to assess the capacity of stability and motor impact in the development of the balance of student athletes by reducing the support surface on the ball in the up plank position, by using three categories of balls of equal size, but with different elasticity and weight. In this study, the second aim was to investigate the differences in maintaining static balance, on different balls, between those who are practicing individual sports or team sports. The total study sample include 48 students, active athletes (45.8% of individual sports and 54.2% of team sports), age X ± SD 18.74 ± 1.94 years. The research included two test sessions (initial and final) applied in two stages. The static balance tests were performed by measuring the time maintaining the up plank position with two and three points of support on the three balls, with different characteristics of elasticity and ranges of deformation: medical ball, handball ball and fitness ball. The results of the study showed that the superior initial and final results were recorded on the fitness ball, and the inferior results on the medicine ball. The upper difference was recorded at the up plank position with two support points (arms, legs) on the fitness ball, at 4980 s, and the lowest in the same test on the medical ball, at 3420 s. The largest difference was recorded at the up plank position with three support points on the handball ball, at 7.082 s, and the lowest in the same test on the medical ball, at 3.093 s. The subjects of the study perceived that the most difficult position to execute was the up plank position on the medical ball with two support points, with 43.8%, and the easiest stability was registered in the up plank position on the fitness ball with three points of support, of 37.5%. The relevance of the research results from the possibility of using different balls in conditions of positioning and body posture with a diminished support base in order to improve physical fitness.

The Effects of COVID-19 Lockdown 1.0 on Working Patterns, Income, and Wellbeing Among Performing Arts Professionals in the United Kingdom (April-June 2020)

This article reports data collected from 385 performing arts professionals using the HEartS Professional Survey during the COVID-19 Lockdown 1.0 in the United Kingdom. Study 1 examined characteristics of performing arts professionals' work and health, and investigated how these relate to standardized measures of wellbeing. Study 2 examined the effects of the lockdown on work and wellbeing in the respondents' own words. Findings from Study 1 indicate a substantial reduction in work and income. 53% reported financial hardship, 85% reported increased anxiety, and 63% reported being lonelier than before the crisis. 61% sought support on finances while only 45% did so on health and wellbeing. Multiple regression analyses, using the Mental Health Continuum-Short Form, Center for Epidemiologic Studies Depression Scale, Social Connectedness Scale, and Three-Item Loneliness Scale as outcome variables, indicate that perceived financial hardship was associated with lower wellbeing and higher depression and loneliness scores. Higher self-rated health was associated with higher wellbeing and lower depression scores. More physical activity before lockdown was associated with higher wellbeing and social connectedness scores, as well as lower loneliness scores, and an increase in physical activity during lockdown compared with before, as well as older age, were associated with higher wellbeing and social connectedness scores, and lower depression and loneliness scores. Thematic inductive analysis of 341 open responses in Study 2 identified five overarching themes characterizing the effects of Lockdown 1.0: lost or uncertain work and income, including canceled work, financial concerns, and uncertainties for the future; constraints of lockdown working, including challenges of working at home, struggles with online work and skill maintenance, and caring responsibilities; loss and vulnerability, including reduced social connections, lack of support, vulnerability, feelings of loss and grief, and concern for others; detrimental effects on health and wellbeing, including anxiety, low or unstable mood, poorer physical health, and lack of motivation; and professional and personal opportunities, including coping well or living more healthily, more time and less pressure, new possibilities and activities, enhanced social connections, and new skills. Lockdown 1.0 had profound effects on performing arts professionals, but our findings reveal some opportunities and compelling links between positive wellbeing and physical activity.

Physical Activity, Sedentary Behavior, Anxiety, and Pain Among Musicians in the United Kingdom

Context and Aims

Although some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders (PRMDs) among musicians, the evidence is still mixed. Furthermore, little is known about musicians’ general engagement in physical activity (PA), their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs.

Methods

Following a cross-sectional correlational study design, both standardized and ad hoc measurements were used to investigate self-reported PA [International Physical Activity Questionnaire – Short Form (IPAQ-SF)], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control (CDC); Determinants of Physical Activity Questionnaire (DPAQ)]; sedentary behavior [Sedentary Behavior Questionnaire (SBQ)]; pain [36-Item Short Form Survey Instrument (SF-36)] and PRMDs (frequency and severity); reported physical exertion (RPE); anxiety [Hospital Anxiety and Depression Scale (HADS)]; practice behaviors (e.g., practice time; taking breaks frequency; warming up); and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018.

Results

Demographic information was obtained from 111 respondents, mostly undergraduate students (UGs) from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information (by 43% of respondents), and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed “abnormal” clinical anxiety and found playing their instruments “somewhat hard” (RPE) on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs.

Conclusion

The relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged.

Health and Wellbeing in Higher Education: A Comparison of Music and Sport Students Through the Framework of Self Determination Theory

Students in Higher Education report high levels of mental health issues and psychological distress. Paradoxical findings on performance-orientated students, such as athletes and musicians, suggest that the demands of highly skilled vocations may enhance wellbeing while being detrimental to physical and mental health. To provide timely and appropriate help, institutions need to understand what areas of health and wellbeing are compromised in different student groups. In this study, we compared performance-orientated (music and sport) students to other students and the general population on a selection of wellbeing (WHO5, PWS, and WEMWBS), mental and physical health (K10, SF12, and PHQ9), and trait measures (TIPI, LOT-R, and PCS). Through an online survey (N = 273), data were collected from bachelor and master students (n = 135 music, n = 67 sport, n = 71 controls). Students' scores were compared to the general population, where norm values were available, and analyzed within and between groups. Multiple regression was performed to investigate trait measures as predictors of wellbeing. All groups scored significantly below population norms for wellbeing and mental health. One third were classed as having moderate to severe depression. Musicians scored higher openness to experience than athletes. While sport students showed a highly homogenous within-group profile, music students' scores differed significantly across study courses (e.g., performance and composition). Predictors for wellbeing were: optimism and emotional stability (all students); additionally conscientiousness (sport and music); and perceived competence (music only). As expected, students reported more health and wellbeing issues than general population. Distinct profiles of wellbeing were apparent for performance-orientated students. Results are in line with Self Determination Theory and suggest the need for institutions to embed health and wellbeing into a 'living curriculum' to accommodate the needs of different student groups. The WHO5 emerged as a parsimonious yet sensitive measure for mental health and wellbeing in student populations.