Singing together for health: Biopsychosocial benefits for people with COPD and their caregivers

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive respiratory illness accompanied by physiological and psychosocial challenges such as stress, stigma, and social isolation. Community-based arts interventions like group singing may offer an accessible means of addressing these challenges. Singing simultaneously engages respiratory function, mood regulation, and social connectedness through shared cultural practice and synchrony. Few studies, however, have examined inclusive singing programs involving both individuals with COPD and their caregivers.MethodsThis study evaluated the biopsychosocial benefits of the Chorpidus Choir, a hospital-based community singing program in Oldenburg, Germany. Forty-seven participants (16 with COPD; 31 without COPD, including family members and caregivers) attended a single choir session. Self-report measures of stress, mood, boredom, and social connectedness were completed before and after singing. Saliva samples were collected pre- and post-session to assess cortisol as a physiological marker of stress.Results and ConclusionsSinging was associated with significant improvements in mood and social connectedness and reductions in self-reported stress, boredom, and cortisol levels. No interaction between time (pre/post) and group (COPD vs. non-COPD) emerged, suggesting comparable benefits across participants. A plausible explanation for the uniform cortisol reduction lies in the respiratory dynamics of singing, which regularize and extend exhalation. Structured breathing patterns engage vagal pathways, promoting parasympathetic activation and autonomic balance. These findings highlight inclusive group singing as an enjoyable, culturally meaningful, and scalable arts-based approach to enhancing wellbeing in chronic illness and caregiving contexts. Keywords: inclusive group singing, COPD, biopsychosocial, cortisol, social connectedness