Group singing or solo singing to improve vascular health in older adults with coronary artery disease (GOT VOICE): A Feasibility Study - Cardiovascular disease (CVD) is the leading cause of death in the country threatening the health of the elderly. Participation in exercise and/or cardiac rehabilitation (CR) programs reduces mortality and risk of a major cardiovascular event in secondary prevention populations, including older adults. Unfortunately, older adults are less likely to participate in regular exercise or CR due to age-related complexities, including multi-morbidities (arthritis, chronic lung disease, diabetes), polypharmacy, frailty, deconditioning, falls, disability, and other challenges that make exercise participation difficult. Alternative rehabilitation therapies are needed to reduce CVD burden and improve health in the aging population. Singing is a physical activity, and the physiological demands of singing are comparable with walking at a moderately brisk pace, suggesting that the health benefits with singing may overlap with that of exercise. Unlike traditional physical exercise, the impact of singing on cardiovascular health, especially in older adults, has not been extensively studied. Endothelial dysfunction predicts cardiovascular events, and physical exercise improves vascular endothelial function. Our team has been the first to demonstrate that solo singing improves microvascular endothelial function acutely, regardless of singing expertise. We studied 65 subjects (mean age 68±7, 40% women), showing a significant improvement in microvascular endothelial function, as measured by the Framingham reactive hyperemia index (fRHI), after 30 minutes of singing in the instructional video arm (30.9%, p=0.007) compared to the rest control. The observed change in fRHI translates into a ~25% reduction in CVD risk, which is comparable to traditional CR participation. Based on these findings, the overall objective of the planned future RCT is to test our central hypothesis that habitual singing over several weeks, similar to habitual exercise, will lead to sustained and favorable vascular adaptation, thereby lowering future CVD risk. The overall objective of this R34 proposal, titled “GrOup Singing or Solo Singing To improve Vascular health in Older adults wIth Coronary artery disEase (GOT VOICE): A Feasibility Study”, is to refine, diversify, and protocolize the singing interventions and test the feasibility of the GOT VOICE parallel randomized control trial design that we would implement in the future, larger clinical trial of efficacy. Forty-eight subjects will be randomized to either (1) in-person group singing or (2) solo singing with an instructional video sing-along series created by a voice expert, or (3) a health education attention control arm. All interventions are 12 weeks in duration. We hypothesize that participation rates in both intervention arms of GOT VOICE will be superior to historical traditional CR program participation rates in adults ≥55 years old with CVD. Feasibility will be determined by recruitment, retention, adherence, and acceptability rates. With a multi- disciplinary team including board-certified music therapists, a voice professor, biostatisticians, a community medicine expert, and a preventive cardiologist and physician scientist with a 6+ year history of collaboration, we are confident in our ability to execute the aims of this proposal.
