The Arts in Psychotherapy 55 (2017) 40–45

Contents lists available at ScienceDirect

The Arts in Psychotherapy

The effect of group singing on the voice and swallow function of

healthy, sedentary, older adults: A pilot study
Lorna E. Segall
University of Kentucky, Lexington, KY, United States

a r t i c l e i n f o a b s t r a c t

Article history: Reduced respiratory function can impact an older adult’s nutritional intake, exercise endurance, and social
Received 20 May 2016 engagement, which can affect an individual’s quality of life. Because respiratory health can be maintained,
Accepted 17 February 2017 regained or rehabilitated through regular exercise and stress management, early intervention may play an
Available online 25 March 2017
important role in the health of older adults. Music therapy may provide effective treatment outcomes. The
purpose of this study was to evaluate the effectiveness of a group singing protocol on the conversational
Keywords:
intensity, maximum phonation time, and mean swallowing pressure of healthy, sedentary, older adults.
Group singing
Participants (N = 20) were randomly assigned to either experimental group A – a 4 week program –
Swallow function
Respiratory health
or experimental group B – an 8 week program. Each group attended twice weekly rehearsals lasting
Music therapy for 45 min. Rehearsals utilized vocal exercises, vocal pedagogy, and singing songs characterized by wide
ranges, lyrical tongue twisters, and dynamic variation. Rehearsals were conducted by a board-certified
music therapist specializing in voice.
Results showed significant increases in all areas of measurement suggesting that group singing inter-
ventions may meaningfully contribute to the respiratory health of the older adult population. Implications
for future research are discussed.
© 2017 Elsevier Ltd. All rights reserved.

Introduction tion. Music therapy, vocal exercise in particular, is an intervention

Age-related decline in the respiratory system can be character-
ized by changes in voice production, decreased ability to combat
respiratory infection, compromised cough reflex, and weakening of
respiratory musculature (Saxon, Etten, & Perkins, 2010). As a result,
reduced respiratory function can impact an older adult’s nutritional
intake, exercise endurance, and social engagement, all of which
can affect an individual’s quality of life (Watsford, Murphy, & Pine,
2007). Maintaining healthy respiratory function is important for
this population as it ameliorates physiological and psychological
issues that often accompany the aging process. Aspiration pneu-
monia, cough effectiveness, isolation, depression, and quality of
life represent several such issues (Eisenstadt, 2010; Meyer, 2005;
Sakano et al., 2014; Saxon et al., 2010). Because respiratory health
can be maintained, regained or rehabilitated through regular exer-
cise and stress management (Sakano et al., 2014), early intervention
may play an important role in the health of older adults. Inter-
vention programs incorporating community-based organizations
which can facilitate large groups of people may be an effective solu-
E-mail address: lorna.segall@uky.edu
that has the potential to provide effective treatment.
Review of literature
Music therapy is the clinical and evidence-based use of music
interventions to accomplish individualized goals within a ther-
apeutic relationship by a credentialed professional who has
completed an approved music therapy program (American Music
Therapy Association website, 2014). Music therapy provides an
enjoyable and rewarding environment for therapy while enhanc-
ing the patient experience and encouraging adherence to treatment
protocols (Wininger & Pargman, 2003). The cornerstone of music
therapy treatment protocols involves utilizing patient preferred
music. Research has demonstrated that use of preferred music
enhances treatment outcomes and compliance (Yinger & LaPointe,
2012; Ziv & Lidor, 2011). Additionally, active music making elevates
patient response and participation. When given a choice between
active music making (lyric analysis, songwriting, and percussion
interventions) or passive music listening (recorded music through
the use of an iPod), more participants chose to attend the active
music making therapy session (Silverman & Leonard, 2012). The
active music making session also reported a higher rate of enjoy-
ment, longer duration of time spent in therapy and an increased rate

http://dx.doi.org/10.1016/j.aip.2017.02.007
0197-4556/© 2017 Elsevier Ltd. All rights reserved.
 L.E. Segall / The Arts in Psychotherapy 55 (2017) 40–45
Table 1
Weekly singing assignments.
Week Assignment
1 Three times each day find your best posture and consciously utilize your diaphragm for inhalation and exhalation. Observe
your breath when you yawn.
2 Observe how you breathe in conversation versus singing. Continue exercises from week 1.
3 Practice sustaining the /ah/ vowel as long as you comfortably can. Remember to find your best posture and utilize
diaphragmatic breathing. Continue exercises from week 1 and week 2.
4 Sing your favorite songs either to yourself or with friends while remaining mindful of your breath. Continue exercises from
weeks 1, 2, and 3.
of perceptions of helpfulness (Silverman & Leonard, 2012). The live
act of singing has demonstrated effectiveness in treating various
issues, such as respiratory function.
Tamplin et al. (2013) found that persons with quadriplegia expe-
rienced improved respiratory function, vocal function, and mood
after participating in a singing protocol. Participants in this study
exhibited significant improvements in areas of speech intensity and
maximum phonation time when compared to the control group.
This study illustrates singing’s impact on the physical and emo-
tional aspects of recovery. A singing protocol for patients recovering
from stroke improved not only their swallowing function but also
showed significant improvements in pitch, respiratory function,
and laryngeal control (Kim, 2010).
Diaphragmatic breathing, as it related to singing, was effective in
significantly improving maximum inspiratory pressure (MIP) and
maximum expiratory pressure (MEP) outcomes in young people
with cystic fibrosis (Irons, Kenny, McElrea, & Chang, 2012). Results
of the study demonstrated a positive impact on participants’ emo-
tional status and quality of life. This increase in quality of life may
be attributed to the capacity for singing to offer emotional expres-
sion and aid patients in coping with stress and discomfort. The
researchers described singing as an all-inclusive exercise for the
respiratory, muscular, and vocal network. It is important to note
that the elements of the respiratory system are not mutually exclu-
sive. Each element coordinates with the other to achieve sound,
pitch, and duration.
Singing is a multi-faceted activity that requires cognitive and
physical engagement while promoting quality of life and treat-
ment rewards (Irons et al., 2012). Furthermore, singing requires
interaction between the voice and the respiratory system to
achieve desired intonation, phrasing, and artistic outcomes. These
artistic outcomes motivate the patient and increase participation
(Yinger & LaPointe, 2012). Singing provides opportunities for group
work, which naturally incorporates the emotional and psycho-
social aspects of care. Singing as a treatment protocol has been
explored regarding its rehabilitative effects on the respiratory func-
tion of many populations including those with multiple sclerosis,
quadriplegia, cystic fibrosis and stroke (Irons et al., 2012; Kim,
2010; Tamplin et al., 2013; Yinger & LaPointe, 2012). In addition,
exploring music’s preventative effectiveness is important.
Cardiovascular disease is one of the most significant and pre-
ventable health issues affecting citizens nationwide (Sun & Buys,
2012). Through proper treatment regimens that include increased
exercise and stress management, cardiovascular disease is pre-
ventable and treatable (CDC). It is the combination of physical
and behavioral management strategies that may increase pre-
ventive treatment outcomes. Singing’s life-long and cross-cultural
elements increase accessibility and effectiveness for participants,
making it a potentially ideal treatment method for thei wide-spread
health issue (Sun & Buys, 2012). The effect of singing on the men-
tal and physical condition of the elderly was explored in a 2014
study (Katsuhisa et al., 2014). Participants indicated feeling more
refreshed, light-hearted, and relaxed via the Visual Analog Scale;
total mood disturbance scores of the Profile of Mood States also
improved. Physiologically, levels of cortisol decreased, indicating
41
lower levels of stress. It is of particular interest to note that these
improvements were achieved regardless of participant’s preference
for singing.
As many older adults fulfill the definition of healthy, but require
assistance with mobility, they could easily be overlooked due to
their relative well-functioning and quality of life. Because this lim-
ited mobility lends itself to a more sedentary lifestyle, it places this
population at greater risk for a compromised respiratory system,
compared to the activity of a more mobile individual. Preventative
onset of respiratory related dysfunction in older, healthy adults
is advantageous as it increases quality of life, lessens age-related
decline, and reduces medically related activities and cost.
Therefore, the purpose of this study was to evaluate the effec-
tiveness of a, group singing protocol on the respiratory, voice
production, and swallow functions of healthy, sedentary, older
adults.
Method
Participants
A convenience sample of 20 healthy, sedentary, older adults (15
females, 5 males) were recruited for this pilot study. Ages of partic-
ipants ranged from 81–94 (M = 85.5, SD = 4.47). Participants were
assigned to either (1) experimental group A or (2) experimental
group B. Experimental group A (n = 10) participated in a singing
protocol program for 45 min, twice a week, for four weeks. Exper-
imental group B (n = 10) participated in the same singing protocol
program for 45 min, twice a week, for eight weeks. To be included in
data analysis, participants must have completed 75% of the singing
protocol.
Participants were recruited via word of mouth from the
researcher at assisted living facilities in North Florida and South
Georgia. Inclusion criteria for participation required an absence
of speech and language disorders, respiratory disorder, dysphagia,
and formal singing lessons within the previous five years. Partici-
pants must also be receiving a regular diet, i.e. no pureed or softened
foods. The researcher informed facility staff of the purpose of the
study so that appropriate individuals could be notified of study
opportunity. Criteria also required that participants be identified
by facility staff as competent and able to participate in the study.
Research approval was granted by the Florida State University IRB
committee. Individuals who indicated an interest in participating
attended an informational presentation outlining the goals of the
study and treatment procedures and were encouraged to ask ques-
tions. Only those indicating a willingness to complete the program
in its entirety were admitted to the study. All signed consent forms
were reviewed.
Definitions
For the purposes of this study, the following operational defi-
nitions were identified. Sedentary was defined as: habitual sitting;
a lifestyle characterized by inaction where activities of daily living
can be performed from a seated position (Mosby, 2009). Healthy
42 L.E. Segall / The Arts in Psychotherapy 55 (2017) 40–45
Table 2
Mann–Whitney U results of pre-test scores to establish group consistency.
MPT SLM
U 49.00 48.00
Z −0.07 −0.15
p 0.93 0.87
MPT – maximum phonation time; SLM – conversational intensity; MSP – mean
swallowing pressure.
was defined as: a condition of physical, mental, and social well-
being. It is also the absence of disease or other abnormal condition
(Mosby, 2009).
Procedures
Pre-test and post-test measures were collected for data anal-
ysis. Pre-test evaluations were individually administered the day
before the first day of the intervention and post-test evaluations
were administered the day after completion of the study by the
researcher.
Dependent measures
Swallowing measures
Mean swallowing pressure (MSP) is defined as the amount of
pressure deployed by the tongue during the act of swallowing.
Tongue elevation strength is often indicative of an individual’s
swallowing ability (Steele, Bailey, & Molfenter, 2010; Stierwalt &
®
Youmans, 2007; Youmans & Stierwalt, 2006). The IOPI is a hand-
held device that measures tongue strength. An individual places a
small, disposable, plastic bulb on the tongue and presses it to the
roof of the mouth. The maximum pressure (Pmax ) is measured in
kilopascals (kPa). The researcher received training from a speech
®
language pathology expert on how to use the IOPI and perform
®
calibration procedures. The IOPI has been used in several experi-
ments to measure tongue strength which is often a reflection of an
individual’s capacity to swallow (Clark, Henson, Barber, Stierwalt,
& Sherrill, 2003; Stierwalt & Youmans, 2007).
During data collection participants were instructed by the
®
researcher on how to use the IOPI. In accordance with the IOPI
user manual participants were instructed to “Press the tongue bulb
®
with your tongue as hard as you can for about 2 seconds” (IOPI , pg
10). Participants were then instructed to rest for 30–60 s and then
repeat the tongue press protocol. In total this was done three times.
Each event was recorded and the highest was noted as peak tongue
strength and calculated during statistical analysis.
Voice measures
Conversational intensity level is defined as the level of vocal
intensity as evidenced during normal conversation (Follmer, 2013).
A DT-85A CEM sound level meter (SLM) recorded measurement
while participants read the passage ‘Limpy the fuzzy, yellow, baby
duck’ aloud. The SLM was positioned on a tripod approximately
12 inches from the participant while reading the passage. This
measurement was ensured via a piece of string attached from
the microphone and extended to the patient’s mouth. Measure-
ments were taken in the same environment on each occasion.
The microphone was held the same distance (12 in.) away from
the participant on each occasion. Participants were sitting in the
same chair or wheelchair for each assessment. Measurement was
recorded in dB. The SLM device was set to max/min indicating that
the average maximum level of dB would be recorded.
Maximum phonation time (MPT) is the maximum time an indi-
vidual can sustain a vowel in one deep breath at a comfortable
pitch and loudness. This measure is commonly used to assess an
Table 3
Mann–Whitney U results of post-test scores.
MSP MPT SLM MSP
35.50 U 47.50 49.50 36.50
−1.10 Z −0.19 −0.038 −1.02
0.27 p 0.84 0.96 0.30
MPT – maximum phonation time; SLM – conversational intensity; MSP – mean
swallowing pressure.
individuals’ level of respiratory function through phonation. MPT
is a feasible, inexpensive, and non-invasive means of evaluating
an individual’s respiratory ability (Choi, Rha, & Park, 2016). The
researcher demonstrated the task for each participant at pre and
post test. The vowel /ah/ was consistently used as a phonation
syllable. A stopwatch was used to record time. Participants were
asked to demonstrate MPT three times. The longest of the three was
recorded for data analysis. Measurement was recorded in seconds.
Singing intervention
Developed by a board-certified music therapist with a specialty
in voice, the singing protocol for this study utilized a four-point
singing method incorporating elements of the vocal pedagogy
for young people by Philips (1996). Forty-five-minute group ses-
sions included: five minutes of posture instruction and alignment
to emphasize the production of healthy tone, ten minutes of
diaphragmatic breathing instruction to acquaint participants with
the anatomy and function of the diaphragmatic muscle, ten minutes
of vocal warm-ups to practice posture and diaphragmatic breath-
ing, and fifteen minutes of singing participant preferred songs to
provide an all-encompassing activity in which to engage the par-
ticipant. To ensure optimal engagement of the apparatus, songs
demonstrating a wide range of pitches and phrasing was incorpo-
rated. Song selection was based on participants’ preferred music
style and genre to ensure optimal enjoyment, engagement and
compliance. Finally, five minutes were allocated for initiation and
closure of session. The music therapist demonstrated appropri-
ate application of techniques and provided an encouraging and
comfortable atmosphere. All sessions were instructed by the same
music therapist. Each week, participants were given daily home-
work assignments, both verbally and in writing, to encourage
continued exercise and self-awareness of breathing and posture
(see Table 1).
Research question #1: How does singing affect participants’ vocal
function as measured by conversational intensity level and maxi-
mum phonation time?
Research question #2: How does singing affect participants’ swal-
low function as evidenced by mean swallowing pressure?
Research question #3: Does a four-week versus eight-week
singing protocol affect participant outcome?
Results
Twenty adults between the ages of 81 and 94 met criteria,
enrolled in and completed the intervention. Of the twenty partic-
ipants, 15 were female, 5 were male and all participants were of
the non-Hispanic/white race. Statistical analyses were calculated
using the IBM SPSS 22 software. Values of p < .05 were identified as
significant. To determine equality of samples baseline MPT, SLM,
and MSP scores were calculated (p > .05) (see Table 2).
Mann–Whitney U analyses of the three post-test dependent
variables scores were used to determine differences between the
four-week and eight-week treatment groups. Results indicated no
significant differences for the three dependent measures of each
group (see Table 3).
 L.E. Segall / The Arts in Psychotherapy 55 (2017) 40–45 43

Table 4 tion, voice, and swallowing function of disease specific populations

Wilcoxon Signed-ranks results of experimental group a and experimental group b.
such as cystic fibrosis, Parkinson’s disease, and muscular dystro-
Group MPT SLM MSP phy (Irons et al., 2012; Katsuhisa et al., 2014; Kim, 2010; Wiens &
Group A Reimer, 1999; Yinger & LaPointe, 2012), but research in the area of
Z −2.67 −2.68 −2.415 singing and the healthy older adult population would benefit from
p p < 0.01 p < 0.01 p < 0.01 continued exploration.
Group B Research Question #1: How does singing affect participant’s
Z −2.87 −2.92 −2.84 vocal function as measured by conversational intensity and MPT?
p p < 0.01 p < 0.01 p < 0.01 Results of the study indicate that both experimental groups sig-
Group A, four-week intervention; Group B, eight-week intervention. nificantly improved in level of conversational intensity and MPT
as a result of the treatment protocol (see Table 4). These results
are reflective of existing research exploring singing’s impact on
Table 5
Means and standard deviations. conversational intensity and MPT (Tamplin et al., 2013). Corrob-
oration of these results with prior research supports the efficacy
Group M SD
of singing as a relevant intervention for older adults. Particu-
Group A & Group B larly as older adults begin to experience age-related impairments
Pre-test
such as limited mobility, isolation, and general physical weak-
Ah 11.75 3.89
SLM 70.25 3.86
ening; incorporating meaningful and multi-faceted interventions
MSP 34.10 5.60 becomes important. Group singing interventions address multiple
Group A & Group B therapeutic objectives simultaneously. While the primary objective
Post-Test of this group singing intervention emphasized physical improve-
Ah 16.15 4.46
ments, the psycho-social benefit, while not measured, was evident
SLM 73.75 3.93
MSP 38.50 4.19 via participant comments. This well-rounded approach to patient
Group A care results in whole-person improvement and may contribute to
Ah 13.90 4.49 increased compliance, response, and quality of life.
SLM 72.35 4.70 Research Question #2: How does singing effect MSP?
MSP 34.35 6.20
Group B
Results of the current study demonstrated that group singing in
Ah 14.00 5.00 either a four-week or eight-week intervention period significantly
®
SLM 71.65 3.80 improved MSP as measured by the IOPI . A meta-analysis of exist-
MSP 37.65 5.06 ing research indicates that a normal population falls within a Pmax
Group A, four-week intervention; Group B, eight-week intervention. range of 40–80 kPa with an average range of 63 kPa. In the present
study pre-test MSP averages and ranges for Group A were 32.3 with
a range of 19–39 kPa. Group B averaged 36.5 kPa and demonstrated
For each experimental group a Wilcoxon Signed-ranks analy- a range of 29–43 kPa. Previous studies demonstrated that, “. . .95%
ses of the pre-test and post-test scores of the three dependent of normal people, including the elderly,” have a Pmax of greater than
measures were calculated to determine statistical outcomes of the 34 kPa (IOPI Medical, 2013). However, considerable variability does
intervention. Results indicated significant differences for all mea- exist even within normal populations that do not demonstrate any
sures in each of the groups (see Table 4). For information regarding swallowing or speech difficulties (Nicosia et al., 2000; Stierwalt &
means and standard deviations for each of the groups in Table 5. Youmans, 2007; Youmans & Stierwalt, 2006). Gender and age may
Although not an intended focus of this study, the psycho-social impact levels of strength.
benefit of group singing in this environment is clear. Music inspired Gender does not appear to contribute to MSP levels for those
meaningful conversations between participants. “It feels so good to who are middle-aged or elderly (IOPI Medical, 2013). Age-related
just talk,” said one participant. “I miss having someone to talk to and decline in tongue strength produces varying outcomes. In 2002
I feel like my voice is stronger from using it more.” After sessions con- Stierwalt and Youmans (2007) utilized 77 healthy adults to
cluded comments such as, “I’m so glad I came” or “I had so much record measures of tongue strength. Negative correlations between
fun” were frequently heard. The group singing protocol demon- age and levels of tongue strength were found. Conversely, 90
strated not only benefits for voice and swallow function but also participants between the ages of 20–79 demonstrated signifi-
encouraged attendance, participation, and enhanced relationships cant differences between tongue strength and age (Stierwalt &
between residents, caregivers, and facility staff members. These Youmans, 2007; Youmans & Stierwalt, 2006). Further research
observations corroborate findings of related research (Katsuhisa is needed to confirm the relationship between age and tongue
et al., 2014; Sakano et al., 2014; Tamplin et al., 2013; Yinger & strength.
LaPointe, 2012; Ziv & Lidor, 2011). ®
Participants enjoyed the immediate feedback the IOPI pro-
vided regarding their MSP gains. The results gave objective and
Discussion measureable incentives for participants to continue attending ses-
sions and participating.
The purpose of this study was to determine if an intensive group Research Question #3: Does a four-week versus eight-week
singing protocol may enhance healthy, sedentary, older adults’ res- singing protocol effect participant outcome?
piration, conversational intensity, and swallowing functions. This Significant differences in both groups suggest that similar
investigation was conducted by comparing two equal treatment results can be achieved within the four-week treatment period.
groups. Each group received the same protocol differing only in Speculation suggests that optimal advancements for Group B may
length of intervention. Significant differences were found among have been reached at four weeks thereby allowing the additional
each experimental group in all measures. The findings of the cur- four weeks to function as a maintenance period. Assessment at
rent study are similar to those of previous research investigating mid-line may have provided a clearer picture regarding participant
the relationship between healthy, older adults and singing (Sakano improvement. Follow-up assessments of each group at the two,
et al., 2014; Follmer, 2013; Maslan, Leng, Rees, Blalock, & Butler, four, or six-week mark, for example, may provide further insight
2011). Literature has also explored the effect of singing on respira- regarding duration of protocol impact beyond post-test measures.
44 L.E. Segall / The Arts in Psychotherapy 55 (2017) 40–45
Prior research indicates treatment periods of 4–6 weeks are widely
used and supported (Follmer, 2013; Irons et al., 2012; Kim, 2010;
Yinger & LaPointe, 2012). Frequency of treatment also appears to
influence treatment outcomes.
Results of the current pilot study demonstrate that group
singing interventions for healthy, sedentary, older adults provide
effective and valuable opportunities for respiratory health. These
findings support the continued need for music facilitated treatment
interventions for this population.
Limitations and challenges of the present study
Limitations of the present study include sample size, a lack
of a control group for comparison, age/gender issues, and mea-
surement. While this study focused on the healthy, sedentary,
older adult, participants demonstrated varying levels of “seden-
tary” and “healthy”. According to the facility lifestyle director, for
some participants this was either one of many activities residents
participated in during the week or this may have been the only
social activity they engaged in. Assessments such as the Physical
Activity Scale for the Elderly (PASE) which measures levels of occu-
pational, household, and leisure activity in adults 65+ (Washburn,
Smith, Jette, & Janney, 1993) may further ensure a homogenous
sample thereby resulting in more accurate reflections of treatment
effect. Ability to maintain appropriate posture as a result of physi-
cal challenges or durable medical equipment may have contributed
to differing levels of response. Variations within the environment
were also challenging.
While every effort was made to ensure similar testing environ-
ments for each group, participants were tested in two different
facilities in their private rooms. Specifically relating to conversa-
tional intensity as measured by a sound level meter, the researcher
worked diligently to minimize background noise and create iden-
tical environments for pre-test and post-test assessments. The
dynamic and unpredictable nature of an assisted living facility is
not always conducive to consistency. Some measures were taken a
second time if sporadic noise instances occurred.
Gender and age play important roles in conversational intensity
levels, respiration, and swallowing function (Strath, 2006; Nicosia
et al., 2000; Sakano et al., 2014; Saxon et al., 2010; Sharma &
Goodwin, 2006) for the aging population. For example, decline in
vocal health of women begins later and is less severe than that
of men (Saxon et al., 2010). In the current study, three times as
many women as men participated. Inconsistency as a result of age
and gender should be considered in future research in an effort to
achieve a more balanced gender distribution.
Implications for future research
Questions raised by this study require continued research to
further understand the relationship between singing, respiratory,
voice, and swallow function of the healthy, sedentary, older adult
population. Interventions for this study were 45 min, twice a week
for either four weeks or eight weeks. Identifying the optimal ther-
apeutic treatment protocol would provide valuable information.
Future research might also explore the relationship between length
of treatment and duration of treatment effects. The length of inter-
vention and intensity of sessions may require re-evaluation.
The current study did not implement a measure of healthy
or sedentary. However, since methods of identifying participants’
activity levels are available these should be applied in further stud-
ies. Future research might also explore retention rates of group
singing programs versus related speech therapies, or participant
perceptions of speech therapies in combination with music ther-
apy. Treatment objectives are most effective when adherence is
high.
Conclusion
Maintaining respiratory health as an older adult is crucial
for combating physiological and psychological age-related issues
such as pneumonia, cough effectiveness, isolation, and depression
(Saxon et al., 2010). Additionally, reduced respiratory function may
impact nutrition, exercise, and the social aspects related to living a
high quality of life (Watsford et al., 2007). Maintaining or regaining
respiratory well-being is possible through exercise and moderating
levels of stress (Tockman, 1994). Music therapy programs focus-
ing on respiratory enhancement can offer effective outcomes (Kim,
2010; Haneishi, 2001; Loewy, 2014; Yinger & LaPointe, 2012).
Incorporating a group singing protocol into the plan of care is
a cost-effective, enjoyable, and valuable method of treating res-
piratory, voice, and swallowing function issues for the healthy,
sedentary, older adult. Continued research in this area is warranted
and should explore longitudinal analyses, intensity of treatment,
and program retention.
Funding support received
None.
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