In order to sing or play a wind instrument, you have to continually take deep breaths. This expands your lungs, promoting healthy clearance of mucus. If you’re a shallow breather, small portions of your lung can collapse, interrupting the circulation of mucus out of your lungs, eventually leading to respiratory infections such as pneumonia and bronchitis.

Inflating your lungs all the way also enables your chest wall (the muscles and other tissue surrounding the ribs) to fully expand, giving the muscles a healthy range of motion. Elasticity (flexibility of the chest wall, which some therapists call elastance) is important, especially if you have muscular dystrophy, so that you’re able to take normal size breaths without overtiring your respiratory muscles.

You don’t want your chest wall to lose its elasticity and get stiff because your respiratory muscles (the diaphragm and the muscles between the ribs, called the intercostals) will have to work harder to allow you to breathe. These muscles enable you to exhale and inhale, and weakening of them also increases the chance of infections in the lungs or respiratory system.

	Dennis Sieloff: The more I sing the more I can sing.

“If you have a stiff chest wall and weak respiratory muscles, those weak respiratory muscles are trying to make that stiff chest wall move, and that’s a really bad combination,” Reynolds says. “By doing exercise to maintain the elastance of the chest wall, it makes it easier for those muscles to work.”

That’s why singing or playing a wind instrument is great exercise for the chest wall. It’s not going to make your respiratory muscles stronger, but it will make it much easier for them to function because they won’t have to work so hard to move a stiff chest wall.

“The more I sing, the more I can sing,” says Dennis Sieloff of Pompano Beach, Fla., who sings every Sunday as part of his church congregation and for fun at home alone or with his wife, Tammy.

Sieloff, 43, who walks with a cane because of myotonic muscular dystrophy (MMD), says that singing strengthens and slows the deterioration of his respiratory system, giving it more stamina. He’s also noticed that bronchitis and respiratory infections are less common now that he’s increased his singing.

Reynolds suggests that everyone with muscular dystrophy be checked by an RT or pulmonologist at least once a year. His suggestion applies even if you have strong lungs and appear to be doing well; the therapist wants to make sure there’s no decline in breathing function. Maybe you don’t even have a lung doctor and need to ask your neurologist for a referral.

Kyle DeVilbiss, 18, of Troy, Ohio, has Duchenne muscular dystrophy (DMD) and has been Reynolds’ patient for five years. Soon to be a senior at Troy High School, DeVilbiss plays the clarinet in concert band and has been playing since fourth grade.

DeVilbiss, who uses a power chair, has never had any respiratory problems but started seeing Reynolds every six months as a precaution because DMD is associated with respiratory issues. He says that playing the clarinet is a fun exercise that can keep his lungs functioning and is probably prolonging his ability to breathe. His brothers, Ryan, 20, and Aaron, 12, also have DMD and have benefited from playing the clarinet.

Aside from the clarinet, DeVilbiss uses a small plastic device called an incentive spirometer that measures lung capacity and encourages deeper breathing. He does this twice a day. After years of playing the clarinet, his lung capacity has increased.

If you experience respiratory problems such as shortness of breath or frequent infections, you’ll need to see the therapist more often or consult a doctor. If your pulmonary function declines, the RT probably will start you on breathing exercises twice a day.

You should ask your RT or pulmonologist if singing or playing a wind instrument would be beneficial to you. Are your lungs in good enough shape to do it effectively? And if your therapist has given you breathing exercises, can you substitute some of the sessions with singing or playing?

Reynolds never substitutes breathing exercises completely with singing or playing an instrument, but he does allow clients to count their music practice as some of their exercise sessions.

“Say you have music lessons in school and you do them every day at school Monday through Friday. That could replace one of your breathing exercise sessions on those days, but you would still need to do your two exercise sessions on the weekend,” Reynolds says. “Now say you have singing lessons a couple times a week. Well, the days you have singing lessons then you could use that singing lesson as one of your exercise sessions for the day.”

The benefits you’ll receive from the deep breathing you need in order to sing or play a wind instrument depend on the progression of your disease, says Reynolds, who’s also assistant professor in the OSU Department of Neurology and a regular host on MDA’s online “Ask the Experts” chats dealing with respiratory issues.

He most often sees people with DMD and amyotrophic lateral sclerosis (ALS) try this type of exercise, but it can benefit most people with neuromuscular disease as long as they have enough lung power to perform.

Kyle DeVilbiss: It's a fun exercise that has probably prolonged my ability to breathe.

If you’ve experienced problems such as shortness of breath, singing or playing an instrument should increase respiratory function. The same rule applies if you’re prone to respiratory infections, but as always, check with the professionals before getting started.

Ryan Roberts of Sapulpa, Okla., has DMD, uses a power chair, and is prone to asthma and pneumonia. Ever since he began singing in seventh grade (an activity that he could enjoy with peers), Roberts, 19, doesn’t have asthma attacks or get pneumonia anymore.

Singing with a barbershop choral group and with friends at church has allowed him to continue being able to breathe deeply and sustain his notes. Singing is his breathing exercise.

“My doctors and physical therapists have encouraged me to continue singing, both as an interest and continued exercise for my lungs and diaphragm,” says Roberts, who graduated from Sapulpa High School in May 2004 and plans to attend Tulsa Community College in the fall, majoring in music.

On the other hand, if you haven’t had any problems, the hope is to keep you at that point. If a neuromuscular disease is diagnosed after you’ve been singing or playing for some time, you usually come to the disease with a stronger respiratory system.

Jackie Barnette of Pasadena, Md., who uses a power wheelchair and a walker for mobility, received a diagnosis of ALS last year. She’s had asthma most of her life but says she's had fewer and less severe attacks partly due to medication and partly due to playing the French horn for 32 years.

	Ryan Roberts and his choral group.

In December, she stopped playing because she’s losing arm strength and doesn’t want to drop the instrument. She still has the lung capacity to play.

A recently retired preschool teacher, Barnette, 45, is used to singing all day. She also sings twice a week in a women’s church group and hasn’t developed the respiratory problems associated with ALS such as shortness of breath.

Lora Clawson, nurse practitioner and director of ALS clinical services at the MDA/ALS Center at Johns Hopkins University in Baltimore, says that Barnette’s breathing is at 100 percent of capacity and attributes her healthy respiratory system to all the horn playing she’d done over the years. Doctors have also told Barnette that singing and playing the horn have reduced the effects of her asthma.

Jackie Barnette: Playing as much as I have has kept the lungs strong.

“Had I not played, I don’t think my lungs would be as strong now,” Barnette says. “The horn is one of the hardest instruments to play because it does require so much air to get through all the tubing. By playing as much as I have it has kept the lungs strong and open.”

Even though there may not be any scientific studies proving the effects of singing or playing a wind instrument on the respiratory system, affirmations of people with neuromuscular diseases speak for themselves.

Maybe you’ve always wanted to play the trumpet. Does the flute or clarinet excite you? Then again, you can always get a harmonica (see “Health in the Harmonica”). Any of these instruments can help strengthen your respiratory system because you’ll be repeatedly taking deep breaths.

Depending on your physical strength, you might want to steer clear of large and bulky instruments like the tuba. Besides being difficult to carry, tubas require even more wind power to play than the smaller instruments. If your voice is your instrument of choice, you don’t have to worry about being able to haul it around.

Keep in mind that as your disease progresses, you may need to switch to a smaller instrument that’s easier to play and transport. If you lack the arm strength to hold the instrument but you still have plenty of lung power, you can simply exercise your lungs by blowing on the thing. (You may want to ask your housemate’s permission first.)

“I can still pull [the French horn] out and hold it and just blow long tones,” Barnette says. “Now that I’ve stopped working, I plan on doing that a couple times a week.”

Since Barnette’s husband, Kim, is a musician, there’s never a shortage of musical instruments to exercise her lungs. Though she’s not teaching anymore, Barnette plans to go to school once a week to sing and play with the children. She has three children and three grandchildren.

Don’t overdo it, Reynolds cautions. With most forms of exercise, there’s a fine line between doing too little and doing too much. With a neuromuscular disease, too much exercise can actually weaken your muscles, but you need enough exercise to keep them active. Singing or playing an instrument is no different.

“Overdoing it” causes your respiratory muscles to weaken. To prevent this from happening, Reynolds suggests that you pay attention to how much you can do before you start feeling fatigued. When you start to tire, it’s time to stop.

There’s no one set time limit for everyone. If you can sing or play for a half hour before your respiratory muscles get tired, then a half hour of singing or playing each day may be just what you need.

DeVilbiss plays the clarinet every day during the hour-long band period at school. He gets out of breath, but he can soon catch his breath and resume playing. The high notes require more air, which is why he tires faster when the music has more high notes.

Also playing the keyboard in Troy High School’s marching band, DeVilbiss hopes to keep up the clarinet as long as he’s able. He plans to major in music education at Wright State University in Dayton, Ohio.

Above all: Have fun! As long as you don’t push yourself, singing or playing a wind instrument puts you on the path to respiratory health.