Health-related quality of life (HRQOL) is a broad concept capturing “an individual’s or group’s perceived physical and mental health over time.”¹ HRQOL is closely related to and frequently used interchangeably with well-being,¹ with the importance of these broad health concepts reflected in their prominence in United Nations Sustainable Development goals: “To ensure healthy lives and promote well-being for all at all ages.”²

An increasing body of evidence notes the health benefits of arts engagement and participation. However, specific health effects and optimal modes and ‘doses’ of arts participation remain unclear, limiting evidence-based recommendations and prescriptions. The performing arts are the most popular form of arts participation, presenting substantial scope for established interest to be leveraged into positive health outcomes. Results of a three-component umbrella review (PROSPERO ID #: CRD42020191991) of relevant systematic reviews (33), epidemiologic studies (9) and descriptive studies (87) demonstrate that performing arts participation is broadly health promoting activity. Beneficial effects of performing arts participation were reported in healthy (non-clinical) children, adolescents, adults, and older adults across 17 health domains (9 supported by moderate-high quality evidence (GRADE criteria)). Positive health effects were associated with as little as 30 (acute effects) to 60 minutes (sustained weekly participation) of performing arts participation, with drumming and both expressive (ballroom, social) and exercise-based (aerobic dance, Zumba) modes of dance linked to the broadest health benefits. Links between specific health effects and performing arts modes/doses remain unclear and specific conclusions are limited by a still young and disparate evidence base. Further research is necessary, with this umbrella review providing a critical knowledge foundation.

Research demonstrates that both music-making and music listening have an ability to modulate autonomic nervous system activity. The majority of studies have highlighted acute autonomic changes occurring during or immediately following a single session of music engagement. Several studies also suggest that repeated music-making and listening may have longer-term effects on autonomic tone—the prevailing balance of sympathetic vs. parasympathetic activity. Autonomic imbalance is associated with a range of neurodegenerative and neurodevelopmental disorders, mental health conditions and non-communicable diseases. Established behavioral interventions capable of restoring healthy autonomic tone (e.g., physical activity; smoking cessation) have demonstrated remarkable efficacy in broadly promoting health and preventing disease and up to 7.2 million annual deaths. Accordingly, this article proposes that music’s suggested ability to modulate autonomic tone may be a key central mechanism underpinning the broad health benefits of music-making and listening reported in several recent reviews. Further, this article highlights how physical activity research provides a relevant roadmap to efficiently advancing understanding of music’s effects on both autonomic tone and health more broadly, as well as translating this understanding into evidence-based policy and prescriptions. In particular, adapting FITT—Frequency, Intensity, Timing, Type—criteria to evaluate and prescribe music-making and listening in observational and intervention studies has excellent prospective utility.

BACKGROUND: Physical symptoms present in a large percentage of instrumental musicians at all levels of expertise, yet the impact of these symptoms on patterns of muscle use and perceived exertion during performance is still unclear. PURPOSE: Quantify the effects of physical symptoms on muscle activity and perceived exertion in skilled violinists during a range of bowing actions. METHODS: Fifty-five professional or university (undergraduate or postgraduate) violinists performed 5 randomly ordered 45-second musical excerpts designed to elicit a range of right arm bowing actions. Surface electromyography data were obtained from 16 muscles of the trunk, shoulder, and right arm during each excerpt performance. Sites of current physical symptoms were reported using a pre-test questionnaire. Average rating of perceived exertion (RPE) for the excerpt performances was obtained immediately after the final excerpt performance. RESULTS: Right upper trapezius muscle activity levels were significantly reduced in participants reporting right shoulder symptoms (p<0.05). Violinists with right wrist symptoms displayed global increases in average muscle activity across all investigated muscles (p<0.03). RPE did not differ significantly between any groups of symptomatic and asymptomatic participants. CONCLUSION: Differential muscle activity patterns appear between right shoulder symptomatic, right wrist symptomatic, and asymptomatic violinists, presenting the possibility of altered biomechanical responses to physical symptoms that vary with symptom location.

BACKGROUND: Mismanagement of fatigue and playing load have been consistently identified as risk factors for playing-related pain and injuries. Studies in sport demonstrate that fatigue management strategies can predict and prevent overuse syndromes and related injuries through consistent assessment of playing load and physical/psychological stress. Self-report strategies show particular responsiveness to both the short and long-term impacts of training. No equivalent fatigue management strategies exist for musicians. Establish key items and feasibility parameters to inform the development of a self-report fatigue management tool for musicians. METHODS: A working party of international experts in musicians’ medicine was invited to complete a two-phase Delphi survey. In Phase I, working party members rated established items from sport (REST-Q subscales with demonstrated responsiveness to both acute and chronic training stresses) with respect to relevance and prospective utility for musicians. Members could also propose additional items and were asked to indicate a maximum feasible questionnaire length. In Phase II, working party members ranked top performing items from Phase I. Consensus best items were determined based on Phase II rankings. RESULTS: A 28-member working party was assembled (15 clinicians, 13 researchers). Of 20 researcher proposed items and 58 working party proposed items, 5 items met consensus criteria: I had pain; I had to play too much; I felt physically fit; I did not get enough sleep; I recovered well physically. A strong majority (89%) of working party members indicated that regular use of a fatigue questionnaire with up to 10 items is feasible. CONCLUSIONS: Key questionnaire items and feasibility parameters for a novel fatigue management tool for musicians are established. Future research in musicians is needed to validate study results and this novel fatigue management tool.

Background/aims: High occupational injury rates are reported in musicians, with a career prevalence of up to 89%. Fatigue and playing (over)load are identified as key risk factors for musicians’ injuries. Self-report fatigue management strategies in sport have demonstrated preventive effects. A self-report fatigue management tool for musicians was developed based on a Delphi survey of international experts and hosted in an online app. The aims of this study are to evaluate the content validity and uptake of this new tool, and explore associations between collected performance quality, physical/psychological stress, pain, injury and fatigue data.Methods: University and professional musicians were asked to provide entries into the online app twice per week for 1–6 months. Entries into the app were designed to take 2–3 min to complete and consisted of the following: 6 questions regarding playing load over the previous 72 h; 5 questions regarding current levels in key physical/psychological stress domains (sleep, recovery, overplaying, pain, fitness); one question self-rating of performance quality over the previous day; one question regarding current musculoskeletal symptoms; a reaction time task to evaluate psychomotor fatigue.Results: N = 96 participants provided an average of 2 app entries (range 0–43). Increased playing time, rating of perceived exertion (RPE), and feelings of having to “play too much” were consistently associated with increased self-rated performance quality (p ≤ 0.004; 6.7 <| t |< 2148.5). Increased ratings of feeling fit and recovering well were consistently associated with reduced pain severity (p < 0.001; 3.8 <| t |< 20.4). Pain severity was increased (6.5/10 vs. 2.5/10; p < 0.001) in participants reporting playing-related musculoskeletal disorders (PRMDs; symptoms affecting playing).Conclusion: The prospective value of regular individual self-report playing load, stress, and performance data collection in musicians is clear. However, limited uptake of the online fatigue management app piloted in this study indicates that new approaches to the collection of these data are needed to realize their potential impact.