This copy is for personal use only - distrib
© Med Sci Monit, 2006; 12(8): CR325-331
PMID: 16865063
Received: 2006.03.20
This copy is for personal use only - distribution prohibited.
Accepted: 2006.03.23
Published: 2006.08.01
Authors’ Contribution:
A Study Design
B Data Collection
C Statistical Analysis
D Data Interpretation
E Manuscript Preparation
F Literature Search
G Funds Collection
LY L
This copy is for personal use only - distribution prohibited.
N A
Background:
O N
SO
Material/Methods:
R
Results:
This copy is for personal use only - distribution prohibited.
PE
Conclusions:
key words:
Full-text PDF:
Word count:
Tables:
Figures:
References:
py is for personal use only - distribution prohibited.
Author’s address:
Current Contents/Clinical Medicine • SCI Expanded • ISI Alerting System • Index Medicus/MEDLINE • EMBASE/Excerpta Medica • Chemical Abstracts • Index Copernicus
WWW. M ED S CI M ONIT.COM
Clinical Research
CR
Effects of a yoga lifestyle intervention on
performance-related characteristics of musicians:
A preliminary study
SE
Sat Bir S. Khalsa1 ABCDEF, Stephen Cope2 ABEG
1
Division of Sleep Medicine BI, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical
School, Boston, U.S.A.
U
2
Kripalu Center for Yoga and Health, Lenox, MA, U.S.A.
Source of support: The contribution of SSK was supported in part by grant K01AT000066 from NCCAM
Summary
Previous research has suggested that yoga and meditation practices are effective in stress manage-
ment, alleviating anxiety and musculoskeletal problems and improving mood and cognitive and
physical performance. Musicians experience a number of challenges in their profession including
high levels of stress, performance anxiety and performance-related musculoskeletal conditions.
Yoga and meditation techniques are therefore potentially useful practices for professional musi-
cians.
Musicians enrolled in a prestigious 2-month summer fellowship program were invited to participate
in a regular yoga and meditation program at a yoga center during the course of the program. The
10 participants in the yoga program completed baseline and end-program questionnaires evaluat-
ing performance-related musculoskeletal conditions, performance anxiety, mood and flow expe-
rience. Fellows not participating in the yoga program were recruited to serve as controls and com-
pleted the same assessments (N=8).
The yoga participants showed some improvements relative to control subjects on most measures,
with the relative improvement in performance anxiety being the greatest.
The results from this preliminary study suggest that yoga and meditation may be beneficial as a
routine practice to reduce performance anxiety in musicians.
musical performance • relaxation • anxiety • flow • musculoskeletal disorders • mood
http://www.medscimonit.com/fulltxt.php?IDMAN=8987
4256
—
1
47
Sat Bir S. Khalsa, Ph.D., Division of Sleep Medicine BI, Brigham and Women’s Hospital, Harvard Medical School,
75 Francis Street, Boston, MA 02115, U.S.A., e-mail: khalsa@hms.harvard.edu
CR325
Electronic PDF security powered by IndexCopernicus.com
This copy is for personal use only - distrib
Clinical Research
BACKGROUND
Yoga is a comprehensive, holistic mind-body practice incor-
porating both cognitive (meditation, concentration) and so-
matic (physical postures, breathing exercises) components.
Yoga is well-known as a practice which can generate men-
This copy is for personal use only - distribution prohibited.
tal and physical well-being. Historically, it has been a spirit-
ual discipline whose ultimate goal is the achievement of an
elevated state of consciousness characterized by a unitive
experience. Research studies have demonstrated that yoga
and meditation are capable of generating positive chang-
es in mood [1–4], stress-coping [3,5], and cognitive [2,6],
physical [1,2,7] and psychomotor performance [2,8]. These
types of benefits have lead to a rapidly increasing popular-
ity of yoga practice in the general population. A 1998 sur-
vey has indicated that 7.5% of the U.S. population (15 mil-
lion) had tried yoga practice [9].
U
Due to the capability of improving psychophysiological func-
tioning, yoga practices have also been applied as therapeu-
tic interventions. Consequently, the practice of yoga therapy
LY L
has also become widespread with numerous books and yoga
institutes offering yoga regimens for the treatment of a wide
This copy is for personal use only - distribution prohibited.
variety of disorders. A 2002 survey of alternative medicine
N A
use has reported that yoga (5.1% of the population), med-
itation (7.6%) and deep breathing exercises (11.6%) were
among the top 10 alternative treatments used by American
O N
adults [10]. Research in yoga’s therapeutic benefit has been
growing steadily over the past 3 decades with clinical trials
on psychiatric conditions such as depression and anxiety,
SO
breathing disorders such as asthma, endocrine disorders
such as diabetes and a variety of musculoskeletal and neu-
rological conditions [11].
The music profession has a number of characteristics,
which predispose it to being a highly stressful occupa-
tion [12,13]; this has been confirmed by survey studies
R
[14,15]. Due in large part to this stress, musicians com-
monly experience a number of problems that negatively
impact their performance ability including both perform-
This copy is for personal use only - distribution prohibited.
PE
ance anxiety and performance-related musculoskeletal
conditions [14,16].
Survey studies have reported that performance anxiety is
highly prevalent in musicians, with surveys reporting up to
69% of musicians affected [17–24]. Performance anxiety is
associated with a number of cognitive and somatic compo-
nents each with a variety of symptoms [16,19,21,25]. The di-
rect consequence of performance anxiety is impairment of
both cognitive and physical aspects of performance, which
can lead to serious professional consequences for the per-
former including withdrawal from the profession [17].
Performance-related musculoskeletal disorders are also
highly prevalent in musicians, with surveys reporting up
to 87% [24,26–28]. These disorders include musculoskel-
py is for personal use only - distribution prohibited.
etal pain syndromes such as overuse syndrome, peripher-
al nerve disorders such as carpal tunnel syndrome, and fo-
cal motor dystonias or muscle cramping and can be serious
enough to limit or terminate the careers of musical per-
formers [28,29]. Furthermore, there is also some evidence
suggesting a causal interplay between the incidence of per-
formance related musculoskeletal disorders and anxiety or
stress [24,29–31].
CR326
Med Sci Monit, 2006; 12(8): CR325-331
Treatments evaluated for musical performance anxiety have
included pharmacological, psychological and behavioral
approaches [16,25,32,33]. Although research studies have
reported benefit of some pharmacological agents, some of
these agents are associated with the side effect of a tenden-
cy to impair performance [16,32,33]. Psychological and be-
havioral approaches have been more widely evaluated, have
been shown to be fairly effective and include cognitive be-
havioral therapy, systematic desensitization, hypnosis, psy-
chotherapeutic approaches and a variety of mind-body tech-
niques including biofeedback, music therapy, Alexander
SE
technique, relaxation training such as progressive muscle
relaxation, breath regulation, and meditation; these have
been applied alone or in combination with other techniques,
(reviewed in refs. [16,32,33]). Recent meta-analyses of psy-
chological and behavioral treatments for musical perform-
ance anxiety have determined that these treatments typical-
ly exhibit medium to large effect sizes [32,33]. Treatments
for preventing or treating performance-related muscu-
loskeletal disorders have included the use of rest (partial
or total), the modification of playing technique, postural
adjustments, physical or occupational therapy, exercise,
pharmacological agents, surgery and a number of relaxa-
tion techniques [28,29,34,35].
Skilled creative musical performance itself is an activity re-
quiring involvement of both a physical technical motor
component and a psychological expressive component,
so improvement or enhancement of performance can be
achieved by improving one or both of these components
[36]. Musical performance has been associated with a uni-
tive/transcendent experience, which has been described
as has the state of “flow” in which there is a greater sense
of creativity, expression, imagination and relaxation, ulti-
mately resulting in a greater experience of enjoyment for
the musical performer and a greater motivation to contin-
ue in the profession [37,38].
Given the benefits of yoga practice and the physical and psy-
chological problems encountered by musicians, it is likely
that yoga practice would be a suitable preventive and ther-
apeutic intervention. In fact, several of the key elements
of yoga practice have already been incorporated into com-
bined treatments for both performance anxiety and musc-
uloskeletal conditions [28]. Accordingly, yoga and medita-
tion have been discussed as potentially useful strategies for
the treatment of performance anxiety and musculoskele-
tal conditions [25,29,35]. Yoga has specifically been advo-
cated and offered as both a preventive and therapeutic in-
tervention [16,39–44].
Similarly, it is likely that yoga practice can enhance musi-
cal performance. On the technical motor level, yoga may
facilitate performance through reducing muscular tension
and improving neuromuscular activity, flexibility, stamina
and coordination [40]. On the psychological level there is
a remarkable concordance between the transcendent state,
which is the goal of yoga and meditation practice, and the
state of flow and immersion that musicians may experience
in their performance. The cultivation of focus, concentra-
tion and, most importantly, mindfulness and awareness in
yoga practice, seem ideally suited for enhancing the mu-
sician’s experience of immersion, flow and enjoyment in
performance.
Electronic PDF security powered by IndexCopernicus.com
This copy is for personal use only - distrib
Med Sci Monit, 2006; 12(8): CR325-331
There is the suggestion that some musicians are already us-
ing yoga techniques. Spahn et al. [24] reported that yoga
comprised 5% of body-oriented training methods practiced
by music students and Hagglund & Jacobs [45] reported that
a small percentage of music students utilize meditation and
yoga as physical and/or extracurricular activities. However,
This copy is for personal use only - distribution prohibited.
despite the recognition of yoga’s potential for musical per-
formance and it’s use and promotion, there are no research
studies on the use of yoga for musicians. Chang [46] report-
ed that a meditation intervention was capable of reducing
performance anxiety in music students and also noted that
the constructive changes in the students’ bodies and thought
processes were considered to be valuable for their musical
performances and that they experienced more moments of
relaxed pleasure even before performances. It is therefore
likely that a yoga intervention combining it’s characteristic
multicomponent approach of meditation, postures, breath-
U
ing exercises and philosophy/psychology may prove to be of
great benefit to musicians by ameliorating performance-re-
lated problems while enhancing performance itself.
LY L
The purpose of this study was to perform an evaluation of
the benefits of a pilot program of a comprehensive yoga
This copy is for personal use only - distribution prohibited.
lifestyle intervention for musicians participating in a sum-
mer music training program.
N A
MATERIAL AND METHODS
O N
Subjects
SO
All subjects in this study were participants in the prestig-
ious high-level annual summer fellowship program of the
Tanglewood Music Center, which is the Boston Symphony
Orchestra’s academy for advanced musical study. The 8-week
residential program provides professional musicians of ex-
ceptional ability the opportunity to work with internation-
ally renowned artists, including members of the Boston
R
Symphony, resident faculty, and guests. A limited number
of fellows are accepted into the program following a formal
competitive application process that includes auditions held
This copy is for personal use only - distribution prohibited.
PE
in major cities across North America. Fellows have the costs
of tuition, room and board covered by their Fellowships.
All fellows are required to be in attendance for the full du-
ration of the program and must be available for study and
performance every day during the program.
The Kripalu Yoga Center in Lenox, Massachusetts is a popu-
lar residential yoga and spiritual retreat center that offers year
round programs and courses in yoga and related disciplines.
In addition to a regular daily schedule of Kripalu Yoga classes
and other recreational and therapeutic activities, the center
is a forum for teachers and experts in a wide variety of spir-
itual and health-related disciplines to provide classes, work-
shops and courses throughout the year. The center includes
numerous dormitory-style accommodations for attendees/cli-
ents and offers a full health-oriented meal service in its dining
py is for personal use only - distribution prohibited.
hall. Kripalu Yoga incorporates classical yoga postures, breath-
ing techniques and meditation as the centerpiece of a yogic
lifestyle and is taught in centers across the country.
The teaching faculty of the Kripalu Yoga Center, which is in
close proximity to the Tanglewood Music Center, extended
an offer to provide a limited number of Tanglewood sum-
mer fellows the opportunity for no-cost participation in the
Khalsa SBS et al – effects of a yoga lifestyle intervention on musicians
Kripalu programs. In order to participate in the Kripalu pro-
grams, fellows were required to send in an application out-
lining their interest in the program. The Kripalu Center
was able to offer participation to 10 fellows who were select- CR
ed from an applicant pool of 25 fellows. The focus of this
study was to evaluate the benefits of the fellows’ participa-
tion in the Kripalu programs. In order to provide a com-
parison control group, 10 fellows were recruited from the
Tanglewood fellows not participating in the yoga program.
The Kripalu participant fellows were not remunerated for
participation, whereas the control group fellows were remu-
SE
nerated with two free meals at the Kripalu Center during
the course of the summer. All participants signed informed
consent for the evaluation procedures.
Program protocol
The fellows began the program with a day-long intensive
orientation that included a group process covering goals
and intentions of the program, 2 yoga practice sessions,
a discussion on the basics and principles of yoga practice,
theory and philosophy, an intoduction to meditation and
an opportunity to acquaint themselves with the other par-
ticipants. The fellows signed informed consent for the re-
search evaluation procedures and completed the full bat-
tery of baseline questionnaires on the next day. Control
group participants met with the program administrators 9
days later to also sign informed consent and complete the
baseline questionnaires. The 8-week Kripalu program of-
fered participation in the following sessions: a) morning
and afternoon Kripalu Yoga sessions held 7 days per week
in either gentle, moderate and vigorous yoga intensity lev-
els – students were allowed to determine their own yoga
class attendance schedule; b) an evening session includ-
ing both a 90-minute intensive yoga session followed by a
2-hour discussion/problem-solving/group interaction ses-
sion addressing practical issues in the practice of yoga and
meditation and psychological issues relevant to musical per-
formance and their progression in the musical profession.
This session was held weekly and facilitated by the senior
instructor and one assistant. The senior instructor has had
previous training in counseling and psychotherapy, and is a
Licensed Independent Social Worker. The counseling and
interpersonal interactions in these sessions all incorporat-
ed an approach intimately relevant to the philosophy and
psychology of yoga and meditation practice; c) 30-minute
early morning meditation sessions held 5 days per week –
this was presented as an optional item; and d) meals in the
dining facility of the center. At the end of the 8-week pro-
gram the Kripalu participant fellows gathered for an all day
retreat that included an overnight stay in the Kripalu dor-
mitories, a yoga class, a group meal and other social activ-
ities. The Kripalu participant fellows completed the end-
program battery of questionnaires on the day following the
retreat, whereas the control group participants completed
the end-program questionnaires 2 days earlier.
Outcome measures
All study participants completed the 5 questionnaires described
below, once at baseline and once at the end of the program:
1. The Performance-Related Musculoskeletal Disorders
(PRMD) questionnaire includes 2 questions utilizing a
visual analogue scale to assess the frequency of occur-
CR327
Electronic PDF security powered by IndexCopernicus.com
This copy is for personal use only - distrib
Clinical Research
rence and severity of PRMDs. Another question assesses
perceived exertion during musical practice on a numer-
ical Borg scale. Other characteristics related to perform-
ance such as practice, performance and rest schedules
and playing history were also assessed. This questionnaire
was a slightly modified version of that used by Ackermann
This copy is for personal use only - distribution prohibited.
(2002) [34].
2. The Performance Anxiety Questionnaire (PAQ) of Cox and
Kenardy (1993) [22] presents 20 statements relating to feel-
ings/symptoms of anxiety. Ten of these are cognitive and 10
are somatic in nature. Response to each statement is rated
as to frequency of occurrence on a numerical scale (1–5)
and all 20 questions are presented separately for the 3 con-
ditions of practice, group and solo performance. Possible
total scores for each condition are from 20 to 100.
3. The Dispositional Flow Scale (DFS-2) is a 36-item question-
naire in which each item is a statement of an experience/feel-
U
ing of flow, which is an optimal psychological state associated
with high levels of performance and is a positive, rewarding
experience [47]. Nine dimensional constructs have been de-
scribed which contribute to the flow experience including
LY L
the balance between challenge and skill, an experience of
action-awareness merging, clear goals, unambiguous feed-
This copy is for personal use only - distribution prohibited.
back, total concentration on the task at hand, total sense of
N A
control, loss of self-consciousness, transformation of time and
autotelic experience. Subjects provide responses to each of
the 36 items on a numerical scale (1–5) as to the frequency
O N
of occurrence of this experience/feeling during a specific
activity. In addition to a total flow score for the activity de-
rived from all 36 questions, subscale scores for each of the
SO
9 dimensions can be calculated from the 4 questions asso-
ciated with each subscale in the questionnaire.
4. The Profile of Mood States The POMS is a well-known,
well-validated, reliable and internally consistent self-report
questionnaire consisting of 65 adjectives rated on a five-
point scale designed to provide a total mood disturbance
score as well as subscale scores for six mood states: ten-
R
sion, depression, anger, vigor, fatigue, and confusion.
The yoga program instructors monitored participation in the
This copy is for personal use only - distribution prohibited.
PE
yoga program and kept records on issues, events and notable
experiences of the participants over the course of the pro-
gram. Participants in the yoga group completed a program
evaluation questionnaire at the end of the program which
asked them to rate their response using a visual analogue
scale with extremes of “not at all” to “very much so” to the
following questions: 1) Did you find the yoga/meditation
program beneficial for you in general? 2) Did you find the
yoga/meditation program beneficial for you as a musician?
3) Would you recommend the yoga/meditation program for
future Tanglewood participants? 4) Do you plan to continue
with yoga and/or meditation practice in the future as a re-
sult of this program? Participants were also asked to note any
comments about the program or their experience of it.
Statistical significance (p<0.05) within and between groups
py is for personal use only - distribution prohibited.
was evaluated using two-tailed T-tests or Wilcoxon Signed
Rank Test or Mann-Whitney Rank Sum Tests if the test for
normality of the distribution being tested failed.
RESULTS
All 10 participants in the yoga group completed the pro-
gram and the baseline and end-program evaluation question-
CR328
Med Sci Monit, 2006; 12(8): CR325-331
naires. The characteristics of this group were: 5 males and
5 females, age range 21 to 30 years, average age 25.5 years
(±3.1 S.D.), 4 were singers, 2 each played violin and viola, and
1 each played horn and cello, and subjects had played/sung
for an average of 14.8 years (±6.3 S.D.). Participants in the
yoga group had a wide variety of levels of prior experience
with yoga practice. Although 10 participants in the control
group enrolled and signed informed consent one subject
did not participate, and of the remaining 9, only 8 complet-
ed the questionnaires at the end of the program. Therefore,
analysis was performed on data from these 8 subjects only.
SE
The characteristics for these 8 subjects were: 4 males and
4 females, age range 21 to 30 years, average age 23.6 years
(±3.0 S.D.), 3 played piano, 2 each played violin and vio-
la, and 1 was a percussionist, and subjects had played for
an average of 16.6 years (±4.4 S.D.). Although 5 subjects in
the yoga group reported some degree of stress in their lives
due to recent life events and circumstances, only 1 subject
in the control group did.
Most of the participants in the yoga group chose to regu-
larly attend the afternoon yoga classes although several at-
tended the morning classes. Only about half of the partici-
pants in the yoga group attended the morning meditation
session regularly. Attendance frequency was high at the be-
ginning of the program, typically 4 to 5 classes per week. It
then decreased to about 3 classes per week as the Tanglewood
schedule intensified, and then increased somewhat near
the end of the program. Attendance at the once-weekly in-
tensive yoga/group interaction evening sessions was typi-
cally 8 to 9 students.
Evaluation of the baseline questionnaire scores indicated
that there were no statistically significant differences be-
tween the 2 groups for any of the average total scores or
subscale scores on all of the questionnaires.
Analysis of the scores from the PRMD questionnaire in-
dicated that there were no statistically significant chang-
es from baseline to end-treatment either within groups or
between groups in average PRMD frequency or severity, or
perceived exertion. Average group scores in frequency and
severity were all below 30 in both groups (possible range 0
to 100) at both baseline and end-program. Average group
scores in perceived exertion were between 11 and 13 in both
groups (possible range 6 to 20) at both baseline and end-
treatment; this score range corresponds to a “fairly light”
level of exertion on the scale.
Performance anxiety scores showed statistically significant
decreases from baseline to end-program for the yoga sub-
jects in all 3 conditions (practice, group and solo perform-
ance), whereas changes in the control group for all 3 con-
ditions were not statistically significant (Figure 1). However,
a statistical comparison between the groups of the baseline
to end-program change scores for the 3 conditions indicat-
ed that only the difference in change in the solo condition
was statistically significant (p=0.050).
On the DFS-2 questionnaire none of the control group
baseline to end-program changes either in total flow score
(from 124.7±22.9 to 129.3±24.9) or in any of the subscales
was statistically significant. In the yoga group there was a
trend for improvement in the total flow score which in-
Electronic PDF security powered by IndexCopernicus.com
This copy is for personal use only - distrib
Med Sci Monit, 2006; 12(8): CR325-331
Practice
Performance anxiety score
60
55 Yoga
50 Control
This copy is for personal use only - distribution prohibited.
45
40
35
Baseline End program
Figure 1. Baseline and end-program total scores on the Performance Anxiety Questionnaire are shown for both groups in three panels representing
the conditions of practice, group performance and solo performance. The filled bars represent values for the yoga group. Error bars
represent standard errors of the mean.
U
creased from 119.8 (±13.9) to 128.7 (±18.7), p=0.058. The
subscales showing the most improvement in the yoga group
LY L
were “sense of control” (p=0.045) and “loss of self-con-
sciousness” (p=0.043). However, comparison of the change
This copy is for personal use only - distribution prohibited.
scores between the two groups on the total flow score or
N A
on any of the subscale scores indicated that the changes in
the yoga group were not significantly different from those
in the control group.
O N
The total mood disturbance scores on the POMS increased
for both the yoga group (45.2±32.1 to 64.6±6.7, p=0.084)
SO
and the control group (25.8±39.7 to 67.4±18.0, p=0.016) al-
though only the control group increase was statistically sig-
nificant. Comparison of the change score between the two
groups on the total mood disturbance indicated that the
change in the yoga group was not significantly different from
that in the control group. The mood subscales that had sig-
nificant changes in the yoga group from baseline to end-
R
program were an increase in anger and a decrease in vigor
and fatigue. In the control group, the significant changes
were an increase in depression, anger and confusion and a
This copy is for personal use only - distribution prohibited.
PE
decrease in vigor. Only the increase in the anger score ap-
peared to be significantly greater in the control group in
comparison with the yoga group (p=0.026).
On the visual analogue scale responses to questions at the
end of the program the yoga subjects averaged scores of
96.3±6.4 (on a scale of 0 to 100) on whether they felt the
program was beneficial, 95.5±6.6 on whether it was benefi-
cial for them as musicians, 98.5±2.1 on whether they would
recommend the program for future Tanglewood partici-
pants, and 93.0±12.9 on whether they planned to continue
with yoga and/or meditation practice in the future as a re-
sult of the program.
Qualitative assessments from the yoga participants suggest-
ed that they found the weekly yoga intensive and group dis-
py is for personal use only - distribution prohibited.
cussion/problem-solving/group interaction sessions to be
the most important source of their improvement over the
summer. Participants found the meditation sessions more
difficult than the yoga sessions, which they preferred, al-
though those that continued regularly with the meditation
sessions reported an improvement in their skill in medita-
tion and some reported this to be the most important in-
fluence on their summer and their music performance. All
Khalsa SBS et al – effects of a yoga lifestyle intervention on musicians
Group Solo
CR
SE
Baseline End program Baseline End program
but two participants reported significant improvements in
their yoga practice skills but all of the participants felt that
yoga practice improved their stamina, concentration and
enjoyment of music performance. Three participants in-
dicated positive benefit from social interactions with oth-
er group members and/or the instructors. Participants
from both groups indicated that they found the summer
music program challenging, and some of the yoga partici-
pants expressed concern that their end-program question-
naires reflected fatigue from the music program. Two par-
ticipants indicated that participation in the yoga program
significantly improved their ability to manage the music fel-
lowship program.
DISCUSSION
Although results of the anxiety, mood and flow measures
numerically showed relatively higher improvements in the
yoga group as compared with the control group, only the
solo performance anxiety scores showed statistically signif-
icant improvements in comparison. The very positive re-
sponses on the yoga program evaluation questionnaire and
comments made by the yoga participants add to the con-
clusion that the yoga lifestyle program was well received by,
and of benefit to, the participants.
It is perhaps not surprising that the measure showing the
greatest relative improvement was performance anxiety. The
yoga intervention had a number of components that were
particularly known to be useful for anxiety including med-
itation, breathing and counseling directed at specific and
individual music performance problems [33,46]. Secondly,
musical performance anxiety is known to be highly preva-
lent even in professional musicians [18,20]. The observation
that performance anxiety is lowest in the practice condition,
moderate in the group condition, and highest in the solo
conditions is expected, and has been demonstrated exper-
imentally in a number of studies [17,19,21,23,25,28].
There are a number of limitations to this study. Although a
control group was incorporated into the protocol, the con-
trol group participants differed significantly from the yoga
group participants. Participants in the yoga program were
highly motivated to undergo the yoga intervention and it is
possible that an expectation of improvement may have con-
CR329
Electronic PDF security powered by IndexCopernicus.com
This copy is for personal use only - distrib
Clinical Research
tributed to their perceived benefit. It is also possible that
the yoga group participants may also have been interest-
ed in participating in the program since they were in more
need of assistance with their musical performance and/or
their mood and stress management than subjects in the con-
trol group. There is some support for this in that more of
This copy is for personal use only - distribution prohibited.
the subjects in the yoga group had ongoing life stressors.
Furthermore, the selective application procedure from the
pool of yoga applicants also likely influenced the character-
istics of the accepted subjects in a direction favorable to a
positive outcome. A randomized controlled trial would ad-
dress some of these issues.
It is also important to note that the intervention involved sig-
nificantly more than just yoga and meditation techniques.
Participants were most likely influenced by the atmosphere
and social environment in the yoga center and also took veg-
U
etarian meals there. Therefore, it is more accurate to think of
the intervention as more of a yoga lifestyle intervention than
one of just yoga and meditation. Furthermore, in addition to
this, the yoga participants also experienced a substantial so-
LY L
cial interaction since they commuted to the yoga center to-
gether, took meals and classes together and underwent group
This copy is for personal use only - distribution prohibited.
social events. This group interaction was encouraged by the
N A
group instructors, especially in the weekly yoga/meditation/
counseling sessions where participants shared their personal
challenges and discussed yoga and meditation-inspired strat-
O N
egies to overcome them. The exit questionnaire confirmed
a strong presence of social interaction and bonding in the
yoga group. Due to this wide range of elements within the in-
SO
tervention, it is difficult to accurately attribute which compo-
nents of the intervention were responsible for the perceived
benefits and to what degree they contributed. Future disman-
tling studies would be useful to determine which components
of the intervention were the most effective.
A significant limitation on the statistical power in this study
R
was the low sample size, which was fixed by limitations
of cost and availability of facilities for the yoga program.
Furthermore, statistical adjustments for multiple compar-
This copy is for personal use only - distribution prohibited.
PE
isons would make all of the statistical comparisons in this
study fail to meet the P<0.05 criterion. The lack of statis-
tical significance could also be due in part to the fact that
all of the subjects in this study were highly functioning suc-
cessful musicians. For example, although the prevalence of
PRMDs can be fairly high in professional musicians, in this
particular group of subjects it was relatively infrequent and
of low severity. This could have limited the potential for im-
provement in all of the outcome measures in the form of
a ceiling effect. A further complication in this study is the
fact that all of the participants were involved in the inten-
sive summer fellowship music program, which participants
found to be increasingly challenging over the course of the
program. It is therefore difficult to be certain of the inter-
pretation of the results since subjects in the control group
showed increases in anxiety and mood disturbance over the
py is for personal use only - distribution prohibited.
course of the program.
CONCLUSIONS
Despite the numerous limitations in this preliminary pi-
lot program from a research perspective, the results do in-
dicate that the approaches used in the yoga intervention
were well-accepted by professional musicians and that they
CR330
Med Sci Monit, 2006; 12(8): CR325-331
are likely to have benefit for both improving performance
characteristics and alleviating problems faced by profes-
sional musicians. Randomized trials with musicians specifi-
cally complaining of PRMD’s, performance anxiety and/or
mood disturbance under average working conditions would
likely show more substantial improvements.
Acknowledgements
We would like to acknowledge the contribution of Susan
Moul and Nancy Buttenheim who served as instructors in
SE
the yoga program and to the Kripalu Yoga Center and the
Tanglewood Music Center for supporting the research com-
ponent of this pilot program. The contribution of SSK was
supported in part by a research career award (K01AT000066)
from the National Center for Complementary and Alternative
Medicine of the NIH.
REFERENCES:
1. Harinath K, Malhotra AS, Pal K et al: Effects of Hatha Yoga and Omkar
Meditation on Cardiorespiratory Performance, Psychologic Profile, and
Melatonin Secretion. J Altern Complement Med, 2004; 10(2): 261–68
2. Ray US, Mukhopadhyaya S, Purkayastha SS et al: Effect of Yogic Exercises
on Physical and Mental Health of Young Fellowship Course Trainees.
Indian J Physiol Pharmacol, 2001; 45(1): 37–53
3. Michalsen A, Grossman P, Acil A et al: Rapid Stress Reduction and
Anxiolysis Among Distressed Women As a Consequence of a Three-Month
Intensive Yoga Program. Med Sci Monit, 2005; 11(12): CR555–61
4. Kirkwood G, Rampes H, Tuffrey V et al: Yoga for Anxiety: a Systematic
Review of the Research Evidence. Br J Sports Med, 2005; 39(12):
884–91
5. Malathi A, Damodaran A, Shah N et al: Psychophysiological Changes
at the Time of Examination in Medical Students Before and After
the Practice of Yoga and Relaxation. Indian J Psychiatry, 1998; 40(1):
35–40
6. Manjunath NK, Telles S: Spatial and Verbal Memory Test Scores
Following Yoga and Fine Arts Camps for School Children. Indian J
Physiol Pharmacol, 2004; 48(3): 353–56
7. Tran MD, Holly RG, Lashbrook J, Amsterdam EA: Effects of Hatha Yoga
Practice on the Health-Related Aspects of Physical Fitness. Prev Cardiol,
2001; 4(4): 165–70
8. Manjunath NK, Shirley T: Improved Performance in the Tower of
London Test Following Yoga. Indian J Physiol Pharmacol, 2001; 45(3):
351–54
9. Saper, Robert B, Eisenberg et al: Prevalence and Patterns of Adult Yoga
Use in the United States: Results of a National Survey. Altern Ther
Health Med, 2004; 10(2): 44–49
10. Barnes, Patricia M, Powell-Griner E et al: Complementary and Alternative
Medicine Use Among Adults: United States, 2002. Advance Data from
Vital Health and Statistics 5-27-2004; (343): 1–20
11. Khalsa SBS: Yoga As a Therapeutic Intervention: A Bibliometric Analysis
of Published Research Studies. Indian J Physiol Pharmacol, 2004; 48(3):
269–85
12. Sternbach D: Addressing Stress-Related Illness in Professional Musicians.
Md Med J, 1993; 42(3): 283–88
13. Parasuraman S, Purohit YS: Distress and Boredom Among Orchestra
Musicians: the Two Faces of Stress. J Occup Health Psychol, 2000; 5(1):
74–83
14. Middlestadt SE, Fishbein M: Health and Occupational Correlates of
Perceived Occupational Stress in Symphony Orchestra Musicians. J
Occup Med, 1988; 30(9): 687–92
15. Kenny DT, Davis P, Oates J: Music Performance Anxiety and Occupational
Stress Amongst Opera Chorus Artists and Their Relationship With State
and Trait Anxiety and Perfectionism. J Anxiety Disord, 2004; 18(6):
757–77
16. Smith AM, Maragos A, van Dyke A: Psychology of the musician. Tubiana,
Raoul and Camadio, Peter. Medical Problems of the Instrumentalist
Musician. London: Martin Dunitz Ltd., 2000; 135–70
17. Fehm L, Schmidt K: Performance Anxiety in Gifted Adolescent Musicians.
J Anxiety Disord, 2006; 20(1): 98–109
Electronic PDF security powered by IndexCopernicus.com
This copy is for personal use only - distrib
Med Sci Monit, 2006; 12(8): CR325-331
18. van Kemenade JF, van Son MJ, van Heesch NC: Performance Anxiety
Among Professional Musicians in Symphonic Orchestras: a Self-Report
Study. Psychol Rep, 1995; 77(2): 555–62
19. Wesner RB, Noyes R Jr, Davis TL: The Occurrence of Performance
Anxiety Among Musicians. J Anxiety Disord, 1990; 18(3): 177–85
20. Marchant-Haycox SE, Wilson GD: Personality and Stress in Performing
Artists. Pers Individ Dif, 1992; 13(10): 1061–68
This copy is for personal use only - distribution prohibited.
21. Miller SR, Chesky K: The Multidimensional Anxiety Theory: An
Assessment of and Relationships Between Intensity and Direction of
Cognitive Anxiety, Somatic Anxiety, and Self-Confidence Over Multiple
Performance Requirements Among College Music Majors. Med Probl
Perform Art, 2004; 19(1): 12–20
22. Cox WJ, Kenardy J: Performance Anxiety, Social Phobia, and Setting
Effects in Instrumental Music Students. J Anxiety Disord, 1993; 7(1):
49–60
23. Kaspersen M, Kaspersen G, Gunnar K: A Survey of Music Performance
Anxiety Among Norwegian Music Students. E Eur J Psychiat, 2002;
16(2): 69–80
24. Spahn C, Richter B, Zschocke I: Health Attitudes, Preventive Behavior,
and Playing-Related Health Problems Among Music Students. Med
Probl Perform Art, 2002; 17(1): 22–28
U
25. Wilson GD, Roland D: Performance anxiety. Parncutt, Richard and
McPherson, Gary E. The Science & Psychology of Music Performance:
Creative Strategies for Teaching and Learning. Oxford: Oxford University
Press, 2002; 47–61
26. Ackermann BJ, Adams RD: Perceptions of Causes of Performance-Related
LY L
Injuries by Music Health Experts and Injured Violinists. Percept Mot
This copy is for personal use only - distribution prohibited.
Skills, 2004; 99(2): 669–78
27. Zaza C: Playing-Related Musculoskeletal Disorders in Musicians: a
N A
Systematic Review of Incidence and Prevalence. CMAJ, 1998; 158(8):
1019–25
28. Bejjani FJ, Kaye GM, Benham M: Musculoskeletal and Neuromuscular
Conditions of Instrumental Musicians. Arch Phys Med Rehabil, 1996;
O N
77(4): 406–13
29. Brandfonbrener AG, Kjelland JM: Music Medicine. Parncutt, Richard and
McPherson, Gary E. The Science & Psychology of Music Performance:
SO
Creative Strategies for Teaching and Learning. Oxford: Oxford University
Press, 2002; 83–96
30. Zaza C, Farewell VT: Musicians’ Playing-Related Musculoskeletal
Disorders: an Examination of Risk Factors. Am J Ind Med, 1997; 32(3):
292–300
31. Jabusch HC, Muller SV, Altenmuller E: Anxiety in Musicians With Focal
Dystonia and Those With Chronic Pain. Movement Disorders: Official
Journal of the Movement Disorders Society, 2004; 19(10): 1169–75
R
This copy is for personal use only - distribution prohibited.
PE
py is for personal use only - distribution prohibited.
Khalsa SBS et al – effects of a yoga lifestyle intervention on musicians
32. Kenny DT: A Systematic Review of Treatments for Music Performance
Anxiety. Anxiety, Stress & Coping: an International Journal, 2005; 18(3):
183–208
33. McGinnis AM, Milling LS: Psychological Treatment of Musical
Performance Anxiety: Current Status and Future Directions.
Psychotherapy: Theory, Research, Practice, Training, 2005; 42(3):
CR
357–73
34. Ackermann B, Adams R, Marshall E: Strength or Endurance Training
for Undergraduate Music Majors at a University? Med Probl Perform
Art, 2002; 17(1): 33–41
35. Green JA, Chamagne P, Tubiana R: Prevention. Tubiana, Raoul and
Camadio, Peter. Medical Problems of the Instrumentalist Musician.
London: Martin Dunitz Ltd., 2000; 531–57
36. Sloboda JA: Individual Differences in Music Performance. Trends Cogn
SE
Sci, 2000; 4(10): 397–403
37. O’Neill SA, McPherson GE: Motivation. Parncutt, Richard and
McPherson, Gary E. The Science & Psychology of Music Performance:
Creative Strategies for Teaching and Learning. Oxford: Oxford University
Press, 2002; 31–46
38. Kenny BJ, Gellrich M: Improvisation. Parncutt, Richard and McPherson,
Gary E. The Science & Psychology of Music Performance: Creative
Strategies for Teaching and Learning. Oxford: Oxford University Press,
2002; 117–34
39. Soen EL: Yoga Within the Music Studio. American Music Teacher, 2004;
54.1: 36–40
40. Hogg K: Strike a Pose: How Guitarists Use Hatha Yoga to Improve
Posture, Flexibility, Focus, and Stamina. Acoustic Guitar, 2001; (104)
41. Shapter L: Injury Prevention and Healing Through Yoga: How Yoga
Can Alleviate – and Prevent – the Aches and Pains of String Playing.
Strings, 2000; (90)
42. Heinrichs C: Yoga Für Musiker: Die Psycho-Physischen Belastungen
Des Orchestermusikers Unter Dem Aspekt Des Möglichen Ausgleichs
Durch Yoga. Musikphysiologie und Musikermedizin, 2000; 7(2): 55
43. Weilerstein D, Neal C: Violin technique. Tubiana, Raoul and Camadio,
Peter. Medical Problems of the Instrumentalist Musician. London: Martin
Dunitz Ltd., 2000; 573–94
44. Montello L: Arts Medicine Editorial. International Journal of Arts
Medicine, 1997; 5(1): 41–42
45. Hagglund KL, Jacobs K: Physical and Mental Practices of Music Students
As They Relate to the Occurrence of Music-Related Injuries. Work, 1996;
6(1): 11–24
46. Chang JC, Midlarsky E:, Lin P: The Effects of Meditation on Music
Performance Anxiety. Med Probl Perform Art, 2003; 18(3): 126–30
47. Jackson SA, Eklund RC: Assessing Flow in Physical Activity: The Flow State
Scale-2 and Dispositional Flow Scale-2. JSEP, 2002; 24(2): 133–50
CR331
Electronic PDF security powered by IndexCopernicus.com
This copy is for personal use only - distrib

Index Copernicus
Global Scientific Information Systems
for Scientists by Scientists
This copy is for personal use only - distribution prohibited.

www. IndexCopernicus.com

SE
EVALUATION & BENCHMARKING

U
PROFILED INFORMATION
NETWORKING & COOPERATION

LY L VIRTUAL RESEARCH GROUPS

This copy is for personal use only - distribution prohibited.

N A
GRANTS
PATENTS
O N
CLINICAL TRIALS
SO

JOBS
STRATEGIC & FINANCIAL DECISIONS
R

Index IC Scientists IC Virtual Research Groups [VRG]

This copy is for personal use only - distribution prohibited.

PE

Effective search tool for Web-based complete research

Copernicus
integrates
IC Journal Master List
Scientific literature database,
including abstracts, full text,
and journal ranking.
Instructions for authors
available from selected journals.
py is for personal use only - distribution prohibited.
collaborators worldwide.
Provides easy global
networking for scientists.
C.V.'s and dossiers on selected
scientists available. Increase
your professional visibility.
IC Patents
Provides information on patent
registration process, patent offices
and other legal issues. Provides
links to companies that may want
to license or purchase a patent.
environment which enables researchers
to work on one project from distant
locations. VRG provides:
customizable
 and individually
self-tailored electronic research
protocols and data capture tools,
statistical
 analysis and report
creation tools,
profiled information on literature,

publications, grants and patents
related to the research project,
administration
 tools.

IC Conferences
Effective search tool for
worldwide medical conferences
and local meetings.
IC Grant Awareness
Need grant assistance?
Step-by-step information on
how to apply for a grant. Provides
a list of grant institutions and
their requirements.
IC Lab & Clinical Trial Register
Provides list of on-going laboratory
or clinical trials, including
research summaries and calls for
co-investigators.

Electronic PDF security powered by IndexCopernicus.com