***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A growing number of empirical studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health . However , the specific benefits of diaphragmatic breathing on mental health remain largely unknown . The present study aim ed to investigate the effect of diaphragmatic breathing on cognition , affect , and cortisol responses to stress . Forty participants were r and omly assigned to either a  breathing intervention group ( BIG ) or a control group ( CG ) . The BIG received intensive training for 20 sessions , implemented over 8 weeks , employing a real-time feedback device , and an average respiratory rate of 4 breaths/min , while the CG did not receive this treatment . All participants completed pre- and post-tests of sustained attention and affect . Additionally , pre-test and post-test salivary cortisol concentrations were determined in both groups . The findings suggested that the BIG showed a significant decrease in negative affect after intervention , compared to baseline . In the diaphragmatic breathing condition , there was a significant interaction effect of group by time on sustained attention , whereby the BIG showed significantly increased sustained attention after training , compared to baseline . There was a significant interaction effect of group and time in the diaphragmatic breathing condition on cortisol levels , whereby the BIG had a significantly lower cortisol level after training , while the CG showed no significant change in cortisol levels . In conclusion , diaphragmatic breathing could improve sustained attention , affect , and cortisol levels . This study provided evidence demonstrating the effect of diaphragmatic breathing , a mind-body practice , on mental function , from a health psychology approach , which has important implication s for health promotion in healthy individuals BACKGROUND Among non-pharmacological therapies , musical intervention is often used for patients with Alzheimer 's disease ( AD ) and patients presenting chronic pain . However , their efficacy is still under debate . OBJECTIVE Our aim was to determine the efficacy of choral singing versus painting sessions on chronic pain , mood , quality of life , and cognition in AD patients . METHODS In this multicenter r and omized controlled trial , 59 mild AD patients were r and omized to a 12-week singing ( SG ; n = 31 ) or painting group ( PG ; n = 28 ) . Chronic pain , anxiety , depression , and quality of life were assessed before , after , and 1 month after the sessions . Cognitive abilities were assessed before and after interventions . The evolution of these different measures was assessed with mixed linear models . The primary data analysis was by intention-to-treat , and completed by a ' per protocol ' approach . RESULTS Both singing and painting interventions led to significant pain reduction ( Time effect : F = 4.71 ; p = 0.01 ) , reduced anxiety ( Time effect : F = 10.74 ; p < 0.0001 ) , improved Quality of Life ( Time effect : F = 6.79 ; p = 0.002 ) , improved digit span ( F = 12.93 ; p = 0.001 ) , and inhibitory processes ( Time effect : F = 4.93 ; p = 0.03 ) . Depression was reduced over time in PG only ( Time x Group effect : F = 4.53 ; p = 0.01 ) . Verbal Memory performance remained stable over time in SG , but decreased in PG ( Time x group effect : F = 9.29 ; p = 0.004 ) . CONCLUSION Findings suggest that singing and painting interventions may reduce pain and improve mood , quality of life , and cognition in patients with mild AD , with differential effects of painting for depression and singing for memory performance This study aim ed to investigate the effects of weekly singings classes on pulmonary function parameters and quality of life ( QoL ) of COPD patients . Forty-three patients were r and omized to weekly classes of singing practice , or h and craft work . They performed spirometry and completed maximal respiratory pressure measurements , evaluations of dyspnea , and the Saint George ’s Respiratory Question naire , before and after 24 training classes . A functional evaluation , immediately after 10 minutes of singing practice , was also performed at the end of the study . Fifteen subjects completed the study in each group . In comparison to controls the singing group exhibited transitory elevations on the dyspnea Borg scale ( p = 0.02 ) , and inspiratory capacity ( p = 0.01 ) , and decreases of expiratory reserve volume ( p = 0.03 ) , just after a short session of singing . There was a significant difference on changes of maximal expiratory pressures in the comparison between groups at the end of training . While the control group showed deterioration of maximal expiratory pressure , the singing group exhibited a small improvement ( p = 0.05 ) . Both groups showed significant improvements of QoL in within group comparisons . We have concluded that singing classes are a well tolerated activity for selected subjects with COPD . Regular practice of singing may improve QoL , and preserve the maximal expiratory pressure of these patients Background There is some evidence that singing lessons may be of benefit to patients with chronic obstructive pulmonary disease ( COPD ) . It is not clear how much of this benefit is specific to singing and how much relates to the classes being a group activity that addresses social isolation . Methods Patients were r and omised to either singing classes or a film club for eight weeks . Response was assessed quantitatively through health status question naires , measures of breathing control , exercise capacity and physical activity and qualitatively , through structured interviews with a clinical psychologist . Results The  singing group ( n=13 mean(SD ) FEV1 44.4(14.4)% predicted ) and film group ( n=11 FEV1 63.5(25.5)%predicted ) did not differ significantly at baseline . There was a significant difference between the response of the physical component score of the SF-36 , favouring the singing group + 12.9(19.0 ) vs -0.25(11.9 ) ( p=0.02 ) , but no difference in response of the mental component score of the SF-36 , breathing control measures , exercise capacity or daily physical activity . In the qualitative element , positive effects on physical well-being were reported in the singing group but not the film group . ConclusionS inging classes have an impact on health status distinct from that achieved simply by taking part in a group activity . Trials registration Registration Current Controlled Trials - IS RCT Background Despite optimal pharmacological therapy and pulmonary rehabilitation , patients with COPD continue to be breathless . There is a need to develop additional strategies to alleviate symptoms . Learning to sing requires control of breathing and posture and might have benefits that translate into daily life . Methods To test this hypothesis we performed a r and omised controlled trial , comparing a six week course of twice weekly singing classes to usual care , in 28 COPD patients . The experience of singing was assessed in a qualitative fashion , through interviews with a psychologist . In addition , we surveyed patients with chronic respiratory conditions who participated in a series of open singing workshops .  Results In the RCT , the physical component score of the SF36 improved in the singers ( n = 15 ) compared to the controls ( n = 13 ) ; + 7.5(14.6 ) vs. -3.8(8.4 ) p = 0.02 . Singers also had a significant fall in HAD anxiety score ; -1.1(2.7 ) vs. + 0.8(1.7 ) p = 0.03 . Singing did not improve single breath counting , breath hold time or shuttle walk distance . In the qualitative element , 8 patients from the singing group were interviewed . Positive effects on physical sensation , general well-being , community/social support and achievement/efficacy emerged as common themes . 150 participants in open workshops completed a question naire . 96 % rated the workshops as " very enjoyable " and 98 % thought the workshop had taught them something about breathing in a different way . 81 % of attendees felt a " marked physical difference " after the workshop . ConclusionS inging classes can improve quality of life measures and anxiety and are viewed as a very positive experience by patients with respiratory disease ; no adverse consequences of participation were observed . Trial Registration Current Controlled Trials - IS RCT N17544114 Objective The purpose of this experimental study was to supplement and exp and on clinical research demonstrating that the provision of social support is associated with lower levels of acute pain . Methods Undergraduates ( 52 men and 49 women ) performed the cold pressor task either alone or accompanied by a friend or stranger who provided active support , passive support , or interaction .  Pain perception was measured on a 10-point scale . Results Participants in the active support and passive support conditions reported less pain than participants in the alone and interaction conditions , regardless of whether they were paired with a friend or stranger . Conclusions These data suggest that the presence of an individual who provides passive or active support reduces experimental pain OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity This study explored the impact of group singing on mood , coping , and perceived pain in chronic pain patients attending a multidisciplinary pain clinic . Singers participated in nine 30-minute sessions of small group singing , while comparisons listened to music while exercising . A short form of The Profile of Mood States ( POMS ) was administered before and after selected singing sessions to assess whether singing produced short-term elevations in mood . Results indicated that pre to post difference scores were significantly different between singing and control groups for only one of the 15 mood variables ( i.e. , uneasy ) . To test the longer term impacts of singing the Profile of Mood States , Zung Depression Inventory , Pain Self-Efficacy Question naire , Pain Rating Self-Statement , and Pain Disability Question naire were administered immediately before and after the singing sessions . All inventories other than the POMS were re-administered 6 months later . One-way ANCOVAs indicated that participants who attended the singing sessions showed evidence of postintervention improvements in active coping , relative to those who failed to attend , when preintervention differences in active coping were controlled for . While the singing group showed marked improvements from pre to postintervention on all mood , coping , and perceived pain variables , these improvements were also observed among comparison participants . The results of this study suggest that active singing may have some benefits , in terms of enhancing active coping , though the limitations of the study and small effect sizes observed suggest that further research is required to fully explore such effects OBJECTIVE Deep and slow breathing ( DSB ) techniques , as a component of various relaxation techniques , have been reported as complementary approaches in the treatment of chronic pain syndromes , but the relevance of relaxation for alleviating pain during a breathing intervention was not evaluated so far . METHODS In order to disentangle the effects of relaxation and respiration , we investigated two different DSB techniques at the same respiration rates and depths on pain perception , autonomic activity , and mood in 16 healthy subjects . In the attentive DSB intervention , subjects were asked to breathe guided by a respiratory feedback task requiring a high degree of concentration and constant attention . In the relaxing DSB intervention , the subjects relaxed during the breathing training . The skin conductance levels , indicating sympathetic tone , were measured during the breathing maneuvers . Thermal detection and pain thresholds for cold and hot stimuli and profile of mood states were examined before and after the breathing sessions . RESULTS The mean detection and pain thresholds showed a significant increase result ing from the relaxing DSB , whereas no significant changes of these thresholds were found associated with the attentive DSB . The mean skin conductance levels indicating sympathetic activity decreased significantly during the relaxing DSB intervention but not during the attentive DSB . Both breathing interventions showed similar reductions in negative feelings ( tension , anger , and depression ) . CONCLUSION Our results suggest that the way of breathing decisively influences autonomic and pain processing , thereby identifying DSB in concert with relaxation as the essential feature in the modulation of sympathetic arousal and pain perception Current evidence suggests that participatory arts activities , and particularly group singing , may contribute to the well-being of older people . However , there is currently a paucity of prospect i ve research from 
    Output:
    
There is a positive trend of singing interventions reducing pain intensity , but more equivocal support for reductions in pain interference and depression .
Group singing appears to have potential to reduce pain intensity , pain interference and depression ; however , we conclude there is only partial support for singing on some pain outcomes based on the limited available evidence of varied quality .
Group singing may be an effective and safe approach for reducing persistent pain and depression in people with long-term health conditions