EXERCISE SCIENCE AND THE SINGING VOICE

by

Nicholas Nesbitt

Submitted to the faculty of the

Jacobs School of Music in partial fulfillment
of the requirements for the degree,
Doctor of Music
Indiana University
May 2023
 Accepted by the faculty of the
Indiana University Jacobs School of Music,
in partial fulfillment of the requirements for the degree
Doctor of Music

Doctoral Committee

_________________________________________
Brian Gill, Research Director/Chair

_________________________________________
Jane Dutton

_________________________________________
Mary Ann Hart

April 14, 2023

ii
 Table of Contents

List of Diagrams iv

List of Tables v

List of Supplemental Materials vi

Chapter 1: Developing and Maintaining a Voice-Conscious Fitness Routine 8

Chapter 2: Fitness Training Elements: Cellular Energy, Principles of Exercise, and Training

Modalities 17

Chapter 3: Application of Fitness Principles to Voice Training 34

Chapter 4: Breathing Exercises 63

Appendix 1: The Vocal Athlete 85

Bibliography 92

iii
 List of Diagrams

Diagram 1.1 - Diet and Physical Activity, Health Promotion, and Disease Prevention Across the

Lifespan 12

Diagram 3.1 - Morphology of the Vocal Folds 59

Diagram 4.1 - Glossopharyngeal Breathing Technique 64

iv
 List of Tables

Table 4.1 - Respiratory Muscle Trainers Reviewed 74

Table S.1 - Characteristics of muscle fiber types found in the larynx. 89

v
 List of Supplemental Materials

PAR-Q+ 80

Evidence Based Exercise Recommendations 82

vi
 The Need for Exercise Science in Singing

There are many questions surrounding the topic of exercise and singing. How are the

muscles of the larynx and tissues of vocal folds impacted by various forms of physical exercise?

Are there specific types of exercises which should be considered dangerous for the voice? Are

there physical exercises which could be advantageous for singers to perform to optimize their

voice training? Which exercises are the most beneficial for singers? With the advent of Opera

broadcasts in HD, classical singers face new pressures to conform to industry-imposed beauty

standards. Sedentary lifestyles and rising obesity rates demonstrate additional challenges for

singers attempting to achieve fitness goals. The discussion of physical fitness, athleticism, and

weight loss in classical singing has received a considerable surge of interest within the past

decade. For example, a cursory search performed in the archives of Classical Singer Magazine

with the keyword “Athletic” yielded 59 results. 37 of 59 articles appear in the past decade, 34 of

which deal specifically with weight loss, fitness, or health. Unfortunately, these articles are

confusing and often provide contradictory information. Further obfuscation arises from general

internet searches, which reveal highly varied and often contradictory opinions about athletic

training and its impacts upon the voice. Singers attempting to find voice-appropriate physical

exercise solutions may encounter and be misled by conflicting opinions, pseudoscience, outdated

information regarding exercise and the voice. The need for evidence-based research on the topic

of the impacts of physical fitness on the singing voice is clear.

While some individuals choose to, as a last resort, take drastic actions and undergo

invasive surgeries as a means to lose weight, there are numerous sustainable, non-invasive

components to weight-loss, health, and fitness. The term ‘vocal athlete’ has been a popular

buzzword within the classical singing community in recent years. It has been used as a means to

explain voice training using exercise-science terminology, in that a singer’s vocal training should

be treated like that of an athlete. This document will explore how athletic training and physical

1
conditioning can be used in parallel with voice. Specifically, this document will explore health

and wellness and how to develop consistent habits to motivate a physical fitness routine; how

underlying metabolic processes govern different exercise modalities; how exercise modalities

impact the body and the voice; and also, how specific exercises can improve the systems which

directly impact the voice, such as the cardiorespiratory system.

While recent pushback against fat shaming and physical/aesthetic biases within the opera

industry portend positively for singers, these pervasive practices still exist. 1 While a somewhat

dated example, the infamous case of Deborah Voigt’s 2004 firing from the Royal Opera House’s

production of Ariadne auf Naxos at Covent Garden. Voigt was removed from the production over

concerns that she would be unable to fit into her costume, a black cocktail dress. In an interview

with the New York Times, Voigt professes that she had struggled with disordered eating habits

and was unable to diet successfully on her own. As a result, she underwent invasive gastric

bypass surgery as a means to shed her weight and conform to industry pressure, explaining that

she “had no choice.” 2 On the other hand, two recent singers who benefitted professionally from

physical aesthetics are Nathan Gunn and Keith Miller. These are “aesthetically pleasing” singers

whose muscle striations have drawn perhaps as much or more attention as the vibrations from

their vocal folds. Certainly, these two have benefitted professionally from their physical

appearances and their athletic physiques. Is it possible that Gunn and Millers’ athletic training

somehow inhibited their vocal technique? A relatively common concern is that engaging in

athletic activities such as weightlifting will inevitably be a detriment to vocal quality, power, and

1. Zach Finkelstein, “Fat-shaming. Bullying. Is Anyone Protecting Our Young Singers?”

The Middleclass Artist, April 5, 2021, https://www.middleclassartist.com/post/fat-shaming-
bullying-is-anyone-protecting-our-young-singers.

2. Anthony Tommasini, “With Surgery, Soprano Sheds a Brünnhilde Body,” The New
York Times, March 27, 2005, http://nyti.ms/1hV4hlo.

2
sustainability. 3 Thorough examination of existing scientific literature may hopefully dispel the

unnecessary myths, but also provide data-driven evidence about potential pitfalls singers should

be aware of before dedicating themselves to diet and exercise programs. Guided by this

information, it is the view of this author that vocal and systemic fitness can form a symbiotic

rather than adversarial relationship.

Many singers find physical fitness to be an elusive, if not impossible feat to achieve. One

of the most prevalent and damaging stereotypes of classical singers is that obesity is

commonplace or perhaps even a requisite for a career as a classical singer. Within the general

public, the stereotype of “the fat lady” still hangs on. There are countless general internet queries

asking the question, “Why are opera singers obese?” One of the most common images in popular

culture is the amply contoured Brünhilde wearing a horned Viking helmet. Further cementing

this stereotype are colloquialisms such as, “It ain’t over till the fat lady sings.” There are also

countless examples of obese classical singers; Luciano Pavarotti, Montserrat Caballé, Jane

Eaglen, to name a few. Marylin Horne discussed the issue of obesity with New York Times

writer, Stephen E. Rubin. Horne Said, “People don't realize it, but ours is a very lonely

profession… We're alone a lot, either resting or preparing, and eating is company. It's possible,

that maybe our extra girth is like having company, too.” 4 There may be some merit to this

stereotype. Even with many recent examples of athletically toned classical singers, there are

many who struggle with obesity. It is important to note that obesity rates in classical singers may

likely correlate more broadly to increased obesity rates in the general population. According to

the CDC, obesity rates in the adult population have steadily increased in the United States over

3. Barbara Doscher, The Functional Unity of the Singing Voice. 2nd ed. (Lanham,
Maryland & London: Scarecrow Press, 1994), 255.

4. Stephen E. Rubin, “NOW IT'S DO-RE-MI; ‐FAT; Pavarotti the Thin? Well, he's
thinner.; Post‐diet Callas, 1955, a wispy 120,” New York Times, February 12, 1978, Accessed
May 8, 2022, https://www.nytimes.com/1978/02/12/archives/now-its-doremi-fat.html

3
the past 20 years. From 1999 to 2015, general obesity rates in the adult population of the United

States adults had risen from 30.5% to 36.5%. 5 This statistic is in stark contrast to increasing

fitness demands emanating from the classical singing industry over the same time period.

The primary goal of this study is to explore and better understand the impacts of physical

exercise on the various anatomical structures involved in singing. Many recent publications

(Leborgne and Rosenberg, Friedlander, etc.) approach voice training from an exercise science, or

sports training perspective. Exercise science has served to optimize physical training and has

undoubtedly led to increasing peak performance of competitive athletes. This information also

has impacted guidelines for the general public. Without engaging with the idea that singers

should be thought of as athletes, voice pedagogy guided by current scientific research has helped

to answer enduring questions about voice training and also has helped teachers and practitioners

optimize voice training and performance practice in the same fashion that exercise science has

allowed athletes to reach peak performance. Being fitness-conscious can sometimes play a role

for business-savvy classical singers. However, due to the precise and nuanced nature of classical

vocal technique as well as the delicate tissues of the larynx, singers have special circumstances

that require a more thoughtful examination of the benefits and potential dangers of different

exercise modalities. The primary goal of any athletic training regimen for singers should be at a

minimum the preservation and, ideally, the improvement of the vocal mechanism. Athletic and

aesthetic considerations for singers should be designed to supplement overall vocal health and

development. Because there remain significant gaps in the scientific literature pertaining to the

demands of specific exercises on the voice, caution is advised where lack of evidence exists.

5. Cynthia Ogden, Margaret Carroll, Cheryl Fryar, and Katherine Flegal, “Prevalence
of Obesity Among Adults and Youth: United States, 2011–2014,” National Center for Health
Statistics 219, (November 2015): 6, Accessed October 23, 2017,
https://www.cdc.gov/nchs/data/databriefs/db219.pdf.

4
 There are myriad opinions on the impacts of physical fitness on the singing voice, yet

many of these opinions are not rooted in, or sometimes run-in opposition to what has been

observed through scientific inquiry. Here are several examples which will be explored in later

chapters: simultaneous running and singing are advantageous for singers; strength and resistance

training will introduce postural impediments which negatively impact singing; and toned muscles

inevitably will create tense voices.

Besides common opinions, there are many myths and unfounded claims which have also

been passed down in traditional classical singing pedagogy. Some of these may have had

practical application, or at the very least, seemed credible at the time they were written, yet have

been thoroughly disproved by modern science. The following examples represent this particularly

well; they may have helped singers sing better at one point in time, and might positively impact

training in specific circumstances- but are not rooted in any physiological reality. Example 1:

Enrico Caruso wrote, “One should breathe with the back of the lungs as well as with the front.” 6

Perhaps this image could be helpful as it presents a focal point for our perceived breathing, that

may help one achieve a fuller breath. However, armed with an understanding of the anatomy and

physiology of the respiratory system, specifically the lungs, we find there is no physiological or

anatomical reality in this imagery-based suggestion. Example 2: Caruso wrote, “In learning to

breathe it is well to think of the lungs as empty sacks, into which the air is dropping like a weight,

so that you think first of filling the bottom of your lungs, then the middle part, and so on until no

more air can be inhaled.” 7 Perhaps it is less egregious, as Caruso at least says “think of,” and then

continues to describe a specific image that may have been helpful to his breathing technique.

However, when judging this claim critically, it is apparent this isn’t based on physiological

6. Enrico Caruso, and Luisa Tetrazzini, Caruso and Tetrazzini on the Art of Singing,
(New York: Metropolitan Opera Company, 1909): 14.

7. Ibid., 14.

5
reality. Sometimes teachers use imagery which can run contrary to physiological reality, but may

achieve the desired result. However, it is crucial for a teacher to be informed of the physiological

realities. To change the wording of Caruso’s maxim from “lungs” to “balloon,” perhaps we start

to see his theory begin to break down. “When inflating a balloon, it is important to inflate the

back of the balloon as well as with the front.” It becomes quite apparent his claim, though

perhaps a colorful image, doesn’t describe the physical realities; humans do not have the capacity

to consciously or unconsciously direct the flow of air into the front or the back of their lungs.

Use of imagery and focusing on this impossible task may have allowed Caruso to take an optimal

breath for his anatomy and physiology. Yet, there is no scientific basis in these maxims. What we

have since discovered about the physiology and physics of breathing differs substantially from

these claims. Also worth noting is that recent studies demonstrate the wide inter-subject

variability of breathing strategies employed by professional singers and that breathing technique,

it turns out, isn’t one-size-fits-all. 8 Further still, recent studies observing breathing patterns and

rating a subject’s perception of them have shown observable reality often differs from an

individual’s perception of how breathing strategies are being employed. Watson and Hixon wrote,

“Subjects' descriptions of how they thought they breathed during singing bore little

correspondence to how they actually breathed.” 9

A clear understanding of the anatomy and physiology of the structures related to singing

would help ground singers and singing teachers in the reality of how our bodies and our voices

function. Further, being informed by the physiological changes associated with exercise might

help singers and teachers better implement athletic training programs and avoid giving

uninformed exercise advice. It can be difficult to effectively evaluate claims made about the

8. Peter Watson and Thomas Hixon, “Respiratory Kinematics in Classical (Opera)

Singers,” Journal of speech and hearing research 28 no.1 (1985): 104,
doi:10.1044/jshr.2801.104.

9. Ibid., 104.

6
confluence of exercise and singing without a working knowledge of the types of exercises that

can be performed and a detailed understanding of anatomy and physiology. Many maxims in the

tradition of classical singing were coined before there was sufficient scientific evidence to

establish the anatomical and physiological realities. The knowledge we have now enables us to

better evaluate claims which were derived from the perceptions of an individual practitioner’s

unique proprioceptive awareness, like Caruso’s breathing technique. Perhaps imagery-based

teaching is useful for some students, but it likely will not work for every individual. Developing a

baseline understanding of the systems involved in singing and how they function can assist

singing teachers and their students to better understand how the individual's unique

proprioception is linked to scientific reality.

7
 Chapter 1: Developing and Maintaining a Voice-Conscious

Fitness Routine

1. Fitness Wellness and Motivation

This chapter will provide some information about developing consistent habits and the

development of a sustainable exercise routine for singers. Exercise, of course, plays an integral

role in living a longer, healthier life. A 2018 study from the CDC states, “inadequate levels of

physical activity were associated with an increased risk of premature death.” 10 Barbara Bushman

writes for the American College of Sports Medicine that knowing and understanding the benefits

of a physical activity and healthy lifestyle “does not always translate into making healthy

choices.” 11 Developing sustainable and healthy nutrition habits is another important factor to

consider. Knowing that proper nutrition and exercise can improve health outcomes and overall

wellness is different from enacting a specific plan of action around fitness and nutrition. Moving

from theoretical understanding of the benefits of physical fitness to an individualized and

sustainable plan of action can be challenging for many individuals. There are an overwhelming

number of choices when deciding on a nutrition and workout plan, not to mention the latest fads

or internet advertisements. For interested individuals who may be struggling to become motivated

or unsure where to start, there are countless research-based resources. ACSM’s Complete Guide

to Fitness & Health is recommended by this author as a good starting point for people new to

fitness and exercise. This resource provides general information regarding motivation for exercise

10. Carlson, Susan A et al., “Percentage of Deaths Associated with Inadequate Physical
Activity in the United States,” Preventing Chronic Disease 15, no.38 (March 29, 2018): 4,
doi:10.5888/pcd18.170354.

11. Barbara Ann Bushman, Complete Guide to Fitness & Health (Champaign, IL: Human
Kinetics, 2017), 3.

8
as well nutrition guidelines for the general public. Further, this resource provides an overview of

different types of exercises, their benefits, and also provides uncomplicated workout plans which

could be particularly helpful for beginners. Developing sufficient motivation to exercise

consistently can be difficult for many people. Every individual is motivated differently and has

different circumstances which may inhibit their ability to train consistently. For singers,

developing a fitness routine which is actionable and vocally sustainable is the ultimate goal.

However, there are many distinct challenges for singers which may prevent consistent habits

including the following factors (and likely many others), including: traveling out of town for

auditions, rehearsals, and performances; irregular schedules causing irregularity of workouts;

finding exercises that don’t impact voice quality; being able to exercise consistently and also

avoid excess fatigue on audition, performance, or rehearsal days; having to prioritize voice

practice over gym time when time is limited.

Fitness is one component of the concept of total wellness, which is defined by Bushman

as simply the “active pursuit of good health.” 12 Singers have added stressors of maintaining vocal

and physical health and reserving energy for the many responsibilities singing requires. The

concept of wellness, as she points out, “reflects physical, emotional, social, intellectual, spiritual,

and occupational aspects.” 13 We make many choices which impact our overall wellness every

day. Each individual experiences different factors and variables which can help or hinder their

ability to set and meet wellness goals and create sustainable habits. 14 Bushman points out that

how we frame our goals is important. She notes that negative framing—exercise as a means to

avoid negative outcomes—is disadvantageous compared to positive framing, or centering our

12. Ibid., 4.

13. Ibid., 4.

14. Ibid., 4.

9
choices more around the intentional pursuit of better health and the benefits we are conferring

when we exercise. 15

In Sports Training Principles, Frank Dick defines fitness as “the level of adaptation to the

stressors of a given lifestyle. It is an essential component in the concept of ‘wellness,’ which

might be defined as a persistent endeavor to achieve the highest probability for total well-

being.” 16 He further elaborates on the factors which contribute to overall wellness, which include:

“fitness, proper nutrition, a positive motivational climate, safety, stress coping strategies,

avoiding substance/alcohol related abuse, critical illness prevention, personal development

ownership, and a balanced lifestyle management (especially time).” 17 For singers, especially,

actively working to balance these factors may lead to a state of increased overall wellness.

Individual assessment of these factors paired with attempts to make wellness-conscious choices

may help individuals develop increased overall wellbeing. Singers must prioritize their career

goals and factor additional time for practice, auditioning, and performance. In terms of how

fitness factors into overall wellness, the benefits of even a little physical activity outweigh the

risks of little to no activity. Later chapters will explore in greater detail specific details about the

impacts of exercise on the body and voice. No matter an individual’s current fitness or wellness

levels, being more active will likely confer some health benefits. 18 Bushman writes,

Research supports the recommendation to sit less as a means to promote health. All-cause
death rates is higher for those who sit more, and that association was found regardless of
how active a person was otherwise. Sitting time has been associated with higher risk for
heart- and metabolic-related issues such as increased waist circumference, poorer insulin
resistance... and changes in cholesterol... Thus, finding ways to infuse more activity into
the day appears to be key. 19

15. Ibid., 3-4.

16. Frank Dick, Sports Training Principles, 5th ed. (London: A&C Black, 2007), 218-19.

17. Ibid., 218-219.

18. Barbara Ann Bushman, Complete Guide to Fitness & Health, 7.

19. Ibid., 7.

10
 There are many factors which impact overall wellness. Diagram 1.1 shows how overall

wellness is influenced and determined over the course of an individual’s lifetime. There are many

factors which impact an individual’s ability to implement diet and exercise into their life. The

positive aspects of focusing on self-care, which includes exercise, cannot be overstated. Physical

fitness appears to be one of the easiest, most cost-effective methods for influencing positive

health and wellness outcomes across the lifetime of the individual. This is especially true for

singers, who often have additional stressors such as job insecurity, the demands of regular vocal

practice, audition stress, rehearsals, performance stress, not to mention industry pressures. Vocal

health is clearly of principal importance for singers. Exercise, mindfully applied, has been

demonstrated to confer positive health benefits. If applied correctly, physical exercise may offer

specific practical benefits to singers. Exercise lowers the risk of many health problems, improves

physical ability across time, and is linked to a reduction in frailty in aging adults. It has also been

clinically demonstrated to improve mental and emotional wellbeing. As stated previously,

regardless of an individual’s current level of physical fitness, incorporation of any additional

physical exercise may yield positive outcomes. 20 Moderation is key, of course. Bushman points

out, “Exercise appears to provide relief from symptoms of depression and anxiety...enhances

well-being and quality of life and is associated with a lower risk of dementia… [and] has the

potential to enhance emotional well-being and improve mood.” 21 There are many psychological

benefits to exercise, and researchers have shown increases in self-confidence, positive body

image, physical relaxation, and also functions as a beneficial distraction. 22 There are many ways

singers can incorporate additional exercise into their routines. Some individuals may prefer some

20. Ibid., 8.

21. Ibid., 8.

22. Ibid., 8.

11
aerobic activity to increase blood flow throughout the body and assist in vocal warmup. Others

may prefer to vocalize before any exercise. The following diagram shows the coaction of

influencers over health outcomes and should be considered by singers. There are a broad range of

factors which can impact an individual’s health and wellbeing over time, and it can be helpful

when making a plan of action to determine what specific influences and factors may be impacting

overall health and wellness. 23

23. Ibid., 3-5.

12
Diagram 1.1 - Diet and Physical Activity, Health Promotion, and Disease Prevention Across the
Lifespan 24

24. “Scientific Report of the 2015 Dietary Guidelines Advisory Committee,” U.S.
Department of Health and Human Services and U.S. Department of Agriculture (2015): 24,
accessed July 26, 2020, http://health. gov/dietaryguidelines/2015-scientific-report/.

13
2. Finite Adaptation Energy

Creating a fitness program that is effective and successful long-term involves

understanding and balancing one’s time, energy, stress related to career, family, social functions,

and individual activities. As Frank Dick notes, “The key to achieving the right strategy is

understanding that there is only one pool of adaptation energy available to cope with cumulative

stressors.” 25 Relating overall fitness to one’s individual lifestyle and habits, and reducing

stressors is one of the keys to motivating a successful exercise routine. However, once a routine

has been established, the benefits are clear. Barbara Bushman writes,

Adults who exercise are better able to handle stress and avoid depression, perform daily
tasks without physical limitation, and maintain a healthy body weight; they also lower
their risk of developing a number of diseases. Exercise continues to be important for
older adults by ensuring quality of life and independence; regular exercise boosts
immunity, combats bone loss, improves movement and balance, aids in psychological
well-being, and lowers the risk of disease. 26

Maintaining wellness and good health is crucial for professional singers. Illnesses such as

the common cold and flu can lead to missed professional opportunities such as auditions,

rehearsals, performances, and ultimately income or career advancement. Regular exercise has

been linked to improved immune system function and has also been shown to improve outcomes

for COVID-19 infections. A 2020 study states:

The benefits of exercise—regular and at appropriate intensity levels—for the immune

system in respiratory infections such as COVID-19 include increased immunovigilance
and improved immune competence, which help in the control of pathogens, a fact that

25. Dick, Sports Training Principles, 220-221.

26. Bushman, Complete Guide to Fitness & Health, 8.

14
 becomes more important considering the immunosenescence and susceptibility of the
elderly population to severe infection. 27

Because of the immunological benefits to regular exercise, singers should strongly

consider including regular exercise as part of their health and wellness practices.

When working towards particular goals, an outcome-oriented approach appears to be less

productive than a process-oriented approach. 28 Kaftan and Freund write, “In a longitudinal study

with overweight women, Freund and Hennecke (2012) found that focusing on the process (dietary

behaviors) rather than on the outcome of dieting (weight loss) is associated with more successful

goal pursuit and achievement.” 29

When pursuing both vocal and fitness goals, focusing on process, rather than outcome-

oriented “end-gaming” could have significant benefits. Kaftan and Freund explain, “When people

perceive the means as particularly instrumental, this not only positively influences their

motivation to pursue a given goal but also how much effort they invest in goal pursuit, and their

performance.” 30

27. Matheus Pelinski da Silveira et al., “Physical exercise as a tool to help the immune
system against COVID-19: an integrative review of the current literature,” Clinical and
Experimental Medicine 21, no.1 (2021): 15-28, doi:10.1007/s10238-020-00650-3.

28. Oliver Kaftan and Alexandra Freund, “The Way is the Goal: The Role of Goal Focus
for Successful Goal Pursuit and Subjective Well-Being,” in Handbook of Well-Being, eds. Ed
Diener, Shigehiro Oishi, and Louis Tay (Salt Lake City: DEF Publishers, 2018): 6,
DOI:nobascholar.com.

29. Ibid., 6.

30. Ibid., 7.

15
3. Benefits of Fitness for Singers

Exercise is compatible with singing in many ways. Beyond the benefits to overall health

and wellness, fitness can improve performance capacity for singers. As an example, when

singing, vocalists utilize their cardiorespiratory systems in a much greater degree than for

everyday speech. Hypothetically, would the same singer who regularly engages in cardiovascular

training and other respiratory muscle training have better or worse breath control than the exact

same singer who didn’t engage in those activities? Later chapters will further explore specific

training modalities as related to voice production. Better understanding of the general benefits of

fitness may motivate some individuals to make a plan of action and implement exercise into their

daily routine. Consistency of training is one of the most important factors for developing systemic

health or making fitness progress. Thankfully, exercise can habit forming. Once consistency of

training is established, quality of exercise becomes more important. It has been demonstrated that

overall physical fitness increases performance capacity; increasing the duration, intensity, and

frequency that a specific activity can be performed. Additionally, physical conditioning of the

heart, lungs, and muscles help with overall physical efficiency and increases muscular strength

reduces overall effort level for performing everyday tasks. 31 Proper motivation and determination

are integral to successfully establishing and maintaining a fitness routine for anyone, including

singers. The next chapters will explore how understanding the underlying principles of exercise

may augment the development and implementation of an optimal fitness routine, leading to

improvements in specific athletic training routines for singers.

31. Keith Saxon and Carole M. Schneider, Vocal Exercise Physiology, (San Diego:
Singular Publishing, 1995), 5.

16
 Chapter 2: Fitness Training Elements: Cellular Energy,

Principles of Exercise, and Training Modalities

1. Cellular Energy, Metabolic Processes and Their Application in Exercise

Science and Voice Training

A more detailed understanding of exercise and training is beneficial to understand how,

on a cellular and metabolic level, our bodies specifically adapt to imposed demands. Different

modes of exercise may impact different metabolic pathways. Understanding of the body’s energy

systems and metabolic processes directly explains how different exercise modalities function. The

cells of laryngeal musculature share the same metabolic pathways as other skeletal muscles, so a

deeper understanding of these processes can be beneficial for singers. Perhaps the most common

discussion about metabolic pathways is the “speed” of the metabolism, or the rate at which our

bodies break down food and convert it to cellular energy. This is often discussed in terms of body

composition and/or body fat percentage. It is important to point out, however, that our bodies

contain multiple metabolic pathways which control the delivery of energy to the cells. This

chapter will serve as a cursory overview to discuss and better appreciate how our bodies function

on a molecular and cellular level, and how different exercise modalities impact these biological

functions.

Understanding the different metabolic systems from which cells draw energy

may be helpful for individuals wishing to implement a balanced and effective training program.

A competitive cyclist and a professional powerlifter are imposing demands upon different

metabolic pathways in their respective exercises. Saxon and Schneider explain that cells have

several metabolic pathways for drawing energy; these pathways consist of the Phosphagen

System (fastest energy source), Glycolysis (medium energy source), and Oxidative

17
Phosphorylation (slowest energy source). 32 Below is a brief overview of how these processes

function.

Phosphagen System

The most quickly and easily accessible energy source in the human body is Adenosine

Triphosphate (ATP) which has been called the “energy currency of life.” 33 ATP is a high-energy

molecule that is produced at the cellular level which is in limited supply and is used very

efficiently by the cell. 34 The metabolic pathway that is associated with this molecule is the

phosphagen system, also known as the alactic anaerobic pathway. 35 When accessing ATP stores,

cells will reserve some ATP to be used in the production of additional energy. Through a

chemical reaction called hydrolysis, cells create energy by cleaving the terminal phosphate

molecule from ATP, thus creating adenosine diphosphate (ADP). 36 Further energy may be

produced when cells remove the terminal molecule in APD to produce adenosine monophosphate

(AMP), which is a “dynamic additive process” where cells may replenish ATP in several ways. 37

For example, cells can recombine ADP and AMP—or other combinations of smaller molecules to

produce ATP. 38 Yet another high-energy phosphate exists within cells called Creatine Phosphate

(CP). 39 CP functions as a reservoir to quickly allow the cell to produce additional ATP. These

32 . Saxon and Schneider, Vocal Exercise Physiology, 15.

33. Dick, Sports Training Principles, 102.

34. Ibid., 102.

35. Saxon and Schneider, Vocal Exercise Physiology, 15.

36. Ibid., 15.

37. Ibid., 15.

38. Ibid., 15.

39. Ibid., 16.

18
energy reserves only allow a muscular cell to produce contractile forces for around 5-10

seconds. 40 In order to produce additional energy, cells must rely on the additional metabolic

pathways, glycolysis and Oxidative Phosphorylation. 41 Heavy weightlifting is a prime example of

use of the phosphagen metabolic pathway. Heavy weightlifting is generally performed through

rapid, vigorous repetitions and sets, which are generally very short in duration, but require a great

amount of energy to perform.

Glycolysis

Another important metabolic process is glycolysis, or the lactic anaerobic pathway.

Through a series of chemical reactions, muscle cells metabolize the molecule glucose and store it

as glycogen, which can be converted into another molecule called pyruvate. The energy released

from this reaction allows the cells to produce additional ATP. 42 Glycolysis is an anaerobic, non-

oxidative process; however, the byproducts of glycolysis can undergo additional changes which

depend on oxygen levels within the cell. For example, Pyruvate will be converted into lactic acid

if there is insufficient oxygen within the cell. During high intensity anaerobic training, this

buildup of lactic acid is one of the key components of muscular fatigue, and one of the reasons

individuals feel their muscles “give out” or “fail” during resistance training. 43 The other main

factor involved in muscular fatigue is the depletion of phosphocreatine. 44 If there is sufficient

oxygen within the cell, pyruvate can be converted to acetyl coenzyme A (acetyl-coA), which

40. Ibid., 16.

41. Ibid., 16.

42. Ibid., 20-21.

43. Ibid., 21.

44. Ibid., 20-21.

19
enters the citric acid cycle, a crucial energy-carrying pathway within the aerobic metabolism. 45

Pyruvate may also be reconverted into glucose in the liver, or released unchanged into the

bloodstream. 46

Oxidative Phosphorylation

Oxidative Phosphorylation is a metabolic pathway in which nutrients are metabolized by

a cell using a process called oxidation. This is the primary metabolic process involved in

cardiovascular exercises. This pathway is aerobic and requires oxygen for the chemical

resynthesis of ATP. 47

To summarize, the Phosphagen system is the most immediate energy source, but also the

most limited supply of energy. Glycolysis is an anaerobic metabolic pathway producing energy

when nutrients and oxygen are insufficient for oxidative phosphorylation, or when an increased

supply of ATP is present. All exercise begins with the phosphagen anaerobic metabolism.

Depending on the activity level and duration however, the aerobic oxidative phosphorylation

pathway will become the primary source of energy for muscle cells if exercise is continued for

more than a few seconds. 48 Mary Sandage points out, this is the case because there are more

energy pathways available for oxidative phosphorylation:

Oxidative mechanisms of energy production allow more energy to be liberated from a

glucose molecule than from glycolytic energy production because the breakdown of
glucose is longer and more involved, which ultimately yields more ATP: 36 molecules of

45. Ibid., 20-21

46. Ibid., 20-21.

47. Ibid., 22.

48. Ibid., 22.

20
 ATP in oxidative phosphorylation versus two molecules of ATP in non oxidative energy
production. 49

Sandage also explains that, “Bioenergetic pathways also work synergistically to meet the

muscle activity requirements.” An endurance athlete, relying primarily on the oxidative

phosphorylation, can tap into glycolytic reserves when climbing a hill, or sprinting to the finish. 50

Another important point is how muscle fiber types are directly linked to metabolic

pathways. Different activities will train different metabolic processes, which impose specific

demands upon different muscle fiber types. Lee et al. explain that different types of training will

cause muscle cells to adapt to the imposed demands, and can cause muscle type conversion,

which can change the density and concentration of different muscle fiber types. 51 Lee et al. also

mention that muscle cells fibers consist of “type I (oxidative slow-twitch), type IIa (oxidative fast

twitch) and type IIx (glycolytic fast-twitch) fibers in humans.” 52 They explain the process of fiber

type transition by stating,

Adult skeletal muscle undergoes conversion between these fiber types in response to
exercise. Endurance training induces the transition from fast-twitch muscle fiber to slow-
twitch muscle fiber, whereas strength training results in slow-twitch to fast-twitch muscle
fiber transition. 53

49. Mary Sandage, and Audrey G Smith, “Muscle Bioenergetic Considerations for
Intrinsic Laryngeal Skeletal Muscle Physiology,” Journal of Speech, Language, and Hearing
Research 60, no.5 (2017): 1254, https://doi.org/10.1044/2016_JSLHR-S-16-0192.

50 Ibid., 1255.

51. Ibid., 364.

52. Seo-Ho Lee, Byung-Ju Kim, Dae-Ryoung Park, and Uh-Hyun Kim, “Exercise
Induces Muscle Fiber Type Switching via Transient Receptor Potential Melastatin 2-Dependent
Ca2+ Signaling,” Journal of Applied Physiology 124, no. 2 (February 1, 2018): 364,
https://doi.org/10.1152/japplphysiol.00687.2017.

53. Ibid., 364.

21
 Understanding that the specific exercise we perform causes our cells to specifically adapt

to the imposed demands is crucial to understanding exercise on a fundamental level.

2. Fundamental Principles of Exercise Science

a. Progressive Overload: Frequency, Intensity, Time, And Type

One of the most important foundational principles in exercise science details how

muscles adapt to changes in training stimuli. This is called the Specific Adaptation Principle, or

Specific Adaptation to Imposed Demand (SAID), which Wendy Leborgne and Marci

Rosenberg have defined in the following excerpt:

Muscles, if trained in the appropriate manner, will undergo muscle fiber changes in
addition to neural and metabolic changes resulting in an adaptation to the new demand
imposed upon them. This concept is referred to as Specific Adaptation to Imposed
Demand (SAID). 54

Understanding how and why specific adaptations occur may provide further insight into

how skeletal muscles adapt to imposed demands and how to optimally train our bodies for

specific tasks. Understanding that muscles will adapt under specific circumstances is important

for developing sustainable exercise programs. The most important question is how to most

optimally stimulate these adaptations. Sustainability and reproducibility are crucial components

to understanding the goal of SAID. While SAID states that muscles adapt to imposed demand,

there are several foundational principles of exercise science that further explain how to most

optimally exercise. The ACSM recognizes the following as the foundational principles of sports

54. Wendy Leborgne and Marci Rosenberg, The Vocal Athlete, (San Diego: Plural
Publishing, 2014), 245

22
training: overload, reversibility, progression, individualization, periodization, and

specificity. 55

The Overload principle dictates that “you cannot train a muscle without demanding more

from it than it is used to giving.” 56 Muscles will adapt to a certain workload. However, if the

workload remains constant, muscles will eventually achieve homeostasis (equilibrium) and will

not adapt further. In order to achieve a desired physiological adaptation, muscles must be trained

by progressively overloading them, or imposing a specific demand upon them which increases

over time. Prescribing an achievable challenge in order to mitigate injury risks is key to

implementing this principle. Attempting exercises which are too difficult for an individual will

increase injury risk and should be modified or avoided. Later chapters discuss how to find the

right level for training difficulty.

The Reversibility (detraining) principle dictates that muscles will return to pre-training

levels of function if the demands placed on them decrease or stop. Kory Kasper writes for ACSM

that the “withdrawal of tissue loading results in loss of beneficial fitness/performance

adaptations.” 57 “If you stop training for two weeks, exercise science research suggests that it

could take up to four weeks to reacquire post-training gains.” 58

The Progression principle dictates that in order to continue to stimulate training

adaptation, training stress must be increased gradually over time in order to maintain tissue

55. Korey Kasper, “Sports Training Principles,” Current Sports Medicine Reports 18, no.
4 (2019): 95-96.

56. Saxon and Schneider, Vocal Exercise Physiology, 47.

57. Kasper, “Sports Training Principles,” 95.

58. Mary Sandage and David D. Pascoe, “Translating Exercise Science into Voice Care,”
Perspectives on Voice and Voice Disorders 20, no.3 (2010): 84-89.

23
overload. 59 Muscles must be challenged beyond what they are used to doing. Increases will

largely depend on individual factors and skill level. Novice and detained individuals will likely

see a faster increase in growth when implementing optimal plans than intermediate and advanced

individuals.

Individualization dictates that training should be modified to “account for an athlete’s

unique capacity for and response to training.” 60 A strength program would necessarily differ for a

beginning or advanced individual in terms of types of exercise prescribed, exercise intensities,

weight and repetition ranges, and periodization. Also, physiological components (genetic, age,

current level, training and injury history), psychological, environmental (habits, nutrition, sleep),

and genetic factors should be considered when implementing training routines. 61

Periodization describes the way that a training routine is structured over time. Different

sports, physical activities require specific training components to effectuate the best outcome

during a performance, and to minimize training risks in the off season. Cycles (micro, meso, and

macro) of training are often implemented to reduce overtraining, injury risk, and burnout during a

training season.

The Specificity principle states that “training must be designed to appropriately target the

specific muscle or muscle group with the intended skill or task.” 62 While there may be general

carryover from one physical task to another, in order to improve an exercise or skill, one must

train in that specific exercise or skill. Leborgne and Rosenberg write, “…consider two activities

59. Kasper, “Sports Training Principles,” 95.

60. Ibid., 95.

61. Ibid., 95.

62. Leborgne and Rosenberg, The Vocal Athlete, 245-6.

24
of running and cycling. Both tasks require the use of the majority of the muscles in the leg, but

training one (running) does not automatically make one skilled in the other (cycling).” 63

b. Components of Training

Additionally, there are several training components which, when utilized in a meaningful

way, optimize the adaptation of muscles during exercise. These involve frequency, intensity, time

(duration), and type of exercise, (FITT), which are described below. 64 The components of training

detailed below specify various means of training and adapting muscles. These components are

combined to achieve proper progressive overload of muscles during physical exercise.

Frequency: This component determines how many times per week you train a given

exercise. The American College of Sports Medicine advocates training at least three days a week

for any exercise regimen is recommended to receive adequate conditioning results. Muscles can

be overused, however. Moderation is advised. Saxon and Schneider discuss overtraining related

to aerobic exercise, “Training 6-7 days a week, for example, provides minimal additional training

improvement and greatly increases the risk of overuse injury.” 65 Also important to note is that

different exercises require different training frequencies. Leborgne and Rosenberg write,

Recommended frequency and duration of muscle training for flexibility are 3 to 7 days
per week with emphasis on holding a given stretch for 15 to 60 seconds. Muscle training
for strength… involves 2 to 3 days per week with emphasis on muscle overload
completing 8 to 12 repetitions for 1 to 3 sets. 66

63. Ibid., 246.

64. Leborgne and Rosenberg, The Vocal Athlete, 245.

65. Saxon and Schneider, Vocal Exercise Physiology, 56.

66. Leborgne and Rosenberg, The Vocal Athlete, 248.

25
 Intensity: is the amount of effort applied in training and is a crucial component for the

successful overload of muscles. If the intensity of an exercise is too easy and places no

mechanical or metabolic strain on an individual, no specific adaptations will occur. 67

Time: is the duration of time one spends doing a particular exercise. It is an important

variable, as it may be used to promote specific adaptations by progressively increasing the

68
duration of exercise over several weeks.

Type: of exercise is self-explanatory; it is the selection of certain exercises to achieve a

specific adaptation. Different forms of exercise will achieve different results, and create different

specific adaptations. Cycling and running are examples of different types of physical exercise.

3. Fitness Training Modalities

This next section will explore the different types of exercise which individuals can focus

on. However, before engaging in physical exercise, ensure you are not at risk of injury or medical

complications. A helpful resource for assessing these risks is the ACSM’s Physical Activity

Readiness Questionnaire for Everyone (PARQ+) (Supplemental Materials), which may help

individuals assess whether a given exercise program is appropriate. This is a pre-screening

questionnaire which issues guidelines to any individual weighing their current health risks prior

to beginning exercise activities. If individuals identify any potential risks, the PARQ+ provides

guidelines and resources for consulting with a fitness professional or physician about pursuing or

continuing an exercise program. 69

67. Saxon and Schneider, Vocal Exercise Physiology, 60.

68. Ibid., 59.

69. Bushman, Complete Guide to Fitness & Health, 19-20.

26
 Training routines and specific results of physical exercise will necessarily be

individualized. Specific health, fitness, or professional goals may determine the kinds of athletic

training individuals undertake. There are myriad approaches to ‘getting fit,’ of course. Some

individuals may prefer walking, cycling, or swimming. Others may prefer sports, or weightlifting.

Personal enjoyment and meeting individual goals are highly variable. However, it is important to

note the benefits and potential concerns related to specific exercise modalities’ impacts on the

body. As a guideline for general fitness and wellness, Barbara Bushman writes, “Each

component—aerobic, muscular, flexibility, and neuromotor exercise training—is important and

should be considered. Although you may have a slightly different focus than someone else, to

meet your own personal health or fitness goals, you need to address each of these fitness

components.” 70

Bushman’s guidance is intended for the general populace. As discussed previously in this

chapter, different training programs utilize and train different metabolic processes. This means

that different exercise modalities will train different metabolic pathways. Cardiovascular exercise

utilizes the aerobic pathways and oxidative phosphorylation. Resistance training will spur specific

adaptations in the anaerobic and non-oxidative pathways. If individuals are training to

specifically optimize muscular strength, there may be negative interactions by concurrent

endurance training. Specific circumstances arise in which aerobic and anaerobic training,

undertaken concurrently, can have negative impacts on fitness progression of each respective

exercise. An article published in Medicine & Science in Sports & Exercise states that training

both endurance and strength exercises concurrently may be ineffective and, in some cases,

counterproductive. 71 Understanding the constraints–that there is limited energy for specific

70. Ibid., 26.

71. Gustavo Nader, “Concurrent Strength and Endurance Training: From Molecules to
Man,” Journal of Medicine & Science in Sports & Exercise 38, no.11 (2006): 1965.

27
adaptations upon the metabolic pathways during athletic conditioning–is crucial for establishing

effective training goals. Ingo Titze writes, “A sprinter or weightlifter, for example, would not

want to perform long endurance exercises if peak muscle force over short periods of time is the

target. Conversely, a long-distance runner would engage in endurance activity rather than short-

burst activity to achieve optimal performance.” 72

This is due to the different metabolic systems being used to train each respective exercise

and the way in which muscle fibers are adapted as a result. Weightlifting places demands on the

Phosphagen (alactic anaerobic pathway) and glycolysis pathways (lactic anaerobic pathway),

while marathon running places principle demands upon the oxidative phosphorylation pathway

(aerobic pathway). There are several studies which have revealed certain conditions which help to

mitigate the potential negatives of concurrently training aerobic and anaerobic exercise. For

example, the demands placed on these different metabolic pathways means that muscles will

effectively adapt to specific methods of training. Gustavo Nader writes, “Strength and endurance

training produce widely diversified adaptations, with little overlap between them. Strength

training typically results in increases in muscle mass and muscle strength. In contrast, endurance

training induces increases in maximal oxygen uptake and metabolic adaptations that lead to an

increased exercise capacity.” 73 Further elaborating on the difference between muscle fiber

adaptations, Ingo Titze discusses the difference in muscle fiber types, as well as the metabolic

processes of each type.

Muscle fibers are typed according to contraction and resistance to fatigue. Some are slow
in response and high in fatigue resistance, others are fast in response and low in fatigue
resistance… Different metabolic processes are responsible for the achievement of these
different fiber types. Slow-contracting and fatigue-resistant fibers have oxidative

72. Ingo Titze, The Principals of Voice Production, (Upper Saddle River: Prentice-Hall,
1994), 44.

73. Gustavo Nader, “Concurrent Strength and Endurance Training: From Molecules to
Man,” 1965.

28
 metabolism, fast-contracting and less fatigue-resistant fibers have glycolytic
metabolism… 74

As individuals embark on an exercise program, it is important to understand specific

effects of training. In Sports Training Principles, Frank Dick expresses the results of training into

three phases, immediate, residual, and cumulative effects. He writes,

1.The immediate effect of training is the body’s reactions to the stressor of the training
stimulus. They include increased heart rate, perspiration, increased blood lactate,
heightened endocrine system involvement and fatigue. This is the catabolic effect of
training. 75

2. The residual effects of training are considered the body’s recovery and preparation
response. Raised general metabolism for some time after exercise. During this time the
body’s resting state is restored with the waste products of energy expenditure removed,
and other stressor-related effects gradually eliminated. The preparation response is seen
in the heightened level of adaptation to further training stimuli. 76

3. Cumulative effect of training is the body’s progressive adaptation through the

preparation response. This is what is measured in fitness monitoring tests over a period of
months or even years. 77

Understanding the differences of each metabolic pathway and how the body adapts to

exercise allows for a more effective approach to establishing physical training goals. A balanced

approach to fitness which will be beneficial for most individuals incorporates a combination of

aerobic and anaerobic exercise. The American College of Sports Medicine recently published a

comprehensive study with prescriptive fitness training guidelines for the general healthy-adult

population (see Supplemental Materials). 78 These guidelines may be an excellent starting point

74. Titze, The Principals of Voice Production, 45.

75. Dick, Sports Training Principles, 225.

76. Ibid., 225.

77. Ibid., 225.

78. Carol Garber et al., “Quantity and Quality of Exercise for Developing and
Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy
Adults: Guidance for Prescribing Exercise,” Medicine & Science in Sports & Exercise 43, no. 7
(2011): 1336.

29
for the general populace, although none of these modalities were specifically focused on the

professional (and aspirational) singing populations. This study also doesn't prescribe specific

workout routines, but provides general guidelines to follow to promote better overall physical

fitness for the general public. The ACSM recommends each of the following exercise modalities:

cardiorespiratory exercise, resistance training, flexibility exercise, as well as neuromotor exercise

training. While they do not provide specific forms of exercise and leave some room for general

interest, the ACSM has prescribed specific exercise parameters: frequency, intensity, time, type,

volume, pattern, and progression. This document by the ACSM was “designed for professionals

who counsel and prescribe individualized exercise to apparently healthy adults of all ages.” 79 The

next section will discuss specific training modalities and their impacts on overall health.

4. Aerobic Exercise

Aerobic exercises are supplied primarily through the oxidative phosphorylation metabolic

processes. This form of exercise is generally referred to as endurance training or ‘cardio.’ Prime

examples of aerobic exercise include swimming, cycling, and jogging. The physiological effects

of cardiorespiratory endurance training are well researched and include decreases in resting heart

rate, submaximal exercise heart rate, and lowered blood pressure. 80 Increases in cardiorespiratory

fitness also decrease risk of heart disease and all-cause morbidity. 81 Regular aerobic training also

has been shown to increase heart size and volume, blood volume in total hemoglobin, cardiac

79. Ibid., 1334.

80. Saxon and Schneider, Vocal Exercise Physiology, 106.

81. Bushman, Complete Guide to Fitness & Health, 79.

30
stroke volume, maximal cardiac output, VO2 max, oxygen extraction from the blood, and also

increased total lung volume. 82

As stated previously, ensuring that an individual is healthy enough to undertake a desired

form of physical exercise is important. If there are any concerns for an individual’s health or

safety, before undertaking a cardiovascular exercise program, consult the ACSM’s PARQ+

questionnaire. This assessment questionnaire will help individuals identify any potential risk

factors which could constrain or prohibit certain forms of physical exercise. Once individuals

have been cleared for exercise, it is advised by the ACSM to assess aerobic and cardiovascular

fitness levels before beginning a training routine. One of the easiest ways to determine this is by

measuring resting heart rate beats-per-minute (BPM). Normal adult heart rates range from 60-100

BPM. It is advised to consult with a doctor if your heart rate lies outside this range. 83 VO2max, is

another widely accepted assessment tool to determine aerobic capacity which evaluates maximal

oxygen consumption during exercise. While knowing one’s VO2max isn’t essential in pursuing

better health, it may be helpful for individuals to establish baseline fitness levels. VO2max is best

calculated in a lab setting, but individuals can estimate their VO2max. Using several formulas.

1) VO2 max = 15.3 x (Maximum HR/Resting HR), or the Rockport Fitness Walking

Test (described below). 84

VO2max = 132.853 - (0.0769 x W) - (0.3877 x A) + (6.315 x G) - (3.2649 x T) - (0.1565 x

H)
W = weight (in pounds)
A = age (in years)
G = gender, G = 0 for female, 1 for male
T = time to complete 1-mile walk (in minutes)
H = number of heart beats (in 10 seconds) at the end of the 1-mile walk 85

82. Ibid., 106.

83. Bushman, Complete Guide to Fitness & Health, 82.

84. Ibid. 82.

31
 ACSM lays out the following guidelines for aerobic activity and training:

ACSM recommends that most adults engage in moderate-intensity cardiorespiratory

exercise training for ≥30 minutes a day for ≥5 days a week for a total of ≥150 minutes a
week, vigorous-intensity cardiorespiratory exercise training for ≥20 minutes a day on ≥3
days a week (≥75 minutes a week), or a combination of moderate- and vigorous-intensity
exercise to achieve a total energy expenditure of ≥500-1000MET minutes a week. 86

5. Anaerobic Exercise

Anaerobic exercises are typically high-intensity activities that are powered primarily

through the phosphagen system and glycolysis. Primary examples within this group are sprinting

and weightlifting. Generally, increasing the size, power, and strength of muscle fiber is the

primary objective of Anaerobic training programs. Most experts agree that a balanced fitness

plan, including anaerobic training, is beneficial for most individuals. Barbara Bushman advocates

balancing various forms of exercise, including resistance training and flexibility and range of

motion-based training.

There are several categories of anaerobic exercise to consider, which include: isometric,

isotonic, and isokinetic exercises.

Isometric exercises involve resistance without movement; muscles contract but the

muscle does not shorten or lengthen. Isometric exercise examples include wall sits, planks, glute

bridges, dead hangs, and isometric squats. While certain exercises such as planks are excellent

choices for developing core stability, isometric exercises are somewhat limited in effectiveness

85. Ibid. 82.

86. Garber et al., “Quantity and Quality of Exercise for Developing and Maintaining
Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults:
Guidance for Prescribing Exercise,” 1334.

32
for total body strength development, as working the full range of motion of a particular

joint/muscle group has been shown to be more effective for muscle development. 87

Isotonic training is perhaps the most common form of anaerobic training. It involves

movement of a muscle or muscle group with added resistance. Weightlifting is the prime example

of this exercise. There are many practical guidelines for developing an appropriate weightlifting

program. The American College of Sports Medicine (ACSM) recommends that a strength

training program should be performed a minimum of two non-consecutive days each week, with

one set of 8 to 12 repetitions for healthy adults or 10 to 15 repetitions for older and frail

individuals. 8 to 10 different types of exercise should be performed that target the major muscle

groups. 88

Isokinetic training involves resistance at a constant speed. Stationary bikes, treadmills, or

weight machines are examples of isokinetic training tools. Because a constant and controlled

resistance is applied in isokinetic exercises, they are generally believed to provide consistency

and additional safety as a result. Isokinetic machines are often used in rehabilitation after injury. 89

87. Bushman, Complete Guide to Fitness & Health, 83.

88. Michael Esco, “ACSM on Resistance Training for Health and Fitness,” American
College of Sports Medicine (2013), accessed October, 15 2017,
https://www.acsm.org/docs/brochures/resistance-training.pdf.

89. Saxon and Schneider, Vocal Exercise Physiology, 84.

33
Chapter 3: Application of Fitness Principles to Voice Training

Individual Fitness Goals for Singers

This section will explore how physical fitness training modalities interact with the voice.

Helping vocalists achieve peak performance requires the implementation of optimal training for

each individual coupled with disciplined, mindful practice. Physical exercise provides many

direct and indirect benefits to singers, which this chapter will explore in detail. Specific fitness

goals for singers may require some tweaks to the general guidelines laid out by fitness experts

such as Barbara Bushman, or the ACSM. High level musical training deals routinely with the

development of optimal vocal habits for each individual. Optimal habits for a singer might be

considered those which meet the demands of the musical/artistic style being sung, can be

consistently produced, and are sustainable across time. There is a growing body of evidence

which supports that direct application of metabolic pathway knowledge, principles of exercise, as

well as their accompanying components can have beneficial outcomes for vocalists engaged in

physical exercise routines. For example, Mary Sandage writes, “Foundational to an exercise

program of any type is an understanding of the muscle duration and intensity requirements for the

target activity, consideration of the muscle fiber type and metabolic characteristics, and a skillful

application of muscle training principles to achieve optimal outcome.” 90

Maintaining flexibility and efficiency of the voice and body are crucial for singers

wishing to train and perform at the highest level. 91 As a result, singers will necessarily need to

establish fundamentally different fitness goals and implement different training routines than a

competitive powerlifter, or a professional cyclist. Special considerations must be made in creating

optimal exercise strategies for singers. The next section will explore the potential benefits and

90. Sandage and Smith, “Muscle Bioenergetic Considerations for Intrinsic Laryngeal
Skeletal Muscle Physiology,” 1254.

91. Saxon and Schneider, Vocal Exercise Physiology, 82.

34
potential drawbacks of exercise; and will also address various unsubstantiated claims of which

singers should be aware.

1. Aerobic Exercise

a. Potential Benefits of Aerobic Exercise for Singers

As discussed in previous chapters, the listed physiological changes are certainly

beneficial for overall health and wellness and these adaptations may also prove specifically

advantageous for singers. For example, breath management and oxygen demands are particular

concerns for all singers and improving cardiorespiratory endurance should clearly be a target for

any singer’s physical training program. 92

Improving aerobic capacity, resting heart rate, and overall endurance all have positive

implications for singers, especially in theatrical performance circumstances in which heavy

costumes, intense staging, or choreography may challenge the cardiorespiratory system. Singers

would likely benefit from increasing aerobic performance capacity, and cardiovascular fitness.

Many modern operatic stagings demand higher aerobic capacity to successfully complete than

many traditional, more static stagings, which were once standard practice. Robert Lepage’s 2010

production of Das Rheingold at the Metropolitan Opera demanded much from the singers. Many

of the singers in this production experienced greater physical requirements such as being

suspended from wire harnesses and physically traversing the massive, 45-ton mechanical set

piece, “the machine.” For example, the Rhinemaidens open the opera suspended from harnesses

above the set. Especially when fully suspended in the air, considerable strain would likely have

been placed on the singers’ torsos, increasing to the physical demands of their staging. In the

same production, the character Loge, while also suspended by a wire harness, was staged to walk

92. Ibid., 106.

35
backwards up a steep incline while simultaneously singing. Anthony Tommasini weighed in by

writing,

Even though the set seemed to be working, the cast is clearly distracted by the physical
demands of the production. It was hard not to fear for the feisty tenor Norbert Ernst,
making his Met debut as Loge, when he had to walk backward up steep planks to report
on the approach of the two giants. Why backward? Well, the wire securing him was
attached to his back. There was no way Mr. Ernst could make this moment look natural. 93

b. Potential Drawbacks of Aerobic Exercise for Singers

There are several specific concerns for aerobic training and singing. In a 2009 study,

Sivasankar and Erickson concluded that accelerated breathing for even short periods of time can

significantly increase the minimum level of lung pressure needed to begin and sustain vocal fold

vibration at a specific pitch, or Phonation Threshold Pressure (PTP). The study does also indicate

that the effects of elevated PTP were short lived. 94 For singers performing cardiovascular

exercise, it is important to maintain adequate hydration, and allow sufficient rest time between

physical exercise and vocalizing as elevated PTP may increase the risk of vocal fatigue and

injury. Circumstances where singers are forced to perform intense choreography or physically

active staging could also pose potential risks. Especially during such performances, having an

increased aerobic capacity through athletic training can help singers not feel “winded,” and risk

rough or heavy onsets brought on by increased PTP.

Another potential issue to be aware, primarily for younger singers, is Exercise Induced

Laryngeal Obstruction (EILO) which, as Hall et al. have pointed out, is “a commonly-

encountered clinical scenario in primary care [which] involves an adolescent or young adult, with

93. Anthony Tommasini, “The Met’s ‘Ring’ Stops Creaking, but Still Doesn’t Work,”
New York Times, March 10, 2019, https://www.nytimes.com/2019/03/10/arts/music/review-met-
opera-wagner-ring-rheingold-lepage.html Accessed September 12, 2021.

94. Mahalakshmi Sivasankar and Elizabeth Erickson, “Short-Duration Accelerated

Breathing Challenges Affect Phonation,” The Laryngoscope 119, No. 8 (2009): 1658-1663,
https://doi.org/10.1002/lary.20530.

36
no past medical history, presenting with wheeze and breathlessness, occurring in association with

exercise.” 95 During exercise, typically the glottis is widened at the level of the vocal folds to

permit greater airflow. During EILO, the glottal and laryngeal opening is instead narrowed, or

obstructed. This differs from exercise induced asthma, although the two may present similarly

and could both be present in the same individual. There are risks of phonotrauma in patients with

EILO. Sataloff et al. write, “Voice changes are common in patients with EILO mostly due to

phonotrauma and increased collision forces between the vocal folds. As a result, there is

formation of nodules, polyps, granuloma, and/or ulceration in 11–25% of the cases.” 96

The presentation of EILO in patients has been shown to be highly individualized, leading

to a wide variety of treatment options based on the patient’s unique condition and include, as

Sataloff et al. write, “voice therapy focused on abdominal and nasal breathing, cognitive therapy

with visual feedback for enhancement of laryngeal muscle control, botulinum toxin therapy,

reflux therapy, psychotherapy, and hypnosis.” 97 Especially for singers who have asthma or have

EILO, aerobic training should be cleared by a medical expert.

c. Addressing Claims About Aerobic Exercise for Singers

A somewhat common claim pertains to the alleged benefits of singing while

simultaneously performing aerobic exercise. There is more than enough evidence to suggest that

aerobic exercise can benefit singers, however simultaneous implementation is highly inadvisable,

95. Andrew Hall et al., “Exercise-induced laryngeal obstruction: a common and

overlooked cause of exertional breathlessness,” The British Journal of General Practice: The
Journal of the Royal College of General Practitioners 66, no. 650 (2016): e683-5,
doi:10.3399/bjgp16X687001

96. Abdul-Latif Hamdan, Robert Thayer Sataloff, and Mary J. Hawkshaw, “Exercise-
Induced Laryngeal Obstruction (EILO) in Athletes,” in Voice Disorders in Athletes, Coaches and
Other Sports Professionals, eds. Abdul-Latif Hamdan, Robert Thayer Sataloff, and Mary J.
Hawkshaw (Springer International Publishing, 2021), 155, https://doi.org/10.1007/978-3-030-
69831-7_8.

97 Ibid., 155.

37
despite claims to the contrary. In an internet search performed on the Google search engine, two

of the top ten articles about voice and physical fitness encouraged singing while simultaneously

performing aerobic exercises. One author, Carrie Hensley, makes several assertions concerning

simultaneous running and singing routines. Some of these assertions include:

Singing while running clears your airways... expands the lungs... builds vocal and
physical stamina... strengthens breathing muscles... is excellent cardio... aids breath
control... helps with posture... helps you lose weight... builds confidence... increases your
energy levels… 98

The alleged benefits offered by Hensley are true of performing cardio and singing

separately. Recent studies have indicated that the risk of voice pathology as well as somatic

injuries increases during simultaneous aerobic exercise and voice use. 99

Hensley’s claims, of course, are opinions and observations from one individual.

However, these assertions could be potentially misleading for singers seeking to improve

cardiovascular endurance as well as singing technique. Hensley, who holds a degree from a well-

regarded institution, makes unsubstantiated claims which could misinform individuals attempting

to improve vocal and aerobic fitness levels. Cardiovascular exercise can play an important role to

help individuals with weight loss; it has been shown to improve cardiorespiratory fitness levels,

increases in stamina, and decreases feelings of fatigue. Cardiovascular exercise has also been

shown to improve cardiopulmonary efficiency and lung capacity. 100 These are all beneficial to

singing and maintaining higher cardiorespiratory fitness levels will likely improve a performer’s

ease on stage. However, vocalizing simultaneously with exercise has been linked in many studies

98. Carrie Hensley, “Singing While Running,” https://howtosingbetter101.com/singing-

while-running/.

99. Anumitha Venkatraman, Robert Brinton Fujiki, and M. Preeti Sivasankar, “A Review
of Factors Associated with Voice Problems in the Fitness Instructor Population,” Journal of
Voice, (June 2021): 1, https://doi.org/10.1016/j.jvoice.2021.05.001.

100. Saxon and Schneider, Vocal Exercise Physiology, 106.

38
to deleterious effects on the tissues of the vocal folds, and the increased occurrence of voice

pathology. As mentioned above, elevated PTP and reduced systemic vocal fold hydration can

increase injury risk of singers. There have been many investigations into the increased risk of

voice pathology among group fitness instructors and other individuals who must use their voices

during exercise, including musical theater performers. The high incidence of voice injury and

pathology in aerobics instructors could be a cautionary tale for singers who might perform an

internet search and discover an article advocating the benefits of simultaneous voice and aerobic

exercise. One study, for example explained the conditions which may lead to increased injuries:

Voicing with concurrent phonation and exercise may be influenced by (1) the increased
cardiovascular requirement during exercise, (2) the increased cognitive load associated
with dual tasking, (3) the altered hydration state associated with prolonged exercise, and
(4) the phonatory dose associated with continued voicing with loud background
music. 101

There are, of course, many scenarios in which the performance of an intense

choreography or staging may challenge singers’ cardiorespiratory fitness. This does not mean that

singers should regularly seek out sub-optimal conditions for voice practice.

Evidence suggests that increasing aerobic fitness levels should be a goal for any singer

and that performing aerobic exercise prior to vocalization can assist with the vocal warmup. One

recent study concluded that aerobic exercise preceding vocal exercise can augment a vocal

warmup routine which can carry several benefits into a vocal performance including: “Faster

muscle contraction and relaxation, greater economy of movement because of lowered viscous

resistance within active muscles, improved oxygen delivery and use by muscles, facilitated nerve

transmission and muscle metabolism, and increased blood flow through active tissues.” 102

101. Anumitha Venkatraman, Robert Brinton Fujiki, and M. Preeti Sivasankar, “A

Review of Factors Associated with Voice Problems in the Fitness Instructor Population,” 1.

102. William McArdle, Frank. Katch, and Victor Katch, Exercise Physiology. 5th Ed.
(Philadelphia: Lippincott Williams & Wilkins, 2001), 575.

39
 The study also found that, “Significant pre to post-exercise increases were found for

mean SPL and mean airflow during voicing, although increased estimated subglottal pressure

approached significance.” 103 The authors recommend exercising in a “conversation range”

meaning that the heart rate for this warm up should be between 55-70% of the maximum heart

rate (220 - age). 104 As mentioned before, elevated PTP is not desirable for singing, yet, increased

body temperature and blood flow related to aerobic activity in the conversation range can be

advantageous.

d. Prescriptive Aerobic Exercise for Singers

There are several important factors when determining a safe and effective aerobic fitness

routine for singers. The mode of aerobic training should be something that is enjoyable and

sustainable for the individual. Claudia Friedlander writes, “It’s important to choose an activity

you enjoy–one that makes you feel good and provides you with enough of a challenge to stay

engaged without causing frustration or intolerable discomfort.” 105

Improving cardiovascular fitness for singers has been shown to have many benefits, and

can be undertaken as simply as putting on a pair of comfortable athletic shoes, and walking

outside. There is nothing wrong with the casual pursuit of better health. However, the best results

for increasing aerobic capacity are gained by using the principles of exercise science, and

pursuing specific and focused training. Aerobic training for singers should optimally be based on

current fitness levels and should focus on progressive overload. The guidelines advocated by the

103. Monica McHenry and Joseph Evans, “Aerobic Exercise as a Warm-Up for Singing:
Aerodynamic Changes,” Journal of Voice 30, no. 6 (November 2016): 693, Accessed August 24,
2021, https://doi.org/10.1016/j.jvoice.2015.08.011.

104. Ibid., 693.

105. Claudia Friedlander, Complete Vocal Fitness: A Singer's Guide to Physical

Training, Anatomy, and Biomechanics, (Lanham, Maryland: Rowman & Littlefield, 2018), 132.

40
ACSM help individuals make objective decisions about their aerobic exercise, and may be a great

place to start for singers. As mentioned previously, Exercise capacity can be measured,

individualized, and increased at an optimal rate based on the goals and the limitations of the

individual. As performance capacity increases, the variables listed below should be increased

based on the individual goals and health/physical constraints. As an example of how altering

variables impact aerobic performance capacity, picture long distance runners versus sprinters.

Both engage in aerobic training routines, however distance runners have trained to maximize the

time variable, while sprinters have trained to maximize the intensity variable.

Frequency: ACSM has identified that an aerobic exercise routine should be performed 3-
5 days a week to obtain optimal results. Singers should attempt to avoid exercising
directly before vocalizing due to the increase of Phonation Threshold Pressure associated
with rapid breathing.

Intensity: Aerobic exercises must place sufficient stress on the cardiorespiratory system.
Elevated heart rate and breathing should be the goal. Individual fitness level is important
for deciding how vigorous the activity should be. Exercise can range from a brisk walk,
to jogging or running. It is important for individuals to calculate maximum safe heart
rate, which can be determined by subtracting your age from 220 (220 - age = ?). Intensity
for beginners will likely be lower at first, and increasing gradually as performance
capacity is increased. Singers should focus on training that mirrors the kind of work they
expect to perform on stage.

Time: The duration of aerobic exercise can be determined by an individual’s current

fitness level, and time commitment available. As training capacity increases, the time of
the exercise may also be increased. Beginners should focus on light activity such as
walking from 20-30 minutes per day. Intermediate should focus on moderate activities
such as jogging for 30-60 minutes per day (150-250 minutes per week). Regular
exercisers should focus on moderate-vigorous exercise jogging or running 30-90 minutes
per day (150-300 minutes per week).

Type: The types of aerobic exercises can be varied based on individual goals and
preferences. These include walking/jogging, cycling, swimming, etc.

Volume: The total amount of exercise reflected in total calories burned. Shorter bouts of
vigorous exercise, or longer bouts of moderate exercise, depending on current fitness
level and individual goals.

41
 Progression: Incrementally increase variables of intensity, time, and/or volume as
performance capacity is increased, accounting for individual fitness levels and specific
goals. 106

2. Anaerobic Exercise

a. Types and Potential Benefits of Anaerobic Training for Singers

There are many benefits of anaerobic training for singers. For example, general lack of

muscle strength and endurance is not life threatening, but strength and endurance are basic

components for overall health and wellbeing. Research has indicated that when muscular strength

is increased, all muscles perform more efficiently, and perceived exertion for tasks is reduced. 107

Saxon and Schneider describe the beneficial physiological effects of resistance training which can

be expressed by increases in:

● Number of contractile proteins,

● Number and size of myofibrils,

● Muscle connective tissues,

● The size and strength of ligaments and tendons,

● Bone mass and density.

● Discharge frequency of motoneurons

● Motor unit recruitment

● Motor skill performance.

● Increase in ATP and CP concentrations within muscle fibers. 108

106. Carol Garber, Bryan Blissmer, Michael Deschenes, et al., “Quantity and Quality of
Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor
Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise,” Medicine & Science in
Sports & Exercise Volume 43 no. 7 (2011): 1335-1337, doi: 10.1249/MSS.0b013e318213fefb.
107. Saxon and Schneider, Vocal Exercise Physiology, 77.

108. Ibid., 108.

42
 Incorporating anaerobic training into one’s lifestyle offers considerable benefits. There

are numerous well-documented downsides to not performing anaerobic training. It has been

shown that muscle mass, strength, and function declines about 5% per decade after age 30, and by

as much as 10% per decade after age 50. 109 Resistance training helps to counteract the rate of

decline of bone density and can help prevent osteoporosis and frailty in older adults. Maintaining

muscular strength should be a priority for anyone, and of course, for singers. 110 Ingo Titze writes,

“The process known as muscle atrophy, occurs naturally with age but can be retarded with

appropriate exercise. Stretching muscles regularly has been shown to maintain ample blood flow

and fiber concentration. If muscle tissue has been lost, vigorous exercise can restore it, provided
111
the neural system is intact.”

Increases in size and contractile force of muscles reduce the perceived effort level of

completing everyday tasks. For singers, increased performance capacity, stamina, and reduced

physical exertion may improve overall vocal performance. As singers age, this only becomes

more important. 112 Mayer et al. write, “Laboratory-based studies showed that 20 to 30 minutes of

strength (resistance) training, 2 to 3 times per week, has positive effects on risk factors for

cardiovascular disorders, cancer, diabetes, and osteoporosis Furthermore, progressive strength

(resistance) training is accepted in treating sarcopenia and to improve postural control.” 113

109. Holloszy, John O, “The Biology of Aging,” Mayo Clinic Proceedings 75, no. 1,
Supplement (January 1, 2000): S3–9. https://doi.org/10.1016/S0025-6196(19)30634-2.

110. Ibid., 102.

111. Titze, 46.

112. Frank Mayer, Friederike Scharhag-Rosenberger, Anja Carlsohn, Michael Cassel,

Steffen Müller, and Jürgen Scharhag, “The Intensity and Effects of Strength Training in the
Elderly,” Deutsches Arzteblatt International 108, no. 21 (May 2011): 360,
https://doi.org/10.3238/arztebl.2011.0359.

113. Ibid., 360.

43
 b. Potential Drawbacks of Anaerobic Exercise for Singers
Isometric resistance training remains a highly controversial subject within the classical

singing world. The most common concerns about resistance training and singing which will be

explored in this section. These common concerns include excess muscle tension, postural

problems, loss of vocal flexibility, and vocal damage due to vocal misuse or abuse during

resistance training exercise.

There isn’t sufficient scientific evidence to support many claims which have been made

about singing and resistance training. One prevalent concern is an increase of muscular tension as

a result of resistance training. As the act of resistance training requires muscle groups involved in

the exercise to contract and tighten, it seems reasonable to assume that muscle tension in the

abdominal muscles, shoulders, and neck would impact the singing voice. There have been several

studies conducted on resistance training and muscle tension and pain disorders which appear to

indicate that resistance training showed an improvement in muscle tension and pain. 114 As

mentioned above, ease of completing everyday tasks, and reduced feeling of overall exertion is

the result of regular resistance training. Excess muscle tension is certainly an issue relevant to

singing and one of the primary reasons weightlifting is discouraged. However, the research

indicates that balanced training (training agonist and antagonist muscle pairs), proper

implementation of good technique, and adequate time spent stretching and performing flexibility

exercises, will more-than-likely be of benefit to singers.

Another noteworthy concern for singers interested in strength training is the increased

subglottic pressure generated while lifting heavy weights and the resistance at the level of the

114. Lars L. Andersen, Michael KjÆr, Karen SØgaard, Lone Hansen, Ann I. Kryger, and
Gisela SjØgaard, “Effect of Two Contrasting Types of Physical Exercise on Chronic Neck
Muscle Pain,” Arthritis Care & Research 59, no. 1 (January 1, 2008): 84,
https://doi.org/10.1002/art.23256.

44
glottis and vocal folds. Forcing air against a closed glottis, or the Valsalva maneuver, is

considered to be one of the most optimal breathing patterns for producing maximal force and for

thoracic stability and the protection of the vertebral column in powerlifting exercises such as

bench press, deadlift, and squat. The Valsalva maneuver carries several potential health risks due

to rapid changes in blood pressure. Phillips and Donofrio discuss the hemodynamic changes

related to the Valsalva maneuver:

During phase 1, there is an increase in intrathoracic pressure that mechanically causes a

brief increase in blood pressure and decrease in heart rate. In early phase 2, there is a
reduction of venous return and a subsequent decrease in stroke volume, causing a
decrease in blood pressure. In late phase 2, the decreased blood pressure activates the
baroreflex that causes a sympathetically mediated increase in heart rate and blood
pressure back toward baseline levels. When the patient terminates the Valsalva
maneuver, blood refills the pulmonary vasculature. This causes the change seen in phase
3 – a temporary further decline in blood pressure. During phase 4, there is an increase in
venous return, which leads to a compensatory decrease in heart rate and increase in blood
pressure that may overshoot baseline blood pressure. 115

Valsalva maneuver also carries various health risks due to these rapid changes in pressure

including stroke and cerebral hemorrhage. 116 The principal concern for singers is that Valsalva

maneuver also creates subglottal pressure (Psub) in excess of 150 cm H2O. For comparison, soft

phonation averages around 3 cm/H2O, normal speech ranges from 4-9 cm/H2O, 117 and

loud singing ranges from 20-70 cm/H2O. 118 While the Valsalva maneuver increases thoracic

115. E.L. Phillips, Peter Donofrio, "Autonomic Disorders," in Encyclopedia of

Neuroscience, ed. Larry R. Squire (Academic Press, 2009): 804, https://doi.org/10.1016/B978-
008045046-9.00628-8.

116. Frank Pott et al., “Middle Cerebral Artery Blood Velocity During Intense Static
Exercise is Dominated by a Valsalva maneuver,” Journal of Applied Physiology 94, no. 4 (2003):
1335, doi:10.1152/japplphysiol.00457.2002.

117. Ron Netsell, “Subglottal and Intraoral Air Pressures During the Inter-Vocalic
Contrast of /t/ and /d/,” Phonetica 20 (March 1, 1969): 70, https://doi.org/10.1159/000259275.

118. Christian T. Herbst, Markus Hess, Frank Müller, Jan G. Švec, and Johan Sundberg,
“Glottal Adduction and Subglottal Pressure in Singing,” Journal of Voice 29, no. 4 (July 1, 2015):
397, https://doi.org/10.1016/j.jvoice.2014.08.009.

45
stability and safety for a weightlifter performing a heavy lift, this may have negative impacts on

the singing voice due to the considerable air pressure the closed glottis must resist. It is unclear

what impact this maneuver would have on singers, as there are presently no studies which

measure the impacts of heavy weightlifting on the tissues of the larynx with complete glottal

closure. The impacts of a specific weightlifting task paired with simultaneous phonation was

studied and published in Folia Phoniatrica et Logopaedica which stated,

Twenty vocally healthy subjects (10 men and 10 women) lifted hand-held weights and
steadily supported them with outstretched arms as they either sustained comfortable
phonation or repeated the syllable /pi/. Both the male and female subjects showed an
increase in the electroglottographic contact quotient, long-term F₀ variability, and
estimated laryngeal airway resistance attributable to an elevated driving pressure. 119

During simultaneous phonation and weightlifting, increases in contact quotient of the

vocal folds and increased subglottal driving pressure are particularly concerning for long-term

vocal maintenance/sustainability and may lead to vocal fatigue or injury. It is not fully understood

whether avoiding phonation during weight lifting may reduce the likelihood of vocal fatigue or

injury, however there are physiological similarities between the Valsalva maneuver and pressed

phonation, which is well-documented. Verdolini et al. write, “Perpendicular impact stress to the

vocal folds is thought to be the primary causal factor for the development of benign vocal fold

lesions of the lamina propria. Specific factors leading to high impact stress are high subglottic

pressure, vocal fold hyperadduction and vocal fold elongation (high pitch) within a given

register.” 120

119. Robert Orlikoff, “Voice Production during a Weightlifting and Support Task,” Folia
Phoniatrica et Logopaedica 60, no.4 (2008):188, https://doi.org/10.1159/000128277.

120. Katherine Verdolini, Clark Rosen, and Ryan Branski, Classification Manual for
Voice Disorders-I 1st ed. (Mahwah, N.J.: Lawrence Erlbaum 2006), 39.

46
 Additional research is recommended in the study of the Valsalva maneuver’s direct

effects upon laryngeal structures during heavy weightlifting without phonation, observing muscle

activation as well as static friction. It is well documented that pressed phonation, or loud,

pressured, high pitched vocalizations supported the mechanical trauma theory of the development

of vocal fold nodules and other benign lesions. The impacts of friction and mechanical stress on

the voice are distinguishing concerns for signers compared to the general populace. This becomes

especially relevant when considering lifting heavy weightlifting at weight ranges which require

the use of the Valsalva maneuver. In a 1994 study, Titze et al., discussed intraglottal pressure and

impact stress during phonation. They write, “Impact pressure peaks were positively related to

subglottal pressure, elongation, and adduction of the vocal folds. The midpoint of the

membranous vocal fold received the maximum impact stress.” 121 The vocal folds must resist

considerable breath pressure during the Valsalva maneuver. Any air that escapes during this

hyperabducted phase would likely be highly pressurized. There is a prevalent notion among many

weightlifters that grunting/yelling leads to an increase in maximal force generation while

engaging in strength activities such as heavy weight lifting. This practice does have some

scientific backing. 122 123

Grunting or yelling during weightlifting is also considered by many to

have a psychological benefit of “psyching up” for a heavy lift. Whether or not an individual is

able to generate more force while grunting, it must be stressed that it is highly inadvisable for

singers to grunt or yell when strength training or performing some other athletic/sports-related

121. Jack Jiang and Ingo Titze, “Measurement of Vocal Fold Intraglottal Pressure and
Impact Stress,” Journal of Voice 8, no. 2 (1994): 132-144, doi: S0892-1997(05)80305-4.

122. Amy Welch and Mark Tschampl, “Something to Shout About: A Simple, Quick
Performance Enhancement Technique Improved Strength in Both Experts and Novices,” Journal
of Applied Sport Psychology 24, no. 4 (October 1, 2012): 418–28,
https://doi.org/10.1080/10413200.2012.688787.

123. Scott Sinnett, Cj Maglinti, and Alan Kingstone, “Grunting’s Competitive

Advantage: Considerations of Force and Distraction,” PLOS ONE 13, no. 2 (February 22, 2018):
e0192939, https://doi.org/10.1371/journal.pone.0192939.

47
activity. While perhaps having some competitive or theoretical advantage under specific

circumstances, grunting/yelling during weightlifting or performing some competitive athletic

event must be questioned in the context of voice training. Vocalizing while subjecting vocal folds

to immense subglottal pressure is a recipe for injury, and studies have linked loud, pressed, high

pitch phonation to phonotraumatic vocal lesions. 124 Titze writes that, “Excessive collision and

acceleration may be responsible for the greatest tissue damage, even though they do not account

for the greatest stresses. This is because they act perpendicularly to the direction of tissue load-

bearing fibers and are applied directly to mucosal tissue.” 125 While no studies have directly

observed the impacts of the Valsalva maneuver, grunting, or yelling on the larynx during weight

lifting, a perceptual study focused on weightlifting and the voice noted that after bouts of heavy

resistance training, subjects noted feelings of vocal fatigue, globus sensation, and other negative

vocal side-effects from lifting. This study also indicates the potential dangers of vocal abuse or

misuse when performing heavy weightlifting:

Nearly half (46%, n = 12/ 26) of self-identified weightlifting athletes reported suffering
from at least one laryngeal symptom (throat pain, change in voice, or globus sensation),
which was significantly higher (P= 0.008) than that reported by the cardio-vascular group
(14%, n = 4/29). The most prevalent laryngeal symptom reported by 25.3% (n = 17) of
participants after weightlifting was the presence of a globus sensation (ie, the feeling of
something stuck in their throat). Throat pain after heavy lifting and a change in voice
quality after weightlifting was reported by 22.9% (n = 16) and 11.4% (n = 8) of
participants respectively. 126

There are instances in which the use of the Valsalva maneuver is physiologically

necessary, of course. It has been observed that subjects without the ability to perform a Valsalva

124. Ingo Titze, “Mechanical Stress in Phonation,” Journal of Voice 8, no. 2 (June 1994):
99–105, https://doi.org/10.1016/s0892-1997(05)80302-9.

125. Ibid., 99.

126. Anna Rumbach et al., “Laryngeal Symptoms in Weightlifting Athletes,” Journal of

Voice 34, no. 6 (2020): 964.e1, doi:10.1016/j.jvoice.2019.06.004.

48
maneuver are unable to generate maximal force and may have compromised ability to lift heavy

objects.

…reduced ability to produce power during lifting may occur when the ability to adduct
the larynx is compromised. This occurs when individuals are unable to build up the
intrathoracic pressure and trap the air that is required for trunk stabilization. It has been
demonstrated that of individuals who had their larynx removed, 57% of them experienced
difficulties in lifting heavy objects after surgery. 127

While no longitudinal studies have directly observed the effects of heavy weight lifting

on professional singers, caution is still advised. Until research has been conducted on the topic,

singers who lift heavy weights should generally attempt to avoid weight ranges which require the

use of the Valsalva maneuver, or any breath-hold technique that requires glottal closure to

maintain stability and should also avoid grunting and yelling while weightlifting. Several studies

have shown that forced exhalation with an open glottis also increases force generation with no

statistically significant difference to the Valsalva maneuver. 128 To perform this breathing pattern,

fully inhale before performing the weightlifting task. During the concentric

(shortening/contracting) portion of the lift, exhale forcefully with an open glottis. Inhale on the

eccentric (lengthening/releasing) portion of the weightlifting task. 129

127. S. Jay, J. Ruddy, and R. J. Cullen, “Laryngectomy: The Patient’s View,” The
Journal of Laryngology & Otology 105, no. 11 (1991): 936,
https://doi.org/10.1017/S0022215100117852, quoted in Kelly Davis, M., Mary J. Sandage, Laura
Plexico, and David D. Pascoe, “The Perception of Benefit of Vocalization on Sport Performance
When Producing Maximum Effort,” Journal of Voice 30, no. 5 (September 1, 2016): 639.e11,
https://doi.org/10.1016/j.jvoice.2015.07.013.

128. Elizabeth Ikeda et al., “The Valsalva Maneuver Revisited: The Influence of
Voluntary Breathing on Isometric Muscle Strength,” Journal of Strength and Conditioning
Research 23, no.1 (2009): 132, doi:10.1519/JSC.0b013e31818eb256.

129. Ibid., 5.

49
 c. Addressing Claims About Anaerobic Exercise for Singers

Weightlifting is widely perceived as the most controversial form of exercise for vocalists.

However, no longitudinal clinical studies have directly measured the effects of anaerobic training

(weightlifting) on changes in performance capacity in professional singers (changes in maximum

pitch range, phonation threshold pressure, voice quality, vocal agility, etc.). There are numerous

blog posts warning of the muscle tension caused by weightlifting, or postural/alignment problems

which happen to those who strength train. Further difficulties arise in assessing proper

implementation of anaerobic training for singers when confronted with conflicting claims on the

internet. For example, one of the first search results for “weightlifting for singers,” using the

Google search engine yielded a blog post written by Marta Woodhull, who self identifies as “one

of Hollywood’s top vocal coaches.” She claims, “Excessive weight training is a drawback for

male singers because it develops the posture incorrectly. Male weight lifters develop rounded

backs, necks that slope forward, tense shoulders, inflexible abs and rigid ribs.” 130

This particular claim exemplifies the difficulty with engaging in fitness topics as related

to singing and the need for evidence-based training protocols for singers. Why would “excessive

weight training” only be a drawback for male singers? Wouldn’t “excessive weight training”

similarly impact female singers? Further, how does Woodhull define “excessive?” Woodhull also

fails to explain which specific exercises should be avoided. Negative postural changes, such as

kyphosis, or “rounded back” as Woodhull phrases it, as this author surmises, would be an

indication of muscle imbalance brought on by an unoptimized anaerobic exercise routine. In fact,

one recent study directly refutes Woodhull’s claims that resistance training leads to rounded

backs, sloped necks, tense shoulders, and rigid abs. This study “aimed to investigate the change in

erector spinae muscle strength and kyphosis angle (rounded back) following eight weeks of TRX

130. Marta Woodhull. “Sports Tips for Singers” Sing for a Living, accessed April, 1,
2021, https://www.singingforaliving.com/articles/sports-tips-for-singers/

50
training in middle-aged men.” 131 The study showed statistically significant reduction in kyphosis

in participants after resistance training exercises (TRX) intervention. 132

Each 60-minute session will include 5 to 10 minutes of warm-up, 40 minutes of core

exercises, and 10 minutes of cooling down exercises. In these sessions, exercises such as
Swedish push-up, chest press, rowing, single-handed rowing, Swedish atomic push-up,
biceps curls movement, standing chest press movement, reverse mountain climber
movements, bridge movement, single-leg squat, TRX spiderman push-up, side plank,
[and] the crunch... 133

The exercises employed in this study focused on total body training, with an emphasis on

erector spinae muscles. Singers should certainly engage in postural exercises that focus on core

stability and erector spinae muscle strength. The exercises in this study are demonstrably useful

for correcting kyphosis and postural imbalances. Performing these without TRX suspension will

require some adjustments. It is important to note that while this study utilized the TRX

suspension system, variations of all of the exercises performed are possible without TRX

equipment which will be explained in greater detail below.

Another example of resistance training not negatively impacting posture comes from “A

Review of Resistance Exercise and Posture Realignment.” Hrysomallis and Goodman write that

“...the fear of developing static postural deviations from exercising is not supported by objective

data.” 134

131. Mahdi Hamidiyeh, Hamidreza Naserpour, and Matin Chogan, “Change in Erector
Spinae Muscle Strength and Kyphosis Angle Following an Eight Weeks TRX Training in
Middle-Age Men,” International Journal of Aging Health and Movement 3, no. 3 (2021): 13.

132. Ibid., 13.

133. Ibid., 13.

134. Con Hrysomallis, and Craig Goodman, “A Review of Resistance Exercise and
Posture Realignment,” Journal of Strength and Conditioning Research 15, no.3 (2001): 390,
PMID: 11710670.

51
 d. Prescriptive Anaerobic Training Routines for Singers

As with any form of exercise, if an individual has any risk factors, or concerns about

beginning or continuing an exercise program, they should take the PARQ+ and consider

consulting with and being cleared by a healthcare professional.

Anaerobic exercise comes in many forms, and there are far too many anaerobic training

modalities and exercises to mention in this document. While implementation and specific

exercises performed may vary between routines, the best routines apply the fundamentals of

exercise science by combining specific variables to achieve adequate effort levels to spur specific

adaptation. Anaerobic training can be performed in a variety of ways. Body weight, free weights

(barbells and dumbbells), resistance bands, and exercise machines are all examples of anaerobic

exercises. Individual taste and health concerns may impact the types of anaerobic training that

can and should be performed and individual discretion is advised. Choosing routines which focus

on total body training (training agonist and antagonist muscle groups, working to counteract

muscle imbalances) and exercises which are enjoyable enough to perform consistently are the

most important factors. When choosing a routine, some individuals may wish to focus on

muscular endurance training using body weight exercises with many repetitions. Other

individuals may choose to include resistance training of some scope variety. In terms of effective

and optimal strength training, recent studies have shown a difference in efficacy between single-

joint isolation workouts (leg extensions or bicep curls, etc.) and multi-joint compound exercises

(squat, lunge, bench press, and deadlift, etc.) The study concluded that, “When total work volume

was equated, RT programs involving MJ exercises appear to be more efficient for improving

muscle strength and maximal oxygen consumption than programs involving SJ exercises, but no

52
differences were found for body composition.” 135 Some caution and moderation are advised for

those specifically endeavoring to use free weights and pursue heavy barbell weight training.

As a word of caution before engaging in any strenuous exercise, individuals should

ensure they are cleared for the specific activity. When beginning an anaerobic (weight lifting)

program, it is advised by the ACSM, and fitness professionals to first determine the theoretical

maximum force which an individual can generate on a given lift. This is called the 1 rep

maximum (1RM). While this number could be theoretically applied to any weight lifting exercise,

this number is most importantly applied to multi-joint movements which constitute the most

common exercises in strength training programs: the bench press, squat, and deadlift. This

number is important as it allows individuals to optimize training and avoid injury risk. Strength

training requires the implementation of progressive overload, and muscles must be sufficiently

challenged in order to stimulate specific adaptation. However, to what percent of an individual’s

1RM should be used will be discussed. Barbara Bushman explains how to calculate 1RM, which

will determine optimal resistance training loads,

First, multiply the number of repetitions you can perform on a given exercise by 2.5. Try
to select a weight you can lift about 10 to 15 times with proper form (note that if you can
lift the weight more than 20 times, the results will be more accurate if you rest and then
repeat the test with a heavier weight). Subtract that number from 100 to determine the
percentage of your theoretical 1RM. Then, divide that number by 100 to produce a
decimal value. Finally, divide the weight you lifted by that decimal value to estimate your
1RM on that exercise. 136

The ACSM has outlined a few guidelines for the general populace, which is also

advisable for singers. As mentioned before, until further research is conducted, singers should

135. Antonio Paoli et al., “Resistance Training with Single vs. Multi-joint Exercises at
Equal Total Load Volume: Effects on Body Composition, Cardiorespiratory Fitness, and Muscle
Strength,” Frontiers in Physiology 8, no. 1105, (Dec. 2017): 1.

136. Bushman, Complete Guide to Fitness & Health, 104.

53
work at weight ranges low enough to avoid use of the Valsalva maneuver. Barbara Bushman

writes,

Because heavy weights are not required to increase the muscular strength of beginners,
weights corresponding to about 60 to 80 percent of the 1RM for 8 to 12 repetitions are
recommended for adults (10 to 15 repetitions for middle-age and older adults with limited
resistance training experience). Although weights that can be lifted more than 15 times
are effective for increasing local muscular endurance, light weights rarely result in
meaningful gains in muscular strength. 137

There is a common assumption among many weightlifters that lifting heavier weights

with lower repetitions is the most optimal method for increased muscle strength and size

(hypertrophy), and that higher repetitions with lower weight would improve muscular endurance

but would not lead to muscle hypertrophy. However, recent studies have concluded that this

assumption is not the case. For example, a study in the Journal of Applied Physiology states,

We reported, using a unilateral resistance training (RT) model, that training with high or
low loads (mass per repetition) resulted in similar muscle hypertrophy and strength
improvements in RT-naïve subjects…Our data show that in resistance-trained
individuals, load, when exercises are performed to volitional failure, does not dictate
hypertrophy or, for the most part, strength gains. 138

Untrained and trained individuals were found to have no significant differences in muscle

hypertrophy when training either lower weight and higher repetitions, or higher weight and lower

repetitions. This information can be translated for singers in the following ways: Finding the

weight which is heavy enough to stimulate muscular adaptation but light enough to avoid the

valving with the larynx should be the primary goal for singers performing resistance training. As

mentioned before, one of the most common breathing strategies is performed by breathing in

137. Ibid.,120.

138. Robert Morton et al., “Neither Load nor Systemic Hormones Determine Resistance
Training-Mediated Hypertrophy or Strength Gains in Resistance-Trained Young Men,” Journal
of Applied Physiology 121, no.1 (2016): 129, doi:10.1152/japplphysiol.00154.2016.

54
during the eccentric movement (releasing the weight and lengthening the muscle) and breathing

out rapidly on the concentric (contracting the weight and shortening the muscle). This strategy

ensures that the individual is not valving at the larynx. In terms of assembling an anaerobic

training program, the guidelines below are advisable for the general population as well as for

singers new to anaerobic training.

Anaerobic Programming for Singers

Beginners should choose a total of 6 exercises, from the following categories: hips and

legs, quadriceps, hamstrings, chest, back, shoulders, biceps, triceps, low back, and abdominal

muscle exercises. Be sure to pair the exercises with agonist/antagonist pairs for more balanced

training (ex. Back and chest, quadriceps and hamstrings, biceps and triceps).

A good starting exercise routine for singers should involve full-body exercises with

primary focus on learning multi-joint movements. Squat, bench press, deadlift, and dumbbell

rows are all advantageous movements. These exercises take some practice in order to develop

proper form. There are many ways to program strength training routines. The following

prescription provides a general outline of variables and a few guidelines that may be helpful to

get started.

Anaerobic Prescription for Singers:

Frequency- Train at least 2-3 days per week, alternating days and muscle groups trained

to allow for muscles to recover. 139

Intensity- the ACSM recommends 2-4 sets consisting of 8-12RM repetitions per set.

Training to the onset of muscle fatigue. RPE 8-9. 140 Singers should consider slightly lower

139. Ibid., 115.

140. Ibid., 115.

55
weight ranges and additional repetitions (10-15) repetitions to avoid using the Valsalva

maneuver.

Time- variable rest time of 2-3 minutes between sets to allow cellular energy to be

replenished and muscular recovery. 141

Type- Focus on balanced, total-body agonist/antagonist workouts. Single-joint (bicep

curls, triceps extensions for example) or multi-joint (squat, deadlift) exercises can be incorporated

in muscular training programs. (Beginners may wish to consider working with a certified personal

trainer to instruct proper form and movement patterns to reduce risk of injury.)

Volume: The total amount of exercise is reflected by the total number of sets performed.

Beginners tend to need lower volume of training to still benefit from training. Intermediate and

advanced lifters will likely need to increase training volume. 2-3 sets with 8-12RM. Because

Singers should be keeping the intensity variable lower with lower weight and higher number of

repetitions, in order to adequately stimulate specific adaptation, it is singers should mindfully

perform sets to muscle-induced fatigue. 142

Progression: When a given training level becomes too easy, weight should be

incrementally increased. For example, if working at an 8-12RM range, when an individual can

consistently and easily reach 12 repetitions, weight should be increased by 2.5-5lbs to the point at

which the Valsalva maneuver would be required. After this point, singers should consider

increasing repetitions and volume of training rather than weight ranges/intensity to avoid the

Valsalva maneuver.

141. Ibid., 115.

142. Robert Morton et al., “Neither load nor systemic hormones determine resistance
training-mediated hypertrophy or strength gains in resistance-trained young men,” 129
doi:10.1152/japplphysiol.00154.2016.

56
 There has been some controversy regarding abdominal and shoulder exercise related to

singers. The general concern from multiple internet sources is specifically leveled against

performing crunches or sit-ups. 143 144 These sources advocate against crunches and sit-ups

because they will lead to rectus abdominis muscle tension, neck tension, spinal

injury/hyperflexion, and difficulty fully releasing abdominal muscles during inhalation resulting

in restricted respiratory function during singing. 145 146 It is important to stress that improper or

imbalanced implementation of any exercise can lead to injury or unintended consequences.

However, ruling out any abdominal exercise isn’t this author’s recommendation. Instead, spinal

flexion exercises like crunches or sit-ups should be accompanied with spinal extension exercises

like the Superman. Isometric exercises like front/side planks are also important to consider as

well. Exercising only one muscle group can lead to muscle imbalances which have been shown to

increase injury risks in some cases. Front/side planks could all be advantageous in promoting core

strength and stability. 147

One final cautionary note about weight changes as a result of exercise. The effects of

training, while generally considered beneficial for overall health, present potential consequences

for singers undergoing rapid or extreme changes in body composition, or the ratio of lean body

143. Colorado Voice Clinic, “Is Your Ab Routine Damaging Your Voice?” Accessed
October 26, 2022, https://www.coloradovoiceclinic.com/post/is-your-ab-routine-damaging-your-
voice.

144. Tim Russel, “The Best Ab Workouts for Singers,” accessed October 26, 2022,
https://www.innovativevoicestudio.com/blogpost/the-best-ab-workouts-for-singers.

145. Colorado Voice Clinic, “Is Your Ab Routine Damaging Your Voice?”
https://www.coloradovoiceclinic.com/post/is-your-ab-routine-damaging-your-voice.

146. Tim Russel, “The Best Ab Workouts for Singers,”

https://www.innovativevoicestudio.com/blogpost/the-best-ab-workouts-for-singers.

147. Todd Ellenbecke, Babette Pluim, Stephane Vivier, and Clay Sniteman, “Common
Injuries in Tennis Players: Exercises to Address Muscular Imbalances and Reduce Injury Risk,”
Strength and Conditioning Journal 31, No. 4 (August 2009): 50, doi:
10.1519/SSC.0b013e3181af71cb.

57
mass to fat. For singers building muscle or undergoing rapid weight loss, technical challenges

specifically associated with changes in respiration techniques may be important to consider.

Resting Expiratory Level, or REL is the state of equilibrium in the respiratory system. It is

generally around 35-40% of total lung capacity for most individuals. However, REL is generally

lower in heavier individuals. 148 This means that heavier individuals have more expiratory

capacity before muscular activation of the internal intercostal or abdominal muscles is required to

expel the remaining air. The re-coordination of these muscles during or after rapid body

composition changes is another challenge to consider. In the case of singers undergoing rapid

weight loss, Saxon and Schneider state,

A balanced diet and maintenance of ideal body weight are significant variables in
the achievement of physical fitness. Ideal body composition plays an important
role in the human sound production. Rapid weight change, for example, affects
spoken and singing voice by requiring a change in the technique necessary to
produce sound. 149

3. Histological Concerns Related to Exercise and the Vocal Folds

a. Microarchitecture, phonotraumatic behaviors, and exercise on the

voice

When combined and implemented effectively, the foundational exercise principles and

components of training can provide singers an additional framework for understanding and

improving their vocal technique. Using the principles outlined above, the muscles of the larynx

can be exercised and trained similarly to other skeletal muscles with a few important caveats

which have to do with the microarchitecture of vocal folds. It is important to note that several

148. Krishnan Parameswaran et al., “Altered Respiratory Physiology in Obesity,”

Canadian Respiratory Journal 13, no. 4 (2006): 206, doi:10.1155/2006/834786.

149. Saxon and Schneider, Vocal Exercise Physiology, 6-7.

58
important factors exist due to the vibratory nature of vocal folds which will limit the extent to

which vocal fold muscles can be trained. The vocal folds consist of several layers of delicate

fibers which can be fatigued or damaged by specific phonotraumatic behaviors, and can be

exacerbated during physical exercise if improperly applied. Below is a diagram and brief

description of the different layers of the vocal folds and also how these are potentially impacted

by phonotraumatic behaviors such as misuse or overuse of the voice:

Diagram 3.1 - Morphology of the Vocal Folds 150

150 “Vocal Folds,” Ento Key, Accessed May 1, 2021, https://entokey.com/of-voice-

production/#Fig3.

59
 Epithelium is the outermost layer of the vocal folds. It is layered and scalelike,

protecting the underlying structures of the vocal folds and also helping to regulate and maintain

vocal fold hydration. 151 The fibers of the innermost layer of the epithelium are called the

basement membrane zone (BMZ). It functions to secure and anchor the epithelium to the lamina

propria. 152 The BMZ is the primary location of occurrence of phonotraumatic lesions such as

vocal fold nodules, which usually form as a result of disruption of anchoring fibers through

overuse or misuse of the voice. 153

Lamina Propria- Consists of Superficial, Intermediate, and Deep layers and is 1.5-

2.5mm thick on average. 154

Superficial Layer of the Lamina Propria- Top layer of lamina propria, also called the

“Reinke’s Space” is found just under the epithelium and plays a key role in vocal fold vibration

and is .5mm thick on average. This is the most movable, elastic layer of the LP. 155 Reinke’s

edema is the most common vocal injury in this space, marked by swelling in this space due to

fluid buildup. It is most commonly associated with smoking, however, gastrointestinal reflux, or

chronic overuse of the voice are also associated.

151. Ciara Leydon et al., “Vocal Fold Surface Hydration: A Review,” Journal of Voice
23, no. 6 (November 2009): 658–65, https://doi.org/10.1016/j.jvoice.2008.03.010.

152. Steven Gray, Shirley Pignatari, and Penny Harding, “Morphologic Ultrastructure of
Anchoring Fibers in Normal Vocal Fold Basement Membrane Zone,” Journal of Voice 8, no. 1
(March 1, 1994): 48–52, https://doi.org/10.1016/S0892-1997(05)80318-2.

153. Steven Gray and Ingo Titze, “Histologic Investigation of Hyperphonated Canine
Vocal Cords,” Annals of Otology, Rhinology & Laryngology 97, no. 4 (July 1988): 381,
https://doi.org/10.1177/000348948809700410.

154. Lucie Bailly et al., “3D Multiscale Imaging of Human Vocal Folds Using
Synchrotron X-Ray Microtomography in Phase Retrieval Mode,” Scientific Reports 8, no. 14003
(September 18, 2018): 2, https://doi.org/10.1038/s41598-018-31849-w.

155. Ibid., 7.

60
 Intermediate Layer of the Lamina Propria- Mostly consists of elastin fibers, but also

has a collagen fiber protein structure which doesn’t allow for as much movement or elongation as

the SLLP. Including the deep layer, the intermediate layer is 1-2mm thick. 156

Deep Layer of the Lamina Propria- Most densely organized band of collagen type I

and III fibers. The deep layer is the most rigid portion of the LP. 157

Thyroarytenoid Muscle- Forms the body of the vocal fold, is about 7-8mm thick, on

average. 158

Physically active voice users such as group fitness instructors and musical theater

ensemble members, who have considerable high-intensity choreography, have a higher incidence

of phonotrauma than the general population. 159 As discussed in previous chapters, simultaneous

phonation and exercise is inadvisable. It is also important to stress the significance of slow,

progressive training to avoid the risk of injury and allow balanced muscular development. When

unsure if a given exercise is too challenging, it is always safer to impose too little challenge, than

too great. Leborgne and Rosenberg say, “Singers most likely get into trouble when they impose

physical demands on the voice they have not yet trained and adapted to.” 160 Another notable

factor which relates to vocal fold vibration, and phonotrauma are gender-related differences, such

156. Ibid., 3.

157. Jean-Michel Prades et al., “Lamina Propria of the Human Vocal Fold:
Histomorphometric Study of Collagen Fibers,” Surgical and radiologic anatomy 32, no. 4 (2010):
377.

158. Lucie Bailly et al., “3D Multiscale Imaging of Human Vocal Folds Using
Synchrotron X-Ray Microtomography in Phase Retrieval Mode,” Scientific Reports 8 (September
2018): 3.

159. Aaron Scott Ziegler, "Effects of vocal intensity and physical activity levels on
phonatory and respiratory function." (PhD diss., University of Pittsburgh, 2014): 4.

160. Leborgne and Rosenburg, The Vocal Athlete, 249.

61
as hyaluronic content and distribution in the vocal folds. Butler et al. write, “In the extracellular

matrix (ECM), these molecules [hyaluronic acid] constitute the interstitial “filler” matrix that is

found surrounding the fibrous or “scaffolding” components, namely the collagens and elastic

fibers… Hyaluronic acid is ubiquitous throughout the body but most concentrated in areas

involved with shock absorption.” 161

Females engaged in athletic training should be particularly aware of the increased risk of

phonotraumatic injuries related to average distribution of hyaluronic acid in vocal folds. Butler et

al. concluded,

Combined, male subjects had a relatively constant distribution pattern throughout the
depth of lamina propria. Female subjects showed relatively less HA in the first 15% of
depth (most superficial) but showed more HA in the deeper 40% to 100%... relatively
less HA in the most superficial area implies less protection from vibratory trauma and
overuse and may explain in part why more female than male patients have phonotrauma
to phonotraumatic lesions. 162

The friction component of vocal fold vibration during phonation is very important to

remember when practicing voice exercises or performing repertoire. It is also an important

consideration when selecting physical exercise routines. Avoiding unnecessary vocal fold friction

during physical exercise should be a goal of singers during exercise. The larynx should be

exercised with care during voice training and certainly be considered in the application of athletic

training.

161. John Butler, Thomas Hammond, and Steven Gray, “Gender-Related Differences of
Hyaluronic Acid Distribution in the Human Vocal Fold,” Laryngoscope 111, no. 5 (January
2001): 907, doi: 10.1097/00005537-200105000-00029. PMID: 11359176.

162. Ibid., 907.

62
 Chapter 4: Breathing Exercises

1. Glossopharyngeal Breathing

a. Overview and Parameters of Glossopharyngeal Breathing

Glossopharyngeal breathing (GPB) is a technique which uses the muscles of the mouth

and pharynx to force boluses of air into the lungs aimed to increase vital capacity (VC). This is

called glossopharyngeal insufflation (GI). The reverse is also possible, which is called

glossopharyngeal exsufflation (GE). This maneuver was developed initially as a means to treat

patients with weakened or failing respiratory function, patients suffering from paralysis who

would otherwise require mechanical ventilation, or other medical conditions which may limit

respiratory muscle function. While in normal individuals, this technique would not replace

normal pulmonary respiratory breathing, it is necessary for patients with neurological conditions,

cervical spinal cord injuries, or those with weak cardiorespiratory function like individuals with

COPD who rely on a mechanical ventilator. Johansson et al. explain, “Individual patterns may

exist, but one cycle of glossopharyngeal insufflation maximally consists of 10-15 ‘gulps’, each

gulp the size of 50-100 ml.” 163

After a maximal inhalation using respiratory muscles, GI is performed as follows:

1) Mouth opening so that air enters the oral and pharyngeal cavities; 2) mouth closure
with tongue and pharyngeal muscles propelling a gulp of air through the open glottis
raising intrathoracic pressure; 3) glottis closure to ensure the air trapped into the lung. 164

163. Kerstin Johansson, Malin Nygren-Bonnier, Brita Klefbeck, and Ellika Schalling,
“Effects of Glossopharyngeal Breathing on Voice in Cervical Spinal Cord Injuries,” International
Journal of Therapy and Rehabilitation 18, no.9 (September 2013): 501,
10.12968/ijtr.2011.18.9.501.

164. Antonella LoMauro, Paolo Banfi, Maria Grazia D'Angelo, and Andrea Aliverti,
“Glossopharyngeal Breathing Can Allow a Lung Expansion Greater than Inspiratory Capacity in
Muscular Dystrophy,” European Respiratory Journal 54, no. 2 (2019): 1,
https://erj.ersjournals.com/content/erj/54/2/1801938.full.pdf.

63
Diagram 4.1 - Glossopharyngeal Breathing Technique 165

165 Malin Nygren-Bonnier et al., “Glossopharyngeal Pistoning for Lung Insufflation in

Children with Spinal Muscular Atrophy Type II,” Acta Paediatrica 98, no. 8 (August 1, 2009):
1324, https://doi.org/10.1111/j.1651-2227.2009.01343.x.

64
 b. Potential Benefits of Glossopharyngeal Breathing Exercises for

Singers

These breathing exercises offer potential relevance for singers. It has been observed and

is generally agreed that singing requires more rapid ventilation with a wider percentage of total

lung capacity being utilized than in conversational speech. Studies have observed the benefits of

glossopharyngeal breathing in competitive athletes, such as breath-hold divers. Loring et al.

explain why these extreme maneuvers may be of interest to researchers. This study may be of

some interest to singers as well.

The practice of GI and GE therefore exposes competitive divers to lung volumes above
TLC and below RV, which are the usual limits considered physiological (and therefore
presumably safe) for normal lungs, thus providing physiologists with an opportunity to
investigate the elastic properties of the respiratory system at both extreme lung
volumes. 166

After filling the lungs to TLC, elite breath-hold divers may increase their TLC by up to

47% performing GI. 167 Tetzlaff et al. also write that, “Elite breath hold divers consistently had
168
higher vital capacity compared to age matched controls.” As elite breath-hold divers descend,

they use GE to equalize ear pressure. Lindholm et al. observed that RV could be reduced by as

much as 21%. 169

166. Stephen Loring et al., “Transpulmonary Pressures and Lung Mechanics with
Glossopharyngeal Insufflation and Exsufflation Beyond Normal Lung Volumes in Competitive
Breath-Hold Divers,” Journal of Applied Physiology 102, no. 3 (March 2007): 841,
https://doi.org/10.1152/japplphysiol.00749.2006.

167. Ibid., 844.

168. Kay Tetzlaff et al., “Going to Extremes of Lung Physiology–Deep Breath-Hold

Diving,” Frontiers in Physiology 12, no. 710429 (July 2021): 1054,
https://doi.org/10.3389/fphys.2021.710429.

169. Peter Lindholm and Sven Nyrén, “Studies on Inspiratory and Expiratory
Glossopharyngeal Breathing in Breath-Hold Divers Employing Magnetic Resonance Imaging

65
 While there have not yet been longitudinal studies on pulmonary adaptations or changes

in Euclidean size of lung tissue by undertaking GI and GE maneuvers, Seccombe et al. observed

that, “These subjects had larger than predicted lung size. It is not clear whether this represents a

consequence of undertaking GI over a long period or a selection effect that allows competitors

with larger lungs than predicted to excel at their chosen sport.” 170

While there is insufficient research at present, training with GPB regularly, and

hyperinflated lung tissue beyond TLC may consequently enable larger total lung capacity. It

appears that one result of regular training in competitive deep-divers is herniation of lung tissue

beneath the sternum and the “distensibility and high performance of trained lungs.” 171 The same

study also found that,

Hyperinflation can be physiological and even protective under abnormal physical

conditions in the sense of acute adaptation to deep breath-hold diving. Dynamic magnetic
resonance imaging is adequate for visualization of the sequence of the glossopharyngeal
insufflation maneuver and the complete reversibility of deliberate hyperinflation...This
hyperinflation, however, is fully reversible and even protective in the sense of an acute
adaptation to an environmental challenge such as deep breath-hold diving. 172

Another study sought to explore training protocols intended to increase vital capacity in free

divers. The authors explained their methodology by stating, “The diver's lung training involved a

set of 5 different lung exercises with yoga and lung packing maneuvers 5 times a week for 11

And Spirometry,” European Journal of Applied Physiology 94 no 5-6 (2005): 647,

doi:10.1007/s00421-005-1358-8.

170. Leigh Seccombe et al., “Lung Perfusion and Chest Wall Configuration is Altered by
Glossopharyngeal Breathing,” European Respiratory Journal 36, no. 1 (July 1, 2010): 151,
https://doi.org/10.1183/09031936.00163209.

171 Monika Eichinger et al., “Lung Hyperinflation: Foe or Friend?” European

Respiratory Journal 32, no. 4 (October 1, 2008): 1116,
https://doi.org/10.1183/09031936.00118807.

172. Ibid.,1113.

66
weeks.” 173 The average VC of the group rose by 7.5% over the course of the 11-week trial. The

study concluded that “vital capacity can be improved by training.” 174

c. Potential Dangers of Glossopharyngeal Breathing Exercises for

Singers

While further research in this area is needed, studies seem to suggest several potential

hazards for engaging in repeated GI beyond TLC. Eichinger et al. concluded that, “lung

hyperinflation induced by deliberate glossopharyngeal insufflation may grossly imitate the

hyperinflation seen in chronic obstructive pulmonary disease patients.” 175 Further, it is possible to

develop a pneumomediastinum, which is a collection of air developing in the intrathoracic

tissues, which is probably caused by lung stress induced by performing GI beyond TLC. 176 There

are other potential dangers to taking GI and GE to extreme lung volumes. Lindholm and Nyrén

observed,

MRI revealed pronounced changes in the volume of intrathoracic blood, with a small
heart and compressed vessels following GI and the opposite, i.e., enlarged vessels during
GE. MRI also showed an invagination of the posterior wall of the trachea, in connection
with GE in certain subjects. 177

Acute cardiac changes as well as hemodynamic changes occur during GI and GE

maneuvers, which were observed in another study:

173. Orio Johansson and Erika Schagaty, “Lung-Packing and Stretching Increases Vital
Capacity in Recreational Freedivers,” European Respiratory Journal 40, no. 56 (September,
2012): 867.

174 Ibid., 867.

175 Monika Eichinger et al., “Lung Hyperinflation: Foe or Friend?” 1116.

176. Loring et al., 841.

177. Lindholm and Nyrén, “Studies on Inspiratory and Expiratory Glossopharyngeal

Breathing in Breath-Hold Divers Employing Magnetic Resonance Imaging And Spirometry,”
646.

67
 During GI, the divers showed a 48% drop in mean arterial pressure (MAP) to 50 mmHg,
with a 88% decrease in pulse pressure (PP), while heart rate (HR) increased by 36% to
103 beats/min and cardiac output (CO) dropped by 79% to 1.3 l/min. The increase in
intrathoracic pressure during GI, measured in separate experiments, is probably
responsible for these hemodynamic changes, by impeding venous return into the chest.
Associated with the drop in MAP during GI were various neurological signs and
symptoms, including dizziness, tunnel vision, involuntary twitching of facial muscles and
one brief episode of loss of consciousness. 178

Significant acute changes to arterial blood pressure, heart rate, pulse pressure, and cardiac

output while performing GI and GE present possible dangers to users packing lungs with extreme

volumes of air. The potential increases in vital capacity and potentially increased normal lung

capacity should be met with caution as there are risks to extreme stretching and contracting of

pulmonary tissues, as well as potential impacts of acute cardiac and hemodynamic changes while

performing GI and GE maneuvers. Much of the research on this topic is concerned with breath-

hold diving, which interacts with changing pressures related to the depth of the dive. Singers

would not be subjecting themselves to the same level of risk imposed upon competitive breath-

hold divers. A study by Nygren-Bonnier in which participants learned GI demonstrated that

participants who successfully learned the breathing technique showed improvements of

pulmonary function, chest expansion, and increased VC in healthy participants, participants with

cervical spinal cord injuries, as well as participants with spinal muscular atrophy.

Performance of a training period of five to eight weeks of GI produced positive effects on

pulmonary function and chest expansion both in the healthy participants, the participants
with CSCI and the children with SMA type II. The improvements were still noticeable
three months after training, regardless of whether the participants had continued to train
or not. 179

178. Jutta Novalija et al., “Cardiovascular Aspects of Glossopharyngeal Insufflation and

Exsufflation,” Undersea Hyperbaric Medicine 34 no. 6 (2007): 415, PMID: 18251438.

179. Malin Nygren-Bonnier, “Glossopharyngeal Breathing.” (Ph.D. Diss., Karolinska

Institutet, Sweden, April, 2008): 30.

68
 Nygren-Bonnier also reported that it is unclear to what degree training can appreciably

increase lung volumes or pulmonary function compared to lung volumes associated with genetic

composition. 180 Nygren-Bonnier wrote, “large lung volumes generally reflect genetic influences

and body size characteristics because exercise training does not appreciably change static lung

volumes.” 181 This study concludes that some increase in thoracic expansion as well as increases

in VC are possible by training GI. 182 This technique might be beneficial for singers in stretching

pulmonary tissue and the thorax to some degree but the hemodynamic risks and potential risk of

orthostatic syncope (fainting) may dissuade some singers from incorporating this form of

training. Further research is needed, as GI has not been studied in the context of voice training or

with the singing population. While it may be of some benefit, moderation is advised in

implementing this technique.

2. Respiratory Muscle Training and The Voice

a. Overview of Respiratory Muscle Training

The human respiratory system plays a role in nearly every aspect of living and of

course, this applies to singing and athletic endeavors. The human respiratory system is, at its most

fundamental level, the means through which the human body exchanges gasses between the

oxygenated atmospheric air and carbon dioxide, which is processed by the alveoli and alveolar

ducts and distributed from the blood to the cells of the body. The rest of the respiratory system

aids in this gas exchange by moving the air in and out of the body. 183 Humans secondarily

180. Ibid., 3.

181. Ibid., 3.

182. Ibid., 3.
183. Jiyuan Tu, Kiao Inthavong, and Goodarz Ahmadi, “The Human Respiratory
System,” In Computational Fluid and Particle Dynamics in the Human Respiratory System, eds.
Jiyuan Tu, Kiao Inthavong, and Goodarz Ahmadi (Dordrecht: Springer Netherlands, 2013), 19,
https://doi.org/10.1007/978-94-007-4488-2_2.

69
evolved to make special use of their respiratory system for the creation of speech sounds and

communication. The muscles of respiration, similar to other skeletal muscles, are subject to

specific adaptation and can adapt to imposed demands.

Respiratory muscle training may be another topic of particular interest for singers.

Breath management, or “breath support/breath control” as it is sometimes termed by singing

teachers, has historically been considered one of the most important, if not the most important

factors for high level singing. Caruso and Tetrazzini, for example, titled breath control the

“Foundation of Singing” in their 1909 book on vocal technique, in which Caruso wrote, "If

singers would learn to breathe correctly, all of the many possible vocal problems will be

avoided." 184 What does it mean to breathe “correctly?” While there can be no doubt that Caruso

and Tetrazzini were masters of their own breathing mechanics, how effective would their specific

breathing patterns be if employed by other singers? The training and control of the respiratory

system will always be a primary concern of singers and teachers. However, understanding and

developing optimal breathing strategies has been shown to be highly individualized; it has been

well documented that breathing strategies vary widely among professional singers likely due to

anatomical and physiological variability. Further, the sensory perception of how one breathes has

been shown to differ from objective observation of a singer’s physiology. 185 While many great

pedagogues and practitioners have highlighted the importance of breathing; and while the gross

anatomical and physiological characteristics of the respiratory system are generally equivalent,

variations and anatomical and physiological differences between individuals necessitates different

184. Enrico Caruso and Luisa Tetrazzini, Enrico Caruso and Tetrazzini on the Art of
Singing, 2.

185. Barbara Griffin, Peak Woo, Jaina Casper, Raymond Colton, and David Brewer,
“Physiological characteristics of the supported singing voice: A preliminary study,” Journal of
Voice, 9 no.1 (1995): 45.

70
breathing patterns for optimal performance. This is perhaps why studies have consistently shown

that breathing strategies among professional singers vary greatly. 186 187 There are, however, some

universal truths for breathing and singing, especially when compared with speech, or other

phonatory tasks. Ray, Trudeau, and McCoy write,

Singing requires a wider range of lung volumes than either speaking or other
phonatory tasks, and therefore requires increased muscle activity to control the
pressures that result. Singing requires increased initiation volumes, closer to 70%–
100% vital capacity (VC), than either speaking (60% VC) or breathing at rest (40%
VC). 188

All skeletal muscles can be trained and conditioned, and are subject to the SAID

principle. This includes the muscles of respiration. The ability to regulate subglottal pressure

during phonation is a vital component for breath management for singing and requires

coordination between the elastic recoil of rib cage and lung tissue as well as the mechanical

forces of the respiratory muscles, which varies based on the amount of air in the lungs at any

given time. The passive forces of lung pressure and elastic recoil decrease during expiration,

meaning a singer will need to exert additional muscular force in order to maintain consistent Psub

during singing, especially towards the end of the expiratory phase of the breath cycle. 189 Ray,

Trudeau, and McCoy write, “Controlled exhalation to and beyond the point of functional residual

capacity, as required for speech and singing, involves an active process whereby the inspiratory

186. Monica Thomasson, and Johan Sundberg, “Lung Volume Levels in Professional
Classical Singing,” Logopedics Phoniatrics Vocology 22, no. 2 (1997): 61-70,
https://doi.org/10.3109/14015439709075316

187. Monica Thomasson, and Johan Sundberg, “Consistency of Phonatory Breathing

Patterns in Professional Operatic Singers,” Journal of Voice 13, no. 4 (1999): 529-41,
doi:10.1016/s0892-1997(99)80008-3.

188. Christin Ray, Michael D. Trudeau, Scott McCoy, “Effects of Respiratory Muscle
Strength Training in Classically Trained Singers,” Journal of Voice 32, No.5 (2018): 644.e26.

189. Ibid., 644.e25.

71
and expiratory muscles contract synergistically to regulate airflow and pressures based on the

volume of air in the lungs.” 190 Increasing the strength of respiratory muscles, it has been

hypothesized, might assist in regulating breathing patterns at the extreme ranges of lung volume

during speech and singing. 191 Respiratory Muscle Training (RMT) is performed by placing a

resistive load during respiration. Specific devices vary in terms of how this resistance is applied,

but the principle is the same- to increase resistance during forced inspiration and expiration in

order to strengthen the muscles which assist in respiration. Respiratory muscle training can be

broken into two categories, those exercises which focus on the muscles of exhalation, or

expiratory muscle training, (EMST) and exercises which focus on the muscles of inhalation, or

inspiratory muscle training (IMST).

Ray, Trudeau, and McCoy studied the impacts of respiratory muscle strength training on

trained classical singers. Even amongst trained singers, the study showed increases in maximal

inspiratory pressure (MIP) and maximal expiratory pressure (MEP) from baseline observations

over the training period, showing strength gains in respiratory muscles. These changes, they

theorize, may positively impact breath control of singers. They write,

The strength of the respiratory muscles may also affect how singers control phonation
and deserves attention as well. Changes in respiratory muscle strength may result in
changes in mechanism of breath support and singing technique. Increased inspiratory
strength may help regulate Ps at high lung volumes, whereas increased expiratory muscle
strength may help regulate Ps at low lung volumes. 192

b. Overview of Relevant Devices and their Functions

There are currently numerous resistance training devices on the consumer market. While

not all of these devices have been subjected to any scholarly review, several of them have been

190. Ibid., 644.e25.

191 Ibid., 644.e25.

192. Ibid., 644.e26.

72
studied and reviewed. Understanding the differences of these devices can help individuals

implement this training to meet their specific demands. For example, Menzes et al. reviewed a

wide variety of RMT devices on the market. They reported that, “The resistance-training devices

fall into the following three main categories, based upon how the load is generated: passive flow-

resistance, dynamically adjusted flow resistance, and pressure threshold valve.” 193

These three main categories appear to have certain benefits and drawbacks. Passive flow-

resistance devices are the least quantifiable, as the amount of resistance will vary with breath

flow. 194 However, these devices appear to be the least expensive. Dynamically adjusted flow

resistance devices provide a continuous dynamic adjustment to flow resistance based on

respiratory flow rate. Menzies et al. write, “Furthermore, the controlled variable can be either the

pressure load or the respired flow rate.” 195 These devices provide more reliable measurements

than passive flow-resistance devices, but they also tend to be more expensive. Pressure threshold

devices require the individual to overcome a set pressure load. Pressure threshold devices offer

the most reliably quantifiable, verifiable intensity by “providing near-flow independent resistance

to respiration.” 196

In their review of RMT devices, Menzes et al. provided a helpful table which categorized

several devices based on several criteria. This review was not designed to determine which device

is the best one, especially because needs for RMT might vary from clinical to home use and are

193. Kênia Menzes et al., “A Review on Respiratory Muscle Training Devices,” Journal
of Pulmonary & Respiratory Medicine 8, no.2 (January 1, 2018): 1, 2
https://doi.org/10.4172/2161-105X.1000451.

194 Ibid., 6-7.

195. Ibid., 2.

196. Ibid., 2.

73
subject to individual needs, budgets, and other factors. 197 Menzes et al. did not provide a

comprehensive review of all devices currently available, as there are far too many devices on the

market, many of which serve the same, or similar function as the ones that were reviewed. The

study did observe some of the most popular devices, however.

Table 4.1 - Respiratory Muscle Trainers Reviewed 198

3. Expiratory Muscle Training

a. Specific Exercises for Expiratory Muscle Training

As mentioned before, expiratory muscle training is when an individual applies a

resistance to the expiratory phase of respiration in order to train the muscles involved in forced

exhalation. While the technique of Pressure threshold loading is associated with Inspiratory

Muscle Training (IMT), there are similar devices available for Expiratory Muscle Training

(EMT). A 2005 study published in the Journal of the Japanese Physical Therapy Association

197. Ibid., 3.

198. Ibid., 3.

74
concludes, “significant reductions were observed in HR (heart rate), VO2/kg and RPE (rating of

perceived exertion) at same load during exercise testing after IMT, and in VO2/kg and RPE after

EMT.” 199 If a singer with high physical and vocal demands can increase respiratory muscle

strength, the benefit of decreased the oxygen demands of a trained respiratory system, it should

increase stamina and decrease laryngeal load. 200

RMST device manufacturers, in general, will provide instructions for performing EMST

exercises with their devices. Important to note is that the foundational principles of exercise

(progressive overload, frequency, intensity, etc.) apply to EMST and IMST exercises. Individuals

will set the training device to the desired resistance setting and will perform a given number of

repetitions and a given number of sets. Over time, with consistent training and technique, the

settings will be made progressively more difficult as the respiratory muscles adapt to the given

load.

4. Inspiratory Muscle Training

a. Specific Exercises for Inspiratory Muscle Training

Inspiratory muscle training applies resistance during the Inspiratory phase of respiration

to exercise the muscles involved in forced Inspiration. Specific training protocols will likely vary

from one device to another. The protocols will be similar to the ones noted above, except the sets

of exercises focus on training the muscles involved in forced inspiration.

One particularly noteworthy inspiratory muscle training technique is called pressure

threshold loading. It is one of the kinds of devices reviewed by Menzes et al. An individual

199. Makoto Sasak, Hajime Kurosawa, Masahiro Kohzuki, “Effects of Inspiratory and
Expiratory Muscle Training in Normal Subjects,” Journal of the Japanese Physical Therapy
Association 8, no.1 (2005): 36, http://doi.org/10.1298/jjpta.8.29.

200. Leborgne and Rosenberg, The Vocal Athlete, 24.

75
forcefully inhales against a device which resists inhalation using a preset pressure. Louise Turner

describes this process:

Pressure threshold loading requires individuals to generate sufficient negative pressure to

surpass a pre-set load to allow flow (an inspiration). Typically, a weighted plunger or
spring loaded value is used to provide near flow-independent resistance to inspiration…
In addition, this training remains relatively simple with no requirement to regulate
breathing pattern or gas exchange which are necessary in other training regimens. 201

For most singers in non-clinical settings, budget friendlier devices which can provide

both EMST and IMST may be advantageous. Being able to set a specific load is certainly

advantageous for training as it increases the specificity of training protocols. Without access to

specific tools, singers can perform RMST using a straw, or even a finger. Dr. Brian Gill, a

professor in the Jacobs School of Music at Indiana University, has explained in his voice practice

that a finger (or fingers) placed on the center of the lips can be used as a resistor for inhalation,

exhalation, as well as during phonation; he goes on to say that using a resistance breath will

“awaken a proprioceptive awareness of how the body needs to expand in order to take a breath

that is sufficient for high-level singing.”

While there are many devices on the market, and each individual may have specific

budgetary and training preferences, it seems to be of particular advantage for singers to

implement respiratory muscle training. Increased load may have unexpected consequences. While

no studies have been conducted on muscle tension related to IMST and EMST, accessory muscle

activation during exercise may lead to unwanted muscle tension if trained improperly. Additional

research may be needed to determine the efficacy of these devices when used for training the

respiratory muscles for singers.

201. Louise Turner, “The Effect of Inspiratory Muscle Training on the Oxygen Cost of
Breathing and Respiratory and Limb Locomotor Muscle Oxygenation,” (PhD Diss., Ann Arbor:
ProQuest, 2010), 44.

76
 Conclusions
There are myriad benefits for singers to exercise concurrently with voice training.

Practical application of exercise science principles may empower singers to achieve specific

training goals to improve cardiorespiratory function, muscle hypertrophy, and body composition.

Aerobic training can improve cardiorespiratory capacity and improve stamina on stage, however

vigorous cardiovascular exercise directly before vocalizing should be avoided.

Regular resistance training is important for developing and retaining muscle mass and

bone density throughout the aging process. Resistance training carries many advantages as

increased muscle size and strength lowers rate of exertion for everyday tasks, which would be

beneficial for singers who often must wear heavy costumes or perform strenuous staging or

choreography. Singers performing resistance training are advised to reduce the weight of lifts to

levels which do not require breath holding techniques like the Valsalva maneuver. Perceptual

studies of laryngeal symptoms indicate that heavy weight lifting with a closed glottis does have a

deleterious impact on the tissues of the vocal folds, and potentially other structures the of the

larynx. Because there are no studies which directly observe the impacts of breath hold patterns for

maximal muscle growth, it is recommended to use forced expiration with an open glottis on the

concentric potion of the lift for singers. Training to muscle fatigue with a rep range of 8-12

repetitions for healthy younger adults, and 12-15 repetitions for healthy older adults is

recommended.

Singers can benefit from understanding the principles of training as a means to better

understand how to implement physical exercise, but also how voice exercises function to induce

specific cellular adaptations and metabolic pathways. While many significant questions remain

concerning safety and best practice for physical exercise for singers, there are clearly

advantageous metabolic, neurological, cardiorespiratory, and muscular adaptations induced

through exercise. Some specific training routines for respiratory muscles, and for stretching

77
pulmonary tissues may be advantageous, but caution is advised when approaching

glossopharyngeal breathing exercises as well as IMST and EMST muscle training exercises as

there has been little research on the impacts of these exercises on the singing voice. Exercises

which strengthen core and erector spinae muscles should also be incorporated, as enhanced

posture can improve performance capacity for singers. Total body routines which include chest,

back, leg, and core strength are encouraged. Multi-joint resistance exercises such as the squat,

lunge, bench press, deadlift, when performed at light enough loads to avoid using the Valsalva

maneuver, are all advantageous for developing better posture and stability for singers. Body-

weight alternatives such as pushups, lunges/single leg squats, planks, crunches, and glute bridges

can be performed safely and without equipment and have also been shown to be beneficial.

Recommendations for Further Research

There are several areas that have not been fully examined by exercise and voice science.

Additional testing of ACSM’s evidence-based exercise recommendations upon trained singers;

comparing fitness progress with any measurable changes in voice quality (maximum frequency

range, amplitude, jitter, etc.) and breath management (vital capacity, maximum sustained pitch,

etc.) is recommended.

Additionally, little is currently known about the Valsalva maneuver’s impact on the

tissues of the vocal folds, or the structures related to singing. At the time of writing, no

longitudinal studies exist which study weight lifting implementing the Valsalva maneuver on

trained singers. Further research is recommended.

For GI and GE maneuvers, much of the research exists on extreme breath hold divers or

patients with acute spinal cord injuries. Particularly for increasing vital capacity or total lung

capacity in singers, additional research into the potential benefits and drawbacks is recommended.

In each of the cases in which the data are not clear or do not exist, care and moderation is advised

78
for singers or teachers interested in incorporating these exercises into fitness/voice training

routines.

79
 Supplemental Materials
PAR-Q+ 202

202
Darren Warburton, Veronica Jamnik, Shannon Bredin, and Norman Gledhill, “The Physical
Activity Readiness Questionnaire for Everyone (PAR-Q+) and Electronic Physical Activity Readiness
Medical Examination (ePARmed-X+),” Health & Fitness Journal of Canada 4, no. 2 (April 14, 2011):, 2011.
https://southlake.ca/wp-content/uploads/2022/12/ParQPlus2023.pdf-fillable_OHSW.pdf

80
81
82
83
 Evidence Based Exercise Recommendations 203

203. Carol Garber, Bryan Blissmer, Michael Deschenes et al., “Quantity and Quality of
Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor
Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise,” 1334.

84
 Appendix 1: The Vocal Athlete

While the topic of training vocalists as athletes falls outside the scope of this document,

some discussion is relevant.

a. Principles of Exercise Related to Voice and Training Vocalists as

Athletes

There is significant commonality, and indeed, many shared goals between the field of

voice and the field of exercise science. Applying the foundational principles of exercise as well as

SAID to voice training has received considerable interest in recent years. To some degree,

principles of exercise can be applied to the training of intrinsic and extrinsic musculature of the

larynx, as well as the muscles of respiration. There are, however, very important differences

between the training of vocalists and the training of athletes. The delicate mucosal cover of the

true vocal folds and friction associated with vocal fold vibration are significant to voice training.

There are, of course, analogous positions between voice and exercise worlds. For example,

professional vocalists and professional athletes share many general training goals. The most

important overlapping goals of voice science and exercise science are maximizing function,

minimizing injury risks, and promoting mechanical sustainability and longevity of one’s

abilities. 204 While laryngeal muscular adaptations and the direct comparison of vocalists and

athletes is a worthy topic of investigation, it isn’t the primary focus of this document. The

principles of exercise may have some merit for voice training. Although these are the author’s

unvetted opinions, they may provide some additional food for thought, or debate.

204. Saxon and Schneider, Vocal Exercise Physiology, 3.

85
 Overload: As mentioned before, muscles adapt to specific imposed demands. In voice

training, assigning repertoire to singers follows the same principle. Assigning pieces which are an

appropriate range, tessitura, phrase length, tempo, etc. are important considerations for students.

The appropriate assignment of repertoire to a student is taking into consideration the principle of

overload, in a sense. A teacher considers the overall challenge level of a piece to meet the skill

level of the individual and be of sufficient challenge to the student.

Reversibility: Anyone who has taken an extended break from voice training that the

detraining, or reversibility principle applies. Neurological and muscular adaptations associated

with singing will detrain if not continually practiced.

Progression: Novice and detained singers will likely experience faster growth than more

advanced singers. All individuals have theoretical limitations.

Individualization: Different individuals will need to implement different plans based on

their own physiology and objectives. Musically, A freshman baritone would necessarily require

different exercises and repertoire prescription than a graduate tenor. Vocalists simultaneously

performing intense choreography and singing in a contemporary Musical Theater style will have

different exercise programming than an operatic performer that is required to carry a heavy prop

or wear a costume over much longer periods of time.

Periodization: Implementing specific training cycles could be applicable within the

context of voice training where training might be tuned to meet the specific needs of a singer. For

example, consider the repertoire or voice training which is performed during the off season when

not actively engaged under contract; the kinds of exercises and repertoire being practiced during

86
audition season; and the kind of vocal exercise and practice that is required during the

rehearsal/performance training. 205

Specificity: For singers, this principle is especially apparent when training in different

vocal styles and genres. Different genres require specific training tools and vocal approaches. A

female identifying vocalist preparing to sing a contemporary pop or musical theater song that

requires thick vocal folds (chest voice), versus the utilization of thin vocal folds (head voice) in a

classical female’s upper register are specific instances of the specificity principle in singing. 206

b. Components of Training applied to Voice

Frequency: Practicing frequently is no different than any other muscular training. Practice needs

to be performed regularly—at least 3 days a week, to gain any benefits. Saxon and Schneider

write, “Because voice lessons typically occur weekly, the student needs to maintain a regular

practice regimen in order to achieve goals in vocal improvement, muscle memory, and vocal

fitness.” 207

Intensity: The intensity with which singers practice requires a delicate balance because

the vocal apparatus is a delicate and finely coordinated system. Any practice that encourages

pressing or forcing the voice is discouraged. The tissues of the vocal folds are delicate, and vocal

exercises and repertoire should be appropriately challenging based on the age, anatomy,

physiology, and skill level of the singer. Remember, the higher the intensity of the vocal task, the

greater will be the accompanying risk of injury.

205. Ibid., 95.

206. Ibid., 249.

207. Ibid., 246.

87
 Time: Daily practice sessions should be long enough to challenge a singer, while short

enough to limit vocal fatigue and injury risks.

Type: Singing different genres, styles, or utilizing different registers are all examples of

different ‘types’ of vocal exercise. There are many other types of vocal exercise, which include

but are not limited to vocal onsets, messa di voce, intervallic leaps, changes in dynamics, and

agility exercises.

c. Intrinsic Laryngeal Skeletal Muscle Fiber Types and their

Adaptation Ability

The muscles of the larynx contain the same metabolic systems as other skeletal muscles.

It is important to note that the muscles of the larynx have fewer muscle fibers than larger limb

muscles and have certain limitations to undergo specific adaptations compared to larger skeletal

muscles. A brief overview of muscle fiber types may be helpful for understanding how the

metabolic pathways function in intrinsic laryngeal skeletal muscles (ILSM). Mary Sandage,

drawing from other researchers (Brooks et al. (2005), Han et al. (1999), Schiaffino and Reggiani

(2011)), has illustrated the types of skeletal muscle fibers by their type, contractile properties

(slow, fast, etc.), fatigue resistance, as well as metabolic properties which are elaborated in the

table below.

88
Table S.1 - Characteristics of muscle fiber types found in the larynx. 208

Muscle fiber type Contractile Fatigue Resistance Metabolic properties

property

Limb Skeletal Muscle

Type I Slow High Slow, oxidative

Type IIa Fast Moderate oxidative glycolytic

Type IIx Fast Low Fast glycolytic

(phosphagen)

Specialized muscle fiber types

Type IIL Superfast Low Fast glycolytic

Slow tonic Slow High High Oxidative

Sandage also explored studies which observed the types of muscle fibers in intrinsic

laryngeal skeletal muscles in human cadavers. Sandage writes, “Human laryngeal muscles have

been described to express Type I, Type IIa, Type IIx, and Type IIL isoforms similar to fiber types

seen in limb skeletal muscle.” 209 There are several issues with the available data on this subject:

1) the sample sizes are small in the existing studies; 2) intersubject variability of muscle fiber

types was reasonably large; and 3), to further complicate this issue, one of the studies did not

disclose ages of the cadavers, which makes drawing certain conclusions about laryngeal muscle

fiber type distribution difficult as it has been demonstrated that as humans age, there is a

208. Mary Sandage, and Audrey G Smith, “Muscle Bioenergetic Considerations for
Intrinsic Laryngeal Skeletal Muscle Physiology,” 1257.

209. Ibid., 1258.

89
conversion process of muscle fibers in which type I fibers tend to transition into type II fibers. 210

Some more concrete observations have been noted in these studies; specifically, the posterior

cricoarytenoid muscle (PCA) has been shown to possess the highest concentration of type I

muscle fibers, having the highest aerobic capacity and best capillary supply of any intrinsic

muscle of the larynx. The PCA muscles are the primary muscles controlling vocal fold abduction

for breathing. The contraction of these muscles pivots the arytenoid cartilages apart, thereby

opening the glottis. 211 Dr. Horst Ganz writes, “High aerobic metabolism of the human posterior

cricoarytenoid muscle is necessary for the almost constant action of this muscle.” 212 As

mentioned above, training capacity and adaptability of ILSM is restricted by their relatively small

size and limited quantity of muscle fibers. Training specific vocal tasks however, could still

theoretically change the density and concentration of fiber types to some degree. Plotkin et al.

also point out that muscle fibers have plasticity and are capable of transitioning based on specific

training. They write:

Evidence suggests that muscle fibers have the ability to undergo fiber type
transition, from hybrid to pure fibers, and between fiber types. The ability to discern
hybrids is necessary to have a high degree of confidence in findings related to fiber type
distribution. 213

While no studies have been conducted observing fiber type transition in vocalists (in-vivo

observations of specific adaptations would be invasive and difficult to measure); given that ISLM

have the same properties as other skeletal muscles, it seems possible that ISLM may be able to

210. Ibid., 1258.

211. Ibid., 1258.

212. Horz Ganz, “The Metabolism of Laryngeal Muscles: Its Influence on the Physiology
and Pathology of the Glottis,” Archives of Otolaryngology 94, no.2 (1971): 97–103.

213. Daniel L. Plotkin et al., “Muscle Fiber Type Transitions with Exercise Training:
Shifting Perspectives,” Sports 9, no. 9 (2021): https://doi.org/10.3390/sports9090127.

90
undergo fiber type transition based on specific vocal activities/training one would perform;

biomechanical adaptations could be stimulated by specific vocal exercises. For example, it might

be interesting to study how/whether by regularly training coloratura exercises, a singer’s muscle

fiber types specifically adapt and transition from Type I to type II fibers.

91
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