[Harp-L] Help wanted for Harmonica Medical/Scientific Study

[John Schaman <jschaman@xxxxxxxxxxxxxxxxxxxx>]

Greetings fellow harp enthusiasts,

I would very much appreciate your help.  I have been subscribed to the
Harp-L digest for a number of months and I have read most posts during that
time.  Being a newcomer to the harmonica world (almost 3 years), I have
found it very informative and helpful.  Although my initial interest was of
a medical/scientific nature, I have developed quite an attachment to this
little instrument.  My day job for 33 years has been in the field of
rehabilitative medicine, primarily cardiac testing and rehabilitation, as
well as musculoskeletal rehab and sports medicine.  Almost three years ago,
I became intrigued by the possibility that playing the harmonica might have
medical/health benefits, primarily pulmonary (lung).

What caught my initial attention was a combination of observations and
findings:

1. Epidemiological data showing a 50% loss in lung function between the ages
of 30 and 70. 
2. The common belief and observation that individuals performing certain
activities such as: horn playing, opera singing, breath-hold diving, etc.
have a lesser decline in lung function with aging compared to the general
population (in other words, the belief that these individuals have ³better
lungs²). 
3. The conclusion that certain lung activities might reduce the loss of lung
function that is assumed to be ³normal² with aging.
4. The conclusion that the observed decline in lung function, although
following a statistical norm for our population, may not be desirable or
optimal for good health and longevity.
5. The long-term observation in my clinic that a rather significant
proportion of my patients who undergo pulmonary function testing are
actually significantly below the ³statistical norm², as provided by the
pulmonary function algorithms (variables used to predict normal values
include age, sex, ethnicity, and height).
6. Reports from several North American and international pulmonary
rehabilitation programs that harmonica playing has pulmonary ³benefits²,
although without any scientific or statistical evidence.

With these things in mind and realizing that the aerobic endurance exercise
prescribed for cardiac rehabilitation patients does not significantly
benefit pulmonary functions, I was convinced that there would be value in
designing a study to research the medical effects of playing the harmonica.
The purpose of the study was to determine if pulmonary exercises could
possibly reduce the epidemiologically observed loss of lung function with
aging.  I decided to use the diatonic harmonica as the respiratory ³tool² in
the program/study.  As the only instrument that ³makes music² with both
blowing and drawing, there is a potentially unique benefit to lung excursion
and ultimately, to lung function.  As I already had the equipment to perform
intricate pulmonary function testing, I designed the research protocol,
which initially appeared very simple and straightforward.  Subjects were to
be patients with heart and lung disease, generally over 40 years of age, who
had not played the harmonica, at least in recent years. Testing was to be
undertaken at the start and the end of the period of time chosen as the
duration of the study.

We named the program H.E.L.P. - Harmonica Exercise for Lung Program, a lung
improvement/rehabilitation program and study.  After months of preliminary
research and preparation the program was launched on November 29, 2007.
Although the study seemed simple and straightforward, we soon learned
otherwise.  We taught the patients to play scales and melodies, in much the
same way that most books and teaching methods seem to advocate.  This
immediately caused ?technique¹ frustrations as these ?older patients¹ found
it hard to play ³single notes.²   I have since learned from harmonica
teachers and advisors to our study that it may take some harmonica students
as long as one year to be able to play ³single notes.²  Furthermore, our
ambulatory patient population didn¹t seem to have their lungs challenged in
the way that I had expected. It is possible that in a more severely diseased
population, our early methods might have been more effective. We spent many
months, with the help of harmonica experts from around the world, devising a
more effective ?harmonica method¹, which essentially involved rhythmic
chordal playing.  In retrospect this made a lot more sense and was much more
effective in achieving the physiological challenges I postulated would be
required.

The present methods of H.E.L.P. differ from standard harmonica teaching
methods in that we are trying to develop the best pulmonary-enhancing
techniques and exercises, somewhat at the expense of musicality.  The
traditional harmonica teaching methods did not achieve the pulmonary effects
that we thought were optimal for our patient population. Our main goal is
to:

1. strengthen the muscles of respiration, including the diaphragm
2. exercise the lungs above the ³comfort zone² in the inspiratory range
3. exercise the lungs below the ³comfort zone²  in the expiratory range

As we progressed, I developed many concerns about scientific validity. We
were essentially doing a Dose-Response Study.  In order to conduct a
³dose-response² study, it is necessary to quantitate harmonica playing, as
some means of quantitating the ³dose² is required.  Duration of playing is
not enough, as there is no quantitation of intensity of playing.  With my
long term experience in cardiac research with respect to exercise, we have
developed a reasonably accurate quantitation of exercise using intensity
(measured quite accurately with heart rate), duration (in minutes) and
frequency (number of times per day, week, etc.).  Unfortunately, there
hasn¹t yet been developed a means of quantitating intensity of harmonica
playing.  I developed several ideas and I tried to work with the University
of Waterloo Bio-Engineering department, so far without success.  I felt the
most likely method to give this measurement is some type of strain gauge on
the chest which measures both frequency and magnitude of chest excursion.
The combination of these two variables should give a reasonably accurate
indicator of harmonica playing intensity.

I have been a member of the SPAH medical committee for the past two years
and I¹ve presented the H.E.L.P. study at both the St. Louis and the
Sacramento meetings.  I had hoped I would receive input from the harmonica
community to overcome some of the obstacles, however, very few diatonic
harmonica players attended my presentations.  This didn¹t surprise me, as
there were always many much more exciting sessions and topics occurring at
the same time.  I¹m sure this will again be the case this year in
Minneapolis, where I¹m presenting the H.E.L.P. study between 2 and 3 pm on
Friday.

If the harmonica is to be taken seriously as an instrument of potential
health improvement, it is paramount that the harmonica gain credibility in
the medical establishment, the scientific community, and in such diverse
fields as the insurance and healthcare industries.  To achieve this, certain
scientific principles must be applied, and unfortunately anecdotal and
promotional strategies may actually be counterproductive.  For this reason I
believe it is important to conduct a study that will stand up to scientific
scrutiny.

I would appreciate any thoughts or suggestions. Sorry for the length of this
post.


Regards,

John
-- 
J. P. Schaman, M.D.
Ontario Aerobics Centre
1010 Hopewell Creek Road
R. R. #2
Breslau, Ontario
N0B 1M0

cell(519)658-3733

Web-sites: 
clinic:  http://www.jschaman.com/
harmonica-lung program: http://www.harp-doc.com/
cfa:     http://www.cfaheart.com/