Vocal Warm-Up Practices and Perceptions in Vocalists: A Pilot Survey

*,Allison Gish, *,Melda Kunduk, Loraine Sims, and Andrew J. McWhorter, *yzBaton Rouge, Louisiana Summary: Objectives. Investigated in a pilot study the type, duration, and frequency of vocal warm-up regimens in the singing community using a survey. Methods. One hundred seventeen participants completed an online survey. Participants included voice students from undergraduate, masters, and doctoral music programs and professional singers. Results. Fifty-four percent of participants reported always using vocal warm-up before singing. Twenty-two percent of the participants used vocal cool down. The most preferred warm-up duration was of 510 minutes in duration. Despite using vocal warm-up, 26% of the participants reported experiencing voice problems. Females tended to use vocal warmup more frequently than males. Females also tended to use longer warm-up sessions than males. Education of the participants did not appear to have any noticeable effect on the vocal warm-up practices. The most commonly used singing warm-up exercises were ascending/descending ve-note scales, ascending/descending octave scales, legato arpeggios, and glissandi. Key Words: Vocal warm-upVocal cool-downVocal injury. INTRODUCTION Vocal warm-up exercises are believed to contribute to the prevention of vocal fold injury in professional voice users. For professional singers and students of singing, a regular vocal warm-up regimen is considered essential.1,2 Despite the wide and longstanding use of vocal warm-up in the singing community, relatively little is known about how vocal warm-up impacts the physiologic characteristics of the vocal folds and affects the acoustic parameters of the voice. Furthermore, there is conicting information in the vocal pedagogy literature about the most effective and widely used vocal warm-up exercises and the optimal frequency and duration of vocal warm-up sessions. Although singers consistently report that vocal warm-up improves voice quality, previous research has failed to identify how vocal warm-up affects the voice.36 Studies investigating the effect of vocal warm-up on phonation threshold pressure have yielded conicting results, whereas studying the effect of vocal warm-up on acoustic parameters of the voice appears promising. A signicant limitation of previous studies is that the warm-up regimens used varied considerably between the studies. Some studies used standardized warm-up protocols,3,4 whereas others allowed participants to use a personalized warm-up routine.6 Furthermore, the duration of warm-up protocols used in previous studies varied considerably, ranging between 7 and 30 minutes. This lack of consistency may be one of the factors contributing to conicting results between studies. By studying the characteristics of vocal warm-up regimens in the singing community, it will be possible to design
Accepted for publication October 6, 2010. Presented at the Voice Foundations 39th Annual Symposium: Care of the Professional Voice in Philadelphia, PA on June 6, 2010. From the *Department of Communications Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana; yDepartment of OtolaryngologyHead and Neck Surgery, Louisiana State University Health Sciences Center, Our Lady of Lake Regional Medical Center-Voice Center, Baton Rouge, Louisiana; and the zSchool of Music, Louisiana State University, Baton Rouge, Louisiana. Address correspondence and reprint requests to Melda Kunduk, Department of Communication Sciences and Disorders, Louisiana State University, 64 Hatcher Hall, Baton Rouge, LA 70893. E-mail: mkunduk@lsu.edu Journal of Voice, Vol. 26, No. 1, pp. e1-e10 0892-1997/$36.00 2012 The Voice Foundation doi:10.1016/j.jvoice.2010.10.005

a warm-up regimen that can be used in future studies investigating the effect of vocal warm-up on the voice. The purpose of this pilot study is: 1. To determine the duration and frequency of vocal warmup sessions in singers. 2. To examine the differences in vocal warm-up regimens in singers from varying sociodemographic groups with varying degrees of singing training. 3. To determine the most frequently used vocal warm-up exercises in the singing community. 4. To examine singers perceptions of the role of vocal warm-up in the prevention of vocal fold injury. 5. To obtain preliminary data on the occurrence of vocal fold injury in singers who use/do not use a vocal warmup regimen.

MATERIALS AND METHODS Participants After the approval of the study by the Louisiana State University Institutional Review Board, adult vocalists were recruited via e-mail to complete a web-based questionnaire. Undergraduate students, graduate students, and professional singers were targeted for the study. Additional participants were recruited from the researchers social network of professional singers. Participants were excluded if they had received less than 1 year of formal singing instruction at the time of completing the survey. Each participant was asked to complete a web-based questionnaire developed by the investigators. Members of the voice faculties at 136 universities in the United States and Canada were contacted via e-mail to briey describe the study, provide a hyperlink to the web-based questionnaire, and to request participation in the web-based questionnaire. Additionally, each voice instructor contacted was asked to forward the letter to vocal performance majors in his or her department. This recruitment letter was also sent to all members of the Southern Region of the National Association of Teachers of Singing,

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which comprises professional singers and voice instructors from Louisiana, Arkansas, and Mississippi. Additional participants were recruited from the investigators social network of professional singers via an announcement posted on their Facebook page. This announcement included the recruitment letter described above and a hyperlink to the web-based questionnaire. Description of the questionnaire The questionnaire used in this study was developed using Survey Monkey, a web-based survey application. The cryptographic protocol Secure Sockets Layer was used to ensure the security of all data collected. The questionnaire consisted of a combination of 69 closed- and open-set questions, with an estimated completion time of 30 minutes. Most questions had a closed set of responses; however, for some questions, the participants were able to include written explanations of responses (eg, if participants selected the option other, they were encouraged to explain this response). The questionnaire addressed characteristics of vocal warm-up in singers, including whether singers consistently use a warm-up regimen, frequency of warm-up sessions, average length of warm-up sessions, and types of exercises/tasks used during a typical warm-up session. For the question concerning types of exercises/tasks used in typical vocal warm-up sessions, an extensive list of exercises described in vocal pedagogy and speechlanguage pathology literature was provided, and participants selected all exercises they use in their warm-up regimens. To examine differences in vocal warm-up regimens in singers with varying degrees of formal training, questions concerning the length of time the singer has been enrolled in formal voice/singing lessons were included. Questions to determine the presence, frequency, and duration of current and past voice problems were also included so that preliminary data on the effect of vocal warm-up on vocal fold injury prevention could be obtained. Additionally, specic voice-related questions were asked to reveal behavioral and medical factors, which may contribute to voice problems. In the section that follows, topics/ questions that were covered in the questionnaire are outlined. 1. Sociodemographic characteristics: (a) age, (b) gender, (c) current education level (eg, freshman, rst-year masters candidate, third-year doctoral candidate), (d) number of years enrolled in formal voice instruction, and (e) geographic region. 2. Vocal warm-up regimen characteristics: (a) use of a vocal warm-up regimen, (b) frequency of vocal warm-up sessions, (c) duration of vocal warm-up sessions, (d) types of exercises/tasks used during a typical vocal warm-up session, and (e) use of a vocal cool-down after singing. 3. Perceptions about vocal warm-up: (a) beliefs about the necessity and importance of vocal warm-up, (b) beliefs about the role of warm-up in the prevention of vocal fold injury, and (c) perception of if/how vocal warm-up affects the voice. 4. Daily vocal use (type and frequency): (a) solo singing, (b) choral singing, (c) speaking, (d) loud talking, and (e) shouting/screaming.

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5. Risks associated with voice disorders: (a) smoking, (b) alcohol consumption, (c) caffeine consumption, (d) dehydration, and (e) occupational-related risks (eg, working in noisy and/or smoky environment). 6. History of voice problems: (a) presence of voice problems within the past year, (b) frequency of voice problems within the past year, and (c) duration of problematic voice episodes within the past year. 7. Medical conditions associated with voice disorders (presence, type, and frequency): (a) presence of gastroesophageal reux disease (GERD) symptoms and (b) allergies.

Data analysis Analyses are descriptive in nature. Vocal warm-up characteristics (ie, type, duration, and frequency) of all participants were presented. Vocal warm-up characteristics were investigated across genders, ages, education levels, and singing experience of participants. RESULTS One hundred eighty-eight people participated in the study, and 117 of the respondents completed the questionnaire, potentially because of the length of the survey. For data analysis purposes, the 117 complete responses were used. Sociodemographic characteristics of the participants are presented in Table 1. Frequency and duration of vocal warm-up Fifty-four percent of the participants reported that they always complete a vocal warm-up before singing. Distribution of reported frequency of using vocal warm-up among the participants is shown in Table 2. Distribution of participants typical warm-up duration is given in Table 3. Warm-up sessions of 510 minutes in duration were used by the largest number of participants (32%) in this study. Only one subject reported using warm-up sessions lasting longer than 30 minutes. The frequency and duration of participants vocal warm-up regimens were further examined according to age, gender, educational classication, singing experience, and geographic region. Results are shown in Tables 2 and 3. The list of vocal activities in which participants used a vocal warm-up before participating is listed in Figure 1. More participants indicated completion of a vocal warm-up before solo singing activities than ensemble singing (eg, choir performance) or speaking activities. For solo singing activities, usage of vocal warm-up among the participants ranged from 75% (before a private voice lesson) to 90% (before a brief solo singing appearance). For ensemble singing activities, warm-up completion ranged from 29% (before opera chorus participation) to 62% (before choir concert participation). Types of vocal warm-up exercises Participants were asked to describe the types of nonsinging exercises used during a typical vocal warm-up session; results are shown in Figure 2. The most commonly used nonsinging warm-up exercises were stretching exercises for the face/ neck/shoulder muscles (62%), breathing exercises (55%), and

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TABLE 1. Sociodemographic Characteristics of Participants Regarding Their Gender, Age, Education, Number of Years of Singing Experience, and Geographic Location Sociodemographic Characteristics of Participants Gender Male Female Age (y) 1830 3140 41+ Educational classication Undergraduate student Masters student Doctoral student Completed undergraduate Completed masters Completed doctorate Number of Participants 36 81 46 21 50 28 29 13 9 7 31

Number of years since rst enrolled in formal voice study 14 9 510 34 >10 74 Geographic region Southern United States Northeastern United States Midwestern United States Western United States International
Number of participants: 117.

65 15 16 16 5

consonants, alternating vowels, syllables, words, and phrases). Of particular interest was participants use of lip and tongue trills and nasal consonants /m/ and /n/ (Table 5). Lip and tongue trills were most commonly used during the glissando (42%) and the ascending/descending ve-note scale sung at a rapid tempo (38%). Nasal consonants /m/ and /n/ were used less frequently with 15% of the participants indicating use of this method for the glissando and the ascending/descending octave scale. Participants were also asked to rate the perceived difculty of the exercise on a scale of 15 (1: least difcult and 5: the most difcult) (Table 6). The singing warm-up exercise rated as the least difcult by participants was the ascending/descending ve-note scale sung at a rapid tempo. The singing exercises rated as the most difcult by participants was the messa di voce sung at a high pitch. Participants were asked to describe the sequence of their typical vocal warm-up regimen. Forty-four percent of participants reported that their vocal warm-up regimen follows the same sequence of singing exercises each day, whereas 56% reported that sequence of singing exercises varies from day to day. The participants who reported following the same sequence of singing exercises each day were asked to indicate which singing exercises they completed rst and last in a warm-up session (Figure 3). The most frequently indicated singing exercises as the rst completed were ascending/descending ve-note scales sung at a rapid tempo or at a slow tempo. The most frequently indicated exercises as the last exercise completed were the ascending/descending arpeggios sung in the staccato style or the legato style. Use of vocal cool-down To gain preliminary data on the use of vocal cool-down in vocalists, participants were asked to indicate whether they complete a vocal cool-down after singing. Only 26 participants reported that they use a vocal cool-down after singing. Most who indicated that they use a vocal cool-down after singing were females, aged 41 and older, with more than 10 years of singing experience. Vocal warm-up perceptions The next section of the questionnaire addressed participants perceptions about the importance of vocal warm-up and its effect on the voice (Table 7). Most participants agreed strongly that voice warm-up is important (72%), their voices are more cooperative after warm-up (74%), and that their voices are more exible after warm-up (70%). Fewer participants agreed strongly that vocal warm-up aids in the prevention of vocal injury (39%). Occurrence of voice problems Thirty participants (26%) reported that they had experienced voice problems in the past year. Fifty-three percent of these participants reported always using vocal warm-up (Table 2). Thirty-seven percent of these participants were in age group 1, 10% were in age group 2, and 53% were in age group 3; 37% were males and 63% were females; 43% were students. For 73% of the participants in this group, 10 or more years had elapsed since their rst voice lesson. The most used warm-up duration in these 30 participants (Table 3) was 510

postural alignment and general stretching exercises (50%).The least commonly used nonsinging warm-up exercises were general aerobic exercise (21%) and laryngeal massage (14%). Only 8% of the participants reported that they do not use nonsinging tasks as part of their vocal warm-up regimens. The next part of the questionnaire asked participants to describe the types of singing exercises they used (Table 4) as part of their vocal warm-up regimens. Thirteen exercises described in the vocal pedagogy literature were included in the questionnaire. For each exercise, participants were asked how often they use the exercise and on what vowel(s) or voiced consonants they typically sing the exercise. The most commonly used singing exercise was the ascending/descending ve-note scale sung at a rapid tempo (52%). Other always used singing exercises included the ascending/descending octave scale sung at a rapid tempo (32%), the ascending/descending arpeggio sung legato (25%), and the glissando (21%). The least commonly used singing exercise was the chromatic scale followed by the messa di voce sung at a high, medium, and low pitch (3%) and ascending/descending thirds (4%). For each singing exercise represented in the questionnaire, participants were asked to indicate which methods they used in executing each exercise (eg, different vowels, preceding

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TABLE 2. Vocal Warm-Up Frequency Among Participants Across Genders, Age Groups, Educational Status, Singing Experience, Geographic Region, and Vocal Health Status Frequency of Vocal Warm-Up Sociodemographic Characteristics of Participants (N) All participants (117) Male participants (36) Female participants (81) Age group 1: 1830 (46) Age group 2: 3140 (21) Age group 3: 41+ (50) Student (70) Nonstudent (47) 14 y singing experience (9) 510 y singing experience (34) >10 y singing experience (74) Southern United States (65) Northeastern United States (15) Midwestern United States (16) Western United States (16) International (5) Participants with reported voice problems (30) Do You Currently Use a Vocal Warm-up Before Singing? Always 63 12 51 20 12 31 36 27 3 17 43 35 7 10 8 3 16 Usually 41 17 24 18 7 16 25 16 4 11 26 21 6 5 7 2 11 Sometimes 11 6 5 8 1 2 9 2 2 5 4 9 1 0 1 0 3 Rarely 2 1 1 0 1 1 0 2 0 1 1 0 1 1 0 0 0 Never 0

minutes. Six participants in this group reported using a vocal cool-down after singing. The most commonly used singing exercises by the participants with reported voice problems was the ascending/descending ve-note scale sung at a rapid

tempo (47%) and the ascending/descending octave scale sung at a rapid tempo (30%) (Table 8). The least commonly used singing exercises were the chromatic scale and ascending/descending thirds.

TABLE 3. Vocal Warm-Up Duration Among Participants Across Genders, Age Groups, Educational Status, Singing Experience, Geographic Region, and Vocal Health Status Duration of Vocal Warm-Up Sociodemographic Characteristics of Participants (N) All participants (117) Male participants (36) Female participants (81) Age group 1: 1830 (46) Age group 2: 3140 (21) Age group 3: 41+ (50) Student (70) Nonstudent (47) 14 y singing experience (9) 510 y singing experience (34) >10 y singing experience (74) Southern United States (65) Northeastern United States (15) Midwestern United States (16) Western United States (16) International (5) Participants with reported voice problems (30) How Long Does Your Typical Vocal Warm-up Last? <5 min 14 6 8 8 2 4 10 4 2 5 7 9 2 1 1 1 4 510 min 37 10 27 14 8 15 22 15 2 10 25 23 4 6 3 1 9 1015 min 29 11 18 10 5 14 19 10 3 9 17 14 4 3 7 1 6 1520 min 26 8 18 11 5 10 13 13 1 9 16 13 3 4 4 2 8 2025 min 6 1 5 3 1 2 4 2 1 1 4 3 1 2 0 0 0 2530 min 4 0 4 0 0 4 2 2 0 0 4 2 1 0 1 0 2 >30 min 1 0 1 0 0 1 0 1 0 0 1 1 0 0 0 0 1

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FIGURE 1. Distribution of vocal activities in which participants warm up before participating (number of participants: 117). DISCUSSION The rst goal of this pilot study was to determine frequency and duration of vocal warm-up sessions in singers and to examine the differences in vocal warm-up regimens in singers from varying sociodemographic groups with varying degrees of singing training. All participants reported that they currently use a vocal warm-up before singing with varying frequency and duration. Although only 53% of all participants always used vocal warm-up (Table 2), another 34% reported using a warm-up usually before singing. The ndings of this study support the notion that regular vocal warm-up is considered essential by most singers, as described in the literature.1,2 The ndings of this study suggest that if a participant is a female, aged 31 years and older with 10 or more years of singing experience, she is more likely to always use a vocal warm-up before singing. Smith et al7 found that in female teachers voice problems were more likely to be present than in males. A more recent study investigating the incidence of voice problems among different occupations in San Juan, Puerto Rico also found that females were more likely to report voice problems than males.8 Studies reporting more voice problems in female speakers might be the incentive for female singers to use vocal warm-up more frequently than males. In the present study, voice problems appeared to occur more in males (31%) than in females (24%). However, most participants who reported voice problems also reported GERD and allergy symptoms. Therefore, future studies are needed to determine the effects of frequency/duration of vocal warm-up and other factors, such as GERD and allergies to vocal injury in singers. This studys ndings suggest that duration of vocal warm-up varies considerably among singers, with warm-up sessions ranging from less than 5 minutes to more than 30 minutes (Table 3). This variability in vocal warm-up regimens was apparent in previous studies reporting on effects of vocal warmup.36 The vocal warm-up duration most used by the participants in this study was 510 minutes. Five female participants reported using warm-up regimens lasting 25 minutes or longer, and three of these participants reported having experienced voice problems in the past year. Miller1,9 cautioned against the use of vocal warm-up regimens lasting longer than 30 minutes. Further studies are needed to determine if vocal warm-up sessions in excess of 30 minutes have a negative impact on vocal health or if singers with voice problems need to use longer vocal warm-up to prepare their instrument for performance. Surveyed singers were asked to identify vocal activities in which they warm up before participating (Figure 1). The results suggest a trend that they are more likely to complete a vocal warm-up before solo singing activities and less likely to

FIGURE 2. Distribution of nonsinging warm-up exercises among participants (number of participants: 117).

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TABLE 4. Distribution of Singing Warm-Up Exercises Used by Participants

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How Often Do You Use Each Singing Exercise as Part of Your Warm-Up Regimen? Singing Warm-Up Exercises Glissando Ascending/descending ve-note scale, rapid tempo Ascending/descending ve-note scale, slow tempo Ascending/descending scale spanning one octave, rapid tempo Ascending/descending scale spanning one octave, slow tempo Ascending/descending arpeggio, legato Ascending/descending arpeggio, staccato Messa di voce, low-range pitch Messa di voce, mid-range pitch Messa di voce, high-range pitch Ascending/descending thirds Descending triplet motive Chromatic scale
Number of participants: 117.

Always 24 61 20 38 6 29 12 4 4 4 5 9 0

Usually 24 27 16 30 11 30 20 13 14 10 19 19 4

Sometimes 32 17 29 31 20 29 19 17 39 20 31 31 26

Rarely 24 7 28 9 26 16 24 33 21 27 17 12 22

Never 13 4 23 9 53 13 42 50 38 56 45 46 65

warm up before ensemble singing. It appears that singers rarely complete a vocal warm-up before extended periods of speaking. Thirty-two percent of the participants reported warming up before teaching voice lessons, which was classied as a speaking activity in the questionnaire. It is important to note that although teaching voice lessons require extended periods of speaking, it also frequently requires the instructor to demonstrate singing examples, which may explain the higher percentage of participants completing a vocal warm-up as compared with the other speaking tasks. Among the nonsinging warm-up exercises (Figure 2), singers are most likely to complete exercises that target the muscles of

the face, head, neck, and the respiratory muscles. Given that these are the muscles most used during singing, this result is expected. This nding is consistent with Goldbergs2 recommendation that vocal warm-up should include stretching exercises for both body and voice. Although general aerobic exercise has been described in the literature,1,9,10 relatively few participants (21%) reported using general aerobic exercise as part of their vocal warm-up regimens. This studys ndings showed that of the queried exercises, there are four singing exercises most commonly used by singers (Table 4). They are ascending/descending ve-note scales, ascending/descending octave scales, ascending/descending legato

TABLE 5. Use of Nasal Consonants and Lip/Tongue Trills in Singing Warm-Up Exercises by Participants How Do You Sing This Exercise? Singing Warm-Up Exercises Glissando Ascending/descending ve-note scale, rapid tempo Ascending/descending ve-note scale, slow tempo Ascending/descending scale spanning one octave, rapid tempo Ascending/descending scale spanning one octave, slow tempo Ascending/Descending Arpeggio, legato Ascending/descending arpeggio, staccato Messa di voce, low-range pitch Messa di voce, mid-range pitch Messa di voce, high-range pitch Ascending/descending thirds Descending triplet motive Chromatic scale
Number of participants: 117.

On the Nasal Consonant /m/ or /n/ 17 17 17 9 6 8 1 4 5 1 5 5 2

On a Lip/Tongue Trill 49 45 30 22 10 14 2 2 1 1 7 3 1

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TABLE 6. Perceived Difculty of Singing Warm-Up Exercises Used by Participants On a Typical Day, How Difcult is This Exercise for You? (l Easiest; 5 Most Difcult) Singing Warm-Up Exercises Glissando Ascending/descending ve-note scale, rapid tempo Ascending/descending ve-note scale, slow tempo Ascending/descending scale spanning one octave, rapid tempo Ascending/descending scale spanning one octave, slow tempo Ascending/descending arpeggio, legato Ascending/descending arpeggio, staccato Messa di voce, low-range pitch Messa di voce, mid-range pitch Messa di voce, high-range pitch Ascending/descending thirds Descending triplet motive Chromatic scale
Number of participants: 117.

1 54 70 45 30 19 32 16 12 13 4 20 24 11

2 34 35 29 43 25 41 31 20 34 21 22 20 14

3 8 6 17 27 15 26 18 16 20 11 19 19 12

4 3 2 4 8 5 4 9 13 10 18 11 8 12

5 0 0 0 0 0 1 0 4 2 8 2 0 6

I Do Not Use This Exercise 18 4 22 9 53 13 43 52 38 55 43 46 62

arpeggios, and glissandi. Each of these exercises serves as a mechanism for stretching the vocal folds, as the singer moves from a low pitch to a high pitch; and, with the exception of the glissando, each targets agility and vocal exibility. In addition, these four exercises were all ranked as being relatively easy (Table 6). These ndings support Millers9 statement that heavy vocalization should never form part of the warm-up series. Of the 51 singers who used a xed warm-up regimen, 31 indicated that they complete the ve-note ascending/descending scale, at either a fast or slow tempo, rst (Figure 3). This result further supports the recommendation that the vocal warm-up should progress from easy to more difcult exercises.1,9 Exercises

targeting variations in loudness (ie, messa di voce), sung in the staccato style, and comprising more complex musical patterns (ie, ascending/descending thirds and descending triplet motive) were less commonly used. These trends were similar between participants of varying age, gender, and singing experience level. Participants described varying methods for executing each exercise (eg, different vowels, preceding consonants, alternating vowels, syllables, words, and phrases). Given their emphasis in the literature, surprisingly few participants reported using nasal consonants /m/ or /n/ or lip and tongue trills as part of their vocal warm-up regimen (Table 5). Lip and tongue trills, exercises described in the literature as a means of improving resonance,11,12

FIGURE 3. First/last singing exercise completed during participants warm-up regimens (number of participants: 51).

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TABLE 7. Vocal Warm-Up Perceptions Among Participants

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For Each Statement, Select the One Answer That Best Describes Your Feeling/Opinion Vocal Warm-Up Perceptions Perceptions about importance of vocal warm-up It is important to warm up before singing. Singers who do not warm up are more likely to injure their voices. If I do not warm up before singing, I could hurt my voice. I am not sure why I am supposed to warm up my voice. I only warm up because my voice teacher tells me to. Perceptions about the effects of vocal warm-up on the voice My voice is more cooperative after I warm up. I feel more condent about my voice after I warm up. It is easier to sing my highest notes after I warm up. It is easier to sing my lowest notes after I warm up. My voice is more exible after I warm up. My voice feels tired after I warm up. I feel more mentally focused after I warm up.
Number of participants: 117.

Strongly Agree 84 46 34 0 1 87 73 80 50 82 1 62

Agree 28 45 40 2 3 21 29 22 19 28 7 37

Neutral/No Opinion 4 15 24 8 12 6 10 8 19 2 13 14

Disagree 1 9 11 24 35 3 4 5 24 3 38 4

Strongly Disagree 0 2 6 82 65 0 1 1 5 0 58 0

were used by up to 49 participants. Fewer participants indicated the use of the nasal consonants /m/ or /n/, as described in the literature.9,13 For both nasal consonants and lip and tongue trills, participants were more likely to use them with the four most commonly used exercises found in this study. Twenty-six participants reported using a vocal cool-down after singing. Females, as with frequency of vocal warm-up, were more likely to use a vocal cool-down than males. Female participants, aged 41 years and older, who are students with 10 or

more years of singing experience appear to be more likely to use a vocal cool-down after singing. This limited data did suggested similar trend in use of vocal cool-down between singers with and without voice problems. Further research on the effect of vocal cool-down on vocal health could lead to better understanding of this exercise in vocal health in singers. The next goal of the present study was to examine singers perceptions of the role of vocal warm-up in the prevention of vocal fold injury. The vast majority of participants use vocal

TABLE 8. Distribution of Singing Exercises Used by Participants With Reported Voice Problems How Often Do You Use Each Singing Exercise as Part of Your Warm-Up Regimen? Singing Warm-Up Exercises Glissando Ascending/descending ve-note scale, rapid tempo Ascending/descending ve-note scale, slow tempo Ascending/descending scale spanning one octave, rapid tempo Ascending/descending scale spanning one octave, slow tempo Ascending/descending arpeggio, legato Ascending/descending arpeggio, staccato Messa di voce, low-range pitch Messa di voce, mid-range pitch Messa di voce, high-range pitch Ascending/descending thirds Descending triplet motive Chromatic scale
Number of participants: 30.

Always 8 14 7 9 2 4 2 2 1 1 0 2 0

Usually 5 8 3 8 0 15 8 5 6 2 6 6 1

Sometimes 7 7 7 9 6 3 4 2 7 3 11 6 3

Rarely 6 0 5 2 5 3 4 6 3 8 1 4 4

Never 4 1 8 2 17 5 12 15 13 16 12 12 22

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warm-up not because their teachers tell them but because they strongly believe that it is important to warm up before singing and because their voices are more cooperative following vocal warm-up. They also report that following a vocal warm-up, it is easier to sing higher notes and their voices are more exible. Some participants strongly agreed that if they did not do vocal warm up they could hurt their voices. Additionally, the ndings suggest that singers believe vocal warm-up improves voice quality and mental focus for singing. This nding is consistent with perceptions of vocal warm-up described in vocal pedagogy literature.2,9 The nal goal of this study was to obtain preliminary data on the occurrence of vocal fold injury in singers who use/do not use a vocal warm-up regimen. Because all of the singers who participated in this study reported using a vocal warm-up before singing, it was not possible to determine if using a vocal warmup plays a role in the prevention of vocal injury. On the other hand, 30 participants reported experiencing voice problems in the past year despite using a vocal warm-up before singing. In this group, 16 participants always used vocal warm-up, and their preference of duration of 515 minutes warm-up sessions was similar to the participants who did not report voice problems. The top four most commonly used vocal warm-up exercises (ie, ve-note scale, octave scale, legato arpeggio, and glissando) were also identical in both groups. However, 77% of participants with voice problems reported allergies (compared with 56% of those without voice problems) and one or more symptoms of GERD (compared with 38% of those without voice problems). Furthermore, when asked to describe his/her voice problems, many participants emphasized upper respiratory symptoms and GERD as the cause of their voice difculties. The literature describes both conditions as known contributors to dysphonia,14 which could explain why these participants experienced voice problems. The results of this study suggest that although vocal warm-up is perceived by singers to improve voice quality and exibility, vocal health and hygiene factors, such as allergies and GERD, are contributing factors to voice problems in singers, despite the regular use of a vocal warm-up. These ndings highlight the importance of further educating singers about the prevention and management of allergy and GERD symptoms. Limitations of present study/implications for future research This pilot studys ndings on vocal warm-up practices in singers warrant future studies. All participants in this study reported that they use a vocal warm-up before singing. This could indicate a possible selection bias because singers who do not use vocal warm-up may have declined to volunteer for this reason. It was also not possible to determine if using a vocal warmup plays a role in the prevention of vocal injury. Future studies investigating singers who are seen at a voice clinic because of their voice problems are of interest because they may reveal the frequency, duration, and type of vocal warm-up regimen in the disordered singing population and allow comparison with the present study population. This survey targeted singers with at least 1 year of formal voice study, and most participants

TABLE 9. Suggested Vocal Warm-Up Regimen for Future Research Studies Suggested Vocal Warm-Up Regimen Duration Nonsinging exercises 515 min (56%) 1. Stretching exercises targeting the face/head/neck muscles (62%) 2. Breathing exercises (55%) 3. Postural alignment exercises (50%) 1. 2. 3. 4. Five-note scale (52%) Octave scale (32%) Arpeggio, legato (25%) Glissando (21%)

Singing exercises

Number of participants: 117. Percentages are based on participants responses; for singing exercises, only always responses are used.

were very experienced singers, having received more than 10 years of formal voice training. Future studies should recruit singers with less than 5 years of formal voice training and singers with no formal voice training should be surveyed to determine how their vocal warm-up regimens differ from the more experienced singers examined in this study. Additionally, participants were not asked what style of singing (eg, classical, musical theater, pop, and so forth) they typically use when performing or to identify their voice classications (ie, soprano, mezzo-soprano, tenor, and baritone/bass). A future study will be of interest to determine if there is a style- or voice classication-specic vocal warm-up regimen to ensure vocal health in professional singers. Future survey studies should also offer open-ended questions to determine if singers are using nontraditional vocal warm-up techniques, such as Titzes semi-occluded vocal tract exercises. CONCLUSIONS A signicant limitation of previous studies is that the warm-up regimens used varied considerably between the studies, and the results of these studies also varied considerably. The results of this study suggest that the warm-up protocols used in some previous studies did not represent the most commonly used exercises in singers. This study found that, indeed, singers vocal warm-up regimens are diverse in duration, exercises used, and the way in which exercises are used (eg, the vowels on which vocalizes are sung, the order in which exercises are sung, and so forth). However, the results of this study reveal several characteristics of singers warm-up regimens that may be incorporated when designing warm-up regimens to be used in future studies on the effect of vocal warm-up on the vocal mechanism (Table 9). This studys ndings suggest that the warm-up regimens should be between 5 and 10 minutes duration and should use simple vocalizes, including ascending/descending ve-note scales, ascending/descending octave scales, ascending/descending arpeggios, and glissandi. The warm-up should also include nonsinging exercises targeting the face,

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head, and neck muscles, breathing exercises, and postural alignment exercises. Acknowledgments Funding for this project was provided by an American Speech, Language, and Hearing Association Students Preparing for Academic and Research Careers (SPARC) Award. The authors thank the survey respondents for generously giving their time to participate in this study. REFERENCES
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