The study was led by Saeed M. Alghamdi of Umm Al-Qura University, together with collaborators spanning respiratory care programs across Saudi Arabia and the National Heart and Lung Institute at Imperial College London. The team set out to explore perceptions regarding the use of traditional Saudi singing and dancing as a method to promote general and respiratory health. Their rationale rests on a simple physiological observation: singing, like breathing, demands precise breath control and recruits many of the same anatomical structures that respiratory therapists target in pulmonary rehabilitation, including the diaphragm, intercostal muscles, and the muscles of the upper airway.

Singing is, at its core, the production of musical tones with the voice, and it requires the coordinated regulation of inhalation, phonation, and controlled exhalation. When people sing sustained phrases, they typically deepen their tidal volume, slow their respiratory rate, and increase minute ventilation efficiency, mirroring techniques used in formal breathing retraining. Dancing adds an aerobic dimension, elevating heart rate and ventilatory demand while building endurance in the muscles of respiration. The concept of Singing for Lung Health, often abbreviated SLH in the respiratory therapy literature, has gained traction in recent years as a structured intervention for people with chronic obstructive pulmonary disease and asthma, and previous research suggests that singing and dancing can improve multiple aspects of health in both healthy individuals and those with respiratory conditions.

To test whether these ideas resonate within a Saudi cultural context, the researchers conducted an observational, cross-sectional survey in the Makkah region. The questionnaire combined closed-ended questions, which yielded quantitative data summarized as frequencies and percentages, with open-ended questions designed to surface the key barriers that might prevent people from engaging in traditional performance practices. Ethical approval was obtained from Umm Al-Qura University in Makkah, and the study was conducted in compliance with the Declaration of Helsinki, with all participants providing informed consent before completing the survey.

The results paint a picture of a population already deeply engaged with these traditions and broadly optimistic about their health value. Of the 273 participants, 153, or 56.0 percent, were female, the majority were aged 21 to 41 years, and 88 participants, representing 32.2 percent, reported having chronic respiratory diseases. Among all respondents, 203 people, or 74.4 percent, reported engaging in Saudi traditional singing and dancing. Within this engaged group, 120 participants, or 59.1 percent, believed that traditional singing and dancing had a positive impact on general health, while 93, or 45.8 percent, agreed that these practices are potentially improving lung health.

One of the most compelling findings was the relationship between active participation and perceived benefit. Participants who actively engaged in traditional singing and dancing were significantly more likely to perceive associated health benefits compared to those who did not, with differences reaching statistical significance at p less than 0.001. This pattern held even though the study could not establish causation; it nevertheless suggests that firsthand experience of the breath work and physical exertion involved in traditional performance may shape how people understand its health potential.

Age emerged as a significant factor in engagement. The association was statistically significant, with a chi-square value of 6.20, p equal to 0.045, and a Cramer’s V of 0.151, indicating a modest but measurable effect. Engagement was highest among participants aged 20 years and under, at 85.3 percent, followed by those aged over 41 years at 75.8 percent, and lowest among those aged 21 to 41 years at 69.8 percent. The authors suggest this pattern may reflect the central role of traditional performance in youth gatherings and older community celebrations, while working-age adults may face time constraints that limit participation.

Gender shaped the barrier landscape in a notable way. Female participants were significantly more likely than males to report a lack of community support as a barrier to practicing traditional singing and dancing, a difference that reached statistical significance at p equal to 0.004. No statistically significant gender differences were observed for other perceived barriers. This finding carries practical weight for any future health promotion program: interventions built around traditional performance would need to address social support structures, particularly for women, if they hope to achieve broad participation across the population.

The study’s authors are careful to frame their findings as perceptual rather than clinical. The survey measured what people in Makkah believe about the health effects of singing and dancing, not objective changes in lung function, exercise capacity, or quality of life. Nonetheless, the conclusion points clearly toward the next step: further research assessing the influence of singing and dancing on clinically relevant parameters would be useful. Such studies could measure forced expiratory volume, respiratory muscle strength, six-minute walk distance, and validated quality-of-life instruments before and after structured programs of traditional performance, providing the evidence base needed to move from cultural intuition to clinical recommendation.

If future trials confirm measurable respiratory benefits, the implications could extend well beyond Saudi Arabia. Culturally grounded interventions often outperform generic health messaging because they arrive wrapped in meaning, identity, and joy rather than obligation. Traditional Saudi singing and dancing, practiced for thousands of years in religious ceremonies, social gatherings, and artistic performances, may offer exactly that kind of vehicle: a form of pulmonary rehabilitation that people already love, passed down through generations, waiting to be recognized as medicine hiding in plain sight. The research was funded by Umm Al-Qura University under grant number 26UQU4340488GSSR02, and the study was registered with the Open Science Framework at 10.17605/OSF.IO/867ME.

Subject of Research: Perceptions of traditional Saudi singing and dancing as a means of promoting general and respiratory health in Makkah, Saudi Arabia.

Article Title: The potential use of traditional singing and dancing for respiratory health promotion in Saudi Arabia: an observational study

Article References: Alghamdi, S. M., Kabrah, S. M., Alhawsawi, H. B., Almushayt, B. S., Bajudah, R. K., Abu Dark, R. M., Aldhahir, A. M., Alsulayyim, A. S., Alasimi, A. H., Philip, K. E., Alzahrani, H. A., Alhindi, A. O., Alhindi, A. O., Alasmari, A. M., Alahmadi, F. H., Alqarni, A. A., & Alqahtani, J. S. (2026). The potential use of traditional singing and dancing for respiratory health promotion in Saudi Arabia: an observational study. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05581-2

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05581-2

Keywords: Saudi Arabia, traditional singing, traditional dancing, respiratory health, health promotion, singing for lung health, respiratory therapy, cultural practices, quality of life, chronic respiratory disease, cross-sectional survey, dance movement therapy

Volara is a respiratory therapy device designed for secretion mobilization and lung expansion, delivering what clinicians call oscillation and lung expansion therapy, or OLE. The device works through two complementary mechanisms: continuous high-frequency oscillation, which loosens and mobilizes mucus from the airways, and continuous positive expiratory pressure, which helps keep airways open and supports lung expansion. Uniquely, the system can simultaneously administer aerosolized medication through an integrated nebulizer, combining three respiratory therapies into a single unit. It is prescribed for patients with chronic respiratory conditions that impair airway clearance, including bronchiectasis, chronic obstructive pulmonary disease, cystic fibrosis, cerebral palsy, amyotrophic lateral sclerosis, muscular dystrophy, and other neuromuscular disorders. Its portability and ease of use make it suitable for home settings, allowing patients who require long-term airway clearance to receive therapy outside the hospital.

The research team, led by investigators at Mathematica with collaborators at Baxter International and Johns Hopkins School of Medicine, conducted a retrospective descriptive analysis using complete administrative claims and encounter data from the Centers for Medicare and Medicare Services Virtual Research Data Center. They identified Medicare fee-for-service and Medicare Advantage beneficiaries who initiated Volara between January 2023 and June 2025, along with Medicaid fee-for-service and managed care enrollees who started the device during calendar year 2023. Initiation was defined by the earliest claim containing the relevant healthcare procedure codes paired with a supplier identifier specific to the device. Patients needed to be at least five years old and continuously enrolled for twelve months before initiation, and Medicaid enrollees dually eligible for Medicare were excluded to avoid incomplete capture of their utilization.

The two cohorts differed dramatically in their demographic and clinical composition. The Medicare cohort comprised 391 enrollees with a mean age of approximately 68 years, of whom 63 percent were female and 78 percent were non-Hispanic White. The overwhelming majority, 93 percent, had pre-existing bronchiectasis, COPD, or neuromuscular disease, with bronchiectasis alone accounting for 36 percent and bronchiectasis combined with COPD for another 33 percent. The Medicaid cohort of 220 enrollees was strikingly younger, with a mean age of just 21 years and 72 percent under age 21. Its disease distribution was broader and different: 37 percent had bronchiectasis or COPD, but substantial proportions had cerebral palsy at 22 percent, neuromuscular disease at 18 percent, prior COVID-19 at 22 percent, and cystic fibrosis at 7 percent. The Medicaid cohort was also more racially and ethnically diverse and lived in neighborhoods with considerably higher social vulnerability, as measured by the CDC Social Vulnerability Index, with 70 percent classified as high vulnerability compared with 43 percent of Medicare patients.

To assess outcomes, the researchers classified patients into mutually exclusive disease segments and measured emergency department visits and inpatient hospitalizations for respiratory exacerbations, along with associated costs, standardized as annualized rates and per-member-per-month costs to account for varying follow-up times. Respiratory events were captured under a broad tier that included COPD, bronchiectasis, COVID-19, asthma, pneumonia, bronchitis, acute respiratory failure, and unspecified respiratory disorders. Clinical risk was assessed using the Elixhauser Comorbidity Index, while social risk was assigned at the ZIP code level. Because payment information is not reported for most Medicaid managed care encounters, the team imputed costs using fee-for-service claims, deriving average shadow prices stratified by year, state, disease segment, event type, demographics, and proxies for severity such as length of stay.

Among Medicare enrollees, the post-initiation period showed consistently lower respiratory-related emergency department use. Annual emergency visit rates fell from 26.3 to 11.0 per 100 patients, a 58 percent reduction, while associated per-member-per-month costs dropped from 21 dollars to 12 dollars, a 39 percent decline. These differences held across all disease segments, ranging from 44 percent lower among patients with both bronchiectasis and COPD to 70 to 81 percent lower in other segments. Hospitalizations also declined, though more modestly: rates fell from 41.2 to 30.4 per 100 patients, a 26 percent reduction, and hospitalization costs fell 11 percent, from 512 dollars to 456 dollars per member per month. The hospitalization improvements were not uniform, however. Patients with COPD saw rates and costs fall by 38 and 36 percent respectively, while neuromuscular disease patients showed similar rates between periods with slightly higher costs afterward.

Subgroup analyses added further nuance. Emergency department reductions appeared across both clinical risk groups and both age groups, but hospitalization patterns diverged sharply. Among Medicare patients with higher clinical risk, hospitalization rates were 33 percent lower after Volara initiation, whereas lower-risk patients actually saw rates rise 8 percent. Social vulnerability produced a similar split: patients in higher-vulnerability neighborhoods experienced 41 percent lower hospitalization rates and 49 percent lower costs post-initiation, while those in lower-vulnerability areas saw costs rise 30 percent despite modestly lower rates. By age, hospitalization rates fell 25 percent among patients 65 and older but rose 6 percent among younger Medicare beneficiaries. Because the pre-initiation period overlapped the COVID-19 pandemic for many patients, the team ran sensitivity analyses excluding COVID-19-related events, and the overall pattern of lower post-initiation utilization and costs remained qualitatively unchanged. Excluding patients with ALS from the neuromuscular segment also did not meaningfully alter the findings.

The Medicaid picture was considerably messier. Emergency department visit rates were nearly flat, at 31.4 per 100 patients before initiation versus 29.6 after, a 5 percent decline, but associated costs rose 24 percent, from 135 dollars to 168 dollars per member per month. Segment-level patterns conflicted: patients with bronchiectasis or COPD had higher emergency visit rates and dramatically higher costs afterward, neuromuscular disease patients had higher rates but lower costs, and cerebral palsy patients showed lower utilization and costs. Hospitalizations told a more favorable story, with rates 24 percent lower and costs 6 percent lower post-initiation overall, though neuromuscular disease patients again moved against the trend. The authors caution that the smaller Medicaid sample makes these exploratory results especially sensitive to noise.

The study’s limitations are substantial and the researchers are explicit about them. As a purely descriptive one-group pre/post design without a comparison group, the analysis cannot establish causation, and regression to the mean may partly explain the lower post-initiation utilization, since some patients likely began Volara after a period of heightened respiratory morbidity such as a hospitalization. Secular changes in healthcare behavior during and after the pandemic cannot be excluded, claims data contain no information on how often or how long patients actually used the device, and concomitant treatments were not examined. Roughly 80 percent of Medicaid costs were imputed, introducing additional uncertainty, and small sample sizes limit generalizability. The study was funded by Baxter, which manufactures the Volara system, though the analysis was conducted by Mathematica under a data use agreement with CMS.

Despite these caveats, the study fills a genuine gap. Prior literature on related airway clearance therapies, including high-frequency chest wall oscillation and oscillating positive expiratory pressure devices, has reported reductions in hospitalizations and costs, but economic evidence specifically for oscillation and lung expansion therapy has been sparse. By documenting who initiates Volara under public insurance and how their utilization patterns shift, the analysis provides hypothesis-generating context for clinicians and payers alike. The pronounced heterogeneity across disease segments, risk strata, and age groups suggests that any future evaluation of the device’s effectiveness will need to account for the fundamentally different populations served by Medicare and Medicaid, from older adults with smoking-related lung disease to children with genetic and neurologic conditions that impair airway clearance. The authors call for comparative study designs with appropriate confounding adjustment to determine whether the observed favorable trends among Medicare beneficiaries reflect a true treatment effect or the interplay of disease course, patient selection, and broader healthcare dynamics.

Subject of Research: Real-world healthcare utilization and costs among Medicare and Medicaid patients initiating Volara oscillation and lung expansion respiratory therapy

Article Title: Characteristics of Medicare and Medicaid Patients Initiating Volara Respiratory Therapy: A Medical Claims Study

Article References: Characteristics of Medicare and Medicaid Patients Initiating Volara Respiratory Therapy: A Medical Claims Study. (n.d.). https://doi.org/10.1007/s12325-026-03762-6

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03762-6

Keywords: Volara, oscillation and lung expansion therapy, Medicare, Medicaid, bronchiectasis, COPD, healthcare resource utilization, emergency department visits, hospitalizations, medical claims, real-world evidence, respiratory therapy