Respiratory Muscle Performance In Wind Instrumentalists: A Systematic Review And Meta-analysis

Wind instrumentalists (WI) are required to generate sufficient respiratory muscle pressures to overcome the resistance of their instruments and accommodate the everchanging demands of musical performance. While it is certain that respiratory muscles play a large role in this pressure generation, it is unclear whether the habitual playing of a wind instrument leads to enhanced respiratory muscle performance. PURPOSE: To systematically review the literature and assess whether respiratory muscle performance is greater in WI compared with controls. METHODS: MEDLINE, Embase, CINAHL, Web of Science, and Scopus databases were searched from inception until the 14th of July 2022 using the terms “respiratory muscle”, “wind instrumentalist”, and relevant synonyms. Eligible studies required WI and control groups, and baseline measures of respiratory muscle performance. Measures of respiratory muscle performance were extracted from each study. Risk of bias was assessed using the AXIS critical appraisal checklist for cross-sectional studies. Pooled effect sizes expressed as mean differences (MD) were calculated using fixed effect meta-analyses. RESULTS: After reviewing a total of 1,393 studies, only four studies were included in the final extraction. Three of these studies measured maximum static inspiratory pressures (i.e., MIPs), two measured maximum expiratory pressures (i.e., MEPs), and one measured maximum breathing capacity (i.e., MBC). The included studies were of relatively low quality (median = 10 out of 20; range = 9-11), mainly due to the reporting of small, unrepresentative, and poorly defined samples. Meta-analyses demonstrated a significant effect for both MEPs (Z = 2.99, P < 0.01, MD = 30.84) and MIPs (Z = 5.23, P < 0.01, MD = 23.13). In the one study that reported a measure of respiratory muscle endurance, there was no observable difference in MBC between the groups. CONCLUSIONS: This study determined that of all the respiratory muscle domains investigated, only strength was significantly greater in wind instrumentalists than controls (MIP: P < 0.01; MEP: P = 0.003); however, the high risk of bias and few studies available for analysis prevents the extrapolation of these findings to the wider, WI population.