The Doctor Is In : Exercise, Hydration, and Singing

Dear Dr. Jahn:

I’ve recently taken up Olympic lifting as a side hobby and I’m worried that it will have an effect on my voice. Are there any negative effects on the voice when you’re doing intensive exercises like CrossFit or Olympic lifting? I haven’t noticed anything so far but wondered because different muscles in my abdomen and neck are being used. Also, do you have any recommendations for specific types of full-body exercise to help with vocal training? 

 

Dear Dr. Jahn:

Toward the end of summer, I was participating in a 10K walk and had some medical challenges that resulted from dehydration. The medics there said I should have had symptoms that I should have recognized, but I don’t remember having any. How do you know if your body has had all the water it needs and is hydrated enough?

 

Dear Readers:

Thank you for these excellent questions! Since they both relate to exercise, I would like to discuss both together. 

Many of us exercise regularly and enjoy both the physical activity as well as how it makes us feel. This has become more challenging with COVID-19, since many gyms are either closed or unsafe. Further, with colder weather (at least in the north) regular outdoor exercise is more difficult. 

Exercise has three main purposes: to maintain strength, agility, and cardiovascular efficiency. Strength training can be focused on specific muscle groups, such as with weightlifting, or can more generally involve different parts of the body, such as swimming. Agility refers to maintaining and improving flexibility: stretching and yoga or, more actively, floor exercises as part of a class. Finally, cardiovascular strengthening requires effort and exertion over time, such as jogging or using a treadmill, StairMaster, or an elliptical machine. All three aspects can be addressed in a sequence or together. 

For singers, a particular area to address is the core. This refers to the postural muscles (like the muscles of the back) and muscles of the abdomen and pelvis. These are the muscles involved in singing—in controlling the breath and posture. Some useful exercises in this regard might be curls, leg lifts, and sit-ups. 

Whichever regimen you choose, you need, first and foremost, to enjoy it! If you don’t, you will find excuses to avoid exercising. While your exercise protocol may change over time, it is important to continue this regularly. When you get older, you may no longer be training for the marathon, but exerting your muscles will continue to improve your circulation and metabolism and can also delay or prevent osteoporosis. So, mix it up—but don’t stop! 

Here, however, are some do’s and don’ts, which specifically apply to singers. While strengthening all your muscles is good, you should not overly concentrate on your upper body. Why? Excessive muscle buildup in the neck and thorax area may contribute to tension in this area. One of my patients, a jazz singer, told me she has stopped doing Pilates for this reason—it was focusing excessively on the chest, and she felt it interfered with breath control when singing. 

 

If you do lift weights, either free weights or on the machines, remember to always exhale as your muscles contract. We tend to hold our breath as we lift, since stiffening the thoracic cage gives our muscles something to brace against but, and for singers especially, forcing the vocal folds together and pushing while we lift may be harmful. One of my patients, a tenor who decided he needed to look more “Helden,” developed a vocal fold hemorrhage from weightlifting this wrong way. If you want to lift weights, do it to build strength and not bulk: use smaller weights with more reps, exhale while lifting, and don’t try to develop massive arms, shoulders, or chest muscles. 

Another caveat, especially for singers, is to avoid very noisy classes, such as spinning. There are several reasons. First, being exposed to those high levels of noise can, over time, damage your hearing. 

The purpose of that noise, the loud music and the instructor yelling over it, is to distract you from the pain of your exercise. Called “cross-modality masking,” this loud music takes your attention off the effort and, ideally, drives you harder in your exercise—possibly to the point of injury. But if you check the noise levels in these classes (which you can, with one of several free sound meter apps available), you will see that the decibel levels are much higher than what is considered safe. 

The second problem with loud exercise classes is that being exposed to constant loud sounds causes your larynx to rise and tighten, in effect producing the posture we see in laryngeal tension dysphonia. Add to this the fact that you are almost certainly breathing through your mouth and not your nose, and you will appreciate that these classes are not ideal for singers. 

Now let’s talk briefly about dehydration. If you are healthy, eating a normal diet, and living a normal life, then your best drink is . . . water! To really need electrolyte beverages, you need to be either ill (such as with chronic diarrhea) or in a state of extreme exertion and exhaustion from exercise. The fashion for sports drinks comes from our subconscious wish to vicariously identify with Olympians. Whether we admit it or not, this is our thought process: somehow, if you wear the right clothes, monitor your body functions on the latest Apple watch, and drink electrolyte drinks, then you, the weekend warrior in the gym, somehow become, if even just for the morning, a professional athlete. 

Water is the common currency of the body; it is how cells derive their nutrition and get rid of waste. And dehydration has a negative effect on most body functions. Again, for singers, hydration is very important for the respiratory and vocal tract. Muscles move better, lungs exchange gases better, and vocal folds vibrate better when there is adequate water on board. An early vocal sign of dehydration is when you cannot easily sing pianissimo at the top of your range and require more muscling to produce the voice. 

Dehydration can be gradual and insensible (such as the water exhaled and lost with perspiration). By the time you are thirsty, you are past the point where hydration is needed, so better to hydrate regularly even if you feel fine. My recommendation for singers is eight eight-ounce glasses of water per day. Attach the schedule to your meals (two with each of three meals and one between), so you don’t forget. 

Obviously, if you are perspiring with heat or exercise, you can drink more. How much is enough? As Dr. Van Lawrence used to say, “Pee pale!” If your urine is light yellow in color, that is a good sign. If your urine is dark and concentrated, more water may be needed. 

A final point regarding hydration, especially important for the cold winter season. Do you have a humidifier? Most of my singer patients say they do, but it is usually sitting in the closet. You need to have a good, strong, easy-to-clean humidifier, which is turned on as soon as the heat goes on. 

My personal favorite is the Venta Airwasher. It should be in your bedroom and running all the time. Keep the heat down, maybe open the window a crack, and run your humidifier. This will go a long way to prevent dryness in the respiratory tract and should reduce your winter colds and allergies. 

—Dr. Jahn 

 

Disclaimer: The suggestions Dr. Jahn provides in these columns are for general information only and are not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician. 

Anthony Jahn, M.D.

Anthony Jahn M.D. is an otolaryngologist with a subspecialty interest in ear diseases, disorders of hearing and balance, and disorders of the voice. He is a professor of clinical otolaryngology at Mount Sinai School of Medicine and is the noted author of Care of the Professional Voice. For more resources, go to his website www.earandvoicedoctor.com.