There is a large and growing body of evidence on the health benefits of engagement in leisure activities (voluntary, enjoyable non-work activities, such as hobbies, arts, volunteering, community group membership, sports, and socialising). However, there is no unifying framework explaining how leisure activities affect health: what the mechanisms of action are by which engagement with leisure activities leads to the prevention, management, or treatment of mental and physical illness. In this Review, we identify and map over 600 mechanisms of action. These mechanisms can be categorised as psychological, biological, social, and behavioural processes that operate at individual (micro), group (meso), and societal (macro) levels, and are synthesised into a new theoretical framework: the Multi-level Leisure Mechanisms Framework. This framework situates understanding of leisure activities within the theoretical lens of complex adaptive systems and aims to support the design of more theory-driven, cross-disciplinary studies.

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Research on choirs and other forms of group singing has been conducted for several decades and there has been a recent focus on the potential health and well-being benefits, particularly in amateur singers. Experimental, quantitative, and qualitative studies show evidence of a range of biopsychosocial and well-being benefits to singers; however, there are many challenges to rigor and replicability. To support the advances of research into group singing, the authors met and discussed theoretical and methodological issues to be addressed in future studies. The authors are from five countries and represent the following disciplinary perspectives: music psychology, music therapy, community music, clinical psychology, educational and developmental psychology, evolutionary psychology, health psychology, social psychology, and public health. This article summarizes our collective thoughts in relation to the priority questions for future group singing research, theoretical frameworks, potential solutions for design and ethical challenges, quantitative measures, qualitative methods, and whether there is scope for a benchmarking set of measures across singing projects. With eight key recommendations, the article sets an agenda for best practice research on group singing.

ObjectiveThe mental health challenges facing people who care for somebody with cancer are well documented. While many support interventions focus on provision of information or cognitive behavioural therapy, the literature suggests that psychosocial interventions could also be of value, especially given the low social support frequently reported by carers. Singing is a psychosocial activity shown to improve social support, increase positive emotions, and reduce fatigue and stress. This study explored whether weekly group singing can reduce anxiety, depression and well-being in cancer carers over a 6-month period.DesignA multisite non-randomised longitudinal controlled study.SettingThe Royal Marsden National Health Service Trust in Greater London.Participants62 adults who currently care for a spouse, relative or close friend with cancer who had not recently started any psychological therapy or medication.InterventionsOn enrolment, participants selected to join a weekly community choir for 12 weeks (n=33) or continue with life as usual (n=29).Outcome measuresThe primary outcome was mental health using the Hospital Anxiety and Depression Scale. The secondary outcome was well-being using the Warwick Edinburgh Mental Wellbeing Scale. Using linear mixed effects models, we compared the change in mental health and well-being over time between the two groups while adjusting for confounding variables including demographics, health-related variables, musical engagement and length of time caring.ResultsParticipants in the choir group showed a significantly greater decrease in anxiety over time than participants in the control group (B=−0.94, SE=0.38, p=0.013) and a significantly greater increase in well-being (B=1.25, SE=0.49, p=0.011). No changes were found for depression. Sub-group analyses showed carers with anxiety or below-average well-being were most likely to benefit.ConclusionsThis study builds on previous research showing the mental health benefits of singing for people with cancer by showing that weekly singing can also support anxiety and well-being in cancer carers.

ObjectivesBereavement is associated with negative affective, cognitive, behavioural and physiological responses. However, factors, such as coping, self-efficacy and self-esteem, can buffer negative effects of grief, and can be increased through mutual support interventions, such as shared leisure activities. This study used a non-randomised controlled design to explore the effects of group choir singing on mental health among people who have been bereaved due to cancer.MethodsA total of 58 adults bereaved in the last 5 years who had not started psychological therapy in the last 12 weeks or medication for anxiety or depression in the last month were recruited and elected to join a choir (n=29) or participate in the non-intervention control group (n=29). Joining a choir involved engaging in 90 min weekly singing and social sessions for 12 weeks with a post-intervention assessment at week 24. We used linear mixed effects models adjusted for demographics, health-related variables, musical engagement and time since bereavement to model changes over time between the two groups in symptoms of anxiety, depression, well-being, self-efficacy and self-esteem.ResultsParticipants who sang in a choir had more stable symptoms of depression and levels of well-being, as well as gradual improvements in their sense of self-efficacy and self-esteem over the 24 weeks. In contrast, those in the control group showed gradual increases in depressive symptoms, reductions in levels of well-being and self-esteem and no improvement in their self-efficacy. These results were independent of all covariates.ConclusionsWeekly group singing could be a promising mutual support intervention for people experiencing grief.Trial registration numberNCT02756780.

There is an increased interest in whether online arts interventions support mental health and social connections. This study explored eight weeks of online group dance as support for young people (aged 16-24) living with anxiety. The applicability of the ‘social cure’ theoretical framework to the novel context of an online dance class was sought. The study utilised an embedded QUAL+quan design, incorporating participatory focus group discussions (n=3 groups; n=11 participants) and one-on-one interviews (n=2 participants), creative reflections (n=16 participants) and ethnographic fieldnotes, and a repeated measures design with surveys at three timepoints (week 1, n=27; week 4, n=18; week 8, n=14). Thematic analysis identified two overarching themes demonstrating how the dance classes i) provided the opportunity to co-construct a meaningful shared identity and ii) supported holistic wellbeing. This was supported by the quantitative findings suggesting lower anxiety, depression, and loneliness, and higher group bonding, self-esteem, and self-efficacy over time. This study expands the social cure to its application to an online dance class for the first time.

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