Health Education

Healthy behaviours in music and non-music performance students

Jane Ginsborg, Gunter Kreutz, Mike Thomas, Aaron Williamon,
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HE
109,3 Healthy behaviours in music and
non-music performance students
Jane Ginsborg
242 Royal Northern College of Music, Manchester, UK
Gunter Kreutz
Institut fur Musik, Carl von Ossietzky Universitat, Oldenburg, Germany
Mike Thomas
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Faculty of Health and Social Care, University of Chester, Chester, UK, and
Aaron Williamon
Royal College of Music, London, UK
Abstract
Purpose The purpose of this paper is to compare the self-reported health-promoting behaviours of
music and non-music performance students in higher education. It also seeks to determine the extent to
which perceived health and self-reported symptoms are associated with lifestyle, emotional affect
state, self-regulation and self-efficacy.
Design/methodology/approach Music performance students from two conservatoires (n 198)
and students of nursing and biomedical science (health students) from two universities (n 65) aged
18-26 years completed the health-promoting lifestyle inventory; the positive and negative affect, the
self-efficacy and the self-regulation scales, as well as reporting their present health and completing an
inventory of musculo- and non-musculoskeletal health problems.
Findings Music performance students score lower than health students on health responsibility,
physical activity and spiritual growth; also on self-efficacy and self-regulation. Music performance
students rate their health, generally, worse than do health students, and report a wider variety of
symptoms, which they rate as more severe than do health students. Perceived present health is
most strongly correlated with reported healthy lifestyle. This in turn is associated with positive affect,
self-efficacy and self-regulation.
Research limitations/implications This is a relatively small-scale investigation of the
health-promoting behaviours and experiences of ill-health reported by two groups of students
following different programmes of study and with different career aspirations. Firm conclusions
cannot therefore be drawn.
Practical implications While nursing and biomedical science students may be atypical in that
they are likely to gain a greater awareness of health issues from their studies, it could be argued that
music performance students need to adopt healthy lifestyles in order to reach their full potential as
musicians, and health promotion should be part of their training.
Originality/value The interrelationships among lifestyle, physical health and psychological
well-being have been studied in a number of populations. The health-promoting behaviours of music
performance students in comparison with those of other students are of particular interest given the
physical and emotional demands of expert music making.
Keywords Music, Students, Lifestyles, Personal health, Performing arts
Paper type Research paper
Health Education
Vol. 109 No. 3, 2009
pp. 242-258 The authors are grateful to two anonymous reviewers for their comments on an earlier draft of
q Emerald Group Publishing Limited
0965-4283
this paper. Jane Ginsborg and Gunter Kreutzs contribution to this research was supported by
DOI 10.1108/09654280910955575 research funding from the Royal Northern College of Music.
 Introduction Healthy
Expert musical performance requires the coordination and mastery of a diverse set of behaviours
physical and psychological skills, and as such, a growing body of research has
examined the health consequences of extended musical training (Guptill et al., 2000; in students
Jabusch and Altenmuller, 2006). A recent concerted programme of work has now
begun to consider the health lifestyles of music performance students in higher
education contexts, as well as the practical implications and applications of this 243
research (Kreutz et al., 2008a, b; Williamon and Thompson, 2006). The present
investigation was designed to expand this research to students of subjects other than
music performance, in this case students of nursing and biomedical sciences, focusing
on the similarities and differences their self-reported health-promoting behaviours,
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other psychological variables and health problems.

It might be thought self-evident that healthy lifestyles promote physical and
psychological health directly (World Health Organisation, 2002). Or rather, it may be
that better health, socio-economic status (Wardle and Steptoe, 2003) and other
psychosocial factors contribute to healthier lifestyles (Pender, 1996), thereby enhancing
health and well-being. Either way, attitudes to health and health-promoting behaviours
have been investigated widely, including those of university students in Hong Kong
(Lee and Yuen-Loke, 2005), college students in the USA (Oleckno and Blacconiere,
1990), nursing students in Kuwait (Al-Kandari and Vidal, 2007) and music performance
students in the UK (Kreutz et al., 2008a, b).
The health-promoting behaviours of music performance students are of particular
interest given the physical and emotional demands of expert music making. Kreutz et al.
(2008a) have shown that music performance students score particularly low, in relation
to the populations on which the tests used were standardized, on some aspects of health
lifestyle (health responsibility, physical activity and stress management) and only
slightly, albeit significantly higher on others (nutrition, spiritual growth and
interpersonal relationships). Kreutz et al. further examined these health-promoting
behaviours in relation to positive and negative affect states, self-efficacy and
self-regulation. Significant inter-correlations between the various measures were found,
suggesting that healthy lifestyle and psychological well-being influence each other.
Kreutz et al. (2008b) also investigated the occurrence of music performance students
musculo- and non-musculoskeletal health problems, and sought to determine the impact
these problems were perceived by respondents to have on the quality of their technique,
practice and performance. Six categories of health problem were identified, using
factor analysis. Five categories were musculoskeletal (elbow/upper arm, left hand, right
arm and hand, spine and orofacial) and one was non-musculoskeletal (fatigue).
Regression analyses showed that fatigue and spinal pain were the most reliable
predictors of self-perceived impaired technique, practice and performance quality.
In order to assess the significance of the findings reported by Kreutz et al. (2008a, b)
in relation to other student populations, the present study compared music
performance and health students health-promoting behaviours, psychological
well-being and health-related experiences. We wish to acknowledge from the outset
that student populations may differ systematically in a variety of ways. However, by
exploring specifically the similarities and differences between their approaches to
health and psychological well-being, we aim to shed light on how students adapt to the
demands of their individual programmes of study.
 HE Our main research questions were as follows:
109,3 RQ1. What are the differences, if any, between the reported health-promoting
behaviours of music performance and health students?
RQ2. What are the differences, if any, between the experiences of ill-health reported
by the two groups of respondents?
244 RQ3. To what extent are these associated, for the two groups of respondents, with
reported health-promoting behaviours, emotional affect state, self-regulation
and self-efficacy?
We also explored sex differences within the data, as previous research has shown
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significant differences between men and women in some aspects of healthy behaviours
of Chinese students (Lee and Yuen-Loke, 2005).

Methods
Respondents
A total of 348 students (242 female and 106 male) from the Royal Northern College of
Music RNCM, Manchester (n 182: 114 female, 68 male), the Royal College of
Music RCM, London (n 67: 46 female, 21 male), the University of Chester UC
(n 63: 57 female, 6 male) and Imperial College London IC (n 36: 25 female, 11
male), responded to the survey.
In an initial inspection of the data, a one-way analysis of variance (ANOVA)
comparing the age of students at their respective institutions revealed a significant
effect (F(3, 344) 55.87, p , 0.0001), such that the UC students were shown to be older
than the other groups of students. Their mean age was 29.81 years (SD 9.6) in
comparison with those from RNCM (20.66 years, SD 3.2), RCM (21.69, SD 3) and
IC (21.69, SD 1.85).
In order to avoid a confound between age and institution, the sample was reduced as
follows:
.
two respondents from RNCM and two respondents from RCM whose ages were
two standard deviations (SDs) above the mean were removed as outliers, as were;
.
about 49 respondents from RNCM aged 18 and under; and
.
almost 36 respondents from UC aged 26 and over.

A subsequent one-way ANOVA confirmed that there was no effect of institution in the
remaining sample, thus allowing the comparison of music performance students at
conservatoires and health students at universities. The dataset used for the analyses
described below is shown in Table I.

RNCM RCM UC IC Total

Female 83 44 27 25 179
Table I. Male 50 21 2 11 84
Respondents by Total 133 65 29 36 263
institution, sex and age Mean age in years (SD) 21.36 (2.4) 21.4 (2.4) 21.28 (2.2) 21.69 (1.85) 21.4 (2.3)
 While the RNCM provides all students with health and safety information at induction Healthy
and access to treatment for those with practice- and performance-related injuries, it did behaviours
not at the time of the survey offer regular programmes to enhance health and well-being.
In contrast, the RCM undergraduate students who responded to the survey had all taken in students
part in seven one-hour sessions entitled Healthy body, healthy mind, healthy music in
their first term at College. The majority of the students at UC were in the Faculty of
Health and Social Care, so the study of health was integral to their degree courses, as it 245
was to the students at IC, who were studying biomedical science.

Measurement instruments
The survey consisted of six questionnaires:
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(1) demographic (age, sex, affiliation to one of the four institutions and year of
study);
(2) the positive and negative affect scale PANAS (Watson et al., 1988);
(3) the health-promoting lifestyle inventory HPLP II (Walker et al., 1987);
(4) the self-efficacy scale SES (Schwarzer and Jerusalem, 1995);
(5) the self-regulation scale SRS (Schwarzer et al., 1999); and
(6) a questionnaire devised by the research team to identify self-reported musculo-
and non-musculoskeletal health problems.

The PANAS consists of 20 adjectives describing positive (ten items) and negative
feeling states (ten items). Participants are required to indicate to what extent [they]
have felt this way over the past week. Each item is rated on a five-point Likert-type
scale ranging from 1 very slightly to 5 extremely. Total scores for the two sets of
items represent each affect state.
The HPLPII measures the frequency of engagement in health-promoting
behaviours. It consists of 52 items that are rated on a four-point Likert-type scale:
1 never, 2 occasionally, 3 frequently and 4 routinely. Scores for all items thus
range from 52 to 208 with a midpoint of 130. This instrument provides a total score for
health-promoting behaviour, as well as six subscales.
The unidimensional SES and SRS scales each consist of ten self-reflective
statements. They describe expected behaviours in situations that require coping (SES)
or regulation of moods (SRS). Each item is rated on four-point Likert-type scales
ranging from 1 not at all true to 4 completely true. Examples of all four scales are
to be found in Table II.
Before respondents completed the inventories that specifically addressed musculo-
and non-musculoskeletal symptoms, they were asked to indicate their present state of
health on a scale from 1 poor to 5 good. The next instruction was:
Please indicate on a scale of 1 (non-existent) to 5 (severe) the degree of pain you have
experienced in the following parts of the body over the past week. You may skip any number
of items. Unmarked items will be counted as non-existent.
The items included sinus(es), nose, lip(s), teeth, tongue, jaw(s), throat, face, neck, upper
spine, middle spine, lower spine, left shoulder, left upper arm, left elbow, left lower arm,
left wrist, left-hand, left-hand fingers, left-hand thumb, right shoulder, right upper arm,
 HE
Subscale Example N a
109,3
HPLP II (Walker et al., 1987)
Health responsibility Discuss my health concerns with health
professionals 9 0.80
Physical activity Follow a planned exercise program 8 0.79
246 Nutrition Eat three to five servings of vegetables every day 9 0.76
Interpersonal relations Touch and am touched by people I care about 9 0.75
Spiritual growth Am aware of what is important in my life 9 0.81
Stress management Pace myself to prevent tiredness 8 0.64
PANAS (Watson et al., 1988)
Positive affect Excited 10 0.85
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Negative affect Nervous 10 0.83

Table II. SES (Schwarzer and Jerusalem, 1995) I am certain that I can accomplish my goals 10 0.88
Summary of SRS (Schwarzer et al., 1999) I can concentrate on one activity for a long time,
psychometric if necessary 10 0.74
instruments, subscales
and reliability measures Notes: N number of items per scale; a Cronbachs a (Kreutz et al., 2008a, b)

right elbow, right lower arm, right wrist, right-hand fingers, right-hand thumb, clavicle
(collarbone) and pelvis.
The inventory that addressed non-musculoskeletal symptoms was preceded by the
following instruction:
Please indicate on a scale of 1 (not at all) to 5 (severe) the extent to which you have
experienced the following non-specific symptoms over the past week. You may skip any
number of items. Unmarked items will be counted as not at all.
The items included sleep disturbance, headache requiring painkilling medication,
concentration problems, vision problems, inappropriate tiredness, sensitivity to the
weather, palpitations of the heart, breathing problems, high-blood pressure, low-blood
pressure, stomach ache, urinary problems, bowel problems and excessive sweating.

Design and procedure

Once the proposal to carry out the study had been approved by Research Ethics
Committees in all four institutions, respondents were invited via e-mail to take part in a
survey. The e-mails, which were nearly identical for the four institutions, contained a
very brief introduction to the nature and purpose of the survey. It was also stated that
respondents would be eligible to take part in a prize draw. The only other differences
between the messages was that the links to the survey web site were different.
The survey itself was constructed using the environment provided by
Surveymonkeyw to which the various measurement instruments were adapted. All
respondent information questionnaires and inventories contained in the different
versions of the survey were identical. The only difference between them was the logo at
the top of the first page of each survey identifying the institutions.
First, the welcome page informed the respondents about the nature, purpose and scope
of the study. It also provided an opportunity to give informed consent immediately after
reading through the general information, or after having read more detailed information
on a separate page that could be accessed by clicking an optional link.
 Respondents provided basic demographic information on the next page and were Healthy
then routed to different pages depending on whether they indicated themselves to behaviours
be students, academic staff, or administrative staff. The only differences between the
student and staff pages were that year of study and musical instrument currently studied in students
were omitted from the latter. All respondents were then directed to the demographic
questionnaire, followed by the PANAS, HPLP II, SES, SRS and finally the health survey.
The HPLPII was divided into two parts for convenience and introduced to the 247
respondents with the following line:
This questionnaire contains statements about your present way of life or personal habits.
Please respond to each item as accurately as possible, and try not to skip any of them.
The health survey was introduced to the respondents with the following sentence:
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Please respond to the following questions about your health status and any physical
problems that you think may have affected your performance recently, by clicking on the
appropriate boxes. The data you provide are, and will remain, confidential.
Finally, respondents were invited to take part in the prize draw by inserting their
e-mail address in an appropriate box. Reassurance was given that questionnaire data
and e-mail addresses would be kept separate.

Statistical analyses
t-tests were used to rule out differences between the overall scores on HPLP II of students
at the two conservatoires and the two universities. Repeated-measures analyses of
variance were undertaken to investigate main effects of and interactions between
student type (music performance/health) and sex on scores on the six subscales of
the HPLP II and ratings representing severity of musculo- and non-musculoskeletal
symptoms. Univariate analyses of variance were used to explore group differences
between overall scores on HPLP II, scores on its subscales, PANAS, SRS and SES,
ratings representing perceived state of present health and the 14 types of musculo- and
non-musculoskeletal symptoms. Finally, correlations between scores on the different
measures were calculated.

Results
Overall HPLP II
As reported for music performance students in Kreutz et al. (2008a), mean scores were near
the midpoint of the scale with the median close to the average value, showing that, once
again, reported adherence to healthy behaviours fell between occasional and frequent.
The grand mean of total scores on HPLP II was 2.51 (SD 0.4). Respondents scored
below this grand mean for health responsibility, stress management and physical activity
but above it for nutrition, spiritual growth and interpersonal relations.
In order to rule out differences between the non-music performance students, who
were studying either nursing (UC) or biomedical science (IC), a t-test was used to
compare the two groups mean overall scores on the HPLP II. There was no significant
difference between them.
A univariate ANOVA with student type (music performance vs health) and sex as
the independent variables and overall score on the HPLP II revealed a statistically
significant effect of student type (F(1, 259) 7.01, p 0.009), such that music
 HE performance students scored lower (M 2.47, SD 0.4) than health students
109,3 (M 2.63, SD 0.4). There was no effect of sex (F(1, 259) 0.98, NS) nor any
interaction between sex and student type.
A repeated measures ANOVA with each of the subscales as within-subjects
independent variables, student type and sex as the between-subjects independent
variables and scores on each of the subscales as the dependent measure was conducted.
248 Mauchlys test of sphericity was significant, so the Greenhouse-Geisser Epsilon was used
to adjust the F-ratio. There was a significant main within-subjects effect of subscale,
indicating differences between the scores on each (F(4, 1,069) 124.93, p , 0.0001) and a
significant interaction between subscale and sex (F(4, 1,069) 3.29, p 0.01). There was
also a significant main between-subjects effect of student type (F(1, 259) 6.75, p 0.01).
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HPLP II subscales
A series of univariate ANOVAs was conducted with student type and sex as the
between-subject independent variables and scores on each of the subscales as the
dependent measures. The range of scores was from 1 never to 4 routinely.
As shown in Table III, there were significant main effects of student type on health
responsibility, physical activity and spiritual growth. In all cases, music performance
students mean scores were lower than those of health students. There was a significant
main effect of respondents sex on interpersonal relations such that female students
mean scores were higher than those of male students. There were no significant
interactions between student type and sex for any of the HPLP II subscales.

Other psychological variables

A further series of univariate ANOVAs was conducted with scores on the
scales representing positive and negative affect (both rated from 1 very slightly
to 5 extremely), self-regulation and self-efficacy (both rated from 1 never to
4 routinely). As shown in Table IV, there were significant main effects of student
type on self-efficacy and self-regulation such that music performance students mean

Main Music
Main effect effect performance Health Male Female Grand
of student of sex students students students students mean
Measure type F(1, 263) F(1, 263) (n 198) (n 65) (n 84) (n 179) (n 263)

HPLPII 7** NS 2.47 (0.4) 2.63 (0.39) 2.42 (0.41) 2.56 (0.4) 2.51 (0.41)
Health
responsibility 13.63 * * NS 1.83 (0.5) 2.12 (0.51) 1.73 (0.49) 1.98 (0.51) 1.9 (0.51)
Physical
activity 5.83 * NS 2.21 (0.64) 2.47 (0.68) 2.25 (0.68) 2.29 (0.65) 2.28 (0.66)
Nutrition NS NS 2.75 (0.59) 2.75 (0.57) 2.57 (0.59) 2.84 (0.55) 2.75 (0.57)
Spiritual
growth 4.16 * NS 2.88 (0.54) 3.0 (0.58) 2.9 (0.58) 2.92 (0.54) 2.9 (0.55)
Stress
management NS NS 2.23 (0.55) 2.36 (0.55) 2.25 (0.48) 2.27 (0.52) 2.26 (0.51)
Table III. Interpersonal
Main effects of student relations NS 6.49 * 2.96 (0.56) 3.09 (0.61) 2.83 (0.59) 3.06 (0.55) 2.99 (0.57)
type and sex on HPLP II,
mean scores and SDs Notes: *p , 0.05; * *p , 0.001
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Effect of student Effect of Music performance Health Male Female Grand mean
type sex studentsa studentsa studentsa studentsa (n 263/259)

Positive affect NS NS 3.39 (0.72) 3.33 (0.73) 3.38 (0.73) 3.37 (0.72) 3.37 (0.72)
Negative
affect NS NS 2.19 (0.74) 2.33 (0.94) 2.15 (0.72) 2.26 (0.82) 2.23 (0.79)
Self-efficacy F(1, 259) 8.16 * 10.75 * * 3.56 (0.62) 3.72 (0.72) 3.74 (0.69) 3.54 (0.62) 3.6 (0.65)
Self-regulation F(1, * NS 3.12 (0.5) 3.3 (0.63) 3.16 (0.61) 3.16 (0.5) 3.16 (0.54)
259) 8.58

Notes: *p , 0.05; * *p , 0.001; aPANAS, n 198 music performance students, 65 health students, 84 males and 179 females; SES and SRS, n 196
music performance students, 63 health students, 83 males and 176 females

psychological variables,
behaviours
in students
Healthy

type and sex on

Main effects of student

and mean scores and SDs

249

Table IV.
 HE scores were lower than those of health students. There was also a significant effect of
109,3 sex on self-efficacy, such that female students mean scores were lower than male
students. There were no effects of student type or sex, nor any interactions between
them, for positive and negative affect.

Perceived state of present health

250 A univariate ANOVA with sex, affiliation and student type as the independent
variables and perceived state of present health (rated from 1 poor to 5 good) as the
dependent measure revealed a main effect of student type (F(1, 254) 6.38, p 0.012)
such that music performance students rated their health as worse (M 3.92,
SD 0.98) than did health students (M 4.37, SD 0.77), although both mean
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scores were above the mid-point of the scale.

Musculoskeletal and non-musculoskeletal problems

Musculoskeletal problems involved the following sites:
.
orofacial: head, sinuses, nose, lips, teeth, tongue, jaw, throat and face;
.
neck and upper, middle and lower spine;
.
left shoulder, upper arm, elbow;
.
right shoulder, upper arm and elbow;
.
left lower arm, wrist, hand, fingers, thumb;
. right lower arm, wrist, hand, fingers and thumb;
.
clavicle and pelvis;
.
left hip, thigh, femoral bone and knee;
.
right hip, thigh, femoral bone and knee;
.
left shin, calf, ankle, heel, foot arch and toes;
.
right shin, calf, ankle, heel, foot arch and toes; and
.
other physical symptoms.

Non-musculokeletal problems were grouped into two types:

(1) Fatigue. Sleep disturbance, headaches, lack of concentration, problems with
vision and inappropriate tiredness.
(2) Miscellaneous. Sensitivity to weather, palpitations, breathing problems,
high-blood pressure and low-blood pressure, stomach-ache, urinary
problems, bowel problems, excessive sweating, acute hearing loss, general
hearing loss, tinnitus, occupational allergies and cramp/focal dystonia.

Respondents were asked to rate musculoskeletal symptoms at each site and

non-musculoskeletal symptoms of each type experienced during the preceding week at
each site using a scale from 1 non-existent to 5 severe.
Proportions of respondents reporting symptoms. In order to calculate the numbers
and percentages of respondents in each group of respondents (music performance vs
health students; male students vs female students), reporting one or more
musculoskeletal symptoms at each site and non-musculoskeletal symptoms of each
type, as shown in Table V, ratings of 1 (non-existent) were removed from the dataset.
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Music performance students Health students

Male Female All Male Female All Male Female
(n 71) Percentagea (n 127) Percentagea (n 198) Percentagea (n 13) Percentageb (n 52) Percentageb (n 65) Percentageb (n 84) Percentagec (n 179) Percentaged

Orofacial 61 30.8 102 51.5 163 82.3 6 9.2 42 64.6 48 73.8 67 79.8 144 80.4
Spine 50 25.3 93 47.0 143 72.2 7 10.8 31 47.7 38 58.5 57 67.9 124 69.3
Upper left arm 29 14.6 57 28.8 86 43.4 3 4.6 10 15.4 13 20.0 32 38.1 67 37.4
Lower left
arm 31 15.7 59 29.8 90 45.5 1 1.5 14 21.5 15 23.1 32 38.1 73 40.8
Upper right
arm 29 14.6 60 30.3 89 44.9 2 3.1 8 12.3 10 15.4 68 81.0 31 17.3
Lower right
arm 43 21.7 73 36.9 116 58.6 3 4.6 13 20.0 16 24.6 46 54.8 86 48.0
Clavicle/pelvis 6 3.0 12 6.1 18 9.1 0 0.0 4 6.2 4 6.2 6 7.1 16 8.9
Upper left leg 17 8.6 29 14.6 46 23.2 2 3.1 10 15.4 12 18.5 19 22.6 39 21.8
Lower left leg 13 6.6 40 20.2 43 21.7 1 1.5 15 23.1 16 24.6 14 16.7 55 30.7
Upper right
leg 16 8.1 28 14.1 44 22.2 2 3.1 11 16.9 13 20.0 18 21.4 39 21.8
Lower right
leg 14 7.1 36 18.2 50 25.3 2 3.1 14 21.5 16 24.6 16 19.0 50 27.9
Other
physical
problems 62 31.3 96 48.5 158 79.8 11 16.9 42 64.6 53 81.5 73 86.9 138 77.1
All multiple
sclerosis (MS) 71 35.9 124 62.6 195 98.5 12 18.5 51 78.5 63 96.9 83 98.8 175 97.8
Fatigue 66 33.3 117 59.1 183 92.4 8 12.3 50 76.9 58 89.2 74 88.1 167 93.3
Miscellaneous
non-MS 58 29.3 99 50.0 157 79.3 7 10.8 37 56.9 44 67.7 65 77.4 136 76.0

Notes: Percentage of all amusic performance students; bhealth students; cmale students; dfemale students
behaviours

each site and of each type

in students
Healthy

respondents reporting
Numbers and

one or more symptoms at

percentages of
Table V.
251
 HE Nearly, all the respondents (98.5 per cent of music performance students and
109,3 96.9 per cent of health students) reported one or more musculoskeletal symptoms.
Orofacial symptoms were reported by 82.3 per cent of music performance students and
73.8 per cent of health students, while problems with the neck and spine were reported
by 72.2 per cent of music performance students but only 58.5 per cent of health
students. Fatigue symptoms were also prevalent: in 92.4 per cent of music performance
252 students and 89.2 per cent of music performance students.
Numbers of symptoms reported. A univariate ANOVA with student type and sex as
the independent variables and total number of sites at which musculoskeletal
symptoms were likely to occur and for which ratings of 2-5 were provided revealed a
main effect of student type (F(1, 258) 8.96, p 0.003), but not sex, such that music
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performance students were likely to report musculoskeletal symptoms at more sites

(M 10.53, SD 6.06) than health students (M 7.6, SD 6.88). A univariate
ANOVA with student type and sex as the independent variables and number of fatigue
symptoms for which ratings of 2-5 were provided revealed a main effect of sex
(F(1, 241) 6.6, p 0.001), but not student type, such that female students were likely to
report more fatigue symptoms (M 3.2, SD 1.18) than male students (M 2.8,
SD 1.24). There were no effects of student type or sex on number of miscellaneous
non-musculoskeletal symptoms reported.
Severity of symptoms. In order to find out if some symptoms would be rated more
severe by one of the two groups of students (music performance vs health; male vs female)
a repeated measures ANOVA with the 12 sites at which musculoskeletal symptoms could
occur and the two types of non-musculoskeletal symptom as within-subjects independent
variables, student type and sex as the between-subjects independent variables, and mean
ratings for each of the symptom types (from 1 to 5) as the dependent measure was
conducted. Mauchlys test of sphericity was significant, and the Greenhouse-Geisser
correction was therefore used. There was a significant main within-subjects effect of
symptom type (F(8, 1,383) 42.58, p , 0.0001) and a significant interaction between
symptom type and student type (F(8, 1,383) 2.24, p 0.025). There was a significant
main between-subjects effect of student type (F(1, 182) 8.24, p 0.005) and a significant
main effect of sex (F(1, 182) 5.38, p 0.021).
In order to find out which symptoms were rated as more severe, a series of
univariate ANOVAs was conducted with student type and sex as the between-subject
independent variables and ratings of each of the symptom types as the dependent
measures (see Table VI for main effects, interactions, means and SDs). Music
performance students rated symptoms worse than did health students in the spine,
lower right arm and hand, and upper and lower left shoulder, arm and hand. Females
reported more severe symptoms in the lower left leg and foot, and fatigue; there was
also a significant interaction between student type and sex for fatigue.

Correlations between dependent measures

In order to assess the strength of associations between reported health-promoting
behaviours, affect, self-efficacy and self-regulation, mean ratings for perceived present
health and for reported musculo- and non-musculoskeletal symptoms, Spearmans
r correlations were calculated between these measures and a correlation matrix
presented in Table VII. A non-parametric test was used since the variables were
measured on four- and five-point scales yielding ordinal data (Brace et al., 2000).
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Main effect of student Main effect Inter-action student Music performance students Health students
Site/type (no.) type of sex type/sex Male Female Total Male Female Total Male Female

Orofacial (9) NS F(1, 246) 8.37 * NS 1.59 (0.59) 1.78 (0.68) 1.71 (0.65) 1.23 (0.26) 1.73 (0.65) 1.65 (0.63) 1.54 (0.57) 1.77 (0.69)
Spine (4) F(1, 247) 4.74 * NS NS 1.9 (0.86) 2.09 (0.1) 2.03 (0.95) 1.6 (0.8) 1.69 (0.86) 1.67 (0.84) 1.86 (0.85) 1.98 (0.97)
Upper left arm(3) NS NS NS 1.47 (0.66) 1.56 (0.74) 1.53 (0.71) 1.3 (0.64) 1.29 (0.6) 1.3 (0.6) 1.45 (0.66) 1.48 (0.66)
Lower left arm (5) F(1, 224) 6.24 * NS NS 1.42 (0.67) 1.47 (0.71) 1.46 (0.7) 1.1 (0.32) 1.18 (0.38) 1.17 (0.37) 1.38 (0.64) 1.39 (0.65)
Upper right arm (3) F(1, 225) 5.62 * NS NS 1.43 (0.7) 1.66 (0.84) 1.57 (0.79) 1.21 (0.6) 1.22 (0.56) 1.22 (0.57) 1.4 (0.68) 1.53 (0.79)
Lower right arm (5) F(1, 221) 6.55 * NS NS 1.44 (0.67) 1.33 (0.73) 1.44 (0.71) 1.03 (0.08) 1.19 (0.59) 1.16 (0.54) 1.39 (0.64) 1.53 (0.79)
Clavicle/pelvis (2) NS NS NS 1.1 (0.3) 1.12 (0.34) 1.11 (0.32) 1 (0) 1.17 (0.57) 1.13 (0.51) 1 (0) 1.13 (0.42)
Upper left leg (4) NS NS NS 1.15 (0.27) 1.26 (0.62) 1.22 (0.52) 1.3 (0.9) 1.22 (0.45) 1.24 (0.57) 1.17 (0.44) 1.25 (0.57)
Lower left leg (6) NS F(1, 204) 4.93 * NS 1.18 (0.48) 1.29 (0.62) 1.25 (0.58) 1.02 (0.05) 1.45 (0.84) 1.36 (0.77) 1.16 (0.44) 1.34 (0.7)
Upper right leg (4) NS NS NS 1.17 (0.41) 1.28 (0.63) 1.24 (0.56) 1.36 (0.92) 1.22 (0.4) 1.25 (0.55) 1.2 (0.52) 1.26 (0.58)
Lower right leg (6) NS NS NS 1.19 (0.52) 1.26 (0.65) 1.23 (0.61) 1.03 (0.07) 1.3 (0.59) 1.25 (0.54) 1.16 (0.48) 1.27 (0.64)
Other physical NS NS NS 1.89 (0.32) 1.78 (0.42) 1.82 (0.39) 1.92 (0.29) 1.82 (0.39) 1.84 (0.37) 1.89 (0.31) 1.8 (0.41)
All MS NS NS NS 1.54 (0.49) 1.66 (0.61) 1.62 (0.57) 1.46 (0.72) 1.51 (0.49) 1.5 (0.53) 1.53 (0.52) 1.62 (0.58)
Fatigue (5) F(1, 253) 6.65 * F(1, 253) 10.95 * * F(1, * 2.27 (0.76) 2.36 (0.75) 2.33 (0.75) 1.59 (0.42) 2.36 (0.77) 2.22 (0.77) 2.17 (0.76) 2.36 (0.75)
253) 6.68
Miscellaneous
non-MS (14) NS NS NS 1.4 (0.38) 1.38 (0.37) 1.32 (0.35) 1.32 (0.37) 1.31 (0.37) 1.32 (0.35) 1.38 (0.38)

Notes: *p , 0.05; * *p , 0.001

non-musculoskeletal
behaviours

for musculoskeletal and

in students
Healthy

problems
Mean ratings (and SDs)
253

Table VI.
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HE

254
109,3

Table VII.
Correlation matrix for
scores on nine measures
Measure HPLP II PoA NeA SES SR PH MS F

HPLP II total
Positive affect 0.476 * *
Negative affect 2 0.261 * * 20.211 * *
Self-efficacy 0.519 * * 0.405 * * 20.244 * *
Self-regulation 0.432 * * 0.307 * * 20.321 * * 0.367 * *
Present health 0.310 * * 0.193 * 20.217 * * 0.179 * * 0.217 * *
Musculoskeletal symptoms 2 0.131 * NS 0.142 * NS NS 20.195 * *
Fatigue symptoms 2 0.377 * * 20.335 * * 0.412 * * 2 0.279 * * 2 0.250 * * 20.334 * * 0.443 * *
Miscellaneous non-MS symptoms 2 0.168 * * 20.172 * * 0.303 * * 2 0.158 * 2 0.171 * * 20.311 * * 0.331 * * 0.446 * *
Notes: *p , 0.05; * *p , 0.01
 While the majority of correlations were significant the coefficients were generally low. Healthy
The strongest association was between scores on the HPLP II and self-efficacy; HPLP behaviours
II scores were also associated comparatively strongly with positive affect and
self-regulation. Positive affect was associated with self-efficacy, while negative affect in students
was associated with fatigue symptoms. These in turn were correlated with
musculo- and non-musculoskeletal symptoms.
255
Discussion
What are the differences, if any, between the reported health-promoting behaviours of
music performance and non-music performance students?
The HPLP II measures reported adherence to health-promoting behaviours. As a
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whole, the students surveyed reported more frequent attention to their nutritional
requirements, spiritual growth and interpersonal relations; they reported less-frequent
recreational physical activity, stress management and taking responsibility for their
health.
Music performance students overall scores on the HPLP II were lower than those of
non-music performance students. Specifically, they scored significantly lower for
health responsibility, physical activity and spiritual growth. While the two groups of
respondents did not differ significantly on positive and negative affect, music
performance students reported lower levels of self-efficacy and self-regulation than
non-music performance students.
There are several possible interpretations of these findings. One is that music
performance students report less-healthy lifestyles than non-music performance
students for reasons, as of yet, unknown. They may relate to individual personality or
social background, or to a combination of these and other factors. Whatever the
reasons, the findings are worrying since musicians are often and correctly likened to
athletes: music performance students need to adopt healthy lifestyles in order to
develop the physical capacity and stamina to give of their best before their peers and
the public, often under challenging and difficult circumstances.
A second possibility is that the students of nursing and biomedical science
(a proportion of these latter students go on to study medicine) who responded to the
survey have healthier lifestyles than music performance students perhaps because of
their greater awareness of health issues and responsibilities arising from their
particular field of study, and perhaps also their exposure to the severe health problems
of others encountered in the course of clinical practice.
Female respondents (music performance and health students alike) scored
significantly higher than male respondents on interpersonal relations and
near-significantly higher on health responsibility and nutrition. In contrast, female
respondents scored lower than male respondents on self-efficacy. These findings, we
would argue, reflect societal differences and indicate the areas to which tutors should
pay particular attention where possible.

What are the differences, if any, between the experiences of ill-health reported by the two
groups of respondents?
Respondents were asked to rate their present state of health on a scale from 1 to 5.
Mean ratings for both groups were above the mid-point, but music performance students
rated their present state of health significantly worse than did health students.
 HE While there were significant, if low, negative correlations for the whole cohort between
109,3 perceived present state of health and ratings for the severity of reported musculo- and
non-musculoskeletal symptoms, there were differences between the experiences of
ill-health reported by the two groups of respondents.
These can be described in two ways. First, music performance students reported
musculoskeletal problems at a wider variety of sites than did health students. Second,
256 music performance students mean ratings for the severity of the symptoms reported
were significantly higher than those of health students for spine, upper and lower right
arm and hand, lower left arm and hand, and fatigue. It may be that music performance
students are more accustomed to identifying the parts of the body associated with
different aspects of playing instruments (e.g. supporting and fingering a violin or viola
with the left hand, and bowing with the right shoulder, upper and lower arm and
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wrist). Or it may be that health students simply rate their own experience of such
symptoms as less severe in comparison with injuries they treat in others.
There were also differences between men and women: the latter were more likely to
experience orofacial symptoms, fatigue and pain/injuries in the lower left leg.

To what extent are perceived present health and reported musculo- and
non-musculoskeletal symptoms associated, for the two groups of respondents, with
reported health-promoting behaviours, emotional affect state, self-regulation and
self-efficacy?
Correlations between ratings representing perceived present health status and reported
symptoms were negative, as would be expected, but too low to reflect each other
accurately. Perceived present health was most strongly correlated with reported
healthy lifestyle. This in turn was associated with positive affect, self-efficacy and
self-regulation, suggesting that all are worth promoting in the interests of better health.

Limitations of the research

This was a relatively small-scale investigation involving two groups of students with
very different career aspirations. In relation to the systematic differences observed
between the reported health-promoting behaviours of music performance and health
students, a third possible explanation besides those presented above is that these
are the result of factors related to the physical and socio-economic environments of the
students various institutions. It would thus be premature to draw firm conclusions
from the data as to the factors underlying the health-promoting behaviours of
individual students following different programmes of study. Nevertheless, the
differences between the two groups warrant further investigation.

Conclusions
To our knowledge, this is the first study that has compared health-promoting
behaviours and self-reported health problems in age-matched groups of music
performance and non-music performance students. Despite its limitations, a number of
significant differences relating to health and psychological well-being emerged as
well as some similarities that should serve as the focus of further research with
larger and wider samples.
It may be that nursing and biomedical science students are better prepared than
music performance students, as part of their training in health and medicine, to engage
 in health-promoting behaviours and, as a result, report somewhat healthier lifestyles. If Healthy
this is the case, then conservatoires have much to learn from those who train health behaviours
professionals. The music performance students comparatively lower scores suggest
that they are not learning or applying the information they are given about health in students
in a way that would be useful to them in their careers as performing musicians. We
would argue that this suggests a need for better health promotion as early as possible
in the training of young musicians, involving instrumental and vocal tutors, who have 257
an important role to play in modelling healthy behaviours and providing advice on
health to their students. We would wholeheartedly support Chesky et al.s (2006)
recommendation that schools of music and conservatoires should adopt health
promotion frameworks within which occupational health courses for students and staff
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are offered.
We would, however, go further than this. The systematic training of musicians can
begin as early as two years of age, and by the time students are admitted onto higher
education courses, the sheer probability that they will have experienced health
problems would seem higher than for non-performance students who do not
accumulate an equivalent 10,000 hours of physically and psychologically taxing
practice (Chaffin and Lemieux, 2004). Unhealthy habits and practices known to be
endemic within the music profession (Wynn Parry, 2004) have ample time to embed
themselves into these young musicians day-to-day work, and it is not surprising,
therefore, to discover that musicians report higher incidences of pain and physical
discomfort and fewer health promoting behaviours. In addition to gaining ground in
the training of higher education music performance students, further effort is also
needed in informing and educating pre-conservatoire musicians on how to achieve a
positive and healthy approach to learning and performing music, as well as how to
build a robust psychological profile suitable for making music at the highest levels
throughout ones life. Such progress will be good not only for individual musicians, but
also for the health of the profession as a whole.

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Corresponding author
Jane Ginsborg can be contacted at: jane.ginsborg@rncm.ac.uk

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