Table 2 Components of community of voices intervention, hypothesized mechanisms of action, outcomes, and specific outcome measures

Attend to conductor, music, and fellow singers; being flexible, organizing materials

Cognitive stimulation, brain

Attention/executive function

• Trailmaking test

• NIH Toolbox Flanker

Learn and recall new music (lyrics, melody, pitch, and rhythm)

Cognitive stimulation, brain

Verbal learning and memory

• NIH Toolbox Rey Auditory Verbal Learning test

Stand and sit, move to rhythm of songs

Balance, body strengthening

Lower body strength, balance, falls

• SPPB Chair stands

• NIH Toolbox Standing Balance

• Self-reported falls

Stand and sit, move to different parts of room, breathe deeply to sing

Stamina

Walking speed

• NIH Toolbox Gait Speed

Singing feels good, is uplifting, is intrinsically pleasurable and emotionally meaningful

Reduce depressive symptoms and anxiety, increase positive emotions

Emotional well-being

• PHQ-8

• NIH Toolbox Sadness

• NIH Toolbox Positive Affect

• NIH Toolbox Fear Affect

Build social network, make new friends

Increase sense of belonging and social support, decrease feelings of loneliness

Social support, loneliness

• NIH Toolbox Loneliness

• MOS Social Support

Somewhere to go, regular activity

Something interesting to do

Interest in daily life

• NIH Toolbox Apathy

Taking on new challenges, mastering new skills with practice over time

Improve sense of mastery, increase confidence

Self-efficacy

• NIH Toolbox Self-Efficacy