Sound, stress, and health in youth orchestras: feasibility of a multimodal psychophysiological health promotion program

Abstract

Background: Young orchestral musicians face significant health challenges, including elevated psychological stress, playing-related musculoskeletal pain, and exposure to high sound pressure levels (frequently 90–100 dBSPL) that pose risks to hearing health. Traditional music education often lacks systematic health promotion and preventative strategies, resulting in a high prevalence of health issues that can compromise long-term performance and well-being. This study addresses the need for a comprehensive, evidence-based program to promote sustainable health and resilience practices in young orchestral musicians. Research question: Can a multimodal, integrated health promotion program combining acoustic, physiological, psychological, and behavioral interventions be feasibly and acceptably implemented into the intense rehearsal culture of European youth orchestras and how do participating musicians engage with the program’s components? Methods: A mixed-methods design was implemented during multi-site summer and autumn camps involving 136 musicians (aged 14–27) from two European youth orchestras. The program consisted of six interlinked modules: (1) orchestral soundscape mapping via 16 microphones to document sound pressure levels, (2) practical interventions including daily warm-ups, ‘BodyFit,’ and mental training workshops, (3) audiometric screening of 77 participants, (4) Virtual Reality Exposure Training (VRET) for performance anxiety, (5) continuous psychophysiological stress monitoring using EmbracePlus smartwatches on 15 musicians, and (6) quantitative pre- and post-camp surveys. Results: Acoustic mapping confirmed significant spatial variation in sound exposure, with peak levels of 88–100 dBSPL, particularly among brass and percussion players. Audiometric screening revealed that while most thresholds were normal, an early high-frequency mild hearing loss was already evident among brass players, highlighting potential hearing-related vulnerabilities. Wearable monitoring successfully identified individual stress patterns that were temporally associated with challenging musical passages and emotional climaxes. Post-intervention surveys indicated short-term, self-reported improvements in stress management and ergonomic awareness among participants who took part the interventions. Overall, the program showed a high degree of uptake, with over 90% engagement across modules, although inconsistent use of hearing protection remained an issue (40% reported inconsistent use). Conclusion: The study demonstrates the feasibility and high degree of uptake of a multimodal health promotion framework within the context of a youth orchestra. By combining objective measurements with practical, evidence-based training, the program demonstrates how health-oriented practices can be integrated into orchestral rehearsal culture, and it provides a concrete starting point for future controlled intervention studies.