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Table 1 Selected studies (RCTs and CTs) of effectiveness of AT a

From: The Alexander Technique and musicians: a systematic review of controlled trials

Study, type of publication Design Participants Experimental intervention(s) Control intervention(s) Outcome measures Main results
Doyle 1984 [24], PhD thesis RCT 72 Short hands-on contact with thought: free neck muscles before playing Short hands-on contact with thought: tighten neck muscles before playing Head-neck relationship 98.6% of subjects showed changes in the head-neck relationship when taking up their instrument to play.
Violin players (Defined as the angle between a line going through the sternal notch and the first dorsal vertebra and a vertical line going through the middle of the chair and measured on photographs) Release in tension in the neck muscles was closely associated with postural changes towards the grid vertical in 71.4% of subjects (p <0.001). When tightening the neck muscles 94.6% moved in a forward direction (p <0.001).
42 female, 30 male, age 11–19 years (music schools, school orchestras)
Dennis 1987 [25], Ed.D. dissertation RCT 13 AT None Music performance (posture, movement, breath control, overall performance) judged by 6 expert observers from video-tapes on a 7-point scale Control group performed better in maximal voluntary ventilation (t-test, p =0.052); no other significant differences between groups occurred.
Young adult wind instrument players 20 sessions, 30 min, over 4 months, one-to-one Respiratory function (standard spirometry, maximal inspiratory and expiratory pressures)
8 female, 5 male, age 22–33 years
Valentine et al. 1995 [26], peer-reviewed mixed methods: 25 AT None Height, peak flow, heart rate AT group showed improvement relative to control group in musical and technical quality, heart rate variance, self-rated anxiety, and positive attitude to performance (ANOVA, p <0.05).
- RCT Music students 15 sessions, one-to-one Music performance and degree of misuseb rated by 4 blinded expert judges from video-tapes Effects were mostly restricted to performance in low stress class situations (with the exception of heart rate variance).
-interviews 21 female, 4 male, age 19–32 years (music department of a university) Music Performance Anxiety Self-Statement
Nowlis mood adjective checklists
Lorenz 2002 [27], master’s thesis RCT 22 sensory awareness and body alignment exercises based on AT None performance anxiety (degree, symptoms) and effects of AT on performance anxiety measured by 4 questionnaires (designed by author) Inconclusive effect of exercises on performance anxiety.
Female choral singers, age 13–16 years (high school) 1 to 4 min exercises, 3 to 4 times weekly, over 13 weeks, group training
Egner and Gruzelier 2003 [28], peer-reviewed RCT 61 1. alpha/theta NF 4. Physical exercise Assessment by 3 expert judges from video-tape in random order on 10-point scales adapted from a standard set of music performance evaluation criteria (overall quality, perceived instrumental competence, musicality/musical understanding and communication) Significant improvements in music performance occurred in the alpha/theta NF group (p <0.01 for 3 out of 4 criteria; mean improvement rate 12%), but no post-training performance changes in any other group.
music students 2. beta1 NF 5. Mental skills training Spielberger’s state-anxiety inventory Reduction in pre-performance anxiety was observed in all 6 groups (p <0.05).
43 female, 18 male, mean age 23.1 ± 2.21 years (college) 3. sensorimotor rhythm NF 6. AT: 15 sessions, 30 min, weekly, over 15 weeks, one-to-one
10 sessions, 15 min, over 6–8 weeks
Valentine and Williamon 2003 [29], conference proceedings RCT 18 AT alpha/theta NF Assessment of AT useb by blinded expert on 7-point scale AT group showed improvement relative to NF group in 7 out of 10 measures of AT use (p <0.05, one-tailed values).
Music students (college) 12 sessions, 30 min, weekly, one-to-one 10 sessions, 15 min, over 6–8 weeks
Mozeiko 2011 [30], dissertation mixed methods: 51 AT none Pain, executive skill function, well-being, awareness Significant changes were found in awareness and executive skill function in AT group compared to control group (MANOVA, p <0.01).
- RCT Female violinists and violists, age 18–34 years 20 sessions, 30 min, twice a week, over 10 weeks, one-to-one - Questionnaires (quantitative, questions from author and previous studies, von Korff scale for pain, 10-point Likert scales) Convergence of quantitative and qualitative data showed also improvement in pain.
-Interviews Lie down in semi-supine position 10–15 min once or twice a day - Interviews (qualitative)
Barlow 1956 [31], peer-reviewed CT 74 AT (“conditioning”) Verbal instructions, manual adjustment, exercises Postural faults (according to author’s scoring system) In the AT group the number of faults decreased from 9 to 4 in women and from 11 to 5 in men. In the control group the number of faults increased from 7.5 to 7.9 in women and from 10.6 to 11.7 in men.c
44 speech and 30 music students
42 female, 32 male (college)
Armstrong 1975 [32], master’s thesis CT 8 AT none Performance anxiety (author’s questionnaire) AT group experienced less nervousness and stress after training, while there wasno change in the control group.
Piano students (music department of a university) 4-6 sessions, 30 to 45 min, over 6 weeks, one-to-one Qualitative observations regarding movement Video-taping revealed less stiffness and increased flexibility in shoulders and neck in the AT group.c
Nielsen 1988 [33], conference proceedings CT 39 1. AT 2. exercises heart rate, BP Exercise group showed
Professional musicians in orchestra 20 sessions, over 8 weeks, one-to-one 7 km running 3 times a week, over 8 weeks feedbacks - significant reduction in heart rate (paired t-test, p <0.05)
3. beta blocker - increase in general well-being (responses on qualitative questionnaires).
40 mg Propranolol, 1.5 h before concert AT group and beta blocker groups showed
4. placebo tablet - significant reduction in systolic BP (p <0.02)
- significant reduction in increases in systolic BP from final rehearsal to concert (p <0.05).
Beta blocker group experienced unwanted side effects.
Engelhart 1989 [34], PhD thesis CT 23 1. AT 2. Progressive muscle relaxation according to Jacobson Tone quality rated by 3 experts on a 9-point Likert scale No significant difference was found after interventions among the 3 groups with respect to change in tone quality.
Beginning singers 10 sessions, 50 min, over 2 weeks, group training 3. Standard vocal exercises Preparatory muscle activity determined by surface EMG Group-time interaction effects occurred for 6 of 18 EMG variables (ANOVA, p <0.05); no overall pattern indicated differences between the 3 groups.
18 females, 5 males, age 18–29 years (students with no previous vocal training) 10 sessions, 50 min, over 2 weeks, group training
Hoberg 2008 [35], master’s thesis CT 12 Selected AT principles included in flute lessons (with author) flute lessons without AT principles (with other teachers) Performance anxiety (author’s questionnaire): AT group had decreased performance anxiety.c
flute students with performance anxiety 18 months 18 months - degree
age 11–18 years - symptoms
  1. a AT Alexander Technique, RCT randomised controlled trial, CT controlled trial, BP blood pressure, NF neurofeedback, EMG electromyography.
  2. b“Use” is an AT term which characterises the manner in which a person moves and behaves while doing something. It is influenced by thinking and emotions and affects the functioning of the whole person.
  3. cNo significance testing was performed for these results.