Music can powerfully evoke and modulate emotions and moods, along with changes in heart activity, blood pressure (BP), and breathing. Although there is great heterogeneity in methods and quality among previous studies on effects of music on the heart, the following findings emerge from the literature: Heart rate (HR) and respiratory rate (RR) are higher in response to exciting music compared with tranquilizing music. During musical frissons (involving shivers and piloerection), both HR and RR increase. Moreover, HR and RR tend to increase in response to music compared with silence, and HR appears to decrease in response to unpleasant music compared with pleasant music. We found no studies that would provide evidence for entrainment of HR to musical beats. Corresponding to the increase in HR, listening to exciting music (compared with tranquilizing music) is associated with a reduction of heart rate variability (HRV), including reductions of both low-frequency and high-frequency power of the HRV. Recent findings also suggest effects of music-evoked emotions on regional activity of the heart, as reflected in electrocardiogram amplitude patterns. In patients with heart disease (similar to other patient groups), music can reduce pain and anxiety, associated with lower HR and lower BP. In general, effects of music on the heart are small, and there is great inhomogeneity among studies with regard to methods, findings, and quality. Therefore, there is urgent need for systematic high-quality research on the effects of music on the heart, and on the beneficial effects of music in clinical settings.
Heart, Music, Emotion, Heart rate, Heart rate variability, Respiratory rate, Blood pressure, Depression
Music is a powerful stimulus for evoking and modulating emotions as well as moods,1–3 and is associated with activity changes in brain structures known to modulate heart activity, such as the hypothalamus, amygdala, insular cortex, and orbitofrontal cortex.2,4,5 Effects of emotions and affective traits on heart activity are due to several pathways transmitting information into the cardiac nerve plexus, such as autonomic and endocrine pathways, blood pressure (BP), and blood gases.5,6 On the other hand, cardiovascular afferent neurons provide the autonomic nervous system (ANS) with information about BP as well as the mechanical and chemical milieu of the heart.7,8 Such sensory information modulates autonomic outflow, and contributes to emotional experience as interoceptive information.9 Owing to these mechanisms, music-evoked emotions have effects on the regulation of regional heart activity, heart rate (HR), heart rate variability (HRV), BP, and respiratory rate (RR).
However, studies on effects of music on the heart have often yielded inconsistent results. These inconsistencies (in both healthy and clinical study groups) are probably due to the use of very inhomogeneous methods and musical stimuli used across studies. Note that the term ‘music’ itself refers to a great variety of musical genres and styles, all subsumed under the umbrella concept of music, and many studies did not clearly specify the particular style of music used, nor the particular emotional effects evoked by the musical stimuli. Thus, it is no wonder that music studies yield a variety of different physiological effects, given the great variety of musical stimuli. For example, use of (i) energizing (usually fast) or tranquilizing (usually slow) music, (ii) self-selected music (usually associated with memories and stronger pleasantness) or experimenter-selected music, (iii) beat-based music (usually with a drum set, e.g. Rock, Jazz, and Latin), or music that is not beat based but based on an isochronous pulse (e.g. most of classical music, which is often also characterized by distinct tension-resolution patterns that have particular emotional effects), or music not based on an isochronous pulse (e.g. many pieces of ‘ambient music’, meditation music, or ‘new age music’), (iv) music with or without lyrics, (v) active music making or passive music listening (and passive listening with or without the presence of a music therapist), and (vi) natural music (e.g. recorded from commercially available CDs) or artificial music stimuli (e.g. without variations in tempo and loudness in order to have maximum control over the acoustical stimulus).
If participants bring their own music (‘participant-selected music’), it is virtually impossible to control any of these variables. On the other hand, studies using experimenter-selected music suffer from a high risk of missing out on positive emotional effects (or even risk annoying the participant or the patient). To help overcoming methodological problems, we will provide methodological recommendations for future studies at the end of this review. Before we do so, we will first review effects of music on the heart in healthy subjects, and then review (potentially) beneficial effects of music in patients with heart disease.
Effects of music on the heart in healthy individuals
Although there are numerous inconsistencies between studies, there are also some consistent findings (summarized in Table 1), which we will review in following [studies included in this review were identified using the database Web of Science (Thomson Reuters, NY, USA) and the keywords ‘music and HR’ and ‘music and HRV’; only studies with healthy participants were included; studies were excluded if they included fewer than 12 participants, if stimuli were <30 s, if there was no adequate control condition, or if data were not acquired during music listening].
Summary of effects of music on heart rate, heart rate variability, and respiration
|Exciting vs. tranquilizing music||↑||↓||↑|
|Music vs. slience||(↑)||(↓)||(↑)|
|Pleasant vs. unpleasant music||(↑)||(↑)|
|Exciting vs. tranquilizing music||↑||↓||↑|
|Music vs. slience||(↑)||(↓)||(↑)|
|Pleasant vs. unpleasant music||(↑)||(↑)|
Heart rate is regulated by numerous reflex-like circuits involving both brainstem structures and intra-thoracic cardiac ganglia, which are in turn under the influence of cortical forebrain structures involved in emotion such as hypothalamus, amygdala, insular cortex, and orbitofrontal cortex.5 Activity of these forebrain structures can be modulated by music-evoked emotions.1,2,4 Generally, emotional arousal is associated with a predominance of sympathetic ANS activity, thus leading to an increase in HR, whereas a predominance of parasympathetic ANS activity leads to a decrease of HR. Correspondingly, several studies report that listening to music evoking higher levels of emotional arousal is associated with higher HR than HR elicited by tranquilizing music,10–18 and that exciting music is associated with higher RR than tranquilizing music.10–15,19 A recent study reported that, if arousal is balanced, even considerable tempo differences (90 vs. 120 beats per minute) do not evoke changes inHR.16 Thus, up to now, there is no evidence for entrainment of HR to musical beats.20
The increase of HR accompanying music-evoked emotional arousal is consistent with the observation that HR increases during music-evoked frissons (i.e. intensely pleasurable feelings with high-emotional arousal involving shivers and/or goosebumps, also referred to as ‘chills’).21–26 This HR increase during musical frissons parallels an increase inRR23–25 or respiratory depth.21 A recent study found an HR increase following piloerection onset (i.e. onset of goosebumps) during a frisson, but no significant increase in HR during chills without piloerection.26 Therefore, to measure reliable HR changes during music-evoked frissons, or ‘chills’, it is recommended to use objective measures of piloerection.24
Music therapy, or just listening to music, can be good for the heart.
Music can make you laugh or cry, rile you up or calm you down. Some say it's good for the soul. It just might be good for the heart, too. Make no mistake — daily doses of Mozart won't clean out your arteries or fix a faulty heart valve. But music can help ease your recovery from a cardiac procedure, get you back to normal after a heart attack or stroke, relieve stress, and maybe even lower your blood pressure a tad.
The sound of healing
Music and healing once went hand in hand. The Chinese character for medicine includes the character for music. In ancient Greece, music was used to ease stress, promote sleep, and soothe pain. Native Americans and Africans used singing and chanting as part of their healing rituals.
In Western medicine, the connection was gradually broken when the art of medicine gave way to the science of medicine. It's slowly being restored as music therapists demonstrate the value of music for treating people with everything from Alzheimer's disease to chronic pain and substance abuse problems. Since 1980, researchers have turned their attention to the effects of music on the cardiovascular system. Most have looked at single variables, such as changes in blood pressure, heart rate, or blood flow through arteries. A few have looked at more holistic effects. For example:
At Massachusetts General Hospital, a nurse-led team found that heart patients confined to bed who listened to music for 30 minutes had lower blood pressure, slower heart rates, and less distress than those who didn't listen to music.
Another nurse-led team at the University of Wisconsin-Milwaukee found that heart attack survivors who listened to restful music in a quiet environment for just 20 minutes were less anxious about their health than those who rested in a quiet room without music.
At Abbott Northwestern Hospital in Minneapolis, men and women who listened to music soon after undergoing cardiac surgery were less anxious and reported having less pain than those who just rested quietly.
At the University of Maryland Medical Center in Baltimore, researchers measured blood flow through the forearm (a stand-in for blood vessel health) as healthy volunteers listened to music or relaxation tapes. Blood flow increased significantly while the volunteers listened to music that evoked joy or to relaxation tapes, and decreased while they listened to music that provoked anxiety.
In a study from Hong Kong, older volunteers who listened to relaxing music for 25 minutes a day for four weeks lowered their systolic pressure (the top number in a blood pressure reading) by 12 points and their diastolic pressure (the bottom number) by 5 points, while a control group that didn't listen to music had no change in blood pressure.
Not all the trials have been successful. Several found that music had little effect on physiological measures like heart rate or blood pressure, or on recovery from cardiac procedures.
Contradictory results shouldn't really be a surprise. One of the biggest hurdles to studying the effects of music on the heart is music itself. It isn't a single, repeatable "therapy" like a statin or stress-reducing breathing exercises. Soothing music, like Debussy's "Clair de lune" or George Winston's "Moon," have different effects on the heart and body than something more rousing, like "Seventy-Six Trombones" from The Music Man, Puccini's "Nessun dorma," or almost anything from the Red Hot Chili Peppers. Music is also highly personal — what you find soothing might sound to someone else like fingernails on a blackboard.
One thrust of current research in music therapy is to see if specific sounds or tempos affect the heart regardless of the listener's musical preferences. Finding a relaxing melody that slows the heart rate, reduces blood pressure, and improves blood flow for opera buffs and rock-and-roll fans alike would make it easier to offer music therapy.
Other mind-body methods
Music is just one of many techniques that have been promoted for healing the mind and body. Others include:
Transcendental Meditation. Practicing the art of Transcendental Meditation can lower blood pressure, improve blood sugar and insulin levels, and ease stress. Other calming strategies, such as yoga or the relaxation response, can do the same.
Massage. After heart surgery, a simple massage decreased pain levels in a study at the Mayo Clinic. Whether massage affects the heart in other ways isn't well known, but it certainly does feel wonderful.
Tai chi. The combination of simple, flowing movements and deep breathing in tai chi offers a safe, rejuvenating form of exercise for people with heart failure.
Guided imagery. A program of directed thoughts and suggestions that help you imagine a relaxed, focused state can lower blood pressure and reduce other problems related to stress.
Prayer. Personal prayer can help evoke the relaxation response, which can reduce your own stress, while praying for a loved one or friend may provide emotional or spiritual support that reduces his or her stress.
Humor. Laughter may be good medicine for the heart and circulation. In a study at the University of Maryland, blood flow improved in volunteers who laughed at funny movie scenes.
Music in play
Today, music therapy is most commonly used for people undergoing a cardiac procedure and for those recovering from a heart attack or learning to cope with heart failure or other cardiovascular condition.
At the Mayo Clinic, for example, the Healing Enhancement Program offers music (along with massage and relaxation therapies) for people having heart surgery. "We encourage patients to listen to music before, during, and after surgery," says Susanne Cutshall, a clinical nurse specialist who heads the program. Studies there indicate that music helps ease pain and anxiety and blocks out distracting or disturbing hospital sounds. The program's team is working with Chip Davis, founder and leader of the rock group Mannheim Steamroller, to create relaxing music that includes sounds from nature. "This soothing music makes you feel like you are outside in a large, open space instead of confined to a hospital room," says Cutshall.
Another important application of music therapy is helping people cope with a cardiovascular condition, whether they are recovering from a heart attack or living with angina, heart failure, or claudication. "Heart disease can be very stressful, and makes some people feel as though they have little control over their lives," says Suzanne Hanser, who chairs the music therapy department at the Berklee College of Music in Boston. Music therapy can alleviate stress, provide a pleasant coping strategy, and impart a feeling of control, she says.
In a trial conducted at a community hospital in Ohio, Hanser and her colleagues found that adding music therapy to standard cardiac rehabilitation led to better control of blood pressure along with better general and mental health than rehab alone. In her work with other cardiac patients, Hanser has seen improvements in sleep, reductions in stress, and the melting away of anxiety. As one patient wrote her, "I can't read notes or play a musical instrument, yet I love music. My body just seems to unwind as I listen."
A third direction is being pioneered by Milford Graves, an internationally acclaimed jazz musician and professor at Bennington College, who has studied the music of the heart for years. Using a custom-built stethoscope, sensors that pick up the heart's electrical activity, and computer software, Graves studies the musical rhythms of an individual's heartbeat. With this equipment, Graves identifies normal and abnormal heart tones. For the latter, he creates a counter-rhythm aimed at retraining the heart that is delivered through acupuncture needles.
"Just as you can tell almost instantly when a violin or piano is out of tune, Milford Graves can do the same with the heartbeat," says Dr. Baruch Krauss, an associate professor of pediatrics at Harvard Medical School who once studied with Graves. How well this works has yet to be formally tested.
Help from nature
Do you have a favorite place? Perhaps you are drawn to a local park or pond, or enjoy strolling a beach to watch the sunset. Maybe you find solace in a church, museum, or library. Visiting "your place" several times a week is a good way to relax, forget your worries, boost vitality, and feel better about yourself, say Finnish researchers (American Journal of Preventive Medicine, May 2009). These restorative effects can be good for the heart, especially one that's under stress. Combine a visit to your favorite place with a long walk, and it's doubly good medicine.
There are several ways to let music into your heart. One is to work with a music therapist. If you can't find one through your cardiologist or medical center, try the American Music Therapy Association (phone, 301-589-3300; e-mail, findMT@musictherapy.org). Think of a music therapist as a guide, someone who can help you find the music that evokes from you the most relaxing responses as well as the most positive ones. He or she may help you become a more active listener, using music to help you ward off negative thoughts, release anxiety, and summon energy. A music therapist may also encourage you to make music with bells, drums, your voice, or other instruments.
Do-it-yourself music therapy is another option. Find some music that makes you feel good. Pick some calm, relaxing pieces, as well as a few stimulating ones. If you are feeling stressed, sit and listen to the soothing music for 20 minutes or so. If you need a pick-me-up, play something energizing. Observe how the music makes you feel, and give in to those emotions. "The goal," says Hanser, "is to stop thinking of music as a treatment and make it an essential part of your everyday life."