Music and medicine: The effects of music on the human being 133 Applied Cardiopulmonary Pathophysiology 16: 133-142, 2012 Music and medicine: The effects of music on the human being Hans-Joachim Trappe Department of Cardiology and Angiology, University of Bochum, Germany Abstract Music may not only improve quality of life but also effect changes in heart rate (HR) and heart rate variability (HRV). A greater modulation of HR and HRV was shown during musical per- formance compared to listening to music. Cerebral flow was significantly lower when listening to “Va pensiero” from Verdi’s “Nabucco” (70.4±3.3 cm/s) compared to “Libiam nei lieti cali- ci” from Verdi’s “La Traviata” (70.2±3.1 cm/s) (p<0,02) or Bach’s Cantata No. 169 „ Gott soll allein mein Herze haben“ (70.9±2.9 cm/s) (p<0,02). There was no significant influence on cere- bral flow in Beethoven’s Ninth Symphony during rest (67.6±3.3 cm/s) or music (69.4±3.1 cm/s). Music significantly decreases the level of anxiety for patients in a preoperative setting compared to midazolam (STAI-X-1 score 36) (p<0.001). Listening to music while resting in bed after open-heart surgery leads to significant differences in cortisol levels between the music (484.4 mmol/l) and the non-music group (618.8 mmol/l) (p<0.02). Key words: music performance, music perception, quality of life, music therapy, cardiovascu- lar system Introduction cardiovascular and respiratory responses with different styles in most subjects, in Listening to music, whether a Mozart sym- whom responses were related to tempo and phony or to Antonio Vivaldi’s “the four sea- were associated with faster breathing (3,4). sons” may not only help to unwind at the Fast music caused increases in blood pres- end of a stressful day. It could also lower sure, heart rate and breathing rate, and re- blood pressure, heart rate and improve heart duced baroreflex sensitivity. Slow music, on rate variability. The idea that music has an ef- the other hand, caused a significant fall in fect on heart rate, blood pressure and cardio- heart rate and breathing frequency com- vascular system has been reported in 1918 pared with the baseline. The responses were by Hyde and Scalapino (1). They reported qualitatively similar in musicians and nonmu- that minor tones increased heart rate and sicians and apparently were not influenced lowered blood pressure, whereas “stirring” by musical preferences, although musicians music increased both blood pressure and did respond more (5). heart rate. There are several individual reac- In recent years, music has been increas- tions to music that are dependent on individ- ingly used as a therapeutic tool in the treat- ual preferences, mood or emotions (2). It has ment of different diseases (6-8). It has been been reported that music showed consistent shown that music therapy not only reduced 134 H.-J. Trappe Figure 1: Brain asso- ciation areas. Localiza- left hemisphere right hemisphere tion of different functio- nal areas in the left or right brain hemisphere abstract thinking emotionality analytic thinking intuition rational thinking spatial reasoning intellect visual reasoning linguistic abilities imagination rhythmic abilities musicality recognition of people analogical thinking cerebral function blood pressure, heart rate and patient anxi- baby or even in children born before the reg- ety but had a significant effect on future ular date of birth. This is a well known inter- events, including reinfarction and death, in action between the baby and the mother and acute coronary syndrome patients who un- will help to avoid colic in newborns. In addi- derwent revascularization (Dr. Predrag Mitro- tion, music is also helpful for the mother pri- viv, ESC congress 2009, Barcelona, personal or to delivery. Yang et al (12) studied the ef- communication). Miller et al showed that mu- fect of music on anxiety alleviation in 120 an- sic also affects endothelial function and in tepartal women on bed rest. These women this study brachial artery flow mediated dila- received music therapy for 30 min on 3 con- tion increased 26% during music phase that secutive days. Music was selected according evoked joy compared to baseline to the women’s own preferences. Usual care (p<0,002)(9). The purpose of the present participants had a 30 minute rest on 3 con- manuscript is to summarize the different ef- secutive days. Variables included anxiety fects of music on health, cardiovascular pa- (State-Trait Anxiety Inventory), and physiolog- rameters, anxiety, pain and to describe what ical responses like vital signs and fetal heart kind of music is helpful for whom and what rate. Anxiety levels decreased and physiolog- kind of music is probably dangerous. ical responses improved significantly in the women with music therapy while on bed rest. In another study by Kim et al (13) it was Effects of music on the cardio- suggested to play music for women during vascular pathophysiology in pregnancy, birth and nursing. Increased sym- the pregnant woman pathetic activity during pregnancy has been proposed as a mechanism for increased inci- It is well known that music, as a stimulus, can dence of arrhythmias and, therefore, music be recognized as early as the twentieth week may help to avoid them (14,15). Occurrence of fetal development. The unborn baby will of cardiac tachyarrhythmias may also be re- recognize all sounds and will “learn” music in lated to physiologic changes occurring dur- this way (10,11). This is the first sensory im- ing pregnancy, such as increased heart rate, pression for the child. There is general agree- decreased peripheral resistance and in- ment that soft sounds with regular and low creased stroke volume. Music with slow rhythms (“lullabies”) are ideal for the unborn rhythms, soft sounds and particularly music Music and medicine: The effects of music on the human being 135 from Mozart is beneficial in these circum- tion in blood pressure (p<0.05). Correlations stances and opens new possibilities for un- were significant both in individual and group- born (and born) babies as well as for the averaged signals (p<0.05). Phrases at 10-sec- mother. It seems possible to prevent cardiac ond intervals by Verdi entrained the cardio- arrhythmias for both mother and the unborn vascular autonomic variables. It is important child as well as to prevent sudden infant to note that no qualitative differences were death. In addition to these cardiovascular ef- observed in recorded measurements be- fects, there is a significant improvement in tween musicians and nonmusicians. In this cognitive function (Binet intelligence scale) study cerebral flow was significantly lower when listening to Mozart’s music (score when listening to “Va pensioero“ (70.4±3.3 57.56) compared to relaxation (score 54.61) cm/s) compared to “Libiam nei lieti calici or silence (score 54.00) (p<0.002). In relation (70.2±3.1 cm/s) (p<0,02) or Bach (70.9±2.9 to each other, the relaxation and silence con- cm/s) (p<0,02). There was no significant influ- ditions did not differ (p=0.43) (16). Music ence on cerebral flow in Beethoven’s Ninth can also be helpful in instances of depression Symphony during rest (67.6±3.3 cm/s) or and more specifically postpartum depression music (69.4±3.1 cm/s). The data by Bernardi (17). It seems that Mozart has benefitial ef- et al. (19) also demonstrate that in addition fects on energy expenditure in growing to conscious chills, which typically are expe- preterm infants (18). rienced by a minority of subjects, there is a common pattern of unconscious response when different subjects listen to the same Effects of music on the music. These autonomic responses were pathophysiology and the more apparent with lyrical responses from an cardiovascular system operatic aria or a typical exciting orchestral phrase than with more “intellectual” solo Bernardi et al. (19) studied 24 young, healthy singing from a Bach cantata. The extent of subjects (12 chorists and 12 nonmusician the responses appeared to be dependent on control subjects) who listened in random or- the specific pattern of the musical profile. der to music with vocal (Puccini’s “Turan- When a sudden crescendo was spaced ade- dot”) or orchestral (Beethoven’s Ninth Sym- quately, or the musical profile exhibited a reg- phony adagio) progressive crescendos, more ular or slow change, then the cardiovascular uniform emphasis (Bach’s Cantata BWV 169 system tracked the musical profile, and skin “Gott soll allein mein Herz haben”), 10-sec- vasomotion was evident. When the musical ond period rhythmic phrases (Verdi’s arias profile changed very rapidly, the overall ef- “Va pensiero” and “Libiam nei lieti calci”) or fect was opposite. Skin vasomotion and a re- silence while heart rate, respiration, blood duction in blood pressure by general relax- pressure, middle cerebral artery flow veloci- ation were observed (19). It has been shown ty, and skin vasomotion were recorded. in other studies by Yoshie et al. (20) and Common responses were recognized by av- Nakahara et al. (21) that music will have ben- eraging instantaneous cardio respiratory re- eficial effects on heart rate, heart rate variabil- sponses regressed against changes in musical ity and anxiety levels in not only skilled pi- profiles and by coherence analysis during anists but also nonmusicians during both per- rhythmic phrases. Vocal and orchestral formance of and listening to music. The find- crescendos produced significant correlations ings of these studies suggest, though, that between cardiovascular or respiratory signals musical performance has a greater effect on and musical profile, particularly skin vasocon- emotion-related modulation in cardiac auto- striction and blood pressures, proportional to nomic nerve activity than musical perception crescendo, in contrast to uniform emphasis, (22,23).