European Journal of Cardiovascular Medicine

Music, an art form for thousands of years, is now a daily part of modern life through widely available electronic devices. With countless genres and styles, music is known to influence emotions, moods, and mental well-being, playing a significant role in overall health. Current evidence from individual studies shows that music primarily captures attention, can suppress various emotions, and alters or regulates mood. It enhances work performance, stimulates arousal, promotes higher cognitive functions, regulates inhibitions, and supports rhythmic movement, among other effects. [1] Music has historical roots in medicine, dating back to the 6th century. Ancient Greek philosopher Pythagoras used music to treat physical and psychological ailments, believing that listening to music could align one with the "physical" harmony of the universe, leading to inner mental harmony and restoring balance in the body to help cure mental disorders.[2] In the early 20th century, there was a push for the validation and use of music for therapeutic purposes, employing the same methodological rigor as any other clinical practice in modern medicine. [3] The autonomic nervous system is the primary regulatory mechanism responsible for maintaining the body's flexibility, homeostasis, and adaptability, both at rest and in stressful conditions. Its control centers are located in the cortical regions (cerebral cortex) and subcortical areas (spinal cord, brainstem, hypothalamus, etc.), and its actions are generally beyond voluntary control. Functionally, it is divided into two components: the sympathetic and parasympathetic divisions, which typically operate in opposition to each other. This system oversees and regulates all essential processes, including internal organ activity, homeostasis, smooth muscle function, heart and gland functions, metabolism, and other critical physiological functions(4). Heart rate variability (HRV) is widely regarded in the literature as one of the key indicators of autonomic regulation of heart function. Even in a normal ECG recording, the time intervals between R-R oscillations can be observed to fluctuate. Musical sound stimulation influences HRV through a neural mechanism that remains not fully understood [5].

Previous research has demonstrated that exposure to various types of music improves sustained attention when compared to a control group. [6] Additionally, various types of music, such as those with high-frequency beats, have been found to enhance alertness and attentional focus. Music has also been shown to have positive effects on physiological responses [7,8] A study conducted by Kirk et al evaluated how exposure to various types of calming music genres affects HRV in 120 healthy adults. The performance discrepancies on sustained attention to response task (SART) were evident when comparing the three active music groups to the no-music control group. In addition, the research revealed a physical change indicating more parasympathetic activity through a higher HRV response in three music groups compared to the group with no music, contributing to existing evidence indicating that music can boost parasympathetic activity and cognitive abilities.[9]

Darki et al, he conducted a survey with 100 participants answering five questions about mood to study how listening to classical music like Beethoven's "Symphony of Fate" and "Moonlight Sonata" affects heart rate, BP, and mood states.[10] Kunikullaya et al. investigated how just listening to an Indian music scale affected cardiovascular electrophysiological parameters. The participants were split in 2 groups, with 34 individuals in each group. Group A experienced the music intervention through passive listening to Hindustani melodic scale elaboration (Bhimpalas raga alaap), while Group B did not receive any intervention except for occasional natural sounds (played every 2 minutes). [11] A study conducted by Adlakha et al in the year 2023, assessed how listening to OM chanting affects the cardiovascular system and HRV. 30 men and 20 women, all averaging 20.98 years old (SD= 1.27), were included in the research. [12]

Research has shown that familiar music is more likely than unfamiliar music to lead to emotional arousal [13]. Predictions and expectations of auditory events in familiar music compositions are higher resulting in elevated dopamine release in the reward system of the brain [14], as well as activation of emotion-related processing [15]. This phenomenon suggests that familiarity might play an important role in the emotional engagement of listeners with the music. Hence the present study was an attempt to assess the effect of different types of music on HRV.

This cross-sectional observational study was conducted in the Department of Physiology at Government Medical College, Patiala, from January to December 2023. A total of 120 subjects, aged 18 to 25, were enrolled based on specific inclusion and exclusion criteria. The study was approved by the Institutional Ethics Committee, and consent was obtained from all participants using a predesigned proforma. Subjects were seated comfortably with their backs towards the recording machine for relaxation. The following anthropometric parameters were measured using standardized techniques: height (cm), weight (kg), body mass index (BMI) calculated via Quetlet's Index (BMI = weight/height²), and body surface area (BSA) using the Dubois & Dubois formula. The study included voluntary participants aged 18 to 25 of both genders. Exclusion criteria ruled out individuals with hypertension, a history or treatment of cardiovascular diseases, diabetes, or those who had taken any drugs within 12 hours prior to testing.

Statistical Analysis

The data was analyzed using IBM SPSS version 20. Frequency percentages was calculated for determining the distribution of the study subjects. Descriptive analysis of the quantitative variables was done that included variables of anthropometric variables and other variables of time-domain and frequency analysis. One-sample Kolmogorov Smirnov test was employed to test the normality. To compare the effectiveness of the music therapy with reference to each genere, paired t-test was used. P-value<0.05 was considered as statistically significant

The present study enrolled a total of 120 study subjects, comprising of more than 50% of females followed by males (as shown in Figure 1).

Table 1: Baseline characteristics of the study subjects

Table 1 provides a detailed overview of the baseline characteristics of the study subjects, covering anthropometric measures, cardiovascular parameters, and heart rate variability (HRV) through time and frequency domain analyses.Anthropometric parameters reveal that the average age of participants was 21.28 years (±2.28), with a mean height of 172.53 cm (±7.06), weight of 70.06 kg (±11.07), and body mass index (BMI) of 23.49 kg/m² (±3.03). The body surface area (BSA) was 1.62 m² (±0.27). These values reflect a relatively young and healthy population.Cardiovascular measurements include an average systolic blood pressure (SBP) of 108.73 mm Hg (±5.48) and diastolic blood pressure (DBP) of 69.18 mm Hg (±5.25), both within normal ranges. The average pulse rate was 83.44 beats per minute (bpm) (±11.25), suggesting a typical resting heart rate for this demographic.In the time domain analysis, which assesses heart rate variability (HRV) in a silent state, the mean RR interval (time between heartbeats) was 0.71 seconds (±0.10), indicating the regularity of heartbeats. The standard deviation of the RR intervals (SDRR) was 0.04 (±0.03), showing low variability. The average heart rate (HR) was 86.21 bpm (±11.91). Other HRV indicators included the root mean square of successive differences (RMSSD) of 26.25 milliseconds (±21.10), NN50 count (number of pairs of successive NN intervals differing by more than 50 ms) of 8.53 (±7.90), and pNN50 (percentage of NN50) at 5.71% (±5.40), suggesting moderate autonomic activity.Frequency domain analysis further explores HRV by examining different frequency components of the heart's oscillations. The very-low-frequency (VLF) peak was 0.03 Hz (±0.01), low-frequency (LF) peak was 0.08 Hz (±0.03), and high-frequency (HF) peak was 0.17 Hz (±0.03). In terms of power, VLF power was 9.37 ms² (±22.01), LF power was 20.25 ms² (±47.47), and HF power was 8.68 ms² (±17.62). These values indicate the distribution of power in different frequency bands, representing different autonomic functions. LF power as a percentage of total power was 47.02% (±15.05), HF power was 26.24% (±14.61), and VLF power was 26.49% (±18.55). The LF/HF ratio was 2.36 (±1.37), suggesting the balance between sympathetic and parasympathetic nervous system activity. Additionally, normalized LF power was 65.38% (±13.08), and normalized HF power was 35.04% (±13.52), further illustrating the autonomic balance in the subjects.

Table 2: Comparison of different intervention with reference to each music genre

Table 2 compares the physiological effects of different music genres—Raag Darbari, POP, and Punjabi music—on blood pressure, heart rate, and heart rate variability (HRV) metrics during silent and music-listening states.Systolic Blood Pressure (SBP): Raag Darbari caused a slight, non-significant increase in SBP (110.02 mm Hg, p=0.13), while POP and Punjabi music significantly raised SBP to 125.17 mm Hg and 120.97 mm Hg, respectively (p=0.00 for both). This indicates that faster-paced music leads to a stronger cardiovascular response.Diastolic Blood Pressure (DBP): Raag Darbari had no significant effect on DBP (68.50 mm Hg, p=0.33), while POP and Punjabi music significantly increased DBP to 79.63 mm Hg and 78.97 mm Hg (p=0.00), suggesting that these genres elevate blood pressure more than Raag Darbari.Pulse Rate (PR): Raag Darbari slightly lowered PR (81.58 bpm, p=0.11), while both POP (86.43 bpm, p=0.04) and Punjabi music (86.33 bpm, p=0.02) significantly increased PR, indicating that these genres increase heart rate more effectively.Heart Rate Variability (HRV): In terms of HRV metrics, Raag Darbari showed minimal effects, while POP and Punjabi music significantly affected parameters like Mean RR interval, LF power, and LF/HF power ratio, reflecting increased autonomic nervous system activity in response to these genres.

The result showed that POP and Punjabi music had a more pronounced impact on increasing blood pressure, pulse rate, and HRV measures compared to Raag Darbari, which showed subtler effects.

Listening to music can affect not only our emotions and feelings but also higher feelings, moods, and affections. It may have its roots in motor rhythms controlling heart rate, breathing, and locomotion, dominated by brain stem the ancient structure; fast, loud sounds produce an increased activation of the brain and some evidence suggests that the musical rhythm can regulate emotion and motivational states.

This study was done between 120 medical students of age group 18 to 25 years evaluate to the effect of different types of music on HRV. The study subjects were taken up amongst the healthy medical students attending the Department of Physiology, Government Medical College, Patiala. All 120 subjects were exposed to 4 different states- Silent State, Raaga Darbari, Pop Music, and Typical Punjabi Music. We studied SBP, DBP Pulse rate, and HRV (both time and frequency domain analysis).

DBP in subjects (in silent state) was 69.183±5.253 mm of Hg.  DBP after exposure to Raaga Darbari, Pop music, and Punjabi music were 68.500±6.136, 79.633±5.609, and 78.967±5.651 mm of Hg, respectively. As compared to silent state, there was a statistically highly significant difference for exposure to POP music, and Punjabi music (p=0.001 for both). While difference between silent state and exposure to Raag Darbari was non-significant (p=0.332).The pulse rate was 83.442±11.253 bpm in silent state, and 81.583±10.477, 86.425±11.305, and 86.333±10.945 bpm when exposed to Raaga Darbari, Pop music, and Punjabi music, respectively. As compared to silent state, there was a statistically highly significant difference for exposure to POP music, and Punjabi music (p ≤0.05 for both). While difference between silent state and exposure to Raag Darbari was non-significant (p=0.106).The findings of the present study correspond with those of Darki et al (2022).[10] Subjects had SBP of 116.0 ± 10.9 mm Hg, and mean resting DBP of 73.15 ± 10.0 mm Hg. With fast music, SBP was 122.1 ± 13.9 mm Hg, and DBP was 79.7 ± 11.2 mm Hg. For slow music, SBP was 110.5 ± 9.7 mm Hg, and DBP was 70.7 ± 9.8 mm Hg. SBP, and DBP difference in resting, fast music, and slow music was statistically significant (p <.05).Studies show that the passive listening task produces a sympathetic response when it is emotionally arousing music.[16] Passive listening to positively valenced music increased HR and was associated with a mind-wandering state.[17] Familiar folk melody resulted in greater pupil dilations (sympathetic arousal) compared to unfamiliar (novel) stimuli.[18] Unfamiliar relaxing music caused a significant relaxation response (galvanic skin resistance, HR and peripheral temperature).[19,20]. Moreover, Kunikullaya et al [11] reported that no change in SBP during music intervention (Bhimpalas raga alaap) but mild increase after the intervention (P = 0.054). DBP increased in both groups (one exposed to music intervention- Bhimpalas raga alaap and other to a few natural sounds). It was significant in group exposed to music intervention (P = 0.009). On the other hand, Suguna S et al[12] also found that post-exposure to fast music causes significant increase in pulse rate (p =0.012), SBP (p = 0.004), DBP (p = 0.018).

The present study showed that comparison to silent state and exposure to Raag Darbari, there was a statistically significant difference for RMSSD, NN50, and pNN50 (%) (p ≤0.05 for all). While there was no significant difference between silent state and exposure to Raag Darbari regarding rest of the time domains (Mean RR, STD (SDRR), and Mean HR). Comparison of silent state and exposure to POP music showed significant differences (p ≤0.05) with respect to mean RR, and MHR. While there was non-significant difference with respect to STD (SDRR), RMSSD, NN50, and pNN50. While comparison of silent state and exposure to Punjabi music showed statistically significant differences (p ≤0.05) with respect to Mean RR, MHR. While there was non-significant difference with respect to STD (SDRR), RMSSD, NN50, pNN50.Similar findings were reported by Kunikullaya et al [11]. Our findings correspond with those of Jain et al [23] who reported that the mean RR interval was increased with both types of music stimuli (Raaga ‘Bhairavi’ and Pop music), but the effect was statistically significant (P=0.0123) with ‘Bhairavi’. As HR is the opposite of the RR interval, it decreased with both types of music stimuli, but notably (P=0.0031) with ‘Bhairavi’ only. Both types of music stimuli showed a significant decrease in SDNN (P=0.0145, P=0.0152). Nonetheless, there was a significant increase in RMSSD (P=0.0106) when listening to 'Bhairavi', while minor variations (P=0.0861) were noticed with Pop music. SDNN (ms), LF (ms2), and LF/HF exhibited a statistically significant variance between the silent state and Pop music.

The findings suggest that different music genres have varying effects on physiological responses. Raag Darbari produced minimal changes in blood pressure and heart rate, while POP and Punjabi music significantly increased systolic and diastolic blood pressure, pulse rate, and heart rate variability. This indicates that faster-paced music (POP and Punjabi) may stimulate the autonomic nervous system more intensely, leading to heightened cardiovascular responses, whereas the slower, classical Raag Darbari has a more calming effect. Thus, music genre plays a crucial role in influencing physiological parameters.

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