Music and medicine: The effects of music on the human being

133Music and medicine: The effects of music on the human being

Introduction

Listening to music, whether a Mozart sym-phony or to Antonio Vivaldi’s “the four sea-sons” may not only help to unwind at theend of a stressful day. It could also lowerblood pressure, heart rate and improve heartrate variability. The idea that music has an ef-fect on heart rate, blood pressure and cardio-vascular system has been reported in 1918by Hyde and Scalapino (1). They reportedthat minor tones increased heart rate andlowered blood pressure, whereas “stirring”music increased both blood pressure andheart rate. There are several individual reac-tions to music that are dependent on individ-ual preferences, mood or emotions (2). It hasbeen reported that music showed consistent

cardiovascular and respiratory responseswith different styles in most subjects, inwhom responses were related to tempo andwere associated with faster breathing (3,4).Fast music caused increases in blood pres-sure, heart rate and breathing rate, and re-duced baroreflex sensitivity. Slow music, onthe other hand, caused a significant fall inheart rate and breathing frequency com-pared with the baseline. The responses werequalitatively similar in musicians and nonmu-sicians and apparently were not influencedby musical preferences, although musiciansdid respond more (5).

In recent years, music has been increas-ingly used as a therapeutic tool in the treat-ment of different diseases (6-8). It has beenshown that music therapy not only reduced

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 heartrate 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 listeningto “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 sollallein 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±3.1cm/s). Music significantly decreases the level of anxiety for patients in a preoperative settingcompared to midazolam (STAI-X-1 score 36) (p<0.001). Listening to music while resting in bedafter 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

134 H.-J. Trappe

blood pressure, heart rate and patient anxi-ety but had a significant effect on futureevents, including reinfarction and death, inacute coronary syndrome patients who un-derwent revascularization (Dr. Predrag Mitro-viv, ESC congress 2009, Barcelona, personalcommunication). Miller et al showed that mu-sic also affects endothelial function and inthis study brachial artery flow mediated dila-tion increased 26% during music phase thatevoked joy compared to baseline(p<0,002)(9). The purpose of the presentmanuscript is to summarize the different ef-fects of music on health, cardiovascular pa-rameters, anxiety, pain and to describe whatkind of music is helpful for whom and whatkind of music is probably dangerous.

Effects of music on the cardio-vascular pathophysiology inthe pregnant woman

It is well known that music, as a stimulus, canbe recognized as early as the twentieth weekof fetal development. The unborn baby willrecognize all sounds and will “learn” music inthis way (10,11). This is the first sensory im-pression for the child. There is general agree-ment that soft sounds with regular and lowrhythms (“lullabies”) are ideal for the unborn

baby or even in children born before the reg-ular date of birth. This is a well known inter-action between the baby and the mother andwill help to avoid colic in newborns. In addi-tion, music is also helpful for the mother pri-or to delivery. Yang et al (12) studied the ef-fect of music on anxiety alleviation in 120 an-tepartal women on bed rest. These womenreceived music therapy for 30 min on 3 con-secutive days. Music was selected accordingto the women’s own preferences. Usual careparticipants had a 30 minute rest on 3 con-secutive days. Variables included anxiety(State-Trait Anxiety Inventory), and physiolog-ical responses like vital signs and fetal heartrate. Anxiety levels decreased and physiolog-ical responses improved significantly in thewomen with music therapy while on bedrest. In another study by Kim et al (13) it wassuggested to play music for women duringpregnancy, birth and nursing. Increased sym-pathetic activity during pregnancy has beenproposed as a mechanism for increased inci-dence of arrhythmias and, therefore, musicmay help to avoid them (14,15). Occurrenceof cardiac tachyarrhythmias may also be re-lated to physiologic changes occurring dur-ing pregnancy, such as increased heart rate,decreased peripheral resistance and in-creased stroke volume. Music with slowrhythms, soft sounds and particularly music

abstract thinking

analytic thinking

rational thinking

intellect

linguistic abilities

rhythmic abilities

recognition of people

emotionality

intuition

spatial reasoning

visual reasoning

imagination

musicality

analogical thinking

left hemisphere right hemisphere

cerebral function

Figure 1: Brain asso-ciation areas. Localiza-tion of different functio-nal areas in the left orright brain hemisphere


from Mozart is beneficial in these circum-stances and opens new possibilities for un-born (and born) babies as well as for themother. It seems possible to prevent cardiacarrhythmias for both mother and the unbornchild as well as to prevent sudden infantdeath. In addition to these cardiovascular ef-fects, there is a significant improvement incognitive function (Binet intelligence scale)when listening to Mozart’s music (score57.56) compared to relaxation (score 54.61)or silence (score 54.00) (p<0.002). In relationto each other, the relaxation and silence con-ditions did not differ (p=0.43) (16). Musiccan also be helpful in instances of depressionand more specifically postpartum depression(17). It seems that Mozart has benefitial ef-fects on energy expenditure in growingpreterm infants (18).

Effects of music on the pathophysiology and the cardiovascular system

Bernardi et al. (19) studied 24 young, healthysubjects (12 chorists and 12 nonmusiciancontrol subjects) who listened in random or-der to music with vocal (Puccini’s “Turan-dot”) or orchestral (Beethoven’s Ninth Sym-phony adagio) progressive crescendos, moreuniform emphasis (Bach’s Cantata BWV 169“Gott soll allein mein Herz haben”), 10-sec-ond period rhythmic phrases (Verdi’s arias“Va pensiero” and “Libiam nei lieti calci”) orsilence while heart rate, respiration, bloodpressure, middle cerebral artery flow veloci-ty, and skin vasomotion were recorded.Common responses were recognized by av-eraging instantaneous cardio respiratory re-sponses regressed against changes in musicalprofiles and by coherence analysis duringrhythmic phrases. Vocal and orchestralcrescendos produced significant correlationsbetween cardiovascular or respiratory signalsand musical profile, particularly skin vasocon-striction and blood pressures, proportional tocrescendo, in contrast to uniform emphasis,which induced skin vasodilation and reduc-

tion in blood pressure (p<0.05). Correlationswere significant both in individual and group-averaged signals (p<0.05). Phrases at 10-sec-ond intervals by Verdi entrained the cardio-vascular autonomic variables. It is importantto note that no qualitative differences wereobserved in recorded measurements be-tween musicians and nonmusicians. In thisstudy cerebral flow was significantly lowerwhen listening to “Va pensioero“ (70.4±3.3cm/s) compared to “Libiam nei lieti calici(70.2±3.1 cm/s) (p<0,02) or Bach (70.9±2.9cm/s) (p<0,02). There was no significant influ-ence on cerebral flow in Beethoven’s NinthSymphony during rest (67.6±3.3 cm/s) ormusic (69.4±3.1 cm/s). The data by Bernardiet al. (19) also demonstrate that in additionto conscious chills, which typically are expe-rienced by a minority of subjects, there is acommon pattern of unconscious responsewhen different subjects listen to the samemusic. These autonomic responses weremore apparent with lyrical responses from anoperatic aria or a typical exciting orchestralphrase than with more “intellectual” solosinging from a Bach cantata. The extent ofthe responses appeared to be dependent onthe specific pattern of the musical profile.When a sudden crescendo was spaced ade-quately, or the musical profile exhibited a reg-ular or slow change, then the cardiovascularsystem tracked the musical profile, and skinvasomotion was evident. When the musicalprofile changed very rapidly, the overall ef-fect was opposite. Skin vasomotion and a re-duction in blood pressure by general relax-ation were observed (19). It has been shownin other studies by Yoshie et al. (20) andNakahara et al. (21) that music will have ben-eficial effects on heart rate, heart rate variabil-ity and anxiety levels in not only skilled pi-anists but also nonmusicians during both per-formance of and listening to music. The find-ings of these studies suggest, though, thatmusical performance has a greater effect onemotion-related modulation in cardiac auto-nomic nerve activity than musical perception(22,23).

136 H.-J. Trappe

It has been shown that the structure of apiece of music has a constant dynamic influ-ence on cardiovascular and respiratory re-sponses, which correlates with musical pro-files (24,25). Specific musical phrases (fre-quently at a rhythm of 6 cycles/min in fa-mous arias by Verdi) can synchronize inher-ent cardiovascular rhythms, thus modulatingcardiovascular control. This occurred regard-less of respiratory modulation, which sug-gests the possibility of direct entrainment ofsuch rhythms and led to the speculation thatsome of the psychological and somatic ef-fects of music could be mediated by modula-tion or entrainment of these rhythms (26).Music as therapy is an option for all since ithas been reported that musicians and non-musicians alike showed similar qualitative re-sponses (cardiovascular and respiratory sys-tem). This suggests that “active” playing ofmusic is not essential to induce synchroniza-tion with music. However, it was pointed outthat musicians appeared to show higher car-diovascular and respiratory modulation in-duced by music. They also tended to respondmore than nonmusicians to more “intellectu-al” music like that of Bach or Mozart (27-29).

Effect of music during cardiaccatheterization

Argstatter et al. (30) analyzed the role of mu-sic in 90 patients who underwent cardiaccatheterization. There were three random-ized groups: Group I represented patientswith “music only” during catheterization pro-cedures, Group II patients had both musicduring catheterization and extended informa-tion prior to the procedure and Group III pa-tients served as controls. In all groups theanxiety score was evaluated with the cate-gories “minimal anxiety – minimal stress” or“severe anxiety – severe stress”. It was be-coming clear that the behavior during theprocedures was significantly better in GroupI and Group II patients in contrast to controls(p<0.05). However, there were no significantdifferences in heart rate and blood pressure

between the three groups. In addition similardrug regimens were used prior to and afterthe procedure. Recently, in the Almut-studythe effect of different types of music duringcardiac catheterization procedures was ana-lyzed by an anxiety score system betweenpatients who had music during the proce-dure compared to those who did not (31). Inaddition to the anxiety score, heart rate andblood pressure were recorded. There werepatients who listened to classical music, me -ditation music, Jazz or silence. In patientswho were not able to select their own music,the most beneficial effect was seen in thosewho had classical music. In patients who se-lected their own music, meditation musicwas most powerful. Although there were sig-nificant differences in the anxiety index be-tween patients with or without music(p<0.05), no significant differences amongthe two groups were observed in heart rateor blood pressure.

Effect of music on the cardio-pulmonary pathophysiologyprior to and after cardiac surgery

The influence of music was studied prior tobypass grafting or valve replacement in 372patients wherein a portion of the group re-ceived midazolam (0.05-0.1 mg/kg) accord-ing to the STAI-X-1 anxiety score (32). Of the372 total patients, there were 177 patientswho had music prior to surgery and 195 pa-tients who received midazolam. There weresignificant differences in the anxiety scoresprior to and after surgery between bothgroups: in the “music group” prior to and af-ter surgery the score was 34 and 36 respec-tively, whereas the score was 30 and 34 inthe midazolam group (p<0.001). Nilsson etal. (33) analyzed 40 patients who underwentbypass grafting or aortic valve replacementand in these patients oxytocin, heart rate,blood pressure, PaO2 and oxygen saturationSaO2 were studied in two groups: one group


had music, the other group served as con-trols. As pointed out by the authors therewere significantly better values of oxytocin(increased) and PaO2 (increased) in the mu-sic group compared to controls (p<0.05). Nosignificant differences were observed regard-ing heart rate, blood pressure and SaO2. Inanother study, Nielsson et al. (34) analyzedthe follow-up of 58 patients after cardiac sur-gery. These patients underwent musical ther-apy (30 min music exposure one day aftersurgery) compared to controls. Evaluation ofcortisol, heart rate, ventilation, blood pres-sure, SaO2, pain and anxiety indices was per-formed. There were significantly lower corti-sol levels in the music group (484.4 mmol/l)compared to patients without music (618,8mmol/l) (p<0.02). There were no significantdifferences in heart rate, blood pressure, res-piration and oxygen saturation between bothgroups. Similar effects have been reported byAntonietti in patients who underwent rehabil-itation after surgery (35).

Effects of music on intensivecare patients, geriatric and terminally ill patients

It is well known that soft and not loud soundshave beneficial effects on patients whiletreated in intensive care medicine and will re-duce pain and stress significantly (36). Soft,silent or quiet classical or meditation music isassociated with the reduced need for seda-tive drugs and reduced perception of pain.Despite the well known effects of music in in-tensive care medicine this kind of “therapy”is observed rarely in daily practice. In addi-tion to this, there are many psychological ef-fects: music from the youth of the patient willlead to improved mood, concentration andmotivation, all of which are essential for theintensive care patient. There are spectaculareffects of music in geriatric patients: musicfrom the youth and music from “better days”will lead to improved mood, motivation, in-creased vitality and will also encourage socialcontacts (36). This is important in geriatrics

and in patients with depressive syndromes.Chan et al. (37) performed a randomizedstudy in 47 people under the age of 65 whounderwent music therapy compared to 24controls. In the music group, there were sta-tistically significant decreases in depressionscores (p<0.001), blood pressure (p<0.001),and heart rate (p<0.001) after one month(p<0.001). The implication of this observa-tion is that music can be an effective inter-vention for older and/or patients sufferingfrom depressive syndromes. Particularly olderpatients with Alzheimer diseases will profitfrom music therapy. We all know that the ter-minal patient presents a unique situation. Ithas been reported that these patients willcontinue hearing although some other organfunctions have been lost. Therefore, musicplays an important role in this situation andmusic from the patient’s youth has the mostimpact. This music might prove to be the lastsource of aesthetic enjoyment and simplehappiness for the dying patient (38,39).

What types of music are goodfor health – which are not?

The most beneficial music for the health of apatient is classical music, which holds an im-portant role in music therapy (40). It hasbeen shown that music composed by Bach,Mozart and Italian composers is the mostpowerful in “treating” patients. It is possibleto select the “ideal” therapy for cardiovascu-lar disturbances, recreation and refreshmentof the immune system, improvement of con-centration and help with depression. Thebeneficial effects of Bach’s music is possiblycaused by his “mathematical” compositionsavoiding sudden changes (Fig. 2,3). Patientswho would receive the most benefit fromclassical music include those with anxiety,depressive syndromes, cardiovascular distur-bances and those suffering from pain, stressor sleep disturbances. Popular music is an“eye-opener”. This music incorporates har-monic melodies that will lead to buoyant spir-it, good mood leading to lift in mood, in-

138 H.-J. Trappe

Figure 2: Johann Sebastian Bach (1685-1750): Fuga in D major (BWV 532) for organ solo. This is atypical example of Bach’s music. The theme is conduced in the same manner four times (“A” – “D”).This explains the typical “Bach effect” avoiding sudden changes in tempo and dynamics (measure 1-19).

Figure 3: Johann Sebastian Bach (1685-1750): Fuga in D major (BWV 532) for organ solo. This is atypical example of Bach’s music. The theme is conduced in the same manner four times (“A” – “D”).This explains the typical “Bach effect” avoiding sudden changes in tempo and dynamics (measure20-35).


creased motivation and general stimulation.Meditation music has sedative effects.Sounds are slow and rhythms few. This kindof music generates spiritual reflection and, assuch, is utilized in Yoga and Tai Chi. Heavymetal and techno are ineffective or even dan-gerous. This music encourages rage, disap-pointment, and aggressive behavior whilecausing both heart rate and blood pressureto increase. Breastfeeding mothers shouldavoid this music because there is a negativeinfluence on milk flow. In addition, plantshave been shown to slow their growth oreven die when exposed to this kind of musicon a permanent basis. Hip Hop and Rap areless frequently effective due to the sounds,but can often have effect due to their words– the important element of which is therhyme structure. Jazz appeals to all senses,but a high degree of concentration is neces-sary when listening to Jazz. There are fewstudies of the effect of Jazz on health. Latin-American music like samba, tango, cha-cha-cha, rumba, reggae or mambo is very rhyth-mic. This music leads to positive mood andbuoyant spirit and induces movement. It in-creases motivation and stimulates activity.Folk is music with a socio-cultural back-ground. It is enriching for intellectual work,leads to confidence and emphasizes protec-tion. However, if folklore is “unusual” in char-acter it can have a negative effect. Schlagermusic are songs to sing alone with, have sim-ple structures but frequently have “earworm-character”. This kind of music is inappropri-ate for influencing health.

When is music not useful?

More recently, several reports have indicatedthe usefulness of music therapy in managingpsychiatric disorders (41,42). Music has beenused in the treatment of psychosis and neu-rosis and now is being used in addressing or-ganic disorders such as dementia. It plays auseful role in allaying anxiety and relaxing pa-tients in critical care. Music therapy has beenused effectively in both adults and children

with psychiatric disorders. It has been used tomodify the behavior of children with autismand pervasive developmental disorders withmoderate success. It has been used to re-duce agitation in patients with dementia bysoothing them and eliminating the social iso-lation of these patients (43,44). Music thera-py has been used in patients with Parkinson’sdisease to improve motor skills and to dealwith emotional problems (45). There is ampleevidence of the usefulness of music therapyin alleviating grief and in combating bouts ofdepression. Music no doubt plays a pivotalrole in the lives of human beings. Incorporat-ing music therapy into regular therapy pro-grams for psychiatric disorders can helpspeed recovery and also help make therapy amore positive experience. Music therapy is avaluable but relatively unexplored asset inthe field of psychiatry and psychotherapy.However, the patient may or may not like themusic chosen by the therapist and thus is giv-en a choice to include music or not. Carefulselection of music that incorporates patient’sown preferences may yield positive results,whereas contrary effects may result from useof the wrong type of music. Selection of“wrong” music can intensify depressive syn-dromes, aggressiveness and anxiety. In addi-tion, feelings toward music may change dur-ing different phases of life and may lead todifferent effects.

Conclusions

Music is used more and more as a therapeu-tic tool, because all subjects, whether musi-cally trained or not, respond in a similar man-ner. Music is a combination of frequency,beat, density, tone, rhythm, repetition, loud-ness, and lyrics. Different basic personalitiestend to be attracted to certain styles of mu-sic. Energy block patterns can intensify, re-duce, or change the natural inclinations of aperson’s identity. Music influences our emo-tions because it takes the place of and ex-tends our languages. Research conductedover the past 10 years has demonstrated that

140 H.-J. Trappe

persistent negative emotional experiences oran obsession and preoccupation with nega-tive emotional states can increase one’s like-lihood of acquiring the common cold, otherviral infections, yeast infestations, hypersensi-tivities, heart attacks, high blood pressure,and other diseases. For better personalhealth, we can then choose „ healthful“ mu-sic and learn to let ourselves benefit from it.The most benefit from music on health isseen in classical and in meditation music,whereas heavy metal or techno are ineffec-tive or even dangerous. There are many com-posers that effectively improve quality of lifeand health, particularly Bach, Mozart or Ital-ian composers. Various studies suggestedthat this music not only makes one happy,but has significant effects on the cardiovascu-lar system and influences significantly heartrate, heart rate variability and blood pressureas well. Music is effective under differentconditions and can be utilized as an effectiveintervention in patients with cardiovasculardisturbances, pain, depressive syndromes,psychiatric diseases, and in intensive caremedicine. A distracting effect of music canprolong exercise by increasing the thresholdfor pain or dyspnea. An externally driven au-tonomic modulation could be of practicaluse to induce body sensation, increase inheart rate or skin vasoconstriction, whichmight finally reach the level of consciousnessor at least create a continuous stimulus to theupper brain centers. This might explain theefficacy of music in pathological conditionssuch as stroke, and it opens new areas formusic therapy in rehabilitative medicine.Nevertheless, the possible therapeutic valueof Bach’s or Mozart’s music on cardiovascu-lar parameters and health should be a pointof immediate interest. The hypothesis thatBach’s or Mozart’s music is helpful on healthhas to be proven by prospective, randomizedanimal and human being studies.

References

1. Hyde IM, Scalapino W. The influence ofmusic upon electrocardiograms and bloodpressure. Am J Physiol 1918; 46: 35-38

2. Koelsch S, Siebel WA. Towards a neural ba-sis of music perception. Trends Cogn Sci2005; 9: 578-584

3. Altenmueller E, Schuermann K, Lim VK, Par-litz D. Hits to the left, flops to the right: dif-ferent emotions during listening to musicare reflected in cortical lateralisation pat-terns. Neuropsychologia 2002; 40: 2242-2256

4. Bernardi L, Porta C, Sleight P. Cardiovascu-lar, cerebrovascular, and respiratorychanges induced by different types of mu-sic in musicians and non-musicians: the im-portance of silence. Heart 2006; 92: 445-452

5. Trappe HJ. Music and health – what kind ofmusic is helpful for whom? What musicnot? Dtsch Med WSchr 2009; 134: 2601-2606

6. Mansky PJ, Wallerstedt DB. Complementa-ry medicine in palliative care and cancermanagement. Cancer J 2006; 12: 425-431

7. Särkämö T, Tervaniemi M, Laitinen S, Fors-blom A, Soinila S, Mikkonen M, Autti T, Sil-vennoinen HM, Erikkilä J, Laine M, Peretz I,Hietanen M. Music listening enhances cog-nitive recovery and mood after middle cere-bral artery stroke. Brain 2008; 131: 866-876

8. Bernatzky G, Bernatzky P, Hesse HP,Staffen W, Ladurner G. Stimulating musicincreases motor coordination in patients af-flicted with Morbus Parkinson. NeurosciLett 2004; 361: 4-8

9. Miller M, Mangano C, Vogel RA. Positiveemotions and the endothelium: does joyfulmusic improve vascular health? Circulation2008; 118: 1148 (Abstract)

10. Hartling L, Shaik MS, Tjosvold L, Leicht R,Liang Y, Kumar M. Music for medical indica-tions in the neonatal period: a systematic re-view of randomised controlled trials. ArchDis in Child, Fetal Neonatal, 2009; 94: 349-354

11. Amagdei A, Baltes FR, Avram J, Miu AC.Perinatal exposure to music protects spatialmemory against callosal lesions. Int J DevNeurosci 2010; 28: 105-109

12. Yang M, Li L, Zhu H, Alexander IM, Liu S,Zhou W, Ren X. Music therapy to relieve


anxiety in pregnant women on bed rest: arandomised, controlled trial. Am J MaternChild Nurs 2009; 34: 316-323

13. Kim J, Wigram T, Gold C. Emotional, moti-vational and interpersonal responsivenessof children with autism in improvisationalmusic therapy. Autism, 2009; 13: 389-409

14. Barron WM, Mujais SK, Zinamam M, BravoEL, Lindheimer MD. Plasma catecholamineresponses to physiologic stimuli in normalhuman pregnancy. Am J Obstet Gynecol1986; 154: 80-84

15. Speranza G, Verlato G, Albiero A. Auto-nomic changes during pregnancy: assess-ment by spectral heart rate variability analy-sis. J Electro Cardiol 1998; 31: 101-109

16. Rauscher FH, Shaw GL, Ky KN. Music andspatial task performance. Nature 1993;365: 611

17. Osuch EA, Bluhm RL, Williamson PC,Théberge J, Densmore M, Neufeld RW.Brain activation to favourite music inhealthy controls and depressed patients.Neuroreport 2009; 26: 1204-1208

18. Lubetzky R, Mimouni FB, Dollberg S, ReifenR, Ashbel G, Mandel D. Effect of music byMozart on energy expenditure in growingpreterm infants. Pediatrics 2010; 125: 24-28

19. Bernardi L, Porta C, Casucci G, Balsamo R,Bernardi NF, Fogari R, Sleight P. Dynamic in-teractions between musical, cardiovascular,and cerebral rhythms in humans. Circula-tion 2009; 30, 119: 3171-3180

20. Yoshie M, Kudo K, Murakoshi T, Ohtsuki T.Music performance anxiety in skilled pi-anists: effects of social-evaluative perform-ance situation on subjective, autonomic,and electromyographic reactions. Exp BrainRes 2009; 199: 117-126

21. Nakahara H, Furuya S, Obata S, Masuko T,Kinoshita H. Emotion-related changes inheart rate and its variability during perform-ance and perception of music. Ann NYAcad Sci 2009; 1169: 359-362

22. Chan MF, Chan EA, Mok E, Kwan Tse FY. Ef-fect of music on depression levels and phys-iological responses in community-basedolder adults. Int J Health Nurse 2009; 18:285-294

23. Koelsch S. A neuroscientific perspective onmusic therapy. Ann NY Acad Sci 2009;1169: 374-384

24. Bernardi L, Sleight P, Bandelli G, Cinetti S,Fattorini L, Wdowczyc-Szulc J. Lagi A. Effect

of rosary prayer and yoga mantras on auto-nomic cardiovascular rhythms: comparativestudy. BMJ 2001; 323: 1446-1449

25. Lin LC, Lee WT, Wu HC, Tsai CL, Wei RC,Jong YJ, Yang RC. Mozart K.448 and epilep-tiform discharges: effect of ratio of lower tohigher harmonics. Epilepsy Res 2010; 89:238-245

26. Grewe O, Nagel F, Kopiez R, Altenmüller E.How does music arouse “chills”? Investigat-ing strong emotions, combining psychologi-cal, physiological, and psychoacousticalmethods. Ann NY Acad Sci 2005; 1060:446-449

27. Marques JC, Vanessa AC, Fiorelli MB, Kasa-hara N. Improved automated perimetry per-formance in elderly subjects after listeningto Mozart. Clinics 2009; 64: 665-667

28. Bock O. Sensimotor adaptation is influ-enced by background music. Exp Brain Res2010; 203: 737-741

29. Lemmer B. Effects of music composed byMozart and Liegeti on blood pressure andheart rate circadian rhythms in normoten-sive and hypertensive rats. ChronobiologyInternational 2008; 25: 971-986

30. Argstatter H, Haberbosch W, Bolay HV.Study of the effectiveness of musical stimu-lation during intracardiac catheterization.Clin Res Cardiol 2006; 95: 14-22

31. Goertz W. Bach oder Jazz – vom Patientenoder vom Los gewählt? Zur Wirkung vonMusik im Herzkatheterlabor. Clin Res Cardi-ol 2009; 86: 802 (Abstrakt)

32. Bringman H, Giesecke K, Thörne A, Bring-man S. Relaxing music as pre-medicationbefore surgery: a randomised controlled tri-al. Acta Anaestesiol Scand 2009; 53: 759-764

33. Nilsson U. The effect of music interventionin stress response to cardiac surgery in arandomized clinical trial. Heart Lung 2009;38: 201-207

34. Nilsson U. Soothing music can increaseoxytocin levels during bed rest after open-heart surgery: a randomized control trial. JClin Nurs 2009; 18: 2153-2161

35. Antonietti A. Why is music effective in reha-bilitation? Stud Health Technol Inform2009; 145: 179-194

36. Schwabe C. Music therapy in geriatric reha-bilitation. Zeitschrift für die gesamte Hy-giene und ihre Grenzgebiete 1981; 27: 937-941

142 H.-J. Trappe

37. Chan MF, Chung YF, Chung SW, Lee OK. In-vestigating the physiological responses ofpatients listening to music in the intensivecare unit. J Clinical Nurs 2009; 18: 1250-1257

38. Silverman MJ. The effect of single-sessionpsychoeducational music therapy on verbal-izations and perceptions in psychiatric pa-tients. J Music Therapy 2009; 46: 105-131

39. Freeman L, Caserta M, Lund D, Rossa S,Dowdy A, Partenheimer A. Music thanatol-ogy: prescriptive harp music as palliativecare for the dying patient. Am J of Hosp Pal-liat Care 2006; 23: 100-104

40. Gess A. Birds like music, too. Science 2007;317: 1864

41. Covington H. Therapeutic music for pa-tients with psychiatric disorders. Holist NursPract 2001; 15: 59-69

42. Brotons M, Marti P. Music therapy withAlzheimer’s patients and their caregivers: apilot project. J Music Ther 2003; 40: 138-150

43. Lou MF. The use of music to decrease agi-tated behaviour of the demented elderly:the state of science. Scand J Caring Sci2001; 15: 165-173

44. Gotell E, brown S, Ekman SL. Caregiversinging and background music in dementiacare. West J Nurs Res 2002; 24: 195-216

45. Pacchetti C, Mancini F, Aglieri R, Fundaro C,Martignoni E, Nappi G. Active music thera-py in Parkinson’s disease: an integrativemethod for motor and emotional rehabilita-tion. Psychosom Med 2000; 62: 386-393

Address for correspondence:Prof. Hans-Joachim Trappe, M.D.Department of Cardiology and AngiologyUniversity of BochumHoelkeskampring 4044625 [email protected]

Documents

Music and medicine: The effects of music on the human being