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Year : 2013  |  Volume : 15  |  Issue : 65  |  Page : 281--287

The effects of different styles of musical auditory stimulation on cardiac autonomic regulation in healthy women

Adriano L Roque1, Vitor E Valenti2, Heraldo L Guida2, Mônica F Campos3, André Knap2, Luiz Carlos M Vanderlei4, Celso Ferreira1, Luiz Carlos de Abreu1,  
1 Post-Graduation Program in Cardiology, UNIFESP, Sao Paulo, SP, Brazil
2 Department of Speech Language and Hearing Therapy, Faculty of Philosophy and Sciences, UNESP, Marília, SP, Brazil
3 Department of Physical Education, Institute of Biosciences, UNESP, Rio Claro, SP, Brazil
4 Department of Physical Therapy, Faculty of Sciences and Technology, UNESP, Presidente Prudente, SP, Brazil

Correspondence Address:
Vitor E Valenti
Department of Speech Language and Hearing Therapy, Faculty of Philosophy and Sciences, UNESP, Marília, SP


The literature investigated the effects of chronic baroque music auditory stimulation on the cardiovascular system. However, it lacks in the literature the acute effects of different styles of music on cardiac autonomic regulation. To evaluate the acute effects of baroque and heavy metal music on heart rate variability (HRV) in women. The study was performed in 21 healthy women between 18 and 30 years old. We excluded persons with previous experience with music instrument and those who had affinity with the song styles. All procedures were performed in the same sound-proof room. We analyzed HRV in the time (standard deviation of normal-to-normal respiratory rate (RR) intervals, root-mean square of differences between adjacent normal RR intervals in a time interval, and the percentage of adjacent RR intervals with a difference of duration greater than 50 ms) and frequency (low frequency [LF], high frequency [HF], and LF/HF ratio) domains. HRV was recorded at rest for 10 min. Subsequently they were exposed to baroque or heavy metal music for 5 min through an earphone. After the first music exposure they remained at rest for more 5 min and them they were exposed again to baroque or heavy metal music. The sequence of songs was randomized for each individual. The power analysis provided a minimal number of 18 subjects. Shapiro-Wilk to verify normality of data and analysis of variance for repeated measures followed by the Bonferroni test for parametric variables and Friedman's followed by the Dunn's post-test for non-parametric distributions. During the analysis of the time-domain indices were not changed. In the frequency-domain analysis, the LF in absolute units was reduced during the heavy metal music stimulation compared to control. Acute exposure to heavy metal music affected the sympathetic activity in healthy women.

How to cite this article:
Roque AL, Valenti VE, Guida HL, Campos MF, Knap A, Vanderlei LM, Ferreira C, de Abreu LC. The effects of different styles of musical auditory stimulation on cardiac autonomic regulation in healthy women.Noise Health 2013;15:281-287

How to cite this URL:
Roque AL, Valenti VE, Guida HL, Campos MF, Knap A, Vanderlei LM, Ferreira C, de Abreu LC. The effects of different styles of musical auditory stimulation on cardiac autonomic regulation in healthy women. Noise Health [serial online] 2013 [cited 2022 Dec 1 ];15:281-287
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The literature has investigated the effects of musical auditory stimulation on human health. [1],[2],[3] Exposure to baroque music presented positive effects on the system cardiovascular. Bernardi et al., [4] studied 24 healthy young adults, they evaluated the effect of music with vocals (for Puccini "Turandot"), orchestra (Beethoven's Ninth Symphony) and progressive crescendos (Bach Cantata BWV 169 "Gott soll allein mein Herz haben") on heart rate (HR), respiratory rate (RR), blood pressure, and middle cerebral artery flow. They observed reduced activity of the sympathetic nervous system.

On the other hand, exposure to heavy metal styles music present negative effects related to stress. Among the responses induced by heavy metal music exposure we may include sleep disorders, fatigue, exhaustion and immunologic activity impairment. [5] It is hypothesized that while baroque music auditory stimulation reduces the sympathetic nervous system activity, heavy metal music auditory stimulation increases sympathetic activity.

A non-invasive method for investigation of autonomic nervous system (ANS) that describes the oscillations of the intervals between consecutive heartbeats is the heart rate variability (HRV). This method is a conventionally accepted term to describe the fluctuations in the intervals between consecutive heartbeats (RR intervals), which are indicated to influence the sinusal node. [6]

Most researches of music therapy have focused on subjects awaiting surgical procedures, receiving treatment, or immediately after surgery, with few researches focusing on the effects of music therapy in treated cancer survivors who finished their treatment. It lacks in the literature studies that focuses on physiological responses to baroque and heavy metal music on HRV.

Although it was reported the benefic effects of musical auditory stimulation for long time, [7] no previous investigated the short term effects of baroque and heavy metal music on HRV. In addition, the relationship between singers and non-music professionals and music was investigated previously. [8],[9],[10] Sα and Pereira [8] reported that exposure to musical auditory stimulation in different styles did not affect the P300 in young females. The knowledge of physiological responses in women induced by music exposure is important to development future therapies in order to prevent the development of cardiovascular disorders. Therefore, we aimed to evaluate the acute effects of relaxant baroque and exciting heavy metal musical auditory stimulation on the time and frequency domain indices of HRV in healthy women, we performed post-hoc test comparison with parametric and non-parametric data according to each distribution. We also investigated the equivalent sound level of auditory musical stimulation of the relaxant baroque and exciting heavy metal music style.


Study population

We analyzed a total of 21 female healthy students non- smokers aged between 18 and 30 years old, selected from our Institution (one African, four Asiatic, and 16 Caucasian). No volunteers were to low-income family. The reason for this selection was to obtain a homogenous sample from a similar socio-economic class. We investigated only women at this age because there is difference between men and women regarding sexual hormones that influences their physiological responses in different situations. Furthermore, age also affects HRV. [11] All volunteers were informed about the procedures and objectives of the study and, after agreeing, have signed a term of informed consent. All study procedures were approved by the Ethics Committee in Research of the Faculty of Sciences of the Universidade Estadual Paulista, Campus of Marilia (Case No. CEP-2011-382) and followed the resolution 196/96 National Health 10/10/1996.

Exclusion criteria

We considered the following exclusion criteria: Cardiopulmonary and auditory disorders, psychological, neurological, and other impairments that prevent the subject known to perform procedures, and treatment with drugs that influence cardiac autonomic regulation. The healthy cardiovascular system of the volunteers was defined by measuring blood pressure, that confirmed their non-hypertensive state and by measuring baseline HR that confirmed their non-tachycardic state. The healthy state of the subjects was confirmed based on previous studies. [12],[13],[14] We also excluded subjects with previous experience with music instrument and classic ballet music, as well as volunteers which like heavy metal and baroque music styles, since it affects cardiovascular responses. [15]

Initial evaluation

Before the experimental procedure, volunteers were identified by collecting the following information: Age, gender, weight, height, and body mass index (BMI). Anthropometric measurements were obtained according to Lohman. [16] Weight was determined by using a digital scale (W 200/5, Welmy, Brazil) with a precision of 0.1 kg. Height was determined by using a stadiometer (ES 2020, Sanny, Brazil) with a precision of 0.1 cm and 2.20 m of extension. BMI was calculated using the following formula: Weight/height 2 , weight in kilograms and height in meters.

Measurement of the auditory stimulation

The measurements of the equivalent sound levels were conducted in a soundproof room, using a SV 102 audiodosimeter (Svantek, Finland). It was programmed the measurement in the "A" weighting circuit; slow response.

The measurement was made during a session, lasting a total of 4 min and 50 s for the relaxant classical baroque music and 5 min and 15 s for the excitatory heavy metal music. We used the insert type microphone (Microphone in real ear), which was placed inside the auditory canal of the subject, just below the microphone, connected to the personal stereo.

Before each measurement, the microphones were calibrated with the calibrator acoustic CR: 514 model (Cirrus Research Plc.).

What we used in the analysis was the Leq (A), which is defined as the equivalent sound pressure level and corresponds to the constant sound level in the same time interval. It contains the same total energy of the sound. We also analyzed the frequency spectrum of the sound stimulation (octave band).

Linear indices of heart rate variability

The HRV behavior pattern was recorded beat-by-beat throughout the monitoring process at a sampling rate of 1000 Hz. During the period of higher signal stability it was selected an interval of 5 min and only series with more than 256 RR intervals were used to analysis, following digital filtering complemented with manual filtering for the elimination of premature ectopic beats and artifacts. Only series with more than 95% sinus rhythm were included in the study. [17]

To analyze HRV in the frequency domain, the low frequency (LF = 0.04-0.15 Hz) and high frequency (HF = 0.15-0.40 Hz) spectral components were used in ms 2 and normalized units, which represents a value relative to each spectral component in relation to the total power minus the very LF components, the ratio between these components (LF/HF). The spectral analysis was calculated using the fast Fourier transform algorithm.

The analysis in time domain was performed by means of standard deviation of normal-to-normal RR intervals (SDNN), the percentage of adjacent RR intervals with a difference of duration greater than 50 ms (pNN50), and root-mean square of differences between adjacent normal RR intervals in a time interval (RMSSD). [18] The HRV analysis is a well-recognized method that investigates the cardiac autonomic regulation, HRV is able to detect bad prognostic in patients with cardiac disorders. [18]

For analysis of linear indexes in time and frequency domain we used the software HRV analysis. [19]


Data collection was carried out in the same sound-proof room for all volunteers with the temperature between 21°C and 25°C and relative humidity between 50% and 60% and volunteers were instructed not to drink alcohol and caffeine for 24 h before evaluation. Data were collected on an individual basis, between 8 a.m. and 12 a.m. to standardize the protocol. All procedures necessary for the data collection were explained on an individual basis and the subjects were instructed to remain at rest and avoid talking during the collection.

After the initial evaluation the heart monitor belt was then placed over the thorax, aligned with the distal third of the sternum and the Polar RS800CX HR receiver (Polar Electro, Finland) was placed on the wrist. The equipment was previously validated for monitoring beat-by-beat HR as well as the use of these data for HRV analysis. [17] The subjects were seated and remained at rest with spontaneous breathing for 10 min with the earphone turned off.

The women variables were compared between pre- and post-test. After 10 min of rest, the subject was exposed to exciting heavy metal (Gamma Ray: "Heavy Metal Universe") or relaxant baroque (Pachelbel: "Canon" in D Major) musical auditory stimulation for 5 min each style. Subsequently, the individual remained at rets for 5 min and then after that period the subject was exposed to musical auditory stimulation for 5 min again. The sequence of songs was randomized for each individual.

Statistical analysis

We applied the statistical power analysis that provided a minimal number of 18 volunteers. We applied the Shapiro-Wilk test to evaluate the distributions. For parametric distributions we applied analysis of variance (ANOVA) for repeated measures test followed by the Bonferroni post-test. For non-parametric distributions we used Friedman test followed by the Dunn's post-test. We compared the HRV indices between the three moments (rest vs. 1 st music vs. 2 nd music). Differences were considered significant when the probability of a Type I error was less than 5% ( P < 0.05). We used the Software GraphPad StatMate version 2.00 for Windows (Graph Pad Software, San Diego California, USA).


The volunteers were exposed to an equivalent sound level approximately between 70 dB and 80 dB. [Figure 1] and [Figure 2] show the measurement for the baroque music while [Figure 3] and [Figure 4] present the equivalent sound level during heavy metal music stimulation.{Figure 1}{Figure 2}{Figure 3}{Figure 4}

Data for baseline systolic arterial pressure (SAP) and diastolic arterial pressure (DAP), HR and mean RR interval, age, height, body weight, and BMI are presented in [Table 1].{Table 1}

In relation to the time-domain index, we did not observe significant changes during exposure to baroque and heavy metal musical auditory stimulation. The SDNN index tended to be reduced during heavy metal music style exposure compared to the control condition, however, there was no statistical significance (ANOVA followed by Bonferroni; P = 0.12). The RMSSD (Kruskal-Wallis followed by Dunn's; P = 0.8) and pNN50 (Kruskal-Wallis followed by Dunn's; P = 0.9) indices were not changed during musical auditory stimulation with the both styles [Table 2].{Table 2}

In [Table 3], we report data regarding frequency-domain indices in response to musical auditory stimulation, in which we observed more intense reactions in the LF (ms 2 ) index. The LF (ms 2 ) index was significantly reduced during heavy metal music auditory stimulation compared to the control condition (Kruskal-Wallis followed by Dunn's; P = 0.025). On the other hand, there was no significant changes with respect to the LF (nu) (ANOVA followed by Bonferroni; P = 0.8), HF (ms 2 ) (Kruskal-Wallis followed by Dunn's; P = 0.1), HF (nu) (ANOVA followed by Bonferroni; P = 0.8) and LF/HF (Kruskal-Wallis followed by Dunn's; P = 0.7) indices [Table 3].{Table 3}


This study was undertaken to investigate the acute effects of relaxant baroque and exciting heavy metal musical auditory stimulation on HRV in healthy women. In this case, HRV was analyzed in the time and frequency domain. As a main finding, we reported that the LF index in absolute units was reduced during exposure to heavy metal musical style. The novelty of our study is the use of ear phones to exposure the volunteers to music.

Based on our results, there were no significant effects of baroque and heavy metal music on the SDNN index. This index represents the sympathetic and parasympathetic activity, it is well-known to be the representative of the global autonomic function of the heart. However, it does not allow to distinguish when changes in HRV are due to increased sympathetic tone or the withdrawal of vagal tone. [18] A previous study reported that chronic baroque musical auditory stimulation increased the SDNN index in patients with breast cancer treated with anthracycline by the end of the 8-week treatment period, [7] indicating improvement of global HRV. Nevertheless, the authors did not specify the equivalent sound level. In our study, the music ranged from 65 to 80 dB.

In relation to the time domain indices of HRV that represents the parasympathetic activity, we failed to show significant changes in the RMSSD and pNN50 indices in responses to acute baroque or heavy metal musical auditory stimulation in women. The findings of a previous study indicated that the parasympathetic nervous system is activated by music therapy. [20] The same authors suggested music therapy to protect the cardiovascular system against congestive heart failure events in elderly patients with cerebrovascular disease and dementia by reducing the levels of both epinephrine and norepinephrine. Taken together, we believe that musical auditory stimulation with moderate equivalent sound level does not present significant acute effects on the parasympathetic regulation of the heart.

With respect to the frequency domain indices of HRV, we observed that the LF in absolute units was significantly reduced during heavy metal musical auditory stimulation. Interestingly, the heavy metal music style presented more intense physiological responses on the LF (ms 2 ) index compared with the baroque music style. This index corresponds to the joint action of the vagal and sympathetic components on the heart, with a predominance of the sympathetic activity. [18] Considering that the time and frequency domain indices that correspond to the parasympathetic activity were not changed, our data suggests that acute heavy metal music influence the sympathetic nervous system. The literature indicated that heavy metal music may lead to stress and restlessness, sleep disturbances, fatigue, exhaustion, impairment of the immune system, hardness of hearing and/or loss of hearing. [20],[21] The literature considers heavy metal as ineffective or even dangerous. This music encourages disappointment, rage, and aggressive behavior while causing both HR and blood pressure to increase. Breastfeeding mothers should avoid this music because there is a negative influence on milk flow. [21] Considering these assumptions, our results suggest that heavy metal musical auditory stimulation acutely influences the sympathetic component of the HR regulation.

Considering the responses of HRV induced by heavy metal musical auditory stimulation observed in our study, some physiological mechanism may be proposed based on the literature. A recent study [22] indicated that previous emotional experiences, induced by auditory stimulation may be quantified by representing physiological responses of arousal in terms of HRV changes corresponding to increased sympathetic activity and alterations in responses in the medial geniculate nucleus of the thalamus, temporal cortices and right amygdala. Nakamura et al., [23] performed a study in anesthetized rats and suggested that musical auditory stimulation influences the sympathetic nerves. This response depends on the auditory cortex. Moreover, Sutoo [5] and Akiyama [24] reported that musical auditory stimulation induces dopamine release and suggested that it may influence various brain functions. Taken together, the literature strongly indicates the interaction brain-cardiovascular system as involved in the cardiovascular responses induced by music.

The HF and LF indices in normalized units were not changed in response to acute musical auditory stimulation. In general, the analysis of previous studies indicated that harmonic music is able to improve the cardiac autonomic regulation. [5],[25] The literature on the effect of music on ANS activity in healthy subjects is quite large. On the other hand, the literature on how music affects individuals with cardiovascular dysfunction is less developed.

According to our findings, we may wonder that the equivalent sound level range (between 60 dB and 80 dB) is not able to acutely influence the linear indices of HRV in the time domain. Conversely, white noise exposure above 50 dB enhances sympathetic activity. [25] They also found strong correlation between LF/HF ratio (LF-HF ration) and noise intensity. LF/HF ratio corresponds to the sympathetic-vagal balance. [26] Thus, noise intensity was indicated to influence cardiac autonomic regulation. The cardiovascular responses to sound may be conducted through many pathways and one example is the startle response mediated by a brainstem circuit. The acoustic startle reflex, a well-known effect of loud sounds on cardiovascular system, is described as the abrupt response of the HR and blood pressure to a sudden loud sound stimulation. The typical intensity used to elicit a startle reflex is 110 dB, and the intensity is much louder than the environmental noise. However, the cardiac accelerative responses that habituated over trials were observed in the subjects evoked by repeated 60 dB and 110 dB white-noise stimuli. [27] The responses were regarded as startle and defense response in humans or a fight/flight reaction in animals. The rise of blood pressure and HR to acoustic startle stimuli indicated an autonomic function responding to the acoustic stimuli. [28] Furthermore, cortical centers and also subcortical processing centers were thought to be involved in the cardiovascular and hormonal responses to a long-term stress activation by the environmental noises even though the noise intensity was as low as 53 dB. [29]

The music we used was a well-known composition from Pachelbel. The literature reported the "Mozart effect," which refers to an enhancement of performance or change in neurophysiological activity associated with listening to Mozart's musical auditory stimulation. The effect may be found in the subsequently improved performance on spatial IQ tests. [29] College students who had spent 10 min listening to Mozart's Sonata K 448 had Stanford-Binet spatial subtest IQ scores 8-9 points higher than students who had listened to a relaxation tape or listened to nothing. The IQ effects did not persist beyond the 10-15 min testing session. There have been several studies that replicated the Mozart effect, showing that exposure to Mozart produces an enhanced spatial performance. [30],[31],[32] However, just as many, if not even more studies have failed to replicate the Mozart effect. [33],[34] We expected that this acute change in the neurophysiological activity in response to Mozart's music would also be observed in the cardiac autonomic regulation. On the other hand, we found no changes in HRV in response to Mozart music.

SAP and DAP were not measured during and/or after musical auditory stimulation because the procedure would affect the cardiac autonomic regulation. The use of sphygmomanometer and inflation on the arms of the volunteers are able to cause changes in the HRV since it influences the blood flow on the arm. A previous study [35] investigate the acute behavior of arterial blood pressure and muscle sympathetic nerve activity using device-guided slow breathing with interactive or calm musical auditory stimulation and they reported that this procedure reduced blood pressure, however, only the device-guided slow breathing decreased the peripheral sympathetic nerve activity. We encourage further studies to investigate the behavior of arterial blood pressure in response to acute relaxant baroque and excitatory heavy metal musical auditory stimulation.

Our study presents some points that are worth to be raised. We investigated a small population, however, statistical analysis provided significant differences for the LF (ms 2 ) analysis. Only female healthy subjects were evaluated, we should be careful when extrapolating this data to different gender and pathological conditions. It is not defined in the literature the standards values for the time and frequency-domain indices of HRV. [12],[13],[17] Many factors are involved in the absence of this definition, such as period of HR record (morning, afternoon, night), gender, and time of record (5, 10, and 15 min). HRV analysis was used to investigate the responses of the cardiac autonomic control, since HRV has been studied for several years. It provided increasing interest in comprehending its clinical utility and mechanisms involved in cardiovascular disorders. The clinical interest of HRV emerged in the 60's when it was demonstrated a well-defined clinical application of HRV in the monitoring area of fetal distress. It was also reported association between reduced HRV and enhanced risk of mortality after acute myocardial infarction. Later, it was confirmed that HRV was a powerful and independent predictor of mortality after acute myocardial infarction. [6],[18],[36]

Our results have substantial implications for the use of musical auditory stimulation as a therapeutic tool. This type of stimulation is used more frequently as a therapeutic tool in different diseases. [37],[38] A very important effect of music is that it may extend exercise by threshold for pain enhancement or dyspnea reduction. [38],[39]


Relaxant baroque music auditory stimulation did not influence the HRV in short period of exposure. However, acute exposure to exciting heavy metal music affected the sympathetic activity in healthy women. We suggest that this style of music presents more significant acute effects compared to relaxant baroque music.


This study received financial support from Fundaçγo de Amparo à Pesquisa do Estado de Sγo Paulo (FAPESP).


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