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The effects of auditory stimulation with music on heart rate variability in

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 CLINICAL SCIENCE

The effects of auditory stimulation with music on

heart rate variability in healthy women
Adriano L. Roque,I Vitor E. Valenti,II Heraldo L. Guida,II Mônica F. Campos,III André Knap,II Luiz Carlos M.
Vanderlei,IV Lucas L. Ferreira,IV Celso Ferreira,I Luiz Carlos de AbreuI
I
Universidade Federal de São Paulo (UNESP), Post Graduation Program in Cardiology, São Paulo/SP, Brasil. II Universidade Estadual Paulista (UNESP),
Faculty of Philosophy and Sciences, Department of Speech Language and Hearing Therapy, Marı́lia/SP, Brasil. III Universidade Estadual Paulista (UNESP),
Faculty of Sciences and Technology, Department of Physical Therapy, Presidente Prudente/SP, Brasil. IV Universidade Estadual Paulista (UNESP), Faculty of
Sciences and Technology, Department of Physical Therapy, Presidente Prudente/SP, Brasil.

OBJECTIVES: There are no data in the literature with regard to the acute effects of different styles of music on
the geometric indices of heart rate variability. In this study, we evaluated the acute effects of relaxant baroque
and excitatory heavy metal music on the geometric indices of heart rate variability in women.
METHODS: We conducted this study in 21 healthy women ranging in age from 18 to 35 years. We excluded persons
with previous experience with musical instruments and persons who had an affinity for the song styles. We evaluated
two groups: Group 1 (n = 21), who were exposed to relaxant classical baroque musical and excitatory heavy metal
auditory stimulation; and Group 2 (n = 19), who were exposed to both styles of music and white noise auditory
stimulation. Using earphones, the volunteers were exposed to baroque or heavy metal music for five minutes. After
the first music exposure to baroque or heavy metal music, they remained at rest for five minutes; subsequently, they
were re-exposed to the opposite music (70-80 dB). A different group of women were exposed to the same music styles
plus white noise auditory stimulation (90 dB). The sequence of the songs was randomized for each individual. We
analyzed the following indices: triangular index, triangular interpolation of RR intervals and Poincaré plot (standard
deviation of instantaneous beat-by-beat variability, standard deviation of the long-term RR interval, standard
deviation of instantaneous beat-by-beat variability and standard deviation of the long-term RR interval ratio), low
frequency, high frequency, low frequency/high frequency ratio, standard deviation of all the normal RR intervals,
root-mean square of differences between the adjacent normal RR intervals and the percentage of adjacent RR
intervals with a difference of duration greater than 50 ms. Heart rate variability was recorded at rest for 10 minutes.
RESULTS: The triangular index and the standard deviation of the long-term RR interval indices were reduced during
exposure to both music styles in the first group and tended to decrease in the second group whereas the white noise
exposure decreased the high frequency index. We observed no changes regarding the triangular interpolation of RR
intervals, standard deviation of instantaneous beat-by-beat variability and standard deviation of instantaneous beat-
by-beat variability/standard deviation in the long-term RR interval ratio.
CONCLUSION: We suggest that relaxant baroque and excitatory heavy metal music slightly decrease global heart rate
variability because of the equivalent sound level.

KEYWORDS: Autonomic Nervous System; Auditory Stimulation; Cardiovascular System; Music.

Roque AL, Valenti VE, Guida HL, Campos MF, Knap A, Vanderlei LC, et al. The effects of auditory stimulation with music on heart rate variability in
healthy women. Clinics. 2013;68(7):960-967.
Received for publication on February 11, 2013; First review completed on March 6, 2013; Accepted for publication on March 14, 2013
E-mail: [email protected]
Tel.: 55 14 3402-1300

& INTRODUCTION healthy young adults and evaluated the effects of music with
vocals (for Puccini ‘‘Turandot’’), orchestra (Beethoven’s
Exposure to classical music presents positive effects on ‘‘Ninth Symphony’’) and progressive crescendos (Bach’s
the cardiovascular system (1). Bernardi et al. (1) studied 24 Cantata BWV 169 ‘‘Gott soll allein mein Herze haben’’) on
heart rate (HR), respiratory rate, blood pressure and middle
cerebral artery flow. The authors indicated that specific
Copyright ß 2013 CLINICS – This is an Open Access article distributed under musical auditory stimulation may synchronize intrinsic
the terms of the Creative Commons Attribution Non-Commercial License (http://
creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- cardiovascular regularity, thereby modulating cardiovascu-
commercial use, distribution, and reproduction in any medium, provided the lar physiology.
original work is properly cited. Similarly, the ‘‘Mozart effect’’ refers to the enhanced
No potential conflict of interest was reported. performance or neurophysiological activity that is associated
DOI: 10.6061/clinics/2013(07)12 with listening to Mozart’s musical auditory stimulation. The

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CLINICS 2013;68(7):960-967 Heart and auditory stimulus
Roque AL et al.

effect can be observed in the spatial IQ tests performed before After agreeing to participate in our study, the subjects signed
and after listening to Mozart. (2). an informed consent. All study procedures were approved by
Exposure to heavy metal music presents negative effects the Ethics Committee in Research of the Faculty of Sciences of
related to stress. The responses induced by heavy metal the Universidade Estadual Paulista, Campus of Marilia (Case
music exposure include sleep disorders, fatigue, exhaustion No. CEP-2011-382) and were in accordance with resolution
and immunologic activity impairment (3). We hypothesized 196/96 National Health 10/10/1996.
that whereas relaxant music auditory stimulation reduces
the sympathetic nervous system activity, heavy metal music Exclusion criteria
auditory stimulation increases the sympathetic nervous We considered the following exclusion criteria: auditory
system activity. and cardiopulmonary disorders, neurological and other
As a noninvasive method for investigating the autonomic impairments that might prevent the subject from performing
nervous system (ANS), heart rate variability (HRV) describes procedures and treatment with drugs that might influence
the oscillations of the intervals between consecutive heartbeats cardiac autonomic regulation. We excluded subjects with
(RR intervals), which is influenced by the sinus node (4). previous experience with musical instruments or classical
The methods used for analyzing HRV include the ballet music and volunteers who like heavy metal and
geometric methods — triangular index (RRtri), triangular baroque music styles because this musical preference might
interpolation of NN interval histogram (TINN) and Poincaré affect their cardiovascular responses (7).
plot. These methods convert RR intervals into geometric
patterns and allow us to analyze HRV through the geometric Initial evaluation
or graphical properties of the resulting pattern (4,5). The Before the experimental procedure, we recorded data on the
RRtri and TINN are calculated from the construction of a volunteers by collecting the following information: age, gender,
histogram of the density of normal RR intervals, which weight, height and body mass index (BMI). We measured
contains the length of the RR intervals on the x-axis and the weight with a digital scale (W 200/5, Welmy, São Paulo/SP,
frequency with which they occur on the y-axis. Joining the Brazil) with a precision of 0.1 kg. We measured height with a
points of the histogram columns forms a shape like a triangle stadiometer (ES 2020, Sanny, São Paulo/SP, Brazil) with a
from which these indices are extracted (4). precision of 0.1 cm and 2.20 m of extension. We calculated the
The Poincaré plot is a two-dimensional graphical repre- BMI using the following formula: weight (kg)/height (m2).
sentation of the correlation between consecutive RR inter-
vals, in which each interval is plotted against the following
interval. We can qualitatively analyze the data by assessing
HRV analysis
the shape formed by its attractor, which shows the degree of The R-R intervals, which were recorded with a portable
complexity of the RR intervals. We can quantitatively analyze HR monitor (with a sampling rate of 1000 Hz), were
the Poincaré plot by fitting an ellipse to the shape formed by downloaded to the Polar Precision Performance program
the plot, which yields the following indices: SD1, SD2 and the (v. 3.0, Polar Electro, Finland). The software enabled us to
SD1/SD2 ratio. The Poincaré plot analysis is based on visualize the HR and extract a cardiac period (R-R interval)
nonlinear dynamics (4). file in ‘‘txt’’ format. After digital filtering complemented with
Although the beneficial effects of musical auditory manual filtering to eliminate premature ectopic beats and
stimulation have been reported (6), no previous studies artifacts, we used at least 256 R–R intervals for the data
have investigated the short-term effects of classical baroque analysis. We included only data series with more than 95%
and heavy metal music on HRV. Additionally, Bernardi and sinus rhythm (4,8). To calculate the indices, we used HRV
co-workers (1) suggested that the autonomic activity on the analysis software (Kubios HRV v.1.1 for Windows,
heart depends on the time at which the music is heard. Biomedical Signal Analysis Group, Department of Applied
Because the HRV analysis requires a minimum of 256 RR Physics, University of Kuopio, Kuopio, Finland).
intervals, we believe it is important to investigate its behavior
during a single exposure to each style of music. Knowing the Time and frequency domain indices of HRV
physiological responses induced by music exposure is To analyze the HRV in the frequency domain, the low
important for developing future therapies that might frequency (LF = 0.04 to 0.15 Hz) and high frequency (HF = 0.15
contribute to the prevention of cardiovascular disorders. to 0.40 Hz) spectral components were used in ms2 and
Therefore, we evaluated the acute effects of relaxant baroque normalized units. In addition, the ratio between these
and excitatory heavy metal musical auditory stimulation on components (LF/HF) represents a value that is relative to each
the geometric HRV indices in women. spectral component in relation to the total power minus the very
low frequency (VLF) components. We calculated the spectral
analysis using the Fast Fourier Transform algorithm (9).
& METHOD
The time domain was analyzed by means of the standard
Study population deviation of normal-to-normal (SDNN) R-R intervals, the
We analyzed 40 healthy female subjects, who ranged percentage of the adjacent RR intervals with a difference of
between 18 and 35 years of age and were selected from our duration greater than 50 ms (pNN50) and root-mean square
institution. We divided the subjects into two groups: Group 1 of differences (RMSSD) between the adjacent normal RR
consisted of 21 healthy women, who were exposed to intervals in a given time interval (9).
relaxant classical baroque musical and excitatory heavy
metal auditory stimulation; and Group 2 consisted of 19 Geometric HRV indices
healthy women, who were exposed to both styles of music The HRV analysis was performed using the following
and white noise auditory stimulation. We informed all the geometrical methods: RRtri, TINN and Poincaré plot (SD1,
volunteers about the procedures and objectives of the study. SD2 and SD1/SD2 ratio). The RRtri was calculated from the

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Roque AL et al.

construction of a density histogram of RR intervals, which on an individual basis; the subjects were instructed to
contains the horizontal axis of all possible RR intervals remain at rest and avoid talking during the data collection.
measured on a discrete scale with 7.8125 ms boxes (1/128 After the initial evaluation, we placed the heart monitor
seconds) and on the vertical axis, the frequency with which belt over the subject’s thorax, aligned with the distal third of
each occurred. The union of points of the histogram the sternum, and the Polar RS800CX heart rate receiver
columns forms a triangle-like shape. The RRtri was obtained (Polar Electro, Finland) was placed on the wrist. The
by dividing the number of RR intervals used to construct the subjects were seated and remained at rest with spontaneous
histogram by their modal frequency (i.e., the RR interval breathing for 10 minutes with the earphones turned off.
that most frequently appeared on RR) (4). After 10 minutes of rest, the subjects were exposed to
The TINN consists of the measure of the base of a triangle. excitatory heavy metal (Gamma Ray’s ‘‘Heavy Metal
The method of least squares is used to determine the Universe’’) or relaxant baroque (Pachelbel’s "Canon in D
triangle. The RRtri and the TINN express the overall Major’’) musical auditory stimulation for 5 minutes each.
variability of the RR intervals (4). Subsequently, the individuals remained at rest for 5 minutes
The Poincaré plot is a map of points in Cartesian and thereafter were exposed to musical auditory stimula-
coordinates that is constructed from the values of the RR tion for 5 minutes. The sequence of songs was randomized
intervals. Each point is represented on the x-axis by the for each individual. In an additional protocol with a
previous normal RR interval and on the y-axis by the different group of women, the subjects were exposed to
following RR interval. both styles of music and white noise auditory stimulation
For the quantitative analysis of the plot, an ellipse was (90 dB) to investigate whether the variation in the equiva-
fitted to the points of the chart, with the center determined by lent sound level of the songs influences HRV.
the average RR interval. The SD1 indices were calculated to
measure the standard deviation of the distances of the points
from the diagonal y = x, and SD2 measures the standard Statistical analysis
deviation of the distances of points from the line y = -x+RRm, Standard statistical methods were used to calculate the
where RRm is the average RR interval. The SD1 is an index of means and standard deviations. The normal Gaussian
the instantaneous recording of the variability of beat-to-beat distribution of the data was verified by the Shapiro-Wilk
and represents the parasympathetic activity, whereas the SD2 goodness-of-fit test (z value of .1.0). For parametric distribu-
index represents the long-term HRV and reflects the overall tions, we applied the one-way ANOVA for repeated-measures
variability. The SD1/SD2 shows the ratio between the short- followed by the Bonferroni post-test. For nonparametric
and long-term variation among the RR intervals (10). distributions, we used the Friedman test followed by Dunn’s
The plot was qualitatively analyzed using HRV analysis post-test. We compared the geometric indices of HRV between
software based on the figures formed by its attractor. The the three moments (Group 1, control condition vs. classical
expected shapes were described by Tulppo et al. (10) as: baroque vs. excitatory heavy metal; Group 2, control condition
1) Figures in which an increase in the dispersion of RR vs. classical baroque vs. excitatory heavy metal vs. white
intervals is observed with increased intervals, characteristic noise). The differences were considered significant when the
of a normal plot. probability of a Type I error was less than 5% (p,0.05). We
2) Small figures with beat-to-beat global dispersion used the Software GraphPad StatMate version 2.00 for
without increased long-term dispersion of RR intervals. Windows (GraphPad Software, San Diego, CA, USA).

Measurement of the auditory stimulation & RESULTS

The equivalent sound levels were measured in a soundproof
room, using an SV 102 audiodosimeter (Svantek, Finland). The The volunteers were exposed to an equivalent sound level
audiodosimeter was programmed to collect measurements in between approximately 70 and 80 dB. Figure 1 shows the
the "A" weighting circuit, indicating a slow response. measurement for the baroque music; Figure 2 presents the
The measurement was made during a session, which equivalent sound level during heavy metal music stimula-
lasted 4 minutes 50 seconds for the relaxant classical tion.
baroque music and 5 minutes 15 seconds for the excitatory Table 1 presents the basal diastolic (DAP) and systolic
heavy metal music. We used the insert-type microphone (SAP) arterial pressures, HR, mean RR, weight, height and
(microphone in real ear), which was placed inside the BMI of the volunteers.
auditory canal of the subject, just below the microphone, Table 2 demonstrates that the SD1 index when listening to
and connected to the personal stereo. the two musical styles tended to be reduced compared with
Before each measurement, we calibrated the microphones the control group but showed no significant changes
using the calibrator acoustic CR: 514 model (Cirrus Research (Friedman test followed by Dunn’s post-test, p = 0.09). The
Plc.). same result occurred with the index TINN, which tended to
be decreased in response to exposure to relaxant baroque
Experimental protocol and excitatory heavy metal music (Friedman test followed
Data were collected in a room with the temperature set by Dunn’s post-test, p = 0.2). In contrast, the RRtri showed a
between 21 ˚C and 25 ˚C and relative humidity regulated significant reduction during exposure to relaxant baroque
between 50% and 60%. The volunteers were instructed not music and excitatory heavy metal music (ANOVA followed
to drink alcoholic or caffeinated beverages for 24 hours by Bonferroni’s post-test, p = 0.03). Moreover, the SD2 index
before the evaluation. The data were collected on an showed a significant reduction during both relaxant
individual basis between 8 AM and 12 PM to minimize baroque and excitatory heavy metal music compared with
the confounding effects of the circadian rhythm. The the control condition (Friedman test followed by Dunn’s
procedures necessary for the data collection were explained post-test, p = 0.04). With regard to the SD1/SD2 ratio, we

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Roque AL et al.

Figure 1 - Equivalent sound level of auditory musical stimulation in the baroque style.

Figure 2 - Equivalent sound level of auditory musical stimulation in the heavy metal style.

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Roque AL et al.

Table 1 - Baseline diastolic (DAP) and systolic arterial Table 2 - Average values followed by their standard
pressure (SAP), heart rate (HR), mean RR interval, weight, deviations for analysis of geometric indices of HRV.
height and body mass index (BMI) of the volunteers.
Index Control Baroque Music Heavy Metal Music
Variable Value
RRTri 13.2¡4 11.6¡4* 10.3¡2*
Age (years) 25.9¡4 TINN 162.8¡106 150¡109 106.9¡83
Height (m) 1.62¡0.09 SD1 28.9¡16 27¡13 27.7¡17
Weight (kg) 67¡10 SD2 62.7¡19 52¡20* 47¡9*
BMI (kg/m2) 25¡4 SD1/SD2 0.452¡9.18 0.527¡0.22 0.563¡0.22
HR (bpm) 77.1¡14
Mean RR (ms) 780¡118 RRtri, triangular index; TINN, triangular interpolation of RR intervals; SDI,
SAP (mmHg) 112¡10 standard deviation of the instantaneous variability of the beat-to-beat
DAP (mmHg) 68¡7 heart rate; SD2, standard deviation of long-term continuous RR interval
variability; SD1/SD2 ratio, ratio between the short- and long-term
variation of the RR intervals.
observed no significant changes (ANOVA followed by *p,0.05 vs. control.
Bonferroni’s post-test, p = 0.56).
To analyze whether the changes in the equivalent sound differences, although they tended to be reduced during
level influences HRV, we applied an additional inclusion of similar conditions. The frequency domain analysis indicated
white noise auditory stimulation. As shown in Table 3, the that the parasympathetic activity on the heart decreased
SD1 index was not different between the four moments during white noise auditory stimulation. We suggest that
(Friedman test followed by Dunn’s post-test, p = 0.5). The acute exposure to relaxant classical baroque and excitatory
TINN index (Friedman test followed by Dunn’s post-test, heavy metal musical auditory stimulation slightly reduces
p = 0.1) and RRTri (ANOVA followed by Bonferroni’s post- the HRV due to their equivalent sound level.
test, p = 0.1) tended to be decreased at the time of exposure In this study, we reported that the SD1 index was
to excitatory heavy metal music compared with control unchanged during exposure to both styles of music. This
condition. The SD2 index tended to decrease during both index represents the transverse axis of the Poincaré plot; it
relaxant baroque and white noise compared with the control indicates the standard deviation of the instantaneous
condition (Friedman test followed by Dunn’s post-test, variability of the beat-to-beat HR. This index represents
p = 0.09). Regarding the SD1/SD2 ratio, we observed no the influence of the parasympathetic activity on the
significant changes (ANOVA followed by Bonferroni’s post- sinoatrial node (4). A reduction in vagal modulation has
test, p = 0.39). been observed in another study related to chronic obstruc-
In the time domain, there was no significant difference tive pulmonary disease (COPD), in which the SD1 index
between the four moments regarding the SDNN (ANOVA was reduced in volunteers with COPD compared with
followed by Bonferroni’s post-test, p = 0.37), RMSSD subjects without the disease (10), which suggests an
(ANOVA followed by Bonferroni’s post-test, p = 0.3) and increased sympathetic tone in the patients with COPD.
pNN50 (ANOVA followed by Bonferroni’s post-test, p = 0.17) Moreover, in a study of obese and eutrophic children (12),
indices (Table 3). In the frequency domain analysis, we the authors evaluated the SD1 index and observed a
observed no changes regarding LF in either normalized significant reduction in the obese subjects compared with
(Friedman test followed by Dunn’s post-test, p = 0.12) or the control group. This reduction is associated with an
absolute (Friedman test followed by Dunn’s post-test, p = 0.2) increased risk of morbidity and mortality from all causes
units and HF in absolute units (Friedman test followed by and the development of various risk factors. Nonetheless,
Dunn’s post-test, p = 0.19). The HF index was reduced in we found no effects of acute relaxant baroque music and
absolute units during exposure to white noise compared with excitatory heavy metal music on the SD1 index.
the control condition (Friedman test followed by Dunn’s Based on our data, the SD2 index in the first group was
post-test, p = 0.04). In contrast, the LF/HF ratio tended to be decreased during exposure to both relaxant baroque and
increased in the same situation compared with the control excitatory heavy metal musical auditory stimulation compared
condition, but this result did not reach significance (Friedman with no music stimulation. However, in the second group, this
test followed by Dunn’s post-test, p = 0.08). index tended to decrease but did not reach significance. The
Figure 3 shows an example of the Poincaré plot patterns SD2 index expresses the overall variability of RR intervals. This
from one subject during no music (A), relaxant baroque long-term component of HRV usually accounts for all other HR
musical auditory stimulation (B) and excitatory heavy metal changes, including changes associated with the baroceptor
musical auditory stimulation (C). reflex loop and thermoregulation, when analyzed for 24 hours
(4). Our results suggest that this stimulation presents slight
& DISCUSSION effects on the global variability of HR.
Chuang and co-workers investigated the effects of long-
Considering the relevance of musical therapy and auditory term, 8-month music therapy intervention on autonomic
stimulation during rehabilitation (13-15), we evaluated the function in anthracycline-treated breast cancer patients. The
acute effects of excitatory heavy metal and relaxant baroque authors observed that the musical therapy improved the
music on the geometric, time and frequency domain indices time and frequency domain indices of HRV. The authors’
of HRV in two groups of healthy women. The results protocol was divided into two activities. During the first part
obtained by the HRV geometric indices in the Group 1 of the study, the subjects were exposed to popular Taiwanese
showed that exposure to both styles of music decreased the songs with moderate, pleasant rhythms and tempos. The
HRV because the RRTri and SD2 indices decreased. In the second part of the study was spent learning how to play
Group 2, the RRTri and SD2 indices did not show significant diverse musical instruments, such as hand bells, ukuleles,

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Roque AL et al.

Table 3 - Average values and their standard deviations for the analysis of the time domain, frequency domain and
geometric HRV indices.
Index Control Baroque Music Heavy Metal Music White Noise

RRTri 13.2¡4 12.1¡3 11.8¡3 12.4¡4

TINN 214.6¡63 205¡22 177.1¡56 211¡95
SD1 27.2¡13 25.5¡13 24.4¡10 23.4¡11
SD2* 61.3¡21 54.1¡22 63.4¡35 55.6¡21
SD1/SD2* 0.44¡0.12 0.46v0.13 0.42¡0.15 0.42¡0.14
SDNN (ms) 49¡17 45.6¡17 43.4¡16 44.4¡17
RMSSD (ms) 38.3¡19 35¡17 32.4¡13 31.9¡15
pNN50 (%) 19.2¡16 15¡15 13.1v12 12.1¡13
LF (ms2) 693.9¡727 691.2¡1109 692.4¡923 717.8¡655
LF (nu) 49.9¡19 51.4¡18 54.5¡15 59.5¡17
HF (ms2) 785.1¡739 723.9¡811 513.9¡459 534.4¡550
HF (nu) 49.9¡20 48.4¡18 45.3¡15 40.4¡17*
LF/HF 1.6¡1.8 1. 53¡1.62 1.58¡1.33 2.2¡2

RRTri, triangular index; TINN, triangular interpolation of RR intervals; SD1, standard deviation of the instantaneous variability of the beat-to-beat heart
rate; SD2, standard deviation of long-term continuous RR interval variability; SD1/SD2 ratio, ratio between the short- and long-term variations of RR
intervals; SDNN, standard deviation of normal-to-normal R-R intervals; RMSSD, root-mean square of differences between adjacent normal RR intervals in a
time interval; pNN50, percentage of adjacent RR intervals with a difference of duration greater than 50 ms; LF, low frequency; HF, high frequency; LF/HF,
low-frequency/high-frequency ratio.
*p,0.05 vs. control.

egg shakers, Cadeson bongos, metallophones and recorders. heavy metal are commonly associated with physiological
Our findings suggest that the relaxant baroque musical arousal (17,18). We believe that acute excitatory heavy metal
auditory stimulation acutely reduces the overall HRV. music can acutely induce stress responses and reduce HRV,
The reduction of the RRTri indices in response to acute as observed by analyzing the geometric indices.
relaxant baroque and excitatory heavy metal music in the As a main finding, both styles of music reduced the
first group and the absence of significance in the second geometric HRV indices, which represent the overall
group support the hypothesis that acute musical auditory variability of the RR intervals. We wonder whether acoustic
stimulation has slight effects on global HRV. The RRTri stimulation reduces the global HRV. Conversely, Roy and
presented a close association with the standard deviation of co-workers (19) investigated the effects of a novel auditory
all RR intervals and did not suffer from the influence of binaural stimulus, called rotating acoustic stimulus, on the
ectopic beats and artifacts because the artifacts and ectopic cardiac autonomic responses. The authors observed a
beats are located outside the triangle (16). Our group decrease in the HR and an increase in the time domain
previously reported reduced values of RRTri in adult RMSSD, SD1, SD2 and the SD1/SD2 ratio after the
patients with COPD (10) and in obese children (12), which stimulation. They suggested that rotating acoustic stimula-
suggests that decreased RRTri is related to increased tion may be a beneficial stimulus for cardiac autonomic
cardiovascular impairment risks. Taken together, the sub- regulation. Music presents different effects on HRV com-
jects in our study tended to present decreased global HRV pared with different styles of auditory stimulation.
during exposure to auditory stimulation with music. Classical music tends to relax the body and possibly
The qualitative visual analysis of Poincaré plot revealed stimulates the parasympathetic nervous system (6).
slight changes during excitatory heavy metal exposure, Nevertheless, there is no direct evidence of a relationship
showing a greater beat-to-beat dispersion of RR intervals between acute classical music and specific components of
and a greater dispersion of RR intervals over the long term. HRV. The elegant study performed by Bernardi and et al. (1)
The qualitative analysis supports the increased responses of observed that during relaxant classical musical auditory
the SD2 and RRTri indices during this condition compared stimulation, there is a moment during which sympathetic
with the control; this finding indicates that the global HRV is activation is accompanied by increases in cerebral blood
reduced during heavy metal musical auditory stimulation. flow velocity and arterial blood pressure, tachycardia and
As we anticipated, the excitatory heavy metal music skin vasoconstriction. The authors (1) showed that sympa-
exposure reduce the global HRV. Both the SD2 and RRTri thetic and parasympathetic activation depends on the music
indices were decreased compared with control period, period. In our study, the volunteers were exposed to the
which included seated rest. Nevertheless, another index same music that contains the same rhythm and decibel
that corresponds to the global HRV, the TINN, was level. However, the music stretches that may influence the
unchanged during relaxant baroque or excitatory heavy ANS with more intensity were not separated because the
metal musical auditory stimulation. We believe that the analysis of HRV requests a minimum of 256 RR intervals; if
acute effects of the music selected induced slight but we separate the music stretch, the RR interval number
significant responses, as observed with the geometric HRV would not reach this number at rest. Our group is presently
indices. Although previous studies have evaluated the effect studying a protocol to verify this important issue.
of different musical styles on stress, the influence of An important variable that we investigated was the music
different styles of musical auditory stimulation on physio- intensity. The absence of white noise is a limitation of many
logical responses has not been widely investigated. The studies that have investigated the effects of music on the
existing studies observed the relaxing effect of classical cardiovascular system. We reported that exposure to white
music whereas genres such as techno music, hip hop and noise significantly decreased the parasympathetic activity on

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Heart and auditory stimulus CLINICS 2013;68(7):960-967
Roque AL et al.

Figure 3 - Visual pattern of the Poincaré plot observed in one subject during the control condition (A), exposure to relaxant baroque
music (B) and exposure to excitatory heavy metal music (C).

the heart, which is indicated by the reduction of HF index, metal music exposure, women presented a higher increase
and tended to increase the sympathetic activity (p = 0.08). in the sympathetic nervous system responses compared
Nakamura et al. (20) observed that the number of c-Fos– with men. The sympathetic responses were evaluated by
reactive cells increased in the auditory cortexes of rats analyzing skin conductance and finger temperature. Men
exposed to white noise compared with nonstimulated rats. In presented more intense autonomic responses after heavy
another study (21), the same group observed no effect of metal musical auditory stimulation, as observed by an
white noise auditory stimulation on gastric vagal nerve increased secretion of salivary amylase. This response is
activity. In both cases, the animals were anesthetized using induced by sympathetic and parasympathetic nerve activ-
urethane, which may have influenced the responses com- ities stimulation (17). Therefore, our data should not be
pared with the conscious state. Our findings suggest that the extrapolated to men.
equivalent sound level is involved in the global HRV In conclusion, relaxant baroque and excitatory heavy
decrease caused by exposure to excitatory heavy metal metal musical auditory stimulation present slight effects on
musical auditory stimulation. the global HRV, as observed through an analysis of the
The responses observed in our study may be explained by a geometric HRV indices. We suggest that the acute effects of
physiological mechanism associated with the brain (15). A relaxant music are different from its chronic effects on HRV
previous study performed in rats indicated that musical and that the equivalent sound level is also involved in this
auditory stimulation decreases the renal sympathetic activity mechanism. Our results report the transient nature of
and arterial blood pressure through histaminergic neurons that music-related patterns and suggest that additional investi-
are located at the suprachiasmatic nucleus of the hypothalamus gations regarding the relationship between musical audi-
(20). The dopamine release in the mesolimbic reward system, tory stimulation and cardiac autonomic regulation are
specifically the nucleus accumbens, was proposed to be necessary to expand the potential practice of music
involved in emotional stimulation when listening to music stimulation in therapeutic applications.
(22). Another investigation in rats indicated that musical
auditory stimulation enhances calcium/calmodulin-depen- & ACKNOWLEDGMENTS
dent dopamine synthesis in the brain, thus decreasing blood
pressure (23). An important issue is the style of music used by Our study received financial support from FAPESP.
the authors because each study used different music. Thus, we
must be careful when we interpret data. & AUTHOR CONTRIBUTIONS
In our study, we investigated only women because the Roque AL, Campos MF, Guida HL, Knap A, Ferreira LL and Valenti VE
literature indicates that there are differences between men performed data collection. Ferreira C, Valenti VE, Guida HL, Abreu LC
and women regarding their physiological responses to and Vanderlei LC participated in the revision of the manuscript. Ferreira
musical auditory stimulation (16). During excitatory heavy C, Valenti VE, Guida HL, Abreu LC and Vanderlei LC determined the

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CLINICS 2013;68(7):960-967 Heart and auditory stimulus
Roque AL et al.

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