Music and Health

Music and health - Harvard Health 7/24/20

Music is a fundamental attribute of the human species. Virtually all cultures, from the most primitive to the most advanced, make music. It's been true through history, and it's true throughout an individual's lifespan. In tune or not, we humans sing and hum; in time or not, we clap and sway; in step or not, we dance and bounce. 

The human brain and nervous system are hard-wired to distinguish music from noise and to respond to rhythm and repetition, tones and tunes. Is this a biologic accident, or does it serve a purpose? It's not possible to say. Still, a varied group of studies suggests that music may enhance human health and performance. 

Music and the brain 

Like any sound, music arrives at the ear in the form of sound waves. The external ear collects sound waves, and the ear canal funnels them to the eardrum. As the waves strike the eardrum, they cause it to vibrate. The vibrations are relayed along the chain of tiny bones in the middle ear until they reach the third bone, the stapes, which connects to the cochlea. 

The cochlea is a busy little world of its own. It is !lled with "uid that surrounds some 10,000 to 15,000 tiny hair cells, or cilia. Vibrations of the stapes send "uid waves through the spiral-shaped cochlea. The "uid waves produce swaying movements of the hair cells. In turn, these cells release chemical neurotransmitters that activate the auditory nerve, sending miniature electric currents to the auditory cortex in the temporal lobe of the brain. 

From there, things get even more complicated. Studies using MRI and positron emission tomography (PET) scans suggest that nerve networks in di#erent parts of the brain bear primary responsibility for decoding and interpreting various properties of music. For example, a small area in the right temporal lobe is essential to perceive pitch, which forms the basis of melody (patterns of pitch over time), chords (several pitches that sound at the same time), and harmony (two or more melodies at the same time). Another nearby center is responsible for decoding timbre, the quality that allows the brain to distinguish between di#erent instruments that are playing the same note. A di#erent part of the brain, the cerebellum, processes rhythm, and the frontal lobes interpret the emotional content of music. And music that's powerful enough to be "spine- tingling" can light up the brain's "reward center," much like pleasurable stimuli ranging from alcohol to chocolate. 

Although every healthy human brain can perform all the complex tasks needed to perceive music, musicians' brains are, so to speak, more !nely attuned to these tasks. At the other end of the spectrum, patients with brain damage may display remarkable defects in musicality; the noted neurologist and writer Dr. Oliver Sacks discusses many fascinating varieties of amusia in his book Musicophilia. 

The neurobiology of music is a highly specialized !eld. But music also has major e#ects on many aspects of health, ranging from memory and mood to cardiovascular function and athletic performance. 


Music and the mind 

Music and health - Harvard Health 7/24/20, 5:23 PM 

The most highly publicized mental in"uence of music is the "Mozart e#ect." Struck by the observation that many musicians have unusual mathematical ability, researchers at the University of California, Irvine, investigated how listening to music a#ects cognitive function in general, and spatial-temporal reasoning in particular. In their !rst study, they administered standard IQ test questions to three groups of college students, comparing those who had spent 10 minutes listening to a Mozart piano sonata with a group that had been listening to a relaxation tape and one that had been waiting in silence. Mozart was the winner, consistently boosting test scores. Next, the investigators checked to see if the e#ect was speci!c to classical music or if any form of music would enhance mental performance. They compared Mozart's music with repetitive music by Philip Glass; again, Mozart seemed to help, improving spatial reasoning as measured by complex paper cutting and folding tasks and short-term memory as measured by a 16-item test. 

How might music enhance cognitive performance? It's not clear, but the researchers speculated that listening to music helps organize the !ring of nerve cells in the right half of the cerebral cortex, the part of the brain responsible for higher functions. According to this construct, music — or at least some forms of music — acts as an "exercise" that warms up selected brain cells, allowing them to process information more e$ciently. It's an interesting theory, but before you rush out to stock up on recordings of Mozart's music, you should know that even in the original research, the "Mozart e#ect" was modest (8 to 9 IQ points) and temporary (15 minutes). And in reviewing 16 studies of Mozart's music and human cognitive function, a Harvard psychologist concluded that the e#ect was even smaller, amounting to no more than 2.1 IQ points. It's a sour note, but it's hardly a requiem for the theory that music may boost cognitive function. In fact, the divergent results should serve as a prelude to additional research. And even if listening to music turns out to have little long-term e#ect on cognition, a 2010 review reported that learning to play an instrument may enhance the brain's ability to master tasks involving language skills, memory, and attention. 


Music and stress 

In every era of human history and in every society around the globe, music has allowed people to express their feelings and communicate with others. More than simply expressing emotions, music can alter them; as British dramatist William Congreve put it in 1697, "Music has charms to soothe a savage breast." 

Few things are more stressful than illness and surgery. Can music reduce stress in these di$cult circumstances? Several trials show it can. 

A study from New York examined how music a#ects surgical patients. Forty cataract patients with an average age of 74 volunteered for the trial. Half were randomly assigned to receive ordinary care; the others got the same care but also listened to music of their choice through headphones before, during, and immediately after the operations. Before surgery, the patients in both groups had similar blood pressures; a week before the operations, the average was 129/82 millimeters of mercury (mm Hg). The average blood pressure in both groups rose to 159/92 just before surgery, and in both groups, the average heart rate jumped by 17 beats per minute. But the patients surrounded by silence remained hypertensive throughout the operation, while the pressures of those who listened to music came down rapidly and stayed down into the recovery room, where the average reduction was an impressive 35 mm Hg systolic (the top number) and 24 mm Hg diastolic (the bottom number). The listeners also reported that they felt calmer and better during the operation. The ophthalmologic surgeons had no problems communicating with their patients over the sound of the music, but the researchers didn't ask the doctors if their patients' improved blood pressure readings made them more relaxed as they did their work. Earlier research, though, found that surgeons showed fewer signs of stress and demonstrated improved performance while listening to self-selected music. 

A study of 80 patients undergoing urologic surgery under spinal anesthesia found that music can decrease the need for supplementary intravenous sedation. In this trial, patients were able to control the amount of sedative they received during their operation. Patients who were randomly assigned to listen to music needed less calming medication than those assigned to listen to white noise or to the chatter and clatter of the operating room itself. 

In the cataract and urologic surgery studies, the patients were awake during their operations. But a study of 10 critically ill postoperative patients reported that music can reduce the stress response even when patients are not conscious. All the patients were receiving the powerful intravenous sedative propofol, so they could be maintained on breathing machines in the intensive care unit (ICU). Half the patients were randomly assigned to wear headphones that played slow movements from Mozart piano sonatas, while the other half wore headphones that did not play music. Nurses who didn't know which patients were hearing music reported that those who heard music required signi!cantly less propofol to maintain deep sedation than those patients wearing silent headphones. The music recipients also had lower blood pressures and heart rates as well as lower blood levels of the stress hormone adrenaline and the in"ammation-promoting cytokine interleukin-6.  

Neither of the operating room studies speci!ed the type of music used, while the ICU trial used slow classical music. An Italian study of 24 healthy volunteers, half of whom were pro!cient musicians, found that tempo is important. Slow or meditative music produced a relaxing e#ect; faster tempos produced arousal, but immediately after the upbeat music stopped, the subjects' heart rates and blood pressures came down to below their usual levels, indicating relaxation. 


Musical medics 

Is there a doctor in the house? 

According to Arnold Steinhardt, a founding member and !rst violinist of the Guarneri String Quartet, chamber music audiences nearly always include many health care practitioners, "everything from podiatrists to psychiatrists, since there seems to be a mysterious and powerful underground railroad linking medicine and music. Perhaps music is an equally e#ective agent of healing, and doctors and musicians are part of a larger order serving the needs of mankind. Perhaps they recognize each other as brothers and sisters." 

Many doctors love music, and many are !ne musicians in their own right, playing everything from Dixieland to rock. There are classical orchestras composed entirely of doctors and medical students in Boston, New York, L.A., Philadelphia, and Houston, to say nothing of similar ensembles abroad. It's not just a question of education or income; apart from a lawyer's orchestra in Atlanta, there are no orchestras composed of attorneys, engineers, computer scientists, or bankers. And several medical schools have started courses that use music to shape future physicians' listening skills. 

Music and mood 

Soothing jangled nerves is one thing; raising sagging spirits, another. Bright, cheerful music can make people of all ages feel happy, energetic, and alert, and music even has a role in lifting the mood of people with depressive illnesses. An authoritative review of research performed between 1994 and 1999 reported that in four trials, music therapy reduced symptoms of depression, while a !fth study found no bene!t. A 2006 study of 60 adults with chronic pain found that music was able to reduce pain, depression, and disability. And a 2009 meta-analysis found that music-assisted relaxation can improve the quality of sleep in patients with sleep disorders. 

Bach may never replace Prozac, but when it comes to depression, even a little help strikes a welcome chord. 


Music and movement 

Falling is a serious medical problem, particularly for people over 65; in fact, one of every three senior citizens su#ers at least one fall during the course of a year. Can music help? A 2011 study says it can. The subjects were 134 men and women 65 and older who were at risk of falling but who were free of major neurologic and orthopedic problems that would limit walking. Half the volunteers were randomly assigned to a program that trained them to walk and perform various movements in time to music, while the other people continued their usual activities. At the end of six months, the "dancers" exhibited better gait and balance than their peers — and they also experienced 54% fewer falls. Similar programs of movement to music appear to improve the mobility of patients with Parkinson's disease. 

Music and stroke recovery 

Few things are more depressing than strokes, and since stroke is the fourth leading cause of death in the United States, few things are more important. Music cannot solve a problem this large, but a 2008 study suggests it can help. 

Sixty patients were enrolled in the study soon after they were hospitalized for major strokes. All received standard stroke care; in addition, a third of the patients were randomly assigned to listen to recorded music for at least one hour a day, another third listened to audiobooks, and the !nal group did not receive auditory stimulation. After three months, verbal memory improved 60% in the music listeners, as compared with 18% in the audiobook group and 29% in the patients who did not receive auditory stimulation. In addition, the music listeners' ability to perform and control mental operations — a skill called focused attention — improved by 17%, while the other patients did not improve at all. 

The research was not able to determine whether music acted directly on injured brain tissues, if it improved the function of other brain structures, or if it simply boosted patient morale and motivation. But other studies suggest that music may promote the brain's plasticity, its ability to make new connections between nerve cells. More research is needed; meanwhile, it seems that a little Beethoven may be good for the brain. 


Heart beats 

You don't have to be a neurophysiologist to understand that music can a#ect the brain and at least a few of its many functions. And even if you're not a cardiologist, you may be interested to learn that music can also help the heart and circulation. 

One way is by reducing stress. A study from Wisconsin evaluated 45 patients who had su#ered heart attacks within the previous 72 hours. All the patients were still in an intensive care unit but were clinically stable. The subjects were randomly assigned to listen to classical music or simply continue with routine care. All were closely monitored during the 20-minute trial. Almost as soon as the music began, the patients who were listening showed a drop in their heart rates, breathing rates, and their hearts' oxygen demands. Music had no e#ect on their blood pressure; however, nearly all heart attack patients are given beta blockers and ACE inhibitors, both of which lower blood pressure on their own. The cardiovascular improvements linked to music lasted for at least an hour after the music stopped, and psychological testing also demonstrated lower levels of anxiety. 

For heart attack victims, even short-term improvements are welcome. But music may also have long-lasting bene!ts. A team of scientists at nine American medical centers randomly assigned 748 patients who were scheduled for cardiac catheterization to receive standard care or standard care plus intercessory prayer (prayer on behalf of others); prayer plus music, imaging, and touch (MIT) therapy; or just MIT therapy. 

The researchers tracked each patient for six months. During that time, there were no di#erences in the risk of major cardiac events; because these were the primary endpoints of the study, the investigators concluded that neither prayer nor MIT therapy was bene!cial. But they also noted that while MIT therapy did not achieve any of the pre-selected goals, patients who received it experienced a clear decrease in anxiety and emotional distress — and they were also 65% less likely to die during the six-month study; prayer was not associated with any potential bene!t. 

MIT therapy had three components: music, imaging, and touch. It's impossible to know if music was the key component, but that possibility would be in tune with other research. 

Without o#ering !nal proof, these studies suggest that music may help the heart and circulation as well as the brain and mind. But how? Slowing the heart rate, lowering blood pressure, and reducing levels of stress hormones are likely explanations, and research presents another possibility. Scientists studied arterial function and blood "ow in 10 healthy volunteers before, during, and after the subjects listened to various types of music, watched humorous videos, or listened to relaxation tapes. Joyful music produced a 26% increase in blood "ow, a bene!t similar to aerobic exercise or statin therapy and well ahead of laughter (19% increase) and relaxation (11%). But the power of music can work both ways; selections that triggered anxiety in the listeners produced a 6% decrease in blood "ow. Men with teenaged children, take note. 

Maladies of musicians 

If there is a link between musicians and medics, perhaps musicians should be able to heal themselves. Many could use the help. 

The most common problems stem from the repetitive motion of playing, often in combination with an awkward body position and the weight or pressure of the musical instrument. A Canadian study found that 39% to 47% of adult musicians su#er from overuse injuries; most involve the arms. The report suggests that musicians are as vulnerable to repetitive-use injury as newspaper workers (41% incidence) and that their risk is only slightly below that of assembly line food packers (56%). And since the survey included only classical musicians, it may underestimate the risk in the world of rock and pop. Even if music is good for the mind, it may not be so good for the wrist. 

A particularly disabling ailment of highly trained musicians is focal dystonia, a movement disorder that may be caused by overuse of parts of the nervous system. Another hazard is hearing loss caused by prolonged exposure to loud music. Brass and wind players may develop skin rashes triggered by allergies to the metal in their instruments. And the list includes disorders ranging from !ddler's neck to Satchmo's syndrome (rupture of a muscle that encircles the mouth). One reassuring note: "cello scrotum," !rst reported in the British Medical Journal in 1974, was revealed to be a hoax 34 years later. 

Concerts, too? 

Most of the studies on music and health rely on individual listening, typically through headphones. That !ts right in with the iPod generation's approach — but what about old-fashioned concertgoing? 

To !nd out, scientists in Sweden evaluated the habits of 12,982 people, recording their previous health, social networks, attendance at concerts and plays, education and income levels, and smoking and exercise patterns. As expected, smoking and previous illness predicted early death; exercise, higher education, and !nancial security predicted long life. 

But there was also an unexpected !nding: attendance at cultural events had a surprisingly powerful e#ect on mortality. In all, people who attended concerts and plays rarely or never were 1.57 times more likely to die during the study period than people who attended frequently. Occasional concertgoers were in between. 

The apparent protection conferred by cultural events was not explained by di#erences in income, social networks, or education. The investigators speculate that music may stimulate speci!c regions of the brain, causing favorable changes in hormone levels or immune function. Or perhaps concertgoers have their own version of a religious experience as they take in what Shakespeare called "music from the spheres." 

It's only one study, and it should be con!rmed before concert tickets take their place in the medicine cabinet. Even now, however, people who like to go to cultural events may get a little extra pleasure from the hope that something enjoyable may actually be healthful. 

Music and Muscles 

Although iPods are perfectly capable of playing relaxing, stress-relieving, blood pressure–lowering classical music, they are more often used to blast up-tempo pop music, especially during workouts. Many athletes are hooked on their music — but does their performance actually bene!t? 

Perhaps. A British study compared the way rock, dance, inspirational music, and no music in"uenced the performance of runners. Many of the athletes thought the music was helpful, but it did not appear to increase their endurance. On the other hand, another investigation from the U.K. found that music increased treadmill-walking endurance. Israeli investigators reported that music boosted peak anaerobic power on a bike ergometer, but the bene!t was very brief. American research found that music improved weight lifting, but a British trial reported that while energizing music boosted strength, relaxing music had the opposite e#ect. 

The Boston Marathon has struggled to ban iPods and other personal listening devices. There may be a legitimate safety issue, but there is little reason to fret about an unfair competitive edge. 

The Science of art 

The ancient Greeks put one god, Apollo, in charge of both medicine and music. Today's doctors tell us that music can enhance the function of neural networks, slow the heart rate, lower blood pressure, reduce levels of stress hormones and in"ammatory cytokines, and provide some relief to patients undergoing surgery, as well as heart attack and stroke victims. But these biological explanations and clinical observations may not do full justice to the e#ect music has on man and his world. Fortunately, poets and philosophers can !ll in the gaps. 

Doctors tell us that social isolation is a cardiac risk factor, and Robert Browning wrote that "He who hears music feels his solitude peopled all at once." Psychologists tell us that expressing emotions is healthful, and Tolstoy explained that "Music is the shorthand of emotion." Clinicians teach that human warmth can blunt many woes, and Shakespeare proclaimed, "If music be the food of love, play on." And in the days when Apollo reigned, Plato explained that "Music is a moral law. It gives soul to the universe, wings to the imagination, and charm and gaiety to life and to everything else."