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How Music Can Influence the Body: Perspectives From Current Research
Article in Voices A World Forum for Music Therapy · April 2016
DOI: 10.15845/voices.v16i2.871
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Voices: A World Forum for Music Therapy, Vol 16, No 2 (2016)
[Position Paper]
How Music Can Influence the Body:
Perspectives From Current Research
By Imogen Nicola Clark & Jeanette Tamplin
Abstract
Music is widely used by people of all ages as a stimulant and relaxant to manage everyday
situations. Whether to motivate us for exercise or to help us unwind after a busy day, we
seem to have an intuitive understanding about the influences music has on our bodies. The
body’s responses to music are both conscious and unconscious, involving entrainment with
rhythm, hormonal and neurological reactions, and changes in mood, emotion, and pain
perception. This article explains these physiological responses to music and provides
guidelines for consideration when selecting music to evoke desired bodily responses.
Applications using music in rehabilitation are also provided to illustrate health­promoting
qualities of music.
Keywords: music, singing, health, body
Editorial note: In 2016, Voices hosted a special edition to accompany the launch of a Massive Open Online Course
(MOOC) on the topic of "How Music Can Change Your Life". Thirteen authors agreed to develop position papers for the
MOOC, with two articles being developed to accompany each of the six topics within it. Each author has highlighted the
theorists and researchers who have influenced their thinking, and included references to their own research or music
practices where appropriate. These papers have been written with a particular audience in mind—that is, the learners
who participate in the MOOC, who may not have had previous readings in any of the fields being canvassed. We hope
that you find these articles interesting, whether reading as a MOOC learner, a regular VOICES reader, or someone who
is discovering VOICES for the first time.
Introduction
Humans have used music throughout history and across diverse cultures as an
environmental modifier to change the way their bodies move and feel (Schneck & Berger,
2006). With recent advances in technology, people of all ages appropriate music with
affordances such as vigor, mastery, and tranquility, so they can regulate their energy levels
for everyday purposes (for example, exercise or relaxation) (DeNora, 2000). Active music­
making opportunities including choirs and drumming circles are also becoming increasingly
popular as a means of supporting physical and emotional health (Clift, 2012; Davidson &
Emberly, 2012).
Our bodies respond to music in conscious and unconscious ways (Clark, Baker, & Taylor,
2016). While we may take the influence of music for granted, there are complex interactions
occurring in our brains and bodies that impact our physical movement, thoughts, and
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feelings (Altenmüller & Schlaug, 2012; Koelsch, Fritz, Cramon, Müller, & Friederici, 2006).
When we listen to music, our bodies respond automatically (Burger, Thompson, Luck,
Saarikallio, & Toiviainen, 2013). We breathe in time, move in time, and our hearts may even
beat in time (Levitin & Tirovolas, 2009; Zatorre, Chen, & Penhune, 2007). Dancers illustrate
this phenomenon beyond timing or rhythm as they capture musical meaning from the full
spectrum of music including melody and harmony with their bodies (Quiroga Murcia &
Kreutz, 2012).
Regulating Effects of Music on the Body
Music is made up of multiple elements including tempo (speed), rhythm, timbre (sound
qualities), dynamics (loudness), harmony, melody (pitch), and sometimes lyrics. Rhythm in
music is particularly influential as it mimics internal bodily rhythms, and is therefore an
external cue that our brains readily recognise and respond to (Zatorre et al., 2007). The
automatic synchronisation of physical movement, heart rate, respiratory rate, and neural
activity with rhythmic cues in music is known as entrainment (Altenmüller & Schlaug, 2013;
Schneck & Berger, 2006; Thaut, 2005). Neurophysiological responses are stimulated by
complex interactions involving all the musical elements, which in turn have a powerful
influence on mood and emotional experience (Schneck & Berger, 2006). Music therapists
utilize these bodily responses from music to modify arousal levels and optimize physical
functioning such as walking and other movement patterns (Tomaino, 2015).
Entrainment Effects
When we entrain with music during movement (for example, walking), it is the phases
between consecutive beats that guide repetitive movement cycles rather than the actual
beat as one might expect (Thaut, 2005; Zatorre et al., 2007). A feedforward/feedback loop
explains this phenomenon (Levitin & Tirovolas, 2009). The brain analyses the pauses
between beats along with the strength of each beat (volume and impact within rhythmic
phrase), and feeds this information forward to the appropriate limb. Simultaneously, the
brain integrates feedback information from the moving limb, including its position in space
and memory of recent movement cycles and uses this information to plan the next
repetition. Since the execution of each movement cycle occurs just before the beat (during
the phase between beats), fine adjustments in limb position and speed are possible.
Entrainment with music and the resulting feedforward/feedback loop reduces errors in
muscle recruitment thereby improving energy efficiency, balance, coordination, and
performance (Levitin & Tirovolas, 2009; Rodriguez­Fornells et al., 2012) (Figure 1).
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Figure 1. Analysis of the beat and the feedforward / feedback loop
Neurophysiological Responses
Vibrations from music have a systemic impact on the entire body from single cells through to
complex systems. Thus, music has a modulating influence on multiple physiological
processes (Schneck & Berger, 2006).
The autonomic nervous system is particularly sensitive to various subtle and overt musical
meanings, leading to neural excitement and states of heightened arousal on one extreme
and neural inhibition with deep relaxation on the other (Zatorre et al., 2007). In addition,
musical experiences can cause the neuroendocrine or hormonal system to release feel
good hormones such as dopamine and serotonin, which imbue intense feelings of pleasure
and reward (Rodriguez­Fornells et al., 2012; Schneck & Berger, 2006). Music also activates
the limbic system, releasing endorphins that can make us feel better and reduce pain
perception (Beaulieu­Boire, Bourque, Chagnon, Chouinard, Gallo­Payet, & Lesur, 2013).
Further, music listening can reduce anxiety levels (known as an anxiolytic effect), by
suppressing the sympathetic nervous system activity, and in doing so, reducing release of
the stress hormone adrenaline (Bradt & Dileo, 2014; Chlan, 1998). Musical tempo, harmony,
melody, rhythm and volume in music can therefore be manipulated to regulate heart rate,
blood pressure, sensory perception, cognitive function, neural activity, and emotional
response depending on the requirements for a given situation (DeNora, 2000; Schneck &
Berger, 2006).
Regulating Effects of Music on Mood and Emotions
Music is commonly appropriated to alter mood and arousal so we feel able to meet the
needs of a given context, situation, or activity (DeNora, 2000). It is likely that you are familiar
with energising or relaxing potentials of music, and regularly draw on these to manage your
energy levels for everyday living. To do this, you will consider the musical components in
certain songs and the emotions, feelings and mood they evoke for you. It is also worth
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noting that your song selection may vary dramatically from one day to the next, and that
your choices in music may not lead to the same responses for someone else (North &
Hargreaves, 2008).
The influence of music is dependent on extrinsic factors that connect you with the music
personally (for example, memories and associations with various parts of your life), and
intrinsic elements within the music (such as rhythm, melody, and harmony) (North &
Hargreaves, 2008). Through our lives we build a legacy of music marking integral time
points. In this way, certain songs easily evoke strong memories, such that we may clearly
see and feel these moments in time (Schneck & Berger, 2006). With respect to intrinsic
elements in music, current theory proposes that pitch related factors have strong impact on
the mood and emotional feel (Zatorre et al., 2007). Generally, stimulative or energising
music includes fast tempo, wide pitch variation, and syncopated rhythms. In contrast,
relaxing or sedative music has slow tempo, low melodic range, and consistent rhythm
(Zatorre et al., 2007).
Variations in Musical Elements that Affect the Body and Mind
Music can be strategically selected for specific purposes. Table 1 lists various elements in
music and how these can be modified to be stimulating or relaxing. However, music is never
prescriptive and the influence of these elements will differ for each of us.
Musical
element
Stimulating
Relaxing
Rhythm/beat
Prominent percussive features. May
include syncopation and pauses
Consistent
Tempo
>120bpm
May include variations.
<80bpm Steady
Volume
Moderate to loud.
May include variations.
Consistent.
Harmony
A sense of tension and release.
Major keys may stimulate positive mood.
Predictable patterns.
Melody
Large intervals and leaps.
May include embellishments.
Limited variation in pitch.
Motifs are predictable.
Form
Music is divided into prominent sections.
Less defined change from one
section to another.
Timbre
Variations in texture.
Layering of instruments.
Limited number of
instruments.
Lyrics and
associations
Uplifting, motivating, inspiring.
May have associations with special
events.
Instrumental only or vocal
without words.
Table 1. Stimulating and relaxing qualities in music
When selecting music, we can choose to play music that is synchronous to our current
mood state or energy level, or we can choose music to shift our mood or energy level
(DeNora, 2000). For example, if someone is feeling despondent they may choose to play
stimulative music to energise them for exercise or music that they associate with positive
memories. Conversely, we may choose to play calming, predictable, relaxing music to help
release tension and stress after a long day at work. However, there are times when we feel
low in energy and mood and want to play music that reflects and acknowledges this state.
Music therapists often use a principle known as the iso principle to match and shift a
patient’s physical or emotional state (Davis, Gfeller, & Thaut, 2008). This involves first
matching live music to a patient’s current mood or physiological response. The therapist
then modifies the music progressively to effect changes in the patient. The iso principle also
underpins the concept of musical entrainment, which will be explored later in this paper.
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Using Music to Reduce Stress and Anxiety
Music can be used to reduce stress and anxiety by employing the regulating effects of music
on the body that were discussed earlier. These include the unconscious physiological effects
and the emotional associations and memories that different music stimulates (Bradt, Dileo &
Shim, 2013; Bradt, Dileo & Potvin, 2013). Music can decrease physiological stress markers
such as cortisol, adrenaline, heart rate, and blood pressure (Chanda & Levitin, 2013; Kreutz
et al., 2012). These effects can be accessed receptively (through listening to music) or
actively through singing or playing music. Many perceived benefits of singing have been
reported in the literature including: physical relaxation and release of physical tension;
emotional release and reduction of feelings of stress; a sense of happiness, positive mood,
and a sense of greater emotional and physical wellbeing (Bailey & Davidson, 2002; Bailey &
Davidson, 2005; Clift, 2008; Clift & Hancox, 2001; Clift et al., 2010). When we sing with
other people, the effects are amplified (Gridley et al., 2012)!
Playing an instrument is another way to access the therapeutic potential of music for stress
management. This may be accomplished through playing a reflective piano sonata to
unwind and express emotions, or by improvising rhythmically and energetically in an African
drumming circle to release tension and stimulate the mind and body.
Using Music for Pain Management
Perception of pain is multifaceted and based on interconnected physiological, psychosocial,
cultural, and personal factors. Many research studies have indicated that music can play a
positive role in pain management (Bradt, 2010; Nilsson, Rawal, & Unosson, 2003; Wang et
al. 2002). However, research evidence is not always consistent regarding the effect of music
on pain perception, with some studies showing no effect (MacDonald et al., 2003; Mitchell &
MacDonald, 2006).
While the exact mechanisms still remain unclear, there are several plausible theories for
why music may affect pain perception.
1. Music acts as a distracting stimulus—Gate Control Theory[1] (Melzack & Wall,
1965).
2. Music can elicit physiological responses that counteract pain, for example, the
release of endorphins (Beaulieu­Boire et al. 2013).
3. Music can induce relaxation through entrainment effects to slow breathing and
heartbeat (Bradt, 2010).
4. Music facilitates a sense of control over pain (Linnermann et al. 2015; Mitchell &
MacDonald, 2006).
5. Music reduces pain perception by reducing stress (Linnemann et al., 2015).
As discussed in the previous section, music can reduce both subjective stress levels and
physiological markers of stress such as cortisol, adrenaline, heart rate, and blood pressure
(Bradt & Dileo, 2014; Chanda & Levitin, 2013; Chlan, 1998; Kreutz et al., 2012).
Using Music to Increase Physical Activity
Theorists suggest that music can have a powerful effect on exercise participation and
adherence (Clark et al., 2016). In fact, the performance enhancing qualities of music are
such that music is banned from a number of competitive sports (Bateman & Bale, 2009).
Most of us do not need theories or research to explain the benefits we experience from
music during exercise. This quote is from male who participated in a research study
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investigating the effect of music listening on physical exercise following cardiac
rehabilitation:
I always use music for walking. . .It soothes me down and keeps me mobile. . . I walk
automatically. It’s really just a no brainer. . . I’m totally focused with music. I keep my
pace. . .It helps me physically and takes my mind off the boredom. It helps my mood.
Several factors in music make it an excellent accompaniment for exercise, provided it has
been selected carefully (Karageorghis & Priest, 2012a; 2012b). First, music facilitates
rhythmic entrainment, thereby improving energy efficiency and exercise performance.
Second, music elicits the release of feel good hormones, which reduce feelings of
discomfort and leads to rewarding experience. Third, music excites the autonomic nervous
system and primes multiple systems in the body (cardiovascular, musculoskeletal, sensory­
motor, neuroendocrine) for action. Fourth, music evokes positive mood and memories. Fifth,
but not final, music diverts our attention away from unpleasant experiences such as fatigue,
pain, and boredom (Clark et al., 2016).
These affordances in music are worthy of consideration with respect to the high levels of
physical inactivity among adults in the developed world (Wen et al., 2011). The World Health
Organisation (WHO, 2011) recommends we complete a minimum of 150 minutes of
moderate intensity exercise every week (for example, 30 minutes brisk walking on 5 days of
the week). Unfortunately, few adults achieve this level of physical activity and, as a result,
are at high risk of chronic ill health such as heart disease, stroke, cancer, and diabetes
(Haskell et al., 2007). Music during exercise leads to improved exercise experience and
performance (Karageorghis & Priest, 2012a; 2012b). Theorists suggest that these benefits
from music listening during exercise also have the potential to increase exercise
participation and adherence (Karageorghis, 2008), which may therefore improve compliance
with physical acitity guidlines. However, evidence supporting the notion of changes in
exercise behaviour as a result of music listening is limited (Clark et al., 2016; Karageorghis,
2008) (Figure 2).
Figure 2. Influences of music on exercise response and experience (Clark et al.,
2016).
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Health Benefits of Singing
There is a growing interest in the application of singing to improve physical health. A recent
systematic review reported that singing can be a meaningful experience that can enhance
psychosocial factors, such as improving mood, reducing anxiety, or increasing motivation
(Clark & Harding, 2012). Quantitative studies have shown physiological health benefits from
singing such as lowered levels of the stress hormone cortisol and increased levels of
salivary immunoglobin A (which boosts the immune system) (Beck, Cesario, Yousefi, &
Enamoto, 2000; Beck, Gottfried, Hall, Cisler, & Bozeman, 2006; Kreutz, Bongard,
Rohrmann, Hodapp, & Grebe, 2004; Kuhn, 2002). Other studies have found increases in
melatonin (Kumar et al., 1999) and oxytocin (Grape, Sandgren, Hansson, Ericson, &
Theorell, 2003) following singing.
Research suggests that singing can improve symptoms for people with respiratory
conditions, including asthma (Wade, 2002), emphysema/chronic obstructive pulmonary
disease (COPD) (Bonhila et al. 2009; Engen, 2005; Lord et al., 2010), and even snoring
(Eley & Gorman, 2010). Some neurological conditions, such as Parkinson’s disease (Di
Benedetto et al., 2009), multiple sclerosis (Wiens, Reimer, & Guyn, 1999), acquired brain
injury, and spinal cord injury, also affect respiratory control (Tamplin, 2015; Tamplin et al.
2013). Singing (and playing wind instruments) requires large volumes of air at high internal
pressure. Inspirations are strong and fast and expirations are extended and controlled to
sustain long notes. This breath support and control are necessary for singing, but more
importantly, they provide skills for dealing with dyspnea (breathlessness) and promoting a
louder, clearer speaking voice. Singing lessons and therapeutic singing interventions
typically involve selected exercises to build muscle strength, coordination and efficiency for
connecting breath to the voice. This may include developing awareness of breathing,
coordinated breathing, rhythmic exercises, and strengthening the muscles used for
respiration. When singing we need to organize our breathing and phonation to the rhythmic
structure of the music. We need to take in deep breaths quickly and control the release of
this air over sustained periods. Learning how to distribute the breath to sing a musical
phrase can have physical health benefits in that it can increase respiratory capacity and
control.
Anecdotal reports have indicated that karaoke singing (Batavia & Batavia, 2003) and beat­
boxing (mouth percussion) may provide benefits for respiratory health (Warms, 2007). A
number of research studies have also indicated that regular singing can reduce sleepiness,
snoring, and sleep apnoea symptoms by increasing the strength of the pharyngeal muscles
(Hilton et al., 2013; Ojay & Ernst 2000; Pai et al., 2008). Other research has found similar
effects on sleep apnoea symptoms from didgeridoo playing (Puhan et al., 2006). Didgeridoo
playing can also improve respiratory function for people with asthma (Eley & Gorman, 2008;
2010) as does other wind instrument playing (Lucia, 1994) and singing (Wade, 2002).
Stuttering is a speech fluency disorder that can involve psychological, motor, and auditory
processing issues. Interestingly, most people who stutter can sing effortlessly which is
probably because they are using different brain networks when they sing (Wan, Ruber,
Hohmann, & Schlaug, 2010). The combination of increased phonation duration, slower
tempo of word production, focus on intonation, and familiarity can all contribute to fluent
sung production of words. Music therapists can address both the anxiety and the motor
difficulty aspects of stuttering through singing by providing opportunities for fluent self­
expression and techniques using rhythmic and melodic cues for speech (Tomaino, 2015).
Applications of Music for People with Health Conditions
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The healing potential of music has been utilised throughout history and in many cultures
(Wheeler, 2015). Music has been used as a modality for therapy and health promotion and
is used by various health professionals to assist people to manage and overcome physical,
psycho­emotional, cognitive, and spiritual challenges (Wheeler, 2015). However, the use of
music as a therapeutic modality is a relatively new phenomenon in many countries. Many
medical practitioners and hospital funding bodies are not convinced that there is sufficient
evidence for the effect of music therapy or music­based interventions in health care
(Schneck & Berger, 2006).
We work as music therapists at a rehabilitation facility of a large publicly funded hospital in
Australia. Our patients are admitted for rehabilitation with various health conditions including
neurological injury (for example, spinal injury, acquired brain injury, stroke) and chronic
disease (such as heart disease, diabetes, multiple sclerosis, motor neuron disease, cancer).
Often referrals for music therapy are made because patients lack motivation for therapy and
have low mood. Our colleagues assume that music will be motivating, improve mood, and
offer creative ways to achieve rehabilitation goals. They are right. From a clinical
perspective we frequently see our patients experience these benefits from music therapy.
However, we have also conducted a number of research projects investigating the effects of
music and music therapy on physical health and emotional wellbeing. Summaries of some
of our relevant music therapy research projects are presented to illustrate how music can
improve the health of people with significant health conditions.
Research project example 1: Music to help people with heart disease
to be more physically active (Clark, Baker, Peiris, Shoebridge, &
Taylor, in press)
Physical activity and exercise are strongly encouraged for older people with heart disease to
prevent further heart attacks and the development of other chronic diseases (Haskell et al.,
2007; Nelson et al., 2007). Rehabilitation programs for people with heart disease (cardiac
rehabilitation) focus on physical activity with the aim of empowering participants with
strategies for long­term health and wellbeing (Briffa et al., 2009). However, people with heart
disease often face significant fears and psychological barriers as they try to establish an
exercise routine following heart attack (Rogerson, Murphy, Bird, & Morris, 2012). They worry
that physical activity might cause another heart attack. As discussed earlier, listening to
music during exercise can support emotional and physical health, and may assist people
with heart disease to lead more physically active lives (Clark et al., 2016).
We conducted a research project with older people who had heart disease. The project
compared effects of listening to personally preferred music during exercise with usual care
alone (no music) over a 6­month period. Music did not make any differences to achievement
of physical activity recommended in guidelines, and thus did not change exercise behaviour.
However, results did suggest that listening to personally preferred music increases exercise
intensity (walking speed and energy consumption), leading to cumulative benefits with
improved fitness, waist circumference, blood pressure, and body mass indices. Participants
also explained how music with positive associations and memories evoked feelings of flow
and positive mood, which reduced experiences of anxiety, boredom, and discomfort during
exercise. As a result, participants felt that listening to music helped them to manage fears
and other psychological barriers during exercise. One participant eloquently summed up the
sentiments of others with the following comment:
The songs bring back all those memories. They might do something to my
endorphins, cause they make me feel happy . . . I’m pretty young for what happened
to me. I have moments of absolute anxiety just briefly about how it happened,
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because I was so fit. It took a lot out of me. But the music was great. It helped to
motivate me just to get out there and do the walking. It did actually get me out there
doing more walking. I’ll keep using it.
Research example 2: Singing to improve respiratory function for
people with quadriplegia (Tamplin et al., 2013; 2014)
Quadriplegia causes paralysis of the muscles normally used for breathing (the abdominal
and intercostal muscles). This makes it difficult to cough effectively and significantly
increases the risk of respiratory tract infections and pneumonia. People with quadriplegia
often run out of air in the middle of a sentence and find it difficult to project their voices to
speak over background noise. We conducted a randomized controlled trial to see if a 12­
week therapeutic group singing intervention could improve respiratory function and voice
projection for people with quadriplegia. We trained participants to use the muscles in their
neck and shoulders more to help control their breath when singing. In comparison to
participants who were allocated to a music listening and discussion group, the singing group
improved their voice projection and maximum respiratory pressures. They also reported that
the singing was enjoyable and motivated physical exercise and social engagement.
Research example 3: Singing to improve speech for people with
neurological conditions (Tamplin, 2008)
Singing shares many of the neural mechanisms used for motor speech, which gives it great
value as a rehabilitation tool for people with neurological speech impairments. Many other
elements, such as rhythm, pitch, dynamics, tempo, and diction are also shared by both
singing and speech. Research has found that singing interventions can be used to improve
speech impairments resulting from stroke (Cohen & Masse, 1993), traumatic brain injury
(Tamplin 2008), and Parkinson’s disease (Di Benedetto et al., 2009; Haneishi, 2001). We
conducted a research study investigating the effect of singing on speech production for
people with non­progressive dysarthria following brain injury. Dysarthria is a motor speech
disorder caused by neurological damage. It is often characterized by limited verbal
intelligibility, loudness, range and naturalness, and abnormal speech rates. Singing can
provide the rhythmic and melodic cues to organise speech production . After an 8­week
individual therapeutic singing intervention we found significant improvements in speech
intelligibility, rate, and perceived naturalness (fluency, prosody, rhythm) (Tamplin, 2008).
There has also been increasing interest and research into the effects of therapeutic choirs
for people with neurological language impairments such as aphasia (eg. Tamplin et al.,
2013).
Conclusion
This article describes how music influences your body, both as a stimulant and relaxant.
Various active and receptive strategies using music are suggested that can be used in
everyday life to improve physical and emotional health. Applications of music described in
case studies provide real life examples of how interventions using music benefit people with
serious health conditions. Music is a readily available and inexpensive, yet powerful
resource that can be accessed in various ways to make a difference to your health and
wellbeing.
Notes
[1] The Gate Control Theory of pain perception posits that attending to a pleasant stimulus
such as music, blocks the central nervous system from processing pain signals (Melzack &
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Wall, 1965).
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