In how far is playing music comparable with physical exercise for the cardiovascular system? How much does the heart rate and blood pressure increase for professional musicians on stage? And can listening to calming music calm the heart? This article explores the relationship between musical features, emotions, and heart function in musicians and their audience.
Disclaimer: The present article does not constitute medical assessment or recommendation. Based on my education as a psychologist, the insights provided solely pertain to psychological and emotional influences on the described physiological symptoms, and my personal summary of scientific research articles. Conclusions regarding individual heart health or cardiac stress during musical activities should always be clarified with a general practitioner, cardiologist, or a specialized sports or musician's physician.
"Broken Heart" - Acrylic Painting with structure/texture material (Teresa Wenhart, 2023)
Making music - a strain on the heart?
Heart rate, which refers to the number of heartbeats per minute (pulse), is predominantly regulated by centers in the brainstem, along with respiration and other vital functions. These deep, evolutionarily ancient brain regions are connected to the brain, particularly the limbic system, which is responsible for emotions. Therefore, emotional arousal increases heart rate and blood pressure, and this is influenced, among other factors, by the individual's evaluation of the situation (e.g., which music personally moves them or, in general, which situation triggers anxiety). An increased heart rate is accompanied by reduced heart rate variability (HRV). Heart rate variability is an indicator of the parasympathetic nervous system, which is the counterbalance to the sympathetic nervous system activated during stress and excitement, and is similarly influenced by emotional processes.
Does making music affect heart function?
The physiological demands of playing music and the stress of performance situations lead, among other things, to an increase in heart rate during performances and a measurable strain on the cardiovascular system. However, this is a conditioning demand that is considered safe for a healthy individual according to the musicians physician Maria Schuppert. The resting heart rate of a healthy person is typically around 60 to 90 beats per minute (bpm), and it varies depending on age, gender, and body mass index. So, how does the pulse typically compare between a concert performance and a rehearsal?
A research team led by Spanish scientist Claudia Iñesta equipped various musicians (orchestra members playing different instruments, chamber musicians, soloists) with portable systems that recorded heart rate and tracked changes in pulse over time (see figures below). In the case of a solo pianist, the research group observed a consistently high average heart rate of 175 bpm during a nearly 40-minute recital, while a string quartet had a slightly lower average heart rate of 159 bpm with individual variations among its members. Even 20 minutes before the performance, heart rates of 100 bpm were already measured.
Heart rate of a pianist during a significant competition performance (Bartok's 14th suite). The average heart rate during the concert was 175 bpm, with a maximum heart rate of 194 bpm.
Heart rate of a well-known 41-year-old pianist during a four-handed piano piece. She maintained an average heart rate of 136 bpm for almost two hours of concert duration, with periods exceeding 150 bpm and a maximum heart rate of 180.
Heart rates of members of a string quartet during a performance. Prior to the concert (concert = blue bar), the lines of the heart rates are in a similar range. This changes with the start of the concert according to the significance of the voices in the quartet.
Three figures (Figure 1, 2, and 5) from Iñesta, Terrados, García & Pérez (2008) showing how making music affect heart function: The heart rates of two solo pianists and four members of a string quartet were recorded from before the start of the concert until the end of the concert.
The fact that the heart rate during rehearsals without an audience in the study was only slightly elevated at 100 bpm demonstrates the significant impact that the stress of performing has on the body, even in cases of ordinary stage fright without actual performance anxiety. During public concerts, the average heart rate of professional musicians is at 60.2% of their theoretically calculated maximum heart rate. On average, they reach peak values of 76.8% of their maximum heart rate during the performance. These values correspond to moderate to high physical activity.
However, despite the temporarily high physiological stress on the cardiovascular system, there is (according to Maria Schuppert and Sebastian Kerber) no evidence of a higher prevalence of cardiovascular diseases among musicians, and such conditions are generally not caused by playing music. Nevertheless, according to musician physician Maria Schuppert, medical professionals need to consider the high occupational cardiac load of musicians when assessing their work capacity, especially in cases of musicians with pre-existing heart conditions.
Particularly for solo musicians, it is important to be aware of the cardiac strain during a concert and to prepare accordingly. This can be achieved through the use of psychological coping strategies to prevent and reduce chronic and acute (stage) stress, as well as through appropriate physical conditioning. Moreover, engaging in physical training has the additional advantage of releasing endorphins (happiness hormones), reducing stress, and proving effective against performance anxiety.
Stress among musicians
One of the first studies on stress-related symptoms examined 2,212 professional musicians in 47 US orchestras in 1988. The result: musicians with psychological or physiological complaints reported significantly higher perceived stress compared to their colleagues. The most common health limitations reported were social phobia, performance anxiety, depression, muscle and joint pain, as well as cardiovascular problems. While the study only demonstrates a general association between complaints and perceived stress and cannot establish a causal influence of stress on the complaints due to the research methodology, it is plausible that work-related (chronic) stress, similar to other professions, is associated with a higher risk of psychological and physiological complaints. Furthermore, the study shows that musicians with solo obligations, particularly woodwind and brass players, percussionists, harpists, and high string players, are more affected by performance-related stress than other musicians.
Furthermore, the study shows that musicians with solo obligations, particularly woodwind and brass players, percussionists, harpists, and high string players, are more affected by performance-related stress than other musicians. In classical music, especially in larger ensembles such as an orchestra, an additional stress factor comes into play: a lack of control or influence over the situation. Not only are the musical scores predetermined and offer less room for improvisation compared to other music genres (such as jazz), but the musical interpretation is largely in the hands of conductors, section leaders, or influenced by group dynamics in orchestral playing. This can make the situation appear as limited in controllability. Lack of control is one of the factors that stress people the most. Additionally, social tensions often arise within the section, the orchestra, between musicians and conductors or agents, which also triggers stress. Lastly, the enormous travel burden of touring orchestras, irregular schedules, and deployment plans can take a toll on both physical and mental well-being.
Listening to Music - Can music relax the heart?
Music has the fascinating power to evoke and alter emotions and moods, and it also influences the heart rate, blood pressure, and breathing of listeners. In general, it must be said that the body of research on the effect of music on heart rate is heterogeneous due to the numerous influencing factors and different study designs, and only small effects have been found, as summarized by a review conducted by renowned neuropsychologists Stefan Koelsch and Lutz Jäncke in 2015.
Excited, energetic music increases heart rate, respiratory rate, and blood pressure compared to calmer, slower music in musicians and a control group, as shown by a research group led by Luciano Bernardi, for example. The musical style or genre apparently played no role; only the tempo mattered. Musicians exhibited a greater increase in respiratory rate with faster music compared to non-musicians. In both groups, heart rate and blood pressure also generally increased while listening to music, compared to silence, by about 1-2 beats per minute. According to this study, pauses within a piece temporarily lowered heart rate and blood pressure, particularly among musicians.
As various studies have shown, such as the work of Michele Orini's research group, the effect of increased heart rate is even greater with music we like compared to music we don't enjoy as much. Music we like also increases skin conductance and enhances respiratory rate and depth. These are further signs of activation of the sympathetic nervous system.
Contrary to various anecdotes, it has not been definitively proven that faster music accelerates the heart while slower music calms it. Rather, the research group led by Roland Krabs found that the emotional arousal of the music is crucial. If the emotional arousal of the slow music in the study was as high as when listening to faster, more arousing music, the physiological parameters did not change.
Whether listening to music relaxes the heart largely depends on the tempo and our conscious and unconscious emotional evaluation. However, since calm music is usually associated with lower activation, it is comparatively more likely to be accompanied by a lower pulse and heart rate. Various other studies have also found that listening to calm, slow, and soft music can reduce stress hormones such as cortisol and also lead to a reduction in the concentration of other stress-related substances in patients with anxiety or in postoperative care. If the music is perceived as positive, it can actually reduce stress, even though or especially because it is perceived as emotionally stimulating!
Animals, Stress, and Music
Animals, especially pets, are actually prone to stress, somewhat "highly sensitive" - just like musicians. :-) On New Year's Eve, most cats hide under their owners' beds (or behind the cello), and they may even startle and fall off the balcony when a construction vehicle passes by. Paradoxically, or perhaps precisely because of this, many animals have a calming effect on stressed bipeds, as numerous studies show, and their presence can even lower blood pressure. A study conducted by Amanda Hampton in 2020 also demonstrated that music specifically composed for cats could reduce their stress levels, while classical music and silence did not have the same effect.
Sources and Further Reading
Altenmüller, E., & Klöppel, R. (2015). Die Kunst des Musizierens: von den physiologischen und psychologischen Grundlagen zur Praxis. Schott Music.
Bernardi, L. Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: The importance of silence. Heart92, 445–452 (2005).
Heather L. Vellers, Conor Irwin und J. Timothy Lightfoot, »Heart Rate Response of Professional Musicians When Playing Music«, in: Medical Problems of Performing Artists 30 (2015), Nr. 2, S.100–105
Hernandez-Ruiz, E., James, B., Noll, J., & Chrysikou, E. G. (2020). What makes music relaxing? An investigation into musical elements. Psychology of Music, 48(3), 327–343.
Koelsch, S., Fuermetz, J., Sack, U., Bauer, K., Hohenadel, M., Wiegel, M., ... & Heinke, W. (2011). Effects of music listening on cortisol levels and propofol consumption during spinal anesthesia. Frontiers in psychology, 2, 58.
Krabs, R. U., Enk, R., Teich, N., & Koelsch, S. (2015). Autonomic effects of music in health and Crohn's disease: the impact of isochronicity, emotional valence, and tempo. PloS one, 10(5), e0126224.
Lawlor, D. A., & Hopker, S. W. (2001). The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. Bmj, 322(7289), 763.
Middlestadt, S.E., & Fishbein,M. (1988), Health and Occupational Correlates of Perceived Occupational Stress in Symphony Orchestra Musicians, in: Journal of Occupational Medicine 30/9
Orini, Michele, Raquel Bailón, Ronny Enk, Stefan Koelsch, Luca Mainardi, and Pablo Laguna. "A method for continuously assessing the autonomic response to music-induced emotions through HRV analysis." Medical & biological engineering & computing 48 (2010): 423-433.
Koelsch, S. & Jäncke, L. (2015), Music and the heart, European Heart Journal, Volume 36/44
Iñesta,C., Terrados, N., García, D. & Pérez, J.A. (2008), Heart Rate in Professional Musicians, in: Journal of Occupational Medicine and Toxicology 3/16.
Schuppert, M., & Kerber, S. (2015). Kardiologische Aspekte in der Musikermedizin. Musik-, Tanz und Kunsttherapie. 25/1, 45–48.
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