The Soundtrack of Wellness

In a laboratory in Pavia, Italy, 24 young adults lay on their backs with headphones on and their eyes closed while researchers played them six kinds of music, from an Indian raga at 55 beats per minute to a Vivaldi presto at 150. As the tempo rose, so did their breathing, blood pressure and heart rate, whether the track was classical or techno. Then came two minutes of silence, slipped in at random, and heart rate, blood pressure and breathing volume fell below where they had been before the music started.

That small 2006 study by Luciano Bernardi and colleagues sums up what this article covers: your body responds to what you listen to, mostly through tempo, loudness and the shape of phrases, and the effects are real but usually modest. You'll find what the research says about heart rate, breathing, blood pressure, sleep, pain and exercise, where popular claims run ahead of it, and how to build four playlists from what holds up. For mood and mental health, see our article on how music affects mood and stress; for what learning an instrument does to the brain, see How Learning an Instrument Rewires Your Brain.

Your breathing and pulse follow the tempo, loosely

In Bernardi's study each track played for two minutes and later for four, in random order. The faster the music, the faster people breathed and the higher their blood pressure and heart rate climbed. Style didn't matter, and neither did whether people liked the track. Slow music, though, did not pull blood pressure or breathing below the resting baseline; only the raga slowed the heart more than rest did. The calmest moment was the silence. At the two extremes, breathing even seemed to fall into step with the music: about one breath to every four quarter-note beats in the slowest tracks and one to every eight in the fastest. The trained musicians' breathing followed the tempo more closely than the non-musicians'.

The six tracks in Bernardi's 2006 study, placed by tempo, with the average number of quarter-note beats per breath. Faster tempos raised breathing, blood pressure and heart rate; the lowest values of all came in the two-minute pause.

Tempo moves breathing, blood pressure and heart rate together, so the same notes can soothe or hurry you. Take the phrase "Morgen früh, wenn Gott will, wirst du wieder geweckt" from Brahms's lullaby: it lasts 12 quarter-note beats. At 60 beats per minute that is 12 seconds; at 120 it is over in 6. Twelve seconds is close to one slow breath at five or six breaths a minute, the pace at which, in Bernardi's earlier study of recited prayers and mantras, the body's own slow waves of heart rate and blood pressure grew larger and lined up with each other. Our Phrasing sheet describes a phrase the same way: connected, like one breath.

Brahms, Wiegenlied (Lullaby), Op. 49 No. 4 (1868), from the pickup in bar 10 to bar 14. The bracketed phrase is 12 quarter-note beats long: 12 seconds at ♩ = 60, 6 seconds at ♩ = 120.

Your heart does not lock onto the beat, though. When Hanna Mütze and colleagues played a djembe pattern 25, 40 or 55 percent faster than each listener's heart rate, or held it steady, the heart neither followed the tempo nor fell into sync with the beats (Musicae Scientiae, 2020). Tempo seems to act through arousal instead, and heart rate and blood pressure move with it. Phrases and swells in loudness seem to pull harder than the beat itself: when Bernardi's team played Puccini, Beethoven, Bach and two Verdi arias to 24 young adults, crescendos raised blood pressure and narrowed the blood vessels of the skin in step with the music, an evenly weighted Bach cantata lowered blood pressure, and Verdi's phrases, which come round about every 10 seconds, drew the body's slow cardiovascular rhythms into line with them (Circulation, 2009).

Composers write tempo two ways. An Italian word gives the character, and a metronome mark gives the speed: ♩ = 60 means 60 quarter-note beats a minute, one per second. Johann Maelzel patented his metronome in 1815, built on a mechanism invented the year before by Dietrich Nikolaus Winkel, and Beethoven was the first well-known composer to give metronome marks for his music, from December 1815. Our Tempo & the Metronome sheet sets the Italian words against the numbers (Adagio 60–76, Allegro 120–168), and the Musical terms & signs chart lists them with the rest of the score's vocabulary. Treat the ranges as rough guides: composers and eras use the words differently.

Reading a metronome mark: the note in the mark is the beat. In cut time the half note gets the click; in 6/8 the dotted quarter does, and the eighth notes run three to a beat.

A mark always names the note that gets the beat. In cut time, the meter of many marches, a half note marked 120 means 120 half notes a minute (Two Beats in a Bar); in 6/8, which our Time Signatures II sheet calls "the rocking of boats and lullabies", a dotted quarter marked 60 puts one big beat in each second.

The scale of an old Maelzel metronome: beats per minute in two columns, with the tempo words beside them. On this one, Adagio sits beside 104 to 120, where our chart puts Andante and Moderato. Photo: Mutatis mutandis, CC BY-SA 3.0, via Wikimedia Commons (cropped).

Blood pressure: a small dip, for now

The most careful recent review keeps the effect in proportion. In 2025 a team at the University of Bristol pooled 182 studies of relaxation methods for people with high blood pressure or prehypertension (BMJ Medicine). In those with high blood pressure, music programs lowered systolic pressure by about 6.6 mmHg over up to three months compared with no treatment or usual care, about as much as breathing exercises (6.65) and less than yoga and tai chi (9.6), though all the estimates overlap. That clears the 5 mmHg the authors count as meaningful, but they rated the certainty of every result as very low, and in the few trials that followed people for longer than three months, no method showed a clear effect. An earlier review of ten trials saw pressure fall in music groups, but where trials had proper control groups, it fell in those groups too, so the authors could not credit the music (Kühlmann and colleagues, 2016).

Short-term fall in systolic blood pressure against no treatment in people with high blood pressure, with 95% credible intervals (Webster and colleagues, 2025). The dashed line marks the 5 mmHg the authors count as meaningful; they rated the certainty of every result very low.

Across 104 randomized trials of music for stress, the physical measures (heart rate, blood pressure, stress hormones) improved less than how people felt, with the largest change in heart rate (de Witte and colleagues, 2020). So enjoy calm music as part of your evening, not as treatment: keep taking prescribed medicine, and measure as your doctor advises.

Sleep: better nights on the questionnaire

The strongest evidence is the 2022 Cochrane review of listening to music for insomnia (Jespersen and colleagues). It pooled 13 randomized trials with 1,007 adults who slept poorly. They listened to prerecorded music once a day, usually at bedtime, for 25 to 60 minutes (36 on average), over three days to three months. On the Pittsburgh Sleep Quality Index, a questionnaire scored from 0 to 21 where lower is better, the music groups ended 2.8 points better than people who got no treatment or usual care: about one standard deviation, judged moderate-certainty evidence. People also reported falling asleep faster and sleeping longer, with low certainty. But in the three trials that recorded sleep with polysomnography, music made no measurable difference to how fast people fell asleep, how long they slept or how often they woke. None of the 13 trials reported harms.

What the 2022 Cochrane review found for adults with insomnia: the questionnaires improved, but sleep recorded by polysomnography did not change in the three trials that measured it.

Control groups matter here. In one of the trials, 64 adults over 60 in Xi'an, China, chose music to play for 30 to 45 minutes a night for three months, and their questionnaire scores fell from 13.5 to 7.3, but a comparison group that received the same sleep advice and phone calls improved too, from 12.3 to 8.7, though less.

As for the kind of music, whether people chose from a set of preselected playlists or simply got the researchers' pick made no measurable difference. The four trials that described their music agree on its features: slow (52 to 85 beats per minute), even in loudness, with no strong accents. No trial compared tempos head to head, so the popular "60 to 80 beats per minute" rule is a reasonable start, not a proven optimum. Real habits vary more. When Scarratt and colleagues analyzed 225,626 tracks from 985 Spotify sleep playlists, sleep music was softer, more often instrumental and slower, about 105 beats per minute on average against 120 for music in general by Spotify's own estimates, but three of its six clusters included popular songs that were "faster, louder, and more energetic than average sleep music."

Lullabies and marches: calm and energy on the page

Calming and rousing music sound different the world over. In an online experiment, 29,357 listeners sorted recordings from 86 mostly small-scale societies into lullabies, dance songs, healing songs and love songs better than chance, and they confused lullabies with dance songs least often; across cultures the two differ in tempo, accent and the regularity of their beat groupings (Mehr and colleagues, Science, 2019). Babies respond too: 144 American infants relaxed, as measured by heart rate, pupil size and skin conductance, when they heard eight unfamiliar lullabies from other cultures rather than other foreign songs (Bainbridge and colleagues, 2021).

Brahms, Wiegenlied, Op. 49 No. 4, bars 1–6: the voice and the piano's bass line (the right hand's chords are left out). Every bar the bass falls to a low E♭ on beat 1, leaps up on beat 2 and comes back down on beat 3.

Brahms's Wiegenlied shows the lullaby recipe in a few bars. It is marked Zart bewegt (tenderly moving) and sways in 3/4, "the spin of every waltz" in our Time Signatures I sheet. The bass rocks low–high–low bar after bar, the voice stays within one octave, and the score has no accent marks. Each of the voice's phrases starts with a pickup, eighth notes that lean into the next bar (Pickup Notes). Brahms wrote it in 1868 for his friend Bertha Faber, a singer, on the birth of her son, and, as the musicologist Max Friedlaender noted, he hid in the piano part a Viennese waltz song by Alexander Baumann that he had heard her sing years before.

Sousa, The Stars and Stripes Forever, song version (1898), the pickup and first eight bars of the chorus: the voice and the piano's left hand (the right hand's off-beat chords are left out). In cut time the beat is the half note, and the bass lands on both beats of every bar.

A march is built for feet. By his own account, John Philip Sousa composed The Stars and Stripes Forever on Christmas Day 1896; it was first performed in 1897, and an act of Congress made it the national march of the United States in 1987. In the 1898 song version its famous trio tune carries Sousa's own words, marked Tempo di Marcia and written in cut time: two big beats a bar, "ONE-two, ONE-two, like feet in a march", as our Two Beats in a Bar sheet says, and the bass strikes every one. Modern marches typically run at about 120 beats per minute, the pace of soldiers walking in step. Where the lullaby rocks in threes without an accent, the march strides in twos, and the song opens with loud accented chords, the kind our Fermata, Tenuto & Accent sheet says shout "HERE!"

The cover of the 1898 song edition, published by the John Church Company of Cincinnati, with Sousa's portrait. Image: public domain, Library of Congress, Music Division.

Music before, during and after surgery

If you have an operation coming up, this is the strongest finding in the field. In The Lancet in 2015, Hole and colleagues pooled 73 randomized trials of adults having surgery (other than on the brain, head or neck), comparing music before, during or after the operation with usual care or other non-drug options. Music reduced pain after surgery, anxiety and the amount of pain medicine used, and raised satisfaction, though hospital stays were no shorter. The choice of music and its timing made little difference, and music helped even when patients were under general anesthesia. A 2018 review of 92 trials put it in everyday terms: on a 100-millimeter scale, anxiety fell by about 21 mm and pain by about 10 mm, though the trials' risk of bias was moderate to high (Kühlmann and colleagues, British Journal of Surgery).

Music around surgery in Hole and colleagues' 2015 meta-analysis of 73 trials: standardized mean differences with 95% confidence intervals, drawn so that bars to the right favor music. Length of stay did not change.

For long-term pain the evidence is thinner. A review of 14 small trials found that music reduced self-reported chronic pain, more so when patients chose the music themselves (Garza-Villarreal and colleagues, 2017). Ask your hospital whether you can bring headphones and a playlist, and treat music as an addition to pain relief, not a replacement.

Exercise: tempo, synchrony and effort

Music changes how exercise feels more than what your heart does. A 2020 meta-analysis of 139 studies with 3,599 participants (Terry, Karageorghis and colleagues, Psychological Bulletin) found that music made exercise more pleasant, improved performance, lowered perceived effort and made oxygen use slightly more efficient, but did not change heart rate. Fast music helped performance more than slow or medium music.

Average effects of music during exercise and sport in Terry and colleagues' 2020 meta-analysis (Hedges' g with 95% confidence intervals). Music made exercise feel better and helped performance; heart rate did not change.

Tempo matters to exercisers' taste. When 28 active students cycled at six intensities and rated music at four tempos, slow music (95–100 beats per minute) was never their favorite, and their preference for fast music (135–140) grew as the work got harder (Karageorghis and colleagues, 2011). Karageorghis and Priest's 2012 review recommends 125 to 140 beats per minute as background for most exercise, from light to hard, and slower music, about 60 to 70 beats per minute (around resting heart rate), after the workout.

Moving in time with the beat adds something. Eleven elite triathletes ran 18 to 20 percent longer before exhaustion when they ran in step with music than with none, and used slightly less oxygen (Terry and colleagues, 2012). The beat can even steer your stride: when researchers in Ghent shifted the tempo of runners' music by up to 3 percent, too little to notice, 16 recreational runners' step rate followed (Van Dyck and colleagues, 2015), though a later study found far less of this unless runners set out to match the beat. To run to the beat, count your steps for 30 seconds, double it, and pick songs at that tempo.

A runner with headphones in the 2015 Rotterdam Marathon. Photo: Peter van der Sluijs, CC BY-SA 3.0, via Wikimedia Commons (cropped).

Brainwaves and binaural beats: what holds up

Your brain does track rhythm. In 2011 Nozaradan's team recorded EEG while people listened to a steady beat and found a response pulsing at exactly the beat's frequency; when listeners imagined the beat as a march or a waltz, a second response appeared at the frequency of that meter (Journal of Neuroscience). Neuroscientists call this neural entrainment. It is part of how you hear a beat, not a switch that relaxes you, and we found no systematic review showing that slow music reliably moves the brain into "alpha" or "theta" states. A 2019 study often quoted as proof that music synchronizes brainwaves measured something else: how alike different listeners' EEG responses were, which fell as the music was repeated, and its authors read that as engagement (Madsen and colleagues, Scientific Reports).

How a binaural beat works, and what 14 EEG studies found when they tested whether it entrains brainwaves (Ingendoh and colleagues, 2023).

Binaural beats are a real perception: play 200 hertz in one ear and 210 in the other, and you hear a beat at the 10-hertz difference. The marketing claim is that the beat drags your brainwaves to that frequency. A 2023 systematic review of 14 EEG studies found five results consistent with that idea, eight against it and one mixed (Ingendoh and colleagues, PLoS One). Some trials report less anxiety before surgery with binaural-beat audio, and a 2025 meta-analysis of 15 such trials found less anxiety on average, but the results varied enormously from trial to trial. If a binaural track relaxes you, enjoy it; the brain-tuning story is unproven.

Four playlists built on the evidence

Here are the tempos from this article on one scale. Remember that the heart's beats per minute and the music's beats per minute share a unit, not a mechanism.

Tempos from the studies in this article beside the adult resting heart rate (MedlinePlus: 60–100). The scales share a unit, not a mechanism: the heart does not lock onto the music's beat.

Build each playlist around one job:

• Calm, 10 to 20 minutes: slow (under about 80 beats per minute, the range Karageorghis and Priest suggest for calming music), steady, soft, with few sudden changes, and music you like. End with two minutes of silence, the calmest stretch in Bernardi's study.
• Focus: in a meta-analysis of 65 studies, background noise, speech and music all cost a little reading comprehension, and lyrics cost the most (Vasilev and colleagues, 2018). Choose soft instrumental music, or silence; there's more in 10 Ways Learning Music Can Boost Your Productivity.
• Sleep, 30 to 45 minutes: slow, soft and instrumental, the same playlist each night, started as you get into bed. In most trials people listened every night, often for several weeks, and in one, sleep improved week by week (Lai and Good, 2005).
• Workout: warm up with mid-tempo songs, work at 125 to 140 beats per minute or at your step rate, and finish with slow music at about 60 to 70.

Four playlists, one job each. The tempo numbers are starting points from the studies above, not prescriptions.

For the sleep playlist, slow down gradually rather than all at once. Composers do the same at the end of a piece: a ritardando slows "like a music box winding down", as our Ritardando & Accelerando sheet puts it. Bring the volume down step by step too, the way The Dynamic Ladder runs from ff, very strong, down to pp, very soft.

A 45-minute wind-down playlist as a plan: start near the tempo of your evening, step the tempo and volume down, and let a timer end in silence. It follows the findings above but has not been tested as a routine.

Whatever you play, keep it safe for your ears. The World Health Organization says you can listen at 80 decibels for up to 40 hours a week but at 90 decibels for only four, and suggests keeping your device at no more than 60 percent of its maximum volume; well-fitted, noise-canceling headphones help you keep it down in noisy places.

Safe-listening limits from the World Health Organization. The louder the sound, the shorter the safe listening time.

From listening to playing

You can also make your own calm music. Beethoven marked the first movement of his Moonlight Sonata Adagio sostenuto, asked for the whole piece to be played very delicately, and wrote sempre pianissimo, always very soft, under its opening. Set a metronome to 60, as our Tempo & the Metronome sheet suggests, and let it hold you to a steady pulse. Our studies of the Moonlight Sonata, Chopin's Prelude in E Minor, marked Largo, and Satie's Gymnopédie No. 1, "slow, soft, and full of feeling", show you how each one works.

Beethoven, Piano Sonata in C♯ minor, Op. 27 No. 2 ("Moonlight"), first movement, bars 1–4, with the first edition's words (Vienna, 1802): play the whole piece very delicately and without dampers, always very soft. The complete score of the Moonlight Sonata is in our sheet music library.

Free worksheets for this lesson

• Tempo & the Metronome — the Italian tempo words against beats per minute, and how to practice with a metronome
• Musical terms & signs — tempo, dynamics and touch words on one two-page chart
• Ritardando & Accelerando — slowing down, speeding up and snapping back to tempo
• The Dynamic Ladder — six volumes from pp to ff, with a Listen panel
• Phrasing — phrase marks, breath marks and question-and-answer phrases in Ode to Joy
• Time Signatures I: Simple Time — 4/4, 3/4 waltz time and 2/2 cut time
• Two Beats in a Bar: 2/4 & Cut Time — 2/4 and cut time, the meters that move like feet in a march, with a metronome exercise at 60 and 120
• Time Signatures II: Compound Time — 6/8, 9/8, 12/8 and 6/4, felt in big dotted beats
• Pickup Notes — songs that start before beat 1
• Fermata, Tenuto & Accent — hold, lean and punch: three marks that change a note's character
• Inside Beethoven's Moonlight Sonata — the slow opening movement, layer by layer
• Inside Chopin's Prelude in E Minor — a sighing Largo melody over chords that sink one note at a time
• The Chords of Gymnopédie No. 1 — Satie's slow two-chord sway and how the left hand plays it

Listen with the tempo in mind

Tempo is the dial your body responds to most: faster music lifts breathing, blood pressure and heart rate, slower music lets them settle, and silence settles them further. The best-supported benefits are less pain and anxiety around surgery and better-rated sleep; blood-pressure effects are small and uncertain, and brainwave tuning is unproven.

Four popular claims and what the studies in this article found.

If you'd like to play your own calm music, a Tissimo teacher can help you choose a piece and a steady tempo in a live lesson: find a teacher. This article isn't medical advice: music adds to treatment for high blood pressure, insomnia or pain, but doesn't replace it.

Sources

• Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: the importance of silence (Bernardi, Porta and Sleight, 2006) — Heart
• Dynamic interactions between musical, cardiovascular, and cerebral rhythms in humans (Bernardi and colleagues, 2009) — Circulation
• Listening to music for insomnia in adults (Jespersen and colleagues, 2022) — Cochrane Database of Systematic Reviews
• The audio features of sleep music: universal and subgroup characteristics (Scarratt and colleagues, 2023) — PLoS One
• Effectiveness of stress management and relaxation interventions for management of hypertension and prehypertension (Webster and colleagues, 2025) — BMJ Medicine
• Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis (Hole and colleagues, 2015) — The Lancet
• Effects of music in exercise and sport: a meta-analytic review (Terry and colleagues, 2020) — Psychological Bulletin
• Music in the exercise domain: a review and synthesis, Part II (Karageorghis and Priest, 2012) — International Review of Sport and Exercise Psychology
• Binaural beats to entrain the brain? A systematic review (Ingendoh, Posny and Heine, 2023) — PLoS One
• Infants relax in response to unfamiliar foreign lullabies (Bainbridge and colleagues, 2021) — Nature Human Behaviour
• Universality and diversity in human song (Mehr and colleagues, 2019) — Science
• Deafness and hearing loss: safe listening — World Health Organization