Cardiac autonomic responses induced by mental tasks and the influence of musical auditory stimulation

Accepted Manuscript

Cardiac autonomic responses induced by mental tasks and the influence of musicalauditory stimulation

Juliana Cristina Barbosa, Heraldo L. Guida, Anne M. G Fontes, Ana M. S Antonio,Luiz Carlos de Abreu, Viviani Barnabé, Renata S. Marcomini, Luiz Carlos M.Vanderlei, Meire L. da Silva, Vitor E. Valenti

PII: S1744-3881(14)00034-6

DOI: 10.1016/j.ctcp.2014.04.001

Reference: CTCP 526

To appear in: Complementary Therapies in Clinical Practice

Received Date: 28 November 2013

Revised Date: 14 April 2014

Accepted Date: 15 April 2014

Please cite this article as: Barbosa JC, Guida HL, Fontes AMG, Antonio AMS, de Abreu LC, BarnabéV, Marcomini RS, Vanderlei LCM, da Silva ML, Valenti VE, Cardiac autonomic responses induced bymental tasks and the influence of musical auditory stimulation, Complementary Therapies in ClinicalPractice (2014), doi: 10.1016/j.ctcp.2014.04.001.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.

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ACCEPTED MANUSCRIPTCardiac autonomic responses induced by mental tasks and the influence of musical

auditory stimulation

Juliana Cristina Barbosa1, Heraldo L. Guida2, Anne M. G. Fontes1, Ana M. S. Antonio4,

Luiz Carlos de Abreu3, Viviani Barnabé5, Renata S. Marcomini2, Luiz Carlos M.

Vanderlei4, Meire L. da Silva2, Vitor E. Valenti*2

1Centro de Estudos do Sistema Nervoso Autônomo (CESNA), Departamento de

Fonoaudiologia and 2Departamento de Fisioterapia e Terapia Ocupacional, Faculdadede

Filosofia eCiências, UNESP. Av. Hygino Muzzi Filho, 737. 17525-900 Marília, SP,

Brasil.2Departamento de Morfologia e Fisiologia, Faculdade de Medicinado ABC. Av.

Príncipe de Gales, 821. 09060-650 Santo André, SP, Brasil.4Programa de Pós-

Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP.Rua Roberto

Simonsen, 305. 19060-900 Presidente Prudente, SP, Brasil. 5Department of

Environmental Health, Harvard Medical School of Public Health.665 Huntington Ave,

II-219 Boston, MA 02115, EUA.

*Corresponding author:

Departamento de Fonoaudiologia

Faculdadede Filosofia eCiências, UNESP.

Av. HyginoMuzzi Filho, 737.

17525-900. Marília, SP, Brasil.

E-mail: [email protected]

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ACCEPTED MANUSCRIPTAcknowledgement

The study was performed at UNESP. We thank Dr. Hani Atrashfor kindly reviewing

English Grammar and Spelling. We also appreciate the Proof-reading-service® for

language editing services.

Conflict of interest

The authors declare no conflict of interest.

Role of the funding source

The study received financial support from FAPESP.

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ACCEPTED MANUSCRIPTCardiac autonomic responses induced by mental tasks and the influence of musical

auditory stimulation

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ACCEPTED MANUSCRIPTAbstract

We investigated the acute effects of musical auditory stimulation on cardiac

autonomic responses to a mental task in 28 healthy men (18–22 years old). In the

control protocol (no music), the volunteers remained at seated rest for 10 minutes and

the test was applied for five minutes. After the end of test the subjects remained seated

for five more minutes. In the music protocol, the volunteers remained at seated rest for

10 minutes, then were exposed to music for 10 minutes; the test was then applied over

five minutes, and the subjects remained seated for five more minutes after the test. In

the control and music protocols the time domain and frequency domain indices of heart

rate variability remained unchanged before, during and after the test. We found that

musical auditory stimulation with baroque music did not influence cardiac autonomic

responses to the mental task.

Keywords: Cardiovascular system; Autonomic nervous system; Hearing

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ACCEPTED MANUSCRIPTINTRODUCTION

The possibility that musical auditory stimulation could serve as a form of non-

pharmacological therapy has been proposed in the literature,1–3 and some styles of

music were observed to influence the cardiovascular and autonomic nervous systems.4

Previous studies in music, psychology, and medicine have suggested the anxiolytic

effects of musical auditory stimulation. These effects have been investigated for self-

selected versus experimenter-selected music and for different music styles.1-4 The

physiological responses to specific music are important to comprehend and could

provide further information concerning alternative and complementary therapies.

It is widely known that cardiac autonomic regulation can be analysed by

measuring heart rate variability (HRV).5-8 This measurement evaluates the oscillations

of consecutive heart beats (RR intervals), which are affected by the autonomic nervous

system’s influence on the heart or, more specifically, on the sinus node. Increased HRV

is an indicator of good adaptation, and is observed in healthy subjects. Reduced HRV,

on the other hand, is usually a sign of abnormal and inadequate adaptation of the

autonomic nervous system, indicating physiological dysfunction.5 HRV can be analysed

in the time domain (SDNN: standard deviation of normal-to-normal R-R intervals;

pNN50: the percentage of adjacent RR intervals with a difference of duration greater

than 50ms; and, RMSSD: root-mean square of differences between adjacent normal RR

intervals in a time interval) and in the frequency domain (LF: low frequency; HF: high

frequency; and, LF/HF ratio).6 It has been observed that different styles of music can

increase or decrease HRV.7, 8

In this sense, cardiac autonomic regulation may be tested through autonomic tests

such as postural change manoeuvres, pressor cold tests and mental tasks. These tests are

important means of diagnosing autonomic dysfunction.9

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ACCEPTED MANUSCRIPTOne study indicated that music therapy improved HRV indices in the time and

frequency domains in patients with breast cancer treated with an antitumoral cardiotoxic

medications.7 Another study showed that previous exposure to musical auditory

stimulation attenuated cardiac autonomic response induced by postural change

manoeuvre in women.8 However, other studies indicated that music intensifies the

endocrine and stress responses induced by a mental task.10 Therefore, it is currently

unclear whether and how cardiac autonomic response is affected by exposure to music.

Understanding the physiological mechanisms involved in cardiac autonomic responses

under music influence could help to better understand the role of music on

complementary therapies in clinical practice. Therefore, this study aimed to investigate

the effects of a baroque musical auditory stimulation on cardiac autonomic responses

induced by a mental task.

METHOD

Study Population

Subjects were 28 healthy male students, all non-smokers, aged between 18 and 22 years

old. All volunteers were informed about the procedures and the objectives of the study

and gave written informed consent. All study procedures were approved by the Ethics

Committee in Research of the Faculty of Sciences of the Universidade Estadual

Paulista, Campus of Marilia (No. CEP-2011-385), and were in accordance with

Resolution 196/96 National Health 10/10/1996.

Exclusion criteria included body mass index (BMI) >35 kg/m2; systolic blood

pressure (SBP) >140 mmHg or diastolic blood pressure (DBP) >90 mmHg (at rest);

cardiac arrhythmias (atrial flutter or fibrillation, multiple ventricular or atrial ectopy,

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ACCEPTED MANUSCRIPTsecond or third degree atrioventricular block); smoking, left ventricular dysfunction;

reported neurological or respiratory disorders; and, relevant auditory disorders.

Initial Evaluation

Baseline information collected included: age, gender, weight, height and body mass

index (BMI). Weight was determined using a digital scale (W 200/5, Welmy, Brazil)

with a precision of 0.1 kg. Height was determined using a stadiometer (ES 2020, Sanny,

Brazil) with a precision of 0.1 cm and 2.20 m of extension. Body mass index (BMI) was

calculated as weight / height2, with weight in kilograms and height in meters.

HRV analysis

The R-R intervals recorded by the portable HR monitor (with a sampling rate of 1000

Hz) were downloaded to the Polar Precision Performance program (v. 3.0, Polar

Electro, Finland). The software enabled the visualization of HR and the extraction of a

cardiac period (R-R interval) file in “txt” format. Following digital filtering

complemented with manual filtering for the elimination of premature ectopic beats and

artefacts, at least 256 R–R intervals were used for the data analysis. Only series with

sinus rhythm greater than 95% were included in the study.11,12 HRV was analysed

during four time periods: the 10-minute period before the test without exposure to

music, the 10-minute period before the test with exposure to music, the five-minute

period during the test and the five-minute period after the test. The geometric indices of

HRV were evaluated. For calculation of the indices, we used HRV Analysis software

(Kubios HRV v.1.1 for Windows, Biomedical Signal Analysis Group, Department of

Applied Physics, University of Kuopio, Finland).

Linear indices of HRV

To analyze HRV in the frequency domain, the low frequency (LF =0.04–0.15 Hz) and

high frequency (HF = 0.15–0.40 Hz) spectral components were used in ms2 and

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ACCEPTED MANUSCRIPTnormalized units (nu), representing a value relative to each spectral component in

relation to the total power minus the very low frequency (VLF) components, and the

ratio between these components (LF/HF). The spectral analysis was calculated using the

Fast Fourier Transform algorithm.13

The analysis in the time domain was performed in terms of SDNN (standard

deviation of normal-to-normal R-R intervals), pNN50 (percentage of adjacent RR

intervals with a difference of duration greater than 50 ms) and RMSSD (root-mean

square of differences between adjacent normal RR intervals in a time interval).14

The mental arithmetic overload test

The task consisted of mental arithmetic operations involving two- and three-

digit numbers (i.e. 287 + 24 - 43/3 + 28) administered continuously over a period of five

minutes. The test had to be performed without verbal stimulation.15 (Supplemental

files).

Measurement of the auditory stimulation

Measurements of the equivalent sound levels were conducted in a soundproof

room using a SV 102 audiodosimeter (Svantek, Poland). The device was programmed

to take measurements in the "A" weighting circuit with a slow response.

The measurement was made during the 10-minute session of relaxing classical

baroque music. An insert-type microphone (MIRE - Microphone In Real Ear) was

placed inside the auditory canal of the subject, just below the speaker, which was

connected to a personal stereo.

Before each measurement, the microphone was calibrated with an acoustic CR:

514 model calibrator (Cirrus Research plc).

For the analysis, we used Leq (A), which is defined as the equivalent sound

pressure level and which corresponds to the constant sound level in the same time

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spectrum of the sound stimulation (octave band). The music ranged from 63-84 dB.

(Figure 1).16,17

Protocol

Data collection was carried out in the same soundproof room for all volunteers;

the temperature was between 21°C and 25°C and the relative humidity was between 50

and 60%. Volunteers were instructed not to drink alcohol or caffeine for 24 hours before

the evaluation. Data were collected on an individual basis, always between 6 and 9 PM

to standardize the protocol. All procedures necessary for the data collection were

explained to each subject separately, and the subjects were instructed to remain at rest

and avoid talking during the collection.

After the initial evaluation, a heart monitor belt was placed over the thorax,

aligned with the distal third of the sternum, and the Polar RS800CX heart rate receiver

(Polar Electro) was placed on the wrist. The equipment had previously been validated

for monitoring heart rate beat-by-beat, as had the use of these data for HRV analysis.

In the control protocol (n=28), after placement of the strap and the monitor,

subjects were seated and remained at rest with spontaneous breathing for 10 minutes

with the earphones turned off. Subsequently, the subjects performed the mental

arithmetic overload test. In the music protocol (n=28), the volunteers were seated and

remained at rest with spontaneous breathing for 10 minutes with the earphones turned

off; then the earphones were turned on and the volunteers were exposed to musical

auditory stimulation before the mental arithmetic test. The sequence of exposition was

randomized for each individual and the mental arithmetic test was based on different

calculations for each protocol.

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ACCEPTED MANUSCRIPTHRV was analyzed in the following periods: control protocol – the 10-minutes

period before the test without exposure to music, the five-minutes period during the test

and the five-minutes period after the test; music protocol – the 10-minutes period before

the test without exposure to music, the 10-minutes period before the test with exposure

to music, the five-minutes period during the test and the five-minutes period after the

test. The subjects were exposed to classical music in the baroque style (Pachelbel:

Canon in D). This music was selected because a recent study from our laboratory

observed that this style influenced HRV responses to orthostatic change maneuver.8

Statistical Analysis

Standard statistical methods were used to calculate the means and standard

deviations. The Shapiro-Wilk test was performed to evaluate the distributions. For

parametric distributions we applied ANOVA for repeated measures followed by the

Bonferroni posttest. For non-parametric distributions we used the Friedman test

followed by Dunn’s posttest. Differences were considered significant when the

probability of a Type I error was less than 5% (p < 0.05). We used GraphPadStatMate

software version 2.00 for Windows (GraphPad Software, San Diego, CA, USA).

RESULTS

Data on baseline systolic (SAP) and diastolic arterial pressure (DAP), heart rate

(HR) and mean RR interval, age, height, body weight and body mass index (BMI) are

presented in Table 1.

Results related to the rest period before the test (Rest), the mental arithmetic

overload test itself (Test) and the period after the test (Post-test) in the control protocol

are presented in Table 2. The SDNN, RMSSD and pNN50 indices were not changed. In

addition, neither the LF and HF in absolute (ms2) and normalized (nu) units nor the

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(Table 3).

Table 4 displays data on the time domain indices in the Rest, Test and Post-test

periods in the music protocol. As in the control group, the SDNN, pNN50 and RMSSD

indices were not different before, during or after the test compared to the values

obtained for the control group during the Rest period.

In relation to the frequency domain indices (LF and HF in absolute (ms2) and

normalized (nu) units as well as LF/HF ratio), no significant responses were induced by

musical auditory stimulation in the music protocol either during or after the mental test

(Table 5).

DISCUSSION

Based on the use of self-selected and experimenter-selected music for alternative

and complementary therapies,1-4 this investigation was undertaken to evaluate changes

in cardiac autonomic modulation induced by a mental task through the well-known

mental arithmetic overload test15 and to determine whether auditory stimulation with the

experimenter-selected baroque music influences this response. The hypothesized effect

of the music on the cardiac autonomic regulation induced by the test was a late increase

in sympathetic modulation on the heart and a parasympathetic decrease.15 In actual fact,

no significant HRV responses were induced by the mental arithmetic overload test in

either the control or the music protocol. Our findings do not provide evidence to

indicate Pachelbel music for musical therapy, since it did not induce significant changes

in cardiac autonomic regulation.

Although some indices almost reached statistical significance in the music

protocol, tending toward a reduction in the parasympathetic modulation of the heart

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ACCEPTED MANUSCRIPTduring the mental task, we failed to observe a significant effect on the cardiac

autonomic response to the mental arithmetic overload test. Among the previous studies

in this area, most have emphasized either mental load or physical load, while only a few

have considered both. In this context, HRV has been widely used to investigate

reactions to mental demands on the autonomic nervous system.18 In this study, HRV

values in the time and frequency domains were compared before, during and after a

mental task, because HRV is sensitive to alterations in mental state.6 The mental task

was expected to reduce the HF power of the heartbeat interval time series and to affect

other indices that correspond to the parasympathetic modulation of the heart, such as

pNN50 and RMSSD, as mentioned above.19 Nevertheless, no significant changes were

observed in those indices during or after the mental task used in this study compared to

the values before the task. It may be surmised that the mental arithmetic overload test

used in this study does not cause significant stimulation of HRV. A previous study

indicated that the addition of mental tasks to a physical computer task did not cause an

additional effect on the HRV parameters related to autonomic modulation. This may

mean that while physical demands have a major influence on HRV responses, the effect

of this type of mental task is not significant.18

In the music protocol, there was no change in the HRV indices during the music

or during or after the mental task. A recent study found that music had a significant

effect on the cardiac autonomic response to a postural change maneuver.9 It was

observed that auditory stimulation with the same music used in this investigation

(Pachelbel’s Canon in D) attenuated the reaction induced by the postural change

manoeuvre in women: in the music protocol, the HRV indices were not different from

those in the seated position, while in the control protocol this manoeuvre caused

significant changes in HRV, i.e. reduction of pNN50, RMSSD, LF and HF indices in

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the music, the parasympathetic withdrawal that was seen in the control protocol was

absent in the same subjects when they were exposed to music before the application of

the postural change test.20 Nevertheless, the present study found no significant effects of

music on the cardiac autonomic response to the mental arithmetic load test.

According to our findings, the changes in the music protocol almost reached

statistical significance, tending toward a parasympathetic reduction during the mental

arithmetic load test as compared to the period of musical auditory stimulation; this

phenomenon was not observed when the same volunteers were subjected to the control

protocol, suggesting that music may slightly intensify the cardiac autonomic responses

induced by this mental task. The effect of relaxing acoustic stimulation and relaxing

music on changes in physiological parameters induced by a laboratory test in healthy

volunteers was recently evaluated.10 The authors reported higher plasma cortisol levels

in women who were exposed to music before the mental task and lower plasma cortisol

levels in those who were exposed to the sound of rippling water. In that study,

autonomic function was analyzed through salivary alpha-amylase responses, and similar

responses were observed in both groups. In the mental task used in that study,10 the

subjects had to calculate backwards in steps of 17 from the number 2043. After each

calculation error the participants were asked to start over from 2043. Some issues

regarding that study and the present investigation are worth mentioning; for example,

that study evaluated women whereas the present study evaluated men. It is also possible

that the mental arithmetic load test used in the present study causes less intense

physiological responses.

Our findings indicate the selected baroque music (Pachelbel: Canon in D) does

not significantly influence cardiac autonomic responses to a mental task. The music

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physiological effects of the Canon in D music from Pachelbel. In this circumstance, this

music was chosen because our group has recently investigated the effects of this

specific stimulation on cardiac autonomic regulation.9,16,17,21 It was observed that this

music significantly influenced HRV indices in the time and frequency domain in

women,16 though it did not cause significant responses in the geometric indices of

HRV.17 The literature indicates that the inconsistency of the published results on heart

rate alterations in response to music are due to individual response specificity in the

autonomic nervous system.22,23 Another issue that may be involved in the inconsistent

data is the period of exposure to musical auditory stimulation. While in some studies

women were exposed to five minutes and it was found significant influence of music on

HRV, 16,17 other investigations reported no significant difference when women were

exposed during 10 minutes to music.8 Based on Iwanaga et al,24 the repetitive exposure

to music may have influenced cardiac autonomic responses to music.

According to this investigation, musical auditory stimulation with Pachelbel’s

Canon in D did not acutely influence cardiac autonomic responses to a mental task. The

sound intensity investigated in this study ranged from 63 to 84 dB. Auditory stimulation

at an equivalent level has elsewhere been reported to induce changes in cardiac

autonomic regulation.25 HRV was evaluated in healthy volunteers during five minutes

of binaural exposure to white noise at a low-to-moderate intensity, i.e. between 50 and

90 dB. The authors observed a significant association between the LF/HF ratio and the

equivalent sound level of the white noise. No changes in arterial blood pressure or basal

heart rate were found. Regardless, subjects who are exposed to noise intensities above

50 dB reportedly exhibit increased sympathetic regulation of the heart as shown through

frequency domain indices analysis, as the LF/HF ratio increases. However, there are

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characterized by a small range of intensity,26 while the intensity of music fluctuates.

Musical auditory stimulation influences the cognitive system,27 but it has not yet been

established whether white noise induces a positive or negative response in the cognitive

system. In this context, it may be postulated that the effects of auditory stimulation on

the cardiac autonomic regulation depend on the type of auditory stimulation.

The intensity of musical auditory stimulation is a relevant point to be discussed.

As mentioned above, noise intensity has been indicated to influence the effect of

auditory stimulation on cardiac autonomic regulation.28 The cardiovascular responses to

auditory stimulation are conducted through several proposed mechanisms, including the

startle reflex, a response mediated by a brainstem circuit. The acoustic startle reflex is a

well-known effect of loud auditory stimulation on heart rate. This reflex is an abrupt

response of the heart rate and blood pressure to a sudden loud auditory stimulation. The

usual intensity used to elicit a startle reflex is 110 dB, and this intensity is much louder

than environmental noise. Nonetheless, subjects repeatedly exposed to 60 dB and 110

dB white-noise stimuli were seen to become habituated over time with regard to their

cardiac response.29 These heart rate and arterial blood pressure responses are regarded

as startle and defence responses in humans and a fight-or-flight response in animals.

The rise in blood pressure and heart rate in response to auditory stimulation indicates an

autonomic function responding to the acoustic stimuli.30

However, after a careful search on Medline/Pubmed database we did not find any

study that investigated the relevance of music intensity on HRV. In this circumstance,

there are some differences between white noise and musical auditory stimulation. White

noise is characterized by a small range in its intensity26 and music presents oscillation of

its intensity. Musical auditory stimulation influences the cognitive system,27 however, it

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system. It may be postulated that the effects of auditory stimulation on the cardiac

autonomic regulation depend on its style.

In this sense, one previous study has indicated a consistent trend towards

increased cardiovascular risk among individuals with a daytime noise exposure level

higher than 65 dBA.30 Another study by Lee et al,25 however, has reported that noises

equal to or greater than 50 dBA induce an immediate and intense sympathetic activation

without inducing a feeling of anxiety. Thus sound or noise stimulation may produce

significant and prompt cardiac stress responses even at relatively low levels such as 50–

60 dBA.25

Although no significant effects of music on cardiac autonomic responses during

and after a mental test were found in the present study, other studies have indicated a

relationship between music and the central nervous system based on physiological

mechanisms. Neurochemical evidence has revealed that strong emotional reactions

induced by music involve reward circuitry and function based on dopamine release in

the nucleus accubens.31 It has also been reported that musical auditory stimulation in

rats increases calcium/calmodulin-dependent dopamine synthesis in the brain, inducing

a blood pressure decrease32. Another study in rats has indicated the importance of the

hypothalamus in the physiological responses induced by music (“Träumerei” from

Kinderszenen Op.15-7).33 Even in rats under anaesthesia, musical auditory stimulation

decreases arterial blood pressure and sympathetic activity. Yet that investigation also

shows that not all music decreases blood pressure and sympathetic activity, as shown

through an analysis of renal sympathetic nerve activity, and that this mechanism is

dependent on an intact cochlea and auditory cortex and is regulated by histaminergic H3

receptors in the suprachiasmatic nucleus of the hypothalamus.

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hormonal and cardiovascular responses to long-term stress activation induced by

environmental auditory stimulation, even at a fairly low noise intensity of 53 dB.34 The

locus coeruleus is indicated to be a central control centre for autonomic function

regulation in response to acoustic stimuli, suggesting its involvement in the acoustic

startle reflex.29

CONCLUSION

Auditory stimulation with music did not significantly influence the cardiac autonomic

responses induced by a mental task consisting of the mental arithmetic overload test in

men, as shown through analysis of the linear indices of HRV. The findings of this study

indicate that this particular choice of music accompanied with a mental task does not

affect heart rate

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FIGURE LEGENDS

Figure 1.Equivalent sound level of auditory musical stimulation of classical style.dB:

Decibel; Hz: hertz. Edited by Roque et al, 2013.

Figure 2.Frequency sound level of auditory musical stimulation of classical style.dB:

Decibel. Edited by Roque et al, 2013.

Table 1. Baseline diastolic (DAP) and systolic arterial pressure (SAP), heart rate (HR), mean

RR interval, weight, height and body mass index (BMI) of the volunteers. Mean+standard

deviation. Legend: m: meters; ms: millisecond; kg: kilograms; bpm: beats per minute; mmHg:

millimeters of mercury. N=28

Variables Value

Age (years) 19.1+ 1

Height (m) 1.74+0.11

Weight (kg) 77.4+15.6

BMI (kg/m2) 25.4+ 2.8

HR (bpm) 83.3+10

Mean RR (ms) 738.7+113.3

SAP (mmHg) 115.6+11.1

DAP (mmHg) 81+9.05

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Table 2. Mean and standard deviation for time-domain indices before (Rest), during the test

(Test) and after the mental arithmetic overload test (Post test) in the control protocol. SDNN -

standard deviation of normal-to-normal R-R intervals; pNN50 - the percentage of adjacent RR

intervals with a difference of duration greater than 50ms; RMSSD - root-mean square of

differences between adjacent normal RR intervals in a time interval.ms – millisecond. N=28.

Index Rest Test Post test p

SDNN 40±10 34±5 35±7 0.5

RMSSD 24± 6 25±11 24±6 0.9

pNN50 6±4 9 ± 9 5 ± 4 0.6

Table 3.Mean and standard deviation for time-domain indices before (Rest), during the test

(Test) and after the mental arithmetic overload test (Post test) in the control protocol. Legend:

LF - low frequency; HF - high frequency; LF/HF - low frequency/high frequency ration; ms -

milliseconds; nu - normalized units. N=28.

Index Rest Test Post test p

LF (ms2) 938±648 569±434 584±296 0.1

LF (nu) 69±11 59±18 60±13 0.5

HF (ms2) 596±560 385 ± 221 624 ± 513 0.4

HF (nu) 30±11 40±18 39±13 0.5

LF/HF 613±1934 240±755 291±916 0.7

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Table 4.Mean and standard deviation for time-domain indices before (Rest), during the test

(Test), during musical auditory stimulation (Music) and after the mental arithmetic overload

test (Post test) in the music protocol. SDNN - standard deviation of normal-to-normal R-R

intervals; pNN50 - the percentage of adjacent RR intervals with a difference of duration

greater than 50ms; RMSSD - root-mean square of differences between adjacent normal RR

intervals in a time interval.ms – millisecond. N=28.

Index Rest Music Test Post test p

SDNN 43.2±8 46±3 31±11 36±12 0.1

RMSSD 25±7 27±5 24±14 25±10 0.9

pNN50 6.85±6.3 7.65±5.05 7 ± 13 7 ± 8 0.9

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Table 5.Mean and standard deviation for time-domain indices before (Rest), during the test

(Test), during musical auditory stimulation (Music) and after the mental arithmetic overload

test (Post test) in the music protocol. Legend: LF - low frequency; HF - high frequency;

LF/HF - low frequency/high frequency ration; ms - milliseconds; nu - normalized units.

N=28.

Index Rest Music Test Post test p

LF (ms2) 1213±674 1345±964 827±751 1258±961 0.1

LF (nu) 60±21 72±5 54±18 68±7 0.3

HF (ms2) 574±383 471±317 392±286 531±382 0.6

HF (nu) 30±8 27±5 45±18 31±7 0.1

LF/HF 2±1 658±2072 110±341 2±1 0.5

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ACCEPTED MANUSCRIPTHighlights

• Musical auditory stimulation with some styles was shown to influence cardiac

autonomic regulation.

• It is not clear in the literature whether music attenuates or intensifies cardiac

autonomic responses induced by autonomic tests.

• We reported that auditory stimulation with Pachelbel (Canon in D) music does

not influence cardiac responses elicited by a mental task.

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7+5= 9+6= 14+3= 18+15=

9-7= 26-14= 35-6= 45-18=

26+12= 24+11= 54+24= 79+48=

36-16= 57-14= 72-26= 80-11=

3+7-6= 9+7-10= 25+28-18= 44+36-27=

21+14-18= 35+50-25= 46+45-60= 94+76-64=

63-17+26= 62-18+28= 78-32+64= 96-36+80=

7-11+5= 18-20+24= 39-55+40= 41-54+63=

Teste Matemático