Volume 64, Issue 1, 2020

Journal of Scientific Research

Institute of Science,
Banaras Hindu University, Varanasi, India.

Evaluation of the Effects of Music Therapy

Using Todi Raga of Hindustani Classical Music
on Blood Pressure, Pulse Rate and Respiratory
Rate of Healthy Elderly Men
Samarpita Chatterjee (Mukherjee)1, Roan Mukherjee2*

1
Department of Hindustani Classical Music (Vocal), Sangit-Bhavana,
Visva-Bharati (A Central University), Santiniketan, Birbhum-731235,West Bengal, India
2
Department of Human Physiology, Hazaribag College of Dental Sciences and Hospital, Demotand, Hazaribag 825301, Jharkhand, India.

Abstract: Several studies have indicated that music therapy may

affect cardiovascular health, in particular, it may bring positive I. INTRODUCTION
changes in blood pressure levels and heart rate, thereby improving
Music may be regarded as the projection of ideas as well as
the overall quality of life. Hence, to regulate blood presure, music
emotions through significant sounds produced by instrument,
therapy may be regarded as a significant complementary and
voices, or both by taking into consideration different elements of
alternative medicine (CAM). The respiratory rate, if maintained
melody, rhythm and harmony. Music plays an important role in
within normal range may promote good cardiac health. The aim of
everyone’s life. Music has the power to make one experience
the present study was to evaluate the changes in blood pressure,
harmony, emotional estasy, spiritual uplifting, positive
pulse rate and respiratory rate in healthy and disease free males
(age 50-60 years), at the completation of 30 days of music therapy
behavioural changes and absolute tranquility. Annoyance in life
intervention. Eighty healthy males were divided randomly into the
may increases in lack of melody and harmony. Music is known
experimental and the control group. Subjects of the experimental
to have healing power. Music has been found to be effective to
group were exposed to music therapy (a twenty minute combat pain (Cepeda et al., 2006), anxiety (Madhusudhan et al.,
instrumental session of Raga Todi of Hindustani Classical Music), 2018; Ghasemi et al., 2017; Jhon and Upendra, 2016), coronary
whereas the control group were not exposed to the raga and were artery disease (Hanser and Mandel, 2005), mental illness (Li et
only kept quite at rest for the same period of time, during the al., 2015), stress (Möckel et al., 1994), and several other forms
period of intervention. Before and after the intervention, blood of health ailments (Sarkar and Utpal, 2015). One of the major
pressure, pulse rate and respiratory rate of the subjects were risk factor for cardiovascular diseases and cerebrovascular
measured. It was found that the values of blood pressure, pulse rate diseases is hypertension.These diseases increases the mobidity
and respiratory rate showed significant (p < 0.001) decrement in and mortality rates among adults. Increased blood pressure
healthy/ asymptomatic subjects exposed to music therapy. In the levels seen at childhood may extend into adult life as
control group, the parameters under study did not vary hypertension (McGill et al., 2001), which eventually leads to the
significantly between the initial and afterward measurements (p > damage of blood vessels of the body. Hypertension is externally
0.05). Thus it may be concluded that raga Todi of Hindustani asymptomatic and causes damage to certain internal organs of
Classical Music have the potential to bring down the blood pressure the body, therefore, it has been referred as ‘Silent Killer’ by the
levels and thereby may restrict the development of cardiovascular World Health Organization (WHO, 1992). In India, the
disorders. incidence of hypertension has been found to be more among
urban adults in comparison to rural adults. The estimated
Index Terms: Blood Pressure, Heart Rate, Respiratory Rate, number of hypertensive Indians will reach two hundred million
Raga Todi, Hindustani Classical Music. by 2025 (Bhalwar, 2009). Evidences gathered many studies
suggest that music may bring positive changes in the blood
pressure levels (do Amaral et al., 2016), and thus may lower the
incidence of other diseases which are associated with

DOI: http://dx.doi.org/10.37398/JSR.2020.640123 159

 Journal of Scientific Research, Volume 64, Issue 1, 2020

hypertension. physiological / psychological changes have been found to be

The American Society of Hypertension in their study have induced by positive emotions (Tugade et al., 2004), which can
noted that the blood pressure measured at regular intervals, as be elicited by raga therapy.
the individual move around, carrying out his/ her normal daily
routine, that is, the 24 -hour ambulatory blood pressure (ABP), III. PRESENT CONCEPT OF HYPERTENSION IN ADULTS
significantly reduced in mild hypertension patients listening Conventionally, systolic blood pressure (SBP) > 140 and
Indian classical raga for half an hour per day, for four weeks diastolic blood pressure (DBP) > 90 mm Hg is widely accepted
(Sherry, 2008). as hypertension (Sadiq et al., 2017). In the year 2018, guidelines
From time to time, continuously, the blood pressure targets framed by the European Society of Cardiology (ESC) / European
have been redefined (Pradhan and Vishwakarma, 2017), to Society of Hypertension (ESH), defined hypertension using the
facilitate early detection of individuals at risk of developing same values of SBP and DBP (Williams et al., 2018). Subjects
hypertension and to expedite the treatment strategies, which having systemic arterial blood pressure more than it are
could be either drug based for hypertensive patients, and non- generally exposed to treatment.
pharmacological therapies and techniques for subjects who are Treated blood pressure must be about 130/ 80 mm Hg, if the
not hypertensive but are at the risk of developing hypertension in patient is able to tolerate drug treatment. In the guidelines (2017)
future. provided by American College of Cardiology (ACC) and
The conventional non-pharmacological strategies to lower American Heart Association (AHA), SBP > 130 and DBP > 80
blood pressure includes life style modifications such as mm Hg were referred as hypertension. Generally, health care
reduction of body weight, dietary modifications, restriction in professionals recommended that all subjects should maintain
the intake of salts, lowering of stress levels, and participation in their blood pressure below 140/ 90 mm Hg. However, the
exercises / physical activity. In recent times, the use of European as well as American guidelines suggests that blood
complementary and alternative medicine (CAM) to reduce blood pressure should be maintained at < 130/ 80 mm Hg.
pressure have gained importance. The CAMs include meditation, Subjects of any age may become hypertensives. However,
yoga, and music therapy (Mcelroy et al., 2012). with age the prevalence of hypertension has been seen to rise.
Hypertension is mainly of two types- Primary hypertension
II. MUSICOLOGICAL ANALYSIS OF INDIAN MUSIC THERAPY (essential hypertension) and Secondary hypertension. Primary
In Sama veda and ancient music therapy related Indian music hypertension is most common and is found in majority (90 - 95
literatures, it has been mentioned that ragas such as Todi, %) of hypertensive patients. It has no single identifiable causes;
Bhupali, Ahir Bhairava, Puriya, Hindol, Bhimpalas and Kausi its causes are unkown and is multifactorial in nature. Genetics,
Kanada are effective in lowering blood pressure (Kunikullaya et sedentary lifestyle, high intake of salts, alcohol intake, smoking,
al., 2016). stress, insulin resistance, aging, and obesity have a role in its
In Indian context, a subject may be said to be exposed to development. Secondary hypertension is less prevalent type,
music therapy when sound (nada), note (swara), melody (raga), affecting 5-10 % of hypertensives. It may occour due to different
music interval (shruti), beat (tala), rhythm (laya) are rightlfully underlying medical conditions such as diseases of kidneys, heart,
and systematically intonated, clinging to the asthetic emotion/ endocrine system and even by drugs (Mohamed et al., 2013).
mood (rasa) and format / mode (thaat) (Sharma, 2007). It may be
mentioned that there are seven notes Sa, Re, Ga, Ma, Pa, Dha IV. BRIEF LITERATURE SURVEY
and Ni of swara. The individual notes may be of decreased pitch In a study conducted on primary educators (age >30 years)
or higher pitch. If the note is in decreased pitch, it is referred as with hypertension at Puducherry, it was found that raga ahir
flat note (komal) whereas if the note is in higher pitch, it is bhairav was effective in reducing the blood pressure. In the
referred as or sharp note (teevra). The natural/ suddha/ pure study, raga Ahir Bhairav was administered to the study subjects
swars are the Shadja (Sa) and Panchama (Pa) with no by using CD for 20-30 minutes (Angeline, 2018).
displacement or distortion (immovable: achalit swars), and the An Indian study among male and female subjects found that
notes Rishabha (ri), Gandhara (ga), Madhyama (ma), Dhaivata listening to Indian classical music for an hour, along with the
(dha), and Nishada (ni) may be either suddha (movable : vikrut/ intake of regular anti-hypertensive medications causes
chalit), komal or teevra. All together there are 12 notes significant lowering of blood pressure at the completation of
(Chaitanya, 1973). Thaat is the format of sequence of selected four months from the start of music therapy (Kulkarni and
swaras with variation in suddha, komal and teevra swaras Chittapur, 2017).
(Sobhana, 1989). Similarly, another study at Nellor, India, found music therapy
Raga is an array of swaras that inputs suitable rasa / asthetic effective in the regulation of blood pressure, heart rate and
emotion/ mood in a song/ music. A raga have the abilty of respiratory rate, after neurosurgery, in patients of traumatic brain
inducing or maginfying feeling of excitement, joy / rejoice, injury (Reddy et al., 2017).
peace, love, compassion, peace, courage , sorrow, and mental / Raga Bhupali, an evening raga, has been found to be useful
emotional calmness (Karuna et al., 2013). This makes raga for lowering heart rate and modulating other cardiac regulation
appropriate for music therapy. A particular raga have a definite factors by lowering the sympathetic activity and raising the
number of komal or teevra swaras, based on which the thaat can vagal tone. Moreover, it may reduce anxiety levels and induce
be easily recognized (Sobhana, 1989). Positive physical /

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positivity in perceived feelings (Nagarjan et al., 2015). B. Inclusion Criteria

In a sample of elderly adults (above 60 years of age) of 1. Individuals between 50-60 years of age.
Chennai, Tamil Nadu , administration of music therapy using 2. Individuals with systemic arterial pressure less than
raga Malkauns for a time period of 22 minutes, in the evening 140/90 mm Hg.
for 30 days was found to be significantly effective in lowering
blood pressure (Lakshmi and Bhushan, 2015). C. Exculusion criteria
In another study, among prehypertensives or stage I 1. Individuals who were lower or above 50-60 years.
hypertensives, lifestyle modification along with the listening of 2. Individuals with hypertension that is, having
raga bhimpalas for three months, obtained promising results in systemic arterial pressure > 140/90 mm Hg.
terms of decrement in blood pressure (Kunikullaya et al., 2016). 3. Individuals who were taking medications or were
A study carried out at Jawaharlal Nehru Medical College, under long term treatment for any illness.
Belgaum, showed that raga Todi was effective in lowering the 4. Smokers and alcoholics.
bood pressure in adults (age > 40 years) of both sexes having 5. Individuals who were under life style or dietary
essential hypertension, when administered for 20 minutes daily modifications for treatment of health related
in the morning, for 30 days along with their regular medication conditions.
(Kamat-Nadkarni, 2013). D. Study protocol
In another study conducted among pre-hypertensive male
(aged 35-40) adults, near Pondicherry, music therapy A control group (n = 40) and an experimental group (n = 40)
intervention (listening Ahir Bhairav using earphones for 20 was formed with the participants. The control group were simply
minutes per day) for 40 days significantly reduced the blood exposed to a resting period for 20 minutes. The subjects of the
pressure (Sobna et al., 2013). experimental group on the other hand was exposed to a 20-
A Sri Lankan study on 45 and 65 years aged male and female minute session of Raga Todi of Hindustani Classical Music
subjects, found that listening Hindustani Classical Music for (Instrumental), employing headphones in a sitting posture.
certain duration in healthy individuals effectively improved All the subjects of the study were asked to remain at rest for 5
cardiovascular and respiratory health, evaluated in terms of SBP, minutes in sitting posture, before the start of the study so that
DBP, Pulse rate and Breathing rate (Siritunga et al., 2013). various physiological parameters of the body remain at a steady
Studies have reported that listening to Indian classical level. The intervention of maintenance of resting state in case of
instrumental music while gastroscopy may reduce blood control group, and exposure to music in case of experimental
pressure, heart rate and breating rate (De Oliveira et al., 2009). group was continued daily (once a day) in the morning hours for
In a study conducted on elderly adults of India, living in old a time period of 30 days.
age homes, it was seen that music therapy intervention At the first day (Pre test- Before Intervention) and on the 30th
employing raga Anandabhairavi of Carnatic music was day (Post test- After Intervention), the determination of blood
successful in decreasing the blood pressure (Mathew, 2008). pressure (SBP and DBP), pulse rate and respiratory rate of the
In a foreign study on adolescents, it was found that relaxing control group and the experimental group subjects were carried
nature of the music may cause loweing of heart rate. Such out. The blood pressure was measured in the sitting position by
findings may be of relevance for the maintenance of good using digital blood pressure apparatus (OMRON HEM-7130).
cardiovascular health (Escher and Evéquoz, 1999). The average of two consecutive measurement, at an intervals of
Thus by analyzing the available studies, it is seen that minimal 5 minutes in the upper arm of the subject were taken to be the
studies have been conducted, to investigate the therapeutic final blood pressure of an individual.
efficacy of Indian ragas in controlling blood pressure in healthy/ The determination of respiratory rate was done by counting
asymptomatic subjects. Hence, the objective of this present the respiratory movements of the chest for one minute from a
study was to investigate the impact of Raga Todi of Hindustani distance (Kumar and Clerk, 2001; Michel, 1995).
Classical Music (Instrumental) on systemic arterial blood It is necessary to mention that initially, a pilot study were
pressure, pulse rate and respiratory / breathing rate in such group conducted for pretesting the study design and for feasibility.
of individuals. Then necessary alterations were made before the final study. All
the measurements of the pre test and post test were done at a
V. MATERIALS AND METHODS similar timing of the day to restrict circadian effects and promote
relaibility of the collected data.
A. Participants Raag Todi (morning raga) used on the experimental group is a
After receiving the approval from the Institutional ethics Sampurna raga and permits seven notes in ascent and seven in
committee and informed consent from the participants of the descent. This deep raaga is known to create an atmosphere full
study, 80 male subjects satisfying the inclusion and exclusion as of Karun and Bhakti ras.
criteria mentioned below was randomly selected for the study. Statistical Analysis: All the data obtained was expressed as
The study was carried out in a private health care unit at mean ± SD (standard deviation). Comparison of the parameters
Burdwan, West Bengal. under study was done by using t- test. A p value of ≤ 0.05 or
lower were considered significant.

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VI. RESULTS and 3).

The complete characteristics of the study participants have Table 2: Analysis of blood pressure in the Control Group
been presented in Table 1. From the table, it was seen that (initially and after resting period), and Experimental Group
majority of the participants were graduate, married and were (before and after exposure to music)
private sector employees. The mean age of the participants were
Control Group (Mean + SD)
was 57 ± 6.
Table 1: Distributions of Participants by Characteristics Variable Pre test- Post test- p-
Initial level After resting value
No. Category Frequency Percentag before resting period of 20
e (%) period of 20 minutes, in no
Education minutes, in no music condition
music condition
1 10 + 2 7 8.75 SBP (mm 137 + 1.26 136.5 + 1.53 >
2 Graduate 44 55 Hg) 0.05
3 Post 23 28.75 DBP 87.1 + 1.62 86.5 + 1.72 >
Graduate (mm Hg) 0.05
4 Higher 6 7.5 Experimental Group (Mean + SD)
Degrees Variable Pre test- Post test- p-
Total 80 100 Before Music After Music value
Marital Status Therapy Therapy
1 Married 75 93.75 Intervention Intervention
SBP (mm 136.3 + 2.42 130.2 + 4.21 <
2 Unmarried 5 6.25 Hg) 0.001
Total 80 100 DBP 86.2 + 1.93 80.5 + 2.51 <
Employment (mm Hg) 0.001
1 Government 22 27.5
employees
2 Private 28 35
employees
3 Business 25 31.25
4 Others 5 6.25
Total 80 100
Mean Age 57± 6

The blood pressure before and after music therapy in the

experimental group, and the blood pressures of the control group
initially and after intervention (rest) have been presented in
Table-2, and illustrated in Figure 1A and 1B. It was found that
after music therapy intervention in the experimental group, the
systolic blood pressure was reduced to 130.2 (mm Hg) from
136.3 (mm Hg) and the diastolic blood pressure was reduced to
80.5 (mm Hg) from 86.2 (mm Hg). The observed drop in blood
pressure were significant (p < 0.001).
The pulse rate and respiratory rate before and after music
therapy in the experimental group, and the same in the control
group initially and after intervention (rest) is presented in Table-
3, and illustrated in Figure 2 and 3. It was seen that the pulse rate
was lowered to 79.8 (bpm) from 85.2 (bpm) and the respiratory
rate dropped to 13.6 (per minute) from 15.7 (per minute), after
music therapy in the experimental group. hese variations were
significant ( p < 0.001).

The variations of SBP, DBP, pulse rate and respiratory rate

VII. DISCUSSION
observed in the control group after exposure to the resting period
was very less and were not not significant ( p > 0.05) (Table 2 The present study evaluated the effects of raga Todi of

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Hindustani Classical Music (instrumental) on vital physiological (Kamat-Nadkarni, 2013). In traumatic brain injury (TBI)
variables (blood pressure, pulse rate and respiratory rate) patients, after neurosurgery, Raga Todi, Hindola and Kalyani
concerned with cardiovascular and respiratory health. The have been seen to cause improvement of respiratory rate, heart
findings revealed that healthy / asymptomatic elderly males rate, and SBP, in a study conducted at Tertiary Hospital of
experienced decrement in systolic blood pressure, diastolic Nellore, India (Reddy et al., 2017). A meta-analysis study,
blood pressure, pulse rate and breathing/ respiratory rate on which evaluated several other studies indicated that listening to
exposure to music intervention (listening to raga Todi) for a time music may result in improvement in the systolic blood pressue
period of 30 days, in the morning hours of the day. An earlier levels and music should be given due importance during the
study found significant lowering of blood pressure on exposure treatment of hypertension (do Amaral et al., 2016). Based on
to long term raga therapy, in chronic hypertensive patients several earlier studies (Angeline, 2018; Kulkarni and Chittapur,
(Kulkarni and Chittapur, 2017). This earlier study to prevent 2017; Kunikullaya et al., 2016; Nagarjan et al., 2015; Sobna et
monotony among the subjects, exposed them to six different al., 2013; De Oliveira et al., 2009; Mathew, 2008 ), it may be
ragas such as Asavari, Ahir Bhairavi, Hansadhwani, Bhimpalas, said that music may be used as a supplement to the main
Darbari and Todi. However, each of the raga was allowed to be treatment of hypertension. Turkish classical music have also
listened for 1 week alternatively for 1 hours a day for a time been found to have positive effects on blood pressure in Turkish
period of 6 months. In contrast, since the present study was only elderly patients with hypertension (Bekiroglu et al., 2013).
of 30 days duration, no such measures were taken to prevent
monotony.

Table 3: Analysis of pulse rate and respiratory rate in the

Control group (initially and after resting period) and
Experimental Group (before and after exposure to music)
Control Group (Mean + SD)

Variable Pre test- Initial Post test- After p-

level before resting period value
resting period of 20
of 20 minutes, minutes, in no
in no music music
condition condition
Pulse Rate 85.4 + 1.87 85.2 + 1.82 > 0.05 Much similar to the present study, a study were conducted in Sri
Per Minute Lanks but with a different raga. In the study at Sri Lanka, a test
Respiratory 16.2 + 0.53 16.0 + 0.62 > 0.05 group formed of asymptomatic male and females of age 45 and
Rate/ min. 46 years were made to listen to Rag Darbari Kanada of Indian
Experimental Group (Mean + SD) classical music for twenty two minutes whereas the control
group were not exposed to music and were simply maintained at
Variable Pre test- Before Post test- After p- silent state for the same duration of time. Before and after-test
Music Therapy Music Therapy value comparison were made. A significant decrease in the blood
Intervention Intervention pressure, pulse rate and respiratory rate were observed in the test
Pulse Rate 85.3 + 1.85 79.8 + 2.39 < 0.001 group after listening to the music (Siritunga et al., 2013).
Per Minute Lowering of the blood pressure (by two - six mm Hg) and
Respiratory 15.7 + 0.82 13.6 + 1.06 < 0.001 heart rate may reduce the risk of developing cardiovascular
Rate/ min. diseases such as coronary artery disease (CAD), hypertension,
stroke (MacMahon, 2000). Individuals having resting heart rate
greater than 84 bpm have increased risk of developing
cardiovascular diseases (Reil et al., 2011; Singh, 2003). At rest,
the normal respiratory rate range is about 8 - 20 breaths per
minute. But nowadays in adults the lower end of respiratory
range have been raised to 15 breaths per minute from 8 breaths
per minute. It may be mentioned that heart disease patients are
seen to have respiratory rate up to about 15 breaths per minute.
Hence, individuals should strive to maintain their respiratory rate
below 15 breaths per minute to reduce their risk for
cardiovascular diseases and associated medical conditions
(Siritunga et al., 2013; Rakhimov, 2011). The results of the
Raga Todi has been found to be effective in lowering blood present study showed that listening to music may be effective in
pressure in essential hypertension patients by an earlier study maintining a respiratory rate below 15 breaths per minute.
The reduction in blood pressure, heart rate and respiratory rate

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due to application of music intervention may be attributed to the sample size, involving both males and females may be helpful to
influence of music on central nervous system, autonomic deeply understand the impact of music therapy on vital
nervous system and endocrine system. More specifically, music physiological parameters such as SBP, DBP, heart rate and
may lower sympathetic drive and enhance vagal control / respiratory rate.
parasympathetic drive. Simultaneously, music by lowering stress
hormone levels such as serum cortisol and adrenaline may ACKNOWLEDGEMENTS
reduce stress (Mockel et al., 1994) and promote relaxation. Slow We are thankful to all the participants of the study. We also
tempo music with soothing notes may be responsible for express sincere gratitude to Senior Physician Dr. Amal
parasympathetic activation (Nagarajan et al., 2015). Rhythms of Chatterjee, MD, Ex-Medical Officer, West Bengal Health
music brings beneficial adaptations in the physiology of bodily Services, for helping the authors to complete this study.
rhythms (Mac Donald et al., 2009). It has been known that, the
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