Music therapy and vagally mediated heart rate variability: A systematic review and narrative synthesis

An increasing body of evidence supports the use of music therapy for improving health and wellbeing. In parallel, there has also been a rising interest in the use of biomarkers to assess its impact. One such biomarker is vagally mediated heart rate variability (vmHRV), which is a non-invasive measure of cardiac parasympathetic nervous system activity. However, the influence of music therapy on vmHRV is currently unclear.

A literature search was performed in December 2023/January 2024 and updated in March 2025. Data related to vmHRV was extracted and risk of bias was evaluated. A narrative synthesis was performed according to the Synthesis Without Meta-analysis (SWiM) guidelines with an effect direction plot.

Twenty-eight studies were included. There was large heterogeneity in study samples, contexts, music therapy interventions, and HRV measurement methods. There was also a high risk of bias. The results indicated increased vmHRV during music therapy. There was also an association between improved vmHRV and other positive health outcomes in these studies.

While current evidence indicates that there are potential positive effects of music therapy on vmHRV, more high-quality research, especially regarding HRV methodology, interpretation and reporting, is needed. A high risk of bias, small sample sizes and heterogeneity in all aspects of the studies prevents any clear conclusions based on the current evidence.