If you’ve had one heart attack, you’re at higher risk of having another. Studies show that cardiac rehabilitation programs can reduce death rates by up to 30% and lower risk of future heart problems. Despite that, roughly half of all patients referred to rehab programs drop out.
To encourage patients to keep coming back, cardiac rehab programs have tried financial incentives, in-home programs and more.
Now Dr. David Alter, a cardiologist and chair of Cardiac Rehabilitation at University Health Network in Toronto, is trying music. Dr. Alter and his team believe the custom music playlists they’re developing could help reverse dropout rates.
Cardiac rehab is a lot like a gym, except that the trainers specialize in working with people who are recovering from serious cardiac events. To safely build their strength and mobility, patients follow customized exercise prescriptions.
And as at most gyms, people arrive with earbuds and a music player loaded with their favourite songs.
Exercise prescriptions remixed
In his Heart & Stroke supported clinical trial, Dr. Alter and his team begin by asking patients for their exercise prescriptions and a list of their favourite artists and genres. From there, they filter potential songs by tempo to align with the patient’s prescribed exercise pace.
Then there’s the final magic step. Dr.Alter brings the patient’s playlist into studio to slightly accentuate each song’s underlying rhythm. Typically, that involves a fine balance of boosting the beat and mixing the song once more so it sounds like the original recording. The technical term for this is rhythmic auditory stimulation (RAS), and it’s so subtle the ear can’t detect it, but it’s enough for the brain to tune in.
Our brains are designed to follow a steady beat, explains Dr. Alter — who is a guitarist and singer-songwriter outside the lab. Neuroscience research shows that providing rhythmic cues lights up the pre-motor cortex, which controls movement. When you accentuate the beat, the brain automatically tunes in to the rhythm.
"Essentially, you’re fooling the brain,” Dr. Alter explains.
And does it work?
Patients who received the enhanced playlists reported feeling less fatigued while exercising. Over a three-month period, those who worked out to the RAS playlists logged 300 minutes per week of extra exercise on average, compared to patients who listened to regular music or no music. Plus the RAS group was more than twice as likely to stick to their exercise prescription.
Cardiac rehabilitation is already considered the gold standard of care, says Dr. Alter. “The benefits that we’re seeing with RAS are over and beyond what’s already achievable.”
There are also promising results with stroke patients in recovery.
“We’ve seen a half mile per hour difference in their stride length with patients listening to the playlists,” Dr. Alter says. “That’s significant. It’s the difference between crossing the street in time before it turns red and not.”
Personal choice is key
Dr. Alter says RAS can be applied to any genre of music, from folksy Bob Dylan to fugal Bach. “The first priority is that people have to like what they’re listening to. If somebody is listening to music that they don't particularly like, all the rest of the stuff is basically useless.”
For now, the study is focused on cardiac and stroke rehabilitation patients who are at high risk of having another event. But Dr. Alter sees potential to extend RAS to a larger group — for example, developing playlists for adolescents to combat the growing childhood obesity epidemic.
“We start with people who need them the most and then we branch out from there because the stakes are higher,” he says. “If we get this right, the implications are significant.”
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