Effect of music intervention on heart rate variability: a systematic review and meta-analysis of randomized controlled trials

Objective To evaluate the effects of music intervention on heart rate variability (HRV). Methods The protocol of this systematic review has been submitted for registration in the PROSPERO databa se, an international prospective register for sys tematic reviews, with ID number CRD420261283257. Data sources included electronic databases searched from inception through January 2026. Randomized clinical trials comparing music intervention with control were included. The primary outcomes were changes in HRV parameters after music intervention or control compared to baseline within each group. Mean differences (MD) with 95% confidence intervals (CI) were calculated for continuous variables. The methodological quality of the studies was assessed according to the Cochrane Handbook. Publication bias was evaluated using funnel plots and Egger’s regression test. Results A total of 24 randomized controlled trials involving 1,295 participants were analyzed. The meta-analysis demonstrated that music intervention significantly increased high-frequency power in normalized units (HFnu) compared to control groups (MD = 7.05, 95% CI: 1.00–13.10, p = 0.02), while significantly decreasing low-frequency power in normalized units (LFnu) (MD = −4.94, 95% CI: −9.13 to −0.76, p = 0.02). Subgroup analyses revealed that patients with stress/anxiety/fear/sleep disorders showed the most substantial improvements across multiple HRV parameters. Short-term interventions (≤30 min) were particularly effective for enhancing HFnu, and participant-selected music yielded superior outcomes compared to standardized music. The overall evidence quality was rated as moderate for the primary outcomes. Conclusion Music intervention significantly improved LFnu and HFnu compared to control groups. People with emotional disorders can improve their HRV through music intervention. Systematic review registration PROSPERO, Identifier: CRD420261283257.