Hektoen International

A Journal of Medical Humanities

Song as a unit for physical activity: A-minor Proposal

Cillin Condon
Dublin, Ireland

Step to the beat. Created by Cillin Condon and photographed by
Anthony Edwards,  St James’ Hospital, Dublin

“Let us go singing as far as we go: the road will be less tedious.”

Physical inactivity is recognized as a significant risk factor for diseases such as stroke, diabetes, and cancer.1 Recommendations for adults include 150 minutes or more of moderate to vigorous physical activity per week, or at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week. Exercise should occur in bouts of at least ten minutes’ duration.2 According to the World Health Organization, 23% of adults and 81% of school-going adolescents are not sufficiently active.3

Physical activity is not readily translated into a unit that is easily understood. Commonly used units are METs, or metabolic equivalent of task; that is, the amount of oxygen a person consumes per unit of body weight in one minute. Activities such as jogging or walking fast are cited as “moderate to vigorous” exercise, but walking fast may be interpreted differently by  people. Another common target is to take 10,000 steps daily. However this target can be achieved without an associated increase in heart rate or by taking very small steps. To get heart rate up into a training or stimulus range, a cadence of 100+ steps per minute is needed.4 Where step length is shortened with aging or disease, the required cadence may be higher.

One difficultly with effectively prescribing physical activity is that there is no accepted best method for facilitating people to become more physically active.5 One approach to solving this dilemma is using song as the unit of prescription for physical activity. Humans have an innate sense of rhythm and are able to detect and follow basic beats from early age. This “rhythmic entrainment” is common to all cultures6 and some suggest that it is hardwired into human brain development.7 Humans have used music to accompany labor and social activities such as marriage, harvest, and religious holidays. Some authors have argued that the hardwiring or development of music has contributed to or complemented the development of language.8,9 Musical styles such as sea shanties and gospel songs have evolved to accompany and alleviate the strain of physical work. Athletes also use music and song to accompany their required cadence while exercising.

Every disease is a musical problem, its cure a musical solution
— Novalis

The body of research around music and healing is largely hospital-based and focused on specific conditions such as Parkinson’s disease, dementia, autism, and mental health. One mechanism of the therapeutic effectiveness is “music’s unique ability to access affective/motivational systems of the brain.”10 Music has been used to calm or control physical aggression in people with mental disorders or learning difficulties. However, other areas of health care have been slow to use the power of music and song. Health promotion and disease prevention are slow processes and their importance is often unrecognized. Music may act as a common language to engage patients. Health professionals may prescribe songs to accompany exercise in term of their duration and tempo, and over time music to accompany dance can be added. Dance is, in general, an activity with social benefits and aerobically challenging movements.

Many rehabilitation classes already use music to motivate participants. One study showed that individualized, self-selected music improved the level of physical activity in people attending cardiac rehabilitation.12 Another study found that older adults preferred songs to accompany exercise that had an emotive component over tempo alone.13 Some researchers have utilized the sensitive nature of rhythm by enhancing the natural beat per minute (bpm) of songs with exercise (rhythmic auditory stimulation). By increasing tempo by ten beats per minute, they have attempted to increase walking distance and speed in patients recovering from stroke.

The words in many songs may prompt a person to engage in movement or exercise in the same way folk songs used to accompany some work activities. Many songs contain lyrics about walking: You’ll never walk alone… I walk the line… These boots were made for walking…

Others call the listener to dance: Dance me to the end of love… Can’t stop the feeling, just dance, dance, dance!… Shake rattle and roll!

Music and song offer both the clinician and patient a common, non-technical, and non-hierarchal language to develop habitual physical activity. In the words of Nile Rodgers, these song lyrics should “speak to the souls of a million strangers.”

A tempo of 125–140 beats per minute (BPM) is useful for most healthy exercisers who do repetitive, aerobic-type activity (slower music is appropriate for warm-up and cool-down).14 Synchronous music, i.e. keeping in time with a musical beat, may improve adherence. Commonly cited barriers to physical activity include a lack of time, fear of exercise, lack of insight into benefits, and feeling bored. Prescribing songs that patients are (a) familiar with, and (b) want to engage with, brings about a new form of shared, non-hierarchal decision making where the health professional and patient can share and comment on what music moves each one (both literally and figuratively). For an overweight, type 2 diabetic patient with arthritic hips who finds it hard to exercise, a heath professional might ask what type of music the person prefers. Walking, dancing, or simply moving in time to three or four songs with a tempo of 115–120 beats per minute equates to ten to twelve minutes of movement with a heart rate of approximately 122 BPM. This is the generally accepted target heart rate for aerobic exercise. As a starting point for exercise promotion, this type of prescription is feasible, measurable, and if the patient selects and increases the number of songs, reinforces ownership of physical activity.

Country & Western Choice (114–120 bpm)Rock Choice (114–120 bpm)
“Harper Valley PTA” by Jeannie C Riley“I Won’t Back Down” by Tom Petty and the Heartbreakers
“Long gone” by Lady Antebellum“No Particular Place to Go” by Chuck Berry
“Everybody Knows” by Dixie Chicks“Bad Medicine” by Bon Jovi

For the purpose of walking to a beat, a person selects a set number of songs with a moderate tempo, increasing the number of songs to get achieve the target of 150 minutes per week. If the individual is able to walk faster, songs with a faster tempo (150–200 bpm) are added, such as “Rock the Casbah” (129 bpm) by The Clash, or “Islands in the Stream” (204 bpm) by Kenny Rogers. Technology has provided some easy solutions to facilitate this with playlists on programs and apps such as Spotify and jog.fm.

Adherence to exercise and self-management treatment among children with life-long conditions such as cystic fibrosis can also be a challenge, especially during the teen years. Encouraging teens to use music as a measure of their physical activity may foster better relationships between health professionals and teens (as well as learning more about the music of different generations). For a teen with cystic fibrosis who has to do lung clearance exercises daily, framing the time in terms of three songs by Demi Lovato or Jason Derulo may be more productive.

Blacking said that “music is a synthesis of cognitive processes which are present in the culture and in the human body: the format takes and the effect it has on people are generated by the social experience of human bodies in different cultural environments.”15 Eliciting from the patient culturally appropriate songs can offer the clinician an avenue to engage people from different backgrounds in physical activity. Heath professionals can harness the power and persistence of songs to promote physical activity with virtually no cost and much to gain.


  1. Ding Ding, Lawson Kenny D, Kolbe-Alexander T, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. The Lancet. 2016;388 (10051 ):1311 – 1324.
  2. Garber CE, Blissmer B, Deschenes MR, et al. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Medicine & Science in Sports & Exercise. 2011;43(7).
  3. WHO. 2017; http://www.who.int/mediacentre/factsheets/fs385/en.
  4. Slaght J, Hrubeniuk TJ, Mayo A, Bouchard DR. Walking Cadence to Exercise at Moderate Intensity for Adults: A Systematic Review. Journal of Sports Medicine. 2017;2017:12.
  5. Zubala A, Stephen MacGillivray, Helen Frost, et al. Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PloS one. 2017;12(7): e0180902. .
  6. Sihvonen AJ, Särkämö T, Leo V, Tervaniemi M, Altenmüller E, Soinila S. Music-based interventions in neurological rehabilitation. The Lancet Neurology 2017;16 (8):648-660.
  7. Mithen S. The music instinct: the evolutionary basis of musicality. Annals of the New York Academy of Sciences. 2009;1169:3-12.
  8. Levitin D. This is your brain on music. London: Atlantic Books; 2006.
  9. Thaut M. The Musical Brain –An Artful Biological Necessity. Karger Gazette. 2009;Music and Medicine(70):2-4.
  10. Hallam Susan, Cross Ian, Thaut M. The Oxford handbook of Music Psychology. Oxford: OUP; 2009.
  11. Chanda ML, Levitin DJ. The neurochemistry of music. Trends in Cognitive Sciences 2013;Vol. 17(4):179-193.
  12. Alter DA, O’Sullivan M, Oh PI, et al. Synchronized personalized music audio-playlists to improve adherence to physical activity among patients participating in a structured exercise program: a proof-of-principle feasibility study. Sports medicine – open. 2015;1(1):23.
  13. Clark I, Baker F, Taylor N. Older Adults’ Music Listening Preferences to Support Physical Activity Following Cardiac Rehabilitation. Journal of music therapy. 2016;53(4):364-397.
  14. BASES. The BASES Expert Statement on the Use of Music in Exercise. Published by the British Association of Sport and Exercise Sciences 2011.
  15. Blacking J. How Musical is Man. London: Faber and Faber; 1973.

CILLIN CONDON, BSc, MSc, MBA, qualified from the University of Teesside, UK in 1993 with a BSc Physiotherapy. He has a MSc in Sports Medicine and MBA from Trinity College in Dublin, Ireland. He has worked for Trinity College Discipline of Physiotherapy as a clinical teacher, coordinator, and lecturer. He is a recent convert to the power of music, taking up the ukulele.

Winter 2018



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