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.
Preference-based tempo-pace synchronized music has been shown to reduce perceived physical activity exertion and improve exercise performance. The extent to which such strategies can improve adherence to physical activity remains unknown. The objective of the study is to explore the feasibility and efficacy of tempo-pace synchronized preference-based music audio-playlists on adherence to physical activity among cardiovascular disease patients participating in a cardiac rehabilitation.



Thirty-four cardiac rehabilitation patients were randomly allocated to one of two strategies: (1) no music usual-care control and (2) tempo-pace synchronized audio-devices with personalized music playlists + usual-care. All songs uploaded onto audio-playlist devices took into account patient personal music genre and artist preferences. However, actual song selection was restricted to music whose tempos approximated patients' prescribed exercise walking/running pace (steps per minute) to achieve tempo-pace synchrony. Patients allocated to audio-music playlists underwent further randomization in which half of the patients received songs that were sonically enhanced with rhythmic auditory stimulation (RAS) to accentuate tempo-pace synchrony, whereas the other half did not. RAS was achieved through blinded rhythmic sonic-enhancements undertaken manually to songs within individuals' music playlists. The primary outcome consisted of the weekly volume of physical activity undertaken over 3 months as determined by tri-axial accelerometers. Statistical methods employed an intention to treat and repeated-measures design.



Patients randomized to personalized audio-playlists with tempo-pace synchrony achieved higher weekly volumes of physical activity than did their non-music usual-care comparators (475.6 min vs. 370.2 min,P< 0.001). Improvements in weekly physical activity volumes among audio-playlist recipients were driven by those randomized to the RAS group which attained weekly exercise volumes that were nearly twofold greater than either of the two other groups (average weekly minutes of physical activity of 631.3 min vs. 320 min vs. 370.2 min, personalized audio-playlists with RAS vs. personalized audio-playlists without RAS vs. non-music usual-care controls, respectively,P< 0.001). Patients randomized to music with RAS utilized their audio-playlist devices more frequently than did non-RAS music counterparts (P< 0.001).



The use of tempo-pace synchronized preference-based audio-playlists was feasibly implemented into a structured exercise program and efficacious in improving adherence to physical activity beyond the evidence-based non-music usual standard of care. Larger clinical trials are required to validate these findings.



ClinicalTrials.gov ID (NCT01752595).
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Canada ; Department of Health Policy, Management and Evaluation, University of Toronto, 40 St George Street, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
David A
DA
Alter
University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Mary
M
O'Sullivan
University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Paul I
PI
Oh
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Sunnybrook Health Sciences, 2075 Bayview Avenue, Toronto, Canada ; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Canada ; Department of Health Policy, Management and Evaluation, University of Toronto, 40 St George Street, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Donald A
DA
Redelmeier
University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Susan
S
Marzolini
University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Richard
R
Liu
University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Faculty of Rehabilitation Medicine, The University of Alberta, 8205 114 Street, Alberta, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Mary
M
Forhan
University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Michael
M
Silver
University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Canada ; Department of Exercise Sciences, Faculty of Physical Education and Health, University of Toronto, 27 King's College Circle, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Jack M
JM
Goodman
Music and Health Research Collaboratory, Faculty of Music, University of Toronto, 80 Queens Park, Toronto, Canada ; Dean's Office, Faculty of Music, University of Toronto, 80 Queens Park, Toronto, Canada ; The University of Toronto, 27 King's College Circle, Toronto, Canada.
Lee R
LR
Bartel