European Journal of Integrative Medicine 9 (2017) 44–49

Contents lists available at ScienceDirect

European Journal of Integrative Medicine

journal homepage: www.elsevier.com/eujim

Review article

A systematic review on the effects of active participation in

rhythm-centred music making on different aspects of health
Angela Frances Yapa , Yu Heng Kwanb,c,d,* , Seng Bin Ange
a
Duke-NUS Medical School, 8 College Road, Singapore 169857, Republic of Singapore
b
Program in Health Systems and Services Research, Duke-NUS Medical School, 8 College Road, Singapore 169857, Republic of Singapore
c
Singapore Heart Foundation, Republic of Singapore
d
Department of Pharmacy, Khoo Teck Puat Hospital, Republic of Singapore
e
Family Medicine Unit, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Republic of Singapore

A R T I C L E I N F O A B S T R A C T

Article history: Introduction: Rhythm-centred music making (RMM) especially drumming and percussion music has been
Received 30 August 2016 shown to be effective in promoting personal and interpersonal well-being. It is widely used both as a
Received in revised form 11 November 2016 treatment as well as an adjunctive therapy for various conditions. Hence, we aimed to provide a
Accepted 11 November 2016
systematic review of the current literature on the effects of active participation of RMM with a focus on
drumming and percussion on an individual. This will inform the undertaking of future focused research
Keywords: in this area.
Recreational music making
Methods: We carried out a literature search using PubMed1 and PsychInfo1 with relevant keywords and
Drumming
Percussion music
employed the PRISMA1 criteria. We included English peer-reviewed articles that studied the effects of
Drum circles drumming or percussion music which were assessed by 2 independent reviewers. The type and year of
Group drumming study, study design, sample size, sample characteristics, intervention as well as outcomes are presented.
Systematic review The effects of RMM were categorised according to physical, psychological and social health.
Results: A total of 4198 articles were identified and reviewed and 18 articles were found to be relevant. 15,
4 and 6 articles were shown to provide evidence of RMM for positive impact on physical, psychological
and social health respectively. 5 and 4 studies were conducted in the geriatrics and the pediatrics setting
respectively with the remainder using psychiatric and general settings.
Conclusions: In this systematic review on the effect of active participation in RMM positive effects were
seen across social, physical and psychological health domains. We hope that this systematic review will
facilitate future focused research in areas that have yet to be explored.
ã 2016 Elsevier GmbH. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Authors contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Finance support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

1. Introduction
* Corresponding author at: Program in Health Systems and Services Research,
Duke-NUS Medical School, 8 College Road, Singapore 169857, Republic of Singapore. Integrative medicine has been defined as “patient-centred,
E-mail addresses: angelafrances@u.duke.nus.edu (A.F. Yap), healing oriented, and embracing conventional and complementary
yuheng@u.duke.nus.edu (Y.H. Kwan), ang.seng.bin@singhealth.com.sg (S.B. Ang).

http://dx.doi.org/10.1016/j.eujim.2016.11.011
1876-3820/ã 2016 Elsevier GmbH. All rights reserved.
 A.F. Yap et al. / European Journal of Integrative Medicine 9 (2017) 44–49
therapies” with a focus on not just the physical body but on the
person as a whole and lifestyle as well [1]. Music has been shown to
be effective in promoting personal well-being as well as
interpersonal well-being, therefore, it has a great potential to be
used as part of integrative medicine [2,3]. It is widely used both as a
treatment as well as an adjunctive therapy for various conditions
for example, improving sleep quality in adults with insomnia [4],
reduction in dementia associated anxiety [5] and reduction in pain
[6].
Rhythm-centred music making (RMM) is defined as the playing
of drums and various other percussion instruments. It is an
innovative music intervention that has been adopted by different
groups for various purposes. Studies have shown that the actual
performance of music as compared to passive listening of music
has beneficial effects on the participant in terms of increased pain
threshold [7], empowerment of an individual as well as improved
group cohesion [8]. RMM is different from other music inter-
ventions as it involves participants in active participation rather
than passive listening. One thing to note is that RMM is different
from music therapy whereby the latter are music interventions
used by an accredited healthcare professional to accomplish
individualized goals [9].
RMM has been adopted by populations with different socio-
economic backgrounds as well as health status like low-income
children [10], university students [11], substance-misusers [12],
demented elderly [13] etc. Not only has RMM been shown to have
health benefits like reducing stress [14], anxiety [15] and
improving mood [16], engaging in RMM has been shown to
improve group dynamics and cohesiveness as well [17]. With the
benefits of RMM being made known, it could be a possible tool
which healthcare providers can use as part of the treatment of
patients.
To date, there is no literature that summarizes the effects of
RMM and as it becomes more popular in the community, there is a
need to consolidate current research advancements in this field in
order to allow the undertaking of future focused research in this
area. This article aims to provide a systematic review on the
current literature of the effects of RMM on different aspects of
health.
2. Methods
We used the PRISMA reporting checklist for the systematic
review. PubMed1 and PsycInfo1 electronic databases were
searched and hand searches were conducted using the references
of related articles. Literature review was from the inception of the
databases till October 2015. The keywords used were drumming
OR health rhythms OR drum music therapy OR drum circle OR
rhythmic music OR percussion music OR percussion instruments
OR recreational music making for PubMed1. The keywords used
were (drumming OR health rhythms OR drum music therapy OR
drum circle OR rhythmic music OR percussion music OR
percussion instruments OR recreational music making).af for
PsycInfo1.
Two independent reviewers (AF Yap and YH Kwan) reviewed
both the article inclusion and data extraction process. The
inclusion criteria of the review were English peer-reviewed
journals that studied the effects of drumming or percussion music
on an individual. Exclusion criteria included review articles, meta-
analyses, case series, case reports, studies without full articles and
studies that included drumming or percussion music making as
part of a protocol with the inclusion of other intervention
modalities.
Studies were then assigned different categories, namely
physical health, psychological health and social health based on
the effects seen on individuals in the study.
45
The studies selected were shown in the table where the study
design, sample size, type of intervention effects as well as category
of effects were reflected. The studies were grouped into 3 different
categories for ease of understanding the effects of RMM on the
participants. The 3 main categories were effects on physical health,
effects on social health and effects on psychological health.
Physical health relates to the functioning of the body, psychological
health relates to emotions, behaviours and thoughts while social
health relates to the degree an individual is functioning as a
member in the community [18]. We chose this method of
presentation as it closely relates to the biopsychosocial model,
which clinicians are very familiar with and allows tailoring of the
appropriate intervention [19,20].
3. Results
A flow chart summary of the literature search is outlined in
Fig. 1. As shown, 4198 articles were retrieved from the literature
search and a total of 3284 articles were retrieved from PubMed1
and 914 articles were retrieved from PsycINFO1. Out of the 58
articles that were relevant to the topic, 40 articles consisting of
articles that fell into the exclusion criteria and duplicates were
removed. A total of 18 articles were left for review. Of these 18
articles, 7 (39%) were randomized controlled trials (RCT), 5 (28%)
were controlled studies, 4 (22%) were qualitative studies and 2
(11%) were uncontrolled trials. 15 articles were grouped under
effects on psychological health, 4 articles under effects on social
health and 6 articles under effects on physical health.
Under Table 1 where the psychological effects of RMM have
been summarized, 15 studies (83.3%) have shown that RMM has led
to improvements in anxiety, depression, anger, stress, mood, self-
esteem and motivation [11–13,15,21–27]. It has also been shown to
facilitate recovery in addiction and empowers the individual
[12,24].
Under Table 2 where the social effects of RMM have been
summarized, 4 studies (22.2%) have shown that RMM has led to a
reduction in sense of isolation, alienation, self centredness,
attention deficit or hyperactivity problems, oppositional defiant
3284 articles 914 articles
retrieved from retrieved from
PubMed® PsycINFO®
4140 articles that were not
relevant were removed
58 articles that were
clearly relevant to the
topic were included
40 articles that fell into the
exclusion criteria including
duplicates were removed
18 articles included
from literature search
15 articles under 4 articles under 6 articles under
Effects on Effects on Social Effects on Physical
health
Psychological health health
Fig. 1. Flow chart on the selection of articles for review.
*Some articles examined multiple effects in a study.
46 A.F. Yap et al. / European Journal of Integrative Medicine 9 (2017) 44–49

Table 1
Effects of active participation in recreational rhythm-centred music making on psychological health.

Study Mean age Country Study design Sample Outcome measure Intervention Effect
and gender size
A group music intervention using Age: 81.3(I) Taiwan Randomised 60 Rating of Anxiety in Playing of The intervention group had a lower
Percussion instruments with vs 79.5(C) controlled Dementia (RAID) percussion anxiety score than the control group.
familiar music to reduce anxiety and 65% Female trial instruments 2 (p = 0.004)
agitation of institutionalized older times a week
adults with dementia [13]. for 6 weeks
Recreational Music-Making alters Age: 67.7 US Randomised 34 Genechip1 Human Recreational Active engagement in the making of
gene expression pathways in (T) controlled Genome U133A 2.0 music- music has been suggested to be more
patients with coronary heart disease 44% Female trial assays making for 1 useful in altering gene expression for
[26]. session stress amelioration as compared to
quiet reading. (P < 0.005)
Recreational Music-making: An Age: 27.5 US Randomised 75 Maslach Burnout Recreational There was a reduction in the scores of
Integrative group intervention for (T) controlled Inventory (MBI) and music- Total Mood Disturbance (p = 0.0006)
reducing burnout and improving 85% Female trial with Profile of Mood making in the intervention group.
mood states in first year associate cross over States (POMS) sessions once
degree nursing students: Insights a week for 6
and economic impact [16]. weeks
The impact of group drumming on Age: 10.5 US Controlled 101 Teacher’s Report Group Participation in group drumming led
social-emotional behaviour in low- (T) trial Form drumming to reduction in feelings of depression
income children [10]. 54% Female once a week (p < 0.02), withdrawal (p < 0.02) and
for 12 weeks anxiety (p < 0.01).
Recreational music making modulates Age: 40.8 US Randomised 32 Real Time Recreational The subjects showed an improvement
the human stress response: a (T) controlled Polymerase Chain music- in stress-induced genomic expression
preliminary individualized gene 78% Female trial Reaction mRNA making for 1 after the recreational music making
expression strategy [16]. analysis session session (p = 0.05).
Immediate effects of group-based Age: 20.8(I) US Controlled 50 Quick Mood Scale Group-based Results showed that the intervention
wellness drumming on affective vs 21.4(C) trial wellness group was more awake, relaxed,
states in university students [11]. 72% Female drumming for cheerful, friendly and clear headed
1 session (p < 0.05).
Complementary Therapy for No US Observation NA NA Drumming Through relaxation, creation of
Addiction: “Drumming Out Drugs” information activity for positive experiences, allowing the
[27]. drug release of emotional trauma,
addiction facilitating reintegration of self as
programmes well as increasing theta-wave
production and brain-wave
synchronization, drumming
facilitates the recovery from
addiction.
The drum circle project: A qualitative Age: 16.5(T) US Observation 9 NA Group Drumming led to improvements in
study with at-risk youth in a school 40% Female drumming self-esteem, stress, anger and
setting [21]. sessions once motivation. Individuals also felt more
a week for 12 open, with increased assertiveness
weeks and creativity.
African drumming: a holistic approach Age: 23.4 South Controlled 34 Stress Anxiety Index Djembe There was a reduction in stress
to reducing stress and improving (young) vs Africa trial drumming for anxiety index scores post-drumming
health [15]? 53.1 (old) 1 session (p < 0.01 in old and p < 0.001 in
73% Female young).
Recreational music-making modulates Age: 27.9 Japan Controlled 63 Profile of Mood Recreational The participants were found to have
immunological responses and mood (young) vs trial States (POMS) music making an improvement in mood states post-
states in older adults [22]. 70.3 (old) for 1 session intervention (p < 0.05).
64% Female
Recreational music-making modulates Age: 38.4 Japan Randomised 40 Profile of Mood Recreational The intervention group had better
natural killer cell activity, cytokines, (T) controlled States (POMS) music- mood compared to the control group
and mood states in corporate 0% Female trial with making for 1 (p < 0.05).
employees [23]. cross over session
The effect of improvisational group Age: No US Randomised 66 Visual Analog Mood Group Participants in the drumming group
drumming versus general music information controlled Scale (VAMS) drumming for demonstrated high on-task
therapy versus activity therapy on 36% Female trial 1 session behaviours, improvements in mood,
mood, session behaviours and positive behaviours as well as high
transfer behaviours of in-patient participation and attendance in
psychiatric individuals [35]. psychiatric treatment (p > 0.05).
An Observational Study of the Impact Age: 84.0 US Observation 117 NA Twice a week Drumming has an important role to
of Vibrotactile Rhythm Playing on (nursing for 5 months play in the empowerment of an
Seniors in Long Term Care [24]. home) vs individual.
78.0 (day
care)
65% Female
Health rhythms: A preliminary inquiry Age: 24 to UK Uncontrolled 7 Stages of Change Health The sessions facilitated the release of
into group-drumming as 56 trial Readiness and Rhythms emotions and helped with the
experienced by participants on a 14% Female Treatment Eagerness group- reduction of stress. It also improved
structured day services programme Scale Version Eight drumming retention and attendance rates for the
for substance-misusers [12]. Drug once a week substance-misuse treatment
(SOCRATESv8D) for 7 weeks. programme (no statistical tests
performed).
 A.F. Yap et al. / European Journal of Integrative Medicine 9 (2017) 44–49 47

Table 1 (Continued)
Study Mean age Country Study design Sample Outcome measure Intervention Effect
and gender size
Find Your Beat: Therapeutic Age: 70 (T) US Uncontrolled 13 Self-report of mood Health Drumming helped in the
Drumming for Parkinson’s Disease 38% Female trial symptoms Rhythms improvement of mood (no statistical
[25]. protocol for 1 tests performed).
session

*NA = Not Applicable. Abbreviations: Intervention (I), control (C), total (T).

Table 2
Effects of active participation in recreational rhythm-centred music making on social health.

Study Mean age Country Study Sample Outcome Intervention Effect

and gender design size measure
Complementary Therapy for Addiction: No US Observation NA NA Drumming Drumming reduces the sense of isolation,
“Drumming Out Drugs” [27]. information activity for drug alienation as well as self-centredness,
addiction allowing participants to connect with
programmes others.
The impact of group drumming on social- Age: 10.5 US Controlled 101 Teacher’s Group drumming Participation in group drumming led to a
emotional behaviour in low-income (T) trial Report protocol once a reduction in attention deficit/hyperactivity
children [10]. 54% Female Form week for 12 weeks problems (p < 0.01), oppositional defiant
problems (p < 0.03) and post-traumatic
stress problems (p < 0.01).
Drumming with Intimate Partner Age: No US Focus group 4 NA Drumming as a Facilitators of drumming groups view
Violence Clients: Getting into the Beat; information study therapeutic drumming as a useful tool in enhancing
Therapists' Views on the Use of 54% Female activity in group cooperation and cohesion,
Drumming in Family Violence intimate partner encouraging emotional expression as well
Treatment Groups [28]. violence clients as for participants to be more involved in
group work and engaged in group
dynamics.
An Observational Study of the Impact of Age: 84.0 US Observation 117 NA Twice a week for 5 Drumming has an important role to play in
Vibrotactile Rhythm Playing on Seniors (nursing months these 4 main themes: Empowerment,
in Long Term Care [24]. home) vs community resonance, bringing out and
78.0 (day bringing together. It enhances
care) communication, creates positive
65% Female experiences for the participants as well as
promoting music-making as a group.

*NA = Not Applicable. Abbreviations: Intervention (I), control (C), total (T).

problems and post traumatic stress problems [10,27]. The
participants were better able to connect to others, with improve-
ments in group cohesion, cooperation and communication [24,28].
Under Table 3 where the effects on physical health of RMM have
been summarized, 6 studies (33.3%) have shown that RMM has led
to improvements in pain tolerance, balance, pulmonary function,
blood pressure and immunological profiles of individuals
[7,15,22,23,29]. It has also been shown to improve Parkinsonian
tremors, finger dexterity, coordination and upper body stiffness
[25].
From the studies, it can be seen that there were 5 and 4 studies
conducted in the geriatrics and pediatrics setting respectively. The
rest were conducted either in patients with psychiatric illnesses or
in the general population.
4. Discussion
Most studies showed an improvement in psychological health
of an individual with lower stress levels, less anxiety, better mood,
higher energy levels and feelings of empowerment [16,24]. There
were also studies which found effects of RMM on physical health
like the reduction in blood pressure, increases in pain threshold,
improvement in symptoms of Parkinsonism and improvements in
immunological response [7,15,22,25] as well as effects on social
health with the empowerment of an individual to participate in
group activities, facilitating social cohesion as well as group
dynamics [24,28]. This is consistent with studies that report music
engaging areas of the brain involved in motivation, emotion,
cognition, motor function [30–32] and gait improvements in
people with stroke [33].
It is noted that there was more evidence supporting the effects
on RMM on physical and psychological health as reflected by more
controlled trials conducted whereas evidence supporting the
effects of RMM on social health appears to be weaker. Perhaps
more studies could be conducted in this area to better understand
the impact of participation in RMM in areas like social isolation,
loneliness, community bonding and group dynamics. Also,
knowing that the active participation in RMM has improvements
in the different health domains of an individual, it would be
interesting to find out the effects of RMM on the quality of life of an
individual which has been recognized as an important health
outcome [34].
Integrative medicine is a concept that is increasingly accepted
by healthcare providers and institutions and RMM could be a
useful non-pharmacological therapy for patients with its benefits
on the physical, psychological and social health on individuals [1].
From the findings of the systematic review, we would like to
recommend physicians to encourage patients take up RMM as a
form of activity with benefits that extend beyond the physical
health of an individual and for researchers to look at the other
possible effects of RMM that has yet to be explored.
The strength of our study is that we had conducted the first
comprehensive review of the literature on the effects of
participation of RMM on an individual. As far as we know, there
has not been a review done on the effects of RMM on different
aspects of health. We have also utilized an approach that included
both qualitative and quantitative studies so that we are able to
48 A.F. Yap et al. / European Journal of Integrative Medicine 9 (2017) 44–49

Table 3
Effects of active participation in recreational rhythm-centred music making on physical health.

Study Age and Country Study design Sample Intervention Effect

gender size
Performance of Music Elevates Pain Threshold and Age: UK Controlled 32 Samba Drumming, a form of music performance increases
Positive Affect: Implications for the Evolutionary 44.2 (I) Trial drumming for pain tolerance via the triggering of endorphin
Function of Music [7]. vs 31.1 1 session release (p < 0.05).
(C)
57%
females
Effects of Movement Music Therapy with the Age: 73.6 Japan Randomized 124 Movement The younger elderly,  74 years old, showed an
Naruko Clapper on Psychological, Physical and (T) control trial music therapy improvement in balance (p = 0.04), pulmonary
Physiological Indices among Elderly Females: A 100% once a week for function (p = 0.05) as well as blood pressure
Randomized Controlled Trial [29]. Female 8 weeks (p = 0.02) in the participants after the movement
music therapy sessions.
African drumming: a holistic approach to reducing Age: South Controlled 34 Djembe The systolic blood pressure was also decreased in
stress and improving health [15]? 23.4 Africa trial drumming for the older population post-drumming (p < 0.01).
(young) 1 session
vs 53.1
73%
Female
Recreational music-making modulates Age: 27.9 Japan Controlled 63 Recreational There was an increase in number of immune cells
immunological responses and mood states in (young) trial music making like lymphocytes, T cells, CD4+ T cells, memory T
older adults [22]. vs 70.3 for 1 session cells as well as production of interferon-gamma
(old) and interleukin-6 post-intervention reflecting an
64% improvement in immunological profile of
Female participants (p < 0.05).
Recreational music-making modulates natural Age: Japan Randomized 40 Recreational The intervention group had a higher NK cell
killer cell activity, cytokines, and mood states in 38.4(T) controlled music-making activity, lower gene expression levels of the stress-
corporate employees [23]. 0% trial with for 1 session induced cytokine interleukin-10 (p < 0.05).
Female cross over
Find Your Beat: Therapeutic Drumming for Age: 70 US Uncontrolled 13 Health Drumming helped in the improvement of physical
Parkinson’s Disease [25]. (T) trial Rhythms symptoms like tremors, hand and finger dexterity,
38% protocol for 1 coordination as well as upper body stiffness (no
Female session statistical tests performed).

*NA = Not Applicable. Abbreviations: Intervention (I), control (C), total (T).

allow researchers to identify future gaps easily and employ
different methods in their study of RMM.
A weakness of the present study is that it is a systematic review
and not a meta-analysis of the current available literature, as such
the magnitude of the effects of RMM on an individual were not
studied, therefore we felt that it was more accurate to portray the
impact of the studies qualitatively. Also, studies where there were
no articles/abstracts retrievable and studies in other languages
were excluded resulting in the possible under-representation of
the effects on RMM. However, the present study has summarized
the current literature as much as possible and studies have been
grouped into the 3 categories to facilitate better understanding of
the effects of RMM and to serve as a platform for easier recall.
In conclusion, RMM has been shown to have numerous effects
on an individual namely, effects on psychological health, effects on
physical health and effects on social health. It is a modality that has
been used in populations of varied backgrounds for the achieve-
ment of different purposes and it could be a new activity with both
physical and non-physical benefits on an individual that physicians
can recommend to patients with the concept of integrative
medicine in mind. We also hope that this study would be able
to serve as a platform for further focused research in areas that
have yet to be explored.
Disclosure
The authors declare no conflict of interest and this research did
not receive any specific grant from funding agencies in the public,
commercial, or not-for-profit sectors.
Authors contribution
All research was done by the authors.
Finance support
No.
Conflict of interest
None.
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