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Dance Exercise for Older Adults: A Pilot StudyInvestigating Standing Balance Following a SingleLesson of Danzon
Azucena Guzman-Garcıa • Leif Johannsen •
Alan M. Wing
� American Dance Therapy Association 2011
Abstract Despite evidence that long-term dance exercise results in improved
functional balance in older adults, it remains unclear whether people must first
achieve a minimum level of skill before they can benefit from the exercise in terms
of body balance. In order to evaluate whether or not exercise during early learning
of dance is beneficial, we asked dance-inexperienced older adults to perform in pairs
a 30-min lesson of danzon. Motion capture and ground reaction force recordings
were used to determine the variability of body sway during quiet, upright standing
before and immediately after the lesson. Significant reductions in variability of sway
normalized by body height were found following the dance exercise. Interestingly,
the taller individual who was instructed to take the ‘‘leader’’ role showed greater
gains. Our findings indicate that learning to dance danzon at a beginner’s level may
be beneficial for balance in the elderly, despite the increased cognitive load in the
early stages of skill acquisition.
Keywords Dance interventions � Danzon � Aging � Posture � Balance � Body sway
Introduction
Short-term improvement in the stability of body balance following various forms of
physical exercise is a relatively robust outcome for older adults (Howe, Rochester,
A. Guzman-Garcıa
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality,
Newcastle upon Tyne NE4 5PL, UK
e-mail: [email protected]
L. Johannsen (&) � A. M. Wing
Behavioural Brain Sciences Centre, School of Psychology, University of Birmingham,
Birmingham B15 2TT, UK
e-mail: [email protected]
123
Am J Dance Ther
DOI 10.1007/s10465-011-9114-6
Jackson, Banks, & Blair, 2007). For example, water-based exercises have been
shown to improve standing and leaning balance and superior shoulder flexibility at
retest in community-dwelling older people (Lord et al., 2006). Soft style martial arts
with slow motion routines such as Tai Chi Chuan have been recommended for
exercising body balance as well (Wolfson, 1996; Judge, 2003). Furthermore, single-
leg strength, balance with eyes open and closed, locomotion and agility were
improved following dance-based aerobic exercise in older women (Shigematsu
et al., 2002). Finally, dance exercises have been reported to result in improved
functional balance both when performed by isolated individuals (Zhang, Ishikawa-
Takata, Yamazaki, Morita, & Ohta, 2006; Buchneret al., 1997) or in pairs and
groups (Sofianidis, Hatzitaki, Douka, & Grouios, 2009; McKinley et al., 2008;
Federici, Bellagamba, & Rocchi, 2005).
In a comparison of older regular social dancers with experience of ballroom, line
and swing dancing against older non-dancers, the social dancers showed not only
better standing balance but also faster gait, longer stride length, and relatively more
time spent in the swing phase per gait cycle (Verghese, 2006). These results were
interpreted as evidence of more stable balance while walking in older social
dancers. More generally, it has been inferred from such findings that engaging
senior populations in a particularly enjoyable form of physical exercise, such as
dance, results in improved physical ability as well as reduced risk for fall-related
injuries (Keogh, Kilding, Pidgeon, Ashley, & Gillis, 2009).
On the other hand, learning to dance is likely to involve significant cognitive
resources, such as attention, executive function, and memory, especially early in
skill acquisition, before the sequencing of movements becomes automatic (Fitts &
Posner, 1967). It might therefore be assumed that learning to dance as a coordinated
pair would show some costs, and not lead immediately to benefits in dynamic
balance stability. Indeed, the ‘‘learning to dance’’ exercise may be experienced as
quite demanding and lead to physical fatigue rather than improvement in balance. It
could have important implications for elderly dance training if dance activities only
begin to show benefits after a specific level of skill is reached. It could even imply
increased risk in initial stages of learning. An important question therefore, is
whether older adults without any previous dance exposure might fail to show any
beneficial gains or even exhibit reductions in dynamic body stability during early
phases of learning to dance.
In order to assess this question, our pilot study focused on a group of
inexperienced older adults who learned the choreography of an unfamiliar pair
dance. For our study, we chose the danzon, a popular Latin ballroom dance enjoyed
by middle-aged and older adults in Mexico. The danzon technique is performed at a
slow-to-moderate speed that allows for the assembling and disassembling of steps,
and for performing small steps in which the feet slide or drag and stop on each beat
along with gentle hip and body movements. These movements contrast with tango
or foxtrot, for example, both of which involve stylized walking, with strong lifted
marked steps between beats (Flores y Escalante, 2006). The danzon style appears to
afford lower physical demands, while still providing moderate cardiovascular
exercise.
Am J Dance Ther
123
Method
Participants
Ten healthy older adults (mean = 65.1 years, SD = 4.2; 9 females, 1 male) were
recruited in five pairs (4 same-gender, 1 mixed-gender) in a community setting.
Subject inclusion criteria were: 60 years of age or older; able to walk independently
without walking aid; must not have experienced any falls in the previous 12 months.
Participants were not involved in any dance exercise on a regular basis prior to this
study. In same-gender pairs, the taller individual was assigned the ‘‘leader role’’
during the dance (average ‘‘leader’’ vertical C7 vertebra’s height = 1424 mm,
SD = 39; average ‘‘follower’’ vertical C7 vertebra’s height = 1361 mm, SD = 24;
t(8) = 3.02, p = 0.02). Written informed consent was obtained from all participants
and the study was approved by the University of Birmingham Ethics Committee.
Materials and Procedure
After familiarization with the music, every pair attended a 30-min danzon lesson,
instructed by Guzman-Garcıa. In this pilot study, the choreography followed by
each pair consisted of a set of four steps: (1) ‘‘danzon entrance’’ pattern (dancers
stand next to each other and touch each other’s hand at the index, middle and ring
fingers) performed at the start, middle and end of a song; (2) ‘‘box step;’’ (3)
‘‘lateral’’ and (4) ‘‘twirl dancing backwards/forwards’’ (in which the leader helps the
follower turn). Each dance sequence lasted about 3 min and ten sequences were
performed. After each sequence, the pair received brief, personalized feedback
about their synchronization, overall body posture, interpersonal coordination and
stepping accuracy.
Immediately before and after the lesson, body sway during quiet upright
standing, with and without vision while facing straight ahead, was recorded
simultaneously for both individuals in a pair. Both participants were standing side-
by-side about one meter apart. The person taking on the ‘‘leader’’ role was always
standing to the left of the ‘‘follower,’’ which coincided with the ‘‘danzon entrance’’
positions at the start and end of each dance sequence. Three standing trials of 15 s
duration were recorded for each vision condition in a random sequence. Each
participant wore comfortable shoes and stood with a 5 cm gap between their feet on
two separate force platforms (model 4060H by Bertec, Columbus, Ohio), used to
record ground reaction forces and moments for determining the anterior–posterior
(AP) and medial–lateral (ML) components of centre-of-pressure (CoP) fluctuations.
CoP fluctuations reflect the generation of ankle torque as part of the central nervous
system’s control of the location of the body’s centre-of-mass (CoM). Body balance
can be considered stable if the horizontal position of CoM is kept within the base of
support defined by the placement of the feet (Winter, 2005).
Participants’ body sway kinematics were captured with an optoelectronic motion
tracking system of twelve cameras (Oqus 300 cameras and Qualisys software,
Gothenburg, Sweden). Participants had reflective markers attached to the seventh
cervical vertebra (C7); right and left shoulders; sternum; elbow; left and right wrist;
Am J Dance Ther
123
back and front of pelvic bones, left and right ankles; back of both shoes as well as
left and right toes. Actual sway of the trunk, in terms of either the C7 or the sternum
markers, was used for approximating CoM motion. Kinematics were recorded at
200 Hz, while data from the force platforms were sampled at 1,000 Hz. Kinematic
and kinetic data were digitally low-pass filtered at 10 Hz and differentiated when
velocity measures were required (dC7, dCoP).
Variability of body sway in terms of the standard deviation (SD) was computed
from each complete trial for the trunk and CoP velocity measures. The resulting
variables (SD dC7, SD dCoP) were normalized by dividing by the participant’s
height and multiplying by 1000 (mm/s 9 1/mm = s-1) and were averaged for each
vision condition. Normalization of body sway by height was performed to control
for differences in height between the ‘‘leader’’ and ‘‘follower’’ roles. As we searched
for exercise effects on two variables, a mixed, repeated-measures, multivariate
analysis of variance (MANOVA) with exercise, sway direction and vision condition
as within-subject factors and dance role as between-subject factor was computed.
Significance levels were set to 0.05. We report conservative Greenhouse-Geisser
corrected p-values, in order to protect our statistical conclusions against violations
of the prerequisites for parametric statistical tests such as the MANOVA.
Results
All significant effects and interactions that resulted from the analysis are listed in
Table 1. On both measures, sway was more variable with closed eyes (dC7:
mean = 6.07 s-1, SD = 1.81; dCoP: mean = 12.70 s-1, SD = 4.70) than with
open eyes (dC7: mean = 3.97 s-1, SD = 0.52 5; dCoP: mean = 7.05 s-1, SD =
0.95) and more variable in the AP (dC7: mean = 5.82 s-1, SD = 1.25; dCoP:
mean = 11.60 s-1, SD = 3.47) than the ML direction (dC7: mean = 4.22 s-1,
SD = 0.99; dCoP: mean = 8.15 s-1, SD = 2.55). Variability of sway was greatest
in the AP direction with eyes closed and smallest in the ML direction with eyes
open.
Table 1 Effect table for MANOVA on the two outcome measures representing body sway
Main effect/interaction Outcome variable
SD dC7 (univariate) SD dCoP (univariate)
Dance exercise F = 3.67#
Dance exercise 9 sway direction F = 6.17*
Dance exercise 9 vision condition F = 10.42* F = 10.32*
Dance exercise 9 vision condition 9 role F = 12.91* F = 10.25*
Sway direction F = 33.95* F = 18.15*
Vision condition F = 16.40* F = 22.75*
Sway direction 9 vision condition F = 8.11* F = 7.98*
* p B 0.05 (significant)# p B 0.10 (marginal)
Am J Dance Ther
123
An effect of practising danzon on body sway was found with less sway after the
exercise. Regarding the change of SD dCoP, a larger reduction was found without
vision (mean = -2.32 s-1, SD = 3.38) than with open eyes (mean = -0.29 s-1,
SD = 1.60) and in the AP (mean = -1.83 s-1, SD = 2.01) than the ML sway
direction (mean = -0.78 s-1, SD = 2.57). Interestingly, both outcome measures
demonstrated a significant interaction between exercise, vision condition, and role.
Figure 1 shows SD dCoP as a function of the danzon exercise for both directions
of sway and vision conditions as well as the participants’ roles. The change in AP
sway in terms of SD dCoP and SD dC7 with closed eyes after the dance lesson for
the two corresponding participants in each pair is shown in Fig. 2. In four out of five
pairs, dCoP sway showed a greater reduction for the ‘‘leader’’ role compared to the
‘‘follower’’ (Fig. 2a). These four ‘‘leading’’ individuals also showed reductions in
their dC7 sway in contrast to their ‘‘following’’ partners, who showed either no
change or increase (Fig. 2b).
Discussion
In a 30 min dance lesson of moderate intensity, inexperienced older adults learning
basic steps of danzon showed a significant reduction of body sway in the AP direction
during normal quiet standing without vision. This finding indicates that older
individuals show immediate improvement of body balance control following a single
dance lesson, despite having to divide their attention to various aspects of learning,
such as performing the danzon sequences in synchrony with their partner and the
music. Interestingly, the individual who acted in the ‘‘leader’’ role showed greater
reduction of sway even when statistical differences in physical body height were
controlled for. Since three of the four pairs showing this effect pattern were all female,
this finding cannot be attributed to biological gender. Rather, it seems that the
requirement to learn to take the ‘‘lead’’ role induced a greater benefit for controlling
body sway without visual feedback. However, it could also mean that the ‘‘leader’’
step sequence is intrinsically more beneficial even though the ‘‘follower’’ needs to be
as skilled in dancing the sequence as the ‘‘leader,’’ in order to perform in a
coordinated and synchronized fashion. With the exception of the leader helping the
follower to perform a turn, dancers were mirroring movements throughout the
choreography. For example at the beginning, middle, and end of the song, both
dancers had to perform the ‘‘danzon entrance’’ step. Even during this symmetric
dance maneuver, however, the ‘‘leader’’ might have implicitly adopted a more active
role than the ‘‘follower’’ by guiding the ‘‘follower’s’’ movements using fingertip
‘‘light touch’’ cues (Johannsen, Guzman-Garcıa, & Wing, 2009). One remote
possibility could be that the ‘‘follower’’ experienced some form of vestibular
aftereffect due to the turn in the training sequence, which could conceivably
counteract any effects of the training. Although a few minutes passed between the end
of the lesson and the following sway assessment, the ‘‘follower’’ might have swayed
slightly more than they would have if they had not performed the turn. In general, this
outcome suggests that during danzon training, pairs should be encouraged to switch
roles regularly in order to attain similar levels of balance benefits.
Am J Dance Ther
123
The results of the present pilot study, albeit significant, are based on a small
sample. Nevertheless, we are not aware of any previously published study of the
physical benefit of the danzon for healthy older adults. Hence, this study should be
of considerable potential interest in the search for effective interventions in
maintaining fitness and balance in older adults. An extension of the dance approach
in a larger study seems warranted. Whether the immediate benefits of learning to
dance for postural stability are caused by the complex dual-task nature of the
exercise, increased levels of arousal or improved sensory processing need to be
B
A
Fig. 1 Body sway (SD of CoP rate of change) in the AP (a) and the ML (b) direction, before and afterthe danzon lesson for both vision conditions and the two ‘‘roles.’’ Open markers indicate the ‘‘leader’’role, closed markers the ‘‘follower.’’ The error bars represent plus and minus one standard error of mean
Am J Dance Ther
123
studied further. Follow-up research should also control for the physical activity,
long-term effects, and active ‘‘dance roles’’ taken by each of the two individuals.
Also, our findings do not imply that danzon exercises are beneficial for standing
balance only in the elderly when practiced as an unfamiliar dance. On the contrary,
we expect that long-term practice, with the accompanying increased exposure and
greater familiarity, would augment any benefits of the dance exercise on body
balance. On the other hand, our results may imply that a dance native to a specific
elderly population, other than the danzon, yet minimally challenging, might become
the dance of choice for improving postural stability.
Danzón role
'Follower' 'Leader'
Cha
nge
in a
/p d
CoP
sw
ay (
s-1)
-6
-5
-4
-3
-2
-1
0
1
Pair IPair IIPair IIIPair IVPair V
Eyes closed
Male participant
Danzón role'Follower' 'Leader'
Cha
nge
in a
/p d
C7
sway
(s-1
)
-4
-3
-2
-1
0
1
2
3
Pair IPair IIPair IIIPair IVPair V
Eyes closed
Male participant
A
B
Fig. 2 Change in normalized AP sway following the danzon lesson in terms of SD dCoP (a) and SD dC7(b) during quiet standing with closed eyes for the individuals of each pair
Am J Dance Ther
123
In conclusion, we have shown that practicing a dance style of moderate intensity,
such as the danzon, with minimal skill, has potential benefits on the sensorimotor
control of body sway, following just a single dance session. Although we cannot be
certain that these immediate training effects last longer than the relatively short time
span of one session, one might speculate that this relatively easy dance routine may
result in long-term improvement in dynamic balance stability and a reduced risk for
fall-related injury if done regularly. Another implication for dancing interventions
in general is that roles should be interchanged regularly, as to maximize the benefits
for both participants in a pair.
Acknowledgement We acknowledge the financial support of the Biotechnology and Biological
Sciences Research Council (BBSRC; BBF0100871) awarded to Professor Alan Wing and the Mexican
National Council for Science and Technology (CONACYT) awarded to Azucena Guzman-Garcıa, PhD
Candidate. Further information about danzon can be provided by the authors on request.
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Author Biographies
Azucena Guzman-Garcıa BA, MRes, PhD CandidateMs. Guzman-Garcıa is a PhD candidate in behaviour and affective states in dementia from the Institute
for Ageing and Health at Newcastle University, UK. She studied psychology at the Universidad de las
Americas, A.C. in Mexico City and she obtained her master’s degree in Neuropsychology and
Rehabilitation from The University of Birmingham, in the UK. Ms. Guzman-Garcıa, a trained Latin
Ballroom dancer, has studied psychomotor practice at the Institut Superieur de Reeducation
Psychomotrice in Paris, France.
Leif Johannsen, Dr. rer. nat, Dipl-PsychDr. Johannsen is a researcher at the Technische Universitat Munchen (Munich, Germany), and the
University of Birmingham, in the UK. His psychology degree was awarded by the University of Potsdam
in 1999. He completed his doctorate in behavioural neuroscience at the University of Tubingen
(Germany) in 2005. His research focuses on effects of light touch contact between two individuals, and on
the interpersonal coordination of movements, posture, and balance.
Alan M. Wing, PhDProfessor Wing studied Physics and Psychology as an undergraduate at Edinburgh University, in the UK.
After completing a PhD in Psychology on timing of movement at McMaster University in Ontario,
Canada, he continued this research in a postdoctoral fellowship at Bell Labs in New Jersey. Professor
Wing then joined the Medical Research Council staff at the Cambridge Applied Psychology Unit where
he studied movement timing as well as anticipatory control of posture in balance and grip. In 1997 he
became Professor of Human Movement in the School of Psychology at The University of Birmingham
(UK) where he set up the Sensory Motor Neuroscience group to focus on sensory factors in control of
posture and movement.
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