Dance to Improve Mobility and Reduce Falls Marie McNeely, PhD Instructor in Physical Therapy and Neurology Washington University in St. Louis Locomotor

Dance to Improve Mobility and Reduce Falls

Marie McNeely, PhDInstructor in Physical Therapy

and Neurology

Washington University in St. LouisLocomotor Control LaboratoryProgram in Physical Therapy

Program in Physical Therapy

Disclosures

• No conflicts of interest to declare


Outline

• The importance of being physically active

• Findings from dance studies

• Future directions for dance research

• Implementation of a dance program


The State of Physical Activity in the U.S.

• 39.6 million people in the United States over the age of 65 in 2009, and this is expected to grow to 72.1 million by 2030 (19% of the population)1

• Approximately 60% of Americans over age 65 do not meet physical activity recommendations2

• Physical activity is particularly reduced in people with chronic conditions like Parkinson disease (PD)3,4


Why Exercise?• Improvements in

AND MORE!

• Circulation

• Lung capacity

• Muscle strength

• Energy

• Self-esteem

• Mood

• Cognition

• Stress response

• Quality of life

• Neuroprotection


Why Exercise is Important for Older Adults

• Falls are a leading cause of morbidity and mortality in older adults5-7, and exercise may prevent falls8

• Frailty may be delayed or reversed with exercise9

• Exercise is important for preventing and managing diabetes, cardiovascular disease, and other health conditions10,11

• Cognition function improves with exercise12,13

• Exercise improves measures of walking speed, time, and distance, which are powerful predictors of mortality and morbidity14


Barriers to Exercise15,16

• Physical discomfort

• Fear of falling

• Comorbidities

• Competing priorities

• Lack of time

• Apathy

• Discomfort in social situations

• Dependence on an instructor

• Affordability

• Belief exercise is not needed

• Belief exercise would not be beneficial


Why Choose Dance?17

• Accessible

• Appealing

• Socially engaging

• Challenges balance

• Complex movements and multitasking

• Targets strength, flexibility, and endurance

• Task-specific training of difficult movements

• Includes music

• Supportive class environment

• Trained instructors

• Evidence supports a wide variety of benefits


Dance Intervention Studies in Older Adults18,19

• Controlled studies have evaluated many dance styles

• Program durations were 4 weeks – 18 months

• Sessions were 1 – 7 times per week for 10 – 90 minutes

• Tango• Salsa• Greek traditional• Caribbean

traditional

• Thai traditional• Turkish folkloristic• Aerobic• Ballroom• Line

• Creative• Contemporary• Adapted• Video game


Dance Programs are Safe, Feasible, and Fun

• No adverse events or no increase in adverse events in older adults, even in vulnerable populations such as chronic heart failure20, stroke21, and Parkinson disease22-24

• “During the dance class, the participants did not want to stop even if they were becoming fatigued.”21

• “Following 12 months of participation, 11 of the 16 individuals in the Tango group chose to continue attending classes even though they had formally completed all study requirements and were no longer expected to attend.”25


Dance Improves Balance• Improved performance in clinical balance tests• Improved static balance and dynamic postural control• Increased balance confidence• Reduced falls

Aerobic Dance Wait List Control0

5

10

15

20

25

30

Single Limb Stance

PrePost

Tim

e (

s)

Graph created with data from Hopkins et al. 1990.26


Dance Improves Walking

Graphs created with data from Granacher et al. 2012.27

Salsa

Dance

No In

terv

entio

n Con

trol

0

20

40

60

80

100

120

140

160

Stride Velocity

Velo

cit

y (

cm

/s)

Salsa

Dance

No In

terv

entio

n Con

trol

0

20

40

60

80

100

120

140

160

Stride Length

Length

(cm

)

Salsa

Dance

No In

terv

entio

n Con

trol

0

0.2

0.4

0.6

0.8

1

1.2

Stride Time

PrePost

Tim

e (

s)


Dance Improves Endurance, Strength, & Flexibility

• Endurance• Lower limb functional strength• Flexibility

Graphs created with data from Janyacharoen et al. 2013.28

Thai

Dan

ce

Home

Exer

cise

Inst

ruct

ions

0

100

200

300

400

6 Minute Walk Test

Dis

tance (

m)

Thai

Dan

ce

Home

Exer

cise

Inst

ruct

ions

0

4

8

12

16

5x Sit to Stand

Tim

e (

s)

Thai

Dan

ce

Home

Exer

cise

Inst

ruct

ions

0

4

8

12

16

Sit and Reach

PrePost

Dis

tance (

cm

)


Dance Improves Functional Mobility

Graph created with data from Holmerova et al. 2010.29

Ballroom Dance RCF Activities Control0

5

10

15

20

25

Timed Up-and-Go

PrePost

Tim

e (

se

c)


More Than a Movement Intervention

Dance Is


Dance Improves Cognition• Task-switching• Attention• Memory

• Visuospatial skills• Reaction time• Information processing

Graph created with data from Zhang et al. 2014.30

Squa

re D

ance

No In

terv

entio

n Con

trol

0

40

80

120

Scale of Elderly Cognitive Function

PrePost - 6mPost - 12mPost - 18m

Sco

re (

po

ints

)


Dance Improves Mood• Reduction in anger• Reduction in depressive symptoms• Improvements in anxiety

Ballro

om D

ance

Wai

t List

Con

trol

0

2

4

6

8

10

Geriatric Depression Scale

PrePost

Sco

re (

po

ints

)

Graph created with data from Vankova et al. 2014.31


Dance Effects on Quality of Life• Quality of life

• General health• Physical functioning

• Mental health• Body pain

Graph created with data from Eyigor et al. 2009.32

• Life satisfaction

Turk

ish f

olk

lori

stic

Dance

No Inte

rventi

on C

ontr

ol

General health

0

20

40

60

80

Score

(poin

ts)

Quality of Life - Short Form Health Survey-36Turk

ish f

olk

lori

stic

Dance

No Inte

rventi

on C

ontr

ol

Physical functioning

72

76

80

84

88

Turk

ish f

olk

lori

stic

Dance

No Inte

rventi

on C

ontr

ol

Mental Health

626670747882

Turk

ish f

olk

lori

stic

Dance

No Inte

rventi

on C

ontr

ol

Pain

020406080

100120

Pre

Post


Future Directions in Studying Dance

• Determine the ideal intervention parameters• Dance style• Frequency• Duration• Intensity

• Examine rates of acquisition and maintenance of benefits

• Direct comparisons between dance interventions

• Investigation of mechanisms of benefits

• Bringing these programs into the community and reaching more people


How Dance May Be Working

• Plasticity-related changes33

• Music may reduce stress and enhance social relationships34


Current Dance Studies in Our Laboratory

• Exercise study comparing three different exercise types and examining the neural mechanisms of benefits in people with Parkinson disease

• Teletango study evaluating remote dance instruction in people with Parkinson disease


Considerations for Developing Dance Programs

• Who are your participants?

• Participant characteristics

• Special populations

• Satisfaction

• Safety/Risk

• Recruitment



• What are your goals for the class

• Aerobic benefits

• Improved movement and mobility

• Cognition

• Mood

• Community

• Social support



• Who will teach and assist with classes?

• Instructors

• Staff

• Volunteers

• Family members



• Where and will the classes take place?

• Space/facilities

• Accessibility



• When and will the classes take place?

• Frequency of classes

• Duration of classes

• Duration of program



• How will the classes be conducted?

• Size

• Music

• Syllabus/Content

• Pace

• Progression

• Adaptability


Case Study: Adapted Tango35

• Developed for Parkinson disease and older adults

• Composed of simple step elements• Movement initiation and cessation• Multi-directional perturbations• Varied speeds and rhythms

• Focus on

• Successfully implemented in the community• participants 36-95 years old

• Foot placement• Whole body coordination• Attention to partner• Path of movement

• Aesthetics


Summary: Why to Consider a Dance Program?

• Provides exercise

• Wide range of benefits for health and well-being

• Feasibility of implementing high-quality programs in a community setting


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http://www.aoa.acl.gov/Aging_Statistics/index.aspx. 2) C.A. Macera, S.A. Ham, M.M. Yore, et al., "Prevalence of physical activity in the United States: Behavioral Risk Factor Surveillance System,

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Dance to Improve Mobility and Reduce Falls Marie McNeely, PhD Instructor in Physical Therapy and Neurology Washington University in St. Louis Locomotor