Review: Physical benefits of dancing for older adults

Physical Benefits of Dancing for Healthy Older Adults: A Review. 2009. Justin W.L. Keogh, Andrew Kilding, Philippa Pidgeon, Linda Ashley, and Dawn Gillis. Journal of Aging and Physical Activity, 2009, 17, 1-23.

Abstract: “Dancing is a mode of physical activity that may allow older adults to improve their physical function, health, and well-being. However, no reviews on the physical benefits of dancing for healthy older adults have been published in the scientific literature. Using relevant databases and keywords, 15 training and 3 cross-sectional studies that met the inclusion criteria were reviewed. Grade B–level evidence indicated that older adults can significantly improve their aerobic power, lower body muscle endurance, strength and flexibility, balance, agility, and gait through dancing. Grade C evidence suggested that dancing might improve older adults’ lower body bone-mineral content and muscle power, as well as reduce the prevalence of falls and cardiovascular health risks. Further research is, however, needed to determine the efficacy of different forms of dance, the relative effectiveness of these forms of dance compared with other exercise modes, and how best to engage older adults in dance participation.

“Keywords: dance, exercise, falls, functional ability”

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Enhancing postural, sensorimotor and cognitive performance in elderly people

Six months of dance intervention enhances postural, sensorimotor, and cognitive performance in elderly without affecting cardio-respiratory functions. 2013. Kattenstroth JC, Kalisch T, Holt S, Tegenthoff M, Dinse HR. Frontiers in Aging Neuroscience. 2013 Feb 26; 5:5.

Abstract: “During aging, sensorimotor, cognitive and physical performance decline, but can improve by training and exercise indicating that age-related changes are treatable. Dancing is increasingly used as an intervention because it combines many diverse features making it a promising neuroplasticity-inducing tool. We here investigated the effects of a 6-month dance class (1 h/week) on a group of healthy elderly individuals compared to a matched control group (CG). We performed a broad assessment covering cognition, intelligence, attention, reaction time, motor, tactile, and postural performance, as well as subjective well-being and cardio-respiratory performance. After 6 months, in the CG no changes, or further degradation of performance was found. In the dance group, beneficial effects were found for dance-related parameters such as posture and reaction times, but also for cognitive, tactile, motor performance, and subjective well-being. These effects developed without alterations in the cardio-respiratory performance. Correlation of baseline performance with the improvement following intervention revealed that those individuals, who benefitted most from the intervention, were those who showed the lowest performance prior to the intervention. Our findings corroborate previous observations that dancing evokes widespread positive effects. The pre-post design used in the present study implies that the efficacy of dance is most likely not based on a selection bias of particularly gifted individuals. The lack of changes of cardio-respiratory fitness indicates that even moderate levels of physical activity can in combination with rich sensorimotor, cognitive, social, and emotional challenges act to ameliorate a wide spectrum of age-related decline.”
“KEYWORDS: VO2max; balance; cognition; dance therapy; enriched environment; intervention; sensorimotor; successful aging”

Amateur dancing & superior sensory, motor and cognitive performance in elderly individuals

Superior Sensory, Motor, and Cognitive Performance in Elderly Individuals with Multi-Year Dancing Activities. 2010. Jan-Christoph Kattenstroth, Izabella Kolankowska, Tobias Kalisch, and Hubert R. Dinse. Frontiers in Aging Neuroscience. 2010; 2: 31.

Abstract: “Aging is associated with a progressive decline of mental and physical abilities. Considering the current demographic changes in many civilizations there is an urgent need for measures permitting an independent lifestyle into old age. The critical role of physical exercise in mediating and maintaining physical and mental fitness is well-acknowledged. Dance, in addition to physical activity, combines emotions, social interaction, sensory stimulation, motor coordination and music, thereby creating enriched environmental conditions for human individuals. Here we demonstrate the impact of multi-year (average 16.5 years) amateur dancing (AD) in a group of elderly subjects (aged 65–84 years) as compared to education-, gender- and aged-matched controls (CG) having no record of dancing or sporting activities. Besides posture and balance parameters, we tested reaction times, motor behavior, tactile and cognitive performance. In each of the different domains investigated, the AD group had a superior performance as compared to the non-dancer CG group. Analysis of individual performance revealed that the best participants of the AD group were not better than individuals of the CG group. Instead, the AD group lacked individuals showing poor performance, which was frequently observed for the CG group. This observation implies that maintaining a regular schedule of dancing into old age can preserve cognitive, motor and perceptual abilities and prevent them from degradation. We conclude that the far-reaching beneficial effects found in the [amateur dancing] group make dance, beyond its ability to facilitate balance and posture, a prime candidate for the preservation of everyday life competence of elderly individuals.”

“Keywords: aging, dance, successful aging, plasticity, neurotrophic factors, intervention, seniors, enriched environment”

Dementia prevention review

Dementia Prevention: Methodological Explanations for Inconsistent Results. Nicola Coley, Sandrine Andrieu, Virginie Gardette, Sophie Gillette-Guyonnet, Caroline Sanz, Bruno Vellas, and Alain Grand. (2008). Epidemiol Rev 30 (1): 35-66.

Abstract: “The prevention of neurodegenerative dementias, such as Alzheimer disease, is a growing public health concern, because of a lack of effective curative treatment options and a rising global prevalence. Various potential risk or preventive factors have been suggested by epidemiologic research, including modifiable lifestyle factors, such as social contacts, leisure activities, physical exercise, and diet, as well as some preventive pharmacologic strategies, such as hormone replacement therapy, nonsteroidal antiinflammatory drugs, and Ginkgo biloba. […] The aim of this paper is to review the epidemiologic data linking potential protective factors to dementia or cognitive decline and to discuss the methodological limitations that could explain conflicting results. A thorough review of the literature suggests that, even if there are consistent findings from large observational studies regarding preventive or risk factors for dementia, few randomized controlled trials have been designed specifically to prove the protective effects of interventions based on such factors on dementia incidence. Because of the multifactorial origin of dementia, it appears that multidomain interventions could be a suitable candidate for preventive interventions, but designing such trials remains very challenging for researchers.”

Below are excerpts from the section “Social contacts, leisure activities, and physical exercise.” (Dance integrates all of these aspects: social engagement, leisure and cognitive activity, and physical exercise).

Prospective longitudinal studies
“Social contacts and social engagement. Fourteen studies have found an inverse relation between the level of late-life social contacts or engagement and the risk of dementia/Alzheimer disease (76–82) or cognitive decline (83–89). Midlife social engagement was assessed by one of these studies (82) but was not found to be related to dementia risk.
Two studies (90, 91) found only certain measures of social engagement to be associated with better cognitive function, and four studies found no association between participation in social activities (92, 93) or social network or support measures (91, 94) and cognition.

“Cognitive activities in late life. Twelve studies have demonstrated a relation between increased participation in cognitive activities in late life and a decreased risk of dementia (76–78, 95), Alzheimer disease (95–98), vascular dementia (95), or cognitive decline or impairment (87, 92, 93, 97,99, 100). No studies were identified that failed to find an association between cognitive activities and outcomes, although the positive effects in one of the above-mentioned studies (87) were seen only in some specific cognitive domains.

“Physical exercise. An increased frequency or intensity of physical exercise or activities in late life was associated with a decreased risk of dementia/Alzheimer disease (76, 77, 95, 101–107) or cognitive decline/impairment in 19 studies (87, 104, 108–115). However, nine studies found no association with dementia/Alzheimer disease (78, 96,97, 116, 117) or cognitive decline/impairment (92, 118–120). Two studies examined the effects of midlife physical exercise on the risk of dementia in late life and found conflicting results (121, 122).”

Physical activity in preventing and managing Alzheimer’s disease

The Role of Physical Activity in the Prevention and Management of Alzheimer’s Disease—Implications for Ontario. Ontario Brain Institute. (2013).

“Approach: To better understand how physical activity can contribute to the prevention and management of Alzheimer’s disease, 871 research articles were reviewed. After closer inspection and quality scoring, 24 randomized control trials and 21 prospective cohort studies examining physical activity and Alzheimer’s disease were selected for further analysis.

“Results: Within older adults with Alzheimer’s disease, regular physical activity improved quality of life (QOL), activities of daily living (ADL), and decreased the occurrence of depression. In older adults without Alzheimer’s disease, those who were very physically active were almost 40% less likely to develop Alzheimer’s disease as those who were inactive. At the population level, it was observed that more than 1 in 7 cases of Alzheimer’s disease could be prevented if everyone who is currently inactive were to become physically active at a level consistent with current activity recommendations. On this basis, potential cost-savings (~$88 to $970 million CDN per year) in healthcare for community-dwelling older adults with Alzheimer’s disease are substantial.” (page 2)

Promoting successful cognitive aging

Enrichment effects on adult cognitive development; Can the functional capacity of older adults be preserved and enhanced?. Hertzog, C., Kramer, A. F., Wilson, R. S., & Lindenberger, U. (2008). Psychological Science in the Public Interest, 9(1), 1-65.

Some excerpts from the abstract:

“We begin with a theoretical framework that emphasizes the potential of behavior to influence levels of cognitive functioning. According to this framework, the undeniable presence of age-related decline in cognition does not invalidate the view that behavior can enhance cognitive functioning.

“We conclude that, on balance, the available evidence favors the hypothesis that maintaining an intellectually engaged and physically active lifestyle promotes successful cognitive aging.

“The longitudinal evidence consistently shows that engaging in intellectually stimulating activities is associated with better cognitive functioning at later points in time. Other studies show that meaningful social engagement is also predictive of better maintenance of cognitive functioning in old age. These longitudinal findings are also open to important rival explanations, but overall, the available evidence suggests that activities can postpone decline, attenuate decline, or provide prosthetic benefit in the face of normative cognitive decline, while at the same time indicating that late-life cognitive changes can result in curtailment of activities.

“Third, there is a parallel literature suggesting that physical activity, and aerobic exercise in particular, enhances older adults’ cognitive function. Unlike the literature on an active lifestyle, there is already an impressive array of work with humans and animal populations showing that exercise interventions have substantial benefits for cognitive function, particularly for aspects of fluid intelligence and executive function. Recent neuroscience research on this topic indicates that exercise has substantial effects on brain morphology and function, representing a plausible brain substrate for the observed effects of aerobic exercise and other activities on cognition.”

Effects of dance on well-being in older persons

Effects of dance on physical and psychological well-being in older persons. Elsie Hui , Bo Tsan-keung Chui, Jean Woo, 2009, Archives of Gerontology and Geriatrics Volume 49, Issue 1, July–August 2009, Pages e45–e50.

Abstract
“This study was aimed at determining the effects of dancing on the health status of older persons. A pool of 111 community-dwelling subjects were allocated to either an intervention group (IG), which included 23 sessions of dance over 12 weeks, or a control group (CG). All participants were assessed at baseline and 12 weeks. Physical outcome measures included the 6-min timed walking test (6MWT), trunk flexibility, body composition, lower limb endurance and strength, balance, the timed up-and-go test (TUG), resting heart rate and blood pressure. Quality of life was assessed by the Medical Outcomes Survey Short Form (SF-36) questionnaire. The IG’s views toward dancing were also evaluated at 12 weeks. Significant difference was observed between the groups in six outcome measures: mean change in resting heart rate, 6MWT, TUG, lower limb endurance and the ‘general health’ and ‘bodily pain’ domains of SF-36. The majority of the dance group felt the intervention improved their health status. These findings demonstrate that dancing has physical and psychological benefits, and should be promoted as a form of leisure activity for senior citizens.”

Physical and psychological benefits of dance

The Value of Arts and Culture to People and Society: an evidence review. Arts Council England. (2014).

The report references other reports, including:

• Keep Dancing: The health and well-being benefits of dance for older people, BUPA, 2011.
• What do we know about the role of arts in the delivery of social care?, Consilium, 2013, Skills for Care.
• Dancing toward well-being in the Third Age: Literature review on the impacts of dance on health and well-being among older adults, Trinity Laban Conservatoire of Music and Dance, 2011.

“The [Consilium] report (2013) concluded that the use of art, when delivered effectively, has the power to both facilitate social interaction and enable those in receipt of social care to pursue creative interests. The review highlights the benefits of dance for reducing loneliness and alleviating depression and anxiety among people in social care environments. Dance has the ability to promote creativity and social integration and allow nonverbal stimulation and communication. The review evidence demonstrates the considerable physical and psychological benefits of using arts with people in receipt of social care.” (page 26)

“In 2011 BUPA published the Keep Dancing report which highlighted a number of issues relating to old people and exercise, and identified the key benefits of dance. Trinity Laban Conservatoire of Music and Dance (TLCMD) published a literature review on the impact of dance on health and wellbeing in older people, also in 2011, called Dancing towards wellbeing in the Third Age.

“TLCMD’s literature review (2011) makes a distinction between dance therapy (a psychotherapeutic activity focusing more on therapeutic than artistic outcomes) and dance interventions and focuses on studies looking at dance interventions. They acknowledge that this boundary is sometimes blurred and included some therapy-weighted studies that are relevant to a dance and health research context.

“The reports from BUPA and TLCMD shared key findings relating to the physical and psychological benefits of dance. Many featured studies focused on activities that were specific to particular conditions such as arthritis, Parkinson’s, dementia and depression. The benefits of dance in relation to the prevention of falls were also evidenced (BUPA, 2011). Alongside evidenced benefits related to particular conditions, overall physical improvements include increased cardio vascular, strength and flexibility and improved balance and gait. These physical benefits vary depending on the individual participant and style of dance undertaken.

“Evidenced psychological benefits include quicker reaction times and cognitive performance”… “The physical benefits when contrasted with sports or other exercises are bolstered by the social and creative aspects which can enhance overall wellbeing. Dance activities create a sense of community and can help counter feelings of isolation. ” (page 29)

“Dance is a key component of many cultures and traditional dance activities can present a more relevant choice of activity for individuals in particular communities. Both reports reference pieces of research that highlight the value of culturally specific dance.” (page 30)

Effects of dance-movement therapy: meta-analysis

Effects of Dance/Movement Therapy: A Meta-Analysis. Meredith Ritter, BA, Kathryn Graff Low, PhD. (1996). The Arts in Psychotherapy Volume 23, Issue 3, 1996, Pages 249–260. *There is not free public access.

“The present study addresses methodological problems that have affected the DMT [dance/movement therapy] literature and evaluates quantitative studies of DMT using meta-analytic techniques. […] The purpose of the present study was to calculate standardized effect sizes for case-control studies of dance/movement therapy and to produce summary statistics reflecting the average change associated with DMT compared to controls. The study also examined the effectiveness of DMT in different samples (e.g. children, psychiatric patients, elderly) and for varying diagnoses (anxiety disorders, schizophrenia, developmental disabilities) using meta-analysis.”

Dance therapy for aging & dementia: compiled research

The American Dance Therapy Association has a Bibliography of Dance/Movement Therapy with Aging and Dementia. Compiled by Lenore Wadsworth Hervey, Ph.D., ADTR, September, 1996 / Updated, 2000 / Updated, 2007 by Heather Hill & Christine Hopkins.