Dance to Improve Mobility and

Reduce Falls
Marie McNeely, PhD
Instructor in Physical Therapy
and Neurology

Washington University in St. Louis

Locomotor Control Laboratory
Program in Physical Therapy
Disclosures

• No conflicts of interest to declare

Program in Physical Therapy

Outline

• The importance of being physically active

• Findings from dance studies

• Future directions for dance research

• Implementation of a dance program

Program in Physical Therapy

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

Program in Physical Therapy

Why Exercise?
• Improvements in

• Circulation • Mood

• Lung capacity • Cognition

• Muscle strength • Stress response

• Energy • Quality of life

• Self-esteem • Neuroprotection

AND MORE!

Program in Physical Therapy

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

Program in Physical Therapy

 Barriers to Exercise15,16
• Physical discomfort
• Discomfort in social
• Fear of falling situations

• Comorbidities
• Dependence on an instructor
• Competing priorities
• Affordability
• Lack of time
• Belief exercise is not needed
• Apathy
• Belief exercise would not be
beneficial

Program in Physical Therapy

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

Program in Physical Therapy

Dance Intervention Studies in Older Adults18,19
• Controlled studies have evaluated many dance styles
• Tango • Turkish • Contemporary
• Salsa folkloristic • Adapted
• Greek traditional • Aerobic • Video game
• Caribbean • Ballroom
traditional • Line
• Thai traditional • Creative
• Program durations were 4 weeks – 18 months

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

Program in Physical Therapy

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

Program in Physical Therapy

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

Single Limb Stance

30

25

20
Pre
Time (s)

15
Post
10

0
Aerobic Dance Wait List
Control

Graph created with data from Hopkins et al. 1990.26

Program in Physical Therapy

 Dance Improves Walking

Stride Velocity Stride Length Stride Time

160 160 1.2

140 140
1
120 120
0.8
100 100

80 80 0.6
Velocity (cm/s)

60 60 Pre
Length (cm)

0.4

Time (s)
Post
40 40
0.2
20 20

0 0 0
ce

ce

ce
l

l
ro
ro

ro

an
an

an
nt

nt
nt
D

D
Co

Co

Co
a

a
n

n
ls

ls

ls
tio

io
tio

Sa
Sa

Sa

nt
en

en

ve
rv

rv

r
te

te

te
In

In

In
o

o
N

N
Graphs created with data from Granacher et al. 2012. 27

Program in Physical Therapy

 Dance Improves Endurance, Strength, & Flexibility
• Endurance
• Lower limb functional strength
• Flexibility
Distance (m)

6 Minute Walk Test 5x Sit to Stand Sit and Reach

16 16
400
12 12
300
200 8 8

100 4 4

Distance (cm)
Pre
Time (s)

0 0 0
Post
ce ns
ce

ce
ns

ns
an tio
an

an
io

io
D c
ct

ct
ru
D
D

ai
ru

ru
s t
ai

ai

st
st

T In
Th

Th
In

In
e
is
e

e
c
is
is

er
c

c
er

er

Ex
Ex

Ex

e
e

om
om

om

H
H

Graphs created with data from Janyacharoen et al. 2013. 28

Program in Physical Therapy

 Dance Improves Functional Mobility

Timed Up-and-Go
25

20

15
Time (sec)

Pre
10 Post

0
Ballroom Dance RCF Activities Control

Graph created with data from Holmerova et al. 2010. 29

Program in Physical Therapy

 Dance Is
More Than a Movement Intervention

Program in Physical Therapy

 Dance Improves Cognition
• Task-switching • Visuospatial skills
• Attention • Reaction time
• Memory • Information processing

Scale of Elderly Cognitive Function

120

80

40
Pre
Score (points)

0 Post - 6m
ce rol Post - 12m
an nt Post - 18m
D Co
are n
u it o
Sq n
ve
ter
I n
o
N

Graph created with data from Zhang et al. 2014.30

Program in Physical Therapy

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

Geriatric Depression Scale

10
9
8
7
Score (points)

6
5 Pre
4 Post
3
2
1
0
Ballroom Dance Wait List Control

Graph created with data from Vankova et al. 2014. 31

Program in Physical Therapy

 Dance Effects on Quality of Life
• Quality of life
• General health • Mental health
• Physical functioning • Body pain

• Life satisfaction

Quality of Life - Short Form Health Survey-36

90 90 82 120
Pre
80 88 80 Post
100
70 86 78

84 76
Score (points)

60 80
74
50 82
72 60
40 80
70
30 78 40
68
20 76
66
20
10 74
64
0 72 62 0

Graph created with data from Eyigor et al. 2009. 32

Program in Physical Therapy

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

Program in Physical Therapy

How Dance May Be Working
• Plasticity-related changes33

• Music may reduce stress and enhance social relationships34

Program in Physical Therapy

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

Program in Physical Therapy

Considerations for Developing Dance Programs
• Who are your participants?
• Participant characteristics

• Special populations

• Satisfaction

• Safety/Risk

• Recruitment

Program in Physical Therapy

Considerations for Developing Dance Programs
• What are your goals for the class
• Aerobic benefits

• Improved movement and mobility

• Cognition

• Mood

• Community

• Social support

Program in Physical Therapy

Considerations for Developing Dance Programs
• Who will teach and assist with classes?
• Instructors

• Staff

• Volunteers

• Family members

Program in Physical Therapy

Considerations for Developing Dance Programs
• Where and will the classes take place?
• Space/facilities

• Accessibility

Program in Physical Therapy

Considerations for Developing Dance Programs
• When and will the classes take place?
• Frequency of classes

• Duration of classes

• Duration of program

Program in Physical Therapy

Considerations for Developing Dance Programs
• How will the classes be conducted?
• Size

• Music

• Syllabus/Content

• Pace

• Progression

• Adaptability

Program in Physical Therapy

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
• Foot placement • Path of movement
• Whole body • Aesthetics
coordination
• Attention to partner
• Successfully implemented in the community
• participants 36-95 years old

Program in Physical Therapy

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

Program in Physical Therapy

 References
1) A.f.C.L. U.S. Department of Health and Human Services, "Administration on Aging (AoA) Aging Statistics,"
http://www.aoa.acl.gov/Aging_Statistics/index.aspx.
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System, 2001," Prev Chronic Dis, vol. 2, no. 2, p. A17, 2005.
3) M. van Nimwegen, A.D. Speelman, E.J. Hofman-van Rossum, et al., "Physical inactivity in Parkinson's disease," J Neurol, vol. 258, no.
12, pp. 2214-2221, 2011.
4) L. Rochester, D. Jones, V. Hetherington, et al., "Gait and gait-related activities and fatigue in Parkinson's disease: what is the
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10) A.H. Abdelhafiz and A.J. Sinclair, "Diabetes, Nutrition, and Exercise," Clin Geriatr Med, vol. 31, no. 3, pp. 439-451, 2015.
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628-636, 2013.
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Maturitas, 2015.

Program in Physical Therapy

 References
19) M.E. McNeely, R.P. Duncan, and G.M. Earhart, “Impacts of dance on non-motor symptoms, participation, and quality of life in Parkinson
disease and healthy older adults,” Maturitas, In press.
20) M. Gomes Neto, M.A. Menezes, and V. Oliveira Carvalho, "Dance therapy in patients with chronic heart failure: a systematic review and
a meta-analysis," Clin Rehabil, vol. 28, no. 12, pp. 1172-1179, 2014.
21) M. Demers and P. McKinley, "Feasibility of delivering a dance intervention for subacute stroke in a rehabilitation hospital setting," Int J
Environ Res Public Health, vol. 12, no. 3, pp. 3120-3132, 2015.
22) L.M. Blandy, W.A. Beevers, K. Fitzmaurice, and M.E. Morris, "Therapeutic Argentine Tango Dancing for People with Mild Parkinson's
Disease: A Feasibility Study," Front Neurol, vol. 6, p. 122, 2015.
23) S. Rios Romenets, J. Anang, S.M. Fereshtehnejad, A. Pelletier, and R. Postuma, "Tango for treatment of motor and non-motor
manifestations in Parkinson's disease: a randomized control study," Complement Ther Med, vol. 23, no. 2, pp. 175-184, 2015.
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Parkinson's disease: a phase II feasibility study," BMC Geriatr, vol. 13, p. 54, 2013.
25) R.P. Duncan and G.M. Earhart, "Randomized controlled trial of community-based dancing to modify disease progression in Parkinson
disease," Neurorehabil Neural Repair, vol. 26, no. 2, pp. 132-143, 2012.
26) D.R. Hopkins, B. Murrah, W.W. Hoeger, and R.C. Rhodes, "Effect of low-impact aerobic dance on the functional fitness of elderly
women," Gerontologist, vol. 30, no. 2, pp. 189-192, 1990.
27) U. Granacher, T. Muehlbauer, S.A. Bridenbaugh, et al., "Effects of a salsa dance training on balance and strength performance in older
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28) T. Janyacharoen, M. Laophosri, J. Kanpittaya, P. Auvichayapat, and K. Sawanyawisuth, "Physical performance in recently aged adults
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31) H. Vankova, I. Holmerova, K. Machacova, L. Volicer, P. Veleta, and A.M. Celko, "The effect of dance on depressive symptoms in nursing
home residents," J Am Med Dir Assoc, vol. 15, no. 8, pp. 582-587, 2014.
32) S. Eyigor, H. Karapolat, B. Durmaz, U. Ibisoglu, and S. Cakir, "A randomized controlled trial of Turkish folklore dance on the physical
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33) M.A. Hirsch and B.G. Farley, "Exercise and neuroplasticity in persons living with Parkinson's disease," Eur J Phys Rehabil Med, vol. 45,
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34) M. Boso, P. Politi, F. Barale, and E. Enzo, "Neurophysiology and neurobiology of the musical experience," Funct Neurol, vol. 21, no. 4,
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35) M. Hackney and K. McKee, "Community-based adapted tango dancing for individuals with Parkinson's disease and older adults," J Vis
Exp, no. 94, 2014.

Program in Physical Therapy

Questions?

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