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Effects of a Salsa Dance Training on Balance and Strength Performance in Older Adults

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Background: Deficits in static and particularly dynamic postural control and force production have frequently been associated with an increased risk of falling in older adults. Objective: The objectives of this study were to investigate the effects of salsa dancing on measures of static/dynamic postural control and leg extensor power in seniors. Methods: Twenty-eight healthy older adults were randomly assigned to an intervention group (INT, n = 14, age 71.6 ± 5.3 years) to conduct an 8-week progressive salsa dancing programme or a control group (CON, n = 14, age 68.9 ± 4.7 years). Static postural control was measured during one-legged stance on a balance platform and dynamic postural control was obtained while walking on an instrumented walkway. Leg extensor power was assessed during a countermovement jump on a force plate. Results: Programme compliance was excellent with participants of the INT group completing 92.5% of the dancing sessions. A tendency towards an improvement in the selected measures of static postural control was observed in the INT group as compared to the CON group. Significant group × test interactions were found for stride velocity, length and time. Post hoc analyses revealed significant increases in stride velocity and length, and concomitant decreases in stride time. However, salsa dancing did not have significant effects on various measures of gait variability and leg extensor power. Conclusion: Salsa proved to be a safe and feasible exercise programme for older adults accompanied with a high adherence rate. Age-related deficits in measures of static and particularly dynamic postural control can be mitigated by salsa dancing in older adults. High physical activity and fitness/mobility levels of our participants could be responsible for the nonsignificant findings in gait variability and leg extensor power.
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Clinical Section / Original Paper
Gerontology
DOI: 10.1159/000334814
Effects of a Salsa Dance Training on
Balance and Strength Performance in
Older Adults
Urs Granacher
a
Thomas Muehlbauer
a
Stephanie A. Bridenbaugh
b
Madeleine Wolf
c
Ralf Roth
c
Yves Gschwind
b
Irene Wolf
b
Rui Mata
d
Reto W. Kressig
b
a
Institute of Sport Science, Friedrich Schiller University Jena, Jena , Germany;
b
Department of Acute Geriatrics,
Basel University Hospital,
c
Institute of Exercise and Health Sciences and
d
Department of Psychology,
University of Basel, Basel , Switzerland
trol was observed in the INT group as compared to the CON
group. Significant group ! test interactions were found for
stride velocity, length and time. Post hoc analyses revealed
significant increases in stride velocity and length, and con-
comitant decreases in stride time. However, salsa dancing
did not have significant effects on various measures of gait
variability and leg extensor power. Conclusion: Salsa proved
to be a safe and feasible exercise programme for older adults
accompanied with a high adherence rate. Age-related defi-
cits in measures of static and particularly dynamic postural
control can be mitigated by salsa dancing in older adults.
High physical activity and fitness/mobility levels of our par-
ticipants could be responsible for the nonsignificant find-
ings in gait variability and leg extensor power.
Copyright © 2012 S. Karger AG, Basel
Introduction
Continuously greying societies in Western industrial-
ized countries demand intense research efforts in the field
of neuromuscular ageing. Specific consequences of neu-
romuscular ageing are tremendous decreases in different
Key Words
Elderly Postural sway Gait Force production
Abstract
Background: Deficits in static and particularly dynamic pos-
tural control and force production have frequently been as-
sociated with an increased risk of falling in older adults. Ob -
jective: The objectives of this study were to investigate the
effects of salsa dancing on measures of static/dynamic pos-
tural control and leg extensor power in seniors. Methods:
Twenty-eight healthy older adults were randomly assigned
to an intervention group (INT, n = 14, age 71.6 8 5.3 years)
to conduct an 8-week progressive salsa dancing programme
or a control group (CON, n = 14, age 68.9 8 4.7 years). Static
postural control was measured during one-legged stance
on a balance platform and dynamic postural control was
obtained while walking on an instrumented walkway. Leg
extensor power was assessed during a countermovement
jump on a force plate. Results: Programme compliance was
excellent with participants of the INT group completing
92.5% of the dancing sessions. A tendency towards an im-
provement in the selected measures of static postural con-
Received: August 11, 2011
Accepted: October 31, 2011
Published online: January 6, 2012
Prof. Dr. Urs Granacher
Institute of Sport Science, Friedrich Schiller University Jena
Seidelstrasse 20
DE–07749 Jena (Germany)
Tel. +49 3641 94 56 70, E-Mail urs.granacher
@ uni-jena.de
© 2012 S. Karger AG, Basel
0304–324X/12/0000–0000$38.00/0
Accessible online at:
www.karger.com/ger
Granacher et al.
Gerontology
2
components of postural control (e.g. reactive and steady-
state balance) and force production (e.g. maximal strength,
rate of force development, muscle power) mainly after the
age of 60
[13] . These deficits are associated with an in-
creased risk of falling in older adults
[4, 5] . Thus, the pro-
motion of balance and force production represents two
important targets in the field of fall prevention. Tradition-
ally, balance and resistance training have been applied to
mitigate age-related processes in the neuromuscular sys-
tem. However, the effects of resistance training appear to
be limited to gains in force production. In fact, a system-
atic review of randomized controlled trials on the efficacy
of resistance training on balance performance could not
detect a clear effect on various measures of standing bal-
ance in older adults (effect size = 0.11)
[6] . Balance train-
ing has proven to be effective in increasing measures of
postural control and force production in seniors
[7, 8] .
However, social interaction during balance training is
limited which might negatively affect both the motivation
of the exercisers and adherence rate during training. Re-
cently, Granacher et al.
[9] suggested an intergenerational
approach (i.e. seniors exercise together with children) in
the promotion of balance in older adults to specifically
address the motivation of the exercisers. Another form of
enhancing motivation and social interaction during train-
ing is to implement dance programmes for the promotion
of physical activity in general and balance and force pro-
duction in particular. Thus, dance may provide a form of
exercise that offers both a conditioning stimulus and a so-
cially interactive and motivating activity that older adults
would like to perform on a permanent basis
[10] . A grow-
ing pool of literature indicates that different types of
dance programmes (e.g. Turkish or Greek folklore dance,
Latin dance, Tango) are effective in improving measures
of postural control
[1115] .
Salsa dance appears to be specifically suited for the
promotion of balance and force production. In fact, salsa
moves are particularly challenging for dynamic postur-
al control and muscle strength/power due to frequent
changes in direction and because the dance steps are per-
formed on the toes of the feet. In addition, salsa specifi-
cally challenges the performance of movements to the
rhythm of the music. Moreover, a stable walking pattern
is characterized by low fluctuations of the gait rhythm.
Thus, salsa dancing may improve spatiotemporal fea-
tures of gait because both aesthetic dancing as well as
stable walking require some sense of rhythm. Finally,
over recent years salsa has become a very popular dance
among young and middle-aged adults and might there-
fore also attract older adults. However, to the authors
knowledge, there is no study available that investigated
the effects of salsa dancing alone on measures of postur-
al control and force production in older adults.
Given that deficits in postural control and force pro-
duction are associated with an increased risk of falling
[4,
5]
, the objectives of this study were to investigate the ef-
fects of a progressive salsa dance programme on mea-
sures of static/dynamic postural control and leg extensor
power in a cohort of older adults. Based on previously
published studies
[11, 1315] , it is expected that salsa
dance improves static and particularly dynamic postural
control as well as muscle power of the leg extensors in
older adults.
M e t h o d s
Participants
Twenty-eight community-dwelling older adults between the
ages of 63 and 82 gave written informed consent to participate in
the study after experimental procedures were explained. The par-
ticipants’ baseline characteristics are presented in table1 . None of
the participants had any history of musculoskeletal, neurological
or orthopaedic disorders that might have affected their ability to
conduct a salsa dance programme or to perform balance and
strength tests. The participants were capable of walking indepen-
dently without any assistive device and they had no prior experi-
ence with the applied tests. Participants were randomly assigned
into an intervention group (INT) and a control group (CON). The
randomization process was done using Research Randomizer, a
programme published on a publicly accessible official website
(www.randomizer.org). Local ethical permission was given by the
EKBB (Ethikkommission beider Basel) and all experiments were
conducted according to the latest version of the declaration of
Helsinki.
Table 1. B aseline characteristics by group
INT (n = 14) CON (n = 14)
Age, years
71.685.3 68.984.7
Body height, cm
167.1810.1 169.188.6
Body mass, kg
72.3813.0 71.9813.0
BMI, kg/m
2
25.984.2 25.184.0
Sex, female/male 9/5 8/6
MMSE
28.581.8 28.380.8
CDT all participants
were classified as
non-pathological
Physical activity, h/week
11.585.3 11.788.3
Values are means and SDs. No group baseline differences were
detected; p > 0.05.
Effects of Dancing in Seniors
Gerontology
3
Salsa Dancing
Participants of the INT group conducted a salsa dance pro-
gramme over a period of 8 weeks (twice weekly) with a total of 16
sessions. The intervention period was chosen based on a previ-
ously published study showing that an 8-week Turkish folklore
dance programme was effective in improving balance function in
the elderly
[15] . Each session lasted 60 min starting with a 10-min
warm-up programme mainly consisting of salsa-specific static
and dynamic balance exercises and ending with a 5-min cool-
down programme (i.e. stretching). The intervention programme
was given by a professional dance instructor in 2 separate exercise
groups in order to keep the participant-to-instructor ratio small
(1 instructor for 6–8 seniors).
Salsa is a partner dance that is characterized by Latin Ameri-
can rhythm and music. The dance programme mainly consisted
of basic steps (e.g. 3-step weight change) and simplest movements
of salsa in forward, backward, transversal and rotational direc-
tions. At the beginning of the programme the 3-step weight
change was taught without a partner. This pattern typically uses
3 steps during every 4 beats, 1 beat being skipped. However, this
skipped beat is often marked by a tap, a kick or a flick. Exercises
like clapping hands, stomping the feet on the dance floor and
walking individually to the rhythm of the music were incorpo-
rated in the acquisition phase. After the participants were able to
accomplish the basic steps individually they were introduced to
partner dance. Both men and women practiced leading while
dancing salsa. This was accomplished in a first step by asking the
lead person to guide their blinded partner over the dance floor.
Progression during salsa dancing was realized by increasing the
tempo of the music from initially 50 to 70 bpm at the end of the
intervention. Of note, salsa can be danced to a count of up to 180
bpm. We further progressed from forward/backward directions
to transversal and rotational dancing directions. In addition, sal-
sa-specific moves like knee swings and hip rotations were con-
tinuously included in the programme. Finally, the participants
learned the technique of toe dancing, which is a typical feature of
salsa that demands high dynamic postural control and muscle
power while moving with an extremely small base of floor con-
tact.
Due to the small participant-to-instructor ratio, salsa dancing
was safe without any intervention-related risk of falling. The par-
ticipants of the CON group maintained their normal physical ac-
tivities throughout the experimental period.
Testing Procedure
Upon entering the gait laboratory, all participants were kindly
asked to complete two different questionnaires (the ‘Freiburg
questionnaire for everyday and sports activities’
©
[16] and the
Mini-Mental State Examination, MMSE
[17] ) and one cognitive
test to evaluate executive function (the Clock-Drawing Test, CDT
[18] ). Thereafter, participants received standardized verbal in-
structions regarding the test procedure with a visual demonstra-
tion of the balance and the power tests. Prior to testing, all par-
ticipants performed one practice trial on each test instrument to
rule out potential learning effects. Measurements of static and
dynamic postural control were conducted in a counterbalanced
order on a balance platform and a pressure-sensitive walkway. In
addition, before- and after-tests included the analysis of jumping
power on a force platform.
Testing Material
Balance Platform
Test circumstances (e.g. room illumination, temperature,
noise) were in accordance with recommendations for post-uro-
graphic testing
[19] . Static postural control was assessed by means
of a balance platform (GKS 1000, IMM, Mittweida, Germany).
The balance platform consists of four uni-axial sensors measur-
ing displacements of the centre of pressure (CoP) in the mediolat-
eral and anterior-posterior directions. For experimental testing
the balance platform was firmly fixed on the floor. Participants
were asked to stand on their dominant leg on the platform with
their supported leg in 30° flexion, hands placed on hips and gaze
fixed on a cross on the nearby wall (the fully extended knee cor-
responds to 0°). The dominant leg was determined according to
the lateral preference inventory
[20] . Participants were instructed
to remain as stable as possible and to refrain from any voluntary
movements during the trials. Data were acquired for 30 s at a sam-
pling rate of 40 Hz
[19] . Five parameters were computed from the
time series of the CoP displacements. First, the displacements of
the CoP in the anterior-posterior direction (CoPap, mm); second,
the displacements of the CoP in the mediolateral direction
(CoPml, mm); third, the total displacements of the CoP (CoPtot,
mm), which represent the summed displacements in the medio-
lateral and anterior-posterior directions; fourth, the surface area
covered by the trajectory of the CoP (CoParea, mm) with a 90%
confidence interval, and fifth, the CoP speed (CoPspeed, mm/s),
which indicates the total distances covered by the CoP divided by
the duration of the sampled period. All of these parameters rep-
resent traditional balance measures, which are widely employed
in clinical practice to assess individuals’ postural control capaci-
ties during unperturbed stance
[21] . Three trials were performed
and their mean was used for further analysis. For all the assessed
CoP variables, intraclass correlation coefficients (ICC) were
6 0.75, indicating an excellent intersession reliability
[21] .
Pressure-Sensitive Walkway
The walking pattern was determined during steady-state
walking on an instrumented 10-metre walkway using the GAIT-
Rite
©
System (Havertown, Pa., USA). Participants walked with
their own footwear at their own speeds, initiating and terminat-
ing each walk a minimum of 2 m before and after the 10-metre
walkway to allow sufficient distance to accelerate to and deceler-
ate from a steady state of ambulation across the walkway. Distri-
bution of pressure during walking was monitored at 80 Hz, en-
abling spatiotemporal gait data to be collected. Because data from
the left and right strides were not statistically different, only data
from the left side were analysed. Besser et al.
[4] reported that 58
strides are necessary for 90% of individuals tested with GAITRite
instrumentation to have reliable mean estimates of spatiotempo-
ral gait parameters. Temporal and spatial parameters of gait seem
to be important in the assessment of mobility in community-
dwelling elderly adults
[22] . Thus, in a first step, means and stan-
dard deviations (SD) of stride time, stride length, and stride veloc-
ity were computed. Stride time was defined as the time (s) between
the first contacts of two consecutive footfalls of the same foot.
Stride length was defined as the linear distance (cm) between suc-
cessive heel contacts of the same foot. Additionally, stride veloc-
ity (cm/s) was calculated as stride length divided by stride time.
To determine gait variability, coefficients of variation (CV) were
calculated for the above-mentioned parameters according to the
Granacher et al.
Gerontology
4
following formula [(SD/mean) ! 100] and used as outcome mea-
sures
[23] . The smaller the CV value, the safer the walking pat-
tern. Intraclass correlation coefficients for the calculated gait pa-
rameters ranged from ICC 0.79 to 0.98
[1] .
Force Platform
Participants performed maximal vertical countermovement
jumps (CMJs) while standing on a one-dimensional force plat-
form (KistlerP type 9290AD, Winterthur, Switzerland). The verti-
cal ground reaction force was sampled at 500 Hz. During the
CMJs, subjects stood in an upright position on the force platform
and were instructed to begin the jump with a downward move-
ment, which was immediately followed by a concentric upward
movement, resulting in a maximal vertical jump. Participants
performed 3 CMJs with a resting period of 1 min between jumps.
For each of these trials, subjects were asked to jump as high as
possible. The mean of 3 trials in terms of maximal jumping pow-
er (W/kg) was taken for further data analysis. The intraclass cor-
relation coefficient was calculated for CMJ power and amounted
to ICC = 0.81.
Q u e s t i o n n a i r e
The ‘Freiburg questionnaire for everyday and sports activities’
[16] assesses basic physical activity level (e.g. gardening, climbing
stairs), leisure time physical activity level (e.g. dancing, bowling)
and sports activity level (e.g. jogging, swimming) of people be-
tween the ages of 18 and 78. Significant test-retest reliability was
reported for the summed physical activity level (r = 0.56). Cross-
correlation with maximum oxygen uptake revealed a significant
correlation coefficient of r = 0.42
[16] .
The MMSE is a valid test of cognitive function. It separates
patients with cognitive disturbance from those without such dis-
turbance. Test-retest reliability of the MMSE is high with r = 0.89.
Cross-correlation with the Wechsler Adult Intelligence Score re-
vealed a correlation coefficient of r = 0.78
[17] . According to Fol-
stein et al.
[17] , a MMSE total score of less than 20 separates pa-
tients with dementia or functional psychosis from cognitively in-
dependently functioning participants and those with anxiety
neurosis or personality disorder.
The CDT is a sensitive screening test for the evaluation of ex-
ecutive function
[18] . The elderly participants were instructed to
draw numbers in a given circle to make the circle look like a clock.
Thereafter, subjects were asked to draw the hands of the clock to
a point in time of their choice which, at the end of the test, they
had to write down in digital form. Depending on the study con-
sulted, inter-rater reliability for the CDT ranges between 75.4 and
99.6%
[18] . Test-retest reliability can be classified as high with an
r value of 0.90
[24] . Cross-correlation with the MMSE revealed a
correlation coefficient of r 1 0.50
[25] . As a result, the test distin-
guishes between pathological and normal test performance.
Statistical Analyses
Data are presented as group mean values 8 SD, unless other-
wise stated. A multivariate ANOVA was used to detect differenc-
es between the study groups in all baseline variables. Balance and
strength parameters were analysed in separate 2 ! 2 [groups
(INT, CON) ! tests (before, after)] ANOVA with repeated mea-
sures on test. Post-hoc tests with the Bonferroni-adjusted were
conducted to identify the comparisons that were statistically sig-
nificant. The classification of effect sizes (ƒ) was determined by
calculating partial η
2
p
. The effect size is a measure of the effective-
ness of a treatment and it helps to determine whether a statisti-
cally significant difference is a difference of practical concern.
f values of 0.10 indicate small, of 0.25 medium and of 0.40 large
effects
[26] . An a priori power analysis [27] with an assumed type
I error rate of 0.05 and a type II error rate of 0.20 (80% statistical
power) was conducted for measures of balance function
[12] and
revealed that 13 persons per group would be sufficient for finding
statistically significant interaction effects. All analyses were per-
formed using the Statistical Package for Social Sciences (SPSS)
version 19.0. The significance level was set at p ! 0.05.
R e s u l t s
At baseline, all subjects met the inclusion criteria (i.e.
MMSE; CDT) for participating in this study. The inves-
tigated results in the MMSE and the CDT indicate that
the older adults of this study were cognitively healthy ( ta-
ble1 ). Findings regarding the ‘Freiburg questionnaire for
everyday and sports activities’ revealed that our partici-
pants could be classified as physically active ( table1 ). All
subjects received treatment or control conditions as allo-
cated. Fourteen participants completed the salsa dance
programme and none reported any adverse events. Pro-
gramme compliance was excellent with participants of
the INT group completing 92.5% of the scheduled danc-
ing sessions. Overall, there were no statistically signifi-
cant differences in baseline values between the two ex-
perimental groups.
Standing Performance
The analysis based on performance during standing
detected a main effect of time for the parameter CoPml
[F(1, 54) = 4.39, p = 0.05, η
2
p
= 0.15, ƒ = 0.42], and a ten-
dency towards a significant group ! test interaction [F(1,
54) = 3.20, p = 0.09, η
2
p
= 0.11, ƒ = 0.35] for the variable
CoPap. The inclusion of additional CoP parameters (e.g.
CoPtot, CoParea, CoPspeed) did not reveal further sig-
nificant findings ( table2 ).
Walking Performance
Stride Velocity. The analysis indicated a significant
main effect of test [F(1, 54) = 13.00, p ! 0.001, η
2
p
= 0.33,
ƒ = 0.70] as well as a significant group ! test interaction
[F(1, 54) = 11.73, p ! 0.01, η
2
p
= 0.31, ƒ = 0.67]. Post hoc
analysis found that participants in the INT group signifi-
cantly increased their stride velocity over the training pe-
riod (p = 0.001, 11.3%) while the participants in the CON
group showed no significant changes ( fig.1 a). The main
effect of group [F(1, 26) = 0.01, p 1 0.05] was not significant.
Effects of Dancing in Seniors
Gerontology
5
Table 2. O utcome measures (ANOVA with repeated measures on test)
Measure INT (n = 14) CON (n = 14) p value
before after before after ti me
time ! group
Standing
CoPtot, mm
1,984.48584.8 1,744.68670.7 2,192.38437.1 2,140.98457.7
0.076 0.243
CoPml, mm
1,210.58342.7 1,078.58441.0 1,448.88358.9 1,310.48297.4
0.046 0.960
CoPap, mm
1,315.08437.5 1,145.58459.9 1,335.18332.8 1,401.38403.4
0.440 0.085
CoPspeed, mm/s
67.1819.5 59.3823.0 74.3814.7 72.9815.6
0.093 0.241
CoParea, mm
2
15.689.2 13.887.4 16.488.4 14.789.6
0.461 0.994
Walking
Stride velocity, cm/s
133.8820.2 148.9825.8 141.8814.4 142.2814.2
0.001 0.002
Stride time, s
1.0280.07 0.9880.07 1.0480.06 1.0580.07
0.018 0.005
Stride length, cm
136.8822.0 145.5826.8 147.6815.0 148.4813.3
0.001 0.006
Stride velocity CV, %
2.781.5 2.481.1 2.381.0 2.480.7
0.637 0.542
Stride time CV, %
1.781.0 1.980.6 1.480.7 1.680.4
0.332 0.916
Stride length CV, %
1.980.8 1.981.1 1.980.8 1.780.6
0.612 0.609
Power
CMJ power, W/kg
14.082.8 15.783.5 16.282.2 19.282.9
0.000 0.098
Val ues are means and SDs.
0
30
60
90
120
150
180
INT
a
11.3%
Stride velocity (cm/s)
CON
0.3%
Group × test
p = 0.002
AfterBefore
0
0.2
0.4
0.6
0.8
1.0
1.2
INT
b
3.9%
Stride time (s)
CON
1.0%
Group × test
p = 0.005
0
30
60
90
120
150
180
INT
c
6.4%
Stride length (cm)
CON
0.5%
Group × test
p = 0.006
Fig. 1. Performance changes during the dancing period in stride velocity ( a ), stride time ( b ) and stride length ( c )
while walking on a pressure-sensitive walkway for the INT group compared to the CON group (mean 8 S D ) .
Granacher et al.
Gerontology
6
Stride Time. The analysis revealed a significant main
effect of test [F(1, 54) = 6.35, p ! 0.05, η
2
p
= 0.20, ƒ =
0.50] as well as a significant group ! test interaction
[F(1, 54) = 9.28, p ! 0.01, η
2
p
= 0.26, ƒ = 0.59]. Post hoc
analysis found that participants in the INT group signifi-
cantly decreased their stride time over the training period
(p = 0.001, 3.9%) while the participants in the CON group
showed no significant changes ( fig.1 b). The main effect of
group [F(1, 26) = 3.62, p 1 0.05] was not significant.
Stride Length. The analysis detected a significant main
effect of test [F(1, 54) = 13.47, p ! 0.001, η
2
p
= 0.34, ƒ = 0.72]
as well as a significant group ! test interaction [F(1, 54) =
9.15, p ! 0.01, η
2
p
= 0.26, ƒ = 0.59]. Post-hoc analysis found
that participants in the INT group significantly increased
their stride length over the training period (p = 0.001,
6.4%) while the participants in the CON group showed
no significant changes ( fig.1 c). The main effect of group
[F(1, 26) = 0.86, p 1 0.05] was not significant.
Stride-to-Stride Variability. In terms of gait variability,
the analysis failed to detect significant main effects of
time, group and group ! test interactions for the CV of
the stride velocity, time, and length parameters ( table2 ).
Power Performance
With regard to CMJ power, the analysis detected a sig-
nificant main effect of time [F(1, 54) = 41.75, p ! 0.001,
η
2
p
= 0.74, ƒ = 1.69]. The main effect of group [F(1, 26) =
4.32, p 1 0.05] and the interaction effect of group ! test
[F(1, 54) = 3.11, p 1 0.05] were not significant ( table2 ).
Discussion
To the authors’ knowledge, this is the first study that
has investigated the impact of salsa dancing on intrinsic
fall-risk factors (i.e. deficits in postural control and mus-
cle power of the leg extensors) in older adults. Eight weeks
of progressive salsa dancing resulted in: (a) a tendency
towards significant improvements in selected measures
of static postural control; (b) a significantly enhanced gait
pattern in terms of increases in stride velocity and length,
and concomitant decreases in stride time, and (c) no sig-
nificant changes in gait variability and muscle power of
the leg extensors.
The present findings are in accordance with the litera-
ture regarding the effects of dancing on measures of bal-
ance function in older adults. Federici et al.
[11] assessed
the impact of Latin dance in a randomized controlled
clinical trial on measures of balance in community-based
inactive seniors. Study participants (age range 5668
years) were randomized to either a dance or a control
group for 3 months. While the dance group participated
in 60-min Latin dance (e.g. Merengue, Bachata) classes
twice a week, the control group did not engage in any
physical activity. Before and after the intervention peri-
od, balance was assessed using 4 different clinical tests
(the Tinetti, Romberg, improved Romberg and Sit-Up
and Go tests). The findings indicated significant im-
provements in balance capability in the dance group.
Conversely, the control group showed a slight but not sta-
tistically significant deterioration in balance function.
Outcomes from a short 4-item psychosocial survey
(smoking, alcohol consumption, sexual habits, sleep
quality) developed by the study investigators also demon-
strated improved subjective assessments of sleep quality
and sexual activity among subjects in the dance group.
Furthermore, 17 of the 20 dance group subjects reported
moderate to great satisfaction with the dance activity.
Based on their results, the authors concluded that Latin
dance may improve balance and hence be a useful tool in
reducing the risk of falling in older adults.
In another study, Shigematsu et al. [13] determined the
effects of dance-based aerobic exercise on indices of fall-
ing in healthy community-dwelling women aged 72–87
years. The intervention group performed an aerobic dance
exercise (side stepping, fast walking, forward/backward
stepping, leg lifts, etc.) for 60 min, 3 days per week for a
total of 12 weeks. Most of the activities were accompanied
by music with changing tempo. The main outcome mea-
sures included balance tests (i.e. single leg balance with
eyes opened/closed, functional reach), strength tests (i.e.
hand grip strength, keeping a half squat position), loco-
motion/agility tests (i.e. walking time around 2 cones,
3-min walking distance), and motor processing tests (i.e.
hand-reaction time, foot tapping). After the dance pro-
gramme, the intervention group showed significantly
greater single-leg balance with eyes closed, improved
functional reach and decreased walking time. However,
measures of strength were not significantly influenced by
dancing. The lack of finding regarding the impact of
dancing on leg extensor power in our study can most like-
ly be explained by the high fitness/mobility level of our
participants with average sports-related physical activities
of 11.5 h/week and an average spontaneous stride velocity
of 133.8 cm/s. In fact, Frey et al.
[16] reported a mean phys-
ical activity level of 9.9 h/week including basic, leisure
time and sports-related activities for seniors aged 70 years
and older. In addition, Oberg et al.
[28] examined habitu-
al gait speed in subjects aged 10–79 years and found that
women and men between the ages of 70 and 79 years
Effects of Dancing in Seniors
Gerontology
7
walked with an average speed of 115 cm/s. Thus, our par-
ticipants’ physical activity and fitness/mobility levels ap-
pear to be above the average values of older age-matched
adults. Moreover, the training stimulus during salsa danc-
ing might not have been specific enough to induce im-
provements in muscle power. It has frequently been re-
ported that power training or high-velocity strength
training have the potential to produce gains in muscle
power in older adults [for a review see
29 ]. Thus, the prin-
ciple of training specificity explains why we did not find
improvements in leg extensor power in our study.
The present study revealed significant increases in
stride velocity in the salsa dance group as compared to the
control group. Given that the magnitude of age-related re-
duction in gait speed varies between 0.1 and 0.7% per year
[28] and that decreases in gait speed are associated with an
increased risk of falling
[30] and functional decline [31] , it
is of great relevance that salsa dancing had the potential to
increase gait speed in older adults. In fact, Hoxie and Ru-
benstein
[31] reported that a walking speed of 122 cm/s is
necessary to cross intersections safely, and observed that
96% of individuals aged 65 and over walk at a slower gait
speed than this when crossing an intersection. Thus, the
regular performance of salsa dancing may delay the onset
of functional and mobility limitations and could help pre-
serve the quality of life and independence of older adults.
This study did not detect significant effects of salsa
dancing on spatiotemporal measures of gait variability in
older adults. In contrast to our findings, Trombetti et al.
[32] were able to examine significant decreases in stride
length variability after 6 months of varied multi-task ex-
ercises, mostly performed to the rhythm of improvised
piano music (i.e. Jaques-Dalcroze eurhythmics) in com-
munity-dwelling adults aged older than 65. In addition,
the music-based exercise programme resulted in a re-
duced rate of falls and a lower risk of falling. Three meth-
odological reasons can most likely explain the discrep-
ancy in findings between our study and theirs. First, the
duration of our salsa dance programme might not have
been long enough to induce changes in measures of spa-
tiotemporal gait variability. Thus, future studies should
extend the intervention period beyond 8 weeks to find out
whether additional adaptive processes in the gait pattern
can be observed following salsa dancing. Second, in our
subjects, spatiotemporal gait variability scores were al-
ready low at baseline (e.g. 1.7% stride time CV) indicating
that the gait pattern was rather stable. In contrast, Trom-
betti et al.
[32] reported a baseline stride time CV of 5.3%.
Kressig et al.
[33] were able to identify a critical threshold
for stride time CV ( 1 4%) that was strongly associated
with fall events in older inpatients. Based on these find-
ings, it can be concluded that the gait pattern of our sub-
jects was stable and risk of fall was low, whereas the gait
pattern of the participants in the study by Trombetti et al.
[32] was unstable and risk of fall was high. Third, with
reference to the principle of training specificity, Jaques-
Dalcroze eurhythmics may have the potential to improve
gait variability due to the high demands of attention
while moving to the melody and rhythm of improvised
and quickly changing piano music. Salsa dance on the
other hand lacks this improvised and unexpected music-
imposed movement and pattern change, which might ex-
plain the missing effect on gait variability.
Conclusions
This study proved that salsa dancing is a safe, feasible
and highly enjoyable exercise programme for older adults.
Salsa dancing seems to specifically be well suited for the
promotion of static and particularly dynamic postural
control, which makes it a useful intervention in reducing
the risk of falling in older adults. However, if the goal is
to induce improvements in spatiotemporal gait variabil-
ity and muscle power, more specific training stimuli ap-
pear to be necessary. Recently, it has been reported that
Jaques-Dalcroze eurhythmics has the potential to im-
prove measures of gait variability and to reduce fall rate
in older adults
[32] . Furthermore, a recent systematic re-
view on the effects of power training indicates that this
training regimen enhances both muscle power and func-
tional performance in older adults
[29] . Taken together,
these findings suggest that dance programmes should in-
clude improvising movement elements to the rhythm of
music and power-specific exercise elements in order to
effectively promote various components of postural con-
trol and force production. However, this hypothesis needs
to be verified in future studies.
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... Dance involves highly coordinated intersegmental movements with body rotations around multiple planes and axes with continuous alternations between one and two-legged stance phases, thus resulting in a continuous need for postural control (Guzmán-García et al., 2011;Douka et al., 2019a). Dance exercise interventions of short (i.e., 8-12 weeks) (Granacher et al., 2012;Sofianidis et al., 2017) or long durations that employ different dance styles, such as traditional/folk or Latin, have been shown to significantly improve the balance performances of healthy old adults (Kattenstroth et al., 2010;Serra et al., 2016). Furthermore, dancing provides dancers with musical experience, acoustic stimulation, and rhythmic motor coordination; for that reason, it is considered a sensory-enriched form of physical activity that can trigger the integration of sensorimotor performance with perceptual abilities in the elderly population (Kattenstroth et al., 2010;Douka et al., 2019b). ...
... In recent years, growing research evidence has stressed the importance of dance as an advantageous exercise modality for improving stability performance (Sofianidis et al., 2009(Sofianidis et al., , 2017Granacher et al., 2012;Rehfeld et al., 2017), which consequently reduces the risk of falls in older adults. The onelegged quiet stance is a challenging balance task because the small base of support requires the successful integration of sensory information from the visual, vestibular, and somatosensory systems by the central nervous system to produce appropriate postural responses (Nashner, 1981;Horak, 2006). ...
... As a result, dancers become very familiar with weight shifts that constantly challenge their postural control system to maintain equilibrium, as their centers of mass are voluntarily shifted to the limits of stability (Rehfeld et al., 2017). For instance, healthy older adults who have been participating in training interventions (8-12 weeks duration) under various styles of dance, either traditional/folk or modern, were able to achieve relevant improvements in one-legged stance balance performance compared with non-trained peers (Granacher et al., 2012;Rehfeld et al., 2017;Sofianidis et al., 2017). Thus, we can argue that the plethora of high-coordination movement repertoires in dancing, which challenges the human sensorimotor system, can trigger neuromuscular adaptational responses and consequently explain the observed superior balance performance of older dancers. ...
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Dance has been suggested to be an advantageous exercise modality for improving postural balance performance and reducing the risk of falls in the older population. The main purpose of this study was to investigate whether visual restriction impacts older dancers and non-dancers differently during a quiet stance balance performance test. We hypothesized higher balance performance and greater balance deterioration due to visual restriction in dancers compared with non-dancers, indicating the superior contribution of the visual channel in the expected higher balance performances of dancers. Sixty-nine (38 men, 31 women, 74 ± 6 years) healthy older adults participated and were grouped into a Greek traditional dance group (n = 31, two to three times/week for 1.5 h/session, minimum of 3 years) and a non-dancer control group (n = 38, no systematic exercise history). The participants completed an assessment of one-legged quiet stance trials using both left and right legs and with eyes open while standing barefoot on a force plate (Wii, A/D converter, 1,000 Hz; Biovision) and two-legged trials with both eyes open and closed. The possible differences in the anthropometric and one-legged balance parameters were examined by a univariate ANOVA with group and sex as fixed factors. This ANOVA was performed using the same fixed factors and vision as the repeated measures factor for the two-legged balance parameters. In the one-legged task, the dance group showed significantly lower values in anteroposterior and mediolateral sway amplitudes (p = 0.001 and p = 0.035) and path length measured in both directions (p = 0.001) compared with the non-dancers. In the two-legged stance, we found a significant vision effect on path length (p < 0.001) and anteroposterior amplitude (p < 0.001), whereas mediolateral amplitude did not differ significantly (p = 0.439) between closed and open eyes. The dance group had a significantly lower CoP path length (p = 0.006) and anteroposterior (p = 0.001) and mediolateral sway amplitudes (p = 0.003) both in the eyes-open and eyes-closed trials compared with the control group. The superior balance performance in the two postural tasks found in the dancers is possibly the result of the coordinated, aesthetically oriented intersegmental movements, including alternations between one- and two-legged stance phases, that comes with dance. Visual restriction resulted in a similar deterioration of balance performance in both groups, thus suggesting that the contribution of the visual channel alone cannot explain the superior balance performance of dancers.
... PEDro Score 11 7 7 9 7 7 7 9 8 In three studies (studies 1, 4 and 5) [10,32,34], the trials had blinded participants or therapists, and three had blinded assessors (studies 1, 4 and 8) [10,32,33]. Seven trials had retention rates of 85% or greater (studies 1, 3, 5-9) [10,27,[29][30][31]33,34], and all of the studies met the intention-to-treat analysis criteria (studies 1-9) [10,[27][28][29][30][31][32][33][34]. All of the studies applied statistical analysis to group differences (studies 1-9) [10,[27][28][29][30][31][32][33][34] and reported point estimates and measurements of variability (studies 1-9) [10,[27][28][29][30][31][32][33][34] as well. ...
... PEDro Score 11 7 7 9 7 7 7 9 8 In three studies (studies 1, 4 and 5) [10,32,34], the trials had blinded participants or therapists, and three had blinded assessors (studies 1, 4 and 8) [10,32,33]. Seven trials had retention rates of 85% or greater (studies 1, 3, 5-9) [10,27,[29][30][31]33,34], and all of the studies met the intention-to-treat analysis criteria (studies 1-9) [10,[27][28][29][30][31][32][33][34]. All of the studies applied statistical analysis to group differences (studies 1-9) [10,[27][28][29][30][31][32][33][34] and reported point estimates and measurements of variability (studies 1-9) [10,[27][28][29][30][31][32][33][34] as well. ...
... Seven trials had retention rates of 85% or greater (studies 1, 3, 5-9) [10,27,[29][30][31]33,34], and all of the studies met the intention-to-treat analysis criteria (studies 1-9) [10,[27][28][29][30][31][32][33][34]. All of the studies applied statistical analysis to group differences (studies 1-9) [10,[27][28][29][30][31][32][33][34] and reported point estimates and measurements of variability (studies 1-9) [10,[27][28][29][30][31][32][33][34] as well. No studies were excluded on the basis of their methodological quality. ...
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(1) Background: The regular practice of dancing benefits the physical condition, improving quality of life and minimising the adverse effects of ageing. Therefore, this review aims to evaluate the impact of dance programmes by quantifying different physical parameters of the lower body in older adults. (2) Methods: A systematic qualitative review in the English language (PubMed, Scopus, OvidSP, Cochrane and PEDro database) until mid-2020 considering the PRISMA guidelines and the PEDro quality criteria considering the following parameters of gait: stride length and width, speed. Physical parameters: flexion and dorsiflexion joint, muscle strength and range of motion were carried out. (3) Results: 9 studies with a population of 544 subjects from 5 continents and 6 types of dances were taken into account. The improvement of some parameters over others depended on the type of dance and the movements generated, having moderate positive effects on strength, agility, mobility and balance. (4) Conclusions: there is a general improvement in the functional capacity of the elderly through the practice of ballroom dancing, with specific improvement of each parameter depending on the type of dance.
... It is composed of static and dynamic balance, which are considered to be relatively independent skills (Sell, 2012;Dehghani & Gunay 2015;Chatzihidiroglou et al., 2018). Several studies reported that children with ASD show reduced body posture control compared to typical developing children (McKinley et al., 2008;Kattenstroth et al., 2010;Granacher, et al., 2012;Paquet et al., 2016). Travers et al. (2013), examined postural stability in adolescents and adults with ASD. ...
... The improvement observed in the dance group is an indication that the program may have had a positive effect on the children's static balance. The studies of Zhang et al. (2008) and Kattenstroth et al. (2010) are in line with the results of the present study that various types of dance have been found to contribute to the enhancement of balance, regardless of the age or mobility level of the participants (McKinley et al., 2008;Granacher et al., 2012;Hackney et al., 2015;Chatzopoulos et al., 2018). The limitations of the research pertain to the distinctiveness of the children in the research. ...
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The purpose of this study was to investigate the effectiveness of a traditional dance program on the balance of primary school students with autism spectrum disorder (ASD). Nineteen primary school students with ASD were randomly assigned into one treatment and the control group. The treatment group consisted of 10 students(11.30±2.26 years old) who took part in a 4-week traditional dance training program (12 sessions), 3 times per week for 45 minutes per lesson, while the control group (9 students, 12±1.41 years old) attended their regular physical education lessons. Prior to and after the intervention, the participants were assessed for dynamic balance (walking forwards on balance beams of the Körperkoordinationstest Für Kinder, KTK test), functional balance (Timed Up and Go test), and static balance (single-leg-stance test). The findings indicated that the treatment group performed significantly better on dynamic balance and Timed Up and Go test. However, there were no significant differences regarding static balance (total excursion of the center of pressure). The results suggest that Greek traditional dances constitute an effective and enjoyable activity for the development of balance in primary school students with ASD.
... An RCT on the effect of salsa in healthy older adults showed improvements in gait variables and balance. 44 Balance was also improved in an RCT on older adults dancing Turkish folklore dance 45 and lower body function was improved in an RCT study in institutionalised older adults. 46 Moreover, in an RCT study on older adults, contemporary dancing has been found superior to Tai Chi and strength training in improving switching of attention. ...
... Previous studies have found lower adherence (56%-79%) for strength training 53 54 than for dancing (87%-92%), 44 55 although the 12-month dance intervention study by Merom and colleagues 49 did only record 51% adherence to training. Salsa should be challenging for muscle strength and dynamic balance, as this dance requires frequently changes in direction, 44 and a similar adaptation in lower body strength between fitness circuit training and dance may occur. The overall reduction in fall rate, due to exercise, has previously been found to be 21%-23%, 32 34 with the one review stating that balance challenging exercise forms have larger effects. ...
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Background Unintentional falls among older adults are of primary importance due to their impact on quality of life. Falling accounts for 95% of hip fractures, leading to an approximately six times increased risk of death within the first 3 months. Furthermore, physical and cognitive parameters are risk factors for falls. The purpose of this study is to examine the effect of a 6-month salsa dance training intervention, compared with regular fitness circuit training and a control group. Methods This study will include 180 older adults: 90 healthy patients and 90 patients with osteoporosis. Participants will be allocated randomly in either of the groups, stratified according to age. Training groups will receive 2 weekly 1-hour training sessions, continuously through 6 months. Participants will be tested at baseline and 6 and 18 months post baseline. Primary outcome will be number of falls and secondary outcomes include bone mineral density, body composition, pain evaluation, weekly physical activity, single-task and dual-task gait patterns, balance, Fullerton Functional Fitness Test and assessment of the mini-BESTest. Discussion This study will investigate the effects of a specially designed dance training programme (Dancing Against falls iN Community-dwElling older adults (DANCE)) to reduce the risk of falling among older adults. The study will investigate the effect against an active and passive comparator, resulting in the possibility to state, if DANCE training should be an alternative to traditional training. Trial registration number NCT03683849 .
... Moreover, the duration of standing on a single leg was significantly longer in the NW group. Although many previous studies have reported improvements in balance after dance intervention [31,39,[122][123][124], our results did not show that such changes occurred after dance training. In the NW and dance groups, the angle of the heel lift was significantly improved, but there was no change in the toe lift. ...
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Aerobic exercise improves executive function—which tends to decline with age—and dual-task training with aerobic exercise improves the global cognitive function. However, home-based older adults could not follow these programs due to social isolation during the coronavirus disease 2019 pandemic. Therefore, we conducted a single-blind randomized controlled trial with 88 healthy older adults without dementia or sarcopenia who were randomly assigned into the Nordic walking (aerobic exercise), dance (dual-task training with aerobic exercise), or control group. The participants in both exercise intervention groups trained for 30 min, three times per week, for 4 weeks. All groups consumed amino acid-containing foods three times per week. We found that both exercise intervention groups showed improvements in executive function, while the dance group showed additional improvement in global cognitive function. The dance group showed a higher maximum gait speed, greater improvement in imitation ability, and improved executive function and cognitive function than the Nordic walking group. The intervention programs did not significantly affect the muscle mass or muscle output than the control group; however, both programs improved the participant neurological functions such as the heel lift, with dance training being the most effective intervention. In conclusion, dance training effectively improves cognitive function.
... The dance protocols in the included studies provide information on the duration of each session, ranging from 10 minutes [82] [32], [35], [36], [37], [38], [39], [40], [42], [44], [46], [47], [48], [52], [53], [55], [56], [57], [58], [62], [64], [66], [67], [68], [69], [70], [72], [74], [81], [85] [54], [73], [76] and 110 minutes [20], [21]. The protocols were conducted between 1 and 3 times per week, and lasted from 3 to 40 weeks. ...
Article
Full-text available
Objective To describe the use of dance-based intervention protocols as a rehabilitation proposal. Method Papers containing protocols used in adult patients and written in Spanish, English, and Portuguese were collected using the following keywords: Physical Therapy; Dance Therapy; Rehabilitation; and Clinical Trial Protocol. The PUBMED, MEDLINE, LILACS, BVS ScienceDirect, PEDro, OTseeker, The Cochrane Library (Cochrane Central Register of Controlled Trials), and Scopus databases were used for the collection of information to define the type of dance, the established protocol, pathologies, and the population involved. Results 70 studies met the eligibility criteria, all of which presented a dance protocol. This was used in the rehabilitation of pathologies covering the neuromuscular, musculoskeletal, and cardiovascular systems, as well as in a healthy population. Positive results were the main outcome measure. Discussion Dance is an innovative intervention strategy for patients with comorbidities or underlying pathologies as well as for those in good health. It offers, without limitations, a field of applicability through the use of a dancing style as a rehabilitation process, generating significant changes in the physical, mental, and social skills of the individual.
... 39 Dancing can increase strength and balance in older adults. 40 Listening to and playing music are beneficial for relaxing the body and mind. 41 Neighbourhoods can be a stressor to elicit depression. ...
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
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