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Dance Movement Therapy: A Promising Lifestyle Intervention in the Management of Chronic Obstructive Pulmonary Disease

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Chronic Obstructive Pulmonary Disease (COPD), a progressive multi-component malady with high morbidity and mortality, is an important public health challenge, throughout the world. Despite remarkable progress in its diagnostic and therapeutic modalities, significant number of patients, especially the elderly, continue to suffer from distressing dyspnoea and harrowing extra-pulmonary manifestations limiting their daily activities, with resultant exercise intolerance. Dance Movement Therapy (DMT), a pleasurable and feasible exercise, has been found to be equally effective at improving a range of health outcomes comparable with other forms of physical activity. Moreover, it has the potential to be a versatile activity with aesthetic expression, attractive to both genders irrespective of age, tempting to those with disabilities, and a fruitful tool in developing self-confidence. As viewed by European Association of Dance Movement Therapy “ DMT bridges the gap between the advantages of dance and the difficulties in performing physical activity and offers a combination of expressive movement and creativity…”. During the current stressful situation, caused by COVID-19 pandemic, the COPD patients, notably those over 70 years, are particularly vulnerable to intensification of symptoms and some of them may experience serious disorders of mental illness. Home isolation, social distancing,limiting outdoor activities and prohibiting participation in group exercises, though being appropriate prophylactic measures, are likely to add to already existing physical inactivity and heighten stress and depression, with deleterious effects on overall well-being. Solo dancing, while restricted to home, is a highly accessible, doable, sustainable and well rewarding alternative.
Journal of Integrative Medicine | Volume 08 | Issue 02 | December 2020
Distributed under creative commons license 4.0 DOI:
Journal of Integrative Medicine
Dance Movement Therapy: A Promising Lifestyle Intervention in the
Management of Chronic Obstructive Pulmonary Disease
Iqbal Akhtar Khan*
Independent Scholar, Lahore, Pakistan
Article history
Received: 13 July 2020
Accepted: 21 July 2020
Published Online: 30 July 2020
Chronic Obstructive Pulmonary Disease (COPD), a progressive multi-
component malady with high morbidity and mortality, is an important
public health challenge, throughout the world. Despite remarkable progress
in its diagnostic and therapeutic modalities, signicant number of patients,
especially the elderly, continue to suffer from distressing dyspnoea and
harrowing extra-pulmonary manifestations limiting their daily activities,
with resultant exercise intolerance. Dance Movement Therapy (DMT), a
pleasurable and feasible exercise, has been found to be equally efcacious
when compared to routinely prescribed physical exercises. Moreover, it has
aesthetic expression, attractive to both genders irrespective of age, tempting
to those with disabilities, and a fruitful tool in developing self-condence.
During the current stressful situation, caused by COVID-19 pandemic, the
COPD patients, notably those over 70 years, are particularly vulnerable
to intensication of symptoms and some of them may experience serious
disorders of mental illness. Home isolation, social distancing,limiting
outdoor activities and prohibiting participation in group exercises, though
being appropriate prophylactic measures, are likely to add to already
existing physical inactivity and heighten stress and depression, with
deleterious effects on overall well-being. Solo dancing, while restricted
to home, is a highly accessible, doable, sustainable and well rewarding
Chronic obstructive pulmonary disease
Dance movement therapy
Lifestyle intervention
COVID-19 Pandemic
Integrative medicine
1. Introduction
“C OPD outstrips all the other compara-
tors-heart failure, ischemic heart disease,
diabetes and renal failure-as the cause of
hospital admissions,” Prof. Darcy Marciniuk Chair of the
Canadian Thoracic Societyʼs COPD Committee [1].
Chronic Obstructive Pulmonary Disease (COPD), a
progressive degenerating lung condition “slowly robbing
its sufferers of the ability to draw life-sustaining breath”,
is a multi- component malady with pulmonary and ex-
tra-pulmonary manifestations. It is an important public
health challenge, throughout the world.
The Canadian Thoracic Society denes it as “a respira-
tory disorder largely caused by smoking, and is character-
ized by progressive, partially reversible airway obstruc-
tion and lung hyper- inflation, systemic manifestations,
and increasing frequency and severity of exacerbations”
[2]. The Global Burden of Disease Study reports a preva-
lence of 251 million cases of COPD globally in 2016. The
*Corresponding Author:
Iqbal Akhtar Khan,
Independent Scholar, Lahore, Pakistan;
Email: pro
Journal of Integrative Medicine | Volume 08 | Issue 02 | December 2020
Distributed under creative commons license 4.0
gure is continually rising, particularly in those aged 65
years and above. It has been estimated that 3.17 million
deaths were caused by the disease in 2015, more than
90% of which were in low and middle-income countries [3].
Currently, it is the 4th leading cause of death globally and
is projected to be the 3rd, by 2030.
With the recognition of poor lifestyle as the major
determinant of chronic diseases (notably COPD) and the
Physical activity: generic prescription for health [4] as
one of the important component of lifestyle intervention,
there is dire need to search for innovatives in the manage-
ment of COPD.
2. Rationale
“There is still a huge gap between scientific knowledge
and population-based interventions, although many ways
to reduce or prevent the burden of COPD are identifi-
able”. Prof.Nicolino Ambrosino Respirologist [5].
Despite remarkable progress in diagnostic and thera-
peutic modalities of COPD, signicant number of patients
continue to suffer from distressing dyspnoea and har-
rowing extra-pulmonary manifestations notably skeletal
muscle weakness and osteoporosis limiting their daily
activities, with resultant exercise intolerance. In a German
prospective cohort study, Waschki et al demonstrated that
physical activity of patients with COPD decreases across
all severity stages and this decline is parallel by a wors-
ening of lung function and health status [6]. Conversely,
Garcia-Aymerich et al, on the basis of a population based
study in Copenhagen, have shown that COPD patients
performing some level of regular physical activity had a
lower risk of both hospitalization and mortality [7].
The slogan “Exercise is Medicine” has its roots in an-
tiquity. It is like medicine because it can be prescribed in
a specic formulation, dosage, frequency and duration on
an individualized basis. The concept is old but is gaining
ground rapidly. Its roots can be traced to the teachings of
Maha Rishi Susruta (oruit 1500 BCE). Garry Egger et al,
while developing National Physical Activity Guidelines,
suggested that “Think of movement as an opportunity, not
an inconvenience”[8]. This approach is very realistic and
would be highly rewarding, if adhered to in the manage-
ment of all chronic diseases (notably COPD). Undoubt-
edly, exercise is a valuable component of pulmonary re-
habilitation programs for those with COPD. However, the
traditional exercise sessions yield sub-optimal response
with resultant inadequate outcomes. Moreover, with an
increase in exercise intensity, the resultant dyanamic hy-
perination is the major contributor to dyspnea, limiting
physical activity.
3. Dance Movement Therapy (DMT)
“The dance of medicine men,priest or shaman belongs to
the oldest form of medicine and psychotherapy in which
the common exaltation and release of tensions was able
to change man’s physical and mental suffering into a new
option on health.We may say that at the dawn of civiliza-
tion dancing,religion, music and medicine were insepara-
ble”. Joost AM Meerlo (1903-1976 CE)-Dutch Psychoan-
alyst Author [9].
Medical Dance ( dance for healing) has its roots in
antiquity.The ancient Greeks were well aware of the link
between physical and psychological states [10].The use of
dance for healing and curative purposes has a long and
venerable history.The modern concept of Dance Move-
ment Theapy (DMT) dates back to the work of Carl
Gustav Jung. (1875-1961), Swiss Psychoanalyist, who
pioneered the abstraction of dance as psychotherapy, in
1916. Mary Starks Whitehouse (1911-1979), a profession-
al dancer and then a teacher, worked further on the appli-
cation of Jungian theory for healing various ailments. In
1942, Marian Chace (1896-1976), a dancer and teacher at
the Denishawn School of Dancing and Related Arts in Los
Angeles, was invited to work at St. Elizabeths Hospital in
Washington, D.C. She was licensed the “First Full-time
Dance Therapist” in 1947. In 1966, she rose to the posi-
tion of Founding President of American Dance Therapy
Association (ADTA). The concept gradually gained pop-
ularity at international level. At present,remarkable and
well-rewarding work on its efcacy is in progress.
Dr. Lynn Berman Physical Therapist is quite right that
the dance:an ideal exercise: a total body work is “a great
way to access all movement planes and access some mus-
cles that get ignored in typical day-to-day activities,”.
But dancing has additional merits which have been enu-
merated by Dr. Shilagh Mirgain Psychologist University
of Wisconsin- “It involves both a mental effort and social
interaction. Regular dancing can help prevent cognitive
decline as we age and is associated with a reduced risk of
DMT has been dened, by ADTA, as the “psychothera-
peutic use of movements to promote emotional,social,cog-
nitive,and physical integration of the individual,for the
purpose of improving health and well-being”.
Fong Yan et al, in a systematic review and meta-anal-
ysis,concluded that DMT is more efficacious than other
forms of usually prescribed physical exercises [11]. The
“Let’s Boogie” Pilot Study, on the feasibility of dance
intervention, revealed that DMT was an enjoyable, safe,
and feasible way to exercise, for COPD patients [12]. DMT
could be an effective intervention for COPD associated
Journal of Integrative Medicine | Volume 08 | Issue 02 | December 2020
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psychological stress. In a population based cross-sectional
Singaporean study, there was signicantly stronger associ-
ation of life event stress with depressive symptoms among
individuals with COPD than among those without [13]. It is
known that around 40% of COPD patients are affected by
severe depressive symptoms or clinical depression [14]. An
interventional study was conducted in Finland to ratify the
effects of adding DMT to usual treatment (TAU ) for pa-
tients suffering from depression. One group received TAU
alone while the other was on TAU plus DMT. The prog-
nosis was found to be much better in the second group [15].
Whereas anxiety and depression are well recognized
comorbidities in COPD patients [16], their rates may be
much more in comparison to those suffering from other
chronic diseases [17]. In a systematic review and meta-anal-
ysis, by Torres-Sanchez et al, cognitive impairment was
found associated with the prole of COPD severity and its
comorbidities [18]. The results of meta-analysis, by Koch et
al,suggest that DMT, in addition to decreasing depression
and anxiety, improves quality of life and cognitive skills
Projects of dance therapy are gaining popularity at var-
ious forums.The benecial effects of DMT, when tested in
group form, have been very promsing. In a multi-centered
Randomised Controlled Trial (RCT), aimed at testing the
efcacy of 10 week DMT group intervention in patients
suffering from stress, signicant improvement in QoL, in
short term and long term follow up, was demonstrated [20].
In an interventional study for pulmonary rehabilitation,
it was found that the group dance classes provide suitable
training to physical tness in COPD patients. The partici-
pants found themselves of not only in good mood,but also
there was distraction from dyspnea [21].
Wellcome Trust-funded interdisciplinary “Life of
Breath Project” (2015-2020) is carrying out an integrative
research program to explore the possibility of DMT as an
ad-on therapy in pulmonary rehabilitation program.When
designed for COPD, it is being used in a collaboration
between King’s College London and choreographer Evan-
gelia Kolyra.
All the participants rated it “extremely enjoyable and
benecial”. Dr. Victoria MacBean,the Academic Lead, re-
marked “ I certainly believe that dance-based exercise has
the potential to enhance clinical care in this population”.
“Dancing Your Way to Better Breathing”, an interesting
combination of therapy and fun, organized by Respiratory
Therapist Joe Wynes, at the Sebastian Community Center
Sebastian Florida, demonstrared the therapeutic effects of
enjoyable dancing for COPD patients.
Undoubtedly, RCT is “Golden Standard” for ascertain-
ing the efcacy of a newly introduced technique or claim.
However, in an under-scored and insufciently sponsored
sub-speciality such as DMT, multi-centered RCTs requir-
ing huge funding are not easy.
The Bezmialem Vakif University Istanbul Turkey has
championed to initiate “The First Interventional (Clini-
cal Trial) Study to Apply Dance-based Exercise Training
in COPD” - with the goal to “to investigate the effect of
creative dance based exercise training on respiratory,
balance and cognitive functions, respiratory and periph-
eral muscle strength and functional capacity in COPD
patients”. It started on September 1, 2019 and the esti-
mate completion date is May 17, 2021. This would bridge
a gap in international literature and the ndings will,most
hopefully, “provide important methodological and proto-
col data required for the fully powered RCT to evaluate
efcacy and mechanisms of action of DMT”.
3.1 DMT for Elderly Patients
“With the diminishing of cognitive skills in elderly, it
is important to enhance the level of embodiment. It is
through body movement that the older adult can express
feelings, and experience a sense of belonging, increased
self- esteem, and personal growth”. Donna New-
man-Bluestein - Panel Presenter ADTA 2017 [22].
COPD is strongly associated with aging. At least 10%
of persons aged 65 years and above, in the United States,
are diagnosed with COPD. Internationally, the gure may
reach up to 16% depending on the country. However, the
gure is still an underestimate because of underdiagnosis
and underutilization of pulmonary function tests [23]. The
over-age 65 population, according to WHO estimates, was
703 million in 2019 and, with consistent growth, is likely
to double to 1.5 billion (22% of total world population) in
2050. Moreover, the number of those 80 years or above is
expected to rise from 125 million to 434 million, by 2050.
The feasibility of DMT in elderly is well recognized.
The two groups which Marian Chace opted to work with,
in 1942, were psychiatric and elderly. It would be highly
advisable to schedule most of the sessions with elderly
in settings of special care type like hospital, community
center or a well-equipped residential home. A warm and
well-greeted atmosphere, under supervision of a trained
therapist, needs to be created for the group. To expect
progress the participants must be motivated to attend
DMT sessions on regular basis. The health outcome is
much better in those who are regularly regular.
DMT has been found to exert benecial effects on over-
all well-being in elderly. Moreover, it improves balance
and mobility and reduces risk of falls which is a serious
problem of aging population [24]. A Brazilian [25] and anoth-
er British study [26] revealed that the impact of uniqueness
Journal of Integrative Medicine | Volume 08 | Issue 02 | December 2020
Distributed under creative commons license 4.0
of dancing was not limited to age-related physical aspects
but also on self-perception and psychological well-being.
3.2 DMT for Patients with Diabilities
“Being disabled should not mean being disqualied from
having access to every aspect of life.” Emma Thompson
(1959-) - British Writer.
There is significant association between COPD and
major physical limitations and comorbidities in elderly
population. In an American telephone survey of health-re-
lated behaviors, it was found that the mobility disability,
had the highest prevalence of 45.9 % in 2016 and 48.4 %
in 2017.Interestingly, the highest prevalence was noted
among those 45-64 years old, contrary to those of 65 years
or above [27]. Clinical depression and anxiety were noted in
40 % and 36% respectively in 60-89 aged outpatients with
COPD, in a university teaching hospital of United King-
dom [28].
Certain Disability Arts Organisations, National Insti-
tutes of Dancing, Disability-related Dance Companies and
National and International Disability Organisations, with
good resources, offer advice and support to persons with
disabilities.They provide more opportunities for disabled
and would be of special interest to COPD patients with
disabilities planning to avail the benets of DMT. Adding
physical activity,in the form of DMT, to such patients is
an effective tool of improving their functional tness.
Wheelchair Dancers Organization (WDO), by provid-
ing well structured supervised dance sessions, to all those
in need of special assistance, has succeeded in bringing
remarkable change in their lives. An inspiring, instructive
and invigorating message from Beverly Weurding, the
Founder, is “We have no limitations except those we place
upon ourselves.”
3.3 DMT for COPD Patients during COVID-19
“The debilitating symptom of breathlessness often limited
COPD patients’ participation in social activities. Conse-
quently, many became socially isolated and prone to de-
veloping depression”. Suk Fong Wai et al [29]
Philip et al have argued that COVID-19 pandemic will
affect all people with chronic respiratory diseases (notably
COPD )having potentially detrimental affects on physical,
psychological and social wellbeing [30]. The present situa-
tion reveals that the individuals with COPD, notably those
over 70 years, are particularly vulnerable to intensication
of respiratory symptoms and some of them may experience
serious psychological disorders [31]. Alarmingly, over one
third of COVID-19 afflicted hospitalized patients were
found to have respiratory pre-existing conditions such as
COPD, as reported by the Centers for Disease Control and
Prevention [32]. It may be due to the infection itself, man-
datory isolation/ quarantine at designated centers ; and
impending hospitalization.
The appropriate prophylactic measures (home isolation,
social distancing, limiting outdoor activities, prohibiting
participation in group exercises) are likely to add to al-
ready existing physical inactivity and heighten stress and
depression, with deleterious effects on overall well-being.
There is tangible need to identify activities which could
have positive impact on their physical and mental health.
Solo dancing, while restricted to home, is a highly acces-
sible, doable, feasible, sustainable and beneficial alter-
native. As suggested by Shilagh Mirgain “Dance just for
yourself, allowing any movements to flow that feel good
- or pretend that someone is watching to enhance your
personal dancing experience.Online group-sessions for
dance are available for those, willing to get benet.
4. Conclusion
“…..The care of the chronically ill is moving toward meth-
ods that aim to preserve and enhance quality of life of our
patients and activities of daily living through identication
of their culture, motivation, caregiver/home trends and
perceptions of daily wellness routines”. Joanne Loewy -
Director Louis Armstrong Center at MSBI.
DMT, a pleasurable and feasible exercise, has been
found to be equally efficacious when compared to rou-
tinely prescribed physical exercises. It has aesthetic ex-
pression, attractive to both genders irrespective of age,
tempting to those with disabilities, and a fruitful tool in
developing self-confidence. Under the present stressful
situation of COVID-19 Pandemic, when COPD patients
are particularly vulnerable to intensication of symptoms,
DMT should be confidently prescribed to them. Even
when delivered remotely,it is more relevant to promote
their physical activity and wellbeing at a time when they
have been subjected to more strict home isolation.
Source of Funding
This research was totally un-funded.
Disclosure Statement
The author has no conicts of interest to disclose.
Journal of Integrative Medicine | Volume 08 | Issue 02 | December 2020
Distributed under creative commons license 4.0
The author is highly grateful to Prof. Nicolino Ambrosino
(Respirologist Italy ) for pre-submission review of the
manuscript and scholarly advice for its improvement.
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... (c)-Novel Add-ons: Dance Movements Therapy (DMT) and Musical Engagement Therapy have emerged as promising effective Add-ons in the management of COPD and depression and are worth trial in the prevailing situation. [54,55]. ...
... DMT has aesthetic expression, attractive to both genders irrespective of age, tempting to those with disabilities, and a fruitful tool in developing self-confidence. [54]. championed to initiate "The First Interventional (Clinical Trial) Study to Apply Dance-based Exercise Training in COPD" -with the goal to "to investigate the effect of creative dance-based exercise training on respiratory, balance and cognitive functions, respiratory and peripheral muscle strength and functional capacity in COPD patients". ...
Full-text available
COPD is a highly incapacitating global public health problem, with pulmonary and extra-pulmonary manifestations and usually associated with significant concomitant chronic diseases. With enhanced understanding, it has extensively been reported as a complex, heterogeneous and dynamic disease affecting patients' health beyond pulmones. Depression, with prevalence of 322 million people, is a major contributor to the overall global burden of disease. In various epidemiological and clinical studies, its prevalence among patients with COPD varies from 18% to 80%. This deadly duo leads to excessive health care utilization rates and costs including increased rates of exacerbation, sub-optimal adherence to prescribed medications, increased hospital admissions, longer hospital stays and increased hospital readmissions. Moreover, there is increased risk of suicidal ideation, suicidal attempts, and suicidal drug overdose. It is a pity that, in significant cases, the co-morbidity remains under-recognized and under-treated. The impact of prevailing COVID 19 pandemic, on the dual burden of COPD and depression, and possible remedial measures including "The 6 ways to boost one's well-being-by Mental Heath UK, "The Living with the Times" toolkit-by WHO" and innovative add-ons like Dance Movement Therapy and Musical Engagement Therapy have been discussed.
... It was also an effective tool for cultivating self-confidence, especially for the disabled. According to the European Association for DMT, DMT filled the gap between the advantages of dance and the difficulties of sports activities by combining expressive exercise and creativity (Khan, 2020;Ye and Chen, 2021). Dryman and Heimberg (2018) revealed that proficient emotion regulators developed fewer depressive symptoms. ...
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The present work aims to efficiently carry out life-death education (LDE) for college students, improve their psychological problems, and reduce suicide accidents by combining LDE with Dance Movement Therapy (DMT). DMT is a psychosomatic cross therapy that treats mental or physical diseases through dance or improvisation. Firstly, this paper introduces LDE and DMT and designs the activities of DMT intervention. Secondly, the relationship between DMT and LDE is analyzed. Finally, a questionnaire survey is conducted on the research objects. The research objects are divided into the experimental group receiving DMT intervention, the control group participating in sports dance courses, and the benchmark group. The research data show no significant difference in interpersonal skills and emotional psychology among the three groups. The DMT intervention group has substantial changes in other factors except for the conflict control ability before and after the intervention. In addition, the questionnaire survey results after the intervention demonstrate that the DMT intervention group gets a significantly higher score in the interpersonal relationship, interpersonal relationship building ability, moderate rejection ability, self-disclosure ability, and emotional support ability. Therefore, DMT intervention positively impacts college students’ interpersonal relationships. After the sports dance course, there are differences in the total score of interpersonal ties and scores of interpersonal relationships building ability, self-disclosure ability, and emotional support ability in the control group, but with no significant difference in moderate rejection ability and conflict control ability. Therefore, compared with traditional psychotherapy methods, the DMT method reported here is conducive to releasing pressure and alleviating physical and mental anxiety. The research content provides new ideas for psychological education in colleges and universities and contributes to improving college students’ suicidal tendencies and helping college students grow up healthily.
... WHO (World Health Organization) also ranked the COPD as the third leading cause of death in COVID 19 patients due to compromised immune response and disease progress to dyspnea, hypoxia, dry cough, excessive fatigue, and sputum production. [45][46][47][48] Lue et al 2020, concluded that COVID-19 patients with specific features like COPD, smoking and HTN, rather than cancer-specific features, are the greatest determinants of severity. 49 A large case series from many countries showed that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognostics. ...
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: Cases of COVID 19 is a challenge for clinicians to evaluate the effect of SARS CoV2 on patients has preexisting medical illness. To assess the potential effect and incidence of COVID 19 with comorbidity. 680 COVID-19 positive cases were included. This research was limited to the admitted patients from October 2020 to February 2021. Applicable data were collected from patient’s files, reviewed and included based on the applicability to the topic. As of October, 2020, our institute had 954 suspected cases of COVID-19 infection. Out of these 680 patients were positive and rests were negative. We obtained data from the hospital records which provided information regarding the age, gender, chief complaints, co-morbidity and its type, positive /negative status and outcomes (Recovered/death). We divided the patients into three groups; (1) had no co-morbidity; (2) had one co-morbidity (3) had two or more co-morbidity and compared their outcomes (Recovery/Death/admitted). We also compared the outcomes of patients those had more than two co-morbidities. clinical data and co-morbidities were examined with SPSS Statistics, Version 23. Most patients were male (76.21%) with commonest complain of difficulty in breathing (46.03%). Among total cases, no co-morbidity was noted in 402 (59.11%) patients, one co-morbidity in 205(30.15%) and more than one co-morbidity in 73 (10.74%) patients. Higher death rate was noted in positive patients with two or more co-morbidities (35.62%). Diabetes and hypertension were the common observed illness with higher death rate in COPD and HTN with CAD (75.00%) patients. Result of this study suggests a strong clinical relationship between COVID-19 and co-morbidities. Patients with pre-existing medical sickness with COVID 19 is a challenge to the physicians as it yielded poorer clinical outcomes. So, the physicians need to be prepared to reorganize their consultative practices during this pandemic period.
... While people are socially isolated because of progressing COPD or due to compulsory confinement in situations like the prevailing Coronavirus disease-19 Pandemic, there is a tangible need to identify activities that could positively impact their physical and mental health. Dance movement therapy in the form of "Dance for Yourself" (solo dancing with the help of easily accessible videos), listening to music, and making music by singing are feasible, accessible, and doable alternatives 36 . ...
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Chronic obstructive pulmonary disease (COPD), a progressive degenerative multi-component disorder, is a life-threatening global epidemic, killing on average one person every 10 s. Distressing dyspnea, exhausting leg fatigue, exaggerated self-perception of ill-being, progressing home bounding, and associated stress with resultant anxiety and depression lead to significantly higher exacerbations and increased hospitalization with prolonged length of stay. Music therapy (MT) (singing and listening), an inexpensive and readily accessible resource, has emerged as a promising interventional strategy with accep- tance on a wider scale because of its unique link to emotions and soothing power. Singing is well known to increase respi- ratory muscle strength, sense of breath control, and arterial oxygen saturation level. In otherwise dyspneic patients, the regular singing exercises help improve breathing coordination and better mood, alleviate anxiety, and improve health-related quality of life. Exercise is the most important tool in slowing COPD progression, but the lack of adherence is the common barrier. The physically stimulating and emotionally inspiring music immerses the individual deeply into the physical activity to the extent that he/she would be saved from boredom and excessive fatigue. The resultant ergogenic effect delays fatigue, increases work capacity, endurance, and productivity. Motivational MT and prescribed graded exercise, in addition to specific therapeutic interventions, could significantly slow down the progression of the disease, which is otherwise incurable.
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Background The prevalence of disabilities is rising steadily, reflecting an aging population and an increasing burden of chronic conditions affecting quality of life. There are scant national data on the prevalence of disability among individuals with chronic obstructive pulmonary disease (COPD). The main objective was to estimate the prevalence of common disabilities among US-based individuals diagnosed with COPD. Methods Data from the BRFSS, a national telephone survey examining health-related behaviors in 2016–2017 were analyzed. The study population consisted of individuals with self-reported COPD (N = 38352 in 2016 and N = 35423 in 2017). The prevalence of disabilities in hearing, vision, cognition, mobility, and independent living were obtained and adjusted with sampling weights. Healthcare access measures were described by type of disability. Results Mobility disability had the highest prevalence of 45.9 (44.8–47.0) % in 2016 and 48.4 (47.3–49.5) % in 2017 among respondents with COPD. The prevalence of disabilities was highest among those 45–64 years old, except for hearing and cognition. Hearing disabilities were most prevalent among males with COPD while cognitive and mobility disabilities were most prevalent among females with COPD. While differences in the prevalence of disabilities were observed, access to health care was similar by disability type and age group among respondents. Conclusion Contrary to expectation, the highest prevalence of disabilities was found not to be among those 65 years old and above. Further research is needed to explain this age-specific shift in the burden of disability, as long-term care planning and prevention support systems should be informed by the demographical patterns of disabilities among individuals with COPD.
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Background: Dance is an embodied activity and, when applied therapeutically, can have several specific and unspecific health benefits. In this meta-analysis, we evaluated the effectiveness of dance movement therapy1(DMT) and dance interventions for psychological health outcomes. Research in this area grew considerably from 1.3 detected studies/year in 1996–2012 to 6.8 detected studies/year in 2012–2018. Method: We synthesized 41 controlled intervention studies (N = 2,374; from 01/2012 to 03/2018), 21 from DMT, and 20 from dance, investigating the outcome clusters of quality of life, clinical outcomes (with sub-analyses of depression and anxiety), interpersonal skills, cognitive skills, and (psycho-)motor skills. We included recent randomized controlled trials (RCTs) in areas such as depression, anxiety, schizophrenia, autism, elderly patients, oncology, neurology, chronic heart failure, and cardiovascular disease, including follow-up data in eight studies. Results: Analyses yielded a medium overall effect (d2 = 0.60), with high heterogeneity of results (I2 = 72.62%). Sorted by outcome clusters, the effects were medium to large (d = 0.53 to d = 0.85). All effects, except the one for (psycho-)motor skills, showed high inconsistency of results. Sensitivity analyses revealed that type of intervention (DMT or dance) was a significant moderator of results. In the DMT cluster, the overall medium effect was small, significant, and homogeneous/consistent (d = 0.30, p < 0.001, I2 = 3.47). In the dance intervention cluster, the overall medium effect was large, significant, yet heterogeneous/non-consistent (d = 0.81, p < 0.001, I2 = 77.96). Results suggest that DMT decreases depression and anxiety and increases quality of life and interpersonal and cognitive skills, whereas dance interventions increase (psycho-)motor skills. Larger effect sizes resulted from observational measures, possibly indicating bias. Follow-up data showed that on 22 weeks after the intervention, most effects remained stable or slightly increased. Discussion: Consistent effects of DMT coincide with findings from former meta-analyses. Most dance intervention studies came from preventive contexts and most DMT studies came from institutional healthcare contexts with more severely impaired clinical patients, where we found smaller effects, yet with higher clinical relevance. Methodological shortcomings of many included studies and heterogeneity of outcome measures limit results. Initial findings on long-term effects are promising.
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Pulmonary rehabilitation (PR) is recommended for all individuals living with a lung condition and chronic breathlessness. This article considers how adopting an interdisciplinary, medical humanities approach to the term ‘pulmonary rehabilitation’ might unpack some of the misconceptions, misrepresentations or negative connotations surrounding it, which have been largely overlooked in explanations of the low uptake of this programme. Taking key insights from Wellcome Trust-funded Life of Breath project, including ethnographic research in community fitness groups in North East England and the ‘Breath Lab’ special interest group, this article outlines how the whole-body approach of PR is not easily understood by those with lung conditions; how experience can inform breath perception through the pacing of everyday life; and how stigma can impact rehabilitation. This article highlights the value of medical humanities in working through communicative challenges evident in the translation of PR between patient and clinical contexts and sets out two arts-based approaches (Singing for Lung Health and dance movement) as potential options that could be included in the PR referral. Finally, the article outlines the need for collaborative research exploring the communication and meaning of healthcare strategies and experiences at the interface of the arts, humanities and medical practice.
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Chronic respiratory diseases are among the four major human chronic diseases. Tobacco smoke as well as environmental pollutants, infections, physical activity and nutritional status play a role in the prevalence, development and/or progression of chronic obstructive pulmonary disease (COPD). Changes in lifestyle are possible and may be beneficial in prevention and comprehensive management of COPD. Population-level interventions aimed at early diagnosis, promotion of vaccinations and prevention of infections, and reductions in smoking, environmental pollutants, physical inactivity, obesity and malnutrition may increase the number of life-years lived in good health. Educational aims To improve awareness of the influence of lifestyle on natural history of COPD. To describe the effects of some interventions to modify lifestyle in prevention and management. To provide information on the main clinical results. To define recommendations and limitations.
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Background: Physical inactivity is one of the key global health challenges as it is associated with adverse effects related to ageing, weight control, physical function, longevity, and quality of life. Dancing is a form of physical activity associated with health benefits across the lifespan, even at amateur levels of participation. However, it is unclear whether dance interventions are equally as effective as other forms of physical activity. Objective: The aim was to systematically review the literature on the effectiveness of structured dance interventions, in comparison to structured exercise programmes, on physical health outcome measures. Methods: Seven databases were searched from earliest records to 4 August 2017. Studies investigating dance interventions lasting > 4 weeks that included physical health outcomes and had a structured exercise comparison group were included in the study. Screening and data extraction were performed by two reviewers, with all disagreements resolved by the primary author. Where appropriate, meta-analysis was performed or an effect size estimate generated. Results: Of 11,434 studies identified, 28 (total sample size 1276 participants) met the inclusion criteria. A variety of dance genres and structured exercise interventions were compared. Meta-analyses showed dance interventions significantly improved body composition, blood biomarkers, and musculoskeletal function. The effect of either intervention on cardiovascular function and self-perceived mobility was equivalent. Conclusion: Undertaking structured dance of any genre is equally and occasionally more effective than other types of structured exercise for improving a range of health outcome measures. Health practitioners can recommend structured dance as a safe and effective exercise alternative.
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We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) included in the study received treatment as usual (TAU). Twenty-one patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES) were medium in favor for the DMT group (d = 0.60-0.79). In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15-0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.
Purpose: Exercise is an effective treatment for individuals with chronic obstructive pulmonary disease (COPD); however, lack of adherence to exercise programs is a common barrier. Innovative approaches to exercise are needed to increase patient engagement and adherence. Dance has been shown to benefit populations with neurological conditions. The aim of our study was to investigate the feasibility of a dance intervention in individuals with COPD. Methods: Twenty individuals with COPD participated in a 1-hr dance class delivered twice a week for 8 wk. The primary outcome measure of the study was the feasibility determined by enrollment rate, attendance rate, adverse events, and participant satisfaction. Secondary outcomes included functional capacity, balance, anxiety and depression, steps count, and health-related quality of life. Results: Of the 47 individuals approached, 37 (79%) were interested in the program and 23 (49%) consented to participate and 20 completed the program with no adverse events and a mean attendance rate of 78%. The mean age ± SD of the participants was 73.4 ± 7.6 yr and 70% were females. Participant satisfaction with the program was high and significant improvements were achieved in the 6-min walk test (P = .03), Balance Evaluation Systems Test (BESTest) (P < .01), Chronic Respiratory Disease Questionnaire (P = .001), and the Activities-specific Balance Confidence scale (P = .007). Conclusion: Dance is an enjoyable, safe, and feasible way to exercise for those with COPD. This pilot study will inform the design of a larger randomized controlled trial to determine effectiveness of dance on exercise capacity, balance, and quality of life for people with COPD.