ArticlePDF AvailableLiterature Review

Abstract and Figures

Background Parkinson’s disease (PD) is a neurodegenerative disorder that presents with motor and nonmotor symptoms such as bradykinesia, resting tremor, postural instability, and cognitive and neuropsychiatric manifestations. Dance therapy or complex motor activity, besides pharmacological treatment, may have benefits in PD patients.Objective To assess the effect of dance in patients with PD.Methods We searched for clinical trials in PubMed, Scopus, and Web of Science, and Cochrane till April 2020 using relevant keywords. Data were extracted and pooled as mean difference (MD) with 95% confidence interval (CI) by Review Manager 5.3.ResultsFourteen randomized controlled trials with 372 patients were included. Dance showed a significant improvement over the control group in term of the Unified Parkinson’s Disease Rating Scale III (UPDRS III) after three (MD = − 4.49, 95% CI [− 6.78, − 2.21], p = 0.00001), six, (MD = − 5.96, 95% CI [− 8.89, − 3.02], p < 0.0001), and 12 months (MD = − 14.58, 95% CI [− 24.76, − 4.4], p = 0.005), and Mini-BES test after 12 months. Compared to exercise, dance showed a significant improvement in Timed Up and Go (TUG) test, Berg Balance Scale (BBS), and Mini-BES test.Conclusion In comparison to other types of exercise or no activity, dance improves the symptoms and outcomes in patients with PD, especially motor symptoms. Dance also has positive effects on balance, functional mobility, and cognition.
This content is subject to copyright. Terms and conditions apply.
Vol.:(0123456789)
1 3
Journal of Neurology
https://doi.org/10.1007/s00415-021-10589-4
REVIEW
Efficacy ofdance forParkinson’s disease: apooled analysis of372
patients
SaraMohamedHasan1,10· SomiaAlshae2,10· ElfatihA.Hasabo3,10· Ma’mounSaleh4,10·
WalaaElnaiem3,10· AyaQasem5,10· YazanO.Alzu’bi6,10· AsmaaKhaled7,10· MohamedSayedZaazouee1,10·
KhaledMohamedRagab8,10· AnasZakaryaNourelden9,10· MohamedFahmyDoheim10,11
Received: 25 February 2021 / Revised: 27 April 2021 / Accepted: 30 April 2021
© Springer-Verlag GmbH Germany, part of Springer Nature 2021
Abstract
Background Parkinson’s disease (PD) is a neurodegenerative disorder that presents with motor and nonmotor symptoms
such as bradykinesia, resting tremor, postural instability, and cognitive and neuropsychiatric manifestations. Dance therapy
or complex motor activity, besides pharmacological treatment, may have benefits in PD patients.
Objective To assess the effect of dance in patients with PD.
Methods We searched for clinical trials in PubMed, Scopus, and Web of Science, and Cochrane till April 2020 using rel-
evant keywords. Data were extracted and pooled as mean difference (MD) with 95% confidence interval (CI) by Review
Manager 5.3.
Results Fourteen randomized controlled trials with 372 patients were included. Dance showed a significant improvement
over the control group in term of the Unified Parkinson’s Disease Rating Scale III (UPDRS III) after three (MD = − 4.49,
95% CI [− 6.78, − 2.21], p = 0.00001), six, (MD = − 5.96, 95% CI [− 8.89, − 3.02], p < 0.0001), and 12 months (MD = − 14.58,
95% CI [− 24.76, − 4.4], p = 0.005), and Mini-BES test after 12 months. Compared to exercise, dance showed a significant
improvement in Timed Up and Go (TUG) test, Berg Balance Scale (BBS), and Mini-BES test.
Conclusion In comparison to other types of exercise or no activity, dance improves the symptoms and outcomes in patients
with PD, especially motor symptoms. Dance also has positive effects on balance, functional mobility, and cognition.
Keywords Parkinson’s disease· Dance· Meta-analysis
Introduction
Parkinson’s disease (PD) is a chronic neurodegenerative
disorder that was first discovered by James Parkinson in
1817 as “Shaking palsy” [1]. Patients usually suffer from
motor symptoms as bradykinesia, resting tremors, postural
instability, high susceptibility to falls, and limited functional
mobility [2, 3] as well as nonmotor symptoms as autonomic
dysfunction, sleep disturbance, cognitive and neuropsychiat-
ric disorders [4, 5]. If the patient is left untreated, symptoms
tend to deteriorate [6].
Some studies recently have stated that dance might have
a considerable role in managing some symptoms of PD
[79], as gait, balance, and coordination. As PD patients
* Mohamed Fahmy Doheim
fahmydoheim@alumni.harvard.edu
1 Faculty ofMedicine, Al-Azhar University, Assuit, Egypt
2 Faculty ofMedicine, Suez Canal University, Ismailia, Egypt
3 Faculty ofMedicine, Khartoum University, Khartoum, Sudan
4 Faculty ofMedicine, Hashemite University, AzZarqa’,
Jordan
5 Medical Analysis, Al-Balqa’ Applied University, Al-Zarqa’,
Jordan
6 Faculty ofMedicine, Jordan University ofScience
andTechnology, Irbid, Jordan
7 Faculty ofMedicine, Tanta University, Tanta, Egypt
8 Faculty ofMedicine, Minia University, Minia, Egypt
9 Faculty ofMedicine, Al-Azhar University, Cairo, Egypt
10 International Medical Research Association (IMedRA),
Cairo, Egypt
11 Faculty ofMedicine, Alexandria University, El-Shatby, 22
El-Guish Road, Alexandria21526, Egypt
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
suffer from mood changes and social isolation [10], dance
may influence the emotional processes [10, 11].
Many studies showed a promising effect of different
dance types on patients with PD [8, 1218]. Therefore, we
conducted this systematic review and meta-analysis to evalu-
ate and synthesize high-quality evidence about the effect of
dance on PD patients.
Methods
We conducted this systematic review and meta-analysis
guided by the Cochrane handbook for systematic reviews
of interventions [19], then we reported using the preferred
reporting items for systematic review and meta-analysis
(PRISMA statement) [20].
Literature search
We searched PubMed, Scopus, Web of Science, and
Cochrane Central Register of Controlled Trials (CENTRAL)
till May 2019 and updated our search on April 2020 using
the following search strategy: (dance OR dancing OR move-
ment therapy) AND (Parkinson OR Parkinson*).
Eligibility criteria andstudy selection
We included all randomized controlled trials (RCTs) com-
pared dance therapy to exercise or no intervention in PD
patients. We excluded the studies which were: (1) thesis or
conference abstract, (2) having data unreliable for extraction,
(3) with language other than English, (4) invitro or animal
studies. Four independent reviewers screened the title and
abstract to exclude irrelevant studies, then the full text to
confirm the inclusion. In cases of disagreement, we did a
group discussion with the supervisor.
Data extraction
Six independent authors extracted the following data from
the included studies: (1) baseline and summary data of par-
ticipants; (2) study outcomes at 10 weeks, 3, 6 or 12 months
including the efficacy measured by many scales: (1) gen-
eral PD symptoms: (a) Unified Parkinson’s Disease Rating
Scale (UPDRS); (2) motor function or balance or gait: (a)
BBS: Berg Balance Scale; (b) TUG: Timed Up and Go test;
(c) FOG: freezing of gait; (d) 6-MWT: 6-min walk test; (e)
forward velocity, m/s; (f) backward velocity, m/s; (3) men-
tal symptom or cognitive functions or quality of life: (a)
AS, Apathy Scale; (b) BDI, Beck Depression Inventory; (c)
MoCA, Montreal Cognitive Assessment; (d) FAB, Fron-
tal Assessment Battery; (e) PDQ-39, Parkinson’s Disease
Questionnaire-39.
Quality assessment
We assessed the quality of the included trials using the
Cochrane Risk of Bias tool provided in Cochrane handbook
for systematic reviews of interventions [19]; we used the
quality assessment table provided in the same book (part
2, chapter2.5). The assessment domains were: (1) random
sequence generation (selection bias); (2) allocation conceal-
ment (selection bias); (3) blinding of participants and per-
sonnel (performance bias); (4) outcome assessment (detec-
tion bias); (5) incomplete outcome data (attrition bias); (6)
other potential sources of bias. The reviewers judged the
domains as: “low risk”, “high risk” or “unclear”.
Data synthesis
We used review manager 5.3 for the analysis and presented
all the outcomes data as mean difference (MD) using the
inverse-variance method. According to Altmans equation,
missed SD of mean change was calculated from standard
error or 95% confidence interval (CI) [21]. We tested the
heterogeneity among the included studies by the Cochran-Q
test and quantified its extent by the I-square test. When sig-
nificant heterogeneity (p ˂ 0.1) was detected, we employed
the random-effects model, and the study causing heterogene-
ity was excluded if possible (sensitivity analysis) [19]. We
conducted a subgroup analysis to assess whether the effect
estimate differ significantly according to dance duration.
Results
Literature search results
Our literature search retrieved 856 citations; of them, 289
duplicates were removed. Additional 434 and 119 records
were excluded during the abstract and the full-text screening,
respectively. Finally, 14 studies were included [1315, 18,
2231] for qualitative and quantitative synthesis of evidence
(see Fig.1; PRISMA).
Characteristic ofincluded studies
All the 14 included studies were randomized controlled tri-
als with a total number of 372 patients. Nine studies com-
pared dance intervention versus no dancing (control group),
and four studies compared dancing versus other types of
exercise, and one study compared dance versus no dancing
versus other types of exercise.
In the first comparison (dance versus no dancing),
patients ranged from 5 up to 26 per group with a total
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
number of patients 142, 127 in dance and the control
group, respectively. The H&Y scale for PD diagnosis
ranged from 1 to 3 in most studies (Table2). Tango classes
for 3 months were the commonest platform used among
studies to measure dance efficacy (Table1). In the sec-
ond comparison (dance versus other types of exercise),
the total number of patients was 54 and 56 patients in the
dance and exercise groups.
Three studies used tango as dance intervention therapy,
while the other two used different types of dancing. The
summary of the included studies and baseline character-
istics of enrolled patients are shown in Tables1 and 2,
respectively.
Studies included in
quantave synthesis
(meta-analysis)
(n = 14)
Full-text arcles assessed
for eligibility
(n = 133)
Idenficaon
Eligibility
Included Screening
PubMed = 157
Web of science = 303
Scopus = 252
Cochrane central = 113
Records screened
(n =538) Records excluded
(n =405)
Duplicate = 289
Full-text arcles excluded,
with reasons
(n = 119)
n=38 conference abstracts
n=26 Different populaon,
intervenon and outcome)
n=26 not randomized
clinical trials
n=7 full text unavailable
n=5 protocol
Studies included in
qualitave synthesis
(n = 14)
Fig. 1 PRISMA flow chart
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
Table 1 Summary of the design and important findings of included studies
Article ID Study design Duration of the study Study arms Criteria of diagnosis Characteristics of ses-
sions
Outcome measures
Duncan and Earhart [15] Randomized-controlled
trial
12 months Tango versus no interven-
tion
Clinically definitive
diagnosis PD and H&Y
stage 1–4
Two classes per week,
1 h community-based
Argentine Tango
classes, 12 months
Motor symptoms (UPDRS
III)
Non-motor symptoms
(UPDRS I)
ADLs (UPDRS II)
Balance (MiniBESTest)
Freezing of gait (FOG_Q)
Endurance (6-MWT)
Upper extremity function
(9HPT)
Velocity walk forward and
backward (GAITRite®
system)
Duncan and Earhart [14] 2-Year Prospective Pilot
Study
24 months Tango versus no interven-
tion
Clinically definitive
diagnosis PD and H&Y
stage 1–4
Two classes per week,
1-h community-based
Argentine Tango
classes, 24 months
Motor symptoms (UPDRS
III)
Non-motor symptoms
(UPDRS I)
ADLs (UPDRS II)
Balance (MiniBESTest)
Freezing of gait (FOG_Q)
Endurance (6-MWT)
Timed Up and Go (TUG)
Dual-task Timed Up and
Go
Velocity walk forward and
backward (GAITRite®
system)
Hackney etal. [8] Randomized preliminary
study
13 weeks Tango versus exercise Clinically definitive
diagnosis PD
Two classes per week,
1-h community-based
Argentine Tango
classes, 20 sessions, 13
weeks
Motor symptoms (UPDRS
III) Balance (BBS)
Freezing of gait (FOG_Q)
Timed Up and Go (TUG)
Velocity walk forward and
backward (GAITRite®
system)
Hackney etal. [18] Randomized-controlled
trial
13 weeks Tango versus exercise Clinically definitive
diagnosis PD
Two classes per week,
1 h community-based
Argentine Tango
classes, 20 sessions, 13
weeks
Velocity walk forward and
backward (GAITRite®
system)
One Leg Stance
Functional reach test
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
Table 1 (continued)
Article ID Study design Duration of the study Study arms Criteria of diagnosis Characteristics of ses-
sions
Outcome measures
Hackney and Earhart [17] Randomized-controlled
pilot study
13 weeks Tango versus waltz/fox-
trot versus no interven-
tion
Clinically definitive
diagnosis PD and H&Y
stage 1–3
Two classes per week,
1 h, 20 sessions, 13
weeks
Motor symptoms (UPDRS
III)
Balance (BBS)
Freezing of gait (FOG_Q)
Endurance (6-MWT)
Timed Up and Go (TUG)
Velocity walk forward and
backward (GAITRite®
system)
Stride length forward and
backward single sup-
port time forward and
backward
Hashimoto etal. [30] Quasi-randomized pilot
trial
12 weeks Combinations of aerobic,
jazz, and tango dances
and classical ballet
movement versus physi-
cal exercise versus no
intervention
Clinically definitive
diagnosis PD
One class per week, 1 h,
12 weeks
Motor symptoms (UPDRS
III)
Balance (BBS)
Timed Up and Go (TUG)
Apathy scale (AS)
Self-rating Depression
Scale (SDS)
Mental rotation task
(MRT)
Lee etal. [22] Randomized-controlled
trial
6 weeks K-Pop Dance Festival
(Nintendo Inc., Japan)
game versus no inter-
vention
_ 30 min of dance exercise
for 6 weeks
Motor symptoms (UPDRS
III)
Balance (BBS)
Timed Up and Go (TUG)
Mental symptoms (AS)
and (SDS) Mental rota-
tion task (MRT)
McKee etal. [24] Randomized-controlled
trial
12 weeks, 12-week
follow-up
Tango versus no interven-
tion
Clinically definitive
diagnosis PD and H&Y
stage 1–4
Two classes per week,
90 min community-
based Argentine Tango
classes, 12 weeks
Motor symptoms (UPDRS
III)
Cognitive function
(MoCA)
Freezing of gait (FOG_Q)
Timed Up and Go (TUG)
Psychosocial (PDQ-39)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
Table 1 (continued)
Article ID Study design Duration of the study Study arms Criteria of diagnosis Characteristics of ses-
sions
Outcome measures
Michels etal. [29] Randomized-controlled
pilot study
10 weeks Dance therapy versus no
intervention
Clinically definitive
diagnosis PD and H&Y
stage 1–4
One class per week, 1 h,
10 weeks
Motor symptoms (UPDRS
III)
Non-motor symptoms
(UPDRS I)
ADLs (UPDRS II)
Balance (BBS)
Timed Up and Go (TUG)
Psychosocial (PDQ-39)
Cognitive function
(MoCA)
Beck Depression Inventory
(BDI)
Fatigue Severity Scale
(FSS)
Visual Analog Fatigue
Scale (VAFS)
De Natale etal. [13] Randomized-controlled
pilot study
10 weeks Tango versus traditional
rehabilitation
Clinically definitive
diagnosis PD
Two classes per week,
1 h, 20 sessions, 10
weeks
Motor symptoms (UPDRS
III)
Balance (BBS)
Endurance (6-MWT)
Timed Up and Go (TUG)
Frontal Assessment Bat-
tery (FAB)
Romenets etal. [23] Randomized-controlled
pilot study
12 weeks Tango versus no interven-
tion
Clinically definitive
diagnosis PD and H&Y
stage 1–3
Two classes per week,
1-h traditional Argen-
tine Tango classes, 20
sessions, 12 weeks
Motor symptoms (UPDRS
III)
Balance (MiniBESTest)
Freezing of gait (FOG_Q)
Timed Up and Go (TUG)
Dual-task Timed Up and
Go Psychosocial (PDQ-
39)
Cognitive function
(MoCA)
Beck Depression Inventory
(BDI) Fatigue Severity
Scale (FSS) Apathy scale
(AS)
Shanahan etal. [31] Randomized-controlled
pilot study
10 weeks Irish set dancing versus
no intervention
Clinically definitive
diagnosis PD and H&Y
stage 1–4
One class per week, 1.5
h + 20 min home dance
programme, 3 times per
week, 10 weeks
Motor symptoms (UPDRS
III) Balance (MiniBEST-
est) Endurance (6-MWT)
Psychosocial (PDQ-39)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
Quality assessment
The quality of the included studies was moderate according
to the Cochrane risk of bias assessment tool. The risk of bias
graph of included studies is shown in Fig.2. The authors’
judgments with justifications are shown in the risk of bias
summary in Fig.3.
Analysis oftheoutcomes
Dance group vs. control group
Movement Disorder Society‑Unified Parkinson’s Disease
Rating Scale I (MDS‑UPDRS I) change The overall effect esti-
mate showed no significant difference between dance group
and control group in UPDRS I at 12 months (MD = 4.06,
95% CI [− 10.21, 2.09], p = 0.2) (Fig. 1A Supplementary).
Pooled results were heterogeneous (p = 0.1, I2 = 63%) and
the heterogeneity could not be resolved.
Movement Disorder Society‑Unified Parkinson’s Disease Rat‑
ing Scale‑II (MDS‑UPDRS II) change The overall effect esti-
mate showed no significant difference between dance group
and control group in UPDRS II at 12 months (MD = − 2.42,
95% CI [− 6.62, 1.78], p = 0.26) (Fig. 1B Supplementary).
Pooled results were homogeneous (p = 0.49, I2 = 0%).
Movement Disorder Society‑Unified Parkinson’s Disease Rat‑
ing Scale III (MDS‑UPDRS III) change The overall effect esti-
mate favored dance over the control in term of UPDRS III
at 3 (MD = − 4.49, 95% CI [− 6.78, − 2.21], p = 0.00001), 6
(MD = − 5.96, 95% CI [− 8.89, − 3.02], p < 0.0001), and 12
months (MD = − 14.58, 95% CI [− 24.76, − 4.4], p = 0.005),
while no significant difference at 10 weeks (MD = 2.03,
95% CI [− 5.22, 1.15], p = 0.21) (Fig.1C Supplementar y).
Pooled results were homogeneous at 10 weeks (p = 0.92,
I2 = 0%), and heterogeneous at 3, 6 and 12 months, respec-
tively (p = 0.05, I2 = 59%), (p = 0.14, I2 = 54%), and
(p = 0.005, I2 = 88). The heterogeneity at 3 months could be
resolved by excluding Romenets etal. [23] (p = 0.13) and t he
effect estimate remained significant (MD = 5.21, 95% CI
[− 7.32, − 3.11], p < 0.00001).
Timed Up and Go test (TUG) change The overall effect
estimate showed that dance significantly reduced TUG
more than the control at 3 months (MD = 1.28, 95% CI
[− 1.99, − 0.57], p < 0.004) (Fig. 2A Supplementary).
Pooled results were homogeneous (p = 0.54, I2 = 0%).
Berg Balance Scale (BBS) change The overall effect esti-
mate significant favored dance over the control at 3 months
(MD = 5.25, 95% CI [3.8, 6.7], p < 0.00001) (Fig.2B Sup-
Table 1 (continued)
Article ID Study design Duration of the study Study arms Criteria of diagnosis Characteristics of ses-
sions
Outcome measures
Solla etal. [25] Randomized-controlled
pilot study
12 weeks Sardinian folk dance ver-
sus no intervention
Clinically definitive
diagnosis PD and H&Y
stage 1–3
Two classes per week,
90 min Sardinian folk
dance classes, 12 weeks
Motor symptoms (UPDRS
III)
Balance (BBS)
Timed Up and Go (TUG)
Endurance (6-MWT)
Psychosocial (PDQ-39)
Cognitive function
(MoCA)
Beck Depression Inventory
(BDI)
Apathy scale (AS)
Volpe etal. [28] Randomized-controlled
pilot study
6 months Irish set dancing versus
physiotherapy
Clinically definitive
diagnosis PD and H&Y
stage 1–3
One class per week, 90
min + 1-h home dance
programme, once a
week, 6 months
Motor symptoms (UPDRS
III) Balance (BBS)
Freezing of gait (FOG_Q)
Psychosocial (PDQ-39)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
Table 2 Baseline characteristics of enrolled patients in included studies
Study ID Country of
origin
Study arms Number
of cases
Age (years) Stage of
the disease
(H&Y)
Hoehn and Yahr Sex (males)
n (%)
Years with PD
Duncan and
Earhart [15]
USA Tango group 26 69.3 (9.69) From 1 to 4 2.6 (0.1) 15 (57.69) 5.8 (5.61)
No interven-
tion (Control)
group
26 69 (7.65) From 1 to 4 2.5 (0.1) 15 (57.69) 7 (5.1)
Duncan and
Earhart [14]
USA Tango group 5 69.6 (6.6) From 2 to 3 2.4 (0.4) 4 (80) 8.7 (7.5)
No interven-
tion (Control)
group
5 69.6 (11) From 2 to 2.5 2.3 (0.3) 4 (80) 7.4 (3.9)
Hackney etal.
[8]
USA Tango group 9 From 2 to 3
Traditional
exercise
10 From 2 to 3
Hackney etal.
[18]
USA Tango group 9 72.6 (6.6) 2.3 (2.1) 6 (66.67) 6.2 (4.5)
Traditional
exercise
10 69.6 (6.641) 2.2 (1.9) 6 (60) 3.3 (1.58)
Hackney and
Earhart [17]
USA Tango group 14 68.2 (5.23) From 1 to 3 2.1 (0.37) 11 (78.57) 6.9 (4.86)
Waltz/foxtrot
group
17 66.8 (9.89) From 1 to 3 2 (0.82) 11 (64.71) 9.2 (6.18)
No interven-
tion (Control)
group
17 66.5 (11.54) From 1 to 3 2.2 (0.82) 12 (70.59) 5.9 (4.12)
Hashimoto etal.
[30]
Japan Dance group 15 67.9 (7) From 2 to 3 2.7 (0.4) 3 (20) 6.3 (4.5)
Exercise group 17 62.7 (14.9) From 2 to 3 2.7 (0.5) 2 (11.76) 7.8 (6.2)
No interven-
tion (Control)
group
14 69.7 (4) From 2 to 4 3 (0.6) 7 (50) 6.9 (4)
Lee etal. [22] Korea Dance group 10 68.4 (2.9) 5 (50)
No interven-
tion (Control)
group
10 70.1 (3.3) 5 (50)
McKee etal.
[24]
Georgia Tango group 24 68.4 (7.5) From 1 to 3 2.5 (3.4) 12 (50) 7 (5.5)
No interven-
tion (Control)
group
9 74.4 (6.5) From 1 to 3 2 (3) 8 (88.89) 7.2 (4.9)
Michels etal.
[29]
USA Dance group 9 66.44 2.1 (3)
No interven-
tion (Control)
group
4 75.5 2.5 (1)
De Natale etal.
[13]
Italy Tango group 9 66 (9.15) 2.5 (0.7) 7 (77.78) 6 (2.07)
Traditional
rehabilita-
tion (Control)
group
7 70 (3.16) 2.6 (0.6) 4 (57.14) 6.33 (2.25)
Romenets etal.
[23]
Canada Tango group 18 63.2 (9.9) From 1 to 3 1.7 (0.6) 12 (66.67) 5.5 (4.4)
No interven-
tion (Control)
group
15 64.3 (8.1) From 1 to 3 2 (0.5) 7 (46.67) 7.7 (4.6)
Shanahan etal.
[31]
Ireland Dance group 20 62.75 (10.25) 1.5 (0.375) 13 (65) 7.375 (4.375)
No interven-
tion (Control)
group[
21 65.75 (8.25) 1.875 (0.375) 13 (61.90) 8.25 (4.75)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
plementary). Pooled results were homogeneous (p = 0.11,
I2 = 55%).
Freezing ofGait (FOG) change The overall effect estimate
showed no significant difference between dance group and
the control group at 3, 6 and 12 months (MD = 0.44,
95% CI [− 2.27, 1.39], p = 0.64), (MD = − 1.44, 95% CI
[− 3.97, 1.1], p = 0.27), and (MD = − 2.69, 95% CI [− 5.6,
0.23], p = 0.07), respectively (Fig. 2C Supplementary).
Pooled results were homogeneous (p = 0.42, I2 = 0%),
(p = 0.19, I2 = 43%) and (p = 0.66, I2 = 0%), respectively.
6‑min walk test (6‑MWT) change The overall effect esti-
mate showed no significant difference between dance
group and control group at 3 months (MD = 95.27,
95% CI [− 31.99, 222.52], p = 0.42), and 12 months
(MD = 19.22, 95% CI [− 32.14, 70.57], p = 0.46) (Fig.3A
Supplementary). Pooled results were homogeneous at 12
months (p = 0.87, I2 = 0%) and heterogeneous at 3 months
(p = 0.0004, I2 = 87%). This heterogeneity was best
resolved by excluding Solla etal. [25] (p = 0.16) and the
effect estimate remained insignificant (MD = 28.19, 95%
CI [− 40.76, 97.14], p = 0.42).
Forward velocity (m/s) change The overall effect esti-
mate showed no significant difference between dance
group and control group at 3 months (MD = 0.02, 95%
CI [− 0.11, 0.15], p = 0.77), and 12 months (MD = 0.10,
95% CI [− 0.04, 0.25], p = 0.24) (Fig.3B Supplementary).
Pooled results were homogeneous (p = 0.66, I2 = 0%) and
(p = 0.90, I2 = 0%).
Backward velocity (m/s) change The overall effect esti-
mate showed no significant difference between dance
group and control group at 3 months (MD = 0.07, 95%
CI [− 0.10, 0.24], p = 0.43), and 12 months (MD = 0.04,
95% CI [− 0.10, 0.18], p = 0.59) (Fig.3C Supplementary).
Pooled results were homogeneous (p = 0.63, I2 = 0%) and
(p = 1.0, I2 = 0%).
Mini‑BES test change The overall effect estimate sig-
nificantly difference between dance over the control at 3
months (MD = 2.68, 95% CI [0.82, 4.54], p = 0.005), and
12 months (MD = 4.91, 95% CI [2.69, 7.12], p = 0.007)
(Fig.4A Supplementary). Pooled results were homogene-
ous (p = 0.58, I2 = 0%) and (p = 0.49, I2 = 0%).
Table 2 (continued)
Study ID Country of
origin
Study arms Number
of cases
Age (years) Stage of
the disease
(H&Y)
Hoehn and Yahr Sex (males)
n (%)
Years with PD
Solla etal. [25] Italy Dance group 10 67.8 (5.9) ≤ 3 2.1 (0.6) 6 (60) 4.4 (4.5)
No interven-
tion (Control)
group
10 67.1 (6.3) ≤ 3 2.3 (0.4) 7 (70) 5 (2.9)
Volpe etal. [28] Italy Dance group 12 61.6 (4.5) From 0 to 2.5 2.2 (0.4) 7 (58.33) 9 (3.6)
Physiotherapy 12 65 (5.3) From 0 to 2.5 2.2 (0.4) 6 (50) 8.9 (2.5)
Fig. 2 The risk of bias graph
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
Beck Depression Inventory (BDI) change The overall effect
estimate showed no significant difference between dance
group and the control group at 3 months (MD = 3.34, 95%
CI [− 10.1, 3.33], p = 0.33) (Fig.4b Supplementary). Pooled
results were heterogeneous (p = 0.007, I2 = 86%) and the
heterogeneity could not be resolved.
Apathy Scale (AS) change The overall effect estimate
showed that dance significantly reduced AS more than the
control at 3 months (MD = 3.37, 95% CI [− 5.86, 0.88],
p = 0.008) (Fig. 4C Supplementary). Pooled results were
homogenous (p = 0.29, I2 = 20%).
Montreal Cognitive Assessment (MoCA) change The over-
all effect estimate showed that dance significantly increased
MoCA more than the control at 3 months (MD = 1.1, 95%
CI [0.36, 1.85], p = 0.004) (Fig.4D Supplementary). Pooled
results were homogeneous (p = 0.69, I2 = 0%).
Parkinson’s Disease Questionnaire‑39 (PDQ‑39) The over-
all effect estimate showed no significant difference between
dance group and the control group at 10 weeks and 3
months (MD = 1.75, 95% CI [− 10.17, 6.66], p = 0.68) and
(MD = 0.83, 95% CI [− 5.98, 7.64], p = 0.81), respectively
(Fig.5A Supplementary). Pooled results were homogenous
(p = 0.68, I2 = 0%) and (p = 0.99, I2 = 0%), respectively.
Sensitivity analysis using azero‑correlation coefficient We
calculate the change with correlation coefficient equals zero
and significance did not change except at 3 months in three
scales: Mini-BES test; Apathy Scale (AS); and Montreal
Cognitive Assessment (MoCA) which became not significant
(MD = 2.69, 95% CI [− 0.29, 5.67], p = 0.08), (MD = 3.28,
95% CI [− 6.59, 0.04], p = 0.05) and (MD = 1.12, 95% CI
[− 0.66, 2.9], p = 0.22), respectively.
Dance group vs. exercise group
Movement Disorder Society‑Unified Parkinson’s Disease
Rating Scale III (MDS‑UPDRS III) change The pooled mean
difference showed no significant difference between dance
group and the exercise group at 3 months (MD = 0.17,
95% CI [− 1.79, 1.45], p = 0.84) (Fig. 5B Supplementary).
Pooled results were homogeneous (p = 0.73, I2 = 0%).
Timed Up and Go test (TUG) change The pooled mean
difference showed that dance significantly reduced TUG
more than the control at 3 months (MD = 1.27, 95% CI
[− 2.27, − 0.27], p = 0.01) (Fig.5C Supplementary). Pooled
results were homogeneous (p = 0.26, I2 = 25%).
Berg Balance Scale (BBS) change The pooled mean differ-
ence showed that dance significantly increased BBS more
than the control at 3 months (MD = 2.06, 95% CI [0.7, 3.42],
p = 0.003). (Fig. 5D Supplementary) Pooled results were
homogeneous (p = 0.17, I2 = 43%).
Gait/Walking Velocity (m/s) change The pooled mean dif-
ference showed no significant difference between dance
group over the exercise group at 3 months (MD = 0.00, 95%
Fig. 3 The risk of bias summary
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
CI [-0.1, 0.1], p = 1.00) (Fig. 6A Supplementary). Pooled
results were homogeneous (p = 1.00, I2 = 0%).
Frontal Assessment Battery change The pooled mean dif-
ference showed that dance significantly increased Fron-
tal Assessment Battery more than the control at 3 months
(MD = 1.64, 95% CI [0.11, 3.17], p = 0.04) (Fig. 6B Sup-
plementary). Pooled results were homogeneous (p = 0.36,
I2 = 0%).
6‑min walk test (6‑MWT) change The pooled mean differ-
ence showed no significant difference between dance group
and the exercise group at 3 months (MD = 23.54, 95% CI
[− 29.63, 76.7], p = 0.8). (Fig. 6C Supplementary) Pooled
results were homogeneous (p = 0.59, I2 = 0%).
Freezing ofgait (FOG) change The pooled mean difference
showed no significant difference between dance group and
the exercise group at 3 months (MD = 0.21, 95% CI [− 1.38,
1.8], p = 0.39) (Fig. 6D Supplementary). Pooled results
were homogeneous (p = 0.38, I2 = 0%).
Sensitivity analysis using azero‑correlation coefficient We
calculate the change with correlation coefficient equals
zero and significance did not change except at 3 months in
TUG, BBS and Frontal Assessment Battery, which became
not significant (MD = 1.28, 95% CI [− 2.72, 0.15],
p = 0.08), (MD = 2.12, 95% CI [− 0.21, 4.45], p = 0.07) and
(MD = 1.74, 95% CI [− 0.12, 3.6], p = 0.07), respectively.
Discussion
We identified 14 clinical trials assessing the effect of dance
in PD patients. Compared to control (no dance), dance
showed significant improvement in MDS-UPDRS III at
3, 6, and 12 months, TUG at 3 months, BBS at 3 months,
Mini-BES test at 3 and 12 months, AS at 3 months, and
MoCA at 3 months. However, in term of MDS-UPDRS I at
12 months, MDS-UPDRS II at 12 months, MDS-UPDRS III
at 10 weeks, FOG at 3, 6, and 12 months, 6-MWT at 3 and
12 months, forward velocity at 3 and 12 months, backward
velocity at 3 and 12 months, BDI at 3 months and PDQ-
39 at 10 weeks and 3 months, results were not statistically
significant.
Compared to exercise, dance showed significant superior-
ity at 3 months in TUG, BBS, and Frontal Assessment Bat-
tery. However, in terms of MDS-UPDRS III, Gait/Walking
Velocity, 6-MWT, and FOG at 3 months, results were not
statistically significant.
The motor subscale UPDRS III was reduced signifi-
cantly at different time points by dance. Previous stud-
ies support this result [2, 3, 27, 3235], especially after
6–12 months of dance practicing [15]. Mak etal. reported
that patients need a training period of at least 6 months
to improve UPDRS III scores [36]. Regarding UPDRS I
and UPDRS II, dance showed insignificant results over the
control which can be interpreted as they are assessed by
self-answered questionnaires by untrained patients, unlike
UPDRS III [15]. Berg Balance Scale (BBS) evaluates per-
son’s balance [37] with a minimal 5-point change to be
detected clinically in PD patients [38] as resulted from
dance compared to control.
Regarding Freezing of Gait (FOG) Questionnaire, some
previous studies, including meta-analysis, reported signifi-
cant improvement with dance therapy [15, 26, 39, 40], while
our results were insignificant [23]. In addition to dance,
visual and auditory cues could improve FOG. [41] Previous
studies showed a significant improvement in 6-MWT with
dance [26, 42], but our result was insignificant. However,
improvement in balance may influence 6-MWT performance
[43].
TUG test assesses functional mobility or neuromotor per-
formance [44]. Dance therapy, especially tango, revealed a
significant improvement of the TUG test over other exercise
or no intervention. Previous studies have reported similar
results [2, 39, 45].
AS, which used to assess mental symptoms [46, 47] was
significantly improved, as stated by our study and a previous
study [32]. The PDQ-39 assesses the quality of life (QoL)
in PD patients [48]. Exercise adherence and QoL were
positively linked [49]; dance also showed a positive effect
regarding the QoL [50, 51]. However, our study showed
insignificant results, which confirm Romenets etal. results
[23]. Our study confirmed the previous findings that dance
has a significant positive effect on cognition evaluated by
MOCA. Moreover, FAB is considered a cognitive meas-
ure [52]. Batson etal. reported a significant FEB improve-
ment with dance [9], while our study reported insignificant
results. A previous study reported a significant increase in
the forward walking velocity and insignificant increases in
the backward walking velocity after 1 year of dance therapy
[15], in contrast, our study showed insignificant results for
both.
Despite the reported positive effect of dance on depres-
sion that measured using BDI [51], our results were insig-
nificant. Dance combined with adjuvants such as external
cues as auditory or visual that derived from the music or the
partner may add more benefits on different parameters [50,
53, 54]. Music therapy alone improves mood, quality of life,
motor function, and activities of daily living (ADL) [55, 56].
Basal ganglia are the most affected structures in PD. Using
positron emission tomography of the healthy adult brain,
basal ganglia appeared among active sites during dancing
[57]. Hence, there may be a clinical relevance between dance
and basal ganglia activity on PD patients.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
Dance, especially tango type, is a physical and cogni-
tive challenging act; it contains multi-directional move-
ment with variable rhythm and speed, it may help increas-
ing body flexibility, muscle strength, and stretch [10, 26,
42, 42, 58]. All these aspects exert a positive effect on
different aspects: balance [10], gait [55], functional mobil-
ity [15, 39, 59], cognition [60, 61], depression, apathy,
quality of life [51], and could affect disease progression.
Moreover, physical activity promotes dopamine release
and may offer neuroprotection [62]. Due to its nature as
a social activity, dance may also help against the social
isolation of PD patients [63]. To better achieve the benefits
of dance, patients should consider regular practicing [33].
In our study, we aimed to synthesize high-quality
evidence, so we performed our work according to the
Cochrane Handbook of systematic reviews and followed
the PRISMA checklist. We included all randomized con-
trolled trials. We performed a subgroup analysis of dif-
ferent durations and scores and a sensitivity analysis to
ensure that none of the individual studies included in the
analysis significantly affected the overall effect estimate.
We analyzed more than one scale or test for the same out-
come. We solved the detected heterogeneity by sensitivity
analysis, and the significance did not change.
Despite having many strength points, some limitations
are present: (1) studies enrolled older people, making
it challenging to apply the study findings in a different
age group. (2) Various characteristics of dance interven-
tions and the type of dance (tango and Irish dance) and
lack of detailed information about the sessions’ nature.
(3) Our study only included trials published in English;
future studies prefer to include other languages for a bet-
ter global estimate. (4) The publication bias could not
be assessed because of a relatively small number of the
included studies.
More trials with larger sample size, detailed description,
tailored design of sessions according to the patient state, and
more extended study periods are needed to achieve further
clear evidence. In addition, clear protocols in the new trials
will achieve better scientific accuracy.
We conclude that compared to other types of exercise or
no activity, dance improves the symptoms and outcomes in
patients with PD, especially motor symptoms; dance also
has positive effects on balance, functional mobility, and
cognition.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s00415- 021- 10589-4.
Acknowledgements We would like to thank our colleagues in the
International Medical Research Association (IMedRA) for their
encouragement.
Funding None.
Declarations
Conflicts of interest None.
References
1. Samii A, Nutt JG, Ransom BR (2004) Parkinson’s disease. Lancet
363(9423):1783–1793
2. dos Santos DM, Komeroski IG, Monteiro EP, Costa RR, Haas
AN (2018) Effects of dance practice on functional mobility, motor
symptoms and quality of life in people with Parkinson’s disease:
a systematic review with meta-analysis. Aging Clin Exp Res
30(7):727–735
3. Lötzke D, Ostermann T, Büssing A (2015) Argentine tango in
Parkinson disease—a systematic review and meta-analysis. BMC
Neurol 15(1):226
4. Gallo PM, McIsaac TL, Garber CE (2014) Walking economy
during cued versus non-cued self-selected treadmill walking in
persons with Parkinson’s disease. J Parkinsons Dis. 4(4):705–716
5. Marinho MS, de Chaves PM, de Tarabal TO (2014) Dupla-tarefa
na doença de Parkinson: uma revisão sistemática de ensaios
clínicos aleatorizados. Rev Bras Geriatr Gerontol 17(1)
6. Poewe W, Mahlknecht P (2009) The clinical progression of Par-
kinson’s disease. Parkinsonism Relat Disord 15(Suppl 4):S28–S32
7. Heiberger L (2011) Impact of a weekly dance class on the func-
tional mobility and on the quality of life of individuals with Par-
kinson’s disease. Front Aging Neurosci. 3:14
8. Hackney ME, Kantorovich S, Levin R, Earhart GM (2007) Effects
of tango on functional mobility in Parkinsonʼs disease: a prelimi-
nary study. J Neurol Phys Ther 31(4):173–179
9. Batson G (2010) Validating a dance-specific screening test for
balance: preliminary results from multisite testing. Med Probl
Perform Art 25(3):110–115
10. Earhart GM (2009) Dance as therapy for individuals with Parkin-
son disease. Eur J Phys Rehabil Med 45(2):231–238
11. Dhami P, Moreno S, DeSouza JFX (2015) New framework for
rehabilitation – fusion of cognitive and physical rehabilitation:
the hope for dancing. Front Psychol. 5:1478
12. Allen JL, McKay JL, Sawers A, Hackney ME, Ting LH (2017)
Increased neuromuscular consistency in gait and balance after
partnered, dance-based rehabilitation in Parkinson’s disease. J
Neurophysiol 118(1):363–373
13. De Natale ER, Paulus KS, Aiello E, Sanna B, Manca A, Sot-
giu G etal (2017) Dance therapy improves motor and cognitive
functions in patients with Parkinson’s disease. Neuro Rehabil
40(1):141–144
14. Duncan RP, Earhart GM (2014) Are the effects of community-
based dance on Parkinson disease severity, balance, and functional
mobility reduced with time? A 2-year prospective pilot study. J
Altern Complement Med 20(10):757–763
15. Duncan RP, Earhart GM (2012) Randomized controlled trial of
community-based dancing to modify disease progression in Par-
kinson disease. Neurorehabil Neural Repair 26(2):132–143
16. Foster ER, Golden L, Duncan RP, Earhart GM (2013) Commu-
nity-based argentine tango dance program is associated with
increased activity participation among individuals with Parkin-
son’s disease. Arch Phys Med Rehabil 94(2):240–249
17. Hackney ME, Earhart GM (2009) Short duration, intensive tango
dancing for Parkinson disease: an uncontrolled pilot study. Com-
plement Ther Med 17(4):203–207
18. Hackney ME, Kantorovich S, Earhart GM (2007) A study on the
effects of argentine tango as a form of partnered dance for those
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
with Parkinson disease and the healthy elderly. Am J Danc Ther
29(2):109–127
19. Higgins JP, Green S (2008) Cochrane handbook for systematic
reviews of interventions. Wiley, Chichester
20. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group
(2009) Preferred reporting items for systematic reviews and
meta-analyses: the PRISMA statement. PLoS Med 6(7):97
21. Stuck AE, Rubenstein LZ, Wieland D, Vandenbroucke JP, Irwig
L, Macaskill P etal (1998) Bias in meta-analysis detected by a
simple, graphical. BMJ 316(7129):469–469
22. Lee N-Y, Lee D-K, Song H-S (2015) Effect of virtual reality
dance exercise on the balance, activities of daily living, and
depressive disorder status of Parkinson’s disease patients. J Phys
Ther Sci 27(1):145–147
23. Rios Romenets S, Anang J, Fereshtehnejad SM, Pelletier A,
Postuma R (2015) Tango for treatment of motor and non-motor
manifestations in Parkinson’s disease: a randomized control
study. Complement Ther Med 23(2):175–184. https:// doi. org/
10. 1016/j. ctim. 2015. 01. 015
24. McKee KE, Hackney ME (2013) The effects of adapted tango
on spatial cognition and disease severity in Parkinson’s disease.
J Mot Behav 45(6):519–529
25. Solla P, Cugusi L, Bertoli M, Cereatti A, Della Croce U, Pani
D etal (2019) Sardinian folk dance for individuals with Par-
kinson’s disease: a randomized controlled pilot trial. J Altern
Complement Med 25(3):305–316
26. Hackney M, Earhart G (2009) Effects of dance on movement
control in Parkinson’s disease: a comparison of Argentine tango
and American ballroom. J Rehabil Med 41(6):475–481
27. Hackney ME, Kantorovich S, Levin R, Earhart GM (2007)
Effects of tango on functional mobility in Parkinson’s disease:
a preliminary study. J Neurol Phys Ther 31(4):173–179
28. Volpe D, Signorini M, Marchetto A, Lynch T, Morris ME
(2013) A comparison of Irish set dancing and exercises for
people with Parkinson’s disease: a phase II feasibility study.
BMC Geriatr. 13(1):54
29. Michels K, Dubaz O, Hornthal E, Bega D (2018) “Dance Ther-
apy” as a psychotherapeutic movement intervention in Parkin-
son’s disease. Complement Ther Med 40:248–252
30. Hashimoto H, Takabatake S, Miyaguchi H, Nakanishi H, Naitou
Y (2015) Effects of dance on motor functions, cognitive func-
tions, and mental symptoms of Parkinson’s disease: a quasi-
randomized pilot trial. Complement Ther Med 23(2):210–219.
https:// doi. org/ 10. 1016/j. ctim. 2015. 01. 010
31. Shanahan J, Morris ME, Bhriain ON, Volpe D, Lynch T, Clif-
ford AM (2017) Dancing for Parkinson disease: a randomized
trial of Irish set dancing compared with usual care. Arch Phys
Med Rehabil 98(9):1744–1751. https:// doi. org/ 10. 1016/j. apmr.
2017. 02. 017
32. Tang L, Fang Y, Yin J (2019) The effects of exercise interven-
tions on Parkinson’s disease: a Bayesian network meta-analysis.
J Clin Neurosci Off J Neurosurg Soc Australas 70:47–54
33. Sharp K, Hewitt J (2014) Dance as an intervention for people
with Parkinson’s disease: a systematic review and meta-analy-
sis. Neurosci Biobehav Rev 47:445–456
34. Michels K, Dubaz O, Hornthal E, Bega D (2018) “Dance Ther-
apy” as a psychotherapeutic movement intervention in Parkin-
son’s disease. Complement Ther Med. 40:248–252. https:// doi.
org/ 10. 1016/j. ctim. 2018. 07. 005
35. Shanahan J, Morris ME, Bhriain ON, Saunders J, Clifford AM
(2015) Dance for people with Parkinson disease: what is the
evidence telling us? Arch Phys Med Rehabil 96(1):141–153
36. Mak MK, Wong-Yu IS, Shen X, Chung CL (2017) Long-term
effects of exercise and physical therapy in people with Parkin-
son disease. Nat Rev Neurol 13(11):689–703
37. Qutubuddin AA, Pegg PO, Cifu DX, Brown R, McNamee S,
Carne W (2005) Validating the Berg Balance Scale for patients
with Parkinson’s disease: a key to rehabilitation evaluation. Arch
Phys Med Rehabil. 86(4):789–792
38. Steffen T, Seney M (2008) Test-retest reliability and mini-
mal detectable change on balance and ambulation tests, the
36-Item Short-Form Health Survey, and the Unified Parkinson
Disease Rating Scale in people with parkinsonism. Phys Ther.
88(6):733–746
39. Kalyani HHN, Sullivan KA, Moyle G, Brauer S, Jeffrey ER, Kerr
GK (2019) Impacts of dance on cognition, psychological symp-
toms and quality of life in Parkinson’s disease. NeuroRehabilita-
tion 45(2):273–283
40. Brichetto G, Pelosin E, Marchese R, Abbruzzese G (2006) Evalu-
ation of physical therapy in parkinsonian patients with freezing of
gait: a pilot study. Clin Rehabil. 20(1):31–35
41. Jiang Y, Norman KE (2006) Effects of visual and auditory cues
on gait initiation in people with Parkinson’s disease. Clin Rehabil.
20(1):36–45
42. Hackney ME, Earhart GM (2010) Effects of dance on balance and
gait in severe Parkinson disease: a case study. Disabil Rehabil.
32(8):679–684
43. Falvo MJ, Earhart GM (2009) Six-minute walk distance in persons
with Parkinson disease: a hierarchical regression model. Arch
Phys Med Rehabil. 90(6):1004–1008
44. Morris S, Morris ME, Iansek R (2001) Reliability of measure-
ments obtained with the Timed “Up, & Go” Test in people with
Parkinson disease. Phys Ther. 81(2):810–818
45. Stegemöller EL, Nocera J, Malaty I, Shelley M, Okun MS,
Hass CJ (2014) Timed up and go, cognitive, and quality-of-
life correlates in Parkinson’s disease. Arch Phys Med Rehabil
95(4):649–655
46. Marin RS, Biedrzycki RC, Firinciogullari S (1991) Reliabil-
ity and validity of the apathy evaluation scale. Psychiatry Res.
38(2):143–162
47. Okada K, Kobayashi S, Yamagata S, Takahashi K, Yamaguchi S.
Poststroke apathy and regional cerebral blood flow. Stroke. 1997;
48. Soh SE, McGinley J, Morris ME (2011) Measuring quality of life
in Parkinson’s disease: Selection of-an-appropriate health-related
quality of life instrument. Physiotherapy 97(1):83–89
49. Thomas DR (2001) The critical link between health-related qual-
ity of life and age-related changes in physical activity and nutri-
tion. J Gerontol A Biol Sci Med Sci 56(10):M599–M602
50. Hackney ME, Earhart GM (2009) Health-related quality of life
and alternative forms of exercise in Parkinson disease. Park Relat
Disord. 15(9):644–648
51. McNeely ME, Duncan RP, Earhart GM (2015) Impacts of dance
on non-motor symptoms, participation, and quality of life in Par-
kinson disease and healthy older adults. Maturitas 82(4):336–341
52. Dubois B, Slachevsky A, Litvan I, Pillon B (2000) The
FAB: A frontal assessment battery at bedside. Neurology
55(11):1621–1626
53. Chuma T, Faruque Reza M, Ikoma K, Mano Y (2006) Motor
learning of hands with auditory cue in patients with Parkinson’s
disease. J Neural Transm. 113(2):175–185
54. Nieuwboer A, Feys P, de Weerdt W, Dom R (1997) Is using a
cue the clue to the treatment of freezing in Parkinson’s disease?
Physiother Res Int. 2(3):125–132
55. Pereira APS, Marinho V, Gupta D, Magalhães F, Ayres C, Teixeira
S (2019) Music therapy and dance as gait rehabilitation in patients
with Parkinson disease: a review of evidence. J Geriatr Psychiatry
Neurol 32(1):49–56
56. Pacchetti C, Mancini F, Aglieri R, Fundaró C, Martignoni E,
Nappi G (2000) Active music therapy in Parkinson’s disease: an
integrative method for motor and emotional rehabilitation. Psy-
chosom Med 62(3):386–393
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Journal of Neurology
1 3
57. Brown S, Martinez MJ, Parsons LM (2006) The neural basis of
human dance. Cereb Cortex. 16(8):1157–1167
58. Hackney ME, Earhart GM (2009) Backward walking in Parkin-
son’s disease. Mov Disord 24(2):218–223
59. Hokkanen L, Rantala L, Remes AM, Härkönen B, Viramo P,
Winblad I (2008) Dance and movement therapeutic methods in
management of dementia: a randomized, controlled study. J Am
Geriatr Soc 56(4):771–772
60. Subramanian I (2017) Complementary and alternative medicine
and exercise in nonmotor symptoms of Parkinson’s disease. Int
Rev Neurobiol 134:1163–1188
61. Keus SHJ, Bloem BR, Hendriks EJM, Bredero-Cohen AB, Mun-
neke M (2007) Evidence-based analysis of physical therapy in
Parkinson’s disease with recommendations for practice and
research. Mov Disord 22(4):451–460
62. Hou L, Chen W, Liu X, Qiao D, Zhou F-M (2017) Exercise-
induced neuroprotection of the nigrostriatal dopamine system in
Parkinson’s disease. Front Aging Neurosci. 9:358
63. Bognar S, DeFaria AM, O’Dwyer C, Pankiw E, Simic Bogler J,
Teixeira S etal (2017) More than just dancing: experiences of
people with Parkinson’s disease in a therapeutic dance program.
Disabil Rehabil. 39(11):1073–1078
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
... Evidence from prior studies: Several studies have reported that dance is associated with improved motor scores on the Movement Disorders Society UPDRS part III (MDS-UPDRS III), functional mobility as measured by the Timed Up & Go, gait speed, balance measured by the MiniBest Test, postural control, and falls [60,[69][70][71][72][73][74]. In a meta-analysis, Hasan et al. [75] found that dance compared to exercise improved the MDS-UPDRS III, Timed Up & Go, Berg Balance Scale, and the MiniBest Test, but found no difference with respect to freezing of gait and the 6min walk test change. Dance was found to influence cognitive functions [70,[76][77][78], including executive function, episodic memory, spatial awareness, cognitive switching, and dual tasking [69,76,77]. ...
... Dance was found to influence cognitive functions [70,[76][77][78], including executive function, episodic memory, spatial awareness, cognitive switching, and dual tasking [69,76,77]. Associations with improved mental health, including anxiety, depression, apathy, and emotional and social well-being, were also reported in most studies, although the evidence is mixed [71,[74][75][76][78][79][80][81]. Results from a cohort study of 49 individuals living with PD suggested that dance improves self-esteem as measured by the Rosenberg Self-Esteem Score and health-related quality of life as measured by the PDQ-39 (Fig. 4) [74]. ...
Article
Full-text available
Parkinson’s disease (PD) is a chronic and complex neurodegenerative disorder. Conventional pharmacological or surgical therapies alone are often insufficient at adequately alleviating disability. Moreover, there is an increasing shift toward person-centered care, emphasizing the concept of “living well”. In this context, arts-based interventions offer great promise, functioning as platforms for creative expression that could provide novel mechanisms to promote quality of life. Here we present a qualitative review of arts-based interventions for PD, including music, dance, drama, visual arts, and creative writing. For each, we discuss their applications to PD, proposed mechanisms, evidence from prior studies, and upcoming research. We also provide examples of community-based projects. Studies to date have had relatively small sample sizes, but their findings suggest that arts-based interventions have the potential to reduce motor and non-motor symptoms. They may also empower people with PD and thereby address issues of self-esteem, foster personal problem-solving, and augment holistic well-being. However, there is a paucity of research determining optimal dosage and symptom-specific benefits of these therapies. If art were a drug, we would have to perform appropriately powered studies to provide these data before incorporating it into routine patient care. We therefore call for further research with properly designed studies to offer more rigorous and evidence-based support for what we intuitively think is a highly promising approach to support individuals living with PD. Given the possible positive impact on people’s lives, arts-based approaches merit further development and, if proven to be effective, systematic inclusion within integrated management plans.
... Vários programas de exercício físico a nível comunitário específicos para esta população foram estudados como uma estratégia de cuidados a longo prazo (Ernst et al., 2023;Radder et al., 2020). Podem ser referidos a título de exemplo os programas de dança (Duncan & Earhart, 2012;Hasan et al., 2022;Jola et al., 2022), tai chi, qigong e yoga (Garcia-Munoz et al., 2023;Liu et al., 2019), caminhada nórdica (Cugusi et al., 2017;Granziera, et al., 2021), exercício aquático (Perez de la Cruz, 2017), boxe (Domingos et al., 2019b;2022c), ténis de mesa (ping-pong) (Inoue et al., 2021), trampolins (Domingos et al., 2019;, pilates (Suarez-Iglesias et al., 2019), além dos disponibilizados à distância com recursos a plataformas digitais (programas online), como por exemplo exercícios com dança (Bek et al., 2022) e dupla tarefa motora e cognitiva (Domingos et al, 2022d). A pandemia de COVID-19 acelerou o desenvolvimento de programas de exercícios especializados que podem ser realizados em casa, desenvolvidos digitalmente através de meios de comunicação ao vivo ou pré-gravados, mas ainda pouco se sabe sobre como os participantes podem interagir e beneficiar destes recursos, pelo que as barreiras à participação devem ser identificadas de forma a desenvolver estratégias que permitam eliminar ou mitigar o seu efeito. ...
... The primary source of guidelines for clinical practice are systematic reviews and meta-analyses [14]. Over the past ten years, several systematic reviews [15][16][17][18][19][20] and meta-analyses [11,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] have shown the efficacy of concomitant in-person dance-based interventions for individuals with PD and compared these to pharmacological usual care alone or other types of physical exercise. A meta-analysis published in 2020 showed a significant improvement in quality of life after dance-based intervention in individuals diagnosed with PD (SMD = −0.30; 5 RCTs) compared to pharmacological usual care [36]. ...
Article
Full-text available
Objective(s) To determine (1) the quality of systematic reviews about dance-based intervention in individuals with Parkinson’s disease (PD) and (2) standard evidence for dance-based intervention efficacy based on the categories of The International Classification of Functioning, Disability, and Health (ICF) from the World Health Organization’s (WHO). Methods The data source included MEDLINE, PUBMED, Embase, Scopus, CENTRAL (Cochrane Library), CINAHL, PEDro, SPORTDiscus, APA PsycNet (APA PsycINFO), LILACS, SciELO, and AMED. Pairs of independent reviewers screened titles, abstracts, and full texts of eligible studies by using the software Covidence. Criteria included: systematic review designs; individuals with PD; dance-based interventions aimed to change critical PD symptoms matched to IFC domains (body functions, activities, and participation). Independent reviewers extracted information regarding the characteristics of all systematic reviews included and appraised quality using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Randomized controlled trials and their risk of bias were identified within each review and were used to perform an updated pairwise meta-analysis. Results Of the 571 manuscripts screened, 55 reviews met the inclusion criteria. The overall confidence in the results of 38 reviews (69%) was rated as ’critically low,’ nine (9%) as ’low,’ one (2%) as ’moderate,’ while seven of 55 reviews (13%) were rated as ’high’. Dance associated with pharmacological usual care is better than pharmacological usual care alone for essential components of ICF, such as motor symptoms severity (body function), depressive symptoms (body function), balance (body function and activity), and functional mobility (activity), but not for gait distance (activity) and quality of life (participation). Dance is also superior to multimodal exercise to improve balance. Conclusions Clinicians and people with PD can refer to this paper for a summary of high-quality reviews and the overall evidence supporting dance as an adjunct rehabilitation. This umbrella review not only underscores the therapeutic potential of dance but also reinforces the use of arts-based approaches into healthcare practices for people with neurological conditions.
Article
Dance or rhythmic movement-based training has demonstrated significant efficacy in addressing a range of motor and cognitive deficits associated with neurodegenerative diseases like Parkinson's and Alzheimer's diseases. Leveraging both human and non-human animal behavioral and neurobiological evidence, I hypothesize a possible untapped role of dance training in mitigating impairments in the motor control of speech, a complex sensorimotor behavior affected in these conditions. Here, this hypothesis is supported by an in-depth examination of motor speech deficits in Parkinson's and Alzheimer's diseases, at a behavioral, physiological, and neural level. Additionally, literature on the impact of dance training on behaviors and brain pathways possibly relevant to speech motor control in populations with neurodegenerative diseases is thoroughly reviewed. Synthesizing these findings, I propose repurposing dance as a novel treatment for motor speech deficits and outline specific experiments to test this hypothesis. By comprehensively investigating the full spectrum of the effects of a motor-based training, i.e., dance, on often overlooked motor-based behaviors, such as speech, we may uncover novel therapeutic avenues of a practice that has already shown promising implications.
Article
Full-text available
As cases of Parkinson’s Disease rise in Europe, there is an urgency to reduce its burden on those living with Parkinson’s and on health services. Whilst the search for a cure is on-going, and the use of medication is an on-going experiment for many people, the engagement with non-pharmaceutical interventions is imperative. Under this topic, the 2024 Policy Framework to Reduce the Burden of Neurodegenerative Diseases in Europe and Beyond notes the important role that non-pharmaceutical interventions play. In exploring in detail the contribution of arts practices, in particular dancing, this paper argues that they have a potentially impactful role to play as non-pharmaceutical interventions for people with Parkinson’s. This discursive article critically engages with current research discussing what factors are important to be considered for the integration of arts practices – in particular dancing - in a successful implementation of a roadmap for better relieving the burden of Parkinson’s. Key points laid out include: It needs to be recognised that arts practices are heterogenous and do not have treatment goals, but do emphasise what the person brings to a process. The lack of standardisation and goals are to be embraced, rather than criticised for being difficult to measure. The evidence around dancing for people with Parkinson’s is not conclusive, yet largely positively framed. To increase understanding of what quality of life and relief of burden feels like to people with Parkinson’s - and so greater success in implementing arts practices as NPIs in a Europe-wide policy - a broader range of studies from different disciplines need to be used in researching or reviewing this area of work; researchers need to actively listen to what matters to people with Parkinson’s and be critically reflective of their own studies consequently. The Action Plan for non-pharmacological interventions in the Policy Framework is welcomed. Policy implementation needs to happen in consultation with dance organisations operating strategically around Europe, with people with Parkinson’s and with those who are underrepresented in Parkinson’s initiatives and dance activity.
Article
Background and purpose Parkinson's disease (PD) causes a decline in motor function, cognitive decline, and impacts the mental health of patients. Due to the high cost and side effects of conventional treatments, the medical community has begun to explore safer and more cost-effective alternative therapies. In this context, arts therapies have gained increasing attention as innovative treatments. This review plans to explore the role and potential of various arts therapies in the rehabilitation of PD patients by analyzing existing literature and case studies. Methods This review comprehensively searched the literature in several databases, including PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure, to assess the effectiveness of different arts therapies in the rehabilitation of patients with PD. Results From 3440 articles screened, 16 met the inclusion criteria. These studies included a variety of therapies, including music, meditation, yoga, art, dance, theatre, video games and play therapy. These different types of arts therapies had a positive impact on the motor, psychological and cognitive rehabilitation of PD patients, respectively. Conclusion The existing literature highlights the great potential of arts therapies in the rehabilitation of people with PD, further confirming the efficacy of arts therapies in enhancing the motor, psychological and cognitive rehabilitation process of people with PD. In addition, this review identifies research gaps in the use of color therapy in PD rehabilitation and highlights the need for further exploration of various arts therapies modalities.
Article
Full-text available
Background: Gait impairments related to Parkinson's disease (PD) include variable step length and decreased walking velocity, which may result in poorer walking economy. Auditory cueing is a common method used to improve gait mechanics in PD that has been shown to worsen walking economy at set treadmill walking speeds. It is unknown if auditory cueing has the same effects on walking economy at self-selected treadmill walking speeds. Objectives: To determine if auditory cueing will affect walking economy at self-selected treadmill walking speeds and at speeds slightly faster and slower than self-selected. Methods: Twenty-two participants with moderate PD performed three, 6-minute bouts of treadmill walking at three speeds (self-selected and ± 0.22 m·sec⁻¹). One session used cueing and the other without cueing. Energy expenditure was measured and walking economy was calculated (energy expenditure/power). Results: Poorer walking economy and higher energy expenditure occurred during cued walking at a self-selected and a slightly faster walking speed, but there was no apparent difference at the slightly slower speed. Conclusion: These results suggest that potential gait benefits of auditory cueing may come at an energy cost and poorer walking economy for persons with PD at least at some treadmill walking speeds.
Article
Full-text available
Background: While dance may improve motor features in Parkinson's disease (PD), it is not yet clear if the benefits extend to non-motor features. Objective: To determine whether dance classes based on Dance for PD ®, improve cognition, psychological symptoms and Quality of Life (QoL) in PD. Methods: Participants were allocated to a Dance Group (DG; n = 17) or Control Group (CG: n = 16). Participants had early-stage PD (Hoehn & Yahr: DG = 1.6±0.7, CG = 1.5±0.8) with no cognitive impairment (Addenbrooke's score: DG = 93.2±3.6, CG = 92.6±4.3). The DG undertook a one-hour class, twice weekly for 12 weeks, while the CG had treatment as usual. Both groups were assessed for disease severity (MDS-UPDRS), cognition (NIH Toolbox ® cognition battery, Trail Making Test), psychological symptoms (Hospital Anxiety and Depression Scale, MDS-UPDRS-I) and QoL (PDQ-39, MDS-UPDRS-II). Results: Group comparison of pre-post change scores showed that selected cognitive skills (executive function and episodic memory), psychological symptoms (anxiety and depression) as well as QoL (PDQ-39 summary index) were significantly improved by the intervention (DG > CG, p's < 0.05, Cohen's d > 0.8). Discussions and conclusion: Dance classes had a clear benefit on psychological symptoms, QoL and a limited cognitive benefit. Follow-up assessment is required to confirm the durability of these effects.
Article
Full-text available
Aim:: This review aims to demonstrate the efficiency of music and dance for gait improvement and symptom alleviation in Parkinson disease. Methodology:: Studies that analyzed sound stimuli and dance in gait improvement in Parkinson disease were searched through PubMed, Scopus, Doaj, MEDLINE, and ScienceDirect databases from November 2017 to April 2018 and repeated in September 2018. Results and discussion:: Forty-five studies met the inclusion criteria to synthesize the findings on dance and music performance as a treatment for classical symptoms of Parkinson disease. Five reviews and 40 experimental papers have shown that rhythmic stimulation and dance provide the motor, cognitive, and quality of life benefits for participants with Parkinson disease. Thus, sound stimuli and dance offer satisfactory effects for gait, improving cognitive abilities such as motor control and adjustment and spatial memory. In addition, these new treatment modalities stimulate the elderly population to practice physical exercise, generating well-being and helping self-esteem. Conclusion:: Dance and music therapy interventions are noninvasive, simple treatment options, which promote gait and cognition.
Article
Full-text available
Epidemiological studies indicate that physical activity and exercise may reduce the risk of developing Parkinson's disease (PD), and clinical observations suggest that physical exercise can reduce the motor symptoms in PD patients. In experimental animals, a profound observation is that exercise of appropriate timing, duration, and intensity can reduce toxin-induced lesion of the nigrostriatal dopamine (DA) system in animal PD models, although negative results have also been reported, potentially due to inappropriate timing and intensity of the exercise regimen. Exercise may also minimize DA denervation-induced medium spiny neuron (MSN) dendritic atrophy and other abnormalities such as enlarged corticostriatal synapse and abnormal MSN excitability and spiking activity. Taken together, epidemiological studies, clinical observations, and animal research indicate that appropriately dosed physical activity and exercise may not only reduce the risk of developing PD in vulnerable populations but also benefit PD patients by potentially protecting the residual DA neurons or directly restoring the dysfunctional cortico-basal ganglia motor control circuit, and these benefits may be mediated by exercise-triggered production of endogenous neuroprotective molecules such as neurotrophic factors. Thus, exercise is a universally available, side effect-free medicine that should be prescribed to vulnerable populations as a preventive measure and to PD patients as a component of treatment. Future research needs to establish standardized exercise protocols that can reliably induce DA neuron protection, enabling the delineation of the underlying cellular and molecular mechanisms that in turn can maximize exercise-induced neuroprotection and neurorestoration in animal PD models and eventually in PD patients.
Article
Full-text available
Parkinson disease (PD) is a progressive, neurodegenerative movement disorder with symptoms reflecting various impairments and functional limitations, such as postural instability, gait disturbance, immobility and falls. In addition to pharmacological and surgical management of PD, exercise and physical therapy interventions are also being actively researched. This Review provides an overview of the effects of PD on physical activity — including muscle weakness, reduced aerobic capacity, gait impairment, balance disorders and falls. Previously published reviews have discussed only the short-term benefits of exercises and physical therapy for people with PD. However, owing to the progressive nature of PD, the present Review focuses on the long-term effects of such interventions. We also discuss exercise-induced neuroplasticity, present data on the possible risks and adverse effects of exercise training, make recommendations for clinical practice, and describe new treatment approaches. Evidence suggests that a minimum of 4 weeks of gait training or 8 weeks of balance training can have positive effects that persist for 3–12 months after treatment completion. Sustained strength training, aerobic training, tai chi or dance therapy lasting at least 12 weeks can produce long-term beneficial effects. Further studies are needed to verify disease-modifying effects of these interventions.
Article
Full-text available
Background Patients with Parkinson’s Disease (PD) undergo motor injuries, which decrease their quality of life (QL). Dance, added to drug therapy, can help treating these patients AimsTo conduct a systematic review with meta-analysis with the aim to analyze the effects of dance classes in comparison to other interventions or to the absence of intervention, in randomized clinical trials (RCTs), on functional mobility, motor symptoms and QL of PD patients Methods The search was conducted in MEDLINE, LILACS, SciELO, Cochrane and PsycINFO (last searched in August 2017). RCTs analyzing dance effects in comparison to other physical training types or to no intervention, on functional mobility, motor symptoms and QL of PD patients were selected. The outcomes assessed were motor symptoms with Unified PD Rating Scale III (UPDRSIII), functional mobility with Timed Up and Go Test (TUG), endurance with 6 min walking test (6MWT), freezing of gait with Freezing of Gait Questionnaire (FOG_Q), walking velocity with GAITRite and QL with PD Questionnaire (PDQ39). Two reviewers independently extracted methodological quality and studies data. Results are presented as weighted mean differences. ResultsFive RCTs were included, totaling 159 patients. Dance promoted significant improvements on UPDRSIII, and a decrease in TUG time when compared to other types of exercise. In comparison to the absence of intervention, dance practice also showed significant improvements in motor scores. Conclusion Dance can improve motor parameters of the disease and patients’ functional mobility.
Article
Objective: This work aimed to assess effects of different exercise intervention on Parkinson's disease (PD) treatment via a network meta-analysis. Methods: Eligible literatures were retrieved from three databases (PubMed, EMBASE and Cochrane Library) up to March 5, 2019 and screened based on established selection criteria. Afterwards, relevant data was extracted and heterogeneity tests were conducted to select appropriate effect models according to chi-square test and I2 statistics. Publication bias of included studies was also performed. Finally, the pairwise and network meta-analyses were carried out to evaluate the efficacy of different exercise training on PD management. Results: Overall, 19 studies encompassing 920 PD patients were identified to explore effects of interventions such as dance, Qigong, tango, resistance training (RT), Taichi and yoga on PD in terms of six indicators including six-minute walk, gait velocity, UPDRS III, PD questionnaire-39 (PDQ-39), timed up and go (TUG) and Berg balance test (BBT). The direct meta-analysis revealed that RT and dance altered the gait velocity and PDR-39 indicator of PD patients. And there was a statistical difference in RT and Tango regarding UPDRS III. Besides, significant differences were also detected among multiple comparisons based on TUG and BBT, containing RT vs control, Tai Chi vs control and Tango vs control for TUG, and dance vs control for BBT. Finally, results of network meta-analysis implied that tango was a good exercise for PD patients according to six different outcome measures. Conclusion: Tango was an optimal and effective option for improving functional mobility of PD patients.
Article
Objectives: Among different exercise models proposed for individuals with Parkinson’s disease (IwPD), the popularity of traditional forms of dance is increasing. The aim of this study was to evaluate the effects of Sardinian folk dance (Ballu Sardu, BS) on functional performance and motor and nonmotor symptoms in IwPD. Design: Single-blind, randomized controlled pilot trial. Settings: Outpatient health clinic. Subjects and interventions: Twenty IwPD (13M, 7F; 67.4 – 6.1 years) were randomly assigned to BS (n = 10) or usual care (n = 10). The dance program consisted of two sessions/week, 90-min/class, for 12 weeks. Outcome measures: Motor and nonmotor symptoms, as well as functional performance, were evaluated using different questionnaires and tests such as the Unified Parkinson’s Disease Rating Scale Part-III (UPDRS-III), 6- min walking test (6MWT), Berg Balance Scale (BBS), Timed Up-and-Go (TUG) test, Five Times Sit-to-Stand Test (FTSST), Back Scratch Test (BST), Sit-and-Reach Test (SRT), instrumented gait analysis, Parkinson’s Disease Fatigue Scale (PFS-16), Beck Depression Inventory, Starkstein Apathy Scale (SAS), and Montreal Cognitive Assessment (MOCA) scale. Results: Repeated-measures analysis of variance revealed significant Time · Group interactions for UPDRSIII and functional variables such as the 6MWT, BBS, FTSST, TUG (all, p < 0.001), BST ( p = 0.04), and gait analysis parameters (stride length, p = 0.031; gait speed, p = 0.049; and gait fatigue index (GFI), p = 0.005). For nonmotor symptoms, significant Time · Group interactions for depression ( p < 0.001), apathy ( p = 0.016), and MOCA scores ( p = 0.012) were observed. Of note, for GFI and SAS, the BS group only showed a trend toward improvement, while the condition of the controls worsened significantly. No between-group differences were observed for SRT and PFS-16. Conclusions: BS is an enjoyable activity, which has been proved to be superior to usual care alone in inducing changes in different motor and nonmotor symptoms associated with PD. Results show that BS can be considered a safe tool for contrasting impairments observed in IwPD due to the intrinsic nature of the neurodegenerative disease.
Article
Background: Previous studies in Parkinson's Disease (PD) have described benefits of dance for motor and non-motor outcomes, yet few studies specifically look at Dance Therapy (DT) as a specific psychotherapeutic model for PD. DT is the psychotherapeutic use of movement to improve physical, emotional, cognitive, and social integration and wellbeing. Objective: 1) Explore the safety and feasibility of a 10-week DT program for PD. 2) Collect pilot data on efficacy of DT. Design/methods: Prospective, randomized-controlled study in subjects with PD. 13 participants randomized 2:1 to DT (n = 9) or support group (n = 4). Assessments were completed 1-2 weeks prior to the first session and after the final session, and included attendance, Hoehn and Yahr Scale (H&Y), Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment, Timed Up and Go, Berg Balance Scale, Beck Depression Inventory, Fatigue Severity Scale, Visual Analog Fatigue Scale, Parkinson's Disease Questionnaire-39, and an exit satisfaction survey. Results: All participants completed the study. The control group was older and had a higher mean baseline MDS-UPDRS III score (27.56 dance vs. 40.75 control) and H&Y score (2.11 dance vs. 2.50 control). 7 of 9 in DT and all control subjects attended at least 70% of classes. All participants in DT enjoyed the classes and most felt they were beneficial. The greatest improvement in motor measures was in MDS-UPDRS III (-4.12 (dance) vs. -1.75 (control)). Non-motor outcomes were explored as well. Conclusions: DT is introduced as an enjoyable mind-body intervention for PD. Further studies powered for efficacy and with groups matched for disease severity are warranted.
Chapter
The use of complementary and alternative medicine (CAM) therapy in nonmotor symptoms (NMS) for Parkinson disease (PD) is growing worldwide. Well-performed, systematic evidence-based research is largely lacking in this area and many studies include various forms of CAM with small patient numbers and a lack of standardization of the approaches studied. Taichi, Qigong, dance, yoga, mindfulness, acupuncture, and other CAM therapies are reviewed and there is some evidence for the following: Taichi in sleep and PDQ39; dance in cognition, apathy, and a mild trend to improved fatigue; yoga in PDQ39; and acupuncture in depression, PDQ39, and sleep.