Content uploaded by Khaled Mohamed Ragab
Author content
All content in this area was uploaded by Khaled Mohamed Ragab on Jul 05, 2021
Content may be subject to copyright.
Vol.:(0123456789)
1 3
Journal of Neurology
https://doi.org/10.1007/s00415-021-10589-4
REVIEW
Efficacy ofdance forParkinson’s disease: apooled analysis of372
patients
SaraMohamedHasan1,10· SomiaAlshae2,10· ElfatihA.Hasabo3,10· Ma’mounSaleh4,10·
WalaaElnaiem3,10· AyaQasem5,10· YazanO.Alzu’bi6,10· AsmaaKhaled7,10· MohamedSayedZaazouee1,10·
KhaledMohamedRagab8,10· AnasZakaryaNourelden9,10· MohamedFahmyDoheim10,11
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
[7–9], as gait, balance, and coordination. As PD patients
* Mohamed Fahmy Doheim
fahmydoheim@alumni.harvard.edu
1 Faculty ofMedicine, Al-Azhar University, Assuit, Egypt
2 Faculty ofMedicine, Suez Canal University, Ismailia, Egypt
3 Faculty ofMedicine, Khartoum University, Khartoum, Sudan
4 Faculty ofMedicine, Hashemite University, AzZarqa’,
Jordan
5 Medical Analysis, Al-Balqa’ Applied University, Al-Zarqa’,
Jordan
6 Faculty ofMedicine, Jordan University ofScience
andTechnology, Irbid, Jordan
7 Faculty ofMedicine, Tanta University, Tanta, Egypt
8 Faculty ofMedicine, Minia University, Minia, Egypt
9 Faculty ofMedicine, Al-Azhar University, Cairo, Egypt
10 International Medical Research Association (IMedRA),
Cairo, Egypt
11 Faculty ofMedicine, Alexandria University, El-Shatby, 22
El-Guish Road, Alexandria21526, 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, 12–18]. 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 andstudy 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) invitro 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, chapter2.5). 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 Altman’s 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 [13–15, 18,
22–31] for qualitative and quantitative synthesis of evidence
(see Fig.1; PRISMA).
Characteristic ofincluded 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 (Table2). Tango classes
for 3 months were the commonest platform used among
studies to measure dance efficacy (Table1). 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 Tables1 and 2,
respectively.
Studies included in
quantave synthesis
(meta-analysis)
(n = 14)
Full-text arcles assessed
for eligibility
(n = 133)
Idenficaon
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 arcles excluded,
with reasons
(n = 119)
n=38 conference abstracts
n=26 Different populaon,
intervenon and outcome)
n=26 not randomized
clinical trials
n=7 full text unavailable
n=5 protocol
Studies included in
qualitave 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 etal. [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 etal. [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 etal. [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 etal. [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 etal. [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 etal. [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 etal. [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 etal. [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 etal. [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 oftheoutcomes
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 etal. [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 etal. [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 etal. [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 etal.
[8]
USA Tango group 9 From 2 to 3
Traditional
exercise
10 From 2 to 3
Hackney etal.
[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 etal.
[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 etal. [22] Korea Dance group 10 68.4 (2.9) 5 (50)
No interven-
tion (Control)
group
10 70.1 (3.3) 5 (50)
McKee etal.
[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 etal.
[29]
USA Dance group 9 66.44 2.1 (3)
No interven-
tion (Control)
group
4 75.5 2.5 (1)
De Natale etal.
[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 etal.
[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 etal.
[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 ofGait (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 etal. [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 etal. [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 etal. [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 azero‑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 ofgait (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 azero‑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, 32–35], especially after
6–12 months of dance practicing [15]. Mak etal. 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 etal. 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 etal. 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 etal (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 etal (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 etal (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 etal (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
A preview of this full-text is provided by Springer Nature.
Content available from Journal of Neurology
This content is subject to copyright. Terms and conditions apply.