Edited by: Mario Bernardo-Filho, Rio de Janeiro State University, Brazil
Reviewed by: Ramesh Kandimalla, Texas Tech University Health Sciences Center, United States; Danúbia Da Cunha De Sá Caputo, Rio de Janeiro State University, Brazil
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Regular physical activity is considered one of the most important factors for lifestyle, for maintaining good health in older ages and increasing life expectancy. Dance is considered an activity that involves coordinating movements with music, as well as brain activation because it is constantly necessary to learn and remember new steps. Dance as a musical-kinetics skill, requires the coordination of body movements with rhythmic stimuli, developing the adaptability of the movement. One-hundred-thirty (130) elderly people aged 60 years and over (mean age 67 years old) with an average of 8 years of education, attended Greek traditional dance sessions for 32 weeks. The frequency was 2 times per week, for 75 min per session. Dances were selected from all over Greece with moderate intensity initially. During the program, they had the opportunity to try with greater intensity dances. At the beginning and after the end of intervention all the participants were evaluated by the Fullerton Senior Fitness Test for their physical fitness, the Single Leg Balance and the Handgrip Strength Test. The results showed a significant improvement in their physical fitness (Chair Stand:
The percentage of people aged 60 and over is growing faster worldwide than any other age group, and the resulting aging population presents challenges and opportunities for all countries increased due to new social and economic demands. Countries adapting to this changing demographic, invest in healthy aging to enable people to live longer and have a healthy life. Healthy Ageing involves creating an environment that allows people to engage actively throughout their lives. Both the elderly and the environments in which they live are diverse, dynamic, changing and playing an important role in determining the physical and mental ability throughout a person’s life. In interaction with each other, they possess incredible possibilities to allow or limit healthy aging (World Health Organisation,
The advanced age besides changes in physical fitness, increases sensitivity to chronic diseases and disabilities, and reduces the quality of life (Wanderley et al.,
Regular physical activity is considered one of the most important factors for lifestyle, maintaining good health in older ages and increasing life expectancy (Lee et al.,
Alternative categories of exercise programs have been performed in elderly people (Hui et al.,
Dance is considered an activity that offers the involvement of different senses and connects movement to music with self-expression and applies different aspects of personality (Kaufmann,
Aweto et al. (
The purpose of this study was to investigate the impact of a Greek traditional dances program on elderly people over the age of 60. Particularly, to investigate whether Greek traditional dance as a form of aerobic exercise, could improve the functional capacity and the well-being of the elderly people.
One-hundred-thirty (130) Greek elderly people aged 60 years and over (mean age 67 years old) with an average span of education 8 years (Q2 = 8, IQR = 6), attended Greek traditional dance sessions for 32 weeks. The frequency of the intervention was twice a week, and each session lasted 75 min. The intervention was performed at the Greek Association of Alzheimer Disease and Relative Disorders (Alzheimer Hellas) and at the Day Care Centers of Municipality of Thessaloniki, Greece. During the program, they had the opportunity to try with greater intensity dances. In the period of 32 weeks, the maximum number of sessions to complete the intervention was 64 and the average presence of the participants was 51 sessions for completing the intervention.
Moreover, we recruited a control group (20 individuals) that it is matched to a smaller group of intervention participants (20 individuals) in demographic and baseline somatometric data. The control group did not receive any type of training and thus it was a waiting group.
For their participation in the research, they had to be in a good functional and emotional condition and to not participate in another dance program. Each of them was required to be examined by a doctor to ensure their participation in a mild intensity activity. In addition, elderly who have been diagnosed with hypertension, cardiac and respiratory failure were excluded from the intervention program. Also, the elderly who did not complete at least 80% of the total attendance hours of the program was rejected by this.
Written consent was requested for their participation in this study, after being given the required explanations for its purpose. At the beginning and after the end of intervention all the participants were evaluated for their fitness and functional capacity by a fitness instructor. Ethical and Scientific Committee of GAARD approved the protocol of this study. Also, the participants signed their acceptance of viewing videos and posting photos related to the traditional dance intervention program in online and/or print media for scientific purposes and public information.
All participants were evaluated both at the beginning of the intervention and after the end of this to investigate any improvement caused by the intervention. They were evaluated on their physical fitness and functional capacity by the Senior Fitness Fullerton Test. This test is safe, it does not require to use any special equipment and is used to assess six parameters such as strength, flexibility, coordination and endurance. Specifically, the test battery consists of: 30-s chair stand, arm curl, chair sit-and-reach, back scratch, 2-min step-in-place, and 8-foot (2.44-m) up and go (Rikli and Jones,
Handgrip strength was measured using a hydraulic hand dynamometer holding the dynamometer in the dominant hand (Saehan Corp., Masan, Korea). Three trials from the dominant hand were calculated and used the best for the analysis. Handgrip strength is expressed in kilograms (kg). Furthermore, the jumping vertical ability was evaluated by free hand countermovement jump using OptoJump system (Microgate, Bolzano, Italy) and the jumping was calculated in centimeters. Lastly, the body mass index (BMI) was calculated following the measurement weight and height of each participant.
Dances were selected for the intervention in the present study were from all over Greece (
Participants in a Greek traditional dance named: Litos and Zonaradikos. They are dancing in the regions of Macedonia and Thrace of Greece.
Demographic data (age, education level, etc.) was first tested for normality assumption using visual inspection of histograms, normal Q-Q plots and boxplots, in terms of skewness and kurtosis as well as using the normality tests (Shapiro-Wilk test) in order to calculate proper descriptive statistics. Since the age and the education level of participants were not approximately normally distributed median and interquartile range were calculated. The proportion of male/female participants was also computed. Similar procedures were followed when analyzing demographic data in a subgroup of intervention participants and matched controls.
Participants underwent an evaluation of physical fitness both before and after the intervention. The assumptions of repeated measures analysis of variance (ANOVA) were not fulfilled and as such, score differences were computed in two-time conditions (post-pre) then explored for normality assumption. Subsequently, we performed Wilcoxon signed-rank tests as the score differences of the tested parameters were not approximately normally distributed. Statistical analysis was performed using the IBM SPSS Statistics (Version 23) and defining setting the significance level (a) to 0.05. Bonferroni correction was used to counteract the problem of alpha inflation due to multiple comparisons.
In the second analysis, we aimed to explore the within changes in each group as well as the between-group differences. Initially, we compared the performance of two groups in the baseline physical assessment performing Mann-Whitney
Demographic data of 130 elderly participants are described in the following table (
Demographic data of elderly participants as age, education years and gender.
Age Median, [Q1, Q3] | Education Median, [Q1, Q3] | Gender Male/Female |
---|---|---|
67.00, [63.00, 71.00] | 8.00, [6.00, 12.00] | 23/107 17.69%/82.31% |
The subgroup of the intervention group did not significantly differ in age, education and BMI relatively to the matched controls [Age—Dance subgroup: 66.50, (62.00, 73.00), Controls: 65.50, (61.00, 69.50),
Planned comparisons of physical assessments test scores in two-time points (before and after the training) showed that neither the height (
However, the participants’ performance significantly altered in most of the physical tests tasks (Chair Stand:
The intervention provoked improvement in almost all the physical fitness parameters.
Physical fitness | Before training Median, [Q1, Q3] | After training Median, [Q1, Q3] | Score change Median, [Q1, Q3] | Test results |
---|---|---|---|---|
Chair Stand | 16.00, [14.00, 18.00] | 17.00, [15.00, 20.00] | 1.00, [0.00, 3.00] | |
Sit and Reach | 2.00, [0.00, 5.00] | 3.00, [0.00, 8.00] | 2.00, [0.00, 5.00] | |
Foot Up and Go | 5.29, [4.64, 5.85] | 4.71, [4.27, 5.17] | −0.45, [−0.93, −0.19] | |
Back Scratch | −8.00, [−16.25, 2.00] | −5.00, [−16.00, 3.25] | 2.00, [−1.00, 4.00] | |
Arm Curl | 24.00, [21.75, 28.00] | 26.50, [24.00, 30.00] | 2.00, [0.00, 4.00] | |
2-min step | 93.00, [80.75, 106.25] | 99.50, [85.00, 114.00] | 6.00, [2.00, 13.25] | |
Balance-1-leg | 22.40, [12.02, 56.87] | 32.44, [14.99, 60.28] | 3.79, [0.29, 15.20] | |
Handgrip | 24.50, [19.75, 30.25] | 26.00, [20.00, 32.00] | 1.00, [−1.00, 4.00] | |
Jump ability | 17.48, [8.87, 67.50] | 20.00, [9.70, 61.25] | 1.00, [−3.23, 3.00] |
A summary of intervention-induced changes in different physical fitness components. *indicates the significant improvement in the participants of these tests after the dance intervention.
The intervention seems to promote significant improvement in Chair stand task as test scores after the training were increased compared to the baseline [pre-training: 16.00, (14.00, 18.00); post-training: 17.00, (15.00, 20.00)]. In more detail, 82 out of 130 participants increased their Chair Stand score, 28 participants did not show any significant change while 20 out of 130 decreased their performance at the aforestated task. Thus, a Wilcoxon signed-rank test determined that there was a statistically significant median increase of 1.00, [0.00, 3.00] in scores at Chair Stand task.
Similar findings were revealed in Sit and Reach task. A significant increase of 2.00, [0.00, 5.00] was observed when comparing test scores at the two-time points [pre-training: 2.00, (0.00, 5.00); post-training: 3.00, (0.00, 8.00)]. More particularly, 83 out of 130 showed enhanced scores at the post-training relative to the baseline, 30 participants decreased their scores while the scores of 17 participants preserved at the two-time points.
Moreover, a Wilcoxon signed-rank test determined that there was a statistically significant median decrease of 0.45, [−0.93, −0.19] in scores at Foot-Up-and-Go task [pre-training: 5.29, (4.64, 5.85); post-training: 4.71, (4.27, 5.17)]. In the Foot-Up-and-Go task 121, out of 130 participants decreased their scores and nine participants showed increased score after the training compared to the baseline. Significant improvement was observed at the Back and Scratch test as a median increase of 2.00, [−1.00, 4.00] [pre-training: −8.00, (−16.25, 2.00); post-training: −5.00, (−16.00, 3.25)]. Eighty-two participants enhanced their scores after training, 15 participants preserved their performance while 33 out of 130 participants showed a decreased in their scores at the Back and Scratch task.
A significant median increase of 2.00, [0.00, 4.00] was observed in Arm curl task when comparing scores both before and after the intervention [pre-training: 24.00, (21.75, 28.00); post-training: 26.50, (24.00, 30.00)]. Ninety-one participants increased their Arm Curl scores, 24 participants showed the opposite finding whereas 15 participants did not change their performance. Moreover, the intervention seems to promote gains in 2-min steps in the place as a median enhance of 6.00, [2.00, 13.25] [pre-training: 93.00, (80.75, 106.25); post-training: 99.50, (85.00, 114.00)]. More precisely, 104 out of 130 participants improved their performance at the 2-min steps in the place task, 25 participants decreased their scores and only one did not show any change.
Ninety-nine out of 130 participants improved their balance as indicated by their enhanced scores at the Balance-1-leg task after the intervention while 31 decreased their performance at the same task when comparing the scores at the two time-points. Furthermore, we observed a significant increase of 3.79, [0.29, 15.20] after the intervention compared to the baseline (pre-training: 22.40, [12.02, 56.87]; post-training: 32.44, [14.99, 60.28]). Additionally, the intervention given seems to induce positive gains in Handgrip task. Sixty-nine participants enhanced their performance after the training compared to the baseline evaluation, 34 had the opposite finding while 27 out of 130 participants remained stable. A significant increase of 1.00, [−1.00, 4.00] was found in Handgrip scores comparing participants’ performance both before and after the training [pre-training: 24.50, (19.75, 30.25); post-training: 26.00, (20.00, 32.00)].
Although subjects showed an increase in their scores at the Jump ability [pre-training: 17.48, (8.87, 67.50); post-training: 20.00, (9.70, 61.25)], score change did not reach statistical significance.
A summary of the aforementioned results is displayed in
In the second analysis we found that the two groups did not have significant differences in their baseline physical performance [all
Alterations in different physical assessment parameters in a dance subgroup (*** denotes
Comparison in somatometric data of the control group in two-time conditions (before and after the waiting period).
Between-group analysis revealed significant differences in the aforementioned tasks in favor of the dance subgroup. More precisely, the intervention subgroup showed greater changes in task scores compared to the control group in the following tasks: Chair Stand [Dance subgroup: 3.00, (2.00, 5.00); Controls: 0.00, (−1.00, 0.00);
In the present study, one-hundred-thirty (130) elderly people participated in an intervention program of Greek traditional dances to investigate how their physical fitness and functional capacity were affected, to enable them to have an independent and autonomous life improving their lifestyle. To assess the beneficial role of dance, we investigated the effect of an elderly dance team lasting 32 weeks with a frequency of two times a week for 75 min each.
The results of the post-intervention evaluations of the elderly compared to the initial pre-intervention evaluation showed significant statistical findings. A significant improvement was observed in the strength of the legs (Chair Stand test), a test that assesses the ease of climbing the stairs, walking speed and reduce the risk of falls. This result is consistent with the results in the Bohannon’s (
Also, a significant improvement was found in the Sit and Reach test which is measure lower back and hamstring flexibility and is important as because tightness in this area is implicated in lumbar lordosis, lower back pain and forward pelvic tilt as well as in the Back-Scratch test which assesses the general shoulder range of motion by measuring how close the hands can be brought together behind the back. In the Sit and Reach test have improved their flexibility by 2.48 cm and in Back-Scratch test have improved their flexibility by 2.07 cm. These significant results of our research are supported by the results of the research by Carvalho et al. (
Their aerobic endurance after dance intervention seems to have improved significantly. Some research shows that improvements in the 2-min test may correspond to improvements in cognitive function (Tanne et al.,
A statistically significant improvement was observed in strength by measuring hand grip (in a rate of about 5.5%), presumably in different gestures ranging from dance to dance, as well as in the same dance. The studies have reported the correlation of hand grip with the reduction of health in the elderly, mainly by linking it to functional disability (Onder et al.,
Keogh et al. (
Physical activities for the elderly people include both regular and recreational actions in their daily social life (climbing stairs or walking) performing various tasks (for people who continue working), participating in different sports games as well as in specially designed exercise programs, such as the traditional dance. Dance beyond many benefits helps individuals to improve their body posture. Proper posture improves overall balance and generally there are positive effects on the body. Bones are well aligned, the vital organs are properly positioned, and the muscles, joints and ligaments can function in the way they should be. Also, good posture contributes to encouraging the normal functioning of the nervous system and is important for health and general well-being. Lima and Vieira (
In a previous research on people over 60 years, showed that social dance supported efforts to relieve physical and psychological degradation, provided a strong sense of pleasure and continuity as well as a vehicle for the changes required by aging. It also provided a strong sense of community as it allowed participants to showcase their “cultural heritage” (Cooper and Thomas,
Furthermore, dance, in addition to physical activity, combines the emotion, social interaction, motor coordination and music, thus creating a thriving environmental condition for individuals. Through the revival of music and dance, the elderly have the opportunity to relive the past through the present. Individuals initiate to understand the meaning of these two, either individually or as a combination, and are benefiting from the positive effects on the body and mind. The importance of social interaction through music places them in a process, so the elderly can share their passion with others. This interaction with other people eliminates the feeling of loneliness and enhances their psychological status. Moreover, it is considered an important fact that their self-esteem and mood increase as they realized they can engage in new skills.
This study demonstrates the effects of traditional dance on people who choose to systematically participate in organized Greek traditional dance lessons as a means of exercise. In the analysis of the control group with a small intervention group, it was observed that in most tests and particularly in Fullerton’s domains, there was an improvement in their performance after the intervention, such as the same was found for all of the 130 participants. However, we should consider that one limitation of the study is the lack of randomization that strengthens the generalization of our results as well as the small number of control subjects recruited.
Greek traditional dance is a physical activity that contributes positively to many factors on the physical health of elderly people by enhancing the well-being outcomes for elderly people. Dance, specifically for the elderly, is a very interesting type of physical activity, because it carries less risk of injury than many other types of exercise. The Greek traditional dance for Greek elderly people is particularly important, because it relates to the tradition, culture, but also their lives. Thus, it is a physical activity more popular and hence readily selectable by the elderly, which can equally have beneficial effects of exercise.
Generally, dance offers a host of physical and mental benefits to individuals, especially when exercised to protect or improve their health. As well, exercise and participation in physical activities are associated with better performance in cognitive functions. Especially, in our previous study, the intervention involved dance training with adaptive difficulty and intensity. The results demonstrated the functional reorganization of cortical rest networks (Zilidou et al.,
Through this research conducted on Greek traditional dances programs, it is believed that dancing could be defined as an important and effective tool for the prevention and the fight against the health problems of the elderly. The results of this study show that dancing contributes to the well-being of the elderly with a view of independent and quality living. Maintaining their physical fitness and functional capacity at satisfactory levels, lead them to a more qualitative and independent lifestyle while the risk of various diseases is reduced.
Dance is demonstrating greatly that it improves the elderly’s functional ability and well-being. Therefore, it is suggested in a new study to investigate the physical effects of dance by combining nutritional education and psychological effects and comparing them with individuals of vulnerable groups such as patients with Parkinson disease. In Parkinson’s disease, a healthy diet and exercise are considered important factors to stay healthy and active while maintaining the satisfactory levels their energy.
Ethical and Scientific Committee of GAARD approved the protocol of this study.
ZV: designed and implemented the dance program, collected the data, guided the analysis, prepared the initial draft of the manuscript, discussed the results and revised the manuscript. LO: implemented the dance program data and revised the manuscript. MV: contributed the physical assessments. DS: co-guided the study.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.