Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

Effects of a Multifactorial Program with Case Management for Falls Prevention on Functional Outcomes in Community-Dwelling Older People: A Randomized Clinical Study

Falls are among the top 10 causes of years lived with disability in people aged 75 and over. Preventive programs like case management (CM) are crucial.

OBJECTIVES

To evaluate the effects of a multifactorial fall prevention program based on CM on physical performance, the presence of pain, and the risk of falls and fractures in older people who have suffered falls.

METHODS

This randomized, single-blind clinical trial with parallel groups, Intervention Group (IG) and Control Group (CG), was composed of 55 older people with a history of falling, living in the community. All participants underwent an initial assessment via video call (containing anamnesis, timed up-and-go test, falls risk score, short physical performance battery, and clinical frax). The IG underwent CM, the physical exercise protocol, and the cognitive stimulation protocol. The CG was monitored through telephone calls and received general health and fall guidance.

RESULTS

No significant results were found in the physical capacity, the presence of pain, the risk of falls, or the fractures between the Intervention and Control Groups and between assessments.

CONCLUSION

This program was not effective in improving functional performance, but it was important for characterizing pain and the probability of fracture in the next 10 years in this population.

Enhancing community engagement, public involvement, and social capital through researchers' participation in community dance projects: unexpected outcomes in underserved communities

BACKGROUND

The Dance and Health project aimed to promote public involvement in health research. Public involvement leads worked with project partner community groups, Aakash Odedra Dance Company and Moving Together, to develop a community engagement project with people living in low-socioeconomic areas/deprivation and diverse ethnic minority groups. Dance and Health included a weekly 60-min dance class and 30 min of facilitated health science discussion, that could either be a public involvement discussion for a research project, an activity about a particular biomedical research theme or ongoing discussions with a visiting researcher. The goal of this paper is to explore the impact of the Dance and Health project on the social capital of participants and provide key learnings on how to engage and build partnerships with people from underserved groups in health research contexts.

METHODS

Qualitative interviews and focus groups were completed which explored participant and dance tutor experiences in community venues. Participants were aged between 22 and 90, most were female and were from Asian ethnic minority groups and White British groups living in deprived neighbourhoods in Leicester. Qualitative data were analysed using qualitative content analysis.

RESULTS

The responses to the Dance and Health project were positive across all the focus groups. Central themes identified were Feedback on the Project, Motivation to Exercise, Criticism of the NHS, Mental Wellbeing, Engagement in a Post Pandemic New Normal, Accessibility and Inclusivity, Empowerment and Building Social Capital.

DISCUSSION

The focus groups evidenced that the project had broad impact. Participants expressed empowerment and ownership and described a range of social capital enrichment generated through the project including networks and friendships, access to the institutional resource of health science, and the opportunity to engage with a health and leisure activity that was valued and meaningful.

Comparative efficacy of physical activity types on executive functions in children and adolescents: A network meta-analysis of randomized controlled trials

OBJECTIVES

This study investigates the impact of various physical activity (PA) types on executive functions (EFs) in children and adolescents.

DESIGN

A systematic review and network meta-analysis of randomized clinical trials.

METHODS

We searched databases such as PubMed, Embase, Cochrane, and Web of Science up to April 2023, including randomized controlled trials involving 6 distinct PA types for healthy children and adolescents. The Cochrane risk of bias tool was used to assess the risk of bias, and a random-effects model in STATA 17.0 was used to calculate standardized mean differences (SMDs) and 95 % confidence intervals (CI).

RESULTS

Ball Games emerged as the most effective modality for improving updating accuracy, securing a SUCRA score of 94.4 %, and for reducing inhibition reaction time, with a SUCRA score of 94.8 %. Cognitively Engaging Physical Activity led in improving inhibition accuracy with a SUCRA score of 71.7 %. Dance excelled in improving update accuracy and reducing shifting reaction time, with SUCRA scores of 86.6 % and 99.5 %, respectively.

CONCLUSIONS

PA has a significant benefit in EFs in children and adolescents, however the size of the effect varies by type of PA. Ball Games emerged as the most efficacious modality for enhancing updating accuracy and for expediting inhibition reaction time. Cognitively Engaging Physical Activity proved to be the preeminent strategy for improving inhibition accuracy. Dance was distinguished as the optimal approach for improving updating accuracy and reducing shifting reaction time.

Using Dancesport as an Educational Resource for Improving Institutionalized Children's Learning Strategies

INTRODUCTION

Specialized studies mention that extracurricular activities (including dance) contribute to the stimulation of multiple intelligences, on whose development the educational process and academic success depend. The aims of the study were to investigate the benefits of dancesport for the development of institutionalized children's learning strategies, and to examine gender-dependent differences in learning strategies, as well as to formulate possible recommendations regarding the practice of dance at the age of preadolescence, from the perspective of school success vectors.

METHODS

Through the School Motivation and Learning Strategies Inventory (SMALSI), we could observe the changes produced in children from the initial phase to the final assessment at the end of a dancesport program. The intervention took place over a period of six months with a frequency of two lessons per week, with each lesson lasting 60 min, and aimed to increase school motivation and performance, considering the learning strategies used by institutionalized children. Thirty institutionalized children, aged 11-12 years old, participated in the research, during which they did not engage in other extracurricular physical activities. The preadolescents were assessed using the School Motivation and Learning Strategies Inventory (SMALSI). This self-report rating scale measures nine areas associated with learning strategies, six of which focus on student strengths (study strategies, note-taking/listening skills, reading/comprehension strategies, writing/research skills, test-taking strategies, and time management/organization techniques), and three are aimed at student liabilities (low academic motivation, test anxiety, and concentration/attention difficulties).

RESULTS

The results show that the biggest improvements in the case of institutionalized children were recorded for study strategies, effectiveness of test-taking strategies, and concentration difficulties. Girls registered significantly better results than boys only in the case of study strategies and for writing/research skills (Mann-Whitney test was used).

DISCUSSION

The study demonstrates the benefits of dancesport practice for the development of institutionalized children's learning strategies, creating a foundation for the improvement of their academic performance and school integration.

CONCLUSIONS

At the end of the dance program, significant improvements in academic interest were observed due to the testing strategies used. Better results were also obtained for the scales of anxiety and difficulty concentrating during tests, where average scores decreased significantly.

The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study

PURPOSE

To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD).

MATERIALS AND METHODS

Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA.

RESULTS

Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise.

CONCLUSIONS

The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings.

TRIAL REGISTRATION

The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315)Implications for rehabilitationThe VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate.Supervision of exergaming by health professionals is essential for successful implementation.The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises.

The psychometric properties of a novel task-based dance self-efficacy measure for older adult dance program participants

BACKGROUND

Self-efficacy for dance may reflect individual differences in factors likely to influence dance program participation. This study investigated the psychometric properties of six novel task-based dance self-efficacy (t-bDSE) questions for older adults participating in two large-scale dance intervention trials (N₁ = 530; N₂ = 131).

METHODOLOGY

Internal consistency of t-bDSE was assessed and items validated according to age, gender, physical ability, cognitive status, psychosocial wellbeing, dance experience and exercise behaviour. Responsiveness of t-bDSE was investigated by comparing dance program participants to control groups.

RESULTS

Internal consistency was high (Cronbach's α = .88). Dance self-efficacy was weaker in participantswith less dance experience, poorer mental health, poorer cognitive and physical abilities, and insufficiently active. t-bDSE scores improved in aged-care trial participants (ηp² = .05, a moderate effect).

CONCLUSIONS

The dance self-efficacy measure demonstrated good criterion and construct validity and can be included in future dance interventions to improve understanding of outcome variability and inform program evaluation.

Development of GERAS DANcing for Cognition and Exercise (DANCE): a feasibility study

BACKGROUND

Dance is a mind-body activity of purposeful rhythmic movement to music. There is growing interest in using dance as a form of cognitive and physical rehabilitation. This manuscript describes the development of GERAS DANcing for Cognition and Exercise (DANCE) and evaluates its feasibility in older adults with cognitive and mobility impairments.

METHODS

The progressive dance curricula were delivered for 15 weeks (1-h class; twice weekly). Participants were eligible if they were community-dwelling older adults aged 60+ with early cognitive or mobility impairment able to follow three-step commands and move independently. Feasibility outcomes included recruitment/retention, adherence, participant satisfaction, safety, and adverse events.

RESULTS

Twenty-five older adults (mean (standard deviation [SD]) age = 77.55 (6.10) years, range 68-90 years) with early cognitive (Montreal Cognitive Assessment score (SD) = 21.77 (4.05)) and mobility (92% were pre-frail/frail as indicated on the Fried Frailty Phenotype) impairments were recruited from a geriatric out-patient clinic or within the community. A total of 20/25 (80%) participants completed the study. Average class attendance was 72%, and self-reported homework adherence "most-days / every day" was 89%. A stepwise progression in the dance curricula was observed with increases in motor complexity and balance demands, and 95% of participants rated the program as a "just-right" challenge. Ninety percent of participants rated GERAS DANCE as excellent, and 100% would recommend the program to a friend or family member. Over 50% of participants connected outside of class time for a self-initiated coffee club. Adverse events of falls and fractures were reported for 2 participants, which occurred at home unrelated to the dance intervention during the study period. Pre-determined thresholds for feasibility were met for all outcomes.

DISCUSSION

GERAS DANCE is a feasible and enjoyable program for older adults with early cognitive or mobility impairments. GERAS DANCE curriculum grading (duration; sequence; instructions) and motor complexity increases in agility, balance, and coordination appear appropriately tailored for this population. Future work will explore the feasibility of GERAS DANCE in new settings (i.e., virtually online, community centers, or retirement homes) and the mind-body-social benefits of dance.

The Effect of an 8-Week Aerobic Dance Program on Executive Function in Children

In the current study, we examined the effect of an aerobic dance program as part of physical education (PE) classes on aspects of primary school children's executive functions (EFs) (inhibition, working memory, and cognitive flexibility). Participants were 41 children (21 boys and 20 girls; M age =10.30, SD = 0.50 years, M height = 134.09, SD= 3.9 cm; M weight = 35.61, SD = 7.85 kg) who were divided into an experimental group (EG) and a no-PE control group (CG). The EG followed an aerobic dance intervention as part of their PE program (45 minute sessions two days per week over eight weeks). Participants in both groups performed EF tests before and after the intervention period to evaluate their mental flexibility, inhibition, and working memory. A two-way mixed model repeated measures ANOVA revealed a significant effect of the aerobic dance program on participants' cognitive flexibility (i.e., on Trails Making Tests _B-A times and committed errors) (p <0.001), and on Stroop measures of inhibition (corrected number of words and corrected errors) (p <0.001 and p <0.01, respectively), with post-hoc analyses showing an improved performance by the EG in working memory (digit recall score) from pre-test to post-test and in comparsion to the CG (p < 0.001). Thus, this 8-week aerobic dance program promoted EF development among primary school children.

Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations

The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from “geriatric giants”. Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 ± 4.9 years, range: 71–89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 ± 16.5, range: 30–85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied.

The VITAAL Stepping Exergame Prototype for Older Adults With Major Neurocognitive Disorder: A Usability Study

Purpose: This study investigates the usability of a stepping exergame in older adults with major neurocognitive disorder (MNCD) residing in a long-term care facility.

Materials and Methods: A mixed methods study was conducted. Participants played exergames for 30 min on one try-out session. During the exergames, the think aloud method was used, and field notes were taken by the facilitator. Following the exergames, participants completed the System Usability Scale (SUS) and a semi-structured in-depth interview about usability including their personal experiences. Audio files were transcribed and a thematic content analysis of the think aloud data, field notes and interviews were performed using NVivo 12.

Results: Twenty-two participants with MNCD were included [mean age = 84.3 ± 5.5 (70–95) years; 81.8% women; Short Physical Performance Battery score = 7.5 ± 3.2 (1–12), Montreal Cognitive Assessment score = 11.9 ± 4.4 (2–19)]. System usability was rated “ok to good” with a mean SUS score of 57.8 (SD = 12.3) with scores ranging from 37.5 to 90.0. Five main themes emerged from the thematic content analysis: (1) perceived user friendliness and acceptability of the exergames; (2) interactional experience; (3) motivational factors; (4) training modalities; and (5) risks. There were no adverse events nor dropouts.

Conclusion: Participants evaluated the usability of the exergames positively. The results indicate that the stepping exergame is usable in older adults with MNCD.

Assessment of the efficacy and safety of a Judo exercise program in improving the quality of life among elderly patients

Objectives: Several reports have shown that Tai Chi Chuan can be an effective way to prevent falls among the elderly. However, an exercise program that can prevent injury during falls has not been reported previously. The judo technique called ukemi is used to prevent injuries. To evaluate whether a judo-based exercise program could prevent falls in the elderly, we had the participants practice ukemi as part of a therapeutic routine. The purpose of this study was to examine the clinical significance of the program and to predict its safety. Methods: From July 2016 to March 2017, we examined 53 individuals who participated in the exercise program. The individuals were divided into high (n=39) and low (n=14) movement ability groups (HMA and LMA groups, respectively), and their physical and psychological functions were evaluated using scores from the Short-Form Health Survey 36. We also collected and analyzed data from questionnaires obtained from 384 patients who participated in the program from July 2016 to July 2019. Results: The HMA group showed a significant increase in the mental component summary scores before and after the exercise program. In the LMA group, physical functioning, social functioning, and physical component summary scores were significantly improved. Of the participants surveyed, 94.8% had a high level of satisfaction, and 93.2% began accepting the exercise as a daily habit. No adverse events were observed during these exercises. Conclusion: This novel exercise program was performed safely, and positive effects were observed, especially in individuals with a low quality of life.

A cost-effectiveness evaluation of Dance to Health: a dance-based falls prevention exercise programme in England

OBJECTIVES

This study aimed to evaluate whether the falls prevention programme Dance to Health provides the health system with an effective and cost-effective means to address the issue of older people's falls.

STUDY DESIGN

This study used a pre-post design; that is, the same assessment measures were used both before and after the programme.

METHODS

Analysis and modelling were conducted using monitoring data (frequencies including session attendance, falls, general practitioner (GP) and hospital visits), comprehensive financial information (including all costs related to the delivery of Dance to Health), and the Public Health England economic model: 'A return on investment tool for falls prevention programmes in older people based in the community'.

RESULTS

Findings from the research show that under the suggested health intervention, there was a 58% reduction in the number of falls. Furthermore, the results also demonstrate that Dance to Health offers a potential cost saving of more than £196m over a 2-year period, of which £158m is a potential cost saving for the NHS.

CONCLUSIONS

The evidence outlines that Dance to Health offers the health system a cost-effective means to address the issue of older people's falls and most importantly a method that produces strong results in terms of falls prevention.

Insights from an early-stage development mixed methods study on arts-based interventions for older adults following hospitalisation

BACKGROUND

A period of hospitalisation can have negative consequences on physical function and autonomy for older adults, including functional decline, dependency and reduced quality of life. Older adults favour activity that focuses on social connectedness, fun and achievable skills.

OBJECTIVE

The primary aim of this early-stage development mixed methods study was to determine the feasibility and acceptability of a randomised crossover trial design and two arts-based interventions tailored for older adults recently discharged from hospital.

MATERIALS AND METHODS

Community-dwelling adults, aged 65 years and older, who reported reduced mobility and less than six weeks post discharge from hospital were invited to participate in the study. Two sites were randomised to either a four-week dance or music therapy intervention, followed by a four-week washout and subsequently to the alternate intervention. Participants and stakeholders were interviewed to share their views and perspectives of the study design and interventions developed.

RESULTS

The arts-based interventions were acceptable and safe for participants. Randomisation was completed per protocol and no implementation issues were identified. The outcome measures used were acceptable and feasible for this group of patients and did not lead to fatigue or excessive assessment time. Participants were positive about their experience of the programme.

CONCLUSIONS

This early development study provides a precursor and several imperative learning points to guide and inform future research in the area. Difficulties in recruitment and attrition were in part due to the barriers encountered when recruiting an incident cohort of vulnerable individuals post hospitalisation.

Effect of a Multimodal Movement Intervention in Patients With Neurogenic Claudication Based on Lumbar Spinal Stenosis and/or Degenerative Spondylolisthesis-A Pilot Study

Chronic low-back pain is a major individual, social, and economic burden. The impairment ranges from deterioration of gait, limited mobility, to psychosocial distress. Due to this complexity, the demand for multimodal treatments is huge. Our purpose is to compare the effects of a multimodal movement intervention (MI) (coordinative–cognitive exercises and dancing program) with standard physical therapy (PT) on gait, physical function, and quality of life in patients with lumbar spinal stenosis (LSS). The study design is based on a 6-week intervention with a two (group: MI/PT) by two (measurement time points: pre-/post-test) parallel group design with random assignment. Twenty-four subjects (18 female/6 male, 70.8 ± 10.6 years old) diagnosed with LSS were included and randomly allocated to the MI or PT group. The primary outcomes are minimum toe clearance (MTC) and double step length (DSL) variability and the Timed “Up & Go” test (TUG). Secondary outcomes are the Brief Pain Inventory, the short Fall Efficacy Scale–International (sFES-I), and the Oswestry Disability Index. Nine subjects for each group could be analyzed. The MTC variability revealed a significant between-group difference in the posttest (p = 0.008) showing a lower MTC variability for the MI compared to the PT group. The MI group displayed an improved TUG (p = 0.031) and a reduced sFES-I (p = 0.044). The decreased MTC variability and fear of falling as well as the improved functional mobility may contribute to a reduced risk of falling. For the subsequent study, further kinematic and cognitive parameters should be analyzed, and the number of participants has to be increased.

Clinical Trial Registration: German Clinical Trial Register (ID: DRKS00021026/URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021026).

Effects of Exercises on a Hard, Soft, and Sand Surface on Functional Outcomes of Community-Dwelling Older Individuals: A Randomized Controlled Trial

This single-blind, randomized controlled trial compared the effects of Thai dance exercise training on hard, soft, and sand surfaces on the functional outcomes of 120 community-dwelling older adults (40 subjects/group). The subjects were involved in a Thai dance exercise program on each surface, according to their groups, for 50 min/day, 3 days/week, for 6 weeks. The functional outcomes were assessed prior to training, at Week 3, and Week 6 after training. Subjects showed a significant improvement in all functional tests at 3 and 6 weeks after training, particularly in those who were trained on a sand surface and a soft surface (7-30% improvement, p < .05). The improvement was especially demonstrated in the complex and demanding motor activities after exercise on a soft and sand surface. Aside from attempting to modify training programs on a hard surface, the current findings suggest an alternative and cost-effective program to promote the levels of independence and safety that can be applied easily in clinical, home-based, and community settings.

A usability study of a multicomponent video game-based training for older adults

Background

Aging is often accompanied by a decline in sensory, motor and cognitive functions. These age- and lifestyle-related impairments may lead to reduced daily life functioning including gait disturbances, falling and injuries. Most daily life activities, e.g. walking, are tasks which require the concurrent interplay of physical and cognitive functions. Promising options for combined physical-cognitive training are video game-based physical exercises, so-called exergames. This study aimed to [i] determine the usability of a newly developed multicomponent exergame and [ii] explore its effects on physical functions, cognition and cortical activity.

Methods

Twenty-one healthy and independently living older adults were included (10 female, 71.4 ± 5.8 years, range: 65–91) and performed 21 training sessions (each 40 min) over seven weeks. The multicomponent exergame included strength and balance training with Tai Chi-inspired and dance exercises. Participants rated the usability of the exergame (System Usability Scale) and reported on their emotional experience (Game Experience Questionnaire). Attendance and attrition rates were calculated to determine training compliance. Before and after the intervention, physical and cognitive functions as well as resting state electroencephalography (EEG) were assessed.

Results

Results showed a high training attendance rate (87.1%, 18/21 training sessions on average) and a low attrition rate (9.5%, 2 drop-outs). System usability was rated high with a mean score of 75/100. Affective game experience was rated favorable. Gait speed under dual-task condition, lower extremity muscle strength and reaction times in a cognitive task (divided attention) showed significant improvements (p < .05). No significant pre-post differences were found for resting state EEG.

Conclusions

The newly developed exergame seems usable for healthy older adults. Nevertheless, some aspects of the exergame prototype can and should be improved. The training showed to positively influence physical and cognitive functions in a small convenience sample. Future trials are warranted which evaluate the feasibility and usability of the exergame training in a more “real-life” in-home setting and assess the behavioral and neuroplastic changes in a larger population after a longer training period with comparison to a control group.

Effects of dance intervention on global cognition, executive function and memory of older adults: a meta-analysis and systematic review

OBJECTIVE

To summarize and assess the effects of dance intervention on global cognition, executive function and memory in older adults.

METHODS

We searched the databases PubMed, Web of Science, Cochrane Library, EMBASE, Clinical Trials.Gov and four Chinese databases (CNKI, CBM, Wan Fang Data and VIP) to identify articles written in English or Chinese and published until April 2018. Randomized controlled trials and quasi-experiment were included if they evaluated the impact of dance on cognition, and individuals aged 60 and over.

RESULTS

Thirteen studies with a total of 1605 participants met the inclusions criteria. Our primary outcomes of interest are cognitive functions and are categorized into three cognitive domains: (1)Global cognition: meta-analyses for outcome related to global cognition indicated a large effect size. In the subgroup of using MMSE, results indicated a significant effect for dance on cognition [MD = 1.57, 95% CI (0.53, 2.61), p = 0.003; I2 = 62%], in the subgroup of using SCEF, effect sizes was statically significant and no heterogeneity between studies [MD = 33.25, 95% CI (30.94, 35.56), p < 0.00001; I2 = 0%]. (2)Executive functioning domain: meta-analyses revealed that there were no significant differences between the two groups in measures of executive function after the one study with a low-quality score was excluded [SMD = 0.13, 95% CI (- 0.02, 0.27), p = 0.09; I2 = 0%]. (3)Memory domain: quantitative analysis showed that dance may benefit memory function in older adults. However, in our review, dance was more effective for elderly cognitions than exercise may be not support.

CONCLUSIONS

Our meta-analysis and systematic review suggest that dance may be a safe and effective approach to improve cognitive function in older adults.

Application of social dance exercise and social support program to improve quality of life for Thai older adults

Purpose

The purpose of this paper is to test the effectiveness of social dance exercise and social support program to improve quality of life (QOL) for older adults in Thailand.

Design/methodology/approach

A quasi-experimental pre-test and post-test research design was used. The participants were 102 older adults selected by systematic sampling technique. Participants were assigned using the matched-pair technique by age, physical fitness test by the Time up and Go test into intervention and control groups of 51 subjects each. Intervention was conducted for 12 weeks, three times weekly, to improve physical, psychosocial and spiritual domains leading to enhanced QOL as measured by the World Health Organization Quality of Life (WHOQOL–BREF–THAI) assessment parameter. Data on QOL were collected before and after a 12-week training period.

Findings

Most adults were between 70 and 79 years old (67 percent). After program completion, before and after mean QOL scores for the intervention group at 60.15 and 95.82, respectively, were statistically significant with p-value<0.05. Post-program QOL shown by the intervention group was significantly higher than the control group (p<0.05).

Originality/value

Application of social dance exercise and social support program is an alternative to traditional methods to improve QOL and maintain functional capacity for older adults.

Regular Latin Dancing and Health Education May Improve Cognition of Late Middle-Aged and Older Latinos

Disparities exist between Latinos and non-Latino Whites in cognitive function. Dance is culturally appropriate and challenges individuals physically and cognitively, yet the impact of regular dancing on cognitive function in older Latinos has not been examined. A two-group pilot trial was employed among inactive, older Latinos. Participants (N = 57) participated in the BAILAMOS^© dance program or a health education program. Cognitive test scores were converted to z-scores and measures of global cognition and specific domains (executive function, episodic memory, working memory) were derived. Results revealed a group × time interaction for episodic memory (p < .05), such that the dance group showed greater improvement in episodic memory than the health education group. A main effect for time for global cognition (p < .05) was also demonstrated, with participants in both groups improving. Structured Latin dance programs can positively influence episodic memory, and participation in structured programs may improve overall cognition among older Latinos.

Training of support afferentation in postmenopausal women

We have recently shown a diminishing of the Menopause Index in old-aged women who underwent special training directed at the enhancement of support afferentation by increasing the plantar forefoot sensitivity (Bazanova et al., 2015). Based on these results we hypothesized, that purposeful training of support afferentation through stimulation of plantar graviceptors by Aikido practice will decrease excessive postural and psychoemotional tension not only in rest condition, but during cognitive and manual task performance too. Fluency of cognitive and motor task performance, EEG alpha power as an index of neuronal efficiency of cognitive control, amount of alpha power suppression as a visual activation measure and EMG power of forehead muscles as a sign of psychoemotional tension were compared in three groups of post-menopausal women: i) 8years training with forefeet support afferentation with Aikido practice (A), ii) 8years fitness training (F) and iii) no dedicated fitness training for past 8years (N). Simultaneous stabilometry, EEG, and frontal EMG recording were performed in sitting and standing up position in eyes closed and eyes open condition. Recording done at rest and while performing cognitive and finger motor tasks. We compared studied parameters between groups with one- and two-way analyses of variance (ANOVAs) with Bonferroni correction for multiple comparisons, followed by post hoc two-tailed unpaired t-tests. The fluency of tasks performance, EMG and alpha-EEG-activity displayed similar values in all groups in a sitting position. Center of pressure (CoP) sway length, velocity and energy demands for saving balance increased when standing up, more in group N than in groups F and A (all contrasts p values<0.002, η²>0.89). Post hoc t-tests showed increased fluency in standing in both Aikido (p<0.01) and Fitness (p<0.05) subjects in relation to untrained subjects. Increasing fluency in motor task performance was in parallel with enhancing the EEG alpha-2-power and decreasing EMG power only in A group (η²>0.77). Fluency in motor task and alpha EEG power decreased, but frontal EMG power increased in response to standing in untrained women (group N) and did not change in F group. Post hoc t-tests showed that EEG amount of alpha-2 power suppression in response to visual activation and frontal EMG power was lower in A than F and N groups (p<0.004) during motor task performance in the standing position. These results were interpreted as showing that training of forefoot plantar surface sensitivity in postmenopausal women decreases levels of psychoemotional tension and increases cognitive control caused by the psychomotor and postural challenges. Thus, Aikido training aimed at learning coordination between manual task performance and balance control by increasing the plantar support zones sensation decreases the cost of maintained vertical position and dependence of motor coordination on visual contribution.

Dancing in time: feasibility and acceptability of a contemporary dance programme to modify risk factors for falling in community dwelling older adults

BACKGROUND

Falls are a common cause of injury in older adults, with the prevention of falls being a priority for public health departments around the world. This study investigated the feasibility, and impact of an 8 week contemporary dance programme on modifiable physical (physical activity status, mobility, sedentary behaviour patterns) and psychosocial (depressive state, fear of falling) risk factors for falls.

METHODS

An uncontrolled 'pre-post' intervention design was used. Three groups of older (60 yrs.+) adults were recruited from local community groups to participate in a 3 separate, 8 week dance programmes. Each programme comprised two, 90 min dance classes per week. Quantitative measures of physical activity, sedentary behaviour, depression, mobility and fear of falling were measured at baseline (T1) and after 8 weeks of dance (T2). Weekly attendance was noted, and post-study qualitative work was conducted with participants in 3 separate focus groups. A combined thematic analysis of these data was conducted.

RESULTS

Of the 38 (Mean Age = 77.3 ± 8.4 yrs., 37 females) who attended the dance sessions, 22 (21 females; 1 male; mean age = 74.8, ±8.44) consented to be part of the study. Mean attendance was 14.6 (±2.6) sessions, and mean adherence was 84.3% (±17). Significant increases in moderate and vigorous physical activity were noted, with a significant decrease in sitting time over the weekdays (p < 0.05). Statistically significant decreases in the mean Geriatric Depression Scale (p < 0.05) and fear of falling (p < 0.005) score were noted, and the time taken to complete the TUG test decreased significantly from 10.1 s to 7.7 s over the 8 weeks (p < 0.005). Themes from the focus groups included the dance programme as a means of being active, health Benefits, and dance-related barriers and facilitators.

CONCLUSIONS

The recruitment of older adults, good adherence and favourability across all three sites indicate that a dance programme is feasible as an intervention, but this may be limited to females only. Contemporary dance has the potential to positively affect the physical activity, sitting behaviour, falls related efficacy, mobility and incidence of depression in older females which could reduce their incidence of falls. An adequately powered study with control groups are required to test this intervention further.

Social Dancing and Incidence of Falls in Older Adults: A Cluster Randomised Controlled Trial

BACKGROUND

The prevention of falls among older people is a major public health challenge. Exercises that challenge balance are recognized as an efficacious fall prevention strategy. Given that small-scale trials have indicated that diverse dance styles can improve balance and gait of older adults, two of the strongest risk factors for falls in older people, this study aimed to determine whether social dance is effective in i) reducing the number of falls and ii) improving physical and cognitive fall-related risk factors.

METHODS AND FINDINGS

A parallel two-arm cluster randomized controlled trial was undertaken in 23 self-care retirement villages (clusters) around Sydney, Australia. Eligible villages had to have an appropriate hall for dancing, house at least 60 residents, and not be currently offering dance as a village activity. Retirement villages were randomised using a computer generated randomisation method, constrained using minimisation. Eligible participants had to be a resident of the village, be able to walk at least 50 m, and agree to undergo physical and cognitive testing without cognitive impairment. Residents of intervention villages (12 clusters) were offered twice weekly one-hour social dancing classes (folk or ballroom dancing) over 12 mo (80 h in total). Programs were standardized across villages and were delivered by eight dance teachers. Participants in the control villages (11 clusters) were advised to continue with their regular activities.

MAIN OUTCOMES

falls during the 12 mo trial and Trail Making Tests.

SECONDARY OUTCOMES

The Physiological Performance Assessment (i.e., postural sway, proprioception, reaction time, leg strength) and the Short Physical Performance Battery; health-related physical and mental quality of life from the Short-Form 12 (SF-12) Survey. Data on falls were obtained from 522 of 530 (98%) randomised participants (mean age 78 y, 85% women) and 424 (80%) attended the 12-mo reassessment, which was lower among folk dance participants (71%) than ballroom dancing (82%) or control participants (82%, p = 0.04). Mean attendance at dance classes was 51%. During the period, 444 falls were recorded; there was no significant difference in fall rates between the control group (0.80 per person-year) and the dance group (1.03 per person-year). Using negative binomial regression with robust standard errors the adjusted Incidence Rate Ratio (IRR) was 1.19 (95% CI: 95% CI = 0.83, 1.71). In exploratory post hoc subgroup analysis, the rate of falls was higher among dance participants with a history of multiple falls (IRR = 2.02, 95% CI: 1.15, 3.54, p = 0.23 for interaction) and with the folk dance intervention (IRR = 1.68, 95% CI: 1.03, 2.73). There were no significant between-group differences in executive function test (TMT-B = 2.8 s, 95% CI: -6.2, 11.8). Intention to treat (ITT) analysis revealed no between-group differences at 12-mo follow-up in the secondary outcome measures, with the exception of postural sway, favouring the control group. Exploratory post hoc analysis by study completers and style indicated that ballroom dancing participants apparently improved their gait speed by 0.07 m/s relative to control participants (95% CI: 0.00, 0.14, p = 0.05). Study limitations included allocation to style based on logistical considerations rather than at random; insufficient power to detect differential impacts of different dance styles and smaller overall effects; variation of measurement conditions across villages; and no assessment of more complex balance tasks, which may be more sensitive to changes brought about by dancing.

CONCLUSIONS

Social dancing did not prevent falls or their associated risk factors among these retirement villages' residents. Modified dance programmes that contain "training elements" to better approximate structured exercise programs, targeted at low and high-risk participants, warrant investigation.

TRIAL REGISTRATION

The Australian New Zealand Clinical Trials Registry ACTRN12612000889853.

Cognitive Benefits of Social Dancing and Walking in Old Age: The Dancing Mind Randomized Controlled Trial

Background

A physically active lifestyle has the potential to prevent cognitive decline and dementia, yet the optimal type of physical activity/exercise remains unclear. Dance is of special interest as it complex sensorimotor rhythmic activity with additional cognitive, social, and affective dimensions.

Objectives

To determine whether dance benefits executive function more than walking, an activity that is simple and functional.

Methods

Two-arm randomized controlled trial among community-dwelling older adults. The intervention group received 1 h of ballroom dancing twice weekly over 8 months (~69 sessions) in local community dance studios. The control group received a combination of a home walking program with a pedometer and optional biweekly group-based walking in local community park to facilitate socialization.

Main outcomes

Executive function tests: processing speed and task shift by the Trail Making Tests, response inhibition by the Stroop Color-Word Test, working memory by the Digit Span Backwards test, immediate and delayed verbal recall by the Rey Auditory Verbal Learning Test, and visuospatial recall by the Brief Visuospatial Memory Test (BVST).

Results

One hundred and fifteen adults (mean 69.5 years, SD 6.4) completed baseline and delayed baseline (3 weeks apart) before being randomized to either dance (n = 60) or walking (n = 55). Of those randomized, 79 (68%) completed the follow-up measurements (32 weeks from baseline). In the dance group only, “non-completers” had significantly lower baseline scores on all executive function tests than those who completed the full program. Intention-to-treat analyses showed no group effect. In a random effects model including participants who completed all measurements, adjusted for baseline score and covariates (age, education, estimated verbal intelligence, and community), a between-group effect in favor of dance was noted only for BVST total learning (Cohen’s D Effect size 0.29, p = 0.07) and delayed recall (Cohen’s D Effect size = 0.34, p = 0.06).

Conclusion

The superior potential of dance over walking on executive functions of cognitively healthy and active older adults was not supported. Dance improved one of the cognitive domains (spatial memory) important for learning dance. Controlled trials targeting inactive older adults and of a higher dose may produce stronger effects, particularly for novice dancers.

Trial registration

Australian and New Zealand Clinical Trials Register (ACTRN12613000782730).

Physical activity and neurocognitive functioning in aging - a condensed updated review

This condensed review gives an overview about two methodological approaches to study the impact of physical activity on cognition in elderly, namely cross-sectional studies and randomized controlled intervention studies with pre- and post-measures. Moreover, this review includes studies investigating different types of physical activity and their relation to cognitive functions in older age. Behavioral data are considered but the main focus lies on neuroscientific methods like event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI).

Aerobic and Cognitive Exercise (ACE) Pilot Study for Older Adults: Executive Function Improves with Cognitive Challenge While Exergaming

Dementia cases are increasing worldwide; thus, investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life. Extensive research confirms the benefits of physical exercise for brain health, yet only a fraction of older adults exercise regularly. Interactive mental and physical exercise, as in aerobic exergaming, not only motivates, but has also been found to yield cognitive benefit above and beyond traditional exercise. This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning. Sixty-four community based older adults (mean age=82) were randomly assigned to pedal a stationary bike, while interactively engaging on-screen with: (1) a low cognitive demand task (bike tour), or (2) a high cognitive demand task (video game). Executive function (indices from Trails, Stroop and Digit Span) was assessed before and after a single-bout and 3-month exercise intervention. Significant group × time interactions were found after a single-bout (Color Trails) and after 3 months of exergaming (Stroop; among 20 adherents). Those in the high cognitive demand group performed better than those in the low cognitive dose condition. Everyday function improved across both exercise conditions. Pilot data indicate that for older adults, cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge.

A prospective field study for sensor-based identification of fall risk in older people with dementia

OBJECTIVE

Aim of this study was to make a fall prognosis in a cohort of older people with dementia in short-term (2 month), mid-term (4 month) and long-term (8 month) intervals using accelerometry during the subjects' everyday life.

METHODS

The study was designed as a longitudinal cohort study. The subjects were recruited from a nursing home and geriatric assessment tests were conducted at baseline. Each subject underwent four visits and was measured at each visit for one week. Gait episodes were detected and gait parameters were extracted from these episodes. These gait parameters were combined with the falls occurred during the study. A decision tree induction method was used to analyze the data.

RESULTS

Forty subjects participated in the study, whereby 12 drop-outs were registered. The geriatric assessment tests were unable to distinguish between the groups (AUC < 0.6). The evaluation of the models induced with the decision tree classification showed a rate of correctly classified gait episodes of 88.4% for short-term, 74.8% for mid-term, and 88.5 % for long-term monitoring.

DISCUSSION AND CONCLUSIONS

We concluded that it is possible to classify gait episodes of fallers and non-fallers in people with dementia during everyday life using accelerometry.

Long-term exercise in older adults: 4-year outcomes of music-based multitask training

Prospective controlled evidence supporting the efficacy of long-term exercise to prevent physical decline and reduce falls in old age is lacking. The present study aimed to assess the effects of long-term music-based multitask exercise (i.e., Jaques-Dalcroze eurhythmics) on physical function and fall risk in older adults. A 3-year follow-up extension of a 1-year randomized controlled trial (NCT01107288) was conducted in Geneva (Switzerland), in which 134 community-dwellers aged ≥65 years at increased risk of falls received a 6-month music-based multitask exercise program. Four years following original trial enrolment, 52 subjects (baseline mean ± SD age, 75 ± 8 years) who (i) have maintained exercise program participation through the 4-year follow-up visit ("long-term intervention group", n = 23) or (ii) have discontinued participation following original trial completion ("control group", n = 29) were studied. They were reassessed in a blind fashion, using the same procedures as at baseline. At 4 years, linear mixed-effects models showed significant gait (gait speed, P = 0.006) and balance (one-legged stance time, P = 0.015) improvements in the long-term intervention group, compared with the control group. Also, long-term intervention subjects did better on Timed Up & Go, Five-Times-Sit-to-Stand and handgrip strength tests, than controls (P < 0.05, for all comparisons). Furthermore, the exercise program reduced the risk of falling (relative risk, 0.69; 95% confidence interval, 0.5-0.9; P = 0.008). These findings suggest that long-term maintenance of a music-based multitask exercise program is a promising strategy to prevent age-related physical decline in older adults. They also highlight the efficacy of sustained long-term adherence to exercise for falls prevention.