The effectiveness of dance movement interventions for older adults with mild cognitive impairment, Alzheimer's disease, and dementia: A systematic scoping review and meta-analysis

OBJECTIVES

To synthesize evidence and summarize research findings related to the effectiveness and feasibility of dance movement intervention (DMI) in older adults with mild cognitive impairment (MCI), Alzheimer's disease (AD), and dementia; to systemically map existing research gaps and research directions for future practice.

METHODS

A systematic search was conducted using six electronic databases: Web of Science, PubMed, PsycINFO, MEDLINE, ScienceDirect, and Cochrane Central Register of Controlled Trials. The methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool for Randomized Trials (RoB 2) and The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I).

RESULTS

29 dance intervention studies (13 RCT studies) were included in the scoping review: 62% of MCI, 10% of AD, and 28% of dementia; a total of 1708 participants (Female=1247; Male=461) aged from 63.8 ( ± 5.24) to 85.8 ( ± 5.27) years old. Eight RCT studies were included in the meta-analysis; results indicated that dance interventions had a significant effect on global cognition, memory, balance, and significantly decreased depression. No significant effects were found for executive function.

CONCLUSIONS

Dance is a non-pharmacological, effective, affordable, and engaging intervention that can be used as a complementary treatment for older adults with MCI, AD, and dementia.

Differences in fall-related characteristics across cognitive disorders

Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making.

Dance Is a Healing Art

The purpose of this review is to evaluate the health benefits of dance and dance therapy in various health domains. Dance interventions included movement therapy with certified therapists, common dances such as ballroom dancing, salsa, and cha-cha as well as ethnic dances, such as the Chinese Guozhuang Dance and the Native American jingle dance. The health domains included depression, cognitive function, neuromotor function, dementia, balance, neurological growth factors, and subjective well-being. The National Library of Medicine, Congress of Library, and the Internet were searched using the terms: dance, dance movement therapy, health, cognitive function, healing, neurological function, neuromotor function, and affective disorders from 1831 to January 2, 2023. Two-thousand five hundred and ninety-one articles were identified. Articles were selected if they provided information on the health benefits of dance in one or more of the above domains as compared to a "non-dance" control population. Studies included systematic reviews, randomized controlled studies, and long-term perspective studies. Most of the subjects in the studies were considered "elderly," which was generally defined as 65 years or older. However, the benefits of DI on executive function were also demonstrated in primary school children. Overall, the studies demonstrated that DI provided benefits in several physical and psychological parameters as well as executive function as compared with regular exercise alone. Impressive findings were that dance was associated with increased brain volume and function and neurotrophic growth function. The populations studied included subjects who were "healthy" older adults and children who had dementia, cognitive dysfunction, Parkinson's disease, or depression.

"I Hear the Music and My Spirits Lift!" Pleasure and Ballroom Dancing for Community-Dwelling Older Adults

Physical activity for older adults is recommended to encourage the maintenance of functional autonomy and improve mental health. Ballroom dancing involves aerobic, strength, and balance work and is an inherently a social activity. This 12-month qualitative study considered the influence of ballroom dancing on health and well-being in community-dwelling older adults. It explores an underreported aspect of physical activity, which may incentivize older people to participate, that is, pleasure. Qualitative data were managed and analyzed using the Framework Analysis approach. Semistructured interviews were conducted with 26 older adult ballroom dancers. Five typologies of pleasure were identified. In addition to "sensual pleasure," "pleasure of habitual action," and "pleasure of immersion," as suggested by Phoenix and Orr, the "pleasure of practice" and "pleasure of community" were also identified. Ballroom dancing produces a strong sense of embodied pleasure for older adults and should be promoted by health and exercise professionals for community-dwelling older adults.

Superior gait performance and balance ability in Latin dancers

Background

Latin dance consists of various fast and stability-challenging movements that require constant body adjustments to maintain proper posture and balance. Although human gaits are assumed to be symmetrical, several factors can contribute to asymmetrical behavior of the lower extremities in healthy adults. These include lower limb dominance, ground reaction forces, lower limb muscle power, foot placement angle, and range of joint motion. Gait impairment can lead to a high risk of falling, diminished mobility, and even cognition impairment. We hypothesized that Latin dancers might have a more symmetric gait pattern and better balance ability than healthy non-dancer controls.

Methods

We investigated the impact of Latin dance training on gait behaviors and body balance. We recruited twenty Latin dancers and 22 normal healthy subjects to conduct walking experiments and one-leg stance tests, and we measured their kinematic data by inertial measurement units. We then defined four performance indexes to assess gait performance and body stability to quantify the potential advantages of dance training.

Results

We found that the two gait asymmetric indexes during the walking test and the two performance indexes during the one-leg stance tests were better in Latin dancers compared with the healthy control group. The results confirmed the superiority of Latin dancers over the healthy control group in gait symmetry and balance stability. Our results suggest that Latin dancing training could effectively strengthen lower limb muscles and core muscle groups, thereby improving coordination and enhancing gait performance and balance.

Conclusion

Latin dance training can benefit gait performance and body balance. Further studies are needed to investigate the effect of Latin dance training on gait and balance outcomes in healthy subjects and patients with gait disorders.

Effects of fundamental movement skills based dual-task and dance training on single- and dual-task walking performance in older women with dementia

OBJECTIVE

The purpose of this study was to compare the effects of fundamental movement skills (FMS)-based dual-task training and dance training on spatio-temporal characteristics of gait performance under single- and dual-task walking conditions among older women with dementia.

METHOD

Thirty-eight elderly females with dementia were randomly assigned to one of two groups: (1) dual-task intervention (DTI, age: 73 ± 6.5 years) or (2) Iranian dance intervention (IDI, age: 72.52 ± 6.01 years). Both groups participated in a 10-week intervention program (3 sessions per week, each lasting 50 min). Gait performance parameters (gait speed, cadence, and stride length) and dual-task costs (DTC) were examined using a gait analysis system. The participants completed three walking trials under two conditions: single- and dual-task. The video data was analyzed using motion analysis software (Frame-DIAS II, DKH, DKH Inc., Tokyo, Japan).

RESULTS

The results showed that both groups significantly improved in terms of all gait variables, and DTC decreased (p < .001) from pre- to post-test for both conditions. However, the main effects for the group and the group-by-time interactions were not significantly different between the two groups (p > .05).

CONCLUSION

These findings showed that DTI and IDI effectively improved gait performance following a 10-week intervention for older women with dementia. Therefore, it is suggested that either training program could decrease DTC and increase gait speed, stride length, and cadence among older females with dementia.

The movement-to-music (M2M) study: study protocol for a randomized controlled efficacy trial examining a rhythmic teleexercise intervention for people with physical disabilities

BACKGROUND

People with physical disabilities need exercise routines that are enjoyable, readily available in the home, adapted to their functional level, and eliminate common barriers to exercise participation related to transportation and time commitment. The purpose of the movement-to-music (M2M) study is to address these issues by establishing a remotely delivered, rhythmic exercise program for people with physical disabilities.

METHODS

The study is a two-arm randomized controlled efficacy trial examining a 12-week remotely delivered M2M intervention (eM2M) in 108 people with physical disabilities. The primary outcomes are changes in cardiorespiratory fitness and muscle strength at post 12-week intervention.

DISCUSSION

The eM2M study will enhance our understanding of an alternative intervention design and delivery mode that removes common barriers to exercise participation experienced by people with physical disabilities. The eM2M intervention may be an alternative option for people with physical disabilities to obtain regular exercise, especially during a pandemic when exercising in indoor facilities may be problematic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03797378. Registered on January 9, 2019, with the trial name "Movement-to-Music: Lakeshore Examination of Activity, Disability, and Exercise Response Study (M2M LEADERS)".

Effects of Dance Interventions on Cognition, Psycho-Behavioral Symptoms, Motor Functions, and Quality of Life in Older Adult Patients With Mild Cognitive Impairment: A Meta-Analysis and Systematic Review

Background: Dance interventions are considered beneficial for older patients with mild cognitive impairment in many aspects. We conducted a comprehensive systematic review and meta-analysis to assess the effects of dance on different aspects (cognitive function, emotions, physical function, and quality of life) of this population. Methods: A systematic search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, Embase, American Psychological Association PsycInfo, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, the Chinese BioMedical Literature Database, the VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang Data database was performed. Two reviewers independently assessed the study quality. Results: Fourteen studies were retrieved from the databases for analysis. The pooled results showed that dance interventions significantly improved global cognition (standardized mean difference [SMD] = 0.73, 95% confidence interval [CI]: 0.47 to 0.99, P < 0.00001), rote memory (mean difference [MD] = -2.12, 95% CI: -4.02 to -0.21, P = 0.03), immediate recall (SMD = 0.54, 95% CI: 0.30 to 0.78, P < 0.0001), delayed recall (SMD = 0.56, 95% CI: 0.26 to 0.86, P = 0.0002) and attention (SMD = 0.38, 95% CI: 0.13 to 0.64, P = 0.003). No significant improvement was found in executive function, language, depression, anxiety, dementia-related behavioral symptoms, motor function, and quality of life. Conclusion: Dance interventions benefit most aspects of cognitive functions. The evidence for the effects of dance on psycho-behavioral symptoms, motor function and quality of life remains unclear. More trials with rigorous study designs are necessary to provide this evidence.

Dance for People with Alzheimer's Disease: A Systematic Review

BACKGROUND

In recent years, several reviews have addressed the effectiveness of dance therapy in dementia, healthy older adults, or the elderly in general. However, reviews regarding the effect of this therapy exclusively on patients diagnosed with Alzheimer's disease have not been found.

OBJECTIVE

The purpose of this study is to review the available literature describing clinical trials which explore the effects of dancing on psychological and physical outcomes, functionality, cognitive function, and quality of life in patients diagnosed with Alzheimer's disease. In addition, this review aims to assess the quality of studies that perform dance therapy interventions in these patients.

METHODS

This study is a systematic review of randomized and non-randomized clinical trials regarding the effect of intervention including a dancing activity in people diagnosed with Alzheimer's disease.

RESULTS

In total, the evidence for this review rests on 12 studies with a total of 349 participants. The findings of this mini-review confirm the positive effect of dance therapy on physical and cognitive function, functionality, psychological outcomes, and quality of life in people with Alzheimer's disease.

CONCLUSION

Most of the studies implementing dance as part of the therapeutic treatment has shown to improve or slow the worsening in the quality of life of patients with Alzheimer's disease and their caregivers. Future research focused on these patients should use a more exhaustive methodology and make a more detailed description of these kind of interventions.

Effects of dance activities on patients with chronic pathologies: scoping review

Introduction

Physical inactivity often accompanies chronic pathologies. This induces a sedentariness that favors complications and patient isolation. There is a growing scientific interest in the practice of art, for such activities leave the usual healthcare framework and include the World Health Organization (WHO)'s three dimensions of health. Dance is a universal activity that has been identified as healthy. This scoping review's aim is to study the benefits, modalities and risks of dance for persons with a chronic pathology.

Method

The literature research was conducted in English and French, using PubMed and Kinedoc's databases, and keywords related to dance and chronic pathologies. Dance activities that did not involve a dance instructor or a trained health professional were excluded. Studies' location and design, the chosen type of dance, pathologies, the number of subjects, modalities, intended effects and adverse effects were then studied.

Results

51 studies were included in this work. 47.5% were RCTs and 47% originate from North America. The number of published studies is strongly increasing. Sixteen different pathologies were studied, with a large predominance of neurology diseases. Targeted effects were the impacts on mental health, quality of life, physical and motor capacities and pathology-specific symptoms. Dance activities are deemed feasible, and no adverse effects were identified.

Discussion

In the event of chronic pathologies, practicing dance is possible; it is stimulating and effective against sedentariness and its adverse effects. Patient adherence is good, and dance seems to respond to the multidimensional component of chronic diseases, while offering unlimited adaptation to patients' physical and cognitive impairments. There are few studies yet, and their methodological quality is moderate, which is why further research work must confirm dance's interest regarding chronic pathologies.

Weight-Loss Outcomes from a Pilot Study of African Dance in Older African Americans

OBJECTIVE

Obesity is a risk factor for both cognitive and physical impairment in late adulthood. Though the rates of obesity are high in many groups, older African Americans are disproportionately affected. A randomized pilot intervention of African Dance was conducted with 28 African American older adults with obesity (mean age = 68.4 ± 5.1 years; mean BMI = 33.4 ± 6.2). The goal of the study was to evaluate the physiological outcomes of a culturally sensitive exercise intervention and specifically changes in weight.

METHODS

Participants were randomly assigned to an African Dance (experimental) or Culture Education (control) group. They attended their assigned class for 1 hour per session, 3 days per week, for 6 months.

RESULTS

There was a significant group × time interaction on weight (P  = 0.005) such that the African Dance group lost weight (mean = 4.0 ± 6.0 lb) while the Culture Education group gained weight (mean = 2.6 ± 3.9 lb).

CONCLUSIONS

These results suggest that a culturally sensitive form of physical activity, African Dance, may be effective for promoting weight loss in a population at increased risk for obesity and cognitive decline.

Improving social inclusion for people with dementia and carers through sharing dance: a qualitative sequential continuum of care pilot study protocol

INTRODUCTION

This study examines the potential of dance to improve social inclusion for people living with dementia and carers. Research suggests that arts-based programmes can improve the health of people living with dementia and carers; however, little is known about how these programmes might address barriers to social inclusion. Addressing barriers requires the development and evaluation of accessible, non-stigmatising and affordable programmes that facilitate social inclusion across the continuum of institutional, community and household care settings.

METHODS AND ANALYSIS

The study involves a qualitative sequential pilot study of the innovative Baycrest NBS Sharing Dance Seniors programme underway in non-metropolitan regions of two Canadian provinces. It focuses on the remotely instructed delivery of the programme in care facilities, community centres and households. The study involves five phases of observations, diaries, focus groups and interviews with programme participants (people living with dementia), carers, coordinators, instructors and volunteers as well as critical reflections among research investigators and knowledge users. NVivo-based thematic and narrative analyses of the qualitative data will produce new knowledge about the experiences, effectiveness and challenges of the dance programme that will inform understanding of whether and in what ways it increases social inclusion and quality of life for older people living with dementia and carers. The findings will identify opportunities for programme expansion and support the further development of arts-based approaches.

ETHICS AND DISSEMINATION

The study is approved by the Research Ethics Boards at Trent University and Brandon University, and by participating organisations according to their governance procedures. The perspectives of people living with dementia and carers are incorporated throughout the study (from design to dissemination) and the study adheres to the ethical considerations when including people with dementia. A series of publicly available reports, seminars and symposia will be undertaken in collaboration with knowledge user and collaborating organisation partners.

Integrating Citizenship, Embodiment, and Relationality: Towards a Reconceptualization of Dance and Dementia in Long-Term Care

Dance, as aesthetic self-expression, is a unique arts-based program that combines the physical benefits of exercise with psychosocial therapeutic benefits. While dance has also been shown to support empowerment, meaningful self-expression, and pleasurable experience, it is rarely adopted to support these aspects of engagement in the context of dementia care. The instrumental reduction of dance to its application as a therapeutic tool can be traced to the contemporary movement towards cognitive science with an emphasis on embodied cognition. This has effectively elided a consideration of how the body itself, separate and apart from cognition, could be a source of intelligibility, inventiveness, and creativity. We argue for the need to broaden the therapeutic model of dance to more fully support embodied and creative self-expression by persons living with dementia. To achieve this, we explore how a relational model of citizenship that recognizes corporeality and relationality as fundamental to human existence brings a new and critical dimension to understanding the importance of dance in the context of dementia. Drawing on this model, we articulate a new kind of ethic characterized by a pre-reflective intercorporeal sensibility that requires the mobilization of public structures and practices to cultivate a relational environment for individuals living with dementia that supports human flourishing.

International Ballroom Dancing Against Neurodegeneration: A Randomized Controlled Trial in Greek Community-Dwelling Elders With Mild Cognitive impairment

BACKGROUND

Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases.

OBJECTIVES

To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI).

METHODS

One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period.

RESULTS

According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales.

CONCLUSION

Dance may be an important nonpharmacological approach that can benefit cognitive functions.

Pilot of a Tailored Dance Intervention to Support Function in People With Cognitive Impairment Residing in Long-Term Care: A Brief Report

Older adults who live in long-term care settings are at risk for functional decline, which may be mitigated by regular exercise. Using a single-group repeated measures design, this pilot study explored the feasibility, acceptability, and preliminary effects of a Waltz-based dance intervention delivered to 13 Canadian, English-speaking, long-term care residents with mild to moderate cognitive impairment. The findings supported intervention feasibility, based on a high completion rate (93%), level of attendance (M = 7.15 of 10 sessions) and level of engagement during dance sessions (M = 1.75 to 1.97 out of 2.00). On average, residents perceived dance sessions positively, and staff and family participants (N = 26) rated them as somewhat acceptable overall (M = 2.37, 0 to 4 scale). Additional research is needed to assess intervention efficacy in a larger sample.

Dance movement therapy for dementia

BACKGROUND

Dementia is a collective name for different degenerative brain syndromes which, according to Alzheimer's Disease International, affects approximately 35.6 million people worldwide. The latest NICE guideline for dementia highlights the value of diverse treatment options for the different stages and symptoms of dementia including non-pharmacological treatments. Relevant literature also argues for the value of interventions that acknowledge the complexity of the condition and address the person as a whole, including their physical, emotional, social and cognitive processes. At the same time, there is growing literature that highlights the capacity of the arts and embodied practices to address this complexity. Dance movement therapy is an embodied psychological intervention that can address complexity and thus, may be useful for people with dementia, but its effectiveness remains unclear.

OBJECTIVES

To assess the effects of dance movement therapy on behavioural, social, cognitive and emotional symptoms of people with dementia in comparison to no treatment, standard care or any other treatment. Also, to compare different forms of dance movement therapy (e.g. Laban-based dance movement therapy, Chacian dance movement therapy or Authentic Movement).

SEARCH METHODS

Searches took place up to March 2016 through ALOIS, Cochrane Dementia and Cognitive Improvement's Specialized Register, which covers CENTRAL, a number of major healthcare databases and trial registers, and grey literature sources. We checked bibliographies of relevant studies and reviews, and contacted professional associations, educational programmes and experts from around the world.

SELECTION CRITERIA

We considered randomised controlled trials (RCTs) in any language, including cross-over design and cluster-RCTs for inclusion. Studies considered had to include people with dementia, in any age group and in any setting, with interventions delivered by a dance movement therapy practitioner who (i) had received formal training (ii) was a dance movement therapist in training or (iii) was otherwise recognised as a dance movement therapist in the country in which the study was conducted.

DATA COLLECTION AND ANALYSIS

The two review authors independently reviewed studies on an abstract/title level and again after reading the full paper, and we independently evaluated methodological quality.

MAIN RESULTS

Of the 102 studies identified through electronic searches and personal communication, after de-duplication we screened 80 at title/abstract level. We then reviewed 19 full papers, none of which met the inclusion criteria. Although three studies mentioned dance movement therapy as their intervention, they were excluded because they were not delivered by a qualified dance movement therapy practitioner. As a result, no studies were included in this review.

AUTHORS' CONCLUSIONS

Trials of high methodological quality, large sample sizes and clarity in the way the intervention is put together and delivered are needed to assess whether dance movement therapy is an effective intervention for dementia.

Rhythm experience and Africana culture trial (REACT!): A culturally salient intervention to promote neurocognitive health, mood, and well-being in older African Americans

The Rhythm Experience and Africana Culture Trial (REACT!) is a multi-site randomized controlled intervention study designed to examine the efficacy of using African Dance as a form of moderate-intensity physical activity to improve cognitive function in older African Americans. African Americans are almost two times more likely than Caucasians to experience cognitive impairment in late adulthood. This increased risk may be attributed to lower level and quality of education, lower socioeconomic status, and higher prevalence of vascular diseases, type 2 diabetes, hypertension, and obesity, all of which are recognized as risk factors for dementia. Fortunately, interventions targeting cardiovascular health (i.e., physical activity) are associated with improved neurocognitive function and a reduced risk for dementia, so African Americans may be particularly suited for interventions targeting cardiovascular health and cognitive function. Here, we describe a randomized intervention protocol for increasing physical activity in older (65-75years) African Americans. Participants (n=80) at two study locations will be randomized into one of two groups. The treatment group will participate in African Dance three times per week for six months and the control group will receive educational training on Africana history and culture, as well as information about health behaviors, three times per week for six months. If successful, the REACT! study may transform community interventions and serve as a platform and model for testing other populations, age groups, and health outcomes, potentially identifying novel and creative methods for reducing or eliminating health disparities.

Exercise programs for people with dementia

BACKGROUND

This is an update of our previous 2013 review. Several recent trials and systematic reviews of the impact of exercise on people with dementia are reporting promising findings.

OBJECTIVES

Primary objectiveDo exercise programs for older people with dementia improve their cognition, activities of daily living (ADLs), neuropsychiatric symptoms, depression, and mortality? Secondary objectivesDo exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?Do exercise programs for older people with dementia reduce the use of healthcare services (e.g. visits to the emergency department) by participants and their family caregivers?

SEARCH METHODS

We identified trials for inclusion in the review by searching ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 4 September 2011, on 13 August 2012, and again on 3 October 2013.

SELECTION CRITERIA

In this review, we included randomized controlled trials in which older people, diagnosed with dementia, were allocated either to exercise programs or to control groups (usual care or social contact/activities) with the aim of improving cognition, ADLs, neuropsychiatric symptoms, depression, and mortality. Secondary outcomes related to the family caregiver(s) and included caregiver burden, quality of life, mortality, and use of healthcare services.

DATA COLLECTION AND ANALYSIS

Independently, at least two authors assessed the retrieved articles for inclusion, assessed methodological quality, and extracted data. We analysed data for summary effects. We calculated mean differences or standardized mean difference (SMD) for continuous data, and synthesized data for each outcome using a fixed-effect model, unless there was substantial heterogeneity between studies, when we used a random-effects model. We planned to explore heterogeneity in relation to severity and type of dementia, and type, frequency, and duration of exercise program. We also evaluated adverse events.

MAIN RESULTS

Seventeen trials with 1067 participants met the inclusion criteria. However, the required data from three included trials and some of the data from a fourth trial were not published and not made available. The included trials were highly heterogeneous in terms of subtype and severity of participants' dementia, and type, duration, and frequency of exercise. Only two trials included participants living at home.Our meta-analysis revealed that there was no clear evidence of benefit from exercise on cognitive functioning. The estimated standardized mean difference between exercise and control groups was 0.43 (95% CI -0.05 to 0.92, P value 0.08; 9 studies, 409 participants). There was very substantial heterogeneity in this analysis (I² value 80%), most of which we were unable to explain, and we rated the quality of this evidence as very low. We found a benefit of exercise programs on the ability of people with dementia to perform ADLs in six trials with 289 participants. The estimated standardized mean difference between exercise and control groups was 0.68 (95% CI 0.08 to 1.27, P value 0.02). However, again we observed considerable unexplained heterogeneity (I² value 77%) in this meta-analysis, and we rated the quality of this evidence as very low. This means that there is a need for caution in interpreting these findings.In further analyses, in one trial we found that the burden experienced by informal caregivers providing care in the home may be reduced when they supervise the participation of the family member with dementia in an exercise program. The mean difference between exercise and control groups was -15.30 (95% CI -24.73 to -5.87; 1 trial, 40 participants; P value 0.001). There was no apparent risk of bias in this study. In addition, there was no clear evidence of benefit from exercise on neuropsychiatric symptoms (MD -0.60, 95% CI -4.22 to 3.02; 1 trial, 110 participants; P value .0.75), or depression (SMD 0.14, 95% CI -0.07 to 0.36; 5 trials, 341 participants; P value 0.16). We could not examine the remaining outcomes, quality of life, mortality, and healthcare costs, as either the appropriate data were not reported, or we did not retrieve trials that examined these outcomes.

AUTHORS' CONCLUSIONS

There is promising evidence that exercise programs may improve the ability to perform ADLs in people with dementia, although some caution is advised in interpreting these findings. The review revealed no evidence of benefit from exercise on cognition, neuropsychiatric symptoms, or depression. There was little or no evidence regarding the remaining outcomes of interest (i.e., mortality, caregiver burden, caregiver quality of life, caregiver mortality, and use of healthcare services).

A Pilot Study: examining the effects and tolerability of structured dance intervention for individuals with multiple sclerosis

PURPOSE

The aims of this pilot were to examine dance as a feasible intervention for persons with multiple sclerosis (MS), specifically to examine issues of tolerability and its longitudinal effects on participants. Dance is an enjoyable physical activity that has been investigated in other neurodegenerative populations but has yet to be studied in MS.

METHOD

A 4-week, two 60-min classes per week, pilot salsa dance intervention was administered to eight individuals with MS. The outcomes measured were effects on gait, balance, self-efficacy, motivation, physical activity and MS symptoms. They were administered at baseline, immediately post-intervention and at 3- and 6-month follow-ups.

RESULTS

Statistically significant pre-post intervention gains were found for the Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Activities-specific Balance Confidence Scale and Godin Leisure Time Questionnaire. Significant improvements were also found for the TUG, DGI and MS Walking Scale between baseline and 3-month follow-up assessments. Participants did not report any problems with fatigue or intolerability with the 60-min suggestions, further supporting the feasibility for the concept of a dance intervention.

CONCLUSIONS

This study suggests that dance for persons with MS may have promise for improving physical activity, gait and balance.

IMPLICATIONS FOR REHABILITATION

Although structured dance has reported benefits in elderly populations and in individuals with cardiovascular and neurological impairments, there is virtually nothing known regarding dance in the MS population. This pilot salsa dance study shows that structured dance demonstrates promise of being well-tolerated, safe and effective at promoting physical activity in people with MS without increased fatigue. A 12-week study has been initiated to test the robustness of initial observations and further examine factors influencing participants' physical activity adherence and behavioral change.

New framework for rehabilitation - fusion of cognitive and physical rehabilitation: the hope for dancing

Neurorehabilitation programs are commonly employed with the goal to help restore functionality in patients. However, many of these therapies report only having a small impact. In response to the need for more effective and innovative approaches, rehabilitative methods that take advantage of the neuroplastic properties of the brain have been used to aid with both physical and cognitive impairments. Following this path of reasoning, there has been a particular interest in the use of physical exercise as well as musical related activities. Although such therapies demonstrate potential, they also have limitations that may affect their use, calling for further exploration. Here, we propose dance as a potential parallel to physical and music therapies. Dance may be able to aid with both physical and cognitive impairments, particularly due to it combined nature of including both physical and cognitive stimulation. Not only does it incorporate physical and motor skill related activities, but it can also engage various cognitive functions such as perception, emotion, and memory, all while done in an enriched environment. Other more practical benefits, such as promoting adherence due to being enjoyable, are also discussed, along with the current literature on the application of dance as an intervention tool, as well as future directions required to evaluate the potential of dance as an alternative therapy in neurorehabilitation.