Abstract
A love of music and dance led Jill R. Baron, MD, MS, FAAFP, IFM, ABIHM, NCMP, to investigate the research on the clinical application of dance as an integrative therapy. Dr. Baron discovered that many dance types, including Zumba® and tango, affect both neurologic and psychologic health, and can help people who have a wide range of medical challenges. Now, Dr. Baron shares her findings and insights on dance with others, helping both integrative medicine practitioners and patients take a new view of dance as an integrative therapy.
There are many different types of dance, however, that can benefit health. One study compared tango dancing versus mindfulness meditation to see how each modality affected stress, anxiety, and depression in 97 participants who had self-reported depression. 3 Participants were assigned to one of three groups—tango, mindfulness meditation, or a wait-list control group. The two experimental groups experienced 1½ half hours per week of either tango or mindfulness meditation over 6 weeks. The results were very interesting and showed that, compared with the control group, participants in the tango and meditation groups experienced significantly reduced levels of depression, and, compared with the control and meditation groups, the tango group experienced significantly reduced levels of stress. So, there are a lot of possibilities for dance in terms of exercise and also for its ability to affect mood and stress.
Along these same lines, another study explored older adults' mood and the effects of dance. 4 In this study, 16 women (average age: 64) were trained in aerobic line dancing. These women experienced a significant increase in vigor and mood and a decrease in tension, depression, fatigue, and anger with just one 75-minute session of aerobic line dancing.
There is also a newer field of study called dance movement therapy, which is actually a form of psychotherapy. Dance movement therapy is practiced in mental health, rehabilitation, medical, educational, and forensic settings, and is offered in nursing homes, daycare centers, private practice, and other settings involved with disease prevention and health promotion. 5 Dance movement therapy is for people of any age (including children) and might benefit individuals, couples, family, and/or groups, and might be effective for people with developmental, medical, social, physical, and psychologic impairments. 5 So, according to all of these study results that I have just shared, and other results, one could certainly view dance as a mind–body therapy.
In terms of specific conditions for which dance may help support health, dance has been shown to have neurologic/rehabilitative effects and to reduce the risk of various neurologic disorders, including cognitive decline in Alzheimer's dementia. Research has also shown a reduced risk for the onset of Parkinson's disease. There may also be a reduced risk of stroke incidence. What research has shown is that exercise—and, by extension, dance—has a neuroprotective effect. So, clinicians should certainly be thinking about prescribing dance for its neuroprotective effects in patients. Dance exercise has also been shown to reduce constipation and reduce the risk of colorectal cancer.
Obesity is another condition that should bring the power of dance to mind.
Obesity is another condition that should bring the power of dance to mind. We know that, unfortunately, the current obesity epidemic is affecting children significantly. In New York City alone, 43% of children are overweight or obese. 6 Interestingly, a prospective cohort study at a public school in New York City examined the effectiveness of an after-school intervention combining dance, nutrition, and lifestyle modifications to see if the intervention reduced risk factors for cardiovascular disease and type 2 diabetes. 6 The study included 64 New York City elementary school children, who were 4th and 5th graders. These children experienced 4 hours of high-intensity freestyle dance per week over 16 weeks. The intervention included high-intensity dance genres such as mambo, cha-cha, and hip-hop, etc. Dance plus diet and lifestyle counseling reduced risk factors for heart disease and type 2 diabetes. It also showed that both non–high-density lipoprotein, total cholesterol, and body mass index dropped in the overweight and obese children, and their endurance improved.
Another study in children explored the use of interactive dance games to prevent and/or treat pediatric obesity, and that study showed that children might be motivated to be active when given the opportunity to play an interactive dance game. 7
Sedentary behavior is another real challenge in society today that could be addressed through incorporating dance into lifestyle behaviors. We are increasingly hearing about how toxic sedentary behavior is for us. Even with 2 hours per day of moderate physical activity—that is moving for 2 hours a day—sedentary behavior is still correlated with an increased risk of all-cause mortality in a dose-dependent manner, according to an article in Current Cardiology Reports. 8 This is pretty impressive information. In the same article, the researchers discussed three factors that contribute to a reduced cardiovascular disease–risk profile: achieving optimal sleep duration; less sedentary behavior time; and more time spent in active behaviors. 8
It is important to point out that moderate-intensity physical activity is ∼3–6 METS [metabolic equivalents], meaning it requires a moderate amount of effort and accelerates heart rate noticeably. Vigorous-intensity physical activity is >6 METS, requiring a large amount of effort and causes rapid breathing and a substantial increase in heart rate. Dancing is typically an example of a moderate-intensity physical activity.
There is also chair dancing, not necessarily in a wheelchair, but for patients who are more frail or physically challenged in some way, and these people can actually start by doing chair dance exercises. Chair exercise can also fulfill the exercise requirements mentioned previously. Cardiovascular chair exercises can raise heart rate and increase endurance, and weights or other resistance props can be used to build strength and build muscle and bone mass, improve balance and prevent falls, and, also, increased flexibility can be achieved—all from chair exercise.
Neuromuscular Integrative Action [NIA] is another interesting and increasingly popular form of dance. I spoke recently with Debbie Rosas, the cofounder of NIA, who described this type of dance as a form of holistic conditioning, which combines dancelike movements with concepts and forms from Eastern and Western philosophies and programs, and is a fitness program. NIA is designed to coordinate the mind and body and to increase mindfulness, which is really important in terms of calming the brain and being more in the present moment.
We know that dance is uniquely expressed in many cultures throughout the world and might be a part of rituals and celebrations, and is also a form of recreation and self-expression. In the Jewish tradition of dance, there is the hora. There is a type of Indian dance called Kathak, and Yangko is a type of dance in China. There are tap dancing, belly dancing, aerial dancing, hip-hop, the hustle, and more. I think it is helpful to experience different modalities of dance to see what one prefers. The point is that there is something for everybody.
One of the things that I found in my research is that, in order to increase adherence for exercise and activity, it is important for people to have fun, especially for people who are older and who do not want to stand up for prolonged periods of time. However, when you put some music on and get these people in chairs and get these people moving, it is terrific. I also want to emphasize that, especially as people get older, people are more isolated, and dancing is a way of connecting with others. For example, when people with MS dance together, participants in studies have talked about how good it feels to be with people who were struggling with similar issues and yet focusing on something positive. Research is also being conducted about dance and people with Parkinson's disease. The Mark Morris Dance Company has recently partnered with
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The interesting thing is that studies have shown that the health benefits of dance in older people are independent of the style of dance.
As I mentioned previously, physical activity and dancing can help maintain brain functionality in aging individuals. Positron emission tomography scan studies showed that dancing elicits multisite brain activations, which implicates the involvement of widespread interacting brain networks. 11
Of course, there is the potential for injury with any type of exercise, and dance is no exception. A warm-up time before people starting fast movements can help prevent injury. In fact, people can begin by doing gentle stretches at home before going out to dance. A cool-down period is also important. If a person has never practiced Zumba, for example, perhaps starting with one class per week is a good idea. It is also important to recommend that people start with proper footwear for aerobics and dance fitness, footwear with enough cushioning and shock absorption as well as medial-lateral and side-to-side stabilities that can permit twisting and turning. Running shoes, for example, are not appropriate for dance.
As clinicians know, there can be many obstacles to patients obtaining enough regular physical activity. Patients may be afraid of falling, feel self-conscious about their appearance, have poor health, feel too weak to exercise, or lack energy. Choosing an exercise activity that a person will truly enjoy certainly increases the likelihood that he or she will stick with it.