Latin dance and cognitive impairment: Importance of una Mezcla of culture and science

The Latino/a/x/e (hereafter referred to as Latino) population in the United States (U.S.) is large and diverse. In 2016 there were almost four million Latinos aged 65 years and older and that number is projected to be almost twenty million by 2060. ¹ The U.S. Latino population is not a monolith: instead, it is made up of different heritage groups with their own cultural, ethnic, and socioeconomic characteristics. Within the U.S. Latino community and across different heritage groups, there is also diversity in various health outcomes, including hypertension, diabetes,^2,3 and Alzheimer's disease and related dementias (ADRD). ⁴ Among Latinos in the U.S., the number diagnosed with ADRD is expected to grow by more than 800%—from nearly 400,000 in 2012 to approximately 3.5 million by 2060. ⁵ Compared to older non-Latino Whites, older Latinos have a higher risk and prevalence of ADRD, partially attributed to longer life spans and the presence of these adverse risk factors such as obesity, metabolic syndrome, type 2 diabetes mellitus, and other cardiovascular conditions. ⁶

Participation in regular physical activity (PA) has been shown to result in many positive mental, physical and cognitive outcomes.^7,8 Participation in regular PA overall has shown to improve cognition and mild cognitive impairment in older adults.^9,10 Yet, meeting PA guidelines and adhering to a program or regime is one of the biggest challenges impeding people from achieving improvements in their health.^10–12 About 50% of people who start a traditional PA program will cease within six months, while those who are in community-based programs and clinical trials have an adherence rate of 52- 66%, respectively. ¹³ Research has shown that exercising in a group setting has higher adherence rates and many additional mental health benefits when compared to exercising alone.^14,15 Thus, having different PA options that may facilitate higher rates of adherence are needed. Compared to traditional exercise, dancing is an alternative mode of PA that can be seen as an engaging social activity. Dance-based interventions facilitate the possibility to dance in pairs with a partner or dance within a group. In a group setting, the establishment of social connections can support an increase in motivation and overall adherence to a PA intervention, as found in tango-based dance interventions delivered to older adults with Parkinson's disease. ¹⁶

Dance has many additional health benefits^17–20 which involve social and emotional engagement ²¹ and improvement in aspects of cognitive function,^18,22–26 mild cognitive impairment (MCI),^27,28 and dementia,^28,29 especially in older adults as they may expect greater cognitive outcomes through PA.^9,10 Dance was found to specifically have a greater cognitive improvement when compared to regular PA interventions because of the psychological outcomes of motivation stress ³⁰ and self-efficacy, ³¹ which is a strong predictor of future engagement in PA. ¹⁰ An 8-week trial that randomized participants into a 4-week Salsa program or a digital dietary intervention group found that participants in both groups reported an increase in their weekly leisure-time physical activity. ³²

In a recent review, it was shown that dance-based interventions were more effective in improving global cognition when compared to formal exercising among older adults with MCI. ²⁶ This may be a result of dance-based interventions being more holistic ²⁹ and integrated type interventions. ²⁸ Dance based interventions have also been shown to relieve symptoms of depression and anxiety which are both behavioral and psychological symptoms of dementia and are persistent during the progression of cognitive impairment.^33–35

Dance has a long-standing history in Latinos.^36,37 A study that assessed the level and types of PA among older Latinos adults (50+) using self-report and accelerometer data found that, across all age groups and both genders, dance was one the most commonly reported forms of leisure-time PA. In the 60–69 and 70 + age groups, 30.8% and 39.7% respectively reported dancing as a form of leisure-time PA. ³⁸ Despite this, prior to our work, there was a dearth of information or support for how dancing could positively influence the health and lives of older Latino adults. Dance can be tailored to different cultures and ages.^18,39,40 Dancing has long been a part of leisure and a way of socializing among Latinos, thus the lack of research on the effects of dancing on improving the overall PA and health of Latinos is surprising and a bit shocking. Dancing is a method to move one's body, but also one of the few that can explicitly include culture with cultural music, frequently happening with other people who speak your language.

Despite the cultural relevance of dance, and the existing health benefits of participating in it, few to no dance programs and interventions have been created with and for older Latinos adults. Additionally, to our knowledge, no dance RCTs have been offered in neighborhoods in which the people live. As a result, we created the BAILAMOS^TM dance program. An overview of the specifics of the program are available elsewhere,^39,41 but based upon our formative work and the extensive experience of the co-creator of the program, we offer merengue, cha-cha cha, bachata, and salsa. These four styles of Latin dance are among the most popular styles in terms of recognition and preference among Latinos. More recent versions of the program have added Cumbia and Kizumba to add to the Caribbean styles already included.

Our work has progressed from a single-group pilot testing of the program ³⁹ to a small-scale randomized controlled trial^39,42 to a large-scale RCT at 12 sites around the Chicagoland area of the impact of the BAILAMOS^TM dance program on cognitive and physical function of older Latinos.^41,43–45 We have also conducted three small trials: one to determine the feasibility of implementing BAILAMOS^TM in older Latinos with mild cognitive impairment^46,47; one to test the impact of BAILAMOS^TM on brain network functional connectivity of older Latinos using MRI^48–50; and one to test the feasibility and impact of adding technological components (Fitbit and text messaging) to the BAILAMOS^TM dance program on physical activity of older Latinos.^51,52 Post-COVID 19, we have offered a remote trial, Cognitive Enhancement and Risk-reduction through Exercise for Brain-Related Outcomes (CEREBRO), which is currently ongoing.

The research of our team has demonstrated that dancing is enjoyable for older Latinos, especially for those who have danced since they were children; but also for those who were not allowed to dance when they were children and now welcome the chance to dance as an older adult. Also, importantly, dancing is a safe mode of PA. Across our studies, no serious adverse events happened (i.e., events that affected the conduct of the research or the risk/benefit of the research). Our research has shown that regular Latin dancing can increase overall PA ⁴⁵ and influence aspects of physical functioning such as mobility ⁴³ and cognitive functioning such as episodic memory and global cognition ⁴² and working memory. ⁴⁴ Additional work of our research group has reported on challenges and solutions to recruiting and retaining older Latinos in RCTs. ⁵³

As we age, the systems of our body lose some of their function. ⁵⁴ For example, our vision worsens, it becomes harder to hear different volumes and pitches, and we lose muscle mass and balance. Dance interventions can influence some of these systems, as they have been shown to improve physical function, strength, flexibility, balance, agility, and gait. ⁵⁵ Tango as a dance intervention, for example, has been shown to improve the motor symptom severity and balance among participants with Parkinson's disease. ¹⁶ Physical function is essential to healthy aging and programs are needed to address the challenges that come with aging. We need more programs that have scientific rationale and rigor, but also consider the interactions of aging, health, and culture, notably because of the rising number of older Latino adults. Aging, and aspects of aging, have been shown to have different meanings across cultures. For example, research has shown the influence of cultures, individual experiences and societal expectations on the perception and experience of older age.^56,57 Also, there is a vast body of literature showing how health and illness are perceived differently across cultures.^58–60 Thus, further exploration and deployment of programs with consideration of the “aging-health-culture” interaction are warranted.

The benefits seen from our BAILAMOS^TM dance program studies speak to the importance of involving the perceptions and input of community members from the intended population, including cultural forms of PA, programs and interventions that occur in communities where older Latinos reside, are linguistically matched, and led by bilingual/bicultural team members. Researchers can reflect on these aspects and determine if and how incorporating related elements in their own interventions with Latinos and other ethnic and racial populations could be accomplished. Future research on dance in Latinos could examine the impact of Latin dance styles that cut across cultural heritages (e.g., Salsa for Mexicans, Puerto Ricans) versus those that are more specific to one group (e.g., folklórico for Mexicans). Related, older Latinos might be most interested in dance styles that are highly prevalent in their home country or region but are not popular outside of those areas. Challenges would include finding dance instructors in the US who have experience teaching the lesser-practiced styles. Additionally, are there specific dance styles that result in the most cognitive gains? Exploring the Latin dance styles that maximize the interaction of individual interest and health gains (e.g., those that result in the greatest increases in cognition) could be examined.

Much is unknown about the mechanisms by which dancing results in health benefits. Given the complexity of dance (e.g., senses involved, environmental influences of other people and music, increases in fitness, physical touch, coordination of movement) it is unknown how much each component contributes to overall cognitive benefits. Examination of such mechanisms could help isolate the most factors and intervene upon them. Also, an understanding of how learning dance and rhythms as a child and their impact on late life health is needed; as well as the role that culture plays in interacting with these factors.

Overall, as personalized medicine gains popularity in the US, continually finding ways to reach individuals and have programming that meets their interests and needs is essential.