Brief Report
Dancing Participation and Cardiovascular Disease Mortality: A Pooled Analysis of 11 Population-Based British Cohorts

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Introduction

Little is known about whether cardiovascular benefits vary by activity type. Dance is a multidimensional physical activity of psychosocial nature. The study aimed to examine the association between dancing and cardiovascular disease mortality.

Methods

A cohort study pooled 11 independent population surveys in the United Kingdom from 1995 to 2007, analyzed in 2014. Participants were 48,390 adults aged ≥40 years who were free of cardiovascular disease at baseline and consented to be linked to the National Death Registry. Respondents reported participation in light- or moderate-intensity dancing and walking in the past 4 weeks. Physical activity amount was calculated based on frequency, duration, and intensity of participation in various types of exercise. The main outcome was cardiovascular disease mortality based on ICD-9 codes 390−459 or ICD-10 codes I01−I99.

Results

During 444,045 person-years, 1,714 deaths caused by cardiovascular disease were documented. Moderate-intensity, but not light-intensity, dancing and walking were both inversely associated with cardiovascular disease mortality. In Cox regression models, the hazard ratios for cardiovascular disease mortality, adjusted for age, sex, SES, smoking, alcohol, BMI, chronic illness, psychosocial distress, and total physical activity amount, were 0.54 (95% CI=0.34, 0.87) for moderate-intensity dancing and 0.67 (95% CI=0.52, 0.87) for moderate-intensity walking.

Conclusions

Moderate-intensity dancing was associated with a reduced risk for cardiovascular disease mortality to a greater extent than walking. The association between dance and cardiovascular disease mortality may be explained by high-intensity bouts during dancing, lifelong adherence, or psychosocial benefits.

Introduction

Epidemiologic research has supported an inverse relationship of physical activity (PA)1, 2, 3 and fitness levels4, 5 with cardiovascular disease (CVD) and all-cause mortality.6, 7 Previous research tended to focus on quantifying PA risk based on the amount and intensity of activities, with the type of activity often treated as a surrogate for intensity level. As different types of PA challenge musculoskeletal, neurologic, and cardiorespiratory systems differently, and involve different levels of psychosocial or cognitive demands, different types of PA may have differential relationships with health.8

Dance is a multidimensional PA, integrating physical, cognitive, emotional, and social elements. To date, only six cohort studies have examined the benefits of specific activity types, other than walking, in relation to health outcomes, including falls,9, 10 incident fatal and non-fatal coronary heart disease,11 all-cause mortality,12, 13 and dementia.14 One study found that frequent dancing (three or more times/week) was associated with a 76% reduction in dementia risk, whereas the protective effect of walking was lower (53%) and only marginally significant.14 Though dementia and CVD share some similar risk factors, the impact of dance on CVD has never been studied. The aims of this study are to examine: (1) whether dance participation offers a greater protection against CVD mortality than walking; and (2) whether risk reduction associated with dancing is age or sex dependent.

Section snippets

Methods

Participants were drawn from the Health Survey for England (HSE) and Scottish Health Survey—a series of 11 independent British population-based cohorts with harmonized methodologies and baseline examinations undertaken in 1994/1997 (HSE only), 1995 (Scottish Health Survey only), 1998, 1999 (HSE only), 2003, and 2004/2006/2008 (HSE only). Samples were drawn using multistage stratified probability design to give a representative sample of the two United Kingdom countries. More details of the

Results

Among 48,390 eligible respondents, 6.5% reported recreational dancing (n=3,169), higher among women (8.2%) than men (4.5%), and 66.3% of the cohort walked at any intensity (66.5% women, 66.0% men). Compared with non-dancers (Table 1), dancers were younger, of a higher social class, had a lower BMI, and were less likely to have long-standing illnesses and psychological distress. Additionally, dancers reported a higher PA volume, including moderate-intensity walking, and a higher proportion of

Discussion

This research suggests that light-intensity walking or dancing did not reduce CVD mortality risk, but both activities at moderate intensity or above were protective. The risk reduction was greater for moderate-intensity dancing than walking, and possibly stronger for women than men. Additionally, these findings support the independent increases in CVD protection by walking at a brisk or fast pace, irrespective of total PA volume.7, 11

Several hypotheses may explain the superior benefit of

Conclusions

The present findings provide empirical support to the use of “dance as exercise” for preventing CVD deaths.26

Acknowledgments

All authors participated in the conceptualization of this paper. DM advised on analysis and drafted the first manuscript. DD advised on analysis and provided critical comments on all drafts. ES led the analysis and provided critical comments on all drafts. All authors read and approved the final draft. ES had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

No financial disclosures were reported by the authors of

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