Original ResearchEffects of Dance/Movement Training vs. Aerobic Exercise Training on cognition, physical fitness and quality of life in older adults: A randomized controlled trial
Introduction
A growing body of research has emphasized the benefits of physical activity on cognition throughout life and during late age (Bherer et al., 2013). More specifically, an inverse relationship has been established between the level of physical activity and cognitive decline (Larson et al., 2006), and longitudinal studies have shown that being physically active was associated with a lower risk of developing dementia (Yaffe et al., 2001). A higher level of physical functioning abilities was also associated with greater processing speed and better executive functions (Desjardins-Crepeau et al., 2014). It is proposed that being physically active improves cognition through cellular and molecular changes, structural and functional brain adaptations, and behavioural and socio-emotional modifications (Stillman et al., 2016).
Aerobic exercise training (AET) has often been studied in relation to executive functions in older populations. Many cross-sectional studies and randomized controlled trials (RCTs) found moderate to strong associations between aerobic fitness and executive functions (Berryman et al., 2013). In addition, some studies have linked higher aerobic fitness to better performance on the general cognitive construct of executive functions using composite scores (Berryman et al., 2013; Netz et al., 2010). However, due to its intensity, AET might not be the most preferred program for sedentary older adults who are not used to exercising.
In addition to the positive impact of AET on cognition in healthy (Colcombe and Kramer, 2003) and cognitively impaired older adults (Groot et al., 2016), studies have also highlighted the benefits of other forms of exercise on cognition (Bherer et al., 2013), namely resistance training (Liu-Ambrose et al., 2012), gross motor skills training or a combination of AET and resistance training (Berryman et al., 2014), coordination training (Voelcker-Rehage et al., 2011; Voelcker-Rehage and Niemann 2013), or yoga (Gothe et al., 2014). For example, a review of the literature suggests that a coordination exercise program (e.g., balance, hand-eye/leg-arm coordination, spatial orientation, motor learning) could also have a beneficial effect on brain structures and functions (Voelcker-Rehage and Niemann, 2013), even though it does not impact cardiorespiratory fitness. Accordingly, a study directly comparing the specific impact of this training program to an AET program over a period of 12 months shows similar improvement in executive control and perceptual speed performance (Voelcker-Rehage et al., 2011).
Local community programs identify dance as one of the most preferred type of physical activity for sedentary older adults (Fan et al., 2013). As a result, interventions based on dance have also recently gained interest in the scientific community, as it offers a combination of physical, cognitive and social activities potentially useful for attenuating age-related decline. In a recent review, McNeely et al. (2015) report a positive effect of dance on executive functions and quality of life in older adults based on ten intervention studies involving different types of dance (e.g., salsa, ballroom, contemporary, etc.) from 8 weeks to 18 months. Forms of Dance/Movement Training (DMT), such as dance/movement therapy, designed to use movement and dance in order to promote physical, social, emotional and cognitive integration of the individual, have also been used in the literature with both clinical and healthy participants. A meta-analysis has shown that it promotes psychological outcomes (i.e., quality of life, well-being, mood and affect, body image) and reduces clinical symptoms related to depression, anxiety, and interpersonal competence (Koch et al., 2014). It thus seems that dancing has the potential to be an affordable, accessible (Guzman-Garcia et al., 2013), and attractive exercise program for long-term sedentary older adults that can also be promising in reducing the burden of aging. However, the specific impacts of DMT on strength, agility and cardiorespiratory health condition, or its use as continuous cognitive stimulation (Ballesteros et al., 2015) remains understudied. Limitations of past studies are, among other things (Predovan et al., 2018), the lack of a structured intervention and, with the exception of a few studies, the absence of active control groups that would allow assessing dance interventions to more structured physical activity programs commonly used with older adult populations, like AET.
The present study compared the effects of a DMT program to an AET program on cognitive, physical and health-related quality of life (QoL) dimensions, using a structured RCT design. Given the reported effect of exercise and dance in previous studies, we hypothesized that participants in the DMT and AET groups would show improved cognition. Secondary hypotheses included increased improvement in health-related QoL in DMT compared to the AET and Control groups and an increase in cardiovascular fitness in the AET group as opposed to the other groups.
Section snippets
Trial design
A single-center, randomized, parallel assignment, open label control trial (Clinicaltrials.gov NCT02455258) with a three-arm design was conducted from March 2015 to April 2016. All potential participants were screened over the phone with a general description of the project and a medical questionnaire to determine their eligibility. If participants met inclusion criteria, they were invited to complete a full geriatric assessment, a neuropsychological screening and pre-testing sessions (T-0).
Participants
In total, 62 participants gave their consent and were randomized to one of the three groups: AET (n = 21), DMT (n = 23), and CG (n = 18) with a total of 41 participants completing post-tests (see Fig. 1 for overview).
Discussion
The present study aimed at empirically comparing the effects of a 12-week DMT program to an AET program on cognition, physical fitness and health-related QoL in healthy, inactive older adults by means of a RCT. Overall, only one of our three hypotheses was confirmed. Firstly, results indicated both executive and non-executive functioning improvement over the 12-week intervention; however, this improvement was not specific to the training groups, since the CG also showed improvement at
Conclusion
Dancing has the potential to be a promising and somewhat inexpensive type of intervention toward reducing the burden of aging. To the best of our knowledge, this is the first randomized controlled trial examining the effects of a DMT program with healthy inactive older adults on cognition, physical fitness and health-related QoL dimensions. This study could serve as a model for designing future RCTs with dance-related interventions.
Clinical relevance
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Future studies addressing the methodological challenges of adapting a DMT program to a RCT design may lead to the development of multimodal physical activity programs tailored to seniors that contribute to their well-being.
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Such studies may influence the way in which health professionals present and discuss exercise with older adults.
Registration
This study is a randomized control trial registered with ClinicalTrials.gov with the identification number NCT02455258.
Funding
This research was done in collaboration with Les Grands Ballets Canadiens de Montréal and supported by the Quebec Ministry of Health and Social Services. Partial support was also provided the Concordia University Chair in Preventive Health Research (L.B.). D.P. was supported by a fellowship (CGS - 128725) from the Canadian Institutes of Health Research.
Conflicts of interest
The authors declare that they have no conflict of interest.
Authors' contributions
LB conceived and designed the study and wrote the grant application to the Quebec Ministry of Health and Social Services. AE contributed to the study design, coordinated the project and provide the first draft of the manuscript. AE, LB and TV actively contributed to manuscript writing and statistical analyses. LB and AE supervised the team of students and assistants that recruited and tested participants and carried out all interventions. TV participated in testing and writing the manuscript.
References (56)
- et al.
Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons
Arch. Gerontol. Geriatr.
(2012) - et al.
Maintaining older brain functionality: a targeted review
Neurosci. Biobehav. Rev.
(2015) - et al.
Executive functions, physical fitness and mobility in well-functioning older adults
Exp. Gerontol.
(2013) The efficacy of dance movement therapy group on improvement of quality of life: a randomized controlled trial
Arts Psychother.
(2012)- et al.
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Psychiatr. Res.
(1989) - et al.
Mini-Mental State" A practical method for grading the cogntiive state of patients for the clinician
J. Psychiatr. Res.
(1975) - et al.
The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials
Ageing Res. Rev.
(2016) - et al.
Assessing cardiorespiratory fitness without performing exercise testing
Am. J. Prev. Med.
(2005) - et al.
Effects of dance movement therapy and dance on health-related psychological outcomes: a meta-analysis
Arts Psychother.
(2014) - et al.
Resistance training and functional plasticity of the aging brain: a 12-month randomized controlled trial
Neurobiol. Aging
(2012)
Impacts of dance on non-motor symptoms, participation, and quality of life in Parkinson disease and healthy older adults
Maturitas
The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis
Cogn. Psychol.
Validation of the French version of the brief pain inventory in Canadian veterans suffering from traumatic stress
J. Pain Symptom Manag.
Development and validation of a geriatric depression screening scale: a preliminary report
J. Psychiatr. Res.
American dance therapy association-general questions
Multiple roads lead to Rome: combined high-intensity aerobic and strength training vs. gross motor activities leads to equivalent improvement in executive functions in a cohort of healthy older adults
Age (Dordr)
A review of the effects of physical activity and exercise on cognitive and brain functions in older adults
J. Aging Res.
Training effects on dual-task performance: are there age-related differences in plasticity of attentional control?
Psychol. Aging
Transfer effects in task-set cost and dual-task cost after dual-task training in older and younger adults: further evidence for cognitive plasticity in attentional control in late adulthood
Exp. Aging Res.
Fitness effects on the cognitive function of older adults: a Meta-Analytic study
Psychol. Sci.
The Five Digits Test on the Assessment of Psychiatric Patients with Heterogeneous Educational Backgrounds: Evidences of Validity on the Assessment of Bipolar Disorder
Physical functioning is associated with processing speed and executive functions in community-dwelling older adults
J. Gerontol. B Psychol. Sci. Soc. Sci.
Walking or dancing: patterns of physical activity by cross-sectional age among U.S. women
J. Aging Health
The effects of an 8-week Hatha yoga intervention on executive function in older adults
J. Gerontol. A Biol. Sci. Med. Sci.
Assessing walking speed in clinical research: a systematic review
J. Eval. Clin. Pract.
Dancing as a psychosocial intervention in care homes: a systematic review of the literature
Int. J. Geriatr. Psychiatry
The effect of a six months dancing program on motor-cognitive dual task performance in older adults
J. Aging Phys. Act.
Dietary Screener Questionnaire in the NHANES 2009-10 [Online]
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