# Exercise as it relates to Disease/Fighting Parkinson's, Dance Vs Exercise?

The below information relates to the journal article ‘A comparison of Irish set dancing and exercise for people with Parkinson’s disease: A phase II feasibility study’

## What is the background to this research?

Parkinson’s disease is a progressive neurological condition affecting roughly one in 500 people, resulting from the death of brain cells producing dopamine. Dopamine is a chemical responsible for regulating our movement and coordination. With less dopamine the body’s ability to regulate movement becomes worse. This can lead to the common symptoms of tremors, stiffness in muscles (rigidity) and freeze of gait when walking. This usually leads to reduced quality of life from a reduction in physical activity, poor mobility, falls and non motor issues such as depression.
Physical exercise has been linked to improvements in Parkinson’s symptoms. Adherence to exercise programs is always a concern though, especially in the elderly. A fun and engaging activity like dance could help combat this concern. While there is evidence to suggest that tango is beneficial to Parkinson’s patients, the authors of this study consider it to be more challenging than Irish set dance.

## Where is the research from?

This study lead by Dr Volpe was conducted in Venice, through the Department of Physical Medicine and Rehabilitation unit out of S. Raffaele Arcangelo Fatebenefratelli Hospital. Dr Volpe specialises in Parkinson’s and has conducted lots of previous research on the disease. Although the physiotherapy program is in accordance with KNGF Guidelines for physical therapy of Parkinson’s disease (Globally recognised) it may not reflect the view of Australian practice. There is no visible evidence of outside funding and the authors declared no competing interests. This suggests findings are unbiased.

## What kind of research was this?

This was a feasibility study to evaluate the possibility of a large scale randomised controlled trial comparing Irish set dance, and standard physiotherapy for people suffering from Parkinson’s. Therefore this was a small randomised controlled trial to assess the effectiveness of their study design. Being a small sample size the implications of the findings are not as conclusive. Despite that a randomised controlled trial ranks in the top three for study design in terms of result quality. The random allocation of participants to an intervention helps to reduce result bias.

## What did the research involve?

The research involved 24 Italians suffering mild-moderately severe Parkinson’s, assessed using the modified Hoehn & Yahr scale. A third party randomly allocated participants to either an Irish set dancing or standard physiotherapy intervention. There were 12 individuals in each and both had similar distribution of gender, age and severity of Parkinson’s.
Both interventions consisted of one 90 minute sessions per week and a home based program utilising video recordings for 6 months. The interventions aimed to improving balance, range of motion, and reducing freeze of gait.
Individuals were assessed at the start, middle and three weeks after completing the intervention. This studies method was well constructed as it ensured that individuals not directly involved in conducting the intervention sessions remained blind to group allocation, reducing result bias.

### Assessment

* The motor component of the Unified Parkinson’s Disease Rating Scale (UPDRS)
* Timed up and Go
* The Berg Balance Scale (BBS)
* Modified Freeze of Gait Questionnaire (FOG)
* Quality of life using the Parkinson’s Disease Questionnaire-39 (PDQ39)

### Limitations

* Parkinson’s medication was only documented rather than controlled
* Assessment was not always conducted during peaks dose of medication. This meant some individuals might have displayed greater motor disability compared to others tested closer to peak in medication resulting in slight inconsistencies of data

## What were the basic results?

Both Irish set dancing and physiotherapy were safe and feasible for sample population used. Compliance/adherence was remarkably high, with a total of 89.4% of intervention sessions delivered across both interventions. Individually 90.9% of Irish dance classes and 87.8% physiotherapy sessions were provided. Both intervention groups improved across all measures of assessment (see table 1). The researchers concluded Irish set dancing showed far better improvements than physiotherapy.
I don’t think the authors are over-emphasising the implications of findings. While this is a small sample size other studies utilising different forms of dance have found similar improvements in symptoms of Parkinson’s.

### Table 1: Means and (standard deviations) of key variables for before and after intervention

| | Irish dancing | Physiotherapy |
| Motor UPDRS Baseline | 24.58 (3.87) | 23.92 (3.50) |
| Motor UPDRS Discharge | 17.52 (3.85) | 21.00 (3.07) |
| BBS Baseline | 36.08 (9.20) | 34.08 (9.14) |
| BBS Discharge | 46.08 (6.75) | 38.92 (9.97) |
| FOG Baseline | 11.42 (2.78) | 10.75 (3.39) |
| FOG Discharge | 4.92 (2.07) | 10.16 (4.47) |
| PDQ39 Baseline | 30.60 (12.06) | 32.58 (7.59) |
| PDQ39 Discharge | 22.16 (10.18) | 27.61 (7.67) |

## What conclusions can we take from this research?

The use of both Irish set dance and standard physiotherapy are both feasible and safe ways of potentially managing symptoms of Parkinson’s. The results were promising, and although a small feasibility study it shines light on another approach to the treatment of a Parkinson’s. A larger sample size is needed to provide more conclusive evidence on the theory that Irish set dance is more beneficial than standard physiotherapy. There are no other studies looking at Irish set dance and Parkinson’s, but lots of studies have looked at other dance types. These studies found similar results, showing that dance improved motor function and quality of life.

## Practical advice

The advice that could be taken from this is that physiotherapy is beneficial for management of Parkinson’s symptoms. As well as that Irish set dance could be a new and engaging way for individuals to manage symptoms. With this in mind it’s important to consult a trained professional who could provide advice or point you in the direction of someone who can help.

## Further information/resources

If you are suffering or know someone who is suffering for Parkinson’s, or just interested follow the links bellow for more information:
http://www.parkinsons.org.au/
http://danceforparkinsonsaustralia.org/

## References

* 1 2 3 Volpe D, Signorini M, Marchetto A, Lynch T, Morris M. A comparison of Irish set dancing and exercises for people with Parkinson’s disease: A phase II feasibility study. BMC Geriatr. 2013;13(1).
* 1 2 3 4 Parkinson's UK - What is Parkinson's? [Internet]. Parkinsons.org.uk. [cited 18 September 2016]. Available from: https://www.parkinsons.org.uk/content/what-parkinsons
* ↑ National Parkinson Foundation: Believe in Better [Internet]. National Parkinson Foundation. [cited 21 September 2016]. Available from: http://www.parkinson.org/understanding-parkinsons/what-is-parkinsons
* ↑ Hirsch M, Toole T, Maitland C, Rider R. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease. Archives of Physical Medicine and Rehabilitation. 2003;84(8):1109-1117.
* 1 2 Morris M, Iansek R, Kirkwood B. A randomized controlled trial of movement strategies compared with exercise for people with Parkinson's disease. Movement Disorders. 2009;24(1):64-71.
* ↑ Guyatt G. Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group. JAMA: The Journal of the American Medical Association. 1995;274(22):1800-1804.
* 1 2 Hashimoto H, Takabatake S, Miyaguchi H, Nakanishi H, Naitou Y. Effects of dance on motor functions, cognitive functions, and mental symptoms of Parkinson's disease: A quasi-randomized pilot trial. Complementary Therapies in Medicine. 2015;23(2):210-219.
* 1 2 Sharp KHewitt J. Dance as an intervention for people with Parkinson's disease: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2014;47:445-456