# Exercise as it relates to Disease/Parkinson’s patients – Can we temp you to tango?

This is an analysis of the journal article "Are the Effects of Community-Based Dance on Parkinson Disease Severity, Balance, and Functional Mobility Reduced with Time? A 2-Year Prospective Pilot Study by Duncan & Earhart (2014) This has been created by 3106298.

## What is the background to this research?

Parkinson's disease (PD) is a progressive neurological condition affecting the central nervous system. It results in the death of cells in the substantia nigra, an area of the brain involved in initiating motor tasks. It is the second most common neurological disorder worldwide, affecting 1 in 100 people over the age of 65 and 1 in 50 over 80. PD is characterised by a number of motor and non-motor symptoms that become more severe as the disease progresses. These are listed in the table below.
| Motor Impairments | Non-Motor Impairments |
| Reduced speed and amplitude of movement | Cognitive decline |
| Difficulty walking | Memory loss |
| Shaking | Depression |
| Loss of balance | Mood disturbances |
| Sudden freezing of movement | |
Whilst there is no cure for PD, symptoms can be managed with medication and physiotherapy . There is high quality evidence to suggest that exercise interventions can improve function and reduce the severity of motor impairments in patients with PD. Compliance with exercises commonly prescribed to PD patients, however, is often hindered by the notion that they are not enjoyable or socially engaging.
Dance is a socially engaging form of exercise that is mentally stimulating, challenges balance and improves strength and flexibility. For PD patients, research has also found that the use of auditory stimuli such as music can improve mobility and reduce motor symptoms. In 2001, the director of the Brooklyn Parkinson's group proposed the idea of a dance class specifically for PD, where patients could learn movement strategies that would be beneficial and enjoyable. The classes were very popular and patients reported significant reductions in symptom severity. The program 'Dance for Parkinson's' was so popular that it expanded internationally. Since the introduction of these programs, much research has gone into investigating the potential benefits of dance for PD.

## Where is the research from?

Duncan and Earhart conducted this study through the Washington University School of Medicine’s Movement Disorders Centre. Since the study was conducted in the United States, we can safely assume that the results and their clinical implications can be applied to an Australia population. There is no evidence to suggest a conflict of interest between the authors or publishers of this article that may cast doubt on its validity.

## What kind of research was this?

This study is a randomised control trial (RCT). Ten participants were randomly assigned to an intervention or control group. A RCT is designated level 2 evidence by the Australian National Health and Medical Research Council. The random allocation of participants reduces bias of selecting groups and a control group allows comparison between outcomes of participants with and without the intervention.
In this study, the therapists conducting the assessments were not aware which intervention the participant had received. This helps to minimise bias in the assessment results. Due to the nature of the intervention the participants and the Tango instructors could not be blinded to which intervention the participants were receiving. This can influence the results due to the potential of the intervention to have a placebo effect.

## What did the research involve?

Participants were assigned to either: an Argentine tango group, they were informed that they were to participate in a community based dance class twice a week, or a control group, they were not prescribed any specific exercise but were advised to maintain their current level of physical activity. Near completion of the first year of the study the Argentine tango participants were given the option to continue dancing for another year.
All participants were assessed prior to commencing the study and at 12 and 24 months. The assessments evaluated the participants motor and non-motor symptom severity, their ability to perform activities of daily living (ADLs), their balance and walking capacity and their ability to perform dual tasks. The participants were all assessed at least 12 hours after administration of their medication to ensure that variations in medication did not influence the assessment results.

## What were the basic results?

The results of this study revealed a reduction in motor and non-motor symptom severity and improved performance of ADLs in the tango group compared to the control group at 12 months. In the tango group, whilst there was no substantial change observed between 12 and 24 months, the improvements were maintained, unlike in the control group where these symptoms deteriorated. Significant improvements were also observed in the Tango participants' balance and capacity to perform dual tasks at both 12 and 24 months compared to controls, who declined over the 2 years. The results of this study showed no significant difference in walking speed or likelihood of freezing of movement between groups.
Summary of Results
| Significant Improvements observed in Argentine Tango group compared to Controls | No significant differences observed between groups |
| Motor and non-motor symptom severity | Freezing of movement |
| Ability to perform ADLs | Walking speed |
| Balance | |
| Ability to perform dual tasks | |

## What conclusions can we take from this research?

The implication of this study is that regular participation in dance classes in particular Argentine Tango can have a vast range of benefits for patients with PD. These findings are consistent with the results of other studies that have investigated the effects dance for PD. This was the first study, however, that looked at whether these improvements would be maintained if dance participation was continued for an additional year.

## Practical advice

The advise that should be taken from this study is that dance can have significant benefits for people with PD. Having said this, it is important to remember that because of the motor impairments associated with PD, these people are a high falls risk. Therefore, when considering a dance class for yourself, a friend or even a patient with PD, you should consider a class that is specifically run for this population. This is because they will have steps in place to modify the dance program to make it safe and to minimise the risk of falls.

## Further resources

If you suffer or your know someone who suffers from PD and you are interested in finding out more about the potential benefits of dance. Check out the website http://danceforparkinsonsaustralia.org/

### References

* ↑ Dauer W, Przedborski S. Parkinson's disease: mechanisms and models. Neuron. 2003;39(6):889-909.
* ↑ Goldstein LH, McNeil JE. Clinical Neuropsychology: A Practical Guide to Assessment and Management for Clinicians: Wiley; 2012.
* ↑ Keus SH, Bloem BR, Hendriks EJ, Bredero‐Cohen AB, Munneke M. Evidence‐based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Movement disorders. 2007;22(4):451-60.
* ↑ Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta‐analysis. Movement disorders. 2008;23(5):631-40.
* ↑ Spaulding SJ, Barber B, Colby M, Cormack B, Mick T, Jenkins ME. Cueing and gait improvement among people with Parkinson's disease: a meta-analysis. Archives of physical medicine and rehabilitation. 2013;94(3):562-70.
* ↑ Westheimer O. Why dance for Parkinson's disease. Topics in Geriatric Rehabilitation. 2008;24(2):127-40.
* ↑ Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC health services research. 2004;4(1):1.
* ↑ Sharp K, Hewitt J. Dance as an intervention for people with Parkinson's disease: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2014;47:445-56.
* ↑ Heiberger L, Maurer C, Amtage F, Mendez-Balbuena I, Schulte-Mönting J, Hepp-Reymond M-C, et al. Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson’s disease. Frontiers in aging neuroscience. 2011;3:14.