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Research analyzes the effects of dance on Parkinson’s disease symptoms

The study is linked to free dance class outreach program for those who carry the disease
Research analyzes the effects of dance on Parkinson’s disease symptoms

The classes are held in the Physical Education School, at the Swimming Center, on Mondays and Wednesdays. Picture by: Rochele Zandavalli/UFRGS

Author: Camila Raposo

The benefits that dance  has brought to patients with Parkinson’s disease - such as relief of motor symptoms, well-being, self-esteem, and socialization - have caught the attention of researchers and health professionals from all over the world. When bringing physical activity and art together, dance has proven to be a promising complement to this disease treatment, which includes drugs, physiotherapy, and - in some cases- surgery.  Showing such recognition for the importance of dance, the World Dance for Parkinson’s Day was established on April, 29th 2017 by an association of 16 groups, composed by 10 countries, dedicated to dance classes for those who carry the disease. The date was chosen in honor of Parkinson’s Awareness Month - April - and International Dance Day - April 29th.

The relation between dance and Parkinson’s disease is the theme of research and outreach projects at UFRGS. Since last year, dance classes have been  offered at the Faculty of Physical Education to people who carry the disease. Currently, there are 12 people, men and women of different ages, participating in the classes. Additionally, the effect that dance has on patients’ lives has already been topic of graduate  and postgraduate projects, and it is currently subject of a Masters project.

The lessons are coordinated by Professor Aline Haas, from the Dance course, who in 2011 started researching about the effects that dance has on neurological diseases.  She studied the use of dance as a method for complementary rehabilitation in patients who had suffered a cerebral stroke. This project was part of Silvia Susana Wolff’s postdoctoral  research. Haas’ study started four years ago, she explains, and although this topic  has been gaining visibility, this is still a novel  research area in Brazil.

“We started by reading studies that prove that dancing is more effective when  compared to other types of intervention, such as  regular physiotherapy practice, for example. Dancing has quite interesting effects in some variables, such as quality of life and gait - which is what we are studying”, Haas comments.

Marcela Delabary has systematically reviewed articles in this area for her dance postgraduate project.  Results show significant change in patients who attended dance classes, mainly related to symptoms affecting mobility and motor coordination.  According to Delabary and Haas, most of these studies used tango and waltz as dance genres.

The researchers’ project carried out at UFRGS was based on two Brazilian genres, namely forró and samba. “We opted for these genres because not only do they underline  the country historical and cultural aspects, but they also rescue patients’ memories . We also intend to work this qualitative aspect in the classes.” Delabary explains. She is now investigating the effects that the regular practice of dance and walk has on Parkinson’s disease patients’  quality of life and gait, a project that is part of her thesis.

“Combining dance and health is a promising area of research. It is different from physical activity, which does not have a collaborative and sensitive aspect to it; an activity that does not value gathering together, sharing or holding hands. Art provides all of these”, Haas points out. “We’ve noticed that walking can be beneficial too, but in a different way because walking is something to do alone, by yourself.  Interacting, coming here,  being in a group of people who share  the same kind of problems, makes all the difference. The social aspect of dance is enriching”.

Delabary emphasizes that it is essential that patients enjoy the activity. “Whatever the program, it will only show results if they adhere to it. In this way, we see dance as one of the beneficial possibilities, as not only is dance a physical activity, but it also has an artistic element.”

Class dynamics

The classes are held  twice a  week and they follow a different protocol from the traditional dance classes, with exercises that meet Parkinson’s disease patients’ needs. The activities are divided into four parts. First, the students sit on chairs to stretch and warm up. Haas explains that this part is done using chairs to ensure  that they will not fall or lose balance, and also to improve mobility and to ‘wake up’ the body”,  In this moment, the students do rhythmic exercises by moving their legs as if they were marching, which needs to be gradually intensified. They must raise their knees higher and higher. After that, they exercise using a bar, when  some element of classic ballet related to balance and weight transferring are used.

The  third part is dedicated to forró and samba dance moves. Those who are familiar with ballroom dance may be surprised by the lack of traditional techniques in these two genres, such as the well-defined male/female roles and the closed position.  “Our focus here is on having them moving, transferring weight from one leg to the other. It is not important for them to  master the movement, but rather to keep  moving. Hass points out that sometimes they  do hold hands in pairs, but it does not matter who is leading or  who is being led. What is important is that they memorize  the sequences and try the movements in pairs.

Finally, there are two possible ways to finish the classes. On Mondays, they finish the  class with ludic exercises: “Simon Says”, “Copycat” in pairs, or create a choreography in order to break the ice in a way that is closer to Art; to be closer to creation and self expression.  On Wednesdays, the end of the class involves more complex exercises, which require more physical effort and motor coordination from the students. The exercises are done in a  circuit like space that provide auditory and visual  stimuli for them to complete the challenging activities.  Even Wednesday classes end in fun, though, when they position themselves in circle and chant their war cry. The idea is to promote socialization.

Perceived benefits and preliminary results

Last semester, Camila Moehler analyzed the effects of dancing  on patients’ quality of life for her Physiotherapy graduation project. By that time, five patients were observed before attending the classes and 24 hours after doing so. The results were compared with the data of a group of Parkinson’s disease patients who did not do any type of physical activity. Quality of life was measured through the Parkinson’s Disease Questionnaire (PDQ-39), approved by the international specialized literature, that contains eight domains: mobility, activities of daily living, emotional well-being, stigma, social support, cognitions,  communication, and bodily discomfort.

Albeit the lack of statistically significant results in this study, which is explained by the low number of participants, as well as by the limitations of the questionnaire - by analysing participants’ feedback the researchers have noticed how much the classes have been beneficial to them. “We have had a positive feedback for the qualitative aspect of the project. We do not evaluate such aspect in in our research, but we have noticed that they have been feeling better and that their symptoms are less evident when they dance”, Haas explains. She reminds us  that many students showed noticeable reduction of certain symptoms, such as shaking and spinal misalignments.

“PDQ-39 is a limited tool. We consider carrying out a study in the future that involves interviews because we can see daily changes. We see that they come more excited, wearing more colorful clothes as the classes advance.We can see their improvement also through what they tell us.” says Haas. Another proof of the success of project  is that the students who attended the classes last year will do it again this year. “It did not matter whether it was raining or sunny, the five students from last year would always come. They are very loyal attendees, since classes are a sort of medicine to them.” Haas continues.

The account by two students, Sílvia da Silva Carvalho, 64 years old, and Eloí Feijó da Silva, 82 years old, who started classes last year, confirm the researchers’ perception. They were diagnosed with Parkinson’s disease eleven years ago, and they have noticed the benefits of regular dancing practice in their daily life: “I enjoy it so much, and when I do not come to class, I miss it, my body misses it. I’ve been coming to UFRGS for four or five year. I started with walks, which is very good, but I like dance better. We always feel better when we come to classes. And when I arrive at home I dance even more. I do not stop, otherwise my body goes all stiff”, explains Carvalho. “I enjoy it too. I feel physically better .” Says Silva. “Waking up early to come to classes is a joy; it makes me feel well. My cholesterol used to be high, and I would fall a lot. Those things are already better than before”.

 

Research progress

For her thesis, Haas plans to compare  the effects of dance and walk in many parameters. In addition to the PDQ-39 questionnaire, she will analyze functional mobility and self-selected walking speed (the one the patient feels more comfortable with), rehabilitation index (the difference between self-selected and ideal speed), and motor symptoms. Kinematic tests will also be applied, they measure frequency, speed, length and contact phase duration. She needs groups of 19 people to participate in her research; however, in order to participate  patients must be over 50, diagnosed with Parkinson’s disease, and not having undergone deep brain stimulation surgery.

In spite of the preconditions to participate in the study, dance classes are opened to anyone who is interested in participating and that has been diagnosed with Parkinson’s disease, regardless of age, of how long the person has been diagnosed, and whether he or she has undergone surgery. The classes are free, and information about enrollment and schedule is available at Faculty of Physical Education web site. On Facebook at project has a fanpage, where it is possible to follow their activities.

 

Original text in Portuguese is available at

<http://www.ufrgs.br/secom/ciencia/pesquisa-analisa-efeitos-da-danca-sobre-os-sintomas-do-parkinson/>.

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