The Effects of Modified Jazz Dance on Balance, Cognition, Mood

1. The Effects of Modified Jazz Dance on Balance, Cognition, & Mood Patricia T. Alpert, DrPH, APN, FAANP Sally K. Miller, PhD, APN, FAANP Harvey W. Wallmann, DPTSc, SCS, LAT, ATC Richard Havey, MA

2. Introduction Physical activity & aerobic exercise in balance preservation & fall reduction well documented (Jessup et al, 2004; Carter et al, 2001, Campbell et al, 1997; Chien et al, 2000; Wolf et al, 2003) Can jazz dance achieve the same results? potential for sustained interest & adherence

3. Background Falling among elderly is often attributed to a decline in balance (Ballard, McFarland, Wallace, Holiday & Roberson, 2004) Changes in cognition & mood may also ? the risk of falling (Palleschi et al, 1996; Bassuk, Glass, & Berkman, 1999) Important to identify strategies that can improve balance, cognition & mood to reduce the risk of falling Falls according to 2000 census: 360,000 � 480,000 fall-related fractures each year Fall related fractures account for $20 billion of annual expenditure, projected to be $32 billion by 2020Falls according to 2000 census: 360,000 � 480,000 fall-related fractures each year Fall related fractures account for $20 billion of annual expenditure, projected to be $32 billion by 2020

4. Literature Review Dance successfully motivated health promotion in older Koreans (Jean & Choi, 2001; Song et al, 2004) Exercise has positive impact on cognition (Paleschi et al, 1996) Dance improves mental status of those with dementia (Dvarak & Poehlman, 1998; Hagen et al, 2003; Teri et al, 1998; Van de Winckel et al, 2004) Social isolation contributes to depression (Anderson, 2002; Dugan & Kivett, 1994; Prince et al, 1998)

5. Literature Review Postural sway (sway) ?�s in older people frequency of falls ?�s as sway increases (Baloh et al., 1995; Horak, 1987; Monsell et al., 1997; Nashner, 1990; Woollacott & Shumway-Cook, 1990) Mechanisms for postural control begin to deteriorate with age also resulting in a decline in postural stability and an ?�d susceptibility to falls (Choy et al., 2003; Fernie et al., 1982; Gill et al., 2001; Lord et al., 1999; Shumway-Cook & Woollacott, 2000; Simoneau et al., 1999)

6. Literature Review Balance has been defined as the process of maintaining the center of gravity (COG) within the body�s base of support (BOS) (Nashner, 1990) Balance can be described as being either static maintaining postural stability while standing quiet or dynamic maintaining postural control during voluntary movement (Woollacott, 2000; Woollacott & Tang, 1997)

7. Literature Review Static balance is often measured using computerized dynamic posturography (CDP) using a computerized forceplate, CDP is used to quantitatively assess sway by measuring shifts in the COG this requires that the COG remain within the BOS (Judge et al., 1995) An inability to correctly maintain this COG over the BOS results in impaired balance Balance utilizes the following sensory systems Visual Somatosensory Vestibular

8. Literature Review Exercise can improve or maintain dynamic balance as well as ? risk of falling in the elderly facilitates independence in mobility and function (Barnett et al., 2003; Nordt et al., 1999; Perrin et al., 1999; Shumway-Cook et al., 1997) Dance-based training has been shown to be beneficial in improving static balance and ?�ing fall risk (Federici et al., 2005; Shigematsu et al., 2002)

9. Literature Review To date, the authors are not aware of studies involving jazz dance training to improve static or functional balance

10. Aims of Study Aim 1: To determine the effect of modified jazz dance on balance Aim 2: To determine the effect of modified jazz dance on cognition Aim 3: To determine the effect of modified jazz dance on mood

11. Design & Instrumentation Prospective descriptive study (pilot study) Used the following measures: NeuroCom Smart� Balance Master Sensory Organization Test (SOT) measurements Folstein Mini Mental Status Examination (MMSE) (Folstein et al, 1975) Geriatric Depression Scale (GDS) (Kieffer & Reese, 2002) Demographic data: age, education, marital status, ethnicity, & employment status

12. The NeuroCom Smart� Balance Master System

13. Instrumentation: The SOT During testing, the platform or surround booth is either fixed or moving (sway-referencing) while subjects keep their eyes either open or closed (Whipple et al., 1993) Subjects are exposed to three 20-second trials for each of 6 different conditions (18 trials total) each trial results in an equilibrium score score is expressed as a percentage between 0% and 100% 0% indicates sway that is large, resulting in a loss of balance, and 100% indicating perfect stability (sway is small) average score of 3 trials for each condition

14. Instrumentation: The SOT Composite equilibrium score the weighted average of all 6 conditions reflects the overall performance on the SOT and is conventionally used as a measure of sway (NeuroCom International Inc., 1994)

15. The Six SOT Testing Conditions

16. Description of the Six SOT Testing Conditions Eyes open, fixed support surface and surround visual, vestibular, and somatosensory modalities available Eyes closed, fixed support surface and surround absent visual input Eyes open, sway-referenced surround and fixed support surface visual input inaccurate Eyes open, sway-referenced support surface and fixed surround somatosensory inputs inaccurate Eyes closed, sway-referenced support surface and fixed surround absent visual input and somatosensory input inaccurate Eyes open, sway-referenced surround and support surface inaccurate visual and somatosensory inputs

17. Inclusion/Exclusion Criteria Inclusion Healthy community-dwelling women > 50 years of age Willing to participate Able to speak English Exclusion Diagnosed with a condition associated with neurological and/or musculoskeletal systems Diagnosed with overt psychiatric illness Taking medications that interfere with balance, mood, cognition and/or coordination

18. Sample Single group of healthy community-dwelling women (N=15) Two dropped out of study due to illness Enrolled in senior dance class during Fall 2005 semester Ranged in age from 52-88 years old (mean=68 years, sd=8.6 years) 92% Caucasian 8% African American

19. Methodology Treatment: modified jazz dance class (15 weeks) Data were collected at: Time 1 (pre-treatment-between weeks 1 and week 2 of jazz class) Time 2 (mid-treatment-between weeks 7 and 8 of jazz dance class Time 3 (post-treatment-after week 15 of jazz dance class)

20. Data Analysis Data analyses were completed using SPSS (v. 13.0) and SAS (v. 9.1) Both descriptive & inferential statistics were used to provide outcome results (were tested for normality) Repeated-measures ANOVA for jazz dance for within group changes over time on predictor variables (balance, cognition, mood) correlations analyses used to relate intervention to each outcome

21. Results Differences in mean MMSE & GDS scores over time were not significant

24. Results---con�t Repeated measures ANOVA showed that balance measures (composite equilibrium scores) improved throughout the study F(2,22) = 23.185, (p< .0005) Post-hoc analyses (pairwise comparisons) indicated ?�s in balance as follows: pre (67.33 � 10.43) to mid (75.25 � 6.97), (p=0.008) mid (75.25 � 6.97) to post (79.00 � 4.97), (p=0.033) pre (67.33 � 10.43) to post (79.00 � 4.97), (p<0.0005)

25. ResultsComposite Equilibrium Scores

26. ResultsCondition 3 Equilibrium Scores

27. ResultsCondition 4 Equilibrium Scores

28. ResultsCondition 5 Equilibrium Scores

29. ResultsCondition 6 Equilibrium Scores

30. Discussion Healthy women attending jazz class one time per week improved balance Findings are consistent with studies showing balance improvement secondary to dance exercise (Federici et al., 2005; Shigematsu et al., 2002; Verghese, 2006) In test conditions SOT 3 through SOT 6, sway-referencing occurs stresses the individual�s balance system by introducing perturbations in either the support platform or the surround booth in response to the individual�s inability to balance in place

31. Discussion SOT 3 (inaccurate visual � surround booth) somatosensory input becomes dominant SOT 4 (inaccurate somatosensory - platform) vision becomes the dominant input SOT 5 (inaccurate platform & vision is absent) vestibular and somatosensory inputs become dominant (eyes closed) SOT 6 (inaccurate visual and somatosensory) all inputs used

32. Discussion Improved balance with jazz dance requires use of Visual Somatosensory Vestibular Jazz dance may tax these systems resulting in improved motor & sensory orientation improves ability to appropriately organize sensory information helps to negotiate when conflicting stimuli are present darkness, unstable surfaces, moving objects, etc.

33. Discussion No improvement in cognition observed small changes but still within normal range No improvement in depression observed small changes but still within normal range May be due to: lack of sensitivity of tools used length of study not long enough

34. Strengths & Limitations Strengths Prospective design with repeated measures Data collection occurred shortly after treatment (changes less likely due to daily activity) Utilized standardized measurement tools Limitations Convenience sample which was also small More likely to already have healthy behaviors More likely to already have strong support system No control group

35. Future Direction Further research needs to be conducted with the following: Larger sample size Including males Control group Longer duration Collect data on functional balance

36. Implications Findings suggest jazz dance improves balance may have implications to decrease the risk for falls in postmenopausal women may have sustainability due to being fun Does not improve cognition or mood