Elders Urged to "Dance to Your Heart's Content"

by Barbara Resnick, PhD, CRNP

Dance is an important form of cardiovascular endurance training in which large muscle groups contract many times against little or no resistance other than that imposed by gravity.

Low-intensity dance involves less large-muscle activity and less lower-extremity impact, and the music should be at a slower tempo. At low intensity, approximately 4 to 5 kilocalories per minute are used during dance.

High-intensity dance involves more use of large-muscle groups and utilizes about 10 to 11 kilocalories per minute. The purpose of this type of activity is to increase the maximal amount of aerobic work that can be carried out, as well as to decrease the physiologic response and perceived difficulty of submaximal aerobic workloads. Extensive adaptations in the cardiovascular system, peripheral skeletal muscle, and metabolism are responsible for these changes in exercise capacity and tolerance.

Beyond Aerobics

In addition to dance's aerobic benefits, there is a significant benefit related to increased flexibility and balance. Low-impact aerobic dance in a group of older women who participated in a 12-week course resulted in improved flexibility and balance along with improved cardiorespiratory endurance. Linked to improvement in balance, dance activities have also been reported to decrease falls in older adults.

Balance is improved by challenging the older individual's balance capabilities by decreasing the base of support (e.g., bringing the legs closer together when standing); altering the ground support (e.g., standing on one leg); decreasing proprioception, vision, or vestibular system input (e.g., standing still with eyes closed); or moving the body's center of mass (e.g., shifting weight from one foot to the other). Dance uses many of these balance-improvement techniques when the individual simply performs the requisite dance steps. The box at right provides examples of techniques to use to improve balance during dance activities.

As with other weight-bearing exercises, dance can improve bone density in older adults with osteoporosis. In a group of women who participated in a regular dance program and trained for approximately three hours each week, there was evidence of improvement in bone density. In particular, the women who had a history of osteoporosis had a statistically significant increase in their bone mineral density over a 12-month period.

Although the long-term physical benefits of dance are certainly of value, for many older adults, the immediate psychological benefit of exercise is even more important. Dance activities--particularly social dance such as ballroom and line or square dancing--can have very positive social-psychological effects in older adults with cognitive impairment. Social dancing seems to be an activity that is preserved in these individuals, and can result in increased communication and social engagement and positive feelings.

Many Options

Dance can range from traditional forms such as ballet, tap, modern, or jazz dance classes to ballroom, square, line dancing or free-form activities. Dance can therefore cover a range of activities, and is appropriate for those who are independent ambulators as well as those who are not. Most older individuals will respond naturally to music and begin to either consciously or unconsciously start jiggling their feet, fingers, or heads. This movement, in and of itself, is a good range-of-motion activity for frail older individuals.

To get aerobic benefits from dance, it is essential to increase the heart rate to a moderate level (i.e., 60% to 80% of the maximum heart rate).A quick way to tell if your older patient is at a moderate level of activity is to see how difficult it is to talk while dancing. At a moderate level, the individual should still be able to carry on a conversation.

Line dancing is one of the best ways to incorporate activities that yield both aerobic and balance benefits. The eight most popular types of line dancing for older adults include: Hustle, Electric Slide, Elvira, Hully Gully, Jive Bunny, Amos Moses, Lambada, and Drinking Champagne. Even the most difficult line dance steps can be made easy, when taught clearly and simply. This can be done during face-to-face classes or through use of the numerous videos available for teaching (see www.centralhome.com/ballroomcountry/senior_citizen_dance_and_exercis.htm).

Older adults can also participate in swing dancing. Some common moves associated with swing dancing include: Basic Single Rhythm, Release Break, Inside Underarm, Outside Underarm, Tuck-ins, Hip Leads, Kick Step, Swivels, Windmill, and Sweetheart.

Similarly, ballroom dancing is another commonly recognized dance activity for older adults. imply by learning five dance steps, the following five dances can be mastered: Big Band Swing, Viennese Waltz, Samba, Hustle, Meringue.

All Settings

One of the advantages of using dance as a form of exercise for older adults is that it will likely be familiar, and is therefore easily learned or recalled.As indicated earlier, even older adults with cognitive impairment can recall dance activities and engage in this wonderful form of exercise.

In the community, numerous dance classes are held regularly, and such classes are often available at senior centers or community colleges, either for free or at low cost.

For older adults in the institutional setting, dance classes can be part of the activity programs. It is important, however, that this be a class or program in which residents dance, rather than simply watching others or a leader or dance team perform.

Innovative and fun activities such as prom night for seniors which can be developed as a special event for seniors alone, or seniors within an institution who partner with a local high school, or invite family members and grandchildren.

A cruise night is another fun way to incorporate dance activities. Training for such special activities can go on throughout the year.

Conclusion

Dance and moving to music are pleasant, natural ways to increase activity in older adults. These individuals are familiar with dance activities and can recall, or easily relearn, familiar steps. The benefits of dancing are multiple and include not only cardiovascular benefits, but also improved balance and flexibility. Dancing also increases social interaction and thus may improve mood and overall quality of life.

Aside from appropriate music, sufficient space, and shoes that are comfortable while providing good support, dance requires no special equipment and is an inexpensive and easy way to help older adults in all settings to move and exercise.

Dr. Resnick is Associate Professor at the University of Maryland School of Nursing and holds a combined clinical faculty position as a geriatric nurse practitioner at Roland Park Place, both in Baltimore. Dr. Resnick is also actively engaged in a research program that focuses on motivation, particularly motivating older adults to engage in health behaviors such as exercise. She is currently the Principal Investigator on an NIA-funded study testing the effectiveness of the Exercise Plus Program in older women who have had a hip fracture.

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