This is a bit of a departure, but remember the long paper on dance as fitness for the elderly that I mentioned before? I’ve decided to share it, with this warning label: It’s quite long and somewhat academic – you might want to read it in chunks. But my professors have been indulgent in letting me write my papers in a mash-up of journalism and APA (scholarly journal) style, and I’ve been told by a couple of people that it’s worth posting, so here goes.
Maybe it will inspire you to dance through your silver and golden years. And Van Morrison is sure to make you want to move.
When it comes to exercise and the elderly, the consensus seems fairly clear: Appropriate physical activity is good for the aging body, mind, and – as research and anecdotal evidence increasingly show – spirits. New studies continue to report varying degrees of benefit from varying forms of exercise; findings may vary but most agree that regular physical activity has benefits that range from enhanced strength, balance, coordination, and endurance to improved cognition and decreased dementia to better psychosocial health and sense of well-being (Lindwall, Rennemark, & Berggren, 2008).
Adding exercise to one’s regimen to add life to one’s years would seem to be a no-brainer, but many people, especially the elderly, have no interest in exercise or no idea where to start. Conflicting reports don’t help; in two days, this writer received two emails, one the New York Times Health Update (April 24, 2012), the other the Psych Central Newsletter (April 25, 2012). Both feature articles touting the benefits of exercise for the aging brain, but Gretchen Reynolds of the Times reports that aerobic exercise such as walking or running is the way to preserve or improve brain function, while Psych Central’s Janice Wood reports that lifting weights does the trick. “A new study shows that an exercise program that features resistance training improves the cognitive functioning of older women,” Wood begins the article that describes a Canadian study of 86 women with mild cognitive impairment.
In the big picture, the type of exercise is not as important as the fact of consistent exercise, and one of the best ways to encourage exercise is to make it fun. This paper will look at research-proven benefits of consistent exercise to keep the aging functional and independent, as well as how elders can have fun while achieving those benefits through dance, specifically three types: ballroom dance, belly or Middle Eastern dance, and choreographed/performance dance.
First, however, is a look at two nonagenarians this writer has the privilege of knowing. Their names have been changed.
A contrast in aging: Two 90-year-olds
As members of the same birth cohort, Burt and Dorothy share many life experiences, though they live in different parts of the United States and have never met. They’re also members of a much smaller group, independent-minded 90-year-olds who live at home alone – definitely by choice. Other commonalities are that each comes from a humble background, has a high school education and a more than comfortable standard of living (Burt owned his own business, as did Dorothy’s husband), and is widowed after a decades-long marriage. Both have been trim to thin their entire lives. Dorothy has a pacemaker; Burt has a couple of heart surgeries in his past.
The similarities stop there, though. At 90, Dorothy is very frail, has mild to moderate cognitive impairment, prefers the company of her cats to humans, walks tentatively at home and fearfully outside her comfort zone, and, except for a bit of flower gardening, lives a sedentary lifestyle. Her beloved crossword puzzles sit unworked these days and she finds bridge club more annoying than fun, partly because “the other women want to talk too much.” Her days of living alone are numbered, as she is unable to carry out some instrumental activities of daily living and has difficulty with some of the ones she can still manage.
Burt, on the other hand, is a testament to active aging. He is sharp, alert, outgoing, and spry; he loves to laugh, and the highlight of most weeks is his regular Sunday evening dance date at the local VFW. Burt has always been a dancer and will “cut a rug,” as he calls it, anywhere there’s music, dance floor or no. When his wife died after a years-long illness, dancing became an even more important part of his life. Though his family is large and very attentive, the company of his peers – although he will tell you he has outlived most of them – and the physical activity at the VFW keep him vitalized. He leaves Sunday afternoon family get-togethers early to head to the dance floor; he dares not leave the ladies waiting. At his afternoon 90th birthday party, which had about 300 guests and featured a live band, Burt danced off and on for the four hours the party lasted. He may not live to dance, but he certainly loves to dance.
Attributing the differences between Dorothy and Burt in activity level, confidence, and mental acuity solely to exercise would be too great a stretch, but the research is there to support the belief that it makes a difference in how they are aging.
The proof is in the research
In a 2008 article published in Aging & Mental Health, Swedish researchers Lindwall, et al., showed confidence in the exercise-mental health correlation.
“Aging is, for most individuals, accompanied with a general decline in cognitive function. Another aspect that seems to accompany aging is a decline in physical activity. From a ‘health-in-old age’ perspective this is most unfortunate, as regular physical activity and exercise has been linked to enhanced physiological as well as psychological and psychosocial health for older adults” (p. 212).
The researchers studied a random sample of urban and rural Swedes 60 and older, 585 men (average age 74) and 817 women (average age 76) (Lindwall, et al., 2008). They determined that “physically active older adults perform better than inactive older adults in a wide range of cognitive function tests,” (p. 212). They found consistent light-intensity exercise sufficient for an association with general cognitive alertness and an association between moving from an active to an inactive lifestyle with lower Mini-Mental State Examination (MMSE) scores, particularly for men. They also cite support “for the notion that physical activity may be protective of future cognitive decline and risk of dementia” (p. 217).
A sound mind is not enough to enable an elderly person to carry out the activities of daily living, however; a certain level of strength, coordination, agility, balance, and flexibility is necessary to function independently, a level that can be achieved and maintained by exercise.
“In addition to a general decline in physical fitness, the aging process is accompanied by a progressive decline in perception, motor behavior, cognition, and memory functions. Therefore, the preservation of everyday life skills and the maintenance of independent living become increasingly important with advancing age. It is well established that physical fitness is intimately associated with cognitive performance in the elderly. Consequently, high levels of physical fitness have been assumed to be a major factor contributing to the maintenance of independent living and everyday competence” (Kattenstroth, Kalisch, Kolankowska, & Dinse, 2011, p. 1).
Physical fitness, or lack thereof, can also affect and perhaps predict “adverse health events in elders” (Cesari, et al., 2009, p. 251). A team of researchers studied 3,024 older people with a mean age of 73.6, using the Short Physical Performance Battery (SPPB) over 6.9 years to evaluate their functional status (Cesari, et al., 2009). The three measures used were usual gait speed, repeated chair stands (standing from a seated position five times without using one’s arms) and standing balance (three variations, ending with standing on one leg). These measures, Cesari, et al., report, have shown good reliability and are “predictive of adverse health-related outcomes in older persons” (p. 252).
Though they admit shortcomings in the study, the authors say that their study population is representative of well-functioning 70- to 79-year-olds and “the results may be useful for evaluating older persons in whom a disabling process is not yet clinically evident, providing a basis for the development of a ‘real’ preventive program” (Cesari, et al., 2009, p. 258).
The most effective preventive, rehabilitative, or maintenance program will not work if an elder isn’t motivated to exercise. This is where the putting fun in function can make a significant difference. Dr. Dafna Merom of the University of Sydney told Asian Scientist Magazine that helpful though it may be, formal exercise may not be the way to go when it comes to elder fitness (Chan, 2012). “Dance is a complex sensory motor rhythmic activity. It also has cognitive and social dimensions. This package as a whole can simultaneously address a wide range of physiological and cognitive risk factors that contribute to falls,” Merom said (Chan, 2012, p. 1).
Merom, who also pointed out that social dancing is fun and available, will lead a year-long international study of the effects of twice weekly ballroom dance classes on the falls and cognition in 450 older people (Chan, 2012).
Dancing in the moonlight years
Merom is not the first person to look at dance and the elderly. Though dance was not a major component of the 21-year Bronx Aging Study, a link between non-specific dancing and reduced dementia risk did appear (Verghese, et al., 2003). “Dancing was the only physical activity associated with a lower risk of dementia,” according to Verghese, et al.’s, article “Leisure Activities and the Risk of Dementia in the Elderly,” published by The New England Journal of Medicine (p. 2512). The authors seem later to lump dance into the broader “leisure” category, despite it being listed in Table 2 (p. 2513) as a physical activity.
“Reading, playing board games, playing musical instruments, and dancing were associated with a lower risk of dementia in our cohort. There was no association between physical activity and the risk of dementia. Exercise is said to have beneficial effects on the brain by promoting plasticity, increasing the levels of neurotrophic factors in the brain, and enhancing resistance to insults. Cognitive and physical activities overlap, and therefore it is not surprising that previous studies have disagreed on the role of physical activities. Although physical activities are clearly important in promoting overall health, their protective effect against dementia remains uncertain” (Verghese, et al., p. 2515).
For anyone who has ever danced, the protection is easy to understand. Not only does dance condition muscles, loosen joints, and increase flexibility, balance and aerobic capacity, it also requires concentration to learn not just new moves but new moves in a specific order. Ballroom dance requires even more mental acuity; dancers quickly have to recognize the rhythm of a song to pick the appropriate dance, men have to decide which moves to do and when, and women not only have to anticipate and follow the men’s moves, but, to paraphrase Ginger Rogers, they have to do it backward. The colloquialism “stretching your brain” comes to mind – which, of course, is a layman’s term (perhaps unknowingly) for promoting plasticity.
A Society for Neuroscience article cites a McGill University study of Argentine tango and the aging brain, in which 30 people aged 62 to 90, all of whom had fallen in the past year and developed a fear of falling, were divided into a walking group or a tango group (Harris, 2005). Each group met for two hours twice a week for 10 weeks.
The article puts Rogers’ famous quote into scientific terms.
“Tango dancing is beneficial to the elderly, says Patricia McKinley, PhD., because it incorporates elements found in standard neurological rehabilitation programs: forward, backward and side-to-side weight shift; one-legged stance; walking on a straight line both backwards and forwards; increasing step length in all directions; and turning within a narrow space” (Harris, 2005).
The music is another plus. “An added benefit of tango is that its movements are performed to music, which is known to facilitate performance of ambulatory activities,” says McKinley (Harris, 2005).
McKinley concluded that tango dancing is ideal for senior citizens and “satisfies three basic requirements for exercise adherence: It’s fun, it’s a group activity, and it has a tangible goal that can be perceived not only by the dancer, but by his or her family and friends” (Harris, 2005).
And-a one: Ballroom dance
For many seniors, ballroom dancing for physical fitness is a continuation of something they’ve always done or returning to something they enjoyed in their younger years, but newcomers need not be deterred or think learning to dance late in life is not worth the effort. To the contrary, at least one study shows that newcomers or amateur dancers benefit more from adding dance to their lives than long-term, expert, or competitive dancers do by continuing the activity at which they already excel.
Kattenstroth, et al., report that years of dancing regularly in old age has a wide range of benefits, including positive effects on posture, sensorimotor capabilities, and cognitive performance, especially when amateur dancers are compared to a non-dancing control group. When studying expert dancers (with “expert” based on dancing 4.5 hours per week for practice and 2.5 hours per week of competition), the researchers found the expert group tested better on reaction time, posture, and balance – which could be expected after years of practice – but no better than the non-dancing control group on cognition and hand-arm motor functions. In the expert group, some functions tested seemed to suffer at the expense of devoting so much time and attention to ballroom dance. The actual positive-aging benefits seemed to be higher for the amateur group members, who not only increased their activity level but were constantly learning new moves (2011).
Again, the “fun factor,” or psychosocial effect, plays a huge part in making ballroom dance an excellent exercise activity for the aging, according to a Dallas Morning News article.
“Dr. Robert K. Rosen, an internist at Baylor University Medical Center at Dallas, says ballroom dancing has several health benefits for senior citizens. In particular, he says the communal nature of dancing helps keep them from becoming isolated or lonely.
“I think anything that can be done to keep them active and interested and involved is an excellent idea, Dr. Rosen says.
‘Ballroom dancing really does challenge every part of your system, from your hearing, vision, mental alertness to coordination and our cardiovascular system.’
Seniors who have frail bones should be careful when ballroom dancing, Dr. Rosen says, as they are more likely to be injured if they fall” (Tenore, 2008).
And-a two: Belly dance
The ancient art of belly dance, though not as widely practiced, offers another fun and expressive physical activity for senior women (though men can certainly do it too). Some might think it for young women only, but the original Mirana, of the Mirana Middle Eastern Dance Company in Little Rock, was well into her 70s and still performing and teaching when she finally retired; women of all ages make up the classes at Arkansas Belly Dance today.
Belly dance (also known as Middle Eastern dance) works the entire body with its undulating movements and requires the same stretching of the brain as ballroom dance – perhaps more than ballroom dance, as the moves newcomers learn are so unfamiliar. Since no partner is required, belly dance can be ideal for divorced or widowed older women who might be shy about going solo to a ballroom dance class, and the all-ages nature of many belly dance classes and troupes makes it an accessible, intergenerational activity in communities where no senior classes are offered. Some senior centers and retirement homes do incorporate the Middle Eastern dance form into their activity schedule, and it has been popular.
An Israeli doctor, Clara Friedman, recently completed a Clalit Health Services study of the effects of belly dance on women’s health, following 129 women with an average age of 49 for a year. The results were impressive. Not only did some of the women decrease their visits to a family doctor, they also saw a general improvement in health (Even, 2011).
“At the end of the year-long workshop, where the women belly danced for two hours a week, their general health assessment rose by an average of 5.54 points to a total 9.09 points, on a scale of 1-10.
“Furthermore, the women’s’ average body mass index (BMI) went down from 25.34 units, and approximately 70% of them described a decrease in their weight. According to the researchers, belly dancing is ‘a safe and pleasant form of physical exercise that has a positive effect on both physical and mental health’” (Even, 2011).
And-a three: Choreographed/performance dance
The sound of tap or jazz shoes on a wooden floor is what calls some seniors into exercise. Maybe it is the fulfillment of a dream, like for this writer’s mother, who took tap dance lessons for the first time in middle age; the money for dance lessons was not there in her youth. Perhaps it is a return to something at which seniors excelled or that they enjoyed in their youth. Whatever the reason, the foot-tapping rhythms and repetitive steps make for heart-pumping workouts, and adult classes are easy to find in most cities of any size.
Sadler’s Wells Theatre in London, England, has taken things several steps further when it comes to seniors and performing arts dance. Their Company of Elders troupe for people 60 and over offers older adults, even those who have never danced before, a chance to train with international choreographers and perform all over England, as well as in Russia, Portugal, and Italy (Ross, 2007). Videos of the Company at www.sadlerswells.com show the joy and confidence the program brings to the 25 dancers selected to be in the troupe. One of the dancers, Sybil Fox, who was 78 and had two new hips and a replaced knee when she was interviewed in 2007, said the benefits go beyond the physical.
“I have always been determined to keep agile and ‘young thinking’ to whatever age I am fortunate to live to. I like to give anything a go at least once. I cannot imagine that any other group could so help me do this. The physical benefits go without saying. We are not treated as ‘old people’ and consequently do not feel old” (Ross, 2007, p. 38).
Ross (2007) reports that Company of Elders members gave the following reasons to participate in organized dance in the later years: an increase in creativity, a boost in self-confidence; an extension of skills, bringing a sense of purpose into late life, improving fitness, and having social interaction with people who enjoy the same things. The men and women of the company are not retired dancers – they come from non-dance backgrounds including a retired chemistry chemist and a former math teacher – but they are definitely dancers now.
Evidence, anecdotal and research-based, is clear: Consistent, age- and skill-level-appropriate exercise is good for the aging brain, body, and soul. The more enjoyable and less regimented the form of exercise, the more likely seniors are to adhere to it, and, according to Lindwall et al. (2008), light or moderate intensity exercise, which has better adherence than more strenuous levels, “seem to be related to the most beneficial effects, at least in terms of mental health” (p. 218).
One would have to agree with the conclusion of Lindwall, et al., (2008) that “from a broader and more applied perspective, the well-known exercise motto ‘never too late to start, always too early to quit’ seems relevant to highlight once again” (p. 217). Those who dance their way through their senior years, whatever form they choose, may find permanent pep in their steps and joy in their hearts. At the very least, they could have a bit of fun and improve their functioning in daily life.
Dim lights, close curtain.