The effect of dance on physical health and cognition in community dwelling older adults: A systematic review and meta-analysis

Figures & data

Table 1. Study characteristics, program components.

Author	Sample size	Dance genre	Partnered? Yes/No	Type of exercise				Frequency	Intensity	Duration	Dosage (frequency × duration)	Control	PEDro
				Aerobic	Strength	Balance	Flexibility
Aguiñaga & Marquez, 2019USA	21	Merengue cha cha cha, bachata, salsa	-	✓	✓	✓	✓	2	-	1-hour × 4 months	32 hours	Wait-list	5/10
Areeudomwong et al., 2019Thailand	78	Thai boxing dancing	No	✓	✗	✓	✓	3	-	30 min × 4 weeks	6 hours	Fall prevention educational booklet	7/10
Bennett & Hackney, 2018USA	23	Line Dancing	No	✓	✗	✓	✗	2	-	1-hour × 8 weeks	16 hours	No intervention	6/10
Cepeda et al., 2015Brazil	34	Ballroom	Yes	✓	✓	✓	✓	3	12–16BORG60–70% HR	1-hour ×8 weeks	24 hours	No intervention	4/10
Cruz-Ferreira et al., 2015Portugal	78	Creative	No	✓	✓	✓	✓	3	-	50 min × 24 weeks	60 hours	No intervention	6/10
Granacher et al., 2012Germany	28	Salsa	Yes	✓	✓	✓	✓	2	-	1-hour ×8 weeks	16 hours	No intervention	5/10
Franco et al., 2020Brazil	82	Rhythmic: movement to rhythmic folk songs	Yes	✗	✗	✓	✗	2	Moderate intensity	1 hour × 12 weeks	24 hours	Education on fall prevention	8/10
Hamacher et al., 2015Germany	50	Line, Jazz, Rock ’n’ Roll, Latin, American Square Dance	-	✓	✓	✗	✓	2	-	1.5 hours × 6 months	144 hours	Health-related exercise	5/10
Hofgaard et al., 2019Faroe Islands	33	Faroese Chain Dance	Yes	✗	✗	✓	✗	2	Tempo ∼90 bts⋅min	30 min × 3 weeks; 45 min × 3 weeks	7.5 hours	Normal daily routines	4/10
Janyacharoen et al., 2013Thailand	42	Thai	No	✓	✓	✗	✓	3	-	40 min × 6 weeks	12 hours	Instruction on general aerobic exercise	6/10
Joung et al., 2019Korea	82	Creative Dance	Yes	✓	✓	✓	✓	2	-	90 min × 8 weeks	24 hours	Stretching	6/10
Krampe, 2013USA	27	Lebed Method	-	✓	✓	✓	✓	3	-	45 min × 6 weeks	13.5 hours	No intervention	4/10
McKinley et al., 2008Canada	30	Tango	Yes	✓	✓	✓	✗	2	-	2 hours × 10 weeks	40 hours	Walking	5/10
Merom et al., 2016Australia	115	Ballroom Dances	Yes	✓	✗	✓	✗	2	-	1-hour × 8 months	69 hours	Walking (Individual ± group)	4/10
Müller et al., 2017Germany	52	Line, Jazz, Rock “n” Roll & Square Dance	-	✓	✗	✓	✓	1 or 2		1.5 hours × 18 months	117 hours	Endurance, strength and flexibility training	5/10
Noopud et al., 2019Thailand	43	Thai Dance	-	✗	✓	✗	✗	1	-	0.5–1.0 hours x12 weeks	10.5 hours	No intervention	4/10
Rodrigues-Rodrigues-Krause et al., 2018Brazil	30	Combination	No	✓	✓	✓	✓	3	59–63% vo2 max	1 hour × 8 weeks	24 hours	a) Stretching or b) Walking	7/10
Rehfeld et al., 2018Germany	52	Variednew routines every two weeks with increasing difficulty	-	✓	✓	✓	✓	2	60–69% vo2 max	90 min × 6 months	72 hours	Conventional fitness training	4/10
Rehfeld et al., 2017Germany	52	Varied: Chassée, Mambo, Cha Cha Cha, Grapevine, Jazz & Square	-	✓	✗	✓	✗	1 or 2	-	90 min × 18 months	144 hours	Endurance; strength and flexibility sport training	4/10
Sejnoha Minsterova et al., 2020Czech Republic	76	Folk, country, African, Greek, Tango	Yes	✓	✓	✓	✗	3	RPE 11–14	60 min × 6 months	~ 72 hours	Life as usual	5/10
Sofianidis et al., 2009Greece	26	Traditional Greek	Yes	✓	✗	✓	✓	2	50–60% Max HR	1-hour × 10 weeks	20 hours	No intervention	4/10
Sofianidis et al., 2017Greece	32	Latin Dance	-	✓	✗	✓	✗	2	-	1-hour × 6 months	48 hours	No intervention	4/10

-: not reported; HR: heart rate, min: minutes; VO₂ Max: maximal oxygen uptake; Max: maximum; Approx.: approximately.

Table 2. Feasibility measures, dropouts, attrition and participation in each intervention   .

Author	Sample size	Dance	Control	Age (mean (SD/ Range))		Droouts Dance group	Dropouts Control group	Attrition Dance group	Attrition Control group	Attendance Dance Group	Attendance Dance Group
Date				DG: Dance CG: Control
Aguiñaga & Marquez, 2019	21	10	11	75.4 (6.3)		4	NR	40%	NR	60%	NR
Areeudomwong et al., 2019	78	39	39	DG: 66.33 (4.33) CG: 67.33 (4.04)		0	0	0%	0%	100%	96%
Cepeda et al., 2015	34	17	17	DG: 69.1 (6.5) CG: 71.5 (7.4)		NR	NR	NR	NR	91.3%	NR
Cruz-Ferreira et al., 2015	78	39	39	DG: 71.1 (3.9) CG: 72.8 (4.5)		7 prior to baseline	14 prior to baseline	0%	NR	>85%	NR
Franco et al., 2020	82	41	41	69 (6.6)		6	5	14.6%	12.2%	67%	NR
Hofgaard et al., 2019	33	17	16	DG: 75 (5) CG: 74 (4)		2	6	11.8%	37.5%	NR	NR
Joung et al., 2019	82	41	41	DG: 70.5 (7.89) CG: 71.77 (7.78)		0	0	0%	0%	98.5%	97.2%
Sejnoha Minsterova et al., 2020	99	49	50	DG: 69:3 (5:3) CG: 68:9 (6:3)		NR	NR	Final sample 76		78.1%	NR
Sofianidis et al., 2009	26	14	12	DG: 69.23 (4.35) CG: 72.57 (5.25)		0	NR	0%	NR	NR	NR
Rodrigues-Krause et al., 2018	30	10	CG (a): 10 CG (b): 10	DG: 66 (63–70) CG (a): 66 (62–70) CG (b) 64 (62–65)		1	CG (a) Walking Group: 1 CG (b) Stretching Group: 2	10%	CG (a): 10% CG (b): 20%	>95%	>95%
Rehfeld et al., 2018	52	26	26	63–80		6	8	23.1%	30.8%	≥70%	≥70%
Rehfeld et al., 2017	52	26	26	DG: 67.21 (3.78) CG: 68.67 (2.57)		14	12	53.8%	46.2%	70%	70%
Bennett & Hackney, 2018	23	12	11	73.4 (8.4)		0	NR	0%	NR	≥80%	NR
Muller et al 2017	52	26	26	DG: 68.25 (3.91) CG: 68.6 (2.79)		14	16	53.8%	61.5%	70%	70%
Sofianidis et al., 2017	32	12	CG (a):12 CG (b): 12	DG: 70.76 (5.0) CG (a) 70.59 (5.1) (Pilates) CG (b)70.37 (5.98) (Control)		0	0	0%	0%	100%	100%
Krampe, 2013	27	15	12	DG: 85.0 (8.49) CG: 85.0 (8.86)		2	1	13.3%	8.3%	NR	NR
Granacher et al., 2012	28	14	14	DG: 71.6 (5.3) CG: 68.9 (4.7)		0		0%	NR	92.5%	NR
Hamacher et al., 2015	50	25	25	DG: 67.23 (3.4) CG: 68.53 (3.09)		6	9	24%	36%	≥70%	≥70%
Merom et al., 2016	115	61	54	69.5 (6.4)		20	16	32.8%	29.6%	78	NR
Noopud et al., 2019	54	27	27	DG: 68.29 (5.82) CG: 67.50 (5.39)		5	6	18.5%	22.2%	81.4%	NR
McKinley et al., 2008	30	15	15	DG: 78.07 (7.6) CG: 74.6 (8.4)		1	4	6.6%	26.6%	>90%	>90%
Janyacharoen et al., 2013	42	22	20	DG: 64.9 (4.0) CG: 66.8 (6.0)		2	2	9.1%	10%	NR	NR

DG, dance group; CG, control group; NR, not recorded/unable to calculate.

Table 3. Summary of meta-analysis findings for key outcomes of interest.

Outcomes	Overall pooled effect	Dance compared to no intervention	Dance compared to other interventions
Mobility	Dance superior*	Dance superior*	Dance superior*
Balance	Dance equivalent	Dance equivalent	Dance equivalent
Gait	Danceequivalent (marginally insignificant for superior effect)	Danceequivalent (marginally insignificant for superior effect)	Dance equivalent (marginally insignificant for superior effect)
Strength	Dance equivalent	Dance equivalent	Dance equivalent
Endurance	Dance superior*	Dance superior*	Dance equivalent
Flexibility	Dance equivalent	Dance equivalent	Dance superior*
Cognition	Dance equivalent	Dance equivalent	Dance equivalent

Figure 1. Forest plot of Dancing versus control for Gait.

Figure 2. Forest plot of dancing versus control for balance.

Figure 3. Forest plot of dancing versus control for mobility.

Figure 4. Forest plot of dancing versus control for strength.

Figure 5. Forest plot of dancing versus control for endurance.

Figure 6. Forest plot of dancing versus control for cognition.

Figure 7. Forest plot of dancing versus control for flexibility.

Table

Concept	Search query	Free text terms / natural language terms (synonyms, UK/US terminology, medical/laymen’s terms, acronyms/abbreviations, more narrow search terms) Consider: phrase searching, proximity operators, truncation, wildcards, field qualification (e.g., textword) Controlled vocabulary terms / Subject terms (MeSH terms, Emtree terms) Consider: explode, major headings, subheadings	Hits
Dance	#1	dance OR dancing	9, 869
	#2	Search: “Dancing”[Mesh] OR “Dance Therapy”[Mesh] Sort by: Most Recent	3,677
	#3	#1 AND #2	9, 869
Age	#4	elderly OR aged OR older OR elder OR geriatric OR old OR senior	6,945,028
	#5	#3 AND #4	2,487
Limits/Filters	#6	Search: #1 AND #2 Filters: Randomized Controlled Trial	273
	#7	Search: #1 AND #2 Filters: Randomized Controlled Trial, from 2007/1/1 - 2020/12/31	213
	#8	Search: #1 AND #2 Filters: Randomized Controlled Trial, English, from 2007/1/1 - 2020/12/31	206

Note: Search terms entered were for population and intervention, we did not enter specific search

terms for outcome so as to source all RCT’s that examined the effectiveness of dance programmes

for older adults and we wanted to include all outcomes related to health and wellbeing. We then

screened and reviewed the articles using our inclusion/ exclusion criteria.

Figure A PRISMA Flow Diagram

Critical appraisal and PEDro tables and scores.

	Aguiñaga & Marquez, 2019	Areeudomwong et al., 2019	Bennett & Hackney, 2018	Cepeda et al., 2015	Cruz-Ferreira et al., 2015	Franco et al., 2020	Granacher et al., 2012	Hamacher et al., 2015
Eligibility Criteria
Random Allocation	✓	✓	✓	✓	✓	✓	✓	✓
Concealed Allocation	✗	✓	✗	✗	✓	✓	✗	✓
Baseline Comparability	✓	✓	✓	✓	✓	✓	✓	✓
Blinded Subjects	✗	✗	✗	✗	✗	✗	✗	✗
Blinded Therapist(s)	✗	✗	✗	✗	✗	✗	✗	✗
Blinded Assessment	✓	✓	✗	✗	✓	✓	✗	✗
Adequate Follow-up	✗	✓	✓	✗	✗	✓	✓	✗
Intention-to-treat	✗	✗	✓	✗	✗	✓	✗	✗
Between Group Statistical Comparison	✓	✓	✓	✓	✓	✓	✓	✓
Point Estimates and variability	✓	✓	✓	✓	✓	✓	✓	✓
Total PEDro Score	5	7	6	4	6	8	5	5
	Hofgaard et al., 2019	Janyacharoen et al., 2013	Joung et al., 2019	Krampe, 2013	McKinley et al., 2008	Merom et al., 2016	Sejnoha Minsterova et al., 2020	Hofgaard et al., 2019
Eligibility Criteria
Random Allocation	✓	✓	✓	✓	✓	✓	✓	✓
2. Concealed Allocation	✗	✗	✗	✗	✓	✗	✓	✗
3. Baseline comparability	✓	✓	✓	✓	✓	✓	✓	✓
4. Blinded Subjects	✗	✗	✗	✗	✗	✗	✗	✗
5. Blinded therapist(s)	✗	✗	✗	✗	✗	✗	✗	✗
6. Blinded Assessment	✗	✓	✓	✗	✗	✗	✗	✗
7. Adequate Follow-up	✗	✓	✓	✗	✗	✗	✗	✗
8. Intention-to-treat	✗	✗	✗	✗	✗	✓	✗	✗
9. Between Group Statistical Comparison	✓	✓	✓	✓	✓	✓	✓	✓
10. Point Estimates and Variability	✓	✓	✓	✓	✓	✗	✓	✓
Total PEDro Score	4	6	6	4	5	4	5	4
	Müller et al., 2017	Noopud et al., 2019	Rehfeld et al., 2017	Rehfeld et al., 2018	Rodrigues-Krause et al., 2018	Sofianidis et al., 2009	Sofianidis et al., 2017	Muller et al. 2017
Eligibility Criteria
Random Allocation	✓	✓	✓	✓	✓	✓	✓	✓
Concealed Allocation	✗	✗	✗	✗	✗	✗	✗	✗
Baseline Comparability	✓	✓	✓	✓	✓	✓	✓	✓
Blinded Subjects	✗	✗	✗	✗	✗	✗	✗	✗
Blinded Therapist(s)	✗	✗	✗	✗	✗	✗	✗	✗
Blinded Assessment	✗	✗	✗	✗	✓	✗	✗	✗
Adequate Follow-up	✓	✗	✗	✗	✓	✗	✗	✓
Intention-to-treat	✗	✗	✗	✗	✓	✗	✗	✗
Between Group Statistical Comparison	✓	✓	✓	✓	✓	✓	✓	✓
Point Estimates and variability	✓	✓	✓	✓	✓	✓	✓	✓
Total PEDro Score	5	4	4	4	7	4	4	5

Aguiñaga, S., & Marquez, D. X. (2019). Impact of Latin dance on physical activity, Cardiorespiratory fitness, and sedentary behavior among latinos attending an adult day center. Journal of Aging and Health, 31(3), 397–414. https://doi.org/10.1177/0898264317733206

 PubMed Web of Science ®Google Scholar

Areeudomwong, P., Saysalum, S., Phuttanurattana, N., Sripoom, P., Buttagat, V., & Keawduangdee, P. (2019). Balance and functional fitness benefits of a Thai boxing dance program among community-dwelling older adults at risk of falling: A randomized controlled study. Archives of Gerontology and Geriatrics, 83(July–August 2019), 231–238. https://doi.org/10.1016/j.archger.2019.04.010

 PubMed Web of Science ®Google Scholar

Bennett, C. G., & Hackney, M. E. (2018). Effects of line dancing on physical function and perceived limitation in older adults with self-reported mobility limitations. Disability and Rehabilitation, 40(11), 1259–1265. https://doi.org/10.1080/09638288.2017.1294207

 PubMed Web of Science ®Google Scholar

Cepeda, C. C., Lodovico, A., Fowler, N., & Rodacki, A. L. (2015). Effect of an eight-week ballroom dancing program on muscle architecture in older adult females. Journal of Aging and Physical Activity, 23(4), 607–612. https://doi.org/10.1123/japa.2014-0101

 PubMed Web of Science ®Google Scholar

Cruz-Ferreira, A., Marmeleira, J., Formigo, A., Gomes, D., & Fernandes, J. (2015). Creative dance improves physical fitness and life satisfaction in older women. Research on Aging, 37(8), 837–855. https://doi.org/10.1177/0164027514568103

 PubMed Web of Science ®Google Scholar

Granacher, U., Muehlbauer, T., Bridenbaugh, S. A., Wolf, M., Roth, R., Gschwind, Y., Wolf, I., Mata, R., & Kressig, R. W. (2012). Effects of a salsa dance training on balance and strength performance in older adults. Gerontology, 58(4), 305–312. https://doi.org/10.1159/000334814

 PubMed Web of Science ®Google Scholar

Franco, M. R., Sherrington, C., Tiedemann, A., Pereira, L. S., Perracini, M. R., Faria, C. S. G., Negrão-Filho, R. F., Pinto, R. Z., & Pastre, C. M. (2020). Effect of senior dance (DanSE) on fall risk factors in older adults: A randomized controlled trial. Physical Therapy, 100(4), 600–608. https://doi.org/10.1093/ptj/pzz187

 PubMed Web of Science ®Google Scholar

Hamacher, D., Hamacher, D., Rehfeld, K., Hökelmann, A., & Schega, L. (2015). The effect of a six-month dancing program on motor-cognitive dual-task performance in older adults. Journal of Aging and Physical Activity, 23(4), 647–652. https://doi.org/10.1123/japa.2014-0067

 PubMed Web of Science ®Google Scholar

Hofgaard, J., Ermidis, G., & Mohr, M. (2019). Effects of a 6-week Faroese chain dance programme on postural balance, physical function, and health profile in elderly subjects: A pilot study. BioMed Research International, 2019, 5392970. https://doi.org/10.1155/2019/5392970

 PubMed Web of Science ®Google Scholar

Janyacharoen, T., Laophosri, M., Kanpittaya, J., Auvichayapat, P., & Sawanyawisuth, K. (2013). Physical performance in recently aged adults after 6 weeks traditional Thai dance: A randomized controlled trial. Clinical Interventions In Aging, 8, 855–859. https://doi.org/10.2147/CIA.S41076

 PubMedGoogle Scholar

Joung, H. J., Lee, Y., & Joung, H. J. (2019). Effect of creative dance on fitness, functional balance, and mobility control in the elderly. Gerontology, 65(5), 537–546. https://doi.org/10.1159/000499402

 PubMed Web of Science ®Google Scholar

Krampe, J. (2013). Exploring the effects of dance-based therapy on balance and mobility in older adults. Western Journal of Nursing Research, 35(1), 39–56. https://doi.org/10.1177/0193945911423266

 PubMed Web of Science ®Google Scholar

McKinley, P., Jacobson, A., Leroux, A., Bednarczyk, V., Rossignol, M., & Fung, J. (2008). Effect of a community-based Argentine tango dance program on functional balance and confidence in older adults. Journal of Aging and Physical Activity, 16(4), 435–453. https://doi.org/10.1123/japa.16.4.435

 PubMed Web of Science ®Google Scholar

Merom, D., Grunseit, A., Eramudugolla, R., Jefferis, B., Mcneill, J., & Anstey, K. J. (2016). Cognitive benefits of social dancing and walking in old age: The dancing mind randomized controlled trial. Frontiers in Aging Neuroscience, 8, 26. https://doi.org/10.3389/fnagi.2016.00026

 PubMed Web of Science ®Google Scholar

Müller, P., Rehfeld, K., Schmicker, M., Hökelmann, A., Dordevic, M., Lessmann, V., Müller, P., Brigadski, T., Kaufmann, J., & Müller, N. G. (2017). Evolution of neuroplasticity in response to physical activity in old age: The case for dancing. Frontiers in Aging Neuroscience, 9, 56. https://doi.org/10.3389/fnagi.2017.00056

 PubMed Web of Science ®Google Scholar

Noopud, P., Suputtitada, A., Khongprasert, S., & Kanungsukkasem, V. (2019). Effects of Thai traditional dance on balance performance in daily life among older women. Aging Clinical and Experimental Research, 31(7), 961–967. https://doi.org/10.1007/s40520-018-1040-8

 PubMed Web of Science ®Google Scholar

Rodrigues-Krause, J., Farinha, J. B., Ramis, T. R., Macedo, R. C. O., Boeno, F. P., Dos Santos, G. C., Costa, R. R., Grazioli, R., Costa, R. R., Pinto, R. S., Krause, M., Reischak-Oliveira, A., & Vargas, J. (2018). Effects of dancing compared to walking on cardiovascular risk and functional capacity of older women: A randomized controlled trial. Experimental Gerontology, 114(December), 67–77. https://doi.org/10.1016/j.exger.2018.10.015

 Web of Science ®Google Scholar

Rehfeld, K., Lüders, A., Hökelmann, A., Lessmann, V., Kaufmann, J., Brigadski, T., Müller, N. G., & Müller, P. (2018). Dance training is superior to repetitive physical exercise in inducing brain plasticity in the elderly. PLoS One, 13(7), e0196636. https://doi.org/10.1371/journal.pone.0196636

 PubMed Web of Science ®Google Scholar

Rehfeld, K., Müller, P., Aye, N., Schmicker, M., Dordevic, M., Kaufmann, J., Müller, P., Hökelmann, A., & Müller, N. G. (2017). Dancing or fitness sport? The effects of two training programs on hippocampal plasticity and balance abilities in healthy seniors. Frontiers in Human Neuroscience, 11, 305. https://doi.org/10.3389/fnhum.2017.00305

 PubMed Web of Science ®Google Scholar

Sejnoha Minsterova, A., Klobusiakova, P., Kropacova, S., Novakova, L., Brabenec, L., Balazova, Z., Grmela, R., Skotakova, A., Svobodova, L., & Rektorova, I. (2020). Multishell diffusion MRI reflects improved physical fitness induced by dance intervention. Neural Plasticity 2020 Special Issue , 8836925. https://doi.org/10.1155/2020/8836925

 PubMedGoogle Scholar

Sofianidis, G., Hatzitaki, V., Douka, S., & Grouios, G. (2009). Effect of a 10-week traditional dance program on static and dynamic balance control in elderly adults. Journal of Aging and Physical Activity, 17(2), 167–180. https://doi.org/10.1123/japa.17.2.167

 PubMed Web of Science ®Google Scholar

Sofianidis, G., Dimitriou, A.-M., & Hatzitaki, V. (2017). A comparative study of the effects of pilates and Latin dance on static and dynamic balance in older adults. Journal of Aging and Physical Activity, 25(3), 412–419. https://doi.org/10.1123/japa.2016-0164

 PubMed Web of Science ®Google Scholar