Dancing with MS: Benefits of
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1 Dancing with MS: Benefits of Ballroom or Recreational Social Dance for Persons with MS 2015 Annual Meeting of the Consortium of Multiple Sclerosis Centers Alexander Ng, PhD, FACSM Program in Exercise Science Marquette University, Milwaukee, WI Lifestyle and MS
2 Goals To understand the contribution ballroom dance, or partnered social dance can have towards an active lifestyle and wellness in persons with MS To understand whether or not partnered social dance can provide symptom relief or otherwise contribute to quality of life in persons with MS Wellness, Quality of Life, and Lifestyle Exercise Nutrition Education MS Wellness Self- Management, Efficacy Social Support Social Interaction Spirituality
3 Exercise and MS Exercise and Physical Activity Historical roots Contemporary view Barriers Disabilities? Choices from Health Care Providers Smith, C. et. al. Disabil. Rehabil., 2009 Advice from clinicians Sommerset, M., et. al. Health Expect, 2001 Lack of community resources Non-traditional/ Complementary Medicine Yoga E.g. Oken B.S. et. al. Neurology, 2004 Tai Chi E.g. Mills, N. et. al. J Bodywork Mov. Ther Active Lifestyle ac vity sedentary behavior Petajan et. al. Ann Neurol 1996, Why Dance and MS? Not-Exercise Not therapy Non-traditional Captures imagination Low Impact Can be graded Part of Active Lifestyle Community Programming
4 Dance and Special Populations Elderly/Older Adults E.g. Kattenstroth J.C. et. al., Frontiers Aging Neruosci, 2013 Mental Illness E.g. Hackney M.E. and Earhart G.M., J Nerv Ment Dis, 2010 Stroke and TBI E.g. Berrol C.F. et. al., Am J Dance Ther, 1997 Chronic Heart Failure Belardinelli R. et. al., Circ MS Salgado R. and de Paula Vasconcelos, Am J Dance Ther 2010 Partnered Dance and Parkinson Disease Parkinsons disease E.g., Hackney M.E. and Earhart G.M Balance and gait Physical Function Social support Tango (Argentine) Mark Morris Purported mechanisms Altered central activation Cueing strategies Task specificity Dual or multitask Aerobic conditioning Earhart G.M. Eur. J. Phys. Rehabil. Med. 2009
5 Revisit: Dance for MS? Rationale from Neurologic populations Exercise is Medicine for everyone including PwMS Can dance as a form of physical activity be particularly useful for someone with MS? A Case for Partnered Dance for PwMS Physical Activity Balance and Support Social Interaction Music Laughter Learning Two klutzes better than one
6 Feasibility and Fun! Help from local OtiMStics 1 day 1-2 hour workshop All comers Wide range Professional instructor for the first time in years I was able to dance with my husband! It was nice to connect and meet others who also have MS,but not focus on the MS, and just enjoy everyone! MS Ballroom Dance at the Pabst Best Place Milwaukee, WI 1 hr/session (graded instructional) 2 sessions/wk 6 of 8 wks Partners or sig other encouraged Pilot 1 Design Aim 1: Characterize Activity Aim 2: Preliminary Efficacy Experimental Pre- tests Dance Post-tests Control Pre- tests Post-tests 0 No Dance 8 wks 16 wks
7 Pre-Post Measurements Questionnaires PROMIS Global Health MS Self-Efficacy Fatigue (FIS) Depression (BDI) MS Functional Composite 25 ft walk time 9-Hole Peg Test 3 s PASAT Balance (Clinical Measures) Berg Balance Dynamic Gait Heart Rate Variability 10 min rest Push Pull 126 (5) bpm, Carwash Waltz 82 (9) bpm, Come Away with me Foxtrot 121 (9) bpm, Fly me to the Moon Rumba 117 (3) bpm, Kokomo Representative Dance Menu
8 Subject Characteristics MS Dance MS Control p N 7 (6F, 1M) 6 (6F) Age (yr) 46 (9) 49 (8) 0.53 Height (cm) 167 (10) 163 (9) 0.76 Weight (kg) 72.2 (23.3) 67.4 (19.0) 0.79 EDSS 2 (2) 3 (3) 0.56 Dance Group 1 required walker for distance, 1 used cane Partners Abilities and Disabilities Fatigue Temperature H 2 O Access and Parking
9 Partnered Dance as Exercise Partnered Social Dance as Exercise! Low to mod intensity based on ACSM guidelines Ng et. al. unpublished *Maximal HR predicted using the Gellish equation:.
10 Complete Data Set N=7 Pre-Dance Post-Dance p PROMIS Global Health 38 (29, 45) 42(27, 48) 0.24 MS Self Efficacy-Control 730 (430, 900) 730 (620,9 00) 0.74 MS Self Efficacy-Function 870 (600, 900) 860 (690, 900) 0.29 MS Exercise Self Efficacy 53 (29, 87) 66 (37,91) 0.11 Fatigue Impact Scale 35 (6, 109) 23 (2, 105) 0.50 Beck Depression Inventory 8 (0, 12) 2 (0, 20) 0.42 N = 7 Wilcoxon Signed Rank Md (range) Ng et. al. unpublished Outlier Removed N = 6 Pre-Dance Post-Dance p PROMIS Global Health 40 (29, 45) 42(34,48) 0.03 MS Self Efficacy-Control 770 (430, 900) 765 (620, 900) 0.46 MS Self Efficacy-Function 865 (600, 900) 865 (690,900) 0.18 MS Exercise Self Efficacy 65 (29, 87) 73 (37,91) 0.21 Fatigue Impact Scale 35 (6, 109) 21 (2,105) 0.07 Beck Depression Inventory 7 (0, 12) 1 (0,5) 0.07 Wilcoxon Signed Rank Md (range) Ng et. al. unpublished
11 No Change in Control Group Pre-Dance Post-Dance p PROMIS Global Health 41 (36, 50) 39(35, 50) 0.41 MS Self Efficacy-Control 765 (510, 850) 745 (470, 890) 0.89 MS Self Efficacy-Function 855 (640, 900) 830 (690, 900) 0.34 MS Exercise Self Efficacy 67 (55, 98) 66 (49,95) 0.75 Fatigue Impact Scale 19 (0, 90) 26 (0, 91) 0.23 Beck Depression Inventory 4 (0, 8) 4 (0, 19) 0.18 N = 6 Control Ng et. al. unpublished
12 Complete Data Set Physical/Cognitive Function Pre-Dance Post-Dance P Berg Balance 55 (40, 56) 56 (45, 56) 0.10 Dynamic Gait Index 22 (13, 23) 22 (18, 24) 0.11 Timed Up and Go (s) 10.2 (8.6, 15.3) 9.8 (7.3, 13.0) Hole Peg (s) 21.3 (17.8, 30.5) 20.2 (18.6, 29.2) ft walk (s) 4.8 (4.1, 7.5) 5.1 (4.3,7.3) 0.87 PASAT 49 (31,55) 54 (45,60) 0.06 HR variability (ms) 42 (20,54) 42 (21, 57) 0.24 N = 7 Wilcoxon Signed Rank Md (range) Ng et. al. unpublished Outlier Removed - Physical/Cognitive Function Pre-Dance Post-Dance p Berg Balance 55 (40, 56) 56 (45,56) 0.07 Dynamic Gait Index 20 (13, 23) 22 (18,24) 0.11 Timed Up and Go (s) 10.3 (8.9, 15.3) 10.1 (7.3, 13.0) Hole Peg (s) 21.6 (17.8, 30.5) 20.8 (18.6, 29.0) ft walk (s) 4.9 (4.0, 7.5) 4.9 (4.3,7.3) 0.53 PASAT 49 (31, 55) 55 (45,60) 0.03 HR variability (ms) 38 (20, 45) 45 (21, 57) 0.03 N = 6 Wilcoxon Signed Rank Md (range) Ng et. al. unpublished
13 No Change in Control Group Pre-Dance Post-Dance p Berg Balance 55 (26, 56) 56 (27, 56) 0.32 Dynamic Gait Index 21 (0, 24) 23 (22, 24) 0.18 Timed Up and Go (s) 9.3 (8.0, 15.2) 9.4 (7.1, 15.1) Hole Peg (s) 21.8 (17.8, 30.5) 16.5 (18.6, 36.0) ft walk (s) 4.4 (3.2, 8.1) 4.5 (3.9, 7.4) 0.89 PASAT 57 (10,59) 49 (5,59) 0.47 HR variability (ms) 35 (24,66) 39 (38, 67) 0.69 N = 6 Ng et. al. unpublished Conclusions Safe and fun form of physical activity/exercise Promising psychological/emotional efficacy Some may improve Promising physical efficacy Some may improve Nobody became worse I don t know how I would have gotten through this time in my life without this program
14 Partnerships: Danceworks and NMSS-WI 8 of 10 weeks Hourly sessions 2x/week Different locations Similar design Purpose: Increase community involvement Increase statistical power Endurance Balance/Stability Mediators HR var Cortisol Focus Groups (qualitative) Courtesy of Danceworks. Photograph by Stephanie Sanchez. Representative Dance Menu Push Pull Waltz Foxtrot Rumba Swing (including triple time) Salsa Tango (American or ballroom) Merengue Wings Nocturne (Celtic Woman) Cheek to cheek Need you now Hit the Road Jack, Club Savoy, Rockin Louie Guantanamera Hernando s Hideaway, Grand Guignol Suavamente
15 Additional Pre- Post-Measurements 6 minute walk test (6MWT) Force Platform Measurements Postural stability Cortisol Awakening Response Stress reactivity Select Preliminary Results-Dance Pre Post p Berg Balance (score) 54 (35-56) 54 (39-56) 0.41 Dynamic Gain Index (score) 20 (1-24) 23 (9-24) min walk test (m) 456 (124) 492 (126) Timed Up and Go (s) 10.4 (3.8) 8.9 (4.4) ft walk test (s) 6.1 (2.5) 5.8 (2.6) Hole Peg (s) 23 (2) 21 (2) 0.04 PASAT 43 (13) 48 (11) 0.05 HR variability (ms) (.018) (.003) Wilcoxon Signed Rank are Median (Range) Paired T Tests are Mean (SD) To date N = 12 Ng et. al. unpublished
16 Select Preliminary Results-Control Pre Post p Berg Balance (score) 51 (42-56) 50 (50-56) 0.71 Dynamic Gain Index (score) 19 (2-23) 19 (2-24) min walk test (m) 471 (99) 489 (97) 0.16 Timed Up and Go (s) 7.9 (1.8) 7.6 (2.1) ft walk test (s) 4.9 (0.8) 4.8 (0.7) Hole Peg (s) 23 (6) 21 (4) 0.22 PASAT 42 (10) 42 (21) 0.93 Wilcoxon Signed Rank are Median (Range) Paired T Tests are Mean (SD) To date N = 7 Ng et. al. unpublished Summary and Limitations Initial pilot results seem to be largely confirmed. Baseline effects or bimodal disability distributions can affect interpretation. Power remains an issue. Only low to moderate exercise intensities investigated.
17 Conclusions Partnered social dance (aka ballroom) can be a fun physical activity that contributes to a active wellness promoting lifestyle for persons with MS. In addition it may secondarily provide therapeutic symptom relief to those with MS. Acknowledgements Marquette University Pamela Landin, MS Jimin Suh Tyler Gregory Sheri Bunyan, PT Shannon Gambon Lauren Kalita Stephanie Raab, BS Cleveland Clinic Deborah Miller, PhD, LSW Danceworks Rachel Payden NMSS Wisconsin Kristen Ruhl MS OptiMStics Funded by grants from the Marquette University Graduate School and the Greater Milwaukee Foundation
18 Acknowledgements Marquette University Pamela Landin, MS Jimin Suh Tyler Gregory Sheri Bunyan, PT Shannon Gambon Lauren Kalita Stephanie Raab, BS Cleveland Clinic Deborah Miller, PhD, LSW Danceworks Rachel Payden NMSS Wisconsin Kristen Ruhl MS OptiMStics Funded by grants from the Marquette University Graduate School and the Greater Milwaukee Foundation
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