The Power of Ballet to Improve and Maintain Physical and Cognitive Health.
Memory defines who we are. Without our memories we have no past, cannot plan for the future and have no context for appreciating the present (Small & Vorgan, 2011).
Exercise has many known benefits including reducing the risk of cardio-vascular disease and diabetes, strengthening the bones and reducing stress. It also appears that regular physical activity benefits the brain (Graff-Radford, J), with research findings from an Edinburgh University showing that physical exercise, diet, and mental stimulation reduced the rate of getting dementia by 46% (Jackson, Pialoux et al, 2016).
Age is the single greatest risk factor for developing memory loss. Fortunately, the same lifestyle choices that protect the body also protect the mind. Studies have shown that genetics, our hereditary pre-disposition for Alzheimer’s Disease (APOE4) accounts for only part of our risk; lifestyle choices have an even greater impact, therefore we have greater control than we may have thought (Small & Vorgan, 2011). These lifestyle choices include getting enough physical exercise, mental stimulation, and social interaction, sufficient sleep, a nutrient rich diet and reduced stress. An effective Alzheimer’s Prevention strategy means adopting all of these lifestyle choices to improve memory and mental agility (Kuzma, E. 2019).
Good balance and stability becomes increasingly important for maintaining body and brain health as we age and helps prevent injuries from falls. Older research volunteers who incorporated balance training into their exercise programme show significant improvements in memory and other cognitive abilities (Small & Vorgan, 2011).
A randomized controlled trial of ‘Exercise plus Behavioural Management in Patients with Alzheimer’s Disease’ showed the link with Alzheimer’s Disease and physical deterioration (Terri, Gibbons, McCurry et al, 2003). When compared with age matched controls, Alzheimer’s patients showed more signs of undernutrition, higher risk of falls and fractures and more rapid decline on measures of mobility. Reduced muscle mass has also been associated with loss of independence. Consequently, improved physical conditioning for patients with Alzheimer’s disease may extend their independent mobility and enhance their quality of life despite the progression of the disease (Dvorak & Poehlman, 1998).
Exercises that improve balance stimulate neural circuits and these neural networks inform us how to react and how much tension is needed in each muscle to stay upright. Dancing therefore is an excellent activity to improve balance and stability in older adults.
Dancing combines emotional and sensory stimulation, social interaction and motor co-ordination, what scientists refer to as “an enriched environmental condition. Brain scans of experienced dancers show strengthened neural circuits in regions involved in motor control, as well as greater plasticity in their brains compared with the brains of novice dancers. Ruhr-University scientists in Germany found that people aged 65 plus years who had an average of nearly 17 years of amateur dancing under their belts had significantly better cognitive, motor and perceptual abilities than a non-dancing control group (Small & Vorgan, 2011). According to a major study by the New England Journal of Medicine, stimulating one’s mind and body by dancing can ward off Alzheimer’s Disease and other dementias as it increases serotonin levels and reduces stress (Serlin, I. 2013).
By developing communication, expression, coordination, balance, creativity and social interaction, dancing engages the brain and improves quality of life. This can help with common symptoms associated with dementia. Ballet is a wonderful way to immerse one’s self in a beautiful atmosphere, surrounded by beautiful music, moves, tradition and people. Ballet prides itself on artistry and refinement, helping to instill grace and poise in even the absolute beginner. The Time to Dance programme, run by the Scottish Ballet and funded by the Life Change Trust, was established to run dementia friendly dance activities for people living with dementia, and their carers across Scotland (www.scottishballet.co.uk, 2017).
Ballet uses non-verbal communication and both sides of the body and brain. The movements are graceful, dignified and beautiful while reducing tension in the hands and wrists. According to Dr. Michael Mosley, (2019), when we experience pscho social stimuli that is meaningful, new neural pathways develop. When we learn something new, a new ability, our brain changes and develops regardless of age.
A ballet dancer has to memorise steps and arm movements, change alignment, count to music, balance and stay upright. As aforementioned, the act of staying upright in itself requires cognitive fortitude. When we engage in movements that cross the midline, or centre of our body, we actually allow one hemisphere of the brain to talk to the other; this essentially creates new neural connections that enhance our neuroplasticity; our brains ability to change. Crossing our arms, legs and even fingers, allows our brains to light up with new activity.
A drive to prove the health benefits of dance for patients at Cambridge University Hospitals has resulted in the ‘Dance for Health Programme’ run by Addenbrooke’s Arts and funded by the Dunhill Medical Trust, which was evaluated by Anglia Ruskin University. Led by a professional dancer with the assistance of nursing staff and health care assistants, the hour-long workshops on wards gave patients the chance to enjoy dance and move within the limits of their abilities. Dr. Stephen Wallis, consultant physician at the Department of Medicine for the Elderly, at Cambridge University Hospitals, found that the project brought enjoyment and a smile for both the patients and staff, while promoting recovery and return to active health (Wallis, S, 2017).
It is well understood that depression can worsen memory loss, and accelerate cognitive decline. Exercise not only increases blood flow and releases endorphins which are the body’s own natural anti-depressant, it also releases the brain messenger serotonin which elevates mood. Additionally, when sedentary people start a fitness programme, their brain grows larger in key memory regions such as the frontal lobe and hippocampus (Small & Vorgan, 2011).
Music and dance not only activate the sensory and motor circuits of our brain, but also the pleasure centres. When we dance our brain releases endorphins, neurotransmitters that create a feeling of comfort, relaxation, fun and power (Leste, A & Rust, J. 1984).
Determining the effectiveness of non-pharmacological therapies including dance, can be difficult because of the large number of unique therapies tested. There are various therapeutic aims such as improved overall quality of life and improvement relative to specific symptoms. There are diverse types of dementia that may be present among participants in a particular study and no standard method for carrying out any individual therapy. With these multiple factors to consider, it is challenging to group together and compare non-pharmacological therapies.
Nevertheless, researchers have pooled data from multiple studies of non-pharmacological therapies to provide insight into their potential effectiveness.
A meta-analysis found that aerobic exercise and a combination of aerobic and non-aerobic exercise had positive effects on cognitive function in people living with Alzheimer’s disease. The review found that exercise has a positive effect on overall cognitive function and may slow the rate of cognitive decline in people with Alzheimer’s disease. It found that cognitive stimulation had beneficial effects on cognitive function and some aspects of well-being. Another Alzheimer’s Association review reported that cognitive stimulation, music-based therapies and psychological treatment improved depression, anxiety and quality of life in people with dementia (Alzheimer’s Association, 2020).
A study conducted by Dr. Deborah E. Barnes (2013), known as ‘Preventing Loss of Independence through Exercise’ (PLIE), noted that a key component of PLIE focused on promoting procedural memory through repetition of the same sequence of simple functional movements and increasing the complexity of these movements over time. While memory for events in people with dementia is very impaired, procedural memory is actually maintained pretty well. Even through patients didn’t necessarily remember being in the class they did remember the sequence of the movements and were therefore building procedural memory.
From these studies it can be deduced that a suitable exercise programme for seniors should include the following considerations:
- Strength training to maintain muscle and bone mass
- Balance or proprioceptive training to prevent falls
- Aerobic or endurance exercises to maintain a healthy cardiovascular system
- A comprehensive stretching programme to maintain joint and muscle flexibility
Such a programme should also allow for some of the difficulties experienced by the elderly including:
- Increased fibrous connective tissue in the joints resulting in stiffness and reduced elasticity and strength of soft tissue material
- decreased capacity for healing
- less capillary blood supply and muscle atrophy.
Dance Therapists believe that “the spark of life started with movement, and dance therapists use those sparks to ignite feelings in those whose lives have dimmed” (Koch, N). They believe people with dementia tune in to other people’s feelings. Fortunately, ballet is renowned for its non-verbal communication. The way we stand, we move, we use space – the way we move displays our attitude. People with dementia often lack motivation so they need others to help connect them to their intrinsic motivation. This is also why we encourage carers to participate in classes too.
Author Dr. John Zeisel says that it is possible to have a decent life with Alzheimer’s disease, a great many people in the first ten years of the condition live their lives to the fullest – renewing and deepening relationships with those they love and who love them (Zeisel, J. 2011).
A sprinkling of Ballet Companies around the world now offer various dance programmes for those with neurodegenerative diseases such as Parkinsons and dementia and foster the active participation of the caregivers too. I believe there is greater scope for Ballet companies all over the world to create and include such programmes which could extend to the provision of workshops to train caregivers and staff at aged care facilities. Ballet as part of an Alzheimer’s Prevention strategy is invaluable for Senior Citizens everywhere. Ballet satisfies both the criteria of a suitable exercise programme for the aged population while being considerate of the physical limitations.
Falls prevention is imperative for the elderly population. Anything that keeps people physically active and prevents them from having falls is ideal.
It is important to note that reducing ‘risk’ of cognitive decline and dementia is not synonymous with ‘preventing’ cognitive decline and dementia. Individuals who take measures to reduce risk may still develop dementia, but may be less likely to develop it later in life than if they had not taken steps to reduce their risk (Alzheimer’s Association, 2020).
Lifestyle choices have tremendous impact on preventing Alzheimer’s Disease. If we can stave off the onset of dementia long enough for people to never experience symptoms in their lifetime, this according to some, could be considered a cure.
Combining physical and mental activities can increase the cognitive reserve, reduce the rate of brain atrophy, stimulate neuroplasticity and neurogenesis and increase brain perfusion as well as combating many of the risk factors associated with developing Alzheimer’s disease. Early prevention is key, given that clinical presentation of symptoms occurs 10-20 years after the biological changes start. Dance challenges the stereotypes of ageing and disease. It also provides a good mix of cognitive and physical stimulation. Above all, it is refreshing for patients and caregivers to experience a treatment that is not a drug regime (Leste & Rust, 1984).
References:
Alzheimer’s Association 2020, Chicago, www.alz.org
Barnes, Deborah E., 2013. ‘PLIE’, American Academy of Neurology (AAN) 65th Annual Meeting. Abstract S24.007. Presented March 20, 2013.
Cambridge Network Ltd., 31.10.17, ‘Dance Research is Step to Well Being’.
Dvorak RV, Poehlman E.T. Appendicular skeletal muscle mass, physical activity and cognitive status in patients with Alzheimer’s disease. Neurology, 1998, 51:1386-1390. http://www.ncbi.nlm.nlh.gov/htbin-post/Entrez/query?
Graff-Radford, Jonathan, M.D. Mayo Clinic.
http://www.alzfdn.org/EducationandCare/musictherapy.html
http://www.caring.com/articles/music-therapy-stroke-diagnosis
Jackson, P., Pialoux, V., Corbett, D. et al, 2016. ‘Promoting Brain Health through Exercise and Diet in Older Adults: A Physiological Perspective, The Journal of Physiology 594, 16, 4485-4498.
Koch, Nana. The American Dance Therapy Association.
Kuzma, E, 2019, Journal of the American Medical Association, July 14.
Leste, A. & Rust, J. (1984) ‘Effects of Dance on Anxiety’, Percept Mot Skills; 58(3): 767-772.
McNamara, Damian 2019, ‘Best Diets for Preserving Brain Health Identified’, Neurology, March 6
Mosley, Michael. 2013, ‘Wonders of the Human Body’, ‘Dr. Michael Mosley’s Programme’, Newcastle University.
Neurology, 1998., 51:1386-1390. http://www.ncbi.nlm.nlh.gov/htbin-post/Entrez/query?
Scottish Ballet, 2017, Time to Dance, Dementia Programme, www.scottishballet.co.uk
Small, Gary, MD & Vorgan Gigi, 2011, ‘Keep Your Brain Healthy for the Rest of Your Life’, The Alzheimer’s Prevention Programme.
Serlin, I. 2013, ‘Dancing Away Dementia’, Psychology Today.
Terri, L., Gibbons, L., McCurry, S., et al JAMA. 2003; 290(15): 2015-2022; doi: 10.1001 / jama.290.15-2015.
Zeisel, John. 2011 ‘I’m Still Here’, Creating a Better Life for Someone with Alzheiimer’s.