Aging Clinical and Experimental Research

https://doi.org/10.1007/s40520-019-01440-y

REVIEW

Dance intervention effects on physical function in healthy older

adults: a systematic review and meta‑analysis
Xuegang Liu1,2 · Pei‑Lin Shen1 · Yung‑Shen Tsai3 

Received: 24 September 2019 / Accepted: 6 December 2019

© Springer Nature Switzerland AG 2020

Abstract
Background and objective  Dancing is a form of physical exercise associated with health benefits in older adults. Regular
dancing can prolong healthy aging, maintain or even improve physical function, and thus enhance their quality of life. The
aim of this review was to evaluate the effects of dance intervention on physical function performance in healthy older adults
in randomized-controlled trials (RCTs).
Methods  Five electronic databases (Cochrane Library, PsycINFO, PubMed, Scopus, and Web of Science) were searched
systematically until the end of June 2018 by two independent reviewers. These searches were limited to the English language
and persons with average age older than 65. The tool from the Cochrane Collaboration was used to assess the risk of bias.
A standard meta-analysis was performed using Review Manager Software version 5.3.
Results  Thirteen RCTs from a total of 1029 older participants were included in this meta-analysis. The results showed that
dance intervention significantly improved mobility function and endurance performance when compared with control groups
for healthy older adults. However, gait was not significantly improved through dancing. Studies included in this review were
not enough to perform meta-analysis for the effectiveness of dance on balance and general health in healthy older adults.
Conclusion  Overall, dance intervention was effective to improve physical function performance in healthy older adults. The
results from this meta-analysis strengthen the evidence from previous individual studies. Properly organized dance interven-
tion would be a safe and effective exercise to incorporate into daily life.

Keywords  Systematic review · Meta-analysis · Dance intervention · Physical function · Healthy older adults

Introduction health services for the elderly must also receive increasing
attention worldwide. Physical exercise has long been proven
The rapid growth of the world economy, low birth rate and effective in improving the physical function of older adults
extended live expectancy, has made aging an emerging issue. [2]. The forms of physical exercise that is designed for older
The population of people aged above 65 reached 962 mil- adults are numerous, including aerobic exercise, dancing,
lion in 2018. This was 12.8% of the world population. It is jogging, Tai Chi, walking, and yoga [3–7]. Research has
estimated that the number of people over 65 will escalate to shown that physical exercise is effective in reducing the risks
1.5 billion by 2050, which will be 16% of the world popula- for diseases and improving body functions such as balance,
tion [1]. As the societal population ages, the development of agility, endurance, and gait speed [8–11]. Physical exercise
intervention has relieved symptoms in diseases prone to
elders such as Parkinson’s [5, 12], diabetes [13], hyperten-
* Yung‑Shen Tsai
[email protected] sion [14, 15], and dementia [16]. Physical exercise is an
effective way to improve the quality of life for older adults
1
Department of Sports Sciences, University of Taipei, [2, 3, 9, 17].
Taipei 111, Taiwan Dancing is deemed a popular and effective physical exercise
2
College of Music, Zhejiang Normal University, that has an excellent effect on physical function (e.g., muscular
Jinhua 321004, China strength, endurance, and balance) [18, 19], and reduces the
3
Graduate Institute of Sports Equipment Technology, risk of falling [20]. The effect of dance is not only to improve
University of Taipei, No.101, Sec. 2, Zhongcheng Rd., Shilin physical and cognitive function, but also as an engaging social
Dist., Taipei City 111, Taiwan

13
Vol.:(0123456789)
 Aging Clinical and Experimental Research

activity which is very important for relieving aging as well as Data search strategy
a promising alternative to traditional exercise programs [3].
Current systematic research has proven that dance interven- Five electronic databases (Cochrane Library, PsycINFO,
tion is effective in improving the symptoms of diseases such PubMed, Scopus, and Web of Science) were systematically
as cardiovascular disease [21], dementia [16], and Parkinson searched until the end of June 2018. The searches were lim-
disease [22]. ited to the English language and people with average age
Dancing is a multi-faceted performance art that combines 65 or older. The search was based on the following terms:
diverse stimuli such as visual, audio, and sensual. Through [Danc* or Dance or Dancing or Ballroom or Ballet or Bolero
dance, one can experience the music flow and movement, acti- or Foxtrot or Jazz or Hip-pop or Latin or Polka or Rumba or
vate one’s memory, and express his or her emotions. Research Samba or Salsa or Tango or Tap or Waltz] and [Older adults
has shown the effectiveness of dance intervention on delaying or Elderly] and [Random*or Randomized or Controlled trial
aging and maintaining mental health in older adults. The wide or clinical trials]. A manual search was also conducted with
variety of dance styles makes it a very original and popular reference lists of key articles published in English.
form of activity in many cultures such as ballet, ballroom, folk,
traditional, and jazz [18, 23]. Each type of dance has its dis-
tinct characteristics and requirements in techniques and move- Study selection
ment styles. For example, the tango focuses on partnership
and the changes in position between the two dancers [24]. The Two authors (X.G.L. and P.L.S.) independently searched the
tango is effective in promoting elders’ motor cognition, stride, literature. Studies were included if they were a full origi-
and shifts in center of gravity [25, 26]. On the other hand, bal- nal study comparing dance interventions to other exercise
let is a graceful, lite, and slow movement dance. It focuses on interventions or no intervention. The inclusion criteria were:
the training of agility and coordination in the whole body [27]. randomized-controlled trial, at least 6 weeks dance interven-
Massive research has demonstrated that dance intervention is tions, participants aged 65 years or older adults without any
effective in relieving the decline in physical function, cognitive known cognitive impairment or disabling disease, and pub-
function, and quality of life linked with aging [3, 18, 28, 29]. lished English language. Any uncertain study design or data
Physical function including balance, endurance performance, were excluded. Studies were excluded if they were system-
flexibility, muscular strength and mobility, and the declining atic reviews, case or pilot studies, dance therapy, movement
in these abilities is regarded as the sign of aging. Evidence has therapy, or creative dance movement, and dance intervention
shown that the effectiveness of dance for physical functioning was combined with other exercise.
reduces the risk of falling and general improves health in older
adults [30, 31]. However, recent reviews lack randomized-con-
trolled trials (RCTs) evaluating physical function related to Data extraction
dance interventions in healthy older adults by meta-analysis.
Previous systematic reviews have looked at the effects of dance The following information from the included studies was
on cognitive function [29], functional and metabolic perspec- extracted: Study ID (authors), study population (number of
tives [23], patients with cardiovascular disease [21], demen- participants, gender, mean age), dance intervention and con-
tia [16], Parkinson disease [32], and falling prevention in the trol groups (type, duration, frequency, length), and outcome
elderly [33]. However, there has not been a comprehensive measures. The measurements were as follows: balance, flexi-
evaluation of dance intervention on physical function (e.g., bility (sit-and-reach), gait speed, short form 36 questionnaire
endurance, balance, mobility, and gait) in healthy older adults. (SF-36), sit-to-stand (STS), 6-min walking test (6MWT),
The aim of this meta-analysis is to conduct a systematic and timed up-and-go (TUG). All outcomes were assessed
analysis of random controlled research on the effectiveness between the baseline and end of intervention.
of dance intervention in the physical function of healthy older
adults. This work provides reliable, suitable suggestions and
guidelines for the health management of healthy older adults. Quality assessment

Risk of bias was evaluated independently by two review-

Methods ers using seven criteria (rating: low risk, unclear, and high
risk) recommended by the Cochrane Collaboration’s tool
This review study followed the Preferred Reporting Items for [35]. The quality assessment criteria included: random
Systematic Reviews and Meta-Analysis (PRISMA) guideline sequence generation, allocation concealment (selection
[34]. This review was registered in the PROSPERO with bias), blinding of participants and personnel (performance
CRD number 42018097106. bias), blinding of outcome assessment (detection bias),

13
Aging Clinical and Experimental Research

incomplete outcome data (attrition bias), selective report- Results

ing (reporting bias), and other bias. When disagreements
arise, they were resolved by discussing or by consulting a Literature search and study characteristics
third author (Y.S.T.).
A total of 671 records were identified through databases
and other sources searching. After duplicates removed,
Data synthesis and analysis 443 records were included during title and abstract screen-
ing. One hundred and one full-text articles were assessed
The main analysis was a comparison of dance intervention for eligibility. After careful screening, 21 records were
groups versus control groups. The outcome measure of this included in the systematic review, and 8 articles reported
meta-analysis was presented as means, standard deviations on different outcome variables were later excluded. Thir-
(SD). The mean differences (MD) with 95% confidence teen records were included in qualitative synthesis (meta-
interval (CI) were calculated in a random-effects inverse analysis). The process diagram of search and identification
variance model for the same outcome measure [32]. Het- is shown in Fig. 1.
erogeneity between groups was assessed using the I2 sta- The characteristics of the 13 included studies are sum-
tistic. Level of significance was set at P < 0.05. Review marized in Table 1. The total sample size of all included
Manager Software, version 5.3 was used for data analysis studies was 1029 participants (126 males, 875 females,
in this study.

Fig. 1  PRISMA diagram for

study selection and identifica- Records identified through Additional records identified
Identification

tion database searching through other sources

(n=656) (n=15)

Records after duplicates removed

˄n=443˅

342 records excluded by abstract:

Records screened Case studies (n=4)
Screening

(n=443) Conference abstract/full report

(n=20)
Intervention without dance (n=262)
Pilot studies (n=11)
Systematic reviews (n=45)

80 records excluded by full-text˖

Full-text articles
Dance + exercise (n=12)
Eligibility

assessed for eligibility

Dance therapy (n=39)
(n=101)
Not relevant outcomes (n=21)
Not original publication (n=1)
< 6 weeks duration (n=1)
Other (n=6)
Studies included in
qualitative synthesis 8 studies excluded˖
Different testing
Included

(n=21)
methods/outcomes (n=8)

Studies included in
qualitative synthesis
(Meta-analysis)
(n=13)

13
 Aging Clinical and Experimental Research

28 unknown) with the sample size range from 23 to 510 (MD: − 2.48, CI − 4.35 to − 0.62, P < 0.01; heterogeneity:
participants, including 543 in dance intervention groups I2 = 89%, ­Chi2 = 27.09, P < 0.001) (Fig. 2c).
and 486 in control groups. The mean participant age was
65 years or older. Dance intervention types included ball-
room [36–38], line [39, 40], folk/traditional [30, 41–43], Endurance performance
tango [26], ballet [44], jazz [40], and salsa [31]. Interven-
tion session duration from 40 to 120-min, frequency 1–3 Four studies used 6MWT to evaluate the endurance perfor-
times per week, and duration ranged from 6 to 12 months. mance of 310 participants [30, 36, 41, 45]. In the 6MWT,
The control groups were required to keep regular daily the distance was significantly increased in dance groups
activities. (MD: 59.71, CI 39.81 to 79.62, P < 0.001; heterogeneity:
In these 13 included studies, functional performance was I2 = 30%, ­Chi2 = 4.27, P = 0.23) (Fig. 3). From these studies,
examined in all the studies, balance ability was measured dance intervention groups had more effectiveness in improv-
in 4 of them [30, 31, 39, 43], and 2 studies used SF-36 [30, ing endurance than control groups.
45]. In addition, the Berg Balance Scale (BBS) [30, 39],
center of pressure (CoP) shifts [31, 43], flexibility [37, 38,
Gait
41, 45], 6MWT [30, 36, 41, 45], STS [26, 30, 37, 38, 41,
42], TUG [36, 37, 44, 45], and gait speed [26, 31, 39, 40,
Gait speed was reported in five studies [26, 31, 39, 40, 42];
42] were also covered in the functional outcomes. We per-
therefore, MD was used for data analysis. Although the out-
formed meta-analysis for the outcome measures included in
comes were favorable to dance, they did not show significant
at least four studies. If an outcome measure was included in
differences in gait speed change between dance groups and
less than four studies, we only report their findings without
control groups (MD: 0.07, CI − 0.02 to 0.17, P = 0.14; het-
conducting further analysis.
erogeneity: I2 = 67%, ­Chi2 = 12.00, P = 0.02) (Fig. 4).

Physical function outcomes

General health
Balance function
Two studies used SF-36 to investigate the effects of dance
Data were reported in association with balance function intervention on general health, pain, and role of emotion [30,
in 4 studies [30, 31, 39, 43]. There was no significant dif- 45]. They both reported that general health was significantly
ference about the CoP shifts through one-leg stance in the improved after exercise. However, there were no significant
anterior–posterior and mediolateral direction in two studies differences in role of emotion between the intervention and
[31, 43]. BBS outcome measures, on the other hand, were control groups after exercise. The findings on the effects of
reported to be improved in the dance intervention groups pain relieve were inconsistent between these two studies.
compared to the control groups in the other two studies [30,
39]. Limited numbers of studies using CoP shifts and BBS
Risk of bias with included studies
as outcome measures resulted in difficulty of performing
meta-analysis for balance function.
Included studies did not always provide enough information
to determine the risk of bias. Their methodological qualities
Mobility function are shown in Fig. 5. There was an unclear risk of bias for
random sequence generation and allocation concealment. It
Four studies provided data on flexibility in dance versus con- is difficult to both blind participants and instructors; there-
trol analysis with 239 participants [37, 38, 41, 45]. There fore, all included studies show a high risk for blinding of
was significant difference between the dance and control participants and personnel (performance bias). Among the
groups (MD: 4.09, CI 1.18 to 7.00, P < 0.01; heterogene- 13 studies, one study presented high risk in the blinding
ity: I2 = 66%, ­Chi2 = 8.93, P = 0.03) (Fig.  2a). Six stud- of outcome assessment [39], two studies presented unclear
ies [26, 30, 37, 38, 41, 42] contributed 626 participants, risk in the blinding of outcome assessment [31, 43], and the
there was an improvement in STS scores in favor of dance majority of the studies had a low risk for detection bias. Only
(MD: − 2.90, CI − 5.23 to − 0.58, P = 0.01; heterogene- one study had a high risk for incomplete outcome data [37],
ity: I2 = 89%, ­Chi2 = 45.20, P < 0.001) (Fig. 2b). TUG was some participants did not complete the posttest in this study,
reported in four studies [36, 37, 44, 45] with showing better and 12 studies had a low risk of “attrition bias”. Selective
results. The results indicated significant improvements in reporting had an unclear risk of bias. All 13 studies had low
the dance group, which showed a reduction in TUG time risk of “other bias”.

13
 Table 1  Characteristics of included studies
Author Participants (female) Mean age ± SD Intervention Control descrip- Intervention Inter- Intervention length Outcomes assessed
description tion session dura- vention
Intervention Control Intervention Control tion frequency

Bennett and Hack- 12 (10) 11 (10) ≧ 65 ≧ 65 Line dance Daily activities 1 h 2×/week 8 weeks BBS, gait speed
Aging Clinical and Experimental Research

ney [39]
Cepeda et al. [36] 19 (19) 15 (15) 69.1 ± 6.5 71.5 ± 7.4 Ballroom dance Daily activities 1 h 3×/week 8 weeks 6MWT, TUG​
Eyigor et al. [30] 19 (19) 18 (18) 73.5 ± 7.6 71.2 ± 5.5 Turkish folklore Daily activities 1 h 3×/week 8 weeks BBS, 6MWT, STS,
dance SF-36
Granacher et al. 14 (Unknown) 14 (Unknown) 71.6 ± 5.3 68.9 ± 4.7 Salsa dance Daily activities 1 h 2×/week 8 weeks CoP shifts, gait
[31] speed
Hamacher et al. 19 (11) 16 (10) 67.2 ± 3.4 68.5 ± 3.1 Line dance, Jazz Daily activities 90 min 2×/week 6 months Gait speed
[40] dance, Square
dance
Holmerova et al. 27 (25) 25 (21) 81.0 ± 9.6 82.8 ± 7.5 Ballroom dance Daily activities 75 min 1×/week 3 months Flexibility test, STS,
[37] TUG​
Hui et al. [45] 52 (50) 45 (44) 68.0 ± 4.5 69.1 ± 4.2 The choreographed Daily activities 50 min 2×/week 3 months 6MWT, flexibility
dance test, TUG, SF-36
Janyacharoen et al. 20 (20) 18 (18) 64.9 ± 4.0 66.8 ± 6.0 Thai dance Daily activities 40 min 3×/week 6 weeks 6MWT, flexibility
[41] test, STS
Machacova et al. 27 (25) 25 (21) 81.0 ± 9.6 82.8 ± 7.5 Ballroom dance Daily activities 1 h 1×/week 3 months Flexibility test, STS
[38]
McKinley et al. 14 (11) 11 (8) 78.1 ± 7.6 74.6 ± 8.4 Argentine tango Daily activities 2 h 2×/week 10 weeks Balance, gait speed,
[26] dance STS
Merom et al. [42] 279 (231) 251 (217) ≧ 65 ≧ 65 Folk dance Daily activities 1 h 2×/week 12 months Gait speed, postural
away, STS
Serrano-Guzman 27 (27) 25 (25) 69.1 ± 4.4 69.5 ± 3.2 Flamenco dance, Daily activities 50 min 3×/week 8 weeks TUG​
et al. [44] Sevillanas, Ballet
steps.
Sofianidis et al. 14 (13) 12 (7) 69.2 ± 4.4 72.6 ± 5.2 Greek traditional Daily activities 1 h 2×/week 10 weeks CoP shifts, dynamic
[43] dance balance

BBS Berg balance scale, CoP center of pressure, SF-36 short form 36 questionnaire, STS sit-to-stand, 6MWT 6-min walking test, TUG​timed up-and-go

13
 Aging Clinical and Experimental Research

Fig. 2  Mean difference in dance intervention effect versus no intervention on mobility function (Flexibility, STS, and TUG)

Fig. 3  Mean difference in dance intervention effect versus no intervention on endurance performance (6MWT)

Discussion better results than the control groups. Dance can signifi-
cantly improve mobility (measured by flexibility, STS, and
From this meta-analysis, we found that a large number TUG) and endurance performance (measured by 6MWT)
of outcomes from the dance intervention groups showed for healthy older adults. The gait and other results did not

13
Aging Clinical and Experimental Research

Fig. 4  Mean difference in dance intervention effect versus no intervention on gait (gait speed)

Fig. 5  Risk of bias graph:

review authors’ judgements
about each risk of bias item
presented as percentages across
all included studies

show significant improvement for the dance intervention Mobility function

groups compared with the control groups.
STS, TUG, and flexibility are important tools for test-
ing mobility function. Mobility function is significantly
Balance function improved after dance intervention according to STS, TUG,
and flexibility measurements. Previous research indicated
Previous studies reported that dance benefited physical that after 8  weeks of dance intervention positively the
function and reduced the risk of falls for healthy older physical function of older adults. The time to complete the
adults [9, 18, 25, 46, 47]. We were unable to perform TUG test had improved from 10.1 to 7.7 s. It was a sig-
meta-analysis for the effects of dance on balance. Only nificant improvement [20]. Following two times a week and
two studies indicated that BBS scores were improved after 10 weeks dance intervention, the performance of STS sig-
dance intervention [30, 39]. BBS is a 14-item objective nificantly improved from 17.12 ± 7.05 to 12.36 ± 4.46 s [26].
measure designed to assess static balance and the risk for Comparing to a study using resistance training, healthy older
fall in older adult populations. The overall balance func- adults were improved in TUG and STS after 6 months of
tion of older adults on the BBS score had a significant training, but there was no significant improvement in long-
improvement in the over 8-week dance intervention group term care older adults [17]. Flexibility is the range of motion
which could delay the decline of body balance and reduce in a joint or in a group of joints. The current study indicates
the risk for falls. However, the results from two other stud- that flexibility can improve the range of motion and increase
ies showed that there was no significant difference between the muscle length [2]. Dancing is a multi-faceted exercise
the dance intervention groups and the control groups in that produces various stimuli such as coordinating the limbs
CoP shift [31, 43]. Single leg standing balance was tested better through movement following the music. The ability
in these two studies. Whether this test is too difficult for to maintain good mobility function ensures body position
older adults to perform that led to similar findings for the stability, which is clinically important, because it reduces
groups with and without dance intervention require further the high fall risk in healthy older adults to either no risk or
study to confirm. lowered fall risk.

13
 Aging Clinical and Experimental Research

Endurance performance safe exercise that can improve gait freezing for healthy older
adults [39]. However, this meta-analysis review showed no
The results from six of the meta-analysis studies on 6MWT significant results associated with gait. The contradictive
showed that the dance intervention groups had significant results among these studies might be, because there were
endurance performance improvement over the control not enough studies included in this review, and also differ-
groups. The 6MWT can be used to measure the endur- ent types of dance intervention might have different effects
ance performance of older adults [7, 15]. Aerobic capac- on elderly’s gait performance. One study showed no sig-
ity declines 30–40% in elderly over aged 65 compared with nificant result with 422 participants. This study displayed a
young adults [48]. Dance implies leg movements, steps, and high weight, which may influence the outcome assessment
interaction which contributed to aerobic endurance perfor- of this meta-analysis. Focusing on the intervention of a sin-
mance. This meta-analysis showed 6MWT significantly gle dance is suggested for in-depth systematic research in the
improved 40 m in walking distance compared with baseline future. Two studies showed that gait performance in older
following 6 weeks dance training [30, 36, 41, 45]. Dance adults is linked to cognitive changes, which is as an impor-
exercise can improve endurance function, because it changes tant external feature of cognitive function [51, 52]. Future
cardiovascular fitness and increases maximal oxygen con- studies should include follow-up work designed to evaluate
sumption ­(VO2max). Two other studies confirmed that dance whether dance exercise in the long term can improve cogni-
intervention helped to increase muscular strength and lower tive function. Some evidence provided cognitive training
limb endurance in older adults, as well as their cardiovas- program that improved gait speed [53] and a composite gait
cular endurance [22]. Dancing involves contracting and task (timed up-and-go) [11] in older adults.
exercising the large leg muscles. Improvements in endur-
ance performance involve dynamic movements of the lower
limbs, such as 6MWT and the 2-min step test [49]. The lower General health
limb endurance may enhance cardiovascular endurance to
eliminate cardiovascular risk factors. It was suggested that SF-36 includes eight indicators: physical functioning, physi-
greater and significant improvement in ­VO2max should be cal role, pain, general health, vitality, social functioning, role
associated with longer training length, about 16–20 weeks of emotion, and mental health [54]. Common SF-36 indica-
(aged 65 years and older) [4]. Six studies were included in tors included in the two studies of this review were general
this meta-analysis with length less than 16 weeks. Future health, pain, and role of emotion [30, 45]. These two studies
dance intervention length should be longer than 16 weeks reported that dance could improve the general health and
which can promote V ­ O2max for healthy older adults. In sum- the quality of life for older adults. Dance intervention did
mary, endurance performance has been improved associated not effectively improve pain and emotional roles in SF-36.
with muscle force production capacity and inability to per- The pain and role of emotion improvement may need the
form daily living activities in older adults [2]. These results assistance of drugs and medical procedures [45]. These
showed a significant increase in endurance outcomes which results were in contrast to the reports of improved mood,
makes it easy to walk, go up and down stairs, and creating social contacts, and total satisfaction after dance intervention
smoother body movements during daily life for healthy older from previous studies [42, 44]. More studies are required for
adults. meta-analysis.
For study quality assessment using seven criteria recom-
Gait mended by the Cochrane Collaboration’s tool, there was a
low-to-moderate risk of bias in all 13 studies. However, a
Gait speed performance following dance intervention did few bias (performance and selection bias) showed a high
not produce significant results compared with the control risk of bias, all studies presented high risk in the perfor-
in this study. However, in other studies, using salsa dance mance bias due to that they did not use blinding, and eight
and dance video game training, significant improvement studies presented unclear risk in the selection bias [30, 31,
occurred in gait in the older adults [31, 50]. Out of five 36–39, 41, 43]. It was difficult to make a judgment for selec-
studies included in this meta-analysis, different types of tive reporting (reporting bias), as there were not enough
dance were involved [26, 31, 39, 40, 42]. We found that details in included studies, these results may influence the
line dancing can improve stride length, stride time, and gait outcome assessment of the intervention group when com-
speed [39, 40]. Line dancing is a simple aerobic dance that pared. In addition, most of included studies only contain
involves continuous integrated leg and trunk movements, small sample size calculations in their methodology [26, 30,
weight transfer, and postural control. Line dancing includes 31, 36, 39–41, 43]. The trials need to be adequately covered
walking in different directions, with abrupt turns and stops, to reduce the risk of random error and consequently false-
knee flexion, stepping, and stomping. Line dancing can be a positive results [55].

13
Aging Clinical and Experimental Research

Dance intervention was reported to enhance the personal widely among the various trials, as did the study methods
psychological function of healthy older adults [56]. Dance and outcomes. In addition, there were not enough evidences
has been proven to be a safe and feasible activity [39]. Dance to check some physical function outcomes due to limited
intervention is considered more effective than other types of number of studies that could be included for meta-analysis.
activity to improve health [57]. Furthermore, dance expe- Finally, the female elderly largely outnumbered the male
rience with specific activities such as rhythm tasks, body elderly in the studies included, which makes it impossible
coordination training, tracking visual, and auditory cues to explore the gender differences in physical function in the
can improve neurocognitive performance [58–60]. Dance present meta-analysis.
is, therefore, a better method to prevent dementia and Par-
kinson’s disease for older adults [32].
Among the 13 studies included in this review, the dance
types most adopted for intervention were ballroom dance Conclusion
[36–38], traditional dance [31, 41, 43], and folk dance [30,
42]. These three dance types significantly improved physi- Only randomized-controlled trials were included in this
cal function of healthy older adults. The common features meta-analysis to investigate the effectiveness of dance inter-
of these three dance types are: mild and soothing rhythm, ventions on physical function in healthy older adults. The
utilizing breathing, diverse variation in steps, and more in results from this meta-analysis reveal that dance can improve
line with the physical strength and intensity of the elderly. mobility and endurance for healthy older adults, but gait was
This provides a future reference for the dance prescription not significantly improved through dancing. Dance exercises
for healthy older adults. A large number of studies have are also attractive for its entertainment effect and high par-
shown that dance therapy has a significant effect on disease ticipation rate, so they may be more preferred and utilized as
prevention and physical function improvement in the elderly an optimal approach to relieve aging. Meanwhile, the sub-
[12, 24, 46, 61]. stantial evidence from this meta-analysis also supports the
suggestion from the American College of Sports Medicine
that dance is an exercise can help to decrease fitness risks
Strengths and limitations and outcomes about sedentary and inactive behavior [63].
These findings will help to confirm the effectiveness and
The dance intervention results were effective on mobility efficacy of dance interventions on physical health indices
and endurance performance in healthy older adults when when compared to daily activities, and properly systematic
compared to no intervention (daily activities). Further- dance program would be a safe and effective exercise to
more, a meta-analysis showed that dance interventions sig- incorporate into daily life for healthy older adults who wish
nificantly improved body composition, blood biomarkers, to improve their physical function.
and musculoskeletal function compared to other forms of
physical activity [57]. Therefore, dance can be a safe and
Funding  This study did not receive any specific grant from funding
popular physical exercise for older adults. These results sup- agencies in the public. This research was funded by the authors.
port new evidence for elderly management. Results from
this meta-analysis and other related review studies suggest Compliance with ethical standards 
that a good dance exercise program for older adults should
conduct two or three times per week, 30–60 min each time, Conflict of interest  The authors declare that they have no conflict of
at least 6 weeks [2, 18, 21, 57]. In addition, it was suggested interest.
that a long-term (e.g., 6 months) dance intervention can pro-
Ethical approval  This is a meta-analysis study. It dose not contain stud-
vide more healthy improvements in older adults [62]. Future ies with human participants and animals performed by the authors of
studies need to ensure that the dance types, frequency, and this study.
intervention duration are tracked to identify which dance
intervention program is the most effective on the physical Informed consent  For this type of study, consent is not required.
health of older adults.
There are limitations that should be highlighted in the
included studies. First, there was wide variability in the
interventions. Different types of dance have different move- References
ment requirements with different characteristics (ballroom
1. Health NIo (2011) Global health and aging. NIH Publication
dance, tango dance, and folk dance). These dance charac-
11:7737
teristics may affect the outcomes for older adults. The inter- 2. Galloza J, Castillo B, Micheo W (2017) Benefits of exercise in the
vention duration and frequency of intervention also varied older population. Phys Med Rehabil Clin N Am 28:659–669

13
 Aging Clinical and Experimental Research

3. Brustio PR, Liubicich ME, Chiabrero M et al (2018) Dancing in 21. Rodrigues-Krause J, Farinha JB, Krause M et al (2016) Effects of
the golden age: a study on physical function, quality of life, and dance interventions on cardiovascular risk with ageing: systematic
social engagement. Geriatric Nurs (New York, NY) 39:635–639 review and meta-analysis. Complement Ther Med 29:16–28
4. Huang G, Gibson CA, Tran ZV et al (2005) Controlled endur- 22. Da Silva FC, Iop RDR, de Oliveira LC et al (2018) Effects of
ance exercise training and ­VO2max changes in older adults: a physical exercise programs on cognitive function in Parkinson’s
meta-analysis. Prev Cardiol 8:217–225 disease patients: a systematic review of randomized controlled
5. Ni X, Liu S, Lu F et al (2014) Efficacy and safety of Tai Chi for trials of the last 10 years. PLoS ONE 13:e0193113
Parkinson’s disease: a systematic review and meta-analysis of 23. Rodrigues-Krause J, Krause M, Reischak-Oliveira A (2019) Danc-
randomized controlled trials. PLoS ONE 9:e99377 ing for healthy aging: functional and metabolic perspectives.
6. Patel NK, Newstead AH, Ferrer RL (2012) The effects of yoga Altern Ther Health Med 25:44–63
on physical functioning and health related quality of life in older 24. Lotzke D, Ostermann T, Bussing A (2015) Argentine tango in
adults: a systematic review and meta-analysis. J Altern Comple- Parkinson disease—a systematic review and meta-analysis. BMC
ment Med 18:902–917 Neurol 15:226
7. Rikli RE, Jones CJ (1998) The reliability and validity of a 25. Hackney ME, Byers C, Butler G et  al (2015) Adapted tango
6-minute walk test as a measure of physical endurance in older improves mobility, motor-cognitive function, and gait but not
adults. J Aging Phys Activ 6:363–375 cognition in older adults in independent living. J Am Geriatr Soc
8. Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L et al (2014) 63:2105–2113
Physical exercise interventions for improving performance- 26. McKinley P, Jacobson A, Leroux A et al (2008) Effect of a com-
based measures of physical function in community-dwelling, munity-based argentine tango dance program on functional bal-
frail older adults: a systematic review and meta-analysis. Arch ance and confidence in older adults. J Aging Phys Act 16:435–453
Phys Med Rehabil 95:753–769 27. Houston S, McGill A (2013) A mixed-methods study into ballet
9. Shanahan J, Coman L, Ryan F et al (2016) To dance or not to for people living with Parkinson’s. Arts Health 5:103–119
dance? A comparison of balance, physical fitness and quality of 28. Dos Santos Delabary M, Komeroski IG, Monteiro EP et al (2017)
life in older Irish set dancers and age-matched controls. Public Effects of dance practice on functional mobility, motor symptoms
Health 141:56–62 and quality of life in people with Parkinson’s disease: a systematic
10. Larsen RT, Christensen J, Juhl CB et al (2018) Physical activ- review with meta-analysis. Aging Clin Exp Res 30:1–9
ity monitors to enhance the daily amount of physical activity 29. Meng X, Li G, Jia Y et al (2019) Effects of dance intervention on
in elderly-a protocol for a systematic review and meta-analysis. global cognition, executive function and memory of older adults:
Syst Rev 7:69 a meta-analysis and systematic review. Aging Clin Exp Res. https​
11. Smith-Ray RL, Hughes SL, Prohaska TR et al (2013) Impact of ://doi.org/10.1007/s4052​0-019-01159​-w
cognitive training on balance and gait in older adults. J Gerontol 30. Eyigor S, Karapolat H, Durmaz B et al (2009) A randomized
B Psychol Sci Soc Sci 70:357–366 controlled trial of Turkish folklore dance on the physical perfor-
12. McNeely ME, Duncan RP, Earhart GM (2015) A comparison of mance, balance, depression and quality of life in older women.
dance interventions in people with Parkinson disease and older Arch Gerontol Geriatr 48:84–88
adults. Maturitas 81:10–16 31. Granacher U, Muehlbauer T, Bridenbaugh SA et al (2012) Effects
13. Nery C, Moraes SRA, Novaes KA et al (2017) Effectiveness of of a salsa dance training on balance and strength performance in
resistance exercise compared to aerobic exercise without insu- older adults. Gerontology 58:305–312
lin therapy in patients with type 2 diabetes mellitus: a meta- 32. Sharp K, Hewitt J (2014) Dance as an intervention for people
analysis. Braz J Phys Ther 21:400–415 with Parkinson’s disease: a systematic review and meta-analysis.
14. Pierce GL (2017) Aortic stiffness in aging and hypertension: Neurosci Biobehav Rev 47:445–456
prevention and treatment with habitual aerobic exercise. Curr 33. Veronese N, Maggi S, Schofield P et al (2017) Dance movement
Hypertens Rep 19:90 therapy and falls prevention. Maturitas 102:1–5
15. Pedrosa R, Holanda G (2009) Correlation between the walk, 34. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting
2-minute step and TUG tests among hypertensive older women. items for systematic reviews and meta-analyses: the PRISMA
Braz J Phys Ther 13:252–256 Statement. Ann Intern Med 3:e123–e130
16. Karssemeijer EGA, Aaronson JA, Bossers WJ et al (2017) Posi- 35. Higgins J, Green S (2011) Cochrane handbook for systematic
tive effects of combined cognitive and physical exercise training reviews of interventions. Wiley, West Sussex
on cognitive function in older adults with mild cognitive impair- 36. Cepeda CC, Lodovico A, Fowler N et al (2015) Effect of an eight-
ment or dementia: a meta-analysis. Ageing Res Rev 40:75–83 week ballroom dancing program on muscle architecture in older
17. Yoshiko A, Kaji T, Sugiyama H et al (2017) Effect of 12-month adults females. J Aging Phys Act 23:607–612
resistance and endurance training on quality, quantity, and func- 37. Holmerova I, Machacova K, Vankova H et al (2009) Effect of the
tion of skeletal muscle in older adults requiring long-term care. Exercise Dance for Seniors (EXDASE) Program on lower-body
Exp Gerontol 98:230–237 functioning among institutionalized older adults. J Aging Health
18. Hwang PW, Braun KL (2015) The effectiveness of dance inter- 22:106–119
ventions to improve older adults’ health: a systematic literature 38. Machacova K, Vankova H, Volicer L et al (2015) Dance as preven-
review. Altern Ther Health Med 21:64–70 tion of late life functional decline among nursing home residents.
19. Vordos Z, Kouidi E, Mavrovouniotis F et al (2017) Impact of J Appl Gerontol 36:1453–1470
traditional Greek dancing on jumping ability, muscular strength 39. Bennett CG, Hackney ME (2017) Effects of line dancing on physi-
and lower limb endurance in cardiac rehabilitation programmes. cal function and perceived limitation in older adults with self-
Eur J Cardiovasc Nurs 16:150–156 reported mobility limitations. Disabil Rehabil 40:1259–1265
20. Britten L, Addington C, Astill S (2017) Dancing in time: fea- 40. Hamacher D, Hamacher D, Rehfeld K et al (2015) The effect of a
sibility and acceptability of a contemporary dance programme six-month dancing program on motor-cognitive dual-task perfor-
to modify risk factors for falling in community dwelling older mance in older adults. J Aging Phys Activ 23:647–652
adults. BMC Geriatrics 17:83 41. Janyacharoen T, Laophosri M, Kanpittaya J et al (2013) Physical
performance in recently aged adults after 6 weeks traditional Thai
dance: a randomized controlled trial. Clin Interv Aging 8:855–859

13
Aging Clinical and Experimental Research

42. Merom D, Mathieu E, Cerin E et al (2016) Social dancing and 54. McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-Item
incidence of falls in older adults: a cluster randomised controlled Short-Form Health Survey (SF-36): II. Psychometric and clinical
trial. Plos Med 13:e1002112 tests of validity in measuring physical and mental health con-
43. Sofianidis G, Hatzitaki V, Douka S et  al (2009) Effect of a structs. Med Care 31:247–263
10-week traditional dance program on static and dynamic bal- 55. Brok J, Thorlund K, Gluud C et al (2008) Trial sequential analysis
ance control in elderly adults. J Aging Phys Act 17:167–180 reveals insufficient information size and potentially false positive
44. Serrano-Guzman M, Aguilar-Ferrandiz ME, Valenza CM et al results in many meta-analyses. J Clin Epidemiol 61:763–769
(2016) Effectiveness of a flamenco and Sevillanas program to 56. Buitenweg JIV, Van De Ven RM, Ridderinkhof KR et al (2018)
enhance mobility, balance, physical activity, blood pressure, body Does cognitive flexibility training enhance subjective mental func-
mass, and quality of life in postmenopausal women living in the tioning in healthy older adults? Aging Neuropsychol 3:1–23
community in Spain: a randomized clinical trial. Menopause 57. Fong Yan A, Cobley S, Chan C et al (2018) The effectiveness
23:965–973 of dance interventions on physical health outcomes compared to
45. Hui E, Chui BTK, Woo J (2009) Effects of dance on physical and other forms of physical activity: a systematic review and meta-
psychological well-being in older persons. Arch Gerontol Geriatr analysis. Sports Med 48:933–951
49:E45–E50 58. Kirsch LP, Drommelschmidt KA, Cross ES (2013) The impact of
46. Filar-Mierzwa K, Dlugosz M, Marchewka A et al (2017) The sensorimotor experience on affective evaluation of dance. Front
effect of dance therapy on the balance of women over 60 years of Hum Neurosci 7:521
age: the influence of dance therapy for the elderly. J Women Aging 59. Henley MK (2013) Is perception of a dance phrase affected by
29:348–355 physical movement training and experience? Res Danc Educ
47. Borges E, Cader S, Vale R et al (2012) The effect of ballroom 15:71–82
dance on balance and functional autonomy among the isolated 60. Blasing B, Calvo-Merino B, Cross ES et al (2012) Neurocognitive
elderly. Arch Gerontol Geriatr 55:492–496 control in dance perception and performance. Acta Physiol (Oxf)
48. Shephard RJ (1987) Physical activity and aging, 2nd edn. Croom 139:300–308
Helm, London 61. Ho RTH, Cheung JKK, Chan WC et al (2015) A 3-arm rand-
49. Brustio PR, Magistro D, Liubicich ME (2015) Changes in tempo- omized controlled trial on the effects of dance movement interven-
ral parameters during performance of the Step Test in older adults. tion and exercises on elderly with early dementia. BMC Geriatrics
Gait Posture 41:217–221 15:127
50. Pichierri G, Murer K, de Bruin ED (2012) A cognitive-motor 62. Keogh JW, Kilding A, Pidgeon P et al (2012) Effects of different
intervention using a dance video game to enhance foot placement weekly frequencies of dance on older adults’ functional perfor-
accuracy and gait under dual task conditions in older adults: a mance and physical activity patterns. Eur J Sport Sci 1:14–23
randomized controlled trial. BMC Geriatrics 12:74 63. Medicine ACoS (2013) ACSM’s guidelines for exercise testing
51. Cohen JA, Verghese J, Zwerling JL (2016) Cognition and gait in and prescription. Lippincott Williams & Wilkins, New York
older people. Maturitas 93:73–77
52. Morris R, Lord S, Bunce J et al (2016) Gait and cognition: map- Publisher’s Note Springer Nature remains neutral with regard to
ping the global and discrete relationships in ageing and neurode- jurisdictional claims in published maps and institutional affiliations.
generative disease. Neurosci Biobehav Rev 64:326–345
53. Verghese J, Mahoney J, Ambrose AF et al (2010) Effect of cogni-
tive remediation on gait in sedentary seniors. J Gerontol Ser A
Biol Sci Med Sci 65A:1338–1343

13