Complete Research Report

THE University of Edinburgh

The Intensity Level Of Sit Dancing Compared To Standing Exercise And Sedentary Behaviour And Its Positive Changes In Mood In Older Adults

BSc (hons) Applied Sport Science

 

By Sasha-Beth Wong

 

 

 

Supervisor: Dr Martine Verheul

ABSTRACT

This study compared the intensities of sit dancing, standing exercise and sedentary behaviour in 13 community-dwelling, older adults (mean age 81.2 ± 7.4 years) and looked at the relationship between sit dancing and affect. The heart rate of the participants was collected during 30minutes of each of sit dancing, standing exercise and sedentary behaviour. The UWIST-MACL was completed by the participants immediately pre-sit dancing and again immediately post-sit dancing. Sit dancing was significantly more intense than sedentary behaviour (p = 0.049) and no significant difference was found between the intensities of sit dancing and standing exercise (p = 0.735). Additionally, hedonic tone (p = 0.003) and energetic arousal (p = 0.013) subscales increased significantly from pre- to post-sit dancing, whilst tense arousal significantly decreased (p = 0.045), indicating a more positive affective valence as a consequence of sit dancing. These findings support the use of sit dancing as an effective form of physical activity, of sufficient exercise intensity, to induce improvements in physical fitness and mood in healthy, community-dwelling older adults.

Keywords: ageing, alternative exercise, exercise therapy, seated dance exercise

 

INTRODUCTION

Increasing participation in physical activity in the older population is presently of much interest. The ageing process appears to produce a negative cycle whereby older adults have significantly reduced muscle mass (Fiatarone-Singh, 2002) resulting in reduced muscular strength, endurance and balance leading to greatly reduced participation in physical activity and ultimately, diminished functional ability. This loss of functional ability is of great concern as a rapid downward spiral is seen involving an increased incidence and fear of falling (Shumway-Cook, Brauer & Woollacott, 2000; Dite & Temple, 2002; Brouwer, Musselman & Culham, 2004; Liu-Ambrose et al., 2004), reduced walking velocity (Whitney et al., 2007) and reduced incidental physical activity (Brouwer, Musselman & Culham, 2004). Due to this lessened physical activity, the risk of falling will be further increased as well as the risk of developing chronic diseases (American College of Sports Medicine, 2009). Therefore, physical activity is important for older adults to improve aspects such as strength, coordination, flexibility, fitness, balance, functional reach, gait speed, and most importantly, maintain the comfortable performance of activities of daily living (ADL) and functional fitness (Hoeppner & Rimmer, 2000; Rogers, Fernandez & Bohlken, 2001; Hay et al. 2002; DiBrezzo et al., 2005; Takeshima et al., 2007; Beswick et al., 2008; Bird et al., 2009; Rose, 2011; Williams et al. 2011; Bird, Hill & Fell, 2012; Chou, Hwang & Wu, 2012), which can help to reduce the impacts of degenerative diseases and injuries.

Numerous studies have demonstrated the aforementioned benefits of exercise for older adults through exercise methods such as aerobic exercise (Deley et al., 2007), resistance training (Schlicht, Camaione & Owen, 2001; Liu-Ambrose et al., 2004; Keogh, Morrison & Barrett, 2007; Deley et al., 2007), balance training (Liu-Ambrose et al., 2004; Nnodim et al., 2006) and even Tae Kwon Do (Cromwell et al., 2007). Tai Chi has also been found to be a popular and beneficial form of physical activity for older adults, which improves balance, coordination, strength, flexibility and psychological benefits including enhanced self-efficacy (Yan & Downing, 1998; Li et al., 2001; Lee, Lee & Ernst, 2009; Nnodim et al., 2006; Pereira et al., 2008; Monroe, 2011). It is important that older individuals are involved in activities that are of sufficiently high enough intensities, elevating the maximum heart rate reserve into the recommended 50-85% exertion range, in order to improve fitness (American College of Sports Medicine, 2009).

Several studies have found dancing for older adults as a specific form of physical activity to be effective for increasing strength, walking speed, aerobic fitness, static and dynamic balance control, and reducing fall prevalence in older adults, often more so than traditional exercise training methods (Judge, 2003; Godzik, 2006; Hackney et al., 2007; McKinley et al., 2008; Eyigor et al., 2009; Sofianidis et al., 2009). McKinley et al. (2008) found 10-weeks of Argentine tango dancing significantly improved muscle endurance, measured by the sit-to-stand (STS) time, balance confidence, assessed through the Activities-Specific Balance Confidence scale (ABC), and faster normal walking speed, compared to a walking-only group. Hackney et al. (2007) also found that 12-weeks of Argentine tango dancing significantly improved static balance, measured by the 1-foot stance test. 8-weeks of Turkish folk dancing has been found to significantly improve aerobic power, assessed using the 6-minute walk test, muscle endurance (STS), Berg Balance Scale scores for static balance, and gait speed, through the stair-climb time assessment (Eyigor et al., 2009).

Furthermore, static and dynamic balance has also been found to significantly improve as a result of 12-weeks of Caribbean dancing (Federici et al., 2005), traditional Korean dancing (Jeon et al., 2000; Song et al., 2004; Jeon et al., 2005), 10-weeks of traditional Greek dancing (Sofianidis et al., 2009) and 10-12 weeks of aerobic/line dancing (Hopkins et al., 1990; Engels et al., 1998; Shigematsu et al., 2002; Young, Weeks & Beck, 2007). Aerobic/line dancing was also found to significantly improve muscular endurance (Hopkins et al., 1990; Engels et al., 1998; Shigematsu et al., 2002; Young et al., 2007), muscular strength (Engels et al., 1998; Shigematsu et al., 2002), flexibility and aerobic power (Hopkins et al., 1990; Engels et al., 1998; Shigematsu et al., 2002). Advantages of dancing for older adults over other types of traditional exercise methods may include the greater enjoyment that dancing provides. Many older adults will have actively participated in some form of dancing at a younger age as dancing often provided the core of much social interaction. To be able to dance again at an older age can provide a positive, youthful, uplifting and mentally fulfilling experience for those involved (Godzik, 2006).

Many older adults, however, are unable to confidently stand, walk or take part in traditional exercise for a period of time, and therefore do not have access to the health benefits provided by these types of activities. Sit dancing is a seated form of dancing which has adapted traditional folk dances from around the world to suit all ability levels, including individuals with difficulty walking or standing. Sit dancing is claimed to positively effect fitness, coordination, muscle toning, proprioception, self-expression, memory, emotional release and stimulate social interaction (Baaijens, 2008). If sit dancing is able to elevate the maximum heart rate reserve to the recommended range of exertion it may be effective in improving fitness of older adults that are unable to confidently stand or exercise for a period of time. Furthermore, sit dancing may provide an enjoyable, and therefore more maintainable, form of physical activity for older adults who are less confident in their ability to participate in traditional forms of exercise and dance, allowing them to be active and dance again.

At present it appears there is no research on sit dancing, therefore, the primary aim of the study was to investigate whether sit dancing elevates the maximum heart rate reserve to the recommended range for improvement of fitness in older adults referred to a social day care centre. A second aim of this study was to directly compare the intensity of sit dancing with the intensity level achieved in standing exercise and during sedentary behaviour in the same population. The Sedentary Behaviour Research Network (2012) define ‘sedentary behaviour’ as any waking activity with an energy expenditure £ 1.5 metabolic equivalents (METS) and a reclining or sitting posture. Finally, the study aimed to determine whether or not sit dancing was able to induce a positive change in the mood of the participants through the use of Matthews, Jones & Chamberlain (1990) UWIST-Mood Adjective Checklist (UMACL).

As no previous research into the physical activity level of sit dancing exists, it is expected that the intensity of sit dancing is significantly higher than sedentary behaviour, but lower than standing exercise.

METHODS

PARTICIPANTS

Thirteen community-dwelling older adults from one community centre participated in the study (mean age 81.2 ± 7.4 years; 8 women, 5 men). This population can be considered vulnerable as the day opportunity service provided is specifically for older adults with mental health, dementia, learning disability and/or physical mobility difficulties. Although the particular centre carried out physical activity classes that involved exercises sitting down, none of the participants had any prior experience of the style of sit dancing involved in this study. To be included into the study, all the participants had to be over the age of 65, living independently and healthy whereby participation in exercise would be symptom free. Seven of the participants required the use of walking aids but were able to stand comfortably for a period of time with support. All participants required transport to and from the day centre by the day centre’s mini bus. Before inclusion into the study, researchers were informed of those participants with cardiovascular problems of a moderate to high level or those that displayed cardio-respiratory symptoms, such as hypertension, as a result of moderate to high exertion; these individuals were then excluded from the study. Individuals with severe cognitive impairments, such as Dementia, were also excluded from the study. All participants read (or were read to for those with vision impairments) a participant information letter and signed an informed consent form. The study was approved by the ethics committee of the Moray House School of Education at the University of Edinburgh.

 

EXPERIMENTAL APPARATUS

The sit dancing sessions were instructed through the use of Marcel Baaijens’ Sit Dancing International (2008) DVD. The first eleven dances, including the warm-up and cool-down were learned by the researcher and subsequently taught to the participants. Exercise intensity was tested using heart rate monitors (Polar Accurex Plus and Polar S610i systems, Polar, Kempele, Finland) that collected heart rate data for each condition. ECG gel was used to aid the connections and collect as accurate data as possible. Polar S69 and Polar S610i heart rate monitors were set to record heart rate data at five-second intervals making them a reliable resource. The heart rate data was uploaded via infrared onto Polar Precision Performance (Polar, Kempele, Finland) analysis software after each testing session. Hard-backed chairs with enough freedom to allow as much movement as possible were arranged in a circular fashion having those participants with the greatest hearing impediments positioned either right next to the instructor or directly opposite.

The Matthews, Jones & Chamberlain, (1990) UWIST-Mood Adjective Checklist (UMACL) was used to investigate any changes in the moods of the participants as a result of the sit dancing. UMACL is a valid and reliable measure, which is based on a three-factor model of affect. The three factors assessed are: (1) Hedonic tone, the dimension from pleasure to displeasure; (2) Energetic arousal dimension, which assess the range of feelings from vigour and energy to tired and sluggish; and (3) Tense arousal dimension, which assess the range of feelings from nervous and tense to relaxed and calm (Niven, Rendell & Chisholm, 2008). A 4-point scale from “definitely” to “definitely not” was used to score the eight items in each subscale.

 

STUDY DESIGN

In this crossover (repeated measures, within groups) design the 13 participants attended the day centre on either a Wednesday (n=6) or a Thursday (n=7) between 11am and 12:30pm. Due to the nature of the day centre and its management, the participants remained in these groups throughout the course of the study and were tested under each condition in these groups at the same time of day. The three conditions (1) exercise whilst standing, (2) sit dancing and, (3) sedentary behaviour – involving sitting, tea/coffee drinking, reading and conversing, were tested on the Wednesday and Thursday of each week over three consecutive weeks.

 

PROTOCOL

The first part of the study involved the researcher spending 3 weeks meeting the day centre staff and the older adults attending the day centre. Familiarisation of the day centre and the testing environment as well as getting to know the participants occurred over these few weeks. The following four weeks was spent introducing sit dancing to the participants, teaching and familiarising them with the first eleven dances from the Sit Dancing International resource, including an appropriate warm up and cool down.

One-week post sit dancing familiarisation the heart rate monitors were used with the participants, but the data for this week were not included in the results. This was intended to allow the participants to gage how the heart rate monitors worked and to feel comfortable using them, thus eliminating any elevation of heart rate from anxiety and nervousness rather than the specific study condition.

Heart rate data was first recorded for 30 minutes duration under the exercise whilst standing condition. The day centre’s qualified support worker, who regularly runs the physical activity and therapy sessions for the older adults, instructed the session. A description of the content of the exercise while standing class and the order and duration each exercise was performed in has been outlined in Table 1. Participants were asked to stand behind their chair and use the chair for stability when necessary.

The following week heart rate data was recorded while the participants were engaging in sedentary behaviour of sitting, drinking tea or coffee, conversing, reading and doing minimal activity for 30 minutes. In the final week, heart rate data was collected under the sit dancing condition. Under this condition, the UMACL was carried out immediately before this tested sit dancing session and again immediately following the session to observe any changes in mood of the participants as a result of the sit dancing.

 

STASTISTICAL ANALYSIS

The Shapiro-Wilk test was used to test for normality of the data with the data found to be normal (sit dancing = 0.422, standing exercise = 0.532, sedentary behaviour = 0.697). A repeated measures analysis of variance (ANOVA) was then employed for the analysis of the differences between the acute heart rates of the participants under each of the three conditions. Pairwise comparisons with Bonferroni correction for multiple testing was used. The mean heart rate (bpm) and standard deviation was calculated for each of the three conditions. Only the first 10 minutes of heart rate data for the exercise whilst standing condition was used to calculate the mean and SD for this condition. This was due to some of the participants not being physically able enough to stand for the 30 minutes duration; 10 minutes was the maximum for the least able participant. A paired samples t-test was used to examine the effect of sit dancing on mood affect. Means and standard deviations were also calculated for each of the three factors assessed in the UWIST-Mood Adjective Checklist.

 

 

Table 1 Order, content and duration of the exercises performed during the 30-minute standing exercise session.

Exercise

Duration (min)

Rock from heel to toe

2

Rock forwards and backwards

2

Rock body in circles

1

Marching on the spot with high knees

2

Wave arms out sideways and back

1

Sway arms above head like a tree

1

Squat up and down

1

Roll shoulders backwards and forwards

2

Raise shoulders up and down

2

Raise hip, one side then the other

1

Stamp feet

2

Stamp feet and wave each arm left, right, forward and up

2

Step backwards then back, repeat with other leg

2

One leg out to the side then back, repeat with other leg

2

Swing hips sideways

1

Shake whole body

1

Reach up to the ceiling then bend all the way down

2

Twist waist and swing arms

1

Boogie - freestyle

2

 

RESULTS

Of the thirteen participants that volunteered to participate in this study two of them did not undertake the sit dancing condition due to illness and being away from the day centre (sit dancing, n=11). Two other participants did not complete the exercise while standing condition due to fear of standing combined with exercising (exercise standing, n=11). All thirteen participants completed the sedentary behaviour condition.

Table 2 presents the means and standard deviations from the nine full sets of data for sedentary behaviour, standing exercise and sit dancing. The repeated measures ANOVA indicated a significant effect of activity (F2,16 = 6.50, p = 0.009). Post hoc, pairwise comparisons showed that sit dancing was of a significantly higher intensity than sedentary behaviour (p = 0.049). Exercise while standing was also significantly more intense than sedentary behaviour (p = 0.033). No significant effect was found between sit dancing and exercise while standing (p = 0.735).

 

 

Table 2 Outcome measures, (mean ± SD).

 

 

Sedentary behaviour

Standing Exercise

Sit Dancing

HR (bpm)

62.2 ± 9.3

80.9 ± 17.5**

73.4 ± 13.5*

 

 

 

 

Activity Duration (min)

30 ± 0

26.1 ± 7.1

30 ± 0

         

Note. HR = heart rate; bpm = beats per minute.

*Significant (p < 0.05) difference between sit dancing and sedentary behaviour. **Significant (p < 0.05) difference between standing exercise and sedentary behaviour

 

 

Additionally, Figure 1 shows that on average both standing exercise and sit dancing were of sufficient intensity (American College of Sports Medicine recommendation of 50-85% maximal heart rate), for improving fitness in older adults – 58.5% (±12.9) and 53% (±9.6) of their maximal heart rate respectively. Sedentary behaviour, on the other hand, was not (45% (±6.9) maximal heart rate).

 

Figure 1   Graph representing the intensities of sit dancing, standing exercise and sedentary behaviour as a percentage of the maximum heart rate (220-age).

 

The paired samples t-test indicated a significant (p < 0.05) interaction effect between sit dancing and affect. Hedonic tone (t10 = -3.96, p = 0.003) and energetic arousal (t10 = -3.00, p = 0.013) subscales increased significantly from pre- to post-sit dancing, whilst tense arousal (t10 = 2.29, p = 0.045) significantly decreased. For reference, Table 3 presents the means and standard deviations for hedonic tone, energetic arousal and tense arousal pre- and post-sit dancing.

 

 

Table 3           Pre- and Post-sit dancing scores for the UMACL subscales (mean ± SD).

 

Pre

Post

Hedonic Tone

25.7 ± 5.6*

28.5 ± 5.1

Energetic Arousal

19.4 ± 5.1*

23.1 ± 4.0

Tense Arousal

16.6 ± 8.4*

13.3 ± 6.3

Note. Maximum score = 32; (n=11)

*Significant (p < 0.05) difference pre- to post-sit dancing.

 

 

DISCUSSION

This study examined the effectiveness of sit dancing as an alternative form of physical activity for healthy, community-dwelling older adults. The study found that sit dancing was able to produce an activity of sufficient intensity (50-85% HRmax) (American College of Sports Medicine, 2009) to induce fitness improvements in eleven older adult participants. Although sit dancing was unable to produce as high an exercise intensity as standing exercise, this difference was not statistically significant (p = 0.735). Furthermore, sit dancing was significantly better for fitness (p = 0.049) than sedentary behaviour and was able to significantly improve the mood (affect) of the participants.

This is a valuable finding in terms of encouraging sit dancing as an alternative and effective form of physical activity, particularly for those with difficulty standing. Participants that were unable to stand for extended periods of time were able to sit dance and enjoyably participate in the physical activity comfortably. Although it appears this is the first study to demonstrate a positive influence of sit dancing on physical fitness and affect in a group of healthy older adults, the results are similar to other studies showing a positive outcome of dancing on physical fitness (Hopkins et al., 1990; Engels et al., 1998; Shigematsu et al., 2002; Song et al., 2004; Hackney et al., 2007; McKinley et al., 2008; Eyigor et al., 2009).

Furthermore, whether older people are unsteady or not, there is an elevated fall risk immediately following physical activity as a result of factors such as increased fatigue. Due to the seated nature of sit dancing, the older adults are able to remain seated following exercise and recover sufficiently before being required to move. Additionally, during the familiarisation and testing phase all participants were able to learn, remember and execute the dance patterns used in sit dancing, regardless of any disabilities or impairments. It is important to note however, that an encouraging, supportive, patient and positive instructor is required to avoid any discouragement and/or drop out by some of the individuals that struggle more than others.

Moreover, all the participants reported enjoying the group sit dancing activity as participation increased socialisation. Specifically, the reported increases in hedonic tone and energetic arousal, and the decrease in tense arousal suggest that sit dancing resulted in a significant shift to a more pleasant affective valence (i.e. more cheerful, happy, and contented) and decreased feelings of anxiety, tension, and sluggishness. These results are consistent with those of Matthews, Jones & Chamberlain (1990) and further support the findings that exercise improves UMACL mood scores by increasing hedonic tone and energetic arousal, whilst decreasing tense arousal (Reed & Ones, 2006; Wininger, 2007; Guszkowska & Sionek, 2009; Myrna-Bekas et al., 2012). Some participants even mentioned that participation in sit dancing helped them to sleep better at night. Therefore, quantitative results combined with the qualitative and observational information received suggests that the utilisation of sit dancing is feasible for this population.

 

LIMITATIONS

A limitation of this study was the small sample of convenience as the 13 participants were recruited from the same day centre near the researchers. Additionally, a higher number of females compared to males participated in this study, limiting the ability to generalise the results. As the study was not a true experimental study there was no control group, which may further decrease the generalisability of the findings. A limitation of the exercise while standing condition was that four of the participants were unable to consistently stand for the full 30 minutes duration. The shortest maximal duration of consistent standing exercise was ten minutes. Furthermore, the UWIST-Mood Adjective Checklist was only carried out pre- and post-sit dancing, and the significant improvements in affect may not have been primarily due to the sit dancing; it is unknown whether exercise while standing and sedentary behaviour could also produce the same conclusions. However, for the interest of this article, the fact that sit dancing was able to significantly improve affect should be regarded valuable. Finally, heart rate data was the only physiological variable used to test the intensity of each condition, again questioning the generalisability of the findings. Although, due to the type of population used in the study, other forms of exercise intensity testing may prove difficult; heart rate data provided a safe, straightforward, non-invasive method of testing.

Finally, previous studies with older adults typically use at least 2-3 sessions per week for 6-16 weeks of the physical activity intervention plus a familiarisation period for any feasible results to be obtained (Teel et al., 1999; Rogers, Fernandez & Bohlken, 2001; DiBrezzo et al., 2005; Takeshima et al., 2007; Beswick et al., 2008; McKinley et al., 2008; Bird et al., 2009; Sofianidis et al., 2009; Bird et al., 2012). Due to the time constraints of this study, and the management and running of the day centre, this was beyond the scope of the present study. This particular study was not intended to be an intervention study, rather, an intensity level study, which may be an important precursor to a future sit dancing intervention study.

 

IMPLICATIONS OF USE

It is clearly apparent that older adults need to participate more regularly in physical activity and moderate-to-high intensity physical activity should be incorporated more regularly in their everyday life (Islam et al., 2004). There is a need for effective programmes that target intrinsic factors associated with increased fall risk (Rose, 2011). Unfortunately, many individuals suffer from poor balance, lack of confidence, heart attack or stroke consequences, obesity and other impairments that impact on their ability to participate in many forms of physical activity. Talkowski et al. (2008) suggest that if an individual feels confident in their physical ability and if the physical activity has positive effects on their functional fitness and quality of life then they are more likely to continue participating in the physical activity. Therefore, sit dancing may be able to provide such benefits and consequently encourage compliance and adherence to physical activity in such a population. Although this study looked specifically at the older adult population, sit dancing could be a useful alternative form of physical activity for any individual with such impairments.

CONCLUSION

In conclusion, this study found that sit dancing was able to induce exercise of sufficient intensity in order to improve physical fitness in healthy older adults. Although sit dancing was found to be of non-significantly lower intensity than standing forms of physical activity, sit dancing was of significantly higher intensity than sedentary behaviour, thus providing evidence that any physical activity, be it seated or standing, is significantly more beneficial than sedentary behaviour. Therefore, these findings should be used to encourage healthy older adults to participate in regular physical activity and to not be discouraged if they are unable or afraid of standing. Activities such as sit dancing should be encouraged by practitioners as it may provide a solution to some of the many reasons for lack of participation in physical activity. Sit dancing could be substituted for traditional methods of exercise for individuals that do not enjoy ‘exercise’, lack the confidence and ability for such movements or have a fear of falling.

Further intervention studies investigating the influence of sit dancing on aspects such as balance, coordination and muscle strength would be highly valuable in addressing the therapeutic benefits of sit dancing. Future sit dancing intervention studies should also take into account appropriate frequencies, intensities and volumes of training for the specific population.

 

 

ACKNOWLEDMENTS:  The author is grateful to the participants for their voluntary and enthusiastic involvement in this study and would like to acknowledge the assistance and support from the day centre staff. The author wishes to thank Marcel Baaijens for the use of his Sit Dancing International resource, Dr Martine Verheul for all the advice and assistance with this dissertation, and finally, Prof B. L. William Wong and Dr Betty P. Ng, for their statistical advice, patience and continuous support throughout the entire study.

REFERENCES

American College of Sports Medicine (2009) Position stand: Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 41(7), pp.1510-1530.

 

Beswick, A. D., Rees, K., Dieppe, P., Ayis, S., Gooberman-Hill, R., Horwood, J. & Ebrahim, S. (2008) Complex interventions to improve physical function and maintain independent living in elderly people: A systematic review and meta-analysis. The Lancet, 371(March 1), pp.725-735.

 

Bird, M., Hill, K. D. & Fell, J. W. (2012) A randomized controlled study investigating static and dynamic balance in older adults after training with pilates. Archives of Physical Medicine and Rehabilitation, 93, pp.43-49.

 

Bird, M., Hill, K., Ball, M. & Williams, A. (2009) Effects of resistance and flexibility exercise interventions on balance and related measures in older adults. Journal of Aging and Physical Activity, 17, pp.444-454.

 

Brouwer, B., Musselman, K. & Culham, E. (2004) Physical function and health status among seniors with and without a fear of falling. Gerontology, 50(3), pp.135-141.

 

Chou, C., Hwang, C. & Wu, Y. (2012) Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 93, pp.237-244.

 

Cromwell, R. L., Meyers, P. M., Meyers, P. E. & Newton, R. A. (2007) Tae Kwon Do: An effective exercise for improving balance and walking ability in older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62(6), pp.641-646.

 

Deley, G., Kervio, G., Van Hoecke, J., Verges, B., Grassi, B. & Casillas, J. M. (2007) Effects of a one-year exercise training program in older adults over 70 years old: A study with a control group. Aging Clinical and Experimental Research, 19(4), pp.310-315.

 

DiBrezzo, R., Shaddon, B. B., Raybon, B. H. & Powers, M. (2005) Exercise intervention designed to improve strength and dynamic balance among community-dwelling older adults. Journal of Aging and Physical Activity, 13, pp.198-209.

 

Dite, W. & Temple, V. A. (2002) A clinical test of stepping and change of direction to identify multiple falling older adults. Archives of Physical Medicine and Rehabilitation, 83(11), pp.1566-1571.

 

Egerton, T., Brauer, S. G. & Cresswell, A. G. (2010) Dynamic postural stability is not impaired by moderate-intensity physical activity in healthy or balance-impaired older people. Human Movement Science, 29, pp.1011-1022.

 

Engels, H. J., Drouin, J., Zhu, W. & Kazmierski, J. F. (1998) Effects of low-impact, moderate-intensity exercise training with and without wrist weights on functional capacities and mood states in older adults. Gerontology, 44(4), pp.239-244.

 

Eyigor, S., Karapolat, H., Durmaz, B., Ibisoglu, U. & Cakir, S. (2009) A randomized controlled trial of Turkish folklore dance on the physical performance, balance, depression and quality of life in older women. Archives of Gerontology and Geriatrics, 48(1), pp.84-88.

 

Federici, A., Bellagamba, S. & Rocchi, M. B. (2005) Does dance-based training improve balance in adult and young old subjects? A pilot randomized controlled trial. Aging Clinical and Experimental Research, 17(5), pp.385-389.

 

Fiatarone-Singh, M. A. (2002) Exercise comes of age: Rationale and recommendations for a geriatric exercise prescription. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57(5), pp.M262-M282.

 

Godzik, H. G. (2006) Young at heart: Ballroom dancing for older adults. The Journal of Active Aging, May/June, pp.22-28.

 

Guszkowska, M. & Sionek, S. (2009) Changes in mood states and selected personality traits in women participating in a 12-week exercise program. Human Movement, 10(2), pp.163-169.

 

Hackney, M., Kantorovich, S. & Earhart, G. (2007) A study on the effects of Argentine tango as a form of partnered dance for those with Parkinson disease and the healthy elderly. American Journal of Dance Therapy, 29(2), 109-127.

 

Hay, J., LaBree, L., Luo, R., Clark, F., Carlson, M. & Mandel, D., et al. (2002) Cost-effectiveness of preventative occupational therapy for independent-living older adults. Journal of American Geriatrics Society, 50(8), pp.1381–1388.

 

Hoeppner, S. C. & Rimmer, J. H. (2000) Postural balance and self-reported exercise in older adults. Adapted Physical Activity Quarterly, 17, pp.69-77.

 

Hopkins, D. R., Murrah, B., Hoeger, W. W. & Rhodes, R. C. (1990) Effect of low-impact aerobic dance on the functional fitness of elderly women. The Gerontologist, 30(2), pp.189-192.

 

Islam, M. M., Takeshima, N., Rogers, M. E., Koizumi, D. & Rogers, N. L. (2004) Relationship between balance, functional fitness, and daily physical activity in older adults. Asian Journal of Exercise and Sports Science, 1(1), pp.9-18.

 

Jeon, M. Y., Bark, E. S., Lee, E. G., Im, J. S., Jeong, B. S. & Choe, E. S. (2005) The effects of a Korean traditional dance movement program in elderly women. Taehan Kanho Hakhoe Chi, 35(7), pp.1268-1276.

 

Jeon, M. Y., Choe, M. A. & Chae, Y. R. (2000) Effect of Korean traditional dance movement training on balance, gait and leg strength in home bound elderly women. Journal of Korean Academy of Nursing, 30(3), pp.647-658.

 

Judge, J. O. (2003) Balance training to maintain mobility and prevent disability. American Journal of Preventative Medicine, 25(3, Suppl.2), pp.150-156.

 

Keogh, J. W., Kilding, A., Pidgeon, P., Ashley, L. & Gillis, D. (2009) Physical benefits of dancing for healthy older adults. Journal of Aging and Physical Activity, 17, pp.1-23.

 

Keogh, J. W., Morrison, S. & Barrett, R. (2007) Strength-training improves the tri-digit finger-pinch force control of older adults. Archives of Physical Medicine and Rehabilitation, 88, pp.1055-1063.

 

Lee, M. S., Lee, E-N. & Ernst, E. (2009) Is Tai Chi beneficial for improving aerobic capacity? A systematic review. British Journal of Sports Medicine, 43, pp.569-573.

 

Li, F., McAuley, E., Harmer, P., Duncan, T. & Chaumeton, N. (2001) Tai Chi enhances self-efficacy and exercise behaviour in older adults. Journal of Aging and Physical Activity, 9, pp.161-171

 

Liu-Ambrose, T., Khan, K. M., Eng, J. J., Janssen, P. A., Lord, S. R. & McKay, H. A. (2004) Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: A 6-month randomized, controlled trial. Journal of the American Geriatrics Society, 52(5), pp.657-665.

 

Matthews, G., Jones, D. M. & Chamberlain, A. G. (1990) Refining the measurement of mood: The UWIST mood adjective checklist. British Journal of Psychology, 81, pp.17-42.

 

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, pp.435-453.

 

Monroe, M. (2011) Finding balance with Tai Chi: What will it take to bring Tai Chi and Qigong to the forefront in fitness? IDEA Fitness Journal, (September 2011), pp.76-78

 

Myrna-Bekas, R., Kalwa, M., Stefaniak, T. & Kulmatycki, L. (2012) Mood changes in individuals who regularly participate in various forms of physical activity. Human Movement, 13(2), pp.170-177.

 

Niven, A., Rendell, E. & Chisholm, L. (2008) Effects of 72-h of exercise abstinence on affect and body dissatisfaction in healthy female regular exercisers. Journal of Sports Sciences, 26(11), pp.1235-1242.

 

Nnodim, J. O., Strasburgh, D., Nabozny, M., Nyquist, L., Galecki, A., Chen, S., et al. (2006) Dynamic balance and stepping versus Tai Chi training to improve balance and stepping in at-risk older adults. Journal of the American geriatrics Society, 54(12), pp.1825-1831.

 

Pereira, M., Oliveira, R., Silva, M., Souza, L. & Vianna, L. (2008) Effects of Tai Chi Chuan on knee extensor muscle strength and balance in elderly women. Brazilian Journal of Physical Therapy, 12(2), pp.121-126.

 

Reed, J. & Ones, D. S. (2006) The effect of acute aerobic exercise on positive activated affect: A meta-analysis. Psychology of Sport and Exercise, 7(5), pp.477-514.

 

Rogers, M. E., Fernandez, J. E. & Bohlken, R. M. (2001) Training to reduce postural sway and increase functional reach in the elderly. Journal of Occupational Rehabilitation, 11(4), pp.291-298.

 

Rose, D. J. (2011) Reducing the risk of falls among older adults: The fallproof balance and mobility program. Current Sports Medicine Reports, 10(3), pp.151-156.

 

Schlicht, J., Camaione, D. N. & Owen, S. V. (2001) Effects of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(5), pp.M281-M287.

 

Sedentary Behaviour Research Network (2012) Standardized use of the terms “sedentary” and “sedentary behaviours”. Applied Physiology, Nutrition and Metabolism, 37, pp.540-542.

 

Shigematsu, R., Chang, M., Yabushita, N., Sakai, T., Nakagaichi, M., Nho, H., et al. (2002) Dance-based aerobic exercise may improve indices of falling risk in older women. Age and Ageing, 31(4), pp.261-266.

 

Shumway-Cook, A., Brauer, S. & Woollacott, M. (2000) Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Physical Therapy, 80(9), pp.896-903.

 

Sit Dancing International. 2008 [DVD] Marcel Baaijens. New Zealand.

 

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, pp.167-180.

 

Song, R., June, K. J., Kim, C. G. & Jeon, M. Y. (2004) Comparisions of motivation, health behaviours, and functional status among elders in residential homes in Korea. Public Health Nursing (Boston, Mass.), 21(4), pp.361-371.

 

Takeshima, N., Rogers, N. L., Rogers, M. E., Islam, M. M., Koizumi, D. & Lee, S. (2007) Functional fitness gain varies in older adults depending on exercise mode. Medicine & Science in Sport & Exercise, 39(11), pp.2036-2043.

 

Talkowski, J. B., Brach, J. S., Studenski, S. & Newman, A. B. (2008) Impact of health perception, balance perception, fall history, balance performance, and gait speed on walking activity in older adults. Physical Therapy, 88(12), pp.1474-1481.

 

Teel, C. S., Carson, P., Hamburg, J. & Clair, A. A. (1999) Developing a movement program with music for older adults. Journal of Aging and Physical Activity, 7, pp.400-413.

 

Williams, B., Doherty, N. L., Bender, A., Mattox, H. & Tibbs, J. R. (2011) The effect of nintendo wii on balance: A pilot study supporting the use of the wii in occupational therapy for the well elderly. Occupational Therapy in Health Care, 25(2-3), pp.131-139.

 

Wininger, S. R. (2007) Improvement of affect following exercise: Methodological artifact or real finding? Anxiety, Stress & Coping: An International Journal, 20(1), pp.93-102.

 

Yan, J. H. & Downing, J. H. (1998) Tai Chi: An alternative exercise form for seniors. Journal of Aging and Physical Health, 6, pp.350-362.

 

Young, C. M., Weeks, B. K. & Beck, B. R. (2007) Simple, novel physical activity maintains proximal femur bone mineral density, and improves muscle strength and balance in sedentary, postmenopausal Caucasian women. Osteoporosis International, 18(10), pp.1379-1387.