Research exploring the potential benefits of dance for patients with respiratory conditions in low-resource settings featured in JAMA.

Chronic respiratory disease is a leading cause of morbidity and mortality globally and disproportionately affects people in low-resource settings. Patients with a chronic lung condition will often be put on a supervised program called pulmonary rehabilitation that includes exercise training, health education, and breathing techniques. The aim of pulmonary rehabilitation is to reduce symptoms such as breathlessness and fatigue, and improve quality of life. Dr Keir Philip from the National Heart and Lung Institute has been investigating what role dance can play as an adjunct to pulmonary rehabilitation - hoping to offer a more engaging and enjoyable way for patients to exercise their lungs. The latest findings have been published in JAMA.

"Dance has the potential for application globally. Everyone can dance their dance." Dr Keir Philip

Dance has been shown to improve motor function and quality of life in older patients and persons with movement disorders. Could similar benefits be seen in patients with chronic lung disease? Dr Philip began developing the concept of using dance with respiratory patients in 2015 when he was working as a doctor on a multidrug–resistant tuberculosis (MDR-TB) ward in a rural South African hospital. His team ran 30-minute dance sessions twice a week on the grass outside the inpatient ward, and visited other local hospitals to bring music and dance to them. Both music and dance moves were selected by the participants, with everyone’s favourite dance moves choreographed into routines.

The sessions were a success with patients anecdotally reporting physical benefits, and they have since evolved as local staff have taken full ownership of the approach, integrating music and dance into the exercise components of pulmonary rehabilitation activities rather than separate sessions. Keir’s work in 2015 led to the foundation of The DanceStrong project which became DanceAble, a collective of dance artists working in health who, in collaboration with the Fresh Air research program at the University of Plymouth, have implemented lung health and pulmonary rehabilitation programs in Uganda, Kyrgyzstan, Vietnam, and Greece. 

I asked Keir a few questions about his work with respiratory patients. 

Why did you decide to look at the benefits of dance?

I worked for many years as a dancer and dance teacher before training as a doctor, including a year as a dance teacher in South Africa (SA). When I had qualified as a doctor, I went back to SA and worked on an MDR-TB ward. When I started, there was no pulmonary rehabilitation or exercise training. Due to public health infection control measures related to MDR-TB, patients would often be kept isolated on the ward for months. The patients were physically, mentally and socially deconditioning and there was a clear need for a holistic physical activity intervention. Dance is a huge part of South African cultures and I was comfortable leading dance sessions. So basically, there was a need, and dance seemed the natural fit.

What is the importance of participants involvement in selection of music or dance moves?

I think it adds an important dimension. The idea is that the sessions are led, but not taught. If you think about it, most aspects of healthcare are decided by healthcare professionals, with patients as passive recipients. This can be highly disempowering, and fails to appreciate and utilise the personal, cultural, and societal resources that people can bring to their own healing.

Are there any benefits other than physical changes?

The psychosocial aspects of chronic respiratory disease are extremely important, yet often overlooked. Dance has the potential to be a useful, non-disease focused, way of helping to address these components of disease. The dance sessions are full of laughter, chatting and music. Staff and patients’ family members often join in. We are currently analysing qualitative data from our work in Uganda, which will help us gain a deeper insight into psychosocial impacts of the sessions, and the potential roles of dance and singing in respiratory health programmes there.

Psychosocial factors are also important modulators of physical impacts. For example, our recent paper in Nature Scientific Reports shows the associations between changes in social isolation, loneliness and physical performance.

I think medical professionals are increasingly appreciating that holistically detrimental conditions require holistically beneficial approaches, and this changing of perspective opens new avenues for intervention. 

Why are you working in low resource settings?

I have been working in various countries including the UK. The work in low-resource settings has gained attention as its particularly novel, but dance has the potential for application globally. Everyone can dance their dance. That said, its not going to be every one’s cup of tea, and we should be clear that these approaches are being developed as adjuncts, not replacements, for established evidence-based interventions.  

Do different dances have different effects – how does salsa compare to twerking?

Hahahaha. No one has done that comparison yet, but I’ll see what my boss thinks.

Different types of dance are likely to have different effects and there is a growing body of research exploring these types of questions. From my experience, I think it's really important that the participants all contribute to the sessions, and the session content is selected to fit them rather than the other way around. In South Africa we focused on House Dance and Popping and Robotics to electronic dance music, while in the Kyrgyz Republic participants wanted traditional cultural dances, so that’s what we did. The important thing is that it comes from the participants, and that they have ownership and enjoy the sessions. The most effective interventions are those with good compliance, so the right dance for the person might be a more useful way to look at it.

What next?

The COVID-19 pandemic has put much of the dance work on hold. When possible, we will be building on our previous work with larger studies assessing impact on established outcome measures.

Read more in JAMA: Dance for Respiratory Patients in Low-Resource Settings 

Photo credit: Stuart Blatson, The 625