Effects of Tropical Latin Dance on Functional Capacity, Waist Circumference, and Quality of Life Compared to Traditional Aerobic Exercise Among Patients With Coronary Artery Disease in the VA Caribbean Healthcare System

Cardiovascular disorders represent the most important health problem worldwide and are the leading cause of mortality and morbidity.1 However, from 2009 to 2018, a decrease in mortality and morbidity in the United States was observed mainly due to improvements in medical care and a reduction in cardiovascular disease risk factors.2 There is plenty of evidence regarding the association of deconditioning and disability with hospital admissions for cardiovascular disorders, including rapid loss of muscular mass and strength that results in slower walking speed and difficulties performing activities of daily living.3 Cardiac rehabilitation programs have been extensively recommended for individuals with cardiac diseases including those with a history of cardiac procedures.4 To return patients to activities of daily living, cardiac rehabilitation programs use physical activities and educational interventions with an emphasis on lifestyle changes.5 The creative approach of dance therapy improves physical and mental conditions, including neurohormonal changes and quality of life (QoL).6 It has been reported that dancing has the potential to function as a supplemental resource for cardiac rehabilitation programs because it is thought to be a motivational physical exercise that can foster positive patient outcomes.5 Furthermore, previous studies have shown the ways in which psychophysiological responses to dance (salsa types) promote health and fitness benefits that generate enjoyable experiences and stimulate an increase in adherence to dance, which provides equal health benefits.7 Despite the benefits of the traditional exercise training, commitment and consistency with these exercise programs are low, and often the participants do not complete the program due to a lack of intrinsic motivation.8 Alternatively, the use of dance as a form of aerobic exercise has achieved greater commitment and participation of patients in exercise programs, in addition to functional capacity and QoL benefits.9 The present study aimed to compare the effects of tropical Latin dance as an exercise program on functional capacity, waist circumference, and health-related QoL dimensions. Given the reported effects of traditional exercise and dance in previous studies, it was hypothesized that subjects in the tropical Latin dance exercise and traditional aerobic exercise groups would show comparable benefits. METHODS We conducted a single-center, parallel, randomized controlled trial with a 1:1 allocation ratio into 2 kinds of cardiorespiratory exercise modalities: dancing exercise (salsa, merengue, and cha-cha-cha) and traditional aerobic exercise (stationary bikes, "NuStep 4000," arm ergometer, and treadmill). Criteria for inclusion were history of open-heart surgery, percutaneous coronary intervention, myocardial infarction, or heart failure and being medically stable over the last 3 mo prior to the study. Patients with uncontrolled hypertension (≥160/90 mmHg), orthopedic or neurological limitations, dementia, or Alzheimer disease were excluded. Patients were randomized to each group. Pre- and post-assessment of the 6-min walk test (6MWT), Short Form Health Survey-36, body composition, and Duke Activity Status Index (DASI) were measured. The protocol consisted of 16 46-min twice weekly sessions of dancing exercise or traditional aerobic exercise at an intensity of 50-70% maximal heart rate using an age-predicted heart rate max equation, monitored using the Quinton Q-Tel cardiac rehabilitation telemetry system. Data were summarized using the mean and SD for continuous variables and frequencies and proportions for categorical variables. Changes between groups were measured using ANCOVA analysis adjusted for baseline measurements. Intragroup changes were explored using a paired t test. The Stata v.15 software was used for all analyses with a significance level of α = .05. RESULTS The study consisted of 92 subjects, of whom 60 completed the protocol, with 30 in each exercise group. Age ranged from 35 to 80 yr, 59 patients were Hispanic, and 1 was African American. Most patients were male, and 1 was female in accordance with the current population of veterans who are predominantly male. There were 32 subjects who dropped out of the study. The reasons for dropping out from traditional aerobic exercise include transportation problems (10), medical instability (5), exercise intolerance (2), failed to report (10), and, for dancing exercise, personal problems (5). Dropouts were replaced until 30 participants in each group completed the program. Two-thirds of participants (67%) in the dancing exercise participated in all sessions, attending a mean of 15.2 ± 1.7 sessions. Traditional aerobic exercise had full participation in 53% of patients with a mean of 14.6 ± 1.9 sessions. Intragroup comparisons were performed to identify the effects of each cardiopulmonary rehabilitation program method and to determine if each provided significant benefits to participants. Subjects assigned to dancing exercises showed significant differences for most QoL indicators except for bodily pain (P = .676, Table 1). The clinical indicators with a significant difference were 6MWT distance (P < .001), waist circumference (P = .037), and DASI (P = .008). In contrast, the traditional aerobic exercise only showed significant improvement on 2 of the QoL indicators: physical function (P = .005) and role physical (P < .001). Additionally, the 6MWT distance (P < .001) and DASI (P < .001) clinical indicators achieved statistical significance. Table 1 - Changes in Quality of Life, Functional Capacity, and Body Composition by Exercise Type in Patients With Coronary Artery Disease in the VA Caribbean Healthcare Systema Dancing Exercise (n = 30) Traditional Aerobic Exercise (n = 30) P Value Pre Post Change (Post-Pre) Pre Post Change (Post-Pre) Quality of life Physical function 37.5 ± 9.5 45.3 ± 8.4 7.8 ± 7.5b 44.8 ± 8.5 48.3 ± 7.1 3.5 ± 6.3b .458 Role physical 37.8 ± 10.4 45.5 ± 8.9 7.6 ± 10.4b 38.7 ± 12.4 46.2 ± 9.3 7.5 ± 9.5b .856 Bodily pain 48.4 ± 35.0 45.5 ± 10.1 −2.9 ± 40.0 43.4 ± 10.8 45.4 ± 11.9 2.1 ± 10.5 .998 General health 44.6 ± 9.9 48.4 ± 9.6 3.8 ± 9.3b 45.1 ± 10.1 47.9 ± 9.9 2.7 ± 7.9 .687 Vitality 48.0 ± 9.1 52.0 ± 8.6 4.0 ± 6.2b 51.5 ± 9.3 52.2 ± 11.1 0.7 ± 8.6 .216 Social functioning 40.3 ± 11.9 45.9 ± 10.1 5.6 ± 10.9b 43.2 ± 9.8 45.6 ± 10.8 2.4 ± 8.8 .388 Role emotional 37.1 ± 15.7 43.3 ± 10.2 6.2 ± 12.0b 42.0 ± 14.3 44.9 ± 11.2 2.8 ± 11.8 .779 Mental health 42.0 ± 13.8 48.5 ± 10.9 6.5 ± 8.0b 48.4 ± 11.9 49.4 ± 12.3 0.9 ± 9.8 .108 Functional capacity 6MWT, m 374.9 ± 79.0 466.6 ± 90.4 91.8 ± 58.0b 440.8 ± 74.3 498.8 ± 77.3 58.0 ± 42.4b .073 DASI, MET 5.7 ± 1.7 9.4 ± 7.6 3.7 ± 7.1b 6.1 ± 1.2 7.1 ± 1.5 1.0 ± 1.2b .038 Body composition Waist circumference, in 40.0 ± 3.4 39.2 ± 3.4 −0.7 ± 1.8b 39.5 ± 4.0 39.4 ± 4.1 −0.1 ± 1.1 .110 Abbreviations: 6MWT, 6-min walk test; DASI, Duke Activity Status Index; MET, metabolic equivalent of task; VA, Veterans Affairs.aData are presented as mean ± SD.bStatistically significant difference on intragroup comparison (P < .05). We found that those assigned to either group had similar changes in QoL, functional capacity, and body composition outcomes. However, after adjusting for baseline measurements, participation in dancing exercise resulted in a significantly larger increase in DASI than that of traditional aerobic exercise (F = 2.64, P = .038) and a trend for increase in the 6MWT distance (P = .073). These results suggest that dancing exercise, in general, improved physical function, functional capacity, and mental health aspects comparable to traditional aerobic exercise. DISCUSSION Cardiac rehabilitation programs require comprehensive interventions to develop healthy lifestyles that result in better QoL and well-being. Dance as therapy improves not only the physical aspect but emotional and cultural aspects, resulting in a multisensory experience that promotes holistic well-being. Previous studies have shown the efficacy of other types of dances such as Waltz and Greek traditional dance in patients with chronic heart failure to improve functional capacity and QoL.9,10 Limitations of our study include the lack of a control group, lack of blinding, a large number of dropouts, the participants being nearly exclusively male, being conducted in a single center, and lack of determination of socialization between groups. In conclusion, we demonstrate that tropical Latin dance improved functional capacity and QoL to the same extent as traditional aerobic exercise.