Research Article| Volume 58, P13-20, March 2023

Effects of creative dance on functional capacity, pulmonary function, balance, and cognition in COPD patients: A randomized controlled trial

  • Meltem Kaya
    Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul 34093, Turkey

    Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul 34408, Turkey
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  • Hulya Nilgun Gurses
    Corresponding author at: Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Silahtaraga St. No: 189, Istanbul 34060, Turkey.
    Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Silahtaraga St. No: 189, Istanbul 34060, Turkey

    Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul 34060, Turkey
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  • Hikmet Ucgun
    Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul 34010, Turkey
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  • Fatmanur Okyaltirik
    Department of Chest Diseases, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
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Published:November 03, 2022DOI:


      • The present study is the first to use creative dance-based exercise training in COPD.
      • Creative dance-based exercise training can be used as aerobic exercise training.
      • PT+CDE resulted in better clinically relevant outcomes than chest PT in COPD patients.



      Exercise training is key to the comprehensive management of patients with chronic obstructive pulmonary disease (COPD). Creative dance can be an innovative approach as effective as traditional exercise training.


      This study aimed to investigate effect of creative dance-based exercise (CDE) training on functional capacity, postural stability and balance, pulmonary and cognitive functions, respiratory and peripheral muscle strength in COPD patients.


      Twenty-four patients with COPD were randomly allocated to either “chest physiotherapy and home-based walking program” (PT) or “CDE alongside home-based chest physiotherapy group” (PT+CDE). Both groups performed chest PT program twice a day for 5 days per week for 8 weeks. PT+CDE group received CDE training 2 days a week for 8 weeks. Primary outcome was six minute walk test (6MWT). Secondary outcomes were postural stability and balance, pulmonary function, maximum inspiratory (MIP) and expiratory (MEP) pressure, peripheral muscle strength, Montreal Cognitive Assessment (MoCA), COPD Assessment Test (CAT), and BODE index. Outcome measures were assessed at baseline and after 8 weeks of training.


      Both groups showed statistically significant improvements in 6MWT distance, MIP, MEP, MoCA score, CAT, and BODE index (p < 0.05). Only with CDE training was achieved improvements in postural stability and balance scores, pulmonary function, and peripheral muscle strength (p < 0.05). The improvements in 6 MWT distance, MEP, MoCA score, and CAT were greater in PT+CDE group (p < 0.05).


      Use of creative dance training in addition to home-based chest PT program was more effective than chest PT program regarding primary and secondary outcomes in COPD patients.



      COPD (Chronic obstructive pulmonary disease)
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      1. Global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease (2021 Report). Global initiative for chronic obstructive lung disease. Available from:

        • Pepin V.
        • Saey D.
        • Laviolette L.
        • Maltais F.
        Exercise capacity in chronic obstructive pulmonary disease: mechanisms of limitation.
        COPD J Chronic Obstr Pulm Dis. 2007; 4: 195-204
        • Cleutjens F.A.
        • Franssen F.M.
        • Spruit M.A.
        • et al.
        Domain-specific cognitive impairment in patients with COPD and control subjects.
        Int J Chronic Obstr Pulm Dis. 2016; 12: 1-11
        • Singh S.S.
        • Bhat A.
        • Mohapatra A.K.
        • Manu M.K.
        • Vaishali K.
        Comparison of reaction time and functional balance in chronic obstructive pulmonary disease and healthy participants.
        Heart Lung. 2019; 48: 570-573
        • Spruit M.
        • Singh S.
        • Garvey C.
        • et al.
        An official American thoracic society/European respiratory society statement: key concepts and advances in pulmonary rehabilitation.
        Am J Respir Crit Care Med. 2013; 188: e13-e64
        • Keating A.
        • Lee A.
        • Holland A.E.
        What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review.
        Chronic Respir Dis. 2011; 8: 89-99
        • Fong Yan A.
        • Cobley S.
        • Chan C.
        • et al.
        The effectiveness of dance interventions on physical health outcomes compared to other forms of physical activity: a systematic review and meta-analysis.
        Sports Med. 2018; 48: 933-951
        • Cruz-Ferreira A.
        • Marmeleira J.
        • Formigo A.
        • Gomes D.
        • Fernandes J.
        Creative dance improves physical fitness and life satisfaction in older women.
        Res Aging. 2015; 37: 837-855
        • Joung H.J.
        • Lee Y.
        Effect of creative dance on fitness, functional balance, and mobility control in the elderly.
        Gerontology. 2019; 65: 537-546
        • Wshah A.
        • Butler S.
        • Patterson K.
        • Goldstein R.
        • Brooks D.
        Let's Boogie”: feasibility of a dance intervention in patients with chronic obstructive pulmonary disease.
        J Cardiopulm Rehabil Prev. 2019; 39 (-E9): E14
        • AmericanThoracicSociety
        ATS statement: guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Cachupe W.J.
        • Shifflett B.
        • Kahanov L.
        • Wughalter E.H.
        Reliability of biodex balance system measures.
        Meas Phys Educ Exerc Sci. 2001; 5: 97-108
        • Miller M.R.
        • Hankinson J.
        • Brusasco V.
        • et al.
        Standardisation of spirometry.
        Eur Respir J. 2005; 26: 319-338
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bédirian V.
        • Charbonneau S.
        • Whitehead V.
        • Collin I.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Selekler K.
        • Cangöz B.
        • Uluc S.
        Power of discrimination of Montreal Cognitive Assessment (MOCA) Scale in Turkish patients with mild cognitive impairement and Alzheimer's disease.
        Turk J Geriatr. 2010; 13: 166-171
        • Belén A.
        ATS/ERS Statement on respiratory muscle testing.
        Am J Respir Crit Care Med. 2002; 166: 518-624
        • Reyes A.
        • Cruickshank T.
        • Nosaka K.
        • Ziman M.
        Respiratory muscle training on pulmonary and swallowing function in patients with Huntington's disease: a pilot randomised controlled trial.
        Clin Rehabil. 2015; 29: 961-973
        • Jackson S.M.
        • Cheng M.S.
        • Smith Jr., A.R.
        • Kolber M.J.
        Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device.
        Musculoskelet Sci Pract. 2017; 27: 137-141
        • Jones P.
        • Harding G.
        • Berry P.
        • Wiklund I.
        • Chen W.
        • Leidy N.K.
        Development and first validation of the COPD assessment test.
        Eur Respir J. 2009; 34: 648-654
        • Yorgancıoğlu A.
        • Polatlı M.
        • Aydemir Ö.
        • et al.
        Reliability and validity of Turkish version of COPD assessment test.
        Tuberc Thorax. 2012; 60: 314-320
        • Celli B.R.
        • Cote C.G.
        • Marin J.M.
        • et al.
        The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
        N Engl J Med. 2004; 350: 1005-1012
        • Nelson M.E.
        • Rejeski W.J.
        • Blair S.N.
        • et al.
        Physical activity and public health in older adults: recommendation from the American college of sports medicine and the American heart association.
        Circulation. 2007; 116: 1094
        • Mahler D.A.
        • Wells C.K.
        Evaluation of clinical methods for rating dyspnea.
        Chest. 1988; 93: 580-586
        • Horowitz M.B.
        • Littenberg B.
        • Mahler D.A.
        Dyspnea ratings for prescribing exercise intensity in patients with COPD.
        Chest. 1996; 109: 1169-1175
        • Gilbert AG.
        Creative dance for all ages.
        Human Kinetics, 2015
        • Cohen J.
        The effect size.
        Stat Power Anal Behav Sci. 1988; : 77-83
        • Faul F.
        • Erdfelder E.
        • Lang A.G.
        • Buchner A.
        G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Kaltsatou A.
        • Kouidi E.
        • Fountoulakis K.
        • et al.
        Effects of exercise training with traditional dancing on functional capacity and quality of life in patients with schizophrenia: a randomized controlled study.
        Clin Rehabil. 2015; 29: 882-891
        • McCarthy B.
        • Casey D.
        • Devane D.
        • Murphy K.
        • Murphy E.
        • Lacasse Y.
        Pulmonary rehabilitation for chronic obstructive pulmonary disease.
        Cochrane Database Syst Rev. 2015;
        • Bishop J.A.
        • Spencer L.M.
        • Dwyer T.J.
        • McKeough Z.J.
        • McAnulty A.
        • Alison J.A.
        Changes in exercise capacity and health-related quality of life at four and eight weeks of a pulmonary rehabilitation program in people with COPD.
        COPD J Chronic Obstr Pulm Dis. 2021; 18: 612-620
        • Bhandari N.J.
        • Jain T.
        • Marolda C.
        • ZuWallack R.L.
        Comprehensive pulmonary rehabilitation results in clinically meaningful improvements in anxiety and depression in patients with chronic obstructive pulmonary disease.
        J Cardiopulm Rehabil Prev. 2013; 33
        • Gomes Neto M.
        • Menezes M.A.
        • Carvalho V.O.
        Dance therapy in patients with chronic heart failure: a systematic review and a meta-analysis.
        Clin Rehabil. 2014; 28: 1172-1179
        • Hackney M.E.
        • Earhart G.M.
        Effects of dance on movement control in Parkinson's disease: a comparison of Argentine tango and American ballroom.
        J Rehabil Med. 2009; 41: 475-481
        • Hill K.
        • Dolmage T.E.
        • Woon L.
        • Coutts D.
        • Goldstein R.
        • Brooks D.
        Defining the relationship between average daily energy expenditure and field-based walking tests and aerobic reserve in COPD.
        Chest. 2012; 141: 406-412
        • Beauchamp M.K.
        • Janaudis-Ferreira T.
        • Parreira V.
        • et al.
        A randomized controlled trial of balance training during pulmonary rehabilitation for individuals with COPD.
        Chest. 2013; 144: 1803-1810
        • Morlino P.
        • Balbi B.
        • Guglielmetti S.
        • et al.
        Gait abnormalities of COPD are not directly related to respiratory function.
        Gait Posture. 2017; 58: 352-357
        • Janyacharoen T.
        • Phusririt C.
        • Angkapattamakul S.
        • Hurst C.P.
        • Sawanyawisuth K.
        Cardiopulmonary effects of traditional Thai dance on menopausal women: A randomized controlled trial.
        J Phys Ther Sci. 2015; 27: 2569-2572
        • Angane E.Y.
        • Navare A.A.
        Effects of aerobic exercise on pulmonary function tests in healthy adults.
        Int J Res Med Sci. 2017; 4: 2059-2063
        • Gabriel D.
        • Kamen G.
        • Frost G.
        Neural adaptations to resistive exercise.
        Sports Med. 2006; 36: 133-149
        • Paiva D.N.
        • Assmann L.B.
        • Bordin D.F.
        • et al.
        Inspiratory muscle training with threshold or incentive spirometry: which is the most effective?.
        Rev Port Pneumol (Engl Ed). 2015; 21: 76-81
        • Nakamura Y.
        • Tanaka K.
        • Shigematsu R.
        • Nakagaichi M.
        • Inoue M.
        • Homma T.
        Effects of aerobic training and recreational activities in patients with chronic obstructive pulmonary disease.
        Int J Rehabil Res. 2008; 31: 275-283
        • Bernard S.
        • Whittom F.
        • Leblanc P.
        • et al.
        Aerobic and strength training in patients with chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 1999; 159: 896-901
        • Spruit M.
        • Gosselink R.
        • Troosters T.
        • De Paepe K.
        • Decramer M.
        Resistance versus endurance training in patients with COPD and peripheral muscle weakness.
        Eur Respir J. 2002; 19: 1072-1078
        • Lobo Y.B.
        • Winsler A.
        The effects of a creative dance and movement program on the social competence of head start preschoolers.
        Soc Dev. 2006; 15: 501-519
        • Merom D.
        • Grunseit A.
        • Eramudugolla R.
        • Jefferis B.
        • Mcneill J.
        • Anstey K.J.
        Cognitive benefits of social dancing and walking in old age: the dancing mind randomized controlled trial.
        Front. Aging Neurosci. 2016; 8: 26
        • Dodd J.W.
        • Hogg L.
        • Nolan J.
        • et al.
        The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study.
        Thorax. 2011; 66: 425-429
        • Cote C.
        • Celli B.
        Pulmonary rehabilitation and the BODE index in COPD.
        Eur Respir J. 2005; 26: 630-636
        • Harrison S.
        • Bierski K.
        • Burn N.
        • et al.
        Dance for people with chronic breathlessness: a transdisciplinary approach to intervention development.
        BMJ Open Respir Res. 2020; 7e000696
        • Rubí M.
        • Renom F.
        • Ramis F.
        • et al.
        Effectiveness of pulmonary rehabilitation in reducing health resources use in chronic obstructive pulmonary disease.
        Arch Phys Med Rehabil. 2010; 91: 364-368