Journal of Women & Aging
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjwa20
The influence of low-impact dance intervention on
bone metabolism, cognition, and function fitness
of old women
Chung Bing Yang, Chin Hsing Hsu, Chih Neng Huang & Te Hung Tsao
To cite this article: Chung Bing Yang, Chin Hsing Hsu, Chih Neng Huang & Te Hung Tsao (2021):
The influence of low-impact dance intervention on bone metabolism, cognition, and function fitness
of old women, Journal of Women & Aging, DOI: 10.1080/08952841.2021.1942766
To link to this article: https://doi.org/10.1080/08952841.2021.1942766
Published online: 05 Jul 2021.
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JOURNAL OF WOMEN & AGING
https://doi.org/10.1080/08952841.2021.1942766
The influence of low-impact dance intervention on bone
metabolism, cognition, and function fitness of old women
Chung Bing Yanga, Chin Hsing Hsub, Chih Neng Huangc, and Te Hung Tsaod
a
Department of Physical Education and Kinesiology, National Dong Hwa University, Hualien, Taiwan; bDepartment of
Recreational Sports and Health Promotion, National Pingtung University of Science and Technology, Pingtung,
Taiwan; cPhysical Education Office, National Taiwan Ocean University, Keelung, Taiwan; dCenter for Exercise and
Health EducationNational Sun Yat-Sen University, Kaohsiung, Taiwan
ABSTRACT
KEYWORDS
This study examined the low-impact dance intervention on the markers of
bone metabolism, cognitive function, and functional fitness of postmeno­
pausal women. Senior women were randomized into low-impact dance (LG)
or control group (CG). Three dance sessions weekly were scheduled in the LG
for 16 weeks. The markers of bone metabolism, bone composition, Stroop
test, and functional fitness were assessed at pre- and post-intervention. The
marker of bone formation, some of cognitive function and functional fitness
were improved in the LG. The low-impact dance intervention benefited the
marker of bone formation, parts of cognitive function and functional fitness.
Weight-bearing exercise;
bone mineral density; lean
body mass
Introduction
It goes without saying that the reduction of bone mineral content is unavoidable with aging. The speed
is gradually faster in bone resorption than in bone formation after the peak age of bone growth, that is,
bone mineral density (BMD) starts to decline at the fourth or fifth decade of human (Khosla & Riggs,
2005). Furthermore, postmenopausal women are faster and earlier than old men in the speed and time
of bone loss at the same age so that the number of bone fracture occurs more frequently in
postmenopausal women (Johnell & Kanis, 2006). On the other hand, exercise can improve this
negative bone condition by attenuating the speed of bone loss (Wen et al., 2017).
Among exercises, the intervention of regular weight-bearing exercises, for example, stepping,
running, resistance training, improved the markers of bone formation and resorption (Karabulut et
al., 2011; Wen et al., 2017). However, several studies found that the engagement of high-impact or intensity training or exercise possibly led to a negative influence on bone mineral content or bone
metabolism of young adults (Barry & Kohrt, 2008; Hughes et al., 2014). Therefore, low-impact
exercises at lower intensity are considered as potential options for weak or sedentary old adults
when they begin to exercise because low-impact exercises, for example, low-impact dance and Tai
Chi Chun, demonstrated similar benefits in BMD, muscular strength, balance, and glucose and lipid
metabolism to higher-impact or intensity exercises (Wayne et al., 2012; Wu et al., 2016). However, the
information concerning the change in the markers of bone formation and resorption by a low-impact
dance intervention is little.
In recent decades, the loss of cognitive function and the occurrence of dementia are important
issues for middle- and old-aged adults (Prince et al., 2013). The studies indicated that a decrease in
cognitive function with aging could be attenuated via the intervention of regular exercise (Chang et al.,
2012; Voss et al., 2013). Therefore, the intervention of regular exercises benefits not only bone health
CONTACT Te Hung Tsao
t1208t2001@gmail.com
Center for Exercise and Health Education of Si Wan College, National Sun
Yat-Sen University, 70 Lienhai Rd., Kaohsiung 80424, Taiwan, R.O.C
© 2021 Taylor & Francis
2
C. B. YANG ET AL.
but also cognitive function. Among exercises, the studies concerning the effect of dance intervention
on cognitive function of old adults are few and equivocal (Merom et al., 2016; Thogersen-Ntoumani et
al., 2017). In fact, dance is very popular among old adults (Hunt et al., 2001). Taken the aforemen­
tioned studies collectively, although the studies indicated that the intervention of low-impact dance
improved lower-extremities’ strength and blood lipids, the influence of bone metabolism by lowimpact dance intervention has been examined scarcely. Also, the change in cognitive function by lowimpact dance intervention is worth exploring. Therefore, this study was to investigate the effect of lowimpact dance on the markers of bone metabolism and cognition. On the other hand, functional fitness
would be examined at the same time in this study because there was a significant association between
functional fitness and activities of daily life of old adults (De Souza Santos et al., 2011). The hypothesis
of this study was that bone metabolism, cognitive function, and functional fitness were improved by
the intervention of low-impact dance.
Methods
Participants
This study was approved by Institutional Review Board (IRB) of the local hospital. On the basis of the
change in bone alkaline phosphatase (ALP) for 3−5% at 0.05 level in the study by Karabulut et al.
(2011), this study required 18 participants (9 participants for each group) to participate in this study
for an 80% of statistical power at a significant level of 0.05. Postmenopausal female participants
(ascertained by the same gynecologist) who were sedentary (accumulated daily steps <5000) were
recruited by phone, e-mail, word of mouth or posters in the community bulletin boards. The
individuals who were younger than 45 years old or chronic metabolic or cardiovascular diseases or
musculoskeletal diseases or took any hormone-related medicine for menopause within the six months
before the study were excluded. Finally, this study recruited 28 volunteers because of the possibility of
drop-out. All participants (n = 28) were randomly assigned to low-impact dance group (LG, n = 14) or
control group (CG, n = 14) by a computerized random number generator after providing their written
informed consent. For lifestyle, the participants in the CG and LG were instructed to maintain the
same lifestyle as previously and refrain from any structured exercise or physical activity during the
investigation. However, no low-impact dance class in the CG was different from the LG with lowimpact courses in physical activity. Regarding the diet, all participants were required to maintain their
eating habits during the experimental period.
Low-impact dance program
The low-impact dance classes were arranged three nonconsecutive days each week (for example,
Monday, Wednesday, or Saturday) during a 16-week. The duration for each class was 60 min,
consisting of a 5-min warm-up, 50-min main class, and 5-min cooling down. The stretches were the
main exercise in the warm-up and cooling down sections. The movements for the lower body in lowimpact dance classes included side-stepping, walking forwards and backwards, circling, lifting the legs,
tiptoeing with the foot to the front, side, and rear, crossing, and heel raises. For the movements of
upper body, there were stretch, circle, shrug, abduction, adduction, and circumduction. The same
dance instructor was responsible for instructing during the entire low-impact dance classes. The heart
rates during all low-impact dance classes were measured using Polar S610i (Kempele, Finland), besides
playing music during each class.
Bone metabolism markers
Before the start and after the completion of low-impact dance intervention, fasting blood samples
(following a fast of at least 10 h overnight) were collected from each participant. The blood sample
JOURNAL OF WOMEN & AGING
3
collection time should be at least 72 h before the start and after the end of low-impact dance program,
respectively. After clotting at room temperature, all blood samples were centrifuged at 3000 rpm for
10 min. The concentrations of bone alkaline phosphatase (ALP) (Ostase, Boldon, UK) and C-terminal
cross-linking telopeptide (CTX) (CrossLaps, Boldon, UK) were analyzed using an enzyme-linked
immunosorbent assay (ELISA). The sensitivity of the kit for ALP and CTX was 0.5 ug/L and 0.1 ng/
mL, respectively. The intra- and inter-assay coefficients of variation (CVs) were <6% for these two
biochemistry variables.
Body composition and bone mass density
Body fat percentage, lean body mass, and bone mass density (BMD) were measured before and after
dance intervention and the time points for the assessments were the same. The above-mentioned
assessments were performed by the same licensed operator using DXA (QDR-Explorer, Hologic, MA,
USA). Each participant was scanned for whole body in a supine position. The measurement of lumbar
spine (mean L1–L4) was the representative of BMD, in which the BMD was expressed as T-score and
classified as normal, low bone mass, osteoporosis or severe osteoporosis according to the criteria
(World Health Organization [WHO], 1994). Before measuring, DXA equipment was calibrated on the
basis of the manufacturer instructions.
Cognition measurement
The assessment of cognition had two parts. The first part was the Mini-Mental State Examination
(MMSE) test for one time, during which participants provided their written informed consent. The
second part was the Stroop test for two times, which were scheduled at pre- and post-impact dance
program, respectively. The higher in scores, the better in the MMSE and Stroop tests. First, the
participants had the MMSE assessment for understanding whether there was any problem for their
cognition condition or not and the result of this part displayed that all participants were normal (the
score was higher than 25). Next, the Stroop test has three experimental conditions: congruent, neutral,
and incongruent. In a congruent condition, the word of the color (six colors) matched with the same
color (e.g., the words “red,” “green,” “blue,” “orange” “yellow” and “purple” were presented in red,
green, blue, orange, yellow, and purple ink colors, respectively). In a neutral condition, the word of the
color was presented in black color ink, for example, red presented in black. In an incongruent
condition, the word of the color was presented in different color, for example, “red” presented in
one of the other five colors ink, but not repeated. In the congruent and neutral conditions, the
participant was asked to identify the corresponding word in each color and black color, respectively.
In the incongruent condition, the participants were asked to identify the corresponding word in the
ink (The word “red” was displayed in blue. The correct answer for the participant was blue). The test
was required to perform as quickly and correctly as possible. The response time and accuracy were
further analyzed.
Functional fitness
The 30-second chair stand, chair sit-and-reach, and 2-min step tests were assessed for lower-body
muscular strength, flexibility, and aerobic capacity, respectively. The order of these three tests was the
30-second chair stand, chair sit-and-reach, and 2-min step test, in which the rest between the tests was
a 10-min. On a “start” signal during the 30-second chair stand, the participants rose to a full standing
position from a chair (43 cm high) and then returned to a fully seated position; they completed as
many full stands as they could in 30 seconds. Throughout the trial, the participants crossed their arms
at the wrist and held against the chest.
With respect to the chair sit-and-reach test, the participant sat on the edge of a chair, with one leg
bent and the other leg extended straight in front with the heel on the floor. Without bending the knee,
4
C. B. YANG ET AL.
the participant slowly reached forward, sliding the hands down the extended leg trying to touch the
toes. Each participant made two tries and an interval of a 3-minute was between the two test trials. The
best distance achieved between the extended fingers and the tip of the toe was the result of this
variable.
The two-minute step test began by customizing minimum knee-stepping height for each partici­
pant. The qualified step could be counted as the height of knee each step at least above the middle
between the kneecap and the front hip bone (iliac crest). When the participant heard “start,” she began
to step (not run) in place as many times as she could within a 2-min period. The total number of
qualified steps by the participant completing was calculated by a tally counter.
Statistical analysis
All data were expressed as mean ± standard deviation (SD) and analyzed for the normality of
distribution by Kolmogorov-Smirnov test (p> .05). The variables at pre-intervention were analyzed
by unpaired samples t-test. After the intervention, the variables were analyzed using multiple general­
ized estimation equation models to test for the main effect and interaction between the factors. When a
significant difference was identified, a Tukey post hoc was utilized for further analyses. The correlations
between the variables were assessed with Pearson correlation coefficients. A p value less than .05 was
regarded as the level of statistical significance. All statistical procedures were conducted using the SPSS
package (version 18, SPSS Inc., Chicago, IL).
Results
All participants completed the whole study without injuries or adverse responses to the low-impact
dance occurring. The study flowchart is displayed in Figure 1.
Table 1 shows the age, body fat percentage, lean body mass, and T-score of BMD of the LG and CG.
Before the intervention of low-impact dance, there were similarities for the variables between the two
groups. After the completion of the intervention, the T-score did not show a significant time, group or
interaction effect. For the body fat percentage and lean body mass, the LG was significantly lower and
higher than the CG (p < .05) at post-intervention, respectively. In addition, the body fat percentage
and lean body mass in the LG were significantly decreased and increased at post-intervention
compared with at pre-intervention by 10% and 8%, respectively. The average heart beats per minute
during low-impact dance classes were 103.1 ± 8.6 beats/min. During the experiment, the participation
and completion rates for each participant in the low-impact dance class were over 95%.
With respect to the markers of bone metabolism, the ALP levels in the LG were significantly higher
than those in the CG after the program completion. In addition, the ALP levels in the LG were
significantly higher at post-intervention than at pre-intervention by 18% (Table 2). However, the ALP
levels in the CG did not show a significant difference between pre- and post-intervention. On the other
hand, the CTX levels, either in the LG or CG, did not show a significant difference between pre- and
post-intervention (Table 2).
Cognitive function
The Stroop test had three assessments, congruent, neutral, and incongruent conditions, in this study.
Before the intervention of low-impact dance, the response times to the three conditions showed
similarities between the LG and CG (Table 3). After the intervention, the response times to the
congruent and neutral conditions, no significant difference was found between the two groups
although the average response times to the two conditions in the LG were shorter than before the
intervention. For the response time to the incongruent condition, the LG was significantly shorter than
the CG. Furthermore, the response time to the incongruent trial in the LG showed significantly shorter
post- compared with pre-intervention by 12%. On the other hand, the accuracy rate (%) of the Stroop
JOURNAL OF WOMEN & AGING
Contacted and
Interviewed (n = 45)
Did not reply or younger than 45 yrs (4)
Although no regular exercise, daily
steps > 5000 steps (7)
Chronic or musculoskeletal diseases (6)
Recruited
(n =28)
Baseline
(n =28)
Measurements:
Body composition
Blood collection
Cognitive function
Functional fitness
Randomization
(n =28)
LG
(n = 14)
CG
(n = 14)
16 weeks
intervention
LG
(n = 14)
CG
(n = 14)
Post-intervention measurement
(the same as at baseline)
Figure 1. The study design and flow chart. LG: low-impact dance group, CG: control group.
5
6
C. B. YANG ET AL.
Table 1. The age and body composition at pre- and post-intervention.
LG (n = 14)
Age (years)
Years of postmenopause
MSSE
Body fat %
Lean body mass (kg)
T-score of BMD
CG (n = 14)
LG (n = 14)
66.9 ± 4.0
16.5 ± 3.7
26.8 ± 1.4
30.1 ± 5.4
37.7 ± 4.0
−0.71 ± 0.52
26.5 ± 5.9*,#
40.8 ± 4.1*,#
−0.67 ± 0.50
Pre
67.5 ± 3.6
15.7 ± 4.4
27.0 ± 1.2
29.0 ± 6.3
38.6 ± 3.9
−0.66 ± 0.47
CG (n = 14)
Post
G
>.05
>.05
>.05
<.05
=.05
>.05
30.2 ± 5.1
37.5 ± 4.1
−0.79 ± 0.48
p-Value
T
G×T
<.05
<.05
>.05
<.05
<.05
>.05
*Significantly different from the CG at post-intervention, #Significantly different from the value in the LG at pre-intervention. LG: lowimpact dance group, CG: control group. BMD: bone mineral density. G: group effect, T: time effect, G × T: an interaction effect
between group and time. MSSE: Mini-Mental State Examination.
Table 2. The markers of bone formation and resorption at pre- and post-intervention.
LG (n = 14)
ALP (ug/L)
CTX (ng/mL)
Pre
20.5 ± 3.8
0.37 ± 0.13
CG (n = 14)
LG (n = 14)
19.2 ± 2.3
0.39 ± 0.24
25.0 ± 5.0*,#
0.35 ± 0.20
Post
CG (n = 14)
18.4 ± 2.9
0.36 ± 0.14
P-value
T
<.00
>.05
G
<.00
>.05
G×T
<.05
=.71
*Significantly different from the CG at post-intervention, #Significantly different from the value in the LG at pre-intervention. ALP:
alkaline phosphatase, CTX: C-terminal crosslinking telopeptide. LG: low-impact dance group, CG: control group. G: group effect, T:
time effect, G × T: an interaction effect between group and time.
Table 3. The three conditions of Stroop test.
LG (n = 14)
Congruent (sec)
Neutral (sec)
Incongruent (sec)
2.00 ± 0.30
1.96 ± 0.31
3.91 ± 0.47
Pre
CG (n = 14)
LG (n = 14)
1.99 ± 0.42
1.75 ± 0.25
3.79 ± 0.56
1.99 ± 0.31
1.88 ± 0.29
3.12 ± 0.46*,#
Post
CG (n = 14)
2.03 ± 0.44
1.72 ± 0.31
3.82 ± 0.46
P-value
T
>.05
>.05
<.01
G
>.05
>.05
<.05
G×T
>.05
>.05
<.05
*Significantly different from the CG at post-intervention; #Significantly different from the value in the LG at pre-intervention. LG: lowimpact dance group, CG: control group. G: group effect, T: time effect, G × T: an interaction effect between group and time.
test did not show a significant difference within the same conditions between pre- and post-low impact
dance in the LG or CG (data not shown).
Functional fitness
After the completion of the experiment, the chair sit-and-reach did not show a significant time, group
or interaction effect. On the other hand, the 30-s chair stand and 2-min step tests in the LG at postintervention were significantly higher compared with the values at pre-intervention by 36% and 15%,
respectively. In addition, these two variables were also significantly higher in the LG than in the CG at
post-intervention (Table 4).
Regarding the relationship between the measured variables, the change in the response time to the
incongruent condition and the change in lean body mass between pre- and post-intervention
Table 4. The functional fitness at pre- and post-intervention.
LG (n = 14)
30-s chair stand (times)
Chair sit-and-reach (centimeters)
2-min stepping (times)
16.7 ± 4.3
6.5 ± 9.7
91.0 ± 20.0
Pre
CG (n = 14)
LG (n = 14)
17.9 ± 2.4
5.8 ± 7.7
93.2 ± 17.9
22.0 ± 5.0 *,#
11.0 ± 9.3
101.8 ± 27.3*,#
Post
CG (n = 14)
17.0 ± 2.8
9.7 ± 7.9
85.5 ± 28.2
G
=.06
=.31
=.05
P-value
T
<.05
>.05
<.01
G×T
=.05
=.57
<.05
*Significantly different from the CG at post-intervention. #Significantly different from the value in the LG at pre-intervention. LG: lowimpact dance group, CG: control group. G: group effect, T: time effect, G × T: an interaction effect between group and time.
JOURNAL OF WOMEN & AGING
7
significantly correlated in the LG (r = −0.83, p < .05). For the relationships between the changes in
other measured variables at pre- and post-intervention, no significant association was found.
Discussion
The primary findings of this study were that the marker of bone formation, ALP, increased, and the
response time to the incongruent condition of the Stroop test was improved in the sedentary
participants after 16 weeks of low-impact dance. In addition, the lower-body muscular strength (30second chair stand test) and aerobic capacity (2-min stepping test) were also enhanced in the LG
compared with the counterparts without the low-impact dance class.
This is the first study to examine whether the low-impact dance influences the markers of bone
metabolism. With respect to bone metabolism, the marker of bone formation, ALP, displayed a
significant increase in the LG after the intervention. This positive result was the same as the studies
which investigated the effect of resistance exercise and resistance exercise with blood flow restric­
tion (Karabulut et al., 2011), and combined aerobic and resistance exercise on ALP concentrations
(Lester et al., 2009). In the current study, the increase percentage (18%) for ALP levels in the LG
was similar to the results of studies by Karabulut et al. (23% and 21% by resistance exercise and
resistance exercise with blood flow restriction, respectively) and Lester et al. (16% and 15.8% by
resistance exercise and combined resistance and aerobic exercise, respectively), respectively. For the
CTX levels, the marker of bone resorption did not significantly differ within the same group or
between different groups at post-intervention, which was in line with the studies displaying no
significant difference for CTX levels after the intervention of the exercises (Karabulut et al., 2011;
Lester et al., 2009). Based on the findings (Ricard & Veatch, 1990), the impact during the first
50 milliseconds, the highest impact force, mean loading rate, and mean impact impulse of lowimpact dance were significantly lower than those of high-impact aerobic dance. Furthermore, no
jump movement was included or allowed in low-impact dance. Therefore, this study suggested that
the intervention of low-impact dance benefitted an increase in the marker of bone formation
similar to those above-mentioned exercises, but no negative influence on the marker of bone
resorption.
Regarding the factor for the change in ALP due to the intervention of exercise, Chilibeck et al.
(2005) proposed that increased muscle mass via combined resistance exercise and creatine supple­
mentation generated more strain on bone during muscle contraction and thus stimulated bone
formation. In this study, the increases in ALP levels as well as in lean body mass in the LG upon the
completion of the experiment were found. However, no significant association was found between
increased lean body mass and elevated ALP levels after the analysis. Therefore, the study cannot make
the same conclusion as the study by Chilibeck et al. and further studies are needed for investigating the
factors for the change of bone formation and resorption during the low-impact dance or exercise
intervention.
On the other hand, despite a significant increase in ALP with no obvious decrease in CTX, it did not
reflect a positive change in BMD in the LG. No significant alteration in BMD in this study was different
from the studies by Kemmler et al. (2010) and Marques et al. (2013), who reported a significant
increase in BMD after 18 months of multiple exercises intervention and 32 weeks of resistance
exercise, respectively, but the same as the studies by Ryan et al. (1994) investigating 16 weeks of
strength training intervention. From the above studies, different invention durations between those
and this studies for the divergence in BMD seemed an issue. After analyzing and comparing with the
other and current studies, a 16-week low-impact dance class might not be long enough to observe the
change in BMD. Therefore, the investigations of low-impact dance with a longer intervention period
on BMD in combination with the markers of bone metabolism in the blood at the same time are
warranted. On the other hand, as mentioned previously, the impact in low-impact dance was lower
than the exercises being performed in other studies. Despite a similar change in ALP by low-impact
dance to other exercises, no data with respect to the impact of low-impact dance in comparison with
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C. B. YANG ET AL.
that of other exercises on BMD has been reported. Therefore, further research for mechanisms
influencing BMD and bone metabolism by the intervention of low-impact dance is warranted.
Cognition function
The research indicated that a decline in cognitive function with aging could be attenuated by the
intervention of exercises, for example, strength training (Chupel et al., 2017), Tai Chi (Taylor-Piliae et
al., 2010), and aerobic exercise (Jonasson et al., 2017). As mentioned previously, dance was a popular
exercise among old adults; however, the studies regarding the effect of dance intervention on cognition
of postmenopausal women were few. In this study, the congruent and neutral conditions did not
significantly differ in the LG or CG after the intervention compared with before the intervention. On
the other hand, the response time to an incongruent condition was significantly shorter in the LG than
in the CG after the intervention and the LG showed obviously faster at post-intervention compared
with at pre-intervention by 12%. This suggested that the inhibition part of cognitive function
improved in the group with low-impact dance intervention, which was similar to the study by
Kosmat and Vranic (2017), but different from the study by Merom et al. (2016). Possible reasons
for the difference were as follows. First, the differences in participants’ fitness and physical activity
between the studies were worth noting. Scherder et al. (2014) suggested that physical activity level
before an exercise intervention played an important factor in cognition improvement for old adults
after an exercise intervention. Fit or active individuals before an exercise intervention may have little
progression in the improvement of cognition after an exercise intervention (Hollmann et al., 2007). In
addition, participants with or without dance experience before dance intervention were a concern. The
characteristics of participants in this study were similar to those in the study by Kosmat and Vranic
(2017), which recruited old sedentary adults without dance or any physical activities. On the contrary,
more than half of the participants in the study by Merom et al. (2016) were fit with dance experience
before the intervention. The conflicting result may be explained in part by the active participants with
regular dance experience vs. sedentary individuals without dance experience.
This study found that the change in the response time to the incongruent condition was
associated with the change in lean body mass between pre- and post-intervention in the LG. This
finding was novel in postmenopausal women; however, two previous studies (Kosmat & Vranic,
2017; Merom et al., 2016) did not mention the change in body composition. Rodríguez-Fernández et
al. (2017) investigated a decline of cognitive function in elderly individuals and found that lean body
mass was related with reduced risk of cognitive decline. In addition, the change in cognitive function
in patients with stroke positively correlated with the change in fat-free mass induced by the
intervention of combined aerobic and resistance training program (Marzolini et al., 2013). These
results displayed that an improvement in cognitive function was associated with an increase in lean
body mass, which was similar to the finding in this study. With respect to possible mechanism or
connectivity between lean body mass and cognition, it may be beyond the scope of this study and
further studies are necessary. On the other hand, dance has been regarded as an excellent activity for
maintaining or improving cognitive function (Brown et al., 2006; Merom et al., 2016). The reasons
were as follows. First, individuals learned and memorized dance movements and sequences and
synchronized them with music during dance, which stimulated cognitive function (Foster, 2013).
Second, there was an additive effect on cognition while motor learning and music were combined
together (Satoh et al., 2014). Thirdly, dance promoted social engagement and interaction, which
benefitted cognitive function of old people (Brustio et al., 2018; Thogersen-Ntoumani et al., 2017).
Finally, one recent study (Tsuji et al., 2019) concluded that the risk of cognition impairment could
be attenuated by exercise group participation. Collectively, the above-mentioned features benefitting
cognitive function were included in the low-impact dance classes and they might be factors for the
improvement of cognition. However, these were the conjectures of this study because these features
were not objectively assessed. Further studies for the speculations and the relationship between lean
body mass and cognition are warranted.
JOURNAL OF WOMEN & AGING
9
Functional fitness
In the current study, the 30-second chair stand and 2-min step tests in the LG after the intervention
were significantly higher compared with the variables before the intervention and the same variables in
the CG after the intervention. These results were similar to the studies examining the effect of lowimpact dance and the other exercise on functional fitness (Engels et al., 1998; Zhao et al., 2017). The
research reported that an elevation in lower extremities’ strength due to the intervention of exercise
training could contribute to the enhancement of functional fitness in middle-aged and elder indivi­
duals (Mazini Filho et al., 2018). In this study, the 30-second chair stand test was the representative of
lower-extremity strength in functional fitness and displayed a significant improvement in the LG at
post-intervention. In addition, the knee extension torque significantly increased in the sedentary
individuals with a 16-week low-impact dance intervention than the same counterparts without the
intervention of low-impact dance (Wu et al., 2016). Consequently, this study concluded that the lowimpact dance improved the functional fitness of postmenopausal women by increasing their lower
extremities’ strength.
In the present study, the body fat percentage and lean body mass in the LG displayed significantly
improved compared with those in the CG after the end of the low-impact dance. The positive results in
the current study were the same as the findings by the studies (Cugusi et al., 2016; Krishnan et al., 2015),
which found a decrease and increase in body fat percentage and muscle mass, respectively. Combined
increased energy expenditure by regular low-impact dance classes and maintained habitual diet
probably led to a negative energy balance after the intervention compared with before the intervention,
which might play a role in the improvements in the body fat percentage and lean body mass of the LG.
However, this was our speculation and the main limitation of this study because we did not collect the
data regarding dietary intake or energy consumption by low-impact dance or physical activity. All
participants were required to refrain from any structured exercise or physical activity and maintain the
same eating habits as previously during the experiment, except for the LG engaging in low-impact dance
classes. Despite all participants complying with those requirements and being asked whether any
relevant change in physical activity or diet habits, this pilot study would be better if this study provided
energy intake or consumption data. Therefore, further studies recruiting more participants with the
longer period intervention of low-impact dance along with collecting the data of energy intake and
consumption on BMD and the markers of bone metabolism in the blood are necessary.
In conclusion, a 16-week low-impact dance program may benefit the marker of bone formation,
some parts of cognition and functional fitness, and body composition. The change in lean body mass
in association with cognition was similar to other studies. In addition, an increase in lean body mass is
beneficial for older adults. Due to apparent declines in lean body mass, muscle strength, and BMD in
older individuals, the preliminary findings in the current study can be an area of interest for further
exploration in possible mechanisms or connections between lean body mass and bone metabolism and
cognition via a more extended intervention of a low-impact dance.
Disclosure statement
No potential conflict of interest was reported by the authors.
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