Running Head: CREATIVE YOGANCE 1

DESIGNING A CREATIVE YOGANCE PROGRAM FOR HEALTHY AGING:

A Pilot Study on Phoebe Allentown Residents

Jacqueline DAmico
Karen Dearborn
Advance Research in Dance
12 December 2017
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Introduction

Today more than ever before, we are seeing an increase in the age of older

persons (Mandelbaum, Rosalin, Albert 2014). With this change in our national

demographic, there comes a need for more activities, therapies and preventative care

measures to maintain quality of life of those in the later stages of life. This older

population is on the rise and practitioners and caregivers need to know how to best care

for these individuals. As we age our body naturally undergoes many physical and mental

changes. Aging is defined as, a process whereby the structures and functions of the body

change after we reach reproductive maturity (Woodyard 2011). As this process is

gradual, these subtle and natural changes can for some time, go unnoticed. In time, they

can have a profound effect on how we act and react to the world around us. One negative

aspect of aging can be characterized by a cognitive decline and physical degradation of

muscles, joint, and bones. Physical activity among older adults needs to be fostered and

offered to make this aged years more enjoyable and allow people to keep their

independence longer and ultimately improve their mood and quality of life overall. Dance

offers exciting potential for promoting health and wellbeing, regardless of age or health

status.

As physicians and research teams continue to study the physical effects and well-

being of patients, many have found that non-pharmacological approaches may be more

beneficial for treatment rather than treatment with medications. For example, in

researching such approaches to treating and managing dementia, more practitioners might

consider the benefits of dance therapy for these patients. With the aging American

population, health practitioners have begun to shift their focus onto successful aging,
CREATIVE DANCE FOR HEALTHY AGING 3

which Hui and colleagues describes as the ability to maintain three key behaviors: (1) low

risk of disease and disease related ability, (2) high mental and physical function and (3)

active engagement with life. For those suffering with certain conditions, whether it is a

orthopaedic, deficit affecting the joints or bones, the heart or the brain, the effects of

dance on physical and psychological well-being in older persons is widely beneficial

(2009).

Purpose & Problem

Presently, my goal is to explore the BrainDance & chair-based yoga practice as a

creative movement intervention in the geriatric population. I will continue to review the

BrainDance and yoga in literature and find the gaps in current study. Currently, the

BrainDance as a creative dance outlet is under explored in current literature. Various

dance styles like contemporary dance, improvisational forms, and ballroom have been

explored. All practiced styles have seen benefits in physical, social, and mental aspects of

aging. For yoga, research is more extensive, however there are no works discussing the

affects of the Baptiste methodology as a chair-yoga modified practice. Both of the

movement forms I plan to implement in my healthy aging program have many

similarities to current forms researched, however I argue that this new fusion of dance

and yoga practices will benefit older adults and add to existing literature on healthy aging

movement activities. I am tasked with creating a creative yogance curricula based on

Anne Green Gilberts creative dance lesson plans, focusing on her BrainDance exercise,

in addition to adapting the Baptiste yoga methodology for a chair-based practice. Lastly,

once the program creation, implementation at a local nursing home and analysis have
CREATIVE DANCE FOR HEALTHY AGING 4

been complete, I plan to discuss and explain the future of and limitations of present

research.

Assumptions

Due to my personal bias, affinity towards sharing somatic practice with all bodies,

my passion for yoga and creative dance in general, and as per current literature I have

already examined; I acknowledge the assumptions I have in creating, teaching, and

analyzing this creative yogance program. First, I assume that combining a chair-based

yoga class and BrainDance will be a healthy and beneficial movement program for aging

bodies. I also assume that these practices will positively affect mood, quality of life

measures and have physical, mental and emotional implications as per similar dance and

yoga-based studies.

Hypothesis

My working hypothesis is as follows: I hypothesize that the combined movement

intervention of creative dance and chair-based yoga as compared to a single intervention

of either treatment will have a greater benefit on promoting healthy aging practices for an

older, physically-inactive population with improvements in mood, measures of quality

life and other physical measures.

Delimitations & Limitations

I will be focusing my current research work on residents at the Phoebe Allentown,

a local healthcare facility that provides a variety of outpatient and short-term

rehabilitation services, and supportive care for older adults. I have limited my literature to

studies from the past 15 years, as this is a newer field of interest in health and medicine.
CREATIVE DANCE FOR HEALTHY AGING 5

Additionally, as full-time student completing her final semester of college, I will be

tasked with a plethora of other academic responsibilities, which may limit the time and

energy I have available to wholly dedicate to this work.

Secondly, limitations begin with the restricted access to articles and literature

covering BrainDance as a movement practice specifically. Various yoga styles, primarily

Hatha Yoga, have been explored in pilot studies, clinical trials and other interventions,

however the Baptiste methodology has yet to be explored for this specific age-range. In

addition to little empirical and quantitative research covering these specific topics, time,

financial support, and IRB approval may limit the scope of my work.

Definition of terms

The first term in a working list of words t to clarify for my audience is Continuing

Care Retirement Community (CCRC), as defined by the American Seniors Housing

Associations, is senior living community which provides housing, healthcare, and other

supportive services starting at independent living, nursing home care until hospice

arrangements (Zarem 2010). Combination of nursing homes, assisted livings, and similar

living situations for older adults, aged 65 and older. Though not specifically advertised as

a CCRC, I believe that Phoebe Allentown is an organization that caters to seniors

healthcare & assistive needs in this way by offering a variety of living options, in-patient

and outpatient rehabilitation services, nursing care, and respite care (About Us n.d.).

The following terms define the movement practices that I am centering my

intervention program on and have been adapted as per my personal experience through

Muhlenberg Colleges teaching dance theory course and my RYT-200hr certification in

the Baptiste Methodology. Anne Green Gilberts BrainDance, as defined by the Creative
CREATIVE DANCE FOR HEALTHY AGING 6

Dance Center, is a series of exercised comprised of eight developmental movement

patterns that healthy human beings naturally move through in the However, working

through these patterns at any age or ability has been found to be beneficial in

reorganizing central nervous system and enlivening neurological pathways. My own

working definitions states its purpose as a holistic movement exercise practice that targets

targeting the physical, social, emotional, intellectual body. Next, my working definition

of the yoga-based intervention is inspired by the Baptiste methodology, which is a

Vinyasa style of teaching based in Hatha Yoga teachings. The focus of this methodology

addresses empowerment and self-discovery through physical practice, strong breath

support, and self-inquiry as well. For my own work, as these classes are extremely

aerobic and often done in a heated room, the specific sequencing of postures will be

adapted and modified using a chair or other assistive devices as props. Lastly, my own

in progress definition of quality of life, addresses overall well-being, encompasses

positive & negative aspects of physical, emotional, and mental health.

Mode of inquiry, methodology, and procedures

The beginnings of this research began with exploring PsychINFO and Google

Scholar databases following the search of these key words: yoga, dance, aging,

elderly, treatment. This search was conducted to obtain general information on the

current literature covering potential case studies, pilot tests, and other works addressing

these topics. Subsequently, a second and third search involved a narrowing of my

research concerns to the following key words: quality of life, creative dance,

happiness, therapeutic effects of yoga. My methodology will consist of a pre-post

CREATIVE DANCE FOR HEALTHY AGING 7

intervention designs, surveys, and questionnaires. I plan to have at least 5-10 residents to

partake in my weekly program. At most, I posit a curriculum of 2 classes per week.

Dependent upon the population available to me at the Phoebe Home, I may restrict

participation

The current study is a pilot study aimed at examining the impact

of a 6-session creative dance workshop (Everyday waltzes programme) on

the quality of life (QOL) in a group of 10 persons with dementia.

Review of important literature

In Activities for the Older Adult: Integration of the Body and the Mind, the

author provides a comprehensive overview of a mergence of physical education

programs, recreational activities and dance that provide older adults with tools for better

quality of life and promoting independent living in later years of life. She covers

movement practices like hatha yoga, Tai Chi, Feldenkrais Method, to name a few and

briefly covers their positive effects for older movers (Birkel 1998).

In Dancing as a psychosocial intervention in care homes: A systematic review of

the literature, dance therapy introduced to long-term care facilities to help people

recovering from dementia. Previous research saw an increase in health and social activity.

Other studies that looked at the influence of various dances: line dance, circle dance, and

ballet showed that patients felt like there was a community and their socialization

improved. A review of several studies done in the DMT field looking at the benefits in

patients with dementia. Overall saw an increase in mood, cognition, communication, and

socialization (GuzmnGarca, Hughes, James, & Rochester 2013).

CREATIVE DANCE FOR HEALTHY AGING 8

In A mixed methods evaluation of complementary therapy services in palliative

care: yoga and dance therapy, yoga, The Lebed Method (TLM) and both interventions in

combination were explored on an older population of cancer patients. Primary concerns

were problems with mobility/fitness, breathing, difficulty relaxing, and fear/anxiety with

reports of psycho-spiritual, physical and social benefits (Selman & Williams 2011).

In New framework for rehabilitation - fusion of cognitive and physical

rehabilitation: the hope for dancing this article questions the efficacy of dance as a

combined therapy for neurorehabilitation programs. This was a comprehensive review of

60+ references looking more toward the cognitive implications of dance for healthy

individuals and those with cognitive impairments as well (patients of stroke, dementia,

PD, etc.). They posit dance as an enjoyable therapy intervention that aids both physical

and cognitive functioning that can lead to greater recall, longer memory spans, increased

social interaction, more refined motor skills, and integrating music for a greater cognitive

benefit. They reiterated that the physical benefits of dancing on older persons are well

known and noted the following limitations or gaps in research: (a) cognition specifically

is less studied as it requires more advance protocol measures like neuroimaging

techniques and would require long-term interventions that have yet to be piloted; (b) it is

unclear how dance is perceived among healthcare professionals as recreation versus a

valid therapy intervention, and therefore could help to explain why dance as a combined

therapy is limited; (c) few studies have compared dance to other exercise interventions;

(d) even fewer studies have looked at the efficacy of different styles of dance, which

researchers believe can only be researched further after dancing, in general, is proven

(Dhami, Moreno, & Desouza 2015).

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References

About Us. Phoebe, Phoebe Ministries, phoebe.org/about-us/.

Bowling, A., Hankins, M., Windle, G., Bilotta, C., & Grant, R. (2013). Older People's

Quality of Life Questionnaire--Brief Version [Database record]. Retrieved from

PsycTESTS. doi: http://dx.doi.org/10.1037/t28733-000

Cruz-Ferreira, A.,Marmeleira, J., Formigo, A., Gomes, D., & Fernandes, J. (2015).

Creative Dance Improves Physical Fitness and Life Satisfaction in Older Women.

Research on Aging, 37(8), 837-855. doi: 10.1177/0164027514568103

Dee Ann Green Birkel (1998) Activities for the Older Adult: Integration of the Body and

the Mind, Journal of Physical Education, Recreation & Dance, 69:9, 23-28, DOI:

10.1080/07303084.1998.10605626

Dhami, P., Moreno, S., & Desouza, J. F. (2015). New framework for rehabilitation -

fusion of cognitive and physical rehabilitation: the hope for dancing. Frontiers in

Psychology, 5, 1-15. doi:10.3389/fpsyg.2014.01478.

Duane, B. (2016). Incorporating Dance Training in Hip Fracture Recovery: A Case

Study. NATIONAL DANCE SOCIETY JOURNAL, 1(1), 11-17. Retrieved December

1, 2017.

Gilbert, Anne Green. BrainDance. Creative Dance Center, Creative Dance Center,

https://www.creativedance.org/about/braindance/

Gin-Garriga, M., Guerra, M., Mar-Dell'Olmo, M., Martin, C., & Unnithan, V. B.

(2009). Modified Timed Get Up and Go Test [Database record]. Retrieved from

PsycTESTS. doi: http://dx.doi.org/10.1037/t23752-000

CREATIVE DANCE FOR HEALTHY AGING 10

GuzmnGarca, A., J. C. Hughes, I. A. James, and L. Rochester. 2013. "Dancing as a

psychosocial intervention in care homes: A systematic review of the literature."

International Journal Of Geriatric Psychiatry 28, no. 9: 914-924.

Hui E. Chui BT-k, Woo J: Effects of dance on physical and psychological well-being

in older persons. Arch Gerontol Geriatr. 2009;49(1):e45e50. doi:

10.1016/j.archger.2008.08.006.

Hwang PW-N. The effectiveness of dance interventions to improve older adults' health: a

systematic literature review. Altern Ther Health Med. 2015;21(5):64.

Mandelbaum, Rosalind, and Albert C. Lo. 2014. "Examining dance as an intervention in

Parkinsons disease: A systematic review." American Journal Of Dance Therapy 36,

no. 2: 160-175.

Schlotz, W., Yim, I. S., Zoccola, P. M., Jansen, L., & Schulz, P. (2011). Perceived Stress

Reactivity Scale [Database record]. Retrieved from PsycTESTS. doi:

http://dx.doi.org/10.1037/t11928-000

Selman LE, Williams J. A mixed methods evaluation of complementary therapy services

in palliative care: yoga and dance therapy. Euro J Cancer Care. 2011;21:8797. doi:

10.1111/j.1365-2354.2011.01285.x.

Sze Yan Tay1 , Christopher Gabriel1 , Simon Kang Seng Ting2 , Shahul Hameed2 , 1

Singapore General Hospital, Singapore, Singapore; 2 National Neuroscience

Institute (SGH Campus), Singapore, Singapore.

Tew, G. A., Howsam, J., Hardy, M., & Bissell, L. (2017). Adapted yoga to improve

physical function and health-related quality of life in physically-inactive older

CREATIVE DANCE FOR HEALTHY AGING 11

adults: a randomised controlled pilot trial. BMC Geriatrics, 17, 131.

http://doi.org/10.1186/s12877-017-0520-6.

Thornberg, K., Lindquist, I., & Josephsson, S. (2012). Experiences of healthy elderly

participating in a creative dance workshop. Advances in Physiotherapy, 14(2), 71-

77. doi:10.3109/14038196.2012.662696.

Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase

quality of life. International Journal of Yoga, 4(2), 4954. doi: 10.4103/0973-

6131.85485

Zarem, Jane E, editor. Todays Continuing Care Retirement Community (CCRC). July

2010. https://www.seniorshousing.org/filephotos/research/CCRC_whitepaper.pdf

Annotated Bibliography

Cruz-Ferreira, A.,Marmeleira, J., Formigo, A., Gomes, D., & Fernandes, J. (2015).

Creative Dance Improves Physical Fitness and Life Satisfaction in Older

Women. Research on Aging, 37(8), 837-855. doi: 10.1177/0164027514568103

The purpose of this study was to look at the effects of a creative dance
intervention on physical fitness and quality of life measures for older women specifically.
Reasoning for choosing a female population came from past research that women show a
decrease in physical fitness sooner than men. Of the various dance styles found to also
improve physical function and other related factors, creative dance seems to be the least
explored. A randomized control design was used to assess effectiveness of creative dance
for these measures. Creative dance has several main objectives of developing body &
space awareness, exploring time dynamic and relationships that make this methodology
distinct from other forms studied (i.e. Argentine tango, jazz dance, etc). For the
experimental group, 50-minute sessions, meeting 3x a week, lasting 24 weeks, were held.
Outcome measures were taken at baseline, at 12 weeks, and at 24 weeks. Results indicate
that at both Week 12 and 24, the experimental group demonstrated better physical fitness
and reported higher life satisfaction as compared to the control group.
CREATIVE DANCE FOR HEALTHY AGING 12

I chose this article because it looked specifically at creative dance, which is a

style of dance I am most interested in at this point in my undergraduate teaching career.
The general design of this experiment is what I may hope to model, should I make it this
far. Their hypothesis and results seem to match many other studies I have come across, so
I am still stuck in a place of finding whats missing.

GuzmnGarca, A., J. C. Hughes, I. A. James, and L. Rochester. 2013. "Dancing as

a psychosocial intervention in care homes: A systematic review of the

literature." International Journal Of Geriatric Psychiatry 28, no. 9: 914-924.

PsycINFO, EBSCOhost(accessed October 1, 2016).

This intervention cover dance therapy as it was introduced to long-term care

facilities, especially to help for people recovering from dementia and other cognitive
declines. Previous studies saw an increase in health and social activity among this
population where the influence of various dance styles like line dance, circle dance, and
ballet showed that patients reported a sense of community and their social skills
improved as well. Ultimately, this provided a review of several studies done in the DMT
field looking at the benefits in patients with memory-related/cognitive decline. Overall
saw an increase in mood, cognition, communication, and socialization.

Hui E. Chui BT-k, Woo J: Effects of dance on physical and psychological well-being

in older persons. Arch Gerontol Geriatr. 2009;49(1):e45e50. doi:

10.1016/j.archger.2008.08.006.

In this article, samples of 111 older Chinese volunteers were recruited for this
study. Participants were between the ages of 60-75 years old, had intact cognitive
functioning, able to move with or without a walking device, and have not danced
regularly. A dance group (IG) and control group (CG) were created respectively, though
the groups were not randomized. They considered their intervention to be a low impact
aerobic dance intervention that was taught in 12 weeks, for 23 sessions, and 50-minutes
per session (10 min. of warming up, 30 min. of dance with periods of rests in between,
ending with a10 min. to cool down). The physical (balance, gait, strength, endurance,
etc.) in addition to QofL measures were taken as with the many studies in current
literature. However, their results did not yield similar findings in literature (Hwang et al.,
Cruz-Ferreira et al.). No significant improvements in balance, flexibility, or lower limb
strength were found between IG and CG. They presuppose that this was due to their CG
CREATIVE DANCE FOR HEALTHY AGING 13

doing higher intensity exercise regularly, though not dance-specific. This would support
that level of dance class intensity affects overall results. Novel to their study, that I have
yet to come across in research thus far, was use of self-report to qualitatively assess the
participants involvement; (1) Is dancing helpful in improving your physical fitness? And
(2) Is dancing helpful in improving your psychological health? Each question was rated
according to a five-point Likert-scale (1 = not helpful to 5 = extremely helpful) (e48).

Hwang PW-N. The effectiveness of dance interventions to improve older adults'

health: a systematic literature review. Altern Ther Health Med. 2015;21(5):64.

In this review, authors reviewed 18 articles (originally, 260 in total, before the
article selection process) in current literature to look at various dance interventions for
older adults. Key words used were dance, aged, older adults. Final articles were
ultimately chosen based on quality of the research, intervention design, physical health
outcomes and attrition rates. Dance styles were varied including ballroom, contemporary,
jazz, and cultural dance like Turkish folklore, Greek and line dancing. Ages and gender
of participants varied as well, where majority of participants were consistently female.
Measurements of muscular strength and endurance and balance were studied most closely
and positive outcomes in these categories were found. Only 1 article found that a dancing
intervention did not improve some measure of physical fitness. Ultimately, dance
interventions increase the physical fitness of older adults that allows them to perform
daily tasks more independently.
I chose this review as means to use their references as jumping off points of other
work. This was published fairly recently and included articles from 1990-2008.It was
helpful in starting to look for the gaps in scientific study. Currently, there are few
standardized measurements used consistently. There is a lack of participation in and men
and inability to control for nutrition in addition, is a current limitation.

Tew, G. A., Howsam, J., Hardy, M., & Bissell, L. (2017). Adapted yoga to improve

physical function and health-related quality of life in physically-inactive older

adults: a randomised controlled pilot trial. BMC Geriatrics, 17, 131.

http://doi.org/10.1186/s12877-017-0520-6

This was a randomized controlled pilot study. There was both an intervention and
control group to be used as comparison. Looking specifically at inactive-older adults,
researchers sought to find the physical and psychological benefits of a short-term yoga
program for this specific population; and look at the efficacy in aiding the physical,
social and mental well being of older people. All participants were generally healthy
CREATIVE DANCE FOR HEALTHY AGING 14

with few conditions to report. The intervention lasted 12 weeks, 1 class per week, 75
minutes per class. They were group-based classes that used physical postures, with the
support of a chair, and breath in practice. Exercises were always modified and catered to
the individual to support an autonomous experience. Home-based programs were also
given and encouraged to complete as supplemental to the weekly class. I liked this
article the most, because it included both an experimental and control group. In this way,
it was easier to believe and follow how this yoga intervention was successful and could
be accepted for further research. Participants in the intervention group scored higher on
standing balance, chair sit-to-stand, and 4-m walking time measures. They were also
interviewed to gain some qualitative feedback, where most reported a range of physical,
mental, and social benefits.
I chose this article to include because of its intervention design and outcome
measures. I am currently back and forth about which movement-based intervention I
might want to look at more closely. Few studies have been done on creative dance
specifically, but yoga is very well covered for examples. I could combine findings and
posit a yogance (yoga dance) intervention and see the implications of merging the
practices.

Thornberg, K., Lindquist, I., & Josephsson, S. (2012). Experiences of healthy elderly

participating in a creative dance workshop. Advances in Physiotherapy, 14(2),

71-77. doi:10.3109/14038196.2012.662696.

The aim of this study was to develop knowledge of older persons experiences of
participating in a creative dance workshop. This was a qualitative design using an
interpretative narrative method of assessing participants involvement through the lens of
physiotherapy. Participants were all physically active and healthy. This intervention
involved movement and reflection as a two-part creative dance practice. They shared
personal stories/memories accompanied with physical movements that ultimately led to
increased perception of quality of life. This study looked only at the cognitive and
physiological implications of aging. No physical fitness outcomes were measured.
I choose the article because it was novel in its approach to studying dance and the
aging body. This was the only article thus far that has used improvisation as a structure
for the dance intervention. They are also looking specifically at a bodymind
connectedness for older persons that I have not read much about.

Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to

increase quality of life. International Journal of Yoga, 4(2), 4954. doi:

10.4103/0973-6131.85485
CREATIVE DANCE FOR HEALTHY AGING 15

This was another review of current literature that addressed the therapeutic
benefits of yoga. A comprehensive review was formed. Its purpose was to introduce
the reader the Hatha yoga tradition and assert its presence in Western medicine as an
alternative therapy that benefits many physical and psychological aspects of the
human body increase muscular strength, flexibility, reduce stress and anxiety,
depression, etc. Ultimately, I feel this article covered the surface level of what I hope
to research. It was fairly general, but specific in which article/study it was referencing
so organization of the whole was good. As I reread the text, I feel this would be
beneficial in including it in my introduction to define terms and provide background
information. It also provides specific effective sequencing that could integrate into
my proposed project.