Dance-based versus conventional exercise in pulmonary rehabilitation: a retrospective service evaluation

Purpose

Pulmonary rehabilitation (PR) is well recognised for improving exercise tolerance and health related quality of life (HRQoL) in people with chronic obstructive pulmonary disease (COPD). Attendance and completion rates remain sub-optimal. Dance is an effective approach to exercise in other chronic disease populations. A dance-based PR programme was introduced in January 2019 as an alternative to conventional PR in an attempt to address long-standing challenges of adherence and completion within the borough of Tower Hamlets. The service evaluation aimed to explore whether a Latin dance-based programme resulted in improvements in exercise tolerance and HRQoL, as compared with a conventional programme running concurrently. Further, to determine any differences in completion rates between the two programmes.

Completion rates were higher in the dance-based PR programme
compared with the conventional programme.
There were no differences
in outcome measures between programmes

Approach

People referred to Barts Health PR services between February and May 2019, with a diagnosis of COPD who were enrolled onto a PR programme at one particular site, were included in the service evaluation. The two concurrent PR programmes were identical, other than the style of aerobic exercise. Both comprised an eight-week rolling programme of twice weekly, two-hourly supervised sessions. Progression was achieved by increasing total continuous aerobic exercise time and titration of intensity using self-reported dyspnoea. The dance routine was choreographed by the physiotherapist leading the programme based on characteristics of Latin dance. Music was standardised across both programmes, using a selection of popular music from 1960s to 1990s. Outcome measures included the incremental shuttle walk test (ISWT) or six-minute walk test (6MWT), COPD Assessment Test (CAT) as a measure of HRQoL and PR completion rates. Owing to a change in service protocol during the time-frame of the service evaluation, differing measures of exercise tolerance were used in the two groups.

Outcomes

Results: Five and 11 people enrolled onto the dance and conventional programmes respectively. No statistically significant differences were identified in baseline characteristics between programmes. During the evaluation period, four people successfully completed the dance-based PR programme and five people completed conventional PR. No statistically significant differences were identified either within- or between- groups for the measures tested. Median change in exercise tolerance following PR was 47.5m in the dance group (ISWT) and 35.0m in the conventional group (6MWT). Median change in the CAT was -2 in the dance group and +1 in the conventional group. Both groups achieved the minimal clinically important difference (MCID) in their respective measures of exercise tolerance. The dance group also met the MCID for the CAT. Completion rate was 34.5% higher in the dance group.

Conclusion(s): Although there were no differences in outcome measures between programmes, completion rates were higher in the dance-based PR programme compared with the conventional programme. Caution should be exercised in interpreting this finding due to the limitations of a small retrospective, single centre service evaluation.

Cost and savings

There were no additional staffing or equipment costs incurred. The cost of venue hire for the newly established dance-programme was planned and budgeted for within the service.

Implications

Exploring alternative ways of delivering a PR service that meets local needs should remain a priority to community providers. For example, the local population of Tower Hamlets has a large Bangladeshi community. Future studies could consider the use of traditional Bangladeshi dance with the aim of optimising engagement.

Top three learning points

No further information. 

Funding acknowledgements

The author’s MSc dissertation with University College London was funded by Barts Charity.