The effects of creative dance based exercise training on respiratory, balance and cognitive functions, respiratory and peripheral muscle strength and functional capacity in patients with chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the main causes of high mortality and morbidity all over the world; which is a common, treatable and preventable disease characterized by progressive and irreversible airflow limitation and has systemic effects besides respiratory system involvement. In patients, increased work of breathing, decreased of pulmonary function, peripheral and respiratory muscle strengths and functional capacity are as important contributors to exercise intolerance. Additionally; other extrapulmonary system problems focused on patients with COPD are affecting balance and cognitive functions. In the guidelines; the importance of multidisciplinary pulmonary rehabilitation (PR) programs for the management of the disease is emphasized and individualized exercise training is an essential component of these programs. In the literature; although there are many studies showing the beneficial effects of traditional exercise training programs in patients with COPD, it is reported that the participation and attendance rates of patients in these programs are low. Despite the potential benefits of creative dance-based exercise training, which is an alternative and innovative approach to increase the compliance and motivation of patients with the exercise program, have been shown in the literature, no study was found in which creative dance was used as an exercise training method in patients with COPD. Therefore; we planned this study to investigate the effects of creative dance-based exercise training on pulmonary, balance and cognitive functions, respiratory and peripheral muscle strength and functional capacity. Our study included 24 patients who were followed up with the diagnosis of COPD in Bezmialem Vakıf University, Faculty of Medicine, Department of Chest Diseases, who met the inclusion criteria and agreed to participate in the study on a voluntary basis. Patients were randomized into two groups as experimental and control. Body composition, pulmonary function test, Modified Medical Research Council Dyspnea Scale, COPD Assessment Test (CAT), BODE index, postural stability, limits of stability and sensory integration tests with Biodex Balance System® (BBS), Montreal Cognitive Assessment (MoCA), respiratory muscle strength, six-minute walking test (6MWT) and peripheral muscle strength measurements were performed of all patients. A home based chest physiotherapy program including diaphragmatic, chest and bilateral segmental breathing exercises, incentive spirometry (Triflo®), breathing control, relaxation positions and effective coughing techniques and physical activity recommendations was given to be repeated twice a day, five days a week for eight weeks to the patients in the experimental and control groups. In addition to this program, the patients in the experimental group received creative dance-based exercise training in Pulmonary Rehabilitation Education and Research Laboratory for eight weeks two days a week under the supervision of a physiotherapist who received creative dance instructor training. All evaluations were repeated at the end of eight weeks. SPSS v.26 program was used for data analysis. Shapiro-Wilk test was used to analyze whether the data showed a normal distribution. Analysis of qualitative variables was interpreted with the χ2-test. For numerical data with normal distribution: Paired Sample T-test was used for intragroup comparisons and Independent Samples T-test was used for intergroup comparisons. For non-normally distributed or ordinal data :Wilcoxon test for intragroup comparisons and Mann Whitney U test was used for intergroup comparisons. The significance level for all statistical tests was set at p<0,05. After eight weeks of training in the experimental group; CAT, BODE index and MoCA scores, all both measured and percent expected values of the pulmonary function test, maximum inspiratory and expiratory pressures (MIP-MEP), right and left M. Quadriceps and M. Biceps muscle strengths, and dominant and non-dominant hand grip strength, 6MWT distance and all parameters of postural stability,limits of stability and sensory integration tests of BBS significantly improved (p<0,05). In the control group; CAT, BODE index and MoCA scores, MIP and MEP values, 6MWT distance, only "medial/lateral" parameter of postural stability test and only "backward/left" parameter of limits of stability test of BBS significantly improved (p<0,05). In the intergroup comparisons of the tests; CAT and MoCA scores, all parameters of pulmonary function test, MEP value, all parameters of peripheral muscle strength, 6MWT distance, all parameters of postural stability and sensory integration tests and all parameters of the limits of stability test except for the right, forward/left and backward/left parameters was higher in the experimental group compared to the control group (p<0,05). As a result; we think that creative dance-based exercise training in COPD patients can be preferred as an alternative to traditional exercise training, as it is an enjoyable and interesting approach that increases motivation and participation rate. In addition, it shows that creative dance-based exercise training can be preferred as an aerobic exercise training method because of it does not require equipment and has exercise variety.