Tango for treatment of motor and non-motor manifestations in Parkinson's disease: A randomized control study

https://doi.org/10.1016/j.ctim.2015.01.015Get rights and content

Highlights

  • Argentine tango can improve balance in patients with Parkinson's disease.

  • There was no benefit of tango on motor severity of Parkinson's disease.

  • Tango has modest benefits upon cognition and fatigue.

  • Tango classes are highly enjoyable and give overall satisfaction.

  • The social aspects that emerged from the tango classes have positive effects.

Summary

Objective

To determine effects of Argentine tango on motor and non-motor manifestations of Parkinson's disease.

Design

Randomized control trial.

Participants

Forty patients with idiopathic Parkinson's disease.

Setting

Movement disorder clinic and dance studio.

Intervention

Two randomized groups: group (N = 18) with 24 partnered tango classes, and control self-directed exercise group (N = 15).

Main outcomes measures

The primary outcome was overall motor severity. Secondary outcomes included other motor measures, balance, cognition, fatigue, apathy, depression and quality of life.

Results

On the primary intention-to-treat analysis there was no difference in motor severity between groups MDS-UPDRS-3 (1.6 vs.1.2-point reduction, p = 0.85). Patient-rated clinical global impression of change did not differ (p = 0.33), however examiner rating improved in favor of tango (p = 0.02). Mini-BESTest improved in the tango group compared to controls (0.7 ± 2.2 vs. −2.7 ± 5.9, p = 0.032). Among individual items, tango improved in both simple TUG time (−1.3 ± 1.6 s vs. 0.1 ± 2.3, p = 0.042) and TUG Dual Task score (0.4 ± 0.9 vs. −0.2 ± 0.4, p = 0.012), with borderline improvement in walk with pivot turns (0.2 ± 0.5 vs. −0.1 ± 0.5, p = 0.066). MoCa (0.4 ± 1.6 vs. −0.6 ± 1.5, p = 0.080) and FSS (−3.6 ± 10.5 vs. 2.5 ± 6.2, p = 0.057) showed a non-significant trend toward improvement in the tango group. Tango participants found the activity more enjoyable (p < 0.001) and felt more “overall” treatment satisfaction (p < 0.001). We found no significant differences in other outcomes or adverse events.

Conclusion

Argentine tango can improve balance, and functional mobility, and may have modest benefits upon cognition and fatigue in Parkinson's disease. These findings must be confirmed in longer-term trials explicitly powered for cognition and fatigue.

Introduction

Parkinson's disease (PD) is characterized by motor dysfunction including tremor, rigidity, bradykinesia, and gait dysfunction, often contributing to falls.1, 2, 3 In addition, PD patients experience many non-motor manifestations, including cognitive, mood and sleep abnormalities.4, 5, 6, 7 These non-motor manifestations are major contributors to disability and impaired quality of life.8 There is accumulating evidence that habitual physical activity is associated with lower risk of developing PD1, 9 suggesting potential slowing of PD progression.10 Regular exercise also improves gait speed, strength, and functional capacity and reduces falls.11 Tai chi training appears to improve balance and functional capacity in mild-to moderate PD.12

Evidence for effects of exercise on many non-motor manifestations of PD is limited. Moreover, traditional exercise programs are often unappealing for patients with PD,13 and over half of do not meet the recommended daily level physical activity.1 Low expectations of benefit, lack of time, and fear of falling are important barriers to exercise participation among ambulatory, community-dwelling persons with PD.13

There is a connection between music and dopaminergic systems pivotal for establishing and maintaining behavior.14 Music-induced emotional states increase reward signals via ventral tegmental area dopamine release, partially explaining how musical experiences can be such potent pleasurable stimuli.15 Combining music with exercise in dance can therefore increase accessibility, enjoyability, and motivation, as well as improving mood and stimulating cognition.

In the general population, maintaining a regular schedule of dancing into old age is associated with preservation of cognitive, motor and perceptual abilities.16, 17, 18, 19 Musical exercise improves cognitive function, mood and behavior in patients with all stages of Alzheimer's disease suggesting that dancing interventions are potentially far more than entertainment activity.20, 21, 22, 23

Argentine tango may be particularly helpful for improving balance and functional mobility in patients with PD.24 Tango's technique requires specific steps that rhythmically entrain forwards/backwards walking; so it may be particularly useful for freezing of gait, and prevention of falls in the backward direction.25, 26 In addition, tango requires working memory, control of attention, and multitasking to incorporate newly learned and previously learned dance elements, stay in rhythm with the music, and maneuver around others on the dance floor.27 This may vary somewhat, depending on the instructor and type of tango (e.g. traditional Argentine tango vs. contemporary electro tango). One of the tango's specific benefits is that dancer must not necessarily rely on specific dance elements he/she has to memorize (although it would help to dance); dancer can do it on a more easy and nevertheless enjoyable way, as well. Finally, social interaction and social supports involved in dance programs may have positive results on mood and compliance.27, 28 Consistent with these possibilities, small trials in normal elderly and in PD patients have suggested improvements in balance, complex gait, spatial cognition, and executive function.27, 29, 30, 31

To further assess potential benefits of tango, we designed a 12 week randomized study of Argentine tango in PD, focusing on both motor and non-motor manifestations of PD.

Section snippets

Methods

This was a two-arm 12-week pilot study assessing tango classes compared to controls (self-directed exercise). This study was authorized by the research ethics board of the McGill University Health Center. All participants gave a written informed consent. This trial was registered with clinicaltrials.gov NCT01573260.

Results

Patient flow is presented in Fig. 1. Recruitment was conducted between August 2012 and April 2014. A total of 40 patients were screened, and 33 randomized. Nine protocol violations occurred: 2 in the controls and 7 in the tango group. 1 control had a relapse in radiculopathy and dropped out because he could not continue with home exercise, and a second (control) dropped out without clear explanation. Among the tango patients, 6 protocol violations occurred because of failure to attend at least

Discussion

In this randomized controlled trial, we found no clear benefit of Argentine tango upon motor severity of PD. However, among secondary outcomes, we found significant improvement of balance, particularly in dual task Timed Up and Go, and borderline improvements in cognition and fatigue.

Although our results suggested no motor benefit of tango, results must be interpreted with caution. Previous studies have suggested that tango training improves motor symptoms particularly after longer training

Conclusions

In summary, our findings suggest potential benefit of Argentine tango upon balance, functional mobility and satisfaction of care, with possible modest benefits on cognition and fatigue. However, there were no significant changes in overall motor severity of disease. These findings must be confirmed in separate longer-term trials explicitly powered to assess effects upon non-motor manifestations of disease.

Funding

This study was supported by grants to Dr. R. Postuma from the Parkinson Society of Canada (grant #4641) and the Fonds de recherché santé Québec.

Conflict of interest statement

Dr. Ronald B. Postuma received personal compensation for travel and speaker fees from Novartis Canada and Teva Neurosciences, and is funded by grants from the Fonds de la Recherche en Santé du Québec, the Parkinson Society of Canada, the Webster Foundation, and by the Canadian Institutes of Health Research.

The authors declared no potential conflicts of interest related to the study.

Acknowledgements

The authors would like to thank Alain Guillot and Cheryl Williams for teaching tango classes, all volunteers from Danceconmigo studio especially Guy Blanchard, and all patients and their family members for their participation in this study.

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