Establishing the optimal frequency of dance movement for neurocognitive and physical outcomes in people at risk of Alzheimer's disease

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PROJECT SUMMARY Dance movement is a form of physical activity that may benefit the brain as much or more than structured aerobic exercise. Despite the potential of dance as an intervention to promote neurocognitive health, gaps in knowledge about essential intervention components are a barrier to definitive trials, specifically:1) a lack of specificity on key prescription parameters including how many times a week dance classes should be taught, 2) need for better estimates of how large an effect dance has on fitness and the brain, and 3) little understanding of the expected time course for change in fitness and the brain in response to dance. The primary aim of this proposal is to test whether weekly dance frequency differentially modifies key outcomes, and from this to test effect sizes to determine sufficient sample sizes for a larger-scale trial. Physical activity promoting interventions tested in older adults have traditionally focused on exercise, i.e., structured physical activity of at least moderate intensity with the express purpose of improving health or fitness. However, in 2003, epidemiological evidence showed that social dance was the only leisure time physical activity associated with lower Alzheimer’s disease risk. Since then, multiple smaller studies have shown benefits of dance movement and dance therapy on mobility and neurocognitive health in older adults, including cardiorespiratory fitness, balance, white matter health, and cognition. Dance movement inherently involves simultaneous cognitive stimulation through motor learning and dual-tasking; social interactions; aerobic physical activity that elevates heart rate and improves cardiorespiratory fitness; and improves balance and reduces fall risk. Dance also satisfies key antecedents of lasting behavior change outlined in contemporary behavioral theories including self-efficacy, intrinsic motivation, autonomy, and relatedness. Dance is also culturally relevant and has been practiced spontaneously for thousands of years. This means dance may result in better long-term adherence than more commonly studied forms of aerobic exercise like brisk walking, where data from our group and others shows that adherence drops significantly after intervention ends. This proposal plans to assess outcomes of 1x/weekly, 2x/weekly, and 3x/weekly dance movement classes and 1x/week music appreciation class control at 4 time-points over 6 months to determine the time course of changes in cardiorespiratory fitness, cognition, and key secondary outcomes in 160 adults ≥ 65 years old at risk for Alzheimer’s disease due to subjective cognitive decline. 1x/weekly is common for community classes and has been tested in multiple dance studies; 2x/weekly is most common in dance research; and 3x/weekly is most common for aerobic exercise interventions like treadmill walking that target CRF. We aim to determine the optimal frequency of dance movement intervention for a Phase III trial that will effect change in relevant outcomes while maintaining attendance.