A standard ballroom and Latin dance program to improve fitness and adherence to physical activity in individuals with type 2 diabetes and in obesity

Felice Mangeri, Luca Montesi, Gabriele Forlani, Riccardo Dalle Grave, Giulio Marchesini, Felice Mangeri, Luca Montesi, Gabriele Forlani, Riccardo Dalle Grave, Giulio Marchesini

Abstract

Objective: To test the effectiveness of a dance program to improve fitness and adherence to physical activity in subjects with type 2 diabetes and obesity.

Research design and methods: Following a motivational interviewing session, 100 subjects with diabetes and/or obesity were enrolled either in a dance program (DP, n = 42) or in a self-selected physical activity program (SSP, n = 58), according to their preferences. Outcome measures were reduced BMI/waist circumference, improved metabolic control in type 2 diabetes (-0.3% reduction of HbA1c) and improved fitness (activity expenditure >10 MET-hour/week; 10% increase in 6-min walk test (6MWT)). Target achievement was tested at 3 and 6 months, after adjustment for baseline data (propensity score).

Results: Attrition was lower in DP. Both programs significantly decreased body weight (on average, -2.6 kg; P < 0.001) and waist circumference (DP, -3.2 cm; SSP, -2.2; P < 0.01) at 3 months, and the results were maintained at 6 months. In DP, the activity-related energy expenditure averaged 13.5 ± 1.8 MET-hour/week in the first three months and 14.1 ± 3.0 in the second three-month period. In SSP, activity energy expenditure was higher but highly variable in the first three-month period (16.5 ± 13.9 MET-hour/week), and decreased in the following three months (14.2 ± 12.3; P vs. first period < 0.001). At three months, no differences in target achievement were observed between groups. After six months the odds to attain the MET, 6MWT and A1c targets were all significantly associated with DP.

Conclusion: Dance may be an effective strategy to implement physical activity in motivated subjects with type 2 diabetes or obesity (Clinical trial reg. no.NCT02021890, clinicaltrials.gov).

Figures

Figure 1
Figure 1
Time course of activity-related energy expenditure in subjects enrolled in the dance program (black circles) or in the self-selected physical activity program (white circles). Data are expressed and mean and 95% confidence interval. Note the much wider confidence interval in the self-selected program, expression of very high variability.

References

    1. American Diabetes Association. Executive summary: Standards of medical care in diabetes--2013. Diabetes Care. 2013;36(Suppl 1):S4–S10.
    1. Montesi L, Moscatiello S, Malavolti M, Marzocchi R, Marchesini G. Physical activity for the prevention and treatment of metabolic disorders. Intern Emerg Med. 2013;8:655–666.
    1. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677–1686.
    1. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33:e147–e167.
    1. Zhao G, Ford ES, Li C, Balluz LS. Physical activity in U.S. older adults with diabetes mellitus: prevalence and correlates of meeting physical activity recommendations. J Am Geriatr Soc. 2011;59:132–137.
    1. Ekkekakis P, Lind E. Exercise does not feel the same when you are overweight: the impact of self-selected and imposed intensity on affect and exertion. Int J Obes (Lond) 2006;30:652–660.
    1. Helitzer DL, Peterson AB, Sanders M, Thompson J. Relationship of stages of change to attendance in a diabetes prevention program. Am J Health Prom. 2007;21:517–520.
    1. Biddle SJ, Fox KR. Motivation for physical activity and weight management. Int J Obes Relat Metab Disord. 1998;22(Suppl 2):S39–S47.
    1. Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N, Santeusanio F, Brunetti P, De Feo P. Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Diabetes Care. 2003;26:404–408.
    1. The Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002;25:2165–2171.
    1. Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N, Ranchelli A, Fatone C, Taglioni C, Santeusanio F, De Feo P. Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care. 2005;28:1295–1302.
    1. Balducci S, Zanuso S, Nicolucci A, De Feo P, Cavallo S, Cardelli P, Fallucca S, Alessi E, Fallucca F, Pugliese G. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES) Arch Intern Med. 2010;170:1794–1803.
    1. Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? J Am Diet Assoc. 2007;107:92–99.
    1. Ford ES, Herman WH. Leisure-time physical activity patterns in the U.S. diabetic population. Findings from the 1990 National Health Interview Survey–Health Promotion and Disease Prevention Supplement. Diabetes Care. 1995;18:27–33.
    1. Lee RE, Mama SK, Medina A, Orlando Edwards R, McNeill L. SALSA: SAving Lives Staying Active to Promote Physical Activity and Healthy Eating. J Obes. 2011;2011:436509.
    1. Kattenstroth JC, Kolankowska I, Kalisch T, Dinse HR. Superior sensory, motor, and cognitive performance in elderly individuals with multi-year dancing activities. Front Aging Neurosci. 2010;2:pii:31.
    1. Miller WR, Rollnick S. Motivational Interviewing. 2. New York: The Guilford Press; 2002.
    1. Associazione Medici Diabetologi, Società Italiana di Diabetologia. Cura del diabete. In: AMD-SID, editor. Standard Italiani per la Cura del Diabete Mellito 2009–2010. Torino: Infomedica; 2010. pp. 29–70.
    1. Forlani G, Lorusso C, Moscatiello S, Ridolfi V, Melchionda N, Di Domizio S, Marchesini G. Are behavioural approaches feasible and effective in the treatment of type 2 diabetes? A propensity score analysis vs. prescriptive diet. Nutr Metab Cardiovasc Dis. 2009;19:313–320.
    1. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;2011(43):1575–1581.
    1. Enright PL. The six-minute walk test. Respir Care. 2003;48:783–785.
    1. Spiller V, Scaglia M, Meneghini S, Vanzo A. Assessing motivation to change towards healthy nutrition and regular physical activity. Validation of two sets of instruments. Mediterr J Nutr Metab. 2009;2:41–47.
    1. Centis E, Trento M, Dei Cas A, Pontiroli AE, De Feo P, Bruno A, Sasdelli AS, Arturi F, Strollo F, Vigili De' Kreutzenberg S, Invitti C, Di Bonito P, Di Mauro M, Pugliese G, Molteni A, Marchesini G. Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes. Acta Diabetol. 2014. e-Pub Jan 20.
    1. Centis E, Moscatiello S, Bugianesi E, Bellentani S, Fracanzani AL, Calugi S, Petta S, Dalle Grave R, Marchesini G. Stage of change and motivation to healthier lifestyle in non-alcoholic fatty liver disease. J Hepatol. 2013;58:771–777.
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38–48.
    1. Miller WR. Motivational interviewing with problem drinkers. Behav Psychother. 1983;11:147–172.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.
    1. Rubin DB. The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials. Stat Med. 2007;26:20–36.
    1. Duncan DB. Multiple range test for correlated and heteroscedastic means. Biometrics. 1957;13:164–204.
    1. Johnson NA, Keating SE, George J. Exercise and the liver: implications for therapy in fatty liver disorders. Semin Liver Dis. 2012;32:65–79.
    1. St George A, Bauman A, Johnston A, Farrell G, Chey T, George J. Independent effects of physical activity in patients with nonalcoholic fatty liver disease. Hepatology. 2009;50:68–76.
    1. Montesi L, Caselli C, Centis E, Nuccitelli C, Moscatiello S, Suppini A, Marchesini G. Clinical Audit: Physical activity support or weight loss counseling for nonalcoholic fatty liver disease? World J Gastroenterol. 2014. in press.
    1. Moscatiello S, Di Luzio R, Bugianesi E, Suppini A, Hickman I, Di Domizio S, Dalle Grave R, Marchesini G. Cognitive-behavioral treatment of non-alcoholic fatty liver disease: a propensity score-adjusted observational study. Obesity (Silver Spring) 2011;19:763–770.
    1. Moscatiello S, Di Luzio R, Sasdelli AS, Marchesini G. Managing the combination of nonalcoholic fatty liver disease and metabolic syndrome. Expert Opin Pharmacother. 2011;12:2657–2672.
    1. Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR, Fava JL, Wing RR. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51:121–129.
    1. Schmidt MD, Freedson PS, Chasan-Taber L. Estimating physical activity using the CSA accelerometer and a physical activity log. Med Sci Sports Exerc. 2003;35:1605–1611.
    1. Di Blasio A, De Sanctis M, Gallina S, Ripari P. Are physiological characteristics of Caribbean dance useful for health? J Sports Med Phys Fitness. 2009;49:30–34.
    1. Olson MS, Williford HN, Blessing DL, Greathouse R. The cardiovascular and metabolic effects of bench stepping exercise in females. Med Sci Sports Exerc. 1991;23:1311–1317.
    1. Wigaeus E, Kilbom A. Physical demands during folk dancing. Eur J Appl Physiol Occup Physiol. 1980;45:177–183.
    1. Vivarelli C, Chiarandini G, Zadro I, Antonutto G, Tuniz D. Estimated energy expenditure in elderly subjects during ballroom dancing. Med Sport. 2008;61:429–442.
    1. Blanksby BA, Reidy PW. Heart rate and estimated energy expenditure during ballroom dancing. Br J Sports Med. 1988;22:57–60.
    1. Herzig KH, Ahola R, Leppaluoto J, Jokelainen J, Jamsa T, Keinanen-Kiukaanniemi S. Light physical activity determined by a motion sensor decreases insulin resistance, improves lipid homeostasis and reduces visceral fat in high-risk subjects: PreDiabEx study RCT. Int J Obes (Lond) 2013. e-Pub Nov 28.
    1. Vähäsarja K, Salmela S, Villberg J, Rintala P, Vanhala M, Saaristo T, Peltonen M, Keinänen-Kiukaanniemi S, Korpi-Hyövälti E, Kujala UM, Moilanen L, Niskanen L, Oksa H, Poskiparta M. Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes: a cross-sectional analysis within a community-based diabetes prevention project FIN-D2D. BMC Public Health. 2012;12:514.
    1. D'Agostino RB Jr. Propensity scores in cardiovascular research. Circulation. 2007;115:2340–2343.
    1. Hibbard JH, Tusler M. Assessing activation stage and employing a "next steps" approach to supporting patient self-management. J Ambul Care Manage. 2007;30:2–8.
    1. Ma J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG, Stafford RS. Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. Arch Intern Med. 2012;9:1–9.

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