NEW YORK—September 12, 2006

Regardless of gender, generation or income group, more and more people are going to the dance floor for a workout versus a gym, and an exercise physiologist at New York City’s Hospital for Special Surgery - a leading center for sports medicine - thinks she knows why. “The best exercise program is one that is safe, balanced, promotes fitness and, importantly, one that people will do regularly because they enjoy it,” according to Polly de Mille, exercise physiologist at the Women’s Sports Medicine Center at Hospital for Special Surgery.

“The social aspects of dance help to make it very attractive for an increasing number of people versus, say, an elliptical training machine. Scientific studies are now also telling us that many things make dancing an excellent fitness regimen with attractive benefits,” de Mille said. Of course, balanced, targeted gym workouts can provide excellent fitness benefits as well, but for some people, the “fun factor” is missing at the gym.

“Those working out in gyms are often plugged into their iPods or their reading material, following their own regimen. Those dancing, however, are often moving in unison, possibly facing one another or touching, and having a communal experience. Connection and cooperation with others is integral to the experience,” she said.

Dance is also very good for balance and posture, according to Beth Shubin Stein, M.D., an assistant attending orthopedic surgeon in the Women’s Sports Medicine Center at Hospital for Special Surgery who is trained in sports medicine and shoulder surgery.

“Dance is also a great aerobic workout, and it tones many different muscle groups,” Dr. Shubin Stein said.

Popular TV programs like ABC-TV’s “Dancing with the Stars,” which returns for its third season September 12, underscore the romance and passion sometimes involved in dance. De Mille cautions, however, that people need to know their limits and pace themselves before considering some of the acrobatic moves seen on TV.

While dance may not be for everyone (de Mille personally finds regular runs in Central Park to be very calming) and a few precautions need to be kept in mind, she says studies clearly show that the health benefits of dance compared to gym workouts are impressive. Specifically: Dance movements are multi-directional versus the straight forward motion on treadmills, ellipticals, Stairmasters, etc. Joint mobility may benefit from the varied movements. One study demonstrated improved range of hip motion and flexibility of the spine on young adults who followed a three-month program of dance training.

Dance movements are weight-bearing and varied compared to a stationary bike. That is important for maintaining or improving bone density. Studies of recreational ballet dancers between the ages of 8-14 show higher bone mineral content in their hips and spine than in girls who did not dance.

Dance requires agility and balance as well as various speeds of movement, skills that are generally not a focus of typical gym workouts. Studies of older populations who engage in dance-based exercise programs demonstrate improvement in balance and agility. This may be important in reducing risks of falls in this population.

Dance is mentally stimulating, requiring focus on coordination and learning movement patterns. Most people will read, listen to music, or watch TV to alleviate the boredom associated with most indoor exercise equipment. Dance requires being mentally engaged with physical movement, a constant mind-body connection.

Emotional responses are common in dance and would rarely occur in a gym workout. The music, movement patterns and mental engagement involved in dance often evoke emotions. One study showed that breast cancer survivors who participated in a 12-week dance and movement program not only improved their shoulder range of motion, but also showed improvements in measures of body image and quality of life.

Dance also can be a substitute for a cardiovascular gym workout. Depending on the type of dance, it can be an excellent cardiovascular workout when done regularly. It would result in the same health benefits associated with any form of activity that involves sustained effort in the target heart rate zone, such as improved cardiovascular function, lipid metabolism, endurance and body composition.

De Mille advises people considering dance as fitness therapy to keep three key points in mind: Treat any pain first -- People should see their doctor and perhaps a physical therapist to have their pain issues diagnosed and treated properly. Pain is a warning signal that something may be wrong.

Wear good shoes -- Dance shoes often don’t have the kind of cushioning and support that other exercise shoes offer. Style should not completely replace sensibility. Dancers should be careful about the footwear they select.

Don’t get swept away — People can challenge themselves more than they should. As with any activity, pacing yourself, listening to your body and knowing your limits is important.

“From a mind-body perspective, anything you do successfully on the physical end will positively affect your mental and emotional states. Dancers have excellent posture, and just standing a little straighter can have a surprising transfer of power to your next board meeting or challenging conversation,” commented Jenny Susser, Ph.D., a sports psychologist at the Women’s Sports Medicine Center at HSS.

The first of its kind in the United States, the Women’s Sports Medicine Center at HSS is a nationally recognized health resource for active women of all ages and abilities, from eager novices to professional athletes.

Read an ABC News piece on dancing for fitness.

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the New York-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at New York-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

Use It or Lose It: Dancing Makes You Smarter
Richard Powers

For centuries, dance manuals and other writings have lauded the health benefits of dancing, usually as physical exercise. More recently we've seen research on further health benefits of dancing, such as stress reduction and increased serotonin level, with its sense of well-being.

Most recently we've heard of another benefit: Frequent dancing apparently makes us smarter.

A major study added to the growing evidence that stimulating one's mind by dancing can ward off Alzheimer's disease and other dementia, much as physical exercise can keep the body fit. Dancing also increases cognitive acuity at all ages.

You may have heard about the New England Journal of Medicine report on the effects of recreational activities on mental acuity in aging. Here it is in a nutshell.


The 21-year study of senior citizens, 75 and older, was led by the Albert Einstein College of Medicine in New York City, funded by the National Institute on Aging, and published in the New England Journal of Medicine. Their method for objectively measuring mental acuity in aging was to monitor rates of dementia, including Alzheimer's disease.

The study wanted to see if any physical or cognitive recreational activities influenced mental acuity. They discovered that some activities had a significant beneficial effect. Other activities had none.

They studied cognitive activities such as reading books, writing for pleasure, doing crossword puzzles, playing cards and playing musical instruments. And they studied physical activities like playing tennis or golf, swimming, bicycling, dancing, walking for exercise and doing housework.

One of the surprises of the study was that almost none of the physical activities appeared to offer any protection against dementia. There can be cardiovascular benefits of course, but the focus of this study was the mind.

There was one important exception: the only physical activity to offer protection against dementia was frequent dancing.

Reading - 35% reduced risk of dementia

Bicycling and swimming - 0%

Doing crossword puzzles at least four days a week - 47%

Playing golf - 0%

Dancing frequently - 76%. That was the greatest risk reduction of any activity studied, cognitive or physical.

Neuroplasticity

What could cause these significant cognitive benefits?

In this study, neurologist Dr. Robert Katzman proposed these persons are more resistant to the effects of dementia as a result of having greater cognitive reserve and increased complexity of neuronal synapses. Like education, participation in mentally engaging activities lowers the risk of dementia by improving these neural qualities.

As Harvard Medical School psychiatrist Dr. Joseph Coyle explains in an accompanying commentary: "The cerebral cortex and hippocampus, which are critical to these activities, are remarkably plastic, and they rewire themselves based upon their use."

Our brain constantly rewires its neural pathways, as needed. If it doesn't need to, then it won't.

Aging and memory

When brain cells die and synapses weaken with aging, our nouns go first, like names of people, because there's only one neural pathway connecting to that stored information. If the single neural connection to that name fades, we lose access to it. As people age, some of them learn to parallel process, to come up with synonyms to go around these roadblocks.

The key here is Dr. Katzman's emphasis on the complexity of our neuronal synapses. More is better. Do whatever you can to create new neural paths. The opposite of this is taking the same old well-worn path over and over again, with habitual patterns of thinking and living.

When I was studying the creative process as a grad student at Stanford, I came across the perfect analogy to this:

The more stepping stones there are across the creek,
the easier it is to cross in your own style.

The focus of that aphorism was creative thinking, to find as many alternative paths as possible to a creative solution. But as we age, parallel processing becomes more critical. Now it's no longer a matter of style, it's a matter of survival — getting across the creek at all. Randomly dying brain cells are like stepping stones being removed one by one. Those who had only one well-worn path of stones are completely blocked when some are removed. But those who spent their lives trying different mental routes each time, creating a myriad of possible paths, still have several paths left.

As the study shows, we need to keep as many of those paths active as we can, while also generating new paths, to maintain the complexity of our neuronal connections.

In other words: Intelligence — use it or lose it.


Intelligence

What exactly do we mean by "intelligence"?

You'll probably agree that intelligence isn't just a numerical measurement, with a number of 100 plus or minus assigned to it. But what is it?

To answer this question, we go back to the most elemental questions possible. Why do animals have a brain? To survive? No, plants don't have a brain and they survive. To live longer? No, many trees outlive us.

As neuroscience educator Robert Sylwester notes, mobility is central to everything that is cognitive, whether it is physical motion or the mental movement of information. Plants have to endure whatever comes along, including predators eating them. Animals, on the other hand, can travel to seek food, shelter, mates, and to move away from unfavorable conditions. Since we can move, we need a cognitive system that can comprehend sensory input and intelligently make choices.

Semantics will differ for each of us, but according to many, if the stimulus-response relationship of a situation is automatic, we don't think of the response as requiring our intelligence. We don't use the word "intelligent" to describe a banana slug, even though it has a rudimentary brain. But when the brain evaluates several viable responses and chooses one (a real choice, not just following habits), the cognitive process is considered to be intelligent.

As Jean Piaget put it, intelligence is what we use when we don't already know what to do.

Why dancing?

We immediately ask two questions:

· Why is dancing better than other activities for improving mental capabilities?

· Does this mean all kinds of dancing, or is one kind of dancing better than another?

That's where this particular study falls short. It doesn't answer these questions as a stand-alone study. Fortunately, it isn't a stand-alone study. It's one of many studies, over decades, which have shown that we increase our mental capacity by exercising our cognitive processes. Intelligence: Use it or lose it. And it's the other studies which fill in the gaps in this one. Looking at all of these studies together lets us understand the bigger picture.

The essence of intelligence is making decisions. The best advice, when it comes to improving your mental acuity, is to involve yourself in activities which require split-second rapid-fire decision making, as opposed to rote memory (retracing the same well-worn paths), or just working on your physical style.

One way to do that is to learn something new. Not just dancing, but anything new. Don't worry about the probability that you'll never use it in the future. Take a class to challenge your mind. It will stimulate the connectivity of your brain by generating the need for new pathways. Difficult classes are better for you, as they will create a greater need for new neural pathways.

Then take a dance class, which can be even more effective. Dancing integrates several brain functions at once — kinesthetic, rational, musical, and emotional — further increasing your neural connectivity.


What kind of dancing?

Do all kinds of dancing lead to increased mental acuity? No, not all forms of dancing will produce the same benefit, especially if they only work on style, or merely retrace the same memorized paths. Making as many split-second decisions as possible is the key to maintaining our cognitive abilities. Remember: intelligence is what we use when we don't already know what to do.

We wish that 25 years ago the Albert Einstein College of Medicine thought of doing side-by-side comparisons of different kinds of dancing, to find out which was better. But we can figure it out by looking at who they studied: senior citizens 75 and older, beginning in 1980. Those who danced in that particular population were former Roaring Twenties dancers (back in 1980) and then former Swing Era dancers (today), so the kind of dancing most of them continued to do in retirement was what they began when they were young: freestyle social dancing -- basic foxtrot, swing, waltz and maybe some Latin.

I've been watching senior citizens dance all of my life, from my parents (who met at a Tommy Dorsey dance), to retirement communities, to the Roseland Ballroom in New York. I almost never see memorized sequences or patterns on the dance floor. I mostly see easygoing, fairly simple social dancing — freestyle lead and follow. But freestyle social dancing isn't that simple! It requires a lot of split-second decision-making, in both the Lead and Follow roles.

At this point, I want to clarify that I'm not demonizing memorized sequence dancing or style-focused pattern-based ballroom dancing. I sometimes enjoy sequence dances myself, and there are stress-reduction benefits of any kind of dancing, cardiovascular benefits of physical exercise, and even further benefits of feeling connected to a community of dancers. So all dancing is good.

But when it comes to preserving (and improving) our mental acuity, then some forms are significantly better than others. While all dancing requires some intelligence, I encourage you to use your full intelligence when dancing, in both the Lead and Follow roles. The more decision-making we can bring into our dancing, the better.


Who benefits more, women or men?

In social dancing, the Follow role automatically gains a benefit, by making hundreds of split-second decisions as to what to do next, sometimes unconsciously so. As I mentioned on this page, women don't "follow", they interpret the signals their partners are giving them, and this requires intelligence and decision-making, which is active, not passive.

This benefit is greatly enhanced by dancing with different partners, not always with the same fellow. With different dance partners, you have to adjust much more and be aware of more variables. This is great for staying smarter longer.

But men, you can also match her degree of decision-making if you choose to do so.

Here's how:

1) Really pay attention to your partner and what works best for her. Notice what is comfortable for her, where she is already going, which signals are successful with her and which aren't, and constantly adapt your dancing to these observations. That's rapid-fire split-second decision making.

2) Don't lead the same old patterns the same way each time. Challenge yourself to try new things. Make more decisions more often. Intelligence: use it or lose it.

The huge side-benefit is that your partners will have much more fun dancing with you when you are attentive to their dancing and constantly adjusting for their comfort and continuity of motion. And as a result, you'll have more fun too.


Full engagement

Those who fully utilize their intelligence in dancing, at all levels, love the way it feels. Spontaneous leading and following both involve entering a flow state. Both leading and following benefit from a highly active attention to possibilities.

That's the most succinct definition I know for intelligent dancing: a highly active attention to possibilities. And I think it's wonderful that both the Lead and Follow role share that same ideal.

The best Leads appreciate the many options that the Follow must consider every second, and respect and appreciate the Follow's input into the collaboration of partner dancing. The Follow is finely attuned to the here-and-now in relaxed responsiveness, and so is the Lead.

Once this highly active attention to possibilities, flexibility, and alert tranquility are perfected in the art of dance partnering, dancers find it even more beneficial in their other relationships, and in everyday life.


Dance often

The study made another important suggestion: do it often. Seniors who did crossword puzzles four days a week had a measurably lower risk of dementia than those who did the puzzles once a week. If you can't take classes or go out dancing four times a week, then dance as much as you can. More is better.

And do it now, the sooner the better. It's essential to start building your cognitive reserve now. Some day you'll need as many of those stepping stones across the creek as possible. Don't wait — start building them now.