The use of dance in pulmonary rehabilitation for Chronic Obstructive Pulmonary Disease
Can dance be used as an alternative to conventional exercise interventions for people with lung disease, and does this have the potential to improve uptake, enjoyment and benefit of exercise therapy?
Approximately 1.2 million people in the UK suffer from Chronic Obstructive Pulmonary Disease (COPD), a life-limiting combination of chronic bronchitis and emphysema that results in breathlessness, cough and frequent chest infections. Although no cure is available, the condition can be managed.
One of the most effective interventions is exercise to improve patients’ strength and fitness, which reduce breathlessness and improving quality of life. Although effective, such exercise classes traditionally have relatively low uptake and poor completion rates in those who do commence a programme, which presents a barrier to effective treatment.
Maintenance of physical activity levels beyond the formal classes is also varied, meaning that treatment effects are often not sustained. Reasons underlying these problems are complex, but may include negative preconceptions about exercise, lack of enjoyment, and discomfort about exercising in public.
The project followed a previous Cultural Institute-brokered collaboration, and developed naturally as a collaborative endeavour to explore an innovative approach to exercise for this patient group out of the Department of Respiratory Medicine’s previous research into muscle strength, exercise performance breathlessness and rehabilitation, as well as the known difficulties with standard rehabilitative approaches.
Dr Gerrard Rafferty, Dr Victoria MacBean and Dr Charles Reilly from the Department of Respiratory Medicine partnered with choreographer Evangelia Kolyra to explore the potential for dance as an exercise therapy for patients with a long-term lung condition called Chronic Obstructive Pulmonary Disease (COPD). COPD affects 1.2 million people in the UK and results in breathlessness, cough and frequent infections. There is no cure for COPD, but exercise classes (usually delivered in a gym setting) are known to be one of the most effective treatments to reduce symptoms and improve quality of life. Poor uptake and attendance at these standard classes reduces the number of people benefitting from exercise and novel approaches are sought to address this issue.
The project, supported by the Cultural Institute, explored patients’ attitudes to dance as an alternative exercise modality. A focus group was held to allow the patients, cultural partner and academics to exchange knowledge and experience, prior to three trial dance classes for five patients living with COPD. Patients gave extremely positive feedback with valuable insights regarding optimal design of future programmes. Data collected within the dance sessions confirmed that participants were exercising at moderate to high intensity, suggesting the sessions provided an appropriate training stimulus. Improvements were seen in participants’ mood and ratings of social cohesion within the group. The data acquired from this project will provide strong support for research grant applications to major funding bodies, which would hope to invite larger groups of patients to attend six weeks of dance sessions and the effect on muscle strength, fitness, quality of life, balance and mood would be investigated.
Speaking about the project, Evangelia commented: 'This project enriched my artistic practice in multiple ways. It was a fulfilling activity as I felt that I was using my knowledge and experience in dance to immediately benefit people on a physical and psychological level and also familiarise them with the performing art of dance. To have the opportunity to create movement/dance classes for a challenging group of people enhanced my creativity in a way that has not happened before. The challenge of working with people who had no or little experience with dance was rewarded with the participants' openness and willingness to overcome their own limits and limitations to a degree that their progress in every session was unexpectedly remarkable. Finally, working with the academic team, I acquired knowledge related to the physiology of the body which will be useful for the next stage of this research and also for my artistic practice in general.'
Between Stepmber and Novemer 2016, the project team untook four workshops with a small group of patients with COPD, initially to explore their opinions of dance as form of exercise and thereafter to trial movement and dance activities. Patients’ opinions and experiences, together with academic input regarding the research evidence around exercise performance and rehabilitation in lung disease, was used as a platform from which cultural partner, choreographer Evangelia Kolyra, developed an exercise programme to trial and refine over the course of the project.
Physiological data was collected during the practical workshops to evaluate the level of exertion achieved with the dance activity, as well as collecting detailed feedback from the patients regarding their experiences of the trial intervention. Patients demonstrated appropriate elevations in heart rate (participants were exercising at moderate to high intensity, a finding supported by participants’ breathlessness ratings), minimal reductions in blood oxygen levels (indicating safety of the intervention), improvements in mood and feelings of social cohesion after each class, and high levels of enjoyment and satisfaction with the classes. The discussions after each class also indicated participants’ distinct preference for this form of exercise over standard gym-based pulmonary rehabilitation classes. All participants rated the classes as 'extremely enjoyable' and stated that they felt the collaborative group nature of the classes beneficial. Interestingly, all participants underestimated the duration of the sessions, suggesting that concentration on the choreography allowed them to exercise for longer and/or at a higher intensity.
Dr Gerrard Rafferty, Department of Respiratory Medicine, Faculty of Life Sciences & Medicine. Ged is a Reader in Human Physiology at KCL and has a background in Physiology. He supervises many of the projects running in the King's Respiratory Muscle Lab as well as teaching within the University. Ged’s research interests include how muscles throughout the body are affected by lung diseases, how best to measure this, as well as different aspects of how we can help adults and children with their breathing particularly when on intensive care.
Evangelia Kolyra, Choreographer. Evangelia is a Greek, London-based choreographer and performer who is interested in performative work which takes place within theatre spaces, site-specific, film and installation contexts. Her work aims to offer audiences a kinaesthetically rich experience of the unexpected, humorous and sometimes dark or sinister sides to the psychology of human experience, presented within highly detailed and physically demanding choreography. She has been featured in various platforms and festivals in Europe (England, Scotland, Greece, Italy, Sweden) and she is working towards developing a cross-disciplinary and highly collaborative practice.
Dr Victoria MacBean, Physiotherapy Research Associate and Knowledge Exchange Associate at King’s. Vicky is a children’s respiratory physiotherapist and has been working in King's Muscle Lab since 2009, measuring how hard the breathing muscles work in children with breathing problems and healthy children. Her research aims to understand how the breathing muscles work differently when children have breathing problems, and to see if we can use this to make decisions about the best treatments to give sick children.
Dr Charles Reilly, Consultant Physiotherapist in Chronic Respiratory Disease at King’s College Hospital NHS Foundation Trust. Charles' job is shared between working directly as a physiotherapist with patients with a variety of long-term breathing problems and research, some of which is within the King's Muscle Lab. Charles has worked in the lab since 2007 and has done much of his research looking at how the breathing muscles work in healthy people and adults with cystic fibrosis, as well as running studies for patients with severe breathlessness.
Find out more about the project team.
King's Muscle Lab blog here, Facebook here, and Twitter here.
Evangelia Kolyra's website here and Twitter here.
The use of dance in pulmonary rehabilitation for Chronic Obstructive Pulmonary Disease is a collaboration between King's College London’s Department of Respiratory Medicine and Evangelia Kolyra, brokered and supported by the Culture Team at King’s.