Introduction
Interventions to promote daily physical activity are important in the management of patients with chronic breathlessness,1 not least because low levels of physical activity are associated with an increased risk of hospitalisation and mortality.2
Pulmonary rehabilitation (PR) is recommended for all individuals with symptoms of breathlessness, yet engagement is often poor and improvements in exercise tolerance do not translate into meaningful gains in physical activity away from the PR setting.3 4 There are likely a number of complex and individualised reasons for this. In part, the language used to describe PR and the unfamiliarity of gym-like spaces may deter people from attending5 and absence of choice in PR programmes (the majority offer either walking or circuit-based exercise) may limit the transferability of culturally appropriate activities into people’s everyday lives. Aligning exercise programmes with activities that are valued, enjoyed and considered to be meaningful by the patient population may help promote uptake and encourage sustainable behaviour change.6
One such activity, aligned with values, previous experience and culture, is dance. Dance programmes have been found to be beneficial for older adults, those at risk of falls and people with neurological conditions including Parkinson’s disease.7–9 They could be a useful adjunct to formal PR for some people, but research is required to provide evidence for this. To date, the only published study examining the feasibility of a dance intervention for people with lung disease has been conducted in Toronto, Canada10 although research in London, UK is also underway. The authors of the Toronto study reported that the delivery of 60-minute dance classes, two times a week for 8 weeks, was feasible (49% uptake and 95% completion rate) and safe.10 Improvements in exercise tolerance, balance, balance confidence and health status were observed but did not reach clinical significance. There were no improvements in daily step count, although the small sample size (n=20) and large variability in daily steps may account for this. It could be that like PR, dance does not translate into improved physical activity away from the intervention setting but there may be other advantages besides this, such as psychological gains associated with group solidarity, friendship and fun. A recent evaluation of the ‘Dance to Health’ programme at Sheffield Hallam University, initiated to reduce falls in older people, reported that the main appeal of dance was ‘meeting new people’ and 87% said they made new friends as a result of participating.9
Understanding the benefits and how they are conferred can help inform and optimise intervention delivery. On an individual level, dance may increase interoceptive awareness (body awareness), making it particularly appropriate for a population of people with chronic breathlessness. Collaborative work within our project with neuroscientists suggested that people with chronic breathlessness have poor interoceptive awareness, partly because of comorbidities such as anxiety and depression.11 This may account for the discordance between symptoms experienced and lung function observed in people with Chronic Obstructive Pulmonary Disease (COPD). If interoception can be enhanced, by drawing awareness to the body as having the potential to provide enjoyable movement rather than ‘exercise’, then symptom management may also be improved, leading to a greater willingness to engage in activities that provoke breathless symptoms.12
The aim of this paper, therefore, is to use a transdisciplinary research approach13 to develop a holistic understanding of dance as a physical activity intervention for people living with chronic breathlessness. Specifically, we will report (1) Decision-making processes; preparatory work informing the content of a tailored dance programme for individuals living with chronic breathlessness in the North East of England, (2) Methods and findings; the content/delivery of dance and information gleaned from functional tests, self-reported questionnaires, heart rate (HR) monitoring and anthropological methods, (3) Feasibility elements; the acceptability of dance, adherence rates and willingness/ability to complete outcome measures.14 This information will inform the delivery of a sustainable community dance programme and a future definitive research trial.