An expert weighs in on seated or standing dance as an activity for Parkinson's during the COVID-19 Pandemic

Parkinson’s disease patients now find themselves stuck in their homes because of the COVID-19 pandemic. It turns out that exercise is super important for treatment of Parkinson’s disease symptoms. Exercise also has other health and wellness benefits. We sat down with David Leventhal (virtually) who runs the Mark Morris Dance company for an interview and tips on seating and standing dance as an exercise during the Corona virus pandemic.

Are you concerned about Parkinson’s patients being stuck in their home during COVID-19 Corona virus pandemic?

I’m concerned about the implications of people living with Parkinson’s being stuck at home because the situation can exacerbate existing challenges that PD imposes—physical inactivity, social isolation, and anxiety. We realize that for many of our constituents living with Parkinson’s, good health depends on staying active, socially connected and inspired while simultaneously following local advisories about social distancing and sheltering at home. Our goal, as a program, is to strike a balance and challenge ourselves to provide opportunities for people to be fully engaged and connected even though they’re at home.

What is the Dance for Parkinson’s disease program?

Dance for PD® offers internationally-acclaimed dance classes for people with Parkinson’s disease in New York City and, through our network of partners and associates, in more than 300 other communities in 25 countries around the world.  In Dance for PD® classes, participants are empowered to explore movement and music in ways that are refreshing, enjoyable, stimulating and creative. Dance for PD, a program of the Mark Morris Dance Group, a renowned modern dance company, also provides teacher training, creates innovative instructional media, and nurtures relationships among other organizations so that classes based on our model are widely available.

Our classes, whether live, streamed or pre-recorded, emphasize a safe, accessible and inclusive approach to movement. That means that people have options to engage fully at whatever level is availability to them at that moment, which we know can change hour-to-hour and day-to-day. The resources we create for At Home use are specially designed to include a seated version of all activities and feature regular reminders about working safely. When standing, we minimize traveling activities, and encourage people who are standing to hold onto a chair for support. More than anything else, we encourage people to join our virtual programming with a partner or spouse—it’s not only safer to dance with someone else, it’s also much more fun. When I look out at the 70-80 people participating in our daily live Zoom classes, it’s heartening to see people dancing at home with their loved ones.

How can Parkinson’s patients stay safe and not fall while doing dance at home during COVID?

Dance for PD integrates movement from diverse dance forms and choreographic repertory, including the work of Mark Morris, to engage participants’ minds and bodies. Each class can be enjoyed seated or standing and addresses PD-specific concerns such as balance, flexibility, coordination, gait, social isolation, and depression in a fully artistic environment—participants are dancers, not patients. Our approach is to “de-medicalize”, de-stigmatize, and de-traumatize the experience of PD, to celebrate possibilities and to normalize the idea that dance is truly for anyone, of any ability. Many Dance for PD programs throughout our network—and all our classes in New York—are free of charge and integrate live music.

If you could give people interested in dance and Parkinson’s disease three reasons to try it, what would they be?

Dance fits Parkinson’s like a glove. If you spent three years in a lab and designed the perfect form of physical activity for people living with PD, I believe that you’d probably come out with something very similar to dance. Three reasons:

Dance is good for you—it is a multi-focal activity that addresses physical, emotional, cognitive and social needs simultaneously and very effectively.

1- Dance sparks your creativity—it makes you think about movement in new ways and engages your imagination in the service of moving better.

2- Dance is fun—the combination of social interaction and music create a joyful, pleasurable experience. And the range of styles and approaches used in our classes and throughout our network mean that there’s something for everyone, whatever your tastes.

3- Another question we often get is whether men can feel comfortable in Dance for Parkinson’s classes. The short answer is yes—many of our classes have as many if not more men than women. People with Parkinson’s need to be as disciplined in how they approach the condition as professional dancers and athletes—they need to train, think strategically and take really good care of themselves. It’s common knowledge that professional athletes, like Lynn Swann, Herschel Walker, Muhammad Ali and Sugar Ray Robinson, have taken ballet and other forms of dance to improve their game; people with Parkinson’s can benefit from the same approach. Besides, it’s good to remember that ballet was popularized and developed by a king, some of the most famous and inspiring dancers have been men (Gregory Hines, Gene Kelly, Mikhail Baryshnikov, Fred Astaire, Savion Glover), and that many forms like Haka and Argentine Tango were, at least originally, predominantly danced by men.

What is the published evidence on dance and Parkinson’s disease?

Evidence from 38 peer-reviewed scientific studies, including eight randomized controlled trials, underpins the effectiveness and benefits of the Dance for PD teaching practice. Reported benefits (see list of articles at bottom) include improvements in balance, gait, and endurance, and reduced motor impairment. Other research suggests that dancing leads to better executive and visuospatial function, reduces symptoms of depression, reduces anger, improves self-efficacy, and reduces social isolation in people living with PD. Participants talk about our program as a lifeline that provides them with an outlet for creativity and connection while they work on building physical strength, coordination, and confidence.

Can you tell us about yourself and how you got involved with Dance in PD?

Like many things in life, my involvement was a happy accident. I started dancing when I was eight—mostly ballet. After college (I was an English Literature major), I moved to New York and ended up dancing with the Mark Morris Dance Group (MMDG) for about 15 years. My fourth year in the company, we built a new 30,000 square foot dance center in Brooklyn and opened our doors to the community. A visionary woman named Olie Westheimer, who had founded a support group called the Brooklyn Parkinson Group (BPG), had an idea that dance might be beneficial for BPG members, and asked if MMDG might be interested in collaborating on a special class for people with Parkinson’s. We responded with an enthusiastic yes, without knowing much about Parkinson’s at the time, and I ended up teaching the first class when the original teacher had a family emergency. I was so inspired by the small group that came to that first session that I asked my colleague, John Heginbotham, if he and I could co-teach going forward, and the program was born. When I stopped performing full-time with the company in 2010, I knew that I wanted to devote my time to developing and expanding the Dance for PD program locally, nationally and internationally, and I’ve been working with an amazing team to try to do that.

David Leventhal is a founding teacher and Program Director for Dance for PD®, a program of the Mark Morris Dance Group that has now been used as a model for classes in more than 300 communities in 25 countries.  He leads classes for people living with Parkinson's disease (PD) around the world and trains other teaching artists in the Dance for PD approach. He's co-produced five volumes of a successful At Home DVD series for the program and has been instrumental in initiating and designing innovative projects involving live streaming and Moving Through Glass, a dance-based smart glasses app for people with Parkinson's. He received the 2016 World Parkinson Congress Award for Distinguished Contribution to the Parkinson's Community and was a co-recipient of the 2013 Alan Bonander Humanitarian Award from the Parkinson's Unity Walk. Leventhal has chapters about dance and Parkinson's in Moving Ideas: Multimodal Learning in Communities and Schools (Peter Lang), and Creating Dance: A Traveler's Guide (Hampton Press). He has spoken about the intersection of dance, Parkinson's and health at the Lincoln Center Global Exchange, Edinburgh International Culture Summit, Harvard Medical School, Penn State Hershey Medical Center, Stanford Medical School, Columbia University Vagelos College of Physicians and Surgeons, Peking Union Medical College Hospital, and Centre Hospitalier Universitaire de Liège (Belgium), among others. He's featured in the award-winning 2014 documentary Capturing Grace directed by Dave Iverson. As a dancer, he performed with the Mark Morris Dance Group from 1997-2011 and received a 2010 Bessie (New York Dance and Performance Award) for his performing career with Mark Morris.

Selected References if you want to read more on the literature of dance and Parkinson’s:

Shanahan, J., Morris, M. E., Bhriain, O. N., Saunders, J., & Clifford, A. M. (2015). Dance for people with Parkinson disease: what is the evidence telling us?. Archives of Physical medicine and rehabilitation, 96(1), 141-153.

de Natale, E. R., Paulus, K. S., Aiello, E., Sanna, B., Manca, A., Sotgiu, G., ... & Deriu, F. (2016). Dance therapy improves motor and cognitive functions in patients with Parkinson’s disease. NeuroRehabilitation, (Preprint), 1-4.

Bearss, K. A., McDonald, K. C., Bar, R. J., & DeSouza, J. F. (2017). Improvements in Balance and Gait Speed after a 12 Week Dance Intervention for Parkinson's Disease. Advances in Integrative Medicine.

Lewis, C., Annett, L. E., Davenport, S., Hall, A. A., & Lovatt, P. (2014). Mood changes following social dance sessions in people with Parkinson’s disease. Journal of Health Psychology, 1359105314529681.

Bognar, S., DeFaria, A. M., O’Dwyer, C., Pankiw, E., Simic Bogler, J., Teixeira, S., ... & Evans, C. (2016). More than just dancing: experiences of people with Parkinson’s disease in a therapeutic dance program. Disability and Rehabilitation, 1-6.

Blandy, L. M., Beevers, W. A., Fitzmaurice, K., & Morris, M. E. (2015). Therapeutic argentine tango dancing for people with mild Parkinson’s disease: a feasibility study. Frontiers in Neurology, 6, 122

Hashimoto, H., Takabatake, S., Miyaguchi, H., Nakanishi, H., & Naitou, Y. (2015). Effects of dance on motor functions, cognitive functions, and mental symptoms of Parkinson's disease: a quasi-randomized pilot trial. Complementary Therapies in Medicine, 23(2), 210-219.

Heiberger, L., Maurer, C., Amtage, F., Mendez-Balbuena, I., Schulte-Mönting, J., Hepp-Reymond, M. C., & Kristeva, R. (2011). Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson’s disease. Frontiers in Aging Neuroscience, 3, 14.

McKee, K. E., & Hackney, M. E. (2013). The effects of adapted tango on spatial cognition and disease severity in Parkinson's disease. Journal of Motor Behavior, 45(6), 519-529.

Sharp, K., & Hewitt, J. (2014). Dance as an intervention for people with Parkinson's disease: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 47, 445-456.

Westheimer, O., McRae, C., Henchcliffe, C., Fesharaki, A., Glazman, S., Ene, H., & Bodis-Wollner, I. (2015). Dance for PD: a preliminary investigation of effects on motor function and quality of life among persons with Parkinson’s disease (PD). Journal of Neural Transmission, 122(9), 1263-1270.

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD

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