The goal of this interventional study is to examine the dose-response effect of Community Dance Programme (CDP) on the physical, cognitive and psychological health of pre-frail and mildly frail community-dwelling older adults. The main questions it aims to answer are: Hypothesis 1: Two sessions of CDP per week (75 minutes each) significantly increase the physical outcomes (i.e. CFS, EFS, SPPB, grip strength) of community-dwelling older adults as compared to one session of CDP per week. Hypothesis 2: Two sessions of CDP per week significantly improve the cognitive outcomes (i.e. MoCA, SDMT) of community-dwelling older adults as compared to one session of CDP per week. Hypothesis 3: Two sessions of CDP per week significantly improve the psychosocial outcomes (i.e. WHOQOL-OLD, De Jong Giervald Loneliness Scale, GPIC scale, SHS, SSQ) of community-dwelling older adults as compared to one session of CDP per week. Intervention: The participants will be asked to attend two sessions of CDP per week for 12 weeks at their respective Active Ageing Centres (AACs). Active control: The participants will be asked to attend one session of CDP per week for 12 weeks AACs. * The participants will be asked to go to the AACs at baseline and after 12 weeks of CDP intervention for the collection of data. * The participants will be asked to wear fitness trackers to track their heart rates during the CDP sessions to ensure that the dance curriculum is kept within the moderate intensity.
Dance interventions have been shown beneficial for older adults, such as improving their physical health, cognitive function, as well as their psychosocial and emotional well-being by ameliorating depression, anxiety, and social isolation. A pilot study (NUS-IRB-2020-808) showed that those in the dancing group reported significantly higher quality of life (p=0.044). The qualitative findings provided insights that older adults enjoyed participating in the creatively crafted dance programme, while learning nature and world travel-based dance movements. Thus, this study aims to use data derived from the pilot study to design and conduct a definitive study to define the dose-response effect that a systematic dance programme may have on physical, cognitive, and psycho-social health in our local aging population. A cluster-randomised trial with a co-design approach and process, evaluation will be applied. A qualitative approach with in-depth, face-to-face, focused group discussions (FGDs-needs assessment) will be conducted for stakeholders (older adults, AAC staff, and dance instructors) to understand their needs (e.g., factors promoting dance, measures to overcome common side effects of dance, social-cultural considerations) and seek their opinions further to develop the Community Dance Programme (CDP). CDP will be developed following the WHO ICOPE's guidelines and validated by a panel of multi-disciplinary experts. The participants will be randomly separated into 2 clusters: Intervention Clusters (2 sessions/week and 75 minutes/session) and Active Control Clusters (1 session/week and 1 hour/session). The interventional face to face sessions will be supported by instructional dance videos which allows the seniors to practice the dance on their own time. 12 weeks of dance sessions will be conducted. Objective assessments and self-reported questionnaires will be used pre and post-CDP. Outcome measures will include physical health (Short Physical Performance Battery, Edmonton Frailty Scale, biomarkers), cognitive function (Montreal Cognitive Assessment, Symbol Digit Modalities Test), psychosocial health (Geriatric Depression Scale, de Jong Gierveld Loneliness Scale, Subjective Happiness Scale, Social Support Questionnaire), and quality of life (WHOQOL).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
284
CDP was designed based on a 12-week dance curriculum, which involves 3 separate blocks of choreography of increasing complexity and intensity. According to World Health Organization, a minimum of 150 minutes of moderate intensity exercise would result in improvement in physical health, therefore, the intervention arm would involve 2 sessions of CDP, 75 minutes per session each week.
CDP was designed based on a 12-week dance curriculum, which involves 3 separate blocks of choreography of increasing complexity and intensity. According to World Health Organization, a minimum of 150 minutes of moderate intensity exercise would result in improvement in physical health, therefore, the active control arm would only include 60 minutes of CDP (1 session) per week to assess the effect of CDP on the cognitive and physical health of older adults.
Lion Befrienders' Active Ageing Centre
Singapore, Singapore
RECRUITINGShort Physical Performance Battery
Evaluates the physical function. This instrument comprises physical tests of standing balance, gait speed, and chair stand. Each component (i.e., balance, gait speed, chair stand) will be scored from 0 to 4, with a score of 0 indicating inability to carry out the test and a score of 4 indicating perfect execution of the test. The total score ranges from 0 to 12, with higher scores indicating higher physical performance
Time frame: From enrollment to the end of the interventional period at 12 weeks.
Clinical Frailty Scale
This is a 9 point-scale which assesses the degree of frailty based on a visual chart which aids trained assessors to evaluate frailty. This scale depends on individual clinical judgement assess if the patient can independently perform tasks such as bathing, dressing, housework, going upstairs, going out alone, going shopping, taking care of finances, taking medications, and preparing meals. The higher the number, the more frail the individual. It is a tool that has been validated and widely used in local clinical and community settings.
Time frame: From enrollment to end of interventional period of 12 weeks
Edmonton Frailty Scale - Acute Care
This is an 11-item questionnaire that examines nine domains of frailty (i.e., cognition, general health status, functional independence, social support, medication use, nutrition, mood, continence, and functioning performance). The scores range from 0 to 17, with higher scores indicating higher levels of frailty. The scores can be categorized into five levels of frailty, namely: fit (0-3), vulnerable (4-5), mild frailty (6-7), Moderate frailty (8-9) and severe frailty (≥10). This instrument has been utilised and validated in a local tertiary hospital, with high acceptability and low inter-rater variability
Time frame: From enrollment to end of interventional period of 12 weeks
Screening for Oral Frailty Tool
The oral frailty scale comprises 6 items, including number of teeth, difficulty in swallowing, difficulty in chewing, difficulty in articulatory oral motor, dry mouth, and oral pain, and is assessed using a yes or no question. The correlations ranged from 0.40 to 0.66 when correlating each item with the total score of the scale. Using frailty and sarcopenia as criteria, the area under the curve for the SOFT was 0.71. The optimal cutoff for the SOFT was 2,
Time frame: From enrollment to end of interventional period of 12 weeks
MOXY (muscle oxygenation)
MOXY (Moxy, Fortiori Design LLC, Minnesota, USA) is a non-invasive small wearable portable device that measures muscle oxygen saturation (SmO2), using near-infrared spectroscopy (NIRS) \[38\]. MOXY measures oxygen levels in the muscles of participants during exercise. Saliva sampling and MOXY oxygen monitoring are non-invasive procedures.
Time frame: From enrollment to the end of the interventional period of 12 weeks.
Examining the rate of DNA methylation
DNA methylation analysis will be conducted on the saliva samples collected from the older adults to examine the DNA methylation patterns at specific DNA sites to detect epigenetic clocks that change with age.
Time frame: From enrollment to the end of the interventional period of 12 weeks
Global Perception of Intergenerational Communications
The Revised Global Perceptions of Intergenerational Communication scale measures both inter and intra intergenerational communication based on four domains, namely: accommodation, non-accommodation, respect/obligation and avoidant communication. The revised GPIC scale has shown cronbach alpha score of 0.7 for the older participants for the respect-obligation factor and higher cronbach alpha scores of 0.79 and 0.77 for in group and out group respectively for the accommodation factor and 0.79 and 0.75 for the in-group and out-group respectively for the non-accommodation score. This indicates a high reliability for the tool.
Time frame: From enrollment to the end of the interventional period of 12 weeks.
Subjective Happiness Scale
Using a "subjectivist" approach to the assessment of happiness, a 4-item measure of global subjective happiness was developed and validated in 14 studies with a total of 2732 participants. Results indicated that the Subjective Happiness Scale has high internal consistency, which was found to be stable across samples. Test-retest and self/peer correlations suggested good to excellent reliability, and construct validation studies of convergent and discriminant validity confirmed the use of this scale to measure the construct of subjective happiness
Time frame: From enrollment to the end of the interventional period of 12 weeks
De Jong Gierveld Loneliness Scale
Loneliness concerns the subjective evaluation of one's situation, characterised by either a smaller than desirable number of relationships with friends (social loneliness), or situations whereby the intimacy in confidant relationships one wishes for has not been realised (emotional loneliness) \[44\]. dJGLS-6 (six-item) will be used to measure social and emotional loneliness.
Time frame: From enrollment to the end of the interventional period of 12 weeks
Social Support Questionnaire-6
This scale is developed by Sarason et al. \[47\]. It is used to measure the number of people providing support to an individual and the satisfaction level of the individual who received the support. The scale consists of 6 items. Rating of the items is from 1 (very dissatisfied) to 6 (very satisfied). With excellent Cronbach alphas of 0.90 and 0.93 for 2 respective domains, the scale has been proved to be valid and reliable.
Time frame: From enrollment to the end of the interventional period of 12 weeks
WHOQOL-OLD
WHOQOL-OLD for older adults to measure the quality of life for elderly. WHOQOL-OLD contain-ing six facets (including sensory abilities; autonomy; past, present, and future activities; social participation; death and dying; and intimacy), with four items in each facet \[48\]. Each of the facets has four items and therefore can obtain a possible score ranging from 4 to 20. The sum of the facet scores results in an overall QOL score.
Time frame: From enrollment to the end of the interventional period of 12 weeks
Geriatric Depression Scale
This scale contains 15 close-ended questions \[42\]. One point is allocated per question with the total scores below four indicating the absence of clinically depressive symptoms while scores between four and nine are indicative of mild to moderate depression. Scores of 10 or more are suggestive of a major depressive episode.
Time frame: From enrollment to the end of the interventional period of 12 weeks
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