Effects of a Jaques–Dalcroze eurhythmics program on postural stability in elderly women

A study model based on randomized controlled trial—parallel group design was used. The manuscript conforms to the CONSORT Guidelines.

Participants

Participants were recruited through advertisements in local newspapers and on the Internet, and covered the Poznań Metropolitan Area, Poland. Eligibility criteria were community-dwelling women aged 65+. Candidates had no contraindications to participation in physical activity and gave informed consent to participate in the experiment. Participants scored at least 8 on the Abbreviated Mental Ability Test29. Subjects taking medications that may interfere with natural control of postural stability, users of orthopedic equipment, patients with neurological disease (Parkinson’s or Alzheimer’s), with significant visual and/or auditory perception assessment, and subjects who undertake or have undertaken regular physical activity in the past 3 years were not eligible for the programme.

Following randomization using the computer program Statistica 13.4 (TIBCO Software Inc., Palo Alto, CA), the participants were divided into two groups: Intervention Group (IG) and Control Group (CG).

Research protocol

The participants’ postural stability was investigated by determining their ability to control the displacement of the body’s center of pressure (COP). For this purpose, the Balance Platform model AccuSway Plus was used, together with the Balance Trainer software. The system recorded changes in COP position in the anteroposterior (AP) and mediolateral (ML) directions. The sampling rate was set at 100 Hz. The COP is a reliable parameter for evaluating postural stability and upright balance control30. The results of the four COP parameters described in Table 1 were statistically analysed.

Table 1 Description of the characteristics analyzed with abbreviations, units, and abilities under study.

Trial design

Two measurement sessions were held: the first (baseline) took place during the week before starting the exercise program and the second (12-week follow-up) straight after its finish (March and June 2016 respectively). Women from IG participated in the exercise programme, while women from CG were advised not to change anything about their current lifestyle, and in particular not to undertake any new structured physical activity. The participants, the JDE specialist as well as those measurements were una of the purpose of this study and the fact of belonging to any group.

The research project as well as all the experiments were positively assessed and approved by the Bioethics Committee at the Poznan University of Medical Sciences (Resolution 1046/15).

The trial has been registered on 20/08/2021 at ClinicalTrials.gov (Identifier: NCT05015777).

Training program

Training sessions took place twice a week for 45 min each over a period of 12 weeks and were held in the university gymnasium. Each training included rhythmic exercises using the Jaques–Dalcroze Eurhythmics method with piano accompaniment and electronically played music. Training sessions were conducted by a JDE specialist.

Each class consisted of three parts: warm-up (~ 10 min), main part (~ 30 min) and cool down (~ 5 min). Exercises with the use of the JDE method consist mainly in the repetition of preset musical sequences using body movements. In addition to the physical layer, the cognitive layer was equally important: while performing a given movement exercise, participants had to focus in order to react appropriately to additional tasks, such as changes in sound pitch of the piece (eg while pitch was high they had to walk on their toes, when low—in a half squat) as well as changes of dynamic, agogic and articulatory sequences in music. Exercises included movements based on rhythmic themes where participants had to adjust the speed of their movement to the tempo of the music, rhythmic transformation of themes and polyrhythms (the arms move in a different rhythm than the legs). There were also inhibition-incitation exercises (inhibition and stimulation of movement, ie stopping moving when the music stops and resuming movement when the accompaniment starts again), improvisation of movements and exercises developing control of body balance, independence of movements and their coordination25.

Balance platform test

Participants had to perform a movement task while standing on a posturographic platform. A Feedback Balance Analysis protocol was used—the subjects saw a point on the screen that was a reflection of their COP. By tilting their body in different directions, they could observe changes in the position of their COP in real time. The participants’ task was to do it in such a way as to direct their COP into the appropriate targets marked on the screen, in the right order (Fig. 1).

Figure 1

Diagram of the targets deployment with an example of the COP path trace (a screenshot from the software used for the tests).

Taking into account the natural heterogeneity of the group in terms of physical due to the age of subjects, the distances of extreme areas in relation to the central area, and thus the range of deflection, were decided to be determined for each participant individually. For this purpose, first the maximum deflections of each subject in the AP and ML directions were determined, and then the software automatically determined the centers of targets at a distance of 75% of the maximum deflection in a given direction. This ensured that each subject leaned their torso relatively the same range and that the task was within their capabilities. The results of maximum torso lean ranges were also statistically analysed.

The test consisted of two main elements: (1) the COP point movement phase and (2) the COP point maintain phase. The task consisted of the COP point movement into individual targets (in a predetermined order), each time the COP point had to be maintained inside the area of ​​each target for at least one second, after which the target became inactive (darker), which was a signal of its correct passing. At the same time, the next (active) target would light up, indicating that the COP point had to be moved into that target, where it again had to be held for a minimum of one second, and so on. Each time the extreme target was passed, it was necessary to return into the central target. A similar trial measuring changes in postural stability in a biofeedback model under the influence of training has already been used in other experiments31,32.

The posturographic platform was fixed to a flat surface, in front of the subject at a distance of 1.5 m at eye level was placed a 27 inch monitor. The room was soundproofed to ensure peace and quiet. On the platform there were lines specifying the proper distances and angles of feet placement in order to ensure that the subject stood in the same place during each subsequent trial. The feet on the platform were placed naturally, one next to the other at hip width, with the toes gently pointing outwards.

Each participant was given verbal instructions on how to perform the test, with particular emphasis on the fact that the test had to be carried out as quickly and accurately as possible, moving the COP point by the shortest possible route to the target, and once reached , trying to keep the COP point as still as possible in the center of target until it became inactive (turned dark). The person the next test performed a demonstration of the entire trial. The final step was for the subjects to perform two pre-test trials, followed by a third trial, the results of which were statistically analysed.

Statistical analysis

The results of descriptive statistics were presented as means with standard deviation (mean ± SD). Postural stability test results were presented as means and confidence intervals at the 95% level. A two-factor analysis of variance (ANOVA) was conducted. An eta square analysis was used to determine effect size. The post-hoc Tukey test was conducted in case of significant main or interaction effects. Differences between groups in the single study session area and between study sessions in the group area were determined using the Mann–Whitney U test with correction for continuity. Statistical significance level was set at 5%. All calculations were carried out using Statistica 13.4 (TIBCO Software Inc., Palo Alto, CA)25.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or benchmark standards.

Informed consent

Informed consent was obtained from all subjects involved in the study.

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