The Exercise Files: An Interview with the Founders of Israel's "Dance Through Life" Program

I recently had the great pleasure of lecturing and teaching adapted tango workshops for people with PD, caregivers and physical therapists in Tel Aviv, Israel! Yulia Gamerman and Rita Elimelsh invited me to come work with their patients and colleagues and I got to see their thriving physical activity for people with PD — which happens to be ballroom dancing! Here I present a short interview with these two dynamos so you can learn a little more about what they are doing overseas.

Rita Elimelsh is a ballroom dance teacher with experience in the field for about 20 years. She has participated in the construction of professional training courses for students of dance training at the Syim campus, Tel Aviv University, and has focused on working with people with Parkinson's disease, with emphasis on improving range of movement, posture and stability, and improving physical fitness.

Yulia Gamerman is a certified physiotherapist with 12 years of experience, graduate B.P.T degree from Tel-Aviv university (2005) and M.P.T Ben-gurion university of Negev (2015). She specializes in the diagnosis and treatment of balance problems among the elderly and Parkinson's patients. Yulia is a researcher in the field of preventing falls, balance and dancing; she is engaged in dance and martial arts.

Dr. Hackney: Tell us about your dance program in Tel Aviv!

Rita: We created the “Dance Through Life” program in 2015. The program combines the principles of physical rehabilitation and ballroom dancing, and is based on 10 years of research and guidelines from you, Dr. Hackney. The dance lessons are specially adapted for people with neurological diseases such as Parkinson's disease (PD), and Multiple Sclerosis (MS) as well as for older adults with balance and movement issues. Working in four towns in the Tel-Aviv area, we lead about 15 ballroom dance lessons per week ranging in difficulty from beginning to advanced. We teach several ballroom dances, including waltz, foxtrot, cha cha cha (a favorite), rumba and of course, tango. PD patients make up 68% of our participants and the others are older adults with balance\movement problems. There is also a special group for MS patients, which is growing.

Dr. Hackney: What inspired you to start a ballroom dancing program for people with PD and now for people with MS? Why did you think dance would work and work in Israel?

Yulia: Actually, Rita and I discovered the therapeutic effects of dance in different ways. When we met, we combined our experience and knowledge to create this special program. Rita was teaching Prof. Rafi Eldor to use ballroom dancing to fight his PD. His results have been very inspiring (You can view his videos on Youtube). Rita realized that dancing is more than just learning new steps. She started teaching more and more people with movement disorders and discovered that dancing has tremendous healing effects. Dance is a universal art of expression by body movement and it is a popular kind of physical activity in Israel. Prof. Eldor’s story became popular after his participation on TV programs, and then people with PD in Israel started looking for opportunities to take dance classes.
I explored the effects of dance on balance and function in the older population and PD patients by writing a literature review for my Physiotherapy Master Degree program. I was happy to discover evidenced-based data supporting the therapeutic effects of dance. Most research data available about dance and PD are coming from you [Dr. Hackney] and your collaborators’ work. I danced in the past. By developing the Dance through life program I was able to combine my hobby of dancing and my profession of physiotherapy.

Dr. Hackney: What have been the challenges in getting your program going in Tel Aviv and surrounding towns?

Rita: First of all, we found that traveling for older adults and people with PD is challenging, so we had to open dancing locations in different towns instead of opening one main location in a central spot. The participants had very different functional levels and we had to be able to adjust the lesson to their different levels. We found that the involvement of the healthy volunteers is essential to provide productive and safe lessons. It was also challenging to recruit enough volunteers.

Another challenge was building progressive and challenging lessons that were still finished with a sense of success and no less fun. We encouraged participants to express themselves though dance and body movements, though they had no previous dance experience. We promoted the idea that you don't have to be a dancer in order to dance. A lot of advertising work was done through leading lectures, publishing articles in newspapers, contacting healthcare specialists, etc.

Dr. Hackney: How do you think these dance programs impact participants with PD and their families?

Yulia: We are witnessing high attendance rates – 86% after a year-and-a-half period.

We feel a lot of pleasure and satisfaction watching the participants having quality time while dancing with their loved ones, communicating with new people, and becoming a big, supportive family.

One of the important and unique components of our program is the additional balance and functional level improvement in our participants. We collect demographics, health status, fall number and physical activity data by questionnaires, and perform the balance and function test before the program and at the follow-up test at each 3-4 month period. After analyzing the follow-up data of about 100 participants for a 1.5-year period, we found a significant improvement in all tests after 3-month attendance in our dance program. After 3 months, the improvement continued to rise to a more moderate extent, reaching significance again after a one-year period in most of the measures.

Dr. Hackney: What are your future plans for dance for different populations?

Rita: We think that dance has big therapeutic potential and could be applied widely in physical and mental rehabilitation. We would like to make dance accessible as a therapy to more kinds of disabilities and continue to explore its effects.

Dr. Hackney: What have you learned about working with people with PD to improve their movement?

Yulia: Dance is about movement, rhythm and expressions – all those are curtailed by PD, but this can be overcome. There is a lot of evidence supporting the importance of physical activity for people with PD. Its role in keeping the functional ability is just as important as those of medications. We found dance to be "a spoonful of sugar that helps the medicine go down in a most delightful way."

Dr. Hackney: Thank you!

Dr. Madeleine E. Hackney, Ph.D, is a Research Health Scientist at the Atlanta VA Center for Visual and Neurocognitive Rehabilitation and an Assistant professor of Medicine in the division of General Medicine and Geriatrics at the Emory School of Medicine. She holds a Ph.D. in Movement Science from Washington University and a BFA in Dance from NYU, Tisch School of the Arts and has also been an American Council on Exercise certified personal trainer since 2000. Dr. Hackney’s extensive research interests include inquiry into challenging exercise programs–traditional exercise, Tai Chi and partnered tango classes–designed to improve physical function and quality of life in people with PD, older adults and those with serious mental illness. In 2014, she co-founded MDT Education Solutions, which has trained dozens of fitness and allied health professionals how to develop and lead safe, evidence-based exercise programs for people with PD at all stages of the disease, including almost all instructors in the PD Gladiators Metro Atlanta Fitness Network (including the YMCA of Metro Atlanta). She is currently the Research Advisor to PD Gladiators.

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