Dr Paula V Quiroga

Patients in the program, who had ischemic or valvular heart disease, chronic heart failure, or congenital heart disease, were taught dance routines developed in a non-rehab population for their measured effects on blood pressure and heart rate, according to Dr Paula V Quiroga (National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico). Fitted with monitors that transmitted the readings to a physical therapist at a central control station, patients performed different dance steps that varied by target levels of exertion, she told heartwire through a translator. They danced to the blues for warm-ups and low-intensity exercise, to rock and roll or to distinctly Cuban danzón rhythms for intermediate levels of exercise, and to vigorous salsa steps for the highest exertion levels.

Quiroga reported on the 560-patient experience with the unusual cardiac-rehab program here at the World Congress of Cardiology 2008. Over two years, the participants developed no serious arrhythmias, angina, or other important complications while dancing, and some showed only occasional runs of ventricular ectopia. Overall, the group experienced few complications, even with 70% of them considered at high clinical risk, according to Quiroga.

The dance routines help overcome the high rate of noncompliance associated with conventional rehab programs, she said; although she has no data to show it, compliance with the novel program appears much greater. Part of that success comes from the enriched social life most participants enjoy as they learn to use the routines recreationally out on the dance floor. "It's a great alternative to the conventional rehabilitation program," she said, "and helps them avoid a sedentary lifestyle."

The observations are consistent with other studies of dance-based rehab in patients with heart failure, according to Dr Mauricio Wajngarten (University of São Paolo, Brazil), who moderated the session that featured Quiroga's report. "They showed more adherence to the program and a similar gain in physical capacity—so it's a good strategy. I wouldn't expect there to be complications or arrhythmias, [however,] because [the exercise] is low-intensity, submaximal. Complications are more likely to be musculoskeletal than cardiac."

The participants, the majority in their 40s, 50s, and 60s but some as old as 80 and as young as four, were each assigned to one of four groups based on their capacities and degree of cardiovascular risk, according to Quiroga. Each group's routines included a variety of tempos, but those at lowest cardiovascular risk, for example, would be assigned more salsa, and those at highest risk would get predominantly blues or danzón, the intensities adjusted according to heart rate.

After four weeks of twice-weekly training sessions, mean exercise tolerance increased by 1.7 METS at stress testing; the mean heart rate during maximal exercise in the routines rose 17% (p<0.001), indicating a training effect. No arrhythmias were ever documented in three-fourths of the group; 18% had occasional runs of ventricular ectopia, and in 7% they were frequent. Ischemic ECG changes were observed in about one-fifth of the population. But there were no instances of angina, acute coronary syndromes, sustained VT or VF, or any cases of sudden death.

The dance routines had been carefully designed to achieve varying heart-rate targets based on monitoring data from healthy volunteers, according to Quiroga. But the original idea to incorporate dance into a formal rehab program, which Quiroga designed with coauthors Drs Mariola Rius Suárez and Hermes Ilarraza-Lomelí (National Institute of Cardiology Ignacio Chavez), came from one of their patients—a dance teacher.