title: Waltz dancing in patients with chronic heart failure: new form of exercise training.
abstract: BACKGROUND
  There is evidence that aerobic exercise improves functional capacity in patients with New York Heart Association (NYHA) class II and III chronic heart failure. However, it is unknown whether dancing is safe and able to improve functional capacity in patients with chronic heart failure.
  
  
  RESULTS
  We prospectively studied 130 patients with stable chronic heart failure (107 men; mean age, 59+/-11 years) in New York Heart Association class II and III and left ventricle ejection fraction <40%. Patients were randomized to supervised aerobic exercise training at 70% of peak o(2) 3 times a week for 8 weeks (group E, n=44) or to a dance protocol of alternate slow (5 minutes) and fast (3 minutes) waltz lasting 21 minutes (group D, n=44). A group that did not undergo exercise training served as control (group C, n=42). On study entry and at 8 weeks, all patients underwent cardiopulmonary exercise testing on a cycle ergometer until volitional fatigue, 2D-echo with Doppler, and endothelium-dependent dilation of the brachial artery. Heart rate was 111+/-15 bpm during exercise training and 113+/-19 bpm during dancing (P=0.59). Peak o(2), anaerobic threshold, e/co(2) slope, and o(2)/W slope were all similarly improved in both E and D groups (+16% and 18%, 20% and 21%, 14% and 15%, 18% and 19%, respectively; P not significant for all comparisons; P<0.001 versus controls). Endothelium-dependent relaxation was also similarly improved (group E, from 2.6+/-1.3% to 5.2+/-1.5%, P<0.001 versus control; group D, from 2.2+/-1.4% to 5.0+/-1.5%, P<0.001 versus control for both E and D). The change in peak o(2) in E and D groups was correlated with changes in peak velocity of early filling wave/peak velocity of late filling ratio (r=-0.58, P<0.001) and endothelium-dependent dilation (r=0.64, P<0.001). Untoward events were rare in both E and D groups.
  
  
  CONCLUSIONS
  In patients with stable chronic heart failure, waltz dancing is safe and able to improve functional capacity and endothelium-dependent dilation similar to traditional aerobic exercise training. Waltz dancing may be considered in clinical practice in combination with aerobic exercise training or as an alternative to it.
authors.affiliation: Cardiologia Riabilitativa, Presidio Cardiologico Lancisi, Ospedali Riuniti, Ancona, Via Conca 71, 60020 Ancona, Italy. r.belardinelli@ao-umbertoprimo.marche.it
authors.forename: Romualdo
authors.initials: R
authors.lastname: Belardinelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Lacalaprice
authors.forename: Chiara
authors.initials: C
authors.lastname: Ventrella
authors.forename: Loretta
authors.initials: L
authors.lastname: Volpe
authors.forename: Ernesto
authors.initials: E
authors.lastname: Faccenda
mesh_terms: D003615:Dancing; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014664:Vasodilation