Zumba for Patients with Parkinson’s

Disease and Freezing Gait Patterns

Savannah Walker & Aidan Reath
 Patient Case
• The patient is a 60-year-old female with a 7-year history of Parkinson’s
Disease (PD). Lately she has experienced severity of symptoms and was
referred for outpatient physical therapy. Her chief complaints include
difficulty walking, especially when she must go through a narrow
doorway, or walk in a crowded place, as well as episodes of gait freezing.
The latter manifests as an inability to initiate gait after she stops or tries to
get something while walking, like taking a tissue out of her pocket, and she
stops abruptly in her tracks. The harder she tries to move, the worse it gets.
Episodes of freezing have lasted up to 20 minutes. She cannot describe
precisely what activities cause the most of her freezing episodes. The
patient wants the physical therapist either to fix this problem or teach her a
strategy of how to prevent or avoid most of the freezing. 
 Clinical Question
• Is Zumba (I) beneficial at decreasing freezing
gait patterns (O) in a 60-year-old female with
Parkinson’s disease (P)?
 Introduction
• Freezing of gait (FOG) is a disabling motor symptom of PD affecting
a patient’s activities of daily living and is the main cause of falling
and fracture risks.1
• Different forms of dancing, including tango, Irish set dancing, Zumba,
and ballroom dancing, have been shown to improve PD symptoms
such as static and dynamic balance, walking speed, quality of life,
mood, and mobility.2, 3
• There is lack of evidence to see if Zumba can decrease freezing gait
and improve gait patterns in people with Parkinson’s.
• The purpose of this study is to see if Zumba can decrease the
occurrence of freezing gait patterns in patients with Parkinson’s
disease.
 Subjects 
• Participants with idiopathic PD manifested by
freezing gait patterns 
• Inclusion criteria:
– Age 55-70 years old
– Diagnosis of idiopathic PD by a medical
practitioner 
– Symptoms of FOG
– Below stage 3.0 on Hoehn and Yahr Staging Scale
of Parkinson Disease2
– Ability to follow simple instructions 
 Subjects 
• Exclusion criteria:
– Cannot speak English 
– Presence of dementia 
– Presence of other neurological disorders not
related to PD
– Serious emotional, cognitive, or behavioral
problems, and serious communication problems
– Cardiovascular and/or musculoskeletal
contraindications to exercise
 Intervention
• Series of Zumba styled dances led by a qualified instructor,
including merengue, cumbia, reggaeton, salsa, belly dancing,
and pop
• Each session includes a stretching and ROM warm-up,
warm-up song, main workout songs, cooldown song, and
stretching and ROM cooldown
• Each session is 50 minutes long with each workout song
representing one style of dancing with a 2-minute break
between each song
• Dance styles include forward steps, side steps, and backwards
steps
 Intervention Protocol
• Warm-up ROM &
stretch (2 min)
• Warm-up song (2 min)
• Main workout songs (28
https://www.thepeterboroughexaminer.com/sports/peterborough-
min) region/2022/03/21/keeping-on-the-move-key-for-parkinsons-disease-
patients.html

• Cooldown song (2 min)

• Cooldown ROM &
stretch (2 min)
• Chairs placed within 2
feet of subject
https://www.thepeterboroughexaminer.com/sports/peterborough-
region/2022/03/21/keeping-on-the-move-key-for-parkinsons-disease-
patients.html
 Study Design
• Phase I clinical trial
– Primary goal: to test efficacy of Zumba in a small group of
patients with PD manifested by FOG
– Secondary goal: to establish eligibility and safety criteria
• Practice: in-clinic, supervised by trained physical
therapists 
– Twice a week, 5 weeks, 10 sessions
• Convenience sample size: 3 subjects, to achieve at
least 80% power with significance level p at least 0.05. 
– Subject size will be verified once first set of data is collected
 Data Collection & Analysis
• Primary Outcomes
– Self-reported FOG Questionnaire1
– Clinically observed FOG1
• Secondary Outcomes 
– Functional Gait Assessment (FGA)4
 Data Analysis 
Evaluation Schedule

PRE-TEST I PRE-TEST II BASELINE POST-TEST I POST-TEST II FOLLOW UP

2 days 2 days 5 weeks 2 days 2 days

4 days 4 days
 Statistics
• Baseline measures
– Self-reported FOG Questionnaire 
– Clinically observed FOG 
– FGA
• Standard deviation ± 2
 Conclusion
• Anticipated results
– Efficacy of the Zumba dancing in participants with
impaired gait patterns and FOG will be supported
– Safety requirements and criteria will be formulated
• Limitations
– PD population has different levels of severity
– Camera quality
 References
1. Sawada M, Wada-Isoe K, Hanajima R, Nakashima K. Clinical features of
freezing of gait in Parkinson's disease patients. Brain Behav.
2019;9(4):e01244. doi:10.1002/brb3.1244
2. Delextrat A, Bateman J, Esser P, Targen N, Dawes H. The potential benefits
of Zumba Gold ® in people with mild-to-moderate Parkinson’s: feasibility
and effects of dance styles and number of sessions. Complement Ther Med.
2016;27:68-73. doi:10.1016/j.ctim.2016.05.009
3. Volpe D, Signorini M, Marchetto A, Lynch T, Morris ME. A comparison of
Irish set dancing and exercises for people with Parkinson’s disease: a phase II
feasibility study. BMC Geriatrics. 2013;13(1). doi:10.1186/1471-2318-13-54
4. Yang Y, Wang Y, Zhou Y, Chen C, Xing D. Reliability of functional gait
assessment in patients with Parkinson’s disease. Medicine. 2016;95(34).
doi:10.1097/md.0000000000004545