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A new type of physical activity from an ancient tradition: the Sardinian folk dance "Ballu Sardu".

The traditional Sardinian folk dance ballu sardu (BS) is still very popular in Sardinia. The origins of BS are almost unknown; it is believed that it may derive from prehistoric sacred ceremonies celebrated to propitiate an abundant hunt or a good harvest, and that it embodies not only an enjoyable social moment but also the expression of a community. (1) This tradition has been transmitted verbally for generations and is currently one of the richest and most interesting in Italy and the Mediterranean regions in general.

Ballu sardu is typically danced in a closed or open circle by couples who are holding hands, palm to palm (a manu tenta): an element that confirms the sense of community on the most important occasions of social aggregation (Fig. 1).

Specific types of dance correspond to different geographic areas; the most common being ballu tundu, a passu torrau, and ballu seriu. In northern and central Sardinia, this dance is lively and animated by leaps with agile movements and is usually supported by a chorus of three or more singers. In other parts of the island, BS is accompanied by traditional and archaic wind instruments: launeddas and the shepherd's sulittu. The accordion was introduced only during the 19th century, and it is not clear if, at the beginning, the human voice or instrumental accompaniment was driving the BS. It is, however, certain that accompaniment with more voices (canto a tenore) is of recent usage.1-5

Ballu sardu requires a highly specialized technique involving both musicians and dancers. During BS, all the dancers are holding hands or arms to form a circle that rotates clockwise. The chest, shoulders, neck, arms, and hips are constantly rigid and tense, with a tonic contraction of the muscles of the upper part of the body. Movement of the legs is predominantly from mid-thigh down. The knees are constantly subjected to a slight drop, to ensure a uniform springing of the forefoot. The heels are almost always kept off the ground, with the calves in constant tension.

Since in BS the movement mainly involves the lower part of the body, it has been defined as the "low dance." (1-5)

The different types of BS are characterized by two major modalities, mono-structured and bi-structured, distinctly differentiated by the use of two alternating rhythms, slow and fast (Seriu and Alligru). The different components of the movement are always present in the dance performance, making BS a vigorous physical workout. In Sardinia, there is a growing number of BS schools, each with folk groups that perform these dances during religious celebrations and public festivals, usually wearing traditional clothing specific of each part of the country.

Despite the vitality and widespread popularity of BS in Sardinia, to date there is no research documenting the characteristics and potential fitness benefits of this form of ancient dance. On the other hand, it has been shown through genetic and anthropological studies that Sardinia is one of the Mediterranean countries with a population that enjoys an unusually high quality of life, as evidenced by a significant number of centenarians, who mainly live in inland areas. (6,7) In our study, we questioned whether the Sardinian folk dance, one of the most noble and ancient island traditions, could contribute to the welfare of the Sardinian people. We based the study on the understanding that each physical activity or sport can be classified according to its contribution to the cardiorespiratory system and related energy expenditure. (8,9) It was intended to determine if the BS can be identified as an effective workout and if people who perform BS fulfill the recommendations of the American College of Sports Medicine (ACSM) for exercise in healthy subjects. (9,10) Furthermore, through the analysis and codification of BS, we sought to know whether this traditional and millenarian activity could act as a protective element against injury.

Materials and Methods

Study Design and Population

The present study is an observational trial conducted on young men and women who practice the BS with intensity and continuity. The study protocol was approved by the Institutional Ethics Committee of the investigators' university, and written informed consent was obtained from all subjects at the time of initial evaluation. Inclusion criteria were between 30 to 40 years of age, with at least 15 years of participation in BS sessions. Exclusion criteria were presence of cardiovascular risk factors (arterial hypertension, dyslipidemia, diabetes mellitus, obesity, and present or past history of smoking) and previous or current cardiovascular or cerebrovascular disease.

Twenty volunteers enrolled in the study (10 men and 10 women, mean age 35.2 [+ or -] 6.3 years, height 162.8 [+ or -] 0.1 cm, weight 63.3 [+ or -] 15.1 kg, BMI 23.05 [+ or -] 3.4 kg/[m.sup.2]). All subjects met the criteria for inclusion. In particular, they possessed a mean experience of 20.6 [+ or -] 8.9 years in BS sessions and practiced at a frequency of not less than 2 times per week (2 [+ or -] 1.1 hours/week). All individuals underwent a complete cardiovascular assessment to exclude the presence of cardiovascular disease: anamnesis, physical examination, blood pressure measurement, 12-lead electrocardiogram, and conventional and tissue Doppler echocardiographic analysis. The anthropometric characteristics of the participants are summarized in Table 1.

Cardiopulmonary Exercise Test

Following admission to the study, all subjects underwent an integrated maximal cardiopulmonary exercise test on an electrically braked stationary cycle ergometer (Medical Graphics Corporation, Minneapolis; USA--Breeze Software integrated with the XScribe 5, Mortara Instrument Europe s.r.l.). Heart rate and rhythm were continuously monitored using a 12-lead ECG, recorded every 30 seconds during both exercise and a 10-minute post-exercise recovery period. Arterial blood pressure was ascertained using the standard cuff technique with a mercury sphygmomanometer placed on the left forearm and measured with the auscultatory technique. A ramp protocol with exercise regimen of a 4-min warm-up at 20 W at a pedal speed of 60 to 65 revolutions/min was applied in order to exclude any cardiovascular problems and to register the principal physiological variables. Breath-by-breath V[O.sub.2], carbon dioxide production (VC[O.sub.2]), minute ventilation (VE), and maximum work (Work, watts) were measured. VO2max and the consumption of oxygen at anaerobic threshold were expressed as absolute value, standardized by weight and as a percentage of the above mentioned values, according to the Wasserman formula. (11) Anaerobic threshold was calculated by two independent skilled operators using the V-Slope method. The test is considered maximal when the patient appeared to give a true maximal effort (point of bodily exhaustion). After a recovery period of about 1 hour from the maximal cardiopulmonary exercise test, participants carried out the BS session.

Ballu Sardu Session Monitoring

We chose to study the ballu tundu as a prototype of BS, because it is the form of dance most widely practiced, with minor variations, from the north to the south of Sardinia. Ballu Tundu is a bi-structured dance performed in a circle with clockwise movement. The BS dynamics include steps and jumps with arrest on the right foot. The interpretation of dancers follows changes in the music rhythm, characterized by a slow and quiet component (passu seriu), and a second more lively and rhythmic one, passu alligru or brinchidu (literally "step skipped").

The performance of BS carried out for this study consisted of about a quarter of an hour (13.8 [+ or -] 0.33 minutes) of ballu tundu, preceded by 5 minutes of warm-up and followed by 5 minutes of cool-down. The dancers wore a radio-telemetric heart rate monitor (Polar Team 2 Pro, Polar Electro Oy, Kempele, Finland). (12) Prior to starting the warm-up period, RHR and blood pressure were recorded. The data resulting from the maximal cardiopulmonary exercise test (HR, VO2max, anaerobic threshold) were included in the calculation of the Polar Team 2 software and used to estimate exercise intensity (EI), V[O.sub.2] consumption, and energy expenditure (EE) during physical performance. The Borg's rating scale (RPE) was used to assess exertion perceived by each dancer at the end of the BS session. (13)

Statistical Analysis

Descriptive statistics are reported as mean [+ or -] SD or frequency (%) for all 20 subjects. Differences in means of the variables of RHR assessed before starting the maximal cardiopulmonary exercise test and before the BS session were tested with the use of analysis of variance. The analyses were performed using InStat (GraphPad Software, Inc.). P-value < 0.05 was considered to be statistically significant.

Results

All dancers examined had a normal anthropometric profile and had practiced the dance for no less than 15 years (Table 1). The recording of 12-lead surface ECG and echocardiographic examination proved to be normal in all subjects (data not shown). Table 2 shows the evolution of hemodynamic parameters during the maximal cardiopulmonary exercise test. HR and systolic and diastolic blood pressure were within normal limits at baseline rest and increased normally during exercise. (11) At the end of effort, HR max was 183 [+ or -] 9.8 bpm, and systolic and diastolic blood pressure were 172.5 [+ or -] 19.6 mmHg and 78.5 [+ or -] 5.3 mmHg, respectively.

The dancers showed a good average aerobic capacity (V[O.sub.2]max: 44.1 [+ or -] 3.2 ml x [kg.sup.-1] x [min.sup.-1]) and an appropriate work rate (general 148.2 [+ or -] 57.8 W, women 101.7 [+ or -] 20.4 W, men 204.0 [+ or -] 26.1 W). (11) After a recovery period of about 1 hour and prior to starting the BS session, the RHR and blood pressure levels were re-measured. No significant differences between the two measurements were found (p = n.s.).

The HR, recorded with the radiotelemetric technique, was analyzed. The average HR throughout the dance session (13.8 [+ or -] 0.3 min) was 146.3 [+ or -] 15.0 bpm (range = 125 to 167 bpm), corresponding to 79.9% [+ or -] 6.5% of that obtained in the preliminary cardiopulmonary exercise test. Figure 2 details the percentage of dance time characterized by HR in the range of 50% to 59%, 60% to 69%, 70% to 79%, 80% to 89%, 90% to 100%, respectively.

To evaluate physical response during the dance session, we used the values of HR and V[O.sub.2] max, placing them in the Polar Team 2 Pro software. (10) The estimated V[O.sub.2] during the dance time was 35.5 [+ or -] 32.3 ml x [kg.sup.-1] x [min.sup.-1], equivalent to 78.6 [+ or -] 15.4% of V[O.sub.2] max consumed at pre-test. The estimated cost of the BS session per participant was 11.2 [+ or -] 2.4 Kcal/min, which corresponds to a total of 157.1 [+ or -] 34.1 kcals for the duration of the BS session. Similarly, the EE during BS resulted in 9.8 [+ or -] 1.5 MET/min. Finally, the average value of the Borg's rating of perceived exertion (RPE) scale was 11.5 [+ or -] 1.2 (range = 10 to 13). These data are displayed in Table 3.

Discussion

In the present study, we showed that during the execution of a BS session subjects danced at an average of 79.9% [+ or -] 6.5% of HRmax and at 78.6% [+ or -] 15.4% of V[O.sub.2] max, and the average MET/min was 9.8 [+ or -] 1.5. According to the Guidelines for Exercise Testing and Prescription individuals should perform exercise between 64% to 94% of HRmax or 40% to 85% of V[O.sub.2]max to improve cardiovascular fitness. (9,10) Thus, all subjects who participated in the sessions of BS demonstrated an energy cost that meets guidelines and is, therefore, sufficient to increase aerobic capacity and induce training effects. Furthermore, BS can be generally defined as a vigorous form of physical activity, both for men and women. These findings are directly related to the rapid and rhythmic movements typical of this dance. Indeed, while the muscles of the upper part of the body are constantly in tension with a tonic contraction, the movements of the legs are very fast, especially from mid-thigh down. The knees are continuously subjected to a slight drop, maintaining a constant springing of the forefoot.

In addition, our data suggest that this task is harder for female than male dancers, since women reached a higher percentage of HRmax, working for a longer time in the anaerobic metabolic phase (data not shown). These particular findings have not been used as results of this study because our research protocol was not designed to distinguish statistically significant differences between males and females. To pursue that goal, we plan to extend the study population, enlisting men and women in equal numbers.

This study found that approximately a quarter of an hour of BS performance results in the consumption of an average of 11 Kcal/min, 9.8 MET/min, and 157 Kcals. Hence, BS activity, performed at least 2 or 3 times a week (2 to 3 hours), can be considered an effective way to maintain and improve cardiovascular health.

This degree of engagement is consistent with the recommendations of the ACSM, which suggest that individuals consume 300 kcal/ workout and a target volume of 500-1000 MET/min/week in order to promote weight loss and maintain a healthy body weight. (10) In addition, it is important to note that the BS sessions usually last longer in training at schools or during popular festivals in the streets, and the heavy traditional dresses often worn by the dancers could cause additional EE.

Our data complement and confirm the results of other studies that have classified different styles of dance through EE. In this context, Massidda and coworkers found that Latin American dances are characterized by an EE up to 9 MET, (14) and Rixon and associates by analyzing caloric expenditure in four modes of aerobic dance showed an EE range of 8 to 10 kcal/ min, comparable to a running speed of about 8 km/h. (15)

Several researchers have investigated the maximal oxygen uptake of dancers, and it was found to be approximately 40 to 47 ml x [kg.sup.-1] x [min.sup.-1], regardless of dance style. (16,17) However, very few studies have specifically analyzed the folk dances of different countries of the world. Among them, a Polish study was similar to ours, showing that the mazur, one of Poland's national folk dances, can be quantified as hard for men and very hard for women and is characterized by high EE. (18) The hambo, an old traditional Swedish dance, has been found to induce effects of physical workout in practitioners, provided it is performed with the frequency and for a duration normally recommended for physical activities. (19)

Many epidemiological and anthropological studies have well documented that Sardinia is a land with long life expectancy and high quality of life for its inhabitants. (6,7) This particular characteristic of the Sardinian population was studied over time and showed significant correlations with genetics, diet, and healthy lifestyle. Furthermore, it has been shown that in areas where the number of centenarians is greatest--the so called "Blue Zones"--there is a high level of individual physical activity, mainly concerning work activities and domestic habits of the people. (7) In such areas of Sardinia, the BS has always been one of the most common activities at social events, such as celebrations and religious ceremonies. It is reasonable to assume that this dance, intensely practiced for many years in the life of a person, may have a role in improving the welfare and quality of life. In addition, based on our assessments, regular participation in sessions of BS, beyond a leisure activity, could represent for the Sardinians a kind of physical workout, which is useful in improving aerobic capacity and favorably controlling body mass.

The use of different forms of dance as a therapeutic tool is increasingly common, especially among those individuals for whom social relations and participation in collective activities play a major role in the achievement of health goals. (20-22) Exercise performed in a group may result in very substantial benefits to people with diseases which, more than others, reduce the physical autonomy and quality of life. (23,24) BS, due to its inherent characteristics, is addressed to both motor-function (coordination, balance, cardiovascular endurance, visual memory, mobility, posture, etc.) and social objectives (group activities, use of music, historical re-enactment, physical contact--a manu tenta). On the basis of its quality, BS, after an appropriate selection of the aptitudes and abilities of patients, might be a valuable therapeutic instrument for treating many neurological, rheumatic, and cardiovascular diseases. (25)

Conclusion, Limitations, and Future Directions

Two limitations of this study are the restricted initial population studied and the analysis of only one type of BS, as the most common among all the existing traditional dances. In addition, observational studies tend to overemphasize the benefits of an intervention, so it will be necessary in future studies to add a control group to see if in fact these benefits are present. Also, the difficulties involved in applying the intervention beyond its cultural context create the principal "natural" limitation of this study.

A future goal is to analyze the other BS forms and increase the number of participants, including a control group. In this way, we will be able to extend the proposal of BS as a training activity for the control and prevention of disease risk factors. For example, we might suggest mono-structured and slower dance forms for older or less fit individuals. We might also incorporate this pleasant and socializing activity into training protocols and rehabilitation programs for special populations. (25)

Another interesting aspect of future research could be to explore a possible correlation between the constant practice of BS and the well-being of the Sardinian population, particularly in those areas where there is a greater presence of centenarians and where the practice of BS is highly common. From this perspective, our study is a starting point in the analysis of potential links between the lifestyle, health, and longevity of the Sardinian people.

Lucia Cugusi, Ph.D., Rosina Di Cesare, M.D., Martino Deidda, Ph.D., M.D., and Giuseppe Mercuro, M.D., Department of Medical Sciences, 'M Aresu,' and Adapted Physical Activity Master Degree Course, University of Cagliari, Cagliari, Italy. Myosotis Massidda, Ph.D., Department of Life and Environmental Science, University of Cagliari, Cagliari, Italy. Daniela Matta, B.Sc., Adapted Physical Activity Master Degree Course, University of Cagliari, Cagliari, Italy. Emanuele Garau, B.A., Accademia di Belle Arti, Sassari, Italy. Gianmario Satta, M.D., and Paolo Chiappori, M.Sc., The 'I Mulini' Medical Centre, Su Planu, Cagliari, Italy. Paolo Solla, Ph.D., M.D., Movement Disorders Center, Institute of Neurology, University of Cagliari, Cagliari, Italy.

Correspondence: Lucia Cugusi, Ph.D., Department of Medical Sciences, 'M. Aresu', University of Cagliari, Strada Statale 554, Km 4.500, 09042 Monserrato (Cagliari); lucia.cugusi@tiscali.it.

http://dx.doi.Org/10.12678/1089-313X.19.3.U8

References

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(15.) Rixon KP Rehor PR, Bemben MG. Analysis of the assessment of caloric expenditure in four modes of aerobic dance. J Strength Cond Res. 2006 Aug;20(3):593-6.

(16.) Wyon M, Head A, Sharp C, Redding E. The cardiorespiratory responses to modern dance classes. Differences between university, graduate, and professional classes. J Dance Med Sci. 2002;6(2):41-5.

(17.) Martyn-Stevens BE, Brown LE, Beam WC, Wiersma LD. Effects of a dance season on the physiological profile of collegiate female modern dancers. Med Sport. 2012;16(1):1-5.

(18.) Maciejczyk M, Fec A. Evaluation of aerobic capacity and energy expenditure in folk dancers. Hum Mov Sci. 2013;14(1):76-81.

(19.) Wigaeus E, Kilbom A. Physical demands during folk dancing. Eur J Appl Physiol Occup Physiol. 1980;45(2-3):177-83.

(20.) McGill A, Houston S, Lee RY. Dance for Parkinson's: a new framework for research on its physical, mental, emotional, and social benefits. Complement Ther Med. 2014 Jun;22(3):426-32.

(21.) Kim SH, Kim M, Ahn YB, et al. Effect of dance exercise on cognitive function in elderly patients with metabolic syndrome: a pilot study. J Sports Sci Med. 2011 Dec 1;10(4):671-8.

(22.) Abreu M, Hartley G. The effects of Salsa dance on balance, gait, and fall risk in a sedentary patient with Alzheimer's dementia, multiple comorbidities, and recurrent falls. J Geriatr Phys Ther. 2013 Apr-Jun; 36(2):100-8.

(23.) Gomes Neto M, Menezes MA, Carvalho VO. Dance therapy in patients with chronic heart failure: a systematic review and a meta-analysis. Clin Rehabil. 2014 Dec;28(12):1172-9.

(24.) Boehm K, Cramer H, Staroszynski T, Ostermann T. Arts therapies for anxiety, depression, and quality of life in breast cancer patients: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2014;2014:103297.

(25.) Durstine JL, Moore GE. ACSMs Exercise Management for Persons with Chronic Diseases and Disabilities. Champaign, IL: Human Kinetics, 2009.

Caption: Figure 1: Bailo sardo, capo di Sassari. Dessin par G. Cominotti et E. Gonin, Grave par A.J. Lallemand [Cagliari: 3T, 198]; from: 11 lithographs made in 7 colors (Paris 1839-1840). View this figure in color at http://dx.doi.org/10.12678/1089-313X.19.3.118.

Caption: Figure 2: Percentage of time spent in specific HR zones compared to HRmax.

Table 1 Anthropometric Characteristics and
Levels of BS Practice of the Participants

Variables            Mean [+ or -] SD (N = 20)

Age (years)              35.2 [+ or -] 6.3
Height (cm)             162.8 [+ or -] 0.1
Weight (kg)             63.3 [+ or -] 15.1
BMI (kg/[m.sup.2])      23.05 [+ or -] 3.4
YBS (years)              20.7 [+ or -] 8.9
TBS (hours/week)          2 [+ or -] 1.1

Data are expressed as mean [+ or -] SD. BMI, body
mass index; YBS: years of participation at
BS sessions; TBS, time spent in the practice
of BS, expressed in hours/week.

Table 2 Cardiopulmonary Exercise Test Data

Cardiopulmonary Exercise Test    Mean [+ or -] SD (N = 20)

RHR (bpm)                           79.1 [+ or -] 14.3
SBP at rest (mmHg)                   114 [+ or -] 11.3
DBP at rest (mmHg)                    72 [+ or -] 8.7
SBPmax (mmHg)                       172.5 [+ or -] 19.6
DBPmax (mmHg)                        78.5 [+ or -] 5.3
HRmax (bpm)                          183 [+ or -] 9.8
V[O.sub.2]max (l/min)                2.9 [+ or -] 0.8
V[O.sub.2]max (ml x                  44.1 [+ or -] 3.2
  [kg.sup.-1] x [min.sup.-1])
Work (watt)                         148.2 [+ or -] 57.8

Data are expressed as mean [+ or -] SD. RHR, resting
heart rate; SBP, systolic blood pressure; DBP, diastolic
blood pressure; VO2max, maximum oxygen uptake expressed
in absolute and indexed for body weight; Work: maximum work.

Table 3 Average Physiological Responses
to the BS Session

Variables (N = 20)                Mean [+ or -] SD

RHR (bpm)                        79.7 [+ or -] 13.8
SBP at rest (mmHg)                116 [+ or -] 10.8
DBP at rest (mmHg)                 73 [+ or -] 7.5
%HR max                           79.9 [+ or -] 6.5
V[O.sub.2] during BS (l/min)      2.2 [+ or -] 0.4
V[O.sub.2] during BS (ml x       35.5 [+ or -] 32.3
  [kg.sup.-1] x [min.sup.-1])
%V[O.sub.2] max                  78.6 [+ or -] 15.4
> AT (min, %)                     9.7 [+ or -] 16.5
MET/min during BS                 9.8 [+ or -] 1.5
Kcal/min                          11.2 [+ or -] 2.4
Kcal (13.8 [+ or -] 0.33 min)    157.1 [+ or -] 34.1
RPE                               11.5 [+ or -] 1.2

Data are expressed as mean [+ or -] SD and percentage.
HR, heart rate; SBP, systolic blood pressure; DBP,
diastolic blood pressure; V[O.sub.2], oxygen uptake
expressed in absolute and indexed for body weight;
AT, anaerobic threshold; MET, metabolic equivalent
(1 MET is defined as the energy to lie or sit quietly,
it is equivalent to a metabolic rate of consuming 3.5 mL
[O.sub.2]/kg/minute); RPE: Borg's rating of perceived
exertion scale.


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Article Details
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Author:Cugusi, Lucia; Massidda, Myosotis; Matta, Daniela; Garau, Emanuele; Cesare, Rosina Di; Deidda, Marti
Publication:Journal of Dance Medicine & Science
Article Type:Report
Date:Jul 1, 2015
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