DanceOn50+: Effects of a Dance Program on Physical and Psycho-emotional Health

The Geriatric Depression Scale (GDS, short version) will be used to assess depressive symptoms. The Geriatric Depression Scale (GDS), short version, is a self-report instrument developed specifically to screen for depressive symptoms in older adults. The short version consists of 15 yes/no questions, selected from the original 30-item version, and is designed to minimize the influence of somatic symptoms that may overlap with physical ageing processes. Its simplicity and clarity make it especially suitable for older populations, including those with mild cognitive impairments.

This tool has been widely validated across various settings and cultures, demonstrating good sensitivity and specificity for detecting clinically relevant depressive symptoms in the elderly. Scores range from 0 to 15, with higher scores indicating greater depressive symptomatology. Cut-off points commonly used are: 0-4 (normal), 5-8 (mild depression), 9-11 (moderate depression), and 12-15 (severe depression).

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Anxiety symptoms will be assessed using the Hamilton Anxiety Rating Scale (HARS), also known as Escala de Ansiedade de Hamilton (EADS) in its Portuguese version. The HARS is a clinician-administered scale that evaluates the severity of anxiety symptoms across psychological and physical domains. It is widely recognized for its high reliability and validity, and is used in both clinical and research settings.

The scale consists of 14 items that assess various aspects of anxiety, such as tension, fears, insomnia, cognitive impairment, somatic complaints, and autonomic symptoms. Each item is rated on a 5-point Likert scale, ranging from 0 (absent) to 4 (severe).

The total score can range from 0 to 56, with higher scores indicating more severe levels of anxiety. The commonly used classification is as follows:

0-17: Mild anxiety 18-24: Moderate anxiety 25-56: Severe anxiety

The Astrand Cycle Ergometer - This sub-maximal test with incremental protocol and performed on a ergometer, standard an open-circuit spirometer technique (Cosmed K5b2, Cosmed, Rome, Italy) will be used.

The knee extensors and flexors will be evaluated using an isokinetic dynamometer at two different angular velocities: 60°/s and 180°/s.

Physical-functional fitness is going to be measured via the Senior Fitness Test (SFT). This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), agility/dynamic balance (8-foot up-and-go test), aerobic endurance (six-minute walk test) and lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively). The chair stand test to assess the strength of the lower body, counting the number of repetitions made in 30s. And the arm curl test to assess the strength on the upper body, using a 3lb (women) and 5lb (men) dumbbell, counting the number of repetitions made in 30s.

Physical-functional fitness is going to be measured via the Senior Fitness Test (SFT). This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), agility/dynamic balance (8-foot up-and-go test), aerobic endurance (six-minute walk test) and lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively). The stand up, walk 8-foot distance (2,44 meters), turn the cone marker around and return to the seated position. The time, in seconds, necessary to complete this test will be registered.

Physical-functional fitness is going to be measured via the Senior Fitness Test (SFT). This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), agility/dynamic balance (8-foot up-and-go test), aerobic endurance (six-minute walk test) and lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively). The stand up, walk 8-foot distance (2,44 meters), turn the cone marker around and return to the seated position. The time, in seconds, necessary to complete this test will be registered.

Physical-functional fitness is going to be measured via the Senior Fitness Test (SFT). This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), agility/dynamic balance (8-foot up-and-go test), aerobic endurance (six-minute walk test) and lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively). The chair sit-&-reach test to assess the flexibility of the lower-body, measured in cm. And The back scratch test to assess flexibility on the upper-body, measured in cm.

The handgrip strength will be measured with a Jamar Plus + Digital hand dynamometer (Sammons Preston Inc., Bolingbrook, Illinois, USA). Measurements will be carried out following the American Society of Hand Therapists recommendations, and each participant will perform three attempts with a pause of 1 min between them. Three attempts will be made for each hand, using the maximum value of the three registers.

Age (years), academic level (primary, secondary, bachelor, master, PhD), civil status (married, separated, widow, single, others), number of medications, diagnosed diseases.

Body mass (kg) will be analyzed with bioimpedance balance.

To assess participants perceived quality of life, the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) will be used. This validated instrument consists of 26 items that measure four key domains: Physical Health, Psychological Health, Social Relationships, and Environment. Each item is rated on a 5-point Likert scale, and scores for each domain are calculated by summing specific items, then transforming the raw scores into a scale from 0 to 100, where higher scores indicate better perceived quality of life.

To assess overall life satisfaction, the Satisfaction with Life Scale (SWLS) will be administered. This instrument includes 5 items that reflect a global evaluation of an individual's life according to their own criteria and values. In this study, responses will be rated on a 6-point Likert scale ranging from 0 ("Strongly disagree") to 5 ("Strongly agree"), resulting in a total score ranging from 0 to 25. Higher scores indicate greater satisfaction with life. Interpretation of total scores typically follows these cut-offs: 0-4 (Extremely dissatisfied), 5-9 (Dissatisfied), 10-14 (Slightly dissatisfied), 15 (Neutral), 16-19 (Slightly satisfied), 20-22 (Satisfied), and 23-25 (Extremely satisfied).

To assess perceived social isolation, this study will use the Portuguese-adapted version of the UCLA Loneliness Scale comprising 16 items. This version was culturally and linguistically validated for the Portuguese population, particularly in older adults, ensuring conceptual equivalence while excluding or modifying items less relevant in this context. Each item is rated on a 4-point Likert scale ranging from 1 ("Never") to 4 ("Often"). Total scores range from 16 to 64, with higher scores indicating greater perceived loneliness. The scale assesses key dimensions of loneliness, including feelings of social disconnectedness, lack of companionship, and emotional isolation.

To evaluate affective states, the study will use the Positive and Negative Affect Schedule (PANAS), a validated self-report instrument measuring two distinct dimensions of mood: Positive Affect (PA) and Negative Affect (NA). The PANAS consists of 20 items, with 10 items assessing PA-enthusiastic, interested, alert, inspired, determined, attentive, active, proud, excited, and strong-and 10 items assessing NA-distressed, upset, guilty, scared, hostile, irritable, ashamed, nervous, jittery, and afraid. Participants rate how much they have experienced each emotion over a specified time frame on a 5-point Likert scale ranging from 1 ("Very slightly or not at all") to 5 ("Extremely"). Scores for each subscale are summed separately, with possible ranges of 10 to 50. Higher PA scores indicate greater positive emotional engagement, while higher NA scores reflect higher levels of distress and negative emotional experience.

Physical Activity will be tested by Accelerometer-based activity monitors GT3X+ Link (ActiGraph)

To assess sleep quality, the study will use the Pittsburgh Sleep Quality Index - Portuguese version (PSQI-PT), a widely validated self-report questionnaire designed to measure sleep quality and disturbances over a one-month period. The PSQI-PT consists of 19 items, which generate seven component scores assessing different dimensions of sleep: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored from 0 to 3, and the sum of these yields a global score ranging from 0 to 21. Higher scores indicate poorer sleep quality, with a commonly used cut-off of >5 to distinguish poor sleepers from good sleepers.

fat-free mass (kg), will be analyzed with bioimpedence balance.

fat mass (%) will be analyzed with bioimpedance balance.

BMI (Kg/m^2) will be analyzed with bioimpedance balance.

Consortium to establish a registry for the Alzheimer's Disease List Test (CERAD), will be used: word list memory; word list recall; and word list recognition. The parameters: total hits and delayed recall hits.

Selective recall test [SRT-List A; parameters: consistent long-term recall, long-term storage, delayed recall, and intrusions] to assess verbal learning and multiple-trial memory.

The Forward Digit Span (DS) test will be used to assess verbal short-term memory. This test is a subtest of the Wechsler Adult Intelligence Scale (WAIS-III).

The Forward DS test requires participants to repeat a sequence of digits in the same order they were presented, assessing their ability to hold and recall information over a short period.

The DS score is determined by the maximum number of digits the participant is able to accurately repeat in the correct order. A performance of 5 to 7 digits falls within the normative range. Scores below this range may indicate potential deficits in attention or short-term memory capacity, while scores above may reflect superior cognitive functioning.

The Stroop Color and Word Test (parameters: words, colors, and words/colors) will be selected to assess response inhibition/cognitive flexibility.

Digit Symbol Substitution Test (DSST, subtest of the Wechsler test of adult intelligence WAIS III) will be used as a measure of high-level information processing speed.

This will be analyzed using an electromyography (EEG) system. All EEG signals will be acquired with the ActiCHamp®, Brain Products,GmbH. With an international 10-20 system with standard 32-channel electrode layout with reference and ground electrodes. The ground will be located on the forehead and the reference will be the Cz channel of the ActiCHamp® equipment. For each participant, the same equipment will be used in all sessions.

Risk of falls will be evaluated through The Fracture Assessment Risk Tool (FRAX).

Qualitative analysis will be testd with Semi-structured interviews.

Working memory will be assessed using the Backward Digit Span subtest from the Wechsler Adult Intelligence Scale - Third Edition (WAIS-III). In this task, participants are required to repeat a sequence of digits in the reverse order of their presentation, evaluating their ability to mentally manipulate and retain verbal information. The Backward DS score is defined as the highest number of digits the participant can accurately reproduce in the correct reverse sequence. Performance typically ranges from 3 to 5 digits, based on normative data. Scores below this range may indicate difficulties in working memory or executive functioning, whereas scores above may suggest enhanced cognitive flexibility and working memory capacity.

Time Frame: Baseline, 6 months