









































ANNALES KINESIOLOGIAE • 15 • 2024 • 1

5

EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT 
AND DANCE ROLLATOR USERS:  

A SINGLE-ARM PILOT STUDY USING LAB-VIDEO-BASED 
DANCE INTERVENTION WITH A FOCUS ON INTEGRATING 
INTER-COMMUNICATION TECHNOLOGY IN ROLLATOR 

DANCE

Niharika BANDARU1, Anita HÖKELMANN1, Abdelaziz TRIKI1, 
Ulrich THIEL1 

1 Otto Von Guericke University Magdeburg, Germany

Corresponding Author:
Niharika BANDARU

Otto Von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, 
Germany

Telephone: +4917684647573
E-mail: niharika.bandaru@ovgu.de

ABSTRACT

The present single-arm pilot study investigates the effects of a video-based dance 
intervention on physical outcomes in elderly individuals utilizing sports and dance rol-
lators. In addition, the dance videos used in the current study are intended to integrate 
into the future Intercommunication Technology (ICT)-Rollator for the elderly. The aim 
is to evaluate the physical outcomes (such as gait, balance, mobility, and hand grip 
strength) during guided movement training (dance) using a video projected in a labora-
tory setting. The pilot study involved six elderly rollator users (aged 85 and above). In 
the initial assessment, subjects were screened for mobility and coordination limitations 
prior to pre-testing using a four-square-step test and the SF-36 questionnaire. Both 
pre-testing and post-testing included assessments of mobility, balance, and spatiotem-
poral gait parameters using the Timed Up-and-Go (TUG) test, Berg Balance Scale 
(BBS), and the Optogait system, respectively. Hand grip strength was measured using a 
hand dynamometer and reaction time was measured using a pipe-drop test. Blood pres-
sure was monitored every 15 minutes during the training sessions to prevent adverse 
events, maintaining an upper range of 140-150/90-96. Adherence rates were measured 
based on the total duration of activity, calories burned per session, and dropout rates. 

Preliminary communication         DOI: https://doi.org/10.35469/ak.2024.428
received: 2023-11-27                  UDC: 796.012-053.9:793.3

mailto:niharika.bandaru@ovgu.de


6

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Post-session questionnaires were administered to verify the respondents’ qualitative 
evaluations of their degrees of exhaustion, enjoyment, impediments, facilitators, and 
suggested changes. The intervention included heart rate monitoring, which revealed 
gradual and slight increases in heart rate intensity and gradual decreases in heart 
rate ranges (HRR) during the dance sessions. The results indicate improvements in 
balance, mobility, gait, and adherence rates. Future longitudinal research will further 
examine the effectiveness of the dance intervention using the ICT-Rollator, comparing 
it to a control group using a conventional rollator. The ICT-Rollator could be a unique 
rehabilitation aid for the elderly, offering promising improvements. 

Keywords: intercommunication technology rollator, dance intervention, scoping re-
view, future longitudinal study, home-based technology interventions.

OCENJEVANJE TELESNIH REZULTATOV PRI STAREJŠIH 
UPORABNIKIH HODULJ S KOLESI ZA ŠPORT IN PLES: 

ENOSKUPINSKA PILOTNA ŠTUDIJA O PLESNI INTERVENCIJI, 
KI TEMELJI NA VIDEOPOSNETKIH, Z VIZIJO INTEGRACIJE 
MEDKOMUNIKACIJSKE TEHNOLOGIJE PRI HODULJAH S 

KOLESI ZA PLESNO TERAPIJO

IZVLEČEK

V pričujoči pilotni študiji z eno skupino je bil raziskan učinek plesne intervenci-
je na osnovi videoposnetkov na telesne rezultate pri starejših, ki uporabljajo športne 
in plesne hodulje s kolesi. Poleg tega so plesni videoposnetki, uporabljeni za inter-
vencijo v pričujoči študiji, vgrajeni v prihodnjo medkomunikacijsko tehnologijo (IKT) 
za hodulje s kolesi za starejše. Trenutni cilj je oceniti telesne rezultate (kot so hoja, 
ravnotežje, mobilnost in moč prijema) vodene gibalne vadbe (ples) z uporabo video 
projekcije v laboratorijskem okolju. V pilotni študiji je sodelovalo šest starejših (85+) 
uporabnikov hodulj s kolesi. Pri začetni oceni smo pred testiranjem z uporabo testa 
korakanja v štirih kvadratih in z vprašalnikom SF36 preverili gibalne in koordinacijske 
omejitve udeležencev. Pred testiranjem in po njem smo preverili parametre gibljivosti, 
ravnotežja in časovnih ter dolžinskih spremenljivk hoje z uporabo časovno merjene-
ga testa vstani in pojdi (TUG), Bergove lestvice za oceno ravnotežja (BBS) oziroma 
sistema Optogait. Hkrati smo z ročnim dinamometrom izmerili moč prijema in izvedli 
test spusta cevi za merjenje odzivnega časa. Poleg tega smo med plesno dejavnostjo 
vsakih 15 minut merili krvni tlak, da bi preprečili neželene dogodke in ohranili zgornji 
razpon 140–150/90–96. V tej pilotni študiji smo sodelovanje udeležencev merili na 
osnovi skupnega trajanja dejavnosti, kalorij, porabljenih na vsakem treningu, in sto-
pnje opustitve. Po vsakem treningu pa smo za sodelujoče pripravili vprašalnik, da bi 



7

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

preverili kvalitativne ocene anketirancev o stopnji izčrpanosti, užitku pri dejavnosti, 
ovirah, olajševalnih dejavnikih in potrebnih spremembah. Intervencija je vključevala 
spremljanje srčnega utripa, ki je pokazalo postopno in rahlo povečanje intenzivnosti 
srčnega utripa in postopno zmanjšanje razponov srčnega utripa (HRR) med plesnimi 
dejavnostmi. Rezultati kažejo izboljšano ravnotežje, mobilnost, hojo in stopnjo sode-
lovanja. Prihodnje longitudinalne raziskave bodo nadalje preučile učinkovitost ple-
sne intervencije z uporabo IKT-hodulj s kolesi in jo primerjale s kontrolno skupino z 
običajnimi hoduljami s kolesi. IKT-hodulje s kolesi so lahko edinstveni pripomoček za 
rehabilitacijo starejših, ki omogoča tudi obetavne izboljšave. 

Ključne besede: hodulja s kolesi z medkomunikacijsko tehnologijo, plesna inter-
vencija, pregled področja uporabe, prihodnja longitudinalna študija, tehnološke inter-
vencije na domu.



8

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

INTRODUCTION

Physical rehabilitation is essential for the elderly, as age increases the risk 
of developing chronic diseases, exacerbates symptoms, decreases cardiovascu-
lar fitness, and limits physical mobility (Langhammer, Bergland, & Rydwik, 
2018). Implementing comprehensive preventive measures, such as physical ac-
tivity interventions, behavioral changes concerning physical activity, lifestyle 
modifications, and promoting a healthy lifestyle, significantly reduces the risks. 
This subsequently enhances the quality of life of older adults. The inclusion of 
physical activity in their daily lives has been demonstrated to improve rehabili-
tation results (Langhammer et al., 2018). 

Furthermore, Xiong, Ye, Wang, and Zheng (2021) conducted a systematic 
review exploring the effects of physical activity on brain health, cognitive he-
alth, and motor abilities in the elderly. Their findings indicate that physical ac-
tivity not only restores and maintains cognitive function and metabolic control, 
but also positively affects brain health by reducing the risk of dementia, depres-
sion, and stress. The findings from previous studies suggest that multimodal 
dance may also have positive effects on grey matter decline and the prevention 
of neurodegenerative diseases in the elderly (Müller et al., 2016). At the same 
time, a study discovered research has shown that a six-month sports dance in-
tervention in seniors aged 63 to 80 years had a positive impact on structural bra-
in changes, cognitive and motor performances, and the molecular mechanism 
of brain-derived neurotrophic factor (BDNF) (Rehfeld, 2015).

According to a study by Meulenberg et al. (2023), dance training holds pro-
mise for enhancing balance, mobility, and gait in Parkinson’s patients. It sugge-
sts that dance therapies may improve quality of life and motor skills. However, 
further research is needed to fully understand and optimize the benefits of dan-
ce training for these populations. According to the above study, dance may be 
more advantageous than pure aerobic-physical interventions for healthy aging, 
because it combines physical activity with cognitive, coordination, and aerobic 
training in a social-emotional setting. Additionally, a meta-analysis by Yuan et 
al. (2022) revealed that dance enhances mobility and general fitness in older 
individuals with cognitive impairment.

Older adults with limited physical health are more likely to experience falls 
due to mobility limitations and balance deficits. Various dance interventions 
have been explored by the studies to improve mobility and balance in the elder-
ly, including low-impact aerobic dance, dance-based aerobic exercise, Turkish 
folklore dance, ballroom dancing, contemporary dance, salsa dance training, 
and creative dance (De Oliveira et al., 2020). Research has shown the beneficial 



9

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

effects of dance-based therapies, such as yoga, Pilates, tai chi, and aerobics 
(Nagano, Sparrow, & Begg, 2022), can be beneficial for improving balance and 
reducing falls in senior citizens. The evidence shows that dance interventions 
can significantly enhance balance and mobility in older adults, highlighting the 
need for structured dance intervention programs (Bahramian et al., 2023).

In the current pilot study, the elderly rollator users received the dance in-
tervention utilizing a sport and dance rollator. This study incorporates social 
cognitive theory, which posits that group training sessions allow participants to 
learn through observation of their peers and the environment, thereby enhan-
cing their self-efficacy and motivation to dance (Bandura, 1977). Over extended 
periods, this intervention may modify the behaviors of both elderly individu-
als with chronic conditions and healthy older adults, enhancing or maintaining 
their physical fitness (Bandura, 1977). 

The current intervention is also based on flow theory by Chen and Tang 
(2023), which emphasizes complete immersion with no distractions, as dance 
with good music can facilitate the enjoyment and loss of self-consciousness. 
The dance intervention upholds clear objectives and provides immediate feed-
back based on blood pressure data, allowing elderly participants to relax thro-
ugh breathing exercises and modify their actions in real-time. Furthermore, the 
intervention maintains a balance between skill and challenge throughout the 
duration, tailoring the movements to the participants’ fitness and fatigue levels.

Ammar et al. (2021) explored the use of digital technology to encourage 
physical activity and a healthy lifestyle among the elderly during pandemic-
-related confinement. This study discussed how digital tools and interventions 
could reduce the negative effects of isolation, support active lifestyles, and en-
hance mental well-being in elderly adults during physical limitations and re-
duced social interaction (Ammar et al., 2021). However, the elderly have low 
engagement in physical activity due to a lack of facilities, mobility issues, li-
ving arrangements, levels of education, and financial constraints. Additionally, 
numerous studies have also failed to consider the psychological status of the 
elderly during rehabilitation (Biering, 2019). 

Furthermore, a preliminary scoping review conducted before the pilot study 
found no technology-based physical activity interventions that could provide 
mobility assistance during dancing. Very few inventions have focused on socia-
lization for the elderly while performing physical activities with the aid of tech-
nology, and only a limited number of studies have provided high-quality feed-
back to users during activities. Research has shown that integrating technology 
into dance programs reduces the risk of falls and improves physical and cogni-
tive functions in the elderly (Franco et al., 2020). According to research, both 



10

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

conventional and technology-aided dance interventions provide safe means of 
improving gait, balance, and mobility in the elderly, thereby enhancing their 
quality-of-life. The dance intervention in the current study involves a warm-up 
that includes active mobilization exercises accompanied by music, followed by 
basic joint motions, dancing in patterns or circles, and dance moves that enhan-
ce lower limb strength, all delivered through videos.

The future goals of this pilot study are to provide psychological support 
through social inclusion platforms and opportunities for physical activity. The 
project also aims to combine interactive games, strength training, gait train-
ing, balance training, and guided movement dance training. The ICT-Rollator 
will assist and provide physical activity training programs, regardless of the 
participant’s location. Therefore, the primary objective of the present pilot stu-
dy is to assess the influence of interventional dance films on the participants’ 
level of commitment and physical results (such as gait, balance, mobility, and 
hand grip strength) during guided movement training (dance), employing a pro-
jected video in a lab environment.

METHODS

Study Design and Participants

Otto von Guericke University Magdeburg, Germany, recruited elderly par-
ticipants for this single-arm, lab-based study through a newspaper advertise-
ment. Initially, six patients, five of whom were women and one man, all aged 85 
or older, participated in the pilot trial. However, the participation of one subject 
was subsequently terminated for confidential reasons. The remaining five parti-
cipants received intervention for five sessions and one extra group session. Due 
to the limited availability of rollators, two participants were simultaneously 
trained to ensure their care and safety while dancing. 

The elderly subjects initially exhibited marked immobility and inactivity 
during four square-step tests, where all participants made considerable errors. 
Furthermore, the SF36 questionnaire also highlighted their initial low functi-
onal mobility levels. The elderly participants were notable for their low levels 
of mobility and activity. They came from a variety of backgrounds, reflecting 
a wide range of life experiences, medical histories, and activity levels. One 
participant had a history of stroke but had completely recovered ten years 



11

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

before the start of the pilot study, which allowed for a thorough analysis of the 
intervention’s effects. 

Before and after the interventions, all 5 participants were tested and scree-
ned using the Timed Up-and-Go (TUG) test for mobility, the hand dynamome-
ter for hand grip strength, the Berg Balance Scale (BBS) for balance, and the 
Barthel Index for quality of life.

Study Procedures

Figure 1: A) Optogait Measurement System; B) Hand Dynamometer; C) Polar;  
D) Sphygmomanometer; E) Test for Reaction Time



12

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Figure 2: Intervention of Pre-Recorded Dance Videos Using a Projector

Preparation Phase: The participants provided their written consent. We 
granted the participants access to the Barthel Index after obtaining their con-
sent, to assess their various histories of falls, surgeries, and strokes. The SF36 
questionnaire and four-square step test were used as a pre-screening tool to 
understand functional mobility and coordination status.

Pre-testing Phase: The Pre-testing was conducted to assess the subjects’ 
physical readiness for the dancing intervention and to gauge its effects from 
pre-testing to post-testing. The TUG test and the Optogait system were used 
during the pre-testing phase to analyze the mobility and spatiotemporal gait 
parameters. The TUG test is a validated tool for assessing mobility in elderly 
women aged 80-93 (Zarzeczny et al., 2017). The BBS, which is also valida-
ted for assessing balance in the elderly, was also fitted to analyze each elderly 
subject’s balance during the pre-testing phase (Pereira, Maia, & Silva, 2013). 
Hand grip strength was measured using a hand dynamometer, and reaction time 
was measured using a pipe with measurements (Figure 1). Pre-testing and as-
sessments of the physical capabilities of the elderly were done before the dance 
intervention.

Intervention Phase: The first session consisted of live dance sessions with 
simple steps. After each intervention session, a post-session questionnaire was 
administered to gather participants’ qualitative evaluations of their degrees of 



13

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

exhaustion, enjoyment, impediments, facilitators, and suggested changes. On 
the second day, the subjects received the dancing intervention using a projector 
and pre-recorded videos. These pre-recorded videos are intended to be inte-
grated with the Rollator’s intercommunication technology. The current study 
objective is to assess how pre-recorded, customized dance videos affect physi-
cal outcomes in the elderly. 

During each session, the POLAR heart rate monitor was placed on the chest 
before the intervention began and will be taken off after the intervention. The 
purpose was to keep track of the participants’ levels of activity during the en-
tire intervention, as well as their minimum, average, and maximum heart rates. 
During all the dance intervention sessions, blood pressure was measured before, 
every 15 minutes during, and after the intervention to avoid adverse events and 
avoid training above the limit of 140-150/90-96 blood pressure. The video-based 
dance intervention was employed in the 2nd, 3rd, 4th, and 5th sessions (Figure 2). 
The final session consisted of a group dance session without videos, held in a 
sports hall to support participants’ psychological well-being and reduce feelings 
of isolation.

Post-testing Phase: All tests administered during pre-testing were repeated 
during post-testing.

Intervention Duration: The intervention lasted four weeks. The senior 
rollator users were given sufficient recovery time between the two sessions 
per week. Each session lasted approximately one hour (60 minutes), with a 
5-minute break every 15 minutes. Training was provided to two participants 
simultaneously.

Intervention Feasibility

The feasibility and utility of the intervention were evaluated based on 
the total duration of activity levels for each session recorded via POLAR. 
Additionally, the total number of calories burned throughout each session, and 
their minimum, average, and maximum heart rates were measured. The number 
of intervention dropouts was also assessed. Quality of life assessments were 
also carried out before and during the sessions. To ensure participants’ safety 
and prevent falls, three supervisors were present, standing three meters from 
the seniors during each session. To avoid the high risk of falls and medical 
emergencies, blood pressure was monitored every 15 minutes.



14

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Statistical Analysis

The pilot study involved a small sample size (N = 5). Descriptive statistics 
(mean and standard deviations) were used to visualize the HRR and average 
heart rate (AHR) intensities for all sessions. Given the small sample size and to 
prevent outliers in the data, medians were used to illustrate the differences bet-
ween gait cycle time, BBS scores, gait speed, TUG test duration, stride length, 
and cadence from pre-testing to post-testing. No inferential statistics were con-
ducted in the current pilot study.

RESULTS

The median and interquartile range (IQR) values for balance, mobility, and 
gait variables are presented in Figure 5 and Table 2. The BBS scores increased 
from a median of 34 (IQR 20) pre-testing to a median of 41 (IQR 33) post-te-
sting. Similarly, the time taken for the TUG test decreased significantly, from a 
median of a median of 47 (IQR 15.375) to a median of 19.29 (IQR 7.28). Gait 
speed increased from a median of 0.385 (IQR 0.3725) to a median of 0.695 
(IQR 0.115), while cadence improved from a median of 41.005 (IQR 57.0725) 
to a median of 100.67 (IQR 37.7375). The median and IQR values show mobi-
lity, balance, and gait improvements in the current pilot study.

Figures 3 and 4 show the comparison of HRR and AHR intensities across 
five training sessions. Table 1 presents the mean and standard deviations of 
fluctuations in HRR and heart rate intensity for all five sessions.



15

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

Figure 3: Comparison of Average Heart Rate Ranges (HRR) Between the Five 
Training Sessions

Figure 4: Comparison of Average Heart Rate (AHR) Intensities Between the 
Five Training Sessions



16

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Table 1. Mean and Standard Deviation of HRR and Heart Rate Intensities:

Number of 
Sessions

Heart Rate Range Heart Rate Intensity

Mean SD Mean SD

Session1 36 12.24 0.80 0.05

Session 2 44.6 13.64 0.73 0.10

Session 3 32.6 11.09 0.81 0.07

Session 4 44.2 12.72 0.73 0.11

Session 5 29.4 10.50 0.84 0.06

Figure 5: Median differences in BBS, Time taken for TUG test, and Gait 
variables



17

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

Table 2: Median and Interquartile Ranges of Gait Variables, BBS, and Time 
taken for the TUG Test

Variables
Pre-Testing Post-Testing

Median Interquartile 
range Median Interquartile 

range

Berg Balance Scale 
Score 34 20 41 33

Timed-Up-and-Go 
Test (sec) 47 15.375 19.29 7.28

Gait Cycle Time 
(sec) 1.618 1.78825 1.2695 0.61525

Stride Length (cm) 123.8 55.075 83.45 23.4

Gait Speed (m/sec) 0.385 0.3725 0.695 0.115

Cadence (steps/min) 41.005 57.0725 100.67 37.7375

DISCUSSION

The current pilot study focused on evaluating the physical outcomes of el-
derly individuals after a dance video intervention supported by a dance rollator 
in a laboratory setting. The results show improvements in mobility, balance, 
and gait, as assessed using the Timed Up-and-Go (TUG) test for mobility, the 
Berg Balance Scale (BBS) for balance, and Optogait system for measure-
ment of spatial-temporal parameters of gait before and after the intervention. 
Previous studies have shown improved mobility in the elderly after dance in-
terventions, assessed through the TUG test. The TUG test is a valuable tool for 
measuring mobility with high participant attendance rates, supported by a study 
by Klotzbier, Korbus, Johnen, and Schott (2021). Balance, gait symmetry, and 
dual-task performance improved after dance intervention assessed by the TUG 
test in populations with specific health problems (Fontanesi & DeSouza, 2021). 
Additionally, dance training has been found to improve spatiotemporal gait pa-
rameters, balance, and TUG test performance in adults with neurological con-
ditions (Patterson, Wong, Prout, & Brooks, 2018). At the same time, research 
considering the elderly with Parkinson’s disease has shown a positive impact 
on functional mobility and gait parameters after modified dance intervention 
(Delabary et al., 2020). Consistent with previous research, our study observed 



18

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

improvements in mobility and reduced variability according to interquartile 
ranges from pre-testing to post-testing (Figure 5; Table 2). Notably, during sc-
reening before the intervention, all participants exhibited maximum errors (>5) 
when tested on the four-square-step test. Therefore, the TUG test is a valuable 
tool for evaluating functional mobility in the elderly. 

In the current study, BBS scores improved from pre-testing to post-testing 
and the variability of scores within the dataset widened. This indicates a bro-
ader range of performance among the subjects and explains diverse responses 
from pre-testing to post-testing. Confirming the results from the current stu-
dy, previous studies found that Cha-Cha dance training significantly enhanced 
balance ability in healthy elderly individuals (Li et al., 2022). The qualitative 
survey conducted after the intervention found that respondents reported fee-
ling more stable when performing domestic tasks, consistent with the impro-
vement in the BBS score from pre-testing to post-testing (Figure 5; Table 2). 
The enhanced balance performance corroborates findings from earlier studi-
es, suggesting that the dance intervention can effectively improve the balance 
in the elderly (Hiyamizu, Morioka, Shomoto, & Shimada, 2011). Studies by 
Pereira et al. (2019) and Moratelli et al. (2022) highlight the benefits of dance 
for Parkinson’s disease, showing improvements in gait and endorsing dance as 
one of the therapeutic interventions for gait in the elderly. Similarly, our active 
trial study showed that gait cycle time and stride length decreased. Moreover, 
gait speed and cadence increased (Figure 5). This is possibly due to enhanced 
speed and better balance (Hak, Houdijk, Beek, & Van Dieën, 2013). 

The video-based dance interventions produced positive results for balance 
and mobility in the elderly rollator user population. Overall, the synthesis of 
these studies suggests that video-based dance interventions can be a promising 
approach to enhancing balance in the elderly population. These can be achieved 
through cognitive-motor training, rhythmic auditory cueing, and engaging in 
dance activities through video games. Such interventions can potentially im-
prove balance, mobility, and gait parameters in elderly rollator users. contribu-
ting to overall well-being and reducing the risk of falls in the elderly.

Furthermore, study research on older women has shown improved better 
heart rate variability and the cardiac autonomic modulation responses after en-
gaging in a dance protocol, indicating a potential increase in heart rate inten-
sity (Pires et al., 2021). Similarly, waltz dancing has been linked to improved 
exercise capacity correlating with heart rate changes in heart failure patients 
(Belardinelli, Lacalaprice, Ventrella, Volpe, & Faccenda, 2008). In the ongoing 
preliminary study, the HRR gradually decreased (Figure 3; Table 1), and heart 
rate intensities slightly increased during the five sessions of dance intervention 



19

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

(Table 1, Figure 4).  In the first, second, and third sessions, there is an increa-
sed AHR intensity, which may be because participants are gradually pushing 
themselves harder (Figure 4), and there is a decrease in HRR due to improved 
movement control (Figure 3). Conversely, the average heart rate intensity in 
the second and fourth sessions gradually reduced, perhaps due to the partici-
pants’ interspersed times of lower-intensity movement or rest between routines. 
Additionally, a wider range of heart rate responses during the second and fo-
urth sessions may signify that participants were engaged in more dynamic and 
diverse movements. Several dance movements were introduced in the second 
and fourth sessions. The fact that the participants’ AHR either stayed the same 
or went down slightly across all the sessions shows that they may be adapted to 
the dancing motions and increased their cardiovascular efficiency. These results 
indicate that a well-planned dance intervention that includes recovery, varie-
ty-oriented, high-intensity, and low-intensity portions can benefit the body’s 
general conditioning and cardiovascular fitness.

The present study had high adherence rates as there were no dropouts and 
all the subjects attended all five sessions, except for the one dropout before 
pre-testing. Hand grip strength showed no noticeable difference, likely due to 
the nature of the dance intervention involving a dance rollator, which the parti-
cipants used for support throughout the session. This restriction in upper body 
movement may have limited the impact on hand grip strength and reaction time. 
While there is substantial research on the benefits of dance interventions for 
improving balance and mobility in the elderly, further studies should focus on 
examining heart rate variables during dance training and the effects on gait pa-
rameters before and after the intervention in elderly rollator users. Moreover, fu-
ture studies should explore exercise intervention plans with or without the use of 
technology to improve upper body strength and activity in elderly rollator users.

Future Study

In future research, a longitudinal study will compare dance and physical reha-
bilitation training over six months using an ICT-Rollator versus a control group 
using a standard rollator (Figure 6). Both groups will undergo the same pre-te-
sting and post-testing questionnaires as used in the pilot study. The length of tra-
ining will be recorded for the control group and the intervention group, and will 
be uploaded to the ICT-Rollator server. The intervention group will have access 
to a social inclusion platform, guided movements, fall prevention sensors, and 
feedback. During the sessions, both visible and audible cues will be provided. 



20

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Figure 6: Initial Digitalized Version of Sport and Dance Rollator

Limitations

The analysis in this study is limited to descriptive statistics due to the small 
sample size. The POLAR values, which also consider heart rate measurements 
taken during intersession breaks, may have affected the results. Additionally, 
because of the elderly participants’ low fitness levels, the pre-testing conducted 
without support resulted in very minimal measurement errors for gait testing. 
Furthermore, the results are preliminary, as the study has a small sample size 
and limited generalizability, which may impact the conclusions.



21

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

CONCLUSION

The ICT-Rollator holds promise as a beneficial tool for the elderly to use 
for physical activity in every living setting, providing support and protection. 
It helps prevent falls using fall detection sensors, guides movement with visual 
and audible cues, and assists in mobility by maintaining an upright posture 
while moving around. The integration of customized dance videos with the 
ICT-Rollator in future studies is expected to further improve balance, mobility, 
and gait. There is a need to conduct a longitudinal study with a larger sample, 
a control group, and a specific dance intervention program for the elderly with 
different health conditions. The pilot study demonstrated excellent adherence 
rates, with no dropouts and all participants completed five training sessions, 
with no adverse events or reported falls occurring during the pilot study sessi-
ons using a sport and dance rollator.

REFERENCES

Ammar, A., Bouaziz, B., Trabelsi, K., Glenn, J., Zmijewski, P., Müller, P., ... 
Hökelmann, A. (2021). Applying digital technology to promote active and healthy 
confinement lifestyle during pandemics in the elderly. Biology of Sport, 38(3), 391-
396. https://doi.org/10.5114/biolsport.2021.100149.

Bahramian, F., Abolfaz, S., Mousavi, A., Aslani, M. A., Ahmadinejad, B., Bayati, 
H., & Jalali, A. (2023). Dance-based interventions on balance and falls in the el-
derly in order to health promotion: a literature review. Journal of Public Health and 
Development, 21(1), 257–271. https://doi.org/10.55131/jphd/2023/2101120.

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. 
Psychological Review, 84(2), 191-215. https://doi.org/10.1037/0033-295x.84.2.191.

Belardinelli, R., Lacalaprice, F., Ventrella, C., Volpe, L., & Faccenda, E. (2008). 
Waltz dancing in patients with chronic heart failure. Circulation: Heart Failure, 
1(2), 107-114. https://doi.org/10.1161/circheartfailure.108.765727.

Biering, P. (2019). Helpful approaches to older people experiencing mental health 
problems: a critical review of models of mental health care. European Journal of 
Ageing, 16(2), 215–225. https://doi.org/10.1007/s10433-018-0490-3.

Chen, Q., & Tang, X. (2023). A summary of research on flow theory-based inte-
ractive mobile advertising design. In M. F. bin Sedon M. Dom, P. T. Zabielskis, 
X. Liu & X. Liu (Eds.), Proceedings of the 2nd International Conference on 
Culture, Design and Social Development (CDSD 2022) (pp. 420–427). https://doi.
org/10.2991/978-2-38476-018-3_48.

De Oliveira, C. R., Figueiredo, A. I., Schiavo, A., Martins, L. A., Telles, M. E., 
Rodrigues, G. A., & Mestriner, R. G. (2020). Dança como uma intervenção 
para melhorar a mobilidade e o equilíbrio em idosos: uma revisão de literatu-
ra [Dance as an intervention to improve mobility and balance in the elderly: a 

https://doi.org/10.5114/biolsport.2021.100149
https://doi.org/10.55131/jphd/2023/2101120
https://doi.org/10.1037/0033-295x.84.2.191 
https://doi.org/10.1161/circheartfailure.108.765727
https://doi.org/10.1007/s10433-018-0490-3
https://doi.org/10.2991/978-2-38476-018-3_48
https://doi.org/10.2991/978-2-38476-018-3_48


22

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

literature review]. Ciência & Saúde Coletiva, 25(5), 1913–1924. https://doi.
org/10.1590/1413-81232020255.20002018.

Delabary, M., Monteiro, E. P., Donida, R. G., Wolffenbuttel, M., Peyré‐Tartaruga, 
L. A., & Haas, A. N. (2020). Can Samba and Forró Brazilian rhythmic dance be 
more effective than walking in improving functional mobility and spatiotempo-
ral gait parameters in patients with Parkinson’s disease? BMC Neurology, 20(1). 
https://doi.org/10.1186/s12883-020-01878-y.

Fontanesi, C. & DeSouza, J. F. X. (2021). Beauty that moves: dance for Parkinson’s 
effects on affect, self-efficacy, gait symmetry, and dual task performance. Frontiers 
in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.600440.

Franco, M. R., Sherrington, C., Tiedemann, A., Pereira, L. S., Perracini, M. R., 
Faria, C. S. G., … Pastre, C. M. (2020). Effect of Senior Dance (DANSE) on fall 
risk factors in older adults: a randomized controlled trial. Physical Therapy, 100(4), 
600–608. https://doi.org/10.1093/ptj/pzz187.

Hak, L., Houdijk, H., Beek, P. J., & Van Dieën, J. H. (2013). Steps to take to enhance 
GAIT stability: The effect of stride frequency, stride length, and walking speed on 
local dynamic stability and margins of stability. PLOS ONE, 8(12), e82842. https://
doi.org/10.1371/journal.pone.0082842.

Hiyamizu, M., Morioka, S., Shomoto, K., & Shimada, T. (2011). Effects of 
dual-task balance training on dual-task performance in elderly people: a ran-
domized controlled trial. Clinical Rehabilitation, 26(1), 58–67. https://doi.
org/10.1177/0269215510394222.

Klotzbier, T. J., Korbus, H., Johnen, B., & Schott, N. (2021). Evaluation of the 
instrumented Timed Up and Go test as a tool to measure exercise intervention ef-
fects in nursing home residents: results from a PROCARE substudy. German 
Journal of Exercise and Sport Research, 51(4), 430–442. https://doi.org/10.1007/
s12662-021-00764-0.

Langhammer, B., Bergland, A., & Rydwik, E. (2018). The importance of physical 
activity exercise among older people. BioMed Research International, 2018, 1–3. 
https://doi.org/10.1155/2018/7856823.

Li, H., Qiu, X., Yang, Z., Zhang, Z., Wang, G., Kim, Y., & Kim, S. (2022). Effects 
of cha-cha dance training on the balance ability of the healthy elderly. International 
Journal of Environmental Research and Public Health, 19(20), 13535. https://doi.
org/10.3390/ijerph192013535.

Meulenberg, C. J. W., Rehfeld, K., Jovanović, S., & Marušič, U. (2023). Unleashing 
the potential of dance: a neuroplasticity-based approach bridging from older adults 
to Parkinson’s disease patients. Frontiers in Aging Neuroscience, 15, 1-9. https://
doi.org/10.3389/fnagi.2023.1188855.

Moratelli, J. A., Alexandre, K. H., Boing, L., Swarowsky, A., Corrêa, C. L., & 
Guimarães, A. C. d. A. (2022). Dance rhythms improve motor symptoms in in-
dividuals with parkinson’s disease: a randomized clinical trial. Journal of Dance 
Medicine & Science, 26(1), 2-7. https://doi.org/10.12678/1089-313x.031522a.

Müller, P., Rehfeld, K., Hökelmann, A., & Müller, N. G. (2016). Dance training-in-
duced grey matter brain plasticity in the elderly. In A. Hökelmann, N. G. Müller, K. 
Witte, & T. Wolbers (Eds.), Proceedings of the International Conference of Sports 
and Neuroscience_Active Healthy Aging 2015 (pp. 117‒121).

https://doi.org/10.1590/1413-81232020255.20002018
https://doi.org/10.1590/1413-81232020255.20002018
https://doi.org/10.1186/s12883-020-01878-y
https://doi.org/10.3389/fpsyg.2020.600440
https://doi.org/10.1093/ptj/pzz187
https://doi.org/10.1371/journal.pone.0082842
https://doi.org/10.1371/journal.pone.0082842
https://doi.org/10.1177/0269215510394222
https://doi.org/10.1177/0269215510394222
https://doi.org/10.1007/s12662-021-00764-0
https://doi.org/10.1007/s12662-021-00764-0
https://doi.org/10.1155/2018/7856823
https://doi.org/10.3390/ijerph192013535
https://doi.org/10.3390/ijerph192013535
https://doi.org/10.3389/fnagi.2023.1188855
https://doi.org/10.3389/fnagi.2023.1188855
https://doi.org/10.12678/1089-313x.031522a


23

ANNALES KINESIOLOGIAE • 15 • 2024 • 1

Niharika BANDARU, Anita HÖKELMANN, Abdelaziz TRIKI, Ulrich THIEL: EVALUATING PHYSICAL OUTCOMES IN ELDERLY SPORT ..., 5–23

Nagano, H., Sparrow, W., & Begg, R. (2022). Exercise and the elderly: Gait and 
balance. In J. Feehan, N. Tripodi, & V. Apostolopoulos (Eds.) Exercise to Prevent 
and Manage Chronic Disease Across the Lifespan (pp. 423–435). https://doi.
org/10.1016/b978-0-323-89843-0.00005-2.

Patterson, K., Wong, J., Prout, E., & Brooks, D. (2018). Dance for the rehabilitation 
of balance and gait in adults with neurological conditions other than Parkinson’s 
disease: a systematic review. Heliyon, 4(3), e00584. https://doi.org/10.1016/j.heli-
yon.2018.e00584.

Pereira, V. V., Maia, R. A., & Silva, S. M. C. de A. (2013). The functional assessment 
Berg Balance Scale is better capable of estimating fall risk in the elderly than the 
posturographic Balance Stability System. Arquivos De Neuro-Psiquiatria, 71(1), 
5–10. https://doi.org/10.1590/s0004-282x2013000100003.

Pereira, A. P. S., Marinho, V., Gupta, D., Magalhães, F., Ayres, C., & Teixeira, S. 
(2019). Music therapy and dance as gait rehabilitation in patients with Parkinson 
disease: a review of evidence. Journal of Geriatric Psychiatry and Neurology, 
32(1), 49-56. https://doi.org/10.1177/0891988718819858.

Pires, F. de O., Pinto, L. M., Costa, H. A., Brito-Monzani, J. de O., Sevilio, M. N. de 
O., Castro, H. de O., … Martins, D. S. (2021). Cardiac autonomic modulation re-
sponse and functional capacity in older women. Revista Brasileira De Medicina Do 
Esporte, 27(2), 129–133. https://doi.org/10.1590/1517-8692202127022020_0029.

Rehfeld, K. (2015). Zum Einfluss eines sportiven Tanztrainings und eines multimoda-
len Bewegungstrainings auf die Gehirnstruktur sowie auf kognitive und motorische 
Leistungen bei Senioren (Unpublished doctoral dissertation). Otto-von-Guericke-
Universität Magdeburg.

Xiong, J., Ye, M., Wang, L., & Zheng, G. (2021). Effects of physical exercise on ex-
ecutive function in cognitively healthy older adults: A systematic review and meta-
analysis of randomized controlled trials. International Journal of Nursing Studies, 
114, 103810. https://doi.org/10.1016/j.ijnurstu.2020.103810.

Yuan, Y., Li, X., & Liu, W. (2022). Dance activity interventions targeting cogni-
tive functioning in older adults with mild cognitive impairment: A meta-analysis. 
Frontiers in Psychology, 13, 1-16. https://doi.org/10.3389/fpsyg.2022.966675.

Zarzeczny, R., Nawrat–Szołtysik, A., Polak, A., Maliszewski, J., Kiełtyka, A., 
Matyja, B., … Wajdman, A. (2017). Aging effect on the instrumented Timed-Up-
and-Go test variables in nursing home women aged 80–93 years. Biogerontology, 
18(4), 651–663. https://doi.org/10.1007/s10522-017-9717-5.

https://doi.org/10.1016/b978-0-323-89843-0.00005-2
https://doi.org/10.1016/b978-0-323-89843-0.00005-2
https://doi.org/10.1016/j.heliyon.2018.e00584
https://doi.org/10.1016/j.heliyon.2018.e00584
https://doi.org/10.1590/s0004-282x2013000100003
https://doi.org/10.1177/0891988718819858
https://doi.org/10.1590/1517-8692202127022020_0029
https://doi.org/10.1016/j.ijnurstu.2020.103810
https://doi.org/10.3389/fpsyg.2022.966675
https://doi.org/10.1007/s10522-017-9717-5

	_Hlk170811436
	_Hlk170812238
	_Hlk170723976
	_Hlk173858569
	_Hlk164762226
	_Hlk164763367
	_Hlk176346919
	_Ref145868645
	_Ref149212889
	_Ref143070381
	_Ref143070369
	_Ref167353927
	_Ref167353591
	_Ref167353547
	_Hlk176171428

