Journal of Bodywork & Movement Therapies 22 (2018) 460e466

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Journal of Bodywork & Movement Therapies

journal homepage: www.elsevier.com/jbmt

PREVENTION & REHABILITATION: PILOT STUDY OF A NON-RANDOMISED CLINICAL TRIAL

Benefits of belly dance on quality of life, fatigue, and depressive

symptoms in women with breast cancer e A pilot study of a non-
randomised clinical trial
Leonessa Boing a, *, Fa

tima Baptista b, Gustavo Soares Pereira a, Fabiana Flores Sperandio a,

ssica Moratelli , Allana Alexandre Cardoso a, Adriano Ferreti Borgatto c,
Je a

Adriana Coutinho de Azevedo Guimara ~es a

a
polis, Santa Catarina, Brazil
Universidade do Estado de Santa Catarina, Floriano
b
Exercise and Health Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
c
polis, Santa Catarina, Brazil
Universidade Federal de Santa Catarina, Floriano

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To analyse the influence of belly dance on the quality of life, fatigue, and depressive symptoms
Received 22 April 2017 in women with breast cancer.
Received in revised form Methods: Pilot study, with a design of non-randomised clinical trial study, analysing 19 women, with 8
23 September 2017
allocated in the experimental group and 11 in the control group. The experimental group underwent 12
Accepted 4 October 2017
weeks of belly dance classes, with a frequency of twice a week and duration of 60 min for each lesson.
Data collection was made through the use of questionnaires containing general information, quality of
Keywords:
life (EORTC QLQ-BR23), fatigue (Piper Fatigue Scale) and depressive symptoms (BECK's Depression In-
Motor activity
Dance therapy
ventory) applied on baseline and after intervention.
Breast neoplasm Results: The experimental group presented significant improvements after the intervention, with an
increase in scores of the functional scale (p ¼ 0.002): body image (p ¼ 0.037) and sexual function
(p ¼ 0.027); and a decrease in scores of the symptomatic scale (p ¼ 0.001): systemic therapy side effects
(p ¼ 0.005) and arm symptoms (p ¼ 0.001) of quality of life, as well the decrease of fatigue (p ¼ 0.036)
and depressive symptoms (p ¼ 0.002). No significant differences were observed in clinical and de-
mographic information at baseline between the experimental and control groups. Also, there was no
significant difference on quality of life, fatigue, and depressive symptoms between the two groups.
Conclusion: Belly dance can be a viable form of physical activity for women with breast cancer. It was
associated with benefits for quality of life, fatigue, and depressive symptoms. Even though there were
significant preepost treatment differences, there was no significance difference between the experi-
mental and control group; and therefore, treatment could have been due to natural history.
© 2017 Elsevier Ltd. All rights reserved.

1. Introduction
Breast cancer treatment can cause some serious effects on the
psychological, physical, emotional and social aspects of women's
lives (Soares et al., 2013), and it can lead to modifications on their
quality of life (Gonçalves et al., 2012). Depressive symptoms are one
of the most common psychological consequences in women with
* Corresponding author. Rua General Estilac Leal, 260, Bloco B apto 105,
88080760 Coqueiros, Floriano
polis, SC, Brazil.
E-mail address: leonessaboing@gmail.com (L. Boing).
breast cancer (Kaminska et al., 2015). Also, another common side
effect of breast cancer treatment is fatigue, present in 75%e95% of
the cases (Mansano-Schlosser and Ceolim, 2014). In this context, it
is suggested that the practice of physical activity can decrease fa-
tigue and depressive symptoms, and can also improve the quality of
life of women with breast cancer (Rogers et al., 2011).
Dance, as a type of physical activity, can be an option for women
with breast cancer to achieve some benefits (Kaltsatou et al., 2011;
Sandel et al., 2005). This kind of activity explores awareness,
expression, and acceptance of the body, which can improve phys-
ical, emotional, and cognitive integration (Dibbell-Hope, 2000).
Furthermore, dance can promote the sharing of feelings and helps

https://doi.org/10.1016/j.jbmt.2017.10.003
1360-8592/© 2017 Elsevier Ltd. All rights reserved.
 L. Boing et al. / Journal of Bodywork & Movement Therapies 22 (2018) 460e466
to reduce the loneliness and isolation of these women (Serlin et al.,
2000).
The literature presents some previous studies that investigated
the effect of dance programs on women diagnosed with breast
cancer, with different methodologies: such as dance therapies
(Sandel et al., 2005; Dibbell-Hope, 2000; Serlin et al., 2000; Crane-
Okada et al., 2012), Greek traditional dance (Kaltsatou et al., 2011),
classical ballet and jazz (Molinaro et al., 1986) and sacred dance
(Frison et al., 2014). Belly dance, in turn, has not yet been studied in
this context. It has characteristics that may contribute to the re-
covery of female identity, a relevant aspect in the physiological and
psychological alterations of women with breast cancer. This mo-
dality of dance enhances the movements of the upper limbs (Abra ~o
and Pedra ~o, 2005), which is essential after surgery for women with
breast cancer. Therefore, belly dance can be an effective alternative
as a type of physical activity for women with breast cancer. Thus,
the objective of this study was analyse the influence of belly dance
in the quality of life, fatigue, and depressive symptoms in women
with breast cancer.
2. Methods
The form of this study is a pilot study with a non-randomised
clinical trial design, according to Transparent Reporting of Evalua-
tions with Non-randomised Designs (TREND) guidelines.
2.1. Participants
The study began with a sample of 22 women (54.1 ± 7.6 years
old); however, only 19 of those women finished the study. The
women were allocated by their preference into two groups: (a)
experimental group or (b) control group. The inclusion criteria for
being part of the sample were: being 40e80 years old; and being in
any adjuvant or neoadjuvant clinical treatment or in the period
after clinical treatment. The exclusion criteria were determined by:
educational level, by the classification as being illiterate, and those
who presented with stage IV breast cancer. At the time of the study,
the women who were in treatment were specifically in hormonal
therapy (53.3% of the sample), chemotherapy (26.7% of the sample)
and radiotherapy (20.0% of the sample).
The group allocation of the sample is presented in Fig. 1. All the
participants were selected from the database of a previous project
‘Physical activity, quality of life and associated factors in women
after breast cancer diagnosis’ realised in The Oncology Research
Center (CEPON) in Brazil by the same researchers. During this
cross-sectional research, 182 included women were invited to enrol
in a pilot study with belly dance classes, but only 61 women
demonstrated any interest. Connections by phone were attempted
to these 61 women and, among them, 16 did not attend to the three
calls made and/or did not return them, 11 had schedule problems to
try the classes and 11 lost interest in the study. This left only 23
eligible women, who were invited to participate in the study. Only
12 women showed interest in becoming part of the experimental
group and in receiving the intervention through belly dance classes.
However, one of them did not appear on the first day of class.
Those women who had no interest in participating in dance
classes, but expressed interest in participating in the study, were
assigned to the control group. Composed of 11 women, the control
group was requested to maintain their usual physical activity level.
Regarding the experimental group, only eight women finished the
12 weeks of intervention with belly dance classes; the other three
women moved away from classes, for the following reasons
respectively: stage IV breast cancer, physical problems because of
chemotherapy treatment and financial difficulties.
461
2.2. Ethical considerations
The study was approved by the Ethics Committee on Research in
Human Beings (CEPSH) of Santa Catarina State University (UDESC),
protocol No. 688.548, and by the Research Ethics Committee (CEP)
of CEPON, protocol No. 818.174. All the patients were invited to
participate in the study voluntarily, and those who agreed signed
the ‘Term of Free and Informed Consent’, ensuring their rights as
research subjects in accordance with the requirements of Resolu-
tion No. 466 of 12 December 2012, of the National Health Council in
Brazil.
2.3. Sample size
The sample size was realised using G*Power 3.1.9.2 software,
with an effect size of 0.80, significance level of 5%, test power of 80%
and non-predictable lost sample, which leads to 11 subjects in each
group. To verify the subjects’ adherence to the dance classes, the
number of classes attended by each woman was divided by the total
dance classes completed, according to the adherence study of
Courneya et al. (2014).
2.4. Intervention
The intervention was developed through the belly dance classes,
which were held twice a week, with a duration of 60 min per class,
in a 12-week afternoon programme taught by a physical education
professional. The classes began with warming-up and stretching
(10 min) with flexion, extension, rotation, abduction and adduction
of the upper and lower limbs. The main part (40 min) was
composed by specific belly dance movements, following an order of
technical evolution: loosening of hips; pendulums and side hits;
undulations and rounds; Egyptian basics and twists; shimmies and
variations; Arabic Dabke folk dance; dance pitcher; dance
tambourine; Arabic Khalije folk dance and dance with the veil.
Practising the movements was explored as individuals or in dy-
namic groups. To finish the session, a relaxation exercise was per-
formed (10 min).
2.5. Data collection
The data were collected through application of an interviewed
questionnaire at the baseline and after the last week of intervention
for both groups. The questionnaire was composed of five blocks: (1)
Personal and clinical information; (2) Quality of life; (3) Fatigue; (4)
Depressive symptoms; and (5) Physical activity.
2.6. Outcomes
Personal information included questions about age, marital
status, education level, employment, economic level, and weight
status. Clinical information included presence of other diseases,
surgery specifications, breast reconstruction, presence of lymphe-
dema and physiotherapy treatment.
Quality of life, the primary outcome, was investigated using the
specific module for breast cancer from the European Organization
for Research and Treatment of Cancer's ‘Quality of Life Question-
naire C30 e EORTC QLQ-C30’ (Michels et al., 2013). It was validated
in Brazil by Michels et al. (2013), with Cronbach's alpha of 0.78 and
0.83 for functional and symptomatic scales respectively. The func-
tional scale is composed of other subscales: body image, sexual
function, sexual satisfaction, and future perspectives. The symp-
tomatic scale is also made of subscales: adverse effects of systemic
therapy, symptoms related to the arms, symptoms related to the
breasts and disturbance due to hair loss. The scores of the
462 L. Boing et al. / Journal of Bodywork & Movement Therapies 22 (2018) 460e466

Fig. 1. Flow chart of the participants through each stage of the study: enrolment, assignment, allocation and intervention exposure, follow-up, and analysis.

questionnaire vary from 0 to 100; for the functional scale, the
highest score represents a better quality of life; for the symptomatic
scale, the highest score represents a worse quality of life.
The secondary outcomes are fatigue and depressive symptoms.
Fatigue was investigated using the Piper Fatigue Scale, which is
validated to women with breast cancer by Piper et al. (1998), pre-
senting a Cronbach's alpha of 0.97. In Brazil, this was validated by
Mota et al. (2009), with a Cronbach's alpha of 0.84e0.94. This
questionnaire is composed of 22 questions, distributed in three
dimensions: behavioural, affective, and sensorial/psychological.
The scores vary from 0 to 10, with the highest value indicating more
intense fatigue for the women. Depressive symptoms were inves-
tigated using the BECK Depression Inventory. In Brazil, this was
validated by Cunha (2001). This instrument is composed of 21
questions. The scores vary from 0 to 63, with the highest score
indicating a greater presence of depressive symptoms and lowest
score representing an absence of depressive symptoms.
To verify the changes in physical activity in the experimental
and control groups, the International Physical Activity Question-
naire (IPAQ) was used (Pardini et al., 1997). Composed of six items,
this questionnaire can verify the number of times that the subject
practises at least 10 min of walking, moderate physical activity or
vigorous physical activity in the last week, in different domains,
namely: domestic, leisure, recreation, and sports.
At the end of the intervention, the women allocated into the
experimental group were submitted to a Likert-type questionnaire
to verify their perception of the magnitude of changes they expe-
rienced after the belly dance class intervention. The questionnaire
comprised a scale from 1 to 7, in which (1) represented a very
significant improvement and (7) a very significant deterioration
 L. Boing et al. / Journal of Bodywork & Movement Therapies 22 (2018) 460e466 463

after the intervention. These scale values aim to group the women
and identify the least clinically important difference by the anchor-
based method (Gadotti et al., 2006).
2.7. Statistics analysis
Data were analysed with the software IBM SPSS Statistics
version 20.0. To verify the association between the personal and
clinical information in both the experimental and control groups,
Fisher's Exact Test was used. To analyse the moments before and
after intervention in the experimental and control groups, the Two
Way Repeated Measures ANOVA and comparison test of Sydak was
opted for. The level of statistical significance adopted in the ana-
lyses of comparison between the groups and associations between
variables was p < 0.05.
3. Results
Regarding personal and clinical information, the results showed
no significant differences on the baseline between the experi-
mental and control groups. Differences were observed only in
employment (p ¼ 0.002), in which most women in the
experimental group reported being housewives; on the other hand,
the majority of the women in the control group were retired, un-
employed or on medical leave (see Table 1).
The comparison between quality of life, fatigue, and depressive
symptoms of women with breast cancer in the experimental and
control groups, on baseline and after 12 weeks of intervention, are
presented in Table 2. No significant differences were found between
groups either at baseline or after the 12-week intervention. The
control group also remained statistically similar both in pre- and
post-evaluation. On the other hand, the experimental group
showed significant differences between the baseline and after the
12-week belly dance intervention. The improvements were
observed in improvements on the R scores for functional scale
(p ¼ 0.002), body image (p ¼ 0.037), sexual function (p ¼ 0.027),
symptomatic scale (p ¼ 0.001), adverse effects of systemic therapy
(p ¼ 0.005) and arm symptoms (p ¼ 0.001). Significant results were
also shown in better scores on fatigue (p ¼ 0.036) and a decrease in
depressive symptoms (p ¼ 0.002). The adherence to belly dance
classes by the experimental group was of 78.6% (IC95%: 71.3e85.9)
(data not presented in table).
The results concerning the practice of physical activity are
shown in Table 3. No significant differences were found in any

Table 1
Baseline characterisation of the women with breast cancer, according to the experimental and control groups. Florianopolis, SC e 2015. (n ¼ 19).

Variables Experimental group (n ¼ 8) Control group (n ¼ 11) P value

n(%) n(%)

Educational level 1.000

Basic schooling 3(37.5) 4(36.4)
Medium schooling 2(25.0) 4(36.4)
Higher education 3(37.5) 3(27.3)
Marital Status 0.370
With partner 3(37.5) 7(63.6)
Without partner 5(62.5) 4(36.4)
Economic Level 0.322
High Class (A þ B) e e
Middle Class (C) e 2(18.2)
Low Class (D þ E) 8(100) 9(81.8)
Weight Status 0.070
Normal weight 6(75.0) 3(27.3)
Overweight 2(25.0) 8(72.7)
Employment 0.002
Two or more jobs e 3(27.3)
Retired, unemployed or on medical leave 2(25.0) 8(72.7)
Housewife 6(63.6) e
Presence of other disease beyond cancer 0.603
Yes 5(62.5) 9(81.8)
No 3(37.5) 2(18.2)
Surgery 0.267
Radical mastectomy 7(87.5) 7(63.6)
Conservative surgery 1(12.5) 4(36.4)
Breast reconstruction 0.689
Immediate 3(37.5) 5(45.5)
Late 2(25.0) 1(9.1)
Did not undergo procedure 3(37.5) 5(45.5)
Lymphedema 1.000
Yes 3(37.5) 4(36.4)
No 5(62.5) 7(63.6)
Physiotherapy 0.177
Yes 7(87.5) 6(54.5)
No 1(12.5) 5(45.5)
Clinical treatment stage 1.000
Undergoing treatment 5(62.5) 7(63.6)
After treatment 3(37.5) 4(36.4)
Actual clinical treatment 0.308
Chemotherapy e 3(42.9)
Radiotherapy e 2(28.6)
Hormone therapy 5(100.0) 2(28.6)

Bold values ¼ p < 0.05.

Source: Constructed by the authors. Fisher's Exact Test. Since changes between baseline and post intervention characteristics were not found, only the data from baseline were
presented.
464 L. Boing et al. / Journal of Bodywork & Movement Therapies 22 (2018) 460e466

Table 2
Comparison between experimental and control groups in primary and secondary outcomes. Florianopolis, SC e 2015. (n ¼ 19).

Variables Experimental group (n ¼ 8) Control group (n ¼ 11) After

x ± dp x ± dp

Baseline After P value* Baseline After P value** P value#

EORTC-BR23
Functional Scale 44 ± 26 65 ± 21 0.002 65 ± 24 68 ± 17 0.601 0.762
Body image 39 ± 23 64 ± 25 0.037 64 ± 38 73 ± 28 0.388 0.526
Sexual function 27 ± 28 50 ± 40 0.027 33 ± 29 29 ± 28 0.582 0.644
Sexual satisfaction 55 ± 40 47 ± 50 1.000 44 ± 34 46 ± 40 0.641 0.461
Future perspective 21 ± 35 37 ± 41 0.255 36 ± 43 48 ± 23 0.330 0.469
Symptomatic Scale 47 ± 17 22 ± 7 0.001 32 ± 17 27 ± 11 0.313 0.354
Adverse effects of systemic therapy 54 ± 21 29 ± 7 0.005 28 ± 21 25 ± 13 0.692 0.444
Breast symptoms 28 ± 25 15 ± 14 0.300 42 ± 30 26 ± 22 0.141 0.233
Arm symptoms 67 ± 21 29 ± 10 0.001 39 ± 29 46 ± 32 0.378 0.167
Hair loss 33 ± 42 22 ± 38 0.312 28 ± 39 0 0.178 1.000
Fatigue 5±3 4±2 0.036 4±2 5±2 0.614 0.196
Depressive symptoms 19 ± 10 11 ± 10 0.002 8±7 11 ± 7 0.162 0.908

Bold values ¼ p < 0.05.

Source: Constructed by the authors. *P value to comparison between baseline and after 12 weeks of the experimental group. **P value to comparison between baseline and
after 12 weeks of the control group. #P value to comparison between the experimental and control group after 12 weeks. Two Way Repeated Measures ANOVA and com-
parison test of Sydak.

comparison of physical activity, both within the groups and in be-
tween each group, at baseline and after 12 weeks of intervention.
The results regarding the women's self-perception of the
magnitude of changes in their quality of life and general health
after the intervention showed that all women in the experimental
group reported a very significant improvement after practising 12
weeks of belly dance classes (data not shown in the table).
4. Discussion
The consequences of breast cancer and its entire treatment are
the main indicatives of worsening the quality of life and well-being
of women with breast cancer. In this regard, alternatives that
involve complementary treatments, which could cause some
improvement in indispensable aspects, are necessary (Sudarshan
et al., 2013). Following the results of the present study, it is
possible to observe that belly dancing can influence quality of life in
a positive way e more specifically on the functional scale, body
image, sexual function, symptomatic scale, systemic treatment ef-
fects and arm symptoms in women of the experimental group e
when the periods of pre- and post-intervention were compared.
Also, belly dancing brought reductions in the women's fatigue
levels and depressive symptoms.
Despite the highlighted changes for the experimental group, the
differences between the groups were not statistically significant
after the 12-week intervention for any of the studied variables. This
behaviour was also observed in a previous study (Frison et al., 2014)
that analysed the influence of circular dance on women with breast
cancer and did not find effects after intervention, in any variable,
between the group who were exposed to dance classes and the
control group. In that sense, it is important to emphasise that there
were no differences between the control and experimental groups
before the intervention, indicating homogeneity of the sample at
baseline. The control group did not present any significant modi-
fication after 12 weeks of intervention; only the experimental
group, who received the belly dance classes, demonstrated
different scores after the 12 weeks. Since the group selection was
not randomised, the search to improve quality of life and the
motivation to participate in dance classes might have affected the
outcome for the experimental group.
One important characteristic of the sample that is worth
mentioning is the heterogeneity of the physical activity undertaken
by women in both the control and experimental groups at baseline.
This variability seems to be higher than previous studies using the
same instrument (Kang et al. 2017), which is probably related to the
differences in social and economic aspects of these women.
The increase in scores of the functional scale for quality of life in
the experimental group could be related to general aspects of the
dance, such as improvements in flexibility and motor coordination.
The dance classes applied in the present study began and ended
with stretching exercises, which could have brought benefits to the
women in the experimental group. It is well known that flexibility
is an important aspect in the daily routine and it could influence
functional capacity, especially in women after breast cancer sur-
gery, since surgery brings limitations in upper-limb movement and
other physical aspects of functional capacity.

Table 3

polis, SC e 2015. (n ¼ 19).
Comparison of the physical activity undertaken between the experimental and control groups. Floriano

Variables Experimental group (n ¼ 8) Control group (n ¼ 11) After

x (dp) x (dp)

Baseline After P value Baseline After P value P value#

AF (minutes per day)

Walking 46 ± 38 40 ± 35 0.623 24 ± 36 17 ± 19 0.459 0.088
Moderate PA 64 ± 71 62 ± 17 0.949 25 ± 38 40 ± 41 0.388 0.167
Vigorous PA 44 ± 68 34 ± 49 0.581 35 ± 61 19 ± 54 0.295 0.553
Mod þ Vig PA 107 ± 123 96 ± 57 0.729 61 ± 89 59 ± 83 0.948 0.293
Total PA 46 ± 38 40 ± 35 0.623 24 ± 36 17 ± 19 0.769 0.174

Source: Constructed by the authors. Values are presented as minutes per day. *P value of comparison between baseline and after 12 weeks from the experimental group. **P
value of comparison between baseline and after 12 weeks from the control group. #P value to comparison between experimental and control group after 12 weeks of
intervention. Two Way Repeated Measures ANOVA and comparison test of Sydak.
 L. Boing et al. / Journal of Bodywork & Movement Therapies 22 (2018) 460e466
Belly dancing promotes a deep association between body and
mind by means of body movements, especially by the upper limbs.
Considering those characteristics, the findings related to reduction
of upper-limb symptoms after the intervention are justified, given
that the activity is composed of movements in all axes of the
shoulder, in different amplitudes. This same response is found in
studies that analysed other dance modalities (Kaltsatou et al., 2011;
Sandel et al., 2005; Crane-Okada et al., 2012). The study by
Kaltsatou et al. (2011) investigated upper limbs through handgrip
strength, which was different from the present study, which
investigated arm symptoms with a quality of life questionnaire.
Also, the study of Kaltsatou et al. (2011) included some upper-body
training in its intervention of Greek dance sessions. The results can
be a consequence of this specific training, different from the pre-
sent study, which provided only belly dance classes to the women.
The findings of the present study revealed a reduction on the
symptomatic scale scores and adverse effects of the systemic
therapy on the experimental group, leading to an improvement in
the quality of life past the intervention. These results relate even
more to women undergoing hormone therapy, since it was the only
type of treatment in which the subjects in the experimental group
still participated. The side effects of hormone therapy could be
associated with the modulator type, such as tamoxifen and aro-
matase inhibitors, menopause symptoms, joint pain, and bone
mass loss (Cantinelli et al., 2006). There are no similar previous
results in relation to the dance practice, but the literature points out
that the practice of general physical activity could contribute to the
reduction of side effects from breast cancer treatment (Backman
et al., 2015), especially related to fatigue (Rogers et al., 2011).
Fatigue is one of the most common types of symptoms for many
types of cancer, caused by a decrease in the concentration of hae-
moglobin and cardiorespiratory capacity. It can be defined as an
unpleasant physical sensation, with cognitive and emotional
symptoms (Mansano-Schlosser and Ceolim, 2014; Sturm et al.,
2014). The results of the present study indicate a decrease in fa-
tigue scores for the experimental groups, which is a positive
indicative, considering the magnitude of importance of fatigue in
women with breast cancer. Concerning the impact of physical ac-
tivity on fatigue levels in cancer, similar results are found in Sturm
et al. (2014), indicating a decrease in fatigue after five weeks of
dance therapy in German patients undergoing cancer treatment.
In addition to the physical benefits of belly dancing, psycho-
logical improvements are also found for the experimental group,
more specifically on the reduction of depressive symptoms scores.
This seems to be a common aspect of dance interventions, since
previous studies showed suchlike results in dance therapy (Crane-
Okada et al., 2012), traditional Greek dance (Kaltsatou et al., 2011)
and circular dance (Frison et al., 2014). Rogers et al. (2011), pointed
out that physical activity in leisure, such as belly dance classes, is
the only one able to significantly reduce depressive symptoms.
Body image is a psychological factor that also benefited from the
dance classes. This aspect is related to the way the mind represents
its own body. Belly dancing is based on an ancient tradition of the
cult of fertility, symbolising women and their sensuality (Abra ~o and
Pedra ~o, 2005). The individual conditions of the chosen dance could
justify the increase in body-image scores of the experimental
group.
As consequence of distortions in body image, the sexuality of
women with breast cancer suffers from deep changes, since these
variables present a close relation. In the present study, a significant
improvement in the sexual function of the experimental group was
noticed, since belly dancing is composed of movements that help
the women to recover and rediscover their own sexuality (Moe,
2014). The majority of women analysed (both control and experi-
mental groups) went through radical mastectomy. It is well known
465
that radical mastectomy modifies the sexual function and body
image (Fallbjork et al., 2013), reinforcing the findings of the present
study.
When the perception of change magnitude is observed, the
experimental group presented a significant improvement. In the
study carried out by Frison et al. (2014), women reported positive
perceptions after the circular dance class intervention in relation to
a decrease in the feeling of solitude. The same behaviour was found
in the present study, where the women, at the end of each session,
commented that the familiarity and friendship inside the group
positively modified their perception of facing life with the prob-
lems and limitations that breast cancer brings. The women affirmed
that the dance classes represented a moment of leisure and therapy.
Also, they considered the classes as a place where they had the
opportunity to share their concerns, to talk with other women who
passed through the same problems, and to express themselves
through movement. Movement therapy can enhance the sociability
of these women, but it is important to future studies to understand
the impact of movement therapy on social behaviour, in compari-
son to socialisation therapy.
Some limitations can be pointed out in the present study; firstly,
the non-randomisation of the women who participated in the tri-
als. The fact that it was women interested in the treatment who
decided to participate in the experimental group could have
influenced the results. However, there were no differences in any
studied variables between the groups before the intervention,
which could be observed as a controlled situation. Another limi-
tation can be pointed out as the baseline differences between the
experimental and control groups. Even though this was not found
to be statistically different, the mean baseline scores for quality of
life were better in the experimental group compared to the control
group, which can be indicated as the motivation of the women in
experimental group to choose participation in a dance intervention.
The sample loss, which was not foreseen during the sample size
calculation, could be also considered as a limitation. But since the
women analysed were participating in clinical treatment for breast
cancer (chemotherapy, radiotherapy, and hormone therapy), it was
inevitable that some of them could not participate in some of the
dancing sessions as a function of intense the side effects from
treatment.
5. Conclusion
The belly dance classes proved to be an effective possibility of
intervention for women with breast cancer. The results of this pilot
study showed that belly dance intervention improved quality of life
and decreased fatigue and depressive symptoms of women with
breast cancer in the experimental group. And also, all the women
from the experimental group reported a very significant change in
their lives after 12 weeks of intervention. Through spontaneous
reports during and after belly dance classes, positive attitudes to-
wards the group as a whole were evident, with a sense of friend-
ship, affectionate ties and sharing of experiences and feelings. All of
these are benefits that go beyond expectations. Thus, this pilot
study may be a sub-study for the development of randomised
clinical trials in this subject, as well as an incentive for new projects
with this population.
Conflict of interest statement
There were no funding or financial benefits to the authors. This
paper has not been presented in the past in any form. No conflicts of
interest have been reported by the authors or by any individuals in
control of the content of this article.
466 L. Boing et al. / Journal of Bodywork & Movement Therapies 22 (2018) 460e466
Financial support
This research did not receive any specific grants from funding
agencies in the public, commercial or not-for-profit sectors.
Acknowledgments
We would like to thank the Centro de Pesquisas Oncolo
gicas
(CEPON) in Brazil for all their support during the data collection and
also, thank you to all the subjects for participating in this study.
References
Abra~o, A., Pedr~ ao, L.A., 2005. Contribuiç~ao da dança do ventre para a educaça ~o
corporal, saúde física e mental de mulheres que freqüentam uma academia de
gin
astica e dança. Rev. Latino-Am Enferm. 13 (2), 243e248. https://doi.org/
10.1590/S0104-11692005000200017.
Backman, M., Browall, M., Sundberg, C.J., Wengstro €m, Y., 2015. Experiencing health
and Physical activity during adjuvant chemotherapy treatment for women with
breast cancer. Eur. J. Oncol. Nurs. 1e8.
Cantinelli, F.S., Camacho, R.S., Smaletz, O., Gonsales, B.K., Braguittoni, E., Junior, J.R.,
2006. A oncopsiquiatria no c^ ancer de mama e consideraço ~es a respeito de
questo ~ es do feminino. Rev. Psiquiatr. Clín 33 (3), 124e133. https://doi.org/
10.1590/S0101-60832006000300002.
Courneya, K.S., Segal, R.J., Gelmon, K., Mackey, J.R., Friedenreich, C.M., Yasui, Y.,
Reid, R.D., Proulx, C., Trinh, L., Dolan, L.B., Wooding, E., Vallerand, J.R.,
McKenzie, D.C., 2014. Predictors of adherence to different types and doses of
supervised exercise during breast cancer chemotherapy. Int. J. Behav. Nutr. Phys.
Act. 11 (85), 1e9. https://doi.org/10.1186/s12966-014-0085-0.
Crane-Okada, R., Kiger, H., Sugerman, F., Uman, G.C., Shapiro, S.L., Wyman-
McGinty, W., Anderson, N.L., 2012. Mindful movement program for older breast
cancer survivors - a pilot study. Cancer Nurs. 35 (4), E1eE13. https://doi.org/
10.1097/NCC.0b013e3182280f73.
Cunha, J.A., 2001. Manual da vers~ ao em portugue ^s das Escalas de Beck. Casa do
Psico
logo, S~ao Paulo.
Dibbell-Hope, S., 2000. The use of dance/movement therapy in psychological
adaptation to breast cancer. Art. Psychother. 27 (1), 51e68. https://doi.org/
10.1016/S0197-4556(99)00032-5.
Fallbjork, U., Rasmussen, B.H., Karlsson, S., Salander, P., 2013. Aspects of body image
after mastectomy due to breast cancer - a two-year follow-up study. Eur. J.
Oncol. Nurs. 17 (3), 340e345. https://doi.org/10.1016/j.ejon.2012.09.002.
Frison, F.S., Shimo, K.K., Gabriel, M., 2014. Dança circular e qualidade de vida em
mulheres mastectomizadas: um estudo piloto. Saúde Debate 38 (101),
277e284. https://doi.org/10.5935/0103-1104.20140025.
Gadotti, I.C., Vieira, E.R., Magee, D.J., 2006. Importance and clarification of mea-
surement properties in rehabilitation. Rev. Bras. Fisioter. 10 (2), 137e146.
https://doi.org/10.1590/S1413-35552006000200002.
Gonçalves, C.O., Tavares, M.C.G.C.F., Campana, A.N.N.B., Cabello, C., Shimo, A.K.K.,
2012. Instrumentos para avaliar a imagem corporal de mulheres com c^ ancer de
mama. Psicol. Teor. Prat. 14 (2), 43e55.
Kaltsatou, A., Mameletzi, D., Douka, S., 2011. Physical and psychological benefits of a
24-week traditional dance program in breast cancer survivors. J. Bodyw. Mov.
Ther. 15 (2), 162e167. https://doi.org/10.1016/j.jbmt.2010.03.002.
Kaminska, M., Kubiatowski, T., Ciszewski, T., Czarnocki, K.J., Makara-Studzin
ska, M.,
Bojar, I., Staroslawska, E., 2015. Evaluation of symptoms of anxiety and
depression in women with breast cancer after breast amputation or conser-
vation treated with adjuvant chemotherapy. Ann. Agric. Environ. Med. 22 (1),
185e189. https://doi.org/10.5604/12321966.1141392.
Kang, K.D., Bae, S., Kim, H., Hwang, I.G., Kim, S.M., Han, D.H., 2017. The relationship
between physical activity intensity and mental health status in patients with
breast cancer. J. Korean Med. Sci. 32, 1345e1350. https://doi.org/10.3346/jkms.
2017.32.8.1345.
Mansano-Schlosser, T.C., Ceolim, M.F., 2014. Fadiga em idosos em tratamento qui-
miotera
pico. Rev. Bras. Enferm. 67 (4), 623e629. https://doi.org/10.1590/0034-
7167.2014670419.
Michels, F.A.S., Latorre, M.R.D.O., Maciel, M.S., 2013. Validity, reliability and un-
derstanding of the EORTC-C30 and EORTC-BR23, quality of life questionnaires
specific for breast cancer. Rev. Bras. Epidemiol. 16 (2), 352e363. https://doi.org/
10.1590/S1415-790X2013000200011.
Moe, A.M., 2014. Sequins, sass, and sisterhood: an exploration of older Women's
belly dancing. J. Women Aging 26 (1), 39e65. https://doi.org/10.1080/
08952841.2014.854574.
Molinaro, J., Kleinfelt, M., Lebed, S., 1986. Physical therapy and dance in the surgical
management of breast cancer: a clinical report. Phys. Ther. 66 (6), 967e969.
Mota, D.D.C.F., Pimenta, C.A.M., Piper, B.F., 2009. Fatigue in Brazilian cancer patients,
caregivers, and nursing students: a psychometric validation study of the Piper
Fatigue Scale-Revised. Supp Care Cancer 17 (6), 645e652.
Pardini, R., Matsudo, S.M.M., Matsudo, V.K.R., Araujo, T., Andrade, E., Braggion, G.F.,
1997. Validation of the international physical activity questionnaire (IPAQ):
pilot study in brazilian young adults. Med. Sci. Sports Exerc 29 (6), 5e9.
Piper, B.F., Dibble, S.L., Dodd, M.J., Weiss, M.C., Slaughter, R.E., Paul, S.M., 1998. The
revised Piper Fatigue Scale: psychometric evaluation in women with breast
cancer. Oncol. Nurs. Forum 25 (4), 677e684.
Rogers, L.Q., Markwell, S.J., Courneya, K.S., McAuley, E., Verhulst, S., 2011. Physical
activity type and intensity among rural breast cancer survivors: patterns and
associations with fatigue and depressive symptoms. J. Cancer Surviv 5 (1),
54e61. https://doi.org/10.1007/s11764-010-0160-8.
Sandel, S., Judge, J.O., Landry, N., Faria, L., Ouellette, R., Majczak, M., 2005. Dance and
movement program improves quality-of-life Measures in breast cancer survi-
vors. Cancer Nurs. 28 (4), 301e309.
Serlin, I., Classen, C., Frances, B., Angell, K., 2000. Symposium: support groups for
women with breast cancer: traditional and alternative expressive approaches.
Arts Psychother 27 (2), 123e138.
Soares, P.B.M., Carneiro, J.A., Rocha, L.A., Gonçalves, R.C.R., Martelli, D.R.B.,
Silveira, M.F., Júnior, H.M., 2013. The quality of life of disease-free Brazilian
breast cancer survivors. Rev. Esc. Enferm. USP 47 (1), 69e75. https://doi.org/
10.1590/S0080-62342013000100009.
Sturm, I., Baak, J., Storek, B., Traore, A., Thuss-Patience, P., 2014. Effect of dance on
cancer-related fatigue and quality of life. Support Care Cancer 22, 2241e2249.
https://doi.org/10.1007/s00520-014-2181-8.
Sudarshan, M., Petrucci, A., Dumitra, S., Duplisea, J., Wexler, S., Meterissian, S., 2013.
Yoga therapy for breast cancer patients: a prospective cohort study. Comple-
ment. Ther. Clin. Pract. 19 (4), 227e229. https://doi.org/10.1016/
j.ctcp.2013.06.004.