THE EFFECT OF A TRADITIONAL DANCE TRAINING
PROGRAM ON DYNAMIC BALANCE OF INDIVIDUALS
WITH MENTAL RETARDATION
VASILEIOS K. TSIMARAS,1 GENOVEFA A. GIAMOURIDOU,1 DIMITRIOS G. KOKARIDAS,2
MARIA P. SIDIROPOULOU,1 AND ASTERIOS I. PATSIAOURAS2
1
Laboratory of Developmental Pediatrics and Special Education, Department of Physical Education and Sport Science, Aristotle
University of Thessaloniki, Thessaloniki, Greece; and 2Department of Physical Education and Sport Science, University of
Thessaly, Trikala, Greece
ABSTRACT
Tsimaras, VK, Giamouridou, GA, Kokaridas, DG, Sidiropoulou, MP,
and Patsiaouras, AI. The effect of a traditional dance training
program on dynamic balance of individuals with mental retar-
dation. J Strength Cond Res 26(1): 192–198, 2012—The
purpose of this study was to evaluate the influence of a Greek
traditional dance training program on the dynamic balance of
individuals with mental retardation (MR). A total of 17
individuals participated in this study. Ten individuals with mild
or moderate MR and 7 individuals with mild or moderate MR
who studied in special schools were assigned to intervention
(MR-I) and control (MR-C) groups, respectively. Pretraining and
posttraining exercise tests were performed to determine the
dynamic balance ability. Dynamic balance ability was measured
by means of a balance deck (Lafayette, Lafayette, IN, USA) in
30-, 45-, and 60-second intervals. The MR-I group underwent
a 16-week Greek traditional dance training program at
a frequency of 3 times per week and for a duration of 45
minutes per season. Posttraining results showed that the
individuals with MR in the MR-I group improved during
treatment, from their baseline scores on dynamic balance
measurements (30 seconds: p , 0.01, 45 seconds: p , 0.05,
60 seconds: p , 0.05). The MR-C group did not show any
improvement between the 2 measurements. In conclusion,
individuals with MR may be able to improve their dynamic
balance when performing a systematic and well-designed Greek
traditional dance training program.
KEY WORDS conventional choreography planning, stability,
persons, intellectual difficulties
Address correspondence to Vasileios K. Tsimaras, tsimaras@phed.auth.gr.
26(1)/192–198
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INTRODUCTION
B
alance ability considerably influences learning and
implementation of new skills and constitutes the
basic factor for success in all athletic activities
(21,22) and is a reliable predicting factor regarding
the development of basic motor skills such as walking,
running, and throwing, academic success and risk of athletic
injuries (7). In the case of individuals with mental retardation
(MR), balance improvement is considered to be most
important because its acquisition even at a minimal level
provides the opportunity to walk, run, and jump in various
ways, whereas individuals with good balance can turn their
attention while participating in more complex and
demanding activities (18).
However, balance constitutes one of the most incomplete
motor skill areas for individuals with MR (38) that is
significantly lower compared with that of individuals without
typical IQ (8). Because of insufficient perception ability and
treatment of environmental stimuli, these individuals dem-
onstrate a poor balance ability (28), which in turn results in
frequent falls and increased injury danger.
According to Cratty (8), balance deficit of children with
MR aged 8–14 years was evident with only 5% of these
children demonstrating the ability to successfully perform
hopping tasks. Children with MR are capable of achieving
performance that is equivalent to the performance of their
peers with a typical IQ only when there is a preceding
appropriate intervention program, with balance improve-
ment attributed to program participation and not to physical
development (17). Evidently, adaptation of the central
nervous system through exercise programs constitutes an
important intervention factor for balance improvement (33).
Dance influences static and dynamic balance to a great
extent and is consequently considered as the ideal physical
activity for children (19) older adults (10), individuals with
kinesthetic difficulties and lack of balance, and for those with
hearing problems (24). Although rhythm difficulties of
individuals with MR are often present, it is evident that
dance improves balance ability and enhances creativity,
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expression, sensitivity, and leadership skills (6). Sherill and dance program. Ten individuals with MR constituted
Delaney (30) reported that through expressive and creative the intervention group (MR-I), whereas 7 individuals with
dance movements, individuals with MR progress toward self- MR made up the control group (MR-C) of the study.
knowledge and understanding of their emotions and The participants of 2 groups were similar in IQ (range 52–67
thoughts. Clearly, dance provides the opportunity to explore, and range 51–65, for the MR-I and MR-C groups,
create, discover, and enjoy and is recognized not only as respectively).
a supportive means of the learning process but also as a tool The level of intelligence because of special school
that contributes to the self-respect of each individual (16). attendance has been already repeatedly evaluated in previous
However, results regarding balance performance of years by the professionals of the Diagnosis and Evaluation
individuals with MR are often reported as contradictory. Center using the Wisk-III Test (14). Regarding the individuals
Thomas’s (34) study comparing balance performance of with MR, the etiology of retardation was prematurity, mild
students with MR on the stabilometer, bass-stick test, and birth hypoxia or unidentifiable. All the subjects were living
jump-turn test after 12 weeks of exercising did not with their families (middle-class) and were attending schools
demonstrate any significant balance improvement. More- for specific vocations. In addition, they were capable of
over, Roswall et al. (27) reported no changes in motor skill understanding visual and verbal instructions.
performance of individuals with MR after 9 weeks of dance All participating individuals with MR were apparently
practice. healthy, with no orthopedic or sensory impairments that
On the other hand, studies observed a significant balance could interfere with the testing protocols. There was no
improvement of individuals with MR after a 9 weeks’ dance chromosomal abnormality or anatomical disorder in the brain
program (26) and 12 weeks of choreography and gross motor detected in CAT scans run for diagnostic purposes in the
ability program (5). In addition, Tsimaras et al. (37) and Pediatric Clinics of the University of Thessaloniki during their
Neofotistou (23) in later studies reported a significant infancy. All the participants and their parents or legal
dynamic balance improvement of adults with MR after an guardians were informed of the purpose of the study. The
exercise program (37) and a rhythmic gymnastics program participants were capable of understanding verbal and visual
(23) lasting 12 weeks, whereas Wang and Huei (40) noted directions, were informed about the testing procedures, plus
that improvement of hopping skills could result in balance written informed consent approved by an Institutional
improvement of children with MR during walking. Review Board for the use of Human subjects was obtained
However, on reviewing the literature, it seems that there is from all the participants and their parents or legal guardians
a lack of research efforts noted regarding the effectiveness of before investigation.
traditional dance programs on improving dynamic balance of The physiological characteristics of individuals with MR in
individuals with MR. Thus, the purpose of this study was to the 2 groups are shown in Table 1. No significant differences
examine the effect of a traditional Greek dance program on were found for age, height, weight, or body mass index
the dynamic balance ability of individuals with MR. between the MR-I and MR-C groups.
Procedures
METHODS The dynamic balance ability was measured by means of
Experimental Approach to the Problem a balance deck (16020 Stabilometer, Lafayette Ins Co), an
The hypotheses developed in the Introduction were tested by instrument of high reliability (r = 0.99) for measuring balance
measuring dynamic balance ability, before and after the ability of individuals with MR (5). The test was demonstrated
application of a traditional dance program, by means of and executed before starting measurement, to familiarize
a balance deck (16020 Stabilometer, Lafayette Ins Co, each participant with the equipment. The dynamic balance
Lafayette, IN, USA) of 17 individuals with mild MR assigned ability was determined by the number of seconds the
to 2 groups (control and in-
tervention) according to their
desire to participate.
Subjects
The participants of the study TABLE 1. Physiological characteristics of participants.*†
were 17 individuals with mild
Groups Age (y) Height (cm) Weight (kg) BMI (kg
m22)
MR all coming from the Center
of Professional Learning of MR-I (n = 10) 18.1 6 2.0 173.0 6 4.5 75.0 6 3.4 25.06 6 1.3
Thessaloniki. The individuals MR-C (n = 7) 18.0 6 1.7 177.0 6 5.2 77.0 6 5.2 24.58 6 2.1
were assigned to 2 groups
*MR-I = intervention group; MR-C = control group; BMI = body mass index.
(control and intervention) ac- †Values are given as mean 6 SD.
cording to their desire to par-
ticipate, or not, in the traditional

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 Effect of a Traditional Dance Training Program

individual could perform standing on

the platform of the stabilometer, in 30-,
45-, and 60-second intervals. The TABLE 2. Greek traditional dance program.
important criterion for the selection of Traditional dance
these intervals was their use in relevant
research studies (5,36,37). A resting Zonaradikos
period of 3–5 minutes was provided Menousis
Giatros
during each interval. The instructions
Chasapicos
given were the same for each individual Chasaposervikos
to avoid the effect of external or internal
motivation. Further, no verbal commu-
nication or interference was allowed
during testing, and the examiners were
the same for each individual.
The clinical examination and measurement of physical
characteristics of the individuals took place at the Laboratory
of Developmental Pediatrics and Special Education in the
Department of Physical Education and Sport Science,
Aristotle University of Thessaloniki.
Measurements of the dynamic balance ability and appli-
cation of the intervention program took place at the indoor
gymnasium of the participants’ school. An orientation session
was provided to the participants, 1 day before the actual
testing sessions. During this session, written instructions
concerning the test procedures and a demonstration of the
test were provided to the participants and their parents or
legal guardians. After the demonstration, the individuals
performed a number of trials to familiarize themselves with
the testing procedures and equipment.
Two examiners, both familiarized with the operation of
equipment and testing procedures conducted all measure-
ments. The research protocol included 2 separate days of
testing. The results showed that there was no significant
difference between the 2 measurements in terms of dynamic
balance ability. Therefore, the purpose of the study was the
Duration Traditional dance Duration
2 min 22 s Tsourapia 2 min 05 s
2 min 29 s Podaraki 2 min 35 s
1 min 38 s Kalamatianos 3 min 00 s
2 min 28 s Tsamikos 3 min 15 s
2 min 21 s Karagouna 3 min 30 s
estimation of the highest performance of each participant,
and the better of the 2 efforts was chosen for data analysis.
Testing for the participants of the MR-I group included
2 measurements (initial and final), before and after the
application of the intervention program, respectively.
Although the individuals of the MR-C group did not
participate in the traditional dance program or in any other
sport or physical activity, they underwent the same measure-
ments as did the individuals of the MR-I group.
The MR-I group followed a 16-week traditional dance
training program, at a frequency of 3 training sessions per
week, for 45 minutes each session. All participants wore
athletic shoes and sport clothes during each session. All the
individuals in the MR-I group did not participate in other
training programs during the research.
Teaching of Greek traditional dances began 1 month before
the application of the intervention program aiming at
avoiding loss of practice time during program sessions.
Overall, 10 Greek traditional dances were practiced (Table 2).
Each session started with a 5-minute warm-up period that
included stretching exercises for avoiding possible injuries in

TABLE 3. Kruskal-Wallis test: Pre-postvalues of dynamic balance.

Conditions: intervals Group N Mean rank Chi-square df Asymp. sig. (2 tailed) p

30 s (Pretest) MR-I 10 7.80 1.41 1 0.236

MR-C 7 10.71
30 s (Posttest) MR-I 10 9.05 0.002 1 0.961
MR-C 7 8.93
45 s (Pretest) MR-I 10 7.45 2.29 1 0.130
MR-C 7 11.21
45 s (Posttest) MR-I 10 8.20 0.610 1 0.435
MR-C 7 10.14
60 s (Pretest) MR-I 10 8.00 0.952 1 0.329
MR-C 7 10.43
60 s (Posttest) MR-I 10 9.15 0.021 1 0.883
MR-C 7 8.79

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TABLE 4. Wilcoxon signed ranks test: Pre-postvalues of dynamic balance.*

Conditions: intervals Group N Mean 6 SD Mean rank z Asymp. sig. (2 tailed) p

30 s (Pretest) MR-I 10 1.73 6 0.99 5.00 22.67† 0.008

30 s (Posttest) 2.56 6 1.44
30 s (Pretest) MR-C 7 3.04 6 2.45 4 21.15† 0.249
30 s (Posttest) 3.10 6 2.55
45 s (Pretest) MR-I 10 2.43 6 1.36 5.50 22.80† 0.005
45 s (Posttest) 3.37 6 1.93
45 s (Pretest) MR-C 7 4.47 6 2.67 4 20.34† 0.735
45 s (Posttest) 4.33 6 2.63
60 s (Pretest) MR-I 10 3.67 6 1.90 5.50 22.80† 0.005
60 s (Posttest) 4.88 6 2.08
60 s (Pretest) MR-C 7 6.07 6 4.55 4.42 22.12‡ 0.034
60 s (Posttest) 5.53 6 4.15
*MR-I = intervention group; MR-C = control group.
†Based on negative ranks.
‡Based on positive ranks.

ankle strain and gastrocnemious muscle. Next, the main part
of the traditional dance program followed. Between dances,
a short rest period of 10–15 seconds roughly was included
along with a 5-minute rest period in the middle of each
session. Each session concluded with a 5-minute cooldown
period including stretching exercises. During each session,
continuous verbal and visual feedback was provided.
During the program, no participant was absent for .10% of
the total number of sessions (5 absences out of 48 sessions).
The safe and comfortable environment provided by the
indoor gymnasium facilities and minimum means (a CD
player and a CD disc) required for running the whole program
contributed to the trouble-free conduction of the intervention
program.
The selection of traditional dances was made according to
the following criteria: (a) Musicmeters and tempo relation, with
slow (e.g., Giatros) and relatively fast dances selected for 2/4
and 4/4 simple music meters, whereas in more demanding
meters such as 7/8 (e.g., Kalamatianos), attention was given to
keeping a medium tempo. (b) Simple steps and shapes in space,
with continuous verbal and visual feedback provided in the
case of rhythm mistakes in more demanding movements (e.g.,
turns). A variety of handholds (simple, crisscross, shoulder
grip, etc) was preferred so as to increase participants’ interest.
(c) Familiar or desirable hearings for participants.
Statistical Analyses
The Statistical Package for Social Sciences (SPSS 16) was used
for statistical analysis of data. Calculation of the means and SDs of
data was included using descriptive statistics. A nonparametric
(Kruskal-Wallis) test was used for analysis of the results in each
experimental condition (balance in 30, 45, and 60 seconds).
Initial and final measurements constituted the dependent
variables, with independent variable being the (control and
intervention) group using the Wilcoxon 2-related sample test.
The level of significance was set at p # 0.05.
RESULTS
The nonparametric Kruskal-Wallis test revealed no significant
results between the MR-I and MR-C groups in each
condition (Table 3).
However, on using Wilcoxon signed rank test, significant
results were observed in each experimental condition (30, 45,
and 60 seconds) in the MR-I group. In addition, statistically
significant differences were noticed in the MR-C group in the
60-second condition with the MR-C group demonstrating
a decreased performance regarding the number of seconds
MR-C individuals could perform standing on the stabilom-
eter (Table 4).
DISCUSSION
Undoubtedly, dance positively affects the balance ability
of individuals of all ages with typical IQs, and intervention
dance programs constitute an effective and safe way for
improving physical and motor skills (29). Tsang and Hui-
Chan (35) pointed out the beneficial influence of an 8 weeks’
Tai-Chi program on the balance ability of elderly individuals.
Similar results were reported by Berryman-Miller (3) who
additionally noted a significant improvement in self-confi-
dence, psychological mood, and sense of well-being of 55- to
85-year-old individuals. As Birkel (4) indicated, dance
practice improves flexibility, balance, muscle strength and
control, timing, body posture, concentration, and relaxing
ability of all adult individuals. Clearly, balance ability
improves with practice especially through dance training
where balance is considered as a prerequisite ability for
successful performance (39). The recent study of

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 Effect of a Traditional Dance Training Program
Maurovouniotis et al. (20) concerning individuals of 6–18
years of age also reported a significant improvement of their
dynamic balance ability after the application of a 12-week
traditional dance program.
Similarly, the results of the individuals with MR of this study
revealed a significant dynamic balance ability improvement of
the individuals in the MR-I group after their participation in
a traditional dance program. This improvement could be first
attributed to the nature of Greek traditional dances themselves.
Greek traditional dances require that participants hold hands
while formatting and moving in a circle. The continuous hand
support that each participant receives on both (left and right)
sides of his or her body constitutes an ideal way of promoting
balance in cases such as the individuals with MR of this study,
minimizing the risk of falling while at the same time promoting
fun, cooperation, and friendship. The different rhythm
according to the characteristics of each dance further improves
eye-hand and eye-foot coordination at different speeds and
circle formations, promoting dynamic balance along with
enjoyment and a sense of companionship developed toward
a common goal of emotional expression and fulfillment
through music and movement.
Balance improvement could also be attributed to the
duration (16 weeks) and frequency (3> training sessions per
week) of the program along with the fact that no participant
of the MR-I group was absent for .10% of the total number of
sessions (5 absences out of 48 sessions). Dynamic balance
improvement of the individuals of the MR-I group as a result
of the traditional dance program application is strengthened
by the fact that performance of MR-C group individuals did
not present any differences between the 2 measurements.
Especially in the final measurement (60-second condition),
the MR-C performance worsened.
The findings of this study support the notion that although
individuals with MR face difficulties to correspond satisfac-
torily in a series of complex activities (9) such as traditional
dances, they are in a position to learn technical movements
(15) and to improve their performance when opportunities of
practicing, motivation, quality teaching, and satisfactory
learning environment are provided as in the case of children
without intellectual problems (13).
The higher levels of dynamic balance ability exhibited by
the participants of the MR-I group because of the application
of the traditional dance program are strengthened by the
findings of previous research studies (2,26), where even
programs that are short in duration (9 sessions, 1.5 per
session) and lower in intensity could produce motor skill
improvement in individuals with mild MR (26). Boswell (5)
also observed a significant dynamic balance improvement in
individuals with MR after the application of 12 weeks of
choreography and gross motor ability program. Similarly,
Smail and Horvat (32) who examined the effect of a balance
program on the equal weight distribution of individuals
with MR reported a significant balance improvement after
12 weeks of exercise.
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However, it is generally acceptable that balance ability of
individuals with MR is less than the balance ability of those
with typical IQs (8,36). Their lower balance performance is
mostly attributed to their slow development rhythm and
their fewer opportunities for participation in physical
activities than to biological factors. Another possible
explanation is their difficulty to process environmental
stimuli and information because of memory problems,
limited comprehension of verbal and visual directives, poor
motor planning, slow progress, and nonsatisfactory commu-
nication with the environment (34). Last, lower dynamic
balance ability performance of individuals with MR could be
attributed to the absence of adapted intervention programs
focusing on the development of skills in which individuals
with MR fall short.
Sit et al. (31) supported the fact that individuals with MR
exercised less compared with individuals with other
disabilities because of their reduced learning ability resulting
from their low level of intellectual development, attention
deficits, poor memory and problems related to eye-hand and
eye-foot coordination, and perception of space and body
knowledge in space. Gallahue and Ozmun (12) stated that
basic movement abilities do not develop as a result of growth
and development; thus, children with MR should be taught
with the use of activities that are more appropriate in terms of
developmental and educational criteria.
The relation between the ability of children to perform
basic motor skills and motor experience emphasizes the
importance of providing qualitative movement experiences
during the developmental phase of basic skills (11). The
sufficient growth of balance is considered essential for the
successful future attendance in physical activities (12) and
enhancement of children’s physical abilities (25).
Through dance practice, participants will also exhibit good
balance ability in different types of activities other than
dancing, so as to maintain their balance on the stabilometer
instrument. Via dance, the use of stimuli through the
vestibular, verbal, and visual system is achieved, leading to
sensory integration and better sense of balance. The
improvement of balance performance of the MR-I individuals
on the stabilometer observed in this study after the
application of a 16-week intervention program, supports
the motor learning theory according to which improvement
of skills such as balance as a result of dance practice
contributes to the successful performance of more complex
goals such as maintenance of balance on the stabilometer (1).
PRACTICAL APPLICATIONS
In the past few years, the value of exercise has been widely
recognized for individuals with MR, as it has been proved that
their participation in specialized exercise programs contrib-
utes to the improvement of physical and motor skills. Motor
improvement is necessary for performing simple, however,
important activities of everyday life such as walking or going

up the stairs, skills that are impossible for anyone to perform
without the existence of sufficient balance.
The results of this study showed that traditional dances
with MR. constitute an exceptional way of exercise for
improving balance and, consequently, for preventing fall
incidents of individuals with MR. Successful performance of
basic motor skills has an overall effect on personality
development of children with MR, because social, emotional,
and cognitive interaction that traditional dances provide has
a direct positive effect on their quality of life.
Traditional dancing is a music-kinetic activity that can be
applied in school programs with simple processes and
without the requirement of particular equipment. Thus, in
a simple but effective way, traditional dancing has the
potential to strengthen feelings of satisfaction and amuse-
ment of those who participate and to maintain their interest
toward exercise for longer periods of time. Consequently,
exercise through traditional dancing should constitute an
integral part of physical education lessons of individuals
with MR.
ACKNOWLEDGMENTS
We are grateful to the groups of individuals with MR for their
participation in this study. Furthermore, we want to express
our gratitude to the families and physical education teachers
of individuals with MR for their cooperation and unfailing
support during traditional dance research. We would also like
to thank the entire laboratory and medical staff for their hard
work for the completion of this study.
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