THEMETABOLICDEMANDSOFCULTURALLY-SPECIFIC

POLYNESIANDANCES

by

WeiZhu

Athesissubmittedinpartialfulfillmentoftherequirementsforthedegree

of

MasterofScience

in

HealthandHumanDevelopment

MONTANASTATEUNIVERSITYBozeman,Montana

November2016

©COPYRIGHT

by

WeiZhu

2016

AllRightsReserved

ii

TABLEOFCONTENTS

1.INTRODUCTION.........................................................................................................1

HistoricalBackground...............................................................................................1StatementofPurpose...............................................................................................3SignificanceofStudy.................................................................................................3Hypotheses...............................................................................................................4Limitations................................................................................................................5Delimitations.............................................................................................................5

2.REVIEWOFTHELITERATURE.....................................................................................6

Introduction..............................................................................................................6HealthStatusinNHOPI.............................................................................................6PA–AStrategyforBetterHealthOutcomes.............................................................9

PhysicalActivityandHealthOutcomes............................................................9PhysicalInactivityinHawaiianPopulations...................................................11

PolynesianDanceStudy..........................................................................................12DancingasaformofPA.................................................................................12ThePolynesianDances..................................................................................14MetabolicDemandsofPolynesianDance......................................................15

Summary.................................................................................................................17

3.THESISMANUSCRIPT...............................................................................................18

Introduction............................................................................................................18Methodology..........................................................................................................22

Participants....................................................................................................22Procedures.....................................................................................................23PolynesianDancesTested..............................................................................23DanceTestingProtocol...................................................................................25MeasurementofCardiometabolicDemands.................................................26MeasurementofBloodLactate.....................................................................27DataProcessingandCalculations..................................................................27StatisticalAnalyses.........................................................................................29

Results.....................................................................................................................30CharacteristicsofParticipants........................................................................30CardiorespiratoryResponsestoPolynesianDancing.....................................31AerobicandAnaerobicContributionstoTotalAEE........................................34

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TABLEOFCONTENTSCONTINUED

Discussion...............................................................................................................38METValuesacrossthePolynesianDancesTested.........................................38GenderComparisonsforMETValues............................................................40AerobicAEE....................................................................................................41AnaerobicAEE................................................................................................42LimitationsandFutureResearch...................................................................43

Conclusions.............................................................................................................44

4.CONCLUSIONS.........................................................................................................46

REFERENCES................................................................................................................48

APPENDIXA:IRBapprovedInformedConsentDocument..........................................53

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LISTOFTABLES

Table Page

1.DescriptivestatisticsforPolynesiandancestudyparticipants....................31

2.CardiorespiratoryresponsesandbloodlactateconcentrationforeachofeightPolynesiandances...........................................................33

3.Aerobicandanaerobicactivityenergyexpenditures(AEE)andtheirrespectivecontributionstototalEEbygenderforeightPolynesiandances........................................................................36

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LISTOFFIGURES

Figure Page

1.Metabolicequivalents(MET)foreightPolynesiandancesbygender....................................................................................................35

2.AerobicandanaerobiccontributionstothetotalactivityenergyexpenditureforeightPolynesiandances.Figure2(a):absoluteaerobicandanaerobicAEE(kcals·min-1);Figure2(b):relativeaerobicandanaerobicAEEtototalAEE(%)...............37

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NOMENCLATURE

Cardiacrehabilitation(CR):isabranchofrehabilitationmedicineandphysicaltherapydealingwithoptimizingphysical function inpatientswith cardiacdiseaseor recentcardiacsurgeries.

Cardiometabolic disorders: a cluster of diseases of cardiovascular disease (CVD),diabetes,andobesity.

Dance therapy: is the psychotherapeutic use of movement and dance to supportintellectual,emotional,andmotorfunctionsofthebody.

Danceroutine:Eachculturaldanceroutineismadeupofdancemovesfromaspecificculture.Atypicaldanceroutinelastsbetween3and5minutes.

Exerciseprescription: refers to thespecificplanof fitness-relatedactivities thataredesignedforimprovingphysicalfitnessandhealth.Itincludesthefrequency,intensity,durationandmodofexercise.

Metabolic demand (ormetabolic cost, energy expenditure, exercise intensity): theenergy consumption of particular physical activities, usually expressed as MET.Moderateintensityactivityrefersto3to5.9MET.

MetabolicEquivalent(MET):isdefinedastheratioofmetabolicrateduringaspecificphysical activity to a reference metabolic rate at rest, set by convention to 3.5mL·kg−1·min−1ofoxygenuptake.TheMETisusedtoexpresstheintensityofactivitiesinawaycomparableamongpersonswhovaryinbodymass.

Oxygenuptake(VO2):therateofoxygenutilizationbytheworkingmuscletissueduringexercise.

Physicalactivity(PA):isdefinedasanybodilymovementproducedbythecontractionofskeletalmusclesthatresult inasubstantial increase incaloricrequirementsoverrestingenergyexpenditure.

PhysicalActivityReadinessQuestionnaire(PAR-Q):Ahealthscreeningquestionnairedesigned to determine whether or not you should see a doctor beforestarting/resumingphysicalactivity.

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ABSTRACT

It is suggested that dancing is a form of exercise that induces favorablephysiologicalandpsychologicaleffectscomparable toaerobicexercise training.ThecurrentstudysoughttomeasurethemetabolicdemandsforseveralPolynesiandances(i.e.,Hawaiianhula,Fijian,Maorihakaandpoiballs,Samoansasaandslap,Tahitian,andTongan),andtoevaluatepossiblegenderdifferencesinthesemeasuresinagroupofexperiencedPolynesiandancers.Thirtyparticipants(13menand17women)weretested through a dance testing protocol, using indirect calorimetry. Metabolicdemands were evaluated in units of metabolic equivalent (MET), as well as bothaerobicandanaerobicactivityenergyexpenditure (AEE)contributions to totalAEE.Onesamplet-testwasusedtocomparethemeanMETvaluesforeachculturaldanceto the cutoff values (3-MET and 6-MET, respectively) for moderate and vigorousphysical activity.Genderdifferenceswereexaminedusing independent t-tests. ThemeanMETvaluesforall,butMaoripoiballsdance,weresignificantlygreaterthan3.0METs.ThemeanMETvalues forSamoansasa,SamoanslapandTahitianwerealsosignificantlygreaterthan6.0METs.Themen’sMETvaluesforHawaiianhula,Samoansasa,Tongan,Fijian,andMaorihakawereallsignificantlygreater(P<0.001)thanthecorrespondingvaluesforwomen,whiletheTahitianMETvaluesweresimilar(P=0.526)between both genders. Aerobic and anaerobic AEE contribute 83.4% and 16.6%,respectively,onaverage, forPolynesiandances,withHawaiianhulabeingthemostaerobic(88.7%and11.3%,respectively)andSamoanslapbeingtheleastaerobic(74.2%and25.8%,respectively).TheaerobicAEEformenwassignificantlygreaterthanthatforwomenfortheHawaiianhula,Samoansasa,Fijian,Maorihaka,andTongan(P<0.001),whilenosignificancegenderdifferencewasobserved inanaerobicAEE(P=0.087-0.989).ThepresentstudyindicatedthatthePolynesiandanceofvariousformsmetthecurrentPArecommendations,andthuscanbeusedasanappropriatemodeof aerobic exercise to increase regular physical activity in the ethnic minorities inHawaiiandthesouthPacificforhealthpromotionanddiseaseprevention.

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CHAPTERONE-INTRODUCTION

HistoricalBackground

Thegrowingpopularityofrecreationalandcompetitivedancinghasparalleled

the growing knowledge documenting the potential health benefits of dance

(Belardinellietal.2008).Dancetherapy,asfirstintroducedtopatientsparticipatingin

cardiac rehabilitation (CR) programs, uses movement to support the physical and

emotionalwell-beingofpatientsandhasbeenprovento improveexercisecapacity

and quality of life. Different forms of dance (i.e., Waltz, Latin, and aerobic dance

training),havebeenimplementedasphysicalactivityinterventionstrategiesinboth

CVDpatientsandhealthypopulations.Forexample,Waltzdancewascompared to

aerobicexercisetrainingandwasreportedtoresultinthesamebeneficialeffects,such

asimprovedfunctionalcapacityandendothelium-dependentdilationinpatientswith

chronicheart failure (Belardinellietal.2008).Aerobicdancetraininghasalsobeen

showntoreducelow-densitylipoproteincholesterol(LDL-C)andtriglyceridelevels,as

wellasloweringsystolicanddiastolicbloodpressure,inhypertensivepatients(Maruf

etal.2014).FavorablepsychologicaleffectshasalsobeenreportedbyDomeneand

hisgroup(2014)inLatinpartneredsocialdance.

DancetherapywasintroducedtoaCRprograminHawaii.TheHulaEmpowering

LifestyleAdaptationStudy(theHELAStudy)(Looketal.2012)isaprojectfundedby

theNationalInstituteonMinorityHealthandHealthDisparities.Theprojectaimedto

2

developacommunity-basedphysicalactivityCRprogramintegratinghuladancing,an

indigenousculturalpractice,asaformofphysicalactivity(PA).Thispracticenotonly

improved functional capacity of participants, but also enhanced their sociocultural

bonds anddeepened their appreciationof theHawaiian culture (Maskarinec et al.

2015b).Therefore,itisreasonabletopredictthatthesetraditionalculturedancescan

beregardedasaneffectiveexercisemodalityforgeneralhealthpromotionforpeople

ofallagesinNativeHawaiiansandotherPacificIslanders.

Polynesiandances,suchastheHawaiianhula,weredevelopedthroughoutthe

Pacific Islands where the Polynesians originally settled. Each Polynesian culture

tendedtohaveitsownculturally-specificdances,themostwell-knownofwhichare

taughtinschoolsandgroupexerciseclasses,practicedbymenandwomenofallages,

and are popular with all ethnicities (Look et al. 2012). Some of themost popular

PolynesiandancesincludethosefromtheHawaiian,Fijian,Maori,Samoan,Tahitian,

andTongancultures.Asaculturally-relatedPA,Polynesiandancecouldbeusedasan

alternativeformofaerobicexerciseforCVDpatientsandforthegeneralpublic.

The application of basic exercise prescription principles (i.e., duration and

frequencyofpreformingthesekindsofdances)isdifficult,however,withoutknowing

the metabolic demands of these dances. Although the metabolic demands of a

comprehensivevarietyofactivitieshavebeenlistedintheCompendiumofPhysical

Activities (Ainsworth et al. 2011), the number of culturally-based activities is very

limited, andmany of those values were based on self-reported exertion levels or

3

unpublished thesis data, without directly measuring oxygen uptake (VO2). To our

knowledge, only one study (Usagawa et al. 2014) has objectively measured the

metabolic demands of hula, one of the Polynesian culture dances. Usagawa and

colleagues(2014)determinedthemetaboliccostofhulatobe5.7to7.5metabolic

equivalents (METs), which is classified as equivalent tomoderate-to-high intensity

exercise.However,hulaisjustoneofmanypopularPolynesiandances.Themetabolic

costs of all other commonly practiced and performed Polynesian dances are

completelyunknown.Duetothelimitedresearchinthisfield,thepresentstudyaims

atdeterminingthemetabolicdemandsofseveralculturally-specificPolynesiandances

thataremostcommonlypracticedandperformedatthePolynesianCultureCenteron

theislandofOahuinHawaii,USA.

StatementofPurpose

Theprimarypurposeofthisstudyistodetermineandcomparethemetabolic

demands of several culturally-specific Polynesian dances within experienced

Polynesiandancers. The secondarypurpose is to compare theexercise intensityof

eachculturaldancewiththecurrentPAguidelinesformoderate(3-MET)andvigorous

(6-MET)intensityexercises.

SignificanceofStudy

Due to limited research in this field, thepresent studywill provideobjective

4

measures on the metabolic demands of several commonly practiced Polynesian

dancesthatarespecifictosixdifferentPolynesiancultures:Hawaiian,Fijian,Maori,

Samoan,Tahitian,andTongan.Inaddition,theresultsfromthisstudywillbeofvalue

tohealthpractitioners,coachesandhealthinterventionresearcherstoprescribePA

dosage for CVD patients and the general public using Polynesian dance as an

alternativeformofPA.

Hypotheses

ItishypothesizedthattheMETvalueforatleastoneofthePolynesiandances

tobetestedissignificantlydifferentfromtheotherPolynesiandances:

H01:μMET1=μMET2=μMET3=μMET4=μMET5=μMET6=μMETn

HA1:μMET1≠μMET2≠μMET3≠μMET4≠μMET5≠μMET6≠μMETn

WhereμMET1toμMETnarethepopulationmeanMETvaluesforthentypesofPolynesian

dance.

It isalsohypothesizedthatallPolynesiandancestobetestedwillhavemean

METvalues≥3.0METs:

H02:μMETi<3.0METs

HA2:μMETi≥3.0METs

Where:μMETirepresentsthepopulationmeanMETvalueforeachPolynesiandanceto

betested.

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Limitations

One limitation of the present study is that the Polynesian dances tested are

dependent upon the skill and experience of each study volunteer. As currently

designed,thisstudywillrequestthateachsubjectperformeachPolynesiandanceof

interest,buteachsubjectmaynotbeabletoperformallthedanceroutines.Whilean

aprioriattemptwillbemadetorecruitsubjectswhocanperformalltheculturaldance

routines, the success of this plan will be unknown until the study is completed.

Therefore,itispossiblethattherewillbemissingdataforsomedancestobetested.

Delimitations

The scope of inference for this study is delimited to experienced Polynesian

dancersduetonon-randomsampling.

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CHAPTERTWO-REVIEWOFTHELITERATURE

Introduction

NativeHawaiiansandotherPacificIslanders(NHOPI)sufferadisproportionately

higher prevalence of cardiometabolic disorders when compared to the general

populationoftheUnitedStates(Mauetal.2009).Physical inactivityandsedentary

lifestyleinthispopulationisanindependentriskfactorforthehigherprevalenceof

cardiovascular diseases (CVD), obesity, andmetabolic syndrome (Grandinetti et al.

2015).CulturaldancesofPolynesia,suchasthehulafromtheHawaiianculture,could

be adopted as culturally-specific form of physical activity (PA) for general health

promotion(Maskarinecetal.2015b).However,itisnecessarytoprescribethedoseof

PA by exercise intensity, duration and frequency, while the knowledge about the

energyexpenditureofthesePolynesiandancesisverylimited.Currently,onlythehula

hashadenergyexpenditureobjectivelyevaluatedforexerciseprescription(Usagawa

etal.2014),whilenootherPolynesiandanceshavebeenmeasureddirectly.Thelack

of research in the determination ofmetabolic demands for Polynesian dances has

promptedthecurrentstudy.

HealthStatusinNHOPI

NHOPI refer to those of indigenous ancestry on the islands of Polynesia,

Melanesia and Micronesia (Mau et al. 2009). This population consists of Native

7

Hawaiians, Caucasians, Blacks, Latinos, and Asian Americans (mainly Japanese,

Filipinos,ChineseandKoreans).

NHOPIhavebeencategorizedashigh-riskpopulationsthataremostsusceptible

to cardiometabolic disorders of CVD, diabetes, and obesity in the United States

(Usagawa et al. 2014). It is worthwhile mentioning that the mortality rate in this

populationareamongthehighestintheUnitedStates(Johnsonetal.2004). Inthe

NHOPI,CVDistheleadingcauseofmortality,whichaccountsfor55%ofalldeaths.

DiabetesstandsoutasamajorriskfactorofCVDinthispopulation.Itisreportedthat

CVDratesarefour-foldhigherinthosewithdiabetesthanthosewithout(Alulietal.

2010). Hawaiians have also been reported to have a higher incidence of type 2

diabetes (Maskarinec et al. 2015a), which could result from central obesity and

physicalinactivity(Grandinettietal.1999).

AreNHOPIgeneticallymoresusceptibletocardiometabolicdiseases?Mauetal.

(2009) found that CVD risk factors, such as high cholesterol concentration,

hypertension,andelevateddiastolicbloodpressureweresignificantlyrelatedtothe

degreeofHawaiianancestry.Accordingtoageneticstudy(Grandinettietal.2006),

prolongedheart-ratecorrectedQTinterval,whichhasbeenblamedforthecauseof

sudden death and increased mortality, was observed in populations of Filipino,

Japanese andHawaiian ancestry, compared to Caucasian populations. Besides, the

oddsofdiabetesdiagnoseswerereported70%higheramongAsianAmericansthan

whitesinHawaii,afteradjustmentforage,genderandBodyMassIndex(BMI)(Kinget

8

al. 2012). Grandinetti et al. (1998) also found that the prevalence of glucose

intolerancewas significantly higher amongNativeHawaiians thanwhites.And it is

interestingtonotethatfullHawaiianssufferedahigherprevalenceofdiabetesthan

part-Hawaiians(Mauetal.2009),suggestingapossiblegeneticfactor.Furthermore,

theprevalenceforoverweightandobesityinthispopulationhit84%(Duncanetal.

2015),comparedto69%ofnationallevel(Ogdenetal.2014).BMIwashigherinboth

NativeHawaiiansandamongotherethnicmixturesthathadNativeHawaiianancestry

(Grandinettietal.1999).Additionally,increasedBMIandwaisttohipratio(WHR)were

significantlyassociatedwithpercentageHawaiianancestry(Grandinettietal.1999).

Collectively,thisevidencesuggestedthattheremightbesomegeneticlinkbetween

Hawaiianancestryandtheonsetofcardiometabolicdiseasesinthispopulation.

However, unhealthy lifestyles were also reported to be responsible for the

higherprevalenceofcardiometabolicdisordersinthispopulation(Kimetal.2013).A

prospectivestudy(Maskarinecetal.2007)indicatedthatduetoahighfrequencyof

smokingandalcoholuse,NativeHawaiianshadthehighestchronicdiseaseriskscores

comparedtootherethnicgroups.ApproximatelyoneinthreeNativeHawaiianswere

smokers,comparedto15%ofadultsmokersintheUSpopulation(Johnsonetal.2004).

Over 51% of Native Hawaiians reported drinking alcohol, slightly higher than the

averagerateof48.6%inthegeneralpopulationoftheUnitedStates(Johnsonetal.

2004).Althoughgeneticinfluencescouldbeacontributingfactortotheonsetoftype

2diabetes(Mauetal.2009),Steinbrecheretal.(2011)investigatedthepreventable

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proportionoftype2diabetesriskinmultiethnicpopulationofHawaii.Theyfoundthat

beingoverweightandphysicallyinactive,aswellassmokingandhavingahighmeat

consumption,weretheprimaryrisksofdiabetesinallethnicgroups.Indeed,Kimetal.

(2008) found thatNativeHawaiiansandFilipinoshavehigher consumptionof local

ethnicfoods,suchasLaulau,Kaluapig,PoiandPortuguesesausage,Pinacbet,Sinigang

andDinengdeng,andthatthepreferenceofconsumingthesetraditionalfoodswas

positivelyassociatedwithtype2diabetesduetothehighenergydensity.

PA–AStrategyforBetterHealthOutcomes

PhysicalActivityandHealthOutcomes

Physicalactivityisdefinedasanybodilymovementproducedbythecontraction

ofskeletalmusclesthatresultsinasubstantialincreaseincaloricrequirementsover

restingenergyexpenditure (Caspersenet al. 1985). PAplays a fundamental role in

healthmaintenanceandinreducingtherisksofchronicdiseases.

ThatPApromoteshealthandfitnesshasbeenrecognizedforcenturiesandis

nowawidelyacceptedconcept.RegularPAhasshort-termbenefits,suchasincreased

energyexpenditure, increased insulinsecretionand insulinsensitivitypost-exercise,

improvedsleepquality,andlong-termbenefits,includingahealthierheart,improved

fitnesslevel,aswellashavinglesschanceofbeingobeseanddevelopingdiabetesand

otherchronicdiseases(JAMAPatientPage2000).Thereisageneralconsensusinthe

literaturethatregularPAisassociatedwithalowerBMI(Okeyoetal.2009),reduced

10

cardiovascular risk (Hegde and Solomon 2015), decreased cancer risk (Thune and

Furberg2001),aswellasabettercognitivefunction(Domeneetal.2014).Inaddition,

there is a graded dose-response relationship between PA and overall health

(Kesaniemietal.2001).Furthermore,itisbelievedthatlifestyleinterventionismore

effective in preventing diabetes and CVD risks, such as hypertension and

hyperlipidemia,thanpharmaceuticaltherapies(Aasetal.2006).Lastly,bothleisure

timeandoccupationalPAwerereportedtohaveagradeddose-responseassociation

withloweroverallcancerrisk(ThuneandFurberg2001).

Physical inactivity has been amajor concern in the past 50 years as people

adoptedmoresedentarytasksasoneoftheirlifestylechangesinthemodernsociety.

WhileitiswelldocumentedthatlessPAisstronglyassociatedwithanincreasedrisk

of all-cause mortality in apparently healthy individuals (Szostak & Laurant 2011),

sedentarytimeisnowbelievedtobeanindependentriskfactorforchronicdiseases

andmortality(Culletal.2015).Boothetal.(2000)foundthatsedentarylifestylescould

beresponsibleforat leastone-thirdofall-causemortality inU.S.adults.Decreased

dailyPAwasalsoreportedtohaveastrongdose-responserelationshipwithmetabolic

disorders(Kesaniemietal.2001).A6-yearlongitudinalstudy(Menaietal.2015)found

that the time spent in watching television and using a computer had a strong

associationwithincreasedBMIandpercentbodyfat.

PhysicalInactivityinHawaiianPopulations

According to the 2008 Guidelines of Physical Activity (USDHHS 2008), the

11

minimaldoseof150minperweekofmoderateintensity,aerobicactivityperformed

inepisodesofatleast10minutesaregenerallyrecommendedintheadultpopulation

tomaintainbodyweightandpreventweightgain,reducecardiovascularriskfactors,

andtoimprovecardiorespiratoryfitnessandoverallwell-being.

However,itisreportedthat59.1%ofmenand64.1%ofwomenoftheNHOPI

(versus51.6%ofmenand56.7%ofwomenoftheoverallU.S.population)didnotmeet

thefederallyrecommendedlevelsofPA(CentersforDiseaseControlandPrevention

(CDC) 2004; USDHHS 2008). Physical inactivity results in the excessive storage of

caloriesinthebody,whichinturnleadstoahigherprovenanceofobesity,diabetes

andmetabolicsyndrome(Szostak&Laurant2011).Physicalinactivityalsoundermines

one’scardiopulmonaryfitness,withelevatedrestingheartrate(RHR)asanindicative

factor.Grandinettietal.(2015)investigatedamultiethniccohortinHawaii,including

Native Hawaiian, Japanese, Filipino, Caucasian, and mixed ethnic ancestries, and

reportedthatthosewithincreasedRHRandwhowerealsolessphysicallyactivewere

morelikelytodevelopinsulinresistance.ElevatedRHRhasalsobeenidentifiedasan

independentriskfactorforCVDandmortality(RuizOrtizetal.2010).

Since regularPA, especiallymoderate-intensity aerobic exercise, can improve

functionalcapacityandserveasanalternativetreatmentforspecificcardiorespiratory

andmetabolic diseases similar to pharmacological treatments (Faude et al. 2015),

increasingPAshouldresultinbeneficialhealthoutcomesintheNHOPI.

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PolynesianDanceStudy

DancingasaFormofPA

Dancinginvolvesrhythmicmovementsofthebodywithmusic.Itisreportedthat

dancing has a similar effect on health as traditional aerobic exercise training (i.e.,

treadmill,stationarybicycle,andstepmachine)(Belardinellietal.2008)andtherefore

canberegardedasanalternativeculturally-specificPA.

Dance therapy, as first introduced to patients participating in cardiac

rehabilitation (CR) programs, uses dance movements to support the physical and

emotionalwell-beingofpatientsandhasbeenprovento improveexercisecapacity

andqualityoflife(Belardinellietal.2008).Differentformsofdance,suchasWaltz,

Latin,andaerobicdancetraining,havebeenusedasinterventionstrategiesinboth

CVDpatientsandhealthypopulations.

Belardinellietal.(2008)examinedthebenefitsandsafetyofWaltzdancingin

patientswith chronic heart failure. They compared aWaltz dance protocolwith a

supervised aerobic exercise training and a control group. The results of the study

showed that Waltz dancing was safe and that both functional capacity and

endothelium-dependentdilation improvedsignificantly inbothtraininggroups(i.e.,

Waltzdancingandaerobictraining),whiletherewasalsonodifferencebetweenthe

two groups. Another randomized study (Maruf et al. 2014) identified that aerobic

dancetrainingfor12weekshelpedreduceLDL-Candtriglyceridelevels,andlowered

systolicanddiastolicbloodpressureinhypertensivepatients.Domeneandhisgroup

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(2014) investigated the effects of Latin partnered social dance using an Exercise

Benefits/BarriersScale(EBBS),andreportedapositivepsychologicaloutlookwithLatin

dance participation. Collectively, these studies demonstrate that dance, as an

alternativeformofaerobicexercise,hasbeneficialeffectsoncardiorespiratoryfitness,

metabolicprofiles,andpsychologicalhealthinbothCVDpatientsandhealthyadults.

Dance therapy has been introduced to a CR program in Hawaii. The Hula

EmpoweringLifestyleAdaptationStudy(theHELAStudy)(Looketal.2012)isaproject

fundedbytheNationalInstituteonMinorityHealthandHealthDisparities.Theproject

aimed todevelopacommunity-basedphysicalactivityCRprogram integratinghula

dancing,anindigenousculturalpractice,asphysicalactivity(PA).Thispracticenotonly

improved functional capacity of participants, but also enhanced their sociocultural

bondsanddeepenedtheirappreciationofHawaiianculture(Maskarinecetal.2015b).

Therefore, it is reasonable to predict that these traditional culture dances can be

regarded as an effective exercise modality for people of all ages in the NHOPI

populationasaformofgeneralhealthpromotion.

ThePolynesianDances

Polynesian dances, such as the hula,were developed throughout the Pacific

Islandswhere thePolynesiansoriginally settled.EachPolynesianculture tended to

haveitsownculturally-specificdances,themostwell-knownofwhicharetaughtin

schoolsandgroupexerciseclasses,practicedbymenandwomenofallages,andare

popularwithallethnicities(Looketal.2012).SomeofthemostpopularPolynesian

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dancesincludethosefromtheHawaiian(indigenouspeoplesoftheHawaiianIslands),

Fijian (indigenous peoples of the Fiji Islands), Maori (indigenous peoples of New

Zealand),Samoan(indigenouspeoplesoftheSamoanIslands),Tahitian(indigenous

peoples of Tahiti), and Tongan (indigenous peoples of The Kingdom of Tonga, a

collection of 177 islands) cultures.Hula, for instance, is aHawaiian-specific dance,

whichcanbeeitherHulaAuana,wherethedanceisaccompaniedbychantandstring

instruments,ortheHulaKahiko,wherethedanceisaccompaniedbychantandancient

drums.Meke,atraditionalstyleofdanceinFiji,isoftenreferredtoasaspiritdance

whichinvolvesquickupperandlowerbodymovementsandjumping.Whilemostof

thePolynesianculturaldances involvebothmenandwomendancingtogether, the

Maori have a clear gender differenceon choreography. For instance, the haka is a

Maori battle dance, traditionally only performedbymenwho standwith hips and

kneesinaslightlyflexedposition.Thisdanceincludesfootmovementsthatresemble

stompingwithhandandarmmovementsthatslaptheuppertorsoandlegs.Dancers

oftenperformthisdanceinaheightenedarousalstateinferringintimidation.Thepoi

balldance,however,ismorecommonforMaoriwomen,wherepoiballsareattached

to one or both ends of a rope and are swung around in different movements

throughoutthedance.TheSamoanculturehastwomajorculturally-specificdances:

Taupo,whichisoftenreferredtoastheprincessdance,andSasa,whichincludesupper

body movements with clapping and slapping mimicking the beat of a drum. The

TahitianOridanceismadeupofquickbodilymovementsfeaturedbywomen’squick

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hip movements (Tamure) and men’s quick knee movements (Pa oti). The Tongan

culturehasthreemajortypesofdance:Nafa(drummer),Taualunga(woman’sgraceful

dance) andMa’ulu’ulu. TheMa’ulu’ulu, usually performedwhile sitting, has upper

bodymovementscharacterizedbyarmandhandmovementsalongwith torsoand

headmovements.AdvancedPolynesiandanceroutinesrequirecomplexmovements,

advanced technique and aesthetics, as well as a high physiological capacity

(Koutedakis&Jamurtas2004).

Nowadays,manyoftheseculturally-specificdancesaretaughtinschoolsorto

exercisegroupsandarecommonlypracticedbymenandwomenofallages,aswellas

withallethnicities(Looketal.2012).Asaculturally-relatedPA,Polynesiandancecould

bemoreattractiveandmoreadherent to theseat-riskpopulations than traditional

aerobicexercise(Maskarinecetal.2015b).

MetabolicDemandsofPolynesianDance

Althoughthemetabolicdemandsofacomprehensivevarietyofactivitieshave

beenlistedontheCompendiumofPhysicalActivitiesbyAinsworthetal.(2011),the

numberofculturally-specificdanceactivitiesisverylimited.Toourknowledge,there

isonlyonestudy(Usagawaetal.2014)thathasobjectivelydeterminedtheenergy

expenditure of hula, one of the Polynesian culture dances. They determined the

metabolic equivalent (MET) value via direct measurements of oxygen uptake and

reported that the hula dance expends 5.7 to 7.5METs,which can be classified as

equivalenttomoderate-to-highintensityphysicalactivity(MVPA).

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WhilehulaisprobablyoneofthemostwidelyrecognizedPolynesiandances,it

isnottheonlyPolynesiandancethat iscommonlypracticedandperformed.Atthe

Polynesian Culture Center on the island of Oahu (Hawaii), some other Polynesian

culturaldancesarefrequentlyperformedtothepublicatthe“Ha:BreathofLife”show,

whichincludesHawaiian,Fijian,Maori,Samoan,Tahitian,andTonganculturedances.

Sofar,thephysiologicaldemandsofthesedancesarecompletelyunknown.

Energyexpenditureofdancevarieswiththeintensityofbodymovements,the

dominanceoftheupperand/orlowerbodylimbs,theskilllevelofthedancers,aswell

as the fitness level of the dancers. According to previous literature,most types of

dance requireat leastamoderate intensity (3.0METs).One study (Massiddaetal.

2011) reported the competitive Latin American dance to be MVPA, where Latin

partneredsocialdancewasdeterminedtorequire5.1and7.3METswhenperformed

moderatelyorvigorously,respectively(Domeneetal.2014).Salsadancingrangesfrom

3.9 to 5.5 METs (Emerenziani et al. 2013), while Waltz dancing was 4.1 METs

(Belardinelli et al. 2008). Finally, recreational ballroom dance (Mixture of Waltz,

Foxtrot,Swing,andCha-Cha)costsanaverageof6.1METsforatotaltestingduration

of30mins(Lankfordetal.2014).

AssumingthattheexerciseintensityofPolynesiandancesisatleastatmoderate

level, thenpracticing these culturally-specificdanceswould contribute favorably to

meeting the U.S. National PA Guidelines (≥150 mins/week of moderate intensity,

aerobicactivity). Therefore, itwouldbeuseful toexamine theexercise intensityof

17

eachtypeofthecommonlypracticedPolynesiandances,andeventuallyprovidemore

information for exercise prescription to the at-risk populations in Hawaii and

throughoutPolynesia.

Summary

AlthoughtheCompendiumofPhysicalActivitiesliststheenergyexpenditurefor

awidevarietyofPAs,thereareaverylimitednumberofculturally-basedactivities.

ManyofthereportedMETvalueswerebaseduponself-reporteddataandnotdirect

measuresofoxygenuptake.Thus,themetabolicdemandsofmostPolynesiandances

areunknown.Thecurrentstudyisdesignedtofilltheobviousgapintheliteratureby

objectivelymeasuringtheexerciseintensityfortheseculturaldances,whichcouldbe

usedthroughmoreappropriateexerciseprescriptionsfortheat-riskNHOPIpopulation.

18

CHAPTERTHREE-THESISMANUSCRIPT

POLYNESIANDANCEASAFORMOFPHYSICALACTIVITY:EXERCISEINTENSITY,ENERGY

EXPENDITURE,ANDENERGYSYSTEMCONTRIBUTIONS

Introduction

NativeHawaiiansandotherPacificIslanders(NHOPI)sufferadisproportionately

high prevalence of cardio-metabolic disorders when compared with the general

population of the United States (U.S.) (Mau et al. 2009). Physical inactivity and

sedentary lifestyle are believed to be independent risk factors contributing to the

higherprevalenceofcardiovasculardiseases(CVD),obesity,andmetabolicsyndrome

(Grandinettietal.2015)intheNHOPIpopulation.Itisreported,forexample,that59.0%

ofmenand64.2%ofwomenoftheNHOPIdidnotmeetthefederallyrecommended

levelsofPA(USDHHS2008;CDC2004).However,thereisageneralconsensusinthe

literature that regularmoderate-to-vigorous intensity physical activity (MVPA) that

satisfiestheU.S.FederalPAGuidelines isassociatedwitha lowerBMI(Okeyoetal.

2009), reduced cardiovascular risks (Hegde and Solomon 2015), improved glucose

tolerance (Slentzetal.2016),aswellasabettercognitive function (Domeneetal.

2014). Thus, by encouraging regular MVPA in this population, the NHOPI could

improveboth cardiovascular andmetabolic fitness levels, aswell asdecrease their

risksformanychronicdiseases.Assuch,MVPAisbeingusedasanequivalentmethod

19

oftherapyforcardiometabolicdiseasesthathassimilarbenefitsaspharmacological

treatments(Faudeetal.2015).

Polynesian dances, such as the well-known Hawaiian hula, refer to a large

collectionofdancesthatareeachspecifictothePolynesiancultures(e.g.,Hawaiian,

Fijian,Maori,Samoan,Tahitian,Tongan,etc.)andPacificislandsonwhichtheywere

developed.SomeofthemostpopularPolynesiandancesaretaughtinschoolsandare

practiced bymen andwomen of all ages and ethnicities (Look et al. 2012). Thus,

PolynesiandancingcouldbeconsideredaculturallyspecifictypeofPAfortheat-risk

NHOPIpopulation.Waltz, aerobicdance, and Latinpartnered social dancehaveall

beenstudiedas intervention tools for increasingMVPA invariouspopulations,and

werefoundtoimprovethefunctionalcapacityandendothelium-dependentdilation

(Belardinellietal.2008),bloodlipidprofileandbloodpressure(Marufetal.2014),as

wellaspsychologicaloutlookfortheparticipants(Domeneetal.2014).Thus,dancing

is considered to be a form of PA that can induce similar physiological effects as

traditional aerobic exercise training (Belardinelli et al. 2008). As a matter of fact,

“dancetherapy”hasbeenintroducedtopatientswithcardiovascularandmetabolic

diseases and has become popular in recent years (Faude et al. 2015). The Hula

EmpoweringLifestyleAdaptations(HELA)study, forexample,successfullyusedhula

dancing, a culturally-relevantdance tonativeHawaiians, as ameans for increasing

MVPAandimprovehealthbenefitsincardiacrehabilitationprogramparticipants(Look

20

et al. 2012). Thus, dancingmay be an effective form of PA for promoting healthy

outcomesinpopulationsthatarereceptivetodancingactivities.

Unfortunately,thereisrelativelylittleobjectiveinformationavailableaboutthe

cardiometabolic consequences of regular dancing, whichmakes the application of

basicexerciseprescriptionprinciples(i.e.,determiningthe“dose”ofexercise)difficult

without knowing the metabolic demands (or exercise intensity, as commonly

expressed with metabolic equivalents (MET) or energy expenditure (EE)) for each

Polynesiandance. Forexample, thereare very fewMETvalues for culturally-based

activitieslistedintheCompendiumofPhysicalActivities(Ainsworthetal.2011),and

noneofthesevalueswerebasedupondirectmeasuresofoxygenuptake(VO2).Sofar,

thehulaistheonlyPolynesiandancetohavedirectMETintensitymeasuresreported

in the literature (5.7 and7.6METs for lowandhigh intensitydances, respectively)

(Usagawa et al. 2014). To our knowledge, the MET intensity for other Polynesian

danceshasneverbeenassessedobjectively(e.g.,usingindirectcalorimetry).Thus,the

lackofMETintensityevaluationsformostPolynesiandancesmaybeadeterrentto

theiruseasMVPAinterventiontoolsfortheNHOPIandotherhighriskpopulations.

WhiletheaerobicdemandsforPolynesiandancingareweaklyunderstood,the

anaerobic energy demands of Polynesian dancing are completely undocumented.

Accordingtotheliterature,thetraditionalstrategyfordeterminingPAMETintensities

istoaveragethelastseveralminutesofdirectly-measuredoxygenconsumptionfora

steady-state bout lasting 3-10 mins. While this strategy provides the information

21

needed to assess aerobic exercise intensity, no information is provided about

anaerobicenergyexpenditureoranaerobicwork intensity.Blood lactatemeasures,

however, takenduring thesamesteady-statebouthavebeenused toestimate the

anaerobic EE for both low and high intensity activities (e.g., weight lifting, rock

climbing,andrunning)(Scott2006;Bertuzzietal.2007;Duffieldetal.2005).Given

thatmanyPolynesiandancesarenotpurelysteady-stateactivities,itmaybeusefulfor

healthcare professionals to know both the aerobic and anaerobic contributions to

whole-body EE (Scott 2005). However, to our knowledge, there have been no

publishedevaluationsofboththeaerobicandanaerobicEEcontributionsforanytype

ofdancing.

Thus, the primary purpose of this study was to measure and compare the

metabolic demands (both aerobic and anaerobic) for several popular forms of

Polynesiandanceascommonlypracticedandperformedbyaconveniencesampleof

experienced Polynesian dancers. When expressed as METs, these results can be

compared to the 2008 U.S. Physical Activity Guidelines (USDHHS) to determine

whether dance intensity exceeds the commonly-used intensity thresholds for

moderate(3.0METs≤“moderate”<6.0METs)orvigorousintensity(≥6METs)PA.We

hypothesized that all of the Polynesian dances tested would exceed the 3-MET

threshold, while some of the dances (but not all) would also exceed the 6-MET

threshold. Since some Polynesian dances are choreographed by gender (withmen

tendingtohavemoreenergeticappearingroutines),wealsohypothesizedthatthe

22

MET intensity for themen’sdanceswouldbe significantlyhigher than that for the

women’s dances. Finally, given the complete lack of information regarding the

anaerobiccontributiontototalEEofdancing,wealsosoughttodescribehowboth

aerobicandanaerobicenergysystemscontributetototalEEofPolynesiandancing.

Methodology

Participants

Participantsofthisstudywereexperienceddancersworkingfull-timeorpart-

time (within thepast12months)performing the“Hā:BreathofLife”showfor the

Polynesian Culture Center on the island of Oahu (Hawaii, USA). Inclusion criteria

included:1)Menandwomenaged18-64years;2)NativeHawaiiansandotherethnic

groupsinHawaiicommonlyidentifiedasNHOPI;3)Thosewhocouldperformatleast

oneofthePolynesiandancesofinteresttothisstudy.Exclusioncriteriaincluded:1)

Pregnantwomen;2)Thosewhoself-identifiedashavinguncontrolledchronicdiseases

ororthopedicconditionsthatcouldadverselyaffectcardiometabolicmeasurements

ortheparticipant’sabilitytodance;3)Thosewhohadcontraindicationstoperforming

MVPA. The study protocolwas approved by the BrighamYoungUniversity (BYU) –

Hawaii (Laie, Oahu) Institutional Review Board. Participants read and signed the

informed consent form that fully described the risks and benefits associated with

participatinginthisstudy.

23

Procedures

Participants who satisfied both inclusion and exclusion criteria were further

screenedwiththePhysicalActivityReadinessQuestionnaire(PAR-Q)tohelpidentify

andexcludethosewithcontraindicationstoMVPA.Demographicandanthropometric

data, suchasage,gender,bodyheightandmass, self-reportedethnicity,aswellas

totalyearsofPolynesiandanceexperience,werecollectedatthebeginningofeach

test session. Prior to their visit, participants were instructed to wear appropriate

clothing and footwear for dancing, to be rested and well hydrated, and to avoid

caffeineintakeatleast2–3hourspriortotesting.Bodyheightwasmeasuredbarefoot

usingaportablestadiometer(InvictaModel#IP0955;InvictaPlasticsLimited,Leicester,

England)tothenearest0.1cm,andbodymasswasobtainedtothenearest0.1kg

usingadigitalscale(Tanitamodel#BF-683W;TanitaCorporationTokyoJapan).These

dataweresubsequentlyusedtocalculatebodymassindex(BMI,kg/m2)asbodymass

(kg)dividedbybodyheight(m)squared.

PolynesianDancesTested

ThePolynesiandancestestedbythisstudywerethosecommonlypracticedand

performedbyexperienceddancersinthe“Hā:BreathofLife”showatthePolynesian

CultureCenter(Laie,Oahu,Hawaii).Thethemeofthisshowwastohighlightspecific

Polynesianculturesbycombiningtraditionalstoriesabouteachculture’soriginwith

traditionalmusicanddancing.Assuch,thisshowfocusedonsixpopularPolynesian

cultures and their respective dances: 1) The Hawaiian hula (both traditional and

24

contemporaryforms)fromtheislandsofHawaii;2)TraditionalFijiandancefromthe

islandsofFiji;3)Maoridances(thehakaforbothmenandwomen,aswellaspoiballs

forwomen)fromNewZealand;4)Samoansasa(menandwomen)andslap(menonly)

dancesfromtheislandofSamoaandAmericanSamoa;5)TraditionalTahitiandance

fromtheislandsofTahiti;6)TraditionalTongandancefromtheislandsofTonga.

TheHawaiianhula, tellsastorywithacombinationofsmoothlycoordinated

hand,head,andlowerbodymotionswhileinastandingposition.Thetraditionalhula

isperformedtoachantandtraditionalHawaiianinstruments(suchasdrums)andis

characteristic of the hula style prior to Westernization of the islands. The

contemporaryhula,incontrast,isperformedtomusicwithmoderninstruments(such

as guitar). TraditionalFijian dance reflects the spiritworld, and is characterizedby

quickupperandlowerbodymovementswithsomejumping.TheMaorihakadance

(forbothmenandwomen)isatraditionalancestralwar(battle)danceduringwhich

dancers perform in a heightened arousal state inferring intimidation. The men

includedmoresquattingmovements,whilethewomenperformedasupportinghaka

witharmmovements,withoutthelargelowerbodysquattingtypemovements.The

Maoripoiballsdance(forwomen),usingpoiballs (twopaddedballsattachedbya

string)asaperformanceequipment,integratesstory-telling,singinganddancing.The

Samoanculturehastwomainformsofdance:thesasa(forbothmenandwomen)and

slap (only formen), both ofwhich depict everyday life activities. Sasa is generally

performedbyalargegroupofpeople,usuallyinaseatedposition,whilesomeparts

25

ofthedancerequirestandingup.Slapistraditionallyperformedbymenandrequires

strengthandstability,duringwhichdancersforcefullyslaptheirhandsontheirown

bodies,insyncwitheachother,withhandsclappingandfeetstampingforwardsand

backwards.TraditionalTahitiandanceisperformedbymenandwomentogetheror

separately, and is characterized by a rapid hip-shaking motion to percussion

accompaniment(i.e.,drums)atafastrhythm.ThetraditionalTongandancefeatures

story-telling through lots of hand and feet gestures. The graceful movements of

womendancerscontrastwiththegreatvigorofthemendancers.Thetempoofallthe

dancemusic used in the “Hā: Breath of Life” show is approximately 130 beat per

minute(bpm),withtheexceptionofthecontemporaryHawaiianhula(80bpm)and

theSamoanslap(180bpm).

DanceTestingProtocol

Participants were tested either individually (i.e., they were the only dancer

tested)oringroupsoftwoorthreewithalldancersbeingtestedsimultaneously.The

group limit of three dancers was set to match the amount of testing equipment

available.Alldancetestingwasperformedinalargeballroomwithhardwoodflooring

on the campus of BYU-Hawaii. Participants, wearing all of the measurement

equipment,beganthetestingwith5minutesofquietsittingforthedeterminationof

sittingrestingmetabolicrate(RMRorVO2REST)andrestingbloodlactateconcentration

([LAREST]). Next, participants were given another 5minutes to warm-up using self-

directedactivities(i.e.,walking, flexibilityexercises,dancing,etc.).Next,asthefirst

26

piece of dance music began, the participants started the first dance routine and

continued for4.5–5.0minutesbeforeanother5minutesofquietsittingrest.The

individualmusicpieceslastedfrom1.5–3.5minuteseach,soeachdancetestingbout

requiredthemusicpiecetobelooped2–3timestoprovidecontinuousmusicfor4.5

–5.0minutes.EventhoughPolynesiandancingdoesnotusuallylastlongerthanthe

longestmusicpiece(i.e.,3.5minutes),thedurationofdancetesting(4.5–5.0minutes)

was considered necessary to provide the best opportunity for steady-state

cardiorespiratoryandbloodlactatemeasures.Inaddition,whendancingasagroupof

2or3simultaneously,thedancersperformedthesamechoreography.Finally,while

mostoftheparticipantsdancedtothe“Hā:BreathofLife”showmusic,afewdancers

brought theirownmusic fordancingwhichwas characteristicof the samecultural

dancestyleandtempoas thatused in theshow.This testingprocess (i.e.,dance5

minutesandrestfor5minutes)wasthenrepeatedforasmanyoftheculturaldances

thattheparticipantscouldperformwithoutself-reportingunduefatigue.Theorder

for performing the dance types was randomly assigned prior to the start of each

testingsession.

MeasurementofCardiometabolicDemands

Thetestingwasconductedunderroomtemperaturebetweenand20–21°C,

relativehumidityof57–71%,andatanaltitudewithin10mabovesealevel.Each

participantwasfittedwithaheartratemonitorcheststrap(PolarElectroInc.,NY,USA)

and a small backpack that carried a portable indirect calorimetry metabolic

27

measurementsystem(OxyconMobile®;VIASYS,SanDiego,CA,USA).Themetabolic

systemwascalibratedpriortoeachtestaccordingtothemanufacturer’sinstructions.

During all testing, participants wore a facemask affixed with an adjustable fabric

headpiecewhichcontainedtheflowtachometerandexpiredgassamplingtubesfor

themetabolicsystem.Heartrate(HR)dataweretransmittedtothemetabolicsystem,

while the real-time respiratory gas measures for oxygen consumption and carbon

dioxideproduction(VCO2)wererecordedcontinuously(breath-by-breath)throughout

theparticipant’srestinganddancetestingwithoutrecalibration.Thebreath-by-breath

samplingby themetabolic systemwas thenusedtosummarizeall cardiometabolic

dataatone-minute sample intervals for subsequentanalyses.The totalmassofall

testingequipmentcarriedbyparticipantswhendancingwas1.5kg.

MeasurementofBloodLactate

Fingertipbloodsamplesweredrawnforlactateanalysis(LactatePlusTM,Nova

BiomedicalUK,Chesire,UK)rightafterRMRmeasurement(whilestillsitting),aswell

as immediately followingeachdanceroutinetocharacterizetheanaerobicexercise

intensity.

DataProcessingandCalculations

Aerobic EECalculations. TheMET (dimensionless)wasused to represent the

aerobic exercise intensity while aerobic activity energy expenditure (aerobic AEE;

kcals·min-1)was calculated to represent thenet aerobic energyproduced from the

28

oxidativesystem.Todeterminethesevariables(METandaerobicAEE),the1-minute

sampleaverageddatafromtheportablemetabolicsystemwereaveragedoverthelast

2minutesforeachdancebout,includingabsoluteVO2(mL·min-1),VCO2(mL·min-1),HR

(beat·min-1),andrespiratoryexchangeratio(RER).First,relativeVO2wascalculatedas:

relative VO2 (mL·kg-1·min-1) = absolute VO2 (mL·min-1)/mass (kg), wheremass was

eithertheparticipant’sbodymass(forRMRmeasurement)orthesumofbodymass

andthe1.5kgequipmentmass(fordancetesting).RelativeVO2wasthentransformed

toMETas:MET=relativeVO2/3.5.AerobicAEEfordancingwascalculatedas:Aerobic

EE(kcals·min-1)=[(EEfordance)–(EEforRMR)],wherebothEEvalueswerecalculated

usingWeir’sequation,EE (kcal·min-1)=3.9xVO2 (mL·min-1)+1.1xVCO2 (mL·min-1)

(Weir1949).

Anaerobic EE Calculations. Anaerobic AEE, or the net anaerobic energy

produced from the glycolytic system,was estimated by the accumulation of blood

lactateconcentration([LA])aboverestingvalues(i.e.,[LAREST]),where1.0mmol·L-1was

assumedtobeequivalenttoarelativeVO2of3.0mLO2·kg-1·min-1(diPrampero1981).

ThisVO2equivalentwasthentransformedintoanaerobicAEE,withaunitofkcals·min-

1,usingacaloricequivalentof20.9kJ(5kcals)perliterofO2(Bertuzzietal.2013).If

thisVO2equivalentwasnegative(i.e.,[LAREST]>[LA]),thentheanaerobicAEEduring

dancewasconsideredtobe0kcals·min-1.Itwasalsoassumedthatthecontributionof

alacticmetabolismduringtheseactivitieswasnegligiblebecausetheATP-PCrsystem

29

ispredominantlyusedduringhigh-intensity(3–5timesthepoweroutputthatelicits

VO2MAX),short-duration(10–15seconds)exercises(Bertuzzietal.2013).

TotalEECalculations.TotalAEEwasthencalculatedasthesumofbothaerobic

AEE (from measured VO2) and anaerobic AEE (from [LA]) contributions. The

contributionofbothaerobicandanaerobicmetabolismsforeachtypeofdancewas

expressedinbothabsolute(kcals·min-1)andrelativeunits(%oftotalAEE).

StatisticalAnalyses

Intraclasscorrelations(ICC)forreliabilitywerecomputedbetweenthelasttwo

minutesoftherawcardiometabolicmeasures:VO2,CO2,andHR(Baumgartnerand

Jackson1995).Descriptivestatisticswerepresentedasmean±SDunlessotherwise

specified.Aone-wayANOVAwithTukey’sHSDpost-hocanalysiswasusedtoevaluate

thedifferencesinMETvaluesacrossdances,whileonesamplet-testswereusedto

comparethemeanMETvaluesforeachtypeofdancetothe3-METand6-METMVPA

thresholds.GenderdifferencesinaerobicandanaerobicEE,aswellastheirrespective

contributionstototalEE,wereexaminedusingindependentt-tests.Allstatisticaltests

wereevaluatedforsignificanceatthe0.05alphalevel,whileaBonferronicorrection

wasusedtocorrectthe0.05alphaforgroupsofsimilartests.Assuch,thet-testsfor

gendercomparisonshadanadjustedalphaof0.008(0.05/6tests),whilethealpha

level was adjusted to 0.006 (0.05 / 8 tests) for the 3-MET and 6-MET threshold

comparisons. All statistical analyses were conducted using SPSS 13.0 for windows

30

(SPSSInc.,Chicago,USA).

Results

CharacteristicsofParticipants

Thedemographicandanthropometricstatisticsforthe13menand17women

participantsarelistedinTable1,suchasage(Mean±SD;22.8±3.1yrs),bodymass

index (BMI; 27.6 ± 5.5 kg·m-2), and Polynesian dance experience (6.6 ± 7.3 yrs).

According to BMI classification standards for adults (American Colleage of Sports

Medicine 2014), the men were represented within all BMI categories from

underweight to obese while the women were classified within normal weight,

overweight,andobesecategories(seeTable1).Inaddition,themeanBMIvaluesfor

menwassignificantlyhigherthanthoseforwomen(P=0.018).Therewerenogender

differencesinrestingHR(HRREST)orVO2REST,butwomenhadsignificantlylower[LAREST]

(1.0±0.4vs.1.5±0.5mmol·L-1;P=0.011),andself-reportedmorePolynesiandance

experiencethanmen(8.9±7.9vs.3.5±5.4yrs;P=0.043).Theself-reportedethnicity

fortheparticipantswasverydiversewith16participantsreportingacombinationof1

–3specificPolynesianethnicities(i.e.,Hawaiian,Fijian,Maori,Samoan,Tahitian,and

Tongan), five others reporting either Asian (n = 2) or Polynesian (n = 3), and the

remainderreportingacombinationof≥1Polynesianwith≥1non-Polynesianethnicity

(White/Caucasian,German,Japanese,orSwedish).

31

Table1.DescriptivestatisticsforPolynesiandancestudyparticipants.

Allsubjects(n=30)

Men(n=13)

Women(n=17)

Age(years) 22.8±3.1 24.1±2.9 21.8±2.9Bodyheight(cm) 168.5±9.7 175.1±9.6 163.5±6.4Bodymass(kg) 79.1±20.6 93.0±23.4 68.4±9.1BMI(kg·m-2) BMIClassificationsa 27.6±5.5 30.2±6.7 25.6±3.3

Underweight 1 1 0 Normal 9 3 6 Overweight 13 3 10 Obese 7 6 1HRREST(beat·min-1) 77.6±12.4 75.2±16.6 79.0±9.5VO2REST(mL·kg-1·min-1) 3.9±1.0 3.9±1.0 4.0±1.1LAREST(mmol·min-1) 1.2±0.5 1.5±0.5 1.0±0.4Danceexperience(years) 6.6±7.3 3.5±5.4 8.9±7.9Allvaluesexpressedasmean±SDunlessotherwisespecified.BMI:bodymassindex.TheparticipantwasconsideredunderweightwhenBMI<20.0;normalweightwhen20≤BMI<25;overweightwhen25≤BMI<30;andobesewhenBMI≥30.HRREST:restingheartrate;VO2REST:restingoxygenuptake;LAREST:restingbloodlactateconcentrationaBMIclassificationareindicatedasthenumberofparticipants

CardiorespiratoryResponsestoPolynesianDancing

Prior to summarizing the cardiometabolic data, the last twominutesof data

were evaluated for intraclass reliability. First, repeatedmeasures ANOVA found no

significantdifferencesbetweenthelasttwominutesofcardiometabolicdata(P=0.17

–0.95).Additionally,theICCcalculationswereconsistentlyhighinmagnitudewithall

values>0.90.GiventhelackofsignificantdifferencesandhighICCvalues,thelasttwo

minutes of cardiometabolic were averaged for all subsequent analyses. Table 2

summarizes the cardiorespiratory and blood lactate responses for each of the

Polynesiandancesevaluated.ApreliminaryanalysisfoundthatmeanMETvaluesfor

32

thetraditionalhula(5.8±1.9;n=6)andcontemporaryhula(6.7±2.6;n=19)were

statisticallysimilar(P=0.436),sothesedatawerepooledandreferredtoas“hula”for

allsubsequentanalyses.Giventhevariedsamplessizesacrossdances(n=3forpoi

ballston=25forhula),theunequalvariances(SD=1.0to3.1METs),aswellasthe

slightly skeweddistributions for somesamples, the sampleswere transformedand

analyzedwiththeplannedOne-wayANOVA.TheANOVAresultsforthetransformed,

however,didnotdifferfromusinguntransformeddata.Thus,theresultsoftheANOVA

withuntransformeddataarereported.TheANOVAcomparingmeanMETacrossthe

danceswassignificant(P=0.001),withonlyMaoripoiballs(lowestmeanMETat3.7)

andSamoanslap(highestmeanMETat9.6)beingstatisticallydifferent.Asshownin

Table 2, percentHRMAX ranged between 64.2% (Tongan) and 79.5% (Tahitian); RER

ranged from 0.81 (Maori poi balls) to 0.95 (Tahitian); and blood lactate from 1.8

mmol·L-1(Maorihaka)to5.2mmol·L-1(Samoanslap).Interestingly,Tahitianhadboth

thehighestpercentHRMAX(79.5%),andthehighestRERvalue(0.95),andamoderately

high[LA] (3.8mmol·L-1),whileSamoanslaphadthehighest [LA] (5.2mmol·L-1)but

neitherthehighestpercentHRMAX(76.7%)northehighestRER(0.93).ThemeanMET

valuesforalldancestested,butMaoripoiballsdance(P=0.168),weresignificantly

greaterthan3.0METs(P=0.003forMaorihaka;P<0.001forHawaiianhula,Samoan

sasaandslap,Tahitian,Tongan,andFijian).ThemeanMETvaluesforSamoansasa,

SamoanslapandTahitianwerealsosignificantlygreaterthan6.0METs(P=0.037,P=

0.001andP<0.001,respectively).

33

Table2.CardiorespiratoryresponsesandbloodlactateconcentrationforeachofeightPolynesiandances.

Dance(n)VO2

(mL·kg-1·min-1) MET HR(beat·min-1) PercentHRMAX(%) RERLA

(mmol·L-1)

Hawaiianhula(25) 22.7±8.4 6.5±2.4*† 138.1±20.3 69.7±10.3 0.82±0.07 2.2±1.9

Fijian(15) 24.5±9.3 7.0±2.6*† 140.7±12.9 71.3±7.4 0.84±0.06 2.4±1.2

Maorihaka(13) 20.8±10.9 5.9±3.1*† 127.1±15.1 64.6±8.2 0.82±0.09 1.8±1.0

Maoripoiballs(3) 13.0±3.7 3.7±1.0 130.4±29.9 65.7±15.2 0.81±0.05 2.7±2.9

Samoansasa(14) 23.1±4.1 6.6±1.2*†‡ 145.6±14.2 73.1±6.7 0.87±0.07 3.0±1.6

Samoanslap(6) 33.6±5.1 9.6±1.5†‡ 150.5±16.5 76.7±8.1 0.93±0.05 5.2±2.0

Tahitian(17) 28.9±6.4 8.3±1.8†‡ 156.9±23.0 79.5±11.3 0.95±0.07 3.8±2.5

Tongan(16) 20.9±8.1 6.0±2.3*† 127.4±23.8 64.2±12.2 0.88±0.06 2.1±1.3

Allvaluesexpressedasmean±SDunlessotherwisespecified.n:samplesize;VO2:oxygenuptake;MET:metabolicequivalent;HR:heartrate;PercentHRMAX:Percentofage-predictedmaximalHR,calculatedasPercentHRMAX=(HR/age-predictedmaximalHR)x100;RER:respiratoryexchangeratio;LA:bloodlactate*Meanvalueformenwassignificantlyhigherthanthatforwomen†significantly≥3METs‡significantly≥6METs

34

GiventhatfiveoftheeightPolynesiandances(i.e.,allbutTahitian,Samoanslap,

andMaoripoiballs)includedgender-specificdancechoreographywithidenticalmusic,

itwasofinteresttocompareMETvaluesbygender.However,splittingtheMETdata

inTable2bygendercreatedsomeextremedifferences insamplesizeandunequal

variances.Thus, inadditiontotheplannedt-tests,theSatterthwaiteApproximation

(Satterthwaite 1946) was used which is a method for handling two-sample

comparisonswith different sample sizes and (or) unequal variances. The statistical

results for this technique,however,were identical to theoriginally-planned t-tests.

Thus,theresultsofthet-testsarereported.WhencomparingtheMETvaluesbetween

menandwomenusingindependentt-tests,themen’sMETvaluesforHawaiianhula,

Samoansasa,Tongan,Fijian,andMaorihakawereallsignificantlygreater(P<0.001;

seeFigure1)thanthecorrespondingvaluesforwomen,whiletheTahitianMETvalues

weresimilar(P=0.526)betweengenders(seeFigure1).

AerobicandAnaerobicContributionstoTotalAEE

CalculationresultsforbothaerobicandanaerobicAEEforbothmenandwomen

are shown in Figure 2(a), while the respective contributions of the aerobic and

anaerobicAEEtothetotalAEEareshowninFigure2(b).AccordingtoFigure2,aerobic

AEEwasthepredominantenergysourceforallPolynesiandancestested.Theaverage

contributionofaerobicAEEtototalAEEwas83.4±14.4%witharangeof74.2±10.9%

(Samoanslap)to88.7±13.7%(Hawaiianhula).Incontrast,themeancontributionof

anaerobicAEEwas16.6±14.4%,witharangeof11.3±13.7%(Hawaiianhula)to25.8

35

±10.9%(Samoanslap).ThesamecalculationsforaerobicandanaerobicAEE,aswell

as the contribution of these AEE sources relative to total AEE, are summarized by

gender in Table 3. The aerobic AEE formenwas significantly higher than that for

womendancingtheHawaiianhula,Samoansasa,Fijian,Maorihaka,andTongan(P=

0.006forHawaiianhula;P<0.001fortheotherfourtypesofdance).Foranaerobic

AEE,incontrast,therewerenosignificantdifferencebetweenmenandwomenforthe

sixdancesperformedbybothgenders(P=0.037–0.500).

1 2 3 4 5 6 7 8 9 10 11 12

METs

Fijian

MaoriHaka

Hawaiianhula

Samoansasa

Tahitian

Tongan

Dances

Men Women

Figure 1.Metabolic equivalents (MET) for eight Polynesian dances by genderwithreferencetothe3-METand6-METthresholdscommonlyusedtodefinemoderateandvigorousexerciseintensities,respectively.Allvaluesexpressedasmean±SD.

36

Table3.Aerobicandanaerobicactivityenergyexpenditures(AEE)andtheirrespectivecontributionstototalEEbygenderforeightPolynesiandances.

Gender(n)

AerobicAEEanditscontributiontototalAEE

AnaerobicAEEanditscontributiontototalAEE

AerobicAEE(kcal·min-1)

p-value Contribution(%)AnaerobicAEE(kcal·min-1)

p-value Contribution(%)

HawaiianhulaM(6) 11.1±4.0

0.006*92.2±7.7 1.0±1.0

0.3297.8±7.7

W(19) 5.0±2.1 87.6±15.1 1.3±2.3 12.4±15.1

FijianM(8) 12.8±4.3 <0.001* 84.6±5.5 2.4±1.1

0.07015.4±5.5

W(7) 4.3±1.0 85.0±14.5 1.1±1.8 15.0±14.5

MaorihakaM(7) 10.2±3.4 <0.001* 88.0±10.1 1.4±1.1

0.03712.0±10.1

W(6) 2.5±0.5 83.8±9.5 0.5±0.3 16.2±9.5Maoripoiballs

W(3) 2.9±1.4 N.A. 81.5±32.1 1.9±3.2 N.A. 18.5±32.1

SamoansasaM(9) 10.1±1.7

<0.001*80.5±16.3 3.0±3.1

0.10919.5±16.3

W(5) 5.7±1.2 81.8±10.6 1.4±1.3 18.2±10.6Samoanslap M(6) 14.5±4.8 N.A. 74.2±10.9 5.1±3.0 N.A. 25.8±10.9

TahitianM(7) 9.8±3.6

0.28284.1±14.1 1.5±1.1

0.04815.9±14.1

W(10) 8.3±2.1 75.3±14.1 3.4±3.0 24.7±14.1

TonganM(12) 10.5±3.7

<0.001*90.0±10.0 1.4±2.4

0.50010.0±10.0

W(4) 1.9±0.4 58.5±16.3 1.4±0.6 41.5±16.3Allvaluesexpressedasmean±SDunlessotherwisespecified.M:men;W:women *MeanvalueforAerobicAEEorAnaerobicAEEwassignificantlyhigherformenthanthatforwomenwhenp-value<0.008

37

Hula Sasa Slap Tahitian Tongan Fijian Haka Poi balls

Polynesian Dances

0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

AEE(kcal·m

in-1)

SD f or Total AEE Anaerobic AEE Aerobic AEE

(a)

Hula Sasa Slap Tahitian Tongan Fij ian Haka Poi balls

Polynesian dances

0

20

40

60

80

100

Perc

ent o

f Tot

al A

EE (%

)

Anaerobic AEE (%) Aerobic AEE (%)

(b)

Figure2.Aerobicandanaerobiccontributionstothetotalactivityenergyexpenditurefor

eightPolynesiandances.MeanvaluesforaerobicandanaerobicAEE,aswellasstandard

deviationsfortotalAEE,areshowninFigure2(a,top)wherethetotalAEEisthesumof

bothaerobicandanaerobicAEE.Therespectivecontributionsasapercentofthetotal

AEEfortheaerobicandanaerobicsystemsareshowninFigure2(b,bottom).

38

Discussion

The present study provides insight into both aerobic and anaerobic metabolic

demandsforseveralpopularformsofPolynesianculturaldance.Ourresultsindicatethat

allPolynesiandancestested(exceptforMaoripoiballs)haveMETintensitiesthatexceed

the3-METMVPAthreshold,andthusmaybeconsideredanappropriateexercisemodality

fortheat-riskNHOPIpopulationtomeetthecurrentrecommendationsforPA(USDHHS

2008).However,itwasalsoclearthatthemen’sdancestendedtohavemuchhigherMET

valuesthanthewomen’sdances(i.e.,Hawaiianhula,Fijian,Maorihaka,Samoansasa,and

Tongan) so both gender and the type of Polynesian dance should to be considered

togetherwhendesigningadance-specificPAintervention.

METValuesacrossthePolynesianDancesTested

ThemeanMETvalues for thePolynesiandancesevaluatedby this study ranged

broadlyfromalowof3.7METsforMaoripoiballsandahighof9.6METsfortheSamoan

slap(seeTable2).Interestingly,theMaoripoiballsandSamoanslapwerealsotheonly

twodancesspecifictoonegender(womenandmen,respectively).ThemeanMETvalues

fortheothersixdancesweremoresimilar(5.9–8.3METs;seeTable2),butincludedboth

menandwomendancers.Whencomparedtothe3-METand6-METthresholdsforMVPA,

all,butMaoripoiballsdance,exceeded3.0METs,whileSamoansasa,Samoanslapand

traditionalTahitianexceeded6.0METs.Thus,thehypothesisthatallPolynesiandances

39

testedwouldexceedthe3-METthresholdwasnearlysatisfied,whilethehypothesisthat

onlysome(notall)ofthedanceswouldexceedthe6-METthresholdheldtrue.

ComparableMETdataforPolynesiandancingisrelativelyscarceinthepublished

research literature.TheHawaiianhula, forexample,appearstobetheonlyPolynesian

dancepreviouslyreporteduponwithdirectmeasuresofoxygenuptake.Usagawaetal.

(2014) evaluated the Hawaiian hula (described by the authors as a combination of

traditional and contemporary forms of hula) in competitive Polynesian dancers and

reportedmeanMETvaluesof5.7and7.6METsforslowtempo(low-intensity)andfast

tempo (high-intensity) hula, respectively. The present studymeasured traditional and

contemporaryhulaseparatelyandfoundthesetwosub-stylesofhulatobestatistically

similar(5.8and6.7METs,respectively;P=0.436).Regardless,bothoftheseevaluations

for hula, whether the style was traditional, contemporary, or some combination,

consistently report the intensity to exceed the 3-MET threshold but not the 6-MET

threshold.

Focusing on ballroomdancing, Lankford et al. (2014) reported that the exercise

intensityoffourdancestyles(5.3,5.3,6.4,and7.1METsforwaltz,foxtrot,chacha,and

swing,respectively)withrecreationaldancersalsoexceededthe3-METthreshold.Recent

workfromourownlab(Zhuetal.2016)focusedonevaluatingthemetabolicdemandsfor

Tinikling,atraditionalPhilippinebamboodance.Usingmostlymiddle-agedadultswitha

recreationalfamiliarityofthedancestyle,TiniklinghadameanMETintensityof6.9METs

whichexceededthe6-METthreshold(P=0.0015).Thecommonalityamongstthesedance

40

studies is that MET values were based upon the indirect calorimetry technique for

assessing aerobicmetabolic demands. However, despite the different types of dances

reported upon (Polynesian, ballroom, Tinikling), the different populations assessed

(competitiveandprofessionaldancers,aswellascollege-agedandmiddle-ageddancers),

theresultsconsistentlysuggestthatmanyformsofdancehaveametabolicdemandthat

easilyexceedsthe3-METthreshold,whilesomealsoexceedthe6-METthreshold.

GenderComparisonsforMETValues

The result of the present study supported our second hypothesis that theMET

intensitiesforsomeofthemen’sdanceswouldbesignificantlyhigherthanthoseforthe

women’sdances(seeFigure1).FiveofthesixPolynesiandancesperformedbybothmen

and women (i.e., Hawaiian hula, Fijian, Samoan sasa, Maori haka, and Tongan) had

gender-specificchoreographywhiledancingto identicalmusic.Forexample,theMaori

haka(atraditionalbattledance)hasmenandwomenperforminginaheightenedarousal

state that encourages yellingwith exaggerated facial expressions. However, themen’s

hakaemphasizeshigh-intensityupperandlowerbodymotions,whilethewomen’shaka

involves relatively quiet standing and less exaggerated upper body motions. These

choreographydifferencesexplainwhywomen’shakahadametabolicdemandofonly3.2

METswhilethemen’shakaaveraged8.3METs.Tahitianwastheonlydancethathadno

significant gender difference inMET values, and could also be classified as vigorous-

intensityPAforbothgenders.

41

Thelowermetabolicdemandsexhibitedbythewomendancersmightalsodueto

thewomendancersreportingmorePolynesiandanceexperiencethanthemen(8.9vs.

3.5 yrs, P = 0.043). This observation is consistent with the women hula dancers in

Usagawa’sstudy(2014)whostartedtrainingattheageof5whilemendancersstartedin

lateadolescenceorearlyadulthood.Assuch, it ispresumedthatmoreyearsofdance

experience would lead to higher dancing skill levels and possibly more energetically

efficientdancemovements.However,thisexplanationseemsunlikelygiventhecontrast

inchoreographybetweenmenandwomendancersdescribedabove.Whileamovement

analysiswasnotperformedonthesedancers,thevisualappearanceofthemen’sdance

choreographyoftenappearedmorehighly energetic (i.e., jumping, stomping,dynamic

largerangeofmotiongestures)whilethewomen’sdancesappearedrelativelysubdued

(i.e.,smoothandgracefulbodymotionswithoutjumpingorstomping).Finally,themen

in thepresent studyalsohada significantlyhigherBMI (30.2kg·m-2) than thewomen

dancers(25.6kg·m-2)whichcouldhaveincreasedtheaerobicenergycostformensimply

because of having more body mass when dancing. While having a higher BMI most

certainlycontributedtoahigherabsoluteenergeticcostsfordancing,itisstillmorelikely

that differences in dance choreography between genders was the primary cause for

genderdifferencesamongstfiveofthePolynesiandancestestedinthisstudy.

AerobicAEE

As for aerobic AEE,we observed themean values for theHawaiian hula, Fijian,

Maorihaka,Samoansasa,Samoanslap,aswellas the traditionalTahitianandTongan

42

dancestorangebetween6.5and14.5kcal·min-1(seeFigure2a).Previousdancestudies,

suchasLankfordetal.’srecreationalballroomdancestudy(2014),reportedthatwaltz,

foxtrot,chacha,andswingcostanaverageof5.9kcal·min-1.ForLatinAmericandancing,

Massiddaetal.(2011)reportedmetabolicratesof9.9,8.3,6.6,8.5,and8.3kcal·min-1for

cha cha, samba, rumba, paso doble, and jive, respectively. Emerenziani et al. (2013)

measuredtheAEEinthreedifferentformsofsalsadance:typicalsalsalesson(5.6and4.5

kcal·min-1),ruedadecasinolesson(6.8and5.3kcal·min

-1),andsalsadancingatnightclub

(7.1and4.2kcal·min-1),formenandwomen,respectively.Thesedataarecomparableto

ourfindingsforHawaiianhula(6.5kcal·min-1),Samoansasa(8.6kcal·min

-1),Tahitian(8.9

kcal·min-1),Tongan(8.3kcal·min

-1),Fijian(8.8kcal·min

-1),andMaorihaka(6.7kcal·min

-1),

thoughthepresentstudyistheonlyonetohavealsoassessedtheanaerobicenergycost.

AnaerobicAEE

Itiswellknownthattheaerobicandanaerobicenergycontributionstototalenergy

expenditure during PA will change in response to exercise intensity and duration

(NummelaandRusko1995),aswellaswithexercisemodalities(Scott2005).Unlikemany

classicformsofaerobicexercise(e.g.,walking,jogging,bicycling),manyPolynesiandances

arenotpurelysteady-stateactivitiesduetochangesinchoreographythatcorrespondwith

changesinmusictempoandduration.Thus,abetterunderstandingoftheaerobicand

anaerobicenergysystemcontributionstototalenergyexpenditureduringdancemaybe

important for correct administration and structuring of exercise prescription. To our

knowledge,thisisthefirststudytoevaluatethebothabsolute(kcals·min-1)andrelative

43

(%oftotalAEE)aerobicandanaerobicAEEduringdancingexercise.Inshort,thecurrent

studyfoundthataerobicenergywaspredominantlyusedforallPolynesiandancestested.

Onaverage,aerobicandanaerobicAEEcontribute83.4%and16.6%,respectively,tototal

AEE for Polynesian dances (see Figure 2b). Across dances, theHawaiian hula had the

highestaerobicenergycontribution(88.7%aerobicand11.3%anaerobicforatotalAEE

of7.7kcal·min-1),whileSamoanslaphadthelowestaerobicenergycontribution(74.2%

aerobic and25.8%anaerobic for a total AEEof 19.6 kcal·min-1). These aerobic energy

contributionsarecomparabletootherenduranceexercises,suchas1500mtrackrunning

(77%and86%formenandwomen,respectively),3000mtrackrunning(86%and94%for

men and women, respectively) (Duffield et al. 2005), and 2000 m rowing (87%) (de

CamposMello et al. 2009). By referring to findings of our study (i.e., the aerobic and

anaerobic AEE contributions to total AEE), health practitioners and researchers could

design interventionprogramsusingoneormore formsof Polynesiandance thathave

absoluteorrelativeaerobicAEEequivalenttotraditionalexercisemodalities(e.g.,Samoan

slapvs.men’s1500mtrackrunning,Hawaiianhulavs.2000mrowing,etc.).

LimitationsandFutureResearch

OnelimitationofthisstudyisthatourparticipantswereallexperiencedPolynesian

dancers.Noviceorbeginnerdancersmayhaveverydifferentcardiometabolicresponses

totheseformsofdance.Whilethedependenceofcardiometabolicresponsesondance

experiencehasbeensuggested(Bertuzzietal.2007),thetopicdoesnotseemtohave

been studied or reported upon in the literature. Second, all the dance testing was

44

performedforadurationof4.5–5minstoensurethattheparticipantsreachedsteady-

stateforrespiratorygasanalysis.However,factorssuchasexercisedurationmayinfluence

the metabolic fate of blood lactate concentration (Gastin 2001), and therefore, the

anaerobic AEE estimates from our study only stands for 4.5 – 5minutes steady-state

measurement,andnotgeneralizabletoanylongerdurationofPolynesiandancing.Other

studylimitationsincludethesmallsamplesizesforsomeofourdancedata(e.g.,n=3for

theMaori poi balls dance), and that an objectivemeasure of aerobic fitness, such as

maximaloxygenuptake(VO2MAX),wasnotmeasuredforourdanceparticipants.

Futureresearchshouldconsiderusingdancerswithamorediverserangeofdance

experienceand skill toprovideamorecompleteunderstandingof theenergy cost for

Polynesiandancing.Also,variousdurationsofdancingexerciseshouldalsobeaddressed

in future studies to provide better evidence of the energy system contributions to

Polynesiandancing. Finally, the current study’s analysisofbothaerobic andanaerobic

contributionstototalenergyexpenditureshouldbeexpandedtoothertypesofdanceto

determinethegeneralizabilityofourobservations.

Conclusions

ThepresentfoundthattheaverageMETintensityformostofthePolynesiandances

evaluated(Hawaiianhula,Samoansasaandslap,Fijian,Maorihaka,andTongan,butnot

Maoripoiballs)exceededthe3-METthreshold.However,whenevaluatedbygender,the

men’sMETvaluesweresignificantlyhigherthanthewomen’svaluesforallbuttraditional

45

Tahitiandance.Thus,whiletheseresultssupporttheuseofPolynesiandancingasameans

topromoteincreasedMVPAforhealthpromotionanddiseasespreventionfortheNHOPI

population,thecardiometabolicdosetobeexpectedwillvarybetweenPolynesiandances,

as well as between genders. Regardless, the present study can serve as a starting

referencefortheprescribeduseofPolynesiandancingbyhealthpractitioners,coaches,

exercisephysiologistandresearchers.

46

CHAPTERFOUR-CONCLUSIONS

The present study provides insight into both aerobic and anaerobic metabolic

demandsforseveralpopularformsofPolynesianculturaldance.Ourresultsindicatethat

theaverageMETintensityformostofthePolynesiandancesevaluated(Hawaiianhula,

Samoansasaandslap,Fijian,Maorihaka,andTongan,butnotMaoripoiballs)exceeded

the3-METMVPAthreshold,andthusmaybeconsideredanappropriateexercisemodality

fortheat-riskNHOPIpopulationtomeetthecurrentPArecommendations. Itwasalso

clearthatthemen’sdancestendedtohaveamuchhigherMETvaluethanthewomen’s

dances(i.e.,Hawaiianhula,Samoansasa,Fijian,Maorihaka,andTongan),andtherefore,

bothgenderandthetypeofPolynesiandanceshouldtobeconsideredtogetherwhen

designingadance-specificPAintervention.

Also,thisstudyisthefirsttoreporttherespectiveaerobicandanaerobicenergy

expendituresfordancingexercise.Wefoundthataerobicenergywaspredominantlyused

forallPolynesiandancestested,andthatthecontributionofaerobicAEEtototalAEEfor

alldancestestedaresimilartotraditionalenduranceexercises(i.e.,running,rowing,etc.).

GiventhatmanyPolynesiandancesarenotpurelysteady-stateactivitiesduetochanges

in choreography that correspondwith changes inmusic tempo and duration, findings

abouttheaerobicandanaerobicAEEcouldbeimportantforcorrectadministrationand

structuringofexerciseprescriptionusingoneormoreformsofPolynesiandance.

Theresultsofourstudy,however,arelimitedtoexperiencedPolynesiandancers,

whoweretestedforadurationof4.5-5minutes.Futureresearchshouldconsiderusing

47

dancers with a more diverse range of dance experience and skill to provide a more

completeunderstandingoftheenergycostforPolynesiandancing.Also,variousdurations

ofdancingexerciseshouldbeaddressedtoprovidebetterevidenceoftheenergysystem

contributionstoPolynesiandancing.Finally,thecurrentstudy’sanalysisofbothaerobic

andanaerobic contributions to total energyexpenditure shouldbeexpanded toother

typesofdancetodeterminethegeneralizabilityofourobservations.

Thus,whilethecurrentstudysupportstheuseofPolynesiandancingasameansto

promote increasedMVPAforhealthpromotionanddiseasespreventionfortheNHOPI

population,thecardiometabolicdosetobeexpectedwillvarybetweenPolynesiandances,

as well as between genders. Regardless, the present study can serve as a starting

referencefortheprescribeduseofPolynesiandancingbyhealthpractitioners,coaches,

exercisephysiologistandresearchers.

48

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53

APPENDIXA

IRBAPPROVEDINFORMEDCONSENTDOCUMENT

54

PartA:ApplicationInformation

1. TitleofStudy: ThePolynesianDanceStudy

2. PrincipalInvestigator:JoelReece 3. Contact Person (if different

fromPI):

Title:

AssistantProfessor

Dept:

ExerciseandSportScience

Title:

Dept:

Address(+zip):

55-220KulanuiSt.#1968

Address(+zip):

Phone:

675-3353

Email:

Joel.reece@byuh.edu

Phone:

Email:

4. Co-Investigator(s)(name&affiliation):

Eli Lankford Brigham Young University Idaho, Daniel Heil Montana State

University,WeiZhuMontanaStateUniversity

5. ResearchOriginatedBy(checkone):

Faculty Student Staff

6. ResearchPurpose(checkallthatapply):

Grant

HonorsThesis

Thesis

Other

Dissertation ORCAScholarship

CourseProject:Whichcourse?

7. CorrespondenceRequest:

Mail CallforPick-Up

PartB:ResearchStudySynopsis

1. ShortStudyDescription:

The primary purpose of this study is to determine themetabolic demands of

dancefrom6differentPolynesiancultures.Participantswillperformdancesfrom

anyofthe6culturaldancestheydesire(i.e.,Samoan,Hawaiian,Tongan,Fijian,

Mauri,andTahitian).Alldanceswillbeperformedwhileparticipantsarewearing

a breath-by-breath analyzer during the duration of the dance session. The

analyzerwillrecordheartrate,oxygenintakeandCO2output.Participantswillalso

wearsmallelectronicactivitymonitors(1oneachwrist;1oneachankle;1onthe

hip)sothatwepredictthemetabolicdemandsofPolynesiandancesinthefuture,

such as for a group intervention. The primary outcome for these datawill be

energyexpenditure.

2. StudyLength:Whatisthedurationofthestudy?

October2015-February2016

3. LocationofResearch:

a. Wherewilltheresearchtakeplace?BYUHcampus,Ballroom

b. WillthePIbeconductingand/orsupervisingresearchactivityatanysites

notunderthejurisdictionoftheBYUHIRB? Yes|No

55

PartB:ResearchStudySynopsis(continued)

4. SubjectInformation:

a. NumberofSubjects:75

b. GenderofSubjects:Maleandfemale

c. AgesofSubjects:18-64

5. PotentiallyVulnerablePopulation(checkallthatapply):

Children

CognitivelyImpaired

Prisoners

Faculty’sOwnStudents

PregnantWomen

Institutionalized

Other.Pleasedescribe

6. Non-EnglishSpeakingSubjects:

WillsubjectswhodonotunderstandEnglishparticipateintheresearch:

Yes|No

Ifyes,pleaseprovidethefollowinginformation:

a. Describeyourresourcestocommunicatewiththesubjects:

b. Intowhatlanguage(s)willtheconsentformbetranslated:

7. AdditionalSubjectConcerns:

Arethereculturalattitudes/beliefsthatmayaffectsubjectsinthisstudy?

Yes|No

Ifyes,pleasedescribeattitudesandhowtheymayaffectsubjects.

Culturaldanceactivitywillbeusedtocollectdata.Itispossiblethatsome

maybesensitivetousingculturedancetocollectdata.Onlyvolunteers

willingtodancefordatacollectionwillbeinvolved.

8. DisseminationofResearchFindings:

a. Willtheresearchbepublished? Yes|No

Ifyes,whereifknown?

Peerreviewedjournal

b. Willtheresearchbepresented? Yes|No

Ifyes,whereifknown?

RegionalandNationalconferences

9. ExternalFunction:

Areyouseekingexternalfunding? Yes|No

Ifyes,pleaseprovidethefollowinginformation:

a. Whatagency?

b. Haveyoureceivedfunding? Yes|No Ifyes,dollaramount?

10. MethodofRecruitment(checkallthatapply):

Flyer

ClassroomAnnouncement

LettertoSubject

ThirdParty

Random

Other

56

PartB:ResearchStudySynopsis(continued)

11. PaymenttoSubject:

Willthesubjectbecompensatedforparticipation? Yes|No

Ifyes,pleaseprovidethefollowinginformation:

a. Amount:

b. FormofPayment:

Cash

Voucher

Check

1099

GiftCertificate

Other

c. Willpaymentbeprorated? Yes|No

Ifyes,pleaseexplain:

d. Whenwillthesubjectsbepaid?

EachVisit StudyCompletion Other

12. ExtraCredit:Willsubjectsbeofferedextracredit? Yes|No

Ifyes,describethealternative:

13. Risks:Identifyallpotentialrisks/discomfortstosubjects.

Nomorethanminimalrisk/discomfort.Therisksinvolvedforparticipatinginthis

studymay includemilddiscomfortduringandafterdance. Thesediscomforts

may includeshortnessofbreath, tiredor sore legs,but thesediscomfortsare

common for anyone who participates in moderate intensity exercise. The

participantsmayalsofeelslightdiscomfortwhilewearingtheequipment(head

strap and face mask, back pack with Oxycon Mobile sensors and heart rate

monitor),butthesediscomfortsaremostlyduetothenoveltyofwearingthis

type of equipment during exercise. All attemptswill bemade to ensure that

participantsarecomfortablewithwearingthemeasurementequipmentbefore

anytestingoccurs.

14. Benefits:a. Aretheredirectbenefitstoparticipants? Yes|No

Ifyes,pleaselistthem.

b. Aretherepotentialbenefitstosociety?Yes

Ifyes,pleaselistthem?

c. IncreasedinformationonwhetherPolynesiandanceisaneffectiveform

ofcardiorespiratoryexercise.

57

PartB:ResearchStudySynopsis(continued)

15. StudyProcedures:a. Whatwillbethedurationofthesubjects’participation?60-90minutes

b. Willthesubjectsbefollowedaftertheirparticipationends? Yes|No

Ifyes,pleasedescribe?

c. Describethenumber,durationandnatureofvisits/encounters?

2visits.Visit1:60-90minutes.Eachsubjectwillbescreenedforparticipation

by completing a Physical Activity Readiness Questionnaire (PARQ). Next,

participants will complete a second brief demographic questionnaire, be

measuredforheightandweight,andbefitfortheequipment.Visit2:Body

compositiontest15-30minutes.

d. Whichofthefollowingdescribethestudy? Therapeutic

Non-therapeutic

e. Listallproceduresthatwillbeperformedtogeneratedatafortheresearch.

A questionnaire will include gender, ethnicity, date of birth, and dance

experience.Otherdatawillincludeaccelerometerdata(wrist,ankle,andhip

monitors), oxygen uptake, CO2 output, heart rate. Blood lactate

measurementswillbetakenafterdancingusingafingerprick.

f. Listallprocedures/questionnairesdonesolelyforthepurposeofthe

researchstudy.

PARQ.Questionnaireforgender,ethnicity,dateofbirth,danceexperience.

Accelerometerdata,oxygenuptake,CO2output,heart rate.Blood lactate

measurementswillbetakenafterdancingusingafingerprick.

g. Listallprocedures/questionnairesparticipantsalreadydoregardlessof

research.

16. InformedConsent:

AreyourequestingWaiverorAlterationofInformedConsent? Yes|No

Ifyes,pleaseprovidethefollowinginformation:

a. Filloutandattachthewaiverofinformedconsent.

b. Brieflydescribeyourprocesstoobtainconsent:

All subjects will be asked to read the informed consent form. Prior to

signing the informed consent form, all subjects will receive verbal

explanation.Priortoparticipation,writtenconsentwillbeobtained.

58

PartB:ResearchStudySynopsis(continued)

17. Confidentiality: a. Arethesubjects’socialsecuritynumbers,BYUHIDnumbersorany

identifiers(otherthanstudynumbersandinitials)beingsentoffsite?

Yes|No

Ifyes,describeandexplainreasons.

b. Willanyentityotherthantheinvestigativestaffhaveaccesstomedical,

healthorpsychologicalinformationaboutthesubject? Yes|No

Ifyes,pleaseindicatewho?

c. Brieflydescribeprovisionsmadetomaintainconfidentialityofdata,

includingwhowillhaveaccesstorawdata,whatwillbedonewiththe

tapes,etc.

DatawillbefiledinalockedcabinetinJoelReece’sofficewithaccesstohim

andprimaryresearchersonly.Atthetimeofparticipationsubjectswillbe

givenasubjectnumbertoidentifyanydatalinkedwiththem. Anystudents

involvedwillonlyhaveaccesstodatawithanidentifyingsubjectnumber.

AnyadditionaldatawillbestoredontheViasysmetabolicsystemcomputer

software;thissoftwareisaccessiblebypasswordonly.

WilltherawdatabemadeavailabletoanyoneotherthePIandimmediatestudy

personnel? Yes|No

If yes, describe the procedure for sharing data. Include with whom it will be

shared,howandwhy.

Ifdataispublishedandpeerswouldliketodofollow-upstudies.Rawdatamaybe

sent,butnoidentifyingnameswillbegiven,onlysubjectnumbers.

PartC:

The attached investigation involves the use of human subjects. I understand the

university’spolicyconcerningresearchinvolvinghumansubjectsandIagree:

1. Toobtainvoluntaryandinformedconsentofsubjectswhoaretoparticipateinthis

project.

2. Toreport to the IRBanyunanticipatedeffectsonsubjectswhichbecomeapparent

duringthecourseof,orasaresultof,theexperimentationandtheactiontaken.

3. Tocooperatewithmembersofthecommitteechargedwithcontinuingreviewofthis

subject

59

4. Toobtainpriorapprovalfromthecommitteebeforeamendingoralteringthescope

oftheprojectorimplementingchangesintheapprovedconsentdocument.

5. Tomaintainthedocumentationofconsentformsandprogressreportsasrequiredby

institutionalpolicy.

6. Tosafeguardtheconfidentialityofresearchsubjectsandthedatacollectedwhenthe

approvedlevelofresearchrequiresit.

Signature*ofthePrincipalInvestigator:___________JoelReece__________________

Date:___________10/7/15___________________

FacultySponsorSignatureNecessaryforAllStudentSubmissions

“IhavereadandreviewedthisproposalandcertifythatitisreadyforreviewbytheIRB

Board.Ihaveworkedwiththestudenttopreparethisresearchprotocol.Iagreetomentor

thestudentduringtheresearchproject.”

CommitteeChair/FacultySponsor(Pleasesignandprint):

____________________________________

Thesis/Dissertation–DateofApprovalbytheProposalReviewCommittee:

____________________________________

Ifsubmittingbyemail,pleasecheckthisboxtoverifythatyouarethePIlistedonthis

applicationandagreetofollowtheitemslistedabove.

PartD:SynopsisoftheProposal

PartD,1-9,shouldonlybe5pagesorless(notincludinginstruments,consentforms,etc.).

Pleaseuse12ptfont,pagenumbersandtheheadingsnotedbelow.

1. SpecificAims

1) Determine the average metabolic cost of Polynesian dance using 6 different

cultures(i.e.,Hawaiian,Tongan,Fijian,Samoan,Mauri,Tahitian).

2) Determinetheaveragemetaboliccost foreachtypeofPolynesiandanceand if

therearemetabolicdifferencesamongculturaldances.

3) Determine the specific metabolic cost of different dances for each cultural

Polynesiandancewhereapplicableandiftherearemetabolicdifferencesamong

dances.

4) Determineifthereisametaboliccostdifferencebetweenmalesandfemaleswhile

performingtheirrespectiveculturaldances.

5) Collectelectronicactivitymonitordataatthewrists,ankles,andthehip,foruse

60

inpredictingthemetabolicrateduringPolynesiandanceforfuturedancestudies.

2. Hypothesis

It is hypothesized that Polynesian dance will have a similar metabolic cost across

cultures.

3. BackgroundandSignificance

The popularity of dance is growing (2, 9, 16, 18), alongwith the knowledge of its

potentialhealthbenefits(3-6,10,12-14,17).Thispopularitycanbeseeninelitelevels,

suchDanceSportbeingconsideredasanadditiontothesummerOlympicGames(18)

and at the beginner level in the streets (9). According to Bauknecht (2), ballroom

dancinghasbeenrevivedinAmericawithsuchshowsas,SoYouThinkYouCanDance

onFoxandDancingwiththeStarsonABC. Healthbenefitsfromdancehaveincluded

increasedbonedensity (13), fitness (3,5,10,12),happiness (4),andpsychological

wellbeing(14).Withthisincreasinginterestarounddanceitisimportanttoevaluate

metabolicdemandsofdancetodeterminepotentialhealthbenefitsassociatedwith

uniquetypesofdance.

Metabolic demands for dance have previously been evaluated in general dance,

ballroomdance,AnishinaabeJingledance,andCaribbeandance(1).Themetabolic

costofdancehasawiderangedependingonthetypeofdance.Forexample,slow

ballroomdance(e.g., foxtrot) ismeasuredat3.0metabolicequivalenttasks(METs)

comparedto11.3METsincompetitiveballroomdance.Withthewidevariabilityof

intensitiesindance,itisimportanttounderstandthemetaboliccostofvariouscultural

Polynesiandance.ByunderstandingthemetaboliccostofPolynesiandance,potential

healthbenefitsandappropriatetrainingprogramsforperformerscanbeidentified.

For example, besides potentially improving dance performance, knowing the

metabolic cost of dance may encourage healthier behavior change to decrease

sedentarytime,increasephysicalactivitywithdance,andleadtoadecreaseofdisease

inareaswherePolynesiandancecanbepracticed.

4. DescriptionofSubjects

Approximately75volunteerparticipants(18yearsandolder)thatareexperiencedin

performingatleastoneculturalroutinetomusicfromtheBreathofLifeHashowat

thePolynesianCulturalCenterwillbe recruited.Prior toparticipation,dancerswill

complete a physical activity readiness questionnaire (PAR-Q) to screen for

contraindicationstomoderate-to-vigorousexercise,aswellassignaconsentform.A

questionnaire evaluating dance experience, demographic statistics, and perceived

functionalabilitywillbecompleted.

5. Confidentiality

61

AllparticipantswillbeassignedasubjectIDnumber.Onlyconsentformswillinclude

the names of participants. All other datawill be kept in a locked filing cabinet or

passwordprotectedsoftware.

6. MethodorProcedures

AlldatawillbecollectedonthecampusofBYU-Hawaiiintheballroomdancehallwith

hardwoodflooring.Priortodancing,ethnicity,height,age,gender,andweightwillbe

recorded.Eachparticipantwillthenbefittedfortwotypesofmeasurementdevices:

1)Portablemetabolicmeasurementsystem(OxyconMobile),and2) fiveelectronic

physicalactivitymonitors(Actical).

MetabolicSystem:TheOxyconMobilehasbeenvalidatedthroughconcurrentstudies

withtheDouglasbagmethod. ItiscommonlyacceptedthattheDouglasbagmethod

is the gold standard for obtaining accurate oxygen consumption (11). The Oxycon

Mobile has been tested against the Douglas Bagmethod in studies such as Hans

Rosdahl (15). The study indicates thatwith theOxyconMobile oxygen uptake is

obtainedthroughbreath-by-breathanalysisandcanbedeterminedwithahighdegree

of validity. The portable metabolic system is worn on a vest with two analyzers

mountedtothebackofthevest.Amaskwithstrapsfasteningitaroundtheheadis

alsowornwithasampletubeattachedtotheanalyzers.

Physical Activity Monitors: The Actical is an accelerometry-based physical activity

monitorthatcanbewornonthewrist,ankle,orhipoftheparticipanttoquantifybody

movement.TheActicalisverysmall(thesizeasmallwristwatch)andlightweight(<20

grams),andhasbeenvalidatedforuseinpredictingtheenergycostofmanyactivities

(including total daily energy expenditure). However, the Actical has never been

validatedforpredictingtheenergycostofPolynesiandance.UseoftheActicalsinthis

studywillallowustoevaluatetheenergycostofPolynesiandanceinthefuturewith

theneedfortheportablemetabolicsystem.

After fitting the participant with these devices, participants will sit quietly for 5

minutestomeasuresittingrestingmetabolicrate.Next,theparticipantswillspend

another 5 minutes engaging in self-directed warmup activities that may include

walkingarounddancehall,flexibilityexercises,aswellasdancing.Next,thefirstpiece

of dancemusic will begin and the participant, along with up to 2 other research

participants,willbeginthefirstdanceroutine(asagrouporindividuallydependingon

participants). After 5minutes of continuous dancing, themusic will stop and the

participantswillbeinstructedtositonachairforanother5minutes.Theparticipants

willthenrepeatthisprocess(i.e.,5minutesofdancefollowedby5minutesofquiet

sitting)forasmanyculturaldancesastheyknow.Participantswhocannotdancetoa

62

specificculturedancewillcontinuetosituntilthebeginningofthenextculturethey

arefamiliarwith.Ifnootherculturedancesareknown,participantscanbedismissed

orcanwaituntilalltheroutinesarecompleted.Finally,immediatelyfollowingeach5-

minutedanceroutine,afingertipbloodsamplewillbedrawnforlactateanalysisusing

standardsamplingmethodology.Incombinationwithmeasuresofoxygenuptakeand

heart rate,measuresofblood lactate areused to characterize the intensityof the

danceexercise.

DanceRoutine:Eachculturaldanceroutineismadeupofdancemovesfromaspecific

culture. While a typical dance routine lasts between 3 and 5 minutes, all dance

routinesinthisstudywilllast5minutestoensurethatallthephysiologicalmeasures

of interest (e.g., oxygen uptake, heart rate, blood lactate) achieve a physiological

plateau.ThemusicplayedforeachdanceroutinewillbeplayedtotheBreathofLife

showtoensureaconsistenttempo.

BodyComposition:Subjectswillbeaskedtocompleteabodycompositiontestusing

theBodpod,within2weeksofdancetesting.Thisisanoninvasivemeasurementusing

airdisplacementlastingapproximately15minutes.Standardprotocolofnoteatingor

exercising2hourspriortotestingwillbefollowed.

7. DataAnalysis

Descriptive statistics of height, age,weight, and BMIwill be presented by gender.

Descriptivestatisticsofmetaboliccosts foreachculturaldanceroutineandtypeof

dancewithinculturalroutinewillalsobepresentedbygender.Repeatedmeasures

ANOVAwillbeemployeddodetermineifdifferencesinmetaboliccostexistamong

culturaldanceroutineswithfollow-upposthoctestswhennecessary. Independent

samplet-Testswillbeemployedtodetermineifdifferencesexistbetweenmalesand

femalesforeachculturaldanceroutine.ReliabilityofActicalmeasurementscompared

to theOxyconMobilemeasurementswill be determinedwith regression analysis.

Finally, standard step-forward multiple regression procedures will be used to

determinethebestpredictionofdanceenergycostusingtheActicalmonitors.

8. Risks

Thisstudywillhavenomorethanminimalrisk.Toensurethis,participantswillallbe

screenedwithaphysicalactivityreadinessquestionnaireandbeaccustomedtothe

culturaldancetheywillperform.

9. Benefits

Benefitsof thestudywillbe increasedknowledgeof thecardiovascularbenefitsof

Polynesiandance.

63

10. Compensation

Nocompensationwillbegivenbytheresearchersforparticipatinginthisstudy.

11. References1. Ainsworth,BarbaraE.,etal."2011CompendiumofPhysicalActivities:asecond

updateofcodesandMETvalues."Medicineandscience in sportsandexercise

43.8(2011):1575-1581.

2. Bauknecht, S.. Popularityof TVdance shows inspiresnew interest inballroom,

salsa.PittsburghPost-Gazette(2009).

3. Cobo,JuanRuiz,S.RosRuiz,andMohamedFaroukAllam."Danceforyourhealth."

JournalofPreventiveMedicineandHygiene52.2(2015).

4. FitnessandWellness;Studiesconfirmsballroomdancing isgoodforhealthand

happiness.(2005,June).WorldDiseaseWeekly,799. RetrievedFebruary1,2010,

fromResearchLibrary.(DocumentID:854598061).

5. Flores,R.Dance forHealth: improving fitness inAfricanAmericanandHispanic

adolescents.March-April1995.110(2)189-193,(1994).

6. Hanna,J.L.Thepowerofdance:healthandhealing.JAltCompMed.1:323-331,

1995.

7. Heil,D.P.,PredictingActivityEnergyExpenditureUsingtheActicalActivityMonitor.

ResearchQuarterlyforExerciseandSport77(1),64-80.(2006)

8. Heil,D.P.,KlippelN.J.Validationofenergyexpenditurepredictionalgorithmsin

adultsusingtheActicalelectronicactivitymonitor.MedicineandScienceinSports

andExercise:35(5), S284(2003).

9. Hipp, J. Aaron, et al. "Taking physical activity to the streets: the popularity of

CicloviaandOpenStreets initiatives in theUnitedStates."American Journalof

HealthPromotion28.sp3:S114-S115(2014).

10. Keogh,JustinWL,etal."Physicalbenefitsofdancingforhealthyolderadults:a

review."JAgingPhysActiv17.4,479-500(2009).

11. Liddell,F.D.K.Estimationofenergyexpenditurefromexpiredair.JApplPhysiol.

18:25-29,(1963).

12. Lima,M.M.S. Ballroom dances as a therapy for the elderly in brazil. American

JournalofDanceTherapy,29(2),129(2007).

13. Matthews,B.L.,K.L.Bennell,H.A.Mckay,K.M.Khan,A.D.G.Baxter-Jones,R.L.

MirwaldandJ.D.Wark.Dancingforbonehealth:a3-year longitudinalstudyof

bonemineralaccrualacrosspubertyinfemalenon-elitedancersandcontrols.Ost

Int.17:1043-1054,(2006).

14. Quin,E.,Frazer,L.,&Redding,E. (2007).Thehealthbenefitsofcreativedance:Improving children's physical and psychological wellbeing. Education& Health,

25(2),31-33.

15. Rosdahl, H., Lindberg, T., Edin, F., & Nilsson, J. TheMoxusModular metabolic

systemevaluatedwithtwosensorsforventilationagainsttheDouglasbagmethod.

64

EuropeanJournalofAppliedPhysiology,113(5),1353-67(2013).

16. Sun, Yamei. "LineDance:AnOpportunity forWomen’sHealthandEquality:An

Analysis Based on Line Dance Surveys of China in the 21st Century."Women,

IdentitiesandCulture1.1(2015).

17. Ward,S.Healthandthepowerofdance.JournalofPhysicalEducation,Recreation

&Dance,79(4),33(2008).

18. World Dance Sport Federation. The aspirations. Retrieved August 8, 2015

https://www.worlddancesport.org/About/Olympic/The_Aspirations.

19. Qualifications20. Four qualified professionals with experience in energy expenditure, dance,

physicalactivity,bodycomposition,andaccelerometry.

Includethefollowinginformationasnecessaryintheappropriateappendix.

AppendixI–ConsentDocument

AppendixII–Questionnaires,Surveys,Instruments,Interviewquestion,etc.

65

AppendixI

ConsenttobeaResearchSubjectforthe

PolynesianDanceStudy

Introduction

ThisresearchstudyisbeingconductedbyDr.JoelReece(BYUH),Dr.EliLankford(BYUI),

Dr.DanielHeil (MontanaStateUniversity), andWei Zhu (MontanaStateUniversity) at

BrighamYoungUniversity–Hawaiitodeterminethemetabolicdemandsofdancefrom6

differentPolynesiancultures.Youwereselectedtoparticipatebecauseyouareabilitiesin

Polynesiandances.

Procedures

You will be asked to participate for 60-90 minutes. First you will be screened for

participationbycompletingaPhysicalActivityReadinessQuestionnaire(PARQ).Nextyou

will complete a second brief demographic questionnaire, bemeasured for height and

weight,andbefitfortheequipment.

The questionnaire will include gender, ethnicity, date of birth, dance experience, and

perceivedfunctionalability.Otherdatawillincludeaccelerometerdata(wrist,ankle,and

hipmonitors),oxygenuptake,CO2output,heartrate.Bloodlactatemeasurementswillbe

takenafterdancingusingafingerprick.Withintwoweeksaftertestingyouwillbeasked

tocompleteabodycompositiontest.

Risks/Discomforts

Therearenomorethanminimalrisksforparticipationinthisstudy.However,youmay

feelphysicaldiscomfortfromthefingerpricktomeasurebloodlactateand/orperforming

thedances.

Benefits

There are no direct benefits to subjects. However, it is hoped that through your

participation researchers will learn more about the metabolism that occurs during

Polynesiandancing.

Confidentiality

Allinformationprovidedwillremainconfidentialandwillonlybereportedasgroupdata

with no identifying information. All data will be kept in a locked storage cabinet or

passwordprotectedandonlythosedirectlyinvolvedwiththeresearchwillhaveaccessto

them. The results of this studywill likely bepublished, butno identifying variablesof

individualparticipantswillbereleased.

Compensation

Nocompensationforparticipationwillbeawarded.

66

Participation

Participationinthisresearchstudyisvoluntary.Youhavetherighttowithdrawatanytime

orrefusetoparticipateentirelyatanytime.

QuestionsabouttheResearch

Ifyouhavequestionsregardingthisstudy,youmaycontactDr.JoelReeceat(808)-675-

3353orJoel.reece@byuh.edu.

QuestionaboutyourRightsasResearchParticipants

Ifyouhavequestionsyoudonotfeelcomfortableaskingtheresearcher,youmaycontact

Dr.BoydTimothy,IRBChair,(808)675-3931,boyd.timothy@byuh.edu

Ihaveread,understood,andreceivedacopyoftheaboveconsentanddesireofmyown

freewillandvolitiontoparticipateinthisstudy.

Signature:_______________________________

Date: _______________________________

67

AppendixII

Questionnaires

SubjectID:_____________

Sex

BirthDate

Height

Weight

Ethnicity

Dancestoperform:

Fijian Tongan Samoan

Hawaiian Mauri Tahitian

DanceExperience:

Beginner Intermediate Expert

HowmanymonthshaveyouperformedPolynesiandance?

PerceivedFunctionalAbility(PFA)

Supposeyouweregoingtoexercisecontinuouslyonan indoortrackfor1mile.Which

exercisepaceisjustrightforyou–nottooeasyandnottoohard?

1. Walkingataslowpace(18minutespermileormore)

2. Walkingataslowpace(17-18minutespermile)

3. Walkingatamediumpace(16-17minutespermile)

4. Walkingatamediumpace(15-16minutespermile)

5. Walkingatafastpace(14-15minutespermile)

6. Walkingatafastpace(13-14minutespermile)

7. Joggingataslowpace(12-13minutespermile)

8. Joggingataslowpace(11-12minutespermile)

9. Joggingatamediumpace(10-11minutespermile)

10. Joggingatamediumpace(9-10minutespermile)

11. Joggingatafastpace(8-9minutespermile)

12. Joggingatafastpace(7-8minutespermile)

13. Runningatafastpace(7minutespermileorless)

How fast could you cover adistanceof 3miles andNOTbecomebreathlessoroverly

fatigued?Berealistic

1. Icouldwalktheentiredistanceataslowpace(18minutespermileormore)

2. Icouldwalktheentiredistanceataslowpace(17-18minutespermile)

3. Icouldwalktheentiredistanceatamediumpace(16-17minutespermile)

4. Icouldwalktheentiredistanceatamediumpace(15-16minutespermile)

68

5. Icouldwalktheentiredistanceatafastpace(14-15minutespermile)

6. Icouldwalktheentiredistanceatafastpace(13-14minutespermile)

7. Icouldjogtheentiredistanceataslowpace(12-13minutespermile)

8. Icouldjogtheentiredistanceataslowpace(11-12minutespermile)

9. Icouldjogtheentiredistanceatamediumpace(10-11minutespermile)

10. Icouldjogtheentiredistanceatamediumpace(9-10minutespermile)

11. Icoldjogtheentiredistanceatafastpace(8-9minutespermile)

12. Icouldjogtheentiredistanceatafastpace(7-8minutespermile)

13. Icouldruntheentiredistanceatafastpace(7minutespermileorless)

(George, J.D. et al. Non-exercise VO2MAX estimation for physically active college

students.MedicineandScienceinSportsandExercise.29,415-423,1997)

69

PHYSICALACTIVITYREADINESSQUESTIONNAIRE(PAR-Q)

Name:________________________________Date:____________________

PAR-Q isdesignedtohelpyouhelpyourself.Manyhealthbenefitsareassociatedwith

regularexercise,andthecompletionofPAR-Q isasensible firststeptotake ifyouare

planningtoincreasetheamountofphysicalactivityinyourlife.

Formostpeople,physicalactivityshouldnotposeanyproblemorhazard.PAR-Qhasbeen

designed to identify the small number of adults for whom physical activity might be

inappropriateorthosewhoshouldhavemedicaladviceconcerningthetypeofactivity

mostsuitableforthem.

Commonsense isyourbestguide inansweringthesefewquestions.Pleasereadthem

carefullyandchecktheYESorNOoppositethequestionifitappliestoyou.

YES NO

[] [] 1.Hasthedoctoreversaidyouhavehearttrouble?

[] [] 2.Doyoufrequentlyhavepainsinyourheartandchest?

[] [] 3.Doyouoftenfeelfaintorhavespellsofseveredizziness?

[] [] 4.Hasadoctoreversaidyourbloodpressurewastoohigh?

[] [] 5.Hasyourdoctorevertoldyouthatyouhaveaboneorjointproblemsuch

asarthritisthathasbeenaggravatedbyexercise,ormightbemadeworse

withexercise?

[] [] 6.Isthereagoodphysicalreasonnotmentionedherewhyyoushouldnot

followanactivityprogramevenifyouwantedto?

[] [] 7.Areyouoverage65andnotaccustomedtovigorousexercise?

Ifyouanswered“YES”tooneormorequestions…

Ifyouhavenotrecentlydoneso,consultwithyourpersonalphysicianbytelephoneorin

personBEFOREincreasingyourphysicalactivityand/ortakingafitnesstest.Tellhim/her

whatquestionsyouansweredYEStoonPAR-Q,orshowyourdoctoryourcopyofthis

form.

Ifyouanswered“NO”tooneormorequestions…

You have a reasonable assurance of your present suitability for a graduated exercise

programoranexercisetest.

NOTE:Postponeexercisetestingifyousufferfromminorillnesssuchasacommoncold.

Signature:___________________________ Date:_______________________

70

BRIGHAM YOUNG UNIVERSITY- HAWAII

Institutional Review Board MEMORANDUM Application Approval Notification TO: Joel Reece FROM: Boyd Timothy, IRB Chair

Brigham Young University – Hawaii 808-675-3931 boyd.timothy@byuh.edu

SUBJECT: IRB Application Number: # (15-11)

The Polynesian Dance Study Approval Date: October 9, 2015 Expiration Date: October 8, 2016 Application Type: New Research Type: Non-exempt Application Review Type: Expedited The Institutional Review Board (IRB) of Brigham Young University – Hawaii approved your application. The research was approved in accordance with 45 CFR 46 of Federal Policy for the Protection of Human Subjects, and the University’s IRB policies and procedures. The IRB approves waiver of signed informed consent as per criteria in 45 CFR 46.116(d). Please reference the IRB application number (above) in any future communication regarding this research. Recruitment/Consent: For research requiring written informed consent, the IRB-approved and stamped informed consent document is enclosed. The IRB approval expiration date has been stamped on the informed consent document. Please keep copies of the consent forms used for this research for three years after the completion of the research.