Effects of Turkish Traditional Dances on Postmenopausal Osteopenic Women

Effects of Turkish Traditional Dances on Bone Mineral Density, Bone Turnover Markers, Balance, Aerobic Capacity and Quality of Life in Postmenopausal Osteopenic Women

The aim of this study is to evaluate the effects of regular Turkish regional dances, in addition to conventional exercises given with a home program, on the quality of life, balance, aerobic capacity, bone mineral density (femoral neck, total and lumbar L1-4 and L2-4 T scores) and bone turnover markers (Type 1 collagen C-telopeptide [CTX-1] and Serum Procollagen 1 N-terminal peptide [P1NP]) of postmenopausal osteopenic women aged 50-60 years. Our study also aims to evaluate the compliance of patients to the exercise programs given to postmenopausal osteopenic women.

-What is the effect of regular Turkish regional dances on balance, aerobic capacity, muscle strength, quality of life, Bone Mineral Densitometry and Bone Turnover Markers in postmenopausal osteopenic women?

Patients who meet the criteria of our study will first be divided into 2 different groups by a closed envelope drawing method performed by a clinic secretary who is not involved in the study. Both groups will be asked to do a home exercise program 3-5 days a week. This home program will include the movements in the attached exercise sheets (Warm-up, Cool-down, Balance and Strengthening exercises, which were created from the sheets taken from https://theros.org.uk). It will be shown by the physiotherapist at the beginning of the study.

In addition to home exercises, participants in the first group will be asked to dance to dance videos from various regions, lasting 30 minutes, at a tempo determined by the study team before the study.

The dance videos will consist of rhythmic and tempo Turkish Regional Dances such as horon, Ankara Dance Tunes, and halay varieties. These videos have been uploaded to the ''Osteopeni folk dances'' YouTube channel and the links to these videos will be shared with the participants. (The videos will be closed to access during the study and only the video link owners will be able to access these videos. Links https://youtube.com/playlist?list=PLxRTiZv\_4GGMtNYzIuGVsde6T\_bzLt0V\&si=W XRPO-GA1iWtGHuw, https://youtube.com/playlist?list=PLxRTiZv\_4GGMVXcRx7uhntLdU4LtvmVC5\&si =nvxk1VGbPia04xQF, https://youtube.com/playlist?list=PLxRTiZv\_4GGMccS\_iYDW3I\_ ODCODEdTx&si=lD-7_fU1vWJ-ZQOn)

Before dancing, 10 minutes of warm-up, 30 minutes of dancing, and 10 minutes of cooling down exercises will be performed. It is planned that patients will dance at least 2 days a week for a minimum of 50 minutes. In addition, it is planned to reach a minimum of 150 minutes/week aerobic exercise target by having them walk briskly for at least 50 minutes once a week.

Participants in the 2nd group will not be prescribed dance, in addition to the home exercise program, they will be recommended to walk only 3 days a week, for a total of 150 minutes per week.

Participants in the 1st group will be given the FORM-1, and participants in the 2nd group will be given the FORM-2, and they will be asked to fill out these forms daily. The form-1 in will ask for the duration of the home exercises or Turkish folk dances that were performed that day. The form in FORM-2 will also ask for the duration of the home exercises that were performed that day. Both groups will also be given the FORM-3, and they will be asked to write down the complications that occurred during the daily exercise.

Only the study group (1st group) will be called monthly and issues such as whether the forms are filled out daily and compliance with the exercises will be discussed.

Inclusion Criteria:

1. Being a postmenopausal woman between the ages of 50-60
2. Not having a known diagnosis of osteoporosis and not having taken any antiresorptive or anabolic agents before
3. Being diagnosed with osteopenia with DEXA taken in the last 6 months at Etlik City Hospital (femoral neck, femoral total L1-4 or L2-4 T score between -1 and -2.5)
4. Being literate
5. Having a 25-Hydroxy vitamin D level in the blood >20 µg/L
6. Having a phone that can be used for communication for oneself or one of the family members, as well as having a smart phone, tablet or computer that can be used to watch videos
7. Being willing to participate in the study

Exclusion Criteria:

1. Having a body mass index >30 kg/m2
2. Having an extremely sedentary lifestyle (International Physical Activity Scale-Inactive according to Short Form)
3. Presence of fragility fracture
4. Presence of malignancy
5. Presence of cardiovascular or respiratory system disease that will prevent exercise (unstable angina, uncontrolled atrial or ventricular arrhythmia, 3rd degree atrioventricular block, severe aortic stenosis, severe asthma-COPD)
6. Presence of current neurological disease that will prevent exercise (CVA, MS)
7. Presence of psychiatric disease that will prevent exercise or cause non-compliance in follow-ups
8. Presence of musculoskeletal system disease that will prevent exercise (Stage 3-4 osteoarthritis, severe spinal stenosis, severe radiculopathy, lumbar surgery within the last 1 year)
9. Presence of known inflammatory joint disease
10. Presence of advanced vision, hearing loss or vertigo etc. that will prevent the patient from doing exercises or regional dances. Having any disease that will disrupt harmony by causing balance problems
11. Using active estrogen or progesterone containing preparations
12. Presence of hyperthyroidism