This trial will be the first to test the effectiveness of typical community social dance programs on falls and age-related cognitive decline. Exercise regimens have previously been shown to protect against cognitive decline in older adults [58, 59] and, in the only prospective study that examined the protective effect of specific activity type, dance was shown to reduce the risk of dementia by 35% . Although the type of activity and dose to prevent cognitive decline is far from being defined, balance training of at least 120 minutes per week is considered as best practice for fall prevention , which is the ‘dose’ tested in this study. Further, the balance training should challenge balance abilities . While the improvement in balance measures through dance may be equivalent to or only marginally better than that in specific balance training exercise, dance has the potential to address a much wider range of fall risk factors than balance training alone due to its synergetic sensorimotor, rhythmical and cognitive demands.
This study will broaden the knowledge for best practice physical activity for fall prevention, as opposed to exercise (i.e., structured repetitive activity to improve dimension of fitness). The Public Health Physical Activity recommendations for older adults issued by the American College of Sports Medicine and the American Heart Association in 2007 highlight the fact that there is limited research on which to base fall prevention recommendations about type and amount of physical activity, hence recommendations are limited to exercise . Currently, with the exception of Tai chi, it is unknown whether other prevalent physical activities provide sufficient challenge to balance abilities. Walking, golf, bowls, cycling, dance or yoga, all are common leisure activities among older people  but their effectiveness in relation to neuromuscular age-related decline is yet to be shown.
The relative effectiveness of different dance styles has been suggested as a future area of research . In this study we assume that both dance styles (traditional and ballroom) are equally effective because they share similar principles: movements are synchronised to music and organised into spatial patterns which tend to be modular in organisation (i.e., composed of discrete sections that are repetitive). For example, the waltz rhythm appears in several folk and ballroom dances. Although there will be approximately 100 participants in each of the dance styles, this study is not powered to ascertain differences between the effects of the two dance styles on fall rates. However, it may be possible to explore differences between their effects on continuous outcome measures.
Many interventions are effective in a pseudo-laboratory setting but lose purchase in the “real world”. Dance compares favourably with other exercise programs in terms of dropout rates. In a comparison of line dancing with Tai chi in eight senior centres in Canada, the average dropout rate was significantly lower (10%) in dance classes than Tai chi classes (23%) . Also, about 40% of those who joined line dancing were motivated by ‘fun’ and 29% by ‘social reasons’, compared to 9% and 1% respectively for Tai chi. This 10% drop-out rate in dance classes is also considerably lower than the average drop-out rate from other senior-specific programs (e.g. cardio, strength, osteo, diabetes), which are reported to be on average 26% after 3 months and 49% after a year. It has also been reported that seniors who switch between activity programs (~21%) over a 3-year period are more likely to maintain exercise participation, suggesting variety helps sustain physical activity behaviour . Variety is intrinsic to dance, which does not suffer from the boredom associated with repetitive exercise training, not only due to the variety of steps, styles and music, but also because it is a social activity. For example, in NSW, a folk dancing group in a culturally diverse suburb of Sydney was established in 1989 and after ten years the group was still running autonomously and survived the departure of its founder , suggesting long-term sustained behaviour.
Current estimates indicate that the population prevalence of dance participation among older Australians is low; in all Australia Exercise Recreation and Sport Surveys only 1.6% of older men and 2.8% of older women reported participation in social dancing in the past 12 months.  In the New South Wales Fall Prevention Survey slightly higher percentages (2.5% and 4% for men and women respectively) reported they danced in the past week . In other countries the reported level is higher, such as in Canada where 10% of older adults participate regularly in social dancing . The low prevalence in Australia can be partially explained by poor accessibility to dance venues and a lack of classes that cater for older adults. It has been noted that participation in physical activity programs, including dance, is higher within Australian retirement villages than in the community . A primary reason for conducting the study in retirement villages was ease of access to a venue. At the completion of this study, we will be able to assess the potential for widespread dissemination. If dance proves to be efficacious, the challenge ahead would be to find ‘in-built’ mechanisms for dissemination such as the enhancement of dance organisations, a GP referral system , and strategies for minimising out-of-pocket expenses and maximising accessibility to venues.