A Novel High Intensity Short Interval Dance Intervention for Non Communicable Disease(NCD) Prevention in Asian Indian Adolescent Girls-THANDAV

A Novel High Intensity Short Interval Dance Intervention for Non Communicable Disease (NCD) Prevention in Asian Indian Adolescent Girls - THANDAV - a pilot study. This proposed developmental grant protocol will take place in India with a duration of 18 months. We will test a personalized exercise and education intervention, aided by digital technology to deliver this novel 'THANDAV' (Taking HIIT And Dance to Adolescents for Victory over NCDs) intervention.

The principal research question will be - Can a culturally appropriate high intensity short duration (10 min) dance intervention become sustainable exercise in Asian Indian girls aged 10- 17 years to improve their physical fitness and prevent NCDs? The burden due to NCDs has reached explosive proportions with the largest increases happening in low and middle-income countries like India. Exercises levels are abysmally low in India with women being less active than men. The benefits of physical activity in adolescents and youth are well established, with most global guidelines recommending at least 60 minutes of moderate to vigorous physical activity per day. Evidence suggests that adolescence is the time of steepest decline in physical activity, thus making our chosen cohort high-risk age group for diabetes and other non-communicable diseases. The age of onset of type 2 diabetes in India is in the age group of 25- 34 years. Hence, efforts to promote physical activity among adolescents and youth are essential.

The barriers to exercising in females include time constraints and exercise not being 'culturally acceptable'. Dance is a socially and culturally accepted form of activity in India. We hypothesize that the short duration and fun element of the THANDAV intervention, coupled with the cultural and social acceptability of dance, will aid the long-term sustainability of such an intervention, which is vital for NCD prevention. We aim to investigate the development, feasibility, acceptability of the intervention and resulting improvements in physical activity and fitness levels in adolescents. The primary outcome will thus be increases in physical activity as measured by step count leading to improvement in fitness levels as measured by heart rate of adolescent girls. After assessing the methodology and impact of the intervention through this pilot study, we plan to apply for the full trial grant wherein we will evaluate the sustainable impact of the THANDAV intervention with an improvised digital design on tangible metabolic health outcomes in a randomized controlled trial mode. The outcomes in the full trial grant will be metabolic parameters including weight, body fat, blood pressure, glucose, lipids, insulin along with important outcome measures including sustainability and scalability.

MDRF has been collaborating with multi-disciplinary investigators from the University of Dundee (UoD), Scotland (UK) since 2017 as part of a 4-year NIHR Global Heath Research Unit on Global Diabetes Outcomes Research. The India-Scotland Partnership for Precision Medicine in Diabetes (INSPIRED) project aims to improve the understanding of genetic, lifestyle and environmental factors underlying the high burden of diabetes and its complications. The THANDAV proposal is an extension of this existing collaboration with Dr. Colin Palmer being the Co-Investigator from University of Dundee (UoD), Scotland (UK).

The proposal aims to study the effect of the THANDAV intervention on physical activity, fitness levels,body weight and fat % in Asian Indian adolescent girls using digital technology.

High intensity interval training (HIIT) is a form of cardiovascular exercise plan alternating short periods of intense aerobic exercise with less intense recovery periods. Effective HIIT regimens can range anywhere from 4 to 20 minutes. Research has shown that HIIT regimens produced significant reductions in whole body fat mass, weight and improvement in cardiovascular fitness in both adults and adolescents. Various socio- cultural (such as not being allowed out late in the evenings) and environmental factors (such as lack of availability of safe places to exercise) prevent Asian Indian adolescent girls from exercising. Moreover, the term exercise has a 'male connotation' in India and exercising outdoors can lead to cultural 'inappropriateness'. However, dance is a culturally acceptable form of exercise, especially for girls. It is actively encouraged in the adolescent age group and is culturally looked upon as healthy, fun, appropriate and 'cool'. We thus incorporated the principles of HIIT in various Indian dance forms to produce this novel intervention called 'THANDAV'. The 10-min THANDAV routine will be developed in association with seasoned choreographers to ensure the ease and safety of the steps being performed. There will be a 2-min high intensity (80-100% of max heart rate (HR)) portion followed by a 30-sec low intensity (40-60% max HR) and four such repetitions will constitute a single 10-min routine. The 'THANDAV' website will offer details about the project and educational content after registration. Once women/girls are part of this online community, it will enable them to post their queries, talk about their experiences, watch 'THANDAVITES' dance videos and share their own on this webpage.

We propose to use the THANDAV intervention as an innovative and novel approach to improve and sustain physical activity in adolescent girls. The proposed outcomes from this project will be as follows:-

(a) Improving fitness levels in girls in order to combat obesity / NCDs

(b) Convince National, state, district government authorities to make THANDAV part of regular PT routines at schools

(c) Dissemination of the intervention to a wider audience including women through THANDAV workshops.

The THANDAV intervention is the 'first of its kind' and targets Asian Indian adolescent girls. This is a socially / culturally acceptable intervention, which can be done in any setting and requires little time. Additionally, we tap into the wide spread use of the digital medium by adolescents to promote healthy behaviors thus ensuring that the intervention could have long-term sustainability and scalability.

THANDAV intervention is thus suitable for Asian Indian girls/women across age groups and socio economic strata.