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After teaching thousands of students over the past 45 years, kumu hula Mapuana de Silva of Halau Mohala ‘Ilima said she believes anyone can benefit from hula in some way. At 72, she said she’s seen how hula has helped to improve her own health and the well-being of her haumana (students).
“Hula is one of the best ways to stay in good health, not necessarily only physically, but mentally, emotionally and spiritually, and especially for Native Hawaiians because this is our culture,” she said. “Anyone who wants to can dance hula. Once you find the right teacher, you’ll find that hula unlocks so many doors to the world.”
De Silva and other kumu hula are partnering with the University of Hawaii’s John A. Burns School of Medicine to study if hula, coupled with other lifestyle interventions, can help improve vascular health and maintain or improve cognitive function for Native Hawaiian and Pacific Islander kupuna at risk for Alzheimer’s disease and dementia. The study builds on previous research that showed hula can help improve blood pressure and reduce the risk of cardiovascular disease and other chronic conditions among Hawaiians, and also aims to address the gap in public health access and research of indigenous communities.
The project is part of a larger initiative nationwide to address health disparities associated with Alzheimer’s disease and dementia among Native Hawaiians, Pacific Islanders, American Indians and Alaska Natives. Led by Washington State University, the project was awarded a $15 million grant from the National Institute on Aging, according to JABSOM.
Researchers are collaborating with 11 tribes, six academic and research institutions, seven Indian organizations and five Native Hawaiian and Pacific Islander community groups to study and better understand Alzheimer’s disease and dementia among indigenous populations.
Joseph Keawe‘aimoku Kaholokula, chairman of Native Hawaiian health at JABSOM and the project’s lead in Hawaii, said the specifics of the program are still being developed but recruitment of more than 200 participants is expected next spring. To qualify for the study, participants must be at least 50 years old, Native Hawaiian or Pacific Islander, have vascular risk factors such as high blood pressure, high cholesterol, obesity and diabetes, and show early signs of memory loss.
Once selected, participants will take hula classes twice a week taught by kumu hula on Hawaii island, Maui and Oahu for three months, and then will receive a mixture of hula and lifestyle intervention sessions focusing on healthful eating, stress management and exercise.
Researchers will monitor participants’ blood pressure, weight, blood sugar levels and cholesterol at different points during the one-year study.
The goal, Kaholokula said, is to get participants into the study early enough to help delay or even prevent them from developing full dementia.
“We’re hoping hula itself will be a cognitive exercise because they have to learn the (Hawaiian) language, memorize songs and chants, and do complex movements,” he said. “Social and cognitive engagement has also been shown to actually help people in reducing their risks for dementia in the future.”
Kaholokula and de Silva agree the research is particularly important for indigenous communities, who they say are over-represented when it comes to these chronic conditions but underrepresented in research and data. Kaholokula said he can recall only a few Alzheimer’s-related studies that have included Native Hawaiians and Pacific Islanders.
Nationally, more than 6 million people are living with Alzheimer’s disease, according to the Alzheimer’s Association. Dementia, a broader term used for a decline in cognitive function that interferes with daily life, and Alzheimer’s disease, the most common cause of dementia, are among the leading causes of death in seniors, even higher than breast and prostate cancer combined.
In Hawaii, 29,000 kupuna aged 65 years and older are living with Alzheimer’s disease, which is the fifth- leading cause of death in the state. That number is projected to jump to 35,000 in 2025.
Research shows NHPIs are more likely than white, Asian and African American populations to develop early onset Alzheimer’s disease and dementia in the U.S. But there is no data available for NHPIs in Hawaii. In 2019, the Alzheimer’s Disease Research Centers, a major source of data on dementia, included just 29 NHPIs out of its more than 38,000 study participants.
But data does show that NHPIs have a higher prevalence of high blood pressure, obesity and diabetes, which are risk factors that increase the likelihood of developing dementia, than any other ethnic group.
De Silva and Kaholokula agree that using culturally based practices when addressing health can be key to providing participants with an activity that resonates with them and to which they feel connected.
During their previous study on how hula can help to improve blood pressure and reduce the risk of cardiovascular disease among Hawaiians, they had an 80% retention of participants over one year, which Kaholokula said is uncommon for clinical trials. It was also one of the first studies to use a cultural practice to address cardiovascular disease in an indigenous population, he said.
They also pointed out that some of the participants joined a halau and have continued dancing even after the study ended.
De Silva said she hopes the benefits of hula will extend beyond the study’s parameters.
“We want to prove that culture, as it exists, already contains the elements needed to stay healthy. That is first and foremost in every study we’ve done,” she said. “We’re not trying to make the people who come into our studies hula dancers. We’re hoping that hula, at the very least, will be the catalyst to motivate them to take charge of their health.”
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Jayna Omaye covers ethnic and cultural affairs and is a corps member of Report for America, a national service organization that places journalists in local newsrooms to report on undercovered issues and communities.
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