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Five years and 784 hula classes later, preliminary research from the University of Hawaii is showing how hula can be an effective method to manage high blood pressure.

The KaHOLO project, also known as Ola Hou I Ka Hula, began as and transformed into a randomized clinical trial backed by funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

For the past five years, UH researchers tracked more than 260 Native Hawaiian participants, mostly female, across three different islands. They attended a one-hour hula session twice a week for three months, thanks to partnering hula groups and health centers. Nearly all participants were taking intensive medication for hypertension when they began the program.

As a result, the dancers reduced their systolic blood pressure , significantly reducing their risk for heart disease and stroke — ailments that Native Hawaiians are four times more likely to experience than non-Hispanic white patients.

“Dancing hula together is a means of exercise, moving, camaraderie, and sweat — a lot of sweat,” said Arma Oana, who lost weight and improved her blood sugar levels after incorporating hula into her weekly routine. “I probably would have had a heart attack or stroke by now.”

Principal investigator Joseph Keawe‘aimoku Kaholokula, a professor and chair of the department of Native Hawaiian health at the University of Hawaii John A. Burns School of Medicine, said he believes it is the largest clinical trial to date focusing on Native Hawaiians exclusively.

It required nothing fancy, such as jazzercise-inspired aerobic hula, he said. Just hula at its traditional core.

“This is the first study that I know of that used an indigenous cultural practice without changing it,” Kaholokula said. “This is above and beyond medical intervention, since all of our participants were under physician care. What it shows is that we can leverage our cultural practices for health promotion.”

The kaholo, or hula’s two-step vamp, also has a literal translation: to move swiftly. When researchers analyzed metabolic equivalents, they found hula could be just as strenuous as a pick-up basketball or tennis match.

But basketball or other exercise interventions may not be as appealing to all patients dealing with hypertension. Hula, however, was an activity within grasp for those involved.

The social support and confidence boost made a clear difference, said Māpuana de Silva, who leads Hālau Mōhala ‘Ilima and guided 10 other kumu hula involved in the study.

After a year, nearly 80% of participants stuck with the program — a rate typically unheard of in clinical trials, Kaholokula said.

The American Heart Association selected the study’s findings as part of its Hypertension 2019 Scientific Sessions held in New Orleans this month.

Mele Look, the study’s co-investigator and director of community engagement at the UH medical school’s Department of Native Hawaiian Health, is exploring the idea of getting hula memberships covered by health insurance plans, just like gym memberships.

“Across the nation, they’re realizing if we want changes and improvement to health especially among minority populations, we have to address them in ways that are culturally relevant,” Look said.