A performance for all: How Dance for Health can nurture our health and wellbeing

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A Performance for All:
How Dance for Health Can
Nurture Our Health and
Wellbeing
Dr Nicoletta P Lekka, MD, MSc, PhD
Consultant Psychiatrist
Member of the IADMS Dance for Health Committee
e
Webinar, British Psychological Society L&HC Branch,
November 11th 2022

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Aims
• To understand how dance can be an important tool
in nurturing our psychological and physical health
and overall wellbeing
• To introduce Dance for Health: explore its positive
impact on physical and mental wellbeing, cover the
latest research, and discuss evidence-based
interventions

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Outline
• What is Health? What is Wellbeing?
• Dance ..and why it matters!
• Evidence-based benefits of dance
• Physical, Social and Mental Health
• Dance Movement Therapy
• Dance for Health
• Short videos – Enjoy!
• Acknowledgements, references, sources, photo credits

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What is Health?
• “Health is a state of complete physical,
mental, and social wellbeing and not
merely the absence of disease or
infirmity”
• “The ability to adapt and self-manage in
the face of social, physical, and
emotional challenges” c. (Photographer) Kazuo ota - Unsplash

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What is Wellbeing?
• Satisfaction with life
• A sense of autonomy, control and self-realisation
• The absence of depression and loneliness
• Wellbeing is important for individuals, societies, and public policy
worldwide, at all stages of life and levels of health
Sheppard & Broughton, 2020

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Dance ...and why it matters!

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Take a moment to reflect…
• What is your earliest memory related to dance?
• Who comes to mind when you hear the word “dancer”?
• What images come to your mind when you think of Dance
for Health?

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The supportive nature of dance
Oneness - aliceunderwoodfilms.com
https://youtu.be/hcEgMqIVHeI
movedancefeel.com
Camilla Greenwell (Photographer)

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What is Dance?
• “Artistic expression through rhythmic
movement to music”
• “Uniquely combines social, cognitive
and fitness components”
Hwang PW and Braun KL 2015, Millman, LSM et al , 2020
c. (Photographer) Kazuo ota - Unsplash

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Types of Dance
• Contemporary, freestyle, ballet,
folk/traditional (from all continents),
ballroom, Latin (e.g. tango, salsa), hip-hop,
tap, jazz...
• Zumba / step-aerobics: dance fitness
programs
Hwang PW and Braun KL 2015, Millman, LSM et al , 2020

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Dance and Healthy Living
• Dance activities: can improve body
composition (incl. BMI and total fat mass),
blood biomarkers (incl. cholesterol,
triglycerides and markers of oxidative stress)
and musculoskeletal function (including
balance, sit-ups and sit-to-stand time)
• Results significantly greater than those seen
with regular exercise interventions in many
studies
Fancourt, D. and Finn, S. (2019)
c. (Photographer) Nadim Merrikh - Unsplash

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Dance and Healthy Living
• Dance: more effective than exercise in reducing body fat
• Weekly dance therapy over several months for those
who are obese: can improve body consciousness,
mental representations linked to body image and
perceived competence to exercise regularly

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Dance and Physical Health
• Dancing involves skills such as coordination
with music and retrieval of sequences of
movements, reinforcing spatial perception
and memory as well as executive functions
(working memory, flexible thinking, and self-
control)
• Dance may be more beneficial than repetitive
physical exercises and activate brain plasticity
mechanisms at a greater extent
Noguera, C et al, 2020
c. (Photographer) Nathalie Jufer, "Senior Stars"

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In older adults, dance may improve
• Muscular strength and endurance, dynamic
balance, and cardiovascular fitness
• Postural stability, physical reaction time,
flexibility, and cognitive performance
• Interoceptive awareness (body awareness)
Harrison, S et al, 2020. Hwang PW and Braun KL, 2015

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• Dance is equal to or greater than exercise in its
effectiveness to improve physical health
• Can help reduce physical health risks and
outcomes associated with sedentary and
inactive behaviour
• Health practitioners can recommend genres of
structured dance as a safe and effective choice,
particularly for those who prefer this form of
activity
Fong Yan et al, 2017
c. (Photographer) Clare Guss-West, "Senior Stars"

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Dance and Health
Dance interventions are used by patients with
• Parkinson's
• Fibromyalgia
• Cancer
• Hypertension
• Rheumatoid arthritis
• Multiple sclerosis
• Dementia
• Depression
• Anxiety
• ...and much more
Fancourt, D. and Finn, S. (2019), Hernandes, J.C. et al, 2018

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Stroke and other acquired brain injuries
• For motor rehabilitation after stroke, dance has been found to improve upper- and
lower-limb motor function, muscular weakness, balance, gait velocity, grip strength
and stride length.
• For individuals in wheelchairs following spinal cord injuries, dance improved the
range of motion, upper body strength and coordination, as well as decreasing weight,
resting pain and reaction time
• For young adults with physical disabilities, dance has been reported to enhance
communication, mobility, interpersonal relationships and community life

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Cerebral palsy
• Dance improved self-care, communication, cognitive function, psychosocial
adjustment and overall functioning, as well as balance, standing ability, gait, walking
and cardiorespiratory fitness
• Dance also improved postural control in children with cerebral palsy and helped with
emotional expression, social participation and attitudinal change
• Parents reported enjoyment and therapeutic benefits for their children from dance
• Promising preliminary studies on wheelchair dance for children with severe cerebral
palsy

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Surgery and invasive
procedures
For chronic pain or fibromyalgia,
following either surgery or injury,
dance programmes of 12–24 weeks
were found to reduce pain and
improve quality of life, depression and
physical function
c. (Photographer) Rainier Ridao - Unsplash

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Degenerative neurological disorders
Parkinson’s Disease (PD)
• Clinically meaningful improvements in motor scores, balance, gait speed and
functional mobility
• Dance studies involving people with PD have also typically shown high compliance
rates, low dropout and continued activity beyond the study period, as well as
improved quality of life and decreased isolation.
Multiple Sclerosis
• Dance has been found to improve gait velocity, stride length, balance, smoothness of
motion and number of steps per minute

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Degenerative neurological disorders
Dementia
• Dance may support speech, as well as speech-related cognition
• Helps to reduce social isolation and loneliness, partly through providing a sense of
security and belonging
• Can help to affirm identity, sense of self, and self-esteem
• Dance movement therapy also supported embodied nonverbal communication, even
when language deteriorated

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Dance and Health Prevention: Frailty
• Dance has been found to improve strength,
flexibility, motor ability, aerobic endurance, muscle
mass and body composition in older adults,
helping to prevent age-related functional decline
• Dance simultaneously trains movement, posture
and flexibility and has been linked with better
balance and lumbar bone density before puberty,
post-menopause, and in women with
osteoporosis
c. Unsplash

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Assisting with Management of Non-Communicable Diseases
Cancer
• Found to help with the management of mental health by reducing stress, anxiety and
depression and improving quality of life
Diabetes
• Dance improved control of blood glucose levels and blood pressure and also provided peer
support for coping with lifestyle changes following diagnosis
CVD
• Reduced heart rate and blood pressure, also improving exercise capacity

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Dance and End-of-Life Care
Palliative care
• Dance can help with coping with pain and
in supporting people with terminal illness
to feel connected with their bodies and
have a sense of self
Bereavement
• Singing and dancing are common funeral
activities across different cultures

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Breathe Dance
https://youtu.be/BiZBTdTAm4E
Breathe Dance - Breathe Arts Health Research

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Scottish Ballet - Dance for Parkinson's
Scotland
https://youtu.be/8VggGDz4SVQ

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Dance and Social Health
• Dance is appealing and socially engaging
• Dancing together disrupts loneliness / isolation
and connects people
• Dance can interfere positively on improving
health, well-being, and the quality of life of people
with different sociodemographic characteristics
c. (Photographer) Mikael Theimer

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Dance and Social Health
• Important mechanisms in group settings: mutual
support, empowerment, mutual trust, cohesion,
experience to be part of something larger,
corrective emotional experiences, social roles,
interpersonal learning
• Dance contributes to a sense of shared purpose
and a feeling of achievement c. (Photographer) Jolanda Prfunder, "Senior Stars"
Koch, SC et al, 2019

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Dance and Mental Health
• Dance can improve emotional, social,
psychological, and physical well-being
• Can promote self-expression, self-
esteem, self-confidence, and self-
motivation

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Dance and Mental Health
• Dance can have a positive impact on
quality of life, subjective well-being, and
body image
• Can improve stress management and
interpersonal skills
• Can decrease depression and anxiety c. Unsplash

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Dance - Trauma and Abuse
Dance can help people with PTSD to build a
healthy relationship with their body, including
• Helping to counteract body armouring (muscle
tensions in response to stress)
• Reducing perceived stress
• Increasing movement (which can become limited
and stiff following trauma)

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Dance interventions and COVID-19
• COVID-19 is affecting global mental health
• Increased levels of anxiety, depression,
insomnia, post-traumatic stress symptoms, and
general negative impact on mental health,
particularly among healthcare workers and
vulnerable groups (e.g. children/adolescents)
• Dance interventions: Possible opportunities for
improved mental health
c. (Photographer) Ahmad Odeh - Unsplash

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Gaps in research
Underrepresentation of
• Younger / middle aged participants
• Men
• Indigenous, LGBTQIAP+, and migrant populations
Sheppard & Broughton, 2020

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Dance and Mindfulness - Similarities
Mindfulness:
• Termination of rumination and automatic negative
thoughts, because of high concentration, focus on the
here-and-now, and a state of mind which allows the
participant to observe feelings and thoughts from a more
distant perspective
Dance:
• Experience of “flow”(a mental state of being fully immersed
and focused), absorption, focus on the here-and-now, high
concentration, physical presence, and joy

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What is Dance Movement Therapy?
• A creative arts therapy (art therapy, drama
therapy, and music therapy are the other arts
therapies)
• Focuses on the expressive or improvisational
aspects of dance as a therapeutic tool, rather
than on specific movement patterns
c. (Photographer) Patrick Pleau - National
Centre for Dance Therapy – Grands
Ballets Canadiens de Montréal

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Dance Movement Therapy and
Mental Health
• The psychotherapeutic use of movement to
promote emotional, social, cognitive, and
physical integration of the individual, for the
purpose of improving health and well-being
• Founded on the principle that movement reflects
an individual’s patterns of thinking and feeling

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Dance Movement Therapy and
Mental Health
A form of psychotherapy that
• Uses non-verbal communication
• Emphasises the human body as its primary means of
communication and expression
• May offer a way to work through issues that are difficult to
articulate because they are painful, frightening, or simply
difficult to access and address through cognitive means
Karkou, V et al, 2019

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Take a moment to reflect…
• What kind of music comes to mind when you think of
Dance for Health?
• Who do you see dancing to it?
• What do you feel when you see people dancing?

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IADMS Dancing for Health Film
https://youtu.be/HjpNV6jCMNY

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Dance for Health
• Dance for Health provides holistic, evidence-based
activities for the individual to manage and adapt to
physical, mental, and social health challenges.
• In Dance for Health sessions, trained teaching
artists engage people as dancers, rather than
patients, in joyful, interactive, artistic practice.
Dance for Health, IADMS

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Facebook ‘Global Dance for Health Community’
• IADMS Global Dance for Health Community promotes dance as a life-long partner for health
and well-being.
• We spotlight and disseminate innovation in both Dance for Health research and practice,
cultivating medical, scientific, and artistic excellence in the field.
• This is a community of supporters and advocates for Dance for Health: of teaching artists,
health care professionals, dancers, lecturers, researchers and education and health care
strategy makers. Our difference is our strength.
• Together we cultivate and magnify Dance for Health advocacy and education, to advance
the implementation of this visionary field for the public at large and in targeted health care
practice.

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Dance for Health (DfH) IADMS Champions
• IADMS Dance for Health Champions are members either working in the field of
DfH, following DfH developments out of personal or professional interest, or new
to DfH and curious to find out more.
• These supporters and advocates for DfH volunteer time, passion, and expertise to
support the initiatives of the IADMS Dance for Health Committee.
• Together we cultivate and magnify internal advocacy and organise activities to
integrate IADMS health care and DfH members.
• Champions take on the role of bridges to advance and diffuse knowledge,
research, and best practice in the field of Dance for Health.

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Dance - A joyful, creative experience
• A meaningful, valued and enjoyed activity
• Great sense of pleasure, leading the individual to
find a sense of belonging
• Feelings of joy, satisfaction and social
connectedness likely to have significant role in
encouraging attendance / completion of a dance
intervention

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Side by Side: Reflections on Two Lifetimes of Dance
‘Even though in this time of uncertainty we are challenged about the
role of dance, we know that we will continue to communicate through
dance. I am reminded that everyone finds his or her own way in
dance, that no one way is the right or only way.’
Ann Kipling Brown
Kipling Brown, A. and Penniston Gray, A., 2021.

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Side by Side: Reflections on Two Lifetimes of Dance
‘I am excited by how people have engaged in dance and with others,
how professional dancers, schools, and companies are generously
sharing their teaching and resources and how many have found
dance to be a new place to connect with family, friends, and
strangers.’
Ann Kipling Brown
Kipling Brown, A. and Penniston Gray, A., 2021.

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Power
https://youtu.be/a5YRtjJZLrs
www.movedancefeel.com
Created by
www.aliceunderwoodfilms.com

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Release
https://youtu.be/ADXdGP-3zY8
Created by

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Joy!
https://youtu.be/bBwzVkIAujg
Created by

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Sources
What is the evidence on the role of the arts in improving
health and well-being?
A scoping review.
Health Evidence Network synthesis report, No. 67
Daisy Fancourt and Saoirse Finn
Copenhagen: WHO Regional Office for Europe; 2019

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References - Sources
• Fong Yan, A., Cobley, S., Chan, C., Pappas, E., Nicholson, L.L., Ward, R.E., Murdoch, R.E., Gu, Y., Trevor, B.L., Vassallo,
A.J., Wewege, M.A. and Hiller, C.E. (2017). The Effectiveness of Dance Interventions on Physical Health Outcomes
Compared to Other Forms of Physical Activity: A Systematic Review and Meta-Analysis. Sports Medicine, [online] 48(4),
pp.933–951. Available at: https://link.springer.com/article/10.1007%2Fs40279-017-0853-5.
• Harrison, S., Bierski, K., Burn, N., Mclusky, S., McFaull, V., Russell, A., Williams, G., Williams, S. and Macnaughton, J.
(2020). Dance for people with chronic breathlessness: a transdisciplinary approach to intervention development. BMJ Open
Respiratory Research, 7(1), p.e000696.
• Hernandes, J.C., Di Castro, V.C., Mendonça, M.E. and Porto, C.C. (2018). Quality of life of women who practice dance: a
systematic review protocol. Systematic Reviews, 7(1)92.
• Hwang PW, Braun KL. The Effectiveness of Dance Interventions to Improve Older Adults' Health: A Systematic Literature
Review. Altern Ther Health Med. 2015 Sep-Oct;21(5):64-70. PMID: 26393993; PMCID: PMC5491389.
• Karkou, V., Aithal, S., Zubala, A. and Meekums, B. (2019). Effectiveness of Dance Movement Therapy in the Treatment of
Adults With Depression: A Systematic Review With Meta-Analyses. Frontiers in Psychology, 10:936. doi:
10.3389/fpsyg.2019.00936.
• Karkou, V. and Meekums, B. (2017). Dance movement therapy for dementia. Cochrane Database of Systematic Reviews.
[online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464250/
• Kipling Brown, A. and Penniston Gray, A., 2021. Side by Side: Reflections on Two Lifetimes of Dance. Frontiers in Psychology, 12.

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References - Sources
• Koch, S.C., Riege, R.F.F., Tisborn, K., Biondo, J., Martin, L. and Beelmann, A. (2019). Effects of Dance Movement Therapy
and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update. Frontiers in Psychology, 10:1806. doi:
10.3389/fpsyg.2019.01806.
• McNeely, M.E., Duncan, R.P. and Earhart, G.M. (2015). A comparison of dance interventions in people with Parkinson
disease and older adults. Maturitas, 81(1), pp.10–16.
• Millman, L.S.M., Terhune, D.B., Hunter, E.C.M. and Orgs, G. (2020). Towards a neurocognitive approach to dance
movement therapy for mental health: A systematic review. Clinical Psychology & Psychotherapy. DOI: 10.1002/cpp.2490
• Noguera, C., Carmona, D., Rueda, A., Fernández, R. and Cimadevilla, J.M. (2020). Shall We Dance? Dancing Modulates
Executive Functions and Spatial Memory. International Journal of Environmental Research and Public Health, 17(6), p.1960;
doi:10.3390/ijerph17061960
• Sheppard A, Broughton MC. Promoting wellbeing and health through active participation in music and dance: a systematic
review. Int J Qual Stud Health Well-being. 2020 Dec;15(1):1732526. doi: 10.1080/17482631.2020.1732526. PMID:
32267216; PMCID: PMC7178871.
Photo credits
• Images by Clare Guss-West, Jolanda Prfunder and Nathalie Jufer are from Clare Guss-West's "Senior Stars" projects with
Konzert Theater Bern and University Bern Institute of Sports Science, Switzerland

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Acknowledgements
For valuable comments and suggestions, my very great appreciation to
• Clare Guss-West (CH)
• Emily Jenkins (UK/NL)
• Emma Redding (AUS)
• Sylvie Fortin (CA)
Dance for Health Committee, International Association for Dance Medicine & Science
(IADMS) www.iadms.org - an interdisciplinary team of teaching artists, dance educators,
researchers, and healthcare professionals
“Promoting dance as a life-long partner for health and wellbeing”

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Speaker
• Dr Nicoletta P. Lekka (MD, MSc, PhD) is a Consultant Psychiatrist in
Sheffield Health and Social Care Foundation Trust working in acute
inpatient services, Honorary Senior Clinical Teacher in Medical Education,
Sheffield University, and Accredited Coach.
• She is a member of the Executive Committee of the Royal College of
Psychiatrists Sport and Exercise Special Interest Group in the role of
Aesthetic Sports and Dance Liaison.
• She is also a member of the International Association for Dance Medicine
& Science (IADMS) Dance for Health committee and the IADMS mental
health advisory group.

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Thank you for listening!
Dr Nicoletta P. Lekka
T: https://twitter.com/nicoletta_lekka

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