IS DANCE THE BEST FORM OF EXERCISE? HEALTH BENEFITS OF DANCE EXPLAINED

“Wherever the dancer steps, a fountain of life will spring from the dust.” - Rumi

Are we made to dance? The likely answer to this question is yes. Anyone who thinks they can’t dance ought to consider how much it is a part of our cultural heritage as human beings before deciding against it! Experts speculate that dancing has likely been a component of human life even before the dawn of civilization, spanning as far back as 1.5 million years ago. Back then it was used as a means of communication between prehistoric humans in order to maintain survival^[1].

Since these ancient times, dance has evolved into something far more than just a means of communication. This article explores the benefits of dance as a highly refined and enjoyable form of exercise, that improves upon health, well-being and the quality of life for most who participate. 

Dance May Be Central to Human Well-Being

Well-being is crucial to optimal health, and often cannot be fulfilled merely through consuming a healthy diet and leading a healthy lifestyle. It demands engaging in activities that inspire a sense of happiness, forging healthy social connections and developing oneself positively. Well-being has been defined in scientific literature as “a multidimensional construct, which includes satisfaction with life, a sense of autonomy, control and self-realization, and the absence of depression and loneliness.”^[2]

Human life is full of opportunities to promote well-being, as a product of our history. Social gatherings are often centered on fulfilling the needs stipulated in the above definition of well-being, with central themes of physical, creative, and spiritual activity. Dance is one element of human existence that has the potential to merge all these themes in order to maintain well-being and therefore have a profound impact on health.

Health Benefits of Dance

Dance is a cross between both an art form and a sport. Both types of activity are associated with enhancing well-being.

Participating in dance has additionally been linked with the following health benefits:

1. Fitness, Coordination and Balance. Dance is best known for improving fitness, coordination and balance in all who participate, no matter their proficiency.^[3] Unlike other forms of exercise, dance improves upon these factors in a fun and creative way that serves to promote spatial intelligence, physical expression and imagination.^[4] Certain types of dance also appear to improve posture, contributing towards overall musculoskeletal fitness.
2. Cardiovascular Health. Long-term participation in moderate-intensity dance classes has been linked with a reduction of mortality in those with cardiovascular disease.^[5] In the elderly, dance has been shown to improve overall systemic oxygenation and cardiorespiratory fitness, therefore improving significantly on cardiovascular health.^[6] These results are more pronounced for physically intensive forms of dance.^[7] Other studies indicate that some forms of dance are capable of lowering blood pressure.
3. Immune Function. Dance has been linked to increasing total white blood cell counts in participants over an 8 week period, particularly those who consumed a beverage enriched in honey beforehand.^[8] Diabetics that attended dance classes over a 4 month period were shown to have a better neutrophil profile with significant reductions in inflammatory markers.^[9] Dance has been shown to enhance IgG antibody production^[10]. Contrary to these findings, some forms of intensive dance, such as ballet, competitive ballroom dance and high-intensity street dance were all shown to increase inflammation levels. This was nevertheless associated with enhancing the adaptive immune response.
4. Mood. Like many forms of exercise, dance is associated with the release of neurotransmitters and neuropeptides, such as serotonin and endorphins, that positively improve upon mood. Studies highlight that dance is able to reduce anxiety^[11], stress^[12] and promote a good mood^[13] in all who participate (this doesn’t apply to performing dance in a competition under stressful conditions^[14]). Physical expression through dance is a great form of emotional release that many often underestimate. Other data reveals that those who participate in dance and dance therapies often show reduced levels of anger over time. The results are not as clear in those with mood disorders, however dance is reported to exert a modestly positive effect in those with depression^{[15] [16]} – the benefit of which increases over time.
5. Cognition. Dance is known in the literature to improve many aspects of cognition, including memory, focus and mental flexibility. Neurobiological markers tested post dance classes indicate that the brain is positively affected through exhibiting physical changes. These include an increase in hippocampus size, grey matter volume, brain-derived neurotrophic factor and enhanced white matter integrity^[17]; all of which suggest better neuroplasticity in dancers. These results also apply to the elderly that participate in dance classes^[18], revealing a potential neuroprotective effect against age-related cognitive decline.
6. Social Well-Being. Aside from improving both mood and cognition, dance is known to enhance several other aspects of one’s mental-emotional health. Life satisfaction increases through practicing dance^[19], as does one’s confidence, connection to self and ability to socialize. Genetic studies reveal that dancers have elevated levels of active genes that regulate serotonin and vasopressin expression, both of which make them far more social^[20]. It’s no secret that a dance class is a great place for meeting new people and making new friends that encourage social well-being and participating in healthier activities. This in turn is linked to improved motivation, reduced anxiety and less depression.
7. Graceful Aging. In a meta-analysis that aimed to assess the benefits of dance for the elderly, it was shown that dance of any style is able to improve metabolism and balance in aged individuals, with or without chronic illnesses. Most data included interventions that spanned a length of 60mins, 3 times a week for a minimum of 12 weeks.^[21]
8. Better Stress and Pain Management. Studies indicate that dance elicits an improvement in perceived control over the body through mastering movement and distracting from pain and/or tension. This has been shown to condition better coping mechanisms in response to stress and pain; thereby decreasing the risk of related disorders, increasing personal resilience and improving life quality.^[22]This benefit falls short in the context of competitive dance, which has been associated with an increased frequency of joint pain and stress.

Dance as a Complementary Therapeutic for Chronic Disease

Dance has not been studied as much as exercise has with respect to enhancing outcomes in patients with chronic diseases. According to one large-scale meta-analysis study, a variety of dances were shown to enhance outcomes for a small amount of patients with the following disorders^[23]:

• Obesity and diabetes
• Heart disease and hypertension
• Lung disease^{[24] [25]}
• Cancer
• Rheumatoid Arthritis
• Fibromyalgia
• Low Back Pain
• Spinal Cord Injury
• Post Stroke Hemiparesis
• Multiple Sclerosis
• Cerebral Palsy
• Parkinson’s Disease
• Alzheimer’s Disease
• Schizophrenia
• Intellectual Disabilities

Participants were asked in most cases to dance once a week for a minimum of 8-12 weeks, however the studies ranged from 2 weeks to 2 years. Modest benefit was only truly seen after 4 weeks across all studies, with the longer studies yielding the best results. Parkinson’s disease is the most studied disorder in relation to dance, to which the most benefit has been proven for patients that participated in dance programs.

Most of the results report an improvement in balance, walking, coordination, pain, cognition, mental health and quality of life. Interestingly, balance, coordination and disease-specific symptoms appeared to herald the greatest improvements across all studies; highlighting the therapeutic potential of dance.

In cases where participants were either under or overweight, there were improvements in body mass index. Social skills, motivation and mood also were noted to improve in a subset of studies, while none of the participants contracted any additional fatigue.

These results ought to be interpreted with caution, as they are among the first of their kind to be published. Nonetheless, they suggest a positive association with dance and enhancing the quality of life for patients.

Dance vs Regular Exercise

When taking into consideration more than 11000 studies, it would appear that dance is equally as effective and even sometimes trumps the benefits associated with other types of structured exercise.

Dance seems to improve upon body composition, musculoskeletal function and blood biomarkers better than other types of exercise, while cardiovascular function and perceived mobility were equivalent across studies. ^[26]

Interestingly, a study conducted on sedentary middle-aged women revealed that dance alone proved to be slightly more effective at improving overall health than dance in combination with a strength training program.^[27] The main outcomes that were more pronounced in those that only did the dance class pertained to enhanced vitality and mental health.

There are several reasons as to why dance seems to be more effective than regular exercise:

• Neuroplasticity Oriented. Research shows that dance is superior to other forms of exercise in terms of promoting neuroplasticity and mental flexibility, particularly in the elderly^[28]. The increased freedom associated with dance inspires the dancer to think, feel and act in new ways that correlate to structural brain changes, therefore capable of aiding in the prevention of age-related cognitive decline. 
• Excellent Adherence. Adherence to dance is much higher than many other forms of exercise, likely due to the social component and the satisfaction that arises with practice through time. Many types of dance are creative and expressive, as well as goal-oriented, all of which help to keep one interested and motivated in continuing the practice.
• Ease of Participation. Moreover, the creative component lends itself to an unlimited adaptability that is central to dance, which allows for anyone to easily participate. This is especially pertinent to many forms of chronic disease in which physical or mental handicaps may prevent a person from attempting specific types of exercise.
• Associated with Improved Satisfaction. In several studies, dance is associated with increased perceptions of joy and satisfaction, which arise from both physical and social activity. The more one practices, the more rewarding dance becomes as one achieves better levels of proficiency. Unlike many repetitive forms of exercise, dance inspires creativity and physical self-expression which gives rise to immense satisfaction through exploring novelty.
• Tailored Fitness. Unlike many types of exercise, dance allows for a much easier transition towards physical fitness. One is able to perform the movements at their pace and practice them until they are fluid. The creative component of dance detracts from the relative demand required from other forms of exercise to exert oneself until physically fit enough to perform the activity. This allows for participants to slowly build their fitness levels up without overexerting themselves and to participate irrespective of their physical constraints.
• Appropriate for all ages. A quick look at the evolution of human culture suggests that all of us are made to dance! Dance has been shown to benefit people of any age, from children to the elderly.
• Inclusion of Music. The rhythmic, musical and creative aspects of dance add yet another layer of benefit to the activity that keeps one focused, motivated, and that promotes mental-emotional well-being^{[29] [30]}. Listening to music alone is known to regulate one’s mood. When combined with dance, the effect is enhanced through regulating the heart beat and enhancing circulation.

Are There Drawbacks to Dancing?

Perhaps one of the few drawbacks with regard to dance is that it may only work a limited set of muscles. This is not so much of a concern for most people, as the need to engage in physical activity is greater than engaging in physically balanced activity. Furthermore, it is rare that exercise programs cater to all muscle sets in the body in a balanced fashion. Dance is still able to improve and maintain adequate physical fitness levels.

The only other drawback currently known pertains to specialized types of dance that promote the use of footwear that could potentially lead to musculoskeletal problems after lifelong use. These include high heeled shoes and pointed ballet shoes.

Competitive forms of dance are typically associated with slightly worse outcomes, as the context involves performing under stressful conditions and intensive training. Most people will not make use of this form of dance, which can be better viewed as a sport best left up to athletes.

Types of Dance: Which is Best?

There is no true answer to the question “what type of dance is best for health and well-being?”. It’s as subjective as one’s taste in music. The answer depends on the person asking and what they hope to achieve from dancing.

For some, the best types of dance are competitive, while others would prefer recreational dance. Dance of various kinds are used as tools for promoting religious and spiritual connection, engaging people in arts and culture, socializing, bio-psychotherapy, and even eroticism.^[31] Styles of dance differ in their physical intensity, complexity and contact with other people. Each of these aspects of dance poses different effects on health and well-being.

A handful of dance types have been surveyed below for their comparative benefits. However, parameters of dance can be difficult to accurately test and thus research in this area is still in its infancy.

Ballroom Dance

Ballroom dance refers to a specific style of dance in which couples move rhythmically together within the context of a specific style. There are more than 10 different types; however most of them have been studied generally as ballroom dance.

Benefits associated with ballroom dance include improved fitness, reaction time^[32] and (in the case of waltz) increases in bone density. Once proficiency has been learned, ballroom dancers are able to stably maintain these benefits through consistent practice. In aged couples who practiced ballroom dance, the activity was associated with increased life satisfaction, “successful” aging and a better social life.^[33]

In studies looking at the effect of ballroom dancing on gender, female ballroom dancers appear to undergo more intensive exercise than their male partners due to their unique hold technique relevant to most styles. Results show that during a dance session, the female dance partner’s heart rate is higher and oxygen consumption is increased.^[34]

When compared against yoga, team sports and individual sports, ballroom dance was linked with the largest decrease in scores for depression.^[35]

However, competitive ballroom dancers were shown to experience an increase in physical complaints on average. When tested in small-scale studies, it was revealed that while ballroom dancing reduces stress and improves physical fitness, it appears to increase inflammation.^[36] Therefore, competitive ballroom dance may not be the best option for those with chronic disease.

This observation may be heightened in women due to having to do intensive physical activity in high heels for hours on end. Wearing high heels has been linked with more musculoskeletal pain, an increase in the risk for injury and bunion onset.^[37]

Theatrical Dance

Theatrical dance refers to forms of dance that are performed in a theatrical setting, often artistically depicting a story or expressing a series of moods. Tap dance and ballet are two of the most popular types of theatrical dance, both of which can be performed in competitive and non-competitive settings:

• Tap Dance

Tap dancing is known to yield a lesser chance of injury compared to other performance dance types.^[38] In a 16 week trial on diabetic patients at a high risk of contracting diabetic foot, tap dancing was shown to improve ankle range of motion, lower extremity strength, balance and posture^[39].

A study conducted on proficient female tap dancers revealed that after practice, tap dancing can be as effective a workout as using a treadmill. The results reveal that it is able to substantially enhance aerobic fitness and cardiovascular health.^[40] Other data highlights the way in which tap dance is able to significantly enhance lower limb coordination.^[41]

The rhythmic aspect of tap dance is akin to making music and is therefore likely able to provide a protective effect on cognition.

• Bollywood Dance

Bollywood dance (aka Indian film dance) is an Indian style of dance that depicts a story, often in Bollywood films. It combines elements of Indian folk and classical dance styles, as well as other styles of dance, including Jazz, Latin ballroom, Hip-Hop and Arabic dance.

While evidence on this dance form is limited, recent studies show that Bollywood dance is able to effectively improve upon fitness and muscle strength. Moreover, Bollywood dancing truly stands out for its balance-enhancing effects. Results suggest that Bollywood dancers have a better sense of balance under challenging conditions^[42] as compared to other types of dancers. Additionally, traditional Indian dance has proven to enhance balance in children with Down Syndrome more effectively than neuromuscular training.^[43]

Bollywood dancing is currently being explored as a way to improve the fitness, health and quality of life in Indian immigrants. So far, this culturally-appropriate dance form was able to improve upon all these parameters in Indian women living in foreign countries, with additional benefits to mental-emotional well-being^{[44] [45]}. Furthermore, this population is noted to be at a mildly higher risk of type 2 diabetes; for which Bollywood dancing was shown to effectively reduce diabetes biomarkers and weight.^[46]

The prevalence of injury and pain-related disorders is much lower in competitive Bollywood dancers as compared to dancers performing other competitive dance forms.^[47]

• Ballet

Most studies report that ballet is capable of improving upon fitness levels, balance and muscle strength^[48]. In spite of the benefits, professional ballet dancers are known to develop joint pain and related diseases, including arthritis. Inflammation is known to increase after intensive ballet classes, resulting in neutrophil cell death and a reduced humoral immune response to potential stressors.^[49]

It is possible that these negatives are only associated with competitive forms of ballet. Other sources indicate that ballet may be associated with either increases or reductions in bone mineral density in the long run. Increases were associated with non-competitive ballet participation.^[50]

• Contemporary Dance

Contemporary dance is an expressive blend of several dance styles, including jazz, modern dance and ballet. It is enjoyed by both the old and young when done in a non-competitive setting.

There is little data on the health benefits of contemporary dance alone. Studies reveal that it has proven superior to both fall prevention programs and taichi in terms of enhancing mental flexibility in those with dementia.^[51] When combined with physiotherapy, contemporary dance has shown to be effective at improving posture and life satisfaction in those with Parkinson’s Disorder.^[52] High-intensity street dance, a type of contemporary dance, greatly improved total white blood cell count in male dancers, however this was observed in conjunction with transient immune suppression.^[53]

As seen with ballet and other competitive dance forms, the risk of injury increases in dancers that transition from amateur to professional. However, once at a professional level, the risk of injury decreases again.^[54] Professional-level contemporary dance is associated with a higher degree of stress compared to other dance forms, and students in top-performance dance schools are at an elevated risk for mental health issues.^[55]

Traditional Dance

Traditional dance is most often non-competitive, social, fun and relaxing, with similar outcomes across all types. Examples include:

• Square dancing is known to be a very fun form of dance that incorporates a major social element which sets it apart from other forms of dance. Studies reveal that the combination of moderate physical activity and social contact inherent in square dance boosts cognitive processing capacity^[56], social cohesion and confidence.^[57]
• Belly dancing is a fun form of exercise, usually performed by women, that is associated with improving body image, quality of life, sexual function and overall well-being^[58]. It may also be able to lower depression and fatigue in those with breast cancer.^[59] Studies indicate that the intensive pelvic exercises that form part of belly dance may be effective at preventing age-related urinary incontinence by improving pelvic floor muscle strength in women^[60].
• Scottish dance was shown to enhance coordination and delay age-related motor problems better than regular physical activity in an aged population. ^[61]
• Greek dance similarly improved upon balance, fitness and hand-grip strength in an elderly group of 130 participants^[62].
• Turkish folklore dance was able to enhance physical fitness, quality of life and balance in senescent women.^[63]
• Tibetan Guozhuang dance proved effective at improving vascular health parameters in the elderly living at high altitudes. Results revealed improvements in bloodflow, reductions in vascular plaque buildup, lower blood pressure as well as a decrease in inflammatory vascular markers in those who participated.^[64]

Recreational (Club) Dancing

Different to all other forms of dance previously discussed, recreational dance lends itself to the ultimate flexibility and is most often carried out amongst young people in a club or party setting.

Health benefits have been documented for such dancing, and include reduced anxiety, improved mood, and better social skills. Nevertheless, the down side of this form of dance pertains to confounding variables, such as dance intensity, alcohol intake, sleep deprivation and the potential use of recreational drugs. If carried out in a healthy context and at a moderate intensity, recreational dancing can be as healthy as non-competitive forms of dance, emulating many of the same benefits.

Dance Movement Therapy

Dance Movement Therapy (DMT) is a form of psychotherapy that makes use of dance and movement to support the mental, emotional and motor functions of the body.^[65] It has been used to treat a wide variety of psychological disorders from eating disorders to depression^[66].

Unlike conventional forms of dance, it is structured in a therapeutic setting wherein a psychologist (often also a trained dancer or choreographer) gets the patient to express themselves through movement and dance. It can emulate elements of cognitive behavioral therapy, as the brain responds to body movements subconsciously. The patient can therefore be guided from their sense of physical expression (emulating a psychopathology) towards that of emotionally beneficial movements which inspire a healthier psychology.

Studies show that by comparison to conventional dance, DMT was more effective at decreasing depression and anxiety, while improving upon quality of life, cognitive function and interpersonal social skills. By comparison, dance was more effective at improving upon psychomotor skills, such as balance and coordination.

DMT also displayed more consistency from participants, likely due to the psychotherapeutic connotations of the practice. Between both forms of movement, the health effects remained either stable or improved after 22 weeks.^[67]

Is Dance Safe for Everyone?

Professional dancers are at an increased risk for acquiring injuries when undergoing intensive training, much like professional athletes. Aside from this population, dance has proven to be exceedingly safe. In every study that tested the effects of dance on participants, there were no adverse effects.

Dance is the type of activity that anyone can participate in, no matter how skilled or unskilled they may be at it. Provided one does not overexert themselves physically or attempt any advanced movements ahead of time, non-competitive dance of any kind is exceedingly safe. Most participants are able to self-regulate their movements when engaging in dance. The activity is also often self-contained, not requiring props or additional equipment which may increase the risk of accidents and injuries.

Conclusion

Dance is one of the safest, most effective and uplifting forms of exercise known to man since prehistoric times. It has been proven superior to most conventional forms of modern day exercise regimens, through enriching social, mental and emotional well-being. Benefits of dance pertain to enhancing cognition, improving fitness, enhancing body image and self-confidence, as well as developing both spatial and creative intelligence. Different forms of dance are known to convey similar benefits when performed at a moderate intensity and in a non-competitive setting.

 

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