Sports Med

https://doi.org/10.1007/s40279-017-0853-5

SYSTEMATIC REVIEW

The Effectiveness of Dance Interventions on Physical Health

Outcomes Compared to Other Forms of Physical Activity:
A Systematic Review and Meta-Analysis
Alycia Fong Yan1 • Stephen Cobley1 • Cliffton Chan2 • Evangelos Pappas1 •

Leslie L. Nicholson2 • Rachel E. Ward3 • Roslyn E. Murdoch1 •

Yu Gu1 • Bronwyn L. Trevor1 • Amy Jo Vassallo1 • Michael A. Wewege3 •
Claire E. Hiller1

Ó Springer International Publishing AG, part of Springer Nature 2017

Abstract compared. Meta-analyses showed dance interventions sig-

Background Physical inactivity is one of the key global
health challenges as it is associated with adverse effects
related to ageing, weight control, physical function, long-
evity, and quality of life. Dancing is a form of physical
activity associated with health benefits across the lifespan,
even at amateur levels of participation. However, it is
unclear whether dance interventions are equally as effec-
tive as other forms of physical activity.
Objective The aim was to systematically review the liter-
ature on the effectiveness of structured dance interventions,
in comparison to structured exercise programmes, on
physical health outcome measures.
Methods Seven databases were searched from earliest
records to 4 August 2017. Studies investigating dance
interventions lasting [4 weeks that included physical
health outcomes and had a structured exercise comparison
group were included in the study. Screening and data
extraction were performed by two reviewers, with all dis-
agreements resolved by the primary author. Where appro-
priate, meta-analysis was performed or an effect size
estimate generated.
Results Of 11,434 studies identified, 28 (total sample size
1276 participants) met the inclusion criteria. A variety of
dance genres and structured exercise interventions were
nificantly improved body composition, blood biomarkers,
and musculoskeletal function. The effect of either inter-
vention on cardiovascular function and self-perceived
mobility was equivalent.
Conclusion Undertaking structured dance of any genre is
equally and occasionally more effective than other types of
structured exercise for improving a range of health out-
come measures. Health practitioners can recommend
structured dance as a safe and effective exercise
alternative.
Key Points
Structured dance of at least 4 weeks’ duration can
significantly improve physical health outcomes
equivalent to other forms of structured exercise.
Clinicians can recommend dance as a safe alternative
form of physical activity/exercise to reduce fat mass,
lower triglycerides, and improve cardiovascular
fitness, flexibility, and day-to-day functionality.

& Alycia Fong Yan

alycia.fongyan@sydney.edu.au 1 Introduction
1
Faculty of Health Sciences, The University of Sydney, Addressing physical inactivity is one of the key health
Sydney, NSW, Australia
challenges for the twenty-first century [1]. A sedentary
2
Sydney Medical School, The University of Sydney, Sydney, lifestyle significantly increases the risk of developing
NSW, Australia
serious health problems, including osteoporosis and car-
3
School of Medical Sciences, UNSW Australia, Sydney, diovascular and metabolic diseases, and increases the risk
NSW, Australia

123

of mortality [2–4]. Not only is physical activity ‘medicine’
for the aforementioned diseases, it also confers innumer-
able benefits during ageing, aiding weight control, main-
taining physical function, and improving longevity and
quality of life [5]. Thus, engagement in physical activity
and exercise should be a habitual component across the
lifespan [3, 6]. Even more alarming than the lack of
physical activity amongst adults, and despite the beneficial
effects of physical activity from a young age being well
known, only 2.5% of children exercise adequately [7]
according to recommended levels [8]. Despite the reported
benefits, physical activity levels continue to decline with
age [9].
What is probably even more challenging than starting an
exercise programme is maintaining moderate or vigorous
physical activity levels throughout adulthood [10]. High
levels of intrinsic motivation appear to be the key to
instituting and maintaining physical activity participation
[11]. Enjoyment has been shown to be a strong predictor of
sustaining physical activity [12, 13], as participants who
find performing a physical activity enjoyable are more
likely to maintain it. Dance is commonly rated as a highly
enjoyable [14, 15], versatile, and adaptable [16] form of
physical activity. There has been notable growth in uptake
amongst older adults [17], though the greatest prevalence
of adult dance participation is in those aged 16–30 [18].
Thus, dance has the potential to contribute to optimal and
sustained participation in physical activity across the
lifespan and to be inclusive for various health conditions.
Dance is broadly defined as moving one’s body rhyth-
mically to music, usually as a form of artistic or emotional
expression. It can be practiced and performed alone, in a
pair, or a group, and often incorporates an intentional
pattern of movement which has an aesthetic value [19] and
requires some degree of physical or technical mastery.
Many different styles have evolved such as folk/traditional,
ballet, ballroom, Latin and hip-hop, with each requiring
their own set of skills and physical patterns of movement.
In this review, the term ‘dance’ encompasses any struc-
tured dance that has a pattern and sequencing of move-
ments with a recognisable technique. This definition of
dance is considered distinct from ‘dance and/or movement
therapy’, which focuses mainly on the expressive or
improvisational aspects of dance as a therapeutic tool [20],
rather than on specific movement patterns.
There is growing evidence regarding the health benefits
of dance across the lifespan, even at amateur levels of
participation. Non-interventional comparative studies
(where participants who currently dance are compared to
non-dancers) have reported that dancers have improved
cardiovascular fitness [21, 22], trunk strength, dynamic
balance [22], and bone mineral content (BMC) [23], when
compared to age- and sex-matched control participants.
123
A. Fong Yan et al.
Dance interventions have also been suggested to decrease
body mass index (BMI) [24] from high risk to normal
categories in adolescents. The positive effects of dance on
cardiovascular fitness, bone health, and obesity prevention
are further supported through a systematic review of the
health benefits of recreational dance in children and young
people [25]. Another systematic review investigating the
health benefits of dance in elderly populations [26] found
improvements in aerobic power, lower body muscle
endurance, strength, flexibility, balance, agility, and gait. In
terms of disease risk, moderate-intensity dancing has been
reported to reduce the risk of cardiovascular disease mor-
tality [27].
Even though previous reviews have provided evidence
for the beneficial effects of dancing, they have focused on
pre/post designs or comparisons with sedentary groups.
Thus, the question in regard to the benefits of dancing
compared to other forms of physical activity remains
unanswered. It is unclear whether dance interventions are
equally as effective as structured exercise programmes.
The lack of evidence base makes it difficult for clinicians
to recommend dance as part of an exercise programme for
the aforementioned benefits.
1.1 Objectives
The aim of the current study was to systematically review
the literature to investigate the effectiveness of structured
dance interventions, in comparison to structured exercise
programmes, on physical health outcome measures. Our
null hypothesis was that dance would be equally as effec-
tive as structured exercise programmes on all measures of
physical health. We hypothesised that there would be
increased adherence with dance interventions compared to
the structured exercise programmes.
2 Methods
The process of completing and reporting this review
adhered to the Preferred Reporting Items for Systematic
Reviews and Meta-Analysis (PRISMA) guidelines [28].
This study was registered in the PROSPERO international
prospective register of systematic reviews.
2.1 Search Strategy
Eligible studies were identified through a systematic search
without language restrictions of MEDLINE, Embase,
PEDro, Cochrane Central Register of Controlled Trials
(CENTRAL), SPORTDiscus, Web of Science, and Scopus
databases from earliest records to 4 August 2017. The
search strategy was designed by authors with assistance of
Dance Interventions and Physical Health
an experienced medical librarian. Conference proceedings
were included, and subsequent full-text publications were
searched. The search was limited to humans. Search terms
were as follows: [danc* or ballet or tap or jazz or ballroom
or salsa or tango or folk] AND [health or activities of daily
living or cardio* or neuromuscular or fall* or oxygen
consumption or VO2 or physical exertion or cholesterol or
glucose or participant* or ‘‘quality of life’’ or respir* or
fitness or flexib* or range of motion or power or balanc* or
pain]. Reference lists of identified and included studies
were also searched for any studies not found in the data-
base search. Inclusion and exclusion criteria for the review
were determined a priori.
2.2 Inclusion Criteria
Studies were included if they were a full original study
comparing forms of dance intervention to a structured
exercise programme. Dance classes must have been used in
the intervention, with dance class defined as instruction of
any dance genre with identifiable movement sequences.
Only studies with dance interventions lasting a minimum
of 4 weeks were included to allow adequate time for
measurable changes in physical outcomes. To be included,
studies must have incorporated measurable physical health
outcomes such as body composition measures, cardiovas-
cular fitness, blood and serum markers for cardiovascular
health, muscular strength, balance, flexibility, and func-
tional tests. Included studies had to report on a comparison
group that performed a structured exercise programme,
which could include aerobic activity and/or progressive
resistance training (PRT). There were no restrictions on
age, clinical condition, or language.
2.3 Exclusion Criteria
Studies were excluded from review if they were systematic
reviews, reviews of literature or single case studies;
investigated the effect of dance on psychological and
mental health outcome measures only; examined the effect
of dance therapy, movement therapy, or creative move-
ment; if the dance intervention was combined with other
types of structured exercise; and if the control group did
not exercise or were given unstructured physical activity.
2.4 Data Extraction
Two independent reviewers screened studies by title and
abstract and then by full text. The primary author solved
any disagreements between reviewers. Data extraction
from each included study was then performed by two
independent reviewers. Data extracted included the fol-
lowing: author names, year of publication, intervention
types (e.g. dance genre, structured exercise type), session
duration, intensity, and frequency, length of intervention,
and population (e.g. age, sex, condition), sample size,
attrition (calculated as the proportion of drop outs from the
initial sample size), adherence to the intervention (calcu-
lated as the proportion of sessions participated in from the
total number of sessions offered) as well as means and
standard deviations of all physical health outcome mea-
sures. The methodological quality of included studies was
independently assessed by two independent reviewers
using the Methodological Index for Non-Randomized
Studies (MINORS) tool [29], with any disagreements
resolved by the primary author.
2.5 Meta-Analysis
During data extraction, it was evident that several studies
commonly examined similar physical outcomes and
sometimes with similar forms of measurement. Therefore,
with complete pre- and post-intervention data reporting, a
meta-analytical synthesis became feasible. When four or
more studies examined a given outcome variable [e.g.
maximal oxygen consumption (VO2max)], mean and stan-
dard deviation data at pre- and post-intervention stages for
both dance and comparison exercise groups were trans-
ferred to Comprehensive Meta-Analysis software (CMA;
version 3). Data related to 13 physical outcomes were
transferred for independent analysis. For each, an invari-
ance random effects model was applied [30], assuming
studies drew potentially from divergent populations and
contexts, included possibly different research designs,
tested different dance genres, and had different exercise
comparison groups. Thus, a true exact effect size was not
expected to exist across studies.
With some physical outcome variables assessed using
consistent forms of measurement and others not, both
unadjusted mean differences (MD) and standardised mean
differences (SMD) were applied as appropriate. Overall
pooled estimates and confidence intervals (CIs) indicated
the effect of dance versus exercise comparison interven-
tions and were summarised in forest plots. The -
Z and p value tested the null hypothesis that pooled
estimates of dance groups were no more effective than
exercise comparison groups. As MD analyses retained their
common unit metric of measurement, their functional
meaning and interpretation was retained (e.g. kg and kg/
m2). Meanwhile, as SMD is on a standard deviation scale
and does not have a unit of measurement, effect sizes were
classified as small (0.2–0.5), moderate (0.5–0.8), and large
([0.8) based on Cohen’s [31] recommendations. Within
any given analysis, the Q statistic (with df and p value)
determined whether included studies shared a common
effect size. If studies shared a similar effect size, the
123

Q value would approximate the degrees of freedom. The I2
statistic identified the proportion of observed variance
reflecting differences in true effect sizes as opposed to
sampling error. If found, moderate (C 0.50) to high values
([75%) were used to suggest heterogeneity in effect sizes
between studies. T2 estimated between-study variance in
true effects, and T estimated the between-study standard
deviation in true effects. To determine the possibility of
publication bias, funnel plot symmetry was assessed with
MD or SMD, respectively, plotted against corresponding
standard error (SE). The Egger test [32] was used to con-
firm asymmetry, while Duval and Tweedie’s [33] ‘trim and
fill’ procedure was applied if asymmetry was present, and
to determine if overall estimates required adjustment based
on missing studies. If the null hypothesis was rejected and
publication bias was present, results of the Egger test and
trim and fill procedure were reported.
Where studies on a particular physical outcome did not
fulfil criteria for meta-analysis, but still reported complete
data (i.e. pre-/post-dance and exercise means, standard
deviations, and sample size), study effect size estimates
were generated using Hedges’ g [34]. Again, effect sizes
were classified as small (0.2–0.5), moderate (0.5–0.8), and
large ([0.8) based on the positive or negative direction of
the favoured trend. Any variables which were only exam-
ined by one study were not reported.
3 Results
The systematic search identified 11,434 records of which
10,803 were excluded during title and abstract screening.
The full texts of the remaining 631 studies were screened
for eligibility. Of these studies, 603 were excluded, with
the most common reasons being the following: 307 studies
did not deploy a comparative research design, 57 studies
combined dance and exercise in their experimental inter-
vention, and 51 studies did not report physical health
outcome measures. Twenty-eight studies met the inclusion
criteria (Fig. 1). One study reported data from the same
cohort in three different publications [35–37], while
another study reported results from the same cohort in two
publications [38, 39], resulting in inclusion of 25 different
studies. On assessment of methodological quality, inclu-
ded studies averaged 17.4 out of a possible 24 (Table 1).
The lowest quality study scored 7 out of 24 [40] for
failing to report on seven of 12 items. The highest
methodological quality score was 23 out of 24 [35] fol-
lowed by 21 out of 24 achieved by two studies
[36, 37, 41].
The demographic data for included studies [35–62] are
summarised in Table 2. The total sample size of all included
studies was 1276 participants (281 males, 813 females, 182
123
A. Fong Yan et al.
unreported) with the lowest sample size being ten and the
highest being 220 participants. A large variety of cohorts
were studied across the lifespan and health spectrum. Dance
genres studied included aerobic dance (12 studies
[40, 44–46, 48, 49, 52, 53, 55, 57, 59, 60]), folk/traditional
(four studies [41, 42, 50, 51]), Latin (five studies
[38, 39, 47, 56, 58, 62]), ballroom (four studies
[43, 47, 54, 61]), and Zumba (one study [35–37]). More than
half of the dance interventions had a class duration of 1 h or
more [35, 36, 38, 39, 41, 45, 47–49, 51, 54, 56, 58, 59, 61, 62],
with nine implementing dance interventions three times per
week [40, 43, 45, 46, 50–53, 55, 57]. Intervention length
ranged from 6 weeks [40, 44, 50] to 18 months [61].
Of the 25 included studies, seven examined cardiovas-
cular function, 11 measured body composition, four
investigated biomarkers, 18 investigated musculoskeletal
and functional outcome measures, and seven studies uti-
lised self-report questionnaires on physical function.
Where studies reported attrition, the mean rate was
16.32%. The highest attrition rate reported was 53.85% for
the cardio exercise group in a study where participants
were not included in the data analysis if adherence was
\70% [61]. Adherence with dance and exercise inter-
ventions was not reported in 13 studies
[40, 43–45, 47, 48, 50, 52, 53, 55, 57, 59, 60], while two
studies only reported adherence for the dance arm of
interventions [42, 54].
No raw data were provided in the study by Viskic-Stalec
and colleagues [60], so their data were extracted from
included graphs. After analysis of the graphs, it was
determined that for the 115 females (aged 16–18 years)
one standard deviation for body weight was reported as
1.2 kg. Since it was deemed unlikely that there was such
little variation in this measure, attempts were made to
contact the first author for verification; however, these
proved unsuccessful. Thus, the decision was made to
exclude the study from meta-analyses steps.
Overall, dance interventions produced similar effects to
structured exercise comparison interventions, with dance
producing potentially greater benefits in some physical
variables. Outcome variables have been categorised and
summarised in Table 3.
3.1 Body Composition Outcomes
Eleven studies [35, 36, 44–46, 49, 51, 52, 54, 59, 60]
examined the effects of dance versus exercise on body
composition variables. Eight studies examined body mass,
six BMI, four measured fat mass as a percentage of body
mass, three skinfold thickness, two fat mass, two fat-free
mass, two waist circumference, two measured bone min-
eral density (BMD), one measured breast circumference,
and one assessed BMC. Based on the eight independent
Dance Interventions and Physical Health

Idenficaon
Records idenfied through Addional records idenfied
database searching through other sources
(n = 33,008) (n = 2)

Records aer duplicates removed

(n = 11,434)
Screening

Records screened Records excluded

(n = 11,434) (n = 10,803)

Full-text arcles Full-text arcles excluded

Eligibility

assessed for eligibility (n = 603)

(n = 631) • Abstract only = 7
• Dance + exercise = 57
• Creave dance = 10
• Dance therapy = 23
Studies included in • Duplicate data = 8
qualitave synthesis • No physical health
(n = 28) outcome = 51
• < 4 weeks duraon =
22
Included

• Wrong study design =

Studies included in 307
quantave synthesis • Unable to be retrieved
(meta-analysis) = 14
(n = 23) • Other = 104

Fig. 1 Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) [28] flow diagram of the study screening process

studies examining body mass, meta-analysis did not iden-
tify a significant pooled MD estimate (body mass = 0.81
kg; 95% CI - 1.97 to 0.36; Z = - 1.36; p = 0.17), sug-
gesting dance interventions did not have a greater effect
on body mass reduction relative to exercise interventions.
However, based on the six studies examining BMI and four
examining total body fat reduction, the null hypothesis was
rejected. Dance intervention—relative to exercise—did
have a significantly greater effect on BMI and total fat
mass reduction, respectively, with SMD = - 0.43 (95% CI
- 0.84 to - 0.02; Z = - 2.43; p = 0.04) and - 0.39 (95%
CI - 0.68 to - 0.09; Z = - 2.57, p = 0.01). Table 3 pro-
vides accompanying statistics from the meta-analyses;
Fig. 2 shows a forest plot related to total fat mass.
In the studies not meta-analytically examined, aerobic
dance interventions led to significantly greater reductions
in skinfold measures compared to yoga (Hedges’ g = -
1.02) [40], a moderately greater effect relative to physical
education classes (g = - 0.49) [55], but a similar effect
compared to jogging and/or cycling (g = - 0.02) [59]
(Table 3). In the two studies [54, 59] examining waist
circumference; neither found a significant effect for either
dance or exercise.
3.2 Cardiovascular Function Outcomes
Seven studies investigated the effect of dance training
(relative to exercise) on indices related to cardiovascular
function [36, 43, 46, 51, 54, 57, 59]. Six examined VO2max
[36, 43, 46, 51, 57, 59]; four examined maximum heart rate
(HR) [43, 46, 51, 57] and peak ventilation (VE)
[36, 46, 51, 57], while blood pressure (BP) [36, 51, 54],
oxygen consumption at anaerobic threshold (VO2AT)
[43, 51, 59] and respiratory exchange ratio (RER)—the
ratio between carbon dioxide produced and oxygen con-
sumed [36, 43, 46]—were assessed in three studies. Peak

123
 A. Fong Yan et al.

Table 1 Quality assessment of Study Item number Total score

the included studies using the
Methodological Index for Non- 1 2 3 4 5 6 7 8 9 10 11 12
Randomized Studies (MINORS)
[28] Arzoglou et al. [42] 2 2 2 2 0 2 1 0 1 2 2 1 17
Barene et al. [36] 2 1 2 2 0 2 2 2 2 2 2 2 21
Barene et al. [37] 2 1 2 2 0 2 2 2 2 2 2 2 21
Barene et al. [35] 2 1 2 2 2 2 2 2 2 2 2 2 23
Belardinelli et al. [43] 2 1 2 2 1 2 2 2 2 2 2 1 21
Burgess et al. [44] 2 2 2 2 0 2 0 0 2 2 2 1 17
Ford et al. [45] 1 1 0 2 0 2 0 0 2 2 1 1 12
Garber et al. [46] 2 1 0 2 0 2 1 0 1 2 1 1 13
Hackney et al. [38] 2 2 2 2 2 0 0 0 2 2 2 2 18
Hackney et al. [39] 2 2 2 2 2 0 0 0 2 2 2 2 18
Hackney and Earhart [47] 2 2 2 2 0 0 0 0 2 2 2 2 16
Hashimoto et al. [48] 2 2 2 2 2 0 0 2 2 2 2 2 20
Heffron et al. [49] 2 1 2 2 0 0 0 2 1 2 1 2 15
Janyacharoen et al. [50] 1 2 2 1 2 2 1 2 1 2 2 2 20
Kaltsatou et al. [51] 2 2 2 2 1 2 1 0 2 2 2 2 20
Kin Isler et al. [52] 2 1 2 2 0 2 0 0 1 2 1 2 15
Kouli et al. [53] 2 0 0 1 1 2 0 0 1 2 2 2 13
Mangeri et al. [54] 2 2 2 2 1 2 1 0 1 2 2 2 19
Mavridis et al. [55] 1 2 2 2 0 2 2 0 1 2 1 2 17
McKinley et al. [56] 2 2 2 2 2 2 1 0 2 2 2 2 21
Milburn and Butts [57] 2 2 2 2 0 2 2 0 2 2 2 2 20
Rani and Sing [40] 0 0 0 1 0 2 0 0 1 2 0 1 7
Rehfeld et al. [61] 2 0 2 2 0 2 2 0 2 2 1 2 17
Rios Romenets et al. [58] 1 2 2 2 1 2 2 2 1 2 1 2 20
Shimamoto et al. [59] 2 0 2 2 0 2 1 0 2 2 1 1 15
Sofianidis et al. [62] 2 2 2 2 0 2 2 0 2 2 0 2 18
Viskic-Stalec et al. [60] 1 1 2 2 0 2 0 0 2 2 1 2 15
Volpe et al. [41] 2 2 2 2 2 2 0 1 2 2 2 2 21
Item numbers: 1—a clearly stated aim; 2—inclusion of consecutive patients; 3—prospective collection of
data; 4—endpoints appropriate to the aim of the study; 5—unbiased assessment of the study endpoint; 6—
follow-up period appropriate to the aim of the study; 7—loss to follow-up less than 5%; 8—prospective
calculations of the study size; 9—an adequate control group; 10—contemporary groups; 11—baseline
equivalence of groups; 12—adequate statistical analyses

O2 pulse and minute ventilation–carbon dioxide production
relationship (VE/VCO2) were examined in two studies
[43, 51]. Based on studies meeting meta-analysis require-
ments, analyses of VO2max, maximum HR, and peak VE
identified that implemented dance interventions had similar
beneficial effects to the exercise interventions utilised as
comparisons. The overall MD pooled estimates were
VO2max = 0.18 mL/min/kg (95% CI - 0.03 to 0.411;
Z = 1.64; p = 0.10), maximum HR = - 0.39 bpm (95%
CI - 2.21 to 1.42; Z = - 0.42; p = 0.66), and peak
VE = - 0.18 L/min (95% CI - 0.11 to 0.49; Z = - 0.42;
p = 0.66). Table 3 provides a summary of associated meta-
analyses statistics; Fig. 3 shows a forest plot related to
VO2max. Review of the smaller number of studies
examining other cardiovascular function outcomes showed
that dance interventions produced a varied effect compared
to exercise, with most variables improving more following
the dance intervention (Table 3). Dance had a greater
effect compared to exercise on both systolic and diastolic
BP (g = - 0.69 to 0.00) [36, 51, 54], and on VO2 AT
(g = - 0.19 to 0.00) [43, 51, 54]. Dance had a similar
effect on RER compared to exercise (g = - 0.01 to 0.00)
[36, 43, 46]. Waltz [43] and Greek traditional dance [51]
had a greater effect at improving VE/VCO2 compared to
supervised cardiovascular exercise training (g = - 0.18
and - 0.16, respectively). Standard exercise had a greater
effect on peak O2 pulse than dance (g = 0.09–0.78)
[43, 51].

123
 Table 2 Demographic data for the included studies
Study Sample size Sex Mean age Population Intervention Session Session Intervention
(SD) duration frequency length

Arzoglou et al. 5 Unknown 16.8 (1.8) Autism Folk/traditional 35–45 min 39/week 8 weeks
[42] dance
5 Unknown 16.6 (1.3) Physical 45 min 29/week 8 weeks
education
Barene et al. 35 F 45.9 (9.6) Hospital employees Zumba 1h 29/week 40 weeks
[36] 37 F 44.1(8.7) Soccer
Barene et al.
[37]
Dance Interventions and Physical Health

Barene et al.
[35]
Belardinelli 44 36 M, 60 (11.0) Stable chronic heart failure Waltz 21 min 39/week 8 weeks
et al. [43] 8F
44 38 M, 59 (10.0) Cardio
6F
Burgess et al. 25 F 13.5 (0.3) Healthy British schoolgirls Aerobic dance 50 min 29/week 6 weeks
[44] 25 F Physical
education
Ford et al. [45] 21 F 19.8 (2.2) Healthy university students Aerobic dance 1h 39/week 8 weeks
17 F Jogging
22 F PRT
15 F Swimming
13 F Sport training
Garber et al. [46] 14 7 M, 7 F 35 (7.0) University employees Aerobic dance 50 min 39/week 8 weeks
11 5 M, 6 F 39 (5.0) Cardio
Hackney et al. 9 6 M, 3 F 72.6 (2.2) Idiopathic PD and age- and sex-matched controls Latin dance 1h 20 classes 13 weeks
[38] 10 6 M, 4 F 69.6 (2.1) PRT
Hackney et al.
[39]
Hackney and 17 11 M, 66.8 (2.4) PD, [40 years, stand for at least 30 min, walk Ballroom dance 1h 29/week 10 weeks
Earhart [47] 6F independently for at least 3 m
14 11 M, 68.2 (1.4) Latin dance
3F
13 11 M, 64.9 (2.3) Tai Chi
2F
Hashimoto et al. 15 3 M, 67.9 (7.0) PD, lived at home, walk independently Aerobic dance 1h 19/week 12 weeks
[48] 12 F
17 2 M, 62.7 PRT
15 F (14.9)

123
 Table 2 continued
Study Sample size Sex Mean age Population Intervention Session Session Intervention
(SD) duration frequency length

123
Heffron et al. 14 F 61 (5.0) Post-menopausal females Aerobic dance 1h 19/week 10 weeks
[49] 15 F 55 (6.0) PRT
Janyacharoen 20 F 64.9 (4.0) Healthy, at least 60 years old, walk independently Folk/traditional 40 min 39/week 6 weeks
et al. [50] dance
18 F 66.8 (6.0) Physical Not Not reported
education reported
Kaltsatou et al. 18 M 67.2 (4.2) Greek males, chronic heart failure stage II–III Folk/traditional 1h 39/week 8 months
[51] dance
16 M 67.1 (7.2) Cardio and PRT
Kin Isler et al. 15 F 20.23 Sedentary female college students Aerobic dance 45 min 39/week 8 weeks
[52] (0.16)
15 F 21.88 Cardio
(2.16)
Kouli et al. [53] 33 Not 10.6(0.2) Grade 5 primary school students Aerobic dance 45 min 39/week 8 weeks
24 stated Physical
education
Mangeri et al. 42 18 M, 58.5 (8.8) T2DM and/or obesity Ballroom dance 2h 29/week 6 months
[54] 24 F
58 34 M, 59.4 (8.5) Cardio
24 F
Mavridis et al. 21 Not 6.6 (0.2) Grade 1 primary school children Aerobic dance 45 min 39/week 12 weeks
[55] 19 stated Physical
education
McKinley et al. 14 3 M, 78.07 [60 years old, healthy, fear of falling, had [1 fall in Tango 2h 29/week 10 weeks
[56] 11 F (7.6) last 12 months, independent
11 3 M, 8 F 74.6 (8.4) Walking
Milburn and 15 F 21.4 US college students Aerobic dance 30 min 49/week 7 weeks
Butts [57] 19 F 19.3 Jogging
Rani and Sing 75 (assume 39 25— Not Not Nicobari college students Aerobic dance 30–60 min 39/week 6 weeks
[40] not stated) stated stated Yoga
Rehfeld et al. 14 7 M, 7 F 67.21 Healthy elderly Ballroom 90 min 29/week then 6 months then
[61] (3.78) 19/week 12 months
12 7 M, 5 F 68.67 Cardio
(2.57)
Rios Romenets 18 12 M, 63.2 (9.9) Idiopathic PD Canada Hoehn and Yahr stage 1–3 Latin 1h 29/week 12 weeks
et al. [58] 6F
15 7 M, 8 F 64.3 (8.1) Physiotherapy Not Not reported Not reported
exercises reported
A. Fong Yan et al.
Dance Interventions and Physical Health

3.3 Biomarker Outcomes

60 high school
Intervention

12 weeks

12 weeks

26 weeks
For biomarkers, four studies investigated the effect of

periods
length

dance related to exercise on several biomarker indices

[36, 43, 52, 54]. Data associated with serum triglycerides,
total cholesterol and high-density lipoprotein (HDL)
cholesterol were able to be taken forward for meta-analy-

Not reported
2–39/week
frequency

ses. Analyses estimated that dance interventions had a

29/week

19/week
Session

significantly greater effect on blood triglyceride reduction

relative to exercise comparisons, with an SMD of - 0.54
(95% CI - 0.80 to - 0.28; Z = - 4.08; p\0.001; see
reported
duration

Table 3; Fig. 4). For blood total cholesterol and HDL

Session

90 min
cholesterol concentrations, although close to significance
Not
1h

1h

based on the four studies available, the null hypothesis was

retained (see Table 3 for associated statistics). In one study
Folk/traditional
Aerobic dance

Aerobic dance

Physiotherapy

F female, M male, PD Parkinson’s disease, PRT progressive resistance training, SD standard deviation, T2DM type 2 diabetes mellitus
examining serum glucose, Zumba had a larger effect than
Intervention

education

exercises

soccer training (g = - 0.83) [36], while in the other two

Physical

dance
Cardio

Pilates
Latin

studies, ballroom dancing had a similar effect (g = 0.00) at

reducing fasting blood glucose relative to the cardio
exercise group [43, 54].
Idiopathic PD modified Hoehn and Yahr stage 0.5–2
Community-dwelling older adults in Thessaloniki,

3rd and 4th grade high school students in Zagreb

3.4 Functional Musculoskeletal Outcomes

Sixteen studies [35, 38–41, 45, 48, 50, 51, 53–58, 60]
reported outcomes related to functional musculoskeletal
Moderately obese Japanese women

measures. Three studies examined range of motion

[53, 55, 60], and five studies examined bilateral sit-and-
reach [35, 40, 45, 50, 60]. Four studies examined gait
velocity [38, 39, 56, 57], performance in the timed-up-and-
go test [39, 41, 48, 58], Berg balance test [39, 41, 48, 51],
and sit ups [40, 45, 53, 55]. Three studies examined per-
formance in the 1-mile walk/run [40, 53, 55] and sit to
Population

Greece

stand test [50, 51, 56]. Two studies examined postural

stability [35, 38], separated the sit-and-reach for each leg
[53, 55], or examined the 6-min walk test [50, 54], push
Mean age

49.1 (7.9)
51.7 (6.1)

61.6 (4.5)

65.0 (5.3)

ups [53, 55] or step test [45, 60]. In outcomes able to be

(5.78)

(5.42)

stated
70.59

70.76

taken forward for meta-analysis (i.e. sit-and-reach; timed

(SD)

Not

up-and-go; sit ups; balance), dance interventions were

found to have a significantly greater effect relative to
3 M, 9 F

4 M, 8 F

7 M, 5 F

6 M, 6 F

structured exercise on the capability to develop flexibility

Sex

via sit-and-reach (MD = 3.05 cm; 95% CI 1.23–4.87;

F
F

F
F

Z = 3.29; p = 0.001; see Fig. 5), improve performance in

the timed up-and-go test (MD = - 1.01 s; 95% CI - 1.23
to - 0.79; Z = - 9.13; p = 0.001) and sit up tests
Sample size

(SMD = 2.56; 95% CI 0.73–4.39; Z = 2.74; p \ 0.006),

and in terms of improving balance (i.e. via the Berg score)
(MD = 2.80; 95% CI 0.25–5.36; Z = - 2.15; p = 0.03;
115
105
37
23
12

12

12

12

see Table 3). The Q statistic suggested evidence of vari-

Table 2 continued

Shimamoto et al.

Volpe et al. [41]

ance in true effects across studies related to sit-and-reach,

Sofianidis et al.

Berg balance scores, and sit ups, while I2 suggested high

Viskic-Stalec
et al. [60]

variance in the proportion of true effects rather than

[59]

[62]
Study

according to sampling error (Table 2). Publication bias

from diverse treatment effects was present in the sit up

123
 A. Fong Yan et al.

Table 3 Summary of the effect of structured dance compared to exercise interventions on the physical health outcome measures
Outcome measure MD or SMD (95% CI) Z value p value Q statistic I2 T2; T

Body composition
Body mass (kg) MD = - 0.81 (- 1.97 to - 1.36 0.17 3.52 (df = 7, p\0.83) 0.00 0.00; 0.00
0.36)
BMI (kg/m2) SMD = - 0.43 (- 0.84 to - 2.43 0.04* 2.43 (df = 5, 0.00 0.00; 0.00
- 0.02) p\0.078)
Total fat mass (% and kg) SMD = - 0.39 (- 0.68 to - 2.57 0.01** 4.04 (df = 3, p\0.25) 25.83 0.02; 0.15
- 0.09)
Circumference (cm) Two studies investigated this variablea
Skinfolds (mm) Three studies investigated different sitesb
Bone mineral density (gm/cm2) Two studies investigated this variablea
Cardiovascular
VO2max (mL/min/kg) MD = 0.18 (- 0.03 to 0.411) 1.64 0.10 0.81 (df = 5, p\0.97) 0.00 0.00; 0.00
Maximum heart rate (bpm) MD = - 0.39 (- 2.21 to 1.42) - 0.42 0.66 0.20 (df = 3, p\0.97) 0.00 0.00; 0.00
Peak ventilation (L/min) MD = - 0.18 (- 0.11 to 0.49) - 0.42 0.66 0.52 (df = 3, p\0.91) 0.00 0.00; 0.00
a
Respiratory exchange ratio Three studies investigated this variable
VO2 AT (mL/min/kg) Three studies investigated this variableb
Systolic blood pressure (mmHg) Three studies investigated this variablea
Diastolic blood pressure (mmHg) Three studies investigated this variablea
Peak O2 pulse (mL/beat) Two studies investigated this variableb
VE/VCO2 Two studies investigated this variableb
Biomarkers
Total cholesterol SMD = - 0.42 (- 1.07 to 0.06) - 1.85 0.06 15.02 (df = 3, 80.03 0.24; 0.49
p\0.002)
HDL cholesterol (mmol/L or mg/dL) SMD = 0.29 (- 0.63 to 0.05) - 1.66 0.09 6.00 (df = 3, p\0.11) 50.04 0.06; 0.24
Triglyceride (mmol/L or mg/dL) SMD = - 0.54 (- 0.80 to - 4.08 \0.001** 3.05 (df = 3, p\0.3) 1.72 0.001; 0.03
- 0.28)
Glucose (mmol/L) and fasting blood Two studies investigated this variablea
glucose
Functional measures
Sit and reach (cm) MD = 3.05 (1.23–4.87) 3.29 0.001** 12.81 (df = 3, p \ 76.59 2.55; 1.59
0.005)
Berg balance score MD = 2.80 (0.25–5.36) - 2.15 0.03* 17.18 (df = 3, p \ 82.53 5.16; 2.27
0.001)
Timed up-and-go test (min) MD = - 1.01 (- 1.23 to - 9.13 0.001** 0.78 (df = 2, p\0.67) 0.00 0.00; 0.00
- 0.79)
Sit ups SMD = 2.56 (0.73–4.39) 2.74 \0.006* 67.08 (df = 3, 95.52 3.29; 1.81
p\0.0001)
Range of motion (°) Four studies measured range of motionc
1-mile walk/run Three studies investigated this variableb
6-min walk test (m) Two studies investigated this variabled
Postural stability Two studies investigated this variablea
Gait Three studies all measured different variables of gaita
Push ups Two studies investigated this variabled
Sit to stand (s) Two studies investigated this variableb
Functional mobility questionnaires
Freezing of Gait Questionnaire Three studies investigated this variableb
Motor Unified Parkinson’s Disease Three studies investigated this variablee
Rating Scale

123
Dance Interventions and Physical Health

Table 3 continued
Outcome measure MD or SMD (95% CI) Z value p value Q statistic I2 T2; T

PDQ39 Three studies investigated this variablea

A negative SMD indicates the dance intervention was more effective, except for sit and reach, Berg Balance, and sit ups, where a positive SMD
indicates the dance intervention was more effective
BMI body mass index, CI confidence interval, HDL high-density lipoprotein, MD mean difference, PDQ39 39-item Parkinson’s Disease
Questionnaire, Q statistic a test of the null hypothesis that all studies shared a common effect size, I2 identifies the proportion of the observed
variance reflecting differences in true effect sizes as opposed to sampling error, SMD standardised mean difference, T between-study standard
deviation in true effects, T2 between-study variance in true effects, VE/VCO2 minute ventilation–carbon dioxide production relationship, VO2AT
oxygen consumption at anaerobic threshold, VO2max maximal oxygen consumption
*Significant difference p\0.05; **significant difference p\0.001
a–e
Insufficient data to perform a meta-analysis
a
No significant effect of either intervention type found by any study
b
Similar improvements found in both dance and exercise groups by each individual study
c
No common measurement and/or site used
d
Each individual study found greater improvements in the dance group
e
All studies differed in their findings

Fig. 2 Standardised mean difference in effect of structured dance compared to exercise interventions on fat mass (% or kg). CI confidence
interval, PRT progressive resistance training, SE standard error

Fig. 3 Mean difference in effect of structured dance compared to exercise interventions on VO2max. CI confidence interval, IV inverse variance,
SE standard error, VO2max maximal oxygen consumption

analysis (Egger test intercept = 14.75, SE = 3.22,
p = 0.04). The ‘trim and fill’ procedure recommended
adjustment to the pooled estimate (1.93; 95% CI
0.26–3.61) based on n = 1 imputed study.
Review of the smaller number of studies examining
other functional musculoskeletal outcomes showed that
ballroom and traditional Thai dance had a greater effect at
improving the 6-min walk test distance compared to cardio
exercise (g = 0.80 [54] and 1.62 [50], respectively). Also,

123

Fig. 4 Standardised mean difference in effect of structured dance compared to exercise interventions on triglycerides. CI confidence interval, SE
standard error
aerobic dance had a greater effect on 1-mile walk/run test
times relative to physical education classes (g = - 1.92)
[53] and yoga (g = - 4.29) [40]. Latin dance increased gait
velocity (with a moderate-large effect) relative to resis-
tance training (g = - 0.71) [38] and cardio exercise
(g = - 1.98) [56]. Similarly, aerobic dance had a moderate
effect on increasing maximal run times relative to jogging
(g = - 0.47) [57]. In patients with Parkinson’s disease, no
significant improvements were made in gait velocity for
either dance or resistance training groups (g = 0.00) [38].
Greek dancing had a small effect on improving sit-to-stand
performance relative to cardio and resistance exercise
(g = 0.33) [51], whereas Latin and traditional Thai dance
had greater improvements relative to walking and general
aerobic exercise (g = 0.74 [56] and 1.25 [50], respec-
tively). Large effects were apparent in push up perfor-
mance in aerobic dance groups compared to physical
education classes (g = 4.08 [53] and 5.05 [55]).
3.5 Functional Mobility Questionnaire Outcomes
Seven studies utilised questionnaires
[37–39, 41, 43, 47, 49, 58] to examine functional mobility
outcomes. These included the Freezing of Gait Question-
naire [39, 41, 58]), the Motor Unified Parkinson’s Disease
Rating Scale (UPDRS) [39, 41, 58], and the Parkinson’s
Disease Questionnaire 39 (PDQ39) [41, 47, 58]. Due to
limited studies (i.e. less than four) examining similar
mobility outcomes, meta-analyses were not conducted.
Case reviewing did identify that a Latin dancing inter-
vention reduced freezing of gait, though with insignificant
interaction effects relative to PRT (g = - 1.10) [39] or a
structured exercise group (g = - 0.40) [58]. A group
training in Irish dance made significant gains above and
beyond a physiotherapy-based exercise group at improving
freezing of gait (g = - 2.55) [41]. Three studies found an
equivalent or greater effect for dance interventions on the
motor UPDRS relative to structured exercise. Specifically,
Latin dance was found to be similar to standard
123
A. Fong Yan et al.
physiotherapy exercises (g = 0.00) [58], and had a greater
effect compared to PRT (g = - 0.48) [39]; while Irish
dance had a large effect compared to physiotherapy exer-
cises (g = - 1.79) [41]. Dance interventions had a mod-
erate-large effect on the PDQ39, with Irish dancing
producing greater improvements compared to physiother-
apy exercises (g = - 0.54) [41], and both Latin and ball-
room dancing groups experiencing more improvement than
a Tai Chi exercise group (g = - 7.05 and - 9.01, respec-
tively) [47].
4 Discussion
4.1 Overview of Main Findings
The aim of the current review was to systematically review
and meta-analytically determine the effectiveness of
structured dance interventions relative to structured exer-
cise programmes on physical health outcomes. Our null
hypothesis was that dance would be equally as effective as
structured exercise programmes on all measures of physi-
cal health. Findings from the review and meta-analysis
reveal that undertaking dance of any genre, with identifi-
able movement sequences, is equivalent to and occasion-
ally more effective than other types of structured exercise
for improving health outcome measures. Of the 13 outcome
measures meta-analysed, dance interventions had a sig-
nificantly greater pooled effect on seven outcomes (54%)
based on evidence available at the present stage. These
relate to body composition (i.e. BMI and total fat mass),
blood biomarkers (i.e. triglyceride), and functional mea-
sures (i.e. sit-and-reach, Berg balance score, timed up-and-
go test, and sit ups). Dance had a similar effect to struc-
tured exercise on the remaining six (46%) outcome mea-
sures (i.e. VO2max, maximum HR, peak VE, body mass,
serum total and HDL cholesterol).
Our secondary hypothesis was that increased adherence
with dance interventions would be apparent relative to the
Dance Interventions and Physical Health
Fig. 5 Standardised mean difference in effect of structured dance compared to exercise interventions on sit-and-reach performance. CI
confidence interval, PRT progressive resistance training, SE standard error
structured exercise programmes. Where attrition was
reported, it was equal if not lower in the dance intervention
compared to the structured exercise intervention in 15
studies, while only two studies reported lower attrition in
the structured exercise group [48, 58]. Of the 12 studies
that reported adherence, the dance interventions had equal
adherence in five studies (42%) [38, 39, 46, 56, 58] and
higher adherence in four studies (33%) [35–37, 41, 49, 51]
relative to structured exercise. The key implication is that
people who do not find traditional forms of structured
exercises engaging can still reap significant equivalent or
better physical health benefits by pursuing exercise in the
form of structured dance classes.
Across the lifespan and irrespective of participant sex
and health condition (e.g. type 2 diabetes and chronic heart
failure), dance was more effective than soccer, cardio
exercise, PRT, and jogging in reducing fat mass. While
acknowledging other factors may account for the consis-
tently favourable finding, it seems that some forms of
dance were more consistently associated with better out-
comes across particular variables. Five of the eight studies
utilised aerobic dance [46, 49, 52, 57, 59], while the other
three studies implemented traditional Greek dance [51],
ballroom [54], and Zumba [36]. Based on information
extracted from these studies, aerobic dance [45, 59] and
Zumba [36] led to significantly greater losses of fat mass
than soccer [36], cardio exercise [45, 59], PRT [45], and
swimming [45]. Participants undertaking aerobic dance
[55, 59] also lowered their skinfold thickness significantly
more than those in physical education [55] and cardio
exercise [59] interventions. Zumba [36], waltz [43], aero-
bic dance [52], and ballroom [54] were also significantly
more effective than soccer [36] and cardio exercise
[43, 52, 54] in reducing serum triglycerides. Zumba [19],
aerobic [18, 28, 45] and folk [35] dancing significantly
improved lower limb/trunk flexibility as assessed by the
sit-and-reach test relative to soccer [35], cardio exercise
[45, 50], PRT [45], yoga [40], and physical education
[53, 55]. However, it is worth noting these trends are
identified in specific study arm comparisons and synthe-
sised comparisons of dance intervention types on particular
variables could not be conducted. On this basis, clinicians
can and should recommend structured dance as part of
physical health interventions that may be targeting or
aiding weight management, improvement of cholesterol
profiles, cardiorespiratory health, as well as general spinal
and lower limb flexibility and mobility. Structured dance
programmes can potentially occur in any genre depending
on the individual’s preference. That said, class duration,
frequency, and intensity of sessions still need to be con-
sidered, and individuals should aspire to progressive
attainment of current guidelines for total volume of weekly
exercise [63].
4.2 Effect of Dance Compared to Exercise
in Different Populations
Healthy adults were assessed for the effect of dance on a
large variety of physical health measures. All but one of the
eight studies investigating healthy adults found that dance
was equal to or greater than exercise in its effectiveness to
improve physical health [35–37, 40, 45, 46, 52, 57]. Post-
menopausal women were found to have greater improve-
ments in bone health from strength training exercise
compared to aerobic dance [49]. Three studies by Barene
and colleagues, which are part of one larger study, had the
largest sample size, and when combined, comprised the
most comprehensive study encompassing cardio-meta-
bolic, bone health, fat mass, pain, work ability, balance,
muscle strength, and flexibility measures [35–37]. One of
these studies had the highest level of study quality [35]
with a well-structured randomised controlled trial design
and intention-to-treat statistical analysis.
In the older population, dance was found to be equal to
structured exercise in its effect on strength [50, 56] and
weight loss [54], but superior in maintaining higher weekly
energy expenditure ([10 metabolic equivalent (MET) h/
week) [54], minimising attrition rates and improving bal-
ance [61, 62], balance confidence, and gait velocities
[50, 54, 56]. With a decline in gait speed of more than
0.15 m/s/year suggested as a useful indicator of falls risk
[64], the greater and ongoing improvement in gait speed by
123

the dance group supports the implementation of dance to
reduce the risk of falls. The population studied by Mangeri
and colleagues [54] were patients who were obese and/or
had type 2 diabetes. A similar population of obese partic-
ipants who were a decade younger also showed comparable
results in cardiovascular fitness in both the dance and
structured exercise groups [59]. The current literature
indicates that dance provides the same or greater benefits to
physical health compared to regular exercise regimes, but
further research in more varying cohorts is needed to
extrapolate the results to the wider adult population.
While a wide variety of physical outcome measures
were collected from the younger population, including
participants as young as 6 years old [55], the most common
assessments were that of flexibility [53, 55, 60] and car-
diovascular health [53, 55, 60]. Functional movements
such as the sit up and push up are a good measure of overall
musculoskeletal health; however, these variables were only
assessed in two studies [53, 55]. No studies examined the
effect of a structured dance or exercise programme on
overall weekly physical activity levels. Although, physical
activity does have a role in weight loss albeit secondary to
dietary management, physical activity has a greater role in
improving physical health over and above weight loss
[4, 65]. Therefore, it is important that future studies
investigating the physical health of children look more
broadly at cardio-metabolic health, musculoskeletal health,
physical activity participation levels, and sedentary
behaviour.
Some of the included studies, conducted on adolescent
and younger adult populations, had methodological flaws
that challenge confidence in their results. One study
investigated the effect of dance and exercise on BMI;
however, only two sessions per week were provided,
totalling 100 min/week [44], less than the American Col-
lege of Sports Medicine guidelines of 150–250 min/week
for maintenance of body weight and more than 250 min/
week for weight loss [66]. The study by Arzoglou and
colleagues found that dance was superior to physical edu-
cation classes at improving balance in teens with autism;
however, the dance group were provided with an additional
session per week [42]. Although the study by Viskic-Stalec
and colleagues included a large sample of younger partic-
ipants, the lack of raw data and unlikely small variability
reported in the results reduced confidence in the study [60].
For future studies in younger populations, the intervention
design and reporting of results should be refined to ensure
confidence in the results.
For those with Parkinson’s disease, training in Latin and
aerobic dance resulted in improved timed up-and-go scores
compared to PRT and home exercises targeted at the dis-
ease [38, 39, 48]. The latest systematic review and meta-
analysis of the effect of dance in people with Parkinson’s
123
A. Fong Yan et al.
disease [67] included five studies, three of which were
included in this review. The two additional studies com-
pared Argentine tango to no intervention, and found that
tango improved disease rating, balance, and walking [68],
and improved physical activity participation levels [69]. In
order to gain a better understanding of the benefits of dance
in people with Parkinson’s disease, more comprehensive
studies with comparisons between dance and standard
physical therapy exercise programmes are warranted.
In patients with heart disease, dance was beneficial for
improving functional capacity and balance. Dance was
equally effective as other exercise interventions at
improving cardiovascular outcome measures in patients
with chronic heart failure [43, 51]; however, dance pro-
vided an additional benefit of improving exercise toler-
ance demonstrated by an increase in maximum treadmill
tolerance time [51]. Although balance was improved by
both exercise and dance groups, in the sample size
studied by Kaltsatou and colleagues, there was a ceiling
effect [51], suggesting a more challenging balance
assessment is required for future studies. In patients with
heart disease, a complementary set of outcome measures
that was not investigated are blood and biomarker vari-
ables such as triglycerides and cholesterol, which are
linked with cardiovascular disease [70, 71]. A more
comprehensive assessment of physical health outcome
measures to understand the effect of dance compared to
structured exercise on cardiovascular health would be
valuable.
4.3 Attrition and Adherence
Overall, attrition rates and adherence were better or similar
for dance compared with exercise. Attrition rates from a
dance intervention were reported as lower
[35–37, 46, 49, 51, 54, 56, 61] or equal to
[38, 39, 43, 47, 48, 50, 57, 62] exercise except for one
study [58]. Of the studies that reported attrition, the attri-
tion rate was 0–53.85%. Adherence was good, with dance
being higher [35–37, 41, 49, 51] or similar
[38, 39, 46, 56, 58] to exercise, and most studies reporting
rates above 80%. Where reasons for attrition or non-ad-
herence were reported, the main reason was injury unre-
lated to the intervention. However, dissatisfaction with
group allocation was also mentioned for both intervention
types. The hypothesis of increased adherence with dance
interventions was cautiously retained, since many studies
reported similar adherence and attrition.
The pleasure and enjoyment experienced by many
through dance offers the additional advantage of increased
likelihood of regular participation and adherence, essential
features for achieving long-term health benefits, and could
explain the results seen in the included studies [35, 51, 54].
Dance Interventions and Physical Health
Previous non-interventional studies have found that the
primary intrinsic motivator for participation in dance was
to have fun [72] or improve mood [73], and while signif-
icant physical benefits were also experienced by partici-
pants, this was a secondary motivator for initial and
maintained participation, thereby likely demonstrating the
enjoyment to adherence link that exists in dance. It has
been suggested that consistency of energy expenditure and
adherence to the exercise programme are key for long-term
maintenance of cardiovascular fitness. Mangeri and col-
leagues reported that ballroom dance resulted in a signifi-
cant increase in 6-min-walk-test distance compared to
structured exercise, also noting that these improvements
continued for up to 6 months for the dance group but only
up to 3 months for the exercise group [54]. Although
energy expenditure was lower for the dance group initially,
the authors attributed the maintenance of energy expendi-
ture and adherence across the whole intervention to the
enjoyment of dance. Conversely, energy expenditure was
highly variable for the exercise group, with both energy
expenditure and adherence decreasing in the latter 3-month
period [54]. Such findings highlight that the high sustained
levels of adherence typically associated with dance could
help enhance the likelihood of physical benefits. Thus,
dance is not only an appropriate physical activity for
improving health and well-being, but also aligns well with
choice and preference, which are prime considerations for
participants and practitioners.
4.4 Quality Assessment
With the overall quality of the included studies being 73%,
we can uphold a degree of confidence in the present results.
However, there are particular items in the MINORS tool that
highlight areas of scientific reporting that can be improved.
Items scoring consistently poorly were the prospective
calculation of study size and reporting of inclusion and
exclusion criteria. Only six studies [35–37, 43, 48–50, 58]
adequately reported a priori calculation of sample size based
on calculations of estimated statistical significance and
power. Another study performed power calculations; how-
ever, post-hoc analyses found the study underpowered for
some outcome measures [41]. Detail and clarity of inclusion
and exclusion criteria were missing in 12 studies
[35–37, 40, 43, 45, 46, 49, 52, 53, 59–62], with one study
excluding males from data analysis even though this was
not identified in exclusion criteria [35–37]. An important
aspect of scientific reporting is the proportion of partici-
pants lost to follow-up. This item requires studies to
assess all participants in follow-up or use an intention-to-
treat analysis accounting for an accurate reflection of the
average compliance to an intervention. Eleven studies
failed to report loss of participants to follow-up
[38–41, 44, 45, 47–49, 52, 53, 60], while only six reported
it adequately [35–37, 43, 55, 57, 58, 62].
In addition to clear reporting of scientific method, there
also needs to be clarity in the reporting of both dance and
exercise interventions implemented. The Consensus on
Exercise Reporting Template (CERT) checklist [74] is
recommended for future studies to ensure sufficient detail
is provided to permit reader understanding and replication.
Required detail includes thorough information on the
content, delivery, and monitoring of exercise interventions;
the credentials of the person(s) delivering the intervention;
and adherence to the study and compliance within the
intervention to dance or exercise content. Such detail in
reporting will permit better comparisons and more accurate
understanding as to how and why a particular dance
intervention is more or less effective.
4.5 Strengths and Limitations
This review is the first to provide a comprehensive syn-
thesis of the literature investigating the effect of structured
dance class interventions relative to forms of exercise on
physical health outcomes. The scope of the systematic
search ensured that the review encompassed all possible
studies and a range of body composition and physiologi-
cally related outcomes (i.e. cardiovascular, blood
biomarkers, functional movement assessments). As data on
many physical health indices were obtained and were able
to be synthesised, comprehensiveness is also a strength. A
strength of identified studies was the consistent application
of experimental or higher-level randomised controlled trial
designs, which assisted in generating more accurate effect
estimates between dance and exercise interventions. Nev-
ertheless, there are also limitations to be considered related
to included studies (e.g. participant and intervention
diversity), analysis and findings.
Despite multiple studies examining similar research
questions using multiple variables, still relatively few
consistently examined similar outcomes to permit data
synthesis. Where meta-analysis was possible, caution is
warranted where fewer data sets were available for pooling,
and particularly where they contained low sample sizes
[75]. It should be noted that dance did not have greater
benefits on many outcome measures. At present it cannot
be determined whether dance has consistently greater
physical health benefits relative to exercise due to limited
data on indices, or whether the degree and intensity of
engagement in the potentially ‘more preferred’ dance may
partially account for findings. Further data from well-
powered studies are still required to ascertain accurate
effect estimates. Included studies embraced a diverse range
of participants [age, (non)clinical, different population
groups], which likely moderated effect estimates. In terms
123

of intervention characteristics, some studies did not provide
appropriate detail as to the structure and content of their
dance or exercise interventions (i.e. session frequency,
intensity, duration, activity format and content, style of
delivery, intervention total duration) and may not have
been necessarily well-matched to control groups (and their
treatments) in an equitable manner; thus controlling these
factors will be important in future studies. Likewise, con-
sistent reporting of key statistics for pre-/post-intervention
in both intervention and control groups is required,
including reporting of intervention and control group
compliance and adherence if the effectiveness and prefer-
ence of interventions is to be identified. Addressing these
limitations will be important to achieve empirical and
practitioner support for the proposed health benefits from
dance interventions.
Although dance has known benefits for cognitive func-
tion [76–81], mental health [48, 82, 83], and quality of life
[84–86], detail on its psychological benefits is beyond the
scope of the current review. Future research should explore
the psychological benefits of structured dance programmes
in comparison to structured exercise programmes.
5 Conclusions
Findings from this systematic review and meta-analysis
provide substantial evidence supporting the proposition
from the American College of Sports Medicine [87] that
dance is an alternative exercise modality that can help
reduce physical health risks and outcomes associated with
sedentary and inactive behaviour. As shown by the inclu-
ded studies and synthesised data, structured dance inter-
ventions can provide an equal, if not greater effect, on
numerous physical health outcome measures relative to
forms of structured exercise. Such interventions are also
attractive, as they may be more preferred, inclusive, and
associated with positive psychological outcomes (e.g.
enjoyment) which may associate well with better inter-
vention compliance and adherence over time. Health
practitioners can recommend genres of structured dance as
safe and effective exercise choices that can reduce fat
mass, lower triglycerides, as well as improve cardiovas-
cular fitness, flexibility, and day-to-day functionality, par-
ticularly for those who prefer this form of exercise. Future
studies need to ensure that dance interventions are equiv-
alent to exercise in terms of session duration, frequency,
intensity, and intervention duration, and that indices of
compliance and adherence are tracked. Such developments
will help confirm the effectiveness and efficacy of dance
interventions on physical health indices when compared to
other intervention types, and will encourage uptake of
dance as part of health intervention and treatment.
123
A. Fong Yan et al.
Acknowledgements The authors thank the student members of
Dance Research Collaborative who assisted in the early stages of the
review and the Faculty of Health Sciences expert librarians who were
consulted regarding the literature search strategy. This work was
initially presented at the 26th Conference of the International Asso-
ciation for Dance Medicine and Science held in Wanchai, Hong Kong
in October 2016.
Author contributions AFY led the project, conceived the study idea
and study design, performed the literature search, and led the
screening, data extraction, quality assessment, data analysis and
interpretation, writing and editing of the paper. SC contributed to the
study design, screening, data extraction and interpretation, and quality
assessment and completed all meta-analyses steps and analysis, along
with results evaluation and write-up, and edited the paper. CEH
contributed to the study design, screening, data extraction and inter-
pretation, quality assessment, writing and editing of the paper, and
provided project oversight and guidance. CC, EP, LLN, REW, BLT,
AJV, and MAW all contributed to the screening, data extraction and
interpretation, quality assessment, and writing and editing the paper.
REM and YG contributed to the screening, data extraction, and
quality assessment processes. All authors approved the final version.
Funding No funding was sought nor awarded for conducting and
completing this meta-analysis and systematic literature review.
Compliance with Ethical Standards
Conflict of interest Alycia Fong Yan, Stephen Cobley, Cliffton
Chan, Evangelos Pappas, Leslie L. Nicholson, Rachel E. Ward,
Roslyn E. Murdoch, Yu Gu, Bronwyn L. Trevor, Amy Jo Vassallo,
Michael A. Wewege, and Claire E. Hiller declare they have no
conflicts of interest relevant to the content of this review.
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