TOPIC

Literature review on the topic-

Investigating fitness training in adult dancers- A Scoping Review

MSc Sports and Exercise Medicine, Queen Mary University of London.

Supervisor: Caroline Jubb

Word Count:1272
(excluding page 1, tables, figures, and references)

Submitted in part fulfilment for MSc Sports and Exercise Medicine, Queen Mary,
University of London 2023/24

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PROPOSED TITLE:
Investigating fitness training in adult dancers- A Scoping Review

BACKGROUND AND RATIONALE:

Dance is a form of physically demanding performance that covers a range of disciplines and
heavily relies on performance aesthetics combining artistic and athletic performance (Farmer
et al., 2023). Dance is generally classified as a set of exercises that are a combination of
short bursts and slow movements that must be performed with precision
(Rodrigues-Krause et al., 2015)
. Dancers in different dance categories are considered athletes as artists
because their routine needs either excellent physical condition or high efficiency, as the visual
beauty of the choreography movements (Cardoso et al., 2017). To meet the professional
demands, dancers are subjected to rigorous training routines that can lead to the
development of injuries in this environment (Cardoso et al., 2017).
Physical fitness may be defined as “the person’s ability to meet the requirements of a specific
physical task”. As in most sports, dance fitness depends on the individuals’ ability to work in
aerobic and anaerobic conditions and their capacity to develop high levels of muscle tension,
i.e., muscle strength (Koutedakis & Jamurtas, 2004b). Joint mobility/muscle flexibility and
body composition are important to dance fitness (Koutedakis & Jamurtas, 2004b).
Improvement in muscular strength appears to have a positive impact on dance performance
and injury prevention ( Ambegaonkar et al., 2021) . To continue an effective and satisfying
dancing career, preserve physical health, enhance performance, and avoid injuries. Fitness is
a fundamental component that supports and elevates several facets of dance artistry and
technique (Ambegaonkar et al., 2021) . Due to the physical demands of choreography, in
addition to technical skills, dancers must have sufficient aerobic endurance and muscle
strength, as well as flexibility and motor control (Mistiaen et al., 2012) which makes fitness
training of paramount importance.
Dancers have a high incidence of injury with chronic injuries being more prevalent than acute
(Dang et al., 2023a) . Although there are movement differences between different dance
types, it is reported that the most affected areas are the lower legs and back, and fatigue,
exercise, and repetition are important (Dang et al., 2023b) . Inadequate physical fitness
levels, such as muscular strength and endurance, are often cited as principal causes of
dance injuries (Dang et al., n.d.) . In terms of applying exercise science to dance, starting
from the premise that art and expressivity are what differentiates dance from sports
developing strategies to improve dancers’ physical fitness should provide a foundation for
optimizing their artistic and technical skills (Rodrigues-Krause et al., 2015).
In order to discover the gaps in the research in this area, we want to map and compile all the
aspects impacting fitness training that will be investigated regarding adult dancers through
this review. Therefore, this literature review is designed to address the topic of physical
training for adult dancers.

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AIM(s):
To investigate fitness training in pre-professional and professional dancers.

OBJECTIVE:
1. To explore current literature, discover, collect, classify, and provide a summary of the
fitness training studied about the pre-professional and professional dancers.
2. Investigate current research/knowledge of the influence of fitness training on dancers'
MSK injuries.

IMPACT:
The gaps that this review discloses could cast questions on the prospects for investigating
fitness training in adult dancers. It can direct future research to conduct a more thorough
investigation of various dancers.
Enhancing knowledge of the significance of fitness training for dancers will also be helpful in
leading the procedures related to the adaptation of fitness training for dancers.
KEYWORDS:
Strength, fitness training, adult dancers, injury, training
Strength Training Dancer
Streng* Training* Danc*
fitness Dancing
Dancers
Adult dancers

METHODS:
CRITERIA FOR ELIGIBILITY:
All published research on dancers from the dance population is intended to be included in the
review. The inclusion criteria for this literature will review and focus on dancers about their
fitness levels and make a comparison with different levels of fitness components and activity
hours.
P- pre or post – or professional adult dancers
I – fitness training
C- between different levels of fitness components/ activity hours
O- improved dance performance and reduced risk of injury

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TABLE 1: INCLUSION AND EXCLUSION CRITERIA

INCLUSION CRITERIA EXCLUSION CRITERIA

Dancers- professional
professional dancers
Age- 18+
Exposure to fitness training
Good physical health
RCTs, Case studies
and pre- Recreational dancers
Individual with any deformity,
neurological disorders, and
degenerative diseases
<18 years of age
Systemic review

INFORMATION SOURCES
Three electronic databases served as the primary information sources for the data included
in this literature review: PubMed, Embase, and Scopus. Both writers conducted the literature
search for key articles on Embase, PubMed, and Scopus databases. The review's final
search results were conducted on 20Th November 2023.

Search term-
The search terms were made using the following keywords and Boolean logic:
(((((strength) OR (fitness training)) AND (dance*)) OR (dancing)) OR (dancer)) OR (adult
dancers)

[where * indicates the search terms with variable endings.]

SEARCH STRATEGY
The previously mentioned keywords served as the basis for the search; the MeSH terms, cut-
off usage, and Booleans were modified depending on the database being searched. A variety
of study designs, including observational studies, case-control studies, cohort studies,
randomized controlled trials, and other literature reviews of original research papers, were
chosen for inclusion. All research studies included at least 1 motor-related injury in adult
dancers. Various dance genres were included like- ballet, jazz, hip-hop, etc.
Specific search phrases were chosen based on these parameters, and the compiled search
results from three databases - PubMed, Trip database, and Scopus added up to 1290 studies
imported to an online review management platform- COVIDENCE.
After removing 302 duplicates, 992 studies were obtained based on title and abstract
evaluation. After independent screening by two writers, 54 studies were assessed for
eligibility in the full text.
The PRISMA flow diagram shown below provides a detailed explanation of the procedure.

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FIGURE 1 PRISMA FLOW DIAGRAM

Identification

Studies from databases/registers (n = 1294)

References from other sources (n = )
Embase (n = 499)
Citation searching (n = )
Scopus (n = 481)
Grey literature (n = )
PubMed (n = 314)

References removed (n = 302)

Duplicates identified manually (n = 28)
Duplicates identified by Covidence (n = 274)
Marked as ineligible by automation tools (n = 0)
Other reasons (n = )

Screening

Studies screened (n = 992) Studies excluded (n = 938)

Studies sought for retrieval (n = 54) Studies not retrieved (n = 0)

Studies assessed for eligibility (n = 54) Studies excluded (n = 44)

Wrong setting (n = 4)
Wrong outcomes (n = 6)
Wrong intervention (n = 17)
Wrong study design (n = 9)
Wrong patient population (n = 7)
Wrong route of administration (n = 1)

Included

Studies included in review (n = 10)

Included studies ongoing (n = 0)

5|Page Studies awaiting classification (n = 0)
RESULT:
From the 54 studies selected for full-text reviews, 10 papers were ultimately included in the
study after applying inclusion and exclusion criteria.
Results for the assignment include data taken from the 5 most pertinent studies. Out of
these, 1 of these is an uncontrolled trial (Mistiaen et al., 2012) , 1 study is a comparative study
(Bronner et al., 2014) , 1 study is a clinical trial (Rodrigues-Krause et al., 2015) and 2 studies
were an observational cohort study (Ramel et al., 1997) , (Wyon et al., 2018) .

The key findings of this review so far are (I) Physiological testing and training for flexibility,
muscular endurance, aerobic capacity, and muscular power and (II) Dance-related injuries.
(A) Physiological testing/training

1. Flexibility- Ballistic Stretching and Static and Dynamic Stretching. These

techniques were designed to maximize range of motion (ROM) while considering
each dancer's unique needs. Regular, specially designed training sessions are
tailored to the dancers' needs, improving their flexibility, coordination, and certainly
their dancing ability.

2. Muscular endurance- Muscular endurance is assessed by measuring the "plank"

position, where the dancer holds a position on the floor with the support of the
forearms while contracting isometrically for the back and stomach. The time taken
to maintain the position (in seconds) was recorded as a measure of muscular
endurance. In addition, dancers benefit from resistance training, circuit training,
and strength training; all of which help them maintain excellent form, move with
precision, and reduce the risk of fatigue.

3. Aerobic Capacity- Aerobic Performance for Dancers measures capacity using a

20-minute VO2 max test and a standard aerobic test. It increases dancers'
strength, allowing them to perform on stage with more energy and less energy.

4. Muscular power- Power is increased by isokinetic and jump tests. Plyometrics,

balance, and coordination exercises improve the control and performance of
dynamic dance.

(B) Injury related to dance.

Injuries are classified as "overuse" or chronic injuries. The most reported injuries occur
to the ankle or foot. Hips, back, and lower back are other areas affected. Significant
improvements in fitness were achieved; fewer injuries, longer injury duration, and less
pain and suffering were reported. Scales such as visual acuity scales, patient-specific
functional scales, and pain scores are used to evaluate the severity of the injury.

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TABLE 2: DATA EXTRACTION TABLE

SL. STUDY TITLE AUTHORS PARTICIPANTS CONCLUSION LIMITATION TYPE OF DANCE

NO (REFERENCES)
.
TOTAL MALE FEMAL FITNESS
E PARAMETERS
1. A Preseason Shaw B, Sheyi 211 103 108 Some of the This study only Professional ballet
cardiorespiratory O, Jennifer B, dancers covers and contemporary
profile of dancers Heather S, demonstrated traditional and dance were
Michelina C, cardiovascular modern dances included in this
Jennifer G, fitness levels lower and does not study.
Megan R, than those of represent all Vo2 Max, Heart
Greg G, endurance athletes, dancers. It rate response, and
Richard G other dancers focuses on lung function were
(Bronner et showed high aerobic preseason covered.
al., 2014) capacity levels. profiles which
There is variety lack follow-up
among dancers as profiles
well as variations in throughout the
each dancer's season.
physiological
makeup.
2. Effects of Wilhelm 41 2 38 Without There was no This study covers
aerobic Mistigen, compromising the control group. pre-professional
endurance, Nathalie A. dancers' visual Some of the dancers and
muscle strength, Roussel, Dirk appeal, students did not evaluates aerobic
and motor Vissers and preprofessional complete the endurance, muscle
control on Steven Truijen dancers' physical assessment, strength, and motor
physical fitness (Mistiaen et fitness increased and some of control.
and al., 2012) when they combined the evaluation
musculoskeletal regular dance was completed
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 injury rate in instruction with an in class, which
preprofessional extra workout affected the
dancers regimen. During the outcome
intervention phase, because of the
a comparatively repeated
significant injury rate performance.
was noted.
3. Fitness training Ramel E, 25 6 4 The dancers in the When Professional ballet
and its effect on Thorsson D, training group said assessing dancers were
musculoskeletal Wollmer P that the fitness musculoskeleta focused in this
pain in instruction had l pain, relying study. Investigate
(Ramel et al., 1997)
professional improved their solely on self- about fitness
ballet dancers overall health and reported parameter such as
ability to handle the metrics may strength training,
mental stress of lead to flexibility,
rehearsal. subjectivity and endurance, and
possible bias. injury prevention.
Measures that
are objective or
clinical
assessments
could improve
the accuracy of
the results.
4. Does Physical Emily 13 0 13 Students who The study may This study covers
fitness affect Twitchett, exercised more had have had a elite vocational
injury occurrence Ph.D., Anna lower Students with small sample ballet dancers.
and time loss Brodrick, higher scores were size, which
due to injury in M.Sc., Alan M. less likely to be could have
elite vocational Nevill, Ph.D., injured. A higher limited how
ballet students? Yiannis level of fitness may broadly the
Koutedakis, be associated with results could be
Ph.D., shorter healing applied to the
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 Manuela times or less severe ballet student
Angioi, M.Sc., injuries, resulting in population.
and Matthew shorter absences Furthermore,
Wyon, from training or the results
Ph.D competition. could not hold
(Twitchett et al., 2010)
for all elite
vocational
ballet students
if the sample
isn't
representative
of the broad
population.
5. Cardiorespiratory Matthew A, 18 9 9 The study highlights This study This study includes
profile and Julie H, Faye the high consists of a elite hip-hop
performance A, Ross C, cardiorespiratory small size dancers and
demand of elite Janine Bryant fitness levels and population and highlights the
hip-hop dancers tremendous includes only cardiorespiratory
(Wyon et al., 2018)
physiological hip-hop fitness level such
demands faced by dancers. as VO2 max and
elite hip-hop heart rate
dancers, particularly response.
those specialized in
Breaking New
Styles.

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Ambegaonkar JP, Chong L, Joshi P. Supplemental education in Dance: a systematic review.

Phys Med Rehabil Clin N Am. 2021 Feb;32(1):117-a hundred thirty five. doi:
10.1016/j.pmr.2020.09.006. Epub 2020 Nov 2. PMID: 33198891.

Bronner S, Ojofeitimi S, Lora JB, Southwick H, Kulak MC, Gamboa J, Rooney M, Gilman G,
Gibbs R. A preseason cardiorespiratory profile of dancers in 9 professional ballet and
contemporary organizations. J Dance Med Sci. 2014;18(2):74-85. doi: 10.12678/1089-
313X.18.2.74. PMID: 24844424.

Dang Y, Chen R, Koutedakis Y, Wyon MA. The Efficacy of physical fitness schooling on
Dance damage. Int J Sports activities Med. 2023 Feb; forty-four (2):108-116. doi:
10.1055/a-1930-5376. Epub 2022 Aug 24. PMID: 36002027; PMCID: PMC9940991.

Farmer C, De’Ath S, Brouner J. Power training Perceptions amongst Vocational Circus and
Dance college students. magazine of Dance medicinal drug & technological know-
how. 2023;0(0). doi:10.1177/1089313X231204164

Koutedakis, Y., Jamurtas, A. The Dancer is an acting Athlete. sports Med 34, 651–661
(2004). https://doi.org/10.2165/00007256-200434100-00003

Mistiaen W, Roussel NA, Vissers D, Daenen L, Truijen S, Nijs J. Results of aerobic

persistence, muscle electricity, and motor control exercise on bodily health and
musculoskeletal injury rate in preprofessional dancers: an uncontrolled trial. J
Manipulative Physiol Ther. 2012 Jun;35(five):381-9. doi: 10.1016/j.jmpt.2012.04.014.
Epub 2012 May additionally 17. PMID: 22607780.

Rodrigues-Krause J, Krause M, Reischak-Oliveira Á. Cardiorespiratory issues in Dance:

From training to Performances. J Dance Med Sci. 2015 Sep;19(3): ninety one-102.
doi: 10.12678/1089-313X.19.3.91. PMID: 26349502.

Ramel E, Thorsson O, Wollmer P. Fitness schooling and its impact on musculoskeletal pain
in professional ballet dancers. Scand J Med Sci sports. 1997 Oct;7(5):293-eight. doi:
10.1111/j.1600-0838.1997.tb00156.x. PMID: 9338948.

Smith AB, Jones CD. injuries in expert Dancers. Rev Bras Med Esporte. 2017 Nov-
Dec;23(6):788-795. https://doi.org/10.1590/1517-869220172306170788

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Twitchett E, Brodrick A, Nevill AM, Koutedakis Y, Angioi M, Wyon M. Does physical fitness
affect harm incidence and time loss because of harm in elite vocational ballet
students? J Dance Med Sci. 2010;14(1):26-31. PMID: 20214852.

Wyon MA, Harris J, Adams F, Cloak R, Clarke FA, Bryant J. Cardiorespiratory Profile and
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