Falling on Your Feet: Dance and Holistic Wellness in Later Life

Special Article - Fall Prevention

Gerontol Geriatr Res. 2017; 3(1): 1028.

Falling on Your Feet: Dance and Holistic Wellness in Later Life

Bailey C¹*, Reynolds J², Hearne C³, Gavin C³ and Iftkhar N4

¹Department of Nursing Midwifery and Health, Northumbria University, UK

²Department of Social Work Education and Community Well Being, Northumbria University, UK

³Helix Arts, 1st Floor, Broadacre House, Newcastle upon Tyne NE1 6HQ, UK

4Company of Others, Newcastle Upon Tyne, England

*Corresponding author: Cathy Bailey, Department of Nursing Midwifery and Health, Northumbria University, Room H005, Coach Lane Campus East, Newcastle upon Tyne, UK

Received: March 17, 2017; Accepted: April 13, 2017; Published: April 20, 2017


This article considers role of dance participation in holistic, later life, health protection. A bi-weekly, 12 week, exploratory, ways to well-being, dance intervention ‘Falling on your Feet’ was designed and managed by X Arts organization and choreographer X and funded by the National Health Service (NHS) England. It reports on findings from the qualitative evaluation that ran in parallel with the programme. Key questions focused on self-reported value of dancing maintaining a healthier and socially connected older age. The intervention attracted 38 community dwelling people aged 65 years and over, 32 of whom consented to the evaluation. Discussion groups, short telephone interviews, observations, a public performance and professional dancer feedback, captured participants’ self-reported benefits.

Participants knew the importance of maintaining and improving strength and balance in later life and reported a range of positive impacts on their physical, cognitive and emotional wellbeing. They valued co-choreography, acquiring the confidence to find their creativity and express this through dance, with group and paired dancing adding to social connections and emotional expression. Particularly striking were their positive expressions of self-ownership, selfpossibility and positive future self well into older age. The findings warrant objective investigations into self reported, positive impacts of dance on strength and balance, social and emotional loneliness and overall self efficacy in later life. ‘Falling on your Feet’ connected with the human scale of health promotion.

Keywords: Dance; Later life; Falls; Qualitative evaluation


Many older people, including those living alone, lead independent and fulfilling lives. However much of the world is ageing with countries such as Japan, Italy, Greece, Germany, France, Portugal, Finland, Bulgaria, Sweden, and Malta having 18% to 26% of their population aged 65 years and over, with countries such as UK and US , not far behind [1]. Ageing is associated with higher levels of disease and disability [2], an increasingly sedentary lifestyle, this sometimes associated with falls and fear of falling [3,4] and relatedly, making greater demands on health and social care costs.

In a recent systematic review on impacts of arts participation on health outcomes for older people, [5] suggest that ageing populations have led to increased interest in health protection and wellness interventions for older people, particularly community programmes developed from evidence based practice. The authors distinguish between art therapies, often delivered in clinical settings by health professionals and therapeutic use of the arts, the latter encompassing professional artists designing and managing, creative or performing arts programmes in community settings. With the potential to reach wide populations, the goal is to promote health and wellness, potentially with a focus on disease prevention or living well with a disability, rather than on healing or ameliorating the effects of disease and disability.

A popular art form, social dance is enjoying a revival; certainly in the US and the UK through TV programmes such as ‘Strictly Come Dancing. A 2011 review of the international evidence on the health benefits of dancing for older people [6] cites physical health benefits of regular dance for older people, including: aerobic exertion increasing breathing and heart rates with potentially, positive heart health benefits and low level resistance exercise, that may improve balance, agility and gait and reduce the risk of falls [7,8]. However, there is still lack of firm evidence, clearly associating regular dance with a reduction in falls [9].

Noice and Kramer [10] recently reviewed the scientific literature on older adults and health impacts of active participation in the arts, including dance. The review focused on wellness studies, in particular those designed to investigate physical, psychological, cognitive and emotional health improvement through arts participation. Participants were aged 60 years and over, able to independently perform activities of daily living and in general good health. In relation to dance, eight studies met the quality criteria. Of these, a randomized control trial [11] randomly assigned two groups who had not participated in regular dance or sports activities for 5 years, to a 6-month dance course (1hr/week under a professional instructor) or to a ‘usual activities’ group. Pre and post testing identified significantly higher performance on a number of cognitive and physical measures for the experimental group, compared with controls. Another study compared a mainly exercise-based freestyle dance regime (FR) with a more cognitively complex, choreographed performance of the same basic moves (CB), both taught by an experienced dance instructor [12]. Findings demonstrated a significantly better performance on a standard reaction time task for the CB group.

Noice et al., also suggest that cognitive improvements are likely to fit with current theories of brain plasticity and cognitive reserve. In an earlier article focusing on creativity and ageing and positive impacts of the arts on health and illness in later life, [13] suggests that neuroscience has advanced understanding of the brain’s plasticity, its ability to adapt and remain vital [14]. He contends that creative and arts related activities stimulate the brain, which in turn creates new synapses (contact points between cells). More synapses lead to better communication among brain cells and an improvement in brain reserve. This might explain [11] study findings as briefly outlined above, in relation to complex choreographed dance moves, leading to better performance on a standard reaction time to cognitive and physical measures, than those doing more exercise based dance moves.

Cohen [13] also suggests that participation in the arts may foster sense of control mechanisms, such as a sense of mastery [15]. For example, participating in and ‘mastering’ a dance class with choreographed moves, can lead to feelings of empowerment that new challenges can be accomplished and indeed, can open up new possibilities. Participants taking part in a dance intervention with a performance element, have self reported additional personal accomplishment and satisfaction in a successful performance and the sense of purpose that the end performance provides to the dance experience [6]. Connolly and Reading, [16] report on a number of studies wherein participants in weekly dance sessions, self-reported improved self-confidence through perceived, physical improvements and also, through taking part in a group performance [17].

Studies focusing on dance and social engagement point to the benefits of social support found in group participatory arts activities, such as dancing [18,19] and the positive impacts of sharing stimulating or productive activities [20,21], such as learning dance moves together. Others however caution that well validated and designed research is still needed to substantiate some descriptive findings such as dance enabling non verbal and expressive communication and, being a sociable and enjoyable activity [16].

With some caution about research design, there is growing evidence of physical, psycho-social and cognitive benefits of dance that in turn, may provide good health protection in later life. However in the UK, the Centre for Policy and Ageing, dance and health report [6] asserts that dance may still be overlooked by policy makers and commissioners focusing more on sports based activities and exercise. Whilst such activities are of real value to health and well- being across the life-course, dancing too, is an activity that the literature suggests, when delivered appropriate to a person’s ability, can be an enjoyable social activity with positive impacts for physical and cognitive health and emotional wellbeing. Below we introduce the ‘Falling on your Feet’ dance intervention programme.

The Dance Intervention: Falling on Your Feet

Through an innovative National Health Service (NHS) England funding call, X Arts, an arts production company with a thirty-year track record of producing creative programmes with artists and communities facing multiple disadvantages, designed and piloted a bi-weekly, 12 week dance for health programme for people aged 65 and over, living independently in an urban area in X in the North East England. The aim of the intervention, ‘Falling on your Feet’, was to promote the physical and mental health and well-being benefits of group, social dancing in later life. A participant recruitment plan was initiated with a number of referral routes, including local health professionals, patient forums and wider third sector partners and this was strengthened by a strong local media campaign including coverage via local BBC Radio X and ITV news.

X Arts produced ‘Guidelines for Dance’ exercise documentation, outlining the dance intervention and advising participants to consult with their GP, if they had not participated in exercise for a while, A short self reported health questionnaire was provided and participants were asked to advise the dance professional leader of any changes in their health condition which may affect their ability to dance and exercise throughout the programme. Such ‘screening’ is common within community delivered services and ensures safe and common sense practice.

38 older adults, 30 females and eight males, showed interest in the taster phase of the programme, with up to 18 participants regularly attending the twice weekly classes. These participants also co-produced a choreographed piece of dance, with nine of them gaining the confidence to participate in a final performance. Known reasons for attrition included health problems, not associated with the dance intervention, family and other commitments. Participants were aged between 65 to 85+, just over half (n=20) were aged 65- 69, of the remaining 18 over 69, five chose not to disclose their age. A number of self reported long term conditions were captured by the health questionnaire including diabetes, arthritis, heart related conditions and poor mental health, in particular anxiety and low level depression. Many had not danced for a long time, apart from at ‘occasions’ such as weddings.

Dance classes took place in a local, accessible, community centre, in a large, light and airy room, on good bus routes and with ample parking. Classes were delivered from January 2016, led by X X, a choreographer and professional dancer, with experience of running ‘Dance for Health’ classes. Each class was planned for about an hour with tea and biscuits at the end, a chance to chat and be sociable.

Values Based Evaluation

A values based evaluation designed and managed by X University, ran in parallel to the intervention [22]. This is a participatory, reflective and ongoing (process) approach, rooted in three questions: What’s important to the participants (values)? Clarifying what’s important (why these values?); Identifying and mapping values-based aspects (processes and outcomes). The evaluation wished to find out the views and opinions of those taking part in the dance class, whether taking part in a regular dance class can help promote the benefits of physical activity for those aged over 65 years, whether there are wider benefits and what was of value to the participants and why. The evaluation was also responsive to what emerged from the process.

Following X University ethical approval, 32 participants consented to take part and from the mid-point data collection phase, 18 participants were still available for data capture. Table 1 gives detail of evaluation data collection. Using short telephone interviews, group discussion and structured feedback, pre dance intervention expectations, early impressions, mid-point feedback and post intervention reflections were captured. One of the evaluation team also observed a dance class. With verbal agreement, the public performance and post-performance audience question and answer session, also forms part of the evaluation data as does a sample from the weekly written feedback from X, the choreographer. At the end of the project, reflective, one to one interviews were carried out with X Arts, X (CEO) and X, (Senior Project Manager and Creative Producer).

Citation: Bailey C, Reynolds J, Hearne C, Gavin C and Iftkhar N. Falling on Your Feet: Dance and Holistic Wellness in Later Life. Gerontol Geriatr Res. 2017; 3(1): 1028.