When does dance stop being good for us? What elite dance teaches us about health-promoting environments

Dance is often celebrated as one of the most powerful forms of physical activity for promoting health and wellbeing. It combines movement, creativity, self-expression, music, social connection, and meaning. Research consistently shows that dance can enhance physical, psychological, and social wellbeing across the lifespan (Burkhardt & Brennan, 2012; Chappell et al., 2021; Delattre et al., 2024; Du et al., 2025). Yet the picture becomes more complicated when we turn our attention to pre-professional and professional dancers. Recent research suggests that many dancers experience anxiety, depression, eating difficulties, injury, fatigue, burnout, and low energy availability (Dwarika & Haraldsen, 2023; Junge & Hauschild, 2023).

So how can the same activity be both health-promoting and health-challenging? The answer may lie not in dance itself, but in the environments in which people dance.

One of the most important lessons emerging from research on dancers' mental health is that we cannot fully understand wellbeing by focusing only on the individual. The conditions surrounding participation matter. As researchers, practitioners, and organisations, we need to consider how training environments, workplace cultures, policies, and practices can either support or undermine health (Cumming et al., 2024; Dwarika et al., 2026).

The dance environment matters

For many people, dance provides joy, connection, challenge, and opportunities for self-expression. These qualities help explain why dance often produces benefits beyond those associated with exercise alone. Movement, music, creativity, and belonging can be powerful contributors to wellbeing (Chappell et al., 2021; Delattre et al., 2024).

However, as dance becomes increasingly professionalised and competitive, additional pressures emerge. Performance is constantly evaluated. Casting decisions may feel uncertain or subjective. Aesthetic expectations can become more demanding. Financial and occupational insecurity may increase. In these contexts, the very factors that support excellence can also create risks to health and wellbeing (Dwarika & Haraldsen, 2023; Kolitsida et al., 2023).

Rather than asking whether dance is good or bad for health, a more useful question is:

What features of high-performance environments help people flourish, and which ones increase risk?

Five ways high-performance environments can undermine health

1. When appearance becomes more important than health

In some dance cultures, particularly those that place a strong emphasis on achieving a specific physique, body image pressures can become a significant source of stress. Efforts to achieve and maintain aesthetic ideals may contribute to disordered eating, low energy availability, and Relative Energy Deficiency in Dance (RED-D). When appearance becomes prioritised over long-term health, both physical and psychological wellbeing can be compromised (Allen et al., 2024; Arcelus et al., 2014).

2. When pain and fatigue become normalised

Many dancers learn early in their training that perseverance is valued. While resilience is an important quality, problems arise when pain, fatigue, or injury are treated as normal and unavoidable aspects of performing.

Research suggests that dancers often feel pressure to continue despite exhaustion, discomfort, or injury. Yet fatigue is associated with reduced performance quality, increased injury risk, lower motivation, and poorer communication (Magrath et al., 2023; Smith et al., 2024). When recovery is not considered a necessity, it is likely that both health and performance will suffer.

3. When perfectionism becomes destructive

Dedication, discipline, and high standards are often celebrated in elite performers. However, these strengths can become vulnerabilities when success is tied to excessive self-criticism or fear of failure.

Perfectionism has been associated with anxiety, burnout, and eating psychopathology among dancers (Nordin-Bates et al., 2011; van Winden et al., 2020). Similarly, when personal identity becomes closely linked to performance outcomes, setbacks such as injury, rejection, or career transitions may feel especially threatening. What begins as a passion can become an all-consuming source of pressure.

4. When dancers lose voice and autonomy

Healthy environments support people's basic psychological needs, including autonomy, competence, and belonging. In contrast, environments characterised by authoritarian teaching approaches, unequal power relationships, or excessive control may undermine wellbeing (Deci & Ryan, 2002; Ryan & Deci, 2000).

Dancers often operate within systems where important decisions about casting, contracts, progression, and opportunities are made by others. When individuals feel they have little voice in decisions that affect them, psychological safety can be diminished and stress can increase (Van Herck & Nordin-Bates, 2026).

5. When support is difficult to access

Research suggests that mental health difficulties in dance may be under-recognised and under-reported. Stigma, low mental health literacy, uncertainty about where to seek support, and concerns about career consequences can all delay help-seeking (Alimena et al., 2016; Fostervold Mathisen et al., 2022; Junge & Hauschild, 2025).

Creating environments where it is safe to talk openly about mental health is therefore essential. Just as dancers seek professional support for physical injuries, they should also be able to access support for psychological difficulties without fear of judgement or negative consequences.

From understanding challenges to creating solutions

If mental health challenges are shaped by the environment, then solutions must extend beyond helping individual dancers to "cope better". We must also create environments that actively promote health and wellbeing.

At the SPRINT Project, we have been exploring how research can be translated into practical action through the SHAPE framework, which offers five principles for creating mentally healthier dance cultures.

S - Safeguarding and safer dance	Everyone involved in dance has the right to participate in environments that are safe, respectful, equitable, and free from harm (Cumming et al., 2024). Safeguarding should not be viewed solely as responding to serious incidents. It also involves proactively creating conditions that prevent harm and promote wellbeing.
H – Holistic health	Supporting dancers means recognising that they are people first and performers second. Physical, psychological, emotional, and social wellbeing are all important. Healthy environments value dancers as whole individuals rather than solely for their performance outcomes.
A – Agency	Dancers should have genuine opportunities to contribute to decisions that affect their training, workload, wellbeing, and development. Strengthening dancers' voice and participation can help foster autonomy, trust, and shared responsibility for wellbeing.
P – Psychologically-informed culture	Mental health should be embedded within organisational culture, rather than treated as an add-on. This includes promoting psychological safety, engaging qualified professionals, using evidence-informed approaches, and creating climates where individuals feel able to speak openly about challenges.
E – Education	Mental health literacy, safeguarding knowledge, and awareness of healthy training practices should be part of ongoing education for dancers, teachers, artistic directors, leaders, and support staff. Building knowledge helps individuals recognise concerns early and respond effectively.

A final thought

Dance itself remains one of the most powerful ways to promote movement, creativity, connection, and wellbeing. The challenge is not to make dance less demanding or less ambitious. Rather, it is to ensure that the environments surrounding dance allow people to pursue excellence without sacrificing their health in the process.

The wider lesson extends beyond dance. Whether in sport, the performing arts, education, healthcare, or academia, we should be asking the same question: what kinds of environments help people perform at their best while also supporting their wellbeing?

Health and performance should not be competing priorities. The most sustainable forms of excellence depend on both.

---

Written by Prof Jennifer Cumming

References:

1. Alimena, S., Air, M. E., Gribbin, C., & Manejias, E. (2016). Utilization of routine primary care services among dancers. Journal of Dance Medicine & Science, 20(3), 95-102. https://doi.org/https://doi.org/10.12678/1089-313X.20.3.9

2. Allen, N., Kelly, S., Lanfear, M., Reynolds, A., Clark, R., Mountjoy, M. L., Wyon, M., & Wolman, R. (2024). Relative energy deficiency in dance (RED-D): A consensus method approach to REDs in dance. BMJ Open Sport & Exercise Medicine, 10(1), e001858. https://doi.org/10.1136/bmjsem-2023-001858

3. Arcelus, J., Witcomb, G. L., & Mitchell, A. (2014). Prevalence of eating disorders amongst dancers: A systemic review and meta-analysis. European Eating Disorders Review, 22(2), 92-101. https://doi.org/10.1002/erv.2271 

4. Burkhardt, J., & Brennan, C. (2012). The effects of recreational dance interventions on the health and well-being of children and young people: A systematic review. Arts & Health, 4(2), 148-161. https://doi.org/10.1080/17533015.2012.665810

5. Chappell, K., Redding, E., Crickmay, U., Stancliffe, R., Jobbins, V., & Smith, S. (2021). The aesthetic, artistic and creative contributions of dance for health and wellbeing across the lifecourse: a systematic review. International Journal of Qualitative Studies on Health and Well-being, 16(1), 1950891. https://doi.org/10.1080/17482631.2021.1950891

6. Cumming, J., Nordin-Bates, S. M., Johnson, C., Sanchez, E. N., & Karageanes, S. J. (2024). High time to enhance dancer welfare: A call to action to improve safeguarding and abuse prevention in dance. BMJ Open Sport & Exercise Medicine, 10(2), e001811. https://doi.org/10.1136/bmjsem-2023-001811

7. Deci, E. L., & Ryan, R. M. (2002). Self-determination research: Reflections and future directions. In E. L. Deci & R. M. Ryan (Eds.), Handbook of Self-Determination Research (pp. 431-441). University of Rochester Press.

8. Delattre, B., Applewhite, B., Buckman, J. E. J., Harmer, C. J., & Murphy, S. E. (2024). Social dance and movement for mental health: A narrative review. Mental Health Science, 2(2), e62. https://doi.org/https://doi.org/10.1002/mhs2.62

9. Du, M., E., H. J., Oliver, H., Rachel, S., & and Huang, C. (2025). Dancing towards wellbeing: A scoping review of dance interventions for therapeutic purposes in educational settings. International Review of Sport and Exercise Psychology, 1-37. https://doi.org/10.1080/1750984X.2025.2471759

10. Dwarika, M. S., & Haraldsen, H. M. (2023). Mental health in dance: A scoping review [Review]. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1090645

11. Dwarika, M. S., Jordan-Dewhurst, T., Tidmarsh, G., Kolitsida, M., Sanchez, E., Quinton, M. L., & Cumming, J. (2026). Risk and protective factors for safeguarding and abuse prevention in dance: A scoping review. International Journal of Sport and Exercise Psychology. https://doi.org/https://doi.org/10.1080/1612197X.2025.2611828

12. Fostervold Mathisen, T. F., Sundgot-Borgen, C., Anstensrud, B., & Sundgot-Borgen, J. (2022). Mental health, eating behaviour and injuries in professional dance students. Research in Dance Education, 23(1), 108-125. https://doi.org/10.1080/14647893.2021.1993171

13. Junge, A., & Hauschild, A. (2023). Behind the curtain: Prevalence of symptoms of depression, generalised anxiety and eating disorders in 147 professional dancers from Six Opera Houses or State Theatres. Sports Medicine - Open, 9(1). https://doi.org/10.1186/s40798-023-00638-9

14. Junge, A., & Hauschild, A. (2025). Prevalence of Mental Health Problems and their Potential Association with Sleep Disturbance, Coping Skills and Social Support in Professional Ballet Dancers. Journal of Dance Medicine & Science, 29(2), 106-115. https://doi.org/10.1177/1089313x241277930

15. Kolitsida, M., Cumming, J., Lavis, A., & Sanchez, E. (2023). The impact of the COVID-19 pandemic on the mental health and wellbeing of dance freelancers in the United Kingdom. Journal of Dance Education, 23(3), 190-199. https://doi.org/10.1080/15290824.2023.2231936

16. Magrath, J., Paglione, V., Morrison, L., & Kenny, S. J. (2023). ‘It shouldn’t be necessary, but it happens a lot’: Undergraduate contemporary dancers’ perceptions of pain, injury, and fatigue. Theatre, Dance and Performance Training, 14(4), 492-510. https://doi.org/10.1080/19443927.2023.2220686

17. Nordin-Bates, S. M., Cumming, J., Aways, D., & Sharp, L. (2011). Imagining yourself dancing to perfection? Correlates of perfectionism among ballet and contemporary dancers. Journal of Clinical Sport Psychology, 5, 58-76.

18. Ryan, R. M., & Deci, E. L. (2000). The darker and brighter sides of human existence: Basic psychological needs as a unifying concept. Psychological Inquiry, 11(4), 319-338. https://doi.org/https://doi.org/10.1207/S15327965PLI1104_03

19. Smith, L.-S., Louw, Q. A., & Brink, Y. (2024). Fatigue and recovery in ballet: Exploring the experiences of professional South African ballet dancers. BMC Sports Science, Medicine and Rehabilitation, 16(1), 237. https://doi.org/10.1186/s13102-024-01026-w

20. Van Herck, A., & Nordin-Bates, S. (2026). Psychological safety: Ballet students´ perceptions and recommendations. Journal of Dance Education, 26(1), 36-47. https://doi.org/10.1080/15290824.2024.2437755

21. van Winden, D., van Rijn, R. M., Savelsbergh, G. J. P., Oudejans, R. R. D., & Stubbe, J. H. (2020). Limited coping skills, young age, and high BMI are risk factors for injuries in contemporary dance: A 1-Year prospective study [Original Research]. Frontiers in Psychology, Volume 11 - 2020. https://doi.org/10.3389/fpsyg.2020.01452