Foundationsforexcellence2009 1

Foundations for Excellence

Promoting health and wellbeing in talented young dancers and musicians
Music and Dance Scheme Conference 2009
The healthy musical body: assessments and support >> Dr Aaron Williamon

Promoting health and wellbeing in talented young dancers and musicians Music and Dance Scheme Conference 2009 Edited by Mary Schwarz
Supported by:
Photo Credits: Front Cover Jo Pitson Back Cover Richard H. Smith
Published by South West Music School, The Barn, Dartington Hall, Totnes TQ9 6DE info@swms.org.uk 01803 847011 Copyright South West Music School 2009 and the individual authors First published 2009 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of the publisher, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to South West Music School. Disclaimer: Statements of fact and opinion in this publication are those of the respective authors and contributors and not of the editor, Foundations for Excellence Programme Committee or South West Music School. Neither the South West Music School, Foundations for Excellence Programme Committee or editor make any representation, express or implied, in respect of the accuracy of the material in this publication and cannot accept any legal responsibility or liability for any errors or omissions that may be made. The reader should make her or his own evaluation as to the appropriateness or otherwise of any experimental technique described. ISBN 978-0-9563338-0-3 Designed and produced by Toucan Design www.toucandesign.co.uk
14.95 incl. p&p
Foreword
This publication is one outcome from the Foundations for Excellence conference held on 24 February 2009 at Dartington Hall, Devon. The conference Programme Committee comprised representatives from the Department for Children, Schools and Families (DCSF) Music and Dance Scheme supported Centres for Advanced Training (CATs) and residential schools, with colleagues from specialist dance and music higher education institutions. The DCSF Music and Dance Schemes aims are: to help identify, and assist, children with exceptional potential, regardless of their personal circumstances, to benefit from world-class specialist training as part of a broad and balanced education, which will enable them, if they choose, to proceed toward selfsustaining careers in music and dance. The Programme Committee identified the need for a greater, shared understanding of the significance of good health and wellbeing, alongside preventative strategies to avoid injury and illness, for enhancing the performance of young dancers and musicians. The conference brought together academics researching health issues in dance and music with practitioners working with talented young people in these sectors. We hope its outcomes, as found in SECTION FOUR: MOVING ON, will have wide application for all those involved in teaching and performing - far beyond the Music and Dance Scheme itself. During the conference some key questions were posed and a number of important issues raised. Why are some dancers more prone to injury than others? How can young musicians and dancers enhance their wellbeing and health and become better performers? How can dancers and musicians better prepare themselves, physically, technically, artistically and psychologically, for performance? What can we learn about the flow of performance? And the importance of exercise and a well-balanced diet for both musicians and dancers? How do we provide teachers and students with the tools to inform their teaching and learning in these areas? There are many more questions that could have been asked. We therefore hope that readers of this publication will find its contents interesting and contribute to what is a fascinating, vital and ongoing debate. Acknowledgements are due to all conference contributors, whose presentations are summarised here; delegates who participated so actively; conference organiser Lisa Tregale of South West Music School; and Mary Schwarz who edited this publication. Robin Kiel MBE Music and Dance Scheme, Department for Children, Schools and Families
Foreword

Promoting health and wellbeing in talented young dancers and musicians Music and Dance Scheme Conference 2009
CONTENTS
5 6 7 SECTION ONE: FOUNDATIONS FOR FITNESS The health of the performer >> Moira McCormack Moira McCormack shared her reflections on observing performers from the top of the profession and how they deal with health issues. Understanding and developing young dancer talent: a health and wellbeing perspective >> Dr Sanna Nordin, Imogen J. Walker and Dr Emma Redding Dr Nordin presented the work she is undertaking as Research Fellow for the Centres for Advanced Training research project with Imogen J. Walker, PhD student and Dr Emma Redding, Principal Investigator. Screening of dancers and its applications: an informed approach to teaching >> Rachel Rist Rachel Rist explored how screening can keep dancers dancing longer and stronger. Screening needs to be in place to produce the foremost dancers with longevity in the profession. The healthy musical body: assessments and support >> Dr Aaron Williamon Dr Aaron Williamons first conference presentation focused on research related to fitness assessments and health resources for RCM (Royal College of Music) musicians, with acknowledgments to colleagues David Wasley (University of Wales Institute, Cardiff); Rosie Perkins (RCM); Wulf Hildebrandt (University of Nottingham); Gunter Kreutz (Carl von Ossietsky University of Oldenburg); and Dr Jane Ginsborg (Royal Northern College of Music). Performance preparation and health: the work of BAPAM >> Dr Sanchita Farruque Dr Farruque talked about her work as a health promoter for musicians with British Association for Performing Arts Medicine (BAPAM), bringing together her background as a professional vocalist and doctor. SECTION TWO: KEY HEALTH ISSUES The noise of performance >> Dr Aaron Williamon Dr Aaron Williamons second conference presentation began with an update on noise exposure legislation. He went on on to describe a research project about orchestral musicians exposure and gave information to support young musicians, and their teachers, understand hearing and noise exposure. Healthy behaviours in music performance and non-music performance students >> Dr Jane Ginsborg Dr Jane Ginsborg presented the work she has undertaken with colleagues Gunter Kreutz (Carl von Ossietsky University of Oldenburg), Mike Thomas (University of Chester) and Dr Aaron Williamon (Royal College of Music).
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Psychological aspects of musical performance and their implications for the education and training of musicians >> Dr Ioulia Papageorgi Dr Papageorgi began her presentation by talking about the role of biological and environmental factors in the development of musical potential. She then talked about findings from her PhD thesis titled Understanding Performance Anxiety in the Adolescent Musician and the research project Investigating Musical Performance: Comparative Studies in Advanced Musical Learning. Practical considerations on eating problems among dancers >> Helen Laws and Dr Emma Redding Helen Laws and Dr Emma Reddings presentation covered the nature, causes and prevalence of eating problems among dancers and offered policy guidelines. Policy framework and best practice in relation to eating disorders in dance schools and companies >> Susan Ringwood Susan Ringwoods paper is offered here as additional advocacy for developing policies on eating disorders that promote health and wellbeing for all. SECTION THREE: POSITIVE PRACTICES Dancing in the moment: dancers flow experiences >> Elsa Bradley Elsa Bradleys presentation focused on optimal experiences flow experiences and the differences between recreational, vocational and professional dancers perceptions of flow whilst dancing. She considered what flow is and its relevance to dance practice and young people. Proprioception >> Kim Pedrick Kim Pedricks presentation included demonstrations and practical exercises in which delegates participated, so they could directly experience proprioception and explore techniques for its development. SECTION FOUR: MOVING ON Programme Committee actions Principles and Practices: promoting health and wellbeing in talented young dancers and musicians ANNEXES Foundations for Excellence conference: summary of delegates evaluations Foundations for Excellence conference: attendees and performers Contributors biographies
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Contents
Foundations for Excellence Conference 2009 Programme Committee Professor George Caird Principal Birmingham Conservatoire, Birmingham City University Timothy English Head of Junior Conservatoire, Birmingham City University Robin Kiel MBE Policy Manager Music and Dance Scheme, Department for Children, Schools and Families Dorothy Nancekievill Director of Music Wells Cathedral School Dr Emma Redding Head of Dance Science Trinity Laban Rachel Rist Director of Dance Tring Park School for the Performing Arts Lisa Tregale Director South West Music School Dr Aaron Williamon Head of the Centre for Performance Science Royal College of Music
SECTION ONE: FOUNDATIONS FOR FITNESS

The section starts with Moria McCormacks abstract for her opening speech at the Foundations for Excellence conference, in which she gives a perspective on the crucial role of the teacher in supporting an informed approach to health by young performers. This is followed by Dr Sanna Nordins report on a major longitudinal research project in young dancer talent development for the Centres for Advanced Training. Rachel Rist describes the benefits of health screening for dancers and Dr Aaron Williamon reports on health and fitness assessments for musicians and the health resources available at the Royal College of Music. The section ends with a summary of support offered by British Association for Performing Arts Medicine (BAPAM) from Dr Sanchita Farruque.
The healthy musical body: assessments and support >> Dr Photo: Aaron Williamon Will Price
The health of the performer Moira McCormack - Head Chartered Physiotherapist, Royal Ballet Company
Moira McCormack shared her reflections on observing performers from the top of the profession and how they deal with health issues. Working with professional dancers we are under pressure to keep dancers dancing, to deal with injuries as they arise, and to predict and prevent injury. Working in an international ballet company is a unique position from which to observe dancers from all over the world tackling their careers and confronting their inevitable problems. Those who have received even a rudimentary education in injury care and prevention, and who are willing to analyse technique, will confront problems and seek out answers. They are the dancers who have been encouraged to question by their teachers. On the other hand, others have been taught inflexibly and have closed minds like their teachers. Their resistance to change makes injury prevention impossible and total recovery difficult. Dancers like these, with huge potential, sadly limit their careers. Professional companies should receive talent fully prepared for expansion, not, as is often the case, in need of technical correction or help in re-educating a healthy lifestyle. Vocational training is an intense, powerful and all consuming experience for the developing artist. It makes a deep impression in those formative years. If it is gauged correctly, you create a well-rounded, confident performer. If not, you create someone limited and lacking in confidence, or someone ambitious but ignorant. The teacher is the central figure. The teacher is the source of inspiration and success, wields enormous influence over the adolescent and leads by example. We must also bear in mind that todays professional dancer is tomorrows teacher, and that less than enlightened teaching is therefore self-propagating. The major threat to productive schooling is injury. Injury wastes money and time in those precious years of training, and in the relatively short professional career. The causes must be fully understood by all those concerned. An injury is not just for the therapist to deal with the mechanism of injury, technical mistakes, fatigue, lack of nutrition or psychological problems must be taken on board by dancer, teacher, therapist and director. It is teamwork that supports the health of the developing artist. Teaching requires both psychological skills and in-depth knowledge of biomechanics. Skill in recognising and accessing what each physique and temperament needs requires reflection, study, discussion and preparation. Teaching requires continued study and development as in other professions. It is a prerequisite to taking on the responsibility of guiding successful careers and in this case, wisely spending the millions of pounds the government invests in training. Continued professional development is demanded in other professions but in dance teaching apparently not. Many professional dancers move on to dance teaching but dance training often excludes them from quality higher education. Moving into teaching does not mean resting on laurels, but moving into continued education themselves. There needs to be far more emphasis on this in producing our future teachers who in turn produce our future performers.
Our challenges:
We need to consider our future professionals in dance and music, in terms of health. We need to confront and expose problems in our handling of these children, and hopefully expand our understanding in order to build them a better future. They are chosen for their aptitude and physical potential and in our dealing with these special and different children we, the teaching and health professions, have to work together and continually question our methods, voracious for new ideas and searching for answers ourselves.
The health of the performer >> Moira McCormack
Understanding and developing young dancer talent: a health and wellbeing perspective Dr Sanna Nordin - Research Fellow, Dance Talent Development In Young People, Laban
Dr Nordin presented the work she is undertaking as Research Fellow for the Centres for Advanced Training research project with Imogen J. Walker, PhD student and Dr Emma Redding, Principal Investigator. Recent research indicates that by taking a systematic, scientific approach we might better understand what talent is and how it is best developed. Talent models and research in sport show an increased recognition of the role of psychological and social factors in addition to traditionally emphasised physiological factors and an emphasis on the role of specific forms of deliberate practice over innate talent.
The model of potential talent predictors in soccer (Williams and Franks, 1998; Williams and Reilly, 2000) includes:
>> physical predictors e.g. height, weight, body fat >> physiological predictors e.g. aerobic capacity, anaerobic power >> psychological predictors e.g. perceptual-cognitive skills, personality characteristics >> sociological predictors e.g. parental support, coach-child interaction In music, MacNamara and colleagues (2008) took a similar scientific approach, finding that:
These [psychological characteristics] appear similar to those employed in other performance domains and support increasing empirical evidence of the development of psycho-behavioural characteristics as a core feature of talent development processes.
>> MacNamara et al., 2008, p. 335
In dance, talent is much talked about and sought after, but definitions of what and how important it is are varied and lacking in research and/or systematic evidence.
Traditional dance talent identification (ID) seems primarily to be based on:

>> technical skill >> physical characteristics (limb lengths, slenderness) and control >> other dance-specific criteria: artistic/creative
Sanders Gifted and Talented Dancers: A Resource Booklet for Teachers deals largely with two factors that only partially overlap with the traditional approaches:
>> psycho-behavioural characteristics >> dance-specific criteria: artistic/creative
Understanding and developing young dancer talent: a health and wellbeing perspective >> Dr Sanna Nordin
There is also a key question to consider, in terms of whether talent is innate or trainable. As one of the most famous dancers said:
Some people seem to think that good dancers are born, but all the good dancers I have known are taught or trained.
>> Fred Astaire
Altogether, it appears that using a systematic, scientific process has helped develop a better understanding of talent ID and talent development in sport and music. The aim therefore is to further such an understanding in dance through a collaboration with Centres for Advanced Training (CATs), with an unprecedented participation of an entire cohort of dancers labelled talented or as having exceptional potential.
The overall procedure of the research is to profile and screen CAT dancers to find out:
>> what are they like? >> how do they develop? The research is longitudinal, with visits to the CATs twice yearly over a two and a half year period. The research is interdisciplinary, for a holistic view, examining factors in the dancers physicality, psychology and background/training. Over time, there will be an examination of whether these factors are related to wellbeing (injury, health); performance outcomes (adherence, graduate destinations); and creativity. The desired outcome is to enhance understanding of how best to develop talent in young dancers.
The first data collection took place over November December 2008 and comprised:
>> 324 dancers from all then active CATs >> 73.8% female >> mixed ethnicities; 78.2% White British
The students were in the following ranges:

>> 10 18 years old (M = 14.47) (where M = mean) >> 1 60 months experience of CAT training (M = 14.58) >> 2 29 hours of CAT training per week (M = 3.34) >> 0 35 hours in other dance schools (M = 4.78) In other words, this was a mixed cohort. Dance literature shows that approximately 80% of pre-professional and professional dancers are injured each year (e.g. Laws, 2005).
In the CATs, only:

>> 57.3% had been injured in the past year >> 23% reported being injured at the time of screening
Injury Locations
The research found that dancers injured in the past year were younger and had spent less time in CAT training. In other words, older dancers who spend more time in CAT training do not seem more likely to get injured. Future research will examine whether psychological and physiological characteristics at baseline may predict injury over time for instance, does fitness guard against injury?
CAT class
23
16.6
Other dance setting Mixed dancing
25.5
32.7
Other physical activity incl. sport and PE Outside all physical activity
2.5
Fitness indicators used included:

>> jump height >> upper body strength >> flexibility >> turnout
In general, there were higher scores for:

>> older dancers (except turnout) >> males on jump height and strength >> females on flexibility and turnout As an example of fitness, turnout and jump height results were presented. There was an average turnout of 53.0 per leg, the range being 26.7 73.2. There was no relationship between turnout (average or discrepancy) and injury. In other words, having large or small external hip rotation, or uneven turnout, does not seem to be associated with injury proneness. There was also a favourable comparison to first year undergraduate contemporary dance students.
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Fitness example: Turnout

Turnout
54.00 53.50
Fitness example: Jump height

70 60
50 53.00 52.50 52.00 51.50 20 51.00 50.50 50.00 10 40
30
Females Males
Females
Males
1st year Undergraduates
CAT students
1st year students
Professional dancers
For jump height, there was a favourable comparison to contemporary first year undergraduate dance students and to contemporary professional dancers.
As an example of psychological characteristics, results relating to passion, self-esteem and the motivational climate were presented. Such personal qualities may be strongly related to talent development, as indicated in the following quotation:
Many other women kicked higher, balanced longer, or turned faster. These are poor substitutes for passion.
>> Agnes de Mille
Over seventy eight percent (78.7%) of the students met criteria for being classified as passionate about dance. Most display an adaptive form of passion dance fits into their lives and exists in harmony with other activities. Some report a more obsessive passion dance threatens to take over and become the main focus for their identity. Previous research suggests such passion is related to injury (Rip, Fortin & Vallerand, 2006) and future research will therefore explore potential health implications for different types of passion. In terms of self-esteem, most dancers displayed healthy levels of self-esteem, with comparatively high scores (M = 3.06 on 1 - 4 scale). Previous literature suggests dancers suffer from low self-esteem (e.g. Bettle et al., 2001; Buckroyd, 2000). Perhaps this is a thing of the past. Because self-esteem is important both for performance and wellbeing, future research will explore what aspects of dance leadership and feedback are related to optimal levels of self-esteem within the CATs. Regarding motivational climate, the psychological atmosphere in the dance studio has previously been found to relate to wellbeing (e.g. Quested & Duda, 2009). In CATs, the motivational climate appears very favourable, and more in line with recommendations for how to structure optimal dance and sports training than CAT dancers other (home) dance training. Future research will explore what aspects of the motivational climate are related to health and wellbeing over time. Science appears capable of generating valid findings and meaningful relationships between variables. So, we believe that dance science can be of assistance in promoting dance health and performance. However, it is not a be all, end all approach - simply a complement to existing teaching and training methods.
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In order to translate findings into practice, CAT results are fed back/presented:
>> to individual dancers >> to teachers (with dancers consent) >> to CATs (as group presentations) >> at national and international conferences (eight presentations planned for 2009) >> as peer-reviewed journal articles We advocate a team based approach for optimising student performance and wellbeing, for example asking dancers and CATs what they want to know, and supporting open communication between CATs, therapists, dance science support staff, teachers and the research team keeping everyone on the same page. Dance science and health professionals can also help, by interpreting research findings; supporting students; and giving talks on relevant topics. They can use results for goal setting; individual training plans; and informing pedagogy (e.g. is flexibility improving?). As researchers, we are always available for information and want to be made use of to make the results applicable to the real-life dance setting. All the material we report on above represents a (very) small overview. The findings collated to date cover 311 variables and only a very small selection has been presented. Many become interesting over time rather than from a single data collection, as they relate to development and change rather than level. For example, aerobic fitness scores at one point in time say little, but if the scores decrease over time, this will suggest improvements in fitness valuable information for those concerned with dancers aerobic capacity.
Research areas
Background
Demographics Hours of dance & other activities Dance experience Health & injury background Performance experience
Psychology
Self-esteem Anxiety Perfectionism Eating attitudes
Physiology
Jump height Upper body strength Flexibility Hypermobility Anthropometry, incl. growth Aerobic fitness
Injury
Type Body area Location Severity Interruption to dancing Treatment
Performancerelated
Adherence / Dropout Graduate destinations Reasons for leaving
Motivational Climate
Passion
Turnout
Perceived causes
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Future research will consider how talented young dancers develop across time. For example:
>> does fitness improve? is this related to the type of dance training? >> does wellbeing change over time? is this related to the motivational climate? >> are there discernible differences between dancers who adhere to the training do well compared to those prone to unfavourable outcomes e.g. injury dropout?
>> are physical and psychological health related to creativity?
An additional in depth qualitative research strand will begin in 2009, looking at some key questions:
>> what are some conceptions of creativity? >> do these differ between students and staff? >> is creativity related to wellbeing?
Fundamentally, one of the key questions will be, are predictors of favourable outcomes (e.g. progressing well in dance):
>> static characteristics of individuals? >> dynamic characteristics of training?
In other words, are there elements of talent that are trainable?
To conclude:
>> there are many examples of favourable results >> as in most samples, the range is wide, with some students faring excellently and others (a minority) not so well >> future work will help uncover some of the reasons why this might be so
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Useful reading
Bettle, N., Bettle, O., Neumrker, U. & Neumrker, K.J. (2001). Body image and self esteem in adolescent ballet dancers, Perceptual and Motor Skills, 93, 297-309. Buckroyd, J. (2000). The Student Dancer: Emotional Aspects of the Teaching and Learning of Dance. London: Dance Books. Laws, H. (2005). Fit to Dance 2: Report of the Second National Inquiry into Dancers Health and Injury in the UK. London: Dance UK. MacNamara, A., Holmes, P. & Collins, D. (2008). Negotiating transitions in musical development: the role of psychological characteristics of developing excellence, Psychology of Music, 36, 335-352. Quested, E. & Duda, J.L. (2009). Perceptions of the motivational climate, need satisfaction, and indices of well- and ill-being among hip hop dancers, Journal of Dance Medicine and Science. Rip, B., Fortin, S. & Vallerand, R.J. (2006). The relationship between passion and injury in dance students, Journal of Dance Medicine and Science, 10, 14-20. Sanders, L. Gifted and Talented Dancers: A Resource Booklet for Teachers. Commissioned by the Dance Network. Williams, A. M. & Reilly, T. (2000). Talent identification and development in soccer, Journal of Sports Sciences, 18, 657-667.
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Screening of dancers and its applications: an informed approach to teaching Rachel Rist - Director of Dance, Tring Park School for the Performing Arts
Rachel Rist explored how screening can keep dancers dancing longer and stronger. Screening needs to be in place to produce the foremost dancers with longevity in the profession. Screening is information gathering for the director of faculty, teachers and the individual student and their parents. It informs progression through the school. Screening needs to be performed by experts, using validated and consistent testing methods. The information gained is critical to understanding what is there, underneath skill what can and cannot be achieved, given the physical resources available and their potential. No one is symmetrical, and understanding imbalances and weaknesses enables you to put in place intervention strategies and inform both training and a potential career.
A dancers training has the same level of pressure on physique and psychology as that for an Olympic athlete, so understanding the body and what care and intervention is needed, appropriate to age and course, is vital.
Screening is not a pass or fail exercise or examination, but rather a data gathering and assessment exercise, with the findings put to use. It is also not an excuse not to offer funding to a student, but rather enables a school to make an informed choice about taking on a student in the knowledge there are problems in some areas on which to work. Many people are involved in screening: the expert (usually a physiotherapist), the child and their parents (initially), the director of faculty, the teachers (very important, as they are in charge of the young persons body) and the medical team. Screening happens at the final audition, on entry to a course and then at least once a year more often in case of injury or rapid physical change, such as a growth spurt. A screening form is used for baseline information i.e. personal details about medical issues or injury; intensity of previous training; and age, body mass index (BMI), onset of puberty and so on. Ranges of movement (noting (a)symmetry in right and left); basic techniques (e.g. how feet land in a simple jump); and proprioceptive skills are also reported. Post 16, information such as a psychological profile or drug/alcohol intake may also be added. Most important of all is the last page the summary of what needs to happen next. This summary goes to the teacher and the student, so they know the need to work on certain aspects. The chosen intervention strategies (e.g. attendance at an ankle clinic, one-to-one Pilates sessions) are implemented, and reviewed. There are challenges to developing and implementing a screening protocol. Cost is a major factor as it takes on average 25-30 minutes for an experienced professional to screen a child. The school has to decide that this investment has a high value because of what is gained through the process. The screening protocol is only the start and the interventions and preventative strategies must be in place. It is important to allow extra days at the start of term for assessments for the new intake and plan to have all students screened by the end of the autumn term. A physiotherapist is best used for dancers, but an informed and trained somatic teacher/professional can also undertake the screening. Even without funds or an expert, you can still take time to assess a students physique, look at the range of movements of joints and large muscle groups and plan to spend a part of class addressing weaknesses. Just five minutes assessment can save time and prevent injury later on. Teachers have good eyes, are aware that each individual has individual challenges and can be proactive in supporting students.
Screening of dancers and its applications: an informed approach to teaching >> Rachel Rist
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A world class training system must have world class medical support, with a team approach to information sharing (e.g. weekly meetings). It is vital the director or head of dance or music has a personal investment in the success of the protocol. Screening can result in teachers at the sharp end knowing their students better; students taking personal responsibility for being proactive in areas of weakness; and dancers and musicians having greater expectations of longevity in their profession.
Key points from conference discussion:

>> the UK is on a level with best world practice in this field; we have been undertaking dance screening for 10-15 years >> dancers need the personal knowledge and responsibility to take care of their own body, and be empowered to say no if a choreographer asks them to do a movement that would injure them >> screening could also be developed to cover psychological aspects (see Dr Sanna Nordin presentation page 5) >> screening could be applied in a wider range of dance forms e.g. South Asian dance >> there is a need to pass on information about screening to all dance schools and music theatre schools
Useful reading
Calvo, J.B. (2001). Analysis of the screening of 1400 dance students. IADMS Conference Proceedings. Potter, K., Kimmerle, M., Grossman, G., Rijven, M., Liederbach, M. & Wilmerding, V. (2008). Screening in a Dance Wellness Program. IADMS Resource Papers. www.iadms.org Pastino, J.D. (2005). Physical screening procedures, in R. Solomon, J. Solomon & S.C. Minton (eds.), Preventing Dance Injuries. Champaign, Illinois, USA: Human Kinetics. Physical Characteristics in a Group of Adolescent Ballet Students: A Three Year Study. www.nureyev-medical.org/articles
Screening of dancers and its applications: an informed approach to teaching >> Rachel Rist
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The healthy musical body: assessments and support Dr Aaron Williamon - Head of the Centre for Performance Science, Royal College of Music
Dr Aaron Williamons first conference presentation focused on research related to fitness assessments and health resources for RCM (Royal College of Music) musicians, with acknowledgments to colleagues David Wasley (University of Wales Institute, Cardiff); Rosie Perkins (RCM); Wulf Hildebrandt (University of Nottingham); Gunter Kreutz (Carl von Ossietsky University of Oldenburg); and Dr Jane Ginsborg (Royal Northern College of Music).
The research aims were to:

>> examine students perceptions and experience of injury and ill health >> establish a robust, yet efficient, protocol for health profiling of music students >> generate targeted performance and health workshops based on the results The study comprised 53 students, 34 women and 19 men, with an average age of 22 years, who were undertaking the compulsory Level 1 Professional Skills course. In order to complete the course assignments, students had to take part in a fitness assessment or a hearing test.
Participants completed a self-report questionnaire on the following:

>> general health >> pain and injury >> health promotion >> self-regulated learning (being self-motivated, having a good orientation to practising) >> trait anxiety (measuring a general predisposition to being anxious) >> perfectionism
The fitness assessment covered:

>> height >> weight >> finger span >> BMI >> sub-maximal cardiovascular fitness (assessed using a step test)
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Examples from the Health Promoting Lifestyle Profile (HPLPII)

Subscale Health responsibility Example Discuss my health concerns with health professionals (n=9). Physical activity Follow a planned exercise programme (n=8). Nutrition Eat 3-5 servings of vegetables every day (n=9). Interpersonal relations Touch and am touched by people I care about (n=9). Spiritual growth Am aware of what is important in my life (n=9). Stress management Pace myself to prevent tiredness (n=8).
Self-report results (cont)

Health Pain Pain Pain Health Self-report results (1)promo during after stops
100
Wellbeing
Perfectionism
Self reg learn
Trait anxiety
Self-report results (2)

Health Health Pain during Pain after Pain during Pain after Pain stops Health promo t+ sg+ ir+ Wellbeing Perfec- Self reg Trait tionism learn anxiety
Health Pain during
80
Pain after Pain stops Health promo
Men
+ + + +
Women +
t+ sg+ ir+
+ +
+ + + + + +
+ +
sg
sg
+ +
60
40
WellSubscale being
Pain stops Health promo Wellbeing
+ + + + +
Example
t+ sg+ ir+sm+
sm concerns + Discuss my health with health Perfectionism tionism professionals (n=9). 20 Self reg Self reg sg+ + learn Physical Follow a planned exercise programme learn activity Trait (n=8). Trait t-hr-sg + anxiety anxiety ir- sm0 Nutrition Eat 3-5 servings of vegetables every day Health Pain during Pain after Pain stops Health Wellbeing Perfectionism Self reg learn Trait anxiety promo (n=9). Interpersonal relations Touch and am touched by people I care The third chart above shows the positive and negative correlations between variables. For about (n=9). example, poor self-regulated learning is related to more experience of pain; a high sense Spiritual growth Am aware of what is important in my life of wellbeing correlates to less perfectionism, better self-regulated learning and less trait (n=9). anxiety. Psychological characteristics can also relate to pain in the body e.g. right hand Stress management Pace myself tolearning prevent tiredness (n=8). pain relates to poor self-regulatory (as below).
PerfecHealth responsibility
t+ sg+ ir+sm+ sm
sg+ t-hr-sgir- sm-
Self-report results (3) (cont) Self-report results

F6: Mouth F1: Upper arm and elbow F5: Oh, that party last night Health
Wellbeing Perfectionism + F4: Spine Self reg learn Self reg learn Trait anxiety +
F3: Right hand

Self reg learn
F2: Left hand
20
18
0 Below target Target Above target
Cardiovascular fitness
100
Men
Women
The following charts show key findings from the fitness assessments with results by gender and whole group:
80
BMI BMI (1)

100
BMI
20 80 0
60
BMI (2) 40
100
Men
Women
80
60
60
Below average
Average
Above average
40
40
20
20
Cardiovascular fitness (1)

100
Cardiovascular fitness
Men Women
Cardiovascular fitness Cardiovascular fitness (2)

100 80
80
BMI
40 100 20 80 0 Below average 60 Average Above average
60
60
40
20
0 Below average Average Above average
40
In summary:
>> students report pain, yet they are healthy
20
0 Below target Target
Cardiovascular fitness >> a majority of students are below average fitness and many do not meet

100
>> health promotion findings are similar to published results (see Dr Jane Above target Ginsborgs presentation on page 28) their target BMI
>> key self-report measures include: wellbeing (7 Qs) self-regulated learning (10 Qs) trait anxiety (20 Qs) fatigue (5 Qs)
80
60
40
20
0 Below average
The Royal College of Music offers a variety of health resources for their students, ranging from provision of information to support through the curriculum.
Average Above average
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RCM health resources:

>> RCM student services with a one-stop shop website >> student injury report form >> Imperial College health centre >> British Association for Performing Arts Medicine (BAPAM) >> compulsory Level 1 Professional Skills course comprising seven one-hour sessions with the following titles: Healthy body, healthy mind, healthy music Stop your posturing Hear no evil Ill be all right on the night ... right? Eat, drink and be merry Sex, drugs and rock and roll Tuning up and toning up and 10 Alexander technique lessons
There are also Level 2, 3 and 4 course units in Alexander technique, psychology of music, and psychology of performance. As well as the fitness assessment scheme, students have taster workshops, for example in yoga, Tai Chi and Pilates, with follow on information about classes. A PhD student is working on the Perform Project, looking at mental skills training and rehearsing, with reference to research and practice in sport.

>> it would be very interesting and relevant to have robust statistics from an adequate study sample to see any differences between students playing different instruments >> it is very important to use appropriate language with young people i.e. that healthy living is of positive enhancement to performance and career longevity >> on the whole student musicians are not very open to fitness; they are often sceptical as they may not have had injuries to date, but will very probably do so in their careers >> the principal study teacher and the student need information so they are well informed and educated in health issues >> there is scope for further research on whether preventative strategies are actually working
Useful reading
Kreutz, G., Ginsborg, J. & Williamon, A. (2008). Music students health problems and health-promoting behaviours, Medical Problems of Performing Artists, 23, 3-11. Kreutz, G., Ginsborg, J. & Williamon, A. (2009). Health-promoting behaviours in conservatoire students, Psychology of Music, 37, 47-60. Ginsborg, J., Kreutz, G., Thomas, M. & Williamon, A. (2009). Healthy behaviours in music and non-music performance students, Health Education, 109, 242-258.
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Performance preparation and health: the work of BAPAM Dr Sanchita Farruque - Health Promotion in Music Development Officer, BAPAM
Dr Farruque talked about her work as a health promoter for musicians with British Association for Performing Arts Medicine (BAPAM), bringing together her background as a professional vocalist and doctor. BAPAM is concerned with performance related injury issues and is aware that the music sector in many ways needs to catch up with the dance sector. Over the last few years BAPAM has focused on the preventative aspects of injury, having been providing curative support for over twenty years.
Performers will have portfolio careers, so learning about health is not just about talent and performance, but also to support possible teaching roles in the future.
Dr Farruque explained the need to target preventative messages to educators to ensure health promotion is part of the curriculum and feeds students motivations. BAPAM has teachers packs readily available and is keen to support the contextualisation of teachers work within health considerations. Dr Farruque is exploring how students best take on information and supports activity based work in music college junior departments. BAPAM provides free first injury assessment to music professionals, teachers and students, and the Musicians Benevolent Fund Scheme can provide some funds for student treatments. However, the aim is to reduce the numbers at clinic, through the application of healthy practices.

>> a whole school approach to health for young performers is needed, and the ability to reach out to freelance teachers working for music services >> musicians need to see themselves as musical athletes >> a students principal teacher is a valuable resource and should be supported with all the relevant information about healthy practices and injury prevention >> overall, a whole cultural change to these issues is needed
Performance preparation and health: the work of BAPAM >> Dr Sanchita Farruque
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SECTION TWO: KEY HEALTH ISSUES

In this section, Dr Aaron Williamon explains the Control of Noise at Work Regulations 2005 and describes the effects of noise damage applicable to dancers as well as musicians. Dr Jane Ginsborg reports on her research with colleagues into music performance students attitudes to health and health promoting behaviours; and the comparison of music performance students experience of health problems with non-music performance students. Dr Ioulia Papageorgis conference presentation focused on the psychological aspects of performance, including musical performance anxiety and strategies to mitigate its negative effects. The section finishes with Helen Laws and Dr Emma Reddings examination of eating problems in young dancers and inclusion of a paper from beat on these issues. We know that unfortunately eating problems are occurring more frequently in young musicians as well, so the information and advice given is useful across both sectors.
The healthy musical body: assessments and support >> Dr Photo: Aaron Williamon Will Price
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The noise regulations
The noise of performance Dr Aaron Williamon - Head of the Centre for Performance Science, Royal College of Music
Dr Aaron Williamons second conference presentation began with an update on noise exposure legislation. He went on to describe a research project about orchestral musicians exposure and gave information to support young musicians, and their teachers, understand hearing and noise exposure. The Control of Noise at Work Regulations 2005 was introduced in April 2006, with the music and entertainment sectors exempted until 2008. The Regulations set out exposure limit values as below, for daily average exposure (eight hours) and peak sound pressure.
Exposure limit values
Exposure limit values Noise exposure limit values
Daily average (8 hours): 87 dB(A) Peak sound pressure: 140 dB(C) Daily average (8 hours): 87 dB(A)
Peak sound pressure: 140 dB(C)

Lower action values Upper action values
average (8 hours)
average (8 hours) peak peak
Lower action values 80 dB(A) 80 dB(A) 135 dB(C) 135 dB(C)
Upper action values 85 dB(A) 85 dB(A) 137 dB(C) 137 dB(C)
For the lower action value, employers have a duty to inform and educate employees about protecting their hearing. For the upper action values, they have a duty to protect employees. Where 0 dB is the threshold of hearing and 130 dB the threshold of pain (with an average rock concert or club producing 123 dB), musicians are exposed to a wide range of sound intensity levels from 80 dB from a cello or double bass at peak, to 135 dB from brass at peak. The distance between the ear and the sound source is significant, so piccolo players 2 are exposed to high levels of noise e.g. 120 dB at peak. A research project into musical noise at work was undertaken by the Centre for Performance Science at the Royal College of Music in collaboration with Bradford Backus from University College London and Chris Clark at the Royal Opera House. Ten musicians (with strings, woodwind, brass and percussion all represented) were followed through a working week (i.e. rehearsals and performances) at the Royal Opera House, with the noise levels to which they were exposed recorded by a discreet recording badge placed 10 cm from the ear. The weeks programme involved four productions, with different pit layouts for the orchestra in each case. Using the information from the recordings of sound levels, the researchers drew up maps that demonstrated hot spots of high noise level, as in the following example:
The noise of performance >> Dr Aaron Williamon
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Katya Kabanova
Noise levels in orchestra pit for Katya Kabanova production
83
DB F 85
H 90 93 Bsn
94
Timp Vla 89 C Tpt 92
90
V2 85 V1
87
Exposure over the working week was also charted, as below. Apart from the double bass player, all musicians were exposed to above 80 dB, indicating that the Royal Opera House had a duty to educate and inform their employees. For some musicians (flute, horn and timpani players), exposure was in the upper action value requiring the Royal Opera House to take measures to protect their hearing.
Personal exposure level (dBA)
Total for week Average day 90 87 85 80 75 Maximum day
Violin 1
Violin 2
Viola
Cello
Double bass
Flute
Bassoon
Horn
Trumpet
Timpani
Working week noise exposure

There is a key issue of responsibility in cases where a musician has multiple employers and it is difficult to take practical steps for monitoring and managing noise exposure outside of work contexts. The Musicians Union has a noise passport, but as it is based on selfreport and not noise dose measurement, it can be imprecise. In terms of students, if they are required to be in a room where their teachers are exposed to noise, then the employer of the teacher is also responsible for them. Young people with normal hearing hear sounds between the frequencies of 20 and 20,000 Hz. The frequency band between 2,000 and 5,000 Hz is a sensitive one that corresponds to frequencies important for speech perception. People can suffer conductive hearing loss when the bones in the middle ear fail to transmit sound. Age can bring about higher frequency hearing loss. Noisy environments, such as manufacturing, can produce a tonal gap. The following charts show normal hearing and the effects of different types of hearing loss.
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Human hearing and hearing loss

10 0 -10 Hearing level (dB) Hearing level (dB) -20 -30 -40 -50 -60 -70 -80 125 250 500 1000 2000 4000 8000 Frequency (Hz) Normal hearing 10 0 -10 -20 -30 -40 -50 -60 -70 -80 125 250 500 1000 2000 4000 8000 Frequency (Hz) High tone loss
10 0 -10 Hearing level (dB) Hearing level (dB) -20 -30 -40 -50 -60 -70 -80 125 250 500 1000 2000 4000 8000 Frequency (Hz) Conductive loss
10 0 -10 -20 -30 -40 -50 -60 -70 -80 125 250 500 1000 2000 4000 8000 Frequency (Hz) Tonal gap
10 0 -10 Hearing level (dB) -20 -30 -40 -50 -60 -70 -80 125 250 500 1000 2000 4000 8000 Frequency (Hz) 35-39 yrs 1-2 yrs 5-9 yrs 15-19 yrs
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The following charts show the ranges of hearing of professional musicians and student musicians:
Range of hearing: professional musicians

-20 -10 RCM Staff Left Audiogram n=16 mean age=49 -20 -10 0 RCM Staff Right Audiogram
Hearing Threshold (dB HL) Hearing Threshold (dB HL)
0 10 -20 20 -10 30 0 40 10 50 20 60 30
RCM Staff Left Audiogram n=16 mean age=49
10 -20 20 -10 30 0 40 10 50 20 60 30
RCM Staff Right Audiogram
40 50 60
0.1250.25 0.5 0.75
1.5
10 12.5 16
40 50
0.1250.25 0.5 0.75
1.5
10 12.5 16
0.1250.25 0.5 hearing: 0.75 1 1.5 2 3 4 6 8 10musicians 12.5 16 Range of student n=81 mean age=24.1975
-20 -10 0 10 -20 20 -10 30 0 40 10 50 20 60 30
RCM Students Left Audiogram
60
-20 -10 0
RCM Students Right Audiogram
0.1250.25 0.5 0.75
1.5
10 12.5 16
Hearing Threshold (dB HL) Hearing Threshold (dB HL)
RCM Students Left Audiogram n=81 mean age=24.1975
10 -20 20 -10 30 0 40 10 50 20 60 30
RCM Students Right Audiogram
40 50 60
0.1250.25 0.5 0.75
1.5 2 3 4 6 Frequency (kHz)
10 12.5 16
40 50 60
0.1250.25 0.5 0.75
10 12.5 16
0.1250.25 0.5 0.75
10 12.5 16
0.1250.25 0.5 0.75
10 12.5 16
The symptoms of noise damage include: impaired speech recognition; impaired pitch discrimination; hyeracusis (delicate sensitivity to loud noises); diplacusis (hearing pitches differently in each ear); and tinnitus (sounds in the head). It is important to help young musicians understand hearing and noise exposure and to ensure they have regular tests. The average sound intensity during a standard working day (eight hours) should not exceed 85 db (A) but it is currently difficult to monitor, as it requires expensive equipment and technical knowledge to do so. Earmuffs and foam earplugs are unsuitable protection. The latter reduce the volume but are not suitable for musicians. Speech perception is amplified over the frequencies of 2,000 and 5,000 Hz due to the shape of the outer ear and ear canal, and foam earplugs that simply block the ear canal typically negate the resonant properties of the ear. There are more advanced earplugs that are suitable for musicians: for instance, a generic (one size fits all) Christmas tree-like set, and individually fitted, custom earplugs with filters that attenuate noise evenly across the frequency spectrum.
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Students at the Royal College of Music attend the University College London Ear Institution for comprehensive hearing tests and they receive free custom fitted earplugs. The hearing assessment scheme includes audiograms; tympanograms (assessing middle ear function); and otoacoustic emissions (OAEs) (non invasive assessment of the inner ear). There is also a policy for staff, who can go to any hearing clinic and be reimbursed for the costs of standard testing.
In addition to ear plugs, other practical options to prevent over exposure to noise include:
>> using acoustic screens properly >> installing absorbent acoustic baffles to reduce reverberation in orchestra pits and practice rooms >> rehearsing quietly and/or using dynamics >> balancing loud works in programmes >> changing ensemble layout >> giving your ears a rest

>> >> some individual differences in hearing are caused by genetic factors. While some people have tough ears, others do not. It is not currently understood why musicians hearing in general is not as bad as those who work in other noisy environments. They may be better protected from loud noise because of their extensive training in listening and perceiving music, although no data currently exists to confirm this. Or it may be that, if someone has a hearing problem, they may have selected themselves out of the profession the size of the room in which musicians play is somewhat important a practice room would need to be much bigger to make a difference to noise exposure. It seems that the most potential damage is from the instrument directly, not the sound bouncing around. Absorbent panels produce a reverberant sound that teachers may prefer, but students typically do not
>> if the hair cells on the cochlear are destroyed, they cannot be regenerated or re-grown and hearing damage is permanent >> personal stereos and listening devices produce sounds close to the head so they are perceived to be softer than they actually are. Listening at levels below 85 dB is generally believed not to be harmful, but with background noise people tend to turn up the volume too far for healthy listening
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Useful reading
Backus B.C., Clark T. & Williamon A. (2007). Noise exposure and hearing thresholds among orchestral musicians, in A. Williamon & D. Coimbra (eds.), Proceedings of the International Symposium on Performance Science 2007 pp 23-28. Published by the European Association of Conservatoires (AEC). http://www.perfomancescience.org Health and Safety Executive (2008). Sound Advice: Noise at Work in Music and Entertainment. http://soundadvice.info Royster, J.D., Royster, L.H. & Killion, M.C. (1991). Sound exposure and hearing thresholds of symphony orchestra musicians, Journal of the Acoustical Society of America, 89, 2793-2803. http://asa.aip.org/jasa.html Wright Reid, A. (2001). A Sound Ear. Published by the Association of British Orchestras (ABO). www.abo.org.uk
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Healthy behaviours in music performance and non-music performance students Dr Jane Ginsborg - Associate Dean of Research and Enterprise, and Director of the Centre for Music Performance Research, Royal Northern College of Music
Dr Jane Ginsborg presented the work she has undertaken with colleagues Gunter Kreutz (Carl von Ossietsky University of Oldenburg), Mike Thomas (University of Chester) and Dr Aaron Williamon (Royal College of Music). Over the past few years, a growing body of research has shown that the physical and psychological demands of expert musical performance may have consequences for musicians health (for example, Williamon & Thompson, 2006). We investigated music performance students attitudes to health and health-promoting behaviours by carrying out an on-line survey at two conservatoires (Kreutz et al., in press). We also investigated students experiences of health problems (Kreutz et al., 2008) and have now gone on to compare the experiences of music performance with non-music performance students. Our first study showed that music performance students score particularly low on some aspects of health lifestyle (health responsibility, physical activity and stress management) but significantly higher on others (nutrition, spiritual growth, interpersonal relationships). We also looked at the extent to which these behaviours were associated with three psychological variables: >> Emotional affect (see Bandura, 1997) >> Self-efficacy (see Callaghan, 2005) and >> Self-regulation (see Maes & Karoly, 2005) We found that they were significantly correlated. This suggests that healthy lifestyle and psychological wellbeing influence each other which has implications for music performance students progress at college and as they begin their professional careers. In our second paper, we reported the occurrence of music performance students musculoskeletal and non-musculoskeletal health problems. These were characterised by six independent factors (see diagram below). There was no evidence to suggest a relationship between health-promoting behaviours and actual health problems, but regression analyses showed that the most reliable predictors of self-perceived impaired technique, practice and performance quality were fatigue and spinal pain.
Sites of health problems More findings (Kreutz et al., 2008b)

F5: Oh, that party last night... F4: Spine F1: Upper arms and elbow
F6: Mouth
F3: right hand
F2: left hand
Healthy behaviours in music performance and non-music performance students >> Dr Jane Ginsborg
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We wanted to find out the extent to which music performance students attitudes to health and experiences of ill-health were similar to or different from those of other kinds of student. Of course there may be many ways in which groups of students differ from each other, but we would at least be able to say something as to how students adapt to the particular demands of their individual programmes of study.
The three research questions were:

>> What are the differences, if any, between the reported health-promoting behaviours of music performance and non-music performance students? >> What are the differences, if any, between the experiences of ill health reported by the two groups of respondents? >> To what extent are these associated, for the two groups of respondents, with reported health-promoting behaviours? Our team also explored sex differences within the data, as previous research has shown significant differences between men and women in some aspects of healthy behaviours of Chinese students. We analysed data from 263 students at four institutions, the Royal Northern College of Music (RNCM), Royal College of Music (RCM), University of Chester (UC) and Imperial College (IC), London.
Research respondents
RNCM Female Male Total Mean age (SD) 83 50 133 21.36 (2.4)
Method: Respondents
RCM 44 21 65 21.4 (2.4) UC 27 2 29 21.28 (2.2) IC 25 11 36 21.69 (1.85) Total 179 84 263 21.4 (2.3)
While the RNCM provides all students with health and safety information at induction and access to treatment for those with practice and performance related injuries, it did not at the time of the survey offer regular programmes to enhance health and wellbeing. In contrast, the RCM respondents had all taken part in seven one-hour health related sessions in their first term at College (see The healthy musical body page14). The majority of the students at UC were in the Faculty of Health and Social Care, so the study of health was integral to their degree courses, as it was to the students at Imperial College, who were studying biomedical science.
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The survey consisted of six online questionnaires:

1 2 3 4 5 6 Demographic (age, sex, affiliation to one of the four institutions, year of study) The Positive and Negative Affect Scale (see Watson et al., 1988) The Health-Promoting Lifestyle Profile II (HPLP II) (see Walker et al., 1987) The Self-Efficacy Scale (see Schwarzer et al., 1995) The Self-Regulation Scale (see Schwarzer et al., 1999) A questionnaire devised by the research team to identify self-reported musculoskeletal and non-musculoskeletal health problems
The Health-Promoting Lifestyle Profile (HPLP II) measures the frequency of engagement in health-promoting behaviours. It consists of 52 items that are rated on a four-point Likerttype scale: 1 (never), 2 (occasionally), 3 (frequently) and 4 (routinely). Scores for all items thus range from 52 to 208 with a midpoint of 130. This instrument provides a total score for health-promoting behaviour, as well as six subscales (see below).
HPLP II
HPLP II
Other psychological variables Other psychological variables

Scale Positive Negative Self-efficacy Selfregulation Example Excited Nervous I am certain I can accomplish my goals I can concentrate on one activity for a long time, if necessary N 10 10 10 10 .85 .83 .88 .74
The second chart above shows the other psychological variables: positive and negative affect, self-efficacy to do with coping behaviours and self-regulation to do with the regulation of moods. Each scale has ten items. The positive and negative affect scale is scored from 1 (very slightly) to 5 (extremely) while the self-efficacy and self-regulation scales are scored from 1 (not at all true) to 4 (completely true). Participants were asked a series of questions about their health. First, was how they rated their present state of health. Second, was how they rated their musculoskeletal symptoms by indicating on a scale of 1 (non-existent) to 5 (severe) the degree of pain they had experienced in particular parts of the body over the preceding week.
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Musculoskeletal symptoms and experience of pain:

>> orofacial, or head: sinuses, nose, lips, teeth, tongue, jaw, throat, face >> neck and upper, middle and lower spine >> left and right shoulder, upper arm, elbow, lower arm, wrist, hand, fingers, thumb >> clavicle and pelvis >> left and right hip, thigh, femoral bone, knee, shin, calf, ankle, heel, foot, arch, toes Thirdly, participants were asked to rate the extent to which they had experienced the following non-musculoskeletal symptoms in the same way:
Non-musculoskeletal symptoms:
>> fatigue: sleep disturbance, headaches, lack of concentration, problems with vision and inappropriate tiredness >> miscellaneous e.g. sensitivity to weather, palpitations, breathing problems, high and low blood pressure etc. The graph below shows that mean scores on the HPLP II for both groups were close to the mid-point of the scale. They scored below the grand mean the off-white bar on the right for health responsibility, stress management and physical activity, but above it for nutrition, spiritual growth and interpersonal relations. The asterisks indicate where the differences between the music performance and the non-music performance students were statistically significant: overall, for health responsibility, physical activity, spiritual growth; and nearsignificantly, for stress management.
Results: HPLPHPLP II Results:
II
* *
* * *
There was a significant main effect of respondents sex on interpersonal relationships and near-significant effects of sex on health responsibility and nutrition, but no interactions between sex and student type, as overleaf:
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Results: Results: effects of respondents sex sex effects of respondents
Results: % of respondents Results (2): % of respondents reporting symptoms reporting symptoms
* *
When we compared the music performance and the non-music performance students self-efficacy, we found that the music performance students scored lower, as did female students. Music performance students also scored lower on self-regulation and rated their present state of health worse than the non-music performance students, though both mean scores were above the mid-point of the scale. Nearly all the respondents (98.5% of music performance students, 96.9% of health students) reported one or more musculoskeletal symptoms. Orofacial symptoms were reported by 82.3% of music performance students and 73.8% of health students, while problems with the neck and spine were reported by 72.2% of music performance students but only 58.5% of health students. Fatigue symptoms were also prevalent: in 92.4% of music performance students and 89.2% of health students.
When we looked at the numbers of symptoms that were reported, we found that:
>> music performance (MP) students reported musculoskeletal symptoms at MORE sites (M = 10.53, SD = 6.06) than non-MP students (M = 7.6, SD = 6.88) (where M = mean and SD = standard deviation) >> women reported MORE fatigue symptoms (M = 3.2, SD = 1.18) than men (M = 2.8, SD = 1.24) When we looked at the severity of the symptoms reported, music performance students rated their symptoms worse than the non-music performance students did in the spine, lower right arm and hand, and upper and lower left shoulder, arm and hand. Female students rated more severe fatigue symptoms.
We calculated correlations between:

1 2 3 4 The ratings for perceived present health The mean ratings for musculoskeletal and non-musculoskeletal symptoms reported by the whole sample The health-promoting lifestyles profile scores (total and subscales) The psychological variables (positive and negative affect, self-regulation and self-efficacy)
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While the majority of correlations were statistically significant the coefficients were generally low. In other words, associations between the four sets of ratings/scores were not necessarily strong.
Results: correlations
Measure Positive Self-eff Self-reg Present health Musculo skeletal Fatigue Misc non MS HPLP II .476
Results (5): Correlations

PoA -.211 .405 .307 .193 -.244 -.321 -.217 .142 -.335 -.172 .412 .303 -.279 -.158 .367 .179 NeA SES
SRS
PH
MS
Negative -.261 .519 .432 .310 -.131 -.377 -.168
.217 -.195 -.250 -.334 .171 -.311 .443 .331 .446
The strongest association was between scores on the HPLP II and self-efficacy. HPLP II scores were also associated comparatively strongly with positive affect and self-regulation. Positive affect (PoA) was associated with self-efficacy, while negative affect (NeA) was associated with fatigue symptoms. These in turn were correlated with musculoskeletal and non-musculoskeletal symptoms.
Findings in relation to the first research question: What are the differences, if any, between the reported health-promoting behaviours of music performance (MP) and non-MP students?
Music performance students overall scores on the HPLP II were lower than those of non-music performance students. Specifically, they scored significantly lower for health responsibility, physical activity and spiritual growth. They also reported lower levels of selfefficacy and self-regulation than non-music performance students. Maybe they have less healthy lifestyles than non-music performance students for reasons to do with their individual personality or social background, or a combination of these and other factors. Whatever the reasons, the findings are worrying since musicians are often and correctly likened to athletes: music performance students need to adopt healthy lifestyles in order to develop the physical capacity and stamina to give of their best when they play or sing to their peers and the public, often under challenging and difficult circumstances. A second possibility is that the students of nursing and biomedical science (a proportion of the latter who go on to study medicine) who responded to the survey have healthier lifestyles than music performance students. This may be due to their greater awareness of health issues and responsibilities arising from their particular field of study, and perhaps also because of their exposure to the severe health problems of others encountered in the course of clinical practice.
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Finally, the female respondents (music performance and non-music performance alike) scored significantly higher than male respondents on interpersonal relations but lower on self-efficacy. This finding probably reflects societal differences, and indicates the areas to which tutors should pay particular attention where possible.
Findings in relation to the second research question: What are the differences, if any, between the experiences of ill health reported by the two groups of respondents?
Participants were asked to rate their present state of health on a scale from 1 to 5. Mean ratings for both groups were above the mid-point, but music performance students rated their present state of health significantly WORSE than did non-MP students. There were also differences between the experiences of ill health reported by the two groups of respondents, and these can be described in two ways. First, music performance students reported musculoskeletal problems at MORE sites than the non-music performance students. Second, music performance students reported WORSE symptoms in the spine, upper and lower right arm and hand, lower left arm and hand, and fatigue. It may be that music performance students are more accustomed to identifying the parts of the body associated with different aspects of playing instruments (e.g. supporting and fingering a violin or viola with the left hand, and bowing with the right shoulder, upper and lower arm and wrist) or it may be that the non-music performance students, who were of course students of nursing and biomedical sciences, simply rated their own experience of such symptoms as less severe in comparison with injuries they treat in others.
Findings in relation to the final research question: To what extent are perceived present health and reported musculoskeletal and non-musculoskeletal symptoms associated, for the two groups of respondents, with reported health-promoting behaviours, emotional affect state, self-regulation and self-efficacy?
Correlations between ratings representing perceived present health status and reported symptoms were negative, as would be expected, but too low to reflect each other accurately. Perceived present health was most strongly correlated with reported healthy lifestyle. This in turn was associated with positive affect, self-efficacy and self-regulation, suggesting that all are worth promoting in the interests of better health. This was a relatively small-scale investigation involving two groups of students with very different career aspirations. The research team observed systematic differences between participants reported health-promoting behaviours but this may simply be attributable to the differences between the physical and socio-economic environments of the four institutions to which they belonged. So the team would not want to draw firm conclusions, especially in relation to individual students behaviours. Nevertheless, it would be worth exploring the differences between the two groups further, and the team intends do so. On conclusion, if nursing and biomedical science students report somewhat healthier lifestyles than music performance students because of their training, then conservatoires have much to learn, and the team would wholeheartedly support Chesky, Dawson and Manchesters recommendation that schools of music and conservatoires should adopt health promotion frameworks within which occupational health courses for students and staff are offered.
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However, given that the systematic training of musicians starts so early, it would not be surprising if students had already formed unhealthy practices by the time they reach conservatoire level and therefore report higher incidences of pain and physical discomfort and fewer health promoting behaviours. So there is also a need to inform and educate pre-conservatoire musicians not just to help them develop good habits physically and psychologically as individuals, but to ensure they can fulfil their potential as performers. There is also a moral imperative to encourage healthier lifestyles: conservatoires are not just there to coach students but have pastoral responsibilities towards them as well.
As students go on to teach the next generation, they could improve the health of the profession as a whole.
Key points from conference discussion
>> there is no evidence that musicians are more hypochondriac than other career population groups >> pain, whether it has a psychological or somatic basis, needs treating >> delegates reported similar high levels of health referrals in their own institutions >> within the school context, timetable pressures may mean students miss physical education lessons, and whilst some sports may not be recommended, general recreational exercise is important, but something in which many students do not engage enough
Useful reading
Chaffin, R. & Lemieux, A.F. (2004). General perspectives on achieving musical excellence, in A. Williamon (ed.), Musical Excellence: Strategies and Techniques to Enhance Performance. Oxford: Oxford University Press, pp19-39. Chesky, K.S., Dawson, M.D. & Manchester, R. (2006). Health promotion in schools of music: initial recommendations for schools of music, Medical Problems of Performing Artists, September, 142-144. Ginsborg, J., Kreutz, G., Thomas, M. & Williamon, A. (2009). Healthy behaviours in music performance and non-music performance students, Health Education, 109, 242-258. Kreutz, G., Ginsborg, J. & Williamon, A. (2008a). Music students health problems and health-promoting behaviours, Medical Problems of Performing Artists, March, 3-11. Kreutz, G., Ginsborg, J. & Williamon, A. (2008b). Health-promoting behaviours in conservatoire students, Psychology of Music, 37, 47-60. Williamon, A. & Thompson, S. (2006). Awareness and incidence of health problems among conservatoire students, Psychology of Music, 34, 411-430. Wynn Parry, C.B. (2004). Managing the physical demands of musical performance, in A. Williamon (ed.), Musical Excellence: Strategies and Techniques to Enhance Performance. Oxford: Oxford University Press, pp 41-60.
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Psychological aspects of musical performance and their implications for the education and training of musicians Dr Ioulia Papageorgi - Lecturer, Institute of Education, University of London
Dr Papageorgi began her presentation by talking about the role of biological and environmental factors in the development of musical potential. She then talked about findings from her PhD thesis titled Understanding Performance Anxiety in the Adolescent Musician and the research project Investigating Musical Performance: Comparative Studies in Advanced Musical Learning.
Biological factors include:

>> maturational staged development >> physical advantages >> mental advantages: some researchers (e.g. Plomin, 1977) believe that a musical accomplishment gene will be eventually identified >> and the identification by Gardner (1983) of musical intelligence
Environmental factors are also key in the development of musical skills, and biographies of great musicians (e.g. Louis Armstrong) evidence the following:
>> frequent exposure to musical stimuli >> opportunities to develop performance presentation skills >> early opportunities to experience intense positive emotional response to music >> opportunities to devote large numbers of hours to practice >> external motivational factors (e.g. key adult parent/teacher) (Sloboda et al., 1996)
There are many theories about the development of expertise and those by Bloom (1985), Sosniak (1985, 1990), Manturzewska (1990), Ericsson & Smith (1991) suggest that:
>> expertise encompasses a process of development that normally spans many years >> formal instruction, practice and parental support are very important >> the longer a person engages in musical activities, the more expert they are likely to become (assuming that they pass through each of the delineated stages successfully)
Psychological aspects of musical performance and their implications for the education and training of musicians >> Dr Ioulia Papageorgi
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The development of expertise

STAGE 6
Systematic withdrawal from professional activity
STAGE 1
Introduction to domain & playful interaction
STAGE 5
Development of interest in others, teaching phase
STAGE 2
SKILL ACQUISITION
Beginning of instruction and deliberate practice
STAGE 4
High performance levels and establishment
STAGE 3
Commitment to music profession made
(Papageorgi et al., in press)

Performers have specific psychological and personality profiles, as below:
Psychological profile:
>> usually very devoted to music >> so committed to their craft that they fail to separate personal identity from performance abilities (Kemp, 1996) >> student musicians relate self-esteem with how well they perform and personal value with performance competence This results in prima donna behaviour or maladaptive behaviour.
Personality profile:
>> introverted: direct energy inwards, reserved character >> independent: autonomous, sovereign, independence of thought >> sensitive: imaginative, intuitive, empathetic >> anxious: suspicious, low self-sentiment, apprehensive, emotional instability These personality traits can make some musicians very vulnerable (e.g. David Helfgott) (Davidson, 2001).
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Particular characteristics that promote musical development and wellbeing in musicians:

>> positive self-concept and self-esteem linked to confidence, perceptions of competence >> high self-efficacy linked to higher levels of performance >> positive outcome expectancies increase motivation and effort investment >> development of metacognitive skills increase practice effectiveness >> positive musical experiences boost confidence and motivation >> self-reliance autonomy, less need for others approval, less fear of negative evaluation, personal interpretation of music >> realistic outlook on performance opportunity to show hard work, everybody makes mistakes, important to do your best >> development of coping strategies deal effectively with performance nerves and unexpected events prior and during performance
Negative influences which affect musicians development, such as:

>> occupational stress >> performance anxiety >> practice avoidance >> absence of intrinsic motivation >> unsupportive agents (parents, teachers, peers) >> negative musical experiences >> lack of musical identity development >> negative view of self (negative self-concept, low self-esteem, poor self-efficacy, perfectionism) can increase performance anxiety and stress Dr Papageorgi then examined the concept of musical performance anxiety. Musical performance anxiety, stage fright and performance anxiety are all terms used to denote musicians apprehension prior to performance.
Performance anxiety is the exaggerated and sometimes incapacitating fear of performing in public.
>> Wilson, 1997
Stage fright is severe anxiety about performance in public.

>> Steptoe, 1989
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Musical performance anxiety is the experience of persisting, distressful apprehension about and/or actual impairment of performance skills in a public context to a degree unwarranted given the individuals musical aptitude, training and level of preparation.
>> Salmon, 1990
Definitions tend to focus on extreme scenarios and negative effects, but this is not always necessarily the case.
Musical performance anxiety has two possible effects:

>> debilitating effects (maladaptive anxiety that is detrimental to performance quality, its effects ranging from minor slips to corruption of a well-prepared performance) >> facilitating effects (adaptive anxiety that facilitates and enhances performance by preparing the body for meeting the demands of task and stimulates alertness and concentration) The diagram below helps to explain the physiology of musical performance anxiety.
Physiology of musical performance anxiety
Situation
Cognitive Appraisal
Emotional Response
Physiological Arousal
Behaviour
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There is a three stage process:

1 2 3 Cognitive appraisal of situation (what is at stake versus how equipped I feel to successfully complete task) Emotional response Autonomic Nervous System (ANS) activation to prepare performers to deal with the task
This can lead to low/medium/high physiological activity (arousal).
During performance, many experiences are affected and regulated by ANS activities:
>> heightened activation of the sympathetic division (SNS) results in high levels of arousal and consequently intense apprehension and anxiety >> strong activation of the parasympathetic division (PNS) (whose main function is to conserve energy) has the exact opposite effect, resulting in low arousal levels and poor physical activation (Salmon & Meyer, 1998, p 218; Kleinknecht, 1991, pp 11-13) The effects of maladaptive performance anxiety include physiological, behavioural and cognitive symptoms.
Physiological symptoms (changes in the physiological state of the organism):

>> increase in heart rate and respiration >> tension in all bodily muscles >> butterflies in the stomach >> dry mouth >> sweaty palms >> cold hands >> tremors >> urinary frequency >> release of hormones such as adrenaline (epinephrine) and cortisol >> gastrointestinal disturbances (Steptoe, 2001; Gabrielsson, 1999) There are reported differences in symptoms related to the requirements of particular instruments. Physiological symptoms result from the triggering of the fight or flight reflex of the human body, stimulated during anxiety or stress situations (Lehrer, 1987). This reflex was very useful to our ancestors in confronting external threats, but the symptoms often scare performers.
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Behavioural symptoms behavioural indicators of anxiety (Gabrielsson, 1999; Steptoe, 2001):

>> tremors >> trembling and shaky hands >> quivering voice >> difficulty in moving naturally >> moistening lips >> errors in performance
Cognitive symptoms effects of anxiety on cognition (Steptoe, 2001):

>> memory slips/failure >> loss of concentration and attention >> heightened distractibility from the task >> misreading of musical score >> maladaptive cognitions task-irrelevant thoughts related to fear of making mistakes, feelings of insufficiency and incompetence, nervousness about potential lack of control while performing, extreme tension, and/or fear about experiencing a blackout can emerge in the form of worry about the results of a potential failure to meet the demands of the performance
Dr Papageorgi then talked about findings from her PhD thesis titled Understanding Performance Anxiety in the Adolescent Musician. The following chart shows results for the attribution of performance failure from a study of 410 students aged 12-19 from the UK and Cyprus:
Attribution of performance failure Attribution of performance failure Attribution of performance failure 410 students, aged 12-19, in UK & Cyprus
410 students, aged 12-19, in UK & Cyprus
Maladaptive anxiety Inadequate preparation Maladaptive anxiety Lack of confidence Inadequate preparation Audience Lack of confidence Negative attitude Audience Situational conditions/circumstances beyond control Negative attitude Pressure Situational conditions/circumstances beyond control Limited performance experience Pressure Examiner Limited performance experience Examiner
52%
42% 52% 8% 42% 7.20% 8% 5.40% 7.20% 2.70% 5.40% 2.10% 2.70% 2.10% 2.10% 1.80% 2.10% 1.80%
(Papageorgi, 2007)
13
13
(Papageorgi, 2007)
ncidence and factors influencing MPA in adolescen musicians

42 Foundations for Excellence
A significant proportion of young musicians in the study (over 10%) experienced high levels of maladaptive A significant proportion of young musicians in the study (over 10%) experienced high levels of maladaptive performance anxiety, as shown below: performance anxiety
Whole sample Percent (N = 410) Highly anxious students Moderately anxious students Low anxious students Total 10.8 69.3 19.9 100.0 Cypriot students (N = 211) 15.0 70.0 15.0 100 British students (N = 199) 6.3 68.4 25.3 100 Male students (N = 172) 3.9 73.9 22.2 100 Female students (N = 236) 16.0 66.0 18.0 100 Younger students (12-15 years old, N = 210) 12.0 64.5 23.5 100 Older students (16-19 years old, N = 196) 9.8 74.1 16.1 100
Levels of maladaptive performance anxiety Wider context of learning and gender can influence The wider context of learning and gender can influence performance anxiety: Cypriot performance anxiety students and females were more anxious. Age, in itself, did not appear to be a key factor,
as there were no age differences between ages 12-19, but age interacted with nationality Cypriot students and females were more anxious i.e. Cypriots became less anxious as they became older; British students became more anxious as they became older.
Age, in itself, did not to a key factor There are manyappear factors predicting MPAbe in adolescent musicians.
No age differences between ages 12-19, but age interacted with Anxiety level may be influenced by: nationality
students self-perceptions , as became evidenced byolder; their perceived level became of Cypriots became>> less anxious as they British more anxiety, self-concept, self-efficacy and perfectionism anxious as they became older >> situational parameters such as the influence of audience presence, the degree of self-exposure and the influence of the venue >> the wider cultural context of learning, evidenced by nationality >> family environment, evidenced by parental attitudes towards the student
Higher levels of anxiety on the AMPAS scale are related to:

>> higher perceived levels of anxiety >> increased sensitivity to anxiety when feeling highly exposed >> negative self-concept >> increase in anxiety when playing in threatening or uncomfortable venues >> low self-efficacy beliefs >> the experience of heightened anxiety in the presence of an audience >> being of Cypriot nationality >> perfectionism >> perceptions of having critical parents with high expectations
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Adolescent musicians Adolescent strategies musicians for coping strategies with MPA for coping with MPA
The following chart shows the results of the study in respect of the adolescent musicians coping strategies:
410 students, aged 410 students, 12-19, UK aged & Cyprus 12-19, Strategies for coping with MPA
Adequate preparation Positive approach to performance Control breathing Release pressure of performance Watch nutrition Perform more regularly Positive self-talk Shut out audience Seek external support Mental imagery Reframing-changing perspective of looking at situation Adequate preparation Positive approach to performance Control breathing Release pressure of performance 10.40% Watch nutrition 7% 5.70% Perform more regularly
UK & Cyprus
30.60% 16.20% 15.30%
16.20% 15.30% 10.40% 7% 5.70% 5.50% 5.20% 4.60% 3.50% 3.50% 2.90% 0.60% 0.60% 0.30%
5.50% 5.20% 4.60% 3.50%
Positive self-talk Shut out audience Seek external support Mental imagery
Reframing-changing 3.50% perspective of looking at situation
Established methods-Alexander Technique, Meditation, Brain Gym, Established Yoga methods-Alexander Technique, Meditation, Brain Gym, Yoga 2.90% Medication-Beta-blockers, tablets Natural anti-stress remedies-Bach's Rescue Remedy Alcohol
0.60% 0.30%
Medication-Beta-blockers, tablets
Natural anti-stress remedies-Bach's Rescue Remedy 0.60% Alcohol
(Papageorgi, 2007)
Dr Papageorgi then went on to highlight the research finding from Investigating Musical Performance: Comparative Studies in Advanced Musical Learning (an Economic and Social Research Council Teaching and Learning Research Programme [ESRC TLRP] funded project). The findings below show that levels of MPA tend to peak immediately prior to a solo/group performance, but reduce once it begins.
16
(Papageorgi, 200
Experience of performance anxiety (IMP project)

5 5 Performance anxiety one hour prior to performance Performance anxiety immediately before performance
Mean group performance anxiety level
Mean solo performance anxiety level
Performance anxiety during performance
0 Western Classical Popular Scottish Traditional Jazz
0 Western Classical Popular Scottish Traditional Jazz
Musical Genre
Musical Genre Papageorgi, 2008; Papageorgi et al., under review
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To achieve highest levels of performance, musicians need to be physically, emotionally and mentally fit.
Many musicians develop their love of music and passion for an instrument before considering how equipped they are for dealing with public performance. Other musicians grow up in an environment where they have many opportunities to display their skills in public at an early age. Regardless of environment, those who suffer detrimental effects usually carry on suffering until they take a step.
>> Classical musician: IMP project
A variety of coping strategies were mentioned by participants in the study, both emotion and problem focused.
Some variations were observed across the four musical genres studied:
>> western classical and Scottish traditional musicians more frequently referred to emotion focused strategies >> popular musicians spoke about problem focused strategies >> jazz musicians referred equally to both types of strategies
Emotion focused strategies were:

>> drinking alcohol / using beta-blockers >> avoiding performance >> being realistic about performance >> using herbal aids >> investing in specialised techniques (e.g. hypnotherapy, NLP) >> maintaining a positive mental attitude and self-image >> reading self-help books >> trying to reduce pressure / take mind off performance >> seeking support from others >> being under-prepared in an effort to reduce the pressure of performance
Problem focused strategies were:

>> practising and being well-prepared >> being proactive about performance >> deep breathing >> exercising >> employing mental rehearsal >> investing in healthy nutrition >> warming up before performance
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In terms of implications and suggestions arising from this research, the following are key considerations:
>> conservatoires have a responsibility to prepare musicians for the demands of performance and should challenge the conception that successful musicians do not experience performance anxiety >> MPA is a normal experience for musicians and becoming aware of its causes and manifestations can help musicians cope more effectively: what matters is how individuals learn to deal with it and how wellsupported they feel in this process by teachers, parents and peers
>> strategies for coping with the demands of performance should be person and performance specific: individuals performance anxiety thresholds will vary between different performance contexts >> techniques focusing on modifying peoples perceptions and facilitating a positive mindset can be particularly useful: e.g. cognitive behavioural therapy, neuro-linguistic programming >> musical performance anxiety should not always have negative connotations. It can help musicians perform better! >> performance expertise develops in a community of practice alongside peer support - we must encourage and foster the development of supportive learning communities
Useful reading
Hallam, S. (2006). Music Psychology in Education. London: Institute of Education. Kemp, A. E. (1996). The Musical Temperament: Psychology and Personality of Musicians. Oxford: Oxford University Press. Lehman, A. C. & Gruber, H. (2006). Music, in K. A. Ericsson, N. Charness, P. J. Feltovitch & R.R. Hoffman (eds.), The Cambridge Handbook of Expertise and Expert Performance. New York: Cambridge University Press, pp 457-470. Papageorgi, I. (2008). Investigating Musical Performance: performance anxiety across musical genres, TLRP: Teaching and Learning Research Briefing, 57. Papageorgi, I. et al. (in press). Investigating Musical Performance: perceptions and prediction of expertise in advanced musical learners, Psychology of Music. Papageorgi, I., Hallam, S. & Welch, G. (2007). A conceptual framework for understanding musical performance anxiety, Research Studies in Music Education, 28, 83-107. Papageorgi et al. (under review). An investigation into performance anxiety experiences of advanced musicians specialising in different musical genres. Robson, B., Davidson, J. & Snell, E. (1995). But Im not ready yet: overcoming audition anxiety in the young musician, Medical Problems of Performing Artists, 10, 32-37. Salmon, G. & Meyer, R. G. (1998). Notes from the Green Room: Coping with Stress and Anxiety in Musical Performance. San Francisco: Jossey-Bass Publishers. Steptoe, A. (2001). Negative emotions in music making: the problem of performance anxiety, in P. N. Juslin & J. A. Sloboda (eds.), Music and Emotion: Theory and Research. Oxford: Oxford University Press, pp 291-307. Welch, G. & Papageorgi, I. (2008). Investigating Musical Performance: how do musicians deepen and develop their learning about performance? TLRP: Teaching and Learning Research Briefing, 61. Williamon, A. (ed.) (2004). Musical Excellence: Strategies and Techniques to Enhance Performance. Oxford: Oxford University Press.
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Practical considerations on eating problems among dancers Helen Laws - Programme Manager, Healthier Dancer Programme, Dance UK and Dr Emma Redding - Head of Dance Science, Trinity Laban
Helen Laws and Dr Emma Reddings presentation covered the nature, causes and prevalence of eating problems among dancers and offered policy guidance. The causes of eating problems are multidimensional, including psychological, physiological and social/environmental/genetic factors, making the underlying reason for an individuals eating problem sometimes hard to pin down precisely. Sixteen percent (16%) of dancers have an eating problem (Laws, 2005) and eating problems have a higher incidence among dancers than the general population (Chatfield et al. 1998, Tseng et al. 2007). Disordered eating habits frequently result in an imbalance between energy intake and expenditure, affecting a dancers ability to cope with the demands of training and potentially leading to more serious problems such as early onset osteoporosis and injury. Problems can occur when a dancer significantly increases their training workload, or is uninformed about the calories or nutritional content in a new diet or when they consciously work with the imbalance, triggering a spiral of negative events. Eating disorders are clinically diagnosed, primarily psychological, conditions.
Physical warnings:
>> menstrual abnormalities / delayed menarche >> sudden change in weight / low body fat >> slow growth >> BMI below 17.5 or below 2nd centile (refusal to maintain a healthy weight) >> abdominal pains / constipation >> skin problems >> constant tiredness
Psychological warnings:
>> highly perfectionistic >> low self-esteem >> fear of weight gain >> denial of problem >> mood swings >> obsessed with food >> distorted body image
Behavioural warnings:
>> playing with food / binging (toilet visits) >> weighing often >> excessive exercise >> sleep disturbances and / or hyperactivity >> wearing baggy clothes >> secretive about eating >> changes in diet >> spending lots on food
Practical considerations on eating problems among dancers >> Helen Laws and Dr Emma Redding
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Serious eating problems can result in:

>> fainting, dizziness >> stress fractures >> irreversible loss of peak bone density >> organ failure >> heart attack >> death In order to deal with problems, it is important to draw up a policy and involve staff and students (and parents) from the start, ensuring an awareness of policy content and encouraging openness, to aid implementation.
There is a range of issues to consider when developing a policy, including:

>> education promoting health / enhanced performance (rather than just tackling problems) >> consistency of message >> observation / health monitoring to help identify any warning signs >> clear guidance on when to intervene, and who should do this >> identifying the need to know staff >> use of back up support e.g. specialists for advice and referral >> designing an activity modification plan, through consensus Dance schools know that eating problems are prevalent and cannot ignore them and talking about the issues does not increase prevalence. Both permanent and visiting staff need to be involved, not least in offering positive role models. Education is key and a team approach to these complicated issues the most effective.
Key points from discussion:

>> BMI scales are for adults, so it is often more useful to use BMI results within a wider context, looking also for drastic changes in weight and/or menstrual health issues. Logging weight on a percentile chart over time may also be helpful. Weighing should be done by a health professional
>> developing an ongoing relationship with parents is helpful >> ensuring young people know they need a healthy body (rather than being thin) to audition is important >> watching for warning signs of obsessive eating (e.g. only fruit) and talking early with students about concepts of body image and what a healthy body is really like, is key >> supporting discussion through an email group and developing a model policy, to be adapted to schools own circumstances and needs, would be a positive next step
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Useful reading
Piran, N. (2005). The role of dance teachers in the prevention of eating disorders, in R. Solomon, J. Solomon & S.C. Minton (eds.), Preventing Dance Injuries. Champaign, Illinois, USA: Human Kinetics. Dyke MBE, S. (ed.) (2001). Your Body Your Risk. London: Dance UK.
Additional references
Celio A. A., Bryson S., Killen J. D. & Taylor C.B. (2003). Are adolescents harmed when asked risky weight control behavior and attitude questions? Implications for consent procedures, International Journal of Eating Disorders, 34, 251-4. Chatfield, S.J. & Nelson, D.P. (1998). What do we really know from the literature about the prevalence of Anorexia Nervosa in female ballet dancers? Journal of Dance Medicine and Science, 2, 6-13. Laws, H. (2005). Fit to Dance 2 Report of the Second National Inquiry into Dancers Health and Injury in the UK. London: Dance UK. Tseng, MM-C., Fang, D., Lee, M-B., Chie, W-C., Liu, J-P. & Chen, W.J. (2007). Two phased survey of eating disorders in gifted dance and non-dance high-school students in Taiwan, Psych Med. 37, 1085-96.
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Policy framework and best practice in relation to eating disorders in dance schools and companies Susan Ringwood Chief Executive, beat
Susan Ringwoods paper is offered here as additional advocacy for developing policies on eating disorders that promote health and wellbeing for all. Eating disorders are a serious mental illness which can lead to long term consequences for physical health and mental wellbeing if undetected and untreated. Eating disorders can affect anyone at any age but girls and young women aged 12-25 are most at risk. Latest research is revealing how much of the condition is due to hard-wired predisposed factors such as genetics, brain chemistry and personality type. These factors interact with the social and cultural environments to make vulnerable individuals at particular risk. Known risks include environments where body shape and size are closely evaluated and thinness is prized; where there is a strong competitive ethos; and where perfectionism can flourish. Bullying, especially about weight and shape, is a particular risk factor as is dieting in any form.
The aim should be to promote health and wellbeing for all, and not just to seek to avoid eating disorders.
Dance schools and companies are encouraged to consider adopting policies and best practice that can minimise these known risks for young people in their establishments. Eating disorders are such a cruel condition. They start very slowly and mimic much of regular adolescent behaviour. They thrive on secrecy and very rarely resolve spontaneously without specialist help, once established. They are also cruel in their effect on the individual who is unlikely to experience the eating disorder as an illness, but rather as a successful solution to living their life. What seems like the answer can in truth lead to long term, irreversible bodily damage and premature death in too many cases. Policies which embrace the whole organisation, rather than seek to address only people with eating disorders, will be most effective and easiest to implement. They will have the additional benefit of reducing the sense of stigma and shame a person with an eating disorder may feel as a result of their illness.
Overarching points to consider:

>> top level commitment that the policy has obvious support from the highest level in the organisation will help create a positive environment in which best practice can flourish >> involvement across the organisation that this is seen as a legitimate matter of concern for all staff members, colleagues and students rather than being consigned to only one professional group >> practicable that the policy addresses areas that are achievable and able to be routinely adopted in everyday practice >> demonstrable that it will be obvious and evident to all that this is a matter taken seriously and applied consistently across the organisation as a whole
Policy framework and best practice in relation to eating disorders in dance schools and companies >> Susan Ringwood
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Specific points:
Health and wellbeing >> dancers should be registered with a general practitioner >> significant weight loss or fluctuating weight should be noted and should trigger a health concern >> loss of form or physique should be noted and acted upon. Frequent injury or repeated minor illness could be signs of a risk factor >> admissions policies should include provision to enquire about eating disorder related risks such as prior treatment for the condition >> clear and consistently applied guidance about the circumstances that would lead to a dancer being considered too ill to work recognising the balance to be found between providing the motivation to get well and compromising frail health >> organisations should establish liaison and contact with appropriate health professionals knowing how and when to access therapeutic support and other specialist interventions Pastoral matters >> ensure staff have access to information and guidance to enable them to support individuals at risk appropriately >> nurture an environment in which students are encouraged to share worries, concerns, and seek help Organisational features >> ensure working practices that encourage regular, healthy eating and discourage all but medically supervised diets >> provide privacy in matters relating to an individuals weight and shape >> reduce unnecessary competitiveness and perfectionism >> adopt robust anti-bullying policies >> provide students with relevant information and the means to access confidential support if needed Emotional environment >> encourage staff to be aware of the dangers of making body related criticism >> adopt self-esteem building practices that focus on reward, not punishment >> provide opportunities to develop emotional resilience >> show respect for differences and create an ethos where shame and blame have no part >> celebrate achievements across a range of domains not just for physical attributes
Sources of information:
>> Beat (www.b-eat.co.uk) Helpline 0845 634 1414 >> National Institute of Health and Clinical Excellence (www.nice.org.uk)
Other reading:
>> Points to consider when establishing policies to cope with eating disorders in dance schools and companies (www.danceuk.org)
Policy framework and best practice in relation to eating disorders in dance schools and companies >> Susan Ringwood
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SECTION THREE: POSITIVE PRACTICES

This section comprises summaries of two conference presentations: the first, on flow and the second, proprioception. Although flow and proprioception are associated in particular with dance, flow has a close alignment with the concept of presence in musicians, and the development of proprioception skills can be highly effective for musicians, considering the physical demands their practice makes on their bodies.
Photo: Asya Verbinsky Practical considerations on eating problems among dancers >> Helen Laws and Dr Emma Redding
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Dancing in the moment: dancers flow experiences Elsa Bradley - Independent dance scientist and educator
Elsa Bradleys presentation focused on optimal experiences flow experiences and the differences between recreational, vocational and professional dancers perceptions of flow whilst dancing. She considered what flow is and its relevance to dance practice and young people. Flow is a term coined by Csikszentmihalyi as:
a subjective, mental state contributing to optimal experience, which is characterised by complete absorption in an activity, at a given moment in time.
>> Csikszentmihalyi, 1990
Applying this definition to dance practice, theoretical crossovers between flow and notions of presence emerge. Giannachi and colleagues (2008) suggest that: presence rests on notions of self-awareness, authenticity and authority in performance whilst Zarrilli (2007) defines presence as: controlled attentiveness and concentration, to achieve the embodiment of a particular task. When dancers audition for the CAT scheme we are looking for presence, and flow theory is an appropriate conduit through which to examine the quantitative and qualitative aspects of dance experience. If we know more, we can support flow experiences more. In one scene in the film Billy Elliot, Billy describes his sense of flow:
I dunno it sort of feels good, sort of stiff and that, but once I get going, then, I like forget everything, and I sort of disappear. I can feel a change in my whole body. Like theres a fire in my body. Im just there, flying. Like a bird. Like electricity. Yeah, electricity.
>> Billy Elliot, 2003. dir. Stephen Daldry
While this is a popular culture definition of flow it is also useful to look at flow from a scientific perspective and consider what we know about it.
Qualitative research in the workplace, leisure activities, sport, theatre and music suggest that there are nine dimensions that match the construct of flow:
>> skill-challenge balance >> action-awareness merge >> clear goals >> unambiguous >> feedback >> concentration >> control >> loss of self-consciousness >> transformation of time >> autotelic experience
Dancing in the moment: dancers flow experiences >> Elsa Bradley
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These terms are self-explanatory except for autotelic experience: this is when we do something for its own sake and the intrinsic enjoyment we get from that activity. If we enjoy what we are doing, the more likelihood that flow can occur. Autotelic experience is the most commonly cited dimension of flow across both qualitative and quantitative studies. Susan Jackson (1995) calls it the most salient dimension of flow and research by Martin and Cutler (2002) with theatre actors showed that tasks were seen to be more enjoyable when in flow. This fundamental sense of enjoyment is borne out by a study by Hefferon and Ollis (2006), from which the following are quotations from dancers:
I dance for myself first and then the audience second. You do this because you love it. It was enjoyable. Most of the performances we did were enjoyable we enjoyed ourselves.
>> Hefferon, K. M. & Ollis, S. (2006). Just clicks: an interpretive, phenomenological analysis of professional dancers experience of flow, Research in Dance Education, 7, 141-159.
My own study is consistent with this research. I undertook quantitative and qualitative data collection methods in order to capture the complexity of experience. Quantitative data revealed that autotelic experience was the most frequently experienced dimension of flow across recreational, vocational and professional dancers.
I fundamentally love it. I feel enjoyment most often, most of the time, which is so nurturing. It feels like I can come back into my body and enjoy that process.
>> Recreational dancer
It was a very stressful time for me the need to succeed, pass, do well, all that stuff affected my enjoyment at that time. I was having more fun away from [college].
>> Vocational dancer >> Bradley, E., Quested, E. & Wyon, M. Dancing in the moment: flow experiences of recreational, vocational and professional dancers. Submitted for presentation at IADMS conference, The Hague, The Netherlands, October 2009.
In looking at the differences between these dimensions and levels of participation, statistical analysis revealed that the vocational dancers reported significantly less frequency of autotelic experience than recreational dancers. Why might this be? Possible reasons are the developing intensification of training which makes dancers of this level of participation more susceptible to burnout and injury. Institutional training can also externalise the learning process and intrinsic motivation is replaced by extrinsic motivation; autonomy can become compromised and competence challenged. So how does all this apply to our work with our students, the maximum likelihood of flow, and ensuring the continued enjoyment of our students? What are the controllable factors which might facilitate flow? What are its antecedents? Overleaf is the Kimiecik and Stein interactional model of personal and situational antecedents which affect the occurrence of flow.
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Ive thought about every possible thing that can happen there are no ifs, or buts, or whats. The fact that Ive done everything possible reassures my conscious mind then I just switch off and let it happen.
>> Jackson, S. A. (1995). Factors influencing the occurrence of flow state in elite athletes, Journal of Applied Sport Psychology, 7, 138-166.
antecedents
Kimiecik and Stein interactional model
Personal factors involved are first, confidence - the belief that one has to succeed. Age and experience may be wrapped up in this. Athletes perceive these to facilitate flow as shown in studies by Jackson (2005) and Russell (2001). Second, mental and physical preparation:
Lastly, there is motivational orientation. Kowal and Fortier (1999) found that if swimmers were intrinsically motivated there was a positive incidence of flow. A study by Jackson and Roberts (1992) showed that task-involved goal orientations positively correlated to the flow state and Lacaille and colleagues (2005) found task-based goals with a focus on enjoyment supported flow. It appears that intrinsic, process-led approaches to learning lead to flow occurring, where autotelic experience can readily occur. So we might want to nurture these approaches in our own students to ensure their autotelic experiences. Situational factors are performance conditions and positive interaction with others. As dance leaders, educators and managers, we may have more control over the situational factors affecting flow.
Hefferon and Ollis found the following situational factors significant:

>> make-up >> lighting >> space >> heat in performance >> views >> natural light in class and rehearsal
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Positive interaction is commonly cited across the studies as vital in achieving flow. In my own study a particular emphasis on non-judgement and trust of dance leaders and peers appears to help flow to occur.
...feeling comfortable, unjudged its about knowing the people you are dancing with... There was so much trust there I trusted the process so much. Wed all danced together and knew each other and we could comfortably get to that place.
So armed with this evidence and knowledge, what steps might we be able to put in place to support the occurrence of flow? Intrinsic motivation is at the heart of all this, as in relation to the dancer themselves and the kind of environment we create for them. Sportbased research suggests process-oriented goals enhance flow, so we could encourage our dancers to adopt these both short and long term. To support autotelic experience, enjoyment must be fostered and the role of the teacher is to nurture, within a motivational learning environment. For example, students at the DanceEast Academy identify personal goals by completing a simple performance profile. These goals form part of their individual training plans, where the students and teachers goals sit alongside and sometimes overlap. Ownership of goals is key to an intrinsic motivational approach to learning.
A user friendly method of addressing the motivational climate in class time might be to draw on Epsteins TARGET principle in order to foster intrinsic motivation and trust between all involved:
>> Task: design of class activities for variety, individual challenge and active involvement, focusing on learning through fun and task-involvement, rather than competition >> Authority: involving dancers in the decision making process, offering leadership roles >> Recognition: recognising individual development rather than rewarding talent >> Grouping: encouraging co-operation by working together, having small groupings and multiple ways of organising those groups >> Evaluation: using criteria for development using self-set goals, involving students in process of evaluation >> Time: providing opportunities and time for improvement, time management, flexibility in reaching goals (various pathways)
Sport research shows that flow can lead to peak performance: we now need to research if this can happen in dance.
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Useful reading
Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New York: HarperCollins. Epstein, J. (1989). Family structures and student motivation: a developmental perspective, in C. Ames & R. Ames (eds.), Research on Motivation in Education. San Diego: Academic Press, pp 259-295. Giannachi, G., Kaye, N., Shanks, M. & Slater, M. (2008). Performing presence: from the live to the simulated. Retrieved January 5, 2009 from University of Exeter website: http://spa.exeter.ac.uk/drama/research/intermedia/conference_announce.shtml Hefferon, K. M. & Ollis, S. (2006). Just clicks: an interpretive phenomenological analysis of professional dancers experience of flow, Research in Dance Education, 7, 141-159. Jackson, S. A. (1995). Factors influencing the occurrence of flow state in elite athletes, Journal of Applied Sport Psychology, 7, 138-166. Jackson, S. A. & Csikszentmihalyi, M. (1999). Flow in Sports: The Keys to Optimal Experience and Performances. Champaign, Illinois, USA: Human Kinetics. Jackson, S. A. & Roberts, G. C. (1992). Positive performance states of athletes: toward a conceptual understanding of peak performance, The Sport Psychologist, 6, 156-171. Kimiecik, J. C. & Stein, G. L. (1992). Examining flow experiences in sport contexts: conceptual issues and methodological concerns, Journal of Applied Sport Psychology, 4, 144-160. Kowal, J. & Fortier, M. S. (1999). Motivational determinants of flow: contributions from self-determination theory, Journal of Social Psychology, 139, 355-368. Lacaille, N., Whipple, N. & Koestner, R. (2005). Re-evaluating the benefits of performance goals: the relation of goal type to optimal performance for musicians and athletes, Medical Problems of Performing Artists, 20, 11-16. Martin, J. J. & Cutler, K. (2002). An exploratory study of flow and motivation in theatre actors, Journal of Applied Sport Psychology, 14, 344-352. Russell, W. D. (2001). An examination of flow state occurrence in college athletes, Journal of Sport Behaviour, 24, 83-107. Zarrilli, P. B. (2007). Senses and silence in actor training and performance, in S. Banes & A. Lepecki (eds.), The Senses in Performance. London: Routledge, pp 47-70.
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Proprioception Kim Pedrick - Specialist physiotherapist

Kim Pedricks presentation included demonstrations and practical exercises in which delegates participated, so they could directly experience proprioception and explore techniques for its development. Deborah Bull has called proprioception the dancers and musicians secret weapon. Proprioception is the ability to sense the position, location, orientation and movement of the body and its parts. The term derives from the Latin proprius meaning ones own. It is a sixth sense, giving feedback about the environment, so people know where they are in space, without using vision or hearing. Proprioception is independent of the other senses and distinct from balance. If you focus on proprioception, you can improve it. Proprioception is essential and needed for balance. Although separate from vision and hearing, it works with these senses. It is developed in the womb from four months and while essential to everyday activity and skills acquisition, our proprioception is sometimes not as good as it could be, and there are ways to improve it. The sport sector has been aware of the importance of developing proprioception for a long time, and dance medicine is now catching up. Both dance and music are art forms that expect much of the physical body. Proprioception is not a single organ; there are proprioceptors (small nerve endings) located throughout the body in joints, muscles, tendons, ligaments and soft tissue. As an example, there are many proprioceptors in our hands. Proprioception is part of the somatosensory system (involving all the senses) and mechanosensitive - stimulated through movement. It can be conscious or unconscious. Proprioception fits with balance, musculoskeletal control, vision and the vestibular apparatus (see diagram below) - the sensory system that provides the dominant input about movement.
Good proprioception awareness can reduce risk of injury and is particularly helpful for young people going through a growth spurt.
Vestibular apparatus
Proprioception >> Kim Pedrick
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th
Muscle spindle
An example of a proprioceptor is the muscle spindle (see diagram below) which senses muscle length and changes in muscle length and sends that information to the brain. There is a density of proprioceptors in the deep neck muscles, jaw muscles and small foot muscles. These proprioceptors are also responsible for muscle tone, so if they go wrong, they provide unhelpful muscle tone.
At junction between muscle and tendon Tendon tension Golgi tendon organ
Another proprioceptor is the Golgi tendon organ (see above) at the junction between the muscle and tendon, which responds to tendon tension and gives feedback e.g. if the muscle is being used hard. Pacinian corpuscles are found everywhere, including in the joints, and respond to pressure changes and vibration. Musicians injury problems such as RSI (repetitive strain injury) can be due to either repetition or vibration. In these cases, the proprioceptors are over stimulated and give a distorted sense of proprioception, especially in the small joints and muscles. The following two diagrams show how proprioception works, with the response to the environment travelling through the central nervous system to the brain to in turn inform a motor response in the muscles.
How proprioception works
Environment (skin,joint,muscle,tendon)
CNS (spinal cord, lower brain, cerebral cortex)
Motor response (muscles)
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Proprioception is important to the musician in terms of posture and position (i.e. always returning to the correct posture without having to do so consciously or inhibiting musical expression) and injury prevention (for example hand dystonia). For the dancer, proprioception is part of aesthetics, feeling the movement (and sense of flow) and being able to achieve greater speed, accuracy, quality and expression and again, avoid injury. Injuries themselves can have long term effects (e.g. ankle sprains) and proprioception is affected by injury, so specific rehabilitation is needed. It is important teachers are aware of all this and can recognise where things can go wrong, and can also support students in ensuring their bodies can respond automatically to conditions, to maintain flow. Under the age of 11, proprioception is not developed. It increases with age and fluctuates with growth. Training can provide some specific improvements. Those with hypermobility a large range of joint movement have decreased proprioceptive acruity, but are often attracted to dance, so proprioceptive and stability training is key.
Poor posture and changes in environment (e.g. chair, shoes, stage and lighting) can all affect proprioception, with these possible consequences:
>> poor co-ordination >> increased cognitive effort >> inefficient motor patterns >> wasted energy/fatigue >> poor performance >> injury/re-injury >> chronic pain Training is first based on an awareness of proprioception. It is important to recognise that the use of mirrors in dance class can produce an over reliance on vision, when it is important for the student to experience and feel movement as well as see it. This will enable the body to retain the movement and bring it back again. With musicians, this can relate to knowing baseline posture. Musicians often do not engage in sufficient warm-up, which would be beneficial for proprioception. Proprioception can be tested, and a baseline established, through specific tests. For instance, Rombergs test involves standing with feet together (touching) and closing the eyes and establishing balance, and then doing the same but with a single leg stand. There is also the Finger-Nose test, undertaken in pairs. The first person closes their eyes and the second gently touches one of the first persons fingers and then asks them to touch their nose with that finger. The test can be repeated with a finger on the other hand. The Space test is another pair exercise. The first person closes their eyes and the second person places one of their hands or feet in position in space. The first person then has to imitate that position with the opposite limb or find the hand or foot with the opposite limb. Other single person tests include Hands Up, where both hands are raised above head. Keeping the left hand as still as possible, the person quickly touches the tip of their nose with the index finger of the right hand. They then use this index finger to touch the tip of the thumb on left hand, then back to the nose, then to the index finger on the left hand and on until each finger has been touched (and the nose in between). This is then repeated with the other hand. The Walking test involves picking a spot in front of you; closing your eyes; walking to it; and seeing how close you get. Repeating these tests improves proprioception, as does general exercise and using full joint range of movements.
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To summarise:
>> proprioception is constant and essential >> improving proprioception can decrease injury risk and improve performance >> loss of proprioception is associated with age; growth spurts; a change in environment; and fatigue or illness >> both music and dance are art forms that rely on the physical body so maintaining and training proprioception is key
Useful reading
Proprioception, IADMS Resource Paper. www.iadms.org Lephart, S. M. & Fu, F.H. (eds.) (2001). Proprioception and Neuromuscular Control in Joint Stability. Champaign, Illinois, USA: Human Kinetics.
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SECTION FOUR: MOVING ON

The Programme Committee met after the conference to consider the delegates evaluations and reflect on the learning and development the event had provided - and also provoked for the future. They agreed a set of actions for moving on debate and practice in promoting health and wellbeing in talented young dancers and musicians.
Photo: Will Price
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Promoting health and wellbeing in talented young dancers and musicians Music and Dance Scheme Conference 2009
Programme Committee actions:

>> to produce and widely disseminate this conference publication >> to distill the collective widsom of conference presenters and delegates into a document, Principles and Practices: promoting health and wellbeing in talented young dancers and musicians >> to encourage organisations and agencies to adopt and implement the Principles and Practices document >> to work in partnership with other organisations such as British Association for Performing Arts Medicine (BAPAM) and Dance UK to develop resources supporting the promotion of health and wellbeing in talented young dancers and musicians >> to organise another conference on health and wellbeing in 2011 >> to continue to work as the Music and Dance Scheme family to fundraise for, commission and/or undertake, the above developments
know more, support more
Programme Commitee Actions
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Principles and Practices: promoting health and wellbeing in talented young dancers and musicians
Our Principles are to:
>> promote good health and wellbeing for performance enhancement >> focus from the earliest opportunity on the individual student as a whole person to support their informed, health aware choices and practices >> invest time, resources and expertise, in collaboration where possible, for the valued return of ensuring longevity in creative professional practice
Our Practices are to:

>> develop, implement and review health related policies and protocols for whole school/faculty adoption >> provide timely health related screening and testing of students with individualised follow-up intervention, support and review >> include health awareness, healthy living and illness/injury prevention in the curriculum >> work within a multi-disciplinary team approach, whilst recognising the key role of the teacher >> keep up-to-date with relevant research directly in our field and in related fields, from which we can apply and develop further good practice >> commit to the training and continuing professional development of all practitioners working with students >> harness collaborative working across schools and across music and dance, wherever possible, to inform our practices >> share and disseminate learning amongst ourselves and wider networks of education and training providers We will monitor these Principles and Practices through our quality assurance and enhancement processes, revising the detailed action plans we draw up, as appropriate.
Principles and Practices
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ANNEXES
I Foundations for Excellence conference: summary of delegates evaluations
Seventeen delegates completed and returned their evaluation forms on the day of the conference and nine returned them later. This total of 26 responses represents 31% of the total 85 conference attendees. All delegates who commented on the organisation and content of the conference were very appreciative of how well it was managed, the stimulation and inspiration the content provoked and the setting in which it was held. One delegate commented that some sessions repeated others to some extent; another noted that they learnt more from the sessions on the other art form than from those on their own art form, where they found no surprises. Many said they benefited from the networking opportunity the conference provided; two delegates wished for time for small group discussion and one recommended that a more practical approach to some of the areas (considering the success of the session on proprioception) would have helped sustain higher levels of engagement. Overall, there was a strong sense that it was extremely useful to meet together as dance and music colleagues.
Key points delegates took away from the conference:

>> reaffirming the sense of the Music and Dance Scheme family, working together for the same ends >> appreciating the positive health benefits of CAT training over other providers >> developing a greater understanding of the crossovers between music and dance and furthering links to enhance synergies e.g. the importance of proprioception for musicians as well as dancers the importance of understanding about hearing and noise exposure for dancers and as well as musicians relating flow in dance to presence in music undertaking screening in music as well as dance
>> ensuring health, wellbeing and injury prevention have a place in the curriculum >> investing in awareness raising of health issues and injury prevention strategies >> the dissemination of information to, and training support for, all relevant colleagues >> keeping up-to-date with research
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Delegates conference inspired learning to implement in their organisation or practice:

>> individualised physical and mental wellbeing schemes >> including proprioception in the curriculum >> developing an eating disorder policy preferably jointly with the other CATs >> undertaking hearing tests for students and noise control measures >> developing and implementing a whole school policy on health and running training (both awareness raising and tailored continuing professional development) >> more integrated work across music and dance >> encouraging healthy eating and fitness in students >> supporting strategies for coping with performance, including the importance of performance review
Support needed to action these developments included:

>> joint working for more effective development >> the conference publication >> future conference opportunities >> help with policy documents >> support/facilitation/input by those experienced in good practice e.g. as visiting speakers and advisers >> centrally provided continuing professional development >> financial support to employ specialists e.g. physiotherapist, nutritionist at a student residential >> a comprehensive shared key document for all young musicians on how to look after their bodies (e.g. diet, exercise, avoiding tension, RSI, etc.) All respondents who answered the question on cross disciplinary learning (23 out of 26) indicated they had learned something from the other discipline that they could implement in their own.
Dance learning from music:

>> hearing and noise research and its application >> strategies for dealing with performance anxiety
Music learning from dance:

>> similarities in injury problems e.g. in relation to small muscles >> awareness of the impact of growing on developing bodies >> proprioception and body awareness >> flow and its relation to presence >> eating disorders >> screening
Annexes
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Other topics delegates recommended for a future conference:
Education and careers

>> talent identification training in mainstream schools with knowledge about appropriate signposting and information on higher education opportunities for the next generation; making pathways between outreach, CATs and vocational schools
>> training and the reality of the job market
Health and wellbeing

>> links between stress in young performers and self-abuse, why so much stress is necessary in achieving goals and high levels of performance >> psychological profiling/eating disorders in young musicians >> healthy dance practice (forcing bodies what is natural and healthy for bodies when still growing what is healthy vs tradition?) >> more specific strategies for injury prevention >> research into the somewhat schizophrenic existence of talented musicians and dancers and how they are regarded by their peer groups during adolescence
Specific areas of interest

>> voice related issues (singing and speech) >> links to the concept of multiple intelligences (kinaesthetic learning)
Research and training

>> parallel research and its outcomes from sports performance >> support for training staff in the research findings, so they understand and can translate it for use in their own practice
Collaborative working within the Music and Dance Scheme

>> ways in which each group of centres could use specialist skills to help other groups e.g. dance teachers deliver core stability for musicians and musicians deliver rhythm studies/music for dancers >> developing specific links between music and dance >> identifying good practice and practitioners >> developing a comprehensive shared key document for all young musicians on how to look after their bodies
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II Foundations for Excellence conference: attendees and performers LAST NAME

ANDERSON ARTHUR BAILEY BARABHUIYA BARSBY BAXTER BETHELL BRADLEY CAIRD CAIRNCROSS CAMERON CHISHOLM COBLEY COLLINS COOK CROOK DALE DAVIS DAY ECCLESTONE ENGLISH EVANS FARRUQUE FIELD FRANCIS FRIEND GINSBORG GRAY GREEN GRUNDY HANLEY HEGARTY HEWITT HOLDEN HUMPHREYS HURST JAMES JENNER-TIMMS JOBBINS JONES KEIR KIEL
FIRST NAME
Stefan Hayley Becky Faruk Kate John Jonathan Elsa George Elizabeth Jacqui Nicolas Sarah Martin Jonah Peter Gillian Penny Jo Vic Timothy Maggie Sanchita Lucy Polly Marion Jane Vanessa Kate John Francesca Lucy Peter Sophie Karen Charlotte Louise Carole Veronica Melanie Patricia Robin
ORGANISATION
Tring Park School for the Performing Arts Northern School of Contemporary Dance Yorkshire Young Dancers Dance4 Youth Music Dance South West The Sage Gateshead Independent dance scientist Birmingham Conservatoire Wells Cathedral School The Sage Gateshead Yehudi Menuhin School Dance South West Laban Youth Dance Academy (Performer) The Purcell School Dance in Devon Trinity College of Music Wiltshire Music Centre Bristol City Council Birmingham Conservatoire The Hammond School BAPAM CAT, The Place Wells Cathedral School (Performer) Trinity College of Music Royal Northern College of Music CAT, The Place National Youth Orchestra Sheffield Music Academy Centre for Young Musicians Dance East Academy Royal College of Music South West Music School Junior Royal Northern College of Music Brannel School Momentum CAT at DanceXchange Wells Cathedral School Laban Sheffield Music Academy Royal Welsh College of Music and Drama MDS, DCSF
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KIRKPATRICK LAMBERT LAWS LONGSTAFF LORD McCLUSKY McCORMACK MEARS NANCEKIEVILL NORDIN OBRADOVIC ONCIL PAPAGEORGI PARR PEAVOT PEDRICK PESTELL PHANG POOLE REDDING REDMAN REYNOLDS RIST SARGENT SCHWARZ SINGER SLAYFORD SMIKLE STIRLING SUBRAMANYAM SUTHERS SWAINGER THRELFALL TREGALE TREGO VIRR WALKER WEITZEL WHITE WHITE WILLIAMON WILLIAMS WILLSHIRE WITNEY
Hannah Rachel Helen Edward Alison Marie Moira Alison Dorothy Sanna Jayne Filiz Ioulia Ken Annelli Kim Louisa Lee Jae Jonathan Emma Drusilla Christine Rachel Gill Mary Malcolm Viv Lee Penny Anusha Kate Sophie Stephen Lisa Karen Colin Imogen Samantha George Toby Aaron John Havilland Tracy
Yorkshire Young Dancers The Sage Gateshead Weekend School Dance UK The Purcell School Dance4 Swindon Dance The Royal Ballet Guildhall School of Music & Drama Wells Cathedral School Laban Wells Cathedral School Wells Cathedral School University of London Devon Music Service Elmhurst School for Dance Tring Park School for the Performing Arts Laban Wells Cathedral School (Performer) The Lowry Laban Guildhall School of Music & Drama Tring Park School for the Performing Arts Tring Park School for the Performing Arts BIMM (Bristol Institute of Modern Music) Yehudi Menuhin School Youth Dance Academy Laban Yorkshire Young Musicians Momentum CAT at DanceXchange Wells Cathedral School (Performer) South West Music School Chethams School of Music South West Music School Wells Cathedral School Aldeburgh Young Musicians Laban Music for Youth Wells Cathedral School (Performer) Wells Cathedral School (Performer) Royal College of Music Wells Cathedral School Royal Scottish Academy of Music and Drama Northern School of Contemporary Dance Yorkshire Young Dancers
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III Contributors biographies

Elsa Bradley is an independent dance scientist and artist, currently Resident Dance Scientist for the DanceEast Academy and Lecturer in Dance at the University of Bedfordshire. She has a degree in Dance in Society (University of Surrey), an MSc in Dance Science and also trained at London Contemporary Dance School. elsab@btopenworld.com Dr Sanchita Farruque trained as a doctor but went straight into a two and half year world music tour after her finals, and continued to tour professionally for a further ten years. Alongside her work for BAPAM, she is now a semi-professional touring singer/song writer, singing/music technology tutor and semi-professional Indian flautist and keyboardist. sanchita@bapam.org.uk Dr Jane Ginsborg read music at the University of York and trained as a singer at the Guildhall School of Music and Drama. Following a freelance career as a professional singer and singing teacher, she studied psychology with the OU; her PhD was awarded by Keele University. She has published widely in music psychology. jane.ginsborg@rncm.ac.uk Helen Laws studied ballet, tap, modern and contemporary dance, has a degree in Dance (Roehampton University) and a Diploma in Arts Management. She wrote Fit to Dance 2 Report of the Second National Inquiry into Dancers Health and Injury in the UK and is a board member of the International Association for Dance Medicine and Science. helen@danceuk.org Moira McCormack trained at The Royal Ballet School and danced with Sadlers Wells Royal Ballet, National Ballet of Canada and London Festival Ballet. She trained as a classical ballet teacher at The Royal Academy of Dancing and graduated in Physiotherapy from Guys Hospital. Moira is a board member of the International Association for Dance Medicine and Science. moira.mccormack@roh.org.uk Dr Sanna Nordin has a BSc in Psychology and Sports Sciences and a PhD in Dance Psychology (University of Birmingham). Alongside the CAT project she works freelance as a dance project evaluator, lecturer and psychology consultant. s.nordin@laban.org Dr Ioulia Papageorgi teaches in the areas of psychology of music and music education, and musicians health and wellbeing. Her research interests focus on psychological factors affecting performing musicians and strategies they employ to cope with the demands of performance, as well as how expertise develops. She has presented her work widely in the international arena. i.papageorgi@ioe.ac.uk Kim Pedrick worked as a professional dancer before gaining her degree in Physiotherapy. She has since undertaken a masters degree in Sports physiotherapy and has specialised in the treatment of dancers of all ages and abilities from student to elite professional. She has presented original research at international conferences and regularly lectures for Dance UK on subjects such as injury prevention, dance injuries and functional anatomy. kimpedrick@msn.com Dr Emma Redding has a BA Hons Dance Theatre (Laban), MSc in Sports Science (University of Essex) and a PhD (City University). She is a dance performer and teacher, leading the MSc Dance Science in her role at Trinity Laban. Emma is a board member of the International Association for Dance Medicine and Science and has published research in several academic journals. e.redding@laban.org Susan Ringwood was a member of the NICE guideline development group for Eating Disorders and is a lay member of their consideration panel for Mental Health. She is an Advisory Board member of the Academy of Eating Disorders (AED) and co-Chair of the Patient and Carers committee, receiving in 2008 the AED Meehan/Hartley award of Leadership in Advocacy and Public Service. Susan is a member of the Royal College of Psychiatrists Eating Disorders section Executive Committee. s.ringwood@b-eat.co.uk Rachel Rist has an MA in Performing Arts and wrote The Injured Dancer and Anatomy and Kinesiology for Ballet Teachers. She is past President of the International Association for Dance Medicine and Science and currently Chair of its Education Committee. Rachel is founder developer of Trinity International Examinations Boards Safe Dance Practice and lectures extensively. rachel.rist@tringpark.com Dr Aaron Williamon researches music cognition, skilled performance and applied psychological and health-related initiatives that inform music learning and teaching. He has performed as a trumpeter in both Europe and North America and is author of Musical Excellence which offers musicians new perspectives and guidance on performance enhancement. awilliamon@rcm.ac.uk
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