Psychosocial and Body Image Variations in Professional Dancers: A Prospective Longitudinal Observational Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Review of the following scientific paper: Psychosocial and Body Image Variations in Professional Dancers: A Prospective Longitudinal Observational Study. Below I am sending my suggestions that can improve the scientific value of the sended paper. Evaluation of the submitted scientific article has been divided into individual sections contained in the manuscript:

1. Abstract. The abstract contains all the information about the scientific work. However, I have a question right from the start. Is the topic of the work consistent with the information contained in the abstract? Are Psychosocial and Body Image Variations and Mental the same thing? Psychosocial and Body Image Variations refer to changes in psychosocial functioning and body image: social relationships and reactions of the environment, self-esteem, acceptance or non-acceptance of appearance, and the impact of appearance on social roles. Mental health, on the other hand, is a broader concept that encompasses general mental state: mood, anxiety level, depression. Please respond to this comment.
   
   
2. Introduction section. I suggest modifying the introduction. It is worth starting the introduction with information about the specifics of the research group and the sport discipline. In addition, is it not worth omitting the WHO information in lines 60-64? Furthermore, please add more citations in lines 76-78 and add a citation in lines 103-105.
   
   
3. Material i methods section. Please describe in detail how the group of dancers was selected for scientific research. In addition, it would be worth adding information about their training experience. However, the biggest problem is the size of the study group. The authors studied only 13 people, divided by gender: 4 men and 9 women. Did the study participants have master's degrees or achieve world-class results in their discipline?
   
   
4. Despite the comments in the section on materials and methods, the section on results was very well described and presented.
   
   
5. Discussion section. Please add citations to lines 366-367.
   
   
6. Please correct the following citations: 20, 21, 22, 24, 25, 26 (publication from 1987 why?), 29, 30, 31. I have observed lackof pages in those references.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

SPORTS MDPI «sports-4085228»

Article for review.

“Psychosocial and Body Image Variations in Professional Dancers: A Prospective Longitudinal Observational Study”

Peer Review Comments

Abstract

Lines 49–52

Exact text:

“findings reveal a progressive psychophysiological imbalance in which the emotional and aesthetic demands of the professional dance environment exceed recovery capacity, resulting in emotional overload and body image distortion.”

This conclusion implies that emotional and aesthetic demands exceeded recovery capacity, but the study did not directly measure recovery strategies, coping resources, or objective workload indicators. I recommend rephrasing this sentence to reflect that the imbalance is inferred from psychometric trends rather than directly assessed. A more cautious formulation would ensure consistency with the observational nature of the study and avoid overstating causal mechanisms.

 

Introduction

Overall Assessment of the Introduction

The introduction is generally well structured and supported by relevant literature. The main areas requiring improvement relate to avoiding overgeneralizations, clarifying the scope of cited findings, and refining causal or absolute statements. These adjustments will enhance precision and strengthen the scientific framing of the study.

Comment 1

Lines 71–75
Exact text:
“dancers experience training routines comparable to those of athletes, enduring long hours of rehearsal, exhaustion, and pain as visible expressions of dedication… nonetheless entails physical demands similar to those found in sports [9,10].”

The phrasing presents exhaustion and pain as inherent or expected components of professional dance practice. This may unintentionally normalize potentially harmful training conditions. I recommend clarifying that these experiences are reported in the literature rather than intrinsic to the discipline. A more neutral formulation would strengthen scientific accuracy and avoid overgeneralization.

Comment 2

Lines 78–84
Exact text:
“Picard and Gaetz [11] identified in female dancers a cyclical trauma pattern… high prevalence of body dysmorphia, eating disorders, anxiety, and depression… Lopes et al. [13] found a high prevalence of alexithymia and depression…”

These statements describe severe psychopathological outcomes but do not specify the characteristics of the samples or methodologies of the cited studies. Without this context, the text risks overgeneralizing these findings to all professional dancers. I suggest adding a brief clarification that these results refer to specific samples and may not be representative of the entire professional dance population.

Comment 3

Lines 94–96
Exact text:
“This condition, in turn, may reduce self-esteem and compromise both psychological well-being and stage performance.”

The transition from BMI–body dissatisfaction associations to broader effects on self-esteem and performance is abrupt. It would be helpful to clarify whether this statement is supported by specific studies or reflects a theoretical interpretation.

Comment 4

Lines 96–100
Exact text:
“longitudinal studies have shown… high stress levels are associated with a greater incidence of musculoskeletal injuries…”

This paragraph merges two distinct themes: rehearsal/performance workload and stress–injury associations. Adding one sentence to explain the mechanism linking these concepts (e.g., fatigue, reduced attentional capacity, increased tension) would improve coherence.

Comment 5

Lines 105–107
Exact text:
“No studies were identified that combine multiple psychosocial indicators using repeated measures…”

The statement is too absolute given that no search strategy is described. Unless a systematic review was conducted, it would be more appropriate to use a cautious formulation such as “to our knowledge” or “few studies have combined…”. This avoids implying a systematic evidence search that was not performed.

 

Materials and Methods

Overall Assessment of the Methods Section

The Methods section is generally detailed and well structured, with clear descriptions of instruments and statistical procedures. The main issues relate to the accuracy of anthropometric data, the need for greater transparency in covariate handling and sensitivity analyses, and the absence of acknowledgment of potential biases. Addressing these points will substantially strengthen the methodological robustness of the study.

Comment 6

Lines 126 Table 1.
Exact text:
“BMI (kg/cm²) 30.1 ± 2.15 33.85 ± 3.11 26.89 ± 1.98 0.004*”

The BMI values reported for professional dancers appear unusually high for this population, particularly the mean BMI of 30.1 kg/m² for the total sample and 33.85 kg/m² for men. These values fall within the clinical obesity range, which is inconsistent with the typical anthropometric profile of professional ballet and contemporary dancers. This raises concerns about either a potential unit error (kg/m² vs. kg/cm²), a data entry issue, or a miscalculation. I strongly recommend verifying the BMI computation and units, as this is a critical variable in the study and may affect the interpretation of body image findings.

Comment 7

Lines 137–141
Exact text:
“The overall conditions of the season, escalating technical demands, aesthetic pressure, performance schedules, and the emotional burden associated with the international tour created a high-demand artistic environment characterized by substantial physical and psychosocial strain. This context justified the longitudinal design aimed at capturing temporal fluctuations throughout the entire cycle.”
This paragraph provides a narrative justification for the longitudinal design but does not specify any objective indicators of workload, training volume, or performance frequency. Without such information, the description remains subjective. Including even basic quantitative descriptors (for example, approximate weekly rehearsal hours or number of performances) would strengthen the methodological justification and improve transparency.

Comment 8

Lines 144–151
Exact text:
“Of the approximately 20 eligible dancers, 13 agreed to participate… No participant was excluded due to injury, and there were no refusals or dropouts across the eight assessment time points, resulting in a 100% retention rate.”

The recruitment process is described, but the potential for selection bias is not acknowledged. Only 13 of 20 eligible dancers participated, and it is unclear whether the non-participants differed systematically in psychological or physical characteristics. This limitation should be explicitly recognized, as it may affect the generalizability of the findings.

Comment 9

Lines 183–185
Exact text:
“All instruments were administered by a single trained evaluator experienced in psychometric assessment, ensuring procedural standardization across all measurement points.”

Using a single evaluator improves consistency but also introduces the possibility of evaluator bias. The manuscript does not report any procedures to assess intra-rater reliability or to ensure scoring stability across the eight time points. A brief acknowledgment of this limitation would improve methodological transparency.

Comment 10

Lines 190–200
Exact text:
“Given the repeated-measures structure… two complementary analytical approaches were used: repeated-measures ANOVA and Linear Mixed Models (LMM)… This dual approach strengthens internal validity.”

The rationale for using both repeated-measures ANOVA and LMM is described, but the manuscript does not clarify how discrepancies between the two methods were handled. It would be helpful to specify whether the two approaches yielded convergent results and which method was prioritized in cases of divergence. This clarification is important for interpretability and statistical coherence.

Comment 11

Lines 203–212
Exact text:
“To control multiple comparisons… the False Discovery Rate (FDR) procedure was applied… Potential covariates… were initially screened… none significantly improved model fit.”

The description of covariate screening lacks detail. It is unclear whether covariates were tested individually or simultaneously, and what criteria were used to determine that they did not improve model fit. Providing a brief explanation of the model comparison procedure (for example, AIC, BIC, likelihood ratio tests) would strengthen the methodological rigor.

 

Results

Comment 12

Lines 222–225
Exact text:
“Significant differences between sexes were observed for body mass… height… and BMI (men: 33.85 ± 3.11; women: 26.89 ± 1.98).”

The BMI values reported here remain inconsistent with typical anthropometric profiles of professional dancers and appear clinically implausible. This issue was already noted in the Methods section, but its presence in the Results reinforces the need for verification. If BMI was miscalculated or misreported, all analyses involving body image interpretation may be affected. I strongly recommend rechecking the raw data and recalculating BMI before drawing conclusions.

Comment 13

Lines 226–235
Exact text:
“The repeated-measures ANOVA revealed a significant time effect for all negative mood dimensions… Post-hoc tests (FDR correction) indicated that differences occurred mainly between the initial (1–2) and final (6–8) assessment points…”

The Results section reports numerous significant pairwise comparisons, but the text does not specify the adjusted p-values after FDR correction. Since FDR can substantially alter significance thresholds, it would be helpful to report the corrected p-values or explicitly state that the values presented already reflect FDR adjustment. This clarification is necessary to ensure transparency in multiple-comparison control.

Comment 14

Lines 236–239
Exact text:
“Linear mixed models confirmed ascending linear trends across all negative mood dimensions (β = 0.49–0.78; p < 0.001)… indicating progressive emotional deterioration…”

The LMM results are presented as confirming the ANOVA findings, but the manuscript does not report confidence intervals for the β coefficients. Confidence intervals are standard in LMM reporting and would allow readers to assess the precision of the estimated trends. Including them would strengthen the statistical reporting.

Comment 15

Lines 248–259
Exact text:
“A significant time effect was observed for general stress… global stress… specific stress… These results demonstrate a progressive imbalance between psychophysical load and recovery…”

The interpretation of stress–recovery imbalance is reasonable, but the Results section includes interpretive language (“demonstrate a progressive imbalance”) that belongs more appropriately in the Discussion. The Results section should remain descriptive. I recommend rephrasing this sentence to a neutral description of the statistical findings and moving interpretive statements to the Discussion.

Comment 16

Lines 265–271
Exact text:
“State anxiety levels showed a significant increase… F(6.72) = 0.66; p = 0.049; η²ₚ = 0.05.”

The F-value reported (0.66) appears inconsistent with the conclusion of a significant time effect (p = 0.049). Typically, an F-value below 1 would not yield statistical significance in repeated-measures ANOVA. This discrepancy suggests a possible reporting error. I recommend verifying the F statistic and degrees of freedom to ensure accuracy.

Comment 17

Lines 278–281
Exact text:
“The mean score rose from 74.6 ± 23.1 (‘no concern’) to 155.9 ± 17.2 (‘high concern’).”

The classification thresholds for BSQ categories are not provided in the Methods or Results. Without these thresholds, readers cannot verify whether the transitions between “no concern” and “high concern” are correctly applied. Please include the BSQ scoring ranges used for classification.

 

Discussion Section

Comment 18

Lines 306–309
Exact text:
“This set of results reveals a pattern of progressive psychophysiological imbalance, suggesting that the emotional and aesthetic demands exceeded the available recovery strategies during the observation period.”

The interpretation that emotional and aesthetic demands “exceeded the available recovery strategies” is plausible but speculative, as no direct measures of recovery strategies or coping resources were collected. I recommend rephrasing this statement to reflect that the imbalance is inferred from psychometric trends rather than directly measured.

Comment 19

Lines 316–318
Exact text:
“dancers in competitive contexts experience greater tension before performances and reduced pleasure afterward, indicating that the competitive environment may attenuate the positive effects of dance on mood [27].”

This interpretation is reasonable, but the manuscript does not clarify whether the company studied here operates within a competitive framework. If the context is not explicitly competitive, the comparison may not be fully appropriate. A brief clarification of the company’s competitive environment would strengthen the argument.

Comment 20

Lines 321–324
Exact text:
“the accumulation of stress and the reduction in perceived recovery… consistent with the psychobiological model proposed by Kellmann and Beckmann [31].”

The Discussion repeatedly references the load–recovery imbalance model, but the study did not measure objective workload indicators (training hours, intensity, performance frequency). Without such data, the link to load–recovery imbalance should be framed more cautiously. I suggest emphasizing that the interpretation is based on psychometric indicators rather than direct workload quantification.

Comment 21

Lines 341–349
Exact text:
“This anxious response is amplified by continuous exposure to evaluative contexts and the internalization of self-image as a marker of competence…”

The manuscript attributes the increase in anxiety to evaluative pressure and internalized body image standards, but these contextual variables were not measured. This should be acknowledged explicitly to avoid overstating causal mechanisms.

Comment 22

Lines 350–356
Exact text:
“The Body Shape Questionnaire (BSQ) scores increased significantly… This trend is consistent with the findings of Picard and Gaetz [11]… sustained by the culture of extreme discipline and aesthetic demand inherent to classical ballet.”

The discussion links BSQ increases to “extreme discipline” and “aesthetic demand,” but the study did not assess motivational climate, coaching style, or aesthetic pressure. These interpretations should be presented as possible explanations rather than definitive causes.

Comment 23

Lines 377–384
Exact text:
“According to this model, prolonged exposure to psychophysical demands without adequate recovery leads to hyperactivation of the HPA axis…”

The manuscript references neuroendocrine mechanisms (HPA axis activation, cortisol release), but no physiological data were collected. This mechanistic explanation should be framed as theoretical background rather than an interpretation of the present findings.

Comment 24

Lines 402–404
Exact text:
“Although the findings of the present study provide valuable insights… but this study presents several methodological limitations…”

There is a grammatical issue in this sentence (“Although… but”). I recommend removing “but” to improve clarity.

Comment 25

Lines 404–408
Exact text:
“the small sample size (n = 13)… limits the statistical power… constrains external validity…”

The limitation is correctly acknowledged, but the Discussion does not address the potential impact of the unusually high BMI values reported earlier. If BMI was miscalculated, this limitation should be explicitly recognized here, as it directly affects the interpretation of body image findings.

Major Comment 26

Lines 408–420
Exact text:
“the absence of a control or comparison group prevents causal inference… all measures were self-reported… the study did not assess contextual variables…”

These limitations are well stated, but the Discussion does not address the potential for evaluator bias, given that all psychometric instruments were administered by a single evaluator. This should be added for completeness.

 

Conclusions

Comment 27

Lines 443–446

Exact text:

“These findings indicate that the emotional, physical, and aesthetic demands of the professional dance environment exceed the individuals’ recovery capacity, promoting emotional overload and psychological vulnerability.”

This conclusion implies a causal relationship between environmental demands and reduced recovery capacity. However, the study did not measure recovery strategies, coping resources, or objective workload indicators. I recommend rephrasing this statement to reflect that the imbalance is inferred from psychometric trends rather than directly assessed. A more cautious formulation would better align with the study’s observational design.

Comment 28

Lines 447–449

Exact text:

“The evidence underscores the need for continuous psychometric monitoring and the implementation of preventive strategies, including emotional regulation, psychological support, and body image management…”

These recommendations are reasonable, but they should be framed as general implications derived from the literature rather than direct outcomes of the present study. Since no intervention was tested, it would be more accurate to state that the findings suggest or support the relevance of such strategies, rather than implying that the study provides direct evidence for their effectiveness

Comments for author File: Comments.pdf

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

sports-4085228

Article: Psychosocial and Body Image Variations in Professional Dancers: A Prospective Longitudinal Observational Study

Review second round.

Dear authors,

The revised version of the manuscript shows clear improvement across multiple areas, including the correction of BMI values, the refinement of causal language, the clarification of methodological procedures, the addition of workload descriptors, and the enhancement of statistical reporting. These revisions substantially strengthen the scientific rigor and transparency of the study. At the same time, a few important issues remain and require further refinement to ensure full methodological consistency and interpretive accuracy. For this reason, I provide you with four additional comments addressing residual concerns related to interpretive phrasing, workload characterization, competitive context justification, and the presence of interpretive statements within the Results section. Addressing these final points will bring the manuscript to a publishable standard.

 

Comment 1, Lines 50–55 (Abstract)

Text: “Indicating a progressive psychophysiological imbalance, as inferred from longitudinal psychometric trends, suggesting that the emotional and aesthetic demands of the professional dance environment may exceed perceived recovery capacity…”

Although you softened the causal language, the revised sentence still implies that the emotional and aesthetic demands of the professional dance environment “may exceed perceived recovery capacity.” This phrasing continues to suggest a causal relationship between environmental demands and reduced recovery capacity, even though the study did not directly measure any variables related to recovery or load. Specifically, no data were collected on recovery strategies, coping resources, objective workload indicators, fatigue markers, or training load. Because these constructs were not assessed, the conclusion that demands exceed recovery capacity remains hypothetical rather than empirically demonstrated. I suggest you further refine the wording to make clear that this interpretation is an inference derived solely from longitudinal psychometric trends, and not from objective indicators of physical or emotional load or recovery.

 

Comment 2 – Lines 149–168 (Methods - Workload Description)

Text: “Participants engaged in one to two rehearsal and training sessions per day from Monday to Friday, in addition to one structured session on Saturdays, corresponding to approximately 10–18 hours of structured training per week, with volume and intensity progressively increasing as performances approached.”

Although the added quantitative description improves clarity, the manuscript still does not specify how training intensity was monitored or estimated. No indicators such as RPE, heart rate, class type duration, or other workload metrics are reported. Without even minimal information on intensity monitoring, the workload characterization remains incomplete. I suggest you clarify how intensity was assessed or explicitly acknowledge that intensity was not objectively monitored.

 

Comment 3 – Lines 283–288

Text:“Linear mixed models confirmed ascending linear trends across all negative mood dimensions… indicating progressive emotional deterioration and inversion of the characteristic ‘iceberg’ mood profile.”

The phrase “indicating progressive emotional deterioration and inversion of the iceberg profile” introduces interpretive language within the Results section. Results should remain strictly descriptive, reporting only statistical outcomes without psychological or theoretical interpretation. I suggest you rephrase this sentence to a neutral description (e.g., “LMM analyses showed positive linear trends across negative mood dimensions”) and move interpretive statements to the Discussion.

 

Comment 4 – Lines 349–358

Text:“…the company operated within a highly demanding and competitive artistic context, characterized by selective preparation processes and participation in international performances.”

Although the revised wording adds some contextual detail, the Methods section does not provide evidence that the company operates within a competitive framework (e.g., adjudicated events, ranking systems, competition-based selection, or performance evaluation). Participation in international performances alone does not establish competitiveness. This creates an inconsistency between Methods and Discussion. I suggest you either (a) add a brief clarification in the Methods describing the specific elements that make the company competitive, or (b) soften the Discussion wording to avoid implying a competitive environment that is not empirically documented.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf