Dose-response Effect of Community Dance Programme on the Physical, Cognitive, Psychosocial Health of Pre-frail and Mildly Frail Older Adults: A Cluster Randomised Trial With Co-design Approach and Process Evaluation
Phase: NA
Conditions: Dance, Older Adults, Frailty at Older Adults, Active Ageing
Sponsor: National University of Singapore

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Research Proposal 
 
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Proposal Title: Dose-response Effect of Community Dance Programme on the Physical, 
Cognitive, Psychosocial Health of Pre-frail Older Adults: An Interventional Study with Co-
design Approach and Process Evaluation 
 
I 
Specific Aims & Hypothesis 
 
Frailty is a complex phenomenon with multiple dimensions in physical, psychological and social 
domains. It is common among older adults, and is characterised by depletion of reserves in multiple 
organ systems leading to physiologic vulnerability such as increased risk of falls, functional decline, as 
well as reduced capacity to withstand and recover from acute injury or stress [1]. Hence, it is important 
to prevent frailty and enable older adults to live healthily in the community.  
Across different musical genres and dance styles, dancing has been shown to improve 
muscular strength, endurance, and balance [2]. Furthermore, dance with music is effective for 
increasing motivation and adherence to prescribed physical exercises [3]. Apart from its benefits 
among healthy older adults, dance can alleviate symptoms experienced by older adults with 
medical conditions by increasing flexibility, balance confidence, and motor performance [4].  
The results of our meta-analysis showed that dance interventions had a significant effect on 
global cognition, memory, visuospatial function, and language in older adults with mild cognitive 
impairment [5]. We also found that dance interventions produced a significant effect on physical function 
and quality of life. The subgroup analysis demonstrated that interventions longer than 3 months and 
higher frequency (3 times per week) had a larger pooled effect size than short-term and less frequent 
dance interventions. In summary, dance interventions have been shown to be beneficial for older 
adults, such as improving their physical health, cognitive function, as well as their psychosocial 
and emotional well-being by ameliorating depression, anxiety and social isolation [5].   
We have recently completed a pilot study of an 8-week dance programme, with 27 older adults 
[Age-mean (SD): 71.04 (6.3)] in the intervention (dancing) group and 27 in the control group [Age-mean 
(SD): 73.81 (5.8)] at Active Ageing Centres. This pilot study showed that those in the dancing group 
reported significantly higher quality of life (p=0.044). The qualitative findings provided insights that older 
adults enjoyed participating in the creatively crafted dance programme, while learning nature and world 
travel-based dance movements [6]. 
However, there are unresolved concerns and issues about a feasible and acceptable 
dance programme that can be tailored in dose and duration. Firstly, some felt it was a steep learning 
curve, as they did not have any foundation in dance. Secondly, the pilot study was underpowered to 
show significant differences in physical function, cognition, mood, and social connection. Additionally, 
the intervention programme was only conducted over 8 weeks (1 time per week, 1 hour per session), 
which was less than the desired duration and frequency of the dance intervention as recommended by 
the meta-analysis [long-term interventions (>3 months) and higher frequency (3 times per week)]. 
Thirdly, 15% of participants dropped out of the dance programme due to fatigue, muscle ache, and 
chronic conditions [6].   
Thus, the overall aim of this study is to use data derived from the pilot study to design and 
conduct a definitive study to define the dose-response effect that a systematic dance programme 
may have on physical, cognitive and psycho-social health in our local population. The primary 
objective of the proposed project is to develop and evaluate a Community Dance Programme, which 
is aimed at promoting physical strength, balance, cognition, and psychosocial well-being of pre-frail 
older adults. An interventional study with co-design approach and process evaluation will be 
applied.  
 
The Specific Aims are to:  
#1: Apply a co-design approach to develop a Community Dance Programme (CDP). 
With the expertise of the multi-disciplinary research team and community partners, we will first conduct 
a Needs Assessment with focus group discussions among older adults to understand the factors 
promoting dance and measures for overcoming common side effects of dance (e.g. fatigue, muscle 
aching). Next, we will engage the stakeholders (older adults, Active Ageing Centres staff, and dance 
instructors) in the co-design process of tailored dance intervention, taking into consideration of older 
adults’ age, physical conditions, and cultural preferences on the type of dance.  
  
#2: Examine the dose–response effect of CDP on quantitative measures of physical, mental and 
psychosocial health, cognition, and quality of life among pre-frail older adults.  
We plan to conduct a cluster randomised controlled trial to examine the dose–response effect of the 
CDP among pre-frail older adults in the community. We hypothesise that the older adults in the 

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intervention clusters with a higher dosage of CDP (3 sessions/week vs. 1 session/week in control 
cluster, over 12 weeks) will have significantly improved physical health (Short Physical 
Performance Battery-primary outcome, Edmonton Frailty Scale, biomarkers: DNA methylation in 
saliva samples and muscle oxygenation via Moxy device), cognitive function (Montreal Cognitive 
Assessment, Symbol Digit Modalities Test), psychosocial and mental health (Geriatric Depression 
Scale, de Jong Gierveld Loneliness Scale, Subjective Happiness Scale, Social Support Questionnaire), 
and higher quality of life (WHOQOL).  
 
#3: Generate qualitative evaluation of the stakeholders’ experiences on the CDP with a focused 
ethnographic approach  
We plan to adopt focused ethnography to systematically and comprehensively explore the 
perspectives and experiences of stakeholders, including older adults, Active Ageing Centres staff, 
and dance instructors. This approach will engage field visits and observations, in-depth focus group 
discussions and intensive data analysis. This design enables the judicious exploration of the distinct 
phenomenon experienced by stakeholders involved in CDP in the community settings.  
 
The Community Dance Programme focuses on preventive health, takes proactive steps to 
stay physically active, and leads to healthier lifestyles. Findings from this study will provide scientific 
evidence on the effective dose of dance programme which balances benefit on improving physical 
function against side effects of muscle ache and fatigue. A distinctive feature of our project is the 
collaborative effort of our multi-disciplinary research team and community partners to develop this 
programme and bring benefits to the pre-frail older adults living in the community. This customized 
dance programme, if proven effective, can be optimized for our local community, which provides a 
platform to promote Healthier SG initiative to a wider population of older adults.  
 
II  
Background & Clinical Significance 
 
World ageing has become one of the most significant social issues in recent years, with the older 
population aged 65 years and above projected to increase from less than 10% to around 17% by 2050 
[7]. A “super-aged” society refers to a country where there are more than 21 percent of the individuals 
who are aged 65 years and older. Singapore will be a super-aged society by 2026, joining other 
countries such as Japan, Italy, and Germany. This phenomenon implicates the importance of healthy 
ageing to reduce healthcare cost and burden in the long run [8]. 
Frailty, common among older adults, may involve weight loss, muscle weakness, low levels of 
physical activity, exhaustion and slowness in walking and movement. It usually results from physical or 
psychological stress, such as trauma, disease, or the loss of a loved one. An individual with frailty may 
lose functional abilities and become care-dependent [9]. According to a systematic review and meta-
analysis involving data of more than 120,000 older adults from 28 countries, the incidence of frailty and 
prefrailty was estimated at 43.4 and 150.6 new cases per 1000 person-years respectively. This study 
suggested that community-dwelling older adults are prone to developing frailty. Hence, increased 
awareness of factors contributing to high risks of frailty is crucial, so as to inform the design of 
interventions to prevent frailty and minimize its consequences [10]. Being a complex and multi-
dimensional phenomenon, a local study reported that multimorbidity, cognitive and functional 
impairment were associated with frailty. Interventions were recommended to be multi-modal to 
affect behavioural change and promote health in the ageing population [11].  
In order to support older adults to live healthily in the community, it is important for them to 
maintain good physical, cognitive and psychosocial health. Evidence shows that older adults lack 
exercise; as a result, they may experience decreasing muscular strength, which could lead to reduced 
sense of balance or even fall. Regular physical activities would help with preventing chronic diseases 
[12]. However, adherence to physical exercises is a significant challenge in the older population. 
Nonetheless, dance with music is effective for increasing motivation and adherence to 
prescribed physical exercises [3]. Dance, as a type of aerobic exercise, is able to significantly 
improve physical conditions of older adults by providing adequate exertion [13]. Across different 
movement-based activities, dancing has been shown to improve muscular strength, endurance and 
balance [2]. Apart from healthy older adults, dance can reduce symptoms experienced by older adults 
with medical conditions by increasing their flexibility, balance confidence and motor performance [4]. 
After dance intervention, older adults tend to have a better understanding of balance, which can 
decrease their risk of fall [14, 15].  
Dancing also promotes the psychosocial well-being of older adults [16]. These activities provide 
enjoyment and enhances community engagement of older adults [13].  Additionally, dance could also 

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be used to support cognition by engaging older adults with movements and music [4, 17]. Not 
only can dance to music be effective for improving cognitive performance among the elderly, it has also 
been shown to help decrease anxiety and depression, as well as improving their quality of life [18-
20]. Low cost is another advantage of dance programmes, as they are more sustainable to be carried 
out within the community [13]. Hence, dancing is one of the most effective programmes for promoting 
healthier ageing among community-dwelling older adults.  
The older adults enjoyed dancing, which could evoke positive memories from the past as 
a form of reminiscence [21]. While integrating dance with reminiscence therapy, tangible prompts such 
as historical items, old photographs, videos, and songs are often used to evoke memories and stimulate 
conversations. A meta-analysis demonstrated that reminiscence-based interventions significantly 
reduced depressive symptoms, improved life satisfaction, enhanced self-esteem, and happiness 
among cognitively intact older adults [22]. Dance with elements of reminiscence intervention can 
enhance one’s quality of life. Additionally, the group-based dance intervention reduces loneliness, 
thereby minimising the risk of social isolation, and provides a platform to develop friendships and 
social support among the older adults [23, 24].  
Generally, it is well recognized that dance and physical exercises impact brain plasticity, 
cognitive and physical functions positively. However, emerging evidence demonstrates that different 
exercise regimes (i.e., variations in frequency, dosage, duration) induce heterogeneous outcomes 
across individuals. However, limited research investigated the dose-response effect of dance 
intervention. Hence, we refer to the research of the dose-response relationship in physical exercise. 
A systematic review examining the dose-response relationship between exercise and cognitive function 
in older adults has demonstrated that exercise programmes with a short session duration and high 
frequency predict higher effect sizes (d=0.43-0.50) in older adults with cognitive impairments [25]. With 
a customised exercise prescription, dosage can be made comparable across individuals, which is 
necessary for validated evidence of the dose-response relationship in physical exercise and dance 
research. This insightful evidence of dose-response relationships could contribute to designing 
more efficient physical training approaches (e.g., dance intervention) against frailty and cognitive 
decline [26].  
Dance is a non-pharmacological and cost-effective approach of physical exercise which 
could be recommended for older adults at a larger-scale community level. Nevertheless, the effect 
of the dance intervention duration and dose-response frequency could be investigated further 
to gain insight into possible maintenance effects, such as one’s cognition, physical, and 
psychosocial function. Additionally, some practical issues need further examination, such as the 
factors promoting dance, overcoming common side effects of dance, and integration of dance 
as a regular programme in the community, to promote sustainability of dance intervention among 
prefrail older adults. Finally, a dance intervention with larger sample size, and varying doses of 
intensity, duration can enable us to more closely investigate the physiological mechanisms 
underlying the effects of dance on desirable ageing outcomes.  
 
Short-term Aims  
Our study aims to determine the effectiveness of a dance programme on the physical function and 
psychosocial health in approximately 200 pre-frail older adults using a CRT design. We aim to 
ascertain the optimal therapeutic dose level and dosing frequency of the dance intervention (i.e., 
number of dance sessions per week. Since a larger number of participants will be involved in the dance 
programme of the proposed study, there is a greater chance to observe for data on side effects. Findings 
from this study will provide scientific evidence on the effective dose of dance programme, which 
balances the benefits on improving physical function against its side effects. Therefore, if proven 
effective, this intervention can be optimized for our local community, while promoting population 
health and the Healthier SG initiative to a wider population of older adults.  
 
Long-term Aims 
In the long term, we plan to conduct the evidence-based dance programme with a wider population 
of pre-frail older adults at multiple AACs across the country. Applying Implementation Science, we will 
undertake a scientific study of strategies to facilitate the uptake of evidence-based research (dance 
programme) into regular use by community practitioners (AAC staff). We aim to reach out to thousands 
of pre-frail older adults; massive testing of the dance intervention provides continuing generation of 
data on the safety and efficacy of the intervention. The field of implementation science seeks to 
systematically close the gap between what we know and what we do (know-do gap) by identifying and 
addressing the barriers that slow or halt the uptake of evidence-based dance intervention [27]. The 
CDP focuses on preventive health and taking proactive steps to stay physically active, which leads 

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to healthier lifestyles, as well as reduced hospitalisation rates and institutionalization at long-term care 
facilities.  
 
III  
Description and Impact  
 
Exploring minimally invasive interventions to improve physical function, cognitive and 
psychosocial health among the ageing population is our key motivation. Dance intervention has 
been shown to bring numerous benefits for older adults, such as improving their cognition, physical and 
psychosocial well-being by ameliorating depression, anxiety, and social isolation [5]. With the evidence 
generated from the meta-analysis and pilot study, we are confident that Community Dance 
Programme (CDP) will make a positive impact on the older adults’ physical, psychosocial, and cognitive 
health. Additionally, findings from this proposed study will provide further scientific evidence on the 
effective dose of the dance programme which balances its benefits on improving physical function 
against its side effects.  
The positive impacts of CDP will encourage older adults to live an active life and maximise 
their social capital within the community. Therefore, CDP promotes the health and well-being of 
pre-frail older adults, while reducing their geriatric-related conditions. The outcomes of the study will 
have tremendous potential to be implemented at a larger scale within the community. Upon completion 
of the project, we will work closely with other AACs and the Agency of Integrated Care (AIC) to 
integrate CDP into their existing programmes. CDP could then benefit a larger population, given the 
evidence gathered from our research.  
In the Singapore’s healthcare landscape, AACs are the community partners who work closely 
with AIC. AIC was formed as an independent corporate entity under MOH Holdings to work with 
stakeholders and partners in developing the Community Care Sector. AIC reaches out to caregivers 
and seniors with information on staying active and ageing well, while connecting people to services they 
need. Hence, our partnership with AIC will facilitate the uptake of the evidence-based dance 
programme across the AACs located island-wide, so as to support healthy and active ageing. 
Additionally, AIC supports partners in strengthening their capability to deliver quality care, bringing them 
together to meet the needs of our ageing population. With the support from AIC and the Age Well 
National Initiative, we will work with our community partners and dance instructors to train and 
equip the community care staff with health assessment and monitoring skill sets, so as to ensure 
the safety of our older adults during the dance intervention.  
 
IV  
Preliminary Studies/Progress 
 
The results of our  meta-analysis showed that dance interventions had a significant moderate effect 
on global cognition (SMD = 0.54, Z = 3.55, p < 0.001), significantly improved memory (SMD = 
0.33, Z = 3.97, p < 0.001), visuospatial function (SMD = 0.42, Z = 2.41, p = 0.02), and language (SMD 
= 0.39, Z = 2.69, p = 0.007) in older adults with mild cognitive impairment (Wu et al., 2021). We found 
that dance interventions produced a significant moderate effect on physical function (SMD = 0.55, 
Z = 3.43, p < 0.001), and a significant effect on quality of life (SMD = 0.93, Z = 5.04, p < 0.001). The 
subgroup analysis demonstrated that long-term interventions (>3 months) and higher frequency (3 
times per week) had a larger pooled effect size than the short-term and less frequent dance 
interventions. The review recommended that selection on the type of dance should consider the 
social-cultural factors; for instance, Latin dance is popular in South American region, whereas line-
dancing has higher popularity in East Asian region.  
The PI and two investigators (A/P Tam, Dr Goh) have completed a pilot study of an 8-week 
dance programme, with a total of 54 older adults participated, 27 older adults [Age/mean (SD): 71.04 
(6.3)] in the intervention (dancing) group and 27 in the control group [Age/mean (SD): 73.81 (5.8)] at 
the AACs in 2021-2022. The results showed that dance is an effective solution to achieve 
significantly higher quality of life (p=0.044). The qualitative findings provided insights that older 
adults enjoyed participating in the creatively crafted dance programme, and they learnt nature and world 
travel-based dance movements from the student instructors. Nevertheless, they felt it was a steep 
learning curve, as some did not have any foundation in dance [4]. However, the pilot study did not 
show any significant improvement in physical function, cognition, mood, and social connection, 
which was inconsistent with the results of meta-analysis. The inconclusive results of the pilot study 
could be due to small sample size, limited number of centres, and its quasi-experimental design. The 
dance practice was conducted over 8 weeks (1 hour session weekly), which was below the desired 
duration and frequency of the dance intervention as recommended by the meta-analysis. Additionally, 
15% participants dropped out of the dance programme due to fatigue, muscle aching, chronic 

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conditions, etc. Hence, there are still unresolved issues and unanswered questions about a 
feasible and acceptable programme that can be tailored in dose and duration, in which a dose-
response analysis of the tangible benefit of a dance programme on multi-dimensional frailty in 
our local population will be needed in the proposed study.  
 
Table 1: Physical, cognitive, and self-reported psychosocial performance Pre- and Post-Intervention 
 
Control group 
Intervention group 
General Linear Model (GLM) 
Physical 
variables 
Unadjusted Mean 
Difference (95% 
CI) 
p (paired t-
test) 
Unadjusted Mean 
Difference (95% 
CI) 
p (paired t-
test) 
Adjusted Mean 
Difference (95% CI) 
p-value 
SPPB 
-0.26  
(-0.47, 0.99) 
0.473 
0.41  
(-0.91, 0.10) 
0.110 
0.46 (-0.38, 1.30) 
0.278 
Hand grip 
0.59  
(-4.25, 3.06) 
0.742 
1.06  
(-3.42, 1.30) 
0.365 
0.01 (-4.36, 4.38) 
0.998 
Cognitive 
variables 
 
 
 
 
Adjusted Mean 
Difference (95% CI) 
p-value 
MoCA 
-0.22  
(-0.83, 1.28) 
0.668 
0.78  
(-1.81, 0.25) 
0.133 
0.64 (-0.76, 2.04) 
0.363 
SDMT 
5.70  
(-11.12, -0.28) 
0.040* 
-1.00  
(-1.05, 3.05) 
0.325 
-6.70 (-12.13, -1.26) 
0.017* 
Psychosocial 
variables 
 
 
 
 
Adjusted Mean 
Difference (95% CI) 
p-value 
Subjective 
happiness 
-0.13  
(-0.19, 0.45) 
0.415 
0.17  
(-0.56, 0.23) 
0.391 
0.12 (-0.30, 0.54) 
0.560 
Quality of life 
3.76  
(-11.28, 3.77) 
0.314 
10.25  
(-20.23, -2.82) 
0.044* 
6.79 (-4.95, 18.53) 
0.251 
Social support 
(satisfaction with 
support) 
0.23  
(-0.48, 0.01) 
0.062 
-0.04  
(-0.32, 0.39) 
0.830 
-0.28 (-0.68, 0.12) 
0.169 
Note: General Linear Model (GLM): added pre-measurement and group type as covariates. *p < .05.  
Abbreviations: SPPB, Short Physical Performance Battery; MoCA, Montreal Cognitive Assessment; SDMT, Symbol Digit 
Modalities Test.  
 
V  
Methods/Approach 
 
Overall Research Design 
An interventional study with co-design approach and process evaluation will be applied. 
The Research Question is: What is a dance programme (genre, intensity, duration, and frequency) 
that strikes a balance between enhancing physical function and minimizing its potential side effects 
among pre-frail older adults, and will also be acceptable in our local population? 
Participants and Eligibility Criteria  
Recruitment posters will be posted at Active Aging Centres (AACs) at Lions Befrienders (LB). LB has 
14 AACs island wide which deliver a full range of integrated services for community-dwelling older 
adults, providing convenient access to services, while creating opportunities for seniors to interact and 
build friendships with members of the community. The Research Assistant (RA) will check eligibility of 
the subjects. Older adults will be recruited from AACs.  
The inclusion criteria are: 1) aged 60 to 85; 2) able to understand and communicate in either English 
or Mandarin; 3) able to give consent to participate; 4) lives within the community setting; 5) obtain at 
least a score of 7 in Edmonton Frail Scale [28]; 6) able to ambulate with minimal assistance; 7) able to 
achieve at least 75% attendance rate of the dance programme; 8) consent to video and audio recording 
of the dance sessions and FGDs.  
The exclusion criteria are older adults with: 1) medical conditions which result in limitation of dancing, 
e.g. walking aids, wheelchair bound; 2) severe cognitive or psychiatric disorders; 3) severe hearing or 
vision impairments; 4) registered in any other dance group during interventional period.  

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Aim #1: Co-design of the Intervention 
Study Design 
The contents of the programme are developed based on our systematic review [5], pilot study, needs 
assessment and content validation, as illustrated in the following process:  
(1) Needs assessment will be conducted for stakeholders, such as the older adults, AAC staff, and 
dance instructors, to understand their needs (e.g., factors promoting dance, measures to overcome 
common side effects of dance, social-cultural considerations) and seek their opinions to further develop 
the programme. A qualitative approach with in-depth, face-to-face, focused group discussions 
(FGDs) will be used. A purposive sample of 20 to 30 participants (older adults, AACs staff, and dance 
instructors) will be recruited. An interview guide will be developed based on the literature review and 
guide the FGDs. Each FGD consists of 5-6 participants and lasts for 45 to 60 minutes. Five to six FGDs 
will be conducted. The decision on the sample size for qualitative study depends on data saturation. 
The qualitative data will provide valuable information in the development of CDP.  
(2) Furthermore, WHO’s Integrated Care for Older People: guidelines on community-level interventions 
(WHO ICOPE) will be applied as the framework to guide the development of CDP to promote the 
intrinsic capacity of older adults. ICOPE is developed based on five intrinsic capacity domains. It 
comprises physical outcomes such as balance, gait, mobility, hand grip strength and vision, as well 
as psychosocial domains including depression symptoms, quality of life and cognition [9, 29].  
(3) Content validation will be evaluated by a panel of multi-disciplinary experts including Dance 
Artist (Ms Ebelle Chong), Geriatric Nurse Scientist (Dr Vivien Wu), Exercise Physiologist (Dr Goh 
Jorming), Consultant Geriatrician (Dr Matthew Chen), Performing Arts Researcher (A/P Liang Peilin), 
AAC Director (Ms Justina Teo), Agency of Integrated Care Director (Ms Charmaine Tan). The panel will 
review the contents of CDP, provide suggestions and make further refinements. This process consists 
of multiple iterations, which aim at designing a customized CDP to meet the needs of our local older 
population with social-cultural consideration.  
 
Novelty – Co-design of Community Dance Programme 
CDP will be developed to promote older adults’ physical, cognitive, and psychosocial health through 
dancing. The outline of CDP is illustrated in Table 2 and 3. Contemporary dance will be used, as it 
promotes a balance between didactic and creative aspects [30]. We plan to integrate nature and travel 
themes, to provide older adults with spaces for creativity and imagination. The CDP includes both 
seated and standing body movement such as leg extensions and lunges to build on their strength 
and balance. Each dance session will last for one hour and will be conducted in a semi-structured 
manner. Apart from the didactic choreography taught by the instructors, the older adult participants will 
be encouraged to improvise and incorporate new dance movements relevant to the theme of that week 
into the existing choreography, whilst actively engaging in the dance sessions. The dance sessions for 
older adults aim to provide progressive learning. The participants will immerse themselves in dance that 
develops their body awareness, focuses on strength building, encourages artistry and expression.  
 
Mode of Delivery 
The chief dance instructor is the artistic director and resident choreographer of Dance Synergy, a 
university contemporary dance society, while being experienced in conducting dance programmes for 
seniors. The chief dance instructor will contribute to the choreography of the dance programme, and 
conduct training for the student instructors. The student instructors will meet older adults at AACs in 
groups of 12 to 16. During each dance session, there will be time reserved for small group practice 
where older adults will be further divided into 4 small groups. The student instructors will help the older 
adults in each small group to recall the dance steps and practice. Both demonstration and small group 
practices will be engaged as the teaching methodology for the workshop.  
 
 
The CDP will be delivered over a period of 12 weeks. Subsequently, the older adults will join 
the CDP to practice under the guidance of the student instructors. Older adults will learn and practice 
the basic steps together for the first few weeks. Then, the student instructors will start teaching on the 
final dance formation. The final dance performance showcase will be during the last week. During each 
session, participants will need to warm up first to prevent injuries. The small group practices also allow 
the older adults to interact with each other and with the student instructors. All the participants will do 
relaxation exercise before ending the session to cool down their bodies and release muscle tension. 
 
Table 2: Structure of the Community Dance Programme 
Week   
Brief Lesson Plan 
1 
Introduction of the Dance programme. Warm up with basic dance steps 

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2-3 
Contemporary Dance (Nature Theme - didactic and creative aspects): Step by step learning and 
practice group dance 
4-5 
Practice - dance formation, Retrospective Reminiscence Theme (Back to 1980’s) 
6-7 
Step by step learning and practice group dance, Travel Theme 
8-9 
Practice - dance formation, Integrated with self-creation of movements 
10-11 
Practice and rehearsal – dance formation with Costumes 
12 
Final dance performance showcase 
 
Table 3: Outline of each dance session 
Duration 
Progress 
10 mins 
Warm up 
15 mins 
Steps learning  
15 mins 
Small groups practice 
10 mins 
Revision  
10 mins 
Relaxation/Cool down 
 
#2: Cluster Randomised Trial (CRT) on the Dose–response Effect of CDP  
Study Design 
A CRT with parallel, single-blind (i.e., participants will be blinded), pre and post-test measures will be 
conducted to examine the dose-response effect of the CDP among pre-frail older adults in the 
community. In order to examine the dose-response effect of the CDP, the dose frequency of intervention 
cluster is designed as:  
Intervention Clusters:  3 sessions per week and 1 hour per session;  
Active Control Clusters: 1 session per week and 1 hour per session. 
Hypothesis: Older adults in the intervention clusters with higher dosage of CDP will have 
significantly improved physical health, cognition, psychosocial health, and higher quality of life.  
 
Randomisation  
Since the CDP is a group-based intervention, a CRT method will be used to avoid contamination, as 
the older adults in the same centre will usually interact and share their experiences with one another. 
CRT is recommended when the target of the intervention is a collective or system rather than an 
individual [31]. We will recruit participants from 10 AACs. The 10 AACs will be randomised into 
intervention and active control clusters; participants from the active control clusters will be recruited 
from 5 AACs, while participants from the intervention clusters will be recruited from the other 5 AACs.  
 
Sample Size 
For the CRT, the sample size is estimated by the method suggested by Hemming et al. [32]. First, the 
conventional sample size estimation was computed using the formula from Matthews [33]. For the effect 
size, as there was no previous study comparing different intensity, we borrowed the effect size reported 
in one systematic review (0.55) and one randomised controlled trial (0.4) which had similar intervention 
as ours [5, 34]. As their studies are comparing the intervention group with control group without the 
intervention, the mid-point of their effect sizes was taken for the sample size estimation. Given an effect 
size of 0.48, 5% level of significance and 80% power, 69 subjects per group are needed to detect the 
difference. The modification formula is then used. Given that the common Intra-class Correlation 
Coefficient (ICC) is 0 to 0.1 from the literature, an ICC of 0.05 is assumed in this study. As we estimate 
about 20 to 30 eligible subjects per centre based on our prior study experiences, the number of subjects 
per arm needed in the CRT becomes 128.  Assuming a 10% attrition rate, a total of 284 participants 
with 142 per group will be recruited.  
 
Outcomes Measurement 
Objective assessments and self-reported questionnaires will be used. Outcome measures will include 
physical health (Short Physical Performance Battery, Edmonton Frailty Scale, biomarkers), cognitive 
function (Montreal Cognitive Assessment, Symbol Digit Modalities Test), psychosocial health 
(Geriatric Depression Scale, de Jong Gierveld Loneliness Scale, Subjective Happiness Scale, Social 
Support Questionnaire), and quality of life (WHOQOL). 
Primary Outcome:  
A) Physical Health - Short Physical Performance Battery (SPPB): evaluates the physical function. 
This instrument comprises physical tests of standing balance, gait speed, and chair stand. Each 
component (i.e., balance, gait speed, chair stand) will be scored from 0 to 4, with a score of 0 indicating 

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inability to carry out the test and a score of 4 indicating perfect execution of the test. The total score 
ranges from 0 to 12, with higher scores indicating higher physical performance [35]. 
Secondary Outcomes:  
B) Frailty - Edmonton Frail Scale (EFS): This is an 11-item questionnaire that examines nine domains 
of frailty (i.e., cognition, general health status, functional independence, social support, medication use, 
nutrition, mood, continence, and functioning performance). The scores range from 0 to 17, with higher 
scores indicating higher levels of frailty. The scores can be categorized into five levels of frailty, namely: 
fit (0–3), vulnerable (4–5), mild frailty (6–7), Moderate frailty (8–9) and severe frailty (≥10). This 
instrument has been utilised and validated in a local tertiary hospital, with high acceptability and low 
inter-rater variability [36]. 
C) Biomarker Analysis: DNAm testing: DNA methylation will be measured to determine biological 
age. Saliva samples will be collected from participants in the fasted state and kept at -80 °C until 
analysis. Genomic DNA will be extracted using a DNeasy kit (Qiagen), followed by purification using 
the QIAamp DNA micro kit (Qiagen, Germany) and an additional ethanol precipitation step. DNA will be 
treated with sodium bisulphite using the EZ DNA methylation kit (Zymo Research, CA,). Cytosine 
methylation covering ~850,000 CpG islands will be quantified using the Human MethylationEPIC (EPIC) 
BeadChip (Illumina, CA, USA) and run on an Illumina iScan System (Illumina, CA) using the 
manufacturer’s standard protocol [37].  
MOXY Oxygen Monitor: MOXY (Moxy, Fortiori Design LLC, Minnesota, USA) is a non-invasive small 
wearable portable device that measures muscle oxygen saturation (SmO2), using near-infrared 
spectroscopy (NIRS) [38]. MOXY measures oxygen levels in the muscles of participants during 
exercise. Saliva sampling and MOXY oxygen monitoring are non-invasive procedures. The RAs will 
instruct the participants on the collection of saliva and MOXY oxygen monitoring at AACs, and the 
procedures involve minimal risk for the participants. 
D) Cognitive Health: Brief cognitive tests comprising Montreal Cognitive Assessment (MoCA) and 
Symbol Digit Modalities Test (SDMT). MoCA is a screening instrument developed to detect mild 
cognitive impairment [39]. Study has proved that MoCA may be relatively more sensitive to detect 
characteristic cognitive deficits due to cardiovascular diseases prevalent in Asian elderly, and it takes 
approximately 12 minutes to complete [40]. We supplement the MoCA with a sensitive processing 
speed test, SDMT for optimal cognitive screening in the proposed study. SDMT is widely used and 
takes approximately 5 minutes [41]. 
E) Psychosocial Health:  
Geriatric Depression Scale (GDS-15): This scale contains 15 close-ended questions [42]. One point 
is allocated per question with the total scores below four indicating the absence of clinically depressive 
symptoms while scores between four and nine are indicative of mild to moderate depression. Scores of 
10 or more are suggestive of a major depressive episode [43]. GDS-15 has good internal consistency, 
test-retest reliability as well as construct validity [42]. 
de Jong Gierveld Loneliness Scale (dJGLS-6): Loneliness concerns the subjective evaluation of 
one's situation, characterised by either a smaller than desirable number of relationships with friends 
(social loneliness), or situations whereby the intimacy in confidant relationships one wishes for has not 
been realised (emotional loneliness) [44]. dJGLS-6 (six-item) will be used to measure social and 
emotional loneliness. The dJGLS-6 scale has shown good psychometric characteristics and reliability, 
with Cronbach’s alphas ranging from 0.81 to 0.85 among older adults [44]. The Chinese version of this 
scale is available, showing good internal consistency among the Chinese elderly population [45].  
Subjective Happiness Scale: Using a “subjectivist” approach to the assessment of happiness, a 4-
item measure of global subjective happiness was developed and validated in 14 studies with a total of 
2732 participants. Results indicated that the Subjective Happiness Scale has high internal consistency, 
which was found to be stable across samples. Test-retest and self/peer correlations suggested good to 
excellent reliability, and construct validation studies of convergent and discriminant validity confirmed 
the use of this scale to measure the construct of subjective happiness [46]. 
Social Support Questionnaire 6 items (SSQ6): This scale is developed by Sarason et al. [47]. It is 
used to measure the number of people providing support to an individual and the satisfaction level of 
the individual who received the support. The scale consists of 6 items. Rating of the items is from 1 
(very dissatisfied) to 6 (very satisfied). With excellent Cronbach alphas of 0.90 and 0.93 for 2 respective 
domains, the scale has been proved to be valid and reliable.  
F) Quality of Life: World Health Organization Quality of Life (WHOQOL) developed WHOQOL-OLD 
for older adults to measure the quality of life for elderly. WHOQOL-OLD containing six facets (including 
sensory abilities; autonomy; past, present, and future activities; social participation; death and dying; 
and intimacy), with four items in each facet [48]. Each of the facets has four items and therefore can 
obtain a possible score ranging from 4 to 20. The sum of the facet scores results in an overall QOL 

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score. Different language versions of WHOQOL-OLD have been evaluated and have shown good 
reliability and validity [49]. 
Social-demographic and Clinical Data: Sociodemographic data includes age, gender, ethnicity, 
religion, marital status, employment status, education, social-economic status, source of financial 
support, household type/ownership, living arrangement and number of children. Clinical data includes 
chronic conditions, blood pressure, body mass index, dietary habits, smoking and drinking status, daily 
activity status (i.e., basic and instrumental activities of daily living), visual and hearing status.  
 
Data Collection  
Objective assessments and self-reported questionnaires will be administered to the older adults. 
Confidentiality and anonymity will be maintained as no identifiers will be recorded in the questionnaires. 
Participants who are assigned to the active control and intervention clusters will be asked to complete 
the questionnaire at two time points: baseline (before CDP) and post-test (end of CDP). (Table 4) 
 
Table 4: Schedule of the Community Dance Programme (CDP) 
Visit 
Time  
Intervention Cluster 
CDP (3 sessions per week) 
Active Control Cluster 
CDP (1 session per week) 
Visit  
Procedure  
Visit  Procedure  
Week 
0 
1 
 Consent-taking  
Baseline Questionnaires and  
Objective Assessment 
1 
Consent-taking  
Baseline Questionnaires and  
Objective Assessment 
Week 
1-12  
2-13  CDP Session 1-36  
(180 mins each session, 3 sessions per week, 
36 sessions in total)  
2-13 CDP Session 1-12  
(60 mins each session, 1 session per week, 
12 sessions in total)  
Week 
13  
14 
Post-test Questionnaires and  
Objective Assessment 
14 
Post-test Questionnaires and  
Objective Assessment 
 
Statistical Analysis 
Descriptive statistics, including mean, standard deviation, frequency, and percentages, will be used to 
summarize the demographic information and outcome at baseline and post intervention. Paired sample 
t-tests will be used to examine the differences in outcome measures between the baseline and post 
intervention among the participants. Analysis of Covariance (ANCOVA) will be used to examine for any 
differences of outcomes at post-intervention. All the analyses will be conducted using IBM SPSS 
(Version 28) and the significance level will be set at 5%.  
 
 
Independent sample t-tests will be conducted to investigate the effectiveness of CDP in 
improving physical health and its associated variables. The independent variables will be the group type 
(i.e., active control vs. intervention clusters) and the time-point (i.e., pre-intervention, post-intervention), 
while the outcome variables will be physical performance, frailty score, cognitive score, psychosocial 
scores, and QOL. Analysis of covariance (ANCOVA) will be conducted to investigate the effectiveness 
of CDP in enhancing levels of the outcome variables for physical and psychosocial health. Post-
intervention will be the outcome variable, while pre-intervention, and the group type (i.e., active control 
vs. intervention clusters) will be selected as covariates in the model.   
 
 
We proposed to use t-test as a preliminary analysis and we will also use linear mixed model to 
explore the effect of group, time, and their potential interactions. Independent sample t-tests will be 
conducted to preliminarily investigate the effectiveness of CDP in improving physical health (e.g. 
physical performance, frailty, cognition and IADL scores). Linear Mixed Model will then be used to 
explore the effectiveness of the CDP after taking the repeated measure data into consideration. 
 
#3: Qualitative Focused Ethnographic Approach on the Stakeholders’ Experiences of CDP  
Study Design 
A focused ethnography will be applied to explore the perspectives and experiences of stakeholders, 
including older adults, AACs staff, and dance instructors systematically and comprehensively. The 
purpose of ethnographic approach is to assess the acceptability, strengths, and limitations of the 
CDP based on the stakeholders’ perspectives. This approach will engage field visits and observations, 
in-depth focus group discussions and intensive data analysis. The triangulation of data from multiple 
sources within a short timeframe compensates for the relatively time-intensive traditional ethnography 
[49]. This design enables a judicious exploration of the CDP in community settings. 
Sampling Methods 
A qualitative approach with in-depth, focused group discussions (FGDs) will be used. The face-to-face 
FGDs will be conducted for older adults, AACs staff, and dance instructors within 2 months after 
completing the intervention. A purposive sample of 20 to 30 older adults in the intervention group, 15-

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20 student instructors, and 10-15 AAC staff will be recruited. Semi-structured FGDs will be conducted 
with older adults to understand their perceptions and experiences regarding the activities, 
delivery, and acceptability of the CDP. FGDs will be conducted with AAC staff and student dance 
instructors to explore their experiences and suggestions on how to improve the CDP. 
Additionally, we will explore with the student dance instructors on their perceptions of working with older 
adults. We will also monitor the attendance, which may reflect the acceptability of CDP. 
 
 
Field visits will be conducted, and the researchers will observe the behaviours and 
interaction of the older adults, student instructors, and AACs staff. Field notes will be taken to 
document the detailed observations. An emic and semi-covert approach would be used to truly 
understand the experiences of participants. An emic approach is selected as it enables the researcher 
to truly understand the landscape from the participants’ perspectives, providing a detailed micro view 
of their experiences [50]. A covert approach is selected for its ability to yield more fruitful data due to 
minimizing the Hawthorne effect, thus minimising the contamination of participants’ behaviours and 
reactions [51]. However, for the purpose of producing more rigorous results, covert observational data 
will be triangulated with FGDs findings, which would be adopting a more overt approach. This will 
ensure congruity of data obtained from covert observations. In conclusion, the ethnographic design 
would enable the researcher to gain a deeper understanding of the experiences of the participants.  
 
Data Collection 
The RA will invite the participants in the intervention clusters, student dance instructors and AAC staff 
for FGDs. Each FGD consists of five to six participants and lasts for 45 to 60 minutes. Five to six FGDs 
will be conducted. The decision on the sample size for qualitative study depends on data saturation. 
The interview guides will be developed based on the literature review, and guide the FGDs. All FGDs 
will be audio-recorded. The qualitative data will provide valuable information for programme evaluation.  
 
Data Analysis 
The audio-recorded interviews will be transcribed into verbatim respectively. The transcripts will be 
analysed in its original language to capture the perspectives of the participants closely. The field notes 
and observation notes will be included in the analysis. Thematic analysis using Braun and Clarke’s six 
steps of analysis will be applied to provide in-depth and rich analysis [52]. All themes and sub-themes 
will be translated to English during report writing by the bilingual research team members to ensure the 
meaning of the translated themes and sub-themes are congruent to the participants’ views. 
 
Ethical Issues 
NUS Institutional Review Board will be sought before data collection. The principal investigator and co-
investigators will explain the purpose of the research to potential participants. Informed consent will be 
obtained from the participants prior to data collection. The participants will be reassured that 
participation in the study is voluntary, and withdrawal from the study will not result in any negative 
consequences. Permission to use the instruments will be obtained from the developers of the 
instruments prior to data collection.   
 
Potential limitations and alternative approaches 
The project will be conducted at 10 AACs based on our prior project experience with LB. The project 
may expand to the remaining AACs within LB depending on the rate of recruitment. We will encourage 
participants to attend all 12 weeks of the dance programme. However, we do provide some flexibility 
by setting a minimum attendance rate of 75% for the dance programme, to give allowance in case the 
participant needs to attend to medical appointment or urgent family matters. In the event of any adverse 
occurrences during the intervention, the researchers and AAC staff who are first aid certified will provide 
the basic care and escalate the emergency services if necessary. Mitigation measures will be in place 
if participants experience adverse effects during or after the CDP. In addition, CDP is also prepared to 
conduct the sessions via a virtual platform (e.g., Zoom) in case of any unpredictable circumstances 
such as the COVID-19 pandemic. 
 
VI  
Roles of Team Members1  
                                               
1 Applicants are encouraged to collaborate with AI, Data Science and/or Technology talent where possible, and the 
necessary budget to engage these talents can be incorporated into the grant applications where needed/applicable. 
 

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The research team comprises of multi-disciplinary experts with extensive experience in ageing, 
neurocognition, chronic disease management, immunology, exercise physiology, and biostatistics 
research as evidenced by their notable contributions to those high impact, peer-reviewed journals.   
Dr Wu Xi Vivien (PI) is experienced with geriatric community care, chronic disease management 
and interventions. Dr Wu has managed national competitive grants (NMRC/PHRG, MOE/TRF). As 
the PI, Dr Wu has conceptualised the study with the input from the team, and will oversee the entire 
project, e.g., ethical application, development of CDP, recruitment, intervention, data collection, 
analysis and report writing. Dr Wu has published extensively in high impact Geriatrics, Health 
Technology, and Nursing journals. Dr Wu, A/P Tam, Dr Goh have worked on the pilot study of dance 
programme and co-authored papers on the ageing research (Please refer to the CVs). 
Prof Koh Woon Puay (Mentor) is an NMRC Clinician Scientist (Senior Investigator) and Assistant 
Dean for Faculty Development in the PI’s institution (NUSMed). Prof Koh is the PI of the Singapore 
Chinese Health Study, a 63,257-strong cohort of middle-aged and elderly Chinese Singaporeans 
established for the long-term study of dietary and environmental determinants of chronic diseases 
common among Singaporeans. As a renowned epidemiologist, she will provide methodological 
guidance on the overall conception and conduct of the study.  
A/Prof Tam Wai San Wilson (Co-I) is an epidemiologist and statistician by training. He is involved 
in the design and analysis of large scale randomized controlled trials on respiratory health [53-55]. 
Besides interventional studies, Dr Tam also conducted cross-sectional surveys for emerging issues, 
e.g., two surveys about the mental well-being among Chinese population during the initial COVID-19 
period have been published in top neurology journals in 2020 and has got more than 300 citations [56, 
57]. He will work on the methodology of CRT to evaluate the dose-response effect of CDP, sampling 
methods and quantitative data analysis.  
Dr Goh Jor Ming (Co-I), Research Asst/Prof, is a translational exercise physiologist [58-60]. His 
study focuses on how physical exercise, including short bouts and marathon-like exercises, can cause 
muscular trauma and the release of high mobility group protein B1 (HMGB1), a prototypical cellular 
DAMP (released as a result of necrotic cell death [61]). This line of investigation helps manage training 
programmes to avoid sudden fatal sepsis-like conditions as well as a syndrome known as overtraining 
[61]. Dr Goh’s leading expertise in how exercise impacts the immune system is valuable for the design 
and management of suitable training programmes for older adults, in collaboration with physiotherapists 
and exercise trainers to avoid overtraining, while providing sufficient stimulus and adaptation to the 
muscular system. He will work on the physical aspect of dance intervention (e.g. intensity), physical 
outcomes and analysis of the biomarkers with ELISA assays in his lab.  
A/Prof Liang Peilin (Co-I) is a researcher in theatre and performance at NUS. Her research interests 
lie in health and wellness in performance, using theatre and performance as a form of sociocultural and 
psychophysical care. She has also led several community projects involving theatre and performances 
in both local and international contexts. Her expertise in qualitative research and performing arts will 
contribute in the co-designing of our dance intervention, ethnographic research and qualitative 
analysis, to engage the participants while optimising the acceptability, delivery, and feasibility of the 
programme.   
Dr Matthew Chen (Co-I) is a Consultant Geriatrician at NUHS, and the current Geriatric Medicine 
lead for NCIS Geriatric Oncology (GOLDEN) service. His clinical and research interests are in frailty 
and geriatric oncology. He is also involved in a large-scale epidemiologic population-based study 
known as the “Healthy Older People Everyday (HOPE)” study – which examines frailty and its factors 
among community-dwelling older adults in Singapore. Dr Chen’s expertise on Geriatric Medicine will 
contribute in the co-designing of the CDP and outcome measures targeting at older adults.  
Ms Justina Teo (Collaborator) is the Director and Head of Department for the Befriending 
Services in Lions Befrienders (LB). She also manages the portfolio of Special Projects and 
Development which includes Research collaborations with various universities and hospitals. She 
currently leads a team of 23 staff in the Befriending Department, providing befriending services to 4,000 
seniors island wide. We have previously worked with LB for our previous research projects such as the 
pilot Community Dance Programme (CDP) and e-Health programme, in which our pilot CDP has been 
documented and published in LB’s Research website [62]. Ms Teo will support the recruitment of the 
participants in LB, co-development of the intervention, as well as facilitating the logistics for the CDP. 
Ms Charmaine Tan (Collaborator) is the Senior Assistant Director for the Healthy Ageing 
Department in Agency of Integrated Care (AIC). She is also the programme lead for AIC Wellness 
Programme, which involves a range of arts, movement, and music-based activities for the Community 
Care sector, especially frail seniors. Our team has previously engaged Ms Tan to explore collaboration 
in healthy ageing programmes. Ms Tan’s expertise and experiences will be valuable in the co-designing 

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of our CDP, as well as to ensure the potential of the CDP to extend beyond a larger scale among older 
adults in Singapore. 
Ms Jobina Tan (Collaborator) is the Senior Associate Director at the Centre for the Arts in NUS. 
She was also the Director for the NUS Arts Festival 2023. She is experienced in coordinating arts and 
performance-related events for the community in NUS and beyond, while ensuring their relevancy and 
engagement. We have previously worked with NUS Centre for the Arts for our previous pilot CDP study, 
where we recruit their chief dance choreographer and student dance instructors to co-design the dance 
intervention and facilitate the dance sessions respectively. Ms Tan will support the management of the 
student dance instructors in NUS for the dance intervention, as well as to support its continuity for the 
community over the long run. 
Ms Ebelle Chong (Collaborator) is the Manager under Office of Student Affairs, at the Centre for the 
Arts in NUS. Ms Chong has an extensive portfolio in Contemporary Dance as a former dancer and 
dance educator. She was the Company Manager of RAW Moves Ltd, a local contemporary dance 
company. During her time with RAW Moves, Ebelle has worked with various local and international 
artists, production crew, as well as statutory boards such as the National Arts Council, Ministry of 
Education, and National Youth Council. As a performer, she has danced for Joavien Ng, Daniel K, 
Susan Yeung and Melissa Quek. Her work w a l l s was commissioned for Forward Moves, a platform 
showcasing local contemporary artistes in the Singapore Arts Festival 2008. She was also an Artist-
Mentor for Open Homes Singapore International Festival of Arts 2015, where she worked with non-
performers to showcase their stories in their living rooms. Ms Chong will assist in coordinating the 
student dance instructors in NUS for the dance intervention, as well as to support the continuity of the 
dance programme over the long run. 
 
 
VII  
How the research furthers the vision/missions of NMRC 
 
Our study consists of a multi-disciplinary field of scientific investigation that examines the dose-
response effect of the CDP among pre-frail older adults in the community. CDP is a locally developed 
dance programme that is customised to the healthcare needs of older adults. Our new preventive 
health model engages the older adults in a proactive manner, which can reduce the burden of 
Singapore’s healthcare system and its limited resources. CDP focuses on building physical 
capabilities, social connection, and enhancing quality of life among pre-frail older adults, while 
providing early intervention to slow down deterioration in age-induced frailty.  
In the long run, this new model of preventive health has the potential to transform care, 
contain healthcare cost inflation, and increase the efficiency of its lean manpower. We aim to build 
capacities of community staff through their engagement in research programs. Hence, they will be 
confident to continue the program to support the community-dwelling older adults after the completion 
of the research. CDP will raise the awareness of health behaviour, thus attracting more older adults to 
engage in preventive health – which better prepare them for healthy ageing. Additionally, it will 
translate scientific knowledge into practice and result in impactful outcomes, such as older adults 
making proactive efforts to stay physically active and socially connected to promote healthy 
longevity.  
In November 2023, the Ministry of Health (MOH), Ministry of National Development (MND) and 
Ministry of Transport (MOT) has announced that around SGD$800 million will be earmarked for 
improving AACs as part of new national Age Well SG initiative to support seniors ageing within their 
communities. Age Well SG is a national programme that focuses on preventive care by keeping 
seniors active and involved in the community, as Singapore heads towards "super-aged" society, 
when the population aged 65 and above hits the 21% in 2026. AIC works closely with AACs to build 
and ensure that care and services remain available and relevant for the seniors in their community. Our 
pilot study has built a solid foundation and has established positive collaboration with AACs and NUS 
Dance Synergy. We have been working with LB AACs on the pilot dance program from 2021 to 2022. 
This has built a strong collaboration between academic and community partners, which established an 
excellent platform to translate research outcomes into practice. 
 
 
 

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VIII 
Translation Pathway 
 
a) Potential Areas of Implementation or Adoption 
 
With the evidence on the benefits of CDP for the older adults, CDP will be made accessible to general 
older adult population. We will work closely with staff of AACs and AIC to conduct training of senior 
volunteers, as well as supporting the elderly in the dance programme. The CDP empowers older adults 
to effectively manage their physical and psychosocial health, while aging gracefully in the community 
with the support from professionals in healthcare and social sectors. We have been working with LB 
AACs on the pilot dance programme from 2021 to 2022. This has built a strong foundation between 
academic and community partners, which established an excellent platform to translate research 
outcomes into practice. 
 
 
We will continue building up with our current community partners to: 1) provide essential 
support for the dance programme in the community spaces; 2) train AAC staff to support the elderly’s 
health and social needs; 3) work with AIC’s new initiative to support the elderly: Silver Generation 
Ambassadors, Befriending and neighbouring teams. ‘Healthier SG’ is a major reform of the healthcare 
system and encompassed under Population Health, AACs and AIC will partner agencies such as, 
Health Promotion Board, People’s Association, Sport Singapore, as well as social and community 
partners to support older adults’ health goals. Our study will pave the way for large-scale community-
based service delivery island wide in support by AACs. Keeping the elderly ageing-in-place with 
good physical and psychosocial health will be a mainstream community service to promote better 
health and well-being for the older adults. Aligning with Age Well SG National initiative, older adults 
will have positive experiences in Healthy Ageing with optimal community healthcare support in place.  
 
b) Patient-related Outcomes 
 
We hypothesise that older adults in the intervention cluster with higher dosage of CDP will have 
significantly improved physical health, cognition, psychosocial health, and higher quality of life. 
Based on this study, we hope to evaluate the dose-response effect of the dance programme. Hence, 
this study will generate scientific evidence to recommend the prescribed effective dosage of the 
dance regime for older adults. This will be a ground-breaking contribution in the scientific field of 
dance intervention globally.  
 
 
Furthermore, the proposed study will establish a new preventive health model in the 
community and promote physical, psychosocial health, cognition, and quality of life among pre-
frail older adults. This novel preventive health intervention will encourage older adults to keep 
physically active and socially engaged. Moreover, it will decelerate the progress of frailty, as well 
as promote healthy ageing through precise and effective dance regime – which can enhance healthy 
longevity.  
 
c) Next steps 
 
In the long run, the CDP can encourage older adults to take proactive approach to manage their 
health effectively with the support from professionals in healthcare and social sectors, thus enabling 
them to age healthily in the community. Our current study will pave the way for future large-scale 
and community-based initiatives island wide in support by AACs and AIC. AIC works closely with 
the community service providers to ensure that older adults are well taken care of by building holistic 
wrap-around care in the community. A Community of Care (CoC) is an overarching framework to build 
local networks of collaboration among providers, and to deliver holistic health and social care for 
residents in their neighbourhood. It places the resident in the centre of the community care ecosystem 
so that better support is provided to help them age in place (AIC, 2022).  
 
 
Within the CoC, the dedicated network of partners come together to provide holistic services 
for the residents. A successful CoC will allow for residents to age in place within their neighbourhoods, 
feel supported, and maintain a high level of participation in the management of their own health. Hence, 
a precise and effective dance programme will provide an option for the community service to promote 
better well-being for the older adults.  Older adults will have healthy ageing with optimal community 
healthcare support in place, as supported by Age Well SG National initiative. We will allocate budget 
on public dissemination and engagement. We will also conduct public talks and workshops to the 
community partners, charities, public sector to promote the support for healthy ageing by stakeholders. 
 
 

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IX 
Key Performance Indicators (KPIs)  
Please fill in the proposed targets for the KPIs listed below. The proposed targets should be achievable 
within the project timeframe. 
  
1. Number of High Impact Publications and Top Conference Proceedings 
KPI Criteria 
Target 
Number of Journal Publications (Top 10%) 
2 
Number of Journal Publications (Not Top 10%) 
2 
 
2. Number of Collaboration Projects 
KPI Criteria 
Target 
Number of Collaboration Projects with Industry, Academic, Public Agency, 
Research Institutes or Centres  
1 
 
3. Cash Funding 
KPI Criteria 
Target (S$) 
Cash Funding from Industry or Public Agency  
0 
 
4. In-Kind Contributions 
KPI Criteria 
Target (S$) 
In-Kind Contributions from Industry or Public Agency  
0 
 
5. Number of Technologies Deployed 
KPI Criteria 
Target 
Number of Technologies Deployed by Industry or Public Agency  
0 
 
6. Number of Patents 
KPI criteria 
Target 
Number of Patents 
0 
 
7. Licenses 
KPI criteria 
Target 
Number of Licenses, Industry or Public Agency  
0 
Licensing Revenue, Industry or Public Agency 
0 
 
8. Number of Successful Start-Ups 
KPI criteria 
Target 
Total Number of Start-Ups 
0 
 
9. Manpower Development (Number of PhD and Masters Students Trained or Being Trained) 
KPI criteria 
Target 
Number of 'New' PhDs Trained or Being Trained  
1 
Number of 'New' Masters Students Trained or Being Trained 
1 
 
10. Health-Specific Outcomes 
KPI criteria 
Target 
Number of registered clinical trials started  
1 
Number of findings that result in new or change in local or international Clinical 
Practice Guidelines and healthcare/health policies, including implementation of new 
or improved medical interventions or diagnostics (can be drugs and procedures) or 
services (e.g. new clinical service and shorter patient waiting time) 
1 
Number of interventions which result in a more cost-effective outcome 
1 
Number of coordinated media coverage of research findings which can help the 
Government to advance public interest 
1 
 
11. Others 
KPI criteria 
Target 
Number of human subjects recruited 
350 

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X 
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Section C: Annex (For Resubmission/Renewal only) 
 
Please note that this Annex is only allowed for Resubmission/Renewal. Any supplemental 

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20 
information/data to the main research proposal is not allowed. 
 
For Resubmission (where applicable), append the following documents to the end of the research 
proposal as Annex B: 
 
Response to past reviewers (no more than 3 pages) 
 
Past review reports (inserted as images) 
 
For Renewal (where applicable), append the following document to the end of the research proposal 
as Annex C: 
 
Summary of progress and research outputs of the previous/existing project (no more than 2 
pages)