Sports Medicine

, Volume 45, Issue 4, pp 557–576 | Cite as

Dose-Response Relationships of Balance Training in Healthy Young Adults: A Systematic Review and Meta-Analysis

  • Melanie Lesinski
  • Tibor Hortobágyi
  • Thomas Muehlbauer
  • Albert Gollhofer
  • Urs GranacherEmail author
Systematic Review



Balance training (BT) has been used for the promotion of balance and sports-related skills as well as for prevention and rehabilitation of lower extremity sport injuries. However, evidence-based dose-response relationships in BT parameters have not yet been established.


The objective of this systematic literature review and meta-analysis was to determine dose-response relationships in BT parameters that lead to improvements in balance in young healthy adults with different training status.

Data Sources

A computerized systematic literature search was performed in the electronic databases PubMed, Web of Knowledge, and SPORTDiscus from January 1984 up to May 2014 to capture all articles related to BT in young healthy adults.

Study Eligibility Criteria

A systematic approach was used to evaluate the 596 articles identified for initial review. Only randomized controlled studies were included if they investigated BT in young healthy adults (16–40 years) and tested at least one behavioral balance performance outcome. In total, 25 studies met the inclusion criteria for review.

Study Appraisal and Synthesis Methods

Studies were evaluated using the physiotherapy evidence database (PEDro) scale. Within-subject effect sizes (ESdw) and between-subject effect sizes (ESdb) were calculated. The included studies were coded for the following criteria: training status (elite athletes, sub-elite athletes, recreational athletes, untrained subjects), training modalities (training period, frequency, volume, etc.), and balance outcome (test for the assessment of steady-state, proactive, and reactive balance).


Mean ESdb demonstrated that BT is an effective means to improve steady-state (ESdb = 0.73) and proactive balance (ESdb = 0.92) in healthy young adults. Studies including elite athletes showed the largest effects (ESdb = 1.29) on measures of steady-state balance as compared with studies analyzing sub-elite athletes (ESdb = 0.32), recreational athletes (ESdb = 0.69), and untrained subjects (ESdb = 0.82). Our analyses regarding dose-response relationships in BT revealed that a training period of 11–12 weeks (ESdb = 1.09), a training frequency of three (mean ESdb = 0.72) or six (single ESdb = 1.84) sessions per week, at least 16–19 training sessions in total (ESdb = 1.12), a duration of 11–15 min for a single training session (ESdb = 1.11), four exercises per training session (ESdb = 1.29), two sets per exercise (ESdb = 1.63), and a duration of 21–40 s for a single BT exercise (ESdb = 1.06) is most effective in improving measures of steady-state balance. Due to a small number of studies, dose-response relationships of BT for measures of proactive and reactive balance could not be qualified.


The present findings must be interpreted with caution because it is difficult to separate the impact of a single training modality (e.g., training frequency) from that of the others. Moreover, the quality of the included studies was rather limited, with a mean PEDro score of 5.


Our detailed analyses revealed effective BT parameters for the improvement of steady-state balance. Thus, practitioners and coaches are advised to consult the identified dose-response relationships of this systematic literature review and meta-analysis to implement effective BT protocols in clinical and sports-related contexts. However, further research of high methodological quality is needed to (1) determine dose-response relationships of BT for measures of proactive and reactive balance, (2) define effective sequencing protocols in BT (e.g., BT before or after a regular training session), (3) discern the effects of detraining, and (4) develop a feasible and effective method to regulate training intensity in BT.


Training Session Training Period Elite Athlete Balance Training Untrained Subject 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No financial support was received for the conduct of this study or preparation of this manuscript. Melanie Lesinski, Tibor Hortobágyi, Thomas Muehlbauer, Albert Gollhofer, and Urs Granacher declare that they have no conflicts of interest.


  1. 1.
    Zech A, Hubscher M, Vogt L, Banzer W, Hansel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. J Athl Train. 2010;45(4):392–403.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Hübscher M, Zech A, Pfeifer K, Hansel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc. 2010;42(3):413–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Zech A, Hubscher M, Vogt L, Banzer W, Hansel F, Pfeifer K. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc. 2009;41(10):1831–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Taube W, Gruber M, Gollhofer A. Spinal and supraspinal adaptations associated with balance training and their functional relevance. Acta Physiol. 2008;193(2):101–16.CrossRefGoogle Scholar
  5. 5.
    Taube W, Gruber M, Beck S, Faist M, Gollhofer A, Schubert M. Cortical and spinal adaptations induced by balance training: correlation between stance stability and corticospinal activation. Acta Physiol. 2007;189(4):347–58.CrossRefGoogle Scholar
  6. 6.
    Granacher U, Gollhofer A, Kriemler S. Effects of balance training on postural sway, leg extensor strength, and jumping height in adolescents. Res Q Exerc Sport. 2010;81(3):245–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Rasool SI, George K. The impact of single-leg dynamic balance training on dynamic stability. Phys Ther Sport. 2007;8(4):177–84.CrossRefGoogle Scholar
  8. 8.
    Oliveira AS, Brito Silva P, Farina D, Kersting UG. Unilateral balance training enhances neuromuscular reactions to perturbations in the trained and contralateral limb. Gait Posture. 2013;38(4):894–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Hoffmann J. Physiological aspects of sport training and performance. Champaign: Human Kinetics Pub Inc; 2002.Google Scholar
  10. 10.
    DiStefano LJ, Clark MA, Padua DA. Evidence supporting balance training in healthy individuals: a systemic review. J Strength Cond Res. 2009;23(9):2718–31.CrossRefPubMedGoogle Scholar
  11. 11.
    Farlie MK, Robins L, Keating JL, Elizabeth M, Haines TP. Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review. J Physiother. 2013;59(4):227–35.CrossRefPubMedGoogle Scholar
  12. 12.
    Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. 4th ed. Philadelphia: Lippincott; 2007.Google Scholar
  13. 13.
    Lesinski M, Muehlbauer T, Busch D, Granacher U. Effects of complex training on strength and speed performance in athletes: a systematic review. Sportverletz Sportschaden. 2014;28(2):85–107.CrossRefPubMedGoogle Scholar
  14. 14.
    Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713–21.PubMedGoogle Scholar
  15. 15.
    Cohen J. Statistical power for the behavioral sciences. Hillsdale: Erlbaum; 1988.Google Scholar
  16. 16.
    Hrysomallis C. Balance ability and athletic performance. Sports Med. 2011;41(3):221–32.CrossRefPubMedGoogle Scholar
  17. 17.
    France EP, Derscheid G, Irragang J, Malone T, Petersen R, Tippett S, Wilk K. Preliminary clinical evaluation of the Breg KAT: effects of training in normals. Isokinet Exerc Sci. 1992;2(3):133–9.Google Scholar
  18. 18.
    Gruber M, Taube W, Gollhofer A, Beck S, Amtage F, Schubert M. Training-specific adaptations of H- and stretch reflexes in human soleus muscle. J Mot Behav. 2007;39(1):68–78.CrossRefPubMedGoogle Scholar
  19. 19.
    Cox ED, Lephart SM, Irrgang JJ. Unilateral balance training of noninjured individuals and the effects on postural sway. J Sport Rehabil. 1993;2:87–96.Google Scholar
  20. 20.
    Verhagen E, Bobbert M, Inklaar M, van Kalken M, van der Beek A, Bouter L, van Mechelen W. The effect of a balance training programme on centre of pressure excursion in one-leg stance. J Biomech. 2005;20(10):1094–100.CrossRefGoogle Scholar
  21. 21.
    Gioftsidou A, Malliou P, Pafis G, Beneka A, Godolias G, Maganaris CN. The effects of soccer training and timing of balance training on balance ability. Eur J Appl Physiol. 2006;96(6):659–64.CrossRefPubMedGoogle Scholar
  22. 22.
    Gioftsidou A, Malliou P, Pafis G, Beneka A, Tsapralis K, Sofokleous P, et al. Balance training programs for soccer injuries prevention. J Hum Sport Exerc. 2012;7(3):639–47.CrossRefGoogle Scholar
  23. 23.
    Malliou P, Gioftsidou A, Pafis G, Beneka A, Godolias G. Proprioceptive training (balance exercises) reduces lower extremity injuries in young soccer players. J Back Musculoskelet Rehabil. 2004;17(3):101–4.Google Scholar
  24. 24.
    Malliou P, Amoutzas K, Theodosiou A, Gioftsidou A, Mantis K, Pylianidis T, Kioumourtzoglou E. Proprioceptive training for learning downhill skiing. Percept Mot Skills. 2004;99(1):149–54.CrossRefPubMedGoogle Scholar
  25. 25.
    Romero-Franco N, Martinez-Lopez E, Lomas-Vega R, Hita-Contreras F, Martinez-Amat A. Effects of proprioceptive training program on core stability and center of gravity control in sprinters. J Strength Cond Res. 2012;26(8):2071–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Hoffman M, Payne VG. The effects of proprioceptive ankle disk training on healthy subjects. J Orthop Sports Phys Ther. 1995;21(2):90–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Soderman K, Werner S, Pietila T, Engstrom B, Alfredson H. Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthrosc. 2000;8(6):356–63.CrossRefPubMedGoogle Scholar
  28. 28.
    Chong RK, Ambrose A, Carzoli J, Hardison L, Jacobson B. Source of improvement in balance control after a training program for ankle proprioception. Percept Mot Skills. 2001;92(1):265–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Sforza C, Grassi GP, Turci M, Fragnito N, Pizzini G, Ferrario VF. Influence of training on maintenance of equilibrium on a tilting platform. Percept Mot Skills. 2003;96(1):127–36.CrossRefPubMedGoogle Scholar
  30. 30.
    Riemann BL, Tray NC, Lephart SM. Unilateral multiaxial coordination training and ankle kinesthesia, muscle strength, and postural control. J Sport Rehabil. 2003;12(1):13–30.Google Scholar
  31. 31.
    Bruhn S, Kullmann N, Gollhofer A. The effects of a sensorimotor training and a strength training on postural stabilisation, maximum isometric contraction and jump performance. Int J Sports Med. 2004;25(1):56–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Kovacs EJ, Birmingham TB, Forwell L, Litchfield RB. Effect of training on postural control in figure skaters: a randomized controlled trial of neuromuscular versus basic off-ice training programs. Clin J Sport Med. 2004;14(4):215–24.CrossRefPubMedGoogle Scholar
  33. 33.
    Rothermel A, Hale SA, Hertel J, Denegar CR. Effect of active foot positioning on the outcome of a balance training program. Phys Ther Sport. 2004;5(2):98–103.CrossRefGoogle Scholar
  34. 34.
    Emery CA, Cassidy JD, Klassen TP, Rosychuk RJ, Rowe BH. Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents: a cluster randomized controlled trial. CMAJ. 2005;172(6):749–54.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Kean CO, Behm DG, Young WB. Fixed foot balance training increases rectus femoris activation during landing and jump height in recreationally active women. J Sports Sci Med. 2006;5(1):138–48.PubMedCentralPubMedGoogle Scholar
  36. 36.
    Yaggie JA, Campbell BM. Effects of balance training on selected skills. J Strength Cond Res. 2006;20(2):422–8.PubMedGoogle Scholar
  37. 37.
    Eisen TC, Danoff JV, Leone JE, Miller TA. The effects of multiaxial and uniaxial unstable surface balance training in college athletes. J Strength Cond Res. 2010;24(7):1740–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Yarrow K, Brown P, Krakauer JW. Inside the brain of an elite athlete: the neural processes that support high achievement in sports. Nat Rev Neurosci. 2009;10(8):585–96.CrossRefPubMedGoogle Scholar
  39. 39.
    Nakata H, Yoshie M, Miura A, Kudo K. Characteristics of the athletes’ brain: evidence from neurophysiology and neuroimaging. Brain Res Rev. 2010;62(2):197–211.CrossRefPubMedGoogle Scholar
  40. 40.
    Taube W, Gollhofer A. Control and training of posture and balance. In: Komi PV, editor. Neuromuscular spects of sport performance. Chichester: Blackwell; 2011. p. 254–69.Google Scholar
  41. 41.
    Malliou VJ, Malliou P, Gioftsidou A, Pafis G, Katsikas CA, Beneka A, Tsiganos G, Godolias G. Balance exercise program before or after a tennis training session? J Back Musculoskelet Rehabil. 2008;21(2):87–90.Google Scholar
  42. 42.
    Muehlbauer T, Gollhofer A, Granacher U. Association of balance, strength, and power measures in young adults. J Strength Cond Res. 2013;27(3):582–9.PubMedGoogle Scholar
  43. 43.
    Muehlbauer T, Gollhofer A, Granacher U. Relationship between measures of balance and strength in middle-aged adults. J Strength Cond Res. 2012;26(9):2401–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Muehlbauer T, Besemer C, Wehrle A, Gollhofer A, Granacher U. Relationship between strength, power and balance performance in seniors. Gerontology. 2012;58(6):504–12.CrossRefPubMedGoogle Scholar
  45. 45.
    Zemkova E. Sport-specific balance. Sports Med. 2014;44(5):579–90.CrossRefPubMedGoogle Scholar
  46. 46.
    Muehlbauer T, Roth R, Bopp M, Granacher U. An exercise sequence for progression in balance training. J Strength Cond Res. 2012;26(2):568–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Melanie Lesinski
    • 1
  • Tibor Hortobágyi
    • 2
  • Thomas Muehlbauer
    • 1
  • Albert Gollhofer
    • 3
  • Urs Granacher
    • 1
    Email author
  1. 1.Division of Training and Movement SciencesUniversity of Potsdam, Research Focus Cognition SciencesPotsdamGermany
  2. 2.Centre for Human Movement SciencesUniversity Medical Centre GroningenGroningenThe Netherlands
  3. 3.Institute of Sport and Sport ScienceAlbert-Ludwigs-University of FreiburgFreiburgGermany

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