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Sports Medicine
Published in: Sports Medicine 12/2015

Open Access 01-12-2015 | Systematic Review

Effects of Strength Training Using Unstable Surfaces on Strength, Power and Balance Performance Across the Lifespan: A Systematic Review and Meta-analysis

Authors: David G. Behm, Thomas Muehlbauer, Armin Kibele, Urs Granacher

Published in: Sports Medicine | Issue 12/2015

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Abstract

Background

The effectiveness of strength training on unstable surfaces (STU) versus stable surfaces (STS) or a control condition (CON; i.e. no training or regular training only) for strength, power and balance performance across the lifespan has not yet been investigated in a systematic review and meta-analysis.

Objective

The aims of this systematic review and meta-analysis were to determine the general effects of STU versus STS or CON on muscle strength, power and balance in healthy individuals across the lifespan and to investigate whether performance changes following STU are age specific.

Data Sources

A computerized systematic literature search was performed in the electronic databases PubMed and Web of Science from January 1984 up to February 2015.

Study Eligibility Criteria

Initially, 209 articles were identified for review. Only controlled trials were included if they investigated STU in healthy individuals and tested at least one measure of maximal strength, strength endurance, muscle power, or static/dynamic balance. In total, 22 studies met the inclusion criteria.

Study Appraisal and Synthesis Methods

The included studies were coded for the following criteria: age, sex, training status, training modality, exercise and test modality. Effect size measures included within-subject standardized mean differences (SMDw) and weighted between-subject standardized mean differences (SMDb). Heterogeneity between studies was assessed using I 2 and χ 2 statistics. The methodological quality of each study was assessed using the Physiotherapy Evidence Database (PEDro) Scale.

Results

Our search failed to identify studies that examined the effects of STU versus STS or CON in children and middle-aged adults. However, four studies were identified that investigated the effects of STU versus CON or STS in adolescents, 15 studies were identified in young adults and three studies were identified in old adults. Compared with CON, STU produced medium effects on maximal strength in young adults and no effects to medium effects in old adults. In addition, large effects were detected on strength endurance in adolescents and in young adults; in old adults, a small effect was found. With regard to muscle power, medium effects were observed in young adults and small effects were observed in old adults. Further, large effects were found for static and dynamic balance in old adults, but only a small effect was found for dynamic balance in young adults. The comparison of STU and STS revealed inconsistent results as indicated by training-induced changes in favour of STU, as well as STS. Small to medium effects were found for maximal strength in adolescents in favour of STS, and small effects were found in young adults in favour of STU. With regard to strength endurance, large effects were found in adolescents in favour of STS and small effects were found in favour of STU. Additionally, we detected small effects in young adults in favour of STU. In terms of muscle power, no effects were observed in adolescents but medium effects were found in favour of STS in young adults. With regard to balance, small effects were detected in adolescents for static and dynamic balance in favour of STU. In young adults, small effects were found for static balance in favour of STS. With regard to dynamic balance, the analysis revealed small effects in young adults in favour of STU.

Limitations

The quality of the included studies was rather low, with mean PEDro scores of 5.8, 4.0 and 5.0 for studies including adolescents, young adults and old adults, respectively. Further, trivial to considerable heterogeneity between studies (i.e. 0 % ≤ I 2 ≤ 96 %) was detected.

Conclusions

Compared with CON, STU is effective in improving muscle strength, power and balance in adolescents, young adults and old adults. However, inconsistent results were particularly found in adolescents and young adults when the specific effects of STU were compared with those of STS. We conclude that the performance of STU compared with STS has limited extra effects on muscle strength, power and balance performance in healthy adolescents and young adults. Given that our systematic search did not identify studies that examined the effects of STU versus STS in children, middle-aged adults and old adults, further research of high methodological quality is needed to determine whether there are additive effects of STU as compared with STS in those age groups.
Literature
1.
Behm DG, Drinkwater EJ, Willardson JM, et al. The use of instability to train the core musculature. Appl Physiol Nutr Metab. 2010;35(1):91–108.CrossRefPubMed
2.
3.
Behm DG. Neuromuscular implications and applications of resistance training. J Strength Cond Res. 1995;9(4):264–74.
4.
5.
Willardson JM. The effectiveness of resistance exercises performed on unstable equipment. Strength Cond J. 2004;26(5):70–4.CrossRef
6.
Schmidtbleicher D. Training for power events. In: Komi PV, editor. Strength and power in sport. Oxford: Blackwell; 2004. p. 381–95.
7.
Behm DG, Drinkwater EJ, Willardson JM, et al. Canadian Society for Exercise Physiology position stand: the use of instability to train the core in athletic and nonathletic conditioning. Appl Physiol Nutr Metab. 2010;35(1):109–12.CrossRefPubMed
8.
Behm D, Colado JC. The effectiveness of resistance training using unstable surfaces and devices for rehabilitation. Int J Sports Phys Ther. 2012;7(2):226–41.PubMedCentralPubMed
9.
Behm DG, Drinkwater EJ, Willardson JM, et al. The role of instability rehabilitative resistance training for core musculature. Strength Cond J. 2011;33(3):72–81.CrossRef
10.
Hamlyn N, Behm DG, Young WB. Trunk muscle activation during dynamic weight-training exercises and isometric instability activities. J Strength Cond Res. 2007;21(4):1108–12.PubMed
11.
Chek P. Physioball exercise for swimming, soccer, and basketball. Sports Coach. 1999;21:30–3.
12.
Verstegen M, Williams P. Physioball routine. In: Verstegen M, Williams P, editors. Core performance. New York: Rodale; 2004. p. 73–88.
13.
Kibele A, Behm DG. Seven weeks of instability and traditional resistance training effects on strength, balance and functional performance. J Strength Cond Res. 2009;23(9):2443–50.PubMed
14.
Viru A, Loko J, Harro M, et al. Critical periods in the development of performance capacity during childhood and adolescence. Eur J Phys Edu. 1999;4(1):75–119.CrossRef
15.
Landow L, Haff GG. Use of stability balls in strength and conditioning. Strength Cond J. 2012;34(1):48–50.CrossRef
16.
Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. Edinburgh: Churchill Livingstone; 2000.
17.
Faigenbaum AD, Westcott WL, Loud RL, et al. The effects of different resistance training protocols on muscular strength and endurance development in children. Pediatrics. 1999;104(1):e5.CrossRefPubMed
18.
Granacher U, Lacroix A, Muehlbauer T, et al. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013;59(2):105–13.CrossRefPubMed
19.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.CrossRefPubMed
20.
Anderson K, Behm DG. The impact of instability resistance training on balance and stability. Sports Med. 2005;35(1):43–53.CrossRefPubMed
21.
Behm DG, Anderson KG. The role of instability with resistance training. J Strength Cond Res. 2006;20(3):716–22.PubMed
22.
Sparkes R, Behm DG. Training adaptations associated with an 8-week instability resistance training program with recreationally active individuals. J Strength Cond Res. 2010;24(7):1931–41.CrossRefPubMed
23.
Sukalinggam CL, Sukalinggam GL, Kasim F, et al. Stability ball training on lower back strength has greater effect in untrained female compared to male. J Hum Kinet. 2012;33:133–41.PubMedCentralCrossRefPubMed
24.
Cosio-Lima LM, Reynolds KL, Winter C, et al. Effects of physioball and conventional floor exercises on early phase adaptations in back and abdominal core stability and balance in women. J Strength Cond Res. 2003;17(4):721–5.PubMed
25.
Romero-Franco N, Martinez-Lopez E, Lomas-Vega R, et al. Effects of proprioceptive training program on core stability and center of gravity control in sprinters. J Strength Cond Res. 2012;26(8):2071–7.CrossRefPubMed
26.
Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro Scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713–21.PubMed
27.
28.
Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando: Academic Press; 1985.
29.
Cohen J. Statistical power for the behavioral sciences. Hillsdale: Erlbaum; 1988.
30.
Deeks JJ, Higgins JPT, Altman DG. Chapter 9: analysing data and undertaking meta-analyses. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Bognor Regis: Wiley-Blackwell; 2008.
31.
Stanforth D, Stanforth PR, Hahn SR, et al. A 10-week training study comparing Resistaball and traditional trunk training. J Dance Med Sci. 1998;2(4):134–40.
32.
Marinkovic M, Bratic M, Ignjatovic A, et al. Effects of 8-week instability resistance training on maximal strength in inexperienced young individuals. Serb J Sports Sci. 2012;6(1):17–21.
33.
Premkumar M, Alagesan J, Vaidya N. Effect of instability resistance training of abdominal muscles in healthy young females—an experimental study. Int J Pharm Sci Health Care. 2012;2(3):91–7.
34.
Seo B-D, Yun Y-D, Kim H-R, et al. Effect of 12-week swiss ball exercise program on physical fitness and balance ability of elderly women. J Phys Ther Sci. 2012;24(1):11–5.CrossRef
35.
Stanton R, Reaburn PR, Humphries B. The effect of short-term Swiss ball training on core stability and running economy. J Strength Cond Res. 2004;18(3):522–8.PubMed
36.
Prieske O, Muehlbauer T, Borde R, et al. Neuromuscular and athletic performance following core strength training in elite youth soccer: role of instability. Scand J Med Sci Sports. 2015. doi:10.​1111/​sms.​12403 (Epub 2015 Jan 6).
37.
Granacher U, Schellbach J, Klein K, et al. Effects of core strength training using stable versus unstable surfaces on physical fitness in adolescents: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2014;6:40.PubMedCentralCrossRefPubMed
38.
Granacher U, Prieske O, Majewski M, et al. The role of instability with plyometric training in sub-elite adolescent soccer players. Int J Sports Med. 2015;36(5):386–94.CrossRefPubMed
39.
Cressey EM, West CA, Tiberio DP, et al. The effects of ten weeks of lower-body unstable surface training on markers of athletic performance. J Strength Cond Res. 2007;21(2):561–7.PubMed
40.
Oberacker LM, Davis SE, Haff GG, et al. The Yo-Yo IR2 test: physiological response, reliability, and application to elite soccer. J Strength Cond Res. 2012;26(10):2734–40.CrossRefPubMed
41.
Sato K, Mokha M. Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners? J Strength Cond Res. 2009;23(1):133–40.CrossRefPubMed
42.
Carter JM, Beam WC, McMahan SG, et al. The effects of stability ball training on spinal stability in sedentary individuals. J Strength Cond Res. 2006;20(2):429–35.PubMed
43.
Cowley PM, Swensen T, Sforzo GA. Efficacy of instability resistance training. Int J Sports Med. 2007;28(10):829–35.CrossRefPubMed
44.
Kibele A, Classen C, Muehlbauer T, et al. Metastability in plyometric training on unstable surfaces: a pilot study. BMC Sports Sci Med Rehabil. 2014;6:30.PubMedCentralCrossRefPubMed
45.
Chulvi-Medrano I, Martinez-Ballester E, Masia-Tortosa L. Comparison of the effects of an eight-week push-up program using stable versus unstable surfaces. Int J Sports Phys Ther. 2012;7(6):586–94.PubMedCentralPubMed
46.
Cug M, Ak E, Özdemir RA, et al. The effect of instability training on knee joint proprioception and core strength. J Sports Sci Med. 2012;11(3):468–74.PubMedCentralPubMed
47.
Mate-Munoz JL, Monroy AJ, Jodra Jimenez P, et al. Effects of instability versus traditional resistance training on strength, power and velocity in untrained men. J Sports Sci Med. 2014;13(3):460–8.PubMedCentralPubMed
48.
Chulvi-Medrano I, Colado JC, Pablos C, et al. A lower-limb training program to improve balance in healthy elderly women using the T-bow device. Phys Sportsmed. 2009;37(2):127–35.CrossRefPubMed
49.
Anderson KG, Behm DG. Maintenance of EMG activity and loss of force output with instability. J Strength Cond Res. 2004;18(3):637–40.PubMed
50.
Drinkwater EJ, Pritchett EJ, Behm DG. Effect of instability and resistance on unintentional squat-lifting kinetics. Int J Sports Physiol Perform. 2007;2(4):400–13.PubMed
51.
Saeterbakken AH, Fimland MS. Muscle force output and electromyographic activity in squats with various unstable surfaces. J Strength Cond Res. 2013;27(1):130–6.CrossRefPubMed
52.
Saeterbakken AH, Fimland MS. Electromyographic activity and 6RM strength in bench press on stable and unstable surfaces. J Strength Cond Res. 2013;27(4):1101–7.CrossRefPubMed
53.
Goodman CA, Pearce AJ, Nicholes CJ, et al. No difference in 1 RM strength and muscle activation during the barbell chest press on a stable and unstable surface. J Strength Cond Res. 2008;22(1):88–94.CrossRefPubMed
54.
Koshida S, Urabe Y, Miyashita K, et al. Muscular outputs during dynamic bench press under stable versus unstable conditions. J Strength Cond Res. 2008;22(5):1584–8.CrossRefPubMed
55.
ACSM. ACSM’s guidelines for exercise testing and prescription. 9th ed. Philadelphia: Wolters Kluwer; 2013.
56.
Kanehisa H, Nagareda H, Kawakami Y, et al. Effects of equivolume isometric training programs comprising medium or high resistance on muscle size and strength. Eur J Appl Physiol. 2002;87:112–9.CrossRefPubMed
57.
Tanimoto M, Sanada K, Yamamoto K, et al. Effects of whole-body low-intensity resistance training with slow movement and tonic force generation on muscular size and strength in young men. J Strength Cond Res. 2008;22(6):1926–38.CrossRefPubMed
58.
Anderson K, Behm DG. Trunk muscle activity increases with unstable squat movements. Can J Appl Physiol. 2005;30(1):33–45.CrossRefPubMed
59.
Blimkie CJ. Age- and sex-associated variation in strength during childhood: anthropometric, morphologic, neurologic, biomechanical, endocrinologic, genetic, and physical activity correlates. In: Gisolfi CV, Lamb DR, editors. Perspectives in exercise science and sports medicine: youth, exercise, and sport. Indianapolis: Benchmark; 1989. p. 99–163.
60.
Round JM, Jones DA, Honour JW, et al. Hormonal factors in the development of differences in strength between boys and girls during adolescence: a longitudinal study. Ann Hum Biol. 1999;26(1):49–62.CrossRefPubMed
Metadata
Title
Effects of Strength Training Using Unstable Surfaces on Strength, Power and Balance Performance Across the Lifespan: A Systematic Review and Meta-analysis
Authors
David G. Behm
Thomas Muehlbauer
Armin Kibele
Urs Granacher
Publication date
01-12-2015
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 12/2015
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-015-0384-x

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