Comparative Effects of Different Balance-Training-Progression Styles on Postural Control and Ankle Force Production: A Randomized Controlled Trial

Abstract

Context: Despite the effectiveness of balance training, the exact parameters needed to maximize the benefits of such programs remain unknown. One such factor is how individuals should progress to higher levels of task difficulty within a balance-training program. Yet no investigators have directly compared different balance-training-progression styles.

Objective: To compare an error-based progression (ie, advance when proficient at a task) with a repetition-based progression (ie, advance after a set amount of repetitions) style during a balance-training program in healthy individuals.

Design: Randomized controlled trial.

Setting: Research laboratory.

Patients or other participants: A total of 28 (16 women, 12 men) physically healthy young adults (age = 21.57 ± 3.95 years, height = 171.60 ± 11.03 cm, weight = 72.96 ± 16.18 kg, body mass index = 24.53 ± 3.7).

Intervention(s): All participants completed 12 supervised balance-training sessions over 4 weeks. Each session consisted of a combination of dynamic unstable-surface tasks that incorporated a BOSU ball and lasted about 30 minutes.

Main outcome measure(s): Static balance from an instrumented force plate, dynamic balance as measured via the Star Excursion Balance Test, and ankle force production in all 4 cardinal planes of motion as measured with a handheld dynamometer before and after the intervention.

Results: Selected static postural-control outcomes, dynamic postural control, and ankle force production in all planes of motion improved (P < .05). However, no differences between the progression styles were observed (P > .05) for any of the outcome measures.

Conclusions: A 4-week balance-training program consisting of dynamic unstable-surface exercises on a BOSU ball improved dynamic postural control and ankle force production in healthy young adults. These results suggest that an error-based balance-training program is comparable with but not superior to a repetition-based balance-training program in improving postural control and ankle force production in healthy young adults.

Keywords: BOSU; Star Excursion Balance Test; ankle strength; center of pressure.

Figure 1.

Forrest plot demonstrating the between-groups effect sizes calculated from the pretest-to-posttest change scores for each of the dependent variables and their 95% confidence intervals. Abbreviation: SEBT, Star Excursion Balance Test.

Figure 2.

Improvement for each patient in the error-based group and the progression of the repetition-based group for the following exercises. A, The anterior hop-to-stabilization exercise. B, The unanticipated-touch exercise over time.