Effects of core training on dynamic balance stability: A systematic review and meta-analysis

Effects of core stability exercises on balance ability of children and adolescents with intellectual disabilities: A systematic review and meta-analysis

BACKGROUND

Children and adolescents with intellectual disabilities (IDs) are at risk of falls due to balance problems. One way to palliate balance deficits among this population is via core stability exercises. However, comprehensive studies that examine the effectiveness of core stability exercises in improving balance in this target population are lacking.

OBJECTIVE

This study aims to summarise and quantify the effectiveness of core stability exercises in improving the balance of this target population.

METHODS

This study followed PRISMA principles and conducted comprehensive searches in six academic databases (PubMed, Web of Science, Medline, Embase, Scopus, and the Cochrane Library) up to June 2023. The inclusion criteria were established via the PICOS framework. The risk of bias was assessed with the Cochrane risk-of-bias tool, and the certainty of the evidence was assessed via the GRADE approach. The meta-analysis was performed via RevMan 5.4, and for data that could not be pooled via meta-analysis, we used a narrative description of the results of each study.

RESULTS

Six studies of 1078 subjects were included. The findings revealed that core stability exercises improved the dynamic balance of children and adolescents with ID but had no significant effect on static (Hedges' g = 1.32, 95% CI [-0.41 to 3.06]) or static‒dynamic (Hedges' g = 1.35, 95% CI [-0.02 to 2.73]) balance compared with the control groups. The quality of evidence based on the GRADE approach was very low.

CONCLUSIONS

Core stability exercises may improve dynamic balance in children and adolescents with ID, but given the scarcity of studies included, definitive conclusions cannot yet be drawn. Although pooled analyses also highlighted improvements in static and static-dynamic balance with large effect sizes over active control groups, the results were not statistically significant and should be interpreted with caution given the wide confidence intervals. The heterogeneity among the identified studies and the limited number of eligible studies may reduce the reliability of the results, but these findings emphasise the need for additional research in this domain.

Single-Leg Countermovement Jump Compensation Assessment: Content Validity of a Checklist

Jump actions are common in several sports, and their performance is related to a myriad of biomechanical and physiological factors, with links to athletic performance and imbalances. Currently, a valid, field-based, easy-to-use tool to assess the quality of an explosive jump movement, similar to the required sports movements, is unavailable. Thus, the present study aimed to design and validate a field-based, easy-to-use tool that can be used to assess the quality of movement during an explosive single-leg countermovement jump (SL-CMJ). Ten experts participated in the content validation process for the checklist, including checking item relevance, definition accuracy, and scoring adequacy. Content validity was measured using the Aikens V format. The checklist included the items "Foot orientation," "Knee valgus/varus," "Internal/external hip flexed orientation," "Pelvis tilt," "Thorax tilt," "Thorax rotation," "Foot pronation/supination," "Asymmetrical hip," and "Lumbo-pelvic association". The items achieved a 0.60-0.99 in relevance, 0.70-1.00 in definition accuracy, and 0.80-0.83 in scoring adequacies in the Aikens V proof. The results from the context validation process suggest that the tool may be appropriate to assess athletes' quality of explosive movement. Furthermore, the results derived from such assessments may help to design better and safer training interventions.

Effect of Core Exercises on Clinical and Functional Outcomes After Total Knee Arthroplasty in Individuals With Knee Osteoarthritis: A Systematic Review

BACKGROUND

Core muscles constitute the centre of the kinetic chain, and core exercises have been effective in improving outcomes in many postsurgical lower extremity musculoskeletal conditions. However, the literature on the implementation of core exercises after TKA has not been summarised.

OBJECTIVE

The objective was to review the evidence on the effect of core exercises on clinical and functional outcomes after TKA in individuals with knee osteoarthritis (OA).

METHODS

PubMed, Scopus, CINAHL, Web of Science, the Cochrane Library, and ProQuest databases were explored with appropriate keywords for studies published on the effect of core exercises on TKA from inception to 1 April 2024. Two authors independently screened the titles and abstracts and full-texts, and a third author solved the discrepancies. Risk of bias assessment was done with the Joanna Briggs Critical Appraisal tool. The final articles were systematically summarised.

RESULTS

A total of 1485 records were retrieved. Sixty-four articles were included for screening full-texts, and four articles were ultimately included. Core exercises were administered for three to 6 weeks. The administration of core exercises along with the standard knee rehabilitation programme significantly improved balance, mobility, knee function, transverse abdominis muscle thickness, transversus abdominis contraction, and quality of life after TKA (p < 0.05).

CONCLUSIONS

Core exercises can be administered as an adjunct to standard rehabilitation programs to improve clinical and functional outcomes after TKA. However, there is a dearth of literature in this domain, and more studies are warranted.

TRIAL REGISTRATION

PROSPERO Registration Number: CRD42024542992.

Acute Effect of Whole-Body Vibration on Trunk Endurance and Balance in Obese Female Students: Randomized Controlled Trial

Background and Objectives: Compared to other subjects, obese people have inferior trunk muscle endurance and balance. A modern method of neuro-muscular training called whole body vibration (WBV) may improve trunk muscle endurance and balance. This study evaluates the impact of a 4-week WBV program on trunk endurance and balance in obese female students. Materials and Methods: Sixty participants from 18 to 25 years of age and with BMI values ≥ 30 were randomly distributed into two equal groups: Group A (WBV group), who received 4 min of WBV, and Group B (sham WBV group), who received WBV with a turn-off device. The training was conducted two days/week for six weeks. Trunk endurance was evaluated using the Sorensen Test (ST) and Trunk Flexor Endurance Test (TFET). The Single-Leg Test (SLT) was used to assess static balance, while the Biodex Stability System measured dynamic balance. Results: The current study demonstrated no significant differences (p > 0.05) in pre-treatment variables between Groups A and B. Post-treatment, Group A showed a significantly higher duration of the Sorensen test, TFET and SLS than Group B (p < 0.001). Moreover, Group A showed significantly lower dynamic balance (p < 0.001) than Group B. Conclusions: WBV has a short-term effect on trunk endurance and balance in obese female students. WBV can be added to the rehabilitation program for obese subjects with deficits in trunk endurance and balance.

Risk factors of falls in rural elderly of Ningxia in China: a prospective cohort study

OBJECTIVES

To identify risk factors associated with falls in older people in rural China.

METHODS

A prospective cohort study was conducted across 27 villages in the rural areas of Ningxia, China. After excluding individuals younger than 60 years, a total of 758 out of the initial 822 participants were ultimately included for the collection of baseline information. Participants were followed up through telephone calls or face-to-face interviews at 3rd, 6th and 12th months following the baseline investigation. The Cox proportional hazards regression model was used to examine risk factors of falls.

RESULTS

A total of 758 participants underwent baseline information surveys, and all samples were included in the Cox model analysis. The study found that being woman (RR=1.879, 95% CI: 1.313 to 2.668), smoking (RR=1.972, 95% CI: 1.238 to 3.143), use of painkillers (RR=1.700, 95% CI: 1.226 to 2.356) and higher systolic blood pressure (SBP) (RR=1.081, 95% CI: 1.013 to 1.154) were associated with higher risk of falls among the elderly in rural China. After excluding those who were lost to follow-up or deceased, 738 participants completed the follow-up. There were 341 men (46.2%) and 397 women (53.8%), with an average age of 66.8±5.0 years. The fall rate in study area was 23.8% during the follow-up period.

CONCLUSIONS

The fall rate among the elderly in rural China was higher than other areas. Our findings revealed that being woman, smoking, medication usage, elevated SBP and people with a higher body mass index were risk factors for developing falls.

The automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without low back pain- A cross-sectional study

BACKGROUND

The postural control and abdominal muscles' automatic activity were found to be impaired in subjects with low back pain (LBP) during static activities. However, the studies are predominantly conducted on younger adults and a limited number of studies have evaluated abdominal muscles' automatic activity during dynamic standing activities in subjects with LBP. The present study investigated the automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without LBP.

METHODS

Twenty subjects with and 20 subjects without LBP were included. The thickness of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles was measured during rest (in supine), static, and dynamic standing postural tasks. To estimate automatic muscle activity, each muscle's thickness during a standing task was normalized to its thickness during the rest. Standing postural tasks were performed using the Biodex Balance System.

RESULTS

The mixed-model analysis of variance revealed that task dynamicity significantly affected thickness change only in the TrA muscle (P = 0.02), but the main effect for the group and the interaction were not significantly different (P > 0.05). There were no significant main effects of the group, task dynamicity, or their interaction for the IO and EO muscles (P > 0.05). During dynamic standing, only the TrA muscle in the control group showed greater thickness changes than during the static standing task (P < 0.05).

CONCLUSIONS

Standing on a dynamic level increased the automatic activity of the TrA muscle in participants without LBP compared to standing on a static level. Further research is required to investigate the effects of TrA muscle training during standing on dynamic surfaces for the treatment of older adults with LBP.

Are trunk stability and endurance determinant factors for whole-body dynamic balance in physically active young males? A multidimensional analysis

OBJECTIVES

Determine if (a) a better trunk stability and endurance are associated with an improved whole-body dynamic balance, and if (b) the assessment tests can be interchanged within each capability.

METHODS

Sixty-three physically active young males performed three trunk stability (i.e., the lumbopelvic stability, the unstable sitting and the sudden loading sitting tests), three trunk muscle endurance (i.e., the Biering-Sørensen, the side bridge and the front bridge tests) and four whole-body dynamic balance (i.e., the tandem and the single-leg stance, the Y-Balance, and the single-leg triple hop tests) tests two times. After assessing the reliability of the variables, a Pearson correlation analysis was performed.

RESULTS

The correlations between trunk stability and endurance tests with dynamic balance tests were non-significant except for the unstable sitting test with both the tandem (r = 0.502) and the single-leg stance (r = 0.522) tests. Moreover, no relationships were observed between the trunk stability and the trunk muscle endurance tests. Interestingly, no relationships were found between most tests within each capability (i.e., trunk stability, trunk endurance, and dynamic balance) except: (i) the front bridge stability test and the back (r = 0.461) and the side (r = 0.499) bridge stability tests; (ii) the two side bridge endurance tests (r = 0.786); (iii) the tandem and the single-leg stance tests (0.439 ≤ r ≤ 0.463); (iv) the Y-Balance and the single-leg triple hop tests (0.446 ≤ r ≤ 0.477).

CONCLUSION

Better trunk function does not seem to be a relevant factor for dynamic balance in young active males. In this population, specific measures are needed as the test interchangeability is questioned.

Effects of Proprioceptive Insoles and Specific Core Training on Postural Stability for Preventing Injuries in Tennis

Tennis is a complex sport based on unpredictability that requires adequate physical and psychological preparation to prevent injuries. The aim of this study was to investigate the effects of 8-week specific core stability training on postural stability in competitive adolescent tennis players, aged between 14 and 19 years old. Sixty-one participants were randomly allocated into two groups: experimental (n = 32) and control (n = 29) groups. The first group wore proprioceptive insoles 8 h a day and performed a detailed training 3 times a week for 8 weeks; the second group only received proprioceptive insoles to wear 8 h a day for 8 weeks. The postural stability parameters (center-of-pressure length, center-of-pressure velocity, and 95% confidence ellipse sway area) included three assessment times: baseline (T0), intermediate test (T1), post-test (T2), and retention test (T3). Data analysis showed a significant improvement in the experimental group compared with the control group, indicating a large effect size in center-of-pressure length, ellipse sway area, and center-of-pressure velocity at T2 and T3 (p < 0.05). In conclusion, our results suggest that a specific and detailed core stability training plays a significant role in improving balance and postural stability in young tennis players, especially in terms of preventing the risk of injury.

Effects of Yoga Training Applied with Telerehabilitation on Core Stabilization and Physical Fitness in Junior Tennis Players: A Randomized Controlled Trial

INTRODUCTION

This study aimed to investigate the effects of yoga training applied with telerehabilitation on core stability, and strength, balance, flexibility, upper extremity stability, body awareness, and quality of life in tennis players aged 6-18 years.

METHODS

Forty tennis players were randomly divided into two groups to participate in this study. The control group (n = 20) continued tennis training and was informed about the importance of the core region. The yoga group (n = 20) received yoga training with telerehabilitation 2 days a week for 8 weeks. Athletes were evaluated with sport-specific core muscle strength and stability tests, the back scratch test, the sit and reach test, the flamingo balance test, the y-balance test (lower quarter), the upper extremity closed kinetic chain stability test, the SF-36, and body awareness questionnaires. Measurements have been done in the tennis club before and after the 8 weeks of training.

RESULTS

A significant increase was determined in core strength and stability, sit and reach, back scratch test, upper extremity stability, and body awareness questionnaire in the yoga group (p < 0.001). Flamingo and Y balance test results were significant (p < 0.002). Positive improvements were found in SF-36s energy-fatigue level, mental well-being, social function (p < 0.042), pain (p < 0.005), and general health (p < 0.001). A significant increase was observed in the core strength measurement mean score in the control group (p < 0.018). Sit and reach test, flamingo test, and body awareness questionnaire were found to be significant after the intervention (p < 0.001). Significant improvements were found in the pain (p < 0.042), and mental well-being (p < 0.001) sub-parameters of the SF-36.

CONCLUSION

In the study, it was concluded that yoga training applied with telerehabilitation in tennis players aged 6-18 has a positive effect on core strength, and stabilization, physical fitness parameters, quality of life, and body awareness.

Einleitung

Mit dieser Studie sollten die Auswirkungen von Yogatraining in Verbindung mit Telerehabilitation auf Rumpfstabilität, Kraft, Gleichgewicht, Flexibilität, Stabilität der oberen Extremität, Körperwahrnehmung und Lebensqualität bei Tennisspielern im Alter von 6 bis 18 Jahren untersucht werden.

Methoden

Vierzig Tennisspieler wurden randomisiert in zwei Gruppen aufgeteilt und nahmen an der Studie teil. Die Kontrollgruppe (n = 20) führte das Tennistraining fort und wurde über die Bedeutung der Rumpfregion aufgeklärt. Die Yoga-Gruppe (n = 20) erhielt an 2 Tagen pro Woche über 8 Wochen ein Yogatraining mittels Telerehabilitation. Die Sportler wurden mittels sportartspezifischer Tests zur Kraft und Stabilität der Rumpfmuskulatur, dem Back-Scratch-Test, dem Sit-and-Reach-Test, dem Flamingo-Balance-Test, dem Y-Balance-Test (unteres Viertel), dem Closed Kinetic Chain Upper Extremity Stability Test sowie dem SF-36 und dem Fragebogen zur Körperwahrnehmung beurteilt. Die Messungen wurden im Tennisclub vor und nach dem 8-wöchigen Training durchgeführt.

Ergebnisse

In der Yoga-Gruppe wurde ein signifikanter Anstieg der Rumpfkraft und -stabilität sowie im Sit-and-Reach-Test, Back-Scratch-Test, der Stabilität der oberen Extremität und beim Fragebogen zur Körperwahrnehmung festgestellt (p < 0,001). Die Ergebnisse des Flamingo-Balance-Tests und des Y-Balance-Tests fielen signifikant aus (p < 0,002). Verbesserungen zeigten sich beim SF-36-Score für Energieverlust und Erschöpfung, psychisches Wohlbefinden, soziale Funktion (p < 0,042), Schmerzen (p < 0,005) und allgemeine Gesundheit (p < 0,001). In der Kontrollgruppe war ein signifikanter Anstieg des mittleren Scores der Rumpfkraftmessung zu beobachten (p < 0,018). Der Sit-and-Reach-Test, der Flamingo-Test und der Fragebogen zur Körperwahrnehmung fielen nach der Intervention signifikant aus (p < 0,001). Bei den Unterparametern Schmerz und psychisches Wohlbefinden des SF-36 wurden signifikante Verbesserungen festgestellt (p < 0,042 bzw. p < 0,001).

Diskussion/Schlussfolgerung

Die Studie kam zu der Schlussfolgerung, dass Yoga-Training bei Anwendung mittels Telerehabilitation bei Tennisspielern im Alter von 6 bis 18 Jahren einen positiven Effekt auf die Rumpfkraft und -stabilisierung, die Parameter der körperlichen Fitness, die Lebensqualität und die Körperwahrnehmung hat.

Effects of physical training programs on female tennis players' performance: a systematic review and meta-analysis

Background: Tennis is among the world's most popular and well-studied sports. Physical training has commonly been used as an intervention among athletes. However, a comprehensive review of the literature on the effects of physical training programs on female tennis players' performance is lacking. Therefore, this systematic review and meta-analysis aimed to determine the effects of physical training on performance outcomes in female tennis players. Methods: A comprehensive search was conducted on Web of Science, PubMed, SPORTDicus, Scopus, and CNKI from inception until July 2023 to select relevant articles from the accessible literature. Only controlled trials were included if they examined the effects of physical training on at least one measure of tennis-specific performance in female tennis players. The Cochrane RoB tool was employed to assess the risk of bias. The CERT scale was used to examine the quality of program information. The GRADE approach was adopted to evaluate the overall quality of the evidence. The Comprehensive Meta-Analysis software was used for the meta-analysis. Results: Nine studies were selected for the systematic review and seven for the meta-analysis, totaling 222 individuals. The study's exercise programs lasted 6-36 weeks, with training sessions ranging from 30 to 80 min, conducted one to five times per week. Muscle power (ES = 0.72; p = 0.003), muscle strength (ES = 0.65; p = 0.002), agility (ES = 0.69; p = 0.002), serve velocity (ES = 0.72; p = 0.013), and serve accuracy (ES = 1.14; p = 0.002) demonstrated significant improvement following physical training, while no notable changes in linear sprint speed (ES = 0.63; p = 0.07) were detected. Conclusion: Although research on physical training in sports is diversified, studies on training interventions among female tennis players are scarce. This review found that existing training programs yield some favorable outcomes for female tennis players. However, further research with high methodological quality is warranted on the tailoring of specific training programs for female tennis players. There should be more consistent measuring and reporting of data to facilitate meaningful data pooling for future meta-analyses.

Weekly cumulative extracurricular core training time predicts cadet physical performance: A descriptive epidemiological study

Background

Core training can enhance athletic performance by enhancing core strength and stability. To achieve this outcome, however, a tailored training program is required; the normal military training curriculum is inadequate. The connection between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and cadet performance is unknown.

Methods

The association between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and performance has been discovered using a descriptive epidemiological study methodology. Questionnaires were used to collect information on personal characteristics and weekly cumulative extracurricular (core) training time, as well as the results of the Chinese Army Physical Fitness Test (C-APFT), which included 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, 800 m breaststroke, horizontal bar pull-ups, 2-min sit-ups, 2-min push-ups, and hand grenade throwing. This study recruited two hundred and twenty male cadets (aged 18 to 23 years, 19.68 ± 0.91) from a military medical university.

Results

(a) The correlation between cumulative weekly extracurricular training time and C-APFT score is significant. The 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, and 2-min push-ups performed the best when participants exercised for 5 to 10 h per week. (b) The number of cadets scoring good or excellent on the C-APFT improves with cumulative weekly extracurricular core training time. The recommended amount of core training for cadets per week is 120 min. (c) The average cumulative weekly extracurricular core training time was a effective predictor of performance on the 400-m steeplechase (R2 = 0.470, F = 10.641, P＜0.01), horizontal bar pull-ups (R2 = 0.238, F = 68.191, P＜0.01), 2-min sit-ups (R2 = 0.280, F = 84.710, P＜0.01), 100-m run (R2 = 0.031, F = 6.920, P＜0.01), 3000-m armed training run (R2 = 0.025, F = 5.603, P＜0.05), 2-min push-ups (R2 = 0.019, F = 4.295, P＜0.05), and hand grenade tossing (R2 = 0.025, F = 5.603, P＜0.05).

Conclusions

Active participation in extracurricular core training can improve cadets' C-APFT scores. An average cumulative weekly extracurricular training duration of 5-10 h showed the most progress, and more than 120 min per week was ideal for extracurricular core training. The amount of extracurricular time spent on core training exercises each week can be used as a predictor of the C-APFT.

Effects of Motor-Cognitive Dual-Task Standing Balance Exergaming Training on Healthy Older Adults' Standing Balance and Walking Performance

Objective: This study examined the effects of motor-cognitive dual-task exergaming standing balance training on healthy older adults' static, dynamic, and walking balance. Methods: Twenty-four adults older than 70 years (control group: n = 9, males = 6, balance training group: n = 15, males = 8) completed the experiment. Dual-tasking standing balance training comprised the accurate control of a ping-pong ball on a tray held with both hands, while standing on one leg (analog training) and three modules of Wii Fit™ exergaming (digital training). The duration of balance training was ∼15 minutes per day, 2 days per week for 8 weeks, in total 16 sessions. We measured one-leg standing time, functional reach distance, walking balance evaluated by the distance walked on a narrow beam (4-cm long, 4-cm wide, and 2-cm high) with single and dual tasking, habitual and maximal walking speed, and muscle strength of the hip extensor, hip abductor, hip adductor, knee extensor, and plantarflexor muscle groups in the right leg at baseline and after 8 weeks. Results: Control group decreased, but balance training group increased one-leg standing time. Only the balance training group improved functional reach distance and hip and knee extensor strength. There was no change in walking speed and walking balance in either group. In the balance training group, changes in maximal speed correlated with changes in dual-tasking walking balance and changes in one-leg standing time correlated with changes in single-tasking walking balance. Conclusion: These results suggest that 16 sessions of motor-cognitive dual-task standing exergaming balance training substantially improved healthy older adults' static and dynamic balance and leg muscle strength but failed to improve walking speed and walking balance. Balance exercises specific to walking balance need to be included in balance training to improve walking balance.