Slackline training and neuromuscular performance in seniors: A randomized controlled trial

Effectiveness of a sensorimotor exercise program on proprioception, balance, muscle strength, functional mobility and risk of falls in older people

Introduction

Sensory systems provide the necessary information for a motor response to be provided. In this sense, the objective of this study is to evaluate the effectiveness of a sensorimotor exercise program on proprioceptive acuity, balance, muscle strength, functional mobility and risk of falls in institutionalized elderly.

Methodology

56 participants (84.6 ± 8.4 years) were randomly distributed between the control (CG, n = 28) and intervention groups (IG, n = 28). The CG performed a protocol based on warm-up, muscle strengthening and warm down and the IG performed the same intervention, with the addition of sensorimotor exercises. Joint Position Sensation (JPS) was evaluated in both limbs at angles of 20° and 45°, balance, functional mobility, fear of falling in the elderly and muscle strength of quadriceps, hamstrings, adductors and abductors in both limbs, before and after the 12 weeks of intervention.

Results

Both groups showed gains in muscle strength. When analyzing functionality through Timed Up and Go (TUG), before and after for each group separately, both showed a significant difference (CG p = 0.002; IG p < 0.001). For the Short Physical Performance Battery (SPPB) variable, there were significant differences in IG in balance (p < 0.001), gait speed time (s) (p = 0.004) and sit-to-stand (p = 0.002). In JPS, significant differences were recorded for Absolute Error 45° Non-Dominant (p = 0.045) and Relative Error 45° Non-Dominant (p = 0.045) in the CG and Relative Error 45° Non-Dominant for IG (p = 0.018). In the Falls Efficacy Scale International (FES-I) variable there were significant improvements in the CG (p = 0.006) and in the GI (p = 0.002). However, only IG showed significant improvements (p = 0.013) for Activities-Specific Balance Confident (ABC) in a comparison between before and after the 12-week research period. When comparing the differences verified with the intervention between CG and IG, only balance SPPB (p < 0.001) and sit-to-stand SPPB (p = 0.022) showed significant values.

Conclusion

He effectiveness of sensorimotor exercises provides balance gain in the elderly (p < 0.001) and positively impacts their confidence (p = 0.013) when performing their duties. It is concluded that the protocol presented in its different levels of difficulty is effective and important for the quality of life of the institutionalized sedentary elderly.

Slackline training for Paralympic alpine sit skiers: Development of human-device multi-joint coordination

PURPOSE

Para-alpine sit skiers face unique challenges in balance control due to their disabilities and the use of sit skis. This study assessed their multi-joint coordination before and after slackline training.

METHODS

Nine alpine sit skiers (6 M/3 F; 27 ± 8 years; height: 168.3 ± 6.0 cm; body mass: 55.4 ± 6.9 kg) with different disabilities (LW10-LW12) volunteered for the experiment. All subjects performed slackline training for 5 weeks (20 sessions). Joint kinematics were captured by vision-based markerless motion analysis. Root mean square (RMS) amplitude, mean velocity and mean power frequency (MPF) were evaluated.

RESULTS

After training, performance improved significantly with an increase in balance time (1041%, p = 0.002), and a decrease in joint angular velocities and RMS amplitude of the sit ski foot (p < 0.05). Joint synergies were developed through in- or anti-phase movements between joint pairs, particularly involving the hip joints (continuous relative phase angles ~0° or 180°, p < 0.001). Multi-joint coordination shifted from large-RMS amplitude of elbows to low-MPF large-RMS amplitude of the hip and shoulders (p < 0.05), with a significant increase of hip weighting (77.61%, p = 0.031) in the principal component analysis. The coordination was maintained with the change of slackline tension (p < 0.05). Athletes with severe trunk disabilities (LW10) had shorter balance time and poorer coordination than athletes with full trunk functions (LW12).

CONCLUSIONS

Our findings showed the development of joint coordination involving better control of the hip and sit skis during the challenging slackline training task.

The optimal method for improving postural balance in healthy young and older people: specific training for postural tasks encountered in personal physical practice

It is well known that regular exercise or physical activity (training) improves postural balance in healthy young and older subjects, but the optimal exercise or physical activity (i.e., likely to induce the greatest postural improvements) and the context in which it is carried out remain to be explored and determined for each population. The most beneficial adaptations would depend, in particular, on gestural conditions (body position, movement and gesture practiced) and material conditions (nature of the ground surface, sports equipment used, type of environment - stable or changing). In fact, the global postural adaptations induced by training do not result from the transfer between different trained and untrained postural tasks, but are the sum of the adaptations related to each trained postural task in healthy young and older subjects. Based on current knowledge, optimal training programs should include the full range of postural tasks encountered in personal physical practice for each population. To date, the method of implementing progressive postural balance tasks with different degrees of difficulty and instability has been used as the effective method to improve postural balance, but it should not be considered as the reference method. Instead, it should be considered as a complementary method to the one based on specific postural tasks. An intervention strategy is proposed for young and older adults consisting of three different steps (general, oriented and specific/ecologic training). However, some parameters still need to be explored and possibly reconsidered in future studies to improve postural balance in an optimal way.

Practice walking on a treadmill-mounted balance beam modifies beam walking sacral movement and alters performance in other balance tasks

The goals of this study were to determine if a single 30-minute session of practice walking on a treadmill mounted balance beam: 1) altered sacral marker movement kinematics during beam walking, and 2) affected measures of balance during treadmill walking and standing balance. Two groups of young, healthy human subjects practiced walking on a treadmill mounted balance beam for thirty minutes. One group trained with intermittent visual occlusions and the other group trained with unperturbed vision. We hypothesized that the subjects would show changes in sacrum movement kinematics after training and that there would be group differences due to larger improvements in beam walking performance by the visual occlusions group. We also investigated if there was any balance transfer from training on the beam to treadmill walking (margin of stability) and to standing static balance (center of pressure excursion). We found significant differences in sacral marker maximal velocity after training for both groups, but no significant differences between the two groups from training. There was limited evidence of balance transfer from beam-walking practice to gait margin of stability for treadmill walking and for single leg standing balance, but not for tandem stance balance. The number of step-offs while walking on a narrow beam had the largest change with training (partial η2 = 0.7), in accord with task specificity. Other balance metrics indicative of transfer had lower effect sizes (partial η2<0.5). Given the limited transfer across balance training tasks, future work should examine how intermittent visual occlusions during multi-task training improve real world functional outcomes.

Effects of stochastic resonance whole-body vibration on sensorimotor function in elderly individuals-A systematic review

Introduction

Due to demographic changes, falls are increasingly becoming a focus of health care. It is known that within six months after a fall, two thirds of fallers will fall again. Therefore, therapeutic procedures to improve balance that are simple and can be performed in a short time are needed. Stochastic resonance whole-body vibration (SR-WBV) may be such a procedure.

Method

An electronic search to assess the effectiveness of SR-WBV on balance in the elderly was conducted using databases that included CINAHL Cochrane, PEDro, and PubMed. Included studies were assessed using the Collaboration Risk of Bias Tool by two independent reviewers.

Results

Nine studies showing moderate methodological quality were included. Treatment parameters were heterogeneous. Vibration frequency ranged from 1 to 12 Hz. Six studies found statistically significant improvements of balance from baseline to post measurement after SR-WBV interventions. One article found clinical relevance of the improvement in total time of the "Expanded Time to Get Up and Go Test".

Discussion

Physiological adaptations after balance training are specific and may explain some of the observed heterogeneity. Two out of nine studies assessed reactive balance and both indicated statistically significant improvements after SR-WBV. Therefore, SR-WBV represents a reactive balance training.

A Quantitative Comparison of Slackline Balancing Capabilities of Experts and Beginners

Mechanical stability criteria are able to explain balance and robustness during simple motions, however, humans have learned many complex balancing tasks for which science lacks a thorough understanding. In this work, we analyzed slackline balancing to define general balance performance indicators. The goal is to not only measure slackline expertise, but to be able to quantify stability during any balance task. For this, we compared beginners that had never balanced on a slackline before to professional slackline athletes. Further, all participants performed a static balance test, based on which we divided beginners into a balance-experienced and a balance-inexperienced group. On average, the balance experienced group was able to balance twice as long on the slackline and therefore, we showed that this static balance experience is a predictor of slackline balance performance. Based on over 300 balancing trials on the slackline of 20 participants, we then defined and evaluated over 30 balance metrics. The parameters can be grouped into quantification of stability and recovery movements, balance specific skills and balance strategies. We found that normalized angular momentum and center of mass acceleration are measures for overall stability, with lower values representing better stability and fewer recovery movements. We showed that improved hand coordination and adjusted stance leg compliance are valuable skills for balance tasks. especially when controlling external forces. Looking at posture and movement strategies, we found that professional slackliners have adapted a different mean pose with larger inertia and an upright head position, when compared to beginners.

Slacklining: A narrative review on the origins, neuromechanical models and therapeutic use

Slacklining, the neuromechanical action of balance retention on a tightened band, is achieved through self-learned strategies combining dynamic stability with optimal energy expenditure. Published slacklining literature is recent and limited, including for neuromechanical control strategy models. This paper explores slacklining's definitions and origins to provide background that facilitates understanding its evolution and progressive incorporation into both prehabilitation and rehabilitation. Existing explanatory slacklining models are considered, their application to balance and stability, and knowledge-gaps highlighted. Current slacklining models predominantly derive from human quiet-standing and frontal plane movement on stable surfaces. These provide a multi-tiered context of the unique and complex neuro-motoric requirements for slacklining's multiple applications, but are not sufficiently comprehensive. This consequently leaves an incomplete understanding of how slacklining is achieved, in relation to multi-directional instability and complex multi-dimensional human movement and behavior. This paper highlights the knowledge-gaps and sets a foundation for the required explanatory control mechanisms that evolve and expand a more detailed model of multi-dimensional slacklining and human functional movement. Such a model facilitates a more complete understanding of existing performance and rehabilitation applications that opens the potential for future applications into broader areas of movement in diverse fields including prostheses, automation and machine-learning related to movement phenotypes.

Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition

Low back pain (LBP) represents the most prevalent, problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns. LBP is a heterogeneous condition with multiple diagnoses and causes. In the absence of consensus definitions, partly because of terminology inconsistency, it is further referred to as non-specific LBP (NSLBP). In NSLBP patients, the lumbar multifidus (MF), a key stabilizing muscle, has a depleted role due to recognized myocellular lipid infiltration and wasting, with the potential primary cause hypothesized as arthrogenic muscle inhibition (AMI). This link between AMI and NSLBP continues to gain increasing recognition. To date there is no 'gold standard' or consensus treatment to alleviate symptoms and disability due to NSLBP, though the advocated interventions are numerous, with marked variations in costs and levels of supportive evidence. However, there is consensus that NSLBP management be cost-effective, self-administered, educational, exercise-based, and use multi-modal and multi-disciplinary approaches. An adjuvant therapy fulfilling these consensus criteria is 'slacklining', within an overall rehabilitation program. Slacklining, the neuromechanical action of balance retention on a tightened band, induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control. Though several models have been proposed, understanding slacklining's neuro-motor mechanism of action remains incomplete. Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints, particularly the knee, and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI (MF-AMI). Therefore, this paper aims to: rationalize why and how adjuvant, slacklining therapeutic exercise may positively affect patients with NSLBP, due to MF-AMI induced depletion of spinal stabilization; considers current understandings and interventions for NSLBP, including the contributing role of MF-AMI; and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action. This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency, present due to AMI. This subsequently allows neuroplasticity, normal neuro-motor sequencing and muscle re-activation, which facilitates innate advantageous spinal stabilization. This in-turn addresses and reduces NSLBP, its concurrent symptoms and functional disability. This process is hypothesized to occur through four neuro-physiological processing pathways: finite neural delay; movement-control phenotypes; inhibition of action and the innate primordial imperative; and accentuated corticospinal drive. Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.

Task-Related Hemodynamic Response Alterations During Slacklining: An fNIRS Study in Advanced Slackliners

The ability to maintain balance is based on various processes of motor control in complex neural networks of subcortical and cortical brain structures. However, knowledge on brain processing during the execution of whole-body balance tasks is still limited. In the present study, we investigated brain activity during slacklining, a task with a high demand on balance capabilities, which is frequently used as supplementary training in various sports disciplines as well as for lower extremity prevention and rehabilitation purposes in clinical settings. We assessed hemodynamic response alterations in sensorimotor brain areas using functional near-infrared spectroscopy (fNIRS) during standing (ST) and walking (WA) on a slackline in 16 advanced slackliners. We expected to observe task-related differences between both conditions as well as associations between cortical activity and slacklining experience. While our results revealed hemodynamic response alterations in sensorimotor brain regions such as primary motor cortex (M1), premotor cortex (PMC), and supplementary motor cortex (SMA) during both conditions, we did not observe differential effects between ST and WA nor associations between cortical activity and slacklining experience. In summary, these findings provide novel insights into brain processing during a whole-body balance task and its relation to balance expertise. As maintaining balance is considered an important prerequisite in daily life and crucial in the context of prevention and rehabilitation, future studies should extend these findings by quantifying brain processing during task execution on a whole-brain level.

Slackline Training in Children with Spastic Cerebral Palsy: A Randomized Clinical Trial

Objective: To assess whether a slackline intervention program improves postural control in children/adolescents with spastic cerebral palsy (CP). Design: Randomized controlled trial. Setting: Patients’ association. Participants: Twenty-seven children/adolescents with spastic CP (9–16 years) were randomly assigned to a slackline intervention (n = 14, 13 ± 3 years) or control group (n = 13, 12 ± 2 years). Intervention: Three slackline sessions per week (30 min/session) for 6 weeks. Main outcome measures: The primary outcome was static posturography (center of pressure—CoP—parameters). The secondary outcomes were surface myoelectrical activity of the lower-limb muscles during the posturography test and jump performance (countermovement jump test and Abalakov test). Overall (RPE, >6–20 scale) rating of perceived exertion was recorded at the end of each intervention session. Results: The intervention was perceived as “very light” (RPE = 7.6 ± 0.6). The intervention yielded significant benefits on static posturography (a significant group by time interaction on Xspeed, p = 0.006) and jump performance (a significant group by time interaction on Abalakov test, p = 0.015). Conclusions: Slackline training improved static postural control and motor skills and was perceived as non-fatiguing in children/adolescents with spastic CP.

Asymmetric interlateral transfer of motor learning in unipedal dynamic balance

Interlateral transfer of learning between the legs in body balance training is a topic of theoretical and practical interest, but it has been left untouched in previous research. In this investigation, we aimed to evaluate the magnitude and asymmetry of interlateral transfer of balance stability following the practice of a challenging task of unipedal support on an unstable base. Thirty participants (18-30 years old) were assigned to two groups practicing either with the right or the left leg. Training consisted of a single practice session of unipedal balance on a platform free to sway in the anteroposterior direction. Balance time (off ground) of either leg in 10-s trials was compared across pre-test, post-test, and 7-day retention. Post-test indicated that both groups had similar performance gains with the trained leg, and equivalent transfer to the transfer leg. Analysis of retention indicated further balance improvement with both transfer legs, while practice with the right leg led to the superior transfer to the untrained leg as compared to the opposite transfer direction. These results suggest that persistent transfer of learning effects for unipedal dynamic balance is bilateral but more prominent in the right-to-left direction.

Effects of Slackline Training on Acceleration, Agility, Jump Performance and Postural Control in Youth Soccer Players

The goal of this study was to assess the effects of a supervised slackline training program in a group of soccer players. Thirty-four male division I under-19 players (16.64 ± 0.81 years) agreed to participate in the study. They were randomly divided into an experimental group (EG) and a control group (CG). The first group (EG) followed a 6-week supervised slackline training program (3 sessions/week; 5-9 min/session), while the CG performed only regular soccer training. Several variables were assessed in all participants: acceleration (20-m sprint test), agility (90º turns test), jump performance (squat jump, countermovement jump), and postural control (Center of Pressure ( CoP) testing: length, area, speed, Xmean, Ymean, Xspeed, Yspeed, Xdeviation, Ydeviation). Ratings of perceived exertion and local muscle ratings of perceived exertions were also recorded after each slackline training session. At post-tests, there was a significant increase only in the EG in acceleration, agility, squat jump and countermovement jump performance, as well as several CoP variables: area in the bipedal support on a firm surface, and length, area and speed in the left leg on a firm surface. The program was rated as “somewhat hard” by the players, while quadriceps, gastrocnemius and tibialis anterior were the most exerted muscles while slacklining. In conclusion, slackline training can be an effective training tool for young, high-level soccer players.

Effects of Exercise Training on Handgrip Strength in Older Adults: A Meta-Analytical Review

BACKGROUND

Handgrip strength measurements are feasible with older adults and a reliable indicator for vitality, physical function, and several risk factors in the ageing process. Interventions with exercise training induce a variety of strength, balance, and endurance improvements. The pooled transfer effects of exercise training on handgrip strength has not been investigated to date. Thus, the objective of this meta-analytical review is to examine the effects of different exercise training on handgrip strength in healthy community-dwelling older adults of 60 years or older.

METHODS

The literature search was conducted in three databases (PubMed, Web of Science, SPORTDiscus) using the following search terms with Boolean conjunctions: (hand grip* OR grip strength OR grip power) AND (sport* OR train* OR exercis* OR strength OR intervention OR endurance OR resistance OR balance OR aerob*) AND (old* OR elder* OR senior*). Non-randomized and randomized controlled trials with an exercise training and handgrip strength as the outcome parameter were screened. Study quality was independently assessed by two researchers using the PEDro scale. Comparison of handgrip strength between the intervention and control groups was conducted by using the hedges g (including adjustment for small sample sizes), calculating standardized mean differences (SMDs). A random effects inverse-variance model was applied for statistical analysis.

RESULTS

Twenty-four trials (mean PEDro score 5.8 ± 0.9) with a total of 3,018 participants (mean age 73.3 ± 6.0 years) were included. Small but significant effects (p < 0.001) on handgrip strength were observed (SMD 0.28, 95% CI 0.13-0.44). Study heterogeneity (I2 56%) and the funnel shape for publication bias analyses were acceptable.

CONCLUSIONS

Meaningful but small transfer effects of a multitude of different training approaches on handgrip strength occurred in healthy community-dwelling older adults. Handgrip strength cannot clearly be recommended to assess general functional performance for all kinds of exercise programs, whereas task-specific training and multimodal training modes seem to provide an appropriate stimulus to also improve handgrip strength.

Validity and Reliability of a Novel Integrative Motor Performance Testing Course for Seniors: The "Agility Challenge for the Elderly (ACE)"

Background: Assessing traditional neuromuscular fall risk factors (i.e., balance, gait, strength) in the elderly has so far mainly been done independently. Functional and integrative testing approaches are scarce. The present study proposes an agility course for an integrative assessment of neuromuscular and also cardiocirculatory capacity in seniors – and tests its criterion validity and reliability.

Methods: Thirty-six seniors (age: 69.0 ± 2.8 years; BMI: 25.4 ± 3.5 kg/m²; sex: 19 males/17 females; weekly physical activity: 9.4 ± 5.5 h) participated. They completed four trials of the Agility Challenge for the Elderly (ACE)-course in two sessions separated by 1 week. The course consists of three segments focusing on different agility aspects. Cardiovascular capacity was assessed by 6-min walk test (6MWT), neuromuscular capacity by static, dynamic and perturbed standing balance tasks, habitual gait speed assessment, and rate of torque development testing. Parameters’ predictive strength for the ACE performance was assessed by regression analysis. Reliability was calculated with intraclass correlation coefficients and coefficients of variation.

Results: Men completed the course in 43.0 ± 5.7 s and women in 51.9 ± 4.0 s. Overall and split times were explained by 6MWT time (ηp2 = 0.38–0.44), gait speed (ηp2 = 0.29–0.43), and to a lesser extent trunk rotation explosive strength (ηp2 = 0.05–0.12). Static and dynamic balance as well as plantar flexion strength explained the performance in some segments to a very small extent (ηp2 = 0.06–0.08). Good between- and within-day reliability were observed for total course and split times: The ICC for the between-day comparison was 0.93 (0.88–0.96) and ranged between 0.84 and 0.94 for split times. The within-day ICC was 0.94 (0.91–0.97) for overall time and 0.92–0.97 for split times. Coefficients of variation were smaller than 5.7% for within and between day analyses.

Conclusion: The ACE course reflects cardiocirculatory and neuromuscular capacity, with the three ACE segments potentially reflecting slightly different domains of neuromuscular (static and dynamic balance, ankle, and trunk strength) performance, whereas cardiocirculatory fitness and gait speed contribute to all segments. Our test can detect changes in overall performance greater than 5.7% and can thus be useful for documenting changes due to interventions in seniors.

Three months of slackline training elicit only task-specific improvements in balance performance

Slackline training is a challenging and motivating type of balance training, with potential usefulness for fall prevention and balance rehabilitation. However, short-term slackline training seems to elicit mostly task-specific performance improvements, reducing its potential for general fall prevention programs. It was tested whether a longer duration slackline training (three months, 2 sessions per week) would induce a transfer to untrained tasks. Balance performance was tested pre and post slackline training on the slackline used during the training, on a slackline with different slack, and in 5 different non-trained static and dynamic balance tasks (N training = 12, N control = 14). After the training, the training group increased their performance more than the control group in both of the slackline tasks, i.e. walking on the slackline (time × group interaction with p < 0.001 for both tasks). However, no differences between groups were found for the 5 non-trained balance tasks, only a main effect of time for four of them. The long-term slackline training elicited large task-specific performance improvements but no transfer to other non-trained balance tasks. The extensive slackline training that clearly enhanced slackline performance did not improve the capability to keep balance in other tasks and thus cannot be recommended as a general fall prevention program. The significant test-retest effect seen in most of the tested tasks emphasizes the need of a control group to adequately interpret changes in performance following balance training.

Effects of the Application of a Program of Adapted Utilitarian Judo (JUA) on the Fear of Falling Syndrome (FOF) for the Health Sustainability of the Elderly Population

This research analyzes the fall history of a group of elderly people and studies the effects of an intervention program based on Adapted Utilitarian Judo (JUA) to teach fall control in subjects with fear of falling syndrome (FOF). We adopted a quasi-experimental research design with pre-post measurement of the experimental group, in a healthy, pre-fragile sample of 12 women aged 71.5 ± 8 years, chosen using non-probabilistic-incidental accessibility sampling. The WHO questionnaire was used for the functional assessment of the fall. To evaluate FOF, we applied the 16-item version of the Falls Efficacy Scale-International (FES-I), (pretest and posttest). This intervention program was based on Adapted Utilitarian Judo and conducted over 8 weeks, with two 60-minute sessions each week. After analyzing the scores obtained by the subjects in the pre and post FES-I, we found that the intervention with the JUA program had been significant for the experimental group with p ≤ 0.004, and there was an 11.9% decrease in the fear of falling (FES-I pos = 18.17). The results show that after the application of the JUA program there were significant improvements in subjects’ perception of FOF, with this being greater in those who had the highest levels of fear of falling before the intervention.

Short-term slackline training improves task-specific but not general balance in female handball players

Slackline training has been shown to improve balance and neuromuscular performance. However, recent studies suggested that balance is task-specific, implying that transferability of balance skills is limited and might depend on the similarity of the tasks. This study therefore investigated if short-term slackline training could improve performance in balance tasks that are either more or less similar to the trained slackline task. Furthermore, we assessed potential transfer effects to other neuromuscular performance tests. 25 female handball players (23.7 ± 3.9 years) participated in our study and were matched to either a slackline training (SLT; n = 14) or a control group (CON; n = 11). The intervention comprised 12 sessions with overall 120 minutes of slackline training using single and double slacklines. Slackline standing time and measures of dynamic and static balance were assessed before and after the intervention, as well as power and sprint-related performance parameters. Two-way repeated-measures ANOVA found a significant group × time interaction for slackline standing time, indicating larger training effects for SLT. For the remaining dynamic and static balance tests, no significant interactions were found. With regard to neuromuscular performance, there was a significant group × time interaction only in change of direction. In essence, the study showed that slackline training induced task-specific balance improvements without affecting general balance. This adds further evidence to the task-specificity principle of balance, although the specificity of the sample as well as the briefness of the intervention should be taken into account when generalizing our findings. Nonetheless, this study contains practical implications for team sports interventions and future balance training studies, highlighting the importance of selecting appropriate balance exercises to yield rapid and the desired training outcomes.

Postural control of Parkour athletes compared to recreationally active subjects under different sensory manipulations: A pilot study

In Parkour activity, the aim is to move from one place to another as quickly and efficiently as possible by running, climbing, swinging, vaulting, rolling, crawling and jumping on tiny obstacles … . Performing these actions places a great demand on the postural control system. The purpose of the present study was to investigate postural control of Parkour practitioners - called Traceurs - compared to recreationally active (RA) subjects in different postural conditions after manipulating the visual and/or proprioceptive sensory inputs. Ten Traceurs (mean experience 5.9 ± 0.9 years; >5 hours per week) and 10 RA subjects participated in this study. We measured the centre of pressure area (CoP_A) of the upright standing bipedal and unipedal postures in different postural conditions: on a firm and on a foam surfaces; on an oscillating surface in the sagittal plane and in the frontal plane in eyes open and eyes closed. To evaluate vision contribution, the Romberg index (RI) was calculated. Results showed that Traceurs presented a significant (P < .001) lower CoP_A values compared to RA subjects in eyes closed condition, suggesting that they were able to maintain a better balance control when vision is removed. Traceurs seems to be less dependent on visual cues (lower RI values) and proprioceptive inputs for maintaining balance than RA subjects. According to our study, Parkour training (experience for at least five years with a minimum of five hours per week) may improve postural abilities of young adult practitioners in specific postural conditions.

Adapted Utilitarian Judo: The Adaptation of a Traditional Martial Art as a Program for the Improvement of the Quality of Life in Older Adult Populations

This article reports on the Adapted Utilitarian Judo project. The use of the foundations and technical elements of traditional Judo, adapted and contextualised to the requirements of the older adult population, orienting the activity toward the field of health and the improvement of the quality of life of the older adult. Its mission is to facilitate maintaining and improving the functionality and autonomy of this population, with respect to the performance of the basic and instrumental activities of daily life. At the same it seeks to achieve this while maintaining the essence of the values that are inherent to the practice of Judo as a traditional martial art. It is argued that Judo, once adapted to focus on a utilitarian function, not only allows to actively influence aspects such as maintaining the physical qualities of the elderly but also fosters other key elements for active and healthy ageing by participating in an ongoing group activity, such as socialisation and self-esteem. More specifically, the paper presents how adapted Judo represents an innovation in the treatment of a risk factor associated with aging: the active prevention of falls. We conclude that Adapted Utilitarian Judo (JUA) is both a timely and relevant as a social and educational tool of great value, responds to propos called for by the international scientific community for programs aimed at improving the health and quality of life of the older adult population, especially in Europe, that is ageing at a fast pace.

Slackline Training (Balancing Over Narrow Nylon Ribbons) and Balance Performance: A Meta-Analytical Review

BACKGROUND

Adequate static and dynamic balance performance is an important prerequisite during daily and sporting life. Various traditional and innovative balance training concepts have been suggested to improve postural control or neuromuscular fall risk profiles over recent years. Whether slackline training (balancing over narrow nylon ribbons) serves as an appropriate training strategy to improve static and dynamic balance performance is as yet unclear.

OBJECTIVE

The aim was to examine the occurrence and magnitude of effects of slackline training compared with an inactive control condition on static and dynamic balance performance parameters in children, adults and seniors.

DATA SOURCES

Five biomedical and psychological databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus) were screened using the following search terms with Boolean conjunctions: (slacklin* OR slack-lin* OR tight rop* OR tightrop* OR Slackline-based OR line-based OR slackrop* OR slack-rop* OR floppy wir* OR rop* balanc* OR ropedanc* OR rope-danc*) STUDY SELECTION: Randomized and non-randomized controlled trials that applied slackline training as an exercise intervention compared with an inactive control condition focusing on static and dynamic balance performance (perturbed and non-perturbed single leg stance) in healthy children, adults and seniors were screened for eligibility.

DATA EXTRACTION

Eligibility and study quality [Physiotherapy Evidence Database (PEDro) scale] were independently assessed by two researchers. Standardized mean differences (SMDs) calculated as weighted Hedges' g served as main outcomes in order to compare slackline training versus inactive control on slackline standing as well as dynamic and static balance performance parameters. Statistical analyses were conducted using a random-effects, inverse-variance model.

RESULTS

Eight trials (mean PEDro score 6.5 ± 0.9) with 204 healthy participants were included. Of the included subjects, 35 % were children or adolescents, 39 % were adults and 26 % were seniors. Slackline training varied from 4 to 6 weeks with 16 ± 7 training sessions on average, ranging from 8 to 28 sessions. Mean overall slackline training covered 380 ± 128 min. Very large task-specific effects in favor of slackline training compared with the inactive control condition were found for slackline standing time {SMD 4.63 [95 % confidence interval (CI) 3.67-5.59], p < 0.001}. Small and moderate pooled transfer effects were observed for dynamic [SMD 0.52 (95 % CI 0.08-0.96), p = 0.02] and static [SMD 0.30 (95 % CI -0.03 to 0.64), p = 0.07] standing balance performance, respectively.

CONCLUSIONS

Slackline training mainly revealed meaningful task-specific training effects in balance performance tasks that are closely related to the training content, such as slackline standing time and dynamic standing balance. Transfer effects to static and dynamic standing balance performance tasks are limited. As a consequence, slackline devices should be embedded into a challenging and multimodal balance training program and not used as the sole form of training.

Is Young Age a Limiting Factor When Training Balance? Effects of Child-Oriented Balance Training in Children and Adolescents

PURPOSE

Balance training (BT) studies in children reported conflicting results without evidence for improvements in children under the age of 8. The aim of this study therefore was to compare BT adaptations in children of different age groups to clarify whether young age prevents positive training outcomes.

METHODS

The effects of 5 weeks of child-oriented BT were tested in 77 (38 girls and 39 boys) participants of different age groups (6-7 y, 11-12 y, and 14-15 y) and compared with age-matched controls. Static and dynamic postural control, explosive strength, and jump height were assessed.

RESULTS

Across age groups, dynamic postural sway decreased (-18.7%; P = .012; [Formula: see text]) and explosive force increased (8.6%; P = .040; [Formula: see text]) in the intervention groups. Age-specific improvements were observed in dynamic postural sway, with greatest effects in the youngest group (-28.8%; P = .026; r = .61).

CONCLUSION

In contrast to previous research using adult-oriented balance exercises, this study demonstrated for the first time that postural control can be trained from as early as the age of 6 years in children when using child-oriented BT. Therefore, the conception of the training seems to be essential in improving balance skills in young children.

Changes in balance coordination and transfer to an unlearned balance task after slackline training: a self-organizing map analysis

How humans maintain balance and change postural control due to age, injury, immobility or training is one of the basic questions in motor control. One of the problems in understanding postural control is the large set of degrees of freedom in the human motor system. Therefore, a self-organizing map (SOM), a type of artificial neural network, was used in the present study to extract and visualize information about high-dimensional balance strategies before and after a 6-week slackline training intervention. Thirteen subjects performed a flamingo and slackline balance task before and after the training while full body kinematics were measured. Range of motion, velocity and frequency of the center of mass and joint angles from the pelvis, trunk and lower leg (45 variables) were calculated and subsequently analyzed with an SOM. Subjects increased their standing time significantly on the flamingo (average +2.93 s, Cohen's d = 1.04) and slackline (+9.55 s, d = 3.28) tasks, but the effect size was more than three times larger in the slackline. The SOM analysis, followed by a k-means clustering and marginal homogeneity test, showed that the balance coordination pattern was significantly different between pre- and post-test for the slackline task only (χ ² = 82.247; p < 0.001). The shift in balance coordination on the slackline could be characterized by an increase in range of motion and a decrease in velocity and frequency in nearly all degrees of freedom simultaneously. The observation of low transfer of coordination strategies to the flamingo task adds further evidence for the task-specificity principle of balance training, meaning that slackline training alone will be insufficient to increase postural control in other challenging situations.

Could Slackline Training Complement the FIFA 11+ Programme Regarding Training of Neuromuscular Control?

The current study compared changes in neuromuscular control between slackline training and the stabilization training elements of the FIFA 11+ programme. Twenty-five students in 2 groups performed a 12-unit training programme. The slackline training group (n = 13) exclusively trained with a slackline. The stabilization training group (n = 12) practised exercises as described in the second part of the FIFA 11+ programme. Improvements in balance were assessed using three tests for dynamic, quasi-static, and perturbed postural control: the star excursion balance test (SEBT), the closed-eye single-leg stance, and the MFT S3-Check. Both groups significantly improved the stability and sensorimotor index of the MFT S3-Check (p < .001), their range on the SEBT (p < .001), and the duration of closed-eye single-leg stance (p < .001). The group × training interaction was significant for the MFT S3-Check (stability index: p = .042; sensorimotor index: p = .004) and the SEBT (dominant leg: p = .003; averaged both legs: p = .016), with the slackline training group showing a larger training effect than the stabilization training group. The results of the present study suggest that slackline training offers similar - or better - improvements in neuromuscular control as the FIFA 11+ warm-up programme. If compliance with the FIFA 11+ programme is declining, then slacklining might offer an alternative approach to reach the training goals of improved sensorimotor control.

Immediate effect of subliminal priming with positive reward stimuli on standing balance in healthy individuals: A randomized controlled trial

BACKGROUND

Information received subconsciously can influence exercise performance; however, it remains unclear whether subliminal or supraliminal reward is more effective in improving standing balance ability when priming stimuli are subconsciously delivered. The present study aimed to compare the effects of subliminal priming-plus-subliminal reward stimuli (experimental) with subliminal priming-plus-supraliminal reward stimuli (control) on standing balance ability.

METHODS

This was a single-blind (outcome assessor), parallel-group, randomized controlled trial involving healthy young adults recruited from a university in Japan. Assessments were conducted at baseline and immediately after intervention. The primary outcome was the functional reach test (FRT) measurement. The secondary outcome was one-leg standing time (OLST) with eyes closed. Of the 52 participants screened, 25 were randomly assigned to experimental and control groups each.

RESULTS

Both interventions were effective for improving the FRT between the baseline and intervention; however, smaller improvements were observed in the experimental group. We found a large between-groups effect size immediately after the intervention for the FRT (d = -0.92). In contrast, there were no differences in improvements in OLST between the 2 groups (d = -0.06); furthermore, neither intervention was found to be effective for this parameter.

CONCLUSION

We concluded that subliminal priming with conscious reward stimuli results in improvements in immediate-term forward reach ability, which is superior to that achieved by subliminal priming with subconscious reward stimuli.

Traditional balance and slackline training are associated with task-specific adaptations as assessed with sensorimotor tests

The purpose of this study was to measure alterations in sensorimotor skills and balance resulting from slackline training and conventional balance training. Forty-three physically fit subjects were randomized into three groups. Two groups practiced three times a week for 15 minutes, including at least once supervised session, on the slackline or perform conventional balance training for 6 weeks. The control group was not allowed to perform any balance training. Before and after the intervention, the subjects underwent sensorimotor and strength tests. The results of our intra-class correlation analysis showed that the stability parameters from the multifunctional training device (MFT, 0.7), the height during the countermovement jump (CMJ, 0.95) and the maximum force (0.88) during leg press showed excellent reliability. A post hoc comparison indicated a larger effect of conventional training (almost 11% reduction in MFT stability) compared with slackline training in group-wide comparisons of the pre- to the post-training measurements. The factor analysis showed that stability and sensorimotor assessment using MFT were correlated, as were height during CMJ and maximal force during leg press, which represented dynamic strength. Because CMJ had the highest intra-class correlation value, it was chosen over maximum force from leg press. For these reasons, only two out of nine measured parameters, namely MFT stability and CMJ, were analysed across groups. The only observed difference between the two groups was MFT stability (slackline - 1.5%, conventional - 13%), whereas the improvement of CMJ was the same (slackline + 3%, conventional + 3%). It can be concluded that slacklining is partly complementary to conventional sensorimotor training.

Effects of Virtual Reality Training (Exergaming) Compared to Alternative Exercise Training and Passive Control on Standing Balance and Functional Mobility in Healthy Community-Dwelling Seniors: A Meta-Analytical Review

BACKGROUND

Balance training is considered an important means to decrease fall rates in seniors. Whether virtual reality training (VRT) might serve as an appropriate treatment strategy to improve neuromuscular fall risk parameters in comparison to alternative balance training programs (AT) is as yet unclear.

OBJECTIVE

To examine and classify the effects of VRT on fall-risk relevant balance performance and functional mobility compared to AT and an inactive control condition (CON) in healthy seniors.

DATA SOURCES

The literature search was conducted in five databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus). The following search terms were used with Boolean conjunction: (exergam* OR exer-gam* OR videogam* OR video-gam* OR video-based OR computer-based OR Wii OR Nintendo OR X-box OR Kinect OR play-station OR playstation OR virtua* realit* OR dance dance revolution) AND (sport* OR train* OR exercis* OR intervent* OR balanc* OR strength OR coordina* OR motor control OR postur* OR power OR physical* OR activit* OR health* OR fall* risk OR prevent*) AND (old* OR elder* OR senior*).

STUDY SELECTION

Randomized and non-randomized controlled trials applying VRT as interventions focusing on improving standing balance performance (single and double leg stance with closed and open eyes, functional reach test) and functional mobility (Berg balance scale, Timed-up and go test, Tinetti test) in healthy community-dwelling seniors of at least 60 years of age were screened for eligibility.

DATA EXTRACTION

Eligibility and study quality (PEDro scale) were independently assessed by two researchers. Standardized mean differences (SMDs) served as main outcomes for the comparisons of VRT versus CON and VRT versus AT on balance performance and functional mobility indices. Statistical analyses were conducted using a random effects inverse-variance model.

RESULTS

Eighteen trials (mean PEDro score: 6 ± 2) with 619 healthy community dwellers were included. The mean age of participants was 76 ± 5 years. Meaningful effects in favor of VRT compared to CON were found for balance performance [p < 0.001, SMD: 0.77 (95 % CI 0.45-1.09)] and functional mobility [p = 0.004, SMD: 0.56 (95 % CI 0.25-0.78)]. Small overall effects in favor of AT compared to VRT were found for standing balance performance [p = 0.31, SMD: -0.35 (95 % CI -1.03 to 0.32)] and functional mobility [p = 0.05, SMD: -0.44 (95 % CI: -0.87 to 0.00)]. Sensitivity analyses between "weaker" (n = 9, PEDro ≤5) and "stronger" (n = 9, PEDro ≥6) studies indicated that weaker studies showed larger effects in favor of VRT compared to CON regarding balance performance (p < 0.001).

CONCLUSIONS

Although slightly less effective than AT, VRT-based balance training is an acceptable method for improving balance performance as well as functional mobility outcomes in healthy community dwellers. VRT might serve as an attractive complementary training approach for the elderly. However, more high-quality research is needed in order to derive valid VRT recommendations compared to both AT and CON.

Improvements in Orientation and Balancing Abilities in Response to One Month of Intensive Slackline-Training. A Randomized Controlled Feasibility Study

Background: Slackline-training has been shown to improve mainly task-specific balancing skills. Non-task specific effects were assessed for tandem stance and preferred one-leg stance on stable and perturbed force platforms with open eyes. It is unclear whether transfer effects exist for other balancing conditions and which component of the balancing ability is affected. Also, it is not known whether slackline-training can improve non-visual-dependent spatial orientation abilities, a function mainly supported by the hippocampus.

Objective: To assess the effect of one-month of slackline-training on different components of balancing ability and its transfer effects on non-visual-dependent spatial orientation abilities.

Materials and Methods: Fifty subjects aged 18–30 were randomly assigned to the training group (T) (n = 25, 23.2 ± 2.5 years; 12 females) and the control group (C) (n = 25, 24.4 ± 2.8 years; 11 females). Professional instructors taught the intervention group to slackline over four consecutive weeks with three 60-min-trainings in each week. Data acquisition was performed (within 2 days) by blinded investigators at the baseline and after the training. Main outcomes Improvement in the score of a 30-item clinical balance test (CBT) developed at our institute (max. score = 90 points) and in the average error distance (in centimeters) in an orientation test (OT), a triangle completion task with walking and wheelchair conditions for 60°, 90°, and 120°.

Results: Training group performed significantly better on the closed-eyes conditions of the CBT (1.6 points, 95% CI: 0.6 to 2.6 points vs. 0.1 points, 95% CI: –1 to 1.1 points; p = 0.011, ηp2 = 0.128) and in the wheelchair (vestibular) condition of the OT (21 cm, 95% CI: 8–34 cm vs. 1 cm, 95% CI: –14–16 cm; p = 0.049, ηp2 = 0.013).

Conclusion: Our results indicate that one month of intensive slackline training is a novel approach for enhancing clinically relevant balancing abilities in conditions with closed eyes as well as for improving the vestibular-dependent spatial orientation capability; both of the benefits are likely caused by positive influence of slackline-training on the vestibular system function.

Exercise-Based Fall Prevention in the Elderly: What About Agility?

Annually, one in three seniors aged over 65 years fall. Balance and strength training can reduce neuromuscular fall risk factors and fall rates. Besides conventional balance and strength training, explosive or high-velocity strength training, eccentric exercises, perturbation-based balance training, trunk strength, and trunk control have also been emphasized. In contrast, aerobic exercise has to date not been included in fall-prevention studies. However, well-developed endurance capacity might attenuate fatigue-induced declines in postural control in sports-related or general activities of daily living. Physical performance indices, such as balance, strength, and endurance, are generally addressed independently in exercise guidelines. This approach seems time consuming and may impede integrative training of sensorimotor, neuromuscular, and cardiocirculatory functions required to deal with balance-threatening situations in the elderly. An agility-based conceptual training framework comprising perception and decision making (e.g., visual scanning, pattern recognition, anticipation) and changes of direction (e.g., sudden starts, stops and turns; reactive control; concentric and eccentric contractions) might enable an integrative neuromuscular, cardiocirculatory, and cognitive training. The present paper aims to provide a scientific sketch of how to build such an integrated modular training approach, allowing adaptation of intensity, complexity, and cognitive challenge of the agility tasks to the participant's capacity. Subsequent research should address the (1) link between agility and fall risk factors as well as fall rates, (2) benefit-risk ratios of the proposed approach, (3) psychosocial aspects of agility training (e.g., motivation), and (4) logistical requirements (e.g., equipment needed).

Effects of supervised slackline training on postural instability, freezing of gait, and falls efficacy in people with Parkinson's disease

PURPOSE

The aim of this study was to assess whether supervised slackline training reduces the risk of falls in people with Parkinson's disease (PD).

METHODS

Twenty-two patients with idiopathic PD were randomized into experimental (EG, N = 11) and control (CG, N = 11) groups. Center of Pressure (CoP), Freezing of Gait (FOG), and Falls Efficacy Scale (FES) were assessed at pre-test, post-test and re-test. Rate perceived exertion (RPE, Borg's 6-20 scale) and local muscle perceived exertion (LRPE) were also assessed at the end of the training sessions.

RESULTS

The EG group showed significant improvements in FOG and FES scores from pre-test to post-test. Both decreased at re-test, though they did not return to pre-test levels. No significant differences were detected in CoP parameters. Analysis of RPE and LRPE scores revealed that slackline was associated with minimal fatigue and involved the major lower limb and lumbar muscles.

CONCLUSIONS

These findings suggest that slacklining is a simple, safe, and challenging training and rehabilitation tool for PD patients. It could be introduced into their physical activity routine to reduce the risk of falls and improve confidence related to fear of falling. Implications for Rehabilitation Individuals with Parkinson's disease (PD) are twice as likely to have falls compared to patients with other neurological conditions. This study support slackline as a simple, safe, and challenging training and rehabilitation tool for people with PD, which reduce their risk of falls and improve confidence related to fear of falling. Slackline in people with PD yields a low tiredness or fatigue impact and involves the major lower limb and lumbar muscles.

Task-specificity of balance training

Despite much research on balance training, it is still unclear whether balance training leads to highly task-specific adaptations or rather non-specific adaptations. Hence, in this study we examined whether balance training increased performance only in the balance task that was trained or also in non-trained tasks. Forty healthy participants (28 m 12 f, 25 ± 4 years, 177 ± 10 cm, 73 ± 14 kg) were assigned to one of two training groups (TGs) or a control group. Both TGs completed six sessions over 2 weeks, only the training device differed. Before and after the training, performance in the trained task as well as in additional untrained tasks was recorded. ANOVAs showed that each TG outperformed the other groups only in the task they had trained (e.g., task trained by TG1: +225% in TG1, only +41% and +30% in TG2 and control, group*time interaction, p<0.001; Untrained task 1: TG1 +48%, TG2 +48%, and control +30%, no significant interaction, p=0.72). In summary, 2 weeks of balance training resulted in highly task-specific effects, no transfer even to very similar tasks was observed. Therefore, we recommend identifying and training exactly those tasks that need improvement, and test the efficacy of training programs using specific tests instead of general tests with limited functional relevance.