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Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis.
Sports Med. 2015 Dec; 45(12):1671-92.SM

Abstract

BACKGROUND

It has frequently been reported that balance and lower-extremity muscle strength/power are associated with sports-related and everyday activities. Knowledge about the relationship between balance, strength, and power are important for the identification of at-risk individuals because deficits in these neuromuscular components are associated with an increased risk of sustaining injuries and falls. In addition, this knowledge is of high relevance for the development of specifically tailored health and skill-related exercise programs.

OBJECTIVES

The objectives of this systematic literature review and meta-analysis were to characterize and, if possible, quantify associations between variables of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan.

DATA SOURCES

A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus up to March 2015 to capture all relevant articles.

STUDY ELIGIBILITY CRITERIA

A systematic approach was used to evaluate the 996 articles identified for initial review. Studies were included only if they investigated healthy individuals aged ≥6 years and tested at least one measure of static steady-state balance (e.g., center of pressure [CoP] displacement during one-legged stance), dynamic steady-state balance (e.g., gait speed), proactive balance (e.g., distance in the functional-reach-test), or reactive balance (e.g., CoP displacement during perturbed one-legged stance), and one measure of maximal strength (e.g., maximum voluntary contraction), explosive force (e.g., rate of force development), or muscle power (e.g., jump height). In total, 37 studies met the inclusionary criteria for review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The included studies were coded for the following criteria: age (i.e., children: 6-12 years, adolescents: 13-18 years, young adults: 19-44 years, middle-aged adults: 45-64 years, old adults: ≥65 years), sex (i.e., female, male), and test modality/outcome (i.e., test for the assessment of balance, strength, and power). Studies with athletes, patients, and/or people with diseases were excluded. Pearson's correlation coefficients were extracted, transformed (i.e., Fisher's z-transformed r z value), aggregated (i.e., weighted mean r z value), back-transformed to r values, classified according to their magnitude (i.e., small: r ≤ 0.69, medium: r ≤ 0.89, large: r ≥ 0.90), and, if possible, statistically compared. Heterogeneity between studies was assessed using I2 and Chi-squared (χ2) statistics.

RESULTS

Three studies examined associations between balance and lower-extremity muscle strength/power in children, one study in adolescents, nine studies in young adults, three studies in middle-aged adults, and 23 studies in old adults. Overall, small-sized associations were found between variables of balance and lower-extremity muscle strength/power, irrespective of the age group considered. In addition, small-sized but significantly larger correlation coefficients were found between measures of dynamic steady-state balance and maximal strength in children (r = 0.57) compared with young (r = 0.09, z = 3.30, p = 0.001) and old adults (r = 0.35, z = 2.94, p = 0.002) as well as in old compared with young adults (z = 1.95, p = 0.03).

LIMITATIONS

Even though the reported results provided further insight into the associations between measures of balance and lower-extremity muscle strength/power, they did not allow us to deduce cause and effect relations. Further, the investigated associations could be biased by other variables such as joint flexibility, muscle mass, and/or auditory/visual acuity.

CONCLUSIONS

Our systematic review and meta-analysis showed predominately small-sized correlations between measures of balance and lower-extremity muscle strength/power in children, adolescents, and young, middle-aged, and old adults. This indicates that these neuromuscular components are independent of each other and should therefore be tested and trained complementarily across the lifespan. Significantly larger but still small-sized associations were found between measures of dynamic steady-state balance and maximal strength in children compared with young and old adults as well as in old compared with young adults. These findings imply that age/maturation may have an impact on the association of selected components of balance and lower-extremity muscle strength.

Authors+Show Affiliations

Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Am Neuen Palais 10, Building 12, 14469, Potsdam, Germany. tmuehlba@uni-potsdam.de.Albert-Ludwigs-University Freiburg, Institute of Sport and Sport Science, Freiburg, Germany.Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Am Neuen Palais 10, Building 12, 14469, Potsdam, Germany.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

26412212

Citation

Muehlbauer, Thomas, et al. "Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: a Systematic Review and Meta-Analysis." Sports Medicine (Auckland, N.Z.), vol. 45, no. 12, 2015, pp. 1671-92.
Muehlbauer T, Gollhofer A, Granacher U. Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis. Sports Med. 2015;45(12):1671-92.
Muehlbauer, T., Gollhofer, A., & Granacher, U. (2015). Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis. Sports Medicine (Auckland, N.Z.), 45(12), 1671-92. https://doi.org/10.1007/s40279-015-0390-z
Muehlbauer T, Gollhofer A, Granacher U. Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: a Systematic Review and Meta-Analysis. Sports Med. 2015;45(12):1671-92. PubMed PMID: 26412212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis. AU - Muehlbauer,Thomas, AU - Gollhofer,Albert, AU - Granacher,Urs, PY - 2015/9/29/entrez PY - 2015/9/29/pubmed PY - 2016/8/3/medline SP - 1671 EP - 92 JF - Sports medicine (Auckland, N.Z.) JO - Sports Med VL - 45 IS - 12 N2 - BACKGROUND: It has frequently been reported that balance and lower-extremity muscle strength/power are associated with sports-related and everyday activities. Knowledge about the relationship between balance, strength, and power are important for the identification of at-risk individuals because deficits in these neuromuscular components are associated with an increased risk of sustaining injuries and falls. In addition, this knowledge is of high relevance for the development of specifically tailored health and skill-related exercise programs. OBJECTIVES: The objectives of this systematic literature review and meta-analysis were to characterize and, if possible, quantify associations between variables of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan. DATA SOURCES: A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus up to March 2015 to capture all relevant articles. STUDY ELIGIBILITY CRITERIA: A systematic approach was used to evaluate the 996 articles identified for initial review. Studies were included only if they investigated healthy individuals aged ≥6 years and tested at least one measure of static steady-state balance (e.g., center of pressure [CoP] displacement during one-legged stance), dynamic steady-state balance (e.g., gait speed), proactive balance (e.g., distance in the functional-reach-test), or reactive balance (e.g., CoP displacement during perturbed one-legged stance), and one measure of maximal strength (e.g., maximum voluntary contraction), explosive force (e.g., rate of force development), or muscle power (e.g., jump height). In total, 37 studies met the inclusionary criteria for review. STUDY APPRAISAL AND SYNTHESIS METHODS: The included studies were coded for the following criteria: age (i.e., children: 6-12 years, adolescents: 13-18 years, young adults: 19-44 years, middle-aged adults: 45-64 years, old adults: ≥65 years), sex (i.e., female, male), and test modality/outcome (i.e., test for the assessment of balance, strength, and power). Studies with athletes, patients, and/or people with diseases were excluded. Pearson's correlation coefficients were extracted, transformed (i.e., Fisher's z-transformed r z value), aggregated (i.e., weighted mean r z value), back-transformed to r values, classified according to their magnitude (i.e., small: r ≤ 0.69, medium: r ≤ 0.89, large: r ≥ 0.90), and, if possible, statistically compared. Heterogeneity between studies was assessed using I2 and Chi-squared (χ2) statistics. RESULTS: Three studies examined associations between balance and lower-extremity muscle strength/power in children, one study in adolescents, nine studies in young adults, three studies in middle-aged adults, and 23 studies in old adults. Overall, small-sized associations were found between variables of balance and lower-extremity muscle strength/power, irrespective of the age group considered. In addition, small-sized but significantly larger correlation coefficients were found between measures of dynamic steady-state balance and maximal strength in children (r = 0.57) compared with young (r = 0.09, z = 3.30, p = 0.001) and old adults (r = 0.35, z = 2.94, p = 0.002) as well as in old compared with young adults (z = 1.95, p = 0.03). LIMITATIONS: Even though the reported results provided further insight into the associations between measures of balance and lower-extremity muscle strength/power, they did not allow us to deduce cause and effect relations. Further, the investigated associations could be biased by other variables such as joint flexibility, muscle mass, and/or auditory/visual acuity. CONCLUSIONS: Our systematic review and meta-analysis showed predominately small-sized correlations between measures of balance and lower-extremity muscle strength/power in children, adolescents, and young, middle-aged, and old adults. This indicates that these neuromuscular components are independent of each other and should therefore be tested and trained complementarily across the lifespan. Significantly larger but still small-sized associations were found between measures of dynamic steady-state balance and maximal strength in children compared with young and old adults as well as in old compared with young adults. These findings imply that age/maturation may have an impact on the association of selected components of balance and lower-extremity muscle strength. SN - 1179-2035 UR - https://www.unboundmedicine.com/medline/citation/26412212/Associations_Between_Measures_of_Balance_and_Lower_Extremity_Muscle_Strength/Power_in_Healthy_Individuals_Across_the_Lifespan:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://dx.doi.org/10.1007/s40279-015-0390-z DB - PRIME DP - Unbound Medicine ER -