The present systematic review and meta-analysis characterized and quantified associations between measures of balance and lower-extremity muscle strength/power in healthy individuals across the lifespan (≥6 years). |
Irrespective of the investigated age group, our analyses revealed predominately small-sized correlations between measures of balance and lower-extremity muscle strength/power. |
The primarily small-sized correlations between proxies of balance and lower-extremity muscle strength/power indicate that these components are independent of each other (i.e., task-specific) and should therefore be tested and trained complementarily across the lifespan. |
The observed age-related differences in associations between measures of dynamic steady-state balance and maximal strength imply that maturity and biological aging may have an impact on selected components of balance and strength. |
1 Introduction
2 Methods
2.1 Literature Search
2.2 Selection Criteria
2.3 Coding of Studies
2.4 Statistical Analyses
3 Results
3.1 Study Characteristics
Study | No. of subjects; sex; age [years (range or mean ± SD)] | Balance test parameter/outcome | Strength/power test parameter/outcome |
z-transformed r
z
values; explained variance (r
2) |
---|---|---|---|---|
Children (n = 3) | ||||
Granacher and Gollhofer [32] | 30; F (16), M (14); 6–7 | RB: 20-s two-legged stance after perturbation with eyes opened, CoP in ap-/ml-direction sSSB: 20-s two-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: ankle plantarflexor RFD: ankle plantarflexor P: CMJ, height, power | RB-MVC: 0.16, 3 % RB-RFD: 0.19, 4 % RB-P: 0.16, 3 % sSSB-MVC: 0.13, 2 % sSSB-RFD: 0.11, 1 % sSSB-P: 0.15, 2 % |
Ibrahim et al. [33] | 94; M; 6–10 | dSSB: 20-s two-legged stance on Biodex Balance System, overall stability index | MVC: hip flexors/extensors, knee flexors/extensors, ankle dorsiflexors/plantarflexors | dSSB-MVC: 0.95, 55 % |
Muehlbauer et al. [34] | 21; F (8), M (13); 7–10 | dSSB: 10-m walk, speed PB: TUG, time; FRT, distance RB: 10-s two-legged stance after perturbation with eyes opened, SO in ap-/ml-direction sSSB: 30-s two-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: leg extensors P: CMJ, height | dSSB-MVC: 0.28, 7 % dSSB-P: 0.46, 18 % PB-MVC: TUG = 0.42, 16 %; FRT = 0.61, 30 % PB-P: TUG = 0.45, 18 %; FRT = 0.44, 17 % RB-MVC: 0.15, 2 % RB-P: 0.17, 3 % sSSB-MVC: 0.09, 1 % sSSB-P: 0.31, 9 % |
Adolescents (n = 1) | ||||
Granacher and Gollhofer [35] | 28; F (15), M (13); 16–17 | RB: 10-s one-legged stance after perturbation with eyes opened, SO in ap-/ml-direction sSSB: 30-s one-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: leg extensors RFD: leg extensors P: CMJ, force, height | RB-MVC: 0.07, 0 % RB-RFD: 0.09, 1 % RB-P: 0.12, 1 % sSSB-MVC: 0.08, 1 % sSSB-RFD: 0.07, 0 % sSSB-P: 0.11, 1 % |
Young adults (n = 9) | ||||
Izquierdo et al. [37] | 12; M; 21 ± 1 | dSSB: alternating knee raise, total CoP displacement area, length RB: 30-s two-legged stance with eyes opened and to score a target in response to an external signal, time to reach/remain in the target | MVC: leg extensors RFD: leg extensors P: CMJ, height; SJ, height; SLJ, distance | dSSB-MVC: 0.10, 1 % dSSB-RFD: 0.34, 11 % dSSB-P: 0.31, 9 % RB-MVC: 0.25, 6 % RB-RFD: 0.18, 3 % RB-P: 0.30, 8 % |
Katayama et al. [38] | 57; F; 23 ± 2 | sSSB: 30-s two-legged stance with eyes opened/closed; 10-s one-legged stance with eyes opened/closed, total CoP displacement area, length | P: knee flexors/extensors | sSSB-P: 0.29, 8 % |
McCurdy and Langford [39] | 42; F (25), M (17); 22 ± 2 | dSSB: one-legged stance with eyes opened on unstable ground; time sSSB: one-legged stance with eyes opened, time | MVC: 1RM unilateral squat | sSSB-MVC: 0.21, 4 % dSSB-MVC: 0.09, 1 % |
Oshita and Yano [40] | 14; M; 21 ± 1 | sSSB: one-legged stance with eyes closed, time | MVC: ankle plantarflexors | sSSB-MVC: 0.13, 2 % |
Piirainen et al. [42] | 10; M; 27 ± 3 | RB: 30-s two-legged stance following a perturbation impulse with eyes opened, CoP displacements in ap-/ml-direction sSSB: 5-s two-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: knee extensors, ankle plantarflexors RFD: knee extensors, ankle plantarflexors | RB-MVC: NR RB-RFD: 0.27, 7 % sSSB-MVC: NR sSSB-RFD: NR |
Oshita and Yano [41] | 12; M; 21 ± 1 | sSSB: two-legged stance with eyes opened, total CoP displacement velocity | MVC: ankle plantarflexors | sSSB-MVC: 0.33, 10 % |
Hesari et al. [44] | 47; F (24), M (23); 20 ± 4 | PB: star-excursion-balance test | MVC: hip flexors/extensors/abductors/adductors | PB-MVC: 0.29, 8 % |
Muehlbauer et al. [43] | 27; F (19), M (8); 23 ± 4 | RB: 10-s one-legged stance following a perturbation impulse with eyes opened, CoP displacements in ap-/ml-direction sSSB: 30-s one-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: ankle plantarflexors RFD: ankle plantarflexors P: CMJ, height, power | RB-MVC: 0.24, 6 % RB-RFD: 0.30, 8 % RB-P: 0.12, 1 % sSSB-MVC: 0.16, 3 % sSSB-RFD: 0.05, 0 % sSSB-P: 0.09, 1 % |
Teyhen et al. [36] | 64; F (11), M (53); 25 ± 4 | PB: Y-balance test, reach distance | MVC: hip external rotators/abductors P: 6-m timed hop test, time; triple crossover hop test, distance | RB-MVC: NR RB-P: 0.35, 11 % |
Middle-aged adults (n = 3) | ||||
Izquierdo et al. [37] | 10; M; 40 ± 2 | dSSB: alternating knee raise, total CoP displacement area, length RB: 30-s two-legged stance with eyes opened and to score a target in response to an external signal, time to reach/remain in the target | MVC: leg extensors RFD: leg extensors P: CMJ, height; SJ, height; SLJ, distance | dSSB-MVC: 0.09, 1 % dSSB-RFD: 0.30, 8 % dSSB-P: 0.38, 13 % RB-MVC: 0.38, 13 % RB-RFD: 0.77, 42 % RB-P: 0.22, 5 % |
Holviala et al. [46] | 26; F; 53 ± 2 | dSSB: 10-m walk, time | MVC: leg extensors | dSSB-MVC: 0.69, 36 % |
Muehlbauer et al. [45] | 32; F (9), M (23); 56 ± 4 | RB: 10-s one-legged stance following a perturbation impulse with eyes opened, CoP displacements in ap-/ml-direction sSSB: 30-s one-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: ankle plantarflexors RFD: ankle plantarflexors P: CMJ, height, power | RB-MVC: 0.09, 1 % RB-RFD: 0.10, 1 % RB-P: 0.09, 1 % sSSB-MVC: 0.09, 1 % sSSB-RFD: 0.15, 2 % sSSB-P: 0.24, 6 % |
Old adults (n = 23) | ||||
Iverson et al. [47] | 54; M; 60–90 | sSSB: sharpened Romberg test, time; one-legged stance test with eyes opened/closed, time | MVC: hip flexors/extensors/abductors | sSSB-MVC: 0.42, 16 % |
Buchner et al. [48] | 409; F (245), M (164); 60–96 | dSSB: 15.2-m walk, gait speed | MVC: knee extensors/flexors, ankle dorsiflexors/plantarflexors | dSSB-MVC: 0.45, 18 % |
Judge et al. [49] | 26; NR; 79 ± 6 | dSSB: 5-m walk, step length | MVC: knee extensors, ankle plantarflexors | dSSB-MVC: 0.62, 30 % |
Izquierdo et al. [37] | 10; M; 71 ± 5 | dSSB: alternating knee raise, total CoP displacement area, length RB: 30-s two-legged stance with eyes opened and to score a target in response to an external signal, time to reach/remain in the target | MVC: leg extensors RFD: leg extensors P: CMJ, height; SJ, height; SLJ, distance | dSSB-MVC: 0.07, 0 % dSSB-RFD: 0.22, 5 % dSSB-P: 0.42, 16 % RB-MVC: 0.19, 4 % RB-RFD: 0.37, 13 % RB-P: 0.43, 16 % |
Ringsberg et al. [50] | 230; F; 75 | dSSB: 30-m walk, time, cadence RB: 20-s two-legged stance with eyes opened on a moving platform, total CoP displacement length sSSB: one-legged stance, time; 20-s two-legged stance with eyes opened/closed, total CoP displacement length | MVC: knee extensors/flexors, ankle dorsiflexors | dSSB-MVC: 0.34, 11 % RB-MVC: NR sSSB-MVC: 0.19, 4 % |
Burnfield et al. [51] | 81; M; 60–92 | dSSB: 10-m walk, gait speed | MVC: hip extensors/flexors, knee extensors/flexors, ankle dorsiflexors/plantarflexors | dSSB-MVC: 0.55, 25 % |
Suzuki et al. [52] | 34; F; 65–84 | dSSB: 10-m forward/backward tandem walk at habitual/maximal speed, time | MVC: ankle plantarflexors/dorsiflexors P: ankle plantarflexors/dorsiflexors | dSSB-MVC: 0.46, 18 % dSSB-P: 0.47, 19 % |
Menz et al. [53] | 176; F (120), M (56); 62–96 | dSSB: 6-m walk, gait speed PB: alternate step test, time sSSB: two-legged stance with eyes opened, total CoP displacement area, length | MVC: knee extensors, ankle dorsiflexors | dSSB-MVC: 0.64, 32 % PB-MVC: 0.56, 26 % sSSB-MVC: 0.34, 11 % |
Tsang and Hui-Chan [65] | 48; F (24), M (24); 70 ± 5 | sSSB: 30-s two-legged stance with eyes opened, total CoP displacement angle RB: one-legged stance while perturbation with eyes opened, CoP displacement angle | MIT: knee flexors/extensors | sSSB-MIT: 0.07, 0 % RB-MIT: 0.47, 19 % |
Callisaya et al. [64] | 278; F (124), M (154); 60–86 | dSSB: 4.6-m walk, speed, cadence, step length/width sSSB: 30-s two-legged stance with eyes closed/opened, total CoP displacement length | MVC: leg extensors | dSSB-MVC: 0.28, 7 % sSSB-MVC: NR |
Melzer et al. [54] | 43, F (27), M (16);78 ± 6 | PB: LOS test, total CoP displacement length sSSB: 30-s two-legged stance with eyes opened, total CoP displacement area, length, velocity | MVC: ankle dorsiflexors/plantarflexors | PB-MVC: 0.46, 18 % sSSB-MVC: 0.08, 1 % |
Piirainen et al. [42] | 20; M; 64 ± 3 | RB: 30-s two-legged stance while perturbation with eyes opened, CoP displacements in ap-/ml-direction sSSB: 5-s two-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: knee extensors, ankle plantarflexors RFD: knee extensors, ankle plantarflexors | RB-MVC: NR RB-RFD: 0.54, 24 % sSSB-MVC: NR sSSB-RFD: NR |
Bouchard et al. [55] | 1,280, F (645), M (635);68 ± 9 | dSSB: 20-foot walk, gait speed | MVC: leg extensors | dSSB-MVC: 0.24, 6 % |
Shimada et al. [56] | 213; F (130), M (83); 65–96 | dSSB: 6-m walk, time PB: TUG, time sSSB: one-legged stance with eyes opened, time | P: CST, time | dSSB-P: 0.39, 14 % PB-P: 0.41, 15 % sSSB-P: 0.05, 0 % |
Spink et al. [57] | 305; 211 (F), M (94); 65–93 | dSSB: 6-m walk, gait speed PB: alternate step test, time sSSB: two-legged stance with eyes opened, total CoP displacement area, length | MVC: ankle plantarflexors/dorsiflexors/inversors/eversors P: CST, time | dSSB-MVC: 0.22, 5 % dSSB-P: NR PB-MVC: 0.38, 13 % PB-P: NR sSSB-MVC: 0.19, 4 % sSSB-P: NR |
Marcus et al. [58] | 109; F (77), M (32); 74 ± 7 | PB: TUG, time | MVC: knee extensors | PB-MVC: 0.48, 20 % |
Muehlbauer et al. [59] | 24; F (13), M (11); 70 ± 5 | dSSB: 10-m walk, gait speed PB: TUG, time; FRT, distance RB: 10-s two-legged stance following a perturbation impulse with eyes opened, SO in ap-/ml-direction sSSB: 30-s two-legged stance with eyes opened, CoP displacements in ap-/ml-direction | MVC: leg extensors P: CMJ, height, power | dSSB-MVC: 0.03, 0 % dSSB-P: 0.17, 3 % PB-MVC: TUG = 0.10, 1 %; FRT = 0.51, 22 % PB-P: TUG = 0.36, 12 %; FRT = 0.21, 4 % RB-MVC: 0.15, 2 % RB-P: 0.08, 1 % sSSB-MVC: 0.32, 10 % sSSB-P: 0.23, 5 % |
Shin et al. [60] | 72; F (43), M (29); 70 ± 6 | dSSB: 8.3-m walk, stride length/time variability | MVC: leg extensors/flexors, ankle dorsiflexors/plantarflexors | dSSB-MVC: 0.07, 0 % |
Forte et al. [27] | 57; F (33), M (24); 70 ± 3 | dSSB: 10-m walk, gait speed | MVC: knee extensors P: CMJ, power | dSSB-MVC: 0.37, 13 % dSSB-P: 0.35, 11 % |
Miyazaki et al. [61] | 124; M; 73 ± 7 | dSSB: 11-m walk, gait speed PB: TUG, time sSSB: one-legged stance with eyes opened, time | MVC: leg extensors | dSSB-MVC: 0.60, 29 % PB-MVC: 0.69, 36 % sSSB-MVC: 0.59, 28 % |
Forte et al. [26] | 57; F (33), M (24); 65–75 | dSSB: 10-m walk, gait speed sSSB: Romberg test, total CoP displacement length, velocity; two-legged tandem stance test with eyes opened, total CoP displacement length, velocity | MVC: knee extensors P: CMJ, power | dSSB-MVC: 0.28, 7 % dSSB-P: 0.27, 7 % sSSB-MVC: 0.35, 11 % sSSB-P: 0.33, 10 % |
Jenkins et al. [62] | 16; M; 72 ± 7 | PB: FRT, distance | MVC: leg extensors RTD: leg extensors at 60–180 °/s P: leg extensors | PB-MVC: 0.23, 5 % PB-RTD: 0.22, 5 % PB-P: 0.54, 24 % |
Pisciottano et al. [63] | 100; F; 71 ± 5 | PB: TUG, time | MVC: knee extensors/flexors | PB-MVC: 0.30, 8 % |
3.2 Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power
3.2.1 Children
3.2.2 Adolescents
3.2.3 Young Adults
3.2.4 Middle-Aged Adults
3.2.5 Old Adults
3.2.6 Age Differences
Comparison | sSSB | dSSB | RB |
---|---|---|---|
Maximal strength | |||
Children vs. young adults | 0.52 (0.30) | 3.30 (0.001) | 0.38 (0.35) |
Children vs. old adults | 1.23 (0.13) | 2.94 (0.002) | 1.05 (0.15) |
Young vs. old adults | 0.68 (0.25) | 1.95 (0.03) | 0.54 (0.29) |
Explosive force | |||
Children vs. young adults | NA | NA | NA |
Children vs. old adults | NA | NA | NA |
Young vs. old adults | NA | NA | 0.90 (0.18) |
Muscle power | |||
Children vs. young adults | 0.06 (0.48) | NA | 0.66 (0.26) |
Children vs. old adults | 0.33 (0.37) | NA | 0.05 (0.48) |
Young vs. old adults | 0.50 (0.31) | NA | 0.51 (0.30) |