Muehlbauer Thomas, Gollhofer Albert, Granacher Urs
Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Am Neuen Palais 10, Building 12, 14469, Potsdam, Germany.
Albert-Ludwigs-University Freiburg, Institute of Sport and Sport Science, Freiburg, Germany.
Sports Med. 2015 Dec;45(12):1671-92. doi: 10.1007/s40279-015-0390-z.
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.
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.
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.
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.
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.
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).
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.
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.
经常有报道称，平衡能力与下肢肌肉力量/功率与体育相关活动及日常活动有关。了解平衡、力量和功率之间的关系对于识别高危个体很重要，因为这些神经肌肉成分的缺陷与受伤和跌倒风险增加有关。此外，这些知识对于制定专门定制的健康和与技能相关的锻炼计划具有高度相关性。
本系统文献综述和荟萃分析的目的是描述并在可能的情况下量化健康个体在整个生命周期中平衡变量与下肢肌肉力量/功率之间的关联。
截至2015年3月，在电子数据库PubMed、科学网和SPORTDiscus中进行了计算机化系统文献检索，以获取所有相关文章。
采用系统方法评估初步筛选出的996篇文章。仅纳入研究年龄≥6岁的健康个体且测试了至少一项静态稳态平衡（例如单腿站立时的压力中心[CoP]位移）、动态稳态平衡（例如步态速度）、主动平衡（例如功能性伸展测试中的距离）或反应性平衡（例如在受干扰单腿站立时的CoP位移）指标以及一项最大力量（例如最大自主收缩）、爆发力（例如力量发展速率）或肌肉功率（例如跳跃高度）指标的研究。共有37项研究符合纳入综述的标准。
纳入的研究根据以下标准进行编码：年龄（即儿童：6 - 12岁，青少年：13 - 18岁，年轻人：19 - 44岁，中年人：45 - 64岁，老年人：≥65岁）、性别（即女性、男性）以及测试方式/结果（即评估平衡、力量和功率的测试）。排除涉及运动员、患者和/或患有疾病人群的研究。提取Pearson相关系数，进行转换（即Fisher z转换后的r z值）、汇总（即加权平均r z值），再转换回r值，根据其大小进行分类（即小：r≤0.69，中：r≤0.89，大：r≥0.90），并在可能的情况下进行统计学比较。使用I2和卡方（χ2）统计量评估研究之间的异质性。
三项研究考察了儿童平衡与下肢肌肉力量/功率之间的关联，一项研究考察了青少年，九项研究考察了年轻人，三项研究考察了中年人，23项研究考察了老年人。总体而言，无论考虑哪个年龄组，平衡变量与下肢肌肉力量/功率之间均发现存在小的关联。此外，与年轻人（r = 0.09，z = 3.30，p = 0.001）和老年人（r = 0.35，z = 2.94，p = 0.002）相比，儿童动态稳态平衡指标与最大力量之间的相关系数虽小但显著更大（r = 0.57），且老年人与年轻人相比也有显著差异（z = 1.95，p = 0.03）。
尽管报告的结果进一步深入了解了平衡指标与下肢肌肉力量/功率之间的关联，但它们无法让我们推断因果关系。此外，所研究的关联可能受到其他变量如关节灵活性、肌肉质量和/或视听敏锐度的影响。
我们的系统综述和荟萃分析表明，在儿童、青少年以及年轻人、中年人和老年人中，平衡指标与下肢肌肉力量/功率之间大多呈现小的相关性。这表明这些神经肌肉成分相互独立，因此在整个生命周期中应进行互补性的测试和训练。与年轻人和老年人相比，儿童动态稳态平衡指标与最大力量之间的关联虽仍小但显著更大，老年人与年轻人相比也是如此。这些发现意味着年龄/成熟度可能会对平衡的选定成分与下肢肌肉力量之间的关联产生影响。
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