Balance training

What it is

How research defines it

A 2022 systematic review defines balance training as training upright posture while standing on the feet¹. The tasks it uses are ones that tend to make a person fall¹. A 2015 meta-analysis describes its main aim as improving postural control³. It does this by challenging how well the body’s centre of gravity stays over its base of support, the feet³.

A 2017 review of studies in athletes found them called balance, sensorimotor, neuromuscular or proprioceptive training⁸.

What balance is made of

A 2006 review gives postural control two goals⁹. Orientation lines up the trunk and head with gravity and the surroundings⁹. Equilibrium keeps the body’s centre of mass (the point where its weight is evenly balanced) steady⁹. It does so when the body is pushed off course, by its own movement or from outside⁹. The review sees this as a complex skill built from sensing and moving together, not a sum of fixed reflexes⁹.

A 2015 meta-analysis sorts balance into three kinds³:

• Steady-state balance: holding a steady position while sitting, standing or walking³.
• Proactive balance: getting ready for a disturbance that can be predicted³.
• Reactive balance: recovering after a disturbance³.

Several studies found only weak to moderate links between these three, so the analysis looked at each one on its own³.

The forms it takes

A 2010 systematic review found programmes used stable or unstable platforms¹⁰. Some added disturbances, such as throwing or catching a ball, or kicking against an elastic band with the other leg¹⁰. A 2017 review of athletes found programmes that moved from standing on two legs to standing on one⁸. Some used visual feedback, such as shifting weight to move a cursor on a screen⁸.

The same 2017 review found studies often used this equipment⁸:

• wobble boards and tilt boards⁸
• Bosu balls (half-ball balance trainers) and Swiss balls (large exercise balls)⁸
• foam mats and inflated rubber discs⁸

Balance tasks are often built into athletes’ training and into falls programmes for older people, a 2016 meta-analysis notes⁵.

What it loads

This section rests mostly on reviews describing how balance works, one position stand and two small lab studies^11,12,13,14.

The senses

A 2006 review describes balance as drawing on three kinds of information⁹. They are touch and body position (somatosensory), the inner ear (vestibular) and vision⁹. The weight given to each depends on the task and surroundings⁹.

A 2002 review describes proprioception as sensing that arises inside the body¹¹. It helps with postural control and joint stability¹¹. Its conscious senses are joint position sense, kinaesthesia (the sense of movement) and a sense of resistance or heaviness¹¹. Its sensors are mechanoreceptors (nerve endings that sense pressure, stretch or movement)¹¹. They sit mostly in muscle, tendon, ligament and joint capsule (the sleeve of tough tissue that encloses a joint)¹¹.

Two of these sensors sit in muscle and tendon, the same review says¹¹. Muscle spindles report a muscle’s length and how fast it changes¹¹. Golgi tendon organs, where muscle meets tendon, report how hard the muscle is pulling¹¹.

The nervous system and the joints

A 2005 review describes balance as nerves and muscles working together¹⁵. The nervous system acts ahead of time and by reflex, alongside the muscles’ active and passive restraints¹⁵. Anticipatory postural adjustments are changes made before a limb moves, to offset the push the movement will cause⁹.

A 2002 review describes joint stability as having static parts, such as ligaments and bone shape, and dynamic parts¹¹. The dynamic part is the nervous system’s control of the muscles that cross the joint¹¹. The peroneal muscles (on the outer lower leg) are active before the foot lands from a step down or a jump¹⁶. That early activity is needed if they are to guard against sudden inversion (the sole turning inward)¹⁶.

The muscles

A 2010 position stand (a professional body’s statement on the evidence) from the Canadian Society for Exercise Physiology reports on unstable surfaces¹². For similar exercises, trunk and limb muscles were more active on unstable surfaces than on stable ones¹². The position stand reports that adding an unstable base to resistance exercises can lower force, power, speed and range of motion¹². It also reports that ground-based lifts such as squats and deadlifts can reach trunk muscle activity as high as, or higher than, unstable surfaces¹².

One lab study tested 10 adults standing on one leg on a balance board¹³. Making the board less stable did not significantly raise activity in three lower-leg muscles¹³. These were the tibialis anterior (front of the shin), gastrocnemius and soleus (calf muscles)¹³. The authors read this as a possible ceiling on ankle muscle activity¹³.

In 30 healthy men doing the single-leg deadlift on a foam pad, ankle sway rose and the hip and knee moved through less range¹⁴. The foam also raised activity in the tibialis anterior and biceps femoris (a hamstring muscle), and in the gluteus maximus (the buttock muscle) while lowering¹⁴.

How the body adapts

Balance improved across age groups

Reviews found balance training improved balance in several groups^2,3,4,10:

• Healthy, active people up to 40: sway (how much the body moves while trying to stand still) and functional balance improved, more with longer programmes¹⁰. The review included 20 randomised trials¹⁰.
• Healthy adults aged 16 to 40: steady-state and proactive balance improved, in 25 randomised controlled trials².
• Healthy adults aged 65 and over living at home: steady-state, proactive and reactive balance improved against passive controls, in 23 trials³.
• Healthy young people aged 6 to 19: static and dynamic balance improved by a moderate to large amount, in 17 controlled trials⁴.

A 2011 Cochrane review of people aged 60 and over found weak evidence that some exercise moderately improved balance scores right after the programme¹⁷. This exercise included walking, balance, coordination and functional tasks, in 94 randomised studies¹⁷.

In a separate study, 27 recreationally active adults aged 40 to 56 did single-leg Romanian deadlifts twice a week for four weeks¹⁸. They were tested on the Y Balance Test (a test of how far a person can reach with one leg while balancing on the other)¹⁸. Afterwards, one reach direction had improved in both legs¹⁸. Static balance did not change¹⁸.

Gains were specific to the task

A 2016 meta-analysis pooled 6 randomised trials in 102 healthy people⁵. In that analysis, people got better at the balance tasks they trained, but showed no clear gain on balance tasks they had not trained⁵.

In that analysis, people got better at the balance tasks they trained, but showed no clear gain on balance tasks they had not trained.

What reviews found about dose

Three meta-analyses reported which settings went with the largest gains^2,3,4:

Group studied	Settings linked to the largest gains, each analysed on its own
Healthy young adults (steady-state balance)	11 to 12 weeks, three sessions a week (six in a single study), 11 to 15 minutes a session2
Healthy adults aged 65 and over (overall balance)	11 to 12 weeks, three sessions a week, 31 to 45 minutes a session3
Healthy adolescents	12 weeks, two sessions a week, 4 to 15 minutes a session4

The older-adult and adolescent reviews looked at one setting at a time, so a row is not a programme tested as a whole^3,4. The young-adult review warned that one setting’s effect is hard to separate from the others².

Each review urged caution^2,3,4. The young-adult and older-adult reviews both found study quality limited^2,3. In the older-adult review, results varied a lot between studies, and dose comparisons were made across studies, not within them³. In adolescents, no single setting predicted the effect on balance⁴. The youth studies did not report training intensity, so it could not be analysed⁴.

Changes in the nervous system

A 2022 systematic review of 14 studies looked at the soleus H-reflex, a spinal reflex¹. After balance training it was consistently smaller in younger adults¹. Older adults showed mixed results, many with a larger H-reflex¹. Younger adults also showed changes at the level of the brain, but the review judged there were too few studies to draw conclusions¹.

Strength and athletic performance

Against strength or plyometric training, a 2010 review found conflicting results or no effect of balance training on strength and sprinting¹⁰. A 2011 review reports that adding balance training improved jumping, agility and shuttle runs in active people and physical education students¹⁹. The same review reports resistance training gave better jump height and sprint time than balance training¹⁹. See resistance training and plyometric training.

What studies found about ankle sprains

Two meta-analyses of trials in sporting groups found fewer ankle sprains with balance or proprioceptive training than in control groups^6,20. The 2015 analysis found fewer sprains in people who had sprained an ankle before⁶. For first sprains, its pooled result was significant, but it came from two trials that were each not significant⁶. The authors judged the evidence for first sprains inconclusive⁶.

A 2007 review linked balance training alone to fewer repeat ankle ligament injuries in recreational athletes and in soccer and volleyball players²¹. It had not clearly been shown to lower ankle injury rates in athletes with no earlier injury²¹. A 2008 review found balance training done beforehand substantially reduced sprain risk, more so in people with an earlier sprain²². A systematic review of seven high-quality trials found balance training alone was linked to fewer ankle sprains, but not significantly fewer injuries overall²³. It also found proprioceptive and neuromuscular training programmes as a whole worked better in athletes who had a past sports injury²³.

People with a past ankle sprain have about 3.5 times the risk of another²⁴. An overview of 46 reviews found the evidence strong for bracing, and moderate for neuromuscular training, in cutting repeat sprains²⁵. The ankle sprain page describes those trials.

What studies found about knee injuries

A 2007 review found conflicting results for the knee, from studies whose programmes differed²¹. In male soccer players, balance training alone went with fewer ACL (anterior cruciate ligament) injuries²¹. Yet in female soccer players it went with more major knee injuries, and in volleyball players with more overuse knee injuries²¹.

What studies found about falls

A 2019 Cochrane review looked at people aged 60 and over living at home⁷. In 39 studies with 7,920 people, groups doing balance and functional exercises had a 24% lower rate of falls than control groups⁷. Programmes combining exercise types, most often balance, functional and resistance exercise, probably lowered the rate of falls by 34%⁷. The review was uncertain about resistance exercise without balance and functional work⁷.

In that review, where trials reported harms, they were mainly minor muscle and joint problems, with two serious events in one trial⁷. Only one trial monitored harms closely in both groups⁷.

A 2017 meta-analysis of older people found larger drops in falls with programmes that challenged balance and ran over 3 hours a week²⁶. It found no evidence that exercise reduced falls in residential care, in stroke survivors or in people just home from hospital²⁶.

Connections

Balance training draws on proprioception, which helps with postural control^9,11. Its sensors, mostly in muscle, tendon, ligament and joint capsule, turn movement into signals carried by nerves¹¹. A 2010 position stand reports that, in similar exercises, trunk and limb muscles were more active on unstable surfaces than on stable ones¹². The single-leg Romanian deadlift adds a balance demand to a hip hinge (bending forward mainly at the hips, with little knee bend)¹⁴. The bird dog has been studied on unstable half-balls²⁷.

Reviews of balance training in sporting groups studied ankle sprains; see ankle sprain, the lateral ankle ligaments and the ankle joint⁶. Related methods include neuromuscular warm-ups, resistance training, plyometric training and free weights and machines^8,10,12.

Sources

1. Sun Y, Hurd CL, Barnes MM, Yang JF (2022). Neural Plasticity in Spinal and Corticospinal Pathways Induced by Balance Training in Neurologically Intact Adults: A Systematic Review.. Frontiers in Human Neuroscience. doi:10.3389/fnhum.2022.921490 PMID 36061497
2. Lesinski M, Hortobágyi T, Muehlbauer T, Gollhofer A, Granacher U (2015). Dose-response relationships of balance training in healthy young adults: a systematic review and meta-analysis.. Sports Medicine. doi:10.1007/s40279-014-0284-5 PMID 25430598
3. Lesinski M, Hortobágyi T, Muehlbauer T, Gollhofer A, Granacher U (2015). Effects of Balance Training on Balance Performance in Healthy Older Adults: A Systematic Review and Meta-analysis.. Sports Medicine. doi:10.1007/s40279-015-0375-y PMID 26325622
4. Gebel A, Lesinski M, Behm DG, Granacher U (2018). Effects and Dose-Response Relationship of Balance Training on Balance Performance in Youth: A Systematic Review and Meta-Analysis.. Sports Medicine. doi:10.1007/s40279-018-0926-0 PMID 29736728
5. Kümmel J, Kramer A, Giboin LS, Gruber M (2016). Specificity of Balance Training in Healthy Individuals: A Systematic Review and Meta-Analysis.. Sports Medicine. doi:10.1007/s40279-016-0515-z PMID 26993132
6. Schiftan GS, Ross LA, Hahne AJ (2015). The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis.. Journal of Science and Medicine in Sport. doi:10.1016/j.jsams.2014.04.005 PMID 24831756
7. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE (2019). Exercise for preventing falls in older people living in the community.. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD012424.pub2 PMID 30703272
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18. Artiom K, Ayelet D (2026). Unilateral Posterior-Chain Training as a Perturbation Strategy for Balance Improvements in Middle-Aged Adults.. International Journal of Exercise Science. doi:10.70252/IJES2026102 PMID 42003890
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22. McKeon PO, Hertel J (2008). Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective?. Journal of Athletic Training. doi:10.4085/1062-6050-43.3.305 PMID 18523567
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24. Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA (2019). Epidemiology of Ankle Sprains and Chronic Ankle Instability.. Journal of Athletic Training. doi:10.4085/1062-6050-447-17 PMID 31135209
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Every source the library cites

Changes

• September 30, 2026 First published.