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Numerous national associations and multiple reviews have documented the safety and efficacy of strength training for children and adolescents. The literature highlights the significant training-induced increases in strength associated with youth strength training. However, the effectiveness of youth strength training programs to improve power measures is not as clear. This discrepancy may be related to training and testing specificity. Most prior youth strength training programs emphasized lower intensity resistance with relatively slow movements. Since power activities typically involve higher intensity, explosive-like contractions with higher angular velocities (e.g., plyometrics), there is a conflict between the training medium and testing measures. This meta-analysis compared strength (e.g., training with resistance or body mass) and power training programs (e.g., plyometric training) on proxies of muscle strength, power, and speed. A systematic literature search using a Boolean Search Strategy was conducted in the electronic databases PubMed, SPORT Discus, Web of Science, and Google Scholar and revealed 652 hits. After perusal of title, abstract, and full text, 107 studies were eligible for inclusion in this systematic review and meta-analysis. The meta-analysis showed small to moderate magnitude changes for training specificity with jump measures. In other words, power training was more effective than strength training for improving youth jump height. For sprint measures, strength training was more effective than power training with youth. Furthermore, strength training exhibited consistently large magnitude changes to lower body strength measures, which contrasted with the generally trivial, small and moderate magnitude training improvements of power training upon lower body strength, sprint and jump measures, respectively. Maturity related inadequacies in eccentric strength and balance might influence the lack of training specificity with the unilateral landings and propulsions associated with sprinting. Based on this meta-analysis, strength training should be incorporated prior to power training in order to establish an adequate foundation of strength for power training activities.
Background and objectives: Age-related losses of lower extremity muscle strength/power and deficits in static and particularly dynamic balance are associated with impaired functional performance and the occurrence of falls. It has been shown that balance and resistance training have the potential to improve balance and muscle strength in healthy older adults. However, it is still open to debate how the effectiveness of balance and resistance training in older adults is influenced by different factors. This includes the role of trunk muscle strength, the comprehensive effects of combined balance and resistance training, and the role of exercise supervision. Therefore, the primary objectives of this doctoral thesis are to investigate the relationship between trunk muscle strength and balance performance and to examine the effects of an expert-based balance and resistance training protocol on various measures of balance and lower extremity muscle strength/power in older adults. Furthermore, the impact of supervised versus unsupervised balance and/or resistance training interventions in the elderly will be evaluated.
Methods: Healthy older adults aged 63-80 years were included in a cross-sectional study, a longitudinal study, and a meta-analysis (range group means meta-analysis: 65.3-81.1 years) registering balance and muscle strength/power performance. Different measures of balance (i.e., static/dynamic, proactive, reactive) were examined using clinical (e.g., Romberg test) and instrumented tests (e.g., 10 meter walking test on a sensor-equipped walkway). Isometric strength of the trunk muscles was assessed using instrumented trunk muscle strength apparatus and lower extremity dynamic muscle strength/power was examined using clinical tests (e.g., Chair Stand Test). Further, a combined balance and resistance training protocol was applied to examine training-induced effects on balance and muscle strength/power as well as the role of supervision in older adults.
Results: Findings revealed that measures of trunk muscle strength and static steady-state balance as well as specific measures of dynamic steady-state balance were significantly associated in the elderly (0.42 ≤ r ≤ 0.57). Combined balance and resistance training significantly improved older adults' static/dynamic steady-state (e.g., Romberg test; habitual gait speed), pro-active (e.g., Timed Up and Go Test), and reactive balance (e.g., Push and Release Test) as well as muscle strength/power (e.g., Chair Stand Test) (0.62 ≤ Cohen’s d ≤ 2.86; all p < 0.05). Supervised compared to unsupervised balance and/or resistance training was superior in enhancing older adults' balance and muscle strength/power performance regarding all observed outcome categories [longitudinal study: effects for the supervised group 0.26 ≤ d ≤ 2.86, effects for the unsupervised group 0.06 ≤ d ≤ 2.30; meta-analysis: all between-subject standardized mean differences (SMDbs) in favor of the supervised training programs 0.24-0.53]. The meta-analysis additionally showed larger effects in favor of supervised interventions when compared to completely unsupervised interventions (0.28 ≤ SMDbs ≤ 1.24). These effects in favor of the supervised programs faded when compared with studies that implemented a small amount of supervised sessions in their unsupervised interventions (−0.06 ≤ SMDbs ≤ 0.41).
Conclusions: Trunk muscle strength is associated with steady-state balance performance and may therefore be integrated in fall-preventive exercise interventions for older adults. The examined positive effects on a large number of important intrinsic fall risk factors (e.g., balance deficits, muscle weakness) imply that particularly the combination of balance and resistance training appears to be a feasible and effective exercise intervention for fall prevention. Owing to the beneficial effects of supervised compared to unsupervised interventions, supervised sessions should be integrated in fall-preventive balance and/or resistance training programs for older adults.