Rochelle Collinwood
Swiss balls
When you hear the words “stability ball”, what do you think? Balance. That is what
is assumed when working with an unstable surface. This is true although there are
many other purposes that will be covered in this review. To begin, there are many
venues that now use swiss balls such as recreational facilities, clinical settings, at
home, and sports training facilities. There is such a wide range of uses and yet
research still needs to be done to determine in what ways it increases strength and
when does the use prohibit progress of strength. Swiss balls have been researched
to find if there is an increase in muscular recruitment and coordination. As of the
literature up to date it seems to be lacking the evidence to make solid claims that it
works.1 The research does conclude that there is significantly more recruitment of
abdominal musculature when performing abdominal stabilizing exercises on a
Swiss ball.1-3 The research is also supportive of the decrease in back pain when the
abdominal musculature is strong and stable. 4-5 This is critical in the clinical setting,
as well as the recreation setting due to the fact that second to the common cold,
back pain is the cause for primary care office visits.4 There are more incidences in
women than men that need to improve their abdominal musculature, which needs
to be taken into considerations when doing a study involving training abdominal
musculature. Women will have more improvement than men in most cases.4
Knowing that Swiss ball training helps in balance and proprioception, there is still a
question about the ability of improving sport performance with Swiss ball training.
The purpose of this review of literature is to allow the reader to make decisions for
themselves about the current research that is published covering the topics that are
mentioned above.
The first article that we are going to take a look at is, Changes in Muscle
Activity and Perceived Exertion during Exercises Performed on a Swiss Ball. The
purpose of this article was to look at the prime movers of the musculature in a
squat, push up, and double leg lowering along with the abdominal muscles using a
electromyographic (EMG) machine.
The methodology began by recruiting twelve individuals, 8 male and 4
females, between the ages 19-25 who were willing to participate in the study. The
subject reported having no musculoskeletal pain, neuromuscular problems, and
have no joint or bone diseases. They were not allowed to be on any performance
enhancing drugs and not allowed to do and resistance or cardiovascular training
during the trial period. They were asked to maintain a normal diet the 24 hours
before testing. Subjects had normal experience with the use of stability balls but
were not accustom to the exercises being performed in the study. They were
hooked up to the machine according to the given protocols and instructed on the
exercises right before they were assigned to them. Then they executed the exercise
3 times for 3 seconds with a 1-2 minute rest in between each set and 5 minutes
between each exercise. The average of the three trials were taken for each exercise.
They were to give a maximal effort each repetition. The subjects and experimenter
were blinded to the immediate results so no direct comparison could be made.
The results of this study concluded that in the squat exercise had no
significant differences compared to the self-standing squat. However the perceived
exertion was significantly with the stability ball compared to the self-standing squat.
The pushup results concluded that there was 10-20 percent more muscle activity in
the top position of the pushup on the swiss ball compared to the normal and incline
pushup. The triceps muscle shows a 25-30 percent increase in the lowered position
on the swiss ball than in the normal and inclined pushup. The perceived exertion
was significantly higher with the use of the swiss ball. Finally, the double leg
lowering was 13 percent higher on the swiss ball then on the stable surface. The
perceived exertion was significantly more with the swiss ball as well.
They concluded that muscle activity increased when performing exercises on
an unstable surface such as a swiss ball. In contrary to that the squat with the
stability ball on the wall was less in muscle activity recruitment. This could be
contributed to the finding of perceived exertion. In both the pushup and double leg
lowering the perceived exertion increased where in the squat it decreased. It is
important to note also that these muscle activity increases come with an acute
response, and should be taken into account when generalizing over the conditioning
effects.
The study brought up great points about the perceived exertion in
correlation with the muscle activity during each activity. The control was the stable
surface that each participant participated on. The randomization of the exercise was
a great way to control for learned response variations. The statistical analysis look
accurate and were able to explain their claims made in the study. The study could be
better with a larger subject group both males and females. The study really took into
consideration that they can’t say anything about long-term results of these
exercises. This treatment does have great promise and could be looked into further
to see if with a long-term protocol if there precedes the same results. This was a
peer reviewed journal article that was published in Canada.
The next article is Muscle Activity of the Upper and Lower Rectus Abdominis
during Exercises Performed on and off a Swiss Ball. The purpose of this study is to
look at any differences that occur in the upper and lower abdominals during curlups on a stable surface, swiss ball curl-ups, swiss ball jackknifes, and swiss ball
rollouts in the muscle activity.
The methodology begins with fourteen healthy adults, 7 male and 7 females,
between the ages of 18-25. All participants exercised regularly and didn’t have any
musculoskeletal pain or diseases. They were asked to refrain from any vigorous
activity 24 hours prior to testing. They performed maximum voluntary contractions
of all the abdominal exercises in random orders. Both the upper and lower
abdominals were measured for electrical activity. The area was shaven and cleaned
before placement of electrodes. Electrodes were not removed until all exercises
were complete. MVICs were performed before beginning any of the exercises on
both the upper and lower abdominals. All exercises protocols were performed with
each participant. They ran 2 by 4 repeated measures analysis of variance. They also
Bonferroni’s multiple comparison.
The results indicate muscle activity in the upper abdominals was
greater than the lowers in the curl-up, Swiss ball curl-up, and Swiss ball roll out.
However the lower abdominals were greater in the jackknife exercise. They also
found that the comparison between the swiss ball curl-up, swiss ball roll out, and
swiss ball jackknife were significantly higher than the curl-up. Then they reported
that the jackknife and swiss ball roll out were much greater than the swiss ball curlup. There was no significant difference between the jackknife and the swiss ball roll
out. There was also no significant difference between the upper and lower
abdominals.
The study concluded that because there was no significant difference
between the two regions that all would be good in a exercise or rehab program.
They did determine that all exercises done on the Swiss ball recruited more muscle
activity and the activity was maximized during the jackknife exercise. The study
recommends ensuring that the participants maintain a neutral spine during the
jackknife and roll out exercises. The study used each subject for his or her own
control group. The statistical analysis reported proved valid for each exercise break
down. This study can be very useful in making a protocol for exercise advancement.
The next study is Stability Ball Training on Lower back Strength has a
Greater Effect on Untrained Females Compared to Males. The purpose of this study
is to compare untrained male and female subjects in the effectiveness of stability
ball training in a short period of time. They are going to compare the ability to build
muscle strength in the back using stability ball training.
The study used 42 subjects, 21 males and females, between the ages of 20-26.
All subjects had no previous experience or history of abdominal or low back pain.
Participants will be asked to participate for 18 sessions, 3 times for 6 weeks doing a
variety of exercises such as crunch, supine leg lift, back extension, reverse back
extenstion, supine rotation, lateral crunch, seated balance, and core endurance all
done on the stability ball. The control group did no exercise at all during this study.
The diets of participants were monitored in order to ensure that there wouldn’t be
any influence on the results. The participants performed three trails of a 1 RM test
for both the back and abdomen but only the best was recorded. They were given a
five minute rest between each trial. They were asked to identify RPE on a scale from
1-10. Each subject was taught proper protocols until they exercises’ were properly
learned. Cadence was kept with a metronome at a rate of 1 rep per second with a 30
second rest between each set. After the balance and core exercises they had 60
seconds to rest. Each session was approximately 30 to 40 minutes including
stretching protocols. Data collected was run through a 2 way ANOVA group versus
gender. They ran a few follow up statistics as well.
Comparison of the pre and post-tests for back and abdominal strength was
definitely significant to the results of the study. The results show that the stability
ball training had the greatest increase in strength in both categories. There was
improvement in the floor-training group compared to the control who lost strength.
Comparing genders there was a significant difference in strength changes between
the males and females. The greatest change was in the stability ball group where
there was a 41% improvement in females and a 12% improvement in males in back
strength and a 32% increase in females and 10% increase in males in abdominal
strength. The females in the control group also lost the most strength from nonexercise.
The study concluded that performing core strengthening exercises on an
unstable surface makes early phase gains in strength. Core strengthening leads to
stressed musculature of the abdominal area along with proprioception activity that
leads to strength gains. The study supported the hypothesis that females would
have more strength gains than males. The study is a year old and covered a variety
of exercises that could be done with the stability ball. The study was controlled for
outliers and made sure everyone was trained sufficiently to get accurate results.
This is a great study to base a core strengthening protocol around for both rehab
and recreational practitioners.
The next study is The Effects of Stability Ball Training on Spinal Stability in
Sedentary Individuals. The purpose of this study is to look at the changes that were
made on spinal stability through stability ball training. This will be evaluated with
the static back endurance test and a side bridge test.
This study is unique because of its focus on just the spinal stability and
nothing else. They began by defining spinal stability as the ability to maintain the
position of the trunk without excessive displacement of the center of gravity. They
recruited 20 sedentary workers from 2 different corporations. These individuals
were 28-49 years old. They were placed in either the experimental or control group
for a 10-week trial that would be monitored. Participants were healthy, those with
back pain were questioned further but it wasn’t a contraindication that would
exclude them from the study. They were placed in there groups by random
assignment. Eighteen participants reported being recreationally active, one
reported teaching fencing and the other played tennis and golf. All subject were
asked to continue in his or her normal routines but not to make any changes. Each
subject was assignment a stability ball that correlated with his or her height. All
exercises were done with the stability ball. A huge focus for this study was teaching
spine neutral in all the exercises. All subject were monitored closely to eliminate any
subjects that would be presenting with problematic symptoms. They took per and
post-test scores and compared them using an ANOVA.
The ANOVA results were run within groups and between groups with
repeated measures. The results show significant increases in the spinal stability in
the experimental group compared to the control group in the posttest scores in the
static back endurance test. The scores increase significantly in the experimental
group from pretest to posttest in the static back test. There was no significant
difference in either group for the pretest for either test. The was no significant
difference in either group for the side bridge test.
The study concluded that the stability ball training does have an effect on
spinal stability. Stability ball training would be recommended for those that work in
a sedentary job or are at risk of back pain due to their job. There are many protocols
that need to be followed for each person; not all programs should be the same. They
recommend further research to be done on stability ball training to refine the
development of training programs. This relates to the Athletic Training field with
various applications. Knowing that trunk endurance can lessen the potential for
back pain can aid in the making of training protocols. This can also play a huge role
with student athletes that sit for a good period of time during the day.
The overall impression of this study gives a different point of view than the
others. There is a need for spinal stability in all people even though this study
focuses a lot on the 30 to 40 year olds. All data collected was statistical analysis
where accurate and statistically significant. The protocols are affordable and ready
for anyone to start using. It is important to do another study looking specifically at
the student population to see if their claims are true.
The next article reviewed will be, The Effect of Short-term Swiss Ball
Training on Core Stability and Running Economy. The purpose of this study was to
look at the effects training on a swiss ball bas on core strength and running economy
in the athletic population.
The methods to the study began with a two sessions to familiarize
participants with protocols to ensure that they would be able to accomplish each
task. Twenty-two males were recruited to participate from a Basketball and Touch
Football team. All participants were familiar with resistance training but had never
used a swiss ball. All participants under the legal age had a parental cosigner on
their informed consent. They were tested using the Sahrmann core stability test and
the swiss ball prone stabilization core stability test. The Sahrmann’s test has five
levels of monitoring that you can get in more detail from the article text. The patient
is working different positions each level to make sure to cover all aspects of the core
musculature. They had a videotape recording in the saggital plane. Swiss ball size
was fit to each participant; correct fitting is so that the participant is parallel to the
ground. The control group just continued with their present physical training
programs. The experimental group added swiss ball training in addition to their
present training. Training took place twice a week for six weeks. Exercises included
Lunges, Supine lateral roll, alternating superman, forward roll on knees, supine 2leg bridge, and supine Russian twist all on the swiss ball. They used an ANOVA with
repeated measures 2 by 2 to determine the effect of training and time on each
parameter measured.
The results of the pretest had no significant statistical difference between the
control and experimental group. The experimental group had improvement in core
stability, which were determined by the significant increase in scores on both the
Sahrmann and Swiss ball prone stabilization test. The control group had no
significant changes in either test. The results were also taken from 18 participants
due to 1 control group member and 3 experimental group members dropped out
due to circumstances outside of the study.
They study concludes that there is no carry over of core stability in
improvement of running economy; determined by VO2 max scores. There was no
change in running posture after the swiss ball training in the experimental group.
There is statistical evidence that swiss ball training has a great effect on core
stability. They only make these claims for the population studied in this experiment.
This study was very helpful in determining that the stability increases come
from stability training whereas the running performance needs a different approach
in order to increase performance numbers. There is carry over from this study that
core stability helps in decreasing back pain that will only keep the participants more
active. There needs to be more studies done to determine if core stability is a key
factor in running posture. This study touched on that a little bit but there needs to
be more research to make any decisions. This isn’t really to informative to make a
decision about weather or not the athletic training field should use this technique. It
is true that core stability is important in exercise so according to that then yes
athletic trainers should help in developing core stability.
The next study is called Swiss Ball Abdominal Crunch with Added Elastic
Resistance is an Effective Alternative to Training Machines. The purpose of this
study was to compare the activation of the abdominal musculature and thigh
muscles during a crunch performed on a swiss ball and an isotonic training machine
using an electromyography technology.
The methods began with the recruitment of 42 untrained adults from a
variety of job descriptions. Exclusion criteria include blood pressure above
160/100, spinal disc herniation, rheumatoid arthritis, and any other
musculoskeletal disorders. The participants included 18 men and 24 women. All
participants ranged from 28 – 67 years old with no participant with back pain over a
7 on the visual analog pain scale. All subject were tested on both the swiss ball and
the isotonic abdominal machine. The protocol for each exercise was taught to each
participant and performed a 10 RM for all the exercises a week before the testing.
All participants followed the protocols though the testing order was randomized.
The scale to define pain was given as 4-10 pain and 0-3 no or minor pain. The
statistics were calculated using a two-way repeated measure ANOVA (2x13). A post
hoc was used to compare any the type of differences when there was a significant
figure.
The results found in this study helped to determine the effectiveness of each
exercise. There was significant muscle activity of the 13 muscles investigated with a
wide variance across exercise and muscle group. The rectus abdominis and oblique
muscles were generally the most active. There was a significant difference between
the rectus abdominis and the two exercises performed. The swiss ball exercise had
more activity than the isotonic abdominal machine. Yet the isotonic machine
showed higher activity in the rectus femoris muscle than on the swiis ball. There
was no significant difference between gender or age group.
The study concluded that both the exercises in this study had high activation
of the abdominal muscles. The difference was that the crunches on the swiss ball
had a higher activation of abdominal muscle than the rectus femoris where the
isotonic crunch machine had the opposite effect. The isotonic machine had higher
activation of the rectus femori than the abdominal muscle. They also concluded that
all age groups and gender groups benefited from the exercises performed in this
study.
This study was informative on the best exercise for the abdominals versus
the hip flexors. One was definitely more appropriate for one versus the other. That
will help a lot in the rehab process to ensure that the patient has the best advantage
to strengthen the muscles that they are focusing on. The study can be improved for
the athletic training field if they focus more on the active athletic population.
The next study looks at the stability ball in a combination to a machine that is
already commonly used in the rehabilitation field a lot. This study is called Stability
Ball Sitting versus a Chair During Sub-maximal Arm Ergometry. The purpose of this
study is to look at the cardiovascular gains that would occur with the need to recruit
more muscles on a stability ball versus a chair. They predict hat there will be an
elevation in cardiovascular gains due to the greater trunk and lag muscle
recruitment.
Twenty-six apparently healthy individuals (12 females and 14 males)
participated in this study for two sessions. One session they were on the stability
ball and the other they were on the chair. This all took place on week after the other.
The chair positioning of each participant determined the stability ball size.
Participants practiced sitting on the ball and perform 50 revolutions per minute
while getting their blood pressure taken. After being educated and set up on the
equipment the participants performed the two tests of four minutes starting with a
four minute rest before beginning followed by three continuous stages at 15W, 30W,
and 45W that lasted four minutes each. The participants had to crank at 50 RPM
during the three stages followed by a two minute cool down period. They had a 45
to 60 minute rest between the two trials. The blood pressure was taken during each
stage along with the EMG readings. The order of testing was randomized as well as
the testing protocols.
The results of the study found that there was no significant difference
between the sitting heights. They found that VO2 max was significantly higher (10
to 18 percent) in the stability ball test than in the chair. However, the blood
pressure and heart rate we not significantly different between the two sitting
groups. The muscle activation was shown to be higher with the stability ball during
all three stages of the exercise. The difference was mainly in the rectus femoris and
oblique muscles with the most difference during the 45W stage. They found no
significant difference between the two sitting positions and the rectus abdominis
muscle.
The conclusion of the study states that the stability ball increases oxygen
consumption during the treatment protocols of this study without a significant rise
in heart rate and blood pressure. This is associated with the increase use of the thigh
muscles and lower leg positioning. The higher VO2 during the stability ball sit has a
lot to do with the muscle activation compared to regular chair sitting. There is
added stability benefit but only at a high work out intensity. In the rehabilitation
field this doesn’t make a really big difference for general rehab programs, yet if the
patient need cardiovascular gains from this exercise it has a positive effect when
using a stability ball. This study has application for those that have lower limb
injuries and need to keep up their cardiovascular abilities for a quicker return to
play.
The last study that will be summarized is Increased Deltoid and Abdominal
Muscle Activity During Swiss Ball Bench Press. The purpose of this study is to
investigate the upper-body and abdominal muscles using electromyography
technology through the concentric and eccentric muscle contractions.
There were fourteen resistance-trained individuals (9 men and 5 women)
with more than six months of training were accepted to participate in this study. All
the subjects were familiar but not fluent in the swiss ball bench press. Subjects do
not have any type of musculoskeletal injuries, disorders, or pain. They don’t have
any joint or bone problems. Subjects were asked to stop any resistance training that
they were currently involved during the study. They were asked to maintain a
healthy diet 24 hours prior to the study. They were asked to eat within 2 hours of
testing. Each subject performed isolated concentric and eccentric dumbbell bench
press on both solid and unstable surfaces. All participants followed the same
protocols in performing all the repetitions. The electrodes were only placed on the
right side of the body. They performed three repetitions for each movement.
The results of this study found that even though there was a significant
difference in weight between males and female the EMG measured similar numbers.
There was no significant difference. There was in fact a significant difference
between the surfaces that the individuals lifted on. The swiss ball resulted in greater
muscle activity versus the stable surface. In the concentric motion there was
significantly more activity in the pectoralis major, Triceps brachii, and anterior
deltoid. The subject perceived exertion was significantly greater on the swiss ball in
both the eccentric and concentric phases.
The conclusion of this study states that there is significant evidence to
support the claims made about the deltoid muscle activity increasing during swiss
ball lifts. It also provides evidence to the increased muscle activity in the abdominal
musculature. They only used expert lifters in this study. There is a possibility that
inexperienced lifters might have elicited other muscle responses. This study would
be appropriate for advanced rehab or strength conditioning. They also conclude that
at a lower intensity there might be different results. There needs to be more studies
done to make a better determination. This study does give accurate and helpful
information about muscle activation for bench press variations.
To conclude this paper, the overall results suggest that doing any resistance
training on an unstable surface will activate more muscle. This in turn has the
potential for strength gains. There are many more studies that need to be done on
specific portions of stability ball training, yet this is a good start. They training also
is applicable to a large variety of subjects. The application of these studies can be
carried across strength and conditioning programs, rehabilitation clinics, and many
more. The use of stability balls will only increase in these fields if used correctly. I
would recommend the use of stability balls after studying the results of all these
studies. There is a good chance of increased ability when relating to proprioception
of muscle fiber. If they are able to fire more efficiently they will be better off.
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