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Purpose <p>Unstable Surface Training (UST) enhances postural control, yet its efficacy for transferable balance and optimal dosing remains debated. To quantify UST effects on balance in healthy individuals and establish evidence-based dose-response guidelines.</p> Methods <p>A systematic search of four databases identified 47 randomized controlled trials. A three-level random-effects meta-analysis was employed to account for data dependency. Sensitivity analyses were performed to identify influential cases and robust dose-response relationships.</p> Results <p>UST significantly improved overall static (Hedges’<i>g</i> = 0.55, <i>P</i> &lt; 0.01) and dynamic balance (<i>g</i> = 0.33, <i>P</i> &lt; 0.01). Subgroup analysis revealed extreme task specificity: gains were largest for functional tasks on unstable surfaces (<i>g</i> = 1.26) but significantly lower for stable-ground laboratory measures (<i>g</i> = 0.45). For static balance, an exploratory meta-regression suggested a non-linear trend peaking at 5–6 weeks; however, this observation should be interpreted cautiously due to study clustering. For dynamic balance, a frequency of 3 sessions/week yielded the highest certainty of improvement (<i>g</i> = 0.45).</p> Conclusion <p>UST is an effective modality for enhancing postural control under labile conditions. While limited transfer to stable surfaces suggests it should serve as a supplementary neural primer, the observed 5–6 week adaptation peak is strictly hypothesis-generating. Future longitudinal trials are required to validate this temporal pattern, whereas an optimal frequency of 3 sessions/week is currently supported for dynamic balance.</p> Graphical Abstract <p></p>

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Quantifying the Efficacy and Dose-Response of Unstable Surface Training in Healthy Individuals: A Multi-Level Modelling Approach to Balance Performance

  • 期刊论文

  • 发表日期：

    2026年7月27日

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  • Shengfa Lin,
  • Zhijie Yan,
  • Zhiyuan Xu,
  • Mao Zhou,
  • Dong Zhang,
  • Ruidong Liu

摘要

Purpose

Unstable Surface Training (UST) enhances postural control, yet its efficacy for transferable balance and optimal dosing remains debated. To quantify UST effects on balance in healthy individuals and establish evidence-based dose-response guidelines.

Methods

A systematic search of four databases identified 47 randomized controlled trials. A three-level random-effects meta-analysis was employed to account for data dependency. Sensitivity analyses were performed to identify influential cases and robust dose-response relationships.

Results

UST significantly improved overall static (Hedges’g = 0.55, P < 0.01) and dynamic balance (g = 0.33, P < 0.01). Subgroup analysis revealed extreme task specificity: gains were largest for functional tasks on unstable surfaces (g = 1.26) but significantly lower for stable-ground laboratory measures (g = 0.45). For static balance, an exploratory meta-regression suggested a non-linear trend peaking at 5–6 weeks; however, this observation should be interpreted cautiously due to study clustering. For dynamic balance, a frequency of 3 sessions/week yielded the highest certainty of improvement (g = 0.45).

Conclusion

UST is an effective modality for enhancing postural control under labile conditions. While limited transfer to stable surfaces suggests it should serve as a supplementary neural primer, the observed 5–6 week adaptation peak is strictly hypothesis-generating. Future longitudinal trials are required to validate this temporal pattern, whereas an optimal frequency of 3 sessions/week is currently supported for dynamic balance.

Graphical Abstract