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

Abstract

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

Keywords

Unstable Surface Training / Instability Training / Balance / Dose-Response / Three-Level Meta-Analysis

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Funding

Fundamental Research Funds for the Central Universities(2025KYPT04)

Beijing Social Science Foundation Project(24YTC035)

RIGHTS & PERMISSIONS

Beijing Sport University

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