Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral One-legged Standing Balance of Adults
Identifieur interne : 001189 ( Pmc/Checkpoint ); précédent : 001188; suivant : 001190Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral One-legged Standing Balance of Adults
Auteurs : Sung Min Son ; Kyung Woo Kang ; Na Kyung Lee ; Seok Hyun Nam ; Jung Won Kwon ; Kyoung KimSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2013.
Abstract
[Purpose] The purpose of the current study was to investigate the changes in one-legged standing balance of the ipsilateral lower limb following unilateral isokinetic strength training. [Subjects and Methods] Thirty healthy adult volunteers were randomly assigned to either a training group or a control group, so that each group included 15 subjects. Subjects in the training group performed unilateral ankle isokinetic exercises of the dominant leg using the Biodex 3 PRO System for a period of four weeks. Ipsilateral one-legged standing balance was evaluated before and after the intervention with three stability indexes of balance using the Biodex System: Anterior-Posterior Stability Index (APSI), Medial-Lateral Stability Index (MLSI), and Overall Stability Index (OSI). [Results] Comparison of pre- and post-test data revealed significant improvements in strength values (dorsiflexion, plantarflexion, eversion, and inversion) and stability indexes (APSI, MLSI, OSI). [Conclusion] These results suggest that ankle strengthening exercise can be considered as a form of exercise that may assist individuals with improvement of balance.
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DOI: 10.1589/jpts.25.1313
PubMed: 24259783
PubMed Central: 3820187
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral
One-legged Standing Balance of Adults</title><author><name sortKey="Son, Sung Min" sort="Son, Sung Min" uniqKey="Son S" first="Sung Min" last="Son">Sung Min Son</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kang, Kyung Woo" sort="Kang, Kyung Woo" uniqKey="Kang K" first="Kyung Woo" last="Kang">Kyung Woo Kang</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Na Kyung" sort="Lee, Na Kyung" uniqKey="Lee N" first="Na Kyung" last="Lee">Na Kyung Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Nam, Seok Hyun" sort="Nam, Seok Hyun" uniqKey="Nam S" first="Seok Hyun" last="Nam">Seok Hyun Nam</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kwon, Jung Won" sort="Kwon, Jung Won" uniqKey="Kwon J" first="Jung Won" last="Kwon">Jung Won Kwon</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Kyoung" sort="Kim, Kyoung" uniqKey="Kim K" first="Kyoung" last="Kim">Kyoung Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24259783</idno><idno type="pmc">3820187</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820187</idno><idno type="RBID">PMC:3820187</idno><idno type="doi">10.1589/jpts.25.1313</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002064</idno><idno type="wicri:Area/Pmc/Curation">002064</idno><idno type="wicri:Area/Pmc/Checkpoint">001189</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral
One-legged Standing Balance of Adults</title><author><name sortKey="Son, Sung Min" sort="Son, Sung Min" uniqKey="Son S" first="Sung Min" last="Son">Sung Min Son</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kang, Kyung Woo" sort="Kang, Kyung Woo" uniqKey="Kang K" first="Kyung Woo" last="Kang">Kyung Woo Kang</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lee, Na Kyung" sort="Lee, Na Kyung" uniqKey="Lee N" first="Na Kyung" last="Lee">Na Kyung Lee</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Nam, Seok Hyun" sort="Nam, Seok Hyun" uniqKey="Nam S" first="Seok Hyun" last="Nam">Seok Hyun Nam</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kwon, Jung Won" sort="Kwon, Jung Won" uniqKey="Kwon J" first="Jung Won" last="Kwon">Jung Won Kwon</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Kyoung" sort="Kim, Kyoung" uniqKey="Kim K" first="Kyoung" last="Kim">Kyoung Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p> [Purpose] The purpose of the current study was to investigate the changes in one-legged
standing balance of the ipsilateral lower limb following unilateral isokinetic strength
training. [Subjects and Methods] Thirty healthy adult volunteers were randomly assigned to
either a training group or a control group, so that each group included 15 subjects.
Subjects in the training group performed unilateral ankle isokinetic exercises of the
dominant leg using the Biodex 3 PRO System for a period of four weeks. Ipsilateral
one-legged standing balance was evaluated before and after the intervention with three
stability indexes of balance using the Biodex System: Anterior-Posterior Stability Index
(APSI), Medial-Lateral Stability Index (MLSI), and Overall Stability Index (OSI).
[Results] Comparison of pre- and post-test data revealed significant improvements in
strength values (dorsiflexion, plantarflexion, eversion, and inversion) and stability
indexes (APSI, MLSI, OSI). [Conclusion] These results suggest that ankle strengthening
exercise can be considered as a form of exercise that may assist individuals with
improvement of balance.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Berg, K" uniqKey="Berg K">K Berg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kristinsdottir, Ek" uniqKey="Kristinsdottir E">EK Kristinsdottir</name></author><author><name sortKey="Jarnlo, Gb" uniqKey="Jarnlo G">GB Jarnlo</name></author><author><name sortKey="Magnusson, M" uniqKey="Magnusson M">M Magnusson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lord, Sr" uniqKey="Lord S">SR Lord</name></author><author><name sortKey="Clark, Rd" uniqKey="Clark R">RD Clark</name></author><author><name sortKey="Webster, Iw" uniqKey="Webster I">IW Webster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gatev, P" uniqKey="Gatev P">P Gatev</name></author><author><name sortKey="Thomas, S" uniqKey="Thomas S">S Thomas</name></author><author><name sortKey="Kepple, T" uniqKey="Kepple T">T Kepple</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Runge, Cf" uniqKey="Runge C">CF Runge</name></author><author><name sortKey="Shupert, Cl" uniqKey="Shupert C">CL Shupert</name></author><author><name sortKey="Horak, Fb" uniqKey="Horak F">FB Horak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kuo, Ad" uniqKey="Kuo A">AD Kuo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kuo, Ad" uniqKey="Kuo A">AD Kuo</name></author><author><name sortKey="Zajac, Fe" uniqKey="Zajac F">FE Zajac</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cappellini, G" uniqKey="Cappellini G">G Cappellini</name></author><author><name sortKey="Ivanenko, Yp" uniqKey="Ivanenko Y">YP Ivanenko</name></author><author><name sortKey="Poppele, Re" uniqKey="Poppele R">RE Poppele</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24259783</article-id><article-id pub-id-type="pmc">3820187</article-id><article-id pub-id-type="publisher-id">jpts-2013-154</article-id><article-id pub-id-type="doi">10.1589/jpts.25.1313</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original</subject></subj-group></article-categories><title-group><article-title>Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral
One-legged Standing Balance of Adults</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Son</surname><given-names>Sung Min</given-names></name><degrees>MS, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kang</surname><given-names>Kyung Woo</given-names></name><degrees>MS, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Na Kyung</given-names></name><degrees>MS, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nam</surname><given-names>Seok Hyun</given-names></name><degrees>MS, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kwon</surname><given-names>Jung Won</given-names></name><degrees>MS, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Kyoung</given-names></name><degrees>PhD, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><aff id="aff1"><label>1)</label> Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Correspondence to: Kim Kyoung, Department of Physical Therapy, College of Rehabilitation
Science, Daegu University: 15 Jilyang, Gyeongsan-si, Kyeongbuk 712-714, Republic of
Korea. E-mail: <email xlink:href="kykim257@hanmail.net">kykim257@hanmail.net</email></corresp></author-notes><pub-date pub-type="epub"><day>20</day><month>11</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>10</month><year>2013</year></pub-date><volume>25</volume><issue>10</issue><fpage>1313</fpage><lpage>1315</lpage><history><date date-type="received"><day>08</day><month>4</month><year>2013</year></date><date date-type="accepted"><day>29</day><month>5</month><year>2013</year></date></history><permissions><copyright-statement>2013©by the Society of Physical Therapy Science</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p> [Purpose] The purpose of the current study was to investigate the changes in one-legged
standing balance of the ipsilateral lower limb following unilateral isokinetic strength
training. [Subjects and Methods] Thirty healthy adult volunteers were randomly assigned to
either a training group or a control group, so that each group included 15 subjects.
Subjects in the training group performed unilateral ankle isokinetic exercises of the
dominant leg using the Biodex 3 PRO System for a period of four weeks. Ipsilateral
one-legged standing balance was evaluated before and after the intervention with three
stability indexes of balance using the Biodex System: Anterior-Posterior Stability Index
(APSI), Medial-Lateral Stability Index (MLSI), and Overall Stability Index (OSI).
[Results] Comparison of pre- and post-test data revealed significant improvements in
strength values (dorsiflexion, plantarflexion, eversion, and inversion) and stability
indexes (APSI, MLSI, OSI). [Conclusion] These results suggest that ankle strengthening
exercise can be considered as a form of exercise that may assist individuals with
improvement of balance.</p></abstract><kwd-group><title>Key words</title><kwd>Postural balance</kwd><kwd>Isokinetic exercise</kwd><kwd>Strength training</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>INTRODUCTION</title><p>Functional balance is defined as the ability to maintain a position and to adjust posture
during functional movement and mobility, such as the movement from one postural position to
another or moving from one location to another<xref ref-type="bibr" rid="r1">1</xref><sup>)</sup>. The maintenance of balance is a complex phenomenon, and it is
influenced by a range of several sensorimotor functions, including muscular strength,
proprioception, and the visual and vestibular sensory system<xref ref-type="bibr" rid="r2">2</xref>, <xref ref-type="bibr" rid="r3">3</xref><sup>)</sup>.</p><p>A standing posture has a high center of gravity (COG) which is maintained over a relatively
small base of support<xref ref-type="bibr" rid="r4">4</xref><sup>)</sup>. Previous studies
have identified two discrete strategies of postural control, and ankle and hip strategies
have often been used to describe maintenance of postural control through specific actions at
those two joints<xref ref-type="bibr" rid="r4">4</xref>, <xref ref-type="bibr" rid="r5">5</xref><sup>)</sup>. Strength of the ankles has been found to correlate with postural
stability and functional tests<xref ref-type="bibr" rid="r6">6</xref>, <xref ref-type="bibr" rid="r7">7</xref><sup>)</sup>. Several studies have also demonstrated the importance of
foot and ankle musculature in the optimal performance of functional motor tasks, such as
walking, running, and jumping<xref ref-type="bibr" rid="r8">8</xref>, <xref ref-type="bibr" rid="r9">9</xref><sup>)</sup>. However, to date, most studies associated with strength
training and balance for the lower limbs have been limited to the hip or knee joint<xref ref-type="bibr" rid="r13">13</xref>,<xref ref-type="bibr" rid="r14">14</xref>,<xref ref-type="bibr" rid="r15">15</xref><sup>)</sup>, and little is known about the effects of
balance after isokinetic training for the ankles. In general, an efficient way to increase
balance ability is resistance training for the hip and knee joint<xref ref-type="bibr" rid="r10">10</xref>,<xref ref-type="bibr" rid="r11">11</xref>,<xref ref-type="bibr" rid="r12">12</xref><sup>)</sup>.</p><p>The purpose of this study was to investigate the changes in the Anterior-Posterior
Stability Index (APSI), Medial-Lateral Stability Index (MLSI), and Overall Stability Index
(OSI) in one-legged standing balance of the ipsilateral lower limb following unilateral
isokinetic strength training for the ankle.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><p>Thirty healthy and physically active subjects were recruited as volunteers for this study.
The subjects were randomly assigned to a training (n=15) or control group (n=15). The
baseline demographic characteristics of the subjects enrolled in the study were as follows.
Each group consisted of five male and 10 female subjects. The mean age, height, weight, and
foot length of subjects in the control group were 23.6 ± 2.35 years, 162.9 ± 8.24 cm, 56.1 ±
12.66 kg, and 241.7 ± 16.65 mm, respectively, and those of the training group were 23.4 ±
2.03 years, 165.5 ± 5.71 cm, 55.5 ± 6.37 kg, and 245.7 ± 14.05 mm, respectively. The
subjects had not participated in a resistance training program for at least six months.
Subjects were excluded if they had; a diagnosed neurologic disease or disorder; acute back
or lower-limb musculoskeletal problems, such as strain, sprain, surgery, or fracture; or
neurologic or vestibular impairment that prevented single-limb stance. All the subjects
understood the purpose of this study and provided their written informed consent prior to
their participation in the study in accordance with the ethical standards of the Declaration
of Helsinki.</p><p>Unilateral training was performed using the Biodex 3 PRO System (Biodex, Inc., Shirley, NY,
USA) for strength training of ankle dorsiflexion and plantar flexion, and inversion and
eversion. Subjects in the training group received training five times per week for four
consecutive weeks. Isokinetic exercise were performed on the right side in five sets of 10
repetitions at the angular velocity of 60°/s with a rest period of 2 min between sets.
Subjects who complained of ankle pain during the training period were excluded from this
study. Subjects in the control group attended health education programs, such as fall
prevention, balance, exercise, and were given general information regarding health promotion
for one hour each week.</p><p>For balance testing, we used a commercial balance device, the Biodex Stability System (BSS)
(Biodex Medical systems, Shirley, NY, USA), a movable balance platform providing up to 20°
of surface tilt in all directions. Measures of postural stability include the stability
indexes of APSI, MLSI, and OSI. These indices are standard deviations of fluctuations around
the zero point rather than around a group mean. One-legged stance between the training and
control group was assessed at level 10 (Level 12 is the most stable, 1 is the least stable)
stability of the BSS for a period of 20 s. The stability indexes were calculated from the
degree of tilt deviation from horizontal and were averaged over three evaluations. For this
test, subjects were instructed to fold their arms across the chest and look straight ahead,
lift the untrained knee from the floor and flex it to 90°at the start of the assessment, and
maintain the position as accurately as possible. Balance measurements using BSS of the
training and control group were performed before and after the four-week intervention
period.</p><p>Statistical analyses were performed using SPSS version 18.0 software. The independent
t-test was used for analysis of differences between the training and control groups, in
terms of the baseline data for age, height, weight, and foot length. All data were evaluated
using separate univariate analyses of variance, and two-way ANOVA with repeated measures
(groups: training group, control group) × 2 (test sessions: pre-test, post-test) on the two
dependent variables. The level of statistical significance was chosen as 0.05.</p></sec><sec sec-type="results" id="s3"><title>RESULTS</title><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title> Comparison of balance ability of the training and control group</title></caption><table frame="hsides" rules="groups"><thead><tr><td align="center" valign="middle" rowspan="3" colspan="1">Parameters</td><td align="center" valign="middle" rowspan="2" colspan="2">Training group (n=15)</td><td align="center" valign="middle" rowspan="2" colspan="2">Control group (n=15)</td><td align="center" colspan="2" rowspan="1">Change Values</td></tr><tr><td align="center" rowspan="1" colspan="1">Training group (n=15)</td><td align="center" rowspan="1" colspan="1">Control Group (n=15)</td></tr><tr><td align="center" rowspan="1" colspan="1">Pre</td><td align="center" rowspan="1" colspan="1">Post</td><td align="center" rowspan="1" colspan="1">Pre</td><td align="center" rowspan="1" colspan="1">Post</td><td align="center" rowspan="1" colspan="1">Post-Pre</td><td align="center" rowspan="1" colspan="1">Post-Pre</td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Dorsiflexion (Nm)</td><td align="center" rowspan="1" colspan="1">8.21 ± 3.34</td><td align="center" rowspan="1" colspan="1">10.64 ± 4.85*†</td><td align="center" rowspan="1" colspan="1">8.66 ± 3.47</td><td align="center" rowspan="1" colspan="1">8.51 ± 3.42</td><td align="center" rowspan="1" colspan="1">2.43 ± 3.19*</td><td align="center" rowspan="1" colspan="1">–0.15 ± 1.96</td></tr><tr><td align="left" rowspan="1" colspan="1">Plantarflexion (Nm)</td><td align="center" rowspan="1" colspan="1">18.50 ± 6.72</td><td align="center" rowspan="1" colspan="1">31.43 ± 11.39*†</td><td align="center" rowspan="1" colspan="1">21.2 ± 7.28</td><td align="center" rowspan="1" colspan="1">20.27 ± 5.38</td><td align="center" rowspan="1" colspan="1">12.93 ± 11.99*</td><td align="center" rowspan="1" colspan="1">–0.97 ± 5.21</td></tr><tr><td align="left" rowspan="1" colspan="1">Eversion (Nm)</td><td align="center" rowspan="1" colspan="1">5.80 ± 2.80</td><td align="center" rowspan="1" colspan="1">9.61 ± 3.25*†</td><td align="center" rowspan="1" colspan="1">4.32 ± 2.47</td><td align="center" rowspan="1" colspan="1">4.51 ± 2.37</td><td align="center" rowspan="1" colspan="1">3.81 ± 1.98*</td><td align="center" rowspan="1" colspan="1">0.19 ± 1.76</td></tr><tr><td align="left" rowspan="1" colspan="1">Inversion (Nm)</td><td align="center" rowspan="1" colspan="1">6.45 ± 2.37</td><td align="center" rowspan="1" colspan="1">11.03 ± 5.22*†</td><td align="center" rowspan="1" colspan="1">6.19 ± 3.17</td><td align="center" rowspan="1" colspan="1">5.28 ± 2.70</td><td align="center" rowspan="1" colspan="1">4.58 ± 4.19*</td><td align="center" rowspan="1" colspan="1">–0.91 ± 1.68</td></tr><tr><td align="left" rowspan="1" colspan="1">APSI (°)</td><td align="center" rowspan="1" colspan="1">0.52 ± 0.33</td><td align="center" rowspan="1" colspan="1">0.36 ± 0.16*†</td><td align="center" rowspan="1" colspan="1">0.51 ± 0.21</td><td align="center" rowspan="1" colspan="1">0.50 ± 0.20</td><td align="center" rowspan="1" colspan="1">–0.16 ± 0.188*</td><td align="center" rowspan="1" colspan="1">–0.01 ± 0.171</td></tr><tr><td align="left" rowspan="1" colspan="1">MLSI (°)</td><td align="center" rowspan="1" colspan="1">0.47 ± 0.21</td><td align="center" rowspan="1" colspan="1">0.26 ± 0.09*†</td><td align="center" rowspan="1" colspan="1">0.47 ± 0.22</td><td align="center" rowspan="1" colspan="1">0.47 ± 0.24</td><td align="center" rowspan="1" colspan="1">–0.21 ± 0.167*</td><td align="center" rowspan="1" colspan="1">–0.01 ± 0.250</td></tr><tr><td align="left" rowspan="1" colspan="1">OSI (°)</td><td align="center" rowspan="1" colspan="1">0.76 ± 0.39</td><td align="center" rowspan="1" colspan="1">0.57 ± 0.25*†</td><td align="center" rowspan="1" colspan="1">0.75 ± 0.34</td><td align="center" rowspan="1" colspan="1">0.75 ± 0.28</td><td align="center" rowspan="1" colspan="1">–0.19 ± 0.205*</td><td align="center" rowspan="1" colspan="1">0 ± 0.214</td></tr></tbody></table><table-wrap-foot><p>* significant difference between pre- and post-test (*p<0.05). † significant
difference compared with the control group (p<0.05). APSI (Anterior-Posterior
Stability Index), MLSI (Medial-Lateral Stability Index), OSI (Overall Stability Index).
Nm (Newton meter)</p></table-wrap-foot></table-wrap><p>No significant differences in terms of distributions of gender, age, height, weight, and
foot length were observed between the two groups. <xref rid="tbl_001" ref-type="table">Table
1</xref> shows the parameters of ankle strength (dorsiflexion, plantarflexion, eversion
and inversion) and stability parameters (ALSI, MLSI and OSI) at the pre- and post-tests of
the two groups. In terms of the parameters of ankle strength (dorsiflexion, plantarflexion,
eversion and inversion) and stability parameters (ALSI, MLSI and OSI), two-way ANOVA with
repeated measures showed significantly large main effects of group (p<0.05), time
(p<0.05), and group-by-time interaction (p<0.05). In addition, changes in pre-test and
post-test values were significant in the training group (p<0.05). However, there were no
significant differences in the control group (p>0.05). These data indicate that the
training group achieved significant improvements in ankle strength and stability over the
4-week intervention period.</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>In the current study, we attempted to investigate the effect of unilateral isokinetic
strength training for the ankle on the one-legged standing balance of the ipsilateral lower
limb. We acknowledge that no studies have been conducted to investigate the effect of ankle
training with isokinetic exercise on the one-legged standing balance of the ipsilateral
lower limb. Our findings show there were significant improvements in ankle strength
(dorsiflexion, plantarflexion, eversion and inversion) and in the APSI, MLSI and OSI
stability indexes of the ipsilateral lower limb in one-leg standing balance in the training
group, compared to the gender- and age-matched control groups.</p><p>In order to support the whole body, muscle action around the ankle is important, because it
is responsible for control of this joint<xref ref-type="bibr" rid="r8">8</xref>, <xref ref-type="bibr" rid="r9">9</xref><sup>)</sup>. One of the most common interventions for
improving postural stability is physical exercise, such as ioskinetic exercise and
progressive resistance exercise<xref ref-type="bibr" rid="r16">16</xref>, <xref ref-type="bibr" rid="r17">17</xref><sup>)</sup>. Our findings indicate that isokinetic
exercise for the ankle improved balance ability. These findings are in agreement with those
of several previous studies, which suggested that strength exercise targeting the lower limb
muscles improves balance ability<xref ref-type="bibr" rid="r12">12</xref>,<xref ref-type="bibr" rid="r13">13</xref>,<xref ref-type="bibr" rid="r14">14</xref><sup>)</sup>.
We think that balance improvement may be a result of better coordination of the muscles
around the ankle after isokinetic training. In addition, increase in balance ability may be
related to promotion of the proprioceptive senses, due to strength exercise, since
proprioceptive function is an important factor of balance ability<xref ref-type="bibr" rid="r18">18</xref><sup>)</sup>. Strength exercise can activate proprioceptive functions,
which might provide feedback to the joint, increase stimulation of the mechanoreceptors,
such as the muscle spindle, Golgi tendon organ and Ruffini nerve endings around the
joint<xref ref-type="bibr" rid="r19">19</xref>,<xref ref-type="bibr" rid="r20">20</xref>,<xref ref-type="bibr" rid="r21">21</xref><sup>)</sup>. Hilberg et al.<xref ref-type="bibr" rid="r19">19</xref><sup>)</sup> used isometric muscular strength training
for knee joints, and reported improved performances in the one-legged standing test and
proprioceptive function after exercise by a training group, compared with control group. On
the basis of these results, we think that balance improvement is influenced by activation of
motor coordination and proprioceptive sense in the ankle joint due to the strength
training.</p><p>Previous studies have reported that the relation between strength training exercise and
balance is a good indicator of dynamic stability in healthy and older adults. Our findings
emphasize that ankle strengthening exercise can be considered as a form of exercise that may
assist individuals in improvement of balance. However, in this study, it is possible that
the training for ankle strength may have simultaneously influenced the activation of the
muscles around the knee joint, which is the joint closest to the ankle, as well as the
muscles around ankle. In addition, the results of our study should be interpreted with
consideration of potential limitations. First, isokinetic training was performed for only
four weeks. If the intervention were carried out for a longer period of time, the result
would possibly show more significant improvements. Second, conduct of a study with older
subjects is needed in order to investigate the therapeutic efficacy of isokinetic strength
training, because older subjects may have a greater need for balance improvement than
younger subjects with regard to the prevention of falls. Future studies may be needed in
order to clarify these issues.</p></sec></body><back><ref-list><title>REFERENCES</title><ref id="r1"><label>1</label><mixed-citation publication-type="journal"><person-group><name><surname>Berg</surname><given-names>K</given-names></name></person-group>: <article-title>Balance and its measure in the elderly: a
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