The effect of attentional focus in balancing tasks: A systematic review with meta-analysis
Purpose: The present study was to use the aggregate data meta-analytic approach to examine the effects of attentional focus during balancing tasks in motor learning. Method: A literature search was conducted based on five electronic database searches, cross-referencing and expert review. Studies included randomized trials of external (EF) versus internal focus (IF). Risk of bias was assessed using a self-developed instrument. Random effects models using the standardized mean difference effect size (ES) were used to pooled results. Heterogeneity was examined using the Q statistic and inconsistency using I2. Results: Of 790 studies screened, 16 representing 541 males and females and up to 17 ES met the inclusion criteria. Analyses indicated that the EF groups outperformed the IF groups for acquisition phase (ES= 0.48, n= 16; CI95%= 0.07 to 0.90, Q= 68.7, I2= 78.2%), retention (ES= 0.44, n= 17, CI95%= 0.14 to 0.74; Q= 26.1, I2= 38.6%), and transfer (ES= 1.41, n= 4, CI95%= 1.00 to 1.82, Q= 22, I2= 0%). Conclusion: The overall results suggest that EF results in better balance learning when compared to IF.
Al-Abood, S. A., Bennett, S. J., Hernandez, F. M., Ashford, D., & Davids, K. (2002). Effect of verbal instructions and image size on visual search strategies in basketball free throw shooting. Journal of Sports Sciences, 20(3), 271-278. https://doi.org/10.1080/026404102317284817
*Becker, K., & Smith, P. J. (2013). Age, task complexity, and sex as potential moderators of attentional focus effects. Perceptual Motor Skills, 117, 1172-1186. https://doi.org/10.2466/23.25.PMS.117x14z3
Bell, J. J., & Hardy, J. (2009). Effects of attentional focus on skilled performance in golf. Journal of Applied Sport Psychology, 21(2), 163-177. https://doi.org/10.1080/10413200902795323
Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2009). Introduction to meta-analysis. United Kingdom: John Wiley & Sons. https://doi.org/10.1002/9780470743386
Bressel, E., Yonker, J. C., Kras, J., & Heath, E. M. (2007). Comparison of static and dynamic balance in female collegiate soccer, basketball, and gymnastics athletes. Journal of Athletic Training, 42(1), 42.
Chew-Bullock, T.S.-Y., Anderson, D. I., Hamel, K. A., Gorelick, M. L., Wallace, S. A., & Sidaway, B. (2012). Kicking performance in relation to balance ability over the support leg. Human Movement Science, 31(6), 1615-1623. https://doi.org/10.1016/j.humov.2012.07.001
*Chiviacowsky, S., Wulf, G., & Wally, R. (2010). An external focus of attention enhances balance learning in older adults. Gait & Posture, 32(4), 572-575. https://doi.org/10.1016/j.gaitpost.2010.08.004
*De Bruin, E. D., Swanenburg, J., Betschon, E., & Murer, K. (2009). A randomised controlled trial investigating motor skill training as a function of attentional focus in old age. BMC Geriatrics, 9(1), 15. https://doi.org/10.1186/1471-2318-9-15
Giagazoglou, P., Kokaridas, D., Sidiropoulou, M., Patsiaouras, A., Karra, C., & Neofotistou, K. (2013). Effects of a trampoline exercise intervention on motor performance and balance ability of children with intellectual disabilities. Research in Developmental Disabilities, 34(9), 2701-2707. https://doi.org/10.1016/j.ridd.2013.05.034
Horlings, C. G., van Engelen, B. G., Allum, J. H., & Bloem, B. R. (2008). A weak balance: the contribution of muscle weakness to postural instability and falls. Nature Clinical Practice Neurology, 4(9), 504-515. https://doi.org/10.1038/ncpneuro0886
Hrysomallis, C. (2007). Relationship between balance ability, training and sports injury risk. Sports Medicine, 37(6), 547-556. https://doi.org/10.2165/00007256-200737060-00007
*Huang, C. Y., Zhao, C. G., & Hwang, S. (2014). Neural basis of postural focus effect on concurrent postural and motor tasks: phase-locked electroencephalogram responses. Behavioural Brain Research, 274, 95-107. https://doi.org/10.1016/j.bbr.2014.07.054
*Kee, Y. H., Chatzisarantis, N., Kong, V. P. W., Chow, J. Y., & Chen, L. H. (2012). Mindfulness, movement control, and attentional focus strategies: effects of mindfulness on a postural balance task. Journal of Sport and Exercise Psychology, 34(5), 561-579. https://doi.org/10.1123/jsep.34.5.561
*Laufer, Y., Rotem-Lehrer, N., Ronen, Z., Khayutin, G., & Rozenberg, I. (2007). Effect of attention focus on acquisition and retention of postural control following ankle sprain. Archives of Physical Medicine and Rehabilitation, 88(1), 105-108. https://doi.org/10.1016/j.apmr.2006.10.028
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., … Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 339, b2700. https://doi.org/10.1136/bmj.b2700
Maddox, M., Wulf, G., & Wright, D. (1999). The effect of an internal vs. external focus of attention on the learning of a tennis stroke. Journal of Sport and Exercise Psychology, 21, 78.
Mazzardo Jr, O. (2004). Contextual Interference: Is it supported across studies? (Master's Thesis). University of Pittsburgh, PA.
McNevin, N., Weir, P., & Quinn, T. (2013). Effects of attentional focus and age on suprapostural task performance and postural control. Research Quarterly for Exercise and Sport, 84(1), 96-103. https://doi.org/10.1080/02701367.2013.762321
McNevin, N. H., Shea, C. H., & Wulf, G. (2003). Increasing the distance of an external focus of attention enhances learning. Psychological Research, 67(1), 22-29.
Meyer, G., & Ayalon, M. (2006). Biomechanical aspects of dynamic stability. European Review of Aging and Physical Activity, 3(1), 29-33. https://doi.org/10.1007/s11556-006-0006-6
*Olivier, I., Palluel, E., & Nougier, V. (2008). Effects of attentional focus on postural sway in children and adults. Experimental Brain Research, 185(2), 341-345. https://doi.org/10.1007/s00221-008-1271-6
Orwin, R. G. (1983). A fail-safe N for effect size in meta-analysis. Journal of Educational Statistics, 157–159. https://doi.org/10.2307/1164923
Pajala, S., Era, P., Koskenvuo, M., Kaprio, J., Törmäkangas, T., & Rantanen, T. (2008). Force platform balance measures as predictors of indoor and outdoor falls in community-dwelling women aged 63–76 years. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(2), 171-178. https://doi.org/10.1093/gerona/63.2.171
Park, S. H., Yi, C. W., Shin, J. Y., & Ryu, Y. U. (2015). Effects of external focus of attention on balance: a short review. Journal of Physical Therapy Science, 27(12), 3929. https://doi.org/10.1589/jpts.27.3929
Peh, S. Y.-C., Chow, J. Y., & Davids, K. (2011). Focus of attention and its impact on movement behaviour. Journal of Science and Medicine in Sport, 14(1), 70-78. https://doi.org/10.1016/j.jsams.2010.07.002
*Rotem-Lehrer, N., & Laufer, Y. (2007). Effect of focus of attention on transfer of a postural control task following an ankle sprain. Journal of Orthopaedic & Sports Physical Therapy, 37(9), 564-569. https://doi.org/10.2519/jospt.2007.2519
*Polskaia, N., Richer, N., Dionne, E., & Lajoie, Y. (2015). Continuous cognitive task promotes greater postural stability than an internal or external focus of attention. Gait & Posture, 41(2), 454-458. https://doi.org/10.1016/j.gaitpost.2014.11.009
Sacks, H. S., Berrier, J., Reitman, D., Ancona-Berk, V. A., & Chalmers, T. C. (1987). Meta-analyses of randomized controlled trials. New England Journal of Medicine, 316(8), 450-455. https://doi.org/10.1056/NEJM198702193160806
*Shea, C. H., & Wulf, G. (1999). Enhancing motor learning through external-focus instructions and feedback. Human Movement Science, 18(4), 553-571. https://doi.org/10.1016/S0167-9457(99)00031-7
Thomas, J. R., & French, K. E. (1986). The use of meta-analysis in exercise and sport: A tutorial. Research Quarterly for Exercise and Sport, 57(3), 196-204. https://doi.org/10.1080/02701367.1986.10605397
*Totsika, V., & Wulf, G. (2003). The influence of external and internal foci of attention on transfer to novel situations and skills. Research Quarterly for Exercise and Sport, 74(2), 220-232. https://doi.org/10.1080/02701367.2003.10609084
Tsigilis, N., Zachopoulou, E., & Mavridis, T. (2001). Evaluation of the Specificity of Selected Dynamic Balance Tests. Perceptual and Motor Skills, 92(3), 827–833. https://doi.org/10.2466/pms.2001.92.3.827
Winter, D. A. (1995). Human balance and posture control during standing and walking. Gait & Posture, 3(4), 193-214. https://doi.org/10.1016/0966-6362(96)82849-9
Wulf, G. (2008). Attentional focus effects in balance acrobats. Research Quarterly for Exercise and Sport, 79(3), 319-325. https://doi.org/10.1080/02701367.2008.10599495
Wulf, G. (2013). Attentional focus and motor learning: A review of 15 years. International Review of Sport and Exercise Psychology, 6(1), 77-104. https://doi.org/10.1080/1750984X.2012.723728
*Wulf, G., Höß, M., & Prinz, W. (1998). Instructions for motor learning: Differential effects of internal versus external focus of attention. Journal of Motor Behavior, 30(2), 169-179. https://doi.org/10.1080/00222899809601334
Wulf, G., & McNevin, N. (2003). Simply distracting learners is not enough: More evidence for the learning benefits of an external focus of attention. European Journal of Sport Science, 3(5), 1-13. https://doi.org/10.1080/17461390300073501
*Wulf, G., McNevin, N., & Shea, C. H. (2001). The automaticity of complex motor skill learning as a function of attentional focus. The Quarterly Journal of Experimental Psychology: Section A, 54(4), 1143-1154. https://doi.org/10.1080/713756012
*Wulf, G., Mercer, J., McNevin, N., & Guadagnoli, M. A. (2004). Reciprocal influences of attentional focus on postural and suprapostural task performance. Journal of Motor Behavior, 36(2), 189-199. https://doi.org/10.3200/JMBR.36.2.189-199
Wulf, G., Shea, C., & Lewthwaite, R. (2010). Motor skill learning and performance: A review of influential factors. Medical Education, 44(1), 75-84. https://doi.org/10.1111/j.1365-2923.2009.03421.x
*Wulf, G., Shea, C., & Park, J.-H. (2001). Attention and motor performance: Preferences for and advantages of an external focus. Research Quarterly for Exercise and Sport, 72(4), 335-344. https://doi.org/10.1080/02701367.2001.10608970
Wulf, G., & Su, J. (2007). An external focus of attention enhances golf shot accuracy in beginners and experts. Research Quarterly for Exercise and Sport, 78(4), 384-389. https://doi.org/10.5641/193250307X13082505158336
*Wulf, G., Weigelt, M., Poulter, D., & McNevin, N. (2003). Attentional focus on suprapostural tasks affects balance learning. The Quarterly Journal of Experimental Psychology: Section A, 56(7), 1191-1211. https://doi.org/10.1080/02724980343000062
Zachry, T.L., Wulf, G., Mercer, J., & Bezodis, N. (2005). Increased movement accuracy and reduced EMG activity as the result of adopting an external focus of attention. Brain Research Bulletin, 67(4), 304-309. https://doi.org/10.1016/j.brainresbull.2005.06.035
Zachry, T. L. (2005). Effects of attentional focus on kinematics and muscle activation patterns as a function of expertise. University of Nevada, Las Vegas.
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