Age and sex differences in human balance performance from 6-18 years of age: A systematic review and meta-analysis

Abstract

Background The process of growing leads to inter-individual differences in the timing of growth, maturational, and developmental processes during childhood and adolescence, also affecting balance performance in youth. However, differences in balance performance by age and sex in youth have not been systematically investigated yet. Objective The objective of the present study was to characterize and quantify age- and sex-related differences in balance performance in healthy youth. Methods A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SPORTDiscus. To be applicable for analysis, studies had to report at least one measure of static steady-state, dynamic steady-state, proactive or reactive balance in healthy children (6–12 years) and/or adolescents (13–18 years). Coding of the studies was done according to the following criteria: age, sex, and balance outcome. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies. Weighted standardized mean differences were calculated and classified according to their magnitude. Results Twenty-one studies examined age-related differences in balance performance. A large effect for measures of static steady-state balance (SMD ba = 1.20) and small effects for proxies of dynamic steady-state (SMD ba = 0.26) and proactive balance (SMD ba = 0.28) were found; all in favor of adolescents. Twenty-five studies investigated sex-related differences in balance performance. A small-sized effect was observed for static steady-state balance (SMD bs = 0.33) in favor of girls and for dynamic steady-state (SMD bs -0.02) and proactive balance (SMD bs = -0.15) in favor of boys. Due to a lack of studies, no analysis for measures of reactive balance was performed. Conclusions Our systematic review and meta-analysis revealed better balance performances in adolescents compared to children, irrespective of the measure considered. Sex-related differences were inconsistent. These findings may have implications for example in terms of trainability of balance in youth that should be investigated in future studies.

Postural stability of 5-year-old girls and boys with different body heights

“…Differences between sexes are equivocal in the literature. Other researchers report no significant sex differences in balance skills at the age of 5–6 [16, 32, 34, 35]. It may be assumed that differences in the obtained results may depend on the use of different methods, measuring platforms or tests, different numbers of study participants or different age groups.…”

“…In turn, boys tend to spend more time engaged in moderate-to-vigorous physical activity and achieve better results in activities which require more speed and strength [21, 22, 23, 24]. Consequently, boys may be at an advantage over girls in terms of proactive balance as they can compensate worse balance with greater muscle strength [35]. It is possible that maturational slowness of the vestibular function seen in young boys is one of the factors responsible for the fact that boys are prone to be more active than girls [32, 38].…”

Effect of practice on learning to maintain balance under dynamic conditions in children: are there sex differences?

“…Balance is important during activities of daily life as well as in sports and poor balance is associated with an increased risk of falling and sustaining injuries [1]. This is particularly important for children as balance performance does not reach the adult-level before late adolescence due to maturation processes of the postural control system [2]. According to Shumway-Cook and Woollacott [3], a distinction is made between static balance where the base of support and the ground remain stationary and only the center of mass moves (e.g., standing on a firm floor) and dynamic balance where the base of support and/or the ground move and the center of mass shifts (e.g., walking).…”

“…With respect to balance performance in youth, findings on sex-related differences are rather inconclusive. For example, a systematic review with meta-analysis [2] examining age-and sex-related differences in balance performance in youth found inconsistent results. More precisely, girls showed superior static balance (standardized mean difference [SMD] = 0.33), while boys performed better in proactive conditions (SMD = − 0.15) and almost no difference was found concerning measures of dynamic balance (SMD = − 0.02).…”

Improvement of Gender Balance Based on the Real-Time Visual Feedback System of the Pressure Center of Smart Wearable Devices: A Case Control Study

“…In addition, men are more likely to sway and cause physical instability than women because of their greater COP displacement during postural control [15]. Static and dynamic exercises show that women are excellent in maintaining static balance, affording posture stabilization and body balance maintenance [16]. Previous studies have shown that men have greater COP displacements after open-eyes/closed-eyes balance training, indicating that men are more unstable than women [17].…”