International Journal of Applied Exercise Physiology

2322-3537 www.ijaep.com
Vol.5 No.2
Received: January 2016 , Accepted: May 2016, Available online: July 2016

Effects of Water and Land-based Sensorimotor Training Programs on Static

Balance among University Students

Abdolhamid Daneshjoo 1*, Ashril Yusof 2

1-
Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport Science, Shahid Bahonar
University of Kerman, Kerman, Iran., 2. Sports Centre, University of Malaya, Kuala Lumpur, Malaysia

ABSTRACT: This study examined the effect of sensorimotor training on static balance in two
different environments; in water and on land. Thirty non-clinical university male students (aged
22±0.85 years) were divided randomly into three groups; water, land and control groups. The
experimental groups performed their respective sensorimotor training programs for 6 weeks (3
times per week). The Stork Stand Balance Test was used to examine the static balance at pre-
and post-time points. Significant main effect between group (P=0.001, η=0.78), and also time
(P=0.001, η=0.72) were found. The post-hoc test showed significant differences between training
in water compared to control group (P=0.001), while no difference between training on land
compared to the control group (P=1.000). The water-based exercises significantly improved
balance in the dominant leg with eyes opened (EO; test in water 10.4%, test on land 7.7%), and
eyes closed (EC; test in water 8%, test on land 1.7%). Similarly in the non-dominant leg, the
water group showed improvement in all conditions (EO; test in water by 10.7%, test on land
6.8%, EC; test in water by 8.8%, test on land 1.6%). However, the land-based exercise just
showed improvement of 0.7% in the dominant leg with EO condition. It is concluded that the
sensorimotor exercises in water can improve static balance more than on land. We suggest using
water-based exercises instead of land-based for improving static balance in the collegiate
population.

KEY WORDS water; land; sensorimotor; balance; Stork Stand Balance Test

INTRODUCTION (ACSM) position stand on balance is

Researches support that having a good neuromotor exercises which included balance,
balance is essential to reduce musculoskeletal coordination, gait, and agility, and sensorimotor
injuries and improve functional daily activity training performed; ≥2 -3 d week-1, 20-30 min
[1, 2]. American College of Sports Medicine day-1 [3]. Generally, balance could be divided

Copyright© Asian Exercise & Sport Science Association (AESA). www.aesasport.com

 Effect of water and land-based programs on static balance
into static and dynamic components, and by
definition static balance is the ability to
maintain the body's center of gravity vertically
over the base of support during quiet standing
with minimal movement [4].
The relationship between balance ability
and sport injury risk among young athletes has
been established in many cases, where a decline
in balance function is commonly seen followed
by injuries e.g. in anterior cruciate ligament tear
of the knee and may predispose to recurring
injury [5]. So assessment of balance function is
important in identifying balance deficits and the
subsequent planning of appropriate
preventative programs [1, 6]. Static balance
may be assessed by having an individual to
maintain a motionless position while standing
on one or both legs using Flamingo test or
Stork Stand Balance Test (SSBT) [1]. SSBT is
a functional assessment which is quick to
administer, convenient, and low expense, and is
a common balance test used by physical
educators, sports and exercise science
specialists and physiotherapists. The control
and regulation of balance depend on continuous
feedback systems of processing visual,
vestibular and proprioceptive inputs and
executing neuromuscular actions [1, 5]. In
order to reduce the balance impairment,
prevention by exercise training which improves
balance seems to be essential. Actually, it is
well recognized that physical training permits a
decrease in risk factors linked with balance by
providing an improvement in static balance [4].
It had been reviewed that exercising in
water provides improvement in afferent
stimulations, reduction in weight bearing, less
fearful of movement, more independent upright
postures and facilitate vestibular inputs [7].
Several studies have compared the effect of
different water-based and land-based exercises
on some physiological factors such as heart
rate, blood lactate [8, 9], oxygen uptake [8],
lumbar motion and level of physical disability
[10]. Few studies focused specifically on
comparing the effects of certain exercise
program in water and land on static balance.
Results by Douris et al. (2003) indicate that
International Journal of Applied Exercise Physiology www.ijaep.com
VOL. 5 (2)
both water and land-based program enhanced
static balance after 6 weeks of activities
(walking, toe raises, heel raises, marching in
place, etc.) [11]. A later work also confirms
these hypotheses where an 8-week balance
specific training program (such as; one leg
standing, tandem walking, overhead lifts,
kickbacks, shoulder rows, squats, and lunges)
carried out in both environments; in water and
on land improved static balance [12]. In a
related study, an aquatic program improves
balance in female with rheumatoid arthritis
[13]. In addition, water exercises such as
walking, marching, sidestepping, kicking, and
twisting have shown improvements in balance
among healthy elderly people [14].
Little information has been published
regarding the effectiveness of improving
stability by sensorimotor training in water and
on land. Furthermore, most researches focus on
investigating the effects of training in water
mainly on elderly and clinical populations, and
there is limited research on younger healthy
population. Ageing has been associated with
decline in sensorial function and muscular
weakness of the lower extremities which
consequently leads to postural instability and
body sway [16]. Since there are vast differences
between young and elderly populations;
physiological, physical and life style, more
attention on young people is merited [15].
Although there has been few studies addressing
the issue of whether training in water is better
than on land in improving static balance, the
findings remain equivocal with few reporting
the former is better [14, 17] or no change [11,
18]. This is further complicated by the different
methodologies employed by the researchers in
their studies; the training program
administered, testing protocols employed, age
group and health status of participants. In other
words it is unknown which exercise program,
water-based and land-based exercises, has
maximum advantage in improving static
balance in the young population. So the aim of
this study was to investigate effects of water
and land sensorimotor program on static
balance in healthy college age population.
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 Effect of water and land-based programs on static balance
METHODS
Thirty (n=30) non-clinical male students
(moderately active) were randomly divided into
3 groups as listed in Table 1; water group (WG,
n=10), land group (LG, n=10) and control
group (n=10). All participants were students at
the University Malaya. Those without any
history of major injuries or diseases
participated in this study, while those involved
in any sport, which may influence balance
abilities, were excluded from this study. The
participants were encouraged to maintain
similar eating habits and sleeping patterns. All
the participants were informed orally about the
procedures they would undergo and their
written consents were taken. The study was
approved by the ethical committee of the
Institute of Research Management and
Monitoring, University of Malaya and the
Sports Centre Research Committee.
Table 1. Demographic Characteristics of the
Participants (Values Are Mean ±SD)
Groups WG LG Control
Age (y) 21.9(0.87) 22.0(0.82) 22.1(0.87)
Height(m) 1.72(0.02) 1.67(0.05) 1.71(0.06)
Weight(kg) 63.2(7.95) 63.9(7.5) 64.1(6.31)
y= year; m= meter; kg= kilogram; WG= water
group; LG= land group
Procedure
Participants in each group attended a
workshop separately to discuss the prescribed
training and were instructed on how to perform
the exercises correctly. All training sessions
were supervised by the same researchers at
same time of the day (between 16.00-20.00) to
ensure their compliance with the programs. The
WG performed sensorimotor training program
in water, and LG carried out the same program,
but on land. The WG performed the exercises
in a swimming pool of shallow water (about;
0.8 m). All participants were encouraged to just
perform their respective program and should
not be involved in any other activities. Before
commencement of the study, the control group
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VOL. 5 (2)
was assured that they would receive the
sensorimotor training program 6 weeks later.
Before starting the sensorimotor
program all participants participated in two
familiarization sessions. The pre-test was
conducted one day prior to the first day of
training, and the post-test 6 weeks later (1 day
after the last training session). The static
balance testing was performed by a different
member of the researcher team who was
blinded to the treatment received by the
participants (Figure 1).
The sensorimotor training program
The sensorimotor training program
followed the same routine for every session.
Before starting the sensorimotor training
program, the participants carried out a 5-min
warm-up. The sensorimotor training program
was performed 3 times per week (total of 18
sessions). The training program groups
consisted of 50 min specific sensorimotor
exercise. In each session 5 min rest was given
between different types of exercises. Some of
these varied exercises consisted of changing
arm position, opening/closing eyes, moving in a
different direction or modifying the base of
support (Table 2).
Static balance test
Static balance was measured using the
Stork Stand Balance Test (SSBT). This test is a
standard test with high test re-test reliability (r
=0.87), and an inter-rater type of reliability
(objectivity; r = 0.99) in terms of assessing
static balance among healthy people adopted
from Johnson and Nelson (1986) [19].
Moreover, Suni et al. (1996) reported inter-rater
ICC values of 0.76 (SEM 13.3 seconds) over a
week for 510 healthy male/female adults [20].
The participants were instructed to remove their
shoes and placed their hands on their hips (at
iliac crests). Then they were asked to lift and
hold the opposite leg against the medial side of
the knee of the stance leg. The timer was
started to record at the time the subjects raised
the heel. The trial ended when the heel of the
involved leg touched the floor, the hands came
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 Effect of water and land-based programs on static balance
off of the hips, or the opposite foot was
removed from the stance leg. This test was
conducted with eyes opened (EO) and eyes
closed (EC) for dominant leg. The participants
performed three attempts and the best time was
recorded for analysis [1, 21]. All balance
assessments performed by a single investigator.
Statistical analysis
To compare the balance between times
(pre-and post-tests), groups (WG, LG and
control), test environment (water, land), legs
(dominant, non-dominant), eyes (eyes opened,
eyes closed) the 2×3×2×2 ×2 (time vs group vs
environment vs leg vs eye) repeated measures
mixed design ANOVA was used as described
by Holcomb et al. [22]. In case of statistical
significance, the post-hoc Bonferroni test was
also conducted. Levene's test was employed for
assessing homogeneity of variance among
groups (P>0.05). Further, the Kolmogorov-
Smirnov test was employed for assessing
normality of the distribution of scores (P>0.05).
The partial eta (η) squared (0.01=small effect,
0.06=medium effect, and 0.14=large effect)
was used to tests effect sizes of each variable
[23, 24]. The level of statistical significance
was set at P <0.05.
STATISTICAL RESULTS
The means of static balance in pre-and post-
tests of the groups are presented in Table 3. The
mixed ANOVA indicated significant main
effect between group (F2,27=49.23, P=0.001)
Familiarization Pre-test 5-min warm-up + 50-min exercise (18
sessions) on 4-8 pm; supervised by a
researcher
Figure 1. Sequence of actions of testing and training sessions
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VOL. 5 (2)
with large effect size (0.78). The results showed
significant main effect in time (F1,27=69.78,
P=0.000, η=0.72), leg (F1,27=5.68, P=0.024,
η=0.17), eye (F1,27=179.91, P=0.001, η=0.87)
and environment of test (F1,27=26.45, P=0.001,
η=0.49). Significant interactions between time
with group (F2,27=63.33, P=0.001), and
environment with group (F2,27=13.48, P=0.001)
time with eye (F1,27=34.86, P=0.001) were
found. But the results did not show significant
interaction between leg with group (F2,27=2.30,
P=0.119) and time with leg (F1,27=0.047,
P=0.830).
The Bonferroni post-hoc test indicated
significant differences between WG compared
to control group (P=0.001) and LG (P=0.001).
But the results did not show significant
difference between LG compared to the control
group (P=1.000). The results showed that
water-based exercises significantly improved
balance in the dominant leg in all conditions
(P<0.05). In the non-dominant leg also water
group showed improvement in all conditions
(P<0.05). But land-based exercise just showed
improvement by 0.7 % in the dominant leg of
EO condition. No significant improvement
were found in the control group (P>0.05)
(Table 3).
Post-test
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 Effect of water and land-based programs on static balance VOL. 5 (2)

Table 2. Exercises, Duration and Intensities of the Structured Sensorimotor Program

Exercise
Week 1: Toe walk (3 item, each item 20m; straight ahead, toes-out, toes-in), 1 leg partial
squat (2 set, each set 15 repetitions), forward backward swing (2 set for each leg, each set
30 repetitions), static high knee (2 set, each set 1 min), 1 leg stand (2 set, each set 1 min),
static kick-back(2 set, each set 1 min)

Week 2: 1 leg partial squat with weight (2 set, each set 15 repetitions), high knee run (2 set,
each set 1 min), toe walk speed (3 item, each item 20m; straight ahead, toes-out, toes-in),
max forward backward leg swing (2 set for each leg, each set 30 repetitions), kick-back run
(2 set, each set 1 min), static across body swing (2 set, each set 15 repetitions)

Week 3: Blind advanced 1 leg balance (3 set, each set 1 min), toe skipping (3 item, each
item 20m; straight ahead, toes-out, toes-in), cross body swing and hand swing (2 set, each
set 15 repetitions), advanced 1 leg balance (3 set, each set 1 min), 1 leg partial squat with
dumbbell swing (2 set, each set 15 repetitions), indo board 2 leg stance (2 set, each set 30
sec)
Week 4: 1 leg balance on a wobble board (2 item in AP and ML, each item 1 min for each
leg) 1 leg squats with lateral hop (2 set, 10 rep at each set for every leg), blind advanced 1
leg balanced with dumbbell fly (2 item, each item 1 min for each leg), 1 footed heel raise (2
set, each set 15 rep), 1 leg partial squat with adding weight (2 set, each set 15 repetitions),
indo board 1 leg stance (2 set, each set 1 min)
Week 5: Blind advanced 1 leg balance (3 set, each set 1 min), 1 leg partial squat with
dumbbell swing (2 set, each set 15 rep), toe walk speed (3 item, each item 20m; straight
ahead, toes-out, toes-in), 1 leg partial squat with adding weight (2 set, each set 15
repetitions)
Week 6: Blind advanced 1 leg balance (3 set, each set 1 min), 1 leg partial squat with
dumbbell swing (3 set, each set 15 rep), toe walk speed (3 item, each item 25m; straight
ahead, toes-out, toes-in), 1 leg partial squat with adding weight (3 set, each set 15
repetitions)

AP= anterior posterior; ML= medial lateral; rep= repetition, sec= second, min= minute

Table 3. Static Balance Test (Values Are Mean ± SD), and Percentage of Change (∆) [Values Are Mean (95%
CI)] From Pre- to Post-Test.
Pre-test Post-test ∆% (95%CI)
Water group
EO 3.4±2.4 11.1±1.8 7.7(5.6 to 9.8) **
EC 0.3±0.2 2.0±1.2 1.7(0.9 to 2.5) **
Land group
EO 2.2±1.5 2.9±2.2 0.7(0.007 to 1.4) *
EC 0.3±0.1 0.4±0.2 0.05(-0.08 to 0.2)
Control group
EO 2.3±1.3 1.8±1.0 -0.6(-1.3 to 0.1)
EC 0.4±0.2 0.8±0.9 0.4(-0.2 to 1.0)

EO= eyes opened; EC= eyes closed; *= p<0.05; significant difference when compare pre- to post-tests;
**=p<0.01; significant difference when compare pre- to post-tests.
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International Journal of Applied Exercise Physiology www.ijaep.com
 Effect of water and land-based programs on static balance
DISCUSSION
The aim of this study was to investigate
the effects of water and land sensorimotor
programs on static balance in healthy college
age population. The study showed that a 6-
week sensorimotor training program in water
was associated with a significant improvement
in static balance from baseline compared to
training on land or control among university
students. In other words, water-based exercise
could be useful to affect the aspects of static
balance in healthy male students. Buoyancy and
hydrostatic pressure offered by water promote
body support and reduce the velocity of falls
which might improve learning by providing
more time to perform compensatory motor
programs [25]. These findings are conflicting
with those that reported balance ability could be
improved equally through of land-based or
water-based exercises [11]. This may be due to
the differences in the types of intervention
programs and age of our participants (22±0.85
years) to those in the reported study (aged
79±11.8years). Ageing has been associated
with decline in sensorial function and muscular
weakness of the lower extremities which
consequently leads to postural instability and
body sway.
In agreement with our results, Simmons
and Hansen (1996) showed that water-based
exercise can improve balance more than land-
based exercises. The buoyancy of water,
exercises can be carried out without
overloading the joints, provides extra support
for the participant to perform the movement
and can be less painful and much easier, which
leads to increased subjects compliance with
exercise [21]. In addition, the effects of water
resistance (i.e., drag forces) may increase
energy expenditure due to hydrostatic pressure
against the movement [26] and decrease
mechanical loads on lower extremity joints due
to no gravity force in the water [27]. The
reduced fear of falling in water is another
important aspect to be considered [25]. Due to
the supportively buoyant environment of the
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VOL. 5 (2)
water, participants are able to accomplish skills
in the water that would be difficult, too painful,
or impossible to perform on land [28]. Because
water is more viscous than air, there is
resistance to most movement in the water
regardless of buoyancy. Viscosity is only
noticeable when there is motion through the
liquid and acts as resistance to movement
because the liquid molecules adhere to the
surface of the body [7]. Water provides a low
load-bearing form of supplementary training
that can be used for recovery and rehabilitation
[29]. The influence of the water-based training
program is more than land-based on the ability
to enhance static balance could also be
explained by the fact that exercising in the
water require more strength to propel the body
forward [30]. There seems to be a positive
relationship between strength and balance [31].
This was further substantiated by Bento and co-
workers who showed that a 12-week water-
based program which included; forward and
backward jogging with arms pushing, pulling,
and pressing; and leaps, kicks, leg crossovers,
improved hip strength [32]. These are the most
plausible explanations for the greater
improvement of static balance in water- than
land-based exercises Based on our results we
suggest using water-based intervention exercise
instead of land-based programs for improving
balance.
The results of present study also showed
significant differences between static balance
with eyes opened and eyes closed, where static
balance was better with opened eyes. These
results are in agreement with finding of
Daneshjoo et al. (2012) who reported more
control in static balance with eyes opened
condition than eyes closed in soccer players.
Stones and Kozma (1998) also reported better
static balance in healthy sighted people
compared to blind people [33]. Moreover,
Giagazoglou and co-workers (2009) compared
static balance between blind and sighted
women, and confirmed that vision plays an
important role than the coding and processing
of other sensory information such as vestibular
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 Effect of water and land-based programs on static balance VOL. 5 (2)
and proprioception [34]. It is reported that
visual input affected neural control of body
sway and that imbalance increases in the
absence of vision inputs [34-36].
The present study examined the SSBT
time with a stopwatch. Therefore, a limitation
of this study was time measuring device. To
account for this, time was measured by an
experienced researcher, which generated the
high reliability of all tests in the present study.
The main finding of present study was
that water based exercise is more useful than
land based exercise to enhance static balance in
male university students. Additionally, the
results showed greater improvement in EO than
EC conditions. It can be suggested that the
sensorimotor exercises in water is appropriate
program to improve static balance. This study
increases the available data base on the positive
effects of sensorimotor program in water on
static balance. This information may be useful
for college age students to know how they can
improve their static balance. The different
levels of difficulty of present program may also
improve the program’s efficiency which
enables coaches and players to individually
adapt to the program.
ACKNOWLEDGEMENT

The authors are grateful to Ushantini

Moorthy, Kong Jin Han, Nurfadhilah Dahniar
Afandi for their help during the early stage of
this project. This research was funded by UM
research grant TC003-2012 and PG180-2014B.

Conflict of interest: The authors have declared

that no competing interests exist.

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 Effect of water and land-based programs on static balance VOL. 5 (2)

REFERENCES
1. Daneshjoo, A., Mokhtar, A.H., Rahnama, N., Yusof, A. The effects of comprehensive warm-up programs on
proprioception, static and dynamic balance on male soccer players. PLoS ONE, 2012.7(12):p.e51568.
2. Caraffa, A., Cerulli, G., Projetti, M., Aisa, G., Rizzo, A. Prevention of anterior cruciate ligament injuries in soccer. Knee
Surg Sport Tra, 1996.4(1):p.19-21.
3. Garber, C.E., Blissmer, B., Deschenes, M.R., Franklin, B.A., Lamonte, M.J., Lee, I.-M., Nieman, D.C., Swain, D.P.
American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining
cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
Med Sci Sports Exerc, 2011.43(7):p.1334-59.
4. Hrysomallis, C. Balance ability and athletic performance. Sports Med, 2011.41(3):p.221-32.
5. Hrysomallis, C. Relationship between balance ability, training and sports injury risk. Sports Med, 2007.37(6):p.547-56.
6. Gribble, P.A., Hertel, J. Considerations for normalizing measures of the star excursion balance test. Meas Phys Educ
Exerc Sci, 2003.7(2):p.89-100.
7. Thein, J.M., Brody, L.T. Aquatic-based rehabilitation and training for the elite athlete. J Ortho Sports Phys Ther,
1998.27(1):p.32-41.
8. Heithold, K., Glass, S.C. Variations in heart rate and perception of effort during land and water aerobics in older
women. J Exer Physiol, 2002.5(4):p.22-8.
9. Eckelison, J., Anderson, T. Physiological response to water aerobics. J Sport Med Phys Fitness, 1992.32(3):p.255-61.
10. Nemčić, T., Budišin, V., Vrabec-Matković, D., Grazio, S. Comparison of the effects of land-based and water-based
therapeutic exercises on the range of motion and physical disability in patients with chronic low-back pain: single-blinded
randomized study. Acta Clinica Croatica, 2013.52(3):p.321-7.
11. Douris, P., Southard, V., Varga, C., Schauss, W., Gennaro, C., Reiss, A. The effect of land and aquatic exercise on
balance scores in older adults. J Geriatr Phys Ther, 2003.26(1):p.3-6.
12. Anderson, R., Fishback, E. Balance specific training in water and on land in older adults: a pliot study. Int J of Aquatic
Res & Educ, 2010.4(3):p.300-11.
13. Suomi, R., Koceja, D.M. Postural sway characteristics in women with lower extremity arthritis before and after an
aquatic exercise intervention. Arch Phys Med Rehabil, 2000.81(6):p.780-5.
14. Simmons, V., Hansen, P.D. Effectiveness of water exercise on postural mobility in the well elderly: an experimental
study on balance enhancement. J Gerontol A Biol Sci Med Sci, 1996.51(5):p.M233-M8.
15. Lin, S.I., Woollacott, M.H. Postural muscle responses following changing balance threats in young, stable older, and
unstable older adults. J Mot Behav, 2002.34(1):p.37-44.
16. Medell, J.L., Alexander, N.B. A clinical measure of maximal and rapid stepping in older women. J Gerontol A Biol Sci
Med Sci, 2000.55(8):p.M429-M33.
17. Arazi, H., Asadi, A. The effect of aquatic and land plyometric training on strength, sprint, and balance in young
basketball players. J Human Sport Exe, 2011.1(6):p.101-11.
18. Schaal, C.M., Collins, L., Ashley, C. Cardiorespiratory responses to underwater treadmill running versus land-based
treadmill running. Int J of Aquatic Res & Educ, 2012.6(1):p.35-45.
19. Johnson, B.L., Nelson, J.K. Practical Measurements for Evaluation in Physical Education. 4 th ed: Edina, Minneapolis,
MN: Burgess; 1986.
20. Suni, J.H., Oja, P., Laukkanen, R.T., Mülunpalo, S.I., Pasanen, M.E., Vuori, I.M., Vartiainen, T.M., Bös, K. Health-
related fitness test battery for adults: aspects of reliability. Arch Phys Med Rehabil, 1996.77(4):p.399-405.
21. Hatzitaki, V., Zlsi, V., Kollias, I., Kioumourtzoglou, E. Perceptual-motor contributions to static and dynamic balance
control in children. J Mot Behav, 2002.34(2):p.161-70.
22. Holcomb, W.R., Rubley, M.D., Lee, H.J., Guadagnoli, M.A. Effect of hamstring-emphasized resistance training on
hamstring: quadriceps strength ratios. J Strength Cond Res, 2007.21(1):p.41-7.
23. Pallant, J. SPSS survival manual: a step by step guide to data analysis using SPSS. 3rd ed: Crows Nest, N.S.W.: Allen &
Unwin; 2007. 263-85 p.
24. Daneshjoo, A., Abu Osman, N.A., Sahebozamani, M., Yusof, A. Analysis of jumping-landing manoeuvers after
different speed performances in soccer players, 2015. PLoS ONE 10(11): e0143323.
25. Vivas, J., Arias, P., Cudeiro, J. Aquatic therapy versus conventional land-based therapy for Parkinson's disease: an
open-label pilot study. Arch Phys Med Rehabil, 2011.92(8):p.1202-10.
26. Gleim, G.W., Nicholas, J.A. Metabolic costs and heart rate responses to treadmill walking in water at different depths
and temperatures. Am J Sports Med, 1989.17(2):p.248-52.
27. Hall, J., Macdonald, I.A., Maddison, P.J., O'hare, J.P. Cardiorespiratory responses to underwater treadmill walking in
healthy females. Eur J Appl Physiol, 1998.77(3):p.278-84.
18
International Journal of Applied Exercise Physiology www.ijaep.com
 Effect of water and land-based programs on static balance VOL. 5 (2)
28. Anderson, R.L., Fishback, E. Balance specific training in water and on land in older adults: a pilot study. Int J Aquatic
Res Educ, 2010.4(3):p.300-11.
29. Silvers, W.M., Rutledge, E.R., Dolny, D.G. Peak cardiorespiratory responses during aquatic and land treadmill
exercise. Med Sci Sports Exerc, 2007.39(6):p.969-97.
30. Miyoshi, T., Shirota, T., Yamamoto, S., Nakazawa, K., Akai, M. Functional roles of lower-limb joint moments while
walking in water. Clin Biomech, 2005.20(2):p.194-201.
31. Tsukagoshi, T., Shima, Y., Nakase, J., Goshima, K., Takahashi, R., Aiba, T., Yoneda, Y., Moriyama, S., Kitaoka, K.
Relationship between core strength and balance ability in high school female handball and basketball players. Br J Sports
Med, 2011.45(4):p.378-.
32. Bento, P.C.B., Pereira, G., Ugrinowitsch, C., Rodacki, A.L.F. The effects of a water-based exercise program on strength
and functionality of older adults. J Aging Phys Act, 2012.20(4):p.469-83.
33. Stones, M.J., Kozma, A. Balance and age in the sighted and blind. Arch Phys Med Rehabil, 1987.68(2):p.85-9.
34. Giagazoglou, P., Amiridis, I.G., Zafeiridis, A., Thimara, M., Kouvelioti, V., Kellis, E. Static balance control and lower
limb strength in blind and sighted women. Eur J Appl Physiol, 2009.107(5):p.571-9.
35. Nashner, L.M., Shupert, C.L., Horak, F.B., Black, F.O. Organization of posture controls: an analysis of sensory and
mechanical constraints. Prog Brain Res, 1989.80:p.411-8.
36. Nougier, V., Bard, C., Fleury, M., Teasdale, N. Contribution of central and peripheral vision to the regulation of stance.
Gait Posture, 1997.5(1):p.34-41.

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