Balance training under fatigue: A randomized controlled trial on the effect of fatigue on adaptations to balance training.

Keller M, Lichtenstein E, Roth R, Faude O. J Strength Cond Res. 2023 Aug 29. doi: 10.1519/JSC.0000000000004620. Epub ahead of print. PMID: 37643391.

Full Text Freely Available

Take-Home Message

Balance training in a non-fatigued state yields better balance performance than training in a fatigued state. If balance training is coupled with other more specific training regiments, balance training should be administered before an activity that may cause fatigue.


Balance training can help prevent ankle injuries. Many injury prevention programs are completed in an unfatigued state. However, fatigue negatively impacts the risk of lower extremity injury. To optimize our delivery of balance training, we need to know whether we should ask athletes to perform the training in a fatigued or unfatigued state.

Study Goal

The researchers completed a randomized controlled trial to assess the neuromuscular performance benefits of balance training while fatigued or not.


Initially, 52 participants completed a pre-test, including a balance assessment on 3 surfaces (wobble board, soft mat, and solid ground), jump height, and shuttle run test before and after high-intensity interval training (HIIT) to induce fatigue. The researchers randomly assigned participants to 1 of 3 groups: 1) balance training alone, 2) balance training while fatigued (after HIIT), and 3) balance training before fatigue (before HIIT). Participants completed 12 sessions over 6 weeks, with at least 48 hours between sessions. All participants completed identical balance training interventions. Participants then completed assessments 2 to 5 days after the last training session, which included a balance assessment, jump height, and shuttle run test.


In all 6 conditions of the balance assessment (3 surfaces, fatigued or not), the group performing balance training while fatigued experienced smaller benefits than the groups performing balance training alone or balance training before fatigue. Regarding performance, both groups performing HIIT had greater jump height and shuttle run improvements than the balance training only group. Four out of the five people lost to follow-up participated in the balance training while fatigued group.


Overall, the study’s results demonstrated that fatigue negatively impacts balance training. Hence, athletes should perform balance training in a non-fatigued state (e.g., at the beginning of a training session). The results also show that balance training can be coupled with performance training for additional benefits. However, the athletes should complete the performance training after balance training to maximize the benefits of each. Finally, almost 1 in 4 people who performed the balance training while fatigued quit the program. This finding may indicate that athletes dislike doing balance training in a fatigued state, which could lead to compliance issues in the real world.    

Clinical Implications

Clinicians should ask athletes to perform balance training at the beginning of a training session (before fatigue starts).

Questions for Discussion

How and when do you implement balance training in your clinical practice? What changes might you make based on the evidence presented in this study?

Written by Kyle Harris
Reviewed by Jeffrey Driban

Related Posts

Balancing Ankle Injuries and Soccer with…Balance
Save the Ankles by Bracing or Balance Training: Either is Better than Nothing
Shake It Up: Vibration Training Improves Balance for Chronic Ankle Instability Group
Simple Balance Test Is Able To Identify Non Contact Lower Extremity Injury Risk
Balance Assessments Unable to Predict ACL Injury in Elite Female Athletes

9 EBP CEU Courses