Background Balance training (BT) programs seem to be appropriate for non-athletes and athletes, but the use of multi-intervention BT protocols make difficult to observe how balance exercises improve neuromuscular control.

Objective The purpose of this study is to evaluate the current knowledge regarding the neuromuscular control adaptations in healthy participants following a BT protocol with exclusively balance exercises.

Design Systematic review.

Setting Randomised controlled trials and controlled clinical trials.

Patients (or Participants) Healthy and physically active participants.

Interventions (or Assessment of Risk Factors) The methodological quality and risk of bias were assessed using a modified Downs and Black checklist.

Main Outcome Measurements The primary outcome is the measurements of electromyography (EMG) activity, like the rate of muscle activation, H-reflex, and M-wave.

Results There were inconsistent findings regarding neuromuscular control outcomes. In relation to muscular activity observed by EMG signs, there was no change in the majority of the studies. However, one study reported a decrease in EMG activity for plantar flexors, and two studies observed an increase in muscular activity for soleus, gastrocnemius medialis, and quadriceps muscles after BT. Concerning H-reflex/M-wave ratio of the soleus muscle, two studies observed no change, while three studies reported significant reduction. Also, the reduction observed in the H-reflex/M-wave ratio was associated with a decrease of the maximal H-reflex and no change of the maximal W-wave. Following BT, the rate of force development normalized by maximum voluntary contraction (MVC) had a transient increase for plantar flexors and leg extensors. Although some authors reported a slight enhancement or no improvement on isometric MVC for plantar flexors, leg extensors, quadriceps, and hamstrings muscles.

Conclusions Despite the moderate level of proof for neuromuscular control enhancement following BT, adaptations in neuromuscular control remain a significant factor to determine an appropriate exercise that would improve specific athletic performance.