SYSTEMATIC REVIEW article
Front. Hum. Neurosci.
Sec. Motor Neuroscience
Effects of height-induced postural threat on static and dynamic balance performance in healthy individuals: A systematic review with meta-analysis
Provisionally accepted
- 1University of Duisburg-Essen, Duisburg, Germany
- 2University of Leicester, Leicester, United Kingdom
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Height-induced postural threat, such as standing or walking at elevation, elicits fear-related adaptations in balance control. Understanding these adaptations is crucial for interpreting motor behaviour under anxiety and for informing rehabilitation and fall-prevention interventions. However, no previous systematic review with meta-analysis has quantified how height exposure influences balance performance. Objective: The objective was to aggregate, characterize, and quantify the effects of height-related postural threat on static and dynamic balance performance. Methods: A systematic literature search in the electronic databases PubMed, Web of Science, and SPORTDiscus was conducted from their inception date until 15 September 2025. Eligible cross-sectional studies compared ground-level (no threat) versus elevated (threat) conditions in healthy participants. Static balance outcomes during upright stance included sway amplitude and frequency; dynamic balance outcomes while walking included gait velocity. Included studies were coded for gender, age, postural threat conditions, balance assessment/outcome, and test modality. Methodological study quality/design and risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies. Heterogeneity was quantified using I² statistics, and sensitivity was evaluated via Leave-One-Out method. Standardized mean differences (SMD) were calculated and analyses were stratified by age group (i.e., children, young adults, older adults). Results: The search identified a total of N=438 records, and twenty-five of them (877 participants) met the inclusion criteria. Concerning static balance (18 studies, 44 comparisons), postural threat resulted in small-sized (SMD=0.20) decreases in sway amplitude measures and in large-sized (SMD=1.06) increases in sway frequency measures, indicating a potentially protective "stiffening" response. However, children did not use the "stiffening" response when standing at height (sway amplitude: SMD=-0.41; sway frequency: SMD=-0.04). Regarding dynamic balance (7 studies, 16 comparisons), postural threat led to large-sized (SMD=1.33) declines in gait velocity, and this was more pronounced for conditions with a high (SMD=1.78) than a low (SMD=1.05) difficulty level. Conclusions: Height-induced postural threat evoked functional changes in static and dynamic postural control. For static balance this is indicative of an effective "stiffening" response which is apparently not yet developed in children. For dynamic balance, the further decrease in gait velocity during difficult walking conditions at height implies a compensatory mechanism to increase stability.
Keywords: "Stiffening" response, age, Height-induced threat, Postural control, standing, task difficulty, Walking
Received: 15 Sep 2025; Accepted: 02 Dec 2025.
Copyright: © 2025 Wissmann, Muehlbauer and Hill. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Anna M. Wissmann
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.