Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults

Guidance for Prescribing Exercise

Carol Ewing Garber, Ph.D., FACSM, (Chair); Bryan Blissmer, Ph.D.; Michael R. Deschenes, Ph.D., FACSM; Barry A. Franklin, Ph.D., FACSM; Michael J. Lamonte, Ph.D., FACSM; I-Min Lee, M.D., Sc.D., FACSM; David C. Nieman, Ph.D., FACSM; David P. Swain, Ph.D., FACSM.


Med Sci Sports Exerc. 2011;43(7):1334-1359. 

In This Article

What Are the Benefits of Neuromotor Exercise Training?

Neuromotor exercise training, sometimes called functional fitness training, incorporates motor skills such as balance, coordination, gait, and agility, and proprioceptive training. Multifaceted physical activities such as tai ji (tai chi), qigong, and yoga involve varying combinations of neuromotor exercise, resistance exercise, and flexibility exercise. Neuromotor exercise training is beneficial as part of a comprehensive exercise program for older persons, especially to improve balance, agility, muscle strength, and reduce the risk of falls.[38,181,194,224,264,350,369] Tai ji, the most widely studied neuromotor activity, and exercises incorporating balance and agility can be effective in improving balance, agility, motor control, proprioception, and quality of life.[69,74,131,132,181,205,222,223,230,363,375,378] Agility and balance training may reduce the risk of falling and fear of falling[194,226,227] and probably reduce the number of falls, although more definitive evidence is needed to confirm this finding.[153,227,228,230,236,264,404]

Few studies have evaluated the benefits of neuromotor exercise training in younger adults. The only English-language study of tai ji in middle-aged adults reported improvements in balance.[363] Limited evidence suggests that exercises involving balance and agility may reduce anterior cruciate injury[165,350] and reduce recurrent ankle injury in men and women athletes.[174] Definitive recommendations as to whether neuromotor exercise is beneficial in young and middle-aged adults cannot be made owing to a paucity of data, although there may be benefit, especially if participating in physical activities requiring agility, balance, and other motor skills. More data are needed in all age groups to elucidate the specific health-related changes resulting from such training and to determine the effectiveness of various exercise types and doses (i.e., frequency, duration, and intensity) and training programs.

What Quality and Quantity of Neuromotor Exercise Are Needed?

The frequency and duration of neuromotor exercise training to accrue health and fitness benefits are uncertain because there is variability in the quality of available studies, the types, duration, and frequency of neuromotor exercise used; there is inconsistent length of the training programs, and no standardized outcome measures have been used.[138,264,404] Further confounding the interpretation of the results, many studies have combined resistance, cardiorespiratory, and/or flexibility training with neuromotor exercise.[138,404] Development of some degree of proficiency in activities, such as balance training and tai ji, may also be important with respect to achieving improvements in physical function and in outcomes such as falls.[404] Studies that have resulted in improvements have mostly used training frequencies of ≥2–3 d·wk−1 with exercise sessions of ≥20–30 min in duration, for a total of ≥60 min of neuromotor exercise per week; however, more research is needed before any definitive recommendations can be made. There is no available evidence concerning the number of repetitions of exercises needed, the intensity of the exercise, or optimal methods for progression.


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