{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:04:36Z","timestamp":1780031076611,"version":"3.53.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Insufficient physical activity and prolonged sedentary behavior among college students are associated with reduced lower-limb muscle strength, impaired dynamic balance, and increased susceptibility to sports-related knee injury. Female college students may be especially vulnerable because of sex-specific neuromuscular and biomechanical characteristics. Tai Chi Chuan may improve proprioceptive control and coordinated knee muscle activation, whereas unstable resistance training may rapidly enhance strength and neuromuscular stabilization. Whether a combined programme can produce complementary central-peripheral benefits remains to be verified in a rigorously designed randomized trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This protocol describes a single-center, parallel-group, randomized controlled trial. Fifty-seven healthy female college students aged 18\u201322\u202fyears will be recruited from Fenyang College, Shanxi Medical University, and randomly allocated in a 1:1:1 ratio to a Tai Chi Chuan group (TCC), unstable resistance training group (URT), or Tai Chi Chuan combined with unstable resistance training group (T\u202f+\u202fURT). All interventions will last 8\u202fweeks, with three 60-min sessions per week. The primary outcomes will be dominant-leg knee extensor peak torque, knee flexor peak torque, and hamstring-to-quadriceps ratio measured using an isokinetic strength testing system at 60 degrees\/s. Secondary outcomes will include overall stability index, anteroposterior stability index, and mediolateral stability index under eyes-open and eyes-closed conditions measured with the Biodex Balance System. Assessments will be conducted at baseline and after the 8-week intervention. Intention-to-treat and per-protocol analyses will be used. Missing data will be handled using multiple imputation where appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This trial is designed to determine whether Tai Chi Chuan combined with unstable resistance training provides superior improvements in knee muscle function and dynamic balance compared with either intervention alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/itmctr.ccebtcm.org.cn<\/jats:uri>\n                      , Identifier (ITMCTR2026000456).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1868830","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:44:46Z","timestamp":1780029886000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effects of Tai Chi Chuan combined with unstable resistance training on knee muscle strength and dynamic balance in female college students: a randomized controlled study protocol"],"prefix":"10.3389","volume":"14","author":[{"given":"Jiping","family":"He","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Shanxi University of Medicine","place":["Fenyang, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Su","sequence":"additional","affiliation":[{"name":"Faculty of Health and Wellness, City University of Macau","place":["Macau, China"]},{"name":"Department of Nursing, Shanxi University of Medicine","place":["Fenyang, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Shanxi University of Medicine","place":["Fenyang, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Men","sequence":"additional","affiliation":[{"name":"Department of Basic Medicine, Shanxi University of Medicine","place":["Fenyang, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinyuan","family":"Yu","sequence":"additional","affiliation":[{"name":"Faculty of Health and Wellness, City University of Macau","place":["Macau, China"]},{"name":"Department of Rehabilitation Engineering, Anting Hospital, Jiading District","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2019\/9791281","article-title":"Physical activity, sedentary behavior, and quality of life among university students","volume":"2019","author":"Nowak","year":"2019","journal-title":"Biomed Res Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3272","DOI":"10.3390\/ijerph17093272","article-title":"Physical activity habits and determinants, sedentary behaviour and lifestyle in university students","volume":"17","author":"Carballo-Fazanes","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.physbeh.2019.02.041","article-title":"Sedentary behavior and physiological health determinants in male and female college students","volume":"204","author":"Vainshelboim","year":"2019","journal-title":"Physiol Behav"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"102605","DOI":"10.1016\/j.psychsport.2024.102605","article-title":"Substitutions of physical activity and sedentary behavior with negative emotions and sex difference among college students","volume":"72","author":"Rong","year":"2024","journal-title":"Psychol Sport Exerc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3390\/brainsci15010078","article-title":"Relationship between sedentary lifestyle, physical activity and stress in university students and their life habits: a scoping review with PRISMA checklist (PRISMA-ScR)","volume":"15","author":"Guerriero","year":"2025","journal-title":"Brain Sci"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"13505","DOI":"10.1038\/s41598-023-40319-x","article-title":"Effects of progressive body-weight versus barbell back squat training on strength, hypertrophy and body fat among sedentary young women","volume":"13","author":"Wei","year":"2023","journal-title":"Sci Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3179","DOI":"10.1002\/ksa.12567","article-title":"Poor knee strength is associated with higher incidence of knee injury in adolescent female football players: the Karolinska football injury cohort","volume":"33","author":"F\u00e4ltstr\u00f6m","year":"2025","journal-title":"Knee Surgery Sports Traumatology Arthroscopy"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.procs.2022.04.062","article-title":"Study on the correlation between lower limb joint muscle strength and balance ability among female college students in soccer","volume":"202","author":"Wang","year":"2022","journal-title":"Procedia Comput Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3468","DOI":"10.1589\/jpts.28.3468","article-title":"Correlation among proprioception, muscle strength, and balance","volume":"28","author":"Wang","year":"2016","journal-title":"J Phys Ther Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1186\/s12891-023-06678-2","article-title":"The effect of foot posture on static balance, ankle and knee proprioception in 18-to-25-year-old female student: a cross-sectional study","volume":"24","author":"Ghorbani","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e126891","DOI":"10.5812\/intjssh-126891","article-title":"Impact of gender, change of base of support, and visual deprivation on postural balance control in young, healthy subjects","volume":"4","author":"Ghram","year":"2021","journal-title":"Int J Sport Studies Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"131008604","DOI":"10.3389\/fphys.2022.1008604","article-title":"Effects of taichi on physical and psychological health of college students: a systematic review","author":"Qi","year":"2022","journal-title":"Front Physiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"131613384","DOI":"10.3389\/fpubh.2025.1613384","article-title":"Tai chi as a preventive intervention for improving mental and physical health in non-depressed college students with high perceived stress","volume":"13","author":"Sun","year":"2025","journal-title":"Front Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"107","DOI":"10.16655\/j.cnki.2095-2813.2024.03.030","article-title":"An analysis of the effects of tai chi training on body balance control in university students","volume":"14","author":"Ziyun","year":"2024","journal-title":"Contemporary Sports Science Technology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"8879","DOI":"10.3390\/ijerph17238879","article-title":"Effect of instability and bodyweight neuromuscular training on dynamic balance control in active young adults","volume":"17","author":"Gon\u00e7alves","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1007\/s40279-015-0384-x","article-title":"Effects of strength training using unstable surfaces on strength, power and balance performance across the lifespan: a systematic review and meta-analysis","volume":"45","author":"Behm","year":"2015","journal-title":"Sports Medicine"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.jelekin.2014.08.013","article-title":"Muscle activation and knee biomechanics during squatting and lunging after lower extremity fatigue in healthy young women","volume":"25","author":"Longpr\u00e9","year":"2015","journal-title":"J Electromyogr Kinesiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.16835\/j.cnki.1000-9817.2018.12.012","article-title":"The effects of stable and unstable tai chi practice on proprioception and balance in female university students","volume":"39","author":"Hua","year":"2018","journal-title":"Chin Sch Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"5928","DOI":"10.1038\/s41598-025-90510-5","article-title":"The impact of 24-forms tai chi on alpha band power and physical fitness in young adults: a randomized controlled trial","volume":"15","author":"Wang","year":"2025","journal-title":"Sci Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3390\/medicina55030060","article-title":"The effects of tai chi Chuan versus core stability training on lower-limb neuromuscular function in aging individuals with non-specific chronic lower back pain","volume":"55","author":"Zou","year":"2019","journal-title":"Medicina"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1519\/00124278-200708000-00020","article-title":"A comparison of two warm-ups on joint range of motion","volume":"21","author":"Beedle","year":"2007","journal-title":"J Strength Cond Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"117","DOI":"10.3390\/sports8090117","article-title":"Reliability of the polar vantage M sports watch when measuring heart rate at different treadmill exercise intensities","volume":"8","author":"Climstein","year":"2020","journal-title":"Sports"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e132605","DOI":"10.1371\/journal.pone.0132605","article-title":"Effectiveness of tai chi on physical and psychological health of college students: results of a randomized controlled trial","volume":"10","author":"Zheng","year":"2015","journal-title":"PLoS One"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1249\/MSS.0000000000003897","article-title":"American College of Sports Medicine position stand. Resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews","volume":"58","author":"Currier","year":"2026","journal-title":"Med Sci Sports Exerc"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3390\/sports9020032","article-title":"Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum","volume":"9","author":"Schoenfeld","year":"2021","journal-title":"Sports (Basel)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1136\/bjsports-2017-098101","article-title":"Isokinetic strength assessment offers limited predictive validity for detecting risk of future hamstring strain in sport: a systematic review and meta-analysis","volume":"52","author":"Green","year":"2018","journal-title":"Br J Sports Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"45","DOI":"10.5152\/clinexphealthsci.2017.132","article-title":"Improving the hamstrings-to-quadriceps strength ratio in sedentary women: comparison of stabilization training and aerobic training after a 6-months follow-up","volume":"7","author":"Duzgun","year":"2017","journal-title":"Clin Exp Health Sci"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s13102-022-00401-9","article-title":"Maximum isometric torque at individually-adjusted joint angles exceeds eccentric and concentric torque in lower extremity joint actions","volume":"14","author":"Andreas","year":"2022","journal-title":"BMC Sports Science, Medicine Rehabilitation"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e189876","DOI":"10.1371\/journal.pone.0189876","article-title":"How to determine leg dominance: the agreement between self-reported and observed performance in healthy adults","volume":"12","author":"van","year":"2017","journal-title":"PLoS One"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1123\/jab.2013-0130","article-title":"Intrarater test-retest reliability of static and dynamic stability indexes measurement using the Biodex stability system during unilateral stance","volume":"30","author":"Arifin","year":"2014","journal-title":"J Appl Biomech"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s40779-019-0212-y","article-title":"Toward more reliable stability measurements instance: recommendations for number of measurements, foot position and feedback -- a cross-sectional study among servicemen","volume":"6","author":"van der Heijden","year":"2019","journal-title":"Mil Med Res"},{"key":"ref32","first-page":"46","article-title":"The effects of tai chi on the knee flexor and extensor muscle groups in university students: a case study at southern medical university","volume":"9","author":"Peng","year":"2020","journal-title":"Youth Sports"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.ptsp.2024.06.002","article-title":"Maturation and biomechanical risk factors associated with anterior cruciate ligament injury: is there a link? A systematic review","volume":"68","author":"Butcher","year":"2024","journal-title":"Phys Ther Sport"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1597480","DOI":"10.3389\/fpubh.2025.1597480","article-title":"University-based physical education as a structured temporal and spatial opportunity for shaping health-oriented lifestyles","volume":"13","author":"Zhang","year":"2025","journal-title":"Front Public Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1493677","DOI":"10.3389\/fnhum.2024.1493677","article-title":"Taichi on the brain: an activation likelihood estimated meta-analysis of functional neuroimaging data","volume":"18","author":"Wang","year":"2024","journal-title":"Front Hum Neurosci"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"103089","DOI":"10.1016\/j.ctim.2024.103089","article-title":"Tai chi for balance and postural control in people with peripheral neuropathy: a scoping review","volume":"86","author":"Yang","year":"2024","journal-title":"Complement Ther Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1089\/jicm.2024.0957","article-title":"The science of tai chi and Qigong as whole person health-part I: rationale and state of the science","volume":"31","author":"Wayne","year":"2025","journal-title":"J Integr Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s11556-024-00353-8","article-title":"Multimodal training protocols on unstable rather than stable surfaces better improve dynamic balance ability in older adults","volume":"21","author":"Rizzato","year":"2024","journal-title":"Eur Rev Aging Phys Act"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e70650","DOI":"10.14814\/phy2.70650","article-title":"The effects of instability training on balance and jump performance in athletes: a systematic review and meta-analysis","volume":"13","author":"Yin","year":"2025","journal-title":"Physiol Rep"},{"key":"ref40","volume-title":"A Study on the Effects of Weight-Bearing Tai Chi on Bone Mass and Balance Ability in Female University Students","author":"Wang","year":"2025"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e817","DOI":"10.1136\/bmjsem-2020-000817","article-title":"Effect of tai chi on muscle strength, physical endurance, postural balance and flexibility: a systematic review and meta-analysis","volume":"7","author":"Wehner","year":"2021","journal-title":"BMJ Open Sport Exerc Med"},{"key":"ref42","first-page":"19","article-title":"The effects of tai chi chuan combined with vibration training on balance control and lower extremity muscle power","volume":"12","author":"Chung","year":"2013","journal-title":"J Sports Sci Med"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1519\/JPT.0000000000000218","article-title":"Tai chi combined with resistance training for adults aged 50 years and older: a systematic review","volume":"43","author":"Qi","year":"2020","journal-title":"J Geriatr Phys Ther"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"151434918","DOI":"10.3389\/fphys.2024.1434918","article-title":"The effect of instability resistance training on balance ability among athletes: a systematic review","volume":"15","author":"Gao","year":"2024","journal-title":"Front Physiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"77","DOI":"10.5114\/biolsport.2025.148534","article-title":"Knee isokinetic strength benchmarks in athletes across sports categories and performance levels","volume":"42","author":"Freire","year":"2025","journal-title":"Biol Sport"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1318-1328","DOI":"10.1109\/TNSRE.2026.3667526","article-title":"Enhanced identification of chronic ankle instability under different conditions: a new evaluation framework based on feature fusion and machine learning","volume":"34","author":"Zhou","year":"2026","journal-title":"IEEE Trans Neural Syst Rehabil Eng"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1868830\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:45:08Z","timestamp":1780029908000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1868830\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2026.1868830"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1868830","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]},"article-number":"1868830"}}