Running head: ATTENTION ON A STABILITY BALL

Students Perception of Attention While Sitting on a Stability Ball

Michelle Ashley, Jillian Battson, Josee Lundquist, and Nicole Quisao
Touro University Nevada

ATTENTION ON A STABILITY BALL

Defining the Constructs

Attention is defined as a fluid process by which a person focuses on a given target. while
maintaining an awareness of background events (Wheatley, 2001)
A stability ball is also known as exercise or balance balls are large, inflatable rubber
balls used to develop and strengthen the core muscles of the body (North, 2011).
Self-regulation is the ability to develop, implement, and flexibly maintain planned
behavior in order to achieve ones goals (Brown & Miller, 1999).
Cognitive engagement is defined as the intentional and purposeful processing of lesson
content. Engagement, in effect, requires strategies that promote manipulation rather than
memorization, as the means through which learners acquire both lesson knowledge and deeper
conceptual insight (Cognitive).
Physical engagement for this study is defined as involuntary active engagement of body
components subconsciously.
As defined by Brown, Miller, and Lawendowski (1999), the constructs were defined as
the following: Receiving is how the participant is receiving relevant information, triggering is a
change in the individuals perception while comprehending the material being received, searching
is the individuals ability to utilize the information being received and search for alternative
options, and implementing is the individuals ability to put the chosen plan into action.
Theoretical Framework
Self-Regulation is the ability to develop, implement, and flexibly maintain planned
behavior in order to achieve ones goals (Brown, Miller, & Lawendowski, 1999). According to
Cleary and Zimmerman (2012), the self-regulation framework is a cyclical feedback loop, a
process that operates in a temporal sequence (before, during, and after a learning activity) and is

ATTENTION ON A STABILITY BALL

largely cognitive in nature. All theories of self-regulation assume that students interpret learning
outcomes as having tangible or intangible personal implications. Behaviorally oriented
approaches focus on tangible outcomes such as material or social gains, whereas cognitively
oriented approaches emphasize intangible outcomes such as self-actualization, self-efficacy, or
reduced cognitive dissonance (Zimmerman, 1990).
Systematic Review of Literature
Stability Ball and Children with Attention Deficit Hyperactivity Disorder
The majority of research available on our current topic is focused towards children with
attention deficit hyperactivity disorder (ADHD). The current research investigates the effects of
two different classroom seating conditions for children, stability balls or chairs. Schilling,
Washington, Billingsley, and Deitx (2003), examined the influence of stability balls on in-seat
behavior and legible word productivity. Schilling et al. (2003) used a single subject time series
design with three students who currently were diagnosed with ADHD. Within this study, the
stability ball was implemented to determine its influence of in-seat behavior in comparison to inseat behavior while seated in a chair. The intervention was twelve weeks in length and through
convenience sampling the participants selected used the stability ball during language arts
(Schilling et al., 2003). All participants, including the subjects were individually fitted for
stability balls and were allowed a week prior to the initial phase of testing to explore the new
seating option therefore decreasing novelty effects. Within the study done by Schilling et al.
(2003) the therapist observed and documented the in-seat behavior of the ball and chair every ten
second interval for the duration of that data collection. The results documented the subjects
displayed increased performance while seated on stability balls versus chairs.

ATTENTION ON A STABILITY BALL

Fedewa and Erwin, (2001) conducted a study to further explore the stability balls effect
on childrens behavior with ADHD as documented in Schilling et al. (2003). This study
continued the research of in-seat and on-task behavior of students while using the stability balls
versus a chair in the classroom setting. The researchers focused on the frequency of the variables
while seated on the stability ball. The sample included a group of 8 students who were observed
three times a week for a period of twelve weeks. Similarly to Schilling et al. (2003) the current
study used a single subject continuous time-series design to evaluate the pre-test and post-test
results of the intervention. In addition, participants were also individually fitted to the stability
balls and were allowed time to orient themselves to limit novelty effects. Through convenience
sampling all participants were given the Attention-Deficit/Hyperactivity Disorder Test (ADHDT)
and the sample was composed of 8 students out of the total 76 participants who scored greater
than or equal to 120 (Fedewa & Erwin, 2011). Observers collected data every thirty seconds
while documenting the samples in-seat on the ball or chair or out of seat on the ball or chair and
if the students were on or off task. In this study, results indicated that there were differences
between the pre-test and post-test scores of the ADHDT assessment displaying lowered mean
quotients while using the stability ball in the classroom. The teachers reported within a social
validity scale that they viewed the stability ball to enhance levels of attention, in-seat behavior
and work completion throughout the intervention (Fedewa & Erwin, 2011).
Stability Ball and Posture
Retail businesses have claimed that stability balls reduce, and even prevent low back pain
because of the promotion of increased core stability and strength, which has been speculated to
reduce lower back pain.

ATTENTION ON A STABILITY BALL

Gregory, Dunk, and Callaghan (2006) conducted a study to compare the difference each
participant of the study experienced with trunk muscle activation, and lumbar spine posture when
sitting on a stability ball verse a traditional office chair, as well as the influence of the task at
hand to the muscle activation and posture. The study consisted of 14 participants, including 7
males with an average age of 25.4 and 7 females with an average age of 22.3 who had not
experiences any lower back pain in last 12 months prior to the study (Gregory et al., 2006). The
participants each sat on both a traditional office chair without arm rests and a stability ball with
hips and knees in 90 degrees of flexion for an hour at a time while participating in 4 different
tasks at a desk. The tasks performed were typing, computer-aided design, typing/mouse
combined work, and reading (Gregory et al., 2006).
According to Gregory et al. (2006), as the participants performed each task on both the
traditional office chair, and stability ball their muscles and posture were being monitored by an
EMG to monitor muscle activation and the ISOTRAK 3Space to monitor postural components.
The data from both instruments was then synchronized to collect pertinent data. Statistical
analysis of the data was performed using the Three-way analyses of variance (ANOVAs), to
compare the sitting on a stability ball, and a traditional office chair, accounting for the different
tasks performed in each position, gender, postural variables, and perceived discomfort. A 95%
confidence level was used to reject the null hypothesis, and to look further into significant
findings, Tukeys post hoc multiple comparisons was used (Gregory et al., 2006).
Gregory et al. (2006) reported no significant differences of the average EMG of the
muscles except the left thoracic erector spinae which had a maximum voluntary contraction of
1.36 % on the chair, and 2.06 % on the ball. According to Gregory et al. (2006), the study did not
discover any significant difference for co-contraction, flexion, or range of flexion when

ATTENTION ON A STABILITY BALL

comparing the two different seated positions. The study discovered a significant difference in
perceived discomfort of the lower back for both sitting positions, but only pain in the entire body
as a whole when using the stability ball. The study also concluded that the task being performed
while in the seated position also had an influence on the discomfort of each participant (Gregory
et al., 2006).
Looking at gender overall, men showed more lumbar flexion compared to women. A
trend that was recognized in the study was the increase in lumbar flexion women had while
sitting on the stability ball compared to office chair, whereas the men showed higher lumbar
flexion in the chair compared to the stability ball (Gregory et al., 2006).
This study didnt find any significant findings to support the benefits of using a stability
ball to replace the typical office chair and stated, the increased reported discomfort and potential
safety issues associated with sitting on an unstable surface question the use of a stability ball as
an office chair (Gregory et al., 2006). Although this study has its limitations including
population size, and a short time period, this study opens up the idea to the biomechanical
differences between prolonged sitting in an office chair, and on a stability ball (Gregory et al.,
2006).
McGill, Kavcic, and Harvey (2006), performed a study to assess the relevance in using
stability balls as opposed to office chairs to reduce lower back pain. It has been suggested that
sitting for a prolonged period of time could cause individuals to have issues with their lower
back. In most situations individuals choose varied sitting positions rather than a single
comfortable position, this is termed dynamic sitting. Dynamic sitting sparked an interest in
using stability balls instead of office chairs, claiming they would reduce back pain and aid in
better posture. Despite the popular use of stability balls in replacement of office chairs, little

ATTENTION ON A STABILITY BALL

quantitative evidence exists to support these claims and hence forms the purpose of this paper
(McGill, Kavcic & Harvey, 2004).
For the current research study, two separate studies were performed. The first study
assessed the differences in torso muscle activation, spine load and stability in men sitting on a
stability ball versus a stool. It consisted of eight male subjects, which were similar in age, height
and weight. The participants sat for 30 min on an exercise ball and 30 min on a wooden stool and
lumbar position was measured every 5 min. There was no significant interaction between time
and seat conditions of any of the muscles observed (McGill et al., 2004).
The second study assessed pressure distribution over the buttocks and posterior thighs
while men sat on a stool, office chair and stability ball. It consisted of seven male subjects. The
participants sat on a stability ball, a wooden stool and a padded office chair. They sat on each
surface for a total of 5 s, this was repeated three times. Pressure measurements were obtained
over the 5 s. There was no significant difference found in pressure distribution among the
different sit surfaces (McGill, Kavcic and Harvey, 2004). The research study failed to find any
beneficial changes to either spine stability or compression while sitting on a stability ball over a
30 min period of time. Based on the study, it appears that sitting on a stability ball has little effect
on spine stability and muscle activity in regards to a static sitting task. A change in muscle
activation might be seen if the individual were performing a dynamic sitting task.
Attention and Posture
According to Huxhold, Li, Schmiedek, and Ulman (2006), postural control in daily
situations routinely takes place while at least one other concurrent task is being performed. It was
found that maintaining an erect stance may tax cognitive factors, such as attentional processes,

ATTENTION ON A STABILITY BALL

when the standing conditions are challenging or when attentional interference between postural
control and cognitive processes is high (Huxhold et al., 2006).
The previous research suggests that an erect stance may affect cognitive performance in
attention if the position of the stance is challenging, or if the attentional cognitive demand is
higher (Huxhold et al., 2006). In other words, if an individual is standing on a surface that has
an uneven terrain while simultaneously completing a cognitive task, it would be difficult to
remain stable and upright. Thus, the individual would focus more on the task of posture and less
on the cognitive task and attention would be divided between two different types of tasks. When
an individual needs to maintain the balance of upright stance while performing a concurrent
cognitive task, attention is divided between the sensorimotor and cognitive tasks (Huxhold et al.,
2006). The sharing of attentional resources between two domains of functioning reduces the
amount of attention that is available for postural control. (Huxold et al., 2006).
Huxhold et al., (2006) conducted a study which tested the theoretical proposition that
postural control sway and cognitive demand are related to each other by a U-shaped function.
Huxhold et al. (2006) studied the role of attentional capacities and examined by contrasting
young and old adults.
A sample of 41 adults participated in the study. The sample consisted of 19 older adults
and 20 young adults, with an approximate even distribution of men and women. Each
participant was tested individually within a single session to measure postural control.
Specifically, ground reaction forces and center of body pressure positions were measured. A
platform with built in sensors was used to measure ground reaction forces, and a computer
measure was used to calculate coordinated of center of body pressure positions. This

ATTENTION ON A STABILITY BALL

measurement indicated the efficacy of postural control. The larger displacement of center of
body pressure signified worse postural control performance (Huxhold et al., 2006).
The experiment included three single-task cognitive conditions while seated and five
experimental conditions in which the participants stood on the force platform. Sequencing
effects in the set of between-condition comparisons of interest used a nested counterbalancing
scheme to rule out sequential effects. Verbal-based and visio-spatial cognitive tasks with varying
levels of cognitive demands were used (Huxhold et al., 2006).
Huxhold et al., (2006) found that their study replicated former findings, which might
implicate that attentional resource competition in dual tasking postural control results in shortterm lapses in postural control behavior (p. 302). When a task is introduced that is not overtly
focused on the highly automatized task of postural performance, it seems that the attention is
shifted away from posture and to the demand of the cognitive task. Huxhold et al., (2006) found
that in older adults, attention decreased when the cognitive demand of a task increased. This
finding was slightly attributed to the generalization that older adults have more limited
attentional capacity. Since younger adults generally have a relatively higher level of cognitive
capacity, it did not challenge them as much in the experiment to split their focus between
cognitive task and postural stance (Huxhold et al., 2006).
Purpose and Overview of the Proposed Study
We chose to focus on the impact that the stability ball has on attention within adults due
to the limitations of previous research. Generally, the previous research focused on children in
the classroom who have ADHD. These previous studies used small sample sizes thus limiting
the ability to generalize to the greater population. Also, some of the studies only sampled one
gender. With the limited research available, we have chosen to study whether students

ATTENTION ON A STABILITY BALL

10

perceptions will change regarding physical and cognitive engagement when sitting in a
traditional chair versus a stability ball.
Hypothesis and Predictions
This study tested the hypothesis that students perception of their physical and cognitive
engagement while attending class will positively increase while seated on a stability ball as
opposed to a traditional chair. In general, we predicted that the stability balls will improve
attention.
Methods
Study Design
This study is a two-group pretest-posttest experimental design. Participants were
randomly assigned to one of two groups: (1) seated on a stability ball; (2) seated on a traditional
chair.
Participants and Setting
Thirty-two participants were recruited to participate in this study. The age of participants
ranged from 23-48 years (M=29, SD=5.15). There were 7 males (22%) and 25 females (78%)
participants.
The race of the participants in the study were as follows; 52% Caucasian/white, 2%
Black/African-American, 17% Asian, 10% Native Hawaiian/Pacific Islander, 17%
Hispanic/Latino, and 2% Non-Hispanic/Latino. The marital statuses of the participants were;
62% single/never married, 35% married, 2% separated, and 2%. The highest level of education
completed was; 90% obtained a four-year college degree and 10% already received a masters
degree.
Instruments and Materials

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11

Attention was measured using the Self-regulation Questionnaire developed by Brown,

Miller, and Lawendowski (1999). The Self-regulation Questionnaire is a sixty-three item
instrument which measures receiving relevant information, evaluating the information and
comparing it to norms, triggering change, searching for options, formulating a plan,
implementing the plan, and assessing. For the purpose of this study the instrument was modified
to address receiving relevant information, triggering change, searching for options, and
implementing the plan. Thirty-six items were carefully selected and inputted in to Qualtrics.
Some example item includes; I usually keep track of my progress toward my goals (receiving);
Others tell me that I keep on with things too long (triggering); I doubt I could change even if I
wanted to (searching); and I get easily distracted from my plans (implementing). Items were
answered on a 5-point likert scale. The Self-regulation Questionnaire (SRQ) has been utilized in
several studies and has been shown to have high validity. The SRQ has also been shown to have
high reliability. From previous studies, the test rettest reliability and internal consistency to the
total SRQ score was also high. As displayed in previous research, the SRQ is valid in measuring
what it intends to measure, self-regulation.
Procedures
Permission was obtained from the Touro University Nevada physical therapy department
to utilize their stability balls. Additional permission was obtained to conduct the study within an
occupational therapy class period from a professor within the occupational therapy department.
Students were enrolled in the Master of Science in occupational therapy cohort at Touro
University Nevada. These students recruited were randomly assigned to either one of the two
groups; stability ball or classroom chair. The participants were given pre-test survey, attended a

ATTENTION ON A STABILITY BALL

12

normal length lecture for approximately thirty minutes, and finally completed a post-test survey.
Participants gave verbal consent prior to completing the survey.
Data Analysis Plan
To analyze the constructs of this study, a doubly multivariate analysis of variance
(MANOVA) was conducted. Pearsons Product-Moment Correlation coefficients were also
requested for relevant variables in the study.
Results
The results of the doubly repeated measures (RM) MANOVA demonstrated that although
neither the interaction nor the individual main effects exhibited statistical significance, the
practical significance of the analyses was robust. Eta Squared coefficients ranged from .07 to .11,
indicating moderate strength of association between the independent variable and the linear
combination of dependent variables. The univariate results demonstrated that the receiving scale
was the only one that exhibited robust practical significance. It appears that participants in the
chair were more attentive at pretest with respect to receiving information whereas those in the
ball were more attentive to receiving information at posttest. The time main effect showed that
searching increased over time, with participants showing greater searching strategies at posttest.
The between-subjects main effect showed that those sitting in a ball were significantly more
attentive to receiving information than those sitting in chairs. Thus, preliminarily the ball appears
to be an effective method at increasing certain aspects of attention. A correlation matrix of the
data is provided on the following page.

ATTENTION ON A STABILITY BALL

13
Correlations

Receiving
Scale Pre

Trigger
Scale Pre

Searching
Scale Pre

Implementi
ng Scale
Pre

Receiving
Scale Post

Trigger
Scale Post

Searching
Scale Post

Pearson
Correlatio
n
Sig. (2tailed)
N
Pearson
Correlatio
n
Sig. (2tailed)
N
Pearson
Correlatio
n
Sig. (2tailed)
N
Pearson
Correlatio
n
Sig. (2tailed)
N
Pearson
Correlatio
n
Sig. (2tailed)
N
Pearson
Correlatio
n
Sig. (2tailed)
N
Pearson
Correlatio
n
Sig. (2tailed)
N

Implementi
ng Scale
Post

Pearson
Correlatio
n

Receivin
g Scale
Pre

Trigge
r
Scale
Pre

Searchin
g Scale
Pre

Implementi
ng Scale
Pre

Receivin
g Scale
Post

Trigger
Scale
Post

Searchin
g Scale
Post

Implementi
ng Scale
Post

.153

.266

.065

.050

.087

.145

-.422*

.419

.149

.727

.795

.649

.461

.025

30

31

31

29

30

28

28

.314

.229

.076

-.053

-.208

.058

.091

.223

.700

.783

.298

.774

30

30

28

29

27

27

.240

-.176

-.052

-.042

-.223

.193

.351

.782

.830

.244

31

30

31

29

29

-.242

-.235

.117

-.044

.206

.212

.554

.823

29

30

28

28

.369*

.234

.375*

.045

.221

.045

30

29

29

.264

.220

.166

.252

29

29

.228
.243
28
1

ATTENTION ON A STABILITY BALL

14

Sig. (2tailed)
N
*. Correlation is significant at the 0.05 level (2-tailed).

Discussion
The main research objective of our study was to examine the impact of a stability ball on
attention within adults within a classroom setting in accordance with the Self-Regulation Theory.
We collected a baseline score for self-regulation while the participants were seated on a
traditional chair. Participants were randomly assigned to one of two treatment conditions:
traditional chair or stability ball. Following the assignment, the participants were seated for
thirty minutes during an occupational therapy course lecture. A posttest was administered after
the treatment condition. This study evaluated the influence of; receiving, triggering, searching,
and implementing in regards to the participants perceived attention during a lecture.
We hypothesized that students perception of their physical and cognitive engagement while
attending class will positively increase while seated on a stability ball as opposed to a traditional
chair. In general, we expected that the stability balls will improve attention.
Out of the four self-regulating variables; receiving, triggering, searching, and
implementing, a notable increase was observed with the receiving variable. The participants
were able to receive relevant information more accurately on a stability ball as opposed to the
traditional chair. From this data, we can infer that more neuronal pathways were activated due to
full body engagement on the stability ball. Furthermore, our results indicate that over time, the
searching variable increased from pretest to posttest showing higher searching strategies on the
stability ball.
Conclusion

ATTENTION ON A STABILITY BALL

15

Our study demonstrated a relationship between attention while seated on a stability ball
in adults. The previous research was limited to school-aged children with ADHD. For this
reason we chose to focus on the adult population, specifically at the graduate level. The
objective was to see if our results would be consistent with the previously studied populations.
Similar to the previous research, our sample size was limited to convenience sampling within the
occupational therapy program. Although we our results aligned with our hypothesis, we would
need to increase the sample size in order to determine the validity of the research. Also,
observing the differences in relation to gender may affect the attention of participants while
seated on a stability ball. Our sample did not account for gender differences. To increase further
validity, the stability ball should be fitted properly based on the participants height.
Overall, our research was consistent with our hypotheses. Further research should be
conducted in order to support the relevance that stability ball seating increases attention and
enhanced learning in the classroom. Also, some of the studies only sampled one gender. With
the limited research available, we have chosen to study whether students perceptions will
change regarding physical and cognitive engagement when sitting in a traditional chair versus a
stability ball.

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16

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