For assistive technology purposes, exercise balls, also referred as stability balls, refers to specifically the large rubber balls serving as an alternative of an office chair for sitting at a desk. Exercise balls are intended to provide low demand regular muscle demands of the torso and balance systems, stimulating the body and enhancing concentration as a side effect. The research on exercise balls varies considerably, with a lack of strong consensus on what, if any, positive effects can be found.
One study looked at 8 students (grades 4-5) with ADHD who showed reduced hyperactivity symptoms while sitting on a stability ball versus no sitting (Fedewa & Erwin, 2011). This positive significant effect on ADHD was replicated in a similar study (Wu et al, 2012). However a more recent study found no impact on students with ADHD on their attentional performance compared to controls (MacPhee et al, 2019). A follow up study looked at 67 grade two students in classrooms who were either given an exercise ball to sit on in class or not (Fedewa, Davis, & Ahn, 2015). This study showed a moderate reduction in disruptive behaviors but also a moderate decrease in on-task behavior when using an exercise ball. A more recent study had a classrooms of students (30 each) complete math tests in one of three conditions: on stability balls, on normal chairs, and on normal chairs with 5 minute exercise breaks (Mead et al, 2016). Students using the stability balls significantly outperformed both other students on their test scores.
An additional factor is length of impact. A study by Gaston, Moore, and Butler in 2016 showed significant improvements of 23 children both in attention and reduced anxiety when sitting on exercise balls instead of standard chairs. This study documented no positive changes early on, but showed an advantage after a three month time period compared to control students without (Gaston, Moore, & Butler, 2016).
A second group of specific population studied is the autism spectrum community. Children with autism have been shown to benefit in terms of engagement with material in an intervention design of four students (Schilling & Scwartz, 2004). Children with autism have also shown reduced disruptive behaviors in an intervention of six students (Bagatell et al, 2010). This was replicated by Kromback and Miltenberger (2019) showing similar, significant positive changes in four autism spectrum students on engagement and sitting behavior. Another study in by Sadr and colleagues showed 15 children with austim showed significantly less disruptive behavior on a stability ball than in a normal classroom chair, or in a bean-bag chair (Sadr et al, 2017).
Other research on exercise balls shows no positive impact on attention. In a randomized controlled study, participants given a concentration task performed no better than participants sitting on office chairs (Mcgill et al, 2006). This was replicated by Olson and colleagues (2019) that had compared 20 students academic performance with and without stability balls, showing no significant difference (Olson et al, 2019). Other literature has actually showed a negative effect, since for long periods, the exercise ball is less comfortable and ergonomic than a well designed office chair (e.g. Kingma, 2009).
A similar tool, dynamic balance chairs, has shown moderate positive effects on worker productivity (Tanoue et al, 2016). A dynamic balance chair is similar to an exercise ball, but provides a seat that can rock and rotate instead of a plastic ball.
Research Rating: ****
This research is peer reviewed and empirically sound. Some studies include very small groups in an intervention model however.
Relatively cheap and fun for kids
Benefits for increased sitting behavior
Has also shown to be a distraction in some studies
May have chance of injury
There is not a consensus on the impact of stability balls positive effects, but there is a general consensus that stability balls are not significant detractors of performance. This makes them an option that can be explored with risk of increasing symptoms.
Research cited seems to benefit children with more significant impairments (ADHD and ASD). Studies completed on entire classrooms show much smaller, almost negligible effects (Fedewa, Davis, & Ahn, 2015). This technology may only benefit students with specific impairments. Age has also been suggested, by Fedewa & Erwin (2011), that students in early elementary grades (2 and lower) may not be able to benefit as much as older students.
Special Consideration: Workflow
Exact prices change frequently, which is why only approximate ranges are listed.
$ - Under $5
$$ - Between $6 and $50
$$$ - Between $51 and $250
$$$$ - Over $250
Bagatell, N., Mirigliani, G., Patterson, C., Reyes, Y., & Test, L. (2010). Effectiveness of therapy ball chairs on classroom participation in children with autism spectrum disorders. American Journal of Occupational Therapy, 64(6), 895-903.
Fedewa, A. L., & Erwin, H. E. (2011). Stability balls and students with attention and hyperactivity concerns: Implications for on-task and in-seat behavior. American Journal of Occupational Therapy, 65(4), 393-399.
Fedewa, A., Davis, M. A., & Ahn, S. (2015). Effects of stability balls on children’s on-task behavior, academic achievement, and discipline referrals: A randomized controlled trial. American Journal of Occupational Therapy, 69(2), 6902220020p1-6902220020p9.
Gaston, A., Moore, S., & Butler, L. (2016). Sitting on a stability ball improves attention span and reduces anxious/depressive symptomatology among grade 2 students: A prospective case-control field experiment. International Journal of Educational Research, 77, 136-142.
Macphee, F. L., Merrill, B. M., Altszuler, A. R., Ramos, M. C., Gnagy, E. M., Greiner, A. R., ... & Pelham, W. E. (2019). The Effect of Weighted Vests and Stability Balls With and Without Psychostimulant Medication on Classroom Outcomes for Children With ADHD. School Psychology Review, 48(3), 276-289.
Mcgill, S.m., et al. “Sitting on a Chair or an Exercise Ball: Various Perspectives to Guide Decision Making.” Clinical Biomechanics, vol. 21, no. 4, 2006, pp. 353–360., doi:10.1016/j.clinbiomech.2005.11.006.
Mead, T., Scibora, L., Gardner, J., & Dunn, S. (2016). The impact of stability balls, activity breaks, and a sedentary classroom on standardized math scores. Physical Educator, 73(3), 433.
Kingma, Idsart, and Jaap H. Van Dieën. “Static and Dynamic Postural Loadings during Computer Work in Females: Sitting on an Office Chair versus Sitting on an Exercise Ball.” Applied Ergonomics, vol. 40, no. 2, 2009, pp. 199–205., doi:10.1016/j.apergo.2008.04.004.
Krombach, T., & Miltenberger, R. (2019). The Effects of Stability Ball Seating on the Behavior of Children with Autism During Instructional Activities. Journal of autism and developmental disorders, 1-9.
Olson, N. A., Panahon, C. J., & Hilt-Panahon, A. (2019). Investigating the Effects of Stability Balls on Classwide Student Behavior and Academic Productivity. Journal of Applied School Psychology, 35(3), 201-214.
SADR, N. M., Haghgoo, H. A., Samadi, S. A., Rassafiani, M., Bakhshi, E., & Hassanabadi, H. (2017). The impact of dynamic seating on classroom behavior of students with autism spectrum disorder. Iranian journal of child neurology, 11(1), 29.
Tanoue, Hironori, et al. “Effects of a Dynamic Chair on Pelvic Mobility, Fatigue, and Work Efficiency during Work Performed While Sitting: a Comparison of Dynamic Sitting and Static Sitting.” Journal of Physical Therapy Science, vol. 28, no. 6, 2016, pp. 1759–1763., doi:10.1589/jpts.28.1759.