Superiority of External Attentional Focus for Motor Performance and Learning: Systematic Reviews and Meta-Analyses

Considerable literature on the role of attentional focus in motor performance and learning has accumulated for over two decades. We report the results of comprehensive meta-analyses that address the impact of an external focus (EF, on intended movement effects) versus internal focus (IF, on movements of body parts) of attention on the performance and learning of motor skills. Values of effect sizes (ES) from 73 studies with 1,824 participants and 40 studies with 1,274 participants were used for examining the effects of EF versus IF on behavioral outcomes of motor performance and learning (separately for retention and transfer phases) respectively. The EF condition was more effective than the IF condition for performance, Hedges’ g value = 0.264 (95% CI[0.217, 0.310]), retention learning, Hedges’ g value = 0.583 (95% CI [0.425, 0.741]), and transfer learning, Hedges’ g value = 0.584 (95% CI [0.325, 0.842]). Multivariable metaregression analyses on behavioral measures further indicated that neither age group, health status, or skill level, nor their two-way interactions, moderated the ES differences between EF and IF in performance, retention, and transfer models (all p >.100). Asecondary analysis on 12 studies with 216 participants that examined the effects of EF versus IF on electromyographic outcomes of motor performance also indicated that EF was associated with more efficient neuromuscular processing, Hedges’ g value = 0.833 (95% CI [0.453, 1.213]). From nine studies with 272participants, performance measured by behavioral outcomes was found to be more effective when a more distal,rather than proximal, EF was used, Hedges’ g value = 0.224 (95% CI [0.019, 0.429]).