Consensus-based guidelines for intervention protocols targeting the foot spring mechanism during landing: A modified Delphi study

Objectives: To reach consensus of opinion on exercise selection and prescription guidelines for training the energetic function of the foot for landing tasks. Design: A modified Delphi design with three rounds of questionnaires. Methods: Twenty-eight expert participants (clinicians n = 16, biomechanists n = 9, exercise physiologist n = 1, sport/exercise scientist n = 1, and athletic trainer n = 1) completed three rounds of questionnaires whereby they answered open-ended questions about optimal foot function, suggested exercises and prescription parameters to target the foot spring and ranked their level of agreement to exercises and prescription statements on 5-point Likert scales. Results: Forty-six exercises were presented to participants, of which 23 reached consensus of agreement. Fifty-four exercise prescription statements were generated from the open responses of participants, and of these, 21 statements reached consensus of agreement, and one reached consensus of disagreement. Conclusions: The exercises that reached consensus were multi-joint, functionally integrated exercises. The exercises included plyometric-based exercises, which is consistent with published literature that has shown that plyometric training increases musculotendinous stiffness and energy recycling. The exercises, however, were dissimilar to exercises previously used in foot training literature. The exercise prescription statements that reached consensus aligned with American College of Sports Medicine (ACSM) exercise prescription guidelines, and the prescription parameters used in plyometric-training literature.