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Attentional Focus Cueing

How and When to Use Internal and External Focus Cues to Optimize Exercise Performance

Reiner, Susannah L. M.S., ACSM-EP

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ACSM's Health & Fitness Journal: 11/12 2021 - Volume 25 - Issue 6 - p 33-41
doi: 10.1249/FIT.0000000000000720
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Abstract

ATTENTIONAL FOCUS AND EXERCISE CUES

Verbal cues are essential tools for fitness and sports professionals to direct the technique and focus and to motivate their clients. Attentional focus occurs when an individual voluntarily concentrates on a specific body activity or muscle engagement while performing an exercise. Typically, attentional focus as discussed in research and practice is divided between external or internal dimensions. Specific cues that are designed to direct a client’s thinking can enhance either an internal or an external focus that results in more effective training. By coaching a client’s attention to focus on specific mind–body or mind–muscle connections, health and fitness professionals can alter the efficiency of movement, force production, and change a client’s overall performance. Guiding a client to think about or pay attention to specific movement strategies should be individualized based on the goal of the exercise and expertise level of the client. Based on the diversity of clients, attentional focus in different exercise settings will be discussed in this article as they apply to exercise performance, skill learning, endurance, and resistance training. Examples of optimal external and internal cues are provided for practical application for health and fitness professionals.

Case Study 1

Your client is performing a barbell deadlift with a relatively heavy load. You continually cue them to hinge from the hips to start the exercise and extend the hips and knees simultaneously to come up. You notice their movement is uncoordinated and they cannot seem to master the technique by focusing on the joint movement. On the next set, you attempt a different tactic and say, “think about driving through the floor” and “pull the bar,” and their movement drastically changes, and they perform the exercise with more confidence and better technique (Figures 1 and 2).

Figure 1
Figure 1:
Preparation for conventional deadlift.
Figure 2
Figure 2:
End ROM of conventional deadlift.

Case Study 2

Your client is performing a cable triceps extension to improve hypertrophy. You notice when you say “pull the rope down,” the client is able to generate more power/speed in the movement but that is not their current goal. You change your approach and discuss focusing on the triceps muscle contracting and the elbow extending. The client is able to control the movement more effectively and maximize their muscular development goals (Figures 3 and 4).

Figure 3
Figure 3:
Preparation for cable triceps extension.
Figure 4
Figure 4:
End ROM for cable triceps extension.

EXTERNAL VERSUS INTERNAL FOCUS

Guiding Attention to an External Focus

External attentional focus is based on cueing that improves the outcome or goal of the movement, interaction with the ground or external forces, or simply the activity of thinking about one’s surroundings. Researchers suggested that cueing with an external focus improved performance of a task, skill, exercise, or desired pattern of movement to a greater degree when compared with an internal focus cue. For example, most complex motions such as the deadlift in case study 1, or when running or jumping, benefit from an external focus. Evidence primarily supports the benefits of an external attentional focus to improve exercise performance. Skilled performance was characterized with high levels of movement effectiveness, including accuracy, consistency, and reliability in achieving the movement goal. In addition, highly skilled individuals have mastered activity efficiency and demonstrated by fluid movements with some level of automatic control, while using as little physical and mental effort as possible (1). An external focus promotes an automatic movement that occurs reflexively through fast and unconscious motor processes (1).

Examples of external focused cues include:

  • Push the ground away from you as you rise from a squat.
  • Think about the desired ball pathway as you throw.
  • Focus on pulling the bar toward you during a bent-over row.

Guiding Attention to an Internal Focus

Internal attentional focus describes an individual’s concentration on the body segment or muscles moving, such as thinking about engaging or contracting a specific muscle or limb to create the movement. In comparison with external focus, the literature reviewed suggested that an internal focus benefits hypertrophy and muscle activation at lighter loads. An internal focus alludes to a mind–body or mind–muscle connection where an individual can consciously control muscle activation by thinking of creating tension in the target muscle. Schoenfeld and Contreras (2) suggested that an individual can effectively focus on the target muscle of the exercise, thereby diminishing the contributions of other muscles. In case study 2, the client was capable of producing more power in their movement with external focus perhaps by using multiple muscle groups to perform the exercise. The external cue would reduce overall muscle activation in the triceps brachii, which is counterintuitive to their training goal. Improving the mind–body connection through internal focus on the triceps brachii contracting would be more effective in this instance. Health and fitness professionals should individualize exercise cues to direct the client’s focus based on the goal of the exercise.

Examples of internal focused cues are as follows:

  • Concentrate on extending the ankle, knee, and hip simultaneously or contract your glutes as you rise from a squat.
  • Focus on landing on your midfoot during running long distance.
  • Focus on contracting the latissimus dorsi while performing a pull-up.

External Focus Cueing Application

Attaining an external focus was found to be advantageous in resistance, speed, jump, and functional balance training (3). For instance, in the isometric mid-thigh pull (IMTP), an all-out measure for total body power that was performed by pulling a bar toward the body in a similar fashion that is used during the start of a power clean, external cues resulted in a significantly higher force production than internal cues (4). The improved performance in the IMTP can transfer to other powerlifting and power-dependent movements. Similar results were observed in sport-specific skills of volleyball hits and soccer kicks, unilateral complex movements, where external cueing was more effective (1). In the general population, these findings can be applied to highly complex movement patterns and advanced drills such as box jumps and Olympic liftings. During balance exercises performed by older adults, externally directed cues that focused on maintaining markers on a balance board in a horizontal position were more beneficial than focusing internally, which drew their attention to maintaining a horizontal foot placement (5). These findings provide valuable cues to help tailor exercises for effective training.

External cues were found to be more effective than internal cues during movements performed at higher speeds because of the limited time available to provide instruction and time for clients to assimilate information that transfers to the activity (5). During quick movements, it is difficult to provide enough internal movement cue information within the time it takes to complete the task. For example, during the deadlift example in case study 1, cueing to address proper ankle, knee, hip, trunk, and arm movements would take much longer than an external cue of “drive through the ground” or “pull the bar.” If internally focused cueing is useful to a particular client in fast or complex movements, it is recommended that brief, concise directives are beneficial in order to accommodate time available during the skill performance (6) (Figure 5).

Figure 5
Figure 5:
Set intention for barbell exercise based on intensity, time, and complexity.

During skill acquisition and coordination development, learning is improved through externally focused instruction across different skills, expertise, and age (1). Accuracy and consistency, important in skill performance, are enhanced with a focus on the outcome or goal of the movement (1). For example, when learning how to hit a tennis ball, focusing on the desired result of the ball leaving the racket was more effective than a focus on the ball coming toward the racket (1). Wulf (1) also observed that by focusing on the movement of a golf club swing along with the targeted trajectory of the ball, clients were more successful at learning the skill compared with focusing internally on movements of the body. When using a new equipment modality or new exercise, clients will benefit from an external focus. For instance, in a medicine ball slam, a client can focus on where the ball will hit the floor or the sound it will make (external) instead of the body parts or muscles associated while performing the throw (internal). Regardless of expertise, an external focus can improve accuracy in exercise performance, especially for those individuals who may overthink their movement patterns. This can be applied to the general population during complex movement performance. Table 1 provides examples of external cues to guide complex movements. External cues also can help to decrease hesitation in movement actions and enhance transitions to a more automated fluid movement sequence. If an individual is focusing too much on systematic biomechanical movements, associated with internal focus, there is a potential of paralysis by analysis resulting in a poor performance. This would explain why the client in case study 1 appeared uncoordinated when trying to perform the heavy-loaded deadlift with internal focus.

TABLE 1 - Examples of Cues for External and Internal Attentional Focus for Athletic Performance
Exercise External Focus Cue (Most Beneficial in Speed and Power Movements) Internal Focus Cue (to Use Only in Technique-Focused Session or Correct Form)
Power clean Push the ground away Engage the leg muscles as hard as you can
Forcefully pull the bar Elbows up
Stay close to the bar
Sprint Push off the ground Activate glutes
Ball of foot rebounds off the groundlike a bouncy ball Drive with the knees
Stay long and low (during acceleration) Kick heel upward
Countermovement jump Push the ground away Explosively extend ankles, knees, and hips all at once
Touch the sky
Get off the ground quickly
Landing technique Do not make a sound on the way down Roll through your toe, ball, heel
Weighted step-up with balance Stay long and narrow Engage abdominals
Push against the step Keep knee in alignment
Keep bar horizontal Keep foot horizontal on step
Engage glutes

Internal Focus Cueing Applications

There are certain instances where an internal focus cue may be the best choice to boost performance. In an athletic setting, sports that are scored on form, precision, or technique, such as gymnastics, dance, or track and field events, benefit from cues that direct full body movements (1). It is imperative to have cognitive control over limbs (e.g., whether a knee or elbow is flexed or extended at a precise angle) in precision sports without sacrificing overall movement efficiency. Internal focused cues may be an important tool applied to clients as they learn a motor skill through ancillary drills and repetition. After working through the learning curve and mastering the precision skills, trainers can draw attention to improving performance with external focus cues to encourage subconscious motor movement patterns. For instance, in a step-up exercise, cueing heel placement on the step (internal cue) is necessary to correct specific technique before moving onto external focus such as pushing against the step. Some clients may respond more to one type of cueing over another. Incorporating different cueing tactics within training sessions and gaining the client’s input may be useful to create a successful program.

There is an abundance of evidence to support the use of internal focus when working at lighter loads for resistance training (Figure 6). The use of internal focus to improve hypertrophy and muscle activation is discussed in more detail below in the resistance training section.

Figure 6
Figure 6:
Client performing dumbbell biceps curl at relatively light load.

CHOOSING A CUE BASED ON THE GOAL AND TARGETED PERFORMANCE

Attentional Focus: Aerobic and Endurance Training

During endurance training, directing the client’s focus can affect physiological and psychological fatigue. In trained endurance runners, running economy, measured at a specific submaximal percent of V˙O2max, was the most efficient when they focused externally by paying attention to the surroundings during a run versus directing attention internally to their breathing or running technique (7). Similar results were found when runners were instructed to focus on distance traveled, running movements, or breathing (8). Focus on distance traveled (external focus) produced the lowest respiratory frequency, and although a focus on running movement (internal focus) produced the lowest V˙O2 consumption, the focus on distance traveled was preferred by runners and perceived as less difficult. Therefore, external focused attention was found to be especially important for novice runners who want to minimize or negate discomfort caused by running’s physiological effort, including common aches and pains.

External focused attention was found to be especially important for novice runners who want to minimize or negate discomfort caused by running’s physiological effort, including common aches and pains. Runners who apply an internal focus will direct their attention to the movement technique and breathing but may experience a higher rate of perceived exertion and effort.

Runners who apply an internal focus will direct their attention to the movement technique and breathing but may experience a higher rate of perceived exertion and effort. In a study by Wrisberg et al. (9), researchers studied participants running in front of a mirror focusing on breath and technique as the internal focus and compared it with external focus by running while watching a video with music. Researchers found that both male and female participants, despite having different heart rate reactions, showed higher rates of perceived exertions (RPEs) when focusing internally in front of the mirror when compared with the external music and video setting (9). Interestingly, this internal cue condition of running in front of a mirror while focusing on technique and breath induced a heightened RPE, which suggested that an external focus while running resulted in a feeling of less effort or an ease in the activity.

As an individual’s experience progresses, there may be a shift from an internal to an external focus, as more experienced runners will more often pay attention to their surroundings and direct attention away from the unpleasant pains of running. Before this natural progression of internal to external focus in running can be achieved, health and fitness professionals should first encourage the development of external focus for their novice clients by cueing runners to think about the distance covered, listening to music, or watching a video. After adapting to the demands of endurance running, clients can then gradually adopt an advanced external focus by thinking about the surrounding environment during independent exercise. When technique and form need to be addressed with an internal focus, trainers can use drills during short runs to evaluate, correct, and change movement patterns. Table 2 provides examples for external focus in aerobic conditioning. By developing an external focus, clients will be more motivated to enjoy the sport over the long term.

TABLE 2 - Examples of Cues for External and Internal Attentional Focus for Aerobic and Endurance Training
Exercise External Focus Cues (Improves Running Economy and RPE) Internal Focus Cue (Only Use in Shorter, Technique-Focused Sessions)
Running Gently fall forward as if someone is holding you up in front of you Focus on inhale and exhale
Focus on distance covered or surroundings Land midfoot
Stay off the ground Engage abdominals
Activate glutes
Drive knees up
Cycling Trace a circle with toe Hinge from the hip
Keep resistance through entire wheel rotation Keep back long with loose grip on handlebars
Engage glutes and hip flexor to circle leg
Engage the abdominals
Rowing Push against seat with hips Keep head in line with spine
Push against the footbeds Engage glutes and quads as you straighten knees
Bring bar to chest Bend elbows and retract shoulders
Walking Lengthen away from the ground Activate glutes
Feel a string pulling you up from crown of head Push hips forward
Shoulders in back pockets Pull shoulders back
Engage abdominals

ATTENTIONAL FOCUS: RESISTANCE TRAINING

Role of Internal Focus in Hypertrophy and Muscle Activation

Based on the goal of the client, load, and speed of contraction, an external or internal focus can be used to maximize results. The effectiveness of internal or external cueing depends on the goal of the exercise and the client’s ability to “tune into the feel” and the intensity of the exercise or task. Applying an internal focus was found to be more effective in achieving goals using lighter loads, about 50% of one-repetition maximum (1RM), and decreased in effectiveness as the loads increased up to 80% of 1RM (2). During another study by Snyder and Fry (10), investigators applied electromyographic assessments to measure muscle activation during a bench press exercise performed with the participants using an internal focus on specific working muscles. Results showed that muscle activation for the primary movers was greatest when using lighter loads. Clients who were cued to focus internally during bench press training also produced sufficient force levels that could improve muscle hypertrophy for the primary groups as well as the smaller agonist muscles. When using lighter loads, cueing internal focus, such as focusing on contracting the biceps in a dumbbell curl or the hamstring in a seated leg curl, can improve activation of the target muscle while still providing enough stimuli for hypertrophy (Figure 7).

Figure 7
Figure 7:
Client performing incline chest press at relatively light load.

Studies have suggested a mind–body connection for maximizing muscle activation by applying an internal focus on specific muscle groups over others in a compound movement. For example, while performing a curl-up, when focusing on isolating the rectus abdominis contraction, the electromyographic activity increased in the rectus abdominis and reduced in the obliques and vice versa when focusing on the obliques when compared with a control group directed to focus on the movement with no mention of muscles targeted (2). Personal trainers can use this strategy in single-joint exercises to isolate the agonists more effectively or to develop specific muscles in a multijoint exercise such as varying the focus between pectoralis major, anterior deltoid, or triceps brachii in a chest press depending on the goal of the client. This strategy also offers some guidance for clients’ focus during light load sets instead of passively going through the motion of the exercise.

The effectiveness of internal focus may be the result of the lighter loads providing a large enough muscle hypertrophy stimulus during exercise, while effectively activating the electrical impulse within the muscle. Evidence from a study by Schoenfeld et al. (11) showed greater muscle thickness in elbow flexor and knee extensor musculature when applying an internal focus during resistance training when compared with an external focus. These findings were more compelling for the elbow flexors than knee extensors, suggesting a potentially stronger mind–body connection with the upper body.

Transitioning to External Cues as Load or Time Increases

By contrast, several studies suggested that when weightlifting, an external cue that drew attention to the weighted bar, as opposed to an internal cue that focused on the muscular effort being produced by the arms, resulted in lower electromyographic activity in the agonist and antagonist muscles (1). During maximum force production, peak torque, or jump heights were reported to be the highest when clients adopted an external focus. By contrast, muscular activation, as measured by electromyographic assessments, was found to be the lowest under the same externally focused condition. Interestingly, participants using externally focused instructions also were able to complete more repetitions to failure at 75% 1RM on bench press and squat exercises with no changes in control group indicating a benefit for focusing externally during muscle strength endurance exercises (12). When a client’s goal is targeting strength endurance (e.g., repetitions to failure) or maximal force production such as in a heavily loaded squat or a weighted pull-up, external cues relating to the bar or floor are most effective for performance. With heavier loads, to overcome the weight, more instructions may be necessary not only to contract the target muscles but also to maintain the pathway of the bar or provide further encouragement (2). This suggests that in complex movements where force production, strength, and speed are paramount, external focus cues are the best choice for efficiency of movement. Table 3 reviews appropriate scenarios for internal and external focus in resistance training (Figure 8).

TABLE 3 - Examples of Cues for External and Internal Attentional Focus for Resistance Training
Exercise Goal External Focus Cue Internal Focus Cue
Squat Strength Bend the bar* Simultaneously extend the ankles, knees, and hips
Spread the floor*
Push against the ground*
Bench press Strength Push the bar away* Activate the pectoralis major
Explosively move the bar toward the ceiling* Move your arms away from you
Extend the elbow
Leg curl Hypertrophy Pull ankle pad toward you Activate the hamstring*
Bend at the knee*
Lat pull-down Hypertrophy Pull the bar down Engage latissimus dorsi to pull arms down*
Try to bend the bar inward Contract biceps to bend elbow*
Bring elbows to side of body*
Deadlift Strength Drive your feet through the floor* Hinge at the hips
Pull the bar* Keep back straight
Extend hip, knee, and ankle
*Most efficient cueing technique based on goal intensity.

Figure 8
Figure 8:
Complex or heavy-loaded barbell movements are facilitated with external focus.

The discrepancies observed between hypertrophy and strength loads and muscle activation may be attributed to the ability to consciously exert neuromuscular control over motor recruitment. At lighter loads, motor recruitment needs are smaller and attentional focus can remain on internal muscle activation. As load increases, more motor neurons need to be recruited to produce the force required to complete a particular exercise. With heavier loads, there may be a weakened conscious control over the primary moving muscles engaged in the exercise, resulting in lower specific muscle activation, and the attentional focus automatically shifts to an all-out movement performance outcome to complete the more difficult repetition or task. For instance, in the triceps extension in case study 2, controlling a single-joint exercise at a lower load and lower speed allows the individual to maintain an internal focus on the muscle contracting.

Keep in mind, when targeting optimal muscle activation and muscle development, an internal focus may be more beneficial. Once the resistance exercise goal is to improve strength and power, cueing clients to apply an external focus will maximize performance.

SUMMARY

Many if not most complex motor skills benefit from external focus while muscle development at lighter loads is improved with an internal focus. Internal focus may have a place in learning a skill or exercise as a novice because at some point an individual’s body movements need to be corrected to achieve proper technique. When working with novices or beginners, a mix of internal and external cues facilitates appropriate muscle activation and overall movement pattern efficiency. When the movement is mastered, motor performance can be more effectively and efficiently trained by cueing an external focus. As a client becomes accustomed to the movement pattern and is ready to progress the exercise, cueing by the trainer can shift more to an external focus. Performance during complex movement patterns can be optimized by applying predominantly externally focused cues. Trainers should consider the speed of the activity being performed, which limits the ability of the client to focus internally; thus, sprinting, jumping, and power movements benefit from external focus. When a client’s goal is to increase hypertrophy, evidence supports that an internal focus during movements that are controlled using lighter loads maximizes localized muscle growth and muscle activation, especially in small muscle groups. If the goal of a resistance training exercise is to achieve maximal strength, an external focus will best facilitate this goal.

Trainers should consider the speed of the activity being performed, which limits the ability of the client to focus internally; thus, sprinting, jumping, and power movements benefit from external focus. When a client’s goal is to increase hypertrophy, evidence supports that an internal focus during movements that are controlled using lighter loads maximizes localized muscle growth and muscle activation, especially in small muscle groups.

Each individual client will respond differently to cues, so health and fitness professionals should plan to incorporate a variety of cueing tactics, as internally or externally focused, within training sessions. Table 4 provides examples of cueing strategies guiding internal and external focus for a single exercise to assess the response of the individual client. By encouraging feedback from clients, exercises and programs can be created, developed, and progressed for the most effective movements and performance to achieve the training goals.

TABLE 4 - Examples of a Combination of Cues to Try with Clients and Observe Movement Patterns and Performance
Exercise Combination of Internal and External Cue
Mid row Put your shoulders in your back pockets (E)
Keep elbow close to side (I)
Squeeze a penny in between shoulder blades (E)
Keep shoulders away from your ears (I)
Pull against the weight (E)
Squat Spread the floor (E)
Spread and press your toes into the ground like your feet are in sand at the beach (E)
Sit in a chair behind you (E)
Draw belly button to spine and brace core (I) (to reduce low back arch)
Knees over pinky toe (I) (to reduce knee valgus)
Push through your heels (I)
Romanian deadlift Hinge at the hip and pull hips behind you (I)
Engage abdominals, hamstrings, and glutes (I)
Keep your body straight as a pole (E)
Resist against the floor (E)
Push-ups Push away/explode away from the floor (E)
Externally rotate your arms against the floor (E)
Engage the core and glutes to maintain straight spine (I)
Keep body straight as a surfboard (E)
Keep body still and only bend elbows (I)
E, external; I, internal.

Each individual client will respond differently to cues, so health and fitness professionals should plan to incorporate a variety of cueing tactics, as internally or externally focused, within training sessions. By encouraging feedback from clients, exercises and programs can be created, developed, and progressed for the most effective movements and performance to achieve the training goals.

BRIDGING THE GAP

Attentional focus cueing should be specific to the client, level of expertise, and goal of the activity. Health and fitness professionals can help clients make a mind–body connection to meet the activity goal and improve performance with external or internal cues. Clients attempting to maximize force jump height or distance or aerobic endurance economy should rely heavily on external attentional focus, whereas those individuals attempting to maximize muscle activation and hypertrophy should choose internally focused cues to meet their goals.

References

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Keywords:

Attentional Focus; External Focus; Internal Focus; Verbal Cueing

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