Objective: To compare the muscle activation and co-contraction patterns of the trunk muscles during four point (4p) hand-knee and hand-foot kneeling positions. Methods: Nineteen healthy volunteers randomly performed exercises in the 4p hand-knee (4 exercises) and hand-foot (3 exercises) kneeling positions, while surface electromyography (sEMG) signals were collected from bilateral rectus abdominis, external oblique, erector spine, and multifidus muscles. The average sEMG and muscle co-contraction index (CCI) based on the sEMG signals were analyzed and compared. Results: Significant differences were found in the sEMG and CCI within and between the positions(p<0.05). In the 4p hand-knee kneeling position with the right hand and left leg lift, the activation degree of all muscles was higher than that of the starting position (p <0.05). In the 4p hand-knee kneeling position with the left leg lift, the ipsilateral multifidus muscle was significantly higher than that in the 4p hand-foot kneeling position (p <0.05). And the activation degree of external oblique muscle and rectus abdominis was higher in the 4p hand-foot kneeling position with right hand lift. A total of 28 muscle matching methods were obtained by pair-to-pair matching of 8 muscles. The starting posture of the 4p hand-knee kneeling position fluctuated the least, indicating that the spine was the most stable, while the index of other exercises fluctuated in a larger range, ranging from 0.28 to 0.80. Conclusion: The effectiveness of the 4p hand-foot kneeling position as core stabilization exercises was proved from two aspects of muscle activation and CCI. The 4p hand-foot and hand-knee kneeling position can be used for strengthening abdominal muscles and back muscles, respectively. And the 4p hand-knee kneeling position with contralateral upper and lower limbs lift was a more advanced exercise for trunk muscles, but take care to avoid sports injuries. The results can be used to help doctors, therapists and physical trainers to select exercises according to the characteristics of practicer, make personalized training plans and improve training efficiency.