Sep 29, 2022
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The inability to stand barefoot on one leg for at least 10 seconds in middle-to-old age has been linked to a near doubling in the risk of death, according to researchers who have just published their findings in the British Journal of Sports Medicine of the BMJ Group. 


The team at Clinimex Medicina do Exercicio in Buenos Aires reported their findings under the title “Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals.” They recommended that the simple and safe balance test be included in routine medical checkups for older adults by their personal physicians and gerontologists. 


Unlike aerobic fitness and muscle strength and flexibility, balance tends to be reasonably well preserved until the sixth decade of life, when it starts to decline relatively fast, noted the researchers. But unfortunately, balance assessment isn’t routinely included in health checks of men and women from their 50s, possibly because there isn’t any standardized test for it, and there are few hard data linking it to clinical outcomes other than falls, they added.


Asked to comment, Prof. Naama Constantini, a leading Israeli sports medicine expert and family-medicine specialist and director of the Rothberg Sport Medicine Center at Jerusalem’s Shaare Zedek Medical Center said she always checks balance of older patients who come to her. As falls by the elderly often result in potentially dangerous head injuries and hip fractures, they should be tested for balance and treated to improve their condition. As this balance test takes only a few seconds, she added, all general practitioners and other physicians who treat the elderly should also use it to assess patients, and anyone with balance problems should be referred to physiotherapists and other relevant professionals. 


The Brazilian researchers wanted to find out whether a balance test might be a reliable indicator of a person’s risk of death from any cause within the next decade, and, as such, might therefore merit inclusion in routine health checks in later life.


Ageing is associated with a progressive decline in physical fitness and reductions or impairments in components of aerobic and non-aerobic fitness, including muscle strength/power, flexibility, balance and body composition. It is also well-established that the combination of sarcopenic obesity (high body fat percentage and sarcopenia, which means low skeletal muscle mass accompanied by low muscle function) and loss of flexibility and balance are detrimental for overall health, placing older adults with frailty more prone to falls – the second leading cause of unintentional injury-based deaths worldwide – and other serious events. Each year around the world, an estimated 684,000 people die from falls, of which over 80% are in low/middle-income countries.


The researchers headed by Dr. Claudio Gil Araujo drew on participants in the CLINIMEX Exercise cohort study, that was established back 1994 to assess links among various measures of physical fitness, exercise-related variables and conventional cardiovascular risk factors with ill-health and death. 


The current study included 1,702 participants aged 51 to 75 (average of 61) at their first checkup, between February 2009 and December 2020. About two-thirds were men.


Weight and several measures of skinfold thickness plus waist size were taken, and details of medical history were also provided. Only those with a stable gait were included. As part of the checkup, participants were asked to stand on one leg for 10 seconds without any additional support. 


To improve standardization of the test, participants were asked to place the front of the free foot on the back of the opposite lower leg, while keeping their arms by their sides and their gaze fixed straight ahead. Up to three attempts on either foot were permitted.


In all, around one in five (20.5% or 348 participants failed to pass the test. The inability to do so rose in accordance with age, more or less doubling at subsequent five-year intervals from the age of 51 to 55 onwards. The proportions of those unable to stand on one leg for 10 seconds were nearly five percent among 51 to 55 year olds; eight percent among 56 to 60 year olds; just under 18% among 61 to 65 year olds; and just under 37% among 66 to 70 year olds. More than half (around 54%) of those aged 71 to75 were unable to complete the test. In other words, people in this age group were more than 11 times as likely to fail the test as those just 20 years younger.


During an average monitoring period of seven years, 123 (7%) people died from cancer (32%); cardiovascular disease (30%); respiratory disease (9%); and COVID-19 complications (7%).\


There were no clear trends in the deaths or differences in the causes between those able to complete the test and those who weren’t able to do so – but the proportion of deaths among those who failed the test was significantly higher: 17.5% vs 4.5%, reflecting an absolute difference of just under 13%.


In general, those who failed the test had poorer health. A higher proportion were obese and/or had heart disease, high blood pressure, and unhealthy blood fat profiles. And type-2 diabetes was three times as common in this group, 38% compared to around 13%. 


After accounting for age, gender and underlying conditions, an inability to stand unsupported on one leg for 10 seconds was associated with an 84% heightened risk of death from any cause within the next decade.


And information on potentially influential factors, including recent history of falls, physical activity levels, diet, smoking and the use of drugs that may interfere with balance wasn’t available.


Nevertheless, the researchers conclude that the 10-second balance test “provides rapid and objective feedback for the patient and health professionals regarding static balance,” and that the test “adds useful information regarding mortality risk in middle-aged and older men and women.”