Standing on one leg for even a short period of time can be a daunting task for many. After the mid-50s, balance quickly diminishes, increasing the risk for falls and other adverse health outcomes. The inability of middle-aged and older adults to stand on one leg for 10 seconds is associated with doubling in the risk of death from any cause within the next 10 years, a study reports. The researchers who conducted the study say that the simple and safe balance test could be included in routine health checks for older adults.
The study describing the findings was recently published online in the journal British Journal of Sports Medicine.
Balance Starts To Wane Away After Sixth Decade Of Life
The researchers note that aerobic fitness, muscle strength and flexibility do not remain well-preserved until the sixth decade of life. However, balance tends to be reasonably well-preserved until that stage. After the sixth decade of life, balance starts to wane relatively rapidly.
Objectives Of The Study
The objective behind the study was to assess whether the ability to complete a 10-second one-legged stance is associated with all-cause mortality and whether it helps one predict the likely course of a medical condition.
The researchers aimed to find out whether a balance test could be considered a reliable indicator of a person’s risk of death from any cause within the next decade. Another objective was to know whether the balance test could be included in routine health checks in later life.
Balance assessment is not routinely included in health checks of middle-aged and older men and women, because there is no standardised test for it, the researchers note. Apart from falls, there is negligible data on the clinical outcomes of balance tests.
How Was The Study Conducted?
Between February 2008 and December 2020, the researchers analysed 1,702 individuals aged 51 to 75 years. Of these, 68 per cent were men, and their average age was 61 years.
The researchers re-examined data from the CLINIMEX Exercise cohort study, which was set up in 1994 to assess association between various measures of physical fitness, exercise-related variables, and conventional cardiovascular risk factors with ill health and death.
In the new study, measures of the participants’ skin fold thickness and waist size were taken. Their weights were also taken. Only the individuals with stable gait were included.
The participants were asked to stand on one leg for 10 seconds without any additional support. The 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. They were instructed to do so in order to improve standardisation of the test.
What Proportion Of Participants Failed The Balance Test?
Around one in five participants failed to pass the test. In other words, out of 1,702 participants, 348 individuals failed to pass the test. They accounted for 20.4 per cent of the participants. The inability to stand on one leg for 10 seconds rose in tandem with age. The researchers note that this inability more or less doubled at five-year intervals from the age of 51 to 55 years onwards.
The participants with the ability to complete the 10-second one-legged stance test were classified as YES, while those with the inability to complete the test were classified as NO.
Nearly five per cent of the participants belonging to the age group of 51 to 55 years were unable to stand on one leg for 10 seconds. About eight per cent of the participants belonging to the age group of 56 to 60 years could not stand on one leg. Also, less than 18 per cent of the participants aged 61 65 years were unable to stand on one leg. The proportion of participants aged 66 to 70 years, who could not stand on one leg, was 37 per cent.
More than half of the participants (54 per cent) aged 71 to 75 years were unable to complete the test. People in the age group of 71-75 years were more than 11 times as likely to fail the test as those just 20 years younger, the study states.
Observations During The Monitoring Period
During an average monitoring period of seven years, 7.2 per cent people died, of whom 4.6 per cent were classified YES and 17.5 per cent were classified as NO.
As many as 123 people died during the average monitoring period of seven years, accounting for seven per cent of the total number of participants. Of the 123 people who died, 32 per cent succumbed to cancer, 30 per cent had cardiovascular disease, nine per cent suffered from respiratory disease, and seven per cent experienced Covid-19 complications.
Proportion Of Deaths Among Those Who Failed The Test Was Higher
The researchers found no temporal trends in the deaths, or differences in the causes, between those able to complete the test and those who were not able to do so. However, the proportion of deaths among those who failed the test was significantly higher.
The proportion of deaths among those who failed the test was 17.5 per cent, while the proportion of deaths among the participants who passed the test was 4.5 per cent. This reflects an absolute difference of just under 13 per cent, the authors note.
What Health Conditions Did The Participants Who Failed The Test Suffer From?
The people who failed the test had poorer health. According to the study, a large number of people were obese, had heart disease, high blood pressure, and unhealthy blood fat profiles. Also, Type 2 Diabetes was three times as common in this group. The proportion of people with Type 2 diabetes among those who failed the test was 38 per cent, while the proportion of people among the participants who passed the test was around 13 per cent.
The researchers accounted for age, sex, and underlying conditions, as part of the study. They conclude that an inability to stand unsupported on one leg for 10 seconds was associated with an 84 per cent heightened risk of death from any cause within the next decade.
Limitations To The Study
Since it is an observational study, it cannot establish the reasons why the inability to stand on one leg is associated with a doubling in risk of death. Moreover, all the participants were white Brazilians. Hence, the findings may not be more widely applicable to other ethnicities and nations, the researchers note.
Also, information on potentially influential factors, including recent history of falls, diet, the use of drugs, physical activity levels, and smoking, that may interfere with balance, was not available.
According to a statement released by the British Medical Journal, the 10-second balance test “provides rapid and objective feedback for the patient and health professionals regarding static balance,” the researchers conclude.
The test “adds useful information regarding mortality risk in middle-aged and older men and women”, the researchers state.
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