Standing on one leg for even a short period of time can be a challenge for many people. After the mid-50s, balance declines rapidly, increasing the risk for falls and other adverse health outcomes. Inability to stand on one leg for 10 seconds in middle-aged and older adults doubles the risk of dying from any cause in the next 10 years, a study suggests. Researchers who conducted the study say that a simple and safe balance test could be added to routine health checks for older adults.
A study detailing the findings was recently published online in the journal British Journal of Sports Medicine.
After the sixth decade of life the balance begins to decrease
The researchers note that aerobic fitness, muscle strength and flexibility are not well preserved until the sixth decade of life. However, the balance is reasonably well preserved up to that point. After the sixth decade of life, balance begins to decline relatively rapidly.
Objectives of the study
The purpose of the study was to assess whether the ability to complete a 10-second one-legged stance was associated with all-cause mortality and whether it could help predict the course of a clinical condition.
The researchers aimed to find out whether the balance test could be considered a reliable indicator of a person’s risk of death from any cause within the next decade. Another aim is to know whether balance testing can be added to routine health checks later in life.
Balance assessment is not routinely included in health screenings of middle-aged and older men and women because there is no standardized test for it, the researchers note. Apart from falls, there is very little data on the clinical outcomes of balance tests.
How was the study conducted?
Between February 2008 and December 2020, researchers studied 1,702 people aged 51 to 75. Of these, 68 percent were men, and their average age was 61 years.
Researchers re-examined data from the 1994 CLINIMEX Exercise Cohort Study to assess the association between physical fitness, exercise-related variables, and conventional cardiovascular risk factors with morbidity and mortality.
In the new study, measures were taken of participants’ skinfold thickness and waist size. Their weight was also taken. Only individuals with stable gait were included.
Participants were asked to stand on one leg for 10 seconds without additional support. Participants were asked to place the front of the free foot on the back of the opposite lower leg with their arms at their sides and gaze straight ahead. They were advised to do so in order to improve the grading of the examination.
What proportion of the participants failed the balance test?
One in five participants did not pass the test. In other words, out of 1,702 participants, 348 people failed the test. They made up 20.4 percent of the participants. Inability to stand on one leg for 10 seconds increased with age. The researchers note that this disability more or less doubles in the five-year span between ages 51 and 55.
Participants who were able to complete the 10-second one-leg stance test were classified as YES, while those who were unable to complete the test were classified as NO.
Nearly five percent of participants aged 51 to 55 were unable to stand on one leg for 10 seconds. About eight percent of participants aged 56 to 60 could not stand on one leg. Also, less than 18 percent of 61 65-year-old participants were unable to stand on one leg. The proportion of participants aged 66 to 70 who could not stand on one leg was 37 percent.
More than half (54 percent) of participants aged 71 to 75 could not complete the test. People aged 71-75 are 11 times more likely to fail the exam than those under 20, the study says.
Observations during observation period
During a median follow-up period of seven years, 7.2 percent died, of whom 4.6 percent were classified as yes and 17.5 percent as no.
During a median follow-up period of seven years, 123 people died, seven percent of the total number of participants. Of the 123 deaths, 32 percent had cancer, 30 percent had cardiovascular disease, nine percent had respiratory disease, and seven percent experienced complications from Covid-19.
The death rate was higher among those who failed the test
The researchers found no temporal trends or differences in causes of death between those who were able to complete the trial and those who could not. However, the mortality rate was significantly higher among those who failed the test.
The death rate among those who failed the test was 17.5 percent, while the death rate among participants who passed the test was 4.5 percent. This represents an absolute difference of less than 13 percent, the authors note.
What medical conditions did the participants who failed the test suffer from?
Those who failed the test were in poor health. According to the study, a large number of people were obese, with heart disease, high blood pressure and unhealthy blood cholesterol profiles. Also, type 2 diabetes was three times more common in this group. The proportion of people with type 2 diabetes who failed the test was 38 percent, while the proportion of participants who passed the test was about 13 percent.
The researchers accounted for age, sex, and baseline conditions as part of the study. They conclude that the inability to stand unsupported on one leg for 10 seconds was associated with an 84 percent increased risk of death from any cause over the next decade.
Limitations of the study
As this was an observational study, the reasons why inability to stand on one leg doubled the risk of death cannot be established. Furthermore, all participants were white Brazilians. Therefore, the researchers note that the findings may not be more broadly applicable to other races and countries.
Also, information on recent history of falls, diet, drug use, physical activity levels, and smoking as influential factors that may interfere with balance is not available.
According to a report published in the British Medical Journal, the researchers conclude that the 10-second balance test “provides rapid and objective feedback to the patient and health care professionals about stable balance.”
The trial “adds useful information regarding mortality risk in middle-aged and older men and women,” the researchers say.
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