Can't do this simple balancing act? You're more likely to die soon

Before you read any further, try standing on one leg for 10 seconds. 

Go on.

If you can't do it, and you're middle-aged or elderly, we have some not-so-great news for you.

A first-of-its-kind 12-year study by an international group of experts from the U.K., U.S., Australia, Finland, and Brazil has revealed that middle-aged and elderly people who cannot balance on one leg for 10 seconds are almost twice as likely to die from any cause within the next 10 years than those who can.

According to the researchers, the findings were so clear-cut that the simple and safe balance test could be included in routine health checks for older adults.

Their findings were published in the British Journal of Sports Medicine.

The ability to balance drops sharply after your 60s

This isn't the first "indicator" that the lead author of the research, Claudio Gil Araujo, of the Clinimex Medicina do Exercicio (Exercise Medicine Clinic), Rio de Janeiro, Brazil, has created. He also developed Flexitest, an innovative method for assessing body flexibility, and the sitting-rising test (SRT), a measure of overall health and a predictor of longevity for middle-aged and older adults.

"I've always been interested in the assessment of physical fitness and its relationship with health. However, [it's] only about 15 years ago (after I met Professor Dusan Hamar), [that] I had my attention directed to balance," said Gil Araujo to IE in an interview. "Static balance testing was incorporated into our comprehensive evaluation protocol at Clinimex in 2008. Since then, we have evaluated more than 4,000 subjects from the ages of six to 102."

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The researchers noted that, unlike aerobic fitness, muscle strength, and flexibility, balance tends to be reasonably preserved until "the sixth decade of life", when it starts to wane relatively rapidly. And yet, balance assessment isn't routinely included in health checks of middle-aged and older men and women. This could be due to the lack of a standardized test and little hard data linking balance to clinical outcomes.

Therefore, the researchers wanted to find out if completing a 10-second one-legged stance (OLS) is associated with all-cause mortality and whether it could add relevant prognostic information, and thus should be included in routine health checks later in life.

Advanced and sophisticated statistical methods were used to analyze data

For this, the researchers drew on participants in the Clinimex Exercise cohort study that was set up in 1994 to assess associations between various measures of physical fitness, exercise-related variables, and conventional cardiovascular risk factors, with ill health and death. 

Gil Araujo stressed that the researchers performed adequate minimum sample size calculations for performing the data analysis. "We were able to periodically access vital data — alive or dead — in our Clinimex Exercise cohort," he said. "And, with the collaboration of some of the best exercise epidemiologists in the world, we could apply very advanced and sophisticated statistical methods to analyze our data. And here we are with one more fascinating and practice-changing study."

The current analysis included 1,702 participants aged 51 to 75 at their first check-up, which took place between February 2009 and December 2020. Sixty-eight percent of them were men.

In the beginning, participants were asked to stand on one leg for 10 seconds without any additional support. To standardize the test, they were asked to place the front of their 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.

One in five (20.5 percent; 348) failed the test, with the inability to complete the test rising with age. More than half (around 54 percent) of those aged 71-75 were unable to complete the test. The researchers noted that those who failed the test had poorer health — they generally had conditions such as obesity, heart disease, high blood pressure, unhealthy blood fat profiles, and/or type 2 diabetes.

Over the next decade, 123 participants died of causes that included cancer, cardiovascular disease, respiratory disease, and COVID-19 complications.

However, the proportion of deaths among those who failed the test was significantly higher. After accounting for age, sex, and underlying conditions, an inability to do the 10-second OLS was associated with an 84 percent heightened risk of death from any cause within the next decade.

'Relevant in terms of prognosis for all-cause mortality'

Gil Araujo mentioned that the results were sort of expected. "I have hypothesized that poor balance was associated with lower survival time. However, the final results were even more impressive than I initially thought; The ability to complete this simple test could be relevant in terms of prognosis for all-cause mortality from a quite extended age range, i.e., 51-75 years old," he says.

And he also drew from his personal experience. "As a physician in clinical practice for over 40 years, I found these results really awesome! For someone aged 51-75 years, the risk of dying is — on average — higher when being unable to complete a 10-s OLS than when having coronary artery disease, obesity, arterial hypertension or high blood cholesterol!" said Gil Araujo.

Perhaps, even before noting the patient's height, weight, and blood pressure measurements during health checks, a 10-s OLS test should be performed, suggested Gil Araujo. "In prognostic terms, for those who are 51-75 years old, it would make a lot of sense," he added.

Gil Araujo added that participants who failed the test often couldn't believe that they were unable to do it. "I think that this is very helpful in changing [their] lifestyles and starting some balance training."

Training-induced change could translate to a better quality of life

The researchers add that the study had its limitations — the participants were all white Brazilians, which meant that the findings may not be more widely applicable to other ethnicities and nations.

But, they stressed that the 10-second balance test "provides rapid and objective feedback for the patient and health professionals regarding static balance" in addition to adding "useful information regarding mortality risk in middle-aged and older men and women".

And so, Gil Araujo hopes that the 10-s OLS test will be standardized in the future. "As a matter of fact, balance is tested here and there but in a poorly standardized way and with no good reference data to compare, and provide feedback for the practitioners and subjects. What's more important is that now, in our study, it is also a predictor of all-cause mortality."

The researchers have a two-goal path next. "We hope to continue to study the relationship between nonaerobic fitness components and health outcomes and to check if training-induced changes in these components will translate into a better quality of life and autonomy and longer survival," added Gil Araujo.

Guess we must head to the gym now

But, what can people do to improve their balance and lengthen their lifespan?

The physician has a wonderful example — himself. 

"I regularly check my health and do resistance/flexibility/balance and aerobic exercises regularly. I've run over 20 half-marathons around the world - I also cycle, swim, and stand-up paddle," Gil Araujo said.

Who knew such simple workouts could be a crucial, determining factor in your own mortality? Off you go to exercise!