Inability to stand on a leg for 10 sec tied to shorter life in older adults

Inability to stand on one leg for 10 seconds (sec) is strongly linked to a higher risk of death, and consequently, a shorter life expectancy in older adults, according to a study in Brazil.

Individuals who couldn’t stand on one leg for 10 sec were nearly four times as likely to die of heart attacks, strokes, cancer, or any cause within 7 years. [Br J Sports Med 2022;doi:10.1136/bjsports-2021-105360]

“These were awesome findings,” exclaimed lead study author Dr Claudio Gil Araújo from the Exercise Medicine Clinic-CLINIMEX in Rio de Janeiro, Brazil. “As a physician who has worked with cardiac patients for over four decades, I was very impressed to know that in men and women aged between 51 and 75 years, it is riskier for survival to not complete the 10-sec, one-legged stance (OLS) test than being diagnosed with coronary artery disease, hypertension, or hypercholesterolaemia.”

Balance declines with age

Unlike aerobic fitness, muscle strength, and flexibility, balance is reasonably preserved until about age 60. But comparatively, balance starts to decline more quickly as people age, said Araújo.

This accounts for the high rates of falls and injury-related deaths in the elderly globally. People older than 60 years suffer the most significant number of fatal falls, according to the WHO. [https://www.who.int/news-room/fact-sheets/detail/falls, accessed 23 June 2022]

Unfortunately, assessment of balance is not routinely added in the clinical assessment of older adults. This could be due to the paucity of data linking balance to poor clinical outcomes other than falls, he added.

Araújo’s team assessed the anthropometric and clinical status, as well as the 10-sec OLS, of 1,702 individuals in Brazil, 68 of whom were men aged 51–75 years enrolled in an exercise study.

Log-rank and Cox modelling were used to compare survival and risk of death based on their ability or inability to complete the 10-sec OLS test using either the left or right foot, with elbows extended and closed to the body. Gaze was at the eye-level range. The test was done under the face-to-face supervision of a physician or a nurse assistant as a precaution against falls or injuries.

2 out of 10 failed the test

As expected, the ability to perform the 10-sec OLS test decreased with age. Overall, 20 percent of participants were unable to stand on one leg for 10 sec. Half of those aged 70 years could not complete the test. The percentage rose to about 70 percent in people aged 76–80 years, and about 90 percent in those aged 81–85 years, Araújo shared.

During a median follow-up of 7 years, 17.5 percent of people who could not complete the OLS test had died vs 4.6 of those who completed the test successfully. “Survival curves were worse for those who were unable to complete the test [log-rank test=85.6; p<0.001],” he added.

After adjusting for age, sex, BMI, and comorbidities (diabetes and history of heart disease), the likelihood of dying from any cause was almost doubled in individuals who were unable to complete the OLS test than in those who completed it (hazard ratio [HR], 1.84; p<0.001).

Araújo said he has been using the OLS test in the clinic for years. “Patients are often unaware they are unable to sustain 10 sec standing one-legged. After this simple evaluation, they are very much willing to engage in balance training,” he said.

The test is safe and simple to incorporate into routine practice. What Araújo is uncertain about is whether exercise or balance training could influence mortality risk in these patients. Studies on the biological mechanisms that could explain the association between poor  OLS balance and death are likewise warranted.