How a 10-Second Balance Test May Help Older Adults Predict Longevity

Fact checked on June 27, 2022 by Vivianna Shields, a journalist and fact-checker with experience in health and wellness publishing.

The ability to balance on one leg may be able to predict life expectancy in middle-aged and older adults, new research has found.

For people over 50 years old, not being able to stand on one foot for 10 seconds was associated with a higher risk of death from all causes within the next decade, according to the study, published Tuesday in the British Journal of Sports Medicine. The findings suggest it may be useful to add the 10-second balance test as part of routine physical exams for that age group.

"We regularly need to stay in a one-legged posture, to move out of a car, to climb, or to descend a step or stairs and so on," lead study author Claudio Gil Soares Araújo, MD, PhD, a sports and exercise physician at the Exercise Medicine Clinic Clinimex, in Rio de Janeiro, told Health. "So not having this ability or being afraid of doing so, is likely related to loss of autonomy and, in consequence, less exercise and the snowball starts."

Here's what to know about how closely balance is linked to longevity—and how you can continue to improve your balance at any age.

Better Balance Linked to Greater Longevity

As individuals age, aerobic fitness, muscle strength, and flexibility tend to diminish gradually, but balance skills remain relatively intact—at least until the sixth decade of life, when they start to diminish quickly, according to researchers.

"It is widely recognized that low aerobic fitness is associated with poor health [but] much less attention has been paid to non-aerobic fitness—muscle strength and power, flexibility, and balance," said Dr. Araùjo. "All these three components of non-aerobic physical fitness are potentially relevant for good health and, even more relevant for survival in older subjects."

Balance tests, however, aren't regularly incorporated into health assessments; mainly because there hasn't been a good, standardized test for balance as it relates to general health outcomes. That's what researchers set out to discover with this new study: Whether the 10-second one-legged stance was associated with all-cause mortality among middle-aged and older adults, and if the test would be a useful addition to routine evaluations.

For the study, researchers examined data from the CLINIMEX Exercise cohort study set up in 1994, which looked at the associations between physical fitness and mortality outcomes. For this specific study, researchers zeroed in on 1,702 people between the ages of 51–75 at their first check-in, where data were collected on weight, waist size, and body fat.

During that first check-in, participants were also asked to complete the 10-second one-legged stance—they were instructed to stand on a flat surface on one leg (right or left), barefoot. The top of the raised foot was to be placed on the back of the standing leg's calf. Participants were given three shots to balance on one leg for 10 seconds.

Overall, about one in five participants—20.4%—were not able to stand on one leg, with older individuals and those in poorer health more likely to fail the balance test. Within the next decade (seven years, on average) 17.5% of the participants who failed the test died, compared to only 4.5% of the participants who passed the balance test.

Even after accounting for factors like age, sex, BMI, and underlying conditions, the risk of death within 10 years from any cause was 84% higher for those who failed the balance test.

Because this was an observational study, researchers weren't able to determine why the balance test was associated with higher risk of mortality within the decade. The causes of death also did not differ between people who did and did not pass the test—the main causes of death were cancer, cardiovascular disease, respiratory disease, and COVID-19 complications. More research is needed to examine the balance test as a predictor of mortality in different demographics and in different situations.

Still, according to researchers, the 10-second balance test "provides rapid and objective feedback for the patient and health professionals" alike, and adding it to routine checks could provide "useful information regarding mortality risk in middle-aged and older men and women."

Overall, "standing on one leg is a very simple, quick, and safe test for heath checks," said Dr. Araújo.

How to Improve Balance at Any Age

Balance is crucial for longevity in many ways. For instance, if your balance is bad, you are much more likely to fall, Kathryn Boling, MD, a primary care physician at Baltimore's Mercy Medical Center, who did not work on the study, told Health. About 680,000 people die each year from falls globally, according to the World Health Organization. Having better balance reduces your risk of falls and fractures that can leave you bed-ridden, Dr. Boling said.

Scott Kaiser, MD, a geriatrician and director of Geriatric Cognitive Health for the Pacific Neuroscience Institute at Providence Saint John's Health Center in Santa Monica, California agrees. "Balance is critical for our health and wellbeing as we get older," Dr. Kaiser told Health. "Falls are a major issue for older people."

The good news is that your balance "can be substantially improved by specific training," Dr. Araújo said.

If you fail the balance test or are iffy on it, try spending a few minutes a day working on it with "simple, practical" balance exercises, Dr. Araújo said. "Balance can always be improved by specific training," he said. "Ideally, static balance should be trained both barefoot and when using regular or sport shoes."

Dr. Araújo recommended trying the following exercises:

• Stand on one leg when you brush your teeth, changing from left to right after 10 or 15 seconds. "You may want to synchronize these position changes with the area of your mouth that you are brushing," he suggested. This exercise should be done barefoot. If this is too difficult, Dr. Araújo recommends taking a 10 second break in between with both feet on the floor.
• Stand next to a door handle and try three reps of standing on one leg for 10 seconds, alternating legs. "It will take just one minute," Dr. Araújo says.

If you're still struggling with your balance, consider seeing a physical therapist. "Physical therapy can not only help you do balancing exercises," said Dr. Boling. "It can also help to strengthen the muscles in your legs and arms so that ultimately you're more fit."