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June 24, 2022

Can you stand on one leg? Here's why the answer matters.

Daily Briefing

    A new study published Tuesday in the British Journal of Sports Medicine suggests that the inability to stand on one leg for 10 seconds nearly doubles the risk of death over the next seven years for individuals in later life.

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    Study details and key findings

    For the study, Brazilian researchers included 1,702 participants ages 51 to 75 in the Clinimex Exercise cohort study, which began in 1994, to assess fitness, health, and cardiovascular risk factors. Overall, participants had a mean age of 61.7 at their initial checkup between 2008 and 2020. The study only included individuals with stable gaits.

    During their initial checkups, participants were asked to complete a 10-second one-legged stance (OLS) with no additional support. Barefoot participants were asked to place the front of their free foot on the back of their lower leg on the opposite side. They were instructed to keep their arms by their sides and look straight ahead for the duration of the test. Each participant was given up to three attempts on either foot.

    In total, 20.4% of participants were unable to complete the 10-second OLS test. Notably, the rate of failure rose with age. For example, the failure rate for the initial exam was:

    • 4.7% for participants aged 51 to 55
    • 8.1% for participants aged 56 to 60
    • 17.8% for participants aged 61 to 65
    • 36.8% for participants aged 66 to 70
    • 53.6% for participants aged 71 to 75

    During a seven-year follow-up, the researchers discovered that 7.2% of participants had died, including 4.6% of participants who successfully completed the OLS test and 17.5% of those who did not.

    After the researchers adjusted for age, sex, BMI, history of heart disease, hypertension, diabetes, and high cholesterol, they determined that risk of death within a 10-year period was 1.84-fold higher in participants who failed the balance test than in those who passed it.

    Commentary

    According to study author Claudio Gil Araujo of Clinimex Medicina do Exercicio in Rio de Janeiro, Brazil, the observational study cannot establish cause and effect. "As participants were all white Brazilians, the findings might not be more widely applicable to other ethnicities and nations, caution the researchers," he said.

    Separately, Naveed Sattar, a professor of metabolic medicine at the Institute of Cardiovascular & Medical Sciences at the University of Glasgow who was not involved in the study, noted that the research was interesting but not conclusive.

    "As one leg standing requires good balance, linked to brain function, good muscle strength and good blood flow, it likely integrates muscular, vascular and brain systems so it is a global test of future mortality risk -- albeit crude," Sattar said.

    "If someone cannot do the 10 seconds and is worried, they should reflect on their own health risks," he said.

    "They could try to make positive lifestyle changes such as walking more, eating less if they realize they could do better -- most underestimate importance of lifestyle to health," Sattar added. "But also they could consult with their doctor if, for example, they have not had risk factors for cardiovascular disease measured or other chronic conditions such as diabetes tested for."

    "The advantages of the 10-second one-legged stance test include that it is simple and it provides rapid, safe, and objective feedback for the patient and healthcare providers regarding static balance," according to Araujo.

    "It can be easily incorporated into the routine of the most clinical consultations, especially for older adults," he added. "Importantly, the 10-second one-legged stance results add useful information regarding mortality risk in middle-age and older men and women beyond ordinary clinical data." (Gleeson, USA Today, 6/23; Hunt, CNN, 6/21; George, MedPage Today, 6/21; Araujo et al., British Journal of Sports Medicine, 6/21)

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