Research Review By Dr. Joshua Plener©


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Date Posted:

September 2022

Study Title:

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals


Araujo C, Souza Silva C, Laukkanen J et al.

Author's Affiliations:

Exercise Medicine Clinic-CLINIMEX, Rio de Janeiro, Brazil; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland; Central Finland Health Care District, Department of Medicine, Finland

Publication Information:

British Journal of Sports Medicine 2022; 56(17): 975-980.

Background Information:

As we age, there is typically a decline in physical fitness parameters such as decreased strength, flexibility and balance (1-5). Older adults are therefore more prone to falls and other serious adverse medical complications (6).

Interestingly, unlike strength, aerobic fitness, and flexibility, balance is reasonably preserved until the sixth decade of life, after which it starts to diminish quickly (7, 8). Although important, balance assessments are not routinely incorporated in the clinical examination of individuals in a general medical environment, and often not in a chiropractic office either!

Having a simple, inexpensive, and reliable balance assessment could be beneficial for health professionals treating older adults, including chiropractors. The aim of this study was to assess whether a 10-second one legged stance (10-s OLS) was independently associated with all-cause mortality in middle and older aged men and women.

Pertinent Results:

Anthropometric, clinical and vital status and 10-s OLS data were assessed in 1702 individuals (68% men) aged 51–75 years between 2008 and 2020. The average age of participants was 61.7 years. 20.4% of participants failed to pass the 10-s OLS test, with the inability to complete the test increasing with age, practically doubling at each subsequent 5-year interval, beginning at age 51-55 years. The proportion of participants not able to complete the test at age 51-55 was 4.7%, with 36.8% of participants not able to complete at 66-70 years and 53.6% not able to complete at age 71-75.

In general, the inability to complete the 10-s OLS test was associated with a significantly higher risk for all-cause mortality. The proportion of deaths in the group that couldn’t complete the test was higher than that in the group that could complete the test, with an absolute difference of 12.9%. Age, BMI and waist-height ratio differed between the two groups, and in general, participants who couldn’t’ complete the test had an unhealthier profile, with a higher percentage of participants having coronary artery disease, hypertension, dyslipidemia, obesity, and diabetes mellitus (which was three times more common!).

Clinical Application & Conclusions:

It is well known that having good balance is required for many daily activities, and a loss of balance is detrimental for one’s health. This study demonstrated that the ability to complete a 10-second one legged stance starts to diminish as one ages, dropping ~50% approximately at every 5-year age group interval. To illustrate, participants in the oldest group (71-75) were 11 times more likely to not be able to complete the test as compared to those in the 51-55 age bracket. Furthermore, age, high waist-height ratio and the presence of diabetes mellitus were associated with participants not being able to complete the test.

This study also showed that middle-aged and older adults who were unable to complete the 10-second one legged stance had lower survival rates over a median of 7 years compared to those who were able to complete the test. In patients who couldn’t complete the test, there was an 84% higher risk of all-cause mortality even after controlling for other potentially confounding variables.

Overall, this is a simple test that can be performed in your clinic which can help tell us as clinicians a lot about an individual. If your patient can’t perform the test for 10-seconds, this might be an area worth working on. You may even prevent a fall, which itself is a tremendous benefit to the patient and the healthcare system! A simple role we can play for our patients is to promote proper physical function, a key component of which is maintaining and even improving balance in our aging patients. Assessment is easy and improving a patient’s balance can be achieved via simple prescription of progressive exercises the patient can do on their own time.

Study Methods:

This was a prospective cohort study with a sample size of 1702 participants aged 51-75 years. These participants voluntarily attended a clinic for an evaluation to assess their aerobic and non-aerobic physical fitness and/or to obtain exercise counselling.

As part of the evaluation, participants were asked to stand on a flat platform and balance statically through their ability to complete a 10 second one legged stance, either on their left or right foot, under the close supervision of a physician and/or nurse assistant to prevent injury. To reduce the influence of strength and flexibility and improve standardization of the test, barefoot participants were instructed to place the dorsal part of their non-supported foot on the back of the opposite lower leg as naturally as possible. Participants were advised to keep their elbows extended, arms naturally close to their body and fix their gaze on a point at a distance of 20m. A simple criterion was applied regarding the ability to complete the 10 second one legged stance on either foot, keeping correct initial position and not requiring any other support.

Study Strengths / Weaknesses:

  • The 10-second one-legged stance test was carried out in a well-controlled environment and under direct surveillance of a healthcare professional.
  • The classification criterion for the test was simple and easy to apply.
  • There was data available for several anthropometric and clinical variables which helped make the analysis more robust.
  • The patient population was primarily made up of white individuals with a higher socioeconomic status and therefore extrapolation of the findings to other patient populations may be limited.
  • Several potential confounding variables were not available for participants such as history of falls, pattern of physical activity or exercise and sports practice, diet, smoking and the use of medications that may interfere with balance.

Additional References:

  1. CGS, Castro CLB, Franca JFC, et al. Sitting-rising test: sex- and age-reference scores derived from 6141 adults. Eur J Prev Cardiol 2020; 27: 888–90
  2. Laukkanen JA, Voutilainen A, Kurl S, et al. Handgrip strength is inversely associated with fatal cardiovascular and all-cause mortality events. Ann Med 2020; 52: 109–19
  3. Medeiros HBdeO, de DSMS, de CGS. Age-related mobility loss is joint-specific: an analysis from 6,000 Flexitest results. Age 2013; 35: 2399–407
  4. Vianna LC, Oliveira RB, CGS. Age-related decline in handgrip strength differs according to gender. J Strength Cond Res 2007;21:1310–4
  5. CGSde. Flexibility assessment: normative values for flexitest from 5 to 91 years of age. Arq Bras Cardiol 2008;90:257–63
  6. Brito LBBde, Ricardo DR, DSMSde, et al. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol 2014;21:892–8
  7. Izquierdo M, Merchant RA, Morley JE, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines. J Nutr Health Aging 2021;25:824–53
  8. Springer BA, Marin R, Cyhan T, et al. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther 2007;30:8–15
  9. Fregly AR, Smith MJ, Graybiel A. Revised normative standards of performance of men on a quantitative ataxia test battery. Acta Otolaryngol 1973;75:10–16

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