It has been known for a while that aerobic fitness is associated with health. However, there has been less attention on non-aerobic fitness – things like flexibility, muscle strength/ power, and balance. But it probably should be highlighted more and balance assessments should be incorporated into clinical examinations, suggests new research.
A new study finds that people who cannot stand on one leg for 10 seconds in mid to later life have a doubled chance of death in the next 10 years. The findings have been published in the British Journal of Sports Medicine.
The study used participants in a CLINIMEX exercise open cohort/ evaluation study, which was originally set up in 1994, to assess the association between various measures of physical fitness and other variables and risk factors. In their paper, the researchers evaluated a cohort of 1,702 participants between 2009 and 2020.
During check-ups, the participants had to stand on one leg for 10 seconds without any additional support. The researchers aimed to standardize this test even more and had the cohort place the front of their free foot on the back of the lower leg, with their arms at their sides, all while gazing straight ahead. The cohort were allowed up to three attempts of this procedure.
The results were astounding.
Overall, one in five of the cohort failed the one-legged stance (OLS) test and there was a correlation between age and failure. Failure seemed to double at five-year intervals from age 51-55 onwards.
The researchers then monitored the cohort over an average of seven years and found that 7 percent (123) of the cohort died. Of those deaths, 32 percent were caused by cancer, 30 percent by cardiovascular disease, 9 percent by respiratory disease, and 7 percent due to COVID-19 complications.
However, there were no temporal trends in the deaths among those who could complete the OLS and those that failed. The proportion of deaths among those that failed was a lot higher: 17.5 percent versus 4.5 percent.
Accounting for age, sex, and health conditions, the researchers determined that those who could not complete the 10-second OLS had an 84 percent heightened risk of death from any cause in the next decade.
But is this test good at predicting the risk of death?
"The bottom line is poor physical fitness."Dr Claudio Gil Araujo
Those who failed the test seemed to have poorer health: Type 2 diabetes was three times more common in the failed group than in the successful one, and there was a higher proportion of obesity, high blood pressure, unhealthy fat profiles, and/ or heart disease.
“I think that poor nonaerobic fitness (normally associated with a sedentary lifestyle, but not always) is the background of most cases of frailty and it is well-known that being frail is strongly associated with a poor quality of life, less physical activity/exercise and so on,” Dr Claudio Gil Araujo, lead author of the paper, told IFLScience.
“The bottom line is poor physical fitness. In addition, of course, it is understood that poor balance is associated with falls. Aged people falling are at very high [risk] of major fractures and other related-complications. This may also play a role in this higher mortality," Araujo added.
"Also remember that we regularly need to do a one-legged posture, to move out of a car, to climb or to descend a step or stair, and so on. [For people who] do not have this ability or [are] afraid in doing so, it is likely related to loss of autonomy and, in consequence, less exercise and the snowball starts.”
"The 10s OLS test [should] be included at the beginning of consultation, together with height, weight, and blood pressure measurements. That’s simple."Dr Claudio Gil Araujo
So, if this test is applied to routine health checks, will it have a big impact?
“YES, A QUITE BIG ONE! I would suggest that for 51-75-year-old people going to a health check, independently of the clinical condition and in any setting,” Araujo told IFLScience.
“The 10s OLS test [should] be included at the beginning of consultation, together with height, weight, and blood pressure measurements. That’s simple," Araujo said.
"As a practical message, if you are younger than 70 years, you are expected (as the majority of those at that age) to successfully complete the 10s OLS. For those older than 70 years of age, if you complete it, you are in better static balance status than your age-peers. Please also note that there are no sex differences in performing the 10s OLS.”
Now, there are more in-depth studies that need to be analyzed.
“We are currently looking at our cohort data to check the association of muscle power and strength (two related but distinct things) and flexibility scores/measurements with all-cause mortality. We are extending our previous study using the sitting-rising test for a larger sample and longer follow-up and including analysis of other causes of natural death, such as these due to cardiovascular diseases,” said Araujo.
Overall, this is a simple and safe test that can be used for routine health checks for older adults.
And for anyone who does fail this test:
“It is well-known the static balance can be substantially improved by specific training. After only few sessions, an improvement can be perceived and this influences quality of life. And this is exactly what we do with the patients that we evaluated and for those that are attending our medically-supervised exercise program.
Unfortunately, we don’t yet have data to assess if improving static balance or performance in our 10s OLS will influence survival, a quite attractive perspective,” said Araujo.