The role of balance in health: What standing on one leg reveals about aging and longevity

Balance might seem like a minor aspect of physical fitness, but recent research highlights its significant role in predicting overall health and longevity, especially for middle-aged and elderly individuals. Studies from various global institutions emphasize that the ability to stand on one leg for an extended period may serve as a powerful indicator of not just physical well-being but also cognitive health and mortality risk.

Balance deteriorates faster than other physical abilities as we age, making it an essential indicator of the aging process. In fact, people who cannot balance on one leg for even 10 seconds are almost twice as likely to die within a decade compared to those who can.

This connection between balance and health is supported by multiple studies, including those from the Mayo Clinic and an international team of researchers from the UK, US, Brazil, Australia, and Finland. The findings from these studies provide important insights for clinicians and individuals alike, suggesting that balance should be regularly assessed as part of routine health checks for older adults.

Balance as a predictor of mortality

A key study published in the British Journal of Sports Medicine followed 1,702 people aged between 51 and 75 over a 12-year period. The participants, all of whom had a stable gait, were instructed to balance on one leg for 10 seconds without any assistance.

Over 20% of participants failed the test, and those who couldn’t balance on one leg were found to have an 84% higher risk of death from any cause within the next decade. The study also accounted for variables such as age, sex, and underlying health conditions, reinforcing the strength of the association between balance and mortality.

Although the research is observational and doesn’t establish a direct cause-and-effect relationship, the findings are nonetheless striking. Balance requires coordination between multiple systems in the body, including the visual, vestibular (inner ear), and somatosensory systems, all of which decline as we age. When any of these systems deteriorate, it increases the likelihood of falls, which are a leading cause of injury and death among older adults.

The connection between balance and cognitive health

Beyond physical fitness, balance is also intricately linked to cognitive function. Poor balance is often associated with a higher risk of cognitive decline and neurodegenerative diseases like Alzheimer’s and dementia. A study from the Mayo Clinic further emphasizes this point, showing that balance declines more rapidly than other physical traits like strength or gait. This suggests that balance is not only a measure of physical coordination but also of brain health.

In the Mayo Clinic study, 40 healthy participants over the age of 50 were tested for various health markers, including grip strength, knee strength, walking speed, and balance. The most notable finding was that balance, specifically the ability to stand on the non-dominant leg, showed the steepest decline with age. This was true for both men and women, with no significant sex differences in the rate of decline.

Dr. Kenton Kaufman, the senior author of the Mayo Clinic study and director of its Motion Analysis Laboratory, highlighted the importance of balance as an indicator of overall health. He noted that balance involves the coordination of several systems that provide feedback to maintain stability, and when these systems begin to fail, the risk of falling increases sharply.

Falls and health risks in older adults

Falls pose a significant health risk for adults over 65, being the leading cause of injuries, according to the CDC. They can lead to physical harm, loss of independence, and reduced quality of life. Many falls result from declining balance, often worsened by factors like weak muscles, poor vision, and slower reflexes, which typically decline with age.

The balance test used in studies offers a simple way to assess fall risk. Dr. Claudio Gil Araujo’s research recommends incorporating the 10-second balance test into routine health exams for older adults. Unlike aerobic fitness and muscle strength, balance can deteriorate quickly after age 50, making it a crucial early indicator of health concerns.

Araujo’s research aligns with other studies, showing that balance starts to decline in the sixth decade of life, and that poor balance correlates with an increased risk of death. His team found that people with poor balance were also more likely to suffer from strokes, cardiovascular issues, and cognitive impairments such as dementia.

The role of balance in gait and strength

Balance is essential but doesn’t function alone; it relies on factors like muscle strength and gait efficiency. Research shows balance declines faster than these other health indicators. For example, the Mayo Clinic study found that while grip and knee strength both decreased with age, balance was a more critical measure of health risks. Interestingly, grip strength declined more sharply than knee strength, yet neither was as revealing as balance in assessing overall health.

In terms of gait, the study found that participants’ walking speeds didn’t change significantly with age, primarily because they were asked to walk at their normal pace rather than their maximum speed. This suggests that while walking speed is often considered a useful marker of health in older adults, it may not be as sensitive an indicator as balance.

Training to improve balance

Balance can be improved with practice at any age. Researchers note that people can train their balance without special equipment, making it an accessible way to maintain health and independence. Simple exercises like standing on one leg or practicing yoga can enhance stability and lower fall risk.

Dr. Kaufman recommends regularly standing on one leg for at least 30 seconds to gauge balance. Successfully doing this indicates good balance and helps train the muscles, reflexes, vestibular, and sensory systems. For an added challenge, try standing on one leg with your eyes closed to strengthen proprioception and inner-ear feedback.

The “use it or lose it” principle applies here. By practicing balance exercises daily, people can slow the decline in balance that naturally comes with aging. The sooner individuals start working on balance, the better their chances of maintaining it into their later years.

Public health implications

The implications of these findings extend beyond individual health. Falls are a major public health concern, particularly in countries with aging populations. In the UK, for example, more than one in three people over the age of 65 experience at least one fall each year. Many of these falls result in serious injuries, such as hip fractures, that require hospitalization and long-term care.

Public health experts argue that including balance assessments in regular health screenings for older adults could help prevent many of these incidents. By identifying people at risk of falls earlier, clinicians can develop targeted interventions that focus on improving balance and muscle strength, potentially reducing the overall burden on healthcare systems.

The broader impact of balance on quality of life

Balancing on one leg may seem like a simple task, but its implications for health and longevity are profound. Studies from around the world consistently show that poor balance is associated with higher risks of falls, cognitive decline, and even death. Regularly practicing balance exercises, along with strength and flexibility training, can help mitigate these risks and improve overall quality of life.

For middle-aged and elderly individuals, balance serves as a critical measure of health. It is more than just a marker of physical fitness—it’s a window into broader issues of neurological and cognitive function. By paying attention to balance and taking steps to improve it, we can help ensure that we age not only gracefully but also healthily.