Nov. 12, 2024 – Doctors and researchers can assess an older person’s health in a few ways.
A handgrip test, for example, is simple to do, and decades of research have shown links between grip strength and health risks, including early death.
Other tests, like timing how fast someone can walk down a hallway or measuring the length of their strides, are a bit more complicated. But the results can show if that person is at risk of falling or becoming disabled.
Both tests have one key disadvantage: You need either special equipment or a trained observer to get accurate measurements.
But there’s one test you can do by yourself, at home, with nothing more than the stopwatch on your smartphone – the one-leg balance test.
And now there’s a compelling reason why you might want to: The length of time you can stand on one leg may indicate how fast you’re aging at the neuromuscular level.
That’s according to a new study from the Mayo Clinic in Rochester, Minnesota, which compared volunteers in their 50s with those who were 20 years older.
The biggest difference between groups was in the ability to balance on one foot. It appears to decline much faster with age than grip strength or gait speed. That decline has serious consequences, as shown in previous studies that linked poor single-leg balance to a risk of repeated falls. It’s also a red flag for premature death.
In the new study, people in their mid-50s averaged 17 seconds on their nondominant leg (usually the left leg for right-handed people, and the right leg for southpaws). The average was 11 seconds for those in their mid-70s.
Why does standing on one foot have such serious implications? To understand that, we need to shift our focus from the bottom of your anatomy to the top.
Tales From the Loop
“Balance is a good measure of health because it reflects how well your body systems are working together,” said Kenton Kaufman, PhD, a professor of musculoskeletal research at the Mayo Clinic and an author of the new study.
Kaufman is an engineer by training, one who began his academic career with a focus on machine design. Many of the principles he learned also apply to the human machine.
“Engineers look at systems,” he said. And in a system, “there’s always a feedback loop.”
With balance, the loop begins with the vestibular system – the movement sensors in your inner ear. “That system detects how your head is moving,” Kaufman said.
It integrates that information with input from your vision and the pressure sensors in your joints and feet. Then it sends signals to the muscles responsible for keeping you upright.
Those muscles complete the loop by sending information back to the vestibular system.
“As we age, all those systems are affected,” Kaufman said.
Nerves degrade, which affects both the urgency and accuracy of the signals they send. We also lose strength and muscle mass, which compromises our ability to act on those signals.
But the biggest age-related challenge to our balance is the decline of the vestibular system. And it’s made worse by a nearly unavoidable aspect of modern life: loud noises.
Anatomy of a Fall
The tiny sensory organs of the vestibular system are right next to your eardrum.
“Not only can loud noise damage your hearing, that same noise can damage your balance organs,” said Devin McCaslin, PhD, chief of the Audiology Division at the University of Michigan Medical Center.
“Age-related decline in the vestibular system is both natural and common,” he said. “This can lead to functional deficits in balance, such as a slow decrease in walking speed and an increased risk of falls.”
Exposure to loud noise speeds the decline. Once the damage is done, it can’t be reversed.
“Currently, the best way to maintain good balance is staying active and maintaining a healthy lifestyle,” McCaslin said. That includes avoiding loud noise whenever you can.
One type of exercise seems to offer the broadest combination of benefits.
Carry On
“I think the most practical thing people can do is resistance training,” said Robert Linkul, a certified strength and conditioning specialist in Sacramento, California, and director of education for Fit Body Boot Camp, who specializes in training older adults.
“The more muscle mass you have, the longer you’ll live, with a higher quality of life and less likelihood of falling.”
But what about focusing on balance specifically? If standing on one foot is important, shouldn’t you practice it – while brushing teeth for example?
“That gets you very good at balancing on one foot while brushing your teeth,” he said. “That’s the only transferable skill. Standing on one foot has no correlation to making your balance better” in real-world situations.
Consider a typical combination of household tasks: You bend down to pick something up, carry it across a room or out to your car, and then bend or reach to set it down.
Loaded carries, an exercise Linkul uses with his older clients in every workout, combines all those movements:
- Bend forward at the hips and pick up weights from the floor.
- Straighten your hips as you lift the weights.
- Carry the weights to the other side of the room.
- Bend at the hips and set the weights back down on the floor.
You can do loaded carries any number of ways:
With the same weight in each hand (called a farmer’s carry)
- With just one weight held at the side (called a suitcase carry)
- With a heavier weight in one hand and a lighter one in the other
- With an unstable object, like a sandbag, held against your chest or across your shoulders
Linkul also does lots of variations of lunges and step-ups, which develop strength in functional movements, helping you stay healthy and independent in your later years.
Stand and Deliver
Kaufman, who’s 72, would never argue against the importance of strength. He was a competitive powerlifter in the 1980s, and he still works out five times a week. He also regularly tests his one-leg balance.
“If you can stand on your leg for 30 seconds, you’re doing really well as an older adult,” he said. But if you can’t manage five seconds, you could be at high risk of falling.
He doesn’t know if single-leg balance is the best way to assess an older person’s neuromuscular health. But it’s certainly the easiest. “It’s something everybody can do at home,” he said. In his study, people kept their eyes open and allowed their arms to move if needed for balance.
If you test both legs and find one or both are perilously close to the five-second danger zone, he recommends talking to your doctor.
