Test of standing on one leg is an indicator of survival, says study

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Can you stand on one leg for ten seconds? This simple balance test can work as an indicator of risk of death in up to ten years for people over 50 years old and should be included in routine exams for the elderly.

The conclusion is from a study published in the British Journal of Sports Medicine this Tuesday (21) that included four Brazilian researchers and others from Finland, the United States, the United Kingdom and Australia.

The research analyzed 1,702 people aged between 51 and 75 years between February 2009 and December 2020. They participate in a cohort study (Clinimex Exercise), created in 1994 to assess associations between various measures of physical fitness with poor health and death.

The results show that the inability to stand on one leg for ten seconds, starting at age 50, is linked to a 3.8-fold greater absolute risk of death (17.5% in the group that did not complete the test and 4.6% in what they completed). When adjusted for all clinical variables, such as sex and body mass index, the risk is almost doubled (1.84).

“It is a much greater risk than having a diagnosis of coronary disease, being obese, hypertensive or being dyslipidemic. So, it is a priority for the doctor to also assess this ability [de ficar em uma perna só]”, says the main author of the research, physician Claudio Gil Soares de Araújo, director of research and education at Clinimex (Exercise Medicine Clinic).

Araújo says that in his clinical experience, with more than 4,000 patients seen, the oldest person to complete the balance test was 91 years old. At the other end, the youngest who failed to complete was 38 years old.

“Balance and other components of physical fitness, like aerobic or non-aerobic, need training, especially when we start to lose, that is, in the sixth decade of life.”

The study is observational and, as such, cannot establish a cause and effect relationship. Another limitation is that information on factors that can influence balance, such as recent history of falls, levels of physical activity, diet, smoking and medication use, were not evaluated at work.

According to Araújo, one of the hypotheses that would explain the higher risk of mortality is that people with balance problems are more prone to falls. Fractures from falls are responsible for about 70% of accidental deaths in people over 75 years of age.

In Brazil, there are more than 600,000 femur fractures per year, 90% of which result from falls. The WHO (World Health Organization) established June 24, next Friday, as World Fall Prevention Day.

According to orthopedist Jorge dos Santos Silva, president of the SBO (Sociedade Brasileira de Ortopedia), the Covid-19 pandemic in all its aspects has contributed to a greater weakening of the elderly, especially those over 80 years old. “The frail elderly are more likely to fall and fracture.”

The geriatrician Maísa Kairalla, coordinator of the Geriatrics and Gerontology care transition outpatient clinic at Unifesp (Federal University of São Paulo), says that the clinics are full of frail elderly people and that a simpler tool, such as the balance test proposed in the study , can be of great value to health professionals.

“Especially in so many places where there is no time to make a better assessment of muscle strength and balance. Or until it can be done by telemedicine. If the person is already bad in a simple test, you can infer that he will not be able to do tests more complex and that deserves immediate attention”, he says.

There are no data in the study published in the BMJ that demonstrate that, by improving balance, the risk of falling or mortality will be changed. “But we can speculate that yes. Just reducing the risk of falling will already be a protective factor and capable of prolonging survival”, says Claudio Araújo.

The aim of the study was to demonstrate that a simple and safe balance test can be a reliable indicator of risk of death and, as such, deserves to be included in routine tests of the elderly.

In all, 1 in 5 (20%) of study participants failed the test. The inability to do so increased with age. The proportions of those unable to stand on one leg for ten seconds were: nearly 5% aged 51-55; 8% between 56-60 years; 18% between 61-65 years; and 37% between 66-70 years.

More than half (54%) of people aged between 71 and 75 failed to complete the test. In other words, people in this age group were more than 11 times more likely to fail the test than those just 20 years younger.

During an average follow-up period of seven years, 123 (7%) people died: cancer (32%); cardiovascular diseases (30%); respiratory disease (9%); and complications of Covid-19 (7%).
But no associations were established between these deaths and balance test results.

In general, those who failed the test were in poorer health: a greater proportion were obese and/or had heart disease, high blood pressure, and unhealthy blood fat profiles. Type 2 diabetes was three times more prevalent in the group that failed the test: 38% versus 13%.

According to the researchers, another limitation of the study is that since the participants were all white Brazilians, the findings may not be more broadly applicable to other ethnicities and nations.

A piece of advice from the study’s lead author: Seniors need to be cautious if they decide to do the balance self-test. “Being close to a wall or a sturdy table so you can lean on if you lose your balance or have someone nearby.”

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