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Aging is associated with a gradual decline in physical fitness and a reduction or alteration, from the age of 60, in muscle strength/power, flexibility, balance and body constitution. These changes make the elderly frail, more prone to falls and accidents, with serious medical consequences. In fact, falls are the second leading cause of accidental death due to injury worldwide. This is why researchers wanted to determine if there was a link between people’s balance and their risk of disease and mortality. They discovered that the balance on one leg would be a determining factor in the predictions. The inability to stand on one leg for 10 seconds, starting at age 60, is linked to a nearly doubling of the risk of death from any cause over the next 10 years. This test could be included in basic health checks for the elderly.
Every year, approximately 684,000 people die from falls worldwide, more than 80% of them in low- and middle-income countries. Although good levels of balance are known to be relevant for many activities of daily living, there is evidence that loss of balance is also detrimental to health and that certain categories of exercise can improve balance. ‘balance.
There are three types of exercises: aerobic, resistance and flexibility. The first is the most important physical activity for heart health. It involves large muscle groups (legs, shoulders, chest and arms) in continuous motion. It increases the endurance of the heart, lungs and muscles, and therefore reduces the workload of the heart. Flexibility is important for everyday life and physical activity, reducing muscle tension, anxiety, fatigue and stress, and improving circulation. Resistance makes it possible to develop muscle mass in particular with moderate-intensity activities. Unlike aerobic fitness, muscle strength and flexibility, balance tends to be reasonably preserved until age 60 and then declines rapidly.
As early as 2014, a Japanese study highlighted the link between aging, age-related disorders and physical health, via balance tests. Specifically, people who fail to balance for more than 20 seconds are more likely to have brain microdamages related to tiny asymptomatic infarctions, knowing that these mini-accidents can be the harbinger of more serious events.
Nevertheless, balance assessment is not routinely included in health checkups for middle-aged and older men and women. This could be because there is no standardized test and little hard data linking balance to clinical outcomes other than falls.
That’s why an international team of researchers wanted to know if a balance test could be a reliable indicator of a person’s risk of death from any cause during the next 10 years of their life. The study was led by the Clinimex exercise medicine clinic in Rio de Janeiro, in partnership with Bristol Medical School, Central Finland Health Care District, Sydney School of Medicine and Health and Cardiology Division of Stanford University. Their work is published in the journal British Journal of Sports Medicine.
A long-term study
The researchers relied on participants in the CLINIMEX Exercise Cohort Study. This was set up in 1994 to assess associations between poor health and risk of death with different measures of physical fitness, exercise-related variables and cardiovascular risk factors.
The current analysis included 1,702 participants aged 51 to 75 (mean 61) when first examined, between February 2009 and December 2020. About two-thirds (68%) were men. Weight, skinfold thickness and waist circumference were measured. Details of medical history were also provided. Only participants with stable gait were included.
As part of the control, participants were asked to stand on one leg for 10 seconds without any support. To improve the standardization of the test, participants had to place the front of the free foot on the back of the opposite lower leg, while keeping their arms at their sides and their gaze fixed straight ahead. Up to three attempts on each foot were allowed. Over 13 years of clinical experience, the test has been remarkably safe, well received by participants and, above all, simple to integrate into routine practice, as it takes less than 1 or 2 minutes to apply.
Amazing results and reliable future diagnostic tests
In total, around 1 in 5 participants (20.5%; 348) did not pass the test. The ability to complete the 10-second test begins to gradually decline with age, regressing by about half at each 5-year interval.
The authors note that more than half (about 54%) of people aged 71 to 75 were unable to take the test. Not to mention that during an average surveillance period of 7 years, 123 (or 7%) people died either of cancer (32%), or of cardiovascular diseases (30%), or of respiratory diseases ( 9%) or complications from COVID-19 (7%).
Nonetheless, there were no clear time trends in deaths, or differences in causes, between those who were able to complete the test and those who were unable. But the proportion of deaths among those who failed the test was significantly higher: 17.5% compared to 4.5%.
Dr Claudio Gil Araujo, of the Clinimex exercise medicine clinic, who led the research, explained in a statement: The 10-second balance test provides quick and objective feedback for the patient and healthcare professionals regarding static balance and adds useful information regarding mortality risk for older men and women “.
In general, those who failed the test were in poorer health: a higher proportion of them were obese and/or suffered from heart disease, high blood pressure and poor lipid profiles. And type 2 diabetes was 3 times more common in this group: 38% versus around 13%.
After controlling for age, gender and underlying conditions, an inability to stand unsupported on one leg for 10 seconds was associated with an 84% increased risk of death from any condition. cause, over the next decade.
However, the authors temper their findings, as this is only an observational study, it does not establish cause. Because the sample of people tested is small in terms of ethnic diversity, the findings may not be reflective of the population. Finally, information on potentially influential factors, including recent history of falls, physical activity levels, diet, smoking, and use of medications that may impair balance, was not available. .
Apart from these caveats, it seems obvious that the systematic application of a simple and safe static balance test, as detailed in this study, would identify middle-aged and older people who are at high risk of death. The authors encourage researchers with access to these data to publish their findings to confirm these results.