Can you stand on one leg for 10 seconds? Why balance can be a matter of life and death – and how to improve your | Health and well-being
UUntil we start to lose our balance, we barely notice it’s there at all. “For many people, it starts with simple things,” says Dr. Anna Lowe, expert on healthy aging and physical activity. “Maybe you used to be able to stand on one leg quickly to put on a shoe, and at some point you stopped doing that. Maybe you used to step out of the tub onto a slippery floor without thinking, and now you have to grab onto something. It’s easy to either miss the signs or just chalk it up to aging – but it’s really something you can influence.”
The key, it is becoming increasingly clear, is to solve the problem before it becomes serious: and that can happen sooner than you think.
What is balance? Perhaps surprisingly, those involved have struggled to settle on a single definition. Technically, it’s a complex interaction of several different systems in your body—from muscles, nerves, vision, and the inner ear to the sensory system that allows you to recognize where your body touches the ground, along with the motion receptors in your joints that tell you where your body is moving. found in space. It’s not something we’re born with, but it’s also not something we learn in the same way as speech—not exactly a skill or a skill, but an ability we acquire early and lose over time.
At its simplest, balance is often defined as the ability to distribute one’s body weight based on support—a definition that confuses movement and physical ability with what other people consider innate. George Locker, a longtime tai chi practitioner and author of Falling is Not an Option, suggests thinking of balance as the thing that allows you to learn how to ride a bike after the first few hours of falling. He describes it as “a quick and automatic response of your postural muscles to a sense of imbalance.” Or thinking of balance as something you build and then something you have – not something you do.
Regardless of your definition, a lack of balance is globally linked to serious health problems. Earlier this year, British Journal of Sports Medicine published the results of a decade-long study involving more than 1,700 middle-aged participants concluded that poor balance was associated with a nearly two-fold increase in the risk of death. Among other health tests, volunteers were asked to stand on one leg with the other leg pressed against it, with their arms at their sides, eyes looking straight ahead. After adjusting for age, sex, and underlying conditions, not being able to hold the position for 10 seconds—after three attempts—was associated with an 84% increased risk of death from any cause.
Around one in five participants failed the test, a percentage that rose with age – more than one in three (37%) fell between the ages of 66 and 70. Other studies have made similar connections, with the ability to rise from the floor to a standing position, balance with one eye closed, or simply walk at a brisk pace all related to longevity.
Obviously, this relationship is complex—in some cases, poor balance is a byproduct of more serious conditions, or related to the same lack of physical activity that causes it—but the amount of body systems involved in balance suggests that it’s likely to be actively maintained to keep other problems at bay.
And sometimes the relationship is causative – The World Health Organization estimates that 684,000 fatal falls occur each year, making falls the second leading cause of death from unintentional injury, with a further 37 million falls severe enough to require medical attention, leaving many more people facing disability or a shortened life century.
Again, some of these crashes are caused by more serious conditions – but many are not. Meanwhile, loss of balance, as Locker notes, is a medical problem without a medical solution: something that cannot be treated with drugs or surgery, despite the life-changing consequences.
As for what causes a lack of balance, there is no simple answer. Lack of activity is traditionally blamed on the global aging of the population – it is estimated that by 2030 12.3% of people on the planet will be 60 and older – increasingly sedentary. But health professionals point out that balance problems can be caused by a number of other factors, many of which are age-related – impaired vision or slowing of nerve signals can be contributing factors, as can decline in other systems. Blood pressure can drop, leading to dizziness, while reflexes and coordination slow with age.
If you experience a sudden, noticeable change in your ability to balance, Lowe says, you should consult a professional—whether it’s caused by a relatively benign inner ear problem or something more serious, it’s better to get informed. But the slow, barely perceptible decline will be what most people should worry about.
Efforts are increasingly being made to redress the imbalance among the groups already most affected by the problem. The first such fall prevention research center in Australia has its own team of neuroscientists dedicated to tracking fall injury patterns, identifying risk factors, and developing prevention strategies—using everything from home video games to obstacle courses to help older adults mitigate risk. The Netherlands, meanwhile, has its own physiotherapist-run, government-rated, and partially health-insurance-covered programs that teach senior citizens the skills more commonly associated with judo.
But part of the problem is that when the balance starts to break, the process becomes a downward spiral. Older people who can’t—or are afraid—to walk outside their homes, let alone engage in anything more strenuous, develop further imbalances as their muscles and sense of balance atrophy, making falls more likely. This means that prevention is better than cure, and since many people’s balance declines from midlife onwards, it’s probably better to start sooner rather than later. “The loss of balance starts at age 45 and it’s very clear,” says Locker. “You look at 45-year-old men walking down the street and they’re starting to lose their glutes, the muscles around the butt, which are among the largest and strongest muscle groups in the body. Many guys grow up with spindly legs through a combination of diet and the type of activity they do, and it’s hard to reverse later. So you have to start prevention in middle age.”
“Upstream interventions are key,” agrees Lowe, who is a physical therapist in addition to her role as an associate professor researching strength and balance in midlife. “You have to stay active: older women are far less active than older men, and general activity, just moving around and doing things, has a big impact on balance. For some people, just try to incorporate an element of balance and muscle strengthening. Can you walk your dog off-road? Can you do yoga or the gym when you’re feeling a little insecure? Single-leg movements like walking lunges are a great test of dynamic balance, but if you’re new to exercise, even bilateral movements like squats can be challenging.”
Locker also says there’s a key difference between balance as defined by many studies—standing upright on one leg—and the kind of single-leg balance that’s important in real-world situations. “Walking on a flat surface doesn’t usually involve a very challenging element of balance, because your legs are usually locked when your foot hits the ground,” he says. “Neither does running, unless you’re doing it off-road, because your feet aren’t in constant contact with the ground. Midlife is the time to choose what I call the bendy-knee, ankle-joint sports—skiing, skating, rollerblading, surfing, and standup paddleboarding. They all involve a type of sustained knee and ankle flexion that builds capacity. Unfortunately, playing some of these sports is not an option for senior citizens – so they will have to find other ways to build the same capacities.”
Tai chi, practiced by about 50 million people in China and more than three times as many worldwide, is one option. As an aerobic workout, it’s not particularly strenuous, but studies have shown that just eight weeks of exercise can improve the condition of older adults. results on the Tinetti test – a common measure of competence in basic tasks such as getting up from a chair and walking – as well as reducing the fear of falling. Longer periods of study show further benefits, with The Yang style proved to be somewhat more effective rather than Sun’s faster-paced style. Again, the former typically uses a lower stance with more bent legs than the latter – suggesting that this style of balance is something to consider.
“Standing on one straight leg is not the same as standing on one bent leg,” says Locker, who began practicing tai chi with a master who “could throw guys half his age and twice his size across the room.” “When the leg is straight, the skeleton supports the body, not the postural muscles. Elderly people are usually consulted to practice brushing their teeth standing on one leg to build balance, but to train the postural muscles to support the lower body, you should use one bent legs.” In this way, over time, you will build not only balance, but also work capacity.
Whatever activity you choose—and whatever stage of life you’re in—the take-home lesson is to work on balance before it’s necessary, not after it becomes a problem. Resistance exercise, whether that means lifting weights or backpacking, has a number of other proven health benefits, from improved bone density to a reduced risk of Alzheimer’s disease and other forms of dementia. As Locker says: everyone is told to save money for their retirement, but no one is taught to save their balance. But both are hard to get back when they are gone.
Just 15 minutes of balance practice a day can be beneficial, but if you have more time, make the most of it. Starting early helps: use the exercises below and practice on a hard, flat surface.
Standing on one leg – with your hands resting on the work surface if you feel unsteady – see how long you can keep your balance. Make it harder by going up on your toes or doing 10 small knee bends. Do this while brushing your teeth.
For this movement, start from a standing position and take a large step forward, bending your front leg until your back knee touches the floor. Then push off the front leg and return to a standing position. Progress to walking lunges, where you move on the ground, jump to alternate sides, and add hand weights to build muscle strength.
Try stepping on a step or box: Place one foot on the box and push up on that heel to step up so both feet end up together. To make sure you’re not using your trailing leg as an assist, keep your toes off the ground on that foot. Advance by using a higher step or by lifting the back leg towards the chest. Try 10 with the right leg, then 10 with the left, and add hand weights to build strength.
Find out more about postural retraining at fallingbalanceexercise.com
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