Is Balance Ability Related to Risk of Death in Older Adults?

Blog Post

Stephen W. Farrell, PhD, FACSM
The Cooper Team
Healthy Aging
May 10, 2023

Among the more well known components of physical fitness are cardiorespiratory fitness, muscular strength, flexibility, and body composition. A lesser-known and somewhat underappreciated fitness component is balance, which tends to deteriorate rapidly beyond the age of 55 or so.

Poor balance places older adults at much greater risk for falls, which can lead to other serious adverse health events. For example, it is well established that falls are the second leading cause of unintentional injury-based deaths worldwide. Despite the strong association between poor balance and adverse health outcomes, balance assessment is seldom included during physical examinations for older adults.

Recently a team of international researchers reported on balance performance and survival in 1702 fully ambulatory adults (68% men) with an average age of 62 years. At baseline, participants underwent several measures of physical fitness, as well as measurements of major risk factors for cardiovascular disease. Included in the fitness testing battery was a one-legged stance test for balance ability. Once the participant assumed the correct starting position (see procedures and picture below) a count of 10 seconds was begun and up to three attempts were allowed. The passing criterion for the test was to complete a one-legged stance on either foot for 10 seconds while maintaining the correct initial position and without any other support. A score of YES was given if the participant could complete the 10-second test, while a score of NO was given for inability to complete the test. A total of 20.4% of participants scored NO. The proportion of NO responders increased sharply with age. For example, while only 4.7% of those ages 51-55 scored NO, this number increased to 70% among those ages 76-80. Additionally at baseline, NO responders generally had an unhealthier profile than YES responders. While obesity and hypertension were more common in the NO group as compared to the YES group, the greatest difference in the two groups was for diabetes, which was three times more common in the NO group.

Participants were then followed for an average of 7 years, during which 123 deaths occurred. After controlling for a number of factors that could ‘muddy the waters’ (e.g., age, diabetes, obesity, hypertension, etc.), NO responders were nearly twice as likely likely to die during follow-up when compared to YES responders.

The authors concluded that the inability to successfully complete the one-legged stance test is associated with nearly a two-fold increase in mortality risk among middle-aged and older adults. They also recommended that balance testing be included during physical examinations of middle-aged and older adults. These findings reinforce the most recent physical activity guidelines for adults, which include a recommendation that balance training be incorporated into the exercise routines of older adults.    

Procedure for One-Legged Stance Test

A partner should be present close to and in front of the participant as a precaution to prevent falls. The participant is barefoot on a level surface. Either foot can be used as the support foot. The arms are held naturally by the sides of the body. The head is in a neutral position with the eyes fixed forward. The top of the non-support foot is placed on the back of the lower leg of the support foot. Once this correct starting position is assumed, a 10-second count is begun. The correct starting position must be maintained throughout the test. Up to three trials are allowed.


Araujo, C.G., et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. British Journal of Sports Medicine, Epub ahead of print: September 19, 2022. Doi:10.1136/bjsports-2021-105360


Stay in touch

Subscribe to our email list for the latest Cooper Institute news and updates.