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To Predict Mortality, You Need a Leg to Stand On
At roughly age 70, half of people could not complete the 10-second test.
Over an average of 7 years of follow-up, 17.5% of people who could not manage the 10-second stand had died, compared with 4.5% of those who could last that long, the study found.
After accounting for age and many other risk factors, such as diabetes, body mass index, and a history of heart disease, people who were unable to complete the standing test were 84% more likely to die from any cause over the study period than their peers with better one-legged static balance (95% CI: 1.23 – 2.78; P < .001).
The researchers said their study was limited by its lack of diversity ― all the participants were relatively affluent Brazilians ― and the inability to control for a history of falls and physical activity. But they said the size of the cohort, the long follow-up period, and their use of sophistical statistical methods helped mitigate the shortcomings.
Although low aerobic fitness is a marker of poor health, much less attention has been paid to nonaerobic fitness ― things like balance, flexibility, and muscle strength and power, Araújo said.
"We are accumulating evidence that these three components of nonaerobic physical fitness are potentially relevant for good health and even more relevant for survival in older subjects," Araújo said. Poor nonaerobic fitness, which is normally but not always associated with a sedentary lifestyle, "is the background of most cases of frailty, and being frail is strongly associated with a poor quality of life, less physical activity and exercise, and so on. It's a bad circle."
Araújo's group has been using the standing test in their clinic for more than a dozen years and have seen gains in their patients, he said. "Patients are often unaware that they are unable to sustain 10 seconds standing one legged. After this simple evaluation, they are much more prone to engage in balance training," he said.
For now, the researchers don't have data to show that improving static balance or performance on the standing test can affect survival ― a "quite attractive" possibility, he added. But balance can be substantially improved through training.
"After only a few sessions, an improvement can be perceived, and this influences quality of life," Araújo said. "And this is exactly what we do with the patients that we evaluated and for those that are attending our medically supervised exercise program."
George A. Kuchel, MD CM, FRCP, professor and Travelers Chair in Geriatrics and Gerontology at the University of Connecticut, Farmington, called the research "well done" and said the results "make perfect sense, since we have known for a long time that muscle strength is an important determinant of health, independence, and survival."
Identifying frail patients quickly, simply, and reliably in the clinical setting is a pressing need, Kuchel, director of the UConn Center on Aging, told Medscape. The 10-second test "has considerable appeal" for this purpose, he said.
"This could be ― or rather should be ― of great interest to all busy clinicians who see older adults in primary care or consultative capacities," Kuchel added. "I hate to be nihilistic as regards what is possible in the context of really busy clinical practices, but even the minute or so that this takes to do may very well be too much for busy clinicians to do."
Araújo and Kuchel reported no relevant financial relationships.
Br J Sports Med. Published online June 21, 2022. Abstract
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