The 10-second one-legged stance: A potential mortality risk prediction tool |
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The 10-second one-legged stance: A potential mortality risk prediction tool
Professor (Dr) Ashok Kumar Das, Consultant Physician and Endocrinologist, Pondicherry Institute of Medical Sciences, Pondicherry,  23 June 2022
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Both aerobic and non-aerobic fitness decline with age. While cardiorespiratory fitness is usually assessed, non-aerobic fitness is not. The components of non-aerobic fitness include balance, flexibility, muscle strength and body composition. Decline in non-aerobic fitness with age is also not conducive to good health.

A new study published in the British Journal of Sports Medicine says that the inability to stand on one leg, without support, for 10 seconds for balance assessment was associated with nearly 2-folds increase in risk for mortality in the coming decade among the middle-aged and older adults.1

A total of 1702 people with stable gait, aged 51-75 years, were enrolled for the study with the objective to investigate the association of one-legged stance with all-cause mortality in middle-aged and older adults who were a part of the ongoing CLINIMEX Exercise cohort study initiated in Brazil in 1994 to examine the link between physical fitness and traditional cardiovascular risk factors with poor health and mortality. More than half (68%) of them were men. The duration of the study was 12 years from 2008 to 2020.

The one-legged stance, using either the left or the right foot, was performed under close supervision to preempt a fall or injury. The study subjects were asked to place the dorsum of one foot on the back of the other leg in the lower part, with arms by the sides and to look straight ahead and hold this position without any other support, for 10 seconds. They were allowed three attempts using either the right or the left foot.

Analysis of data revealed that overall, 20.4% of the participants could not complete the 10 second one-legged stance. The percentage of unsuccessful participants was  4.7% in 51–55 year-age group, 8.1% in 56–60 year-age group, 17.8% in the 61–65 year-age groups, 36.8% in the 66–70 year-age group, while it was 53.6% in those aged 71–75 years. This number further increased to around 70% for those aged 76–80 years, and nearly 90% for those aged 81–85 years.

There were 123 deaths (7.2%) due to any cause, over a median follow-up of 7 years; of these, 4.6% deaths occurred in those who could complete the 10-second one legged stance, while 17.5% deaths were in the group who failed to complete this balance assessment. The most common cause of death was cancer (32%) followed by cardiovascular deaths (30%), respiratory deaths (9%) and Covid-19-related complications (7%). The age adjusted hazard ratio was found to be 2.18. After adjusting for age, sex, and comorbid conditions such as diabetes, CAD, HT, dyslipidemia, overweight/obesity, the risk for all-cause mortality was 84% higher in those who were unable to stand unaided on one leg for 10 seconds with hazard ratio of 1.84, compared to those who could balance themselves.

This study shows that the ability to complete the test diminished with advancing age and over a median of 7 years, survival was lower among middle-aged and older adults with inability to complete the 10-second one-legged stance test. The 10-second one-legged stance is a simple to perform and inexpensive tool and can be easily adopted in clinical practice to quickly identify frail older adults, particularly at the primary care level. Such individuals are more prone to falls with their associated adverse outcomes. The authors therefore suggest inclusion of this test in the routine health assessments for middle-aged and older adults to further enhance mortality risk prediction.


  1. Araujo CG, et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 21 June 2022. doi: 10.1136/bjsports-2021-105360.
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