- Danine Fruge, MD, board-certified family practice physician and medical director at Pritikin Longevity Center
- Dawn Skelton, PhD, exercise physiologist and professor of aging and health at Glasgow Caledonian University
- Michael Roizen, MD, Chief Wellness Officer at Cleveland Clinic
- Scott Kaiser, MD, board-certified family physician and geriatrician, and director of Geriatric Cognitive Health for the Pacific Neuroscience Institute
Based on a recent study in which researchers asked more than 1,700 people ages 51 to 75 to stand on one leg for 10 seconds and then checked in on their health during a followup period of seven years, it’s clear that failing this one-leg test is linked with a significantly higher risk of all-cause mortality (or dying for any reason). In fact, 17.5 percent of the total deaths that occurred during the study’s time window were people who couldn’t do the balance test, while only 4.6 percent were people who could. To be clear, those deaths weren’t caused by a lack of balance—but the correlation shows that poor balance could be an indicator of other issues at play, whereas good balance, by contrast, may be a sign of health, both now and in the future.
“Keeping your balance requires more complicated connections than a 60-person family.” —Michael Roizen, MD, internal-medicine physician
The reason why likely has to do with all the systems that need to fire in order to achieve good balance. “Keeping your balance requires more complicated connections than a 60-person family,” says internal-medicine physician Michael Roizen, MD, author of the upcoming release The Great Age Reboot. “You have sensors throughout your limbs that interact with position sensors in your ears and others in your eyes, all of which are integrated in an area in the back of your brain called your cerebellum and in motor nerves that send messages to all your skeletal muscles to keep you upright.” Chances are, if your body is capable of making all those connections, you’re less likely to also have a chronic condition (that would impede those pathways) and more likely to have full function of your brain and nervous system.
Because all of the above systems naturally decline with age, along with balance itself, it’s easier to test the link between balance and longevity in older people. That is, two 20-year-olds might be able to manage the 10-second, one-leg balance test without even being particularly “good” at balance, while for two 70-year-olds who’ve experienced normal age-related neurologic decline, the test would show more clearly whether or not they’ve maintained their ability to balance—and all the body processes that doing so entails.
To be sure, this one-leg test is far more indicative than just a person’s ability to walk well, says family-practice physician Danine Fruge, MD, medical director at Pritikin Longevity Center. “You can think of walking as falling forward,” she says. “There’s a lot of momentum involved that could really mask a balance problem. But with standing on one foot, you can really elicit or bring out a potential balance issue in someone who wasn’t aware that they had one.”
Though many of the health implications of good versus poor balance are still being teased out, what we know for sure is that balance involves so much more than just leg strength, says Dr. Fruge: “You’re really looking at the body’s overall ability to function and coordinate its activity.”
Below, physicians break down the likely links between good balance and longevity, and share advice for improving the former to boost the latter.
Here are 3 different pathways through which having good balance may boost your longevity
1. Balance and physical fitness
Perhaps the most obvious connection between balance and longevity is that folks with better balance also tend to be more physically fit (and reap all the health benefits therein) compared to those with poor balance.
“We know that if you are feeling unstable in any way—whether overtly, as in, you notice that you’re wobbly, or less directly, perhaps in contemplating whether you really want to do that walk because the surface is uneven, or the like—that means you’re going to be less active,” says exercise physiologist Dawn Skelton, PhD, professor of Aging and Health in the Department of Physiotherapy and Paramedicine at Glasgow Caledonian University. “And as soon as you’re less active, all the health issues that sedentary behavior brings will begin to kick in.”
Though some decline in balance is, again, normal with age, much of the reason why balance problems can eventually cut into your fitness and longevity is often tied to underlying issues with the vestibular ocular reflex, says Dr. Skelton, referring to the system that coordinates inputs from your ears and eyes to facilitate balance. For example, if you have vision issues (perhaps due to slow degeneration with age) or you’re dehydrated (whether from painkillers or kidney disease or something else) causing your inner ears to become less moist, you’re going to have balance issues and, in turn, be less likely to move your body, she says. Whereas, someone without those underlying issues would have both better balance and a higher chance of living longer.
Perhaps even more immediately, being less active due to balance issues can cause you to lose muscle mass quickly, which can increase your risk of falling, says geriatrician Scott Kaiser, MD, director of Geriatric Cognitive Health at the Pacific Neuroscience Institute. And falls are a major threat to wellbeing, he says: “Every 20 minutes, someone in this country dies from a fall, and besides all those deaths, falls can cause severe injuries like hip fractures, brain injuries, and all sorts of critical problems that can leave you bedridden.”
At that point, not only are you unlikely to do any real physical activity for a while (thus upping your mortality), but also, you’re more likely to develop depression, pneumonia, and all the other conditions that can come with being stuck in bed, says Dr. Fruge. Whereas, on the contrary, you would have been substantially more likely to avoid that entire spiral—and, in turn, increase your longevity—by maintaining your balance and activity levels from the outset.
Build that balance with this 20-minute workout for balance:
2. Balance and cognition
Though scientists aren’t exactly sure why, practicing and achieving good balance has been shown to improve certain brain functions—particularly, memory and spatial cognition. One potential explanation is the fact that balancing requires different parts of the brain to fire together, as it takes in sensory inputs from all over the body. And that process may strengthen neural pathways, boosting neuroplasticity (aka the brain’s ability to wire and rewire itself).
The result? “Brain connections that foster balance can also foster improved cognitive function,” says Dr. Roizen. And with better cognition, you’re also “better able to enjoy your friends and your passions longer, as if you were many years younger,” he says.
It’s also the case that because balancing is a pretty complex process in the brain, it may be one of the first things to go in the case of a brain issue. In fact, a 2014 study found that being unable to balance on one leg for 20 seconds was associated, in particular, with a higher risk of cerebral small vessel disease (a brain condition that can lead to stroke) in folks who were otherwise asymptomatic. That’s all to say, if you are able to balance well, there’s a greater chance that your brain is, in fact, firing effectively on all cylinders (and is not subject to a condition like the above), boosting your chances of living longer.
3. Balance and the nervous system
Just as balance requires much of the brain, it also makes a special request of the nerves throughout the body, requiring them to send proprioceptive signals based on your surroundings. “Proprioception is your body’s ability to understand its place in space,” says Dr. Fruge. So, if your balance is poor, it could be an indicator that your nerves have lost some of their proprioception—which could, in turn, be the result of an underlying condition.
For example, take diabetes, which is known to increase mortality risk. “With diabetes, you can get nerve damage in your feet, which can make it significantly more difficult to balance on one foot,” says Dr. Fruge. “Maybe you don’t notice it when you’re standing on two feet because there’s still enough sensory input reaching the brain, but as soon as you try to do one foot, perhaps the emerging deficit shows up.”
A similar scenario could play out with a brain injury, like a mini stroke, or a circulation issue relating to heart disease; all of these can diminish the nervous system’s capacity for proprioception and cause you to struggle with balance, says Dr. Fruge. And at the same time, any of these conditions would reduce your chances of living a long life.
Reverse that pathway, though, and there’s more evidence for the link between good balance and longevity. That is, if you are, in fact, able to balance well, it’s likely that your nerves are capable of good proprioception, meaning you’re less likely to have a chronic health condition (like one of the above) lurking beneath the surface.
“The reason we think balance is associated with longevity is because it requires keeping your brain and nervous system’s integration circuitry intact.” —Danine Fruge, MD, family-practice physician
Even beyond that, good proprioception also allows you to use balance exercises in order to train your neurological system to be even more fit, says Dr. Fruge. (Remember that neuroplasticity bit above?) “The reason we think balance is associated with longevity is because it requires keeping your brain and nervous system’s integration circuitry intact,” says Dr. Fruge.
How to increase balance at any point in life to help safeguard your longevity
As a starting point, the exercise used in a few of the studies above—simply standing on one leg—is a great one for improving balance. If you’re worried about falling, try the exercise facing a corner, so you can lean against one of the walls if you start to lose balance, suggests Dr. Roizen. Once you’re confident, you can also practice standing on one leg while doing other tasks like brushing your teeth or washing dishes.
In addition to that, the experts recommend incorporating some dynamic balance exercises into your rotation, too—that is, exercises that require you to balance while moving through space, as opposed to just doing a static hold. “One simple example is using the stairs, since that requires a change in level, or doing a toe-walk or heel-walk, where you’re reducing your base of support,” says Dr. Skelton. Of course, yoga and dance fall into this category, too, as they both require you to balance and coordinate your body while it’s in motion.
Overall, the key with balance training is really to mix it up and keep it challenging. “The more different forms of movement you’re doing, the better,” says Dr. Skelton. “And don’t worry if you feel a little wobbly, either. That just means your brain is working hard to keep you upright.” And so long as you’re keeping those neurons firing, you’re contributing to your longevity, too.
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