WHY BALANCE IS IMPORTANT

How long can you stand on one leg? 5 seconds? Or 10 seconds? And why is this relevant? A new study claims it might be.

Based on the study published in the British Journal of Sports Medicine, experts say the inability to stand on one leg for at least 10 seconds can be an indicator of general health problems.

Researchers have found that volunteers who struggled with a single leg balance test were more likely to be at a higher risk of losing their life within a decade. Scientists have now suggested that this simple balance test should be a part of routine checkups.

What does the study say?

The research team, led by Claudio Gil Araujo from Rio de Janeiro, Brazil, examined 1702 individuals (of which 68% were men) aged between 51 to 75 years. The study was conducted between 2008 and 2020.

At the start, the participants in the study were asked to lift one foot and place it behind the backside of the other lower leg. The arms were placed by their sides and they were asked to look forward.

Each participant was given three attempts. Results showed that 20.4% of the study participants (which means 1 out of 5 people) were unable to balance on one foot. The study also found that:

•  5% of participants between 51 and 55 years of age failed.
•  8% of those between 56 and 60 years of age failed.
•  18% of those 61 and 65 years of age failed.
•  About 37% of those between the ages of 66 and 70 years failed.
• 54% of those between 71 and 75 years of age failed to stand on one foot.

We can see here that the number of those who could not balance increased with age.

In the next 10 years, 123 participants died of various causes. After considering numerous variables like the underlying health condition, body mass index, age, and gender, researchers concluded that balance disorders like the inability to stand unsupported on one leg for 10 seconds were linked with a whopping 84% of increased risk of death within a decade.

Overall, those who failed the test tended to have cardiovascular diseases, higher body weights, high cholesterol, or type-2 diabetes. Factors such as current physical activity regimen, recent falls, diet, medication use, or smoking, were not considered.

While the study found a link between balance and the risk of early death, it doesn't explain what may be causing the risk. You should also note that successfully performing a 10-second balance will not prevent heart disease, diabetes, or other diseases but may be an indicator of it.

Experts believe that a person in their 50s typically should be able to balance on one leg for around 40 seconds. Likewise, people in their 60s should be able to for 20 seconds, and someone in their 70s for 10 seconds.

Adding a balance component to routine physical exams for older people could provide doctors with important health information, according to the researchers.

What are balance disorders?

With age, our flexibility diminishes.People may start experiencing issues with  walking and balancing as they enter their 50s.

A balance disorder is the inability to stay upright and move around confidently. It may also cause dizziness, lightheadedness, double vision, motion sickness, and the feeling that the room around you is spinning.

If your balance is good, you can maintain and control your body's position. This should happen both while you remain still or whether you are moving. It will help you get around, carry out daily activities and stay independent.

A good balance will also help you get up from a chair without falling, walk without staggering, bend over without falling or climb stairs without tripping. While these things may appear trivial, it requires proper functioning from several parts of the body including our brains, eyes, ear, muscles, and nerves.

Balance disorders are one of the most common reasons older people seek help from a physician. But age is not the only reason behind unsteadiness or feeling off-balance.

Yes, older people have more health problems in general and experience changes in the balance system as age increases. But even for younger people, losing balance could be a symptom of several underlying health disorders.

Before we take a look at some of the conditions that cause balance problems, let's understand the mechanism behind balance.

How does the balance system work?

Our sense of balance comes from many different systems working together that stabilize the body and vision.

Good balance depends on:

1. Correct information from our eyes, the organ of balance, or the vestibular system inside our ears, along with the joints, muscles, and tendons.
2. The brain (including the brainstem), which is making sense of all this information.
3. Eye movements to keep the objects that are in your vision stable and maintain your balance.

Why is it harder to balance with your eyes closed?

The eyes help you see where your head and body are in relation to the environment around you. It also aids to sense the motion between you and the surrounding world.

Closing your eyes removes the primary source of information to the brain, which makes it all the more challenging.

In the same way, the sensors in your tendons, muscles, and joints help your brain know where your legs and feet are positioned compared to the ground. It also gives an idea of how the head is positioned in regard to your shoulder and chest.

The inner ear has balance organs that tell the brain about the position and movement of your head. There are three sets of tubes in each ear (known as the semicircular canals) that sense when you move your head around. They also help to keep the vision clear.

Additional structures deep inside the ears tell the brain when the head is moving in a straight line (like when you are going up or down in an elevator or riding in a car) and sense the position of the head even when it is still (if it is upright or tilted).

So, all the information from your vision, balance organs, joints, muscles, and tendons are all sent to the brain stem where they are put together.

The brain, as remarkable as it already is, can control balance by utilizing the information that is most important for a particular situation.

For instance, at night or in the dark, the information from your eyes is reduced or may not be accurate. The brain will therefore use more information from the inner ear and legs.

Likewise, if you are walking on a beach, the information coming from the legs and feet will be less reliable due to the sand. Here the brain will use information from the eyes and ears.

Once the brain stem processes all of this information, it then sends messages to different parts of the body (including the eyes). Your body will then move in a way that will help keep your balance and have a clear vision while you are moving around.

So, what is losing balance a symptom of?

The recent study was observational only, so the scientists did not establish cause and effect. But several conditions cause balance problems. Let's explore each of them in detail.

Ear problems

Now that we know the role of the inner ear in maintaining a good balance, it is obvious that any disease affecting it will cause problems.

Inner ear disorders like Meniere’s disease or labyrinthitis (swelling in the inner ear) are typically accompanied by imbalance or vertigo (the sensation that you, or the environment around you, is moving or spinning).

Circulation problems

Low or high blood pressure can also create balance issues.

Standing up too quickly can cause some people to experience a significant drop in their blood pressure, resulting in feeling lightheaded or faint leading to imbalance.

Nervous system diseases

What neurological disorders cause balance problems? Several do! Some of them are:

• Brain tumor
• Brain hemorrhage
• Alzheimer’s disease
• Parkinson’s disease
• Multiple sclerosis
• Arnold-Chiari malformation
• Guillain-Barré syndrome
• Peripheral neuropathy
• Spinal cord compression
• Migraine
• Stroke
• Cerebral palsy

Muscular disorders

As we already know, muscular strength is an important factor for balance control.

Diseases like muscular dystrophy and weakness can lead to difficulties with walking, creating an imbalance.

Trauma

People with traumatic brain and neck injuries often have problems with balance.

This could be due to injury to the parts of the brain that controls movements, and vision, or due to the associated medications.

Joint issues

Arthritis, gout, or other joint issues causing pain can cause unstable joints which may contribute to your loss of balance.

Alcohol

Chronic alcohol abuse is often associated with a disturbed gait and balance, likely caused by alcohol-induced damage to the nervous systems

Dehydration

Drinking water helps maintain the balance of body fluids which ensures proper circulation, digestion, and absorption.

Dehydration has been known to increase heart rate, elevated body temperature, increase oxygen consumption, cause fatigue, and decreased stability.

Obesity

Being overweight can cause balance issues.

Studies have shown that overweight individuals sway more than normal-weight individuals and that a decrease in body weight leads to improved balance control.

Nutritional deficiency

Vitamin B12 is necessary for healthy brain and nerve function, both of which are implicated in balance.

Ataxia, or impaired balance and coordination, is a neurological symptom that can be caused by vitamin B12 deficiency.

Low blood sugar

When your blood glucose levels get too low, it can cause dizziness, lightheadedness, and cause balance problems. Just think of the days when you skipped lunch!

Medications

Several medications can disrupt the balance of the body such as:

• Anti-hypertensives.
• Tranquilizers.
• Anti-seizure drugs (anticonvulsants).
• Antidepressants.
• Sedatives.
• Certain analgesics or painkillers.
• Antihistamines ( prescribed to relieve allergy symptoms).
• Aminoglycosides (a type of antibiotic).
• Anxiolytics (anti-anxiety drugs).
• Sleep aids (over-the-counter and prescription forms).
• Diabetes drugs, such as insulin, glyburide, and glipizide.
• Certain chemotherapeutics (anti-cancer drugs).

Pregnancy

During pregnancy, the burgeoning baby bump shifts the center of gravity. Because your body is not accustomed to this, you'll be less coordinated and may find it harder to maintain your balance.

At the same time, the hormones that loosen your joints and ligaments cause you to retain extra fluid, throwing off your balance.

Heart Conditions

Narrow or blocked blood vessels, a thickened heart muscle (hypertrophic cardiomyopathy), or abnormal heart rhythms (heart arrhythmia), can reduce blood flow and cause lightheadedness or a fainting feeling.

How are balance disorders diagnosed?

Doctors can diagnose balance disorders with the help of physical and neurological examinations.

Starting, they will ask questions about your symptoms, their frequencies and severity, and your medical history

They can also use several tests to identify the cause of balance problems such as:

• Hearing and ear test.
• Vision tests like watching eye movements.
• An MRI or CT scan to check the brain and spinal cord.
• Evaluation for muscle problems using a nerve conduction study or electromyogram.
• Blood tests.

How are balance disorders treated?

The treatment for balance disorders depends upon the underlying cause. It may include medication, physical therapy, or surgery. Eating healthy, exercising regularly, and stopping and changing medications that are causing balance problems may help. 

Now coming back to the results of the study. You may want to know how to improve single-leg balance.

Balance exercise can help you maintain your balance at any age.

For instance, balance on one foot while you're standing for some time at home or when you're out and about. Alternatively, you can try standing up from a seated position without using your hands. You may even try walking in a line, heel to toe, for a short distance.

Conclusion: Why is my equilibrium off and what does it mean?

Balance is an important component of overall fitness, muscular strength, aerobic endurance, and mobility. Balance problems can be a reflection of many different medical conditions, the majority of which may not require medical treatments. But if you have persistent problems, you should see a doctor to rule out serious health problems.

To search for the best Ear Nose And Throat (ENT) healthcare providers in Germany, India, Malaysia, Spain, Thailand, Turkey, the UAE, the UK and the USA, please use the Mya Care search engine. 

Resources

• Araujo, Claudio Gil et al. “Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals.” British journal of sports medicine, bjsports-2021-105360. 21 Jun. 2022, doi:10.1136/bjsports-2021-105360
• Balance Problems and Disorders. National Institute on Aging. Available from: https://www.nia.nih.gov/health/balance-problems-and-disorders
• InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does our sense of balance work? 2010 Aug 19 [Updated 2017 Sep 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279394/
• Handrigan, G., Hue, O., Simoneau, M. et al. Weight loss and muscular strength affect static balance control. Int J Obes 34, 936–942 (2010). https://doi.org/10.1038/ijo.2009.300

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