What a 10-Second One-Leg Balance Test Can Tell You

A 2022 study in the British Journal of Sports Medicine followed 1,702 adults aged 51 to 75 for a median of seven years. Participants who could not complete a 10-second one-legged stance had an 84% higher adjusted hazard of death from any cause than those who completed it.

The finding is important, but it has limits. The study was observational. It does not prove that poor balance causes death, and it does not prove that practicing the test or improving the score will extend life.

The one-legged stance is a static balance test. It reflects the combined performance of sensory, neurological, musculoskeletal, and cognitive factors. A poor result cannot identify which component is impaired, and it should not be used as a stand-alone diagnostic test.

Used correctly, the test can be a simple functional signal. It may identify a reason to look more closely at gait, strength, vision, medication effects, neuropathy, vestibular symptoms, joint disease, or broader health status.

This newsletter explains what the study actually found, how to approximate its protocol safely, and how to interpret the result without turning an association into a diagnosis.

What the study actually found

Araújo and colleagues evaluated 1,702 adults between 51 and 75 years of age who attended a single exercise medicine clinic in Brazil. All participants were ambulatory. People with unstable gait or signs of an acute vestibular or otoneurological disorder were excluded.

The research protocol. Participants stood barefoot on a flat platform. The top of the raised foot rested against the back of the opposite lower leg. Arms remained alongside the body, and the participant fixed the gaze on a point at eye level two meters away. A physician or nurse assistant supervised the test. Up to three attempts were allowed. A participant passed by maintaining the position for 10 seconds on either foot without support.

The result. A total of 348 participants, or 20.4%, could not complete the test. During a median follow-up of seven years, 123 participants died. Mortality was 4.6% among those who passed and 17.5% among those who failed.

The adjusted association. After adjustment for age, sex, body mass index, coronary artery disease, hypertension, diabetes, obesity, and dyslipidemia, inability to complete the test was associated with an adjusted hazard ratio of 1.84. In plain language, the adjusted hazard of all-cause mortality was 84% higher in the group that failed.

That number describes a group-level association. It is not a personal forecast, and it does not mean that an individual who fails has an 84% chance of dying.

The test added limited information beyond established factors

The investigators examined whether the stance result improved a prediction model built from established clinical variables. The model C-index increased from 0.799 to 0.809 after the test was added. The increase did not reach conventional statistical significance (p=0.06). Other statistical measures suggested possible incremental value.

The practical conclusion is modest. The test may add useful functional information, but it should complement routine clinical assessment rather than replace it.

What the test measures

The one-legged stance is a test of static postural balance. Remaining upright on one foot requires the body to combine sensory information with rapid motor responses while maintaining enough strength, joint control, and attention to hold the position.

Performance can be influenced by age, physical conditioning, pain, arthritis, prior injury, lower-extremity strength, sensation, vision, vestibular function, neurological disease, medications, fatigue, fear of falling, and other factors. More than one factor may be present at the same time.

The mortality study did not measure the biological mechanism connecting balance performance with survival. The authors specifically called for additional research to explain that association.

Balance can be informative without being specific

A poor balance result can function as a marker of reduced physiological reserve or accumulated disease burden. It cannot tell you whether the cause is neuropathy, vestibular disease, cerebellar dysfunction, muscle weakness, medication effects, or another condition.

Another longitudinal study followed 316 community-dwelling adults older than 60. Inability to stand on one leg for five seconds was associated with a higher risk of injurious falls, but it did not independently predict all falls. The investigators cautioned that no single factor was accurate enough to serve as the sole measure of fall risk.

That caution applies here. A simple test may reveal that more evaluation is worthwhile. It does not provide the diagnosis.

How to perform the 10-second test safely

The mortality study was conducted under direct supervision by a physician or nurse assistant. A home attempt is not identical to a professionally administered test.

Do not attempt the test unsupported if you have an unstable gait, recent falls, significant dizziness, severe neuropathy, a recent lower-extremity injury or operation, or a neurological or musculoskeletal condition that affects balance. Ask a clinician or physical therapist to supervise you.

To approximate the research protocol:

• Use a flat, firm surface and remove your shoes.
• Stand beside a sturdy counter or have another person close enough to assist if you begin to fall. Do not hold the counter unless needed for safety.
• Place the top of the raised foot against the back of the opposite lower leg.
• Keep your arms naturally alongside your body.
• Fix your gaze on a point at eye level about two meters, or six to seven feet, away.
• Have another person time the attempt. Stop if the raised foot leaves position, the standing foot moves, or you need support.
• Allow up to three attempts. The study classified participants as passing if they completed 10 seconds on either foot.

Stop immediately if you feel faint, develop chest pain, experience marked shortness of breath, or notice sudden neurological symptoms. Sudden new imbalance, facial weakness, speech difficulty, or severe headache requires urgent medical evaluation.

How to interpret the result

If you complete 10 seconds

You passed the specific threshold used in the Araújo mortality study. That is reassuring with respect to this one measure, but it does not establish that your balance is normal for your age or rule out cardiovascular, neurological, metabolic, or musculoskeletal disease.

If you cannot complete 10 seconds

A failed attempt is a signal, not a diagnosis. Repeat the test only if it is safe and the first effort was affected by distraction or unfamiliarity. Persistent inability to complete 10 seconds deserves attention, especially when accompanied by falls, gait changes, numbness, weakness, dizziness, visual difficulty, or a recent decline in function.

There are no validated red, yellow, green, or reserve categories based on five-, ten-, thirty-, or sixty-second cutoffs from the mortality study. The study evaluated a single binary threshold: able or unable to complete 10 seconds.

Age changes expected performance

A separate study of 549 healthy adults measured the best of three one-leg stance trials, with a 45-second maximum. The averages below provide context, but they came from a different protocol and should not be treated as diagnostic cutoffs.

• 50-59: 41.2 seconds with eyes open; 8.3 seconds with eyes closed.
• 60-69: 32.1 seconds with eyes open; 4.4 seconds with eyes closed.
• 70-79: 21.5 seconds with eyes open; 3.1 seconds with eyes closed.
• 80-99: 9.4 seconds with eyes open; 1.9 seconds with eyes closed.

Eyes-closed testing is a separate, more difficult assessment. Expected times decline sharply with age. It should not be described as the “real” test, and it should not be attempted alone by someone at risk of falling.

What to do after a poor result

Do not use the result to diagnose yourself. The next step is to place it beside your symptoms, medical history, medications, gait, strength, and other functional findings.

A clinician may consider:

• Recent falls, near-falls, gait changes, and fear of falling.
• Medication effects, alcohol use, dehydration, or symptoms of orthostatic hypotension.
• Vision, hearing, vestibular symptoms, and sensory loss in the feet.
• Joint pain, range of motion, lower-extremity strength, and prior injuries.
• Neurological findings, cognition, and other changes in daily function.
• Cardiovascular and metabolic risk when clinically appropriate.

A physical therapist can perform a broader balance and gait assessment and determine whether training should emphasize strength, balance, mobility, gait, vestibular rehabilitation, or another need.

Can training improve the score?

Balance performance can improve with practice and appropriately designed exercise. The 2022 mortality study did not test an exercise intervention, so it cannot tell us whether improving the 10-second score reduces mortality.

Training should be individualized and performed with appropriate support. Repeatedly practicing an unsupported one-leg stance is not the right starting point for someone who is already at risk of falling.

What the data does not say

It does not prove causation. Poor balance may reflect other health problems that also raise mortality risk.

It does not identify the impaired system. The test cannot distinguish among neurological, vestibular, sensory, visual, muscular, joint, medication-related, or other causes.

It does not establish a monthly biomarker protocol. No study cited here validates monthly self-testing, a minimum meaningful change, or a specific lead time before a fall, fracture, or diagnosis.

It does not prove that a better score extends life. That question would require an intervention trial with clinical outcomes.

It does not replace established assessment. Blood pressure, metabolic risk, cardiovascular evaluation, medication review, physical examination, gait assessment, and appropriate laboratory or imaging studies answer different questions.

The cohort also had important limitations. Participants came from one Brazilian exercise clinic and were primarily White and from higher socioeconomic groups. The investigators did not have data on several potential confounders, including recent falls, physical activity, diet, smoking, or medications that might interfere with balance.

The bottom line

The 10-second one-legged stance is a simple static balance test with a meaningful observational association. In one cohort of adults aged 51 to 75, inability to complete it was associated with an 84% higher adjusted hazard of all-cause mortality over a median of seven years.

The test is useful because balance captures information that is not contained in a blood test. Its value comes from being a broad functional signal, not from diagnosing six hidden systems or predicting an individual future with precision.

If you can complete 10 seconds safely, you have passed the threshold used in this study. If you cannot, especially after repeated safe attempts or in the presence of other symptoms, bring the result to your physician or physical therapist.

Use the test as a reason to ask a better clinical question, not as an answer by itself.

References

1. Araújo CG, de Souza e Silva CG, Laukkanen JA, et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 2022;56(17):975-980. doi:10.1136/bjsports-2021-105360.

2. Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8-15. doi:10.1519/00139143-200704000-00003.

3. Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Rubenstein LZ, Garry PJ. One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc. 1997;45(6):735-738. doi:10.1111/j.1532-5415.1997.tb01479.x.