Can you pass the ‘old man test’?

Try putting on your socks and shoes while standing on one foot—sounds easy, right? But it’s a quick and effective way to assess your functional balance.

The ‘old man test’ evaluates three key factors:

1. Lower body strength

Your ability to maintain balance while standing on one leg depends on the strength of your lower body, particularly around your hips and pelvis. Weakness in these areas affects your ability to control weight shifts, which is essential for everyday movements such as:

• Walking and running (80% of walking involves standing on one leg!)
• Climbing stairs
• Navigating uneven terrain

2. Functional mobility of the hips, knees, and ankles

Limited movement—especially in the hips and ankles (to a lesser degree the knee) can make it difficult to lift your foot high enough to put on a sock or shoe. Restricted hip mobility impacts essential daily activities like sitting, walking, and running. Similarly, limited ankle mobility directly affects your balance and confidence when moving over uneven surfaces.

3. Sensory coordination: vision, joint senses, and balance

As we age, vision declines, and joint sensors can become less responsive due to inactivity. A reduction in balance leads to decreased mobility, reinforcing a cycle of underused joint senses and reduced confidence with one leg standing tasks.

Why Is balance so important?

Good balance is a result of good muscle strength, joint mobility, and sensory coordination (between vision, vestibular system, and proprioception). Without it, even simple tasks become challenging, such as:

• Putting on your shoes and socks
• Walking on uneven ground (e.g., stepping over curbs or onto nature strips)
• Climbing stairs or getting on and off escalators
• Engaging in high-level activities like running, skiing, or sports requiring quick direction changes such as football, basketball and tennis.

Poor balance leads to reduced confidence, decreased activity levels, and a cycle of declining muscle strength, mobility, and coordination.

The biggest risk: falls

Lack of balance significantly increases the risk of falls, particularly in older adults. Falls can result in serious injuries like broken hips, wrists, or even other serious issues such as head injuries and brain hemorrhages.

Consider this:

• Hip fractures often require surgery, which can lead to reduced mobility and complications such as pneumonia.
• The incidence of postoperative pneumonia in elderly hip fracture patients ranges from 4.1% to 19.05%.
• The one-year mortality rate for hip fracture patients with serious pulmonary complications can be as high as 44%.

Is your ability to balance on one leg an indicator of good health?

Absolutely! Here’s why:

1. Falls and fracture risks

Balance is a key factor in fall prevention and reduces the likelihood of hip fractures. The consequences of a hip fracture can be severe, with mortality rates for pneumonia-related complications reaching 14% within 30 days and exceeding 70% within six months in nursing home residents.

2. Signs of underlying health issues

Poor balance may be linked to:

• Sarcopenia (age-related muscle loss), which affects mobility, confidence, and also diabetes management due to reduced GLUT4 sensors for insulin on muscle – your natural protein stores and your bone health.
• Poor vision, leading to difficulties judging distances and maintaining balance.

How to improve your balance?

Start working on the following 3 things:

1. Work on your muscle strength

Building muscle strength, particularly around the hips, pelvis, and legs—is key to improving balance. Strength training also benefits heart and brain health, glucose management, and mobility. Not sure where to start? Seek guidance from a physiotherapist or other health professionals trained in exercise therapy.

2. Get regular eye checks

Since vision is a crucial component of balance, maintaining good eyesight is essential. Seeing your optometrist regularly and having the appropriate vision correction will address one of the 3 fundamental components of balance.

3. Train your balance functionally

Rather than simply standing on one leg, focus on exercises that mimic real-life movements:

• Side-to-side walking or running
• Navigating stairs, high steps, or uneven ground
• Sports or activities that require quick directional changes

By incorporating these strategies, you can maintain confidence in movement, reduce the risk of falls, and improve overall longevity. So, can you pass the ‘old man test’? give it a try and see how your balance measures up!

References

• Chang, Shih-Chieh MD, MSa,d,g; Lai, Jiun-I MD, PhDa; Lu, Mei-Chind; Lin, Kuan-Hung MDc,e; Wang, Wei-Shu MD, PhDf; Lo, Su-Shun MDh; Lai, Yi-Chun MD, MAa,b,d,*. Reduction in the incidence of pneumonia in elderly patients after hip fracture surgery: An inpatient pulmonary rehabilitation program. Medicine 97(33):p e11845, August 2018. | DOI: 10.1097/MD.0000000000011845  
• Lee, S. H., & Kim, K. U. (2022). Risk Factors for Postoperative Pneumonia in the Elderly Following Hip Fracture Surgery: A Systematic Review and Meta-Analysis. Geriatric Orthopaedic Surgery & Rehabilitation, 13, 21514593221083825. https://doi.org/10.1177/21514593221083825 

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