The Art and Science of Fitness | Balance — the simple key to a healthy life

More than 40% of participants of the Delhi Half Marathon were in the 35-45 year age group — the age when many people realise the need to pick up a physically active lifestyle. I stood at the 3, 9, and then, at the 12 km mark, video-recording more than 5,000 participants. Their spirit was visible, but their balance? Not so much.

When most of our time is spent only on one leg at a time, balance becomes very important. This is often taken for granted by all doctors, coaches, and trainers, most unaware that falling happens to be the second leading cause of unintentional injury-based deaths worldwide. Even to stand on both feet, we need to have good balance.

Balance is an important indicator for falls. A study done by Dr Claudio Gil Araujo and colleagues, published in the British Journal of Sports Medicine in June, reported that a simple 10-second one-legged stance (10-s OLS) predicts survival in middle and older individuals. Stated differently, people who can do this simple balance test have a much higher chance of living longer than those who couldn’t successfully do the test.

Previous studies have shown that balance diminishes rapidly after the mid-50s, but more recent studies indicate that this struggle begins in the mid-40s. The ability to do the 10-s OLS is cut almost in half, at each subsequent 5-year age group interval.

10-s OLS test

This simple test should be done by everyone. Stand barefoot on either leg, having the non-supported foot on the back of the leg that one is standing on. It’s important to stand close to a wall or table, just in case there is a need for support. You also need to have your elbows by your sides and look straight ahead. Now start the time and attempt this test three times to get to 10 seconds, the third attempt being the one that counts. Once done, repeat with the other foot.

Most in sports and exercise would think that balance is all about muscle balance. This isn’t the complete truth. The three systems that help us see (eyes), hear (ears), and feel (skin, muscles and joints), come together to help us maintain our physical balance throughout life. This is what we know as a sense of equilibrium.

As Dr Kshitij Malik, an audio-vestibular physician, and a specialist for hearing and balance problems, points out that “all these three assess your orientation in space and will give input to your brain, cerebellum and higher centre, which then devise a strategy to optimise your balance. You would need to shift your centre of gravity to the front or back, turn left or right and so on. If any of the three were to become weak, you are more susceptible to imbalance in those situations. If your muscle-joint sensation has become weak, you are more likely to fall on uneven surfaces, because you’ll not get that sensation. If your ears are weak, you are more likely to fall in areas of low light and uneven surfaces. The 10-second one-legged stance is testing all three.”

Vision, hearing and feeling are senses that get the message, but what about execution? Dr Malik adds, “Ultimately, muscle-joint power is the one that executes balance. Even if all the sensors are working well but your muscle-joint power is weak, you will not be able to balance well. So knowing is not enough if we don’t finally put it into practice.”

We need to get those muscles and joints moving to improve our balance. It is important to play sports and run injury-free, but it’s even more important for us to ensure that while we do these activities, that we maintain our equilibrium. Our ancestors weren’t necessarily playing sports or going to the gym, but they still managed to lead a far more active lifestyle than us. We need to reclaim that life, throughout the day, not only in the gym, road or playground.

People who tend to have poor balance also tend to have higher chances of having coronary artery disease, hypertension, diabetes mellitus, obesity and so on. One of the common factors in both tends to be small vessel disease where blood vessels become hard and eventually get blocked. When this happens in the ears, it can lead to hearing loss, further leading to poor balance. When the same happens in the heart, it leads to a heart attack, when in the brain, it leads to stroke, and when in the kidney, to kidney failure.

Poor balance does not directly lead to these diseases, but it is important to keep unintentional injury at bay. Also, the balance test and our work on improving balance help our overall health.

Exercise to improve balance

Heel raises: Start with both legs. Stand barefoot close to the wall, taking some support from the wall, while keeping your toes on ground, raise both your heels off the ground. Keep the movement slow. When you can’t go any higher, slowly come down. Repeat this 10 times. Do this simple exercise at least three times a day, as it can be done at any time, anywhere. This will help you mobilise your ankle joints, improve your walking and running, and will help with balance. In about a week you can start doing single-leg heel raises with wall support. In a few weeks, you’ll be able to do un-supported single-leg heel raises.

Walking barefoot: Walking barefoot on grass or the floor with pebbles is also helpful. Walk for 5-10 minutes in the morning and evening. Since there is a high density of nerve endings in the sole of your feet, this exercise helps in improving balance.

Squats: Many people think that they can’t squat. But put simply, anyone who can sit, can squat. If you have pain or are very unfit, start with sitting on a dining chair. Then get up slowly, and slowly go down and sit again. Do that slowly a few times. Once you become comfortable with that, reduce the sitting time in between. In a few days or weeks, you’ll progress to the stage where you will be able to start moving up as soon as your backside touches the chair. Now you are starting to do good-quality squats. There is no rush to get to this. No matter what stage you are at, and how many squats you can do, do them 3-5 times a day.