Balance Fades When You Stop Practicing It. Start at the Bathroom Sink.

Stand on one leg. Right now. Count to ten.

Easy? Good. Most people in their forties pass without a second thought.

The catch: almost nobody practices it. And balance fades when it goes unused.

Last week’s issue made the case for a stronger skeleton. This week is the other half of the same story. A broken hip usually takes two things: a bone that gives, and a fall that asks it to. Issue 28 was about the bone. This one is about the fall.

What’s Actually Happening

Balance feels like something you’re born with. Some people have it and some don’t. In fact it’s a fast, nonstop conversation between three sensors and your brain. Like any conversation, it gets clumsier when you stop having it.

The three inputs. Your eyes tell you where the horizon is. Your inner ear (the vestibular system) senses gravity and every tilt and turn of your head. And thousands of stretch and pressure sensors in your feet, ankles, knees and hips, together called proprioception, report where each part of your body is and how hard it’s pressing on the ground. Your brain blends all three many times per second and sends small corrections to the muscles around your ankles, hips and trunk. You never notice it happening. That is the point.

The three inputs back each other up. Close your eyes and your inner ear and feet pick up the slack. Stand on a soft mat and your eyes and inner ear do more of the work. That backup is why most of us feel steady most of the time. It’s also why the system can lose ground for years before you notice.

What the numbers say about age. In a study of 549 healthy adults, the average time people could stand on one leg with their eyes open was about 43 seconds for those aged 18 to 39, about 27 seconds by 60 to 69, and about 15 seconds by 70 to 79. Close your eyes and the numbers collapse at every age: even the youngest group averaged roughly 13 seconds. Take away vision and you find out how much your feet and inner ear are carrying on their own.

A larger study tested 1,702 adults aged 51 to 75 with a simple standard: stand on one leg for 10 seconds, the other foot resting against the back of the standing calf, arms at your sides, eyes straight ahead, up to three tries. The researchers noted that balance tends to hold up reasonably well until about the sixth decade of life, then declines relatively quickly. The share of people who could not hold 10 seconds roughly doubled with each five-year band:

• about 5% at ages 51 to 55
• about 8% at 56 to 60
• just under 18% at 61 to 65
• just under 37% at 66 to 70
• about 54% at 71 to 75

That same study also found that people who failed the test were more likely to die over the following seven years or so: about 84% higher risk after adjusting for age, sex and existing conditions. Before that number scares you, read the fine print. It was an observational study in one Brazilian cohort. The people who failed were already more likely to have diabetes, heart disease and high blood pressure. And nobody showed that practicing balance changes that number. Here’s the honest takeaway. A 10-second stand is a quick, free window into how well several systems are working together. Use it as a gauge, nothing more.

Why it matters before it matters. The CDC reports that more than one in four adults 65 and older falls each year, that fewer than half of them tell their doctor, and that one fall doubles the chance of another. Falls caused 88% of emergency visits and hospitalizations for hip fractures and 83% of hip fracture deaths in older adults. Nearly 319,000 older Americans are hospitalized for a hip fracture every year. That is the bone story from last week meeting the balance story from this one.

The good news: it is a skill, so it trains like one. The largest review of the evidence, a 2019 Cochrane review of 108 randomized trials and more than 23,000 people living at home, found that exercise reduced the rate of falls by about 23%. The type mattered. Programs built mainly on balance and functional exercise reduced falls by about 24%. Programs combining balance, functional and strength work probably reduced them by about 34%. Tai chi may reduce them by about 19%. For walking-only or strength-only programs, the evidence was too thin to say.

One honest limit: participants averaged 76 years old, so these numbers describe people already in the higher-risk years. They are not proof of what balance training does at 45. What they show is that balance responds to practice even late in life. Starting earlier simply means you are maintaining a skill instead of rebuilding it.

How long does it take? A meta-analysis of balance training in healthy older adults found that programs shorter than about 11 weeks produced smaller effects. Give it a season.

What It Feels Like

Early balance decline rarely announces itself as “my balance is going.” It shows up sideways:

• You reach for the railing on stairs you used to take without a thought
• Putting on socks or pants standing up has turned into a sitting-down job
• You wobble getting out of the car or stepping off a curb
• You catch your toe on a rug edge or a raised sidewalk more than you used to
• Uneven ground like gravel or wet leaves makes you slow down and watch your feet
• The dark makes you noticeably less steady than daylight does
• You’ve stopped doing anything on one leg at all, not even hopping or kicking a ball

None of these is a diagnosis. Each is a sign the system is getting less practice than it used to. And if any of them comes with dizziness, a spinning sensation, numbness in your feet, or a recent fall, that is a conversation for your provider first (Move 5).

5 Moves

1. Take the 10-second test, safely, and write down your number. Stand next to a kitchen counter so you can grab it if you need to. Use the same setup the researchers did: rest the front of your lifted foot against the back of your standing calf, arms at your sides, eyes fixed on a point ahead. Try each leg, up to three attempts. If that was easy, see how long you can hold it, up to about 30 to 45 seconds. This is your starting point, and that’s all it is. If you have fallen in the past year, feel dizzy, or are worried about trying it, skip the test and go straight to Move 5.

2. Practice in the cracks of your day. Balance responds to frequent, short practice better than to an occasional heroic session. Stand on one leg while you brush your teeth, one leg per minute. Do it while the coffee brews or while you wait for the microwave. Hold the counter lightly at first, then use one finger, then let go. That is a few minutes a day you were already spending standing still.

3. Make it a little harder, one variable at a time. Once standing on one leg for 30 seconds feels easy, challenge one input. Turn your head slowly side to side (that loads the inner ear). Stand on a folded towel or cushion (that makes your feet work harder). Close your eyes for a few seconds with the counter right there (that removes vision). Change only one thing at a time. Stop where it feels hard but controlled. If you’re lunging for the counter, back off.

4. Pair balance with strength, and train while you move. The strongest results in the fall-prevention research came from programs that combined balance, everyday movement patterns and strength. Real falls happen while you are moving, so train that way: heel-to-toe walking along a hallway, step-ups onto a low stair, slow lunges, single-leg deadlifts with a hand on a wall, and the loaded carries from Issue 28, which train your bones and your balance at the same time. Tai chi is a good option if you prefer a class. Keep at it for at least three months before judging the result.

5. Fix your surroundings, and bring in a physical therapist when something feels off. Your balance system runs on information, so give it good information. Get your vision checked. Wear shoes with a firm sole that stays on your foot. Add lighting to stairs and hallways now that evenings are getting darker, and deal with the loose rug. Ask your provider whether any of your medications affect balance; the CDC lists sedatives, some antidepressants and even some over-the-counter medicines. And if you have dizziness or vertigo, numbness in your feet, a diagnosed condition that affects balance, or have fallen even once, tell your provider and ask about a physical therapist. October is National Physical Therapy Month, and a physical therapist can test all three of your balance systems separately and build a plan for the specific one that is lagging. No article does that.

The Bottom Line

Balance is a skill. Three sensors and your brain practice it together all day, and like any skill, it fades when you stop using it. For most people the slide speeds up somewhere in their fifties, long before anyone thinks to check.

The fix takes a few minutes a day. Know your number. Stand on one leg while you brush your teeth, and make it a little harder over time. If something feels off, bring in your provider and a physical therapist.

Last week was about building a bone strong enough to survive a fall. This week is about making the fall less likely in the first place. You want both.

Save this. Send it to someone who sits down to put their socks on.
— Noah

Educational content. Not medical advice.

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