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It's Not Just Balance In Life, But Ability To Balance

By American Heart Association News

Stand on one leg. Can you stay that way for 20 seconds?

Yoga lovers, among others, have always preached the importance of balance in health and fitness. Some experts believe that a simple one-leg test could be an indicator of problems, particularly stroke risk.

"Vision, inner ear and problems in the cerebellum, as well as sensation in the feet and leg weakness, can all impact balance," said Shari Rosen-Schmidt, M.D., a neurologist in Plano, Texas. "If you can't stand on one foot for 20 seconds, especially if you could before, maybe you should be further evaluated for vascular problems and other issues affecting balance."

The term "vascular" refers to arteries, veins and capillaries that carry blood to and from the heart. When arteries become clogged or blocked, they are risk factors that can lead to major events, such as heart attack and stroke.

Rosen-Schmidt, co-medical director of the Stroke Program at Texas Health Presbyterian Hospital Plano, said there is a possible link between balancing ability and small blood vessel damage in the brain, which can result in stroke.

study in 2014, published in the journal Stroke, was led by Yasuharu Tabara, Ph.D., of the Kyoto University Graduate School of Medicine in Japan. His team had nearly 1,400 men and women with an average age of 67 try to balance on one leg for one minute, then performed MRI scans of their brains to assess their small blood vessels.

The results suggested that people who could not break the 20-second barrier with higher incidences of reduced cognitive function, microbleeding in the brain and small lacunar infarctions, a minor stroke that is sometimes undetected.

"Our study found that the ability to balance on one leg is an important test for brain health," Tabara said at the time. "Individuals showing poor balance on one leg should receive increased attention, as this may indicate an increased risk for brain disease and cognitive decline."

Rosen-Schmidt said she believes the 20-second standard might be too low.

"In most people it should be 30 or 40 seconds, but that decreases as we age," she said. "But balance is an even bigger deal as you age because of the risk of falling."

At the same time, Rosen-Schmidt said, the balance test is far from definitive, "because some people just have bad balance. But if someone has always had good balance and tries it and says, 'Hey, I can't do this,' that might be a warning," she said, suggesting anyone with that experience should make a doctor's appointment.

The study's focus on small blood vessels shouldn't make anyone underestimate the risk, Rosen-Schmidt said.

"We see a lot of small vessel strokes," she said. "That means the area of the brain that dies is less than 1.5 centimeters. But those can cause a devastating stroke. They're very important."

At the least, spending 20 seconds on one leg thinking about the dangers of stroke may not be a bad idea. Strokes are the nation's fifth-leading cause of death, and the millions of people who survive them can face severe physical and mental challenges.

Although stroke risk increases as people age, and factors such as family history play a major role, healthy lifestyles can make a big difference. The American Heart Association/American Stroke Association has a list of recommendations to reduce stroke risk: don't smoke, control your weight, blood pressure, cholesterol and blood sugar, eat a healthy diet and stay physically active.

"This is all stuff we know we should be doing," Rosen-Schmidt said.

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