Friday, May 02, 2008

Unipedal standing

Less scholarly, perhaps, to just call it standing on one foot. Unipedal or onefooted, these Japanese orthopedists wondered if a daily balancing act might make old people less prone to pitch to earth and break their hips(1).

During their six month study, they divvied a pack of old folks at high risk of falling into two groups. The test subjects stood on one foot, then the other, one minute per side for three sessions each day. The other group just stood their ground in the usual manner.

Dr. Sakamoto previously calculated the load-bearing effects of stork-like posturing on the femoral head(2) or that part of the hip bone connected to the pelvic bone. This area is susceptible to loss of bone density and fracture when an old person goes to ground. He concluded that unipedal standing placed a load equivalent to 2.75 times the body weight on the involved femoral head, and one minute of time spent doing so was the equivalent of 53 minutes of walking with respect to benefits to bone density.

Let's see, one minute per side x 3 sessions per day equals six minutes of balancing acts vs. 318 minutes of walking. Well, how would you rather spend your discretionary time?

Alas, either six months is not long enough to determine the benefits of unipedal standing on old Japanese fogies, or you can't fool Mother Nature. At the end, there was a sort of significant decrease in falls in the test group compared to controls, and only one hip fracture in both groups.

I don't know whether I'm going to do this or not. Maybe if I could wear my Yoga Toes while balancing and thus do all my weird self-trials at once.
(1)Sakamoto, K et al. Effects of unipedal standing balance exercise on the prevention of falls and hip fracture among clinically defined high-risk elderly individuals: a randomized controlled trial. J Orthop Sci. 2006 Oct;11(5):467-72.
(2)Sakamoto, K. Effects of unipedal standing balance exercise on the prevention of falls and hip fracture. Clin Calcium. 2006 Dec;16(12):2027-32.

Thanks to Jacob Schor, ND and his always excellent newsletter for calling my attention to these articles. You can subscribe at


Eric, AKA The Pragmatic Caregiver said...

Unipedal standing is also used by physical therapists to treat IT band issues and quad tightness. It's an excellent thing to do while brushing one's teeth (Sonicare's Quadpacer reminds you to change legs after a minute).

If you really want to make it hard, close your eyes.


Ruth said...

Unipedal stance is a common balance test and I give it as an exercise to most of my ambulatory patients. I would think the decrease in hip fractures is due to decreased falls from better balance. Many older people cannot do this at all and that puts them at a significantly increased risk of falls. It is a component of the standardized Berg Balance Test.

Femail doc said...

Eric: Always happy to see you comment. You are a fountain of interesting information.

I looked up Sonicare's Quadpacer, thinking perhaps the Quad of it all was so that obsessive multitaskers could exercise their quads as well as their gums. It doesn't appear as though they had that outcome in mind, but I do love its every 30 second beep that reminds the brusher to move to a new quadrant of the mouth.

I want one, but unfortunately I already have the old beepless Sonicare to wear out first.

Ruth: Likewise, love it when you comment. I found, on trying this little unipedal business yesterday, that by the end of a minute I'm quite wobbly. My vestibular system is not so hot; I'm terribly prone to motion sickness.

Fortunately, I think I can ace the rest of the Berg Balance Test which includes, per my Googled research:

Sitting to standing
Standing unsupported
Sitting unsupported
Standing to sitting
Standing with eyes closed
Standing with feet together
Reaching forward with an outstretched arm
Retrieving object from floor
Turning to look behind
Turning 360 degrees
Placing alternate foot on stool
Standing with one foot in front of the other foot
Standing on one foot

Ruth said...

Yes, that is the Berg Balance test I use. Some older people cannot stand unsupported (#1) and then we use a lower level test, the Elderly Mobility Scale. Many people have difficulty with the last 3 components of the Berg, but I am sure you would ace them. Then we move to a higher level test, the Community Balance and Mobility scale. It's all about scores and outcome measures these days.

Wendy said...

Ouch - after a minute my feet hurt. I think 30 seconds would be better. Nice to read all the info on this.

Anonymous said...

Some of this was discussed at a recent conference at SLU medical school in St. Louis. The lecturer actually had us all out of our seats trying this with and without our eyes closed. (Guess he thought it would be funny if one of those middleaged docs rolled down the sloping floor to the bottom). Of note is that he did say that if you practice it 15-20 seconds on each side every day it improves balance. No promises about fracture prevention, though.

Femail doc said...

Wendy: My feet were second only to my balance as the show-stopper for me in unipedal standing. Great, huh, old feet can't even take 2.75 times the body weight for 1 minute.

Anon: The vision of a hallful of aging doctors wobbling on one foot suggests a great episode for Candid Camera.