Unipedal Standing:

Jacob Schor, ND, FABNO

April 30, 2008

Hillel, a famous rabbi who lived in Jerusalem during the time of King Herod, was asked if he could summarize the Torah while standing on one foot. His famous reply  that he made on one foot was,

"That which is hateful to you, do not do to your fellow. That is the whole Torah; the rest is the explanation. Now go and learn." (Talmud: Shabbat 31a.)

This article is not about Hillel’s ‘golden rule’ but rather on his method of standing. “Unipedal Standing” is the scientific term for standing on one foot.  Daily minute long intervals may be a useful intervention to prevent falls and hip fractures in the elderly.

In the October 2006 issue of the Journal of Orthopedic Science, K. Sakamoto and colleagues reported on the effect of unipedal standing on frequency of falls and hip fractures in an elderly population.  This has got to be the least expensive, least intrusive and lowest technological intervention I have ever read about for preventing hip fractures.

The “unipedal standing balance exercise’ as the researchers call it was simple.  Stand on each leg for a minute with your eyes open three times a day.  If you need to, hang onto something so you don’t fall down.

The researchers recruited subjects, average age just less than 82 years old, and randomized them, some to serve as controls and some to do the ‘exercises.’ The number of falls and hip fractures for a six month period were tracked.  Data was collected for 315 unipedal standers and 212 control subjects that presumably rarely stood on one foot.

The 315 subjects in the exercise group recorded 118 falls in the six month test period.  The 212 control subjects recorded 121 falls. There was one hip fracture in each group.  The difference in number of falls was statistically significant but not the number of fractures. [1]

Sakamoto published again in the December 2006 issue of Clinical Calcium.   The abstract of the study listed on PubMed is a good example of why it is worthwhile to pay a little extra money for good translation services.

Sakamoto points out that unipedal standing increases the weight load on the femoral head by a factor of 2.75 over standing on two legs, something I guess would be called bipedal standing.

Bone density and bone strength is improved by mild stress to the bone.  That’s why we make all the fuss on weight bearing exercise.  By Sakamoto’s calculations, standing on one foot for a minute would have an effect on bone density equivalent to walking 53 minutes. [2]

Repeating his exercise three times a day would have an effect equivalent to taking three almost hour long walks a day.  For older people who are not that mobile, unipedal standing may be an interesting option.

It appears to improve balance enough that it decreases spontaneous falls by about a third.  Second, it produces mild strain to the bone, in theory decreasing the chance of fracture if the person does fall.

For people who are too frail for rigorous workouts or even walking, unipedal standing offers an alternative ‘exercise.’  Even for those of us who do exercise routinely, a few minutes on one foot may still provide added advantage.  If for no other reason, it gives us the time we need to think of Hillel and maybe even his lesson.

The references:

[1]  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.

    Sakamoto K, Nakamura T, Hagino H, Endo N, Mori S, Muto Y, Harada A, Nakano T, Itoi E, Yoshimura M, Norimatsu H, Yamamoto H, Ochi T; Committee on Osteoporosis of The Japanese Orthopaedic Association.

    Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.

    BACKGROUND: The aim of this study was to assess the effectiveness of the unipedal standing balance exercise for 1 min to prevent falls and hip fractures in high-risk elderly individuals with a randomized controlled trial. This control study was designed as a 6-month intervention trial. SUBJECTS: Subjects included 553 clinically defined high-risk adults who were living in residences or in the community. They were randomized to an exercise group and a control group. METHODS: Randomization to the subjects was performed by a table of random numbers. A unipedal standing balance exercise with open eyes was performed by standing on each leg for 1 min three times per day. As a rule, subjects of the exercise group stood on one leg without holding onto any support, but unstable subjects were permitted to hold onto a bar during the exercise time. Falls and hip fractures were reported by nurses, physical therapists, or facility staff with a survey sheet every month. This survey sheet was required every month for both groups. RESULTS: Registered subjects were 553 persons ranging in age from 37 to 102 years (average, 81.6 years of age). Twenty-six subjects dropped out. The number of falls and hip fractures for the 6-month period after the trial for 527 of the 553 subjects for whom related data were available were assessed. The exercise group comprised 315 subjects and the control group included 212 subjects. The cumulative number of falls of the exercise group, with 1 multiple faller omitted, was 118, and the control group recorded 121 falls. A significant intergroup difference was observed. However, the cumulative number of hip fractures was only 1 case in both groups. This difference was not statistically significant. CONCLUSIONS: The unipedal standing balance exercise is effective to prevent falls but was not shown to be statistically significant in the prevention of hip fracture in this study.

[2] Clin Calcium. 2006 Dec;16(12):2027-32.

    [Effects of unipedal standing balance exercise on the prevention of falls and hip fracture]

    [Article in Japanese]

    Sakamoto K.

    Showa University School of Medicine, Department of Orthopaedic Surgery.

    To prevent hip fracture there are three methods: 1) falls prevention, 2) treatment of osteoporosis and 3) hip protectors. The improvement of the osteoporosis of the proximal hip demands nutrition involved medication as bisphosphonate and mechanical stress. Unipedal standing captures the 2.75 times weight load to the femoral head. Unipedal standing for one minute is equivalent to the amount of integral load gained through walking for approximately 53 minutes. Unipedal standing balance exercise in one minute 3 times per one day is useful to create the proximal femoral bone density and to prevent falls but is not statistically definition to prevent hip fracture. We believe daily unipedal standing balance exercise should contribute toward overcoming prevention of hip fractures.