A measure of balance

Simple tests that may indicate whether you’re at risk of falling

Harvard Health Publishing

Balance is something you take for granted until it fails you. If stumbles have become more frequent, even if you’ve escaped with only a jolt of adrenaline or a minor knee scrape, they could be a wake-up call that your balancing skills need attention.

“As you age, balance becomes even more essential, and you should approach it like any other part of your fitness,” says Kaitlyn Buckwell, a strength and conditioning specialist with the Center for Sports Performance and Research at Harvard-affiliated Mass General Brigham. “Strong balancing skills not only can protect you from falling, but they can also reduce the likelihood of a severe injury if you do.”

Four-stage balance test

How can you tell if your balance is unbalanced? Take the four-stage balance test, a simple baseline assessment that physical and occupational therapists use to evaluate balance and an individual’s risk of falling.

The test measures how long you can stand in a series of positions. Each stance is harder than the one before.

“The goal is to maintain balance for at least 10 seconds without needing support before advancing to the next stance,” Buckwell says.

Perform the tests barefoot, keeping your arms at your sides or extended out, and your gaze straight ahead. “Do them near a wall, chair or another person in case you do lose your balance,” Buckwell says.

1 Side-by-side

Stand on a flat surface with your feet positioned next to each other so they touch. Hold the position without moving your feet.

2 Semi-tandem

Place the instep of the arch of one foot so it’s next to and touching the big toe of the other foot. Hold the position without moving your feet. Switch foot positions and repeat.

3 Tandem

Place one foot in front of the other, so the heel and toes touch. Hold the position without moving your feet. Switch foot positions and repeat.

4 Single-leg

Stand with your feet hip-width apart, hands on your hips. Lift one foot off the floor to about mid-calf height. Hold this position for 10 seconds, or until the raised foot touches the ground or you lose your balance. Switch foot positions and repeat.

What do the results mean?

If you can’t hold the tandem or single-leg for 10 seconds (or if you can’t progress to the tandem stance at all), you are at high risk of falling, and you should see a physical therapist for further evaluation, according to Buckwell. “They can help you improve your balance through exercises that increase joint stability, mobility and strength,” she says.

Advanced balance tests

Even if you easily pass the four-stage balance test, your balancing skills still may need attention.

“More advanced tests can gauge your balance and coordination during everyday movements, when you are most likely to stumble or fall,” Buckwell says.

Here are three tests she recommends. “All these tests also act as balancing exercises. Practicing them regularly not only helps monitor your balance skills, but also improves them,” she says.

1 Single-leg variations

Variations of the single-leg test are a good measure of overall balance and can assess how well you maintain stability on a single support.

“One-leg standing — that is, shifting most of your weight to one leg — is something we do every day, although we may not notice it, such as when we’re walking, stepping off a curb or climbing stairs,” Buckwell says.

Retake the single-leg test on each leg, only this time hold the pose for as long as possible. In general, adults ages 65 and older should aim for 10 to 30 seconds. “Being able to stand on one foot for close to 30 seconds is a sign of good balance,” Buckwell says.

Be aware that the balancing times may vary slightly between the right and left legs.

“We often have a dominant leg just like a dominant hand, so you may find that one leg is weaker than the other and can’t hold the balance as long,” Buckwell says. “This can help identify if you have a muscle imbalance that needs attention.”

If you can hold the pose for longer than 30 seconds, make it more challenging. For instance, close your eyes while holding the pose, stand on a foam pad instead of the floor or reach for an object on a nearby table or on the floor.

2 Heel-to-toe walking

This test gauges your balance, coordination and body awareness as you walk. Assume the tandem standing position: one foot in front of the other, the heel and toes touching, arms to the sides or extended out. Gazing straight ahead, walk heel-to-toe as if you’re on a tightrope for 10 steps, then turn around and walk back to the starting point. The goal is to complete the test in 20 seconds or less. “Slower times may indicate a lack of balance and increased risk of falls,” Buckwell says.

3 Timed up and go (TUG)

TUG assesses functional mobility and fall risk. From a seated position, stand and walk in a straight line at a normal pace for 10 feet, turn around, walk back and sit down. “Generally, you want to complete the test in 12 seconds or less,” Buckwell says. “Times over 12 seconds may indicate a higher risk for falls.”

Patients opting for GLP-1 injections over pills

CHRIS PRENTICE AND MARIAM SUNNY
Reuters

Many patients have opted for injectable forms of the wildly popular GLP-1 obesity medications through a pilot program of the U.S. government’s Medicare health insurance program for Americans ages 65 and older, according to early indications from doctors and analysts.

The U.S. Centers for Medicare & Medicaid Services this month launched an 18-month trial program that for the first time opens access to Novo Nordisk’s Wegovy and Eli Lilly’s Foundayo and Zepbound as weight-loss treatment alone for a monthly cost of $50.

Millions of people are expected to qualify, and doctors are already being flooded with interest from patients aged 65 and older. For the most part, they say the process is going well, with some hiccups.

Many pharmaceutical industry experts had expected that patients would prefer pills over injections, for convenience. Novo’s U.S. chief Jamey Millar in June said the firm’s research indicated that Medicare beneficiaries prefer the oral pill to the injectable on a two-to-one basis.

Yet eight of 10 doctors interviewed by Reuters and three pharma sector analysts said many are opting for the injectables.

“Hands down — these patients are asking for injections as they know they work and it has been so costly in the past,” said Dr. Sarah Ro, director of University of North Carolina Health’s weight-management program.

Ro said patients who meet the criteria have been generally receiving approvals quickly once the clinicians became familiar with the process.

U.S. approvals for injectable Zepbound and Wegovy were based on separate trials in which the Lilly drug helped patients lose more than 22% of their weight after 72 weeks, while Wegovy led to 15% weight loss after 68 weeks.

Oral Wegovy led to about a 14% reduction in body weight over 64 weeks, and Foundayo about an 11% reduction over 72 weeks, in separate studies.

“Prescribing patterns have evolved over time as new options have become available, but the majority of patients are still prescribed injectable therapies,” said analysts with investment bank William Blair in a July 13 note, citing a call with an obesity medicine specialist.

Still, demand for the Wegovy pill has been strong, and analysts said the most recent publicly available data from data firm IQVIA show that prescriptions for Lilly’s pill Foundayo jumped in the week to July 10. IQVIA did not confirm the data.

But patients generally seem to be opting for the injectables once they learn about the efficacy.

“A year ago if you’d asked me, I would have thought people would be jumping at the pill,” said RBC Capital Markets analyst Trung Huynh. “But it turns out that for most people, it’s all about efficacy.”

Spokespeople for Lilly and Novo said they were pleased with the new Medicare program. The Lilly spokesperson said the program is “working very well” and the firm is encouraged by the strong interest. Neither drugmaker provided any details about specific volumes.

A CMS spokesperson said the Medicare program’s first weeks have been “positive” with most authorizations completed in under 12 hours.

But patients’ ability to get coverage under the demo has been mixed, according to both doctors and patients.

Katie Smith, who asked her doctor to send in the prescription on July 1, said she is still waiting for word if she’ll be covered. The Virginia retiree said she is frustrated after years of being unable to access these medications due to cost. The companies’ directto-consumer prices range from $149 to $449 per month.

“I’m not really sure what’s happening,” she said.

The process has also been “cumbersome” for doctors, said Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai’s Center for Weight Management and Metabolic Health in Los Angeles.

“This has required numerous hours and numerous clinical staff and clinicians to come together to make standardized protocols, order sets, and troubleshoot to try to get through the red tape to get access to GLP1RAs for our patients,” she said.

Still, many are seeing success. Dr. Christina Nguyen of weightloss clinic Knownwell in Atlanta said nationwide it had received approvals for about 200 patients in the first week.

“We’re getting several approvals every day, if the patient meets the criteria,” she said.

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