Associations Between Factors Across Life and One-Legged Balance Performance in Mid and Later Life: Evidence From a British Birth Cohort Study

Introduction: Despite its associations with falls, disability, and mortality, balance is an under-recognized and frequently overlooked aspect of aging. Studies investigating associations between factors across life and balance are limited. Understanding the factors related to balance performance could help identify protective factors and appropriate interventions across the life course. This study aimed to: (i) identify socioeconomic, anthropometric, behavioral, health, and cognitive factors that are associated with one-legged balance performance; and (ii) explore how these associations change with age.

Methods: Data came from 3,111 members of the MRC National Survey of Health and Development, a British birth cohort study. Multilevel models examined how one-legged standing balance times (assessed at ages 53, 60-64, and 69) were associated with 15 factors across life: sex, maternal education (4 years), paternal occupation (4 years), own education (26 years), own occupation (53 years), and contemporaneous measures (53, 60-64, 69 years) of height, BMI, physical activity, smoking, diabetes, respiratory symptoms, cardiovascular events, knee pain, depression and verbal memory. Age and sex interactions with each variable were assessed.

Results: Men had 18.8% (95%CI: 13.6, 23.9) longer balance times than women at age 53, although this difference decreased with age (11.8% at age 60-64 and 7.6% at age 69). Disadvantaged socioeconomic position in childhood and adulthood, low educational attainment, less healthy behaviors, poor health status, lower cognition, higher body mass index (BMI), and shorter height were associated with poorer balance at all three ages. For example, at age 53, those from the lowest paternal occupational classes had 29.6% (22.2, 38.8) worse balance than those from the highest classes. Associations of balance with socioeconomic indicators, cognition and physical activity became smaller with age, while associations with knee pain and depression became larger. There were no sex differences in these associations. In a combined model, the majority of factors remained associated with balance.

Discussion: This study identified numerous risk factors across life that are associated with one-legged balance performance and highlighted diverse patterns of association with age, suggesting that there are opportunities to intervene in early, mid and later life. A multifactorial approach to intervention, at both societal and individual levels, may have more benefit than focusing on a single risk factor.