Optimizing one-leg standing test duration for screening functional decline in community-dwelling older adults

• The one-leg standing test (10–60 s) was associated with mobility and balance. • The one-leg standing test, at any duration, shows no association with past-year fall history. • 10-s one-leg stand test may screen severe functional impairments. • 30-s one-leg stand test may detect general mobility limitations. • 60-s one-leg stand may identify early decline in high-functioning adults. This cross-sectional study aimed to investigate whether the ability to maintain one-leg standing test for varying durations (10, 30, or 60 s) is associated with physical function and fall history. 158 community-dwelling older adults participated. They performed the one-leg standing test for a maximum of 60 s and were categorized into those who could or could not maintain the position at each time point. Physical function was assessed through mobility (gait speed and five times sit-to-stand test), balance (Timed Up and Go (TUG) test and two-step test), and knee extension strength. Fall history was self-reported. The proportions unable to maintain standing increased with test durations: 14.6 % for 10 s, 26.6 % for 30 s, and 41.1 % for 60 s. Independent t -tests showed that the maintained groups demonstrated significantly better mobility and balance performance than the non-maintained groups at each duration (all p < 0.01), and that the maintained groups at 10 s and 30 s exhibited significantly greater knee extension strength ( p < 0.01). Multiple regression analyses confirmed that the one-leg standing was independently associated with physical function outcomes. Chi-square tests revealed no significant association between standing duration and fall history. The one-leg standing test was consistently associated with physical function but showed limited ability to predict fall history. A shorter duration (10 s) effectively detected severe impairments, whereas a longer duration (60 s) was more sensitive for identifying early declines. The choice of test duration should be guided by the specific functional deficits being assessed.