VITRUVIAN EXERCISE PHYSIOLOGY
News & Information
FRAILTY & EXERCISE
The World Health Organisation defines healthy ageing as:
' the process of developing and maintaining functional ability '
Approximately 3% of people aged 65 and over in England are living with severe frailty, 12% with moderate frailty and 35% with mild frailty, and the numbers continue to rise. Frailty is associated with a number of negative health and social outcomes. These include:
• Higher levels of dependence
• High risk of falls
• Difficulty performing daily functional activities
• Disability
• Hospitalisation and mortality
Frailty prevalence increases with age and is more common in women than men. A definition of frailty, offered by Fried et al, suggests it is a clinical syndrome in which three or more of the below criteria are present;
Unintentional
weight loss
Low levels of physical activity
Slow
walking speed
Self-reported exhaustion
Weakness
Evidence shows that meeting 3 or more of these criteria was predictive of worse outcomes for falls, hospitalisations, disability, and death. Individuals meeting 1 or 2 criteria had an intermediate risk of these outcomes.
Assessing Frailty
There are several ways to assess functional capacity for older adults.
One such method is the Short Physical Performance Battery (SPPB). It was developed by the National Institute on Ageing and is designed to capture limitations in lower body function that relate to gait, balance, and strength.
It involves 3 tests (demonstrated below):
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Balance for time (feet together, semi tandem, tandem)
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Walking speed (normal walking speed timed over 4 metres)
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Sit to stand (5 repetitions performed as fast as possible)
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The tests are standardised and scored, and used to predict future risk of falls, disability, and those individuals that could benefit from early intervention. Tests are not performed if considered unsafe and thus scored accordingly.
Feet Together
Semi-tandem
Tandem
Walking Speed - 4m
Sit to Stand x5
The below figure outlines the scoring criteria for the SPPB. Following completion of the tests, the scores are tallied to create an overall performance score;
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0 -3 (disability / very poor performance)
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4-6 (poor performance)
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7-9 (moderate performance)
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10-12 (good performance)
(Silva et al, 2021)
Another way we can assess functional capacity is the SARC-F Questionnaire. This questionnaire is a fast and useful tool for professionals to screen for patients showing signs of sarcopenia (see more on sarcopenia here). Signs suggestive of sarcopenia include deficiencies in;
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Strength
-
Walking
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Rising from a chair
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Climbing stairs
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Experiencing falls
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Why Screen
Sarcopenia has a prevalence rate of approximately 10% among individuals aged 60 and above. Ignoring sarcopenia can lead to reduced quality of life, impaired function, and increased mortality rates. Scores for the SARC-F of 4 or more indicate further physical testing may be warranted.
The SARC - F
S
Strength: How much difficulty do you have in lifting and carrying 10 pounds? None, 0. Some, 1. A lot or unable, 2.
A
Assistance in walking: How much difficulty do you have walking across a room? None, 0. Some, 1. A lot, use aids, or unable, 2.
R
Rise from a chair: How much difficulty do you have transferring from a chair or bed? None, 0. Some, 1. A lot or unable without help, 2.
C
Climb stairs: How much difficulty do you have climbing a flight of 10 stairs? None, 0. Some, 1. A lot or unable, 2.
F
Falls: How many times have you fallen in the past year? None, O. Less than 3 falls, 1. 4 or more falls, 2.
(David Propst, PA-C)
Exercise as Prevention and Management for Frailty
Appropriate physical activity and exercise is considered essential for the prevention and treatment of frailty. Resistance training forms a key component of this due to its positive effect on muscle strength, mass, power, functional capacity and decreased falls risk. Improvements in muscle strength are correlated with decreased risk of falls, decreased hospitalisation rates, greater independence and improved quality of life. ​
Exercises should not only focus on developing strength, but also power, as muscle power has been shown to deteriorate faster than strength. Further information on developing muscle mass, strength and power can be found here; Sarcopenia page
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Resistance training combined with balance and gait training exercises are safe and tolerable for frail elderly individuals when prescribed appropriately, taking into account relevant medical history and current abilities. Supervised exercise interventions consistently show improvements to physical function and self reported function.
The Vitruvian Team.
International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. Izquierdo et al. Journal of nutrition, health & aging. 2021.
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Short Physical Performance Battery as a Measure of Physical Performance and Mortality Predictor in Older Adults: A Comprehensive Literature Review. Silva et al. International Journal of Environmental Research and Public Health. 2021.
What does the medical record reveal about functional status? A comparison of medical record and interview data. Bogardus Jr, S.T et al. J Gen Intern Med. 2001.
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Development and validation of an electronic frailty index using routine primary care electronic health record data. Clegg, A et al. Age Ageing. 2016.
Frailty in Older Adults: Evidence for a Phenotype. Fried et al. Journal of Gerontology. 2001.
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Ageing Clinical and Experimental Research. Lopez et al. 2017.
Benefits of resistance training in physically frail elderly: a systematic review. Lopez et al. 2018
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Office for National Statistics, Estimates of the population for the UK, England and Wales, Scotland and Northern Ireland, mid-2018 based. 2018.