Contributor: Ronan Factora, MD
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The word “frail” often is used to describe the appearance of an older adult. The term itself suggests vulnerability, slowness and disability. The medical definition of frailty requires that three of these characteristics be present:
- Shrinking/weight loss (10 pounds or more in one year)
- Physical exhaustion (self-reported)
- Muscle weakness (measured by weak grip strength)
- Decline in walking speed
- Low physical activity
Unfortunately, low physical activity is a common way of life for many Americans. I can honestly say that physical activity and/or exercise is probably the most difficult prescription for my patients to fill.
Inactivity is common
Much of their time is spent in sedentary pursuits — if not watching TV, then in front of a screen (such as a computer or handheld device), reading, doing puzzles — anything but moving around. As a result of inactivity, their muscles lose their functional capacity and tone, and may eventually become infiltrated with fat.
Aside from the obvious change in the composition of the muscles, their ability to function is also affected. As a result, this also leads to physical exhaustion, muscle weakness, and potentially a decline in walking speed. Lack of physical activity alone also could lead to decline in walking speed due to a loss of muscle tone, muscle function, and cardiovascular endurance.
Low physical activity is not only a consequence of weight loss and muscle mass loss — it can become a cause. Higher physical activities compel a person to actually eat more, to replenish the body with the calories that it expends. When you are not physically active, appetite declines and leads to inadequate protein and calorie intake (which is used maintain muscle mass and support/sustain physical activity).
One can see how all of these frailty characteristics are interrelated. Developing frailty does not happen overnight — it takes years for frailty syndrome to develop as a consequence of low physical activity and weight loss. When it does develop, reversal is extremely difficult.
The secret to maintaining independence
Generally speaking, people want to maintain independence and a good quality of life through aging, and they want to avoid disability as much as possible. Many people mistakenly assume frailty is part of normal aging. It’s true that many aging persons do become frail, but there are a number of interventions that can prevent or even reverse frailty. Though it may seem simple, all individuals should do the following to help reduce the risk of developing disability and frailty:
Reduce the amount of sedentary time spent on a daily basis. Cut back on sitting around during the day. I recommend no more than three hours daily of this.
Introduce a routine exercise regimen. A cardiovascular exercise regimen can help with endurance and walking speed — it may also help increase your appetite. Resistance and weight training can help preserve muscle mass. Exercises should be done for at least 30 minutes daily four or more days of the week. This is really the minimum; people should shoot for more of this
Avoid losing weight, particularly if you are inactive, as weight loss leads to more muscle mass loss than fat loss.
Making physical activity routine sounds easy and straightforward, but from my clinical perspective, regular exercise can be difficult for older patients to sustain. Despite the challenge, this simple intervention can be the foundation for avoiding frailty and disability and maintaining independence and a high quality of life.