Continuing Education Module
Mitigating Frailty: Opportunities Ahead
Modified leg press using resistive bands
by Linda McAllister PT, DPT and Carole Lewis PT, PhD, FAPTA
As the proportion of the older adult population rises in the Unted States, the number of older adults with frailty is also increasing. Frailty has been defined in varying ways, but a well- accepted definition marks frailty by unintentional weight loss, low strength, reduced physical activity, the feeling of exhaustion, and slow walking speed.1 Frailty can have a slow, insidious onset, with sarcopenia often silently present and putting one at increased risk for developing frailty. A critical feature of frailty is that it is a state of vulnerability. Frailty can lead to a downward spiral. Older adults with this syndrome have increased risk for falls, disability, hospitalizations, and mortality. 2,3 Varied approaches toward addressing frailty have been studied. One component emerges from systematic reviews that shows more promise for improvement: physical activity intervention.4 Muscle weakness is a key marker of frailty; targeting this weakness is essential. Resistive training protocols stand out as being “consistently effective” in the treatment of frailty.5 Muscle strength training with protein supplementation have also shown consistently greater effectiveness.6 Physical therapists can play a key role by applying well-dosed, robust strengthening interventions. Falvey et al have proposed that high-intensity resistive training should be the cornerstone of interventions for hospital associated deconditioning (which can rapidly uncover frailty) instead
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of a traditional lower intensity approach.7 Decades of research has shown that older adults, even sedentary and those with multi-morbidity, can participate in higher intensity strength training and demonstrate meaningful improvements.8 Benefits include reduced falls and fear of falling and improved physical performance. High-intensity resistive training is also shown to be one of the most effective exercise modalities to improve preferred gait speed.9 High-intensity motor control interventions of gait and balance can also mitigate frailty: participants have demonstrated an improvement in their frailty classification, e.g., moved from “frail” to “pre- frail.”10 Many referrals to PT are reactive, initiated because of an illness or injury. Frailty puts older adults at higher risk for these negative events. Physical therapists are uniquely poised to identify and address this vulnerability. Although our typically reactionary medical system pushes us to focus on the new injury or illness, physical therapists can look deeper to see underlying frailty or susceptibility to frailty. Here is a great opportunity for prevention! Therapists can address the weakness that made one vulnerable to an adverse event in the first place. Although getting “back to baseline” is a common therapy paradigm, one’s baseline can potentially be improved with the right exercise interventions, increasing functional reserve and resilience to help prevent future adverse events.7 Often,
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