Frailty Prevention Facts
Introduction:
Healthy lifestyles incorporating physical activity and exercise have been shown to be highly beneficial for persons aged 75 and above. Reductions in functional decline, coronary heart disease, and disability prior to death along with increased life expectancy have all been demonstrated.
What is frailty?
It is a condition involving atrophy or wasting of our muscles. Wasting of the muscles is termed sarcopenia. It is first noticed in the neck or thigh muscles. Just as osteoporosis involves weakening of the bones sarcopenia weakens the muscles. Whereas both conditions are inevitable they can be slowed down by staying active.
A sedentary lifestyle (e.g., watching TV/movies, or surfing the net) invites deconditioning, depression, and obesity. An inactive lifestyle leads to a loss of balance function which can result in falls. It also leads to a loss of leg strength when getting up and down from chairs, the bed or toilet seat. Fortunately exercise has been shown to slow down the progression of both osteoporosis and sarcopenia and allow an older person to live independently as long as possible .
Is there a way to prevent the loss of function with age? Inactivity is a precursor of frailty. You can restore function and prevent a loss of quality of life with aging. See your doctor and exercise specialist to help you remain active
When should I see a doctor?
Symptoms of inactivity-related loss of function include difficulty with walking speed, ability to walk up or down stairs or perform simple tasks (e.g., reaching overhead, putting on a shirt, hooking a bra, lifting a gallon of milk, or carrying groceries). You should see a doctor before starting any vigorous exercise program or activity (slow jogging, speed walking, tennis, heavy gardening, and shoveling snow). You should also see a doctor if you have any serious health care conditions and you wish to start a moderate exercise program.
What can I do for myself?
Start to take long walks (30-45 min >3d/wk), or play active games. Realize that if swimming or biking are your only forms of exercise, you will not increase your bone density. The most important thing is to realize that inactivity is as important a risk factor for poor health as high blood pressure, obesity or smoking!
In a landmark report the Surgeon General of the United States stated that older people regardless of gender or socioeconomic class are not exercising as much as they should, with women generally less active than men. 30% of women ages 60-69 engage in no leisure-time activity compared with 17% of men. In 80 year olds 62% of women and 40% of men engage in no leisure-time activity. The Surgeon General calls for at least 30 minutes of physical activity per day.
Ways to increase your activity.
All sedentary, older persons without cardiovascular disease should start with a low-intenisty exercise program after seeing their doctor. Examples include:
- Gait training
- Balance exercises
- Tai chi
- Self-paced walking
- Lower extremity resistance training with elastic tubing or ankle weights
Many people avoid activities as they age because of pain due to arthritis. Unfortunately, this is a slippery slope because the discomfort with activity or exercise can lead to avoidance of activity/exercise which only leads to greater weakness and instability of the muscles and joints. The key is to experiment until you find what exercises you tolerate the best. Restricting your activities is doomed to promote greater joint irritation not less!
Remember, stiff, rusty tissues hurt with activity, but this will actually loosen them up. Underused or weak muscles will hurt after exercise, but such post-exercise or delayed onset muscle soreness is normal. if you garden for the first time all year and are sore later you never think you have injured yourself. You realize you are working out of shape muscles!
A Tai Chi class is one of the best forms of exercise to improve balance and maintain leg strength. This can prevent falls and disabling hip fractures.
During exercise or activity warning signs to look out for include:
- Chest pain
- Shortness of breath
- Dizzyness
If any of these occur you should rest. If they persist or recur then a physician visit is warranted.
If low intensity exercises are well tolerated progress to moderate intensity exercises. Examples include:
- Strength training
- Fast walking
- Swimming
- Bicycling
Weight training can be performed 2-3x/wk. Weight training increases muscle strength and flexibility, bone density, balance, cardiovascular fitness, burns calories, and improves mood. Exercise discomfort decreases over time. Strengthening will improve the stability of degenerative joints such as in the knee, but does take time.
Ways to Modify Your Activities
Get into the habit of walking and taking stairs when possible. Avoid escalators and elevators when stairs are available. Walk for short trips instead of driving. Spousal support is one of the most important ways to encourage active lifestyles. Find friends or partners to stay active with.
Rehabilitation
If you have a disease like hypertension, diabetes, osteoporosis, spinal stenosis, arthritis, or heart disease avoidance of activity because of fear of making condition worse is unfounded and under appropriate medical supervision is actually the road to recovery. The solution is to realize that exercise is vital for maintaining function in life in spite of these medical conditions. Exercise can improve cardiovascular fitness, lower blood pressure, slow the loss of bone density, and reduce back or leg pain or weakness.
If you have an injury (e.g., strain or sprain) or have had a knee replacement or hip replacement it is important to stay active because deconditioned tissues heal slowly due to a lack of circulation and nourishment. Gradual reactivation promotes healing and restoration of function. For each week of inactivity it takes at least two weeks of exercise to get back to square one. Gradually resume near normal activities under the guidance of a rehabilitation specialist. Modify activities under appropriate supervision. Rehabilitate strength, flexibility and function and then resume an active lifestyle