Many readers responded to my recent column on how exercise can help reverse frailty among older adults. Some wanted to share their experiences; others sought clarification on key aspects of the research I cited. As promised, I am delving further into the topic in this edition of The Checkup.
Anne from Vermont wrote that her mother lived to 98 and was in good health until her final year. She would describe a neighbor or friend as frail, but never herself, Anne recalled. “Is frailty an actual medical diagnosis, or is it one of those things you know when you see it?”
Sara E. Espinoza, a geriatrician and professor at Cedars-Sinai Medical Center, explained to me that frailty is a medically recognized syndrome associated with a higher risk of adverse outcomes such as falls, hospitalization and death. One way to think about it is as a state of increased vulnerability.
“People who are frail are just not able to recover from medical illnesses or other stresses as well as people who are more robust,” Espinoza said.
Two of the most commonly used tools to assess frailty are the Fried frailty phenotype and the Rockwood frailty index. The first assessment considers five factors: walking speed, grip strength, physical activity levels, exhaustion and unintentional weight loss. The second takes a broader approach, accounting for accumulated health problems including chronic diseases, cognitive impairment and difficulties performing everyday activities.
Clinicians use these assessments to identify patients at higher risk of falls, hospitalization and other complications. Frailty scores can also help predict how well someone recovers after surgery and whether they need additional support to continue living independently.
Richard from D.C. had a related question: “How is frailty different from healthspan?”
Healthspan is a relatively new term that refers to the number of years a person lives in good health, meaning free from diseases or disabilities that substantially limit daily activities. Espinoza says there is no consensus on how to measure healthspan, though frailty may be one useful indicator of physical functioning.
She is encouraged by emerging research showing that frailty can be reduced, potentially allowing older adults to remain active and independent for more years — thereby increasing their healthspan.
“I’ve been active all my life and was running marathons until I was 68 and triathlons until 75,” wrote George, a retired internist from Maryland. After he suffered a stroke at 76, his doctors advised him to take it easy and rest. “I wanted to get back to endurance exercise, but I got the sense they couldn’t imagine an old guy like me doing this. … How much of this is data-backed versus ageism in medicine?”
I agree with George about the need to change prevailing perceptions about older adults and physical activity within the medical profession. Margaret Danilovich, a physical therapist and director of clinical programs at Agilon Health, told me ageism certainly exists in health care. “There is this feeling that these are complex patients, they are frail, there’s not much that can be done,” she said.
But this assumption is mistaken. As she and her colleagues showed in a recent study published in PLOS One, nearly 70 percent of older adults who participated in a 16-week intensive walking program became less frail. Such interventions require considerable time and effort, but they can help change health care providers’ expectations about what older patients can achieve.
Both Espinoza and Danilovich believe that older people widely misunderstand their own physical abilities. Danilovich told me that when she asks sedentary older patients about their level of activity, she frequently hears, “Well, I’m old, what do you expect?” Many could not imagine themselves engaging in vigorous exercise.
Yet in her study, many participants in their 80s and beyond rose to the occasion. They completed a demanding walking program and became more active in their daily lives.
“If we lower our expectations of people, we don’t give them meaningful opportunities to show what they are actually capable of,” she said.
Samantha from California had specific questions about the study’s methodology. “How can a study like that be randomized? … Wouldn’t participants figure out which group they are participating in, and [wouldn’t that] subconsciously influence their health?” She also wanted to know about long-term follow-up. “Were the participants still active a year or two later?”
Danilovich said her team randomized participants at the retirement community level for precisely the reason Samantha raised. Instead of assigning residents within the same community to different exercise groups, the researchers randomly assigned entire facilities to the vigorous or casual walking program. “The purpose was to avoid contamination,” she said, like participants talking about the study in the dining hall and figuring out the differences.
As for long-term follow-up, Danilovich said this is the next phase of her research. She recognizes that the level of personalized support in the study’s exercise sessions may be difficult to scale. Her team is now exploring how technology such as smartphones and smartwatches could replicate the encouragement and monitoring, making intensive exercise programs accessible to more people. They will also follow participants over longer periods to determine whether physical activity gains can be sustained.
But people don’t need personal trainers or fancy technology to get started. “We see so many things out there with expensive machines and fancy gyms,” Danilovich said. “Perhaps we just need to keep it to the basics and get outside and walk.”
That’s sound advice for everyone. Those who want to be more active can work with their doctors and other clinicians to determine what’s safe, then challenge themselves to walk farther and increase the intensity. Aim for improvement, regardless of age.
Have more questions on exercise and frailty? Do you have advice for other readers? I plan to cover this topic again soon. Please write to me!
The post What even is frailty? Answering questions about exercise in older age. appeared first on Washington Post.
