Exercise prescription to reverse frailty

Abstract

Abstract:Frailty is a clinical geriatric syndrome caused by physiological deficits across multiple systems. These deficits make it challenging to sustain homeostasis required for the demands of everyday life. Exercise is likely the best therapy to reverse frailty status. Literature to date suggests that pre-frail older adults, those with 1-2 deficits on the Cardiovascular Health Study-Frailty Phenotype (CHS-frailty phenotype), should exercise 2-3 times a week, for 45-60 min. Aerobic, resistance, flexibility, and balance training components should be incorporated but resistance and balance activities should be emphasized. On the other hand, frail (CHS-frailty phenotype ≥ 3 physical deficits) older adults should exercise 3 times per week, for 30-45 min for each session with an emphasis on aerobic training. During aerobic, balance, and flexibility training, both frail and pre-frail older adults should work at an intensity equivalent to a rating of perceived exertion of 3-4 ("somewhat hard") on the Borg CR10 scale. Resistance-training intensity should be based on a percentage of 1-repetition estimated maximum (1RM). Program onset should occur at 55% of 1RM (endurance) and progress to higher intensities of 80% of 1RM (strength) to maximize functional gains. Exercise is the medicine to reverse or mitigate frailty, preserve quality of life, and restore independent functioning in older adults at risk of frailty.Key words: aging, frailty, exercise prescription, exercise training, resistance exercise, exercise recommendations.Résumé : La fragilité est un syndrome gériatrique clinique qui résulte de déficits physiologiques de plusieurs systèmes. Ces déficits constituent un défi pour le maintien de l'homéostasie exigée dans la vie de tous les jours. L'exercice physique est vraisemblablement le meilleur traitement pour contrer l'état de la fragilité. D'après la documentation existante, les personnes âgées au seuil de la fragilité, soient celles présentant 1 ou 2 déficits selon le phénotype de fragilité dans l'Étude sur la santé cardiovasculaire (« CHS »-phénotype de fragilité), devraient effectuer des exercices 2 à 3 fois par semaine à raison de 45 à 60 minutes par séance. Les séances devraient comprendre des exercices aérobies, contre résistance, de flexibilité et d'équilibre, mais devraient surtout mettre l'accent sur la résistance et la flexibilité. D'autre part, les personnes âgées présentant 3 déficits ou plus selon le CHS-phénotype de fragilité devraient effectuer des exercices physiques 3 fois par semaine à raison de 30 à 45 minutes par séance et mettre l'accent sur l'entraînement aérobie. Au cours des séances d'entraînement aérobie, d'équilibre et de flexibilité, les personnes âgées frêles et au seuil de fragilité devraient effectuer des efforts de niveau 3-4 (« assez difficile ») sur l'échelle CR10 de Borg. On devrait effectuer les exercices contre résistance à un pourcentage du maximum estimé (« 1RM »). Les programmes devraient démarrer à 55 % 1RM (endurance) et progresser vers des intensités plus élevées, soit 80 ...

Frailty and quality of life in adult survivors of childhood cancer

“…Bray et al (Table 1) [14] recently proposed a literature based, structured exercise prescription for pre-frail and frail older adults that could be tested for efficacy among adult survivors of childhood cancer. This type of intervention is safe and has demonstrated preliminary efficacy to improve fitness in small samples of childhood sarcoma and ALL survivors.…”

“…In older adults and in childhood cancer survivors, frailty, represented by a constellation of three or more of: low lean muscle mass, muscle weakness, slow walking speed, low energy expenditure, and/or self-reported exhaustion, is associated with new onset of chronic disease and mortality. Additionally, in older adults, and in persons with chronic disease, frailty is associated with diminished quality of life [10, 11, 12, 13], an association that is heightened among persons who also have depression [14]. The association between frailty and quality of life, and the additional potential contribution of depression to this association have not been investigated among adult survivors of childhood cancer.…”

“…However, there are data suggesting that physical performance limitations, less than optimal fitness, and poor emotional health influence perceived well-being among adult survivors of childhood cancer. This is important because individual components of the frailty phenotype and problems with emotional health are amenable to rehabilitation efforts in older adults [15, 16, 17] and in those with chronic disease [14, 18]. Thus, among adult survivors of childhood cancer who are frail and/or who are experiencing depression, providing intervention has potential to prevent new onset chronic disease, extend lifespan, and improve overall quality of life.…”

Launching a new initiative

“…The most effective interventions are often multicomponent and interdisciplinary programs that capitalize on the older adult's remaining assets. Recommendations for exercise (Bray et al 2016) and nutrition (Laur et al 2017) interventions are already reported within APNM.…”

“…The recommendations for exercise to reverse frailty (Bray et al 2016) provide evidence to support a targeted, multi-component exercise strategy based upon the individual's level of frailty or frailty phenotype. For example, older adults transitioning toward frailty often do not recognize the subtle changes (sarcopenia, dynapenia, osteopenia) that reduce lower leg strength and increase fall risk.…”