Attenuating frailty in elderly using exercise and nutrition
Frailty can be seen as the weakening of health (defined as the resilience or capacity to cope and to maintain and restore one’s integrity, equilibrium, and sense of well-being in 3 domains: physical, mental, and social).
Clinically, it has been defined as a "multifactorial syndrome characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability to develop increased dependency and/or death".
Sarcopenia is the presence of low muscle mass plus low muscle function associated with aging.
Both these entities are strongly linked and the main predictors of negative health outcomes such as falls, disability, hospitalization, and death. They are considered treatable conditions that may be reversible.
But what are effective intervention options?
This overview of 10 selected reviews, evaluating thousands of community dwelling persons >65 yrs of age, suggests that resistance and balance exercise may be the first treatment step, with a possible effect of nutritional supplementation (mostly amino acid supplementation) added to exercise to improve outcomes.
Outcome measures were muscle strength (handgrip, knee extension), physical performance (5 m gait speed, TUGT), incidence of falls, and ADL status.
Description of the mode and intensity of exercise are highly variable (gait, balance, strength/ resistance training, vibration exercise), and thus the optimal exercise regimen to minimize frailty and sarcopenia remains uncertain. Nutrition recommendations currently include optimizing protein intake and correcting vitamin D insufficiency.
Exercise and nutritional interventions seem to be safe and are recommended from a public health point of view in older populations, both healthy or with a wide range of co-morbid problems. Therefore, there seem to be no clear reasons to avoid these interventions in frail or sarcopenic patients.
Do you provide your elderly patients with nutritional advice and what is your typical exercise intervention?
> From: Lozano-Montoya et al., Clin Interv Aging 12 (2017) 721-740. All rights reserved to The Author(s). Click here for the online summary.