Frailty Syndrome: How Physical Therapy Can Help [Infographic]

Frailty is a common syndrome among older adults that involves loss of muscle strength, exhaustion, low levels of physical activity, and an increased risk of falling. Inactivity and the subsequent sarcopenia, or a decrease in the amount and quality of muscle, is a major cause of frailty in older adults. Physical therapy can play a critical role in helping those with frailty restore overall mobility, strength, and aerobic capacity through a customized therapeutic exercise, strengthening, and balance training program. Check out our infographic on how physical therapy can help address frailty syndrome to learn more!

Understanding Frailty Syndrome

Frailty is a common syndrome among older adults that involves loss of muscle strength, exhaustion, low levels of physical activity, and an increased risk of falling. Older adults can become frail due to a trauma like a broken hip, chronic disease like diabetes or heart disease, persistent pain from arthritis, or an overall reduction in physical activity. Those who have more than one chronic health condition are more likely to become frail as they age.

Inactivity and the subsequent physical deconditioning that results from that is a major cause of infertility. Research has shown that spending eight or more days in the hospital over a one-year period is linked to loss of leg strength in otherwise healthy aging adults. Inactivity can cause weakness in body systems and leads to loss of muscle strength and power, stiff joints, balance problems, and reduced aerobic capacity of the heart and lungs.

Sarcopenia can develop, which is a decrease in the amount and quality of muscle, which lowers energy and can cause older adults to exert more effort for simple movements. For example, those with less leg strength and muscle mass exert nearly 90% of their energy reserve to maintain their walking speed, whereas those that are stronger only use 64% of their energy reserve to maintain their walking speed.

When diagnosing frailty syndrome, physicians assess five common factors of frailty: 1) unintended weight loss (losing more than 10 pounds in the last year), 2) general feeling of exhaustion three or more days of the week, 3) muscle weakness, or sarcopenia, 4) slow walking speed, and 5) low levels of physical activity. If an older adult has three of the five factors, they are diagnosed with frailty syndrome; if they have one or two factors, they are placed in the “pre-frailty” category.

Common signs of frailty include:

• Severe fatigue, weakness, and exhaustion

• Low energy

• Weight loss

• Difficulty standing, sitting, and walking

• Trouble sitting out of bed or out of a chair without help

• Inability to perform simple household tasks

• Poor balance or fear of falling

• Inability to work or socialize with friends

Physical Therapy for Frailty Syndrome

Physical therapy can play a critical role in helping those with frailty restore overall mobility, strength, and aerobic capacity through a customized therapeutic exercise, strengthening, and balance training program. The therapist designs a personalized treatment program following a thorough evaluation that involves a review of medical history and medications and an assessment of gait speed, leg strength, muscle and grip strength, balance, and distance walk tests to measure exercise capacity.

Physical therapy for frailty syndrome can include:

• Flexibility exercises to stretch and lengthen tight muscles

• Progressive balance training program to improve dynamic balance, postural control, and reduce the risk of falling

• Targeted strength training to improve muscular strength, power, and endurance, specifically targeting the core and hips for a strong base of support and the legs to enhance walking gait and power

• Aerobic training to enhance aerobic endurance and heart and lung capacity, such as walking, water aerobics, or stationary cycling

• Range of motion exercises to gently guide joint movement and increase joint mobility

• Use of heat, ice, manual therapy, and deep heat ultrasound to reduce and manage pain

• Home safety modification education to reduce fall risk, such as removing loose rugs, clearing clutter, or adding grab bars in the bathroom

Research has shown that exercise can improve physical function and reduce frailty progression in frailty syndrome patients. Current clinical guidelines strongly recommend that older adults with frailty undergo a progressive individualized exercise program based on high-intensity resistance training, complemented by balance and aerobic training under the supervision of a physical therapist. High-intensity resistance training enhances muscle strength and mobility and addresses fall risk. The resistance training program should engage major upper and lower body muscle groups that are crucial for function and mobility, incorporating leg press and chess press exercises, as well as single-muscle group strength training targeting the triceps, knee extensors, and hip abductors.

Balance exercises are also an important aspect of a frailty syndrome exercise program and should focus on key muscles critical for functional performance, particularly muscles of the spine and hips. Balance training should involve activities that challenge center of gravity control, multisensory training, postural strategy enhancements, and gait pattern variations. Aerobic training is another key component of a frailty syndrome exercise program and should be a progressive program, slowly rebuilding the individual’s heart and lung capacity through gradually more demanding aerobic activities, from water aerobics to cycling to walking.

Are you or a loved one experiencing signs of frailty? Start working with a physical therapist today to regain strength and function and return to the activities you love!