Physical Therapy to Address Frailty in the Older Population

Frailty is a common syndrome among older adults that involves loss of muscle strength, exhaustion, low levels of physical activity, and 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 help those with frailty restore overall mobility, strength, and cardiorespiratory capacity safely through a customized therapeutic exercise, strengthening, and balance training program.

What is Frailty?

Frailty is a common syndrome among older adults and is associated with an increased risk of falling, hospitalization, and disability. While it is more common in older adults, frailty can occur in people of any age due to trauma, disease, persistent pain, a reduction in physical activity, or having more than one chronic health condition (high blood pressure, diabetes, stroke, heart disease) as they age.

Inactivity is a major cause of frailty, which can cause weakness in all body systems and lead to loss of muscle strength and power, stiff joints, balance issues, and reduced aerobic capacity of the heart and lungs. Sarcopenia, which is a decrease in the amount and quality of muscle, is also a major contributor to frailty.

There are five factors of frailty:

• Unintended weight loss (losing more than 10 pounds in the last year)

• General feeling of exhaustion three or more days of the week

• Muscle weakness, or sarcopenia

• Slow walking speed

• Low levels of physical activity

If you have three of the five factors, you are considered to have frailty syndrome, whereas if you have one or two of the factors, you are in the “pre-frailty” category.

Frailty can be a vicious cycle. When you feel exhausted, you are more likely to not be physically active, which contributes to the loss of muscle and strength. When sarcopenia occurs (the quality and quantity of your muscle decreases), the cardiovascular system is also affected and your energy decreases. It then takes much more effort to move, so you move less. 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 to maintain their walking speed.

Physical Therapy for Frailty 

Physical therapy can help those with frailty restore overall mobility, strength, and aerobic capacity through a customized therapeutic exercise, strengthening, and balance training program. The physical therapist first conducts a thorough evaluation that involves a review of history and medications, gait speed and leg strength tests, muscle strength and grip strength evaluations, balance assessments, and distance walk tests to measure exercise capacity. Based on this assessment, the therapist designs a customized treatment program to address frailty.

Physical therapy for frailty can include:

• Flexibility exercises to stretch and lengthen tight muscles

• Progressive balance training program to improve dynamic balance and postural control

• Targeted strength training to improve muscular strength, power, and endurance, targeting the core, arms, and legs

• Aerobic training to enhance aerobic endurance and heart and lung capacity, e.g. walking, water aerobics, or cycling

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

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

• Home safety modification education

Research has shown that combining aerobic and strength training is effective in successfully treating frailty. For example, a study of 64 frail older men and women involving a nine-month program of strength training and walking exercise found that patients’ endurance increased, improving VO2 in patients by 14%. A study of frail patients in hospitals and nursing homes demonstrated that 10 weeks of resistance training increased muscle strength by 113%, whereas non-exercising patients only had a 3% increase.

A systemic review of exercise interventions for the management of frailty found that with respect to a specific type of exercise program, multicomponent training was found to have a more positive effect on the functional ability and adverse health consequences of individuals with frailty. Interventions lasting longer than five months seemed to result in greater benefits on the adverse health consequences of frail people. The duration for each session of exercise that was most beneficial was 30–45 minutes, which is less than what is usually recommended for healthier older adults.

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!