Physical Activity and Frailty: What do we Know?
Physical activity is as an umbrella term for being active. It includes exercise (a planned, structured, repetitive and deliberate program) as well as leisure time activities.
Everyone benefits from physical activity:
- Adults at risk of frailty and those living with frailty
- Adults living in long term care, including those at the extremes of age
- Hospitalized adults, including those who are critically ill
Experimental trials have shown that even individuals living with frailty can improve their physical function, helping them to minimize and delay aging-related declines. Aerobic, muscle-strengthening, and multi-component physical activity programs all demonstrate benefits. The improvements appear to be somewhat greater with activity programs that include specific muscle strengthening and balance training activities.
Physical activity has many benefits. Even moderate but regular exercise can produce improvements, and adjusting exercises for your ability and fitness levels is important.
- Improves ability to perform daily tasks
- Helps prevent weak bones and muscle loss
- Improves joint mobility
- Improves sleep quality
- Reduces the risk of chronic conditions
- Extends years of activity and independent living
- Lowers risk of dementia
- Reduces likelihood of falling and risk of serious injury if you do fall
There is well-documented evidence that muscle strength decreases with advancing age. Muscle strength decreases approximately 12% to 15% each decade after the age of 50 in both males and females.
Many people know that strength training can help build and maintain muscle mass and strength even into old age. What many of us don’t know is that strong muscles also keep our bones strong. Stronger bones are less likely to break as we age, and keeping our muscles and bones strong is very important for mobility into old age.
The effect of physical activity on physical function is of high importance to older adults living with frailty. Evidence suggests the effects of physical activity are greater in older adults living with frailty compared to non-frail older adults.
Multi-component physical activity training is better than any one type of activity. Multi-component activities include a combination of activity types, such as:
Aerobic exercise (or endurance activities):
- Gets your heart pumping and supplies oxygen to your brain and organs
- Involves many repetitions and use of large muscle groups: walking, jogging, swimming, cycling, taking a dance class, pushing a lawn mower
- Aim to do these at least 20-30 minutes per day at a moderate intensity
- Make muscles do more work than they are used to doing during activities of daily living
- Weight training with free weights, weight machines, resistance bands or even just your own body weight
- Aim to do strength exercises 2 days/week
- Key to building strength is that you must make your exercise program more difficult week by week and month by month. This is called progression.
Possible ways to challenge yourself with muscle-strengthening activities:
- Increase the number of repetitions (but no more than 12)
- Increase the number of sets
- Increase the resistance
- Increase the number of muscle groups or exercises
- Resistance exercise training has been found to increase strength in older adults. In fact, there have been multiple studies demonstrating that these changes can occur even into one’s 90s
- Stretches your muscles to help your body stay flexible
- Being flexible gives you more freedom of movement, which benefits your everyday activities and other forms of exercise
- Challenge your flexibility and balance with exercises like yoga, leg raises, swimming, and tai chi
- Strengthens the muscles that help keep you upright, including your legs and core
- These kinds of exercises can improve stability and help prevent falls
- Trains your muscles to work together and prepares them for daily tasks by reproducing common movements you might do during everyday living
- Involves using various muscles in the upper and lower body at the same time
How Can I Get Active?
Health Canada recommends that older adults take part in physical activity at least 2.5 hours per week—so thirty minutes each day—which you can break into 10 minute intervals: minutes count!
Innovations Presented at CFN’s Annual Conference
ABLE –Arts-Based exercise enhancing LongEvity (p. 16)
Elders in Motion (p. 29)
Canadian Society for Exercise Physiology
Sarcopenia & Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT Trial)
International Osteoporosis Foundation
NWT Recreation & Parks Association
Heart and Stroke Foundation of Canada
Ottawa Public Health
National Institute on Aging
Active Aging Canada
2018 Physical Activity Guidelines Advisory Committee. (2018). 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services. Retrieved from https://health.gov/paguidelines/second-edition/report/
Binder, E. F., Yarasheski, K. E., Steger-May, K., Sinacore, D. R., Brown, M., Schechtman, K. B., & Holloszy, J. O. (2005). Effects of progressive resistance training on body composition in frail older adults: Results of a randomized, controlled trial. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 60(11), 1425-1431. doi: 10.1093/gerona/60.11.1425
Centers for Disease Control and Prevention. (1999). A report of the surgeon general: Physical activity and health, older adults. [Website]. Retrieved from https://www.cdc.gov/nccdphp/sgr/olderad.htm
Cesari, M., Vellas, B., Hsu, F. C., Newman, A. B., Doss, H., King, A. C., Manini, T. M., Church, T., Gill, T. M., Miller, M. E., & Pahor, M. (2015). A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 70(2), 2216-222. doi: 10.1093/gerona/glu099
Crocker, T., Forster, A., Young, J., Brown, L., Ozer, S., Smith, J., Green, J., Hardy, J., Burns, E., Glidewell, E., & Greenwood, D. C. (2013). Physical rehabilitation for older people in long-term care. Cochrane Database Systematic Review. (2). doi: 10.1002/14651858.CD004294.pub3
de Souto Barreto, P., Morley, J. E., Chodzko-Zajko, W., H Pitkala, K., Weening-Djiksterhuis, E., Rodriguez-Mañas, L., Barbagallo, M., Rosendahl, E., Sinclair, A., Landi, F., Izquierdo, M., Vellas, B., & Rolland, Y. (2016). Recommendations on physical activity and exercise for older adults living in long-term care facilities: A taskforce report. Journal of the American Medical Directors Association, 17(5), 381-392. doi: https://doi.org/10.1016/j.jamda.2016.01.021
Ferri, A., Scaglioni, G., Pousson, M., Capodaglio, P., Van Hoecke, J., & Narici, M. V. (2003). Strength and power changes of the human plantar flexors and knee extensors in response to resistance training in old age. Acta Physiologica Scandinavica, 177(1), 69-78. doi: 10.1046/j.1365-201X.2003.01050.x
Fiatarone, M. A., Marks, E. C., Ryan, N. D., Meredith, C. N., Lipsitz, L. A., & Evans, W. J. (1990). High-intensity strength training in nonagenarians: Effects on skeletal muscle. The Journal of the American Medical Association, 263(22), 3029-3034. doi: https://doi.org/10.1001/jama.1990.03440220053029
Fiatarone, M. A., O’Neill, E. F., Ryan, N. D., Clements, K. M., Solares, G. R., Nelson, M. E., Roberts, S. B., Kehayias, J. J., Lipsitz, L. A., & Evans, W. J. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. The New England Journal of Medicine, 330(25), 1769-1775. doi: 10.1056/NEJM199406233302501
Kho, M. E., Molloy, A. J., Clarke, F. J., Reid, J. C., Herridge, M. S., Karachi, T., Rochwerg, B., Fox-Robichaud, A. E., Seely, A. J. E., Mathur, S., Lo, V., Burns, K. E. A., Ball, I. M., Pellizzari, J. R., Tarride, J. E., Rudkowski, J. C., Koo, K., Heels-Ansdell, D., & Cook, D. J. (2019). Multicentre pilot randomised clinical trial of early in-bed cycle ergometry with ventilated patients. BMJ Open Respiratory Research, 6(1), e000383. doi: 10.1136/bmjresp-2018-000383
Kredlow, M. A., Capozzoli, M. C., Hearon, B. A., Calkins, A. W., & Otto, M. W. (2015). The effects of physical activity on sleep: A meta-analytic review. Journal of Behavioral Medicine, 38(3), 427-449. doi: 10.1007/s10865-015-9617-6
Landi, F., Abbatecola, A. M., Provinciali, M., Corsonello, A., Bustacchini, S., Manigrasso, L., Cherubini, A., Bernabei, R., & Lattanzio, F. (2010). Moving against frailty: Does physical activity matter? Biogerontology, 11(5), 537-545. doi: 10.1007/s10522-010-9296-1
Larsson, L. (1983). Histochemical characteristics of human skeletal muscle during aging. Acta Physiologica Scandinavica, 117(3), 469-471. doi: https://doi.org/10.1111/j.1748-1716.1983.tb00024.x
Lindle, R. S., Metter, E. J., Lynch, N. A., Fleg, J. L., Fozard, J. L., Tobin, J., Roy, T. A., & Hurley, B. F. (1997). Age and gender comparisons of muscle strength in 654 women and men aged 20-93 yr. Journal of Applied Physiology, 83(5), 1581-1587. doi: 10.1152/jappl.19188.8.131.521
Liu, C. K., & Fielding, R. A. (2011). Exercise as an intervention for frailty. Clinics in Geriatric Medicine, 27(1), 101-110. doi: 10.1016/j.cger.2010.08.001
McCartney, N., Hicks, A. L., Martin, J., & Webber, C. E. (1995). Long-term resistance training in the elderly: effects on dynamic strength, exercise capacity, muscle, and bone. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 50(2), B97-104. doi: 10.1093/gerona/50a.2.b97
McCartney, N., Hicks, A. L., Martin, J., & Webber, C. E. (1996). A longitudinal trial of weight training in the elderly: Continued improvements in year 2. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 51(6), B425–433. doi: 10.1093/gerona/51a.6.b425
National Institute on Aging. (2004). Exercise: A guide from the National Institute on Aging. [Website]. Retrieved from https://www.onhealth.com/content/1/exercise_for_seniors#toca
Public Health Agency of Canada. (2019). Physical activity tips for older adults (65 years and older). [Website]. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/physical-activity-tips-older-adults-65-years-older.html
Puts, M. T. E., Toubasi, S., Andrew, M. K., Ashe, M. C., Ploeg, J., Atkinson, E., Ayala, A. P., Roy, A., Rodríguez Monforte, M., Bergman, H., & McGilton, K. (2017). Interventions to prevent or reduce the level of frailty in community-dwelling older adults: A scoping review of the literature and international policies. Age and Ageing, 46(3), 383-392. doi: 10.1093/ageing/afw247
Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J. C. T., & Lord, S. R. (2017). Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine, 51(24), 1750-1758. doi: 10.1136/bjsports-2016-096547
These are general health guidelines and should not be considered personal medical advice. Speak to your doctor before starting any new exercise programs. You should consult your health care provider and discuss each element outlined above to ensure that each element of the AVOID Frailty campaign is personally customized for you.