What interventions reduce frailty syndrome?

From the Guidelines

Regular physical exercise, particularly resistance training and multicomponent exercise programs, is the most effective intervention to reduce frailty, as evidenced by a recent narrative review of leading journals in geriatrics and gerontology 1.

Key Interventions to Reduce Frailty

The following interventions have been shown to effectively reduce frailty:

• Regular physical exercise, including resistance training and multicomponent exercise programs combining strength, balance, and endurance activities for 30-45 minutes, 2-3 times weekly 1
• Proper nutrition, focusing on adequate protein intake (1.0-1.5 g/kg/day), vitamin D supplementation (800-1000 IU daily) for those with deficiency, and overall caloric sufficiency to maintain muscle mass
• Addressing polypharmacy by regularly reviewing and reducing unnecessary medications to minimize adverse effects that contribute to frailty 1
• Treating underlying medical conditions such as cardiovascular disease, diabetes, and depression, which can accelerate frailty progression
• Cognitive stimulation through social engagement and mental activities to maintain cognitive function, closely linked to physical frailty
• Preventive care, including vaccinations, vision and hearing assessments, and fall prevention strategies

Novel Exercise Modes

Novel exercise modes that have been reported to improve physical functioning in older adults with frailty include:

• Dance 1
• Inspiration and body vibration training 1
• Muscle power training (high speed resistance training) 1
• Computerised-based programs (e.g., delivered on a tablet computer) 1
• Tai Chi 1
• Exergames, which involve technology-based exercise that requires physical activity to play 1

Multidimensional Interventions

Multidimensional interventions that combine exercise/physical activity and/or nutritional intervention with one or more additional interventions, such as medication management, pharmacotherapy, and psychosocial intervention, have been shown to prevent progression to frailty in pre-frail adults aged 80 years and over 1. Home-based exercises combined with health education and telephone support have been found to reduce sedentary behavior in older adults with frailty 1.

From the Research

Interventions to Reduce Frailty

Several interventions have been identified to reduce frailty in older adults, including:

• Physical activity and exercise, which can improve functional status and reduce age-related oxidative damage and chronic inflammation 2
• Multicomponent physical exercise programs, such as the Vivifrail program, which aim to maintain mobility, musculoskeletal function, and optimal function of other body systems 3
• Prehabilitation, which includes physical therapy, exercise, and home modifications, has been shown to significantly reduce the number of frailty markers present or the prevalence of frailty 4
• Comprehensive geriatric assessment (CGA), although the findings are mixed 4

Types of Exercise Interventions

Different types of exercise interventions have been studied, including:

• Resistance training, which appears to be beneficial for improving muscular strength, gait speed, and physical performance 5
• Aerobic training, which can improve cardiovascular function and reduce the risk of chronic diseases 2
• Balance and flexibility training, which can improve mobility and reduce the risk of falls 5
• Multicomponent exercise programs, which combine different types of exercise and appear to be the most effective way to improve physical function parameters in frail older people 5

Characteristics of Effective Exercise Interventions

The characteristics of effective exercise interventions for frail older adults are not yet fully understood, but the following have been identified:

• Frequency: 2-3 times per week 5
• Duration: 10-90 minutes per session, with a total duration of 5-72 weeks 5
• Intensity: moderate to high intensity exercise appears to be more effective than low intensity exercise 5
• Combinations: multicomponent exercise programs that combine different types of exercise appear to be more effective than single-component programs 5