Exercise and Frailty

Something you might want to try: Assessing strength and balance.

We know that physical activity can help people to maintain their functionality, independence, and quality of life, preventing and delaying some of the diseases which affect people as they age. The illnesses affected range from osteoporosis to cardiovascular disease and cognitive decline, as well as the syndromes which together can be described as frailty. Kidd, Mold, Jones et al, (2019) go further stating that physical activity interventions are the key to maintaining independence in pre-frail and frail older adults.

Older people tend to become less active – with 47% of people aged 75-84 being inactive, and 70% of those over 85 years. Over half of all inactive people across the UK are aged 55 and over.

Increasing physical activity has the potential to improve strength, decrease the risk of reduced bone mass, improve balance and overall fitness. Activity can also be an important way of reducing isolation and increasing well-being for older people. Improving strength and balance is particularly important to reduce falls, which are a common injury for older people and may lead to people no longer living independently at home. For advice about Falls Prevention from NHS Education for Scotland (NES) CLICK HERE

Evidence from NIHR suggests that a range of approaches may be effective in promoting exercise in older people, including both supervised exercise, from walking groups to dance classes, and behavioural approaches such as motivational counselling and tailored activity plans. They suggest that older people are more likely to keep exercising with group classes in a centre than through home-based activity. NIHR also suggest that there is a need for interventions that combine supervised exercise opportunities with an understanding of behavioural change principles as these are the most effective in increasing activity over time.

Increasing inactivity is also more likely in certain groups including women, smokers and those with a longstanding illness, depressive symptoms, arthritis, those who were obese, those with lower starting fitness or have weaker social networks. This suggests a need for more tailored approaches to get those people active. More effort also needs to be directed at these groups as they are the most likely to benefit and least likely to take part.

What Can You do to Promote Increased Activity

Firstly, you have to an awareness of what is available so the first issue to consider is “Are physically active social and group-based opportunities available for older people in your locality? If they are where are they and how do you refer people to go?

Secondly, this is a link to the Age Concern site “Being active as you get older” On the site is a lot of advice and links to other Age Concern resources that are designed to encourage older people to find the best way to keep their bodies moving. You will also find a resource designed for older people with one or more long term conditions called “We are Undefeatable” which is a good place to start. Note that if you follow that link you will also find Age Concern’s Falls Prevention advice.

Finally make use of the following acronym when promoting activity and reducing inactivity. F.I.T.T. This stands for start gently and build up your Frequency (the number of times per week you exercise) or Intensity (how hard you exercise) or Time (go for longer) or Type of exercise (e.g. build up from slow walking to brisk walking). Remember that the target is to get the person to be more active so any increase in activity no matter how it is achieved will be beneficial.

To help, here is something to try. It might not be useful for many people that you would identify as frail but anyone in a Pre-frail group may benefit from using this App. Its called iPrescribe and it creates a 12-week exercise plan based on health information entered by the user. It then sets the duration and intensity of the exercise based on this information. See https://www.nhs.uk/apps-library/iprescribe-exercise/

Some additional reading:

Academy of the Royal Medical Colleges (2015) Exercise: The miracle cure and the role of the doctor in promoting it. Available at: http://www.aomrc.org.uk/wp-content/uploads/2016/05/Exercise_the_Miracle_Cure_0215.pdf

Kidd, T., Mold, F., Jones, C. et al. (2019) What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials. BMC Geriatrics, 19, 184 doi:10.1186/s12877-019-1196-x

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