Frailty -a serious problem avoidable by diagnosis and positive action

You know the story: “Mum’s got a bit frail… Dad has difficulty getting up the stairs, now …?my folks don’t seem to be able to do much for themselves these days, it’s very sad to see”

This is frailty – a combination of loss of muscle [sarcopaenia] and loss of strength [dynopaenia] that causes adverse outcomes, eg difficulties in all activities of daily living, likelihood of osteoporosis and falls, also meaning higher risk of hospitalisation, a longer hospital length of stay and risk of re-admission if there is an illness. The final consequences are loss of independence and death sooner than might be expected. The good news is you can prevent it or recover from it.

Have I/ my parents/ my friends got it?

You can see loss of muscle in a thin person but not when someone has body fat obscuring the muscle: sarcopaenia doesn’t mean thinness. The critical thing is to test function. The distance walked in 6 minutes [or the speed of walking calculated from that]; how many times someone sitting on a dining chair can get up to full standing and sit down in 30 seconds; grip strength and if you can sit on the bottom step of your stairs and get up without using your hands are all good tests, taken together.

Why does it happen?

This is not an inevitable feature of age, by any means. The principal problem is couchpotato-ism i.e. doing less and less exercise and being ‘un-fit’. However, reduced sex hormone and growth hormone output are important too. For some, insufficient protein in their diet is a contributory factor. Both sex hormones, oestrogen and testosterone affect muscle growth and repair and both are reduced as we age and after menopause. Oestrogen is as important in men as women [men have more oestrogen in their bloodstream that an untreated postmenopausal woman]. As we all know, testosterone builds muscle [as in bodybuilder cheating] but as most people or doctors don’t, oestrogen slows muscle loss and enhances repair so both have a critical role.

Can He Fix it?

Just like Bob the Builder – yes he can! And so can you. A systematic review of all published randomised trials showed that sarcopenia could be reversed by combined physical exercise and protein/amino acid supplement combinations*. Separate trials show the impact of sex hormone replacement, Including one of my own published research papers**

'This approach works for prevention too.Exercise is needed to to improve function [strength] and be done consistently.?It needs to be combination of muscle strength building i.e. resistance training; such as squats, stair climbs etc that use body weight on machines or with weights in a gym or with Pilates or Yoga classes.?

?For the additional necessary aerobic exercise, activities such as swimming, walking [best done with Nordic Poles] or cycling will work and dancing is also a good option .?

?Critically the exercise needs to be ‘pretty tough’ i.e. an 8 out of 10 when10 is the maximum, but 3-4 activities a week for 30-40 minutes are enough - as long as there is consistency [and you find your strength is improving].?Joining a class or if you can afford it having a trainer [for a group of older people say] helps a great deal.?

?You should also be ensuring that you are reaching the necessary protein intake of 100 g per day, overall.

Summary

We can modify our exercise and diet to prevent frailty and initiate recovery for any one affected.

Resistance training, protein and/ or?amino acid supplements and possible hormone treatment should be considered.

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* Cruz-Jentoft A.J., Landi F., Schneider S.M., et al: Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 2014; 43: pp. 748-759

** S. K. Phillips, K. M. Rook, N. C. Siddle, S. A. Bruce, R. C. Woledge; Muscle weakness in women occurs at an earlier age than in men, but strength is preserved by hormone replacement therapy.?Clin Sci (Lond)?1 January 1993; 84 (1): 95–98. doi:?https://doi.org/10.1042/cs0840095