Frailty – prevention

In my last blog I defined (rather imprecisely) frailty but I failed to tell you how you might check yourself for the condition. So here are a couple of tests to use if you think that you may be getting frail or be at risk:

1. Walking speed. Time yourself over a measured distance or, if you have a smart watch or smart phone, let them do it for you. You need to walk as fast as you can for a mile. Anything over 1 and 3/4 mph and you are not frail. Anything under 1 and 1/4 mph and you probably are.
2. Get up and go test. You need a watch with a second hand. Sit in a chair without arms. Get up and walk three paces, turn round and return to the chair and sit down. Under 10 seconds is fine, over 20 seconds is characterestic of frailty. Between 10 and 20 seconds indicates probable “pre-frailty”.

Causes of frailty

The main cause of frailty is a combination of muscular weakness and physical unfitness. The two are closely related and nearly always combined. They also share a root cause – a lack of exercise over a prolonged period causing loss of muscle mass and strength known as sarcopenia. This is often down to one or more of the degenerative conditions of later life which include high blood pressure, heart disease, stroke, type 2 diabetes, Parkinson’s disease, dementia, osteoarthritis and so on and so on. All of these conditions are more common in people who take little exercise – and thus have low levels of physical fitness to start with. All these conditions also impede normal levels of physical activity and thus aggravate unfitness.

As we age we all lose muscle mass and our physical fitness declines. If we start as unfit and then develop one of the diseases which further reduces activity we are sitting ducks for frailty.

This week’s illustration shows the progression of physical fitness throughout life. We get fitter over the first 20 or so years – then in our mid twenties we start to decline, losing about one to two percent of our functional capacity each year. This loss of fitness happens to us all but the rate of loss is much greater in sedentary people than in active people. Those who take plenty of exercise  delay the rate of loss of capacity so that they might never reach the point of dependency, illustrated by the straight line in the lower part of the graph.

Prevention of frailty

Aerobic exercise

The recommendations of the Department of Health in the UK and most other “westernised” countries is that we should take moderately vigorous exercise for 150 minutes per week in bouts of ten minutes or more – or about half an hour on five days a week. Moderate exercise can include brisk walking, bicycling, playing doubles tennis, playing golf, swimming and water aerobics, dancing, lawn mowing etc, etc. These efforts should make you a bit short of breathe but you would be able to talk but not sing.

Alternatively take 75 minutes per week of vigorous exercise – running, hard swimming, hard cycling, playing such games as football, netball or hockey, skipping, training in the gym, stair climbing etc, etc. These should make you significantly breathless – you would not be able to hold a conversation.

Muscle strengthening exercise

The DoH recommends doing muscle strengthening on two days per week. Examples include  weight lifting, pilates, heavy gardening, using resistance bands, push ups and sit ups etc, etc.

Is this enough?

Well, yes – sort of. This level of exercise is a compromise. The more exercise you take the greater the benefit, though the steepest part of the exercise/benefit curve is the beginning, going from doing nothing to doing something. Thereafter the slope of the curve decreases so that as you increase your effort you get less bangs for your bucks.

So, the recommended levels of exercise take into account how well the recommendations are likely to be followed. Set at easily managed levels they are more likely to be followed than if the targets are increased to a level which most are unlikely to wish to follow. However, remember that more is better – if you can be bothered!

Next week

I will move on to how much exercise we take – and some possible regimes