How to Become Anti-Frail: The Importance of Physical Fitness

“You live as if you were destined to live forever, no thought of your frailty ever enters your head.”

― Lucius Annaeus Seneca

What is Frailty?

Alas, as you age, you risk become frail.

Frailty increases as you get older because advancing age incrementally impairs the function of your organs. As a result, your ability to respond to everyday stressors is reduced, which greatly increases your chance of becoming sick or disabled (1).

For example, frail adults are at high risk of suffering a disability, falls, worsening mobility, low quality of life, cognitive decline, hospitalization, nursing home admission, and death (1)!

The obvious conclusion is that frailty sucks, and you should do your best to avoid it.

Frailty is a Syndrome, Not a Disease

Before we go on, it’s worth highlighting the difference between a syndrome versus a disease.

A syndrome is ‘a recognizable complex of symptoms and physical findings which indicate a specific condition for which a direct cause is not necessarily understood’ (2).

In contrast, a disease has (i) a well-characterized mechanism, (ii) clearly identifiable diagnostic features and disease progression, and importantly (iii) response to specific treatments (2).

Frailty is largely the result of aging (1, 3, 4), although lifestyle and genetics do play an important role. Because we don’t fully understand the interactions between these complex processes, frailty is currently classified as a syndrome.

The Link Between Physical Fitness and Frailty

Frailty can be clinically diagnosed using five criteria (6). These are (i) low grip strength, (ii), low energy, (iii) slowed waking speed, (iv) low physical activity, and (v) unintentional weight loss (6).

Intriguingly, these diagnostic criteria are tightly linked to your state of physical fitness. Consider that being strong, fast, active, and having high energy levels while maintaining a healthy weight all indicate that you are physically fit.

This suggestive relationship between physical fitness (or lack thereof) and frailty prompted Dr. Casajús and Colleagues to analyze twenty independent studies and interrogate exactly how physical fitness correlates with frailty (5).

This is an important question because it redefines frailty from an untreatable syndrome to a cluster of treatable diseases (5). This in turn lays a foundation for developing new therapies to treat and prevent frailty.

What the Researchers Found

1. Strength

The Author’s found a strong correlation between low lower-body strength and frailty (5). They also demonstrated a significant correlation between low upper-body strength and frailty (5).

Handgrip strength is convenient, reproducible, and provides a good estimate of overall strength. Reassuringly, the Author’s also found that frail individuals also tended to have low grip strength (5) and that this correlated well with poor lower-body strength (5).

In conclusion, frailty is strongly associated with poor overall body strength. Notably, frail people tend to have particularly weak legs, which greatly reduces their mobility and increases their risk of falling.

2. Aerobic Fitness

Three studies assessed the relationship between aerobic capacity and frailty (5). All three studies found a strong link between low aerobic fitness and frailty (5), suggesting that frail people have a reduced level of aerobic fitness compared to non-frail individuals (5).

3. Flexibility

The Authors analyzed three studies that measure flexibility in frail and non-frail individuals. Two studies showed that frailty is indeed associated with a loss of flexibility. However, the third study did not (5). Although this suggests that frailty is associated with the loss of flexibility, more studies are required to confirm this correlation (5).

4. Balance

Eight separate studies assessed balance in frail and non-frail individuals (5) . All of the studies were consistent in showing that frail individuals tend to have worse balance than non-frail individuals (5). Thus, we can conclude that frail individuals often have an impaired sense of balance.

5. Walking Speed

The Author’s assessed two measures of walking speed, usual walking speed, and maximal walking speed. Importantly, both are reduced in frail individuals (5). Therefore, we can conclude that frail people display an impaired walking ability compared to non-frail individuals.

Take Home Message

Frail people are physically unfit. They display a marked reduction in strength, aerobic capacity, balance, and walking speed, and likely reduced flexibility (5).

The link between frailty and reduced physical fitness is important because it suggests that improving your physical fitness may reduce or even prevent your chances of becoming frail.

In our next anti-frail article, we will explore how resistance training can help you avoid frailty and stay fit and healthy into old age.    

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References and Further Reading

1.            E. O. Hoogendijk et al., Frailty: implications for clinical practice and public health. Lancet 394, 1365-1375 (2019)

2.            F. Calvo, B. T. Karras, R. Phillips, A. M. Kimball, F. Wolf, Diagnoses, syndromes, and diseases: a knowledge representation problem. AMIA Annu Symp Proc 2003, 802 (2003).

3.            C. López-Otín, M. A. Blasco, L. Partridge, M. Serrano, G. Kroemer, The hallmarks of aging. Cell 153, 1194-1217 (2013).

4.            G. V. Mkrtchyan et al., ARDD 2020: from aging mechanisms to interventions. Aging (Albany NY) 12, 24484-24503 (2020).

5.            D. Navarrete-Villanueva et al., Frailty and Physical Fitness in Elderly People: A Systematic Review and Meta-analysis. Sports Med 51, 143-160 (2021).

6.            L. P. Fried et al., Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56, M146-M157 (2001).

Acknowledgements

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