For the Health of It!

It is with great pride that we introduce this inaugural installment of our Senior Research Director’s new column, which will appear in each issue. To give our author feedback, contact her at the email listed at the end of the article.

Margaret Daniolovich

Fight the Frailty Syndrome: Get Checked and Get Moving!

It’s important to evaluate frailty in all people over the age of 70, and they should participate in exercise programs to improve muscle strength and aerobic endurance.

Many times, I have heard older adults with mobility challenges or who appear thin described as “frail.” However, for older adults, frail should not be used as an adjective. Instead, frailty is the correct term that refers to geriatric medical syndrome, a condition that affects approximately 20% of all older adults and up to 80% of nursing home residents. Frailty is characterized by a constellation of factors that reduce an individual’s capacity to withstand and recover from stressors. Functional deficits such as balance problems, weakness, decreased endurance, and reduced walking speed contribute to difficulties completing activities of daily living (ADLs) and further restrict physical activity capabilities. This accelerates frailty, limits health, and reduces independence. For this reason, the British Geriatrics Society recommends that all people over the age of 70 receive an assessment for frailty annually.

The frailty syndrome consists of five categories: exhaustion, involuntary weight loss, low physical activity, slow gait speed, and poor muscle strength. While there are more than 29 different frailty measures used in research and clinical practice, the FRAIL Scale is a five-item tool for people to screen their own frailty. Answering “yes” to three or more questions means a screening result of “frail” while “yes” answers to one or two questions identifies someone as “pre-frail.” The FRAIL Scale questions are:

  1. Are you fatigued?
  2. Do you have difficulty climbing one flight of stairs?
  3. Do you have difficulty walking one block?
  4. Do you have more than five illnesses?
  5. Do you have weight loss greater than 5% of body weight?

How to Reduce Frailty

Frailty intervention trials have tested pharmacotherapy, nutrition, exercise, and comprehensive medical programs, with exercise trials being the most consistently effective intervention. Given that recommendation, exactly how should you exercise to prevent or reduce frailty?

Resistance exercise is the primary mechanism for improving muscle strength which is reduced normally with aging and further decreased by frailty. Resistance exercise involves strength training in which you move your body against weights, resistance from a machine, or your own body weight. Certainly, the effect of resistance training may not be as robust in older adults with frailty compared to healthy or younger people, but those with frailty can nevertheless improve muscle strength in response to exercise. Age is not a reason to avoid strength-building exercises. For the optimal strength-building exercise, older adults should participate in resistance exercise two times per week, lifting heavy weights. The weights one uses should be approximately 70 to 80% of the most weight a person can lift at one time.

Despite the known benefits of resistance exercises to build strength, only 10% of older adults engage in this mode of exercise at the recommended dose of two times per week. As an intervention, walking addresses the frailty criteria of gait speed, physical activity, and fatigue, making walking an appropriate therapeutic target for decreasing frailty. However, much like resistance exercise, the intensity of activity matters. Older adults should strive for 150 minutes of aerobic activity each week that increase heart rate and breathing rates.

Pilot Study Result. In a small pilot study I conducted at Weinberg Community, five residents underwent a high-intensity walking intervention for 12 sessions over 6 weeks. At the end of the intervention, all residents had reduced or reversed their frailty and they improved all measures of their walking speed, cardiovascular endurance, and balance. The results from this study provided the data for my NIH-funded clinical trial in 10 retirement communities across Chicago and a Retirement Research Foundation clinical trial currently on-going at Weinberg Community.

The evidence is clear: all older adults, but particularly those with frailty, need to be more active! If you are unsure of how to get started being more active, consult with a physical therapist or a certified exercise professional. Any activity you do is better than sitting, but for the optimal health benefits, increase the intensity!

To submit ideas or questions for this column, please email Dr. Margaret Danilovich at