Exercise to prevent frailty

Prevention of Frailty through exercise Exercise is important for preventing frailty because muscle function and motor skills are the most important components affecting the physical frailty condition itself. As shown in the figure below, when healthy aging fails and motor skills deteriorate due to illness, nutritional abnormalities, and decreased activity, frailty eventually follows (Figure 1).

Figure 1. Frailty eventually appears as a result of decreased motor abilities, and treatment of frailty must be accompanied by improvement in motor abilities. Once frailty appears, the patient has little power to exercise and little power to move, and as the heart and muscles are not used, their functions deteriorates at a faster rate, which leads to a vicious cycle of frailty. As the patient`s physical strength deteriorates, they lose power to exercise even more, their cognitive function or mood worsens, their nutritional intake worsens, and finally their whole body conditions worsen.

Figure 2. Once the vicious cycle of frailty begins, the patient lose power to exercise, making them unable to exercise, and eventually their physical strength deteriorates even more. Therefore, in order to help the older people prevent the progress of frailty and have a healthy and strong old age, various studies have been conducted to create diverse exercise programs and to apply them in local communities, hospitals, and nursing homes (Fiatarone, 1994) First of all, in order to determine what kinds of beneficial effects of exercise on frailty have been demonstrated by the previous studies, the types of exercise required for the older people should be addressed. In general, exercise is categorized as aerobic exercise, such as long-distance running, which can increase cardiorespiratory endurance, and resistance exercise, such as lifting heavy dumbbells, which can increase muscle mass and improve muscle strength. However, almost all exercise includes both aerobic and anaerobic exercise components. Therefore, although classified either as aerobic exercise or resistance exercise, most exercises can improve both cardiorespiratory endurance and muscle strength/muscle mass. For this reason, most exercise programs for the older people tend to include both of these elements (Liu, 2011).

Figure 3. In general, exercise is categorized as aerobic exercise, which can increase cardiorespiratory endurance, and resistance exercise, which can increase muscle mass and improve muscle strength, but almost all exercise includes both aerobic and anaerobic elements, both of which are required for preventing frailty in the older people. First of all, aerobic exercise, sometimes referred to as endurance exercise, usually means continuing more than 10 minutes of exercise, mainly involving movement of large muscles, which includes not only exercises such as biking, walking, and swimming, but also household chores such as wiping with a cloth. It is recommended to exercise for at least 30 minutes at a time, 5~7 times a week, to the extent that the performer feels it a little difficult or that the heart rate reaches 40~60% of the maximum heart rate. Resistance exercise and muscle-strengthening exercise mean increasing muscle strength by utilizing body weight or other weights, or the contraction force of an elastic band, which are recommended to be performed at least 2-3 times a week. In addition, the lower extremity exercise is of special importance for the older people, as it is critical to maintain their ability to move on their own and to prevent falls. (e.g. standing up from sitting, standing on the heel, climbing stairs, etc.) In addition, balance exercise is also necessary to prevent falls that frequently occur as a result of frailty and can lead to fractures of the hip joints with poor prognosis (bed sores, hospitalization in nursing homes due to dysfunction, aspiration pneumonia due to bed-ridden life, and additional muscle weakness). Therefore, most exercise programs designed for the older people also include elements of balance exercise. (Shubert, 2011)

Figure 4. Balance exercise is also necessary to prevent falls The balance exercise includes static balance exercises that maintain balance in a non-moving state and dynamic balance exercises that reduce the supporting surface while moving as if walking on a virtual line. It is recommended to perform these exercises as often as possible by incorporating them into everyday life. There are also alternative ways to perform exercise that combines flexibility, muscle strength, and balance exercises, such as yoga and tai chi. So far, the results of the exercise or multi-faceted intervention studies on frailty that have been conducted overseas showed that when interventions, including exercise, were applied to people even with some frailty condition for 6~12 months, their motor ability and frailty index improved. Among those studies, the well-known LIFE-P study conducted in the United States showed improvements in overall physical function (including walking speed, muscle strength, and sense of balance) of 424 participants during the 12-month program (LIFE-P study group, 2006). In addition, in a study recently conducted in 241 older people in Australia, a trend of improvements in frailty indices and physical function was observed. (Cameron, 2013); similar studies have been conducted in various parts of the world, including Singapore (Ng et al, 2015) and Spain (Tarazona-Santabalbina, 2016). Contrary to past perceptions, new perceptions that the progress of frailty can be delayed by employing multiple methods that combine exercise, nutrition, etc. and that health can be regained at least to some extent are developing. To date, nonetheless, there is lack of research on what kind of exercise Korean older people need in order to prevent frailty. In recent years, research on frailty interventions, including community-based exercises, has been conducted in Pyeongchang (https://youtu.be/pB-gW0N9Atg), and the Korean Frailty and Aging Cohort Study (KFACS, http://www.kfacs.kr/) is currently conducting research to establish evidence required for the creation of national-based guidelines. To older people, exercise is often difficult to start on their own, and they are often afraid to start exercise on their own when their physical strength is declining. However, as introduced above, various intervention studies are underway, based on which more and more exercise programs that many older people can participate in are increasing through various medical institutions, health centers, and communities. Now, frailty can be overcome with certainty.