Frailty again

The outcome of all I have been discussing over the past few blogs is the frailty of old age – the condition which eventually assails the under active. If you fall into that gap in life, alarmingly labelled “terminal morbidity” (between the end of healthspan and the end of life), you probably suffer one of the common diseases of old age – the non-communicable diseases. And  you are almost certainly “frail”. Frailty is, I believe, the most important condition of later life for causing illness, disability, dependence and unnecessary cost for both the individual and for society as a whole.

Sarcopenia

Frailty is caused by physical unfitness and sarcopenia. The derivations are “Sarco-” (a Greek root word meaning “flesh” or “muscle) and “- penia” (a suffix of Greek origin, from penía, meaning poverty,  that signifies a lack of a particular substance or cell type). Sarcopenia is therefore a progressive loss of muscle mass and strength leading to impaired physical function. It is promoted by increasing age, inactivity and chronic illness.

Sarcopenia is in effect a disease of muscles, not only a reduction in muscle bulk but also a decrease in function caused by degenerative changes such as fat infiltration and fibrosis (scarring). Sarcopenia not only hampers day-to-day activities but also increases the risk of falls , fractures, the risk of heart disease, the need for long-term care and all cause mortality. Sarcopenia doubles the cost of hospital costs for those who need admission. It also significantly delays discharge from hospital following both planned and emergency admission.

What does the future hold?

The outlook is not good. Decreasing physical activity in later life together with the projected increase in the number of elderly people mean an inevitable increase in frailty in the coming decades. A recent study of the physical abilities of past generations at particular ages was sobering. The analysis of data on more that 100,000 people from several generations in England, the US and Europe revealed that “baby boomers” born after WW2 were about 150% more likely to suffer cancer, lung disease and heart problems when they were in their 50s and 60s  than were those born before the War were at the same age. This trend is likely to continue with Gen Z being more likely to be obese and have diabetes than are baby boomers.

What can be done?

The modern treatment of medical problems is medication – “a pill for every ill”. However, no medication has ever been shown to prevent or treat sarcopenia. It is only physical exercise which has been found to improve such aspects of sarcopenia as muscle strength, muscle quantity and quality and physical performance, particularly the ability to perform activities of daily living.

What sort of exercise?

A recent meta-analysis (gathering data from a number of different studies) of exercise regimes for people with sarcopenia has helped to point the way. The study team found that any form of physical exercise improved physical performance and muscular strength but that resistance-based interventions were the more effective in both cases. Perhaps the DoH needs to update its exercise recommendations and increase the emphasis on strength based training versus aerobic exercise?

Mr Google provides an endless list of possible strengthening or resistance training programmes. It seems to me that the ideal regime consists of a set of exercises which use a wide variety of muscle groups, which need little equipment and which can be completed quickly every day – for me, preferably first thing to get the pesky thing out of the way. One possible set is:

1. Sit to Stand Squats

Target Muscles: Quadriceps, Hamstrings, Glutes

Sit on the edge of a sturdy chair with feet flat on the floor, hip-width apart.
Cross your arms over your chest or extend them in front of you for balance.
Lean forward slightly from your hips and press through your heels to stand up.
Slowly sit back down, controlling the movement.

Perform 2-3 sets of 10-15 repetitions.

2. Push-Ups (Modified)

Target Muscles: Chest, Shoulders, Triceps

Start in a plank position with your hands slightly wider than shoulder-width apart. For a modified version, place your knees on the ground.
Lower your body toward the ground by bending your elbows, keeping your body in a straight line from head to knees/toes.
Push through your palms to return to the starting position.

Perform 2-3 sets of 8-12 repetitions.

3. Dumbbell Rows

Target Muscles: Upper Back, Biceps

Stand with feet hip-width apart, holding a dumbbell in each hand, palms facing the body.
Bend at the hips slightly, keeping your back straight and core engaged.
Pull the dumbbells towards your hips, squeezing your shoulder blades together.
Slowly lower the dumbbells back to the starting position.

Perform 2-3 sets of 10-12 repetitions.

4. Standing Calf Raises

Target Muscles: Calves

Stand with feet hip-width apart, using a chair or wall for balance if needed.
Slowly raise your heels off the ground as high as possible, feeling the contraction in your calves.
Hold for a second, then slowly lower your heels back to the ground.
Perform 2-3 sets of 12-15 repetitions.

Cool-Down

End each session with a 5 minute cool-down of comfortable walking and stretching, focusing on the muscles worked during the exercises.

And listen to your body – if any of the exercises cause pain, stop!