Physical activity and exercise: Strategies to manage frailty

Abstract

Frailty, a consequence of the interaction of the aging process and certain chronic diseases, compromises functional outcomes in the elderly and substantially increases their risk for developing disabilities and other adverse outcomes. Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems. And, though frailty and sarcopenia are related, they are two different conditions. Thus, strategies to preserve or improve functional status should consider systemic function in addition to muscle conditioning. Physical activity/exercise is considered one of the main strategies to counteract frailty-related physical impairment in the elderly. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity. Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work. Each type improves different aspects of physical functioning, though they could be combined according to need and prescribed as a multicomponent intervention. Therefore, exercise intervention programs should be prescribed based on an individual's physical functioning and adapted to the ensuing response.

Highlights

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  Intrinsic capacity close to disability threshold and low potential recovery due to low functional reserve lead to frailty.

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  Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems.

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  Exercise reduces age-related oxidative damage and inflammation and improves mitochondrial function among other benefits.

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  Multicomponent intervention should be considered in order to impact different aspects of physical function in the elderly.

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  Exercise interventions should be prescribed based on individual’s physical functioning and adapted to the ensuing response.