Exercise Deficiency Diseases of Ageing: The Primacy of Exercise and Muscle Strengthening as First Line Therapeutic Agents to Combat Frailty

Norman R Lazarus, Mikel Izquierdo, Irene J Higginson, Stephen D. R. Harridge. J Am Med Dir Assoc. 2018 Sep;19(9):741-743

In the management of older patients, frailty has emerged as one of the most relevant clinical syndromes which will exponentially increase with population ageing. Despite no strict definition, it is clear that that frailty describes a distinctive ageing-related health state in which multiple body systems gradually lose their in-built physiological reserves. It has attracted increasing interest due to its direct relationship with adverse health effects such as physical and mental functional decline, institutionalization, disability, hospitalization, quality of life, morbidity and increased mortality. Accordingly, the treatment of frailty should be focused on improvement in overall functionality, as opposed to the diagnosis and treatment of specific diseases.

Inactivity has, in particular, been shown to be a major contributor to one of the core components of frailty, namely the loss of skeletal muscle mass and functional decline (i.e. sarcopenia). The detrimental effects of exercise removal (including enforced bed rest) on these physiological systems can be compared to the symptomatology that is presented by patients with diagnosed frailty. As the benefits of exercise are global, exercise deficiency will have effects not only on systems that are traditionally thought of as being exercise dependant, but also on more remote systems mimicking the mosaic of presenting symptoms in frailty. With continued lack of physical activity second and third systems failure are inevitable as the toxic mix of inactivity, poor diets, pain and if present, breathlessness, negatively impact and distort the trajectory of the inherent ageing process. The parallels that exist between frailty and exercise deficiency can be seen in the unpredictable presentations and variation of symptomology that can occur.

This editorial focuses on the deficiency of physical activity and exercise as key in the trajectory towards frailty and, because of its known benefits across multiple systems, especially skeletal muscle, the prescription of exercise as a front-line treatment to improve frailty / intrinsic capacity.

Lazarus NR, Izquierdo M, Higginson IJ, Harridge SDR. Exercise Deficiency Diseases of Ageing: The Primacy of Exercise and Muscle Strengthening as First-Line Therapeutic Agents to Combat Frailty. J Am Med Dir Assoc. 2018 Sep;19(9):741-743