How to prevent frailty in the elderly?
It is widely accepted in today's society that frailty is a normal part of aging. Along with this notion, comes words like 'lao Le mei you yong' or 'old and useless' which is what I often hear from patients while working as a physiotherapist. Many elderly have succumbed to the idea that aging means a degradation of function which ultimately leads to reduced participation in the community where they withdraw from social activities and consequently contribute to isolation and loneliness.
This does not have to be the case. We can shift the paradigm in which being active, even in the golden years can be the default. Active elderlies can function in society and even contribute and push back retirement if they wish to because they feel energized and able bodied. How many young adults strength train regularly? How many elderly can still get up from the floor without use of their hands? The thing about function is this - Use them or lose them. There are no two ways about it. When we start to cut back on activities, our bodies begin to get used to not doing those activities and it gets harder and harder to restart.
There are a couple of ways to achieve this. The first step is to start training young. As age is also relative, when i say young, i mean now - younger than your future self. The opposite of FRAIL is STRONG. We need to build strong bodies. The stronger we are when we are younger, the more leeway we have even if we were to degrade. The World Health Organization and the Health Promotion Board recommends at least 2x/week of strengthening and balance exercises in adults above 18 years of age. This would suffice if we were just maintaining strength. If we want to improve strength, the frequency has to increase to 3-4x/week, with the suitable intensity in each session. A personal trainer or strength and conditioning coach would be able to assist in the programming and guidance in terms of proper technique. Even if you do not have a coach or trainer, it is still safe if you start slow and progress gradually and stop during signs of discomfort or pain. Household objects may be used as weights for instance, using a 5kg or 10kg sack of rice to perform squats or placing objects in a bag to perform a shoulder press. Alternatively, resistance bands which are widely available these days may be a good option that doesn't take up much space while giving you the resistance you need.
Once you already have begun the first step, you would be ready for the next step which is - Don’t Stop. Muscle atrophy and strength loss can happen rapidly in patients with bed rest as reported in Uros Marusics et al’s article. As the saying goes “ You snooze, you lose” -muscles that is. With any adaptation, muscles get stronger with training. Conversely, when we stop training, muscles lose their stimulation and hence get weaker. In order to maintain your gains, a minimum of 2x/week of strength training is required ( assuming you are exercising at the correct intensity). If we were to stop activities that feel difficult, we would eventually not be able to perform that task. Many elderlies refrain from taking the stairs in fear that they would wear out their cartilages faster. Over time, they would get weaker and eventually, they may lose the strength to climb stairs all together. We can use pain as a guide to tell us if we are suitable to perform that task at that present moment. For example, if there is no pain climbing stairs for an individual, go ahead and climb stairs. In this case, stair climbing would not be harmful, However, if there is pain with every step. Please seek help through an Orthopedic Surgeon or a Musculoskeletal Physiotherapist. It may not necessarily mean that you should be refraining from climbing stairs your entire life. Once the root causes of pain are fixed,strength is restored and there is no pain when climbing stairs, you may resume reclaiming your function of stair climbing once again.
To summarize, the way to tackle are as follows :
Get Strong
Stay Strong
Our bodies were designed to last a whole lifetime if we do the right thing and take care of it, not by avoiding activities, but by getting it stronger. If we can do this as a society, perhaps we get a fighting chance in managing the impending aging population crisis.
References
1.https://www.who.int/news-room/fact-sheets/detail/physical-activity
3. Uros Marusic, et al. Nonuniform loss of muscle strength and atrophy during bed rest: a systematic review. Journal of Applied Physiology.Volume 131Issue 1July 2021 Pages 194-206
