Seniors can prevent frailty by picking up the pace

Older adults who are considered frail or on the verge of becoming frail can significantly get stronger and more resilient by stepping up the pace of their walking. A study published in the scientific journal PLOS One found that increasing the pace of your walking by 14 steps per minute can help ward off physical decline.

Frailty is a medical condition characterized by reduced strength, endurance and physiological function. It makes older adults highly vulnerable to falls, injuries and illnesses.

Nida Shuttari, MD, a gerontology specialist at North Falmouth Primary Care, said that preventing frailty is very important for the older population. She also noted that the topic will continue to grow in importance in the upcoming years.

“I tell my patients we’re literally in the midst or about to be in the midst of the silver tsunami,” she said. “The baby boomer generation is aging, so frailty is a concept that will keep coming up because the biggest risk factor for frailty is increased age.”

But aging does not have to cause frailty and as the study showed, frailty is also reversible, she noted.

The Importance of Physical Activity

Dr. Shuttari recommends that patients get 150 minutes of moderate-intensity exercise per week, which amounts to 30 minutes a day, five days a week. Brisk walking is an easy way to achieve this goal because it doesn’t require any equipment or gym memberships. Many of her patients find 30 minutes a day to be overwhelming, so she recommends breaking it into three 10-minute chunks. If that is still too difficult, she suggests beginning with three five-minute chunks of time and work your way up. She also likes to add resistance training for strength and balance.

“My favorite activity that I recommend is something called a chair stand,” she said. “You take your arms and cross them over your chest when you are sitting on a chair. You try to get up from the chair without using your arms. You repeat that. You get up and you sit back down.”

She recommends starting with one set of 10 to 15 chair stands and then gradually increasing that to three sets a day over time. Chair stands help strengthen your quads, which is essential for good gait and balance, she said.

Walking also helps with blood pressure regulation, muscle strength, osteoporosis prevention, mood and sleep, which are all things that also affect frailty.

As a result of the 12-week walking intervention study in PLOS One, lead researcher Daniel Rubin, MD, created a smartphone app called WalkTest that can accurately measure walking cadence. The free app, which can be found in the Apple App Store, was deliberately designed to be easy for seniors to use, but Dr. Shuttari said that many of her older patients struggle to use technology. If that is the case, she recommends that seniors try to get a sense of how many steps they are getting in a minute by setting a timer for a minute and counting how many steps they take.

“Let’s say you are getting 70 steps per minute,” she said. “Set a target to increase by five to 10 steps per day per minute. Just increase slowly because you also want to make sure you are doing it in a safe way. If you’re using an assistive device, keep using that assistive device. It’s about finding your sweet spot. If it doesn’t feel right, slow down and try again later.”

The Importance of Nutrition

A healthy diet and proper hydration can also help prevent frailty. Getting enough protein is especially important. Dr. Shuttari recommends getting at least one gram of protein per kilogram of body weight. She also recommends that patients follow the Mediterranean diet for cognitive and physical health. The diet emphasizes eating legumes, lentils, fish for protein as well as whole grains, fruits and vegetables. Nuts are another excellent source of protein for cognitive health.

In addition, she recommends that her patients get 1200 milligrams of calcium and 600 units of Vitamin D a day. She recommends 800 units of Vitamin D after age 70.

“I want them to also make sure that they’re hydrating properly,” she said. “As we get older our thirst receptors are not working as efficiently as they used to so it’s easy to become dehydrated.” Dehydration is the most common reason for ER visits among her patients, she said.

She recommends aiming for six to eight eight-ounce glasses of water a day. That amount can sound overwhelming to patients who are not used to drinking that much water, so she recommends slowly increasing the amount you’re drinking. There are water bottles that help measure how much you are drinking. Some people like infusing the water with fruit for more flavor.

Other Ways to Reduce Frailty

“The other thing that’s also important for frailty that I can’t emphasize enough is social interaction,” Dr. Shuttari said.

She’s noticed that many older adults on the Cape don’t have family in the area, so it’s easy for them to become isolated. She recommends going to programs or classes at local libraries or community and senior centers. Places of worship can also be another great place to socialize and volunteer, which is also good for our physical and cognitive health, she said.

Polypharmacy, when patients take five or more medications, also increases frailty risks. Since every medication also causes side effects, it’s not unusual for doctors to prescribe a second medication to treat the side effects of the first medication. This can lead to what’s referred to as “prescribing cascades,” Dr. Shuttari said. She tries to whittle down her patients’ medication lists as much as she can do safely.

Another thing that concerns her is when patients regularly take ibuprofen or Advil to help with pain, because these over-the-counter medications, called NSAIDS, can increase blood pressure. If a patient does not share this with their provider, a provider might be inclined to add an antihypertensive medication to help control blood pressure, she said.

Eyesight and hearing are also important to avoid frailty. Seniors should have an eye exam and a hearing test every year. Hearing is very important for socializing and Dr. Shuttari has noticed that patients who are hesitant to go out and socialize often have hearing problems.

Good sleep is another way to prevent frailty. It also helps with mood and cognition so she recommends at least seven hours every night.

“Those are really the big buckets for frailty prevention,” she said. “Physical activity, thinking about nutrition, looking at the medication list, staying socially engaged and working on sleep and mood.”