PT Guide to Sarcopenia and Frailty

Frailty is a common syndrome among older people. It’s associated with an increased risk of falling and increased hospitalization, disability, and death. The risk of becoming frail increases in the oldest-old, especially those aged 80 or older. Most older adults in nursing homes are frail. Sarcopenia, which is a decrease in the amount and quality of muscle, is a major contributor to frailty. The 5 factors for frailty are:

  • Unintended weight loss (more than 10 pounds in the past year)
  • General feeling of exhaustion 3 or more days per week
  • Muscle weakness
  • Slow walking speed
  • Low levels of physical activity

Key points:

  • Keep moving! The more you sit or lie down, the more strength and energy you’ll lose, and your heart health will be affected, too.
  • You might feel overwhelmed by thought of moving around, but you can start slow and make small changes.
  • Your physical therapist can work with your health care team or with you individually or in a group to safely improve your strength, speed, and balance—so you can get back to the activities you want to do!
  • Having an exercise partner increases your chances of success.

What Is Frailty, and How Does Sarcopenia Contribute to It?

Not all older people are frail. You may be considered to be frail if you have 3 of 5 factors:

  • Unintended weight loss (more than 10 pounds in the past year)
  • General feeling of exhaustion on 3 or more days per week
  • Muscle weakness
  • Slow walking speed
  • Low levels of physical activity

Having 1 or 2 of the above factors might indicate a risk for frailty, called “pre-frailty.”
Frailty is a vicious circle. If you feel exhausted, you are more likely to just “sit around” or lie in bed. In turn, being inactive results in a loss of muscle and strength. When the quality and quantity of muscle decreases (sarcopenia), your cardiovascular system is affected too, and your energy reserve decreases. So, because it takes so much effort for you to move, you move less. Think of it this way: people with less leg strength and less muscle mass than people who are stronger actually use almost 90% their energy reserve to maintain their walking speed, whereas the people who are stronger use only 64%.

How Can a Physical Therapist Help?

Your physical therapist will perform an evaluation that includes:

  • A review of your history, including any weight loss, health conditions, previous falls, and any devices that you might be using for stability, such as a walker or cane
  • A review of your medications, especially to identify whether they might be contributing to your feelings of fatigue and whether they might interfere with increased exercise
  • Tests for walking speed (called “gait speed”)
  • Tests of leg strength, such as ability to rise from a chair
  • Muscle strength tests, such as grip strength
  • Distance walk tests to measure your exercise capacity
  • Tests of your balance and your risk of falling

Your physical therapist will serve as an important member of your health care team and will work closely with you to design a treatment program. Your physical therapist’s overall purpose is to help you reach your goals for mobility and activities that are meaningful to you.

Your therapist will show you how you can start slow and make small changes. You can do this even while you’re watching TV: you can stand up during each commercial for the entire length of that commercial, and then sit back down again.

Improve Your Strength and Speed

Your physical therapist will design exercises targeted to strengthen your legs and your trunk:

  • Different muscle groups might be exercised on every other day; that way, every day you can exercise without tiring out one part of your body too much.
  • You’re likely to get the best results by exercising often, with increasing weights and multiple sets

People with sarcopenia and frailty can make very rapid progress during the early part of their rehabilitation. Research shows that physical therapist-supervised, high-intensity exercise is not harmful to people with frailty.

Because sarcopenia and frailty can make you move slowly, your therapist will monitor how fast you are able to do your strengthening and walking exercises. For instance, the therapist might instruct you to do one set of an exercise as fast as possible, decreasing the weight if necessary. The therapist might use intervals of fast-paced walking and chair stands. You also might be asked to increase your speed during training for daily activities such as dressing.

Return You to Your Daily Activities

Physical therapists design what’s called “functional exercise,” which can help you resume activities that you’ve had difficulty doing or stopped doing. Special exercises and training will increase your confidence in your ability to keep your balance and reduce your risk of falling. The exercises might be done with a group and might include folding clothes in a standing position, vacuuming, emptying and loading a refrigerator, making a bed, and getting in and out of a bed.

Improve Your Balance and Agility

Because falls are common in people who are frail, your physical therapist will develop a balance training program that might include:

  • Practicing tasks of stepping up and down a stair with and without support
  • Rapidly changing directions while you walk
  • Walking on different type surfaces and with different lighting, such as with sunglasses on or under bright light
  • Turning your head while you’re walking or doing tasks

Educate the Family

Your physical therapist can educate both you and your family about the negative effects of prolonged sitting and bed rest. The therapist will show how to use a pedometer to count the number of steps you take, a timer to signal the need to get up and move, and how to reduce your dependence on aids such as scooters or lift chairs. Your therapist will help you set goals for the number of steps to take (a target within 10,000 steps per day is recommended) and how much aerobic activity to do.

Modify Your Home for Safety

Your physical therapist will work with you and your family to modify your home to reduce hazards that might put you at a higher risk of falling. Modifications might include:

  • “Anchoring” area rugs to avoid slips and trips
  • Moving cords to avoid trips
  • Changing the lighting to decrease glare and increase light
  • Bathroom adaptations such as rails and grab bars

When you get stronger, your physical therapist can work with you to find an activity group or an exercise partner, so that you can

Can this Injury or Condition be Prevented?

The best treatment for sarcopenia and frailty is to prevent them from ever happening. Physical therapists can evaluate frailty risk factors in older people who are living in the community and provide:

  • Strengthening exercises and physical activities designed to prevent sarcopenia
  • Balance training and fall-risk assessments

Research indicates that community exercise programs encourage participation in social and physical activity and that specific strengthening and balance exercise may be particularly useful for people who are identified as “pre-frail.”

*Guide is Courtesy of APTA (American Physical Therapy Association)