Fighting Frailty --The Secret to
Staying Strong as You Age
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Last updated October 23, 2016 (originally published October 22, 2015)
By Susan Callahan, Associate Editor and Featured Columnist

[Health and fitness articles are reviewed by our team of Doctors,
Registered Nurses, Certified fitness trainers and other members of our
Editorial Board.]

After you turn 50, the slow, silent process of pre-frailty
begins. Left unchecked, this process can lead to full blown
frailty, the condition of muscle wasting, weakness and lack of
reserves that makes us up to 80% more vulnerable to
chronic disease such as heart disease, cancer and diabetes.

Once thought of as an inevitable part of aging, frailty is now
understood to be a medical condition which scientists have
learned to combat.

Frailty is what we look like when old age “catches up with
us”. And it  is progressive. About 7% of all adults over the
age of 65 are frail, studies show. Up to 30% of those over
age 75 are frail. But by the time we are 85, a whopping 45%
of us are frail, according to a 2009 study from scientists at
Rush University Medical Center in Chicago.  

Your risk of frailty spikes  by 7 times in just 20 years from 65
to 85.  This is why you should think of  this critical 20 years
period starting at age 65 as the “Frailty Zone”.  

For many years, scientists assumed that frailty was just a
natural part of aging, something unavoidable. Now, that view
is changing.  Studies are starting to show that being frail is
not an inevitable part of growing old.  How do you avoid
becoming frail as you age?  What are the health dangers of

Why Does Frailty Matter Anyway?

Frailty matters. Doctors, observing which elderly survive in
the hospital wards, have long known that the more frail you
are, the lower your chance of survival from almost any

If you are frail, your risk for cognitive decline and Alzheimer’
s increases by 63%, the researchers from Rush University
found in a different study in 2010.

If you are frail, you have a 42% risk for ending up in the
hospital within a year, according to a 2015 study from Johns
Hopkins University’s Center on Aging.

If you are frail, your risk for developing
heart disease
increases by 28.5%, according to a 2006 study from the
University of Pittsburgh.Health ABC study from

If you are frail, you have an 85% increased risk of dying
from all causes.

What Exactly Is Frailty?

The word “frailty” comes from the French word frêle” which
means something which is of  little resistance.

As pervasive and important as frailty is, scientists have had a
hard time defining it.

Some scientists define frailty as a combination of conditions
that include, muscle weakness, feeling tired (falling asleep
during conversations), walking with a slow gait, having
unsteady balance. Other scientists also include a decline in
cognitive ability ( can you remember names and places,
figure out puzzles).

In 2008, a large study of 9294 persons in France (the “Three
City Study” of Bordeaux, Dijon and Montpellier)  was
conducted by the Institut Nationale de la Sante’  et de la
Recherche Medicale. Harvesting  data from this study, other
studies have defined frailty as having 3 of the following 4

  • weight loss

  • weakness

  • exhaustion

  • slowness

  • low activity

Frailty Is an Accumulation of Deficits

But perhaps the most ambitious group of scientists defines
frailty as an accumulation of deficits.

In 2008, these scientists, notably scientists from Dalhousie
University in Halifax, Nova Scotia and Yale University School
of Medicine, developed a “frailty index”.

This idea of a frailty index makes intuitive sense. As we age,
we start to accumulate deficits --- we can’t lift as much
weight, we don’t hear or see as well, we may have cognitive
declines, we may not walk as fast or walk at all, we may not
be very active anymore, we develop chronic diseases such as
diabetes and heart disease --- all of these little and big
deficits add up over time. When we accumulate too many of
them, we are frail.

What kinds of “deficits” put us on the road to frailty? The
kind of tell-tale signs of pre-frailty may surprise you. For
example, do you feel as though everything is an effort?  
Doctors have learned that may indicate you are at risk for pre-

Here is the list of deficits you should try to be aware of as
you age. As you scan the bullet list below, take note of any of
these frailty factors that apply to you now, as opposed to a 5
years ago. That will give you some idea of whether you are
on a steep path to frailty:

  • Help Bathing

  • Help Dressing

  • Help getting in/out of Chair

  • Help Walking around house

  • Help Eating

  • Help Grooming

  • Help Using Toilet

  • Help up/down Stairs

  • Help lifting 10 lbs

  • Help Shopping

  • Help with Housework

  • Help with meal Preparations

  • Help taking Medication

  • Help with Finances

  • Lost more than 10 lbs in last year

  • Stayed in Bed at least half the day due to health (in last

  • Cut down on Usual Activity (in last month)

  • Walk outside

  • Feel Everything is an Effort

  • Feel Depressed

  • Feel Lonely

  • Have Trouble getting going

  • High blood pressure

  • Heart attack

  • Congestive Heart Failure

  • Stroke

  • Cancer

  • Diabetes

  • Arthritis

  • Chronic Lung Disease

  • MMSE ( a low score on this test for cognitive

  • Peak Flow ( a low measurement on this test of lung

  • Shoulder Strength

  • BMI

  • Grip Strength

  • Usual Pace of Walking

  • Rapid Pace

Although scientists may not exactly agree on all the
components of frailty, you can see from the various
definitions what frailty means --- you’ve slowed down, you
are weak, and you’re very vulnerable in that state to almost
any disease or condition. Hit with a setback, you just don’t
have the resources to rally and fight back.

Being vulnerable to other disease or illnesses is the most
worrying consequence of frailty. It is one of the things most
of us fear about growing older --- that overall weakness and
decline, leaving us in such a weakened state that when the
winds of bad luck blow, as they do for everyone at some
time, they knock us down.  And we stay down.

Frailty Makes You More Vulnerable to Disease

Frailty is a bother all by itself. Being weaker and more
unsteady means you are more likely to fall and falling means
that you risk being dependent on others. You may lose your
ability to live independently.

But apart from these factors, frailty packs a double punch of
danger because frailty actually increases the risk that you will
develop other chronic diseases, scientists have learned. If
you are frail, you are more likely to develop heart disease
because you are unable to be as active. Inactivity also drives
up your risk for diabetes, makes arthritis symptoms worse
and on and on.

But frailty is not inevitable.

Top 7 Tips to Prevent Frailty

You can stave it off by regularly challenging your muscles
(walk up the stairs, lift grocery bags), your cognition (keep
reading, solve puzzles) and walking regularly at a good pace.

Here is the complete list of things you can do to boost your
body's physical reserves as you age:

Lift and Carry Your Own Grocery Bags

As you can see from the list of the deficits, one of the deficits
that defines frailty is your inability to lift 10 pounds.  Why is
this so? The cause is age-related decline in muscle strength
called “
sarcopenia”.  With sarcopenia, you become more and
more frail as you lose more and more muscle mass until,
finally, you are too weak to do anything. You look wasted
away. Sarcopenia is what gives 80 year olds that bag of
bones, "old" look.

In 1998, a large team of doctors led by Dr. Maria Fiatarone
and Dr. Evelyn O’Neil of Harvard Medical School conducted a
study to see whether resistance training could improve
sarcopenia in frail elderly. The study’s participants included
63 women and 37 men who were an average age of 87 years

After 10 weeks of weight training focusing on the hip
extensors and the knee extensors, the participants
experienced a shocking 113% increase in muscle strength.
The participants exercised 3 days per week, with a day of
rest in between.

The weight training didn’t just increase overall muscle
strength. It also increased stair-climbing power by 28.4%
and  put more pep in the step of the 87 year olds, increasing
their walking speed by 11.8%.  

Work Your Backside to Strengthen Your Hips

Hip extensors don’t sound sexy but they are. These are the
muscles which help you to lift your hips from a bent position
back into alignment with your legs.  

You use them naturally when you go up stairs as you bend
your legs (hip at and angle to your thigh) then straighten
your legs as you get to the next step (hip lined up with your
legs).  The main muscles you use to perform these actions in
your hips are your backside (gluteus maximus) and your

As the study from Harvard Medical School found, seniors who
train their hip extensors gain loads of strength. You don’t
need gym equipment to train your hip extensions. Stair
climbing helps. Here is another exercise to train your hip
extensors. Lie on your back with your knees up.

Pull in your stomach muscles as though you are trying to
push your belly button to your spine. Notice that with your
knees up and your feet on the floor, your hips are at an angle.

Now, lift your hips up from the floor. You’ll feel your backside
engaged.  Doing this exercise 8 times (lifting your hips up
equals 1 time) three times a week will train your hip
extensors about as well as gym equipment.

If you do have access to gym equipment, the exercise to train
your hip extensors are the stand-up cable pulleys. Attach a
pulley to your ankle. The other end of the pulley is attached
to weights. Choose the lightest weight to start.  Then,while
standing, pull your ankle behind you gently.  Have a trainer
check your form as you start using the machine.

The key is not to let yourself get to the point where
sarcopenia starts. If you are not yet wasting away from
sarcopenia, you should regularly include various kinds of
weight training in your week.  

Moreover, “weight training”  does not mean that you need to
get to the gym and start lifting dumb bells and kettle bells --
though this would be effective.

Instead, think of "weight training" as any exercise that
makes you use your own body weight against gravity.
Climbing stairs is a quintessential weight training exercise
because you have to move your entire body weight  up
against gravity.

By walking up stairs, you increases the muscle strength of
your quadriceps, the largest muscle in your body. You can
also carry your own grocery bags, small luggage, laundry or
bags of mulch when you garden.  These small “lifts” can be
just as effective as a gym in building and sustaining muscle

Build Muscle Strength with Yoga

Hatha yoga poses such as the Sun Salutation, the Warrior
Poses, and others build muscle strength in your legs,
shoulders, arms and back.  Yoga poses should be done
slowly and never to the point of pain. Over time, you will gain
strength and flexibility.

Do Push-ups or at Least Try

Push-ups are one of the best tests for your overall body
strength. Push-ups challenge your body to lift its weight
using your arms and shoulders all the while maintaining your
back in a safe position. To do so, your body also needs a
strong core (abs).

Most women over the age of 50 are unable to do a single
push-up, military style. You should start doing half push-ups,
where you rest on your knees.

To “graduate” from half-push ups to full push-ups, one of
the best tools I have found is the downward dog position in
yoga.  I went to the gym for several years with the intention
of strengthening my shoulders enough to do full, military
style push-ups and nothing worked. Only downward dog
strengthened my shoulders enough to let me gradually begin
to do a single full push-up.

Consider Supplements

After consulting with your doctor, you may want to consider
certain amino acid supplements to fight sarcopenia. Once you
develop sarcopenia, reversing it is not always easy.

Scientists have found that an approach that uses muscle
building supplements, such as  essential amino acid (EAA)
supplements, including approximately 2.5 g of leucine, and β-
hydroxy β-methylbutyric acid (HMB). Interestingly, other
protein supplements have not shown to be consistently
beneficial once sarcopenia sets in.

Using  amino acid supplementation in combination with
weight training works in many cases to  reverse sarcopenia,
studies have found.

Lower Inflammation to Fight Both Frailty and Heart

When scientists first began to study frailty, they noticed that
some of the same markers for frailty also appeared as
markers for
cardiovascular disease. In particular, they
noticed that with both conditions, the body produced higher
than normal levels of inflammation, whose markers are “c-
reactive protein” and “interleukin 6”. Over the years, some
scientists have developed a theory that what we are seeing
as frailty is really a manifestation of early or parallel
developing cardiovascular disease.

At the cellular level, these inflammatory compounds act on
immune cells and cell communication molecules (cytokines) to
damage your arterial wall, and at the same time promote
frailty, a 2010 study lead by Dr. C.O. Weiss of Johns Hopkins
University found.

These stealthy, so-called “subclinical” processes operate at
the micro level, with a cumulative impact too tiny to be
recognized for many years.  

Because at the cellular level, frailty and cardiovascular
disease have common enemies of inflammation, lowering
your overall internal
inflammation levels should be a high
priority as you age.

One of the best ways to lower inflammation is to stay active.
But the other, equally important way to lower inflammation in
your body is to eat a low-inflammatory diet.

There are several ways to accomplish this. You can eat a
Mediterranean diet that features vegetables, olive oil, nuts
and fish. You can follow the DASH diet favored by the
American Heart Association that features vegetables, whole
grains, lean meats and fish and nuts as well as heart healthy
oils such as olive oil and canola oil.

What all such low-inflammatory diets have in common is the
emphasis on vegetables (especially dark leafy greens), fish
and other heart-healthy proteins (egg whites, lean chicken
and lean meats), and
low-glycemic carbohydrates (whole

Make Friends with Your Dentist to Combat Frailty  

It doesn’t seem logical but your dental health may affect your
risk for frailty.  Just as being sedentary and eating fatty
foods promote inflammation at the cellular levels which
eventually is expressed a frailty or heart disease, so too does
gum disease.

When you have
gum disease --- periodontitis--- a steady
stream of bacteria pours from your gums into the blood
vessels of your gums. These bacterial culprits, by name, are
Porphyromonas gingivalis, Prevotella intermedia, Tannerella
forsythia, Treponema denticola, and Aggregatibacter
actinomycetemcomitans. Once these bacteria enter your
gums, all havoc breaks loose.

From there, it’s a quick trip into your larger blood stream,
where the bacteria causes inflammation everywhere your
blood travels, to your heart, lungs, even your brain. The far-
traveling bacteria from gum disease is one of the reasons
scientists now advise you to keep a sanitary mouth to lower
your risk for Alzheimer’s.  

Having periodontal disease also raises your risk for a heart
attack by 4.42 times higher  than those who do not have
such disease, according to a 2005 study from the University
of Granada’s Andalusian School of Public Health in Spain.

Having periodontal disease raises your risk for developing
insulin resistance and
diabetes, a 2005 study from Juntendo
University in Japan has found.

Periodontal disease has a strong link with aging and frailty,
and periodontal care  is a “major and fundamental step for
an active and healthy aging”, according to a 2013 study from
the University of Naples Federico II.

To maintain healthy teeth and gums, you need to make a trio
to the dentist/periondontist each and every 6 months at a
minimum for cleaning and if necessary, scaling.  In between
visits, you should brush twice daily with an electric
toothbrush, use mouth wash, and use an tiny interdental
brush to clean between your teeth.

Getting older is always good news because it means you're a
survivor. Congratulations. And all of us have an opportunity
to improve our vitality, and stay independent and strong as
we age by fighting frailty. You've take the first step by
educating yourself about the enemy and arming yourself with
tools to undermine frailty's silent attack on your health.


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