In the United States as many as 15% of independent living older adults are frail, with another 45% described as pre-frail. Frailty is the presence of multiple syndromes that are correlated with increased fall risk, loss of independent living, and mortality. Frail and pre-frail older adults can benefit greatly from evidenced-based, prescriptive exercise.
In our ACSM Health & Fitness Journal article Just What the Doctor Ordered we describe the proper exercise prescription and progression for frailty, called Get Up, Stay Up, Go. Initially, high intensity, progressive resistance training is employed to build the muscle strength needed to transfer (bed to floor, sit to stand). High intensity balance training that includes failure (which allows for recovery practice) is then used to increase stability. Cardiorespiratory exercise is the last stage of the prescription, employed after strength and balance are good enough to control fall risk.
Because most older adults have complicated medical histories, it is important to create a holistic pre-screening process that evaluates more than just physical function. Assessing cognition, nutritional status, and medication use are a few of the screenings that should be added to a normal battery of physical assessments such as body composition and blood pressure.
A comprehensive list of useful screening tools exercise professionals can employ to create safe and effective exercise plans is available in Just What the Doctor Ordered, including ways to evaluate frailty and falls risk. Add some of these to your client assessment portfolio and become a more valuable member of your older clients’ health care teams.
Jeff Schlicht, Ph.D., is a professor of health promotion and exercise science at Western Connecticut State University. He is a member of ACSM's Exercise is Medicine Older Adult Committee.
