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Is It Ethical Not to Prescribe Physical Activity for the Elderly Frail?

      Physical inactivity is a key factor contributing to the onset of muscle mass and function decline (ie, sarcopenia), which in turn appears to be a vital aspect related to frailty.
      • Rodriguez-Mañas L.
      • Fried L.P.
      Frailty in the clinical scenario.
      Poor health, disability, and dependency are not inevitable consequences of aging. The promotion of a healthy lifestyle and physical exercise, and the avoidance of sedentariness have proven to be effective for frail older adults, enhancing their independence and, most likely, reducing health-related costs. Recently, it has been also proven that physical activity, as an intervention, is one of the most important components in improving the functional capacity of frail seniors.
      • Cadore E.L.
      • Casas-Herrero A.
      • Zambom-Ferraresi F.
      • et al.
      Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians.
      • Cadore E.L.
      • Moneo A.B.
      • Mensat M.M.
      • et al.
      Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint.
      • Tarazona-Santabalbina F.J.
      • Gomez-Cabrera M.C.
      • Perez-Ros P.
      • et al.
      A multicomponent exercise intervention that reverses frailty and improves cognition, emotion, and social networking in the community-dwelling frail elderly: A randomized clinical trial.
      • Abizanda P.
      • Lopez M.D.
      • Garcia V.P.
      • et al.
      Effects of an oral nutritional supplementation plus physical exercise intervention on the physical function, nutritional status, and quality of life in frail institutionalized older adults: The ACTIVNES study.
      • Morley J.E.
      • Vellas B.
      • van Kan G.A.
      • et al.
      Frailty consensus: A call to action.
      • Ng T.P.
      • Feng L.
      • Nyunt M.S.
      • et al.
      Nutritional, physical cognitive, and combination interventions and frailty reversal among older adults: A randomized controlled trial.
      • Cadore E.L.
      • Rodríguez-Mañas L.
      • Sinclair A.
      • Izquierdo M.
      Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: A systematic review.
      Among several comorbidities that may coexist in frailty syndrome, diabetes is one of the most prevalent.
      • Sinclair A.J.
      • Dunning T.
      • Rodriguez-Mañas L.
      Diabetes mellitus in older people–New insights and residual challenges.
      In frail patients with diabetes, enhancement in functional capacity is crucial and may be more beneficial than attention to metabolic control alone.
      • Sinclair A.J.
      • Dunning T.
      • Rodriguez-Mañas L.
      Diabetes mellitus in older people–New insights and residual challenges.
      To counteract this functional decline, exercise interventions including resistance training are quite effective in improving muscle strength and power, balance control, and gait ability and in reducing incidence of falls in frail elderly.
      • Cadore E.L.
      • Casas-Herrero A.
      • Zambom-Ferraresi F.
      • et al.
      Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians.
      • Cadore E.L.
      • Moneo A.B.
      • Mensat M.M.
      • et al.
      Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint.
      • Tarazona-Santabalbina F.J.
      • Gomez-Cabrera M.C.
      • Perez-Ros P.
      • et al.
      A multicomponent exercise intervention that reverses frailty and improves cognition, emotion, and social networking in the community-dwelling frail elderly: A randomized clinical trial.
      • Cadore E.L.
      • Rodríguez-Mañas L.
      • Sinclair A.
      • Izquierdo M.
      Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: A systematic review.
      The main interventions that have proven effective to prevent and even reverse the frail state are physical exercise, multidimensional geriatric assessment, and intervention on major geriatric syndromes, with emphasis on proper adjustment of medication. Interventions to promote physical activity in the population have been effective in improving mobility and function. Exercise intervention may improve functional capacity even in polypathologic aging patients who have diabetes mellitus resulting in severe functional decline.
      • Cadore E.L.
      • Izquierdo M.
      Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: Improving functional status and quality of life.
      Other interventions, such as nutritional or pharmacologic interventions, are unsuccessful, although nutritional
      • Bauer J.M.
      • Verlaan S.
      • Bautmans I.
      • et al.
      Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: A randomized, double-blind, placebo-controlled trial.
      • Bauer J.
      • Biolo G.
      • Cederholm T.
      • et al.
      Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE study group.
      and testosterone interventions
      • Snyder P.J.
      • Bhasin S.
      • Cunningham G.R.
      • et al.
      Testosterone Trials Investigators. Effects of testosterone treatment in older men.
      • Srinivas-Shankar U.
      • Roberts S.A.
      • Connolly M.J.
      • et al.
      Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-fraril and frail elderly men: A randomized, double-blind, placebo-controlled study.
      • Travison T.G.
      • Basaria S.
      • Storer T.W.
      • et al.
      Clinical meaningfulness of the changes in muscle performance and physical function associated with testosterone administration in older men with mobility limitation.
      • Sih R.
      • Morley J.E.
      • Kaiser F.E.
      • et al.
      Testosterone replacement in older hypogonadal men: A 12-month randomized controlled trial.
      • Amory J.K.
      • Watts N.B.
      • Easley K.A.
      • et al.
      Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone.
      have been successful in some trials. Accordingly, an important conceptual idea for frailty is that the focus should be on functionality and not on the diagnosis of disease for older patients.
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