New analysis questions frailty outcome for older adults

Physical activity should be a priority for frail and nonfrail older adults

New analysis questions frailty outcome for older adults

In the world of geriatrics research, the impact of physical activity on frailty has often been discussed. Now, a secondary analysis of a randomized, controlled trial could offer some insight on the topic.

Researchers examined data collected from a trial that included 1,635 community-dwelling older adults in eight centers across the United States. The participants ranged from 70 to 89 years of age and had functional limitations. One group received an intervention that included a structured, moderate-intensity physical activity program incorporating aerobic, resistance, and flexibility activities. The other group participated in a health education program that mainly consisted of workshops and stretching exercises. After a 2-year follow-up, researchers found no statistically significant difference in frailty measures between the group that received the exercise intervention and the group given health education.

Emily Peron, PharmD, MS, BCPS, BCGP, FASCP, assistant professor of geriatrics at Virginia Commonwealth University School of Pharmacy in Richmond, said she was initially surprised that the frailty findings were not more impressive. Results from the 2013 Lifestyle Interventions and Independence for Elders (LIFE) study have consistently supported physical activity to reduce the risk of major mobility disability among older adults with existing functional limitations, she said. This analysis, published in the Annals of Internal Medicine, was a secondary analysis of the LIFE study on physical activity and frailty.

“Although there was no significant reduction seen in overall risk of frailty with the physical activity or health education group, this does not negate the value of either intervention,” said Peron.

Peron’s own research has focused on the relationship between medication use and functional status in older adults. A common thread she’s noticed between studies of pharmacologic and nonpharmacologic interventions for this patient population is that small changes—like walking 150 minutes a week—can make a big difference.

“I think the take-home message overall from the LIFE study is that it is never too late to make a lifestyle change,” said Peron. “From this secondary analysis, in particular, I think the biggest take away is that physical activity [as tolerated] should be a consideration for all older adults, not just those who are considered nonfrail by one definition or another.”

Peron pointed out that the Annals article is unique in that it calls into question the use of frailty as an outcome measure.

In the accompanying Annals editorial to the secondary analysis, Rebecca Brown, MD, MPH, and Kenneth Covinsky, MD, MPH, wondered the same thing. They define frailty as a state of decreased physiologic reserve and increased vulnerability to stressors and say that increasingly, frailty has been recognized as a strong predictor of poor health outcomes. However, no single, universally accepted definition of frailty exists, they wrote.

For this secondary analysis, a standard definition was used to classify whether participants were frail. It included measurements of weight loss, energy level, and the ability to get up from a chair with the use of arms. To participate in the study, the groups had to be able to walk a quarter of a mile (400 m) without assistance. Major mobility disability was defined as not being able to walk a quarter of a mile within 15 minutes without assistance.

For the full article, please visit for the April 2018 issue of Pharmacy Today.