We often use the word “frail”, but what does that mean? In a nutshell, it means someone who has problems with the activities of daily living (ADLs). What would those be? Some examples would be:
- Climbing the stairs in their home
- Doing their laundry
- Household cleaning
- Shopping
- Gardening
- Getting down on the floor, and off the floor
You can imagine that having difficulties with these basic activities would have a large ripple effect, and limit somebody’s quality of life. They’d have problems with things like:
- Travel
- Leisure activities, like golf, tennis, hiking, etc.
- Playing with their grandkids
- Volunteering for causes that are important to them
…and more.
Original source: here.
There’s also the risk that if the frailty goes on long enough, someone could lose their independence, and need a family member or professional caregiver to take care of them.
All the more reason to stay strong.
We have plenty of clients who’ve improved their function. People like:
- Valerie, who stopped using her cane and pain medications
- Jacqui, who improved her strength by 40% despite fibromyalgia
- Stellis, who eliminated her knee pain in 8 sessions, at age 83
…and others.
This was with just 1-2 times per week of exercise. But what if we worked with a client who had no limitations?
- They had enough money to exercise with a trainer each workout (the majority of our clients work with their trainer 1-2 times per week, with an additional 1-3 on their own) – 5-6 times per week
- They had enough time to exercise the necessary amount
- They had no problems with nutritional compliance
If this was the case, we could get someone from frail to fit fast. Really fast. Depending on someone’s baseline level of frailty they could regain full function in 1-3 months. Even if they’ve lost some independence already.
Make no mistake about it. Even 1-2 times per week is better than nothing. It’ll get someone functional, but it’ll take longer (3-18 months).
But in this article, I’ll outline the Cadillac version of that program. I call it “Frail to Fit Fast.” If you want to see whether or not this program is right for you (or a loved one), feel free to just fill out the application form on our home page.
The Exercise Strategies
The 4 biggest gifts I can give to someone who is frail are (in no particular order):
- The ability to squat
- The ability to lunge
- Greater grip strength
- Good cardiovascular endurance
Why those 4 specifically? The frail person probably isn’t training for a sport, and doesn’t have any competitive ambitions. Basic daily life is their “sport.” And right now, it’s difficult. These 4 “gifts” make daily life much easier. Why? Let’s break it down:
Squat
You’re already squatting dozens or hundreds of times per day anyway. Only you don’t call it squatting. You call it “getting off the chair” or “getting off the couch” or “getting off the toilet.” Ideally, this is an easy movement, that you do without thinking. But once this becomes laborious, it takes a lot of effort, and a lot of your energy.
If we can improve someone’s strength and range of motion, a lot of these activities become easier.
As I always say, “life is easier when you’re stronger.”
Lunge
Strongly related to the squat is a lunge. A lunge is essentially a 1.5-legged squat. Whenever you get out of your car, you’re doing a lunge. Picking something up off the floor could be a lunge, and lots of other activities.
In someone frail, this takes a lot of energy, and may even come with sound effects (groaning) and knee or back pain.
If we can get this movement stronger, a whole world of possibility opens up to them, including some athletic movements, like tennis… even if they have no desire to do so. It’s just nice to know that it’s an option.
Grip Strength
You use your grip for a lot of things – from opening jars, to carrying groceries and more. But in one particular instance, it can be literally lifesaving. How? Because if you lose your balance, and you start to fall, you’ll grab on to whatever is around – cupboards, handles, bannisters, etc.
And a fall for someone frail is a lot more damaging to someone who isn’t. A fall can result in a broken bone, which can further limit mobility, and that may be the end of their independence. One study found that when the elderly fall, if they break a hip, 46.7% of them die within 5 years. Not good.
But if they have good enough grip strength to hold on to something on the way down, they can prevent a fracture or break.
Cardiovascular Endurance
Lots of studies have found a really strong relationship between cardiovascular endurance and death. The greater the cardiovascular endurance, the lower the risk of dying in the near future.
In general, cardiovascular endurance is measured by VO2max. That’s the maximal oxygen consumption. The units are ml/kg/min. So how many millilitres of oxygen can you take in per kilogram of bodyweight per minute.
One study took people with an average age of 59, and divided them into 5 categories, based on their VO2max.
- Category 1: VO2max under 22.4 ml/kg/minute
- Category 2: 22.4-28.2
- Category 3: 28.2-32.9
- Category 4: 32.9-38.6
- Category 5: over 38.6
The results:
- The lowest category had a 2.2 higher risk of dying from any cause (not just heart attacks and strokes), compared to the highest category
- The lowest category had a 2.8 higher risk of dying from heart attacks, heart failure and strokes compared to the highest category.
- The lowest category had a 1.8 higher risk of dying from cancer compared to the highest category.
Fortunately, just because you’re in the lowest category now doesn’t mean that you have to stay there. Improving your category is very doable. But it takes work.
So these are the 4 biggest gifts I can give to someone who is frail. But I wouldn’t stop there. I’d be using other strategies to improve full-body strength.
And now, let’s address the elephant in the room: isn’t 5-6 days per week of exercise too much for someone frail?
Paradoxically, no. Someone out of shape can tolerate a lot more exercise than someone in great shape.
A person in great shape taps into more of their potential, so they have more to recover from. Frail folks are so far from their potential, they can recover quickly from it… even if they’re frail.
As for what specifically I would have a frail person do – I don’t know. I don’t have a “frail person program.” Every program for every client is individual, based on the results of their assessment, and each person’s unique progression.
Some people have osteoarthritis. Others don’t. Some people have osteoporosis, or high blood pressure or diabetes, and others don’t. So each program would be different, but in general, I’d give each frail person the 4 biggest gifts I talked about earlier.
Each workout might be 30-35 minutes of strength training, and 25-30 minutes of cardio. Not each strength training workout would be the same, and not every cardio workout would be the same. When we have 5-6 days per week, we have the opportunity to target different things. Whereas with someone who exercises 1-2 times per week, we really have to prioritize.
Yes, we can give exercise prescriptions for clients to follow on their own. And lots of them do, and get great results. But why do I think we can do even better if all of their workouts were with a trainer? A couple of reasons:
Appropriate Progression
With our frail clients, I find that they are too conservative with their progressions. They are too scared to raise the weight in different exercises. Their muscles and joints can handle it. Their mind can’t.
When you know you’re frail, you’re constantly concerned about doing the wrong thing. But a personal trainer knows when you’re ready to progress to the next weight, and when you’re not (not every personal trainer – just ones who have special training in frailty). So the difference between doing all the workouts with a trainer vs. 1-2 with a trainer and 1-2 on your own would be as much as missing 20-30% of the fitness/health benefits you could have had if all the workouts were with a trainer.
Rep-by-Rep Adjustments
Sometimes, you’re doing an exercise, and for whatever reason, it starts to hurt. The trainer can make an adjustment right then and there, and you continue the exercise pain-free.
On your own, a few things can happen:
- You can push through the pain, and make it worse
- You just skip the exercise, and miss out on the benefits
- You can try to modify it yourself, and miss out on the effectiveness
Heart Rate Monitoring
Cardio workouts are more effective when you use specific heart rates to adjust the speed, incline, intensity and duration. Sure, you can make good progress by just doing something. But you can make better progress by doing it right.
Nutrition
Although supplement recommendations are based on a person-by-person basis (on the results of a thorough questionnaire, and sometimes bloodwork), as a generality, the 3 biggest nutrients the elderly need to be mindful of are:
Protein
Lots of studies have found that people on a higher protein diet gain more strength than those on a lower protein diet.
For instance, in one study, researchers recruited 72 people with an average age of 79. Half of them had a protein intake of less than 1 gram/kg/day, and the other group had 1.2 grams/kg/day.
Despite a pretty modest difference in protein intake, here were the results:
- The low protein group had a 2.9% improvement in grip strength. The higher protein group had an 11.7% improvement in grip strength.
- The low protein group improved their walking speed by 4.4%. The high protein group improved their walking speed by 11.4%
- The low protein group improved their overall physical performance by 5.7%. The high protein group improved their overall physical performance by 19.8%.
And this is just one example. Plus, 1.2 grams/kg of protein is still a low protein intake. I’d have my frail folks eating over 2.0 grams/kg.
Vitamin B12
After the age of 60, people’s ability to extract vitamin B12 from food decreases. So although their diet hasn’t changed, their ability to absorb it has.
That’s why it’s important to test for vitamin B12, and if it’s low, supplement with it.
What do you need vitamin B12 for? Lots!
- Red blood cell production – so if your B12 levels are low, you have less energy, so you’re sluggish.
- Brain function – you can have poor memory because of a simple B12 deficiency
…and more.
Vitamin D
Just as there are decreases in the absorption of B12, there can be worse ability to make vitamin D as well.
This is another one that I would first test, and if it’s low, supplement with it.
One other additional supplement that I would use with someone frail is creatine. It helps improve the recovery time between exercises in the same session (but not between sessions). And there are cognitive benefits to it as well (faster brain function).
These are the nutrients/supplements that would be top of mind for me. I may recommend additional ones based on the results of:
- Present health conditions
- Symptoms
- Blood work
So this would be my Cadillac version of the “Frail to Fit Fast” program. Even the regular program works great, and you’d still get 70-80% of the results. But the bump in compliance would get it about as good as possible, and allow you to significantly and quickly improve your strength and function, and decrease frailty.
Here are some predictions of the results you could see in about 2-3 months on this program:
- A full-body strength improvement of 30-40%
- A 20% improvement in endurance (you’ll be able to go farther before fatiguing)
- A 40-50% improvement in balance.
- A 15-30% improvement in walking speed.
As a result, you can:
- Restore physical abilities that you lost years or decades ago.
- Enjoy activities like hiking, travelling and more.
- Get stronger.
- Have more energy to get more done in your day.
- Play with your grandkids.
- Volunteer for causes that are important to you.
…and more. In 1-3 months. Of course, that’s the “hard and fast” phase. Fortunately, maintenance takes a lot less than progress. If it took you 5-6 days to make this progress, you can maintain with only 2 days per week. Or 5-6 days, but instead of an hour, only 20-30 minutes a day.
If you want to see whether or not the “Frail to Fit Fast” program is for you, just fill out the application form on our home page.