90% of Us Will Experience Frailty in Old Age — Start Your Prevention Now
In this article you will learn
- what frailty is and why you want to be member of the unfrail 10%
- what kinds of exercise works preventive
- what kinds of food support your prevention
You can use the behavioral hints in this text as a primary, secondary or even tertiary prevention, although not every hint works equally well for all three fields of prevention.
Frailty
Visualize yourself walking around at your usual pace, maybe with groceries in your hands or just for fun on a trail you never walked on before with roots and rocks covering the ground.
Now think of the same activities but this time it’s not you who is performing. This time it’s your grandmother, your elderly neighbor, the old man you recently saw crossing the street…
Definition
Frailty is theoretically defined as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.
Sorry, what did you say?
Frailty means an age-related decline the older you get. You get weaker and slower and what a young body is capable of may mean a challenge when the person is old.
Example
My own grandma lived in apartment on the second floor, no elevator. She used a walking stick in one hand and had to hold on to furniture with the other hand while walking around slower than a turtle. My uncle, one of her two sons, did all of the shopping because it would have been too exhausting for her. Nevertheless sometimes she had appointments outside. The way back to her apartment — front door to apartment door — would take one hour. One hour for two floors whilst my uncle was supporting her by doing a wild mixture of walking and crawling on all fours behind her to secure his mother against a fall and making sure she lifted her feet high enough to put it onto the next step and not kicking against it. He literally manually helped her lift her feer and it still took one hour. She refused to move out “because of the great view” and — yes — my uncle was co-dependent.
Quick tests
Test yourself (part one)
Try this: Stand upright and let yourself tilt forward, as if you were a statue that tips over. There will be a moment when you take a step forward with one leg. This will prevent you from falling — instead you end up in a lunge-like position.
Now imagine that you are not able to take that step forward and instead you fall. There are several possible outcomes: Maybe you raise your arms in order to prevent your head from hitting the ground (but fractures of the radial bone because of falls are one of the most common fractures at all); maybe you can’t even raise your arms and you hit your head (traumatic brain injury is a possible result in this version). No matter how you look at it — a step forward would have helped the best.
Test yourself (part two)
Are you in danger of frailty? One of the quickest tests comes here:
Sit upright on a chair, not against the back of the chair and not using the armrests (cross your arms in front of you so that the hands come to rest on the opposing shoulders). Now stand up and sit down again for a total number of five repetitions.
If this took you longer than eleven seconds this can indicate a weakness in your lower extremities.
You can find another version over the duration of thirty seconds including the average number of repetitions per age group here.
Causes of frailty
All in all it is known that our body functions change as we get older. Frailty is the result of mutations in our mitochondria and the decrease of certain muscle fibers. Other changes include the reduced physiological reserve in brain cells, endocrine system, immune system, musculoskeletal system, cardiovascular and respiratory systems and the renal system.
Activity is most often reduced in higher ages and not everyone has access to important or beneficial nutrients and/or training.
Prevention of frailty: Functionality
Use your body as it was meant to be used:
10.000 steps per day seem kind of solid.
Our ancestors were hunters and gatherers and our whole body is designed to walk long distances. I won’t explain this in detail since there are plenty of good articles on medium on this topic, for example by Jennifer Geer who takes a look at where exactly the number of 10.000 steps per day originated while Dhimant Indrayan aims for ≥ 16.000 steps.
One reason to do lots of steps lies in the functionality itself: You want to have legs to support you, so you have to use them in advance. By walking (on many different surfaces) you not only strengthen your muscles but also train your sensorimotor system to deal with obstacles.
Prevention of frailty: Exercise and Fitness
You should aim at building up strength. To be more precise, you should be training explosive strength, because that’s the kind of strength that prevents you from falling without a proper reaction.
Take a look at your reaction at “Test yourself (part one): It’s just this one step that saves you from falling, but the reaction time — the time needed to recruit the muscle fibers — means you have to use your explosive strength in these muscles. That’s the same type of muscle fibers (the fast twitch fibers or type II fibers) that athletes like Florence Griffith-Joyner or Su Bingtian use(d) to get out of the starting block, Tom Brady and other QBs use to throw a football etc.
These type II fibers are required for a quick/strong/explosive motion but can’t work for a long duration. That’s why sprinters can finish a marathon but they mostly won’t be in the leading group (due to a lack of type I fibers that are specialized in endurance), while marathoners of course can sprint but won’t earn many medals in races against professional sprinters (due to the marathoner’s lack in type II fibers).
How to effectively train your explosive strength
Try to do your workout in an explosive style. That’s it, mostly. Do your muscle contractions as explosive as possible as you perhaps already know from plyometric training.
Maybe you find some inspiration here or in one of the other countless Tutorials that are available online for free. You don’t have to be as fit as the instructors but you will surely get the idea of explosive strength as opposed to very slow repetitions.
Explosive strength: Beginners — Watch out!
If you are older than 30 years and are not a gym rat you should start with endurance training aiming at the sensorimotoric system for six to eight weeks. Your tendons are most likely not used to explosive strength or high loads. By starting with endurance you strengthen your tendons so that they are prepared for higher loads in order to avoid ruptures.
For your own safety you might consider talking to your doc beforehand. If they give you a go there is no reason to not train your explosive strength no matter how old you are.
The main problem (at least here in Germany) is, that many people (not only the elderly themselves but also older physicians and physios) are of the opinion that training explosive strength is not beneficial for the elderly despite contrary science:
- Lower limb explosive strength capacity in elderly women: effects of resistance training and healthy diet
- Changes in agonist-antagonist EMG, muscle CSA, and force during strength training in middle-aged and older people
- Muscle Strength Is Associated With Physical Function in Community-Dwelling Older Adults Receiving Home Care. A Cross-Sectional Study
Prevention of frailty: Beneficial food
There are several ingredients known to support your body systems in prevention of frailty.
- Protein
- Vitamin D
- Omega-3
For Protein
You don’t need dietary supplements and you don’t necessarily need meat. Aim for Eggs, Low fat quark, Greek Yoghurt, Milk, Chicken breast, Parmesan, Beef, Trout, Salmon, Oatmeal, Almonds, Pumpkin seeds, Chickpeas, Brokkoli, Quinoa, Spinach, Soybeans
Here you find a Johns Hopkins table of protein content in common foods.
For Vitamin D
Herring, Salmon, Eggs, Mackerel, Chanterelles, Beef liver, Whole milk…
Take a look at the different tables from the NIH or another one from Johns Hopkins Medical (including calcium).
For Omega-3
Go for fish or nuts and/or seeds.
Have another NIH table with all you need about Omega-3.
Walking is man’s best medicine. -Hippocrates
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