Exercise and Frailty in Older Adults

Exercise and Frailty in Older Adults

By Jennifer Green, MS

Photo of Jennifer Green who is a NCHPAD Visiting Information Specialist.
Jennifer Green, NCHPAD Visiting Information Specialist
The physical decline associated with aging can be caused by different factors, including normal aging and disease. Frailty can be found across the entire age spectrum, but elderly adults, typically those older than 65 years of age, have a greater risk. Although frailty is a common term, there is no consensus on its definition. The most widespread standard for the diagnosis of frailty is based on the presence of muscle weakness, lower physical activity, slow walking speeds, physical exhaustion, and unintentional weight loss. Frailty in older adults usually manifests itself as a disability associated with other chronic diseases or syndromes that are frequently linked with aging. Typically, frail adults are more dependent on others. They also tend to display a slower recovery from illnesses, undergo more falls and injuries, have more acute illnesses and are more often hospitalized. Evidence shows that structured exercise training has a positive impact on older adults and may be used for managing weaker muscles.

Physical activity is a promising strategy for improving muscle strength, endurance, and maximal aerobic power in older adults. Other improvements include flexibility, balance, motor control, and coordination. These benefits can result in decreased risk of falling while enhancing mobility. Exercise has also been shown to prevent or delay cognitive impairment, while increasing socialization and self-esteem. These benefits improve functional limitations and have important implications for maintaining or promoting independence in daily living activities, especially for those who are frail as a result of aging or disease.

An exercise program designed for frail individuals should reflect medical and social needs. Two major contributors that can determine a program's success are past exercise experience and goal setting; both of which should be discussed with the client prior to beginning a program. The camaraderie and relationship between the trainer and the client can greatly enhance the exercise program. An effective exercise plan for older, frail adults should not only be comprehensive and address functional needs, but should also be pleasurable, specific, realistic, and safe.

The primary goal for this population is to increase functional capacity and independence; therefore careful attention must be paid when choosing modes of activity. A multi-dimensional approach for improved health is important. Fitness professionals should choose exercises that activate large muscle groups and supply functional benefits, such as walking, cycling, rowing, swimming, as well as chair exercises. Performing aerobic physical activity 3-5 days per week and eventually accumulating 60 minutes of activity on these days, whether by continuous activity or in small bouts, should be a goal for your clients.

Adding strength training to the program will help increase overall muscular strength, decrease the risk of falling, and increase hand strength to assist with activities of daily living. It is suggested for frail individuals to start a strength training program without any weights and slowly progress from there. It should be a goal to incorporate 3 days of strength training per week with the sessions lasting 20 minutes. As with any other populations, flexibility training should be incorporated most days of the week.

It is also suggested with frail older adults that a comprehensive exercise program incorporate neuromuscular activities to increase gait, coordination, balance, flexibility, prevent falls, and increase hand-eye coordination and reaction times. Some of these activities can include one-foot stand, stair climbing, balloon activities, chair stand exercises, as well as practicing falling techniques.

While the benefits of an exercise program for older frail adults are numerous, there are several special considerations fitness professionals must be aware of when working with these individuals. Reaching target heart rate should not be the main focus of aerobic activity, instead try using RPE and the talk test to measure intensity levels. For aerobic exercise prescription, VO2peak, METs and RPE are often best. It is also suggested to avoid ballistic movements, neck circumduction, and isometric and static resistance exercise that may cause a dangerous increase in blood pressure.

The benefits of physical activity for frail older adults are well documented. With a comprehensive exercise program that includes neuromuscular activities, as well as focuses on functional activities and promoting independence, health fitness professionals can help older adults continue to stay independent.


Moreland, J., Richardson, J., Chan, D. H., et al. (2003). Evidence-based guidelines for the secondary prevention of falls in older adults. Gerontology, 49(2), 93-116.

Simmonds, M. J., Ph.D., PT., MCSP., & Derghazarian, T. P. (2009). Muscular dystrophy. In J. L. e. a. Durstine (Ed.), ACSM's exercise management for persons with chronic diseases and disabilities (3rd ed., p. 306). Champaign, IL: Human Kinetics.

Thompson, W. R., PhD, FACSM, Gordon, N. F., MD, PhD, MPH, FACSM, & Pescatello, L. S., PhD, FACSM (Eds.). (2010). ACSM's guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.


Please send any questions or comments to Jennifer Green at Jennifer Green.

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