The third age is fragile, always. In a different way and measure it is for everyone. But it is possible to counteract the physical frailty of the elderly, to slow down motor disability over the years, and therefore to live longer independently. A study involving 16 clinical centers in 11 European countries published in the BMJ (British medical journal) determined and described in detail – and this is the novelty of the research – a precise program of moderate physical activity that combined with personalized dietary advice, in the ‘span of an observation period reduced the risk of developing motor disabilities in over 70s by 22%. “The intervention – explain the authors – can be proposed as a strategy to preserve mobility in elderly people at risk of disability”.
I study
The study was coordinated by researchers from the Department of Geriatric and Orthopedic Sciences of the Catholic University, Rome Campus and the Agostino Gemelli IRCCS University Hospital Foundation coordinated by Roberto Bernabei, Francesco Landi and Emanuele Marzetti within SPRINTT, Sarcopenia and Physical Railty IN older people: multi-componenT Treatment strategies), a European project funded in 2014 by the Innovative Medicines Initiative (a public-private partnership between the European Commission and the European Federation of Pharmaceutical Industries).
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Physical frailty and sarcopenia
SPRINTT examined a sample of 1,519 men and women aged 79 on average with physical frailty and sarcopenia. Physical frailty is a condition associated with aging that can be defined as a reduced ability of the body to adapt to stressful events, such as, for example, the pandemic.
Symptoms? Sense of tiredness and fatigue, reduced walking speed, weight loss, sedentary lifestyle. Frailty often causes disabilities, falls, hospitalizations, reduced quality of life. Sarcopenia is the loss of strength and muscle mass that accompanies aging, which tends to increase over the years, becoming a major cause of disability.
What is sarcopenia
The definition of physical frailty and sarcopenia is based on a validated test battery, the Short Physical Performance Battery (SPPB), which measures the functional performance of the elderly in a standardized way through balance, gait and muscle strength tests. This condition is evaluated with DEXA, a radiological exam similar to that used for diagnosing osteoporosis.
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1519 participants followed up to three years
But back to the study: the sample was divided into two groups, 760 participants followed the combined program of physical activity with technological support and nutrition, and 759 (the controls) participated in a seminar on healthy aging. All 1519 participants were monitored for up to 36 months. The intervention group participated in moderate intensity physical activity sessions 2 times per week in the study center and up to 4 times per week at home. Activities included brisk walking sessions, muscle strengthening exercises mainly of the lower limbs, balance exercises and flexibility exercises.
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No tools needed
All activities were customized, that is, measured on the basis of each person’s abilities and did not require specific equipment. The amount of physical activity practiced was measured periodically with an actimeter (an instrument that contains motion-sensitive sensors and measures motor activity) placed on the thigh for 7 days, in this way it was possible to monitor progress and customize the type and the intensity of each person’s physical activity. All participants received personalized nutritional counseling and individual diet plans. Participants in the control group received training in healthy aging and a short program of upper-body stretching exercises or relaxation techniques once a month.
The results
Among those who had greater impairment in physical function at the start of the study (having a PPS score of 3-7), motor disability (the inability to walk independently 400 m in less than 15 minutes) occurred in 47%. of participants in the active intervention and in 53% of controls. Physical function improved more in the intervention group than in controls both after 24 months and after 36 months.
In study participants with better basic motor skills (those who initially scored 8 or 9 on the PPS), the intervention did not change the risk of developing motor disability and had marginal effects on physical performance.
They move better
“Multicomponent intervention was associated with a reduction in the incidence of motor disability in older adults with physical frailty and sarcopenia and SPPB scores of 3-7 (those with greater impairment of physical function, ndr) – is the authors’ conclusion – Physical frailty and sarcopenia can be targeted to preserve mobility in vulnerable older people.
The fragility? Slowness of movement and loss of muscle
But what is fragility really? What do we mean when we say that the elderly are frail? “There is a moment when you realize that your father, your mother walks more slowly than when you met him the last time: here, this is the realization of the concept of fragility”, he says. Roberto Bernabei, Director of the Department of Aging, Neurological, Orthopedic and Head-Neck Sciences and of the Rehabilitation and Physical Medicine UOC Agostino Gemelli University Hospital Foundation and Full Professor of Internal and Geriatric Medicine at the Catholic University campus of Rome, and first author of the publication on BMJ.
Fragility means walking slowly. For sarcopenia
“Especially in the last two years there has been a lot of talk about fragility, defining it as something vague, but if we want to actualize it, concretize it, fragility basically means walking slowly. And this – adds the geriatrician – is supported by the second concept: sarcopenia. The two things together are fragility. With our study we have said that there is a way to block fragility, and, exaggerating, to block aging, and for the first time we have provided, so to speak, the type and dosage of this system. “.
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Physical activity is not enough
A system, which is not just made up of exercise, study participants also got personalized dietary advice. “Physical activity is not enough, you need an adequate protein supply: if I don’t throw in the petrol, that is the proteins, the muscle will only decay, weaken”, explains Bernabei. Moving on to the dosage? “1.2 grams of protein per day for every kilo of weight and 40 minutes of daily physical activity, which, mind you, is not just any physical activity, but a specific activity. It is not walking around looking at the windows, so to speak” , And what is it, instead, for example?
40 minutes of walking per day
“It is walking for 40 minutes a day, and doing counter-resistance exercises: putting on two small weights at your ankles and pulling them up and down while sitting for 15 minutes twice a day”, advises Bernabei. “Many times elderly people have been told to do physical activity: but the question is to do serious physical activity, well done, right and put in gasoline. With our work we have defined the quantity and type of what is needed to counteract the fragility”.
The right proteins
It is impossible not to wonder if and to what extent a program of this type can be transferred from a controlled study to everyday life, to the homes of our elderly. Can it be? “Brisk walking for 40 minutes a day and twice a day lifting two 1-kilo cans of peeled tomatoes for 15 minutes and eating that amount of protein for get gas, it is not difficult, it can be done. After all, the beauty of the work we have just published is this “, concludes Bernabei.
The new recipe
The new research confirms the benefits of structured physical activity in older adults, as it explains Thomas Gillprofessor at Yale School of Medicine in the editorial introducing the publication on the British Medical Journal. Gill acknowledges that translating study results into clinical practice even when rigorously designed, but argues that the evidence obtained from SPRINTT, along with that of another large US study, the LIFE Study, “provides compelling evidence that the ability to move independently can be preserved in community-resident frail elderly through physical activity, with walking as the main modality. “
Pathological and successful aging
Fragility is inherent in aging, they said at the beginning. But the fact is that from frailty we pass to functional limitations and motor disability, that is to aging pathological, which is a big commitment both for people and for the socio-health systems: pathological aging to suffer and costs, too. Contrary to successful aging, which according to geriatricians must be promoted, by developing safe, effective strategies to counter frailty and its risks and by preserving mobility in elderly people so that they do not incur a further decline in functional abilities.
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The numbers of fragility in Italy
From the Istat report “Health conditions of the elderly population in Italy – Year 2019“, published last July, it appears that in Italy there are about 3 million and 860 thousand elderly people with serious difficulties in the basic activities of daily life, equal to over 28% of the population aged 65 and over. Of these 2 million are 833 thousand have serious difficulties in walking or climbing or descending stairs without the help of a person or the use of aids. People with severe difficulties in motor functions and basic activities are more often women from the southern regions than men and to women living in the Center or in the North. It is estimated that in Italy about 1.4 million elderly people (10.1%) live with a strong reduction in autonomy in the essential activities of daily life, compared to an EU22 average of 8.5%.