Research news: Frailty can be reversed
13th June 2016
Researchers based at the Cicely Saunders Institute and Royal Brompton & Harefield NHS Foundation Trust have found that patients with COPD respond favourably to rehabilitation. And in some cases frailty can be reversed.
The study, funded by the National Institute for Health Research and the Medical Research Council, is published today in the journal Thorax. The findings have wider implications for treating frailty, which affects one in ten over-65s, where adapting other rehabilitation programmes could potentially benefit more patients.
A quarter of patients (209 out of 816) recruited from the Harefield Hospital Pulmonary Rehabilitation Programme were found to be frail and had double the odds of not being able to complete their rehabilitation, mainly due to exacerbation of their condition and/or hospital admission. But frail patients who completed the eight-week rehabilitation programme (55% of the 209) scored consistently better in measures of breathlessness, exercise performance, physical activity and health status compared to non-frail participants. After rehabilitation, 71 out of 115 (61%) previously frail patients no longer met the criteria for frailty.
Frailty increases your risk of becoming dependent on others. It affects an estimated one in every 10 people aged over 65 years and is consistently associated with a greater risk of falls, disability, hospitalization and death. Although frailty is usually linked to age-related decline, chronic diseases like COPD can accelerate the rate of decline and hasten a frail state.
In COPD, shortness of breath can be accompanied by other health-related problems including muscle weakness, osteoporosis and fatigue, symptoms which are also linked to physical frailty. Identifying frailty early in the course of disease is important, as interventions can then be introduced to try to prevent further decline, hospital admission or death in those at high risk.
Pulmonary rehabilitation targets many components of frailty including slowness, fatigue, weakness and physical inactivity, providing a more holistic approach to improve overall health. It is thus highly effective not only in improving symptoms such as breathlessness, but also in boosting physical function and health status more generally.
The study gives strong grounds to explore how better to support patients who are frail through more comprehensive and tailored programmes akin to those offered for COPD. Frailty programmes are being piloted within healthcare services for the elderly, but there is scope to help many more people.
Dr Matthew Maddocks, Cicely Saunders International Lecturer for Older People said: “Frailty affects one in ten over-65s, and one in four over-80s. We now have a good understanding of how to measure frailty through various tests, and our latest study shows that a combination of exercise training and education can help to reverse this in many people. Although pulmonary rehabilitation is aimed at people with respiratory problems, it involves working the arms and legs to strengthen the muscles, and uses walking and cycling to improve fitness and balance. This model could be adapted to benefit older adults in other healthcare settings.”
Maddocks M, Kon SSC, Canavan JC, Jones SE, Nolean CM, Labey A, Polkey MI, Man WD. Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax. doi:10.1136/thoraxjnl-2016-208460. Epub 2016 Jun 13.