What is the evidence that frailty can be reversed?
A central feature of physical frailty, as defined by the phenotype model, is loss of skeletal muscle mass and function (sarcopenia). There is a growing body of evidence for beneficial interventions to address this aspect of frailty and this has been reviewed recently 22. The benefits of exercise in older people with frailty shows that home-based and group-based interventions result in improvement in both mobility and functional ability. Strength and balance training is a key component although a wide range of approaches have been employed and the optimal exercise regimen remains uncertain.
The place of nutritional interventions also needs to be considered although evidence remains limited. Recommendations currently include optimising protein intake and correcting vitamin D insufficiency. A number of drug interventions have been proposed to improve muscle mass and function. Testosterone improves muscle strength but is also associated with adverse effects, particularly on the cardiovascular system. Growth hormone probably improves mass more than function. There is also interest in the idea of ‘new tricks for old drugs’ such as the angiotensin-converting enzyme inhibitors which appear to improve the structure and function of skeletal muscle. Currently there is not sufficient evidence for this to be translated into clinical practice.