Physical Therapist's Guide to
Frailty and Debility
Frailty is a syndrome of overall body weakness resulting in a loss of strength, flexibility, balance, and endurance. It results in an inability to perform everyday activities, such as preparing meals, washing, dressing, or caring for a family member. Debility is the loss of the ability to move around normally, or productively, in one’s home and community. Frailty and debility occur in people who have not moved their bodies for an extended period of time. In the elderly population in the United States, people develop frailty at a rate of 9.6%. A condition called “prefrailty” develops in 47% of the elderly population. Young people also can become frail and debilitated from trauma, disease, chronic pain, or any reduction in physical activity. Among critical care patients in hospitals, up to 30% are found to be frail. People who have diabetes and coronary artery disease at midlife are more likely to become frail as they age.
Physical therapists help individuals experiencing frailty and debility restore their strength, flexibility, endurance, balance, and overall mobility, reduce their chronic pain, and improve their daily function.
What are Frailty and Debility?
When a person’s body does not move for a long period of time, he or she can suffer loss of strength, flexibility, endurance, balance, and mobility (the ability to move easily and perform common activities). Specific problems that can result are:
- Muscles become smaller, weaker, and tighter (known as “sarcopenia”).
- Joints become stiffer.
- Heart and lung function (cardiovascular system) weakens.
- The natural sense of balance malfunctions.
All of these effects lead to frailty—being too weak, tired, and unsteady to perform normal daily activities.
Frail people often are scared or reluctant to perform activities that make them tired and avoid doing them, which increases their frailty over time. Some frail people do not understand how to improve their condition, so they continue being inactive.
The risk of becoming frail increases in people aged 80 or older because they often reduce their physical activity due to:
- Chronic pain
- Fatigue from medications or diseases
- Fear of discomfort or pain
- Lack of understanding of how aging can cause frailty
- Lack of understanding of the importance of physical activity at all ages
Younger people also can suffer frailty and debility, if they have been inactive or on bed rest for a period of time due to illness, surgery, or injury.
When a person becomes frail or debilitated from lack of movement, he or she is at a greater risk of falling and suffering injuries that can lead to hospitalization, disability, and death.
Signs and Symptoms
Someone who suffers from frailty or debility may experience:
- Severe fatigue, weakness, or exhaustion
- Low energy
- Difficulty standing, sitting, or walking
- Difficulty getting out of bed or out of a chair, without help
- Difficulty walking
- Inability to perform simple household tasks
- Fear of losing one’s balance and falling
- Inability to work
- Inability to socialize with friends and family
How Is It Diagnosed?
Frailty and debility can be diagnosed by your physician or by a physical therapist. Your physical therapist will conduct a thorough examination to determine your:
The physical therapy examination will include questions about your health, symptoms, and how well you move around, as well as hands-on physical testing and observation of your movements.
How Can a Physical Therapist Help?
Physical therapists help frail or debilitated individuals gradually improve their activity levels. Your physical therapist will design a treatment program based on your specific condition to help you regain the stamina and endurance needed to return to enjoyable and important daily physical activities. Your physical therapist will work with you to safely get you moving again.
Your physical therapist will help you:
Reduce pain. Physical therapy treatment is a safe way to treat chronic pain. Your physical therapist may use different types of treatments and technologies to control and reduce your pain. Exercise is one of the best ways to reduce pain, and your physical therapist will choose the most effective and safe exercises for you to do.
Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement. These might begin with "passive" motions that the physical therapist performs for you to gently move your joints, and progress to “active” exercises and stretches that you can do yourself.
Improve flexibility. Your physical therapist will determine if any muscles are tight, begin to gently stretch them, and teach you how to stretch them.
Improve strength. Your physical therapist will choose and teach you the correct exercises and equipment to use, to steadily and safely restore your strength.
Improve endurance. Regaining your muscular endurance is important. Your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities.
Improve balance. Regaining your sense of balance is important to prevent falling. Your physical therapist will teach you exercises to improve your balance ability.
Learn a home program. Your physical therapist will teach you simple exercises to do on your own. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.
Return to activities. Your physical therapist will discuss activity goals with you and use them to set your recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible.
Educate your family. Your physical therapist can educate both you and your family about the negative effects of prolonged sitting and bed rest, and about ways to prevent and limit frailty.
Modify your home for safety. Your physical therapist can help you and your family reduce hazards in the home that could increase your risk of falling.
Can this Injury or Condition be Prevented?
Frailty and debility may be prevented by:
- Remaining physically active throughout life.
- Remaining physically active during illnesses and injuries, as much as you are able.
- Avoiding too much bed rest at any age.
- Addressing chronic pain.
- Managing the use of medication.
Physical therapists can help people figure out many different, creative ways to remain physically active during treatment and recovery from almost any health problem. Physical activity keeps muscles strong, joints flexible, and balance and mobility working properly. If a person stays as active as possible at all times, frailty and debility can be prevented or greatly reduced.
Real Life Experiences
Mary is an 80-year-old woman who lives with her daughter's family. Over the past year, Mary has stayed in bed longer each day; her activity levels have dropped, and she has had more difficulty moving around the house. Recently, she lost her balance and fell, but fortunately, the emergency department physician reported no injuries. Her daughter decides to call the family’s physical therapist.
Mary’s physical therapist conducts an examination and finds that she has a medical history of cancer and high blood pressure, and takes many medications. Mary describes feeling exhausted, and reports that she sits or lies down for most of the day. He notices that Mary walks very slowly and has trouble keeping her balance. He gently tests Mary’s muscles and finds that they are weak and tight.
Mary’s physical therapist designs an exercise program to steadily strengthen and stretch her muscles, and improve her balance and endurance. He also starts her on a program of performing familiar tasks, such as folding laundry and emptying the dishwasher, to help her regain her strength and coordination.
At each session, Mary’s physical therapist makes the tasks fun, and slowly increases the difficulty of each activity, which prompts continuous improvements in her physical abilities and endurance. He teaches Mary and her daughter some simple exercises that she can do at home. As Mary masters each new task, her daughter is happy to hear her laugh again.
At the end of 8 weeks of therapy, Mary is able to get herself out of bed in the morning, dress herself, and cook a meal. Her daughter notices that she is more talkative and looks forward to her daily exercise routine. Mary continues her physical therapy sessions for 4 more weeks.
Today, Mary's walking speed, walking distance, and balance have improved dramatically, and her risk of falling has decreased. She is thrilled to attend her granddaughter's college graduation!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with frailty and debility.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of frailty. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Hartley P, Adamson J, Cunningham C, Embleton G, Romero-Ortuno R. Higher physiotherapy frequency is associated with shorter length of stay and greater functional recovery in hospitalized frail older adults: a retrospective observational study. J Frailty Aging. 2016;5:121–125. Article Summary on PubMed.
de Vries NM, Staal JB, van der Wees PJ, et al. Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up. J Cachexia Sarcopenia Muscle. 2016;7:422–435. Free Article.
Mori K, Akezaki Y. Role of physical therapists in health care of the elderly. Nihon Eiselgaku Zasshi. 2016;71:126–132. Article Summary on PubMed.
Bagshaw M, Majumdar SR, Rolfson DB, Ibrahim Q, McDermid RC, Stelfox HT. A prospective multicenter cohort study of frailty in younger critically ill patients [erratum in: Crit Care. 2016;20(1):223]. Crit Care. 2016;20:175. Free Article.
Bagshaw SM, Stelfox HT, McDermid RC, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ. 2014;186:E95–E102. Free Article.
Falvey JR, Mangione KK, Stevens-Lapsley J. Rethinking hospital-associated deconditioning: proposed paradigm shift. Phys Ther. 2015;95:1307–1315. Free Article.
Strandberg TE, Sirola J, Pitkälä KH, Tilvis RS, Strandberg AY, Stenholm S. Association of midlife obesity and cardiovascular risk with old age frailty: a 26-year follow-up of initially healthy men. Int J Obes (London). 2012;36:1153–1157. Article Summary on PubMed.
Daniels R, van Rossum E, Metzelthin S, et al. A disability prevention programme for community-dwelling frail older persons. Clin Rehabil. 2011;25:963–974. Article Summary on PubMed.
Peterson MD, Gordon PM. Resistance exercise for the aging adult: clinical implications and prescription guidelines. Am J Med. 2011;124:194–198. Article Summary on PubMed.
Snyder A, Colvin B, Gammack JK. Pedometer use increases daily steps and functional status in older adults. J Am Med Dir Assoc. 2011;12:590–594. Article Summary on PubMed.
Matsuda PN, Shumway-Cook A, Ciol MA. The effects of a home-based exercise program on physical function in frail older adults. J Geriatr Phys Ther. 2010;33:78–84. Article Summary on PubMed.
Gine-Garriga M, Guerra M, Pages E, et al. The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial. J Aging Phys Act. 2010;18:401–424. Article Summary on Pubmed.
Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38:105–113. Article Summary on PubMed.
Peterson MJ, Giuliani C, Morey MC, et al. Physical activity as a preventative factor for frailty: the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci. 2009;64:61–68. Free Article.
Daniels R, van Rossum E, de Witte L, et al. Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res. 2008;8:278. Free Article.
Orr R, Raymond J, Fiatarone Singh M. Efficacy of progressive resistance training on balance performance in older adults: a systematic review of randomized controlled trials. Sports Med. 2008;38:317–343. Article Summary on PubMed.
Bohannon RW. Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis. Phys Ther. 2007;87:1642–1650. Free Article.
Morley JE, Kim MJ, Haren MT, Kevorkian R, Banks WA. Frailty and the aging male. Aging Male. 2005;8:135–140. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Revised by Andrea Avruskin PT, DPT. Reviewed by the editorial board.