Physical Therapy Guide to Frailty
Frailty is a syndrome in which a person becomes unable to deal with everyday stress placed on the body. Their muscles may lack strength and power. Their heart and lungs may lose the capacity to help them take part in daily activities and life events. These changes make it difficult or impossible to do things like bathe, dress, care for a family member, prepare meals, or attend social activities.
People of any age can become frail due to trauma, disease, persistent pain, or a reduction in physical activity. People who have more than one chronic health condition at midlife — such as high blood pressure, diabetes, heart disease, or stroke — are more likely to become frail as they age.
Physical therapists help individuals with frailty restore their overall mobility (movement), so they can return to desired activities. They help them improve their:
- Strength and flexibility.
- Aerobic capacity (the ability of the heart and lungs to get oxygen to muscles).
- Balance control.
What Is Frailty?
Frailty is the inability to perform daily activities due to factors such as muscle weakness and the loss of heart and lung capacity. Inactivity is a major cause of frailty. Inactivity can occur due to the presence of health conditions, an injury, or lifestyle choices. Being inactive, regardless of the reason, can cause weakness in all body systems. It only takes a few days in the hospital to experience a decline in the strength needed to move. Spending eight days or more in the hospital over a one-year period is linked to a loss of leg strength in otherwise healthy aging adults. Up to 30% of critical care patients in hospitals are frail.
When a person is not physically active, specific problems can result, including:
- Small, weak, and rigid muscles (known as sarcopenia).
- Stiff joints.
- Weakened heart and lung function (cardiorespiratory system).
- Balance problems and an increased risk for falls.
Frail people often are scared to perform activities, or don’t want to do them because it makes them tired. This lack of activity increases frailty over time, creating a challenging pattern of physical inactivity and frailty. Some people do not understand how to improve their condition, so they continue to be inactive.
When a person becomes frail from lack of physical activity, they are at a higher risk of falling. Falls often cause injuries that can lead to hospitalization, disability, and death.
Signs and Symptoms
Someone who suffers from frailty may experience:
- Severe fatigue, weakness, and/or exhaustion.
- Low energy.
- Weight loss.
- Difficulty standing, sitting, or walking.
- Trouble getting out of bed or a chair without help.
- Inability to perform simple household tasks.
- Poor balance or fear of falling.
- Feeling unable to work.
- Inability to socialize with friends and family.
How Is It Diagnosed?
Frailty can be diagnosed by your physician or by a physical therapist. Your physical therapist will conduct a thorough examination to determine your:
- Lung (aerobic) capacity.
- Balance and posture.
- Fall risk.
- Mobility (movement).
- Muscle power.
Your physical therapist will ask you or a caregiver questions about your health, symptoms, and how well you move around. They also will conduct a hands-on examination and will observe your movements.
How Can a Physical Therapist Help?
Physical therapists help frail individuals gradually improve their activity levels. Your physical therapist will design a personalized treatment plan based on your specific needs. The plan will help you regain the ability to perform necessary daily physical activities, and return to the activities you enjoy. Your physical therapist will work with you to safely get you moving again!
Your physical therapist will help you:
Reduce pain. Physical therapy treatments offer a safe way to manage persistent pain. Your physical therapist may use different types of treatments and technologies, and prescribe exercises to control and reduce your pain. Your physical therapist will choose the most effective and safe exercises for you, based on your unique needs and goals.
Improve motion. Your physical therapist will choose specific activities and methods to help restore your movement. These may begin with “passive” motions that the physical therapist performs for you to move your joints gently. Then you may progress to “active” exercises and stretches that you can do yourself.
Improve flexibility. Your physical therapist will determine if any of your muscles are tight. They will teach you exercises to loosen them up, and to keep them flexible.
Improve strength. Your physical therapist will choose the correct exercises for you and recommend the proper equipment to use. Doing these exercises will help you steadily and safely restore your strength, power, and muscular endurance.
Improve aerobic endurance. Your physical therapist will help you improve the capacity of your heart and lungs (aerobic endurance) through prescribed exercise, so you can safely return to your desired activities.
Improve dynamic balance and postural control. Regaining your sense of balance is important to prevent falling. Your physical therapist will teach you fall-prevention strategies — including prescribed exercises to improve your ability to recover from a loss of balance.
Learn an at-home program. Your physical therapist will design a home-exercise program for your specific needs and will teach you how to do the exercises. Doing these exercises on your own at home will help you continue to build strength and develop a lifelong habit of physical activity and health.
Return to activities. Your physical therapist will create activity goals with you and use them to set long-term goals to help lessen any future injury or decline.
Educate your family. Your physical therapist will educate you and your family about the harmful effects of prolonged sitting, inactivity, and bed rest. They will teach you ways to prevent and limit frailty.
Modify your home for safety. Your physical therapist will help you and your family identify and reduce hazards in your home that could increase your risk of falling.
Can This Injury or Condition Be Prevented?
Frailty may be prevented. Physical therapists recommend that you do the following to avoid becoming frail:
- Remain physically active throughout your life.
- Stay physically active during illnesses and injuries, as much as you are able.
- Avoid too much bed rest.
- Address persistent pain so you can be more active.
- Manage your medicines by consulting with your physician or pharmacist.
Physical therapists can help you determine many creative ways to remain physically active during recovery from many health problems. Physical therapists are movement experts who improve your quality of life through hands-on care, patient education, and prescribed movement. Your physical therapist also can give you activities to do to prevent future movement problems.
Physical activity keeps muscles strong, joints flexible, and balance and mobility intact. Staying as active as possible at all times can greatly reduce or prevent frailty.
Follow these physical activity guidelines to see how active you should be compared to your peers.
Physical therapists work in many different settings. If you are working with a physical therapist while you are in the hospital, ask how they can help you improve your physical activity and reduce the time you are inactive. Evidence suggests that engaging in physical activity during a hospital stay can speed your recovery.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to manage a variety of health conditions and injuries. You may want to consider:
- A physical therapist who is a board-certified clinical specialist or who completed a residency program 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. Find a PT is an online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
If you are looking for a physical therapist in your community, consider the following:
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people with frailty.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible.
The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and 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.
Katzmarzyk PT, Powell KE, Jakicic JM, et al. Sedentary behavior and health: update from the 2018 Physical Activity Guidelines Advisory Committee. Med Sci Sports Exerc. 2019;51(6):1227–1241. Article Summary in PubMed.
Curcio F, Liguori I, Celluare M, et al. Physical Activity Scale for the Elderly (PASE) score is related to sarcopenia in noninstitutionalized older adults. J Geriatr Phys Ther. 2019;42(3):130–135. Article Summary in PubMed.
US Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. Washington, DC: US Department of Health and Human Services; 2018.
Bauman A, Merom D, Bull FC, et al. Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence and interventions to promote “active aging.” Gerontologist. 2016;56 Suppl 2:S268–S280. Article Summary in PubMed.
Cesari M, Nobili A, Vitale G. Frailty and sarcopenia: from theory to clinical implementation and public health relevance. Eur J Intern Med. 2016;35:1–9. Article Summary in PubMed.
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(2):121–125. Article Summary in PubMed.
de Vries NM, Staal JB, van der Wees PJ, et al. Patient-centered 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(4):422–435. Article Summary in PubMed.
Mori K, Akezaki Y. Role of physical therapists in health care of the elderly [article in Japanese]. Nihon Eiselgaku Zasshi. 2016;71:126–132. Article Summary in PubMed.
Bagshaw M, Majumdar SR, Rolfson DB, et al. 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. Article Summary in PubMed.
Falvey JR, Mangione KK, Stevens-Lapsley J. Rethinking hospital-associated deconditioning: proposed paradigm shift. Phys Ther. 2015;95(9):1307–1315. Article Summary in PubMed.
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(2):E95–E102. Article Summary in PubMed.
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 (Lond). 2012;36(9):1153–1157. Article Summary in PubMed.
Peterson MD, Gordon PM. Resistance exercise for the aging adult: clinical implications and prescription guidelines. Am J Med. 2011;124(3):194–198. Article Summary in 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(1):61–68. Article Summary in PubMed.
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. Article Summary in PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Revised and reviewed in 2020 by Liana Logsdon, SPT, and Jacqueline Osborne, PT, DPT, board-certified clinical specialist in geriatric physical therapy. Authored in 2011 by Andrea Avruskin PT, DPT.