The edition · Geriatrics
Brisk walking reversed frailty more often than casual walking in a cluster trial
Fourteen retirement communities randomised to walking at about 70% or under 60% of maximum heart rate. Also: sarcopenia in Indian adults with type 2 diabetes, why comorbidity counts stop predicting disability in frail inpatients, and opioid use after hip fracture.
The edition in brief
In a cluster-randomised trial across 14 retirement communities, prefrail and frail adults (mean age 79) who did supervised walking at about 70% of maximum heart rate, three times a week for 16 weeks, more often improved by at least one frailty category than those walking at a casual pace (69.6% vs 46.4%; OR 2.91), with better gait speed and six-minute walk distance; attendance was similar. A meta-analysis of seven Indian studies (1,359 adults with type 2 diabetes) estimated sarcopenia prevalence at about 27%, but certainty was very low and the plausible range in a new population ran from 7% to 66%. In 1,299 older inpatients in Japan, a higher Charlson comorbidity score predicted hospital-associated disability in non-frail patients (OR 1.44) but not in frail patients, suggesting frailty, not disease count, is the better guide once someone is frail. In 114,055 older adults with hip fracture in Ontario, benzodiazepine dispensing after discharge fell from 34% to 13% between 2008 and 2024, but opioid dispensing remained high at 45%.
About one in four Indian adults with type 2 diabetes had sarcopenia, with very wide uncertainty
Look for low muscle strength in older Indian adults with type 2 diabetes, and build resistance exercise into their care.
In frail inpatients, comorbidity counts stopped predicting loss of function
Assess frailty on admission; in frail older patients, the comorbidity count does not predict who will lose function.
After hip fracture, benzodiazepine use fell sharply but opioid dispensing stayed high
After hip fracture, plan an opioid taper at discharge and avoid benzodiazepines.
Measure lying and standing blood pressure in every older person who falls
Check lying and standing blood pressure in every older person who falls, and review culprit drugs.
Walking at about 70% of maximum heart rate reversed frailty more often than casual walking
For prefrail and frail older adults who can walk, consider supervised brisk walking rather than casual walking to reverse frailty.
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