Walking at about 70% of maximum heart rate reversed frailty more often than casual walking

Design

Cluster-randomised, assessor- and participant-blinded trial

Population

105 prefrail or frail adults aged 60 or over in 14 retirement communities (165 recruited)

Primary outcome

Improvement of at least one frailty category on SHARE-FI at 16 weeks

Effect

69.6% vs 46.4%; OR 2.91 (95% CI 1.19 to 7.13)

This cluster-randomised trial allocated 14 retirement communities to supervised high-intensity walking, targeting about 70% of maximum heart rate, or casual-speed walking below 60%, for 45 minutes three times a week over 16 weeks. Participants were 165 prefrail or frail adults aged 60 or over who could walk at least 10 feet with no more than moderate help; 105 were analysed. Mean age was 79 and most were women.

Improvement by at least one frailty category occurred in 69.6% of the high-intensity group and 46.4% of the casual group (OR 2.91, 95% CI 1.19 to 7.13). Gait speed improved more (by 0.08 m/s) and six-minute walk distance by about 49 m more. Attendance was similar in both groups, so the extra intensity did not cost adherence.

Walking is the exercise older people are most likely to do, and the common advice to walk gently may be underselling it. Pushing to a pace that raises the heart rate meaningfully, with supervision, appears to do more. Losses to follow-up were substantial, and the trial was in retirement communities, so supervision and safety arrangements need adapting for home-based programmes.

• Encourage prefrail and frail older adults who can walk to build up to a brisk pace, not just a gentle stroll.
• Aim for about 45 minutes, three times a week, building up gradually.
• Use a simple intensity guide: breathing harder but still able to talk.
• Screen for unstable cardiac symptoms and falls risk before increasing intensity.
• Arrange supervision or a walking partner for those with balance problems.

Why it matters

It suggests the intensity of walking, not just walking itself, determines whether frailty improves.

Don't overread it

A third of recruits were not in the analysis, and the trial ran with supervision in retirement communities; results at home may be smaller.

The statistics, in plain English

An odds ratio of 2.91 means nearly three times the odds of moving to a less frail category. The interval (1.19 to 7.13) excludes no effect but is wide, reflecting the small numbers.

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