By Anna Horner | News & Views

Frailty is an important consideration in cardiac and pulmonary rehabilitation (CR/PR), where adults aged 65 and older make up a sizable portion of the participant population, according to Daniel E. Forman, MD, Professor of Medicine and Chair of the Section of Geriatric Cardiology at the University of Pittsburgh. Although frailty is increasingly common in CR/PR participants, Dr. Forman says how to measure and account for this condition as part of care is the topic of much debate. “Frailty has been defined in different ways, but it involves weakening and diminished resilience,” he explains. “People who are frail are prognostically going to do worse than people who are not, and frailty is quite prevalent in older adults with cardiac and pulmonary disease.”

In a 39^th AACVPR Annual Meeting pre-meeting workshop titled, “Value of Rehabilitation in Frail Adults,” Dr. Forman and other presenters will discuss how CR and PR professionals can meet the needs of frail older adults to help them achieve positive outcomes. When cardiac rehab was developed 20 to 30 years ago, frailty was not part of the paradigm, says Dr. Forman. “We talk about ejection fraction, the degree of ischemia, and how many blood vessels were blocked, but we really don’t measure frailty,” he notes. “But it’s become an interest in cardiac rehab, and cardiology in general. Because cardiac rehab is a time to restore and recover, it’s a key place to think about frailty and ways to overcome some of the limitations that it otherwise means for a typical patient.”

During the multidisciplinary workshop, participants will learn about the clinical significance of frailty in older adults and other patient populations, how frail adults can benefit from CR/PR programs, how to customize assessments and exercise prescriptions for these participants, and how to optimize nutritional status to improve outcomes. They also will gain an understanding of screening/assessment protocols and interventions intended to reduce or prevent frailty among patients in CR/PR programs.

“Practitioners who deliver CR/PR — from exercise physiologists to nurses and physicians to nutritionists — don’t have a well-informed language or thought process around frailty, so this session aims to address that gap,” Dr. Forman says. “The session will provide some insights about the best measure for frailty, help understand the differences in language in some of the literature, and provide actionable strategies to address frailty.”

According to Dr. Forman, the session will cover how to recognize and gauge frailty and what to do about it. “One consideration is how to change exercise prescription to accommodate for frailty by including aerobic exercise as well as strength and balance training, both of which become more important for the frailer population,” he explains. “It also is important to think about nutrition as part of the path toward optimal recovery.”

Dr. Forman emphasizes the value of attending the session, noting, “We will provide participants with concrete information about measuring frailty, with real experiences of exercise prescription, so they will come away from it feeling they could do something similar the next day in their own programs.” He says that for frail older adults, the benefits of CR/PR are that they can remain independent and become stronger and more resilient, with more strength capacity and better balance translating into fewer falls. “It’s really about trying to understand the exercise experience and how to moderate it so it’s safe and tolerable and that the patient feels the motivation to continue,” Dr. Forman concludes.