Physical activity in older patients: Push your performance capacity to prevent and limit frailty!

Sustained independence during aging reduces morbidity and mortality. Optimal physical activity (PA) is essential for independent living in older adults by preventing sarcopenia, the loss of muscle mass, strength and physical performance - the road to frailty. The aim of this narrative review is to establish a theoretical foundation for the development of PA programs in older adults. PA and exercise interventions are considered due to the established dose-response relationship with performance capacity, whereby the 'dose' refers to the combination of exercise frequency, intensity, time and type. Initially, improvements may be observed with minimal PA, but further improvements in functional capacity require increased exercise dose to reach optimal levels. In older adults, and even more so in frail individuals, increasing the dose beyond the individualized optimal level can result in adverse effects. The exercise dose should therefore be carefully adjusted, specifically in older adults with frailty. Multidimensional and/or clinical assessments are applied to identify older adults in a state of pre-frailty or frailty. While such assessments are necessary, they are insufficient for controlling the exercises dose. Rating of perceived exertion and delayed onset of muscle soreness in association with objective testing of physical capabilities, are recognized as appropriate, albeit subjective, assessments of the optimal exercise dose and sufficient recovery time between exercise sessions for older and frail adults. Regular monitoring of objective and subjective markers of exercise response will assist older and frail adults in tailoring their exercise programs to ensure positive outcomes.