If regular exercise were a drug, it would be prescribed for everyone - and particularly older people, given that the reductions in risk of mortality and many age-related conditions are sizable in comparison to what can be achieved via medical technology at the present time. Frailty and sarcopenia in particular are amenable to treatment via structured exercise programs: a perhaps surprisingly large degree of the loss of muscle mass and strength is a matter of disuse in later life, rather than the presently unavoidable damage of aging. Yet we live in a world in which near everyone in wealthier regions of the world exercises too little, and as a consequence suffers the declines of age more rapidly.
Physical function (i.e., aerobic capacity, gait speed, and muscle strength) has been proposed as a biomarker of healthy ageing, as it is predictive of adverse health events, disability, and mortality. The role of physical exercise as a therapeutic strategy for prevention of both disease and the associated decline in functional capacity has been emphasised repeatedly. Supervised exercise interventions in hospitalised older people (aged ≥75 years) have been proved to be safe and effective in preventing or attenuating functional and cognitive decline.
Unfortunately, few studies have explored the potential role of tailored physical activity guidelines to maximise exercise-related effect on function. Also, exercise has not been fully integrated into primary or geriatric medical practice and is almost absent from the core training of most medical doctors and other health-care providers. Physical trainers should be included in health-care systems to help manage physical exercise programmes for older patients.
Taking into consideration current evidence about the benefits of exercise for frail older adults, it is unethical not to prescribe physical exercise for such individuals. To promote healthy and dignified ageing, it is therefore essential to help health-care systems to more efficiently implement evidence-based exercise programmes for frail older adults in all community and care settings.