Rehabilitation programmes can help reverse frailty

One in four patients with COPD referred for exercise rehabilitation are frail, but nevertheless can respond favourably to rehabilitation and their frailty can be reversed, finds a new study.

The study led by King's College London and Royal Brompton & Harefield NHS Foundation Trust has wider implications for treating frailty, which affects one in ten over-65s, where adapting other rehabilitation programmes could potentially benefit more patients.

The study measured the prevalence of frailty using a range of tests in 816 patients (average age 70 years) with stable COPD (chronic obstructive pulmonary disease) and looked at whether frailty affected the completion and outcome of rehabilitation for their condition.

A quarter of patients (209 out of 816) recruited from the Harefield Hospital Pulmonary Rehabilitation Programme were found to be frail and had double the odds of not being able to complete their rehabilitation, mainly due to exacerbation of their condition and/or hospital admission.

However, the study found that frail patients who completed the eight-week rehabilitation programme scored consistently better in measures of breathlessness, exercise performance, physical activity and health status compared to non-frail participants. After rehabilitation, 71 out of 115 previously frail patients no longer met the criteria for frailty.

Whilst rehabilitation of older people typically focuses on fall prevention strategies through balance training and education, the outcomes of this latest study provide strong grounds to explore how better to support patients who are frail through more comprehensive and tailored programmes akin to those offered for COPD.

First author Dr Matthew Maddocks said that the study shows that a combination of exercise training and education can help to reverse this in many people. This model could be adapted to benefit older adults in other healthcare settings.

Senior author Dr William Man added, "Although COPD is primarily a lung disease, many organ systems can be affected, contributing to the syndrome of frailty. This stresses the importance of a holistic approach and how interventions such as exercise training can bring great benefits to people with lung disease without necessarily treating the lungs."

The study is published in the journal Thorax.