As people age, there is usually some tendency to lose physiologic reserves such as muscle mass, bone mass and cardiopulmonary capacity. Frailty is a loss of physiologic reserves that leads to physical disability. Not every loss of physiologic reserves will lead to disability. If one has built up a large margin of safety in one's youth, some loss of reserves in one's middle and older years will not cause a dip below the threshold of functional loss. For example, if one has been physically active throughout life, eaten a balanced diet rich in calcium, and, for women, taken hormone replacement therapy after menopause, one's bones should be strong and dense enough that a low-energy fall will probably not cause a fracture. Although it is true that many persons with a physical disability are frail, many persons who are still fully functional are also frail in that they are perilously close to the threshold of strength, bone mass or cardiac capacity below which they will not be able to function normally. Surgery, infection or similar stressful events may drop them below that critical threshold. The best way to avoid frailty is to prevent it from occurring. A lifelong pattern of habitual aerobic activity such as running, bicycling, swimming and/or hiking, combined with resistance (strength) training and flexibility (stretching) exercise, is most effective in the prevention of frailty. Unfortunately, most people have not pursued such a program throughout their lifetimes. At Johns Hopkins Physical Medicine and Rehabilitation, our skilled physiatrists (rehabilitation physicians) and allied health professionals work to prevent frailty on all fronts. Young, strong individuals are advised on exercise and lifestyle patterns that can prevent frailty for a lifetime. Potentially frail individuals (those with minimal physiologic reserves) are treated with exercise, flexibility training, medication and lifestyle counseling in an effort to prevent them from crossing the threshold into frailty. Finally, in the already frail individual, we work to prevent contracture, pressure sores, fractures and other complications while trying to augment the patient's strength, fitness and function as much as possible. Dr. Barbara de Lateur, Professor and Director of the Department of Physical Medicine and Rehabilitation at Johns Hopkins has long-standing interest and more than 30 years' experience in the use of exercise in the prevention and treatment of frailty. She and the rest of our skilled faculty and staff stand ready to help your patients in both inpatient and outpatient settings. To schedule an appointment or for additional information, please contact any of our outpatient facilities or call our main number at 410-532-4700. | 
