Optimizing fracture prevention and rehabilitation in frail older persons: the exercise and physiotherapy perspective

There is a large body of research that has informed evidence based
practice in optimising fracture prevention and rehabilitation in frailer
older people [1]. However, there are many barriers to delivery, uptake
and adherence to individually tailored, multicomponent exercise
programmes. To target frailty and sarcopenia we need to implement
supervised progressive resistance training, if we want to focus on
fracture prevention we need to implement weight bearing impact and
specific balance challenging activities. The World Falls Guidelines
also remind us that these interventions need to be a minimum of
3 9 pw and for[12 wks [2]. Supervised delivery of such interventions
is lacking in most countries and even where this support
exists, uptake and adherence is poor. There is growing evidence that
for some individuals, the prescription needs to start with breaking up
prolonged periods of sitting and increasing volume of light activity, to
support self efficacy with additional behaviour change techniques to
progress on, over time, to more effective prescriptions [3]. People
with diagnosed osteoporosis should be as active as possible and only
avoid activities with a high risk of falls if they are naı¨ve to those
activities [4] and strength and balance exercise should be key components
[5]. Older adults with multiple long-term conditions are
willing to engage in resistance exercise if they are appropriately
supported [6]. Physiotherapy input is warranted for the very frail/comorbid/
high risk fallers but specific training can support transition to
community exercise instructor support to ensure sustainable behaviour
change and effective dose over time.