Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America.
Prog Cardiovasc Dis. 2021 Jul-Aug;67:26-32. doi: 10.1016/j.pcad.2021.01.005. Epub 2021 Feb 6.
Frailty is a highly prevalent multisystem syndrome in older adults with heart failure (HF) and is associated with poor clinical prognosis and increased complexity of care. While frailty is neither disease nor age specific, it is a clinical manifestation of aging-related processes that reflects a reduced physiological ability to tolerate and recover from stress associated with aging, disease, or therapy. Within this context, physical frailty, which is distinctly oriented to physical functional domains (e.g., muscle weakness, slowness, and low activity), has been recognized as a critical vital sign in older persons with HF. Identification and routine assessment of physical frailty, using objective physical performance measures, may guide the course of patient-centered treatment plans that maximize the likelihood of improving clinical outcomes in older HF patients. Exercise-based rehabilitation is a primary therapy to improve cardiovascular health in patients with HF; however, the limited evidence supporting the effectiveness of exercise tailored to older and frail HF patients underscores the current gaps in management of their care. Interdisciplinary exercise interventions designed with consideration of physical frailty as a therapeutic target may be an important strategy to counteract functional deficits characteristic of frailty and HF, and to improve patient-centered outcomes in this population. The purpose of this current review is to provide a better understanding of physical frailty and its relation to management of care in older patients with HF. Implications of movement-based interventions, including exercise and physical rehabilitation, to prevent or reverse physical frailty and improve clinical outcomes will further be discussed.
衰弱是老年心力衰竭（HF）患者中一种普遍存在的多系统综合征，与不良临床预后和增加的护理复杂性相关。虽然衰弱既不是一种疾病，也不是特定于年龄的，但它是与衰老相关过程的临床表现，反映了生理能力下降，无法耐受和从与衰老、疾病或治疗相关的压力中恢复。在这种情况下，以身体功能领域（如肌肉无力、缓慢和低活动）为重点的身体衰弱，已被认为是老年 HF 患者的重要生命体征。使用客观的身体表现测量来识别和常规评估身体衰弱，可以指导以患者为中心的治疗计划的进程，最大限度地提高改善老年 HF 患者临床结局的可能性。基于运动的康复是改善 HF 患者心血管健康的主要治疗方法；然而，支持针对老年和衰弱 HF 患者进行的运动的有效性的有限证据突显了当前在管理他们的护理方面存在的差距。考虑到身体衰弱作为治疗靶点的跨学科运动干预可能是对抗衰弱和 HF 特征性功能缺陷以及改善该人群以患者为中心的结局的重要策略。本综述的目的是更好地理解身体衰弱及其与老年 HF 患者护理管理的关系。还将进一步讨论基于运动的干预措施（包括运动和身体康复）预防或逆转身体衰弱和改善临床结局的意义。
