Are You At Risk Of Frailty? New Study Provides Hope For Older Adults - Save Our Bones

A meta-analysis published in 2021 offers compelling evidence that physical activity interventions positively impact the health and well-being of frail and pre-frail older adults.

Frailty is a somewhat loosely defined condition, which complicates research into effective interventions. Generally, it describes a state of increased vulnerability that can accompany aging.

Today, we’ll dive into these complexities to better understand how to prevent frailty and the associated negative health outcomes of aging.

Defining Frailty And Pre-Frailty

Frailty is a clinically diagnosable state in which an older adult is at increased risk for poor health outcomes including falls, hospitalization, and mortality. Although frailty is clinically recognized, there's no universally accepted metric for its diagnosis.

In 2001, a group of researchers at the Center on Aging and Health at The John Hopkins Medical Institution proposed that to be considered frail a patient should meet three out of five diagnostic criteria: low grip strength, low energy, slowed walking speed, low physical activity, and/or unintentional weight loss.1

Pre-frailty denotes a state where one is at risk of developing frailty. An older adult who meets just one or two of the diagnostic criteria listed above may be considered pre-frail.

A peer-reviewed scientific article published in the Cork Open Research Archive in 2021 offered a consensus statement from 23 experts about pre-frailty. Those experts agreed that pre-frailty can be caused by physical, cognitive, nutritional, social, and socio-economic factors.2

They concurred that pre-frailty is both preventable and reversible, emphasizing the need for health professionals to monitor patients and recommend timely interventions.


Frailty is a state in which older adults are at increased risk for poor health outcomes including falls, hospitalization, and mortality. Diagnostic criteria include low energy, slowed walking speed, low physical activity, and/or unintentional weight loss. Pre-frailty is a state where one is at risk of developing frailty. Experts agree that pre-frailty is both preventable and reversible through timely interventions.

How To Prevent Or Reverse Frailty

A meta-analysis published in 2021 analyzed 26 studies that included 8,022 pre-frail and frail older adults. Each of the studies measured the impact of a physical activity intervention on the health outcomes of participants.3

The reviewers included studies that measured several types of physical activities, including muscle-strengthening, aerobics, mobilization and rehabilitation, and mixes of aerobic and muscle-strengthening exercises.

The researchers noted that only a few studies used frailty as an outcome, and the inconsistent application of these methods rendered the study’s results inconclusive. In spite of that uncertainty, the study authors did observe positive impacts on the health outcomes of participants after physical activity interventions.

The researchers included the following in the conclusion of their article:

“Our review showed a significant benefit of physical activity interventions of various types on certain outcomes including mobility, ADLs, cognitive function, quality of life and frailty when compared to control groups in frail adults aged 65 years or more. The effect sizes ranged from small to large, with low to moderate certainty of evidence. When we looked at all physical activity interventions together, there was a large effect on frailty, a medium effect on quality of life, ADLs and mobility, and a small effect on cognitive function.”3

The key takeaway is that interventions involving physical activity can positively influence various health outcomes, including frailty.


A meta-analysis of 26 studies found that physical activities had a positive impact on a variety of health outcomes among older frail and prefrail study participants.

Frailty, Pre-Frailty, And Bone Health

Frailty has a direct relationship to bone health. Frailty outcomes, such as an increased risk of falls, diminished physical function, and sarcopenia, pose threats to bone health. Sarcopenia is the loss of muscle mass. It impairs the body’s ability to build new bone since bone adds mass in response to the stress applied by muscle.

Pre-frailty potentially carries the same risks. Fortunately, prevention and reversal is possible, according to the 2021 consensus statement on pre-frailty. Those experts stated:

“Pre-frailty might be reversed or attenuated by targeted interventions including physical activity, nutritional interventions, healthy lifestyle and social participation, tailored to the individual.”2

Those intervention strategies will sound familiar to Savers, as they are the pillars of the Osteoporosis Reversal Program. The overlap reinforces confidence in the Save Institute, and illustrates the links between frailty, pre-frailty, and bone health.

It’s also great news for those already using the ORP to pursue healthier bones– the same interventions the ORP uses to build strong bones will help prevent or reverse the components of frailty and pre-frailty.


The outcomes of frailty threaten bone health, including the risk of falls, reduced physical function, and muscle loss (sarcopenia). Pre-frailty is a predictor of the same risks, however, experts agree that it can be reversed and prevented through interventions including physical activity, nutrition, and lifestyle changes. These are the primary strategies employed by the Osteoporosis Reversal Program.

What This Means To You

Regular physical activity is essential both for preventing frailty and for building strong and healthy bones.

The Save Institute responded to the need for accessible, customizable, easy-to-stick-with exercise programs by creating SaveTrainer. SaveTrainer is a digital platform for building your ideal set of physical activities guided by professional trainers and tailored to your exact needs and abilities.

Whether you’re interested in yoga flows, strength training, guided meditations, aerobic workouts, or a combination of these,– SaveTrainer offers all this and more. Since it’s all online, it’s available to you anywhere, anytime, without limitation.

You have the power to include healthy activity habits that will keep your body, mind, and bones strong and long-lasting. Embrace your power, and live your life to the fullest.





The Top 14 Things You’re Doing That Are Damaging Your Bones... And More!

  • Stop The Bone Thieves! report
  • Email course on how to prevent and reverse bone loss
  • Free vital osteoporosis news and updates.
Get It Free Now

Comments on this article are closed.

  1. s


    I bought your savers program a long time ago and recommended to friends too:-)

    I am now 79 yrs old and do all kinds of “light” exercises, including Yoga and gardening.

    I broke my R knee cap a few yrs ago as I tripped on the garden house which has slowed me down a lot, aggravating , as I have to modify my Yoga poses:-( asit hasn’t healed completely!!. But, I push myself. Also do a lot of physical therapy exercises for other problems. My mantra – use it or lose it!

    I have a couple of items you mentioned in the frailty section. it is scary!

    It annoys the heck out of me as I want to be more active.



  2. K Gopal Rao

    What abt Yoga as a preventive measure?

  3. Vickie Lepore

    I’ve noticed several positions in Save Trainer routines that can stress the anterior spine… (Superman (no mention of using a pillow under abdomen to mitigate stress). I am concerned, confused when I refer to other physical therapists that point out the positions that osteoporosis patients should avoid.

    • Vivian Goldschmidt, MA

      Hi Vickie! Some Savers might find it beneficial to do ground exercises on a carpet or a soft mat (or in the case of the Superman exercise to have a towel or pillow supporting the abdomen/hips). Others may prefer to avoid the exercise all together. It all depends on your own individual fitness level, mobility, and history. Understanding your body’s limits and differentiating between healthy stress and over-extension or over-exertion is key. Remember that doing a move modified to a more safe range of motion for you is not only acceptable but recommended.

      Additionally, we are aware of the claims that those with osteoporosis or even osteopenia should not bend or twist the spine. That seems to only apply to those with very severe osteoporosis, past vertebral fractures, or hyperkyphosis.

      In fact, a 10-year study conducted in 2016 titled “Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss” concluded that “Yoga appears to raise BMD in the spine and the femur safely”. The researchers also wrote that “No yoga-related serious injuries were imaged or reported.”.

      This is the link to the study:

      And this article shows all the poses that were used for the study:

      This article contains information on yoga for bone health and guidelines for which poses to avoid:

      I hope this helps! If you still have concerns, we recommend consulting with a reputable physical therapist so he or she could guide you on which exercises are safe for you to do. It seems that you already have one, which is great. Remember that at the end of the day, you are in charge of what works and what doesn’t work for your body. Please don’t hesitate to reach out with any other questions.

    • Sharon

      Check out very recent YouTube video by Margaret Martin on safe way to get benefits of superman without stressing spine.
      Also check recent exercise on this site( weekend challenge) to reverse dowager’s hump, I think this a good exercise for working back muscles.

  4. Kelsey Fickling

    Hi Vivian, in November I’ll be 92years old. I was diagnosed with Osteoporosis at 75years old. My GP gave me a script to get Fosamax- thankfully my Chemist told me that in USA Merck were already in court dealing with people who were sufferingfrom the effects of Fosamax. I found a GP who was a Phytotherapist- then I went on line looking for more information. Not sure when I found you – I think you were 45ish?? I’m going to the GYM twice weekly for strength training- my great nephew is my trainer – he’s an Exercise Physiologist. I still walk unaided, have good balance. Unfortunately I have scoliosis that appeared when I was around 80. I have to work hard at keeping my back straight. I bought your Dencerise ?? After a year my computer “died” and I stopped doing those exercises. I started a great program called Feldenkrais. I can still get down on the floor and up again unaided. I still live alone- have assistance with housework, and shopping, water my own garden- rake leaves etc.. I’m very grateful for your help and advice over many, many years.Thank you Vivian. I live in Queensland, Australia.

    • Vivian Goldschmidt, MA

      You’re very welcome, Kelsey! And I thank you for being a Saver and for sharing your inspirational story with our community 🙂

  5. Rosemary Hamp

    Hi Vivian! I am 81 years old and have severe Osteoporosis but still can do my housework, laundry, ironing, gardening, walking our dog and my exercises, yoga, stepping, etc., etc., Do you think I am too old to reverse my SEVERE osteoporosis or is it too late for me now, in spite of good nutrition and exercise, to build new bone density? Looking forward to hearing your opinion please Vivian. Thank you.
    Rosemary. (Perth, Western Australia).

    • Vivian Goldschmidt, MA

      It’s never too late to improve your bone health, Rosemary! Take a look at what some elderly Savers have experienced with that:

      Keep up with your active lifestyle and stay healthy!

  6. Ita

    Thank you. Ita.

    • Vivian Goldschmidt, MA

      My pleasure!

  7. Gwyneth Rushton

    Very encouraging to read the benefits of different exercise programs thanks.

    • Vivian Goldschmidt, MA

      You’re welcome!

Get Started With Your FREE
Natural Bone Building Kit.

Get a free copy of our ‘Stop The Bone Thieves’ eBook, exclusive content that you can’t find anywhere else, plus vital osteoporosis news and updates.

Get It Free

Get Your Free Bone-Building Kit


‘Stop The Bone Thieves’ guide, exclusive info, plus vital osteoporosis news and updates.