Frail in your 40s? What to know about ‘pre-frailty’ and how to reverse it
When some women first walk into the gym at The Bone Clinic, their bones are thinning, their bodies are stooped, and they’re often leaning on a walking stick.
“They see people lifting heavy weights and say, ‘I could never do that’. But they do, and it’s not long before they’re standing straighter and carrying their own groceries,” says Professor Belinda Beck from the School of Allied Health, Sport Sciences and Social Work at Griffith University, and director of the Brisbane-based clinic which runs an exercise program to strengthen muscle and bone.
“Frailty isn’t inevitable with age, and it can be reversed. Our bread and butter is seeing people become functional again.”
Frailty might seem a long way off in your 40s, but research from Flinders University has found that almost half of 40- to 49-year-olds have what’s known as “pre-frailty”, meaning they already have signs of poor muscle strength and poor balance. But why?
You could blame convenience technology, like the computers, remote controls and robot lawn mowers that have stolen so much movement over the last few decades, but it’s more complex than that.
“In our study, pre-frailty was associated with more loneliness, more negative attitudes towards ageing, and having a sense of feeling older than your chronological age,” says researcher Dr Tom Brennan of Flinders University, one of the authors of a 2024 review of interventions to prevent or reverse pre-frailty and frailty.
“If we want to prevent frailty, we should ask more about what’s happening in someone’s life. How confident are they about being active? Do they see changes in their health as something they can work on improving, or something they have to accept as they get older?” he says.
“But part of the challenge is that people in middle age may think ‘frailty’ has nothing to do with them – talking about maintaining strength, confidence and the ability to keep doing things they enjoy may make prevention feel more relevant.”
Another reason to head off frailty sooner rather than later is new research linking frailty in older adults to a 74 per cent higher dementia risk.
“Muscle is important for so many reasons as you get older. If you’re frail, you’re less able to engage in things that help prevent dementia, like physical activity and social interaction. If it’s becoming harder to go out, you might not be seeing friends, and we know that social connection is linked to dementia risk,” says Dr Katya Numbers from the UNSW Sydney’s Centre for Healthy Brain Ageing (CHeBA) who did the research into frailty and dementia.
The effect of muscle loss on the brain may also be playing a part. When muscles exercise, they produce myokines (substances that help protect the brain), which may be part of why a University of Sydney study found that lifting weights slowed or stopped degeneration in parts of the brain vulnerable to Alzheimer’s.
But preventing frailty – now affecting more than 20 per cent of over 65s – isn’t always as simple as urging older people to pick up weights, Numbers says, adding that the CHeBA study also found living alone seemed to compound dementia risk in people who were frail.
“Frail older adults living alone had almost double the risk of dementia compared with robust adults living alone. We need to look at the whole person. You’re not going to sign up for strength training if you’re feeling lonely and miserable. ”
We should also let older people do things for themselves when they can, says Beck.
“Sometimes chivalrous husbands don’t let their wives lift heavy things ‘so they don’t hurt themselves’, but unfortunately this just makes it more likely their wives will become frail and less likely to be able to do things for themselves,” she says.
“If you lose that chivalrous husband or become his carer, suddenly you’ll be the one who has to do the heavy lifting.”
Her research at Griffith University into building bone strength is the basis of The Bone Clinic’s program. Called ONERO, it combines high-intensity resistance training and impact exercises with balance training. It’s supervised by exercise physiologists and available around Australia.
“I want to get the program available on the Medicare Benefits Schedule, so that cost isn’t a barrier. If more people could access strength training programs, the effect would be huge – we would have fewer hip fractures, and keep more people out of aged care. Ultimately, it’s about quality of life,” she says.
“The message that frailty isn’t a normal part of ageing and can be prevented needs to target people at all life stages – not just once you’ve crossed the threshold into frailty,” says Dr Coralie Wales who heads Strong Australia, a charity that promotes the importance of maintaining strength.
“If you lose physical strength, you lose the foundation of a healthy old age and your enjoyment of life.”
