According to the evidence available and the fact that free multicomponent tailored exercise programmes exist, it becomes gradually less and less ethical not to do so.

I believe a more suitable word would be "wrong." The term "ethical" implies that a practitioner might know that physical activity will be beneficial, yet doesn't provide it. In either situation, however, frail older adults are not being prescribed physical activity and this is unfortunate. These persons should be educated on the benefits of exercise among frail older adults. Evidence is cited below.

de Labra, C., Guimaraes-Pinheiro, C., Maseda, A., Lorenzo, T., & Millán-Calenti, J. C. (2015). Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC geriatrics, 15, 154. https://doi.org/10.1186/s12877-015-0155-4

Dear Dennis W Klima,

I don't agree with your opinion (you are very polite, we have to get tough on this issue). In my opinion, not prescribing EXERCISE for frail older adults is "wrong" (like you said) AND "unethical". Thinking about a drug in general, if there is one that is more efficient for patients, with reduced cost and practically zero side effects, it would be unethical not to prescribe it. Why is this not the case of exercise?

Perhaps because there is no industry behind it and no one would benefit from it.

Patients deserve the best treatment and I understand that it is also the role of physicians to know the best treatments for their patients.

There is still a lot of work to be done in this field, but there is already powerful evidence on this subject.

And this discussion is very interesting, greetings to all.

I suggest the follow reference:

Izquierdo, M., Rodriguez-Mañas, L., Casas-Herrero, A., Martinez-Velilla, N., Cadore, E. L., & Sinclair, A. J. (2016). Is it ethical not to prescribe physical activity for the elderly frail?. Journal of the American Medical Directors Association, 17(9), 779-781. Article Is it ethical not precribing physical activity in the elderly frail?

Good Afternoon---Thank you so much for the reference. I really agree with your point---we should consider exercise as important as medication so that we can better keep our frail older adults healthy and without falls. It should be at the forefront of our discussions with patients. And there are so many ways to make it appealing: neighborhood walking, group exercise, community-based programs, and task-circuits set up for frail adults to ensure health status.. Activities can even be incorporated in nursing homes. Thank you for a great discussion.

Giné-Garriga, M., Guerra, M. & Unnithan, V.B. The effect of functional circuit training on self-reported fear of falling and health status in a group of physically frail older individuals: a randomized controlled trial. Aging Clin Exp Res 25, 329–336 (2013). https://doi.org/10.1007/s40520-013-0048-3

de Labra, C., Guimaraes-Pinheiro, C., Maseda, A. et al. Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr 15, 154 (2015). https://doi.org/10.1186/s12877-015-0155-4