Frailty has been described as a clinical state of vulnerability to stress, consequence from decline of resilience and physiological reserves and progressive decline on ability of homeostasis maintenance. The aim of this study was to evaluate the complexity of R-R intervals (RR) in resting supine (REST) and standing (STAND) position in 3 groups: frail, pre-frail and non-frail. Eighty older people (60-94 years old) were divided into frail group (n = 6), pre-frail (n=36) and non-frail group (n=38). The RR series were recorded at REST and during STAND for 10 minutes in each position. Short sequences of RR were analyzed by conditional entropy (CE) and approximate entropy (ApEn). Position, group and interaction effects were evaluated by two-way repeated-measures ANOVA. CE indicated only position effect while ApEn showed only group effect. ApEn seems to be more suitable for assessing changes in the complexity in frailty syndrome.

Aim Frailty syndrome is related to decreased physiological complexity, functional capacity and cognition. Physical exercise has been suggested to slow down and reverse this syndrome. However, evidence of its effectiveness is not as straightforward as conventionally admitted, as there is a lack of trials with rigorous methodology. The purpose of this study was to describe the Pre‐Frail Multicomponent Training Intervention protocol. Methods Cardiovascular, motor control and neuromuscular systems of pre‐frail older adults will be assessed by measuring the complexity of the output of these systems. Functional capacity and cognition will be assessed by specific tools. A 16‐week training protocol will be carried out on three alternate days, with 60‐min sessions, and combining aerobic, muscle strength, flexibility and balance exercises. The objective of this intervention is to improve the cardiovascular, motor control and neuromuscular systems, as well as functional capacity and cognition of pre‐frail older adults. The assessment of these systems will be carried out using gold standard devices. Results The results of the present study might allow clinical and functional support for the evaluation of the variables analyzed. Conclusion This protocol is easily reproducible and requires low‐cost materials, thus the Pre‐Frail Multicomponent Training Intervention could be a therapeutic strategy for pre‐frail older adults. Geriatr Gerontol Int 2019; 19: 684–689.

Frailty is related to a decrease in the physiological reserves, which causes difficulties in maintaining homeostasis. An example of physiological mechanisms for cardiovascular homeostasis is the baroreflex. The aim of this study was to compare baroreflex among frail, prefrail, and nonfrail individuals, in supine and orthostatic positions. Community-dwelling older adults were evaluated and categorized into frail, prefrail, or nonfrail groups, according to frailty phenotype. The RR interval (RRi) and systolic blood pressure (SBP) series were recorded for 15 min in the supine and 15 min in the orthostatic positions. Mean and variance of RRi and SBP, and baroreflex evaluated by phase, gain (α), and coherence (K 2 ) were determined. A two-way repeated measures ANOVA, with Tukey's post hoc, was applied for group, position, and their interaction effects. The significance level established was 5%. Prefrail and frail participants did not present a significant decrease in mean values of RRi after postural challenge (893.43 to 834.20 ms and 925.99 to 857.98 ms, respectively). Frail participants showed a reduction in RRi variance in supine to orthostatic (852.04 to 232.37 ms 2 ). Prefrail and frail participants showed a decrease in K 2 after postural change (0.69 to 0.52 and 0.54 to 0.34, respectively). Frail participants exhibited lower values of K 2 (0.34) compared to nonfrail and prefrail participants (0.61 and 0.52, respectively). Baroreflex indicated the presence of decoupling between heart period and SBP in frail and prefrail. Thus, reduced K 2 might be a marker of the frailty process.

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