Diet and Exercise Frailty Intervention in Cardiac Device Patients

Abstract

Background Frailty is an aging-associated vulnerability to poor health comes when challenged by physiologic stressors. Frailty is a common problem amongst the elderly and is associated with increased mortality and health care resource utilization. Frailty is common in recipients of cardiac devices. What is not known is whether interventions will improve frailty and if this changes patient outcomes. Methods There are four chapters in this thesis. In chapter 1, a review of the current state of frailty research, methods of measurement, biomarkers, imaging modalities and interventions are presented. In chapter 2, a pilot randomized controlled trial is proposed to determine if a supervised exercise program and nutritional supplement improves physical frailty in cardiac device patients. Chapter 3 presents the results of the pilot study to date. In chapter 4, we discuss the challenges faced during the COVID-19 pandemic with respect to recruitment and conducting the trial and changes to the protocol that could have improved the study and adapted to the current state of research. Results There are two conceptual models of frailty which include the frailty phenotype and frailty index. Frailty instruments are abundant and there is no gold standard measurement. Frailty biomarkers, imaging techniques in their current state are complementary measures and are not yet ready for clinical practice. The DEFINIT P trial is single centre RCT involving 24 cardiac device patients randomized to 12 month supervised exercise program and nutritional supplement. Recruitment was halted due to COVID-19 pandemic. Conclusions Frailty is common in cardiac device recipients. A gold standard frailty instrument is not yet established though efforts are currently underway. The DEFINIT P study is feasible with respect to recruitment and consent targets but whether the adherence target to the exercise intervention and nutritional supplement is achieved remains unknown due to stopping the pilot trial as a result of the COVID 19 pandemic.