LAUSR

As allied health professionals, we read with great interest the recent work by Rodriguez-Pascual and colleagues on the frailty syndrome in very old patients with Heart Failure (HF) [1]. The findings of increased 1-yearmortality, hospital readmission and functional decline is clinically important and supports our insights as clinicians that frailty should be used for risk stratification and treatment selection. From an applied viewpoint, wewould like to add to the discussions regarding the practical implications of these findings. Frailty and pre-frailty syndromes are potentially reversible with physical activity/exercise. Whilst there is an agreement that supports this statement in patients without HF [2,3], the evidence for those with HF is scarce and caution should be taken when generalising these recommendations. Sarcopenia, frailty and cardiac cachexia affect the capacity to perfom exercise. In contrast, resistance training can improve strength and functional capacity in patients with HF [4]. However, to date, there is a clear under-representation of older adults across trials