**Chapter 7 101**

Combined Ketogenic Diet and Walking Exercise Interventions in Community Older Frailty and Skeletal Muscle Sarcopenia *by Jia-Ping Wu*

Preface

Interest in the frail elderly, or rather the concept of frailty, is increasing as the aging population continues to grow. The Latin writer Publio Terenzio Afro stated in the comedy *Formione*, "*Senectus ipsa est morbus*" ("old age is a disease in itself"). Of the opposite opinion is Cicero, who in *De senectute* exalts the advantages of the third age. Undoubtedly, frailty is a dynamic condition of increased vulnerability, reflecting age-related pathophysiological changes of a multisystemic nature, associated with an increased risk of adverse outcomes, such as institutionalization, hospitalization, and death. Having ascertained that frailty in the elderly is determined by a disorder of multiple physiological systems that interact with each other, we can make two

1.Frailty is a physiological syndrome characterized by the reduction of functional reserves and the decreased resistance to stressors resulting from the cumulative

2.Frailty is a dynamic state that affects an individual who experiences losses in

Regardless of the operational definitions, in the frail elderly, the physiological reduction of the body's homeostatic mechanisms occurs in an accelerated and clinically detectable manner as pathological. Aging is accompanied by a progressive decrease in muscle mass known as sarcopenia, which limits autonomy and makes elderly people more vulnerable to external aggressions. Sarcopenia can affect 20% of the population between the ages of 65 and 70 and up to 40% of over-octogenarians and can be associated with alterations in the individual's immunological capacity. The effects of poor nutrition and sarcopenia overlap, contributing to the functional decline of the musculoskeletal system, responsible for impaired gait and balance

The disease thus becomes an integral part of everyday life and the elderly feel even

The highly negative impact of multidimensional risk compromised of isolation and mortality confirms that fragility is the most common condition associated with mortality in the elderly. Low levels of activity and decreased protein and micronutrient intake in the diet can unleash fragility and accelerate it. For these reasons, it becomes crucial in clinical practice to identify, measure, and treat frailty. The primary objective of treatment is the preservation of maximum personal and social autonomy. Proper nutrition characterized by a sufficient energy intake and associated with the implementation of protein intake and targeted and constant physical exercise can promote the health and autonomy of the elderly and prevent serious

one or more functional domains (physical, psychic, social).

basic assumptions:

complications.

decline of multiple physiological systems.

correlated with a high risk of falls and fractures.

weaker, less efficient, and of great burden to the family.
