FEATUREFOCUS despite a growing older population worldwide.“ We need a better way,” he said.
Dr. Zanotto calls the aging of the MS population one of the most important demographic shifts occurring in the field today.“ As more people live longer and healthier lives with MS, promoting healthy aging and preventing frailty will likely become an increasingly important goal of MS care. Rather than asking only‘ How do we reduce disability?’ we should also begin asking,‘ How do we maximize resilience and healthspan?’ Frailty provides a useful framework for answering that question.”
“ MS care has traditionally focused on relapses, MRI changes, and disability progression, which
are critically important,” said Dr. Zanotto.“ However, frailty provides a different lens through which we can understand health in people living with MS. It helps us evaluate overall resilience, not just neurological impairment. Importantly, recent research suggests that frailty may be more strongly associated with quality of life and falls than disability or comorbidity measures alone. This means that assessing frailty could help clinicians identify individuals at higher risk for adverse outcomes and develop more personalized treatment and rehabilitation plans.”
Definitions:
Frailty- a condition of reduced strength, physical function, and ability to adapt
Physiological reserve- the capacity of the body to function beyond basic resting needs when faced with a physical challenge, illness, or injury
Resilience- the ability to withstand or recover from functional decline following acute and / or chronic health challenges
Comorbidities- having two or more medical or mental health conditions at the same time
Social Vulnerability- demographic and socioeconomic factors( such as poverty, lack of access to transportation, and crowded housing) that adversely affect the ability of people or communities to repair and recover from stressors
1. Zanotto T, Tabatabaei A, Lynch SG, et al. Reducing frailty in frail people with multiple sclerosis: Feasibility of a 6-week multimodal exercise training program. PLoS One. 2026 Apr 15; 21( 4): e0347063. doi: 10.1371 / journal. pone. 0347063
2. Al Worikat N, Molaei F, Zanotto A, et al. Frailty in multiple sclerosis: A scoping review. Multiple Sclerosis and Related Disorders 92( 2024) 106157. doi: 10.1016 / j. msard. 2024.106157
3. Canevelli M, Jackson-Tarlton C, Rockwood K. Frailty for neurologists: Perspectives on how frailty influences care planning. Lancet Neurol. 2024; 23( 11): 1147-57. doi: 10.1016 / S1474-4422( 24) 00291-6
4. Zanotto T, Al Worikat N, Zanotto A, et al. Frailty, disability, and comorbidity in multiple sclerosis: Overlap and distinct associations with quality of life and falls. Multiple Sclerosis and Related Disorders 108( 2026) 107043; 108. doi: 10.1016 / j. msard. 2026.107043
5. Mah JC, Andrew MK, Quach J, et al. Changes in frailty predict social vulnerability among home care clients living in the community followed for ten years. The Journal of Frailty & Aging. 2025; 14( 2): 100031. doi: 10.1016 / j. tjfa. 2025.100031
6. Zanotto T, Galperin I, Pradeep Kumar D, et al. Effects of a 6-week treadmill training with and without virtual reality on frailty in people with multiple sclerosis. Arch Phys Med Rehabil. 2025 Feb; 106( 2): 187-194. doi: 10.1016 / j. apmr. 2024.09.010
7. Canadian Frailty Network’ s Avoid Frailty Campaign: www. cfn-nce. ca / frailty-matters / avoid-frailty
8. Jafari Z, Andrew M, Rockwood K. A systematic review and meta-analysis of air pollution and increased risk of frailty. Age and Ageing. 2025; 54( 5). doi: 10.1093 / ageing / afaf129
9. Rockwood K. An unsuitable old age: The paradoxes of elder care. CMAJ. 2005 Dec 6; 173( 12): 1500-1. doi: 10.1503 / cmaj. 051045 10. The STRONG Study: https:// sites. google. com / view / nourishteam / strong-study
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