health - care professionals are accustomed to seeing frail older persons , but rarely do they recognize the role of sarcopenia in the pathogenesis of frailty . even more rarely do they institute an aggressive treatment regimen to improve the older person s quality of life . for this reason , six societies , including the scwd , published a consensus statement that defined frailty as  a medical syndrome with multiple causes and contributors that is characterized by diminished strength , endurance and reduced physiologic function that increases an individual s vulnerability for developing increased dependency and/or death  . for this reason , they agreed that  all persons older than 70  years and all individuals with significant weight loss ( 5  % ) due to chronic disease , should be screened for frailty . an objective definition for a physical frailty phenotype was created and validated in 2001 by fried et al . . their definition included weight loss , exhaustion , weakness ( grip strength ) , walking speed , and low physical activity . they found that it was present in approximately 7  % of persons in the cardiovascular health study . based on this schema , a simple five - point questionnaire was developed by the international association of nutrition and aging ( table  1 ) . this consists of adding together all the deficits a person has and then mathematically designating a frailty score . while this is highly predictive of poor outcomes , it is more of a comorbid score than a physical frailty index . it has also been recognized that persons with psychosocial frailty as well as physical frailty tend to have even worse outcomes [ 510].table 1the simple frail scale 
 fatigue 
 resistance ( can you climb a flight of stairs ? ) 
 aerobic ( can you walk a block ? ) 
 illness ( > 5 ) 
 loss of weight ( 5  % in 6  months)three or more positive answers , frail ; one or two positive answers , prefrail the simple frail scale three or more positive answers , frail ; one or two positive answers , prefrail the frail ( fatigue , resistance , aerobic , illness , and loss of weight ) scale has been validated by six separate studies and appears to perform as well as the other more complex scales [ 1116 ] . of the five components of the frail scale , both resistance ( climb a flight of stairs ) and aerobic ( walk one block ) are clearly components of sarcopenia as now defined by multiple groups [ 1721 ] . in addition , while there are many causes of fatigue ( e.g. , anemia , endocrine disorders , sleep apnea , polypharmacy , depression , and vitamin b12 deficiency ) , it is now well recognized that a major cause of fatigue in conditions such as heart failure is poor muscle function [ 22 , 23 ] . while weight loss is not universal in sarcopenia , loss of muscle can lead to weight loss in persons who do not develop obese sarcopenia , and it is a hallmark of cachexia [ 25 , 26 ] . the frailty consensus statement recommended that the treatments for frailty should be exercise ( resistance and aerobic ) , protein - calorie supplementation , vitamin d , and reduction of polypharmacy . the evidence that exercise ( particularly resistance exercise ) when maintained can have marked effects on frailty and sarcopenia is now very strong [ 2833 ] . the major problem is that this form of exercise therapy needs to be provided in a long term , i.e. , for at least a year , where it performs better than conventional physical therapy . it is the time that health - care agencies fund  coaches  to do twice weekly home visits to do resistance exercise for a year or longer . there is increasing evidence for exercise to be coupled with high quality protein to provide optimal muscle performance [ 3539 ] . persons with low vitamin d have been demonstrated to have decreased strength and increased falls [ 40 , 41 ] . replacement of vitamin d in these persons appears to improve strength and decrease hip fractures . calorie replacement decreases mortality and possibly improves function in persons with malnutrition . for an optimal effect in addition to these basic treatments , there is an increasing interest in developing drugs to treat sarcopenia . testosterone has been demonstrated to increase muscle mass and strength in older persons with and without frailty [ 4651 ] . its possible side effects have led to enthusiasm to produce selective androgen receptor molecules , and one of these , enobosarm , has shown some promise . a variety of other drugs are in earlier stages of development for treating sarcopenia and cachexia . frailty can be screened for by general practitioners as demonstrated by the gerontopole frailty screening tool [ 54 , 55 ] . a simple screening tool , the frail , takes less than 15  s to do and does not require a physician to administer it . treatments for frailty clearly exist . for these reasons we suggest that it is time to couple sarcopenia and frailty and increase its community awareness . if physicians begin to recognize sarcopenia and physical frailty and utilize the simple management strategies available , they will begin to have revealed to them the wonders of watching frail , and sarcopenic persons become more functional and happier in a way similar to how each few steps in a hidden garden reveals yet another wonder .