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Dynamics of Stability

The Physiologic Basis of Functional Health and Frailty

^a Hebrew Rehabilitation Center for Aged, Beth Israel Deaconess Medical Center, and Harvard Medical School Division on Aging, Boston, Massachusetts

Lewis A. Lipsitz, Hebrew Rehabilitation Center for Aged, 1200 Centre Street, Boston, MA 02131 E-mail: Lipsitz{at}mail.hrca.harvard.edu.

Decision Editor: John A. Faulkner, PhD

Under basal resting conditions most healthy physiologic systems demonstrate highly irregular, complex dynamics that represent interacting regulatory processes operating over multiple time scales. These processes prime the organism for an adaptive response, making it ready and able to react to sudden physiologic stresses. When the organism is perturbed or deviates from a given set of boundary conditions, most physiologic systems evoke closed-loop responses that operate over relatively short periods of time to restore the organism to equilibrium. This transiently alters the dynamics to a less complex, dominant response mode, which is denoted "reactive tuning." Aging and disease are associated with a loss of complexity in resting dynamics and maladaptive responses to perturbations. These alterations in the dynamics of physiologic systems lead to functional decline and frailty. Nonlinear mathematical techniques that quantify physiologic dynamics may predict the onset of frailty, and interventions aimed toward restoring healthy dynamics may prevent functional decline.

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