Provocative testing in community dwelling older adults: a path to identify physical resilience

Background: Resilience is the capacity of an organism to both resist and recover from stressors, and its decline can be an early indicator of susceptibility that precedes frailty, disability, and death. This study explores the use of provocative tests — time-based responses to non-harmful challenges — as potential indicators of resilience. Methods: Provocative tests were performed in 50 community-dwelling adults (24 men, 26 women), aged 23-82 years and included cognitive challenges, strength and heart rate recovery after exercise, cold exposure, blood occlusion, and resistance to balance perturbations. Results: Age was associated with declines in recovery from cold-water hand immersion (r² = 0.18, P=0.002) and upper-arm blood occlusion (r² = 0.11, P = 0.023). Susceptibility to balance perturbations also increased with age (r² = 0.10, P = 0.025). Notably, heart rate and strength recovery post-exercise did not correlate with age, although older participants walked shorter distances (r² = 0.54, P < 0.0001) and curled less weight (r² = 0.17, P = 0.0003). Cognitive performance in the Stroop Color and Word test was unaffected by exercise but did show age-related declines (r² = 0.53, P < 0.0001). A composite resilience score derived from the measures inversely associated with age (r² = 0.17, P = 0.0027). Additionally, responses to cold-water immersion and blood occlusion correlated in older adults (r² = 0.31, P = 0.002, n = 18), suggesting interrelated physiological responses. Conclusions: These findings support provocative testing to identify early signs of declining resilience and guide interventions targeting age-related vulnerability.