Ghrelin Plus Strength Training in Frail Elderly Study

Inclusion Criteria: * Individuals with three, four or five frailty criteria using the Fried frailty criteria Exclusion Criteria: 1. Diabetes mellitus or fasting glucose ≥ 126 mg/dL 2. Hospitalization for stroke, myocardial infarction, coronary artery bypass graft surgery, vascular surgery in the past six months. 3. New York Heart Association Class III or IV congestive heart failure 4. Therapy for cancer in the past 12 months, except non-melanoma skin cancer 5. BMI ≥ 30 kg/m2 6. Current use of corticosteroids other than topical, ophthalmic, and inhaled preparations 7. Therapy with megestrol acetate or dronabinol within the last 6 weeks 8. Thyroid stimulating hormone measured as \< 0.4 uIU/L or greater than 10uIU/L 9. Abnormal liver function tests (LFTs \> 2x upper limit of normal) 10. Hemoglobin \< 11g/dL 11. Insulin-like growth factor-I (IGF-I) above the age-specific reference range 12. History of surgery within the last 30 days 13. Hip fracture of hip or knee replacement within the previous 6 months or unable to walk 14. Deemed unsafe to participate by one of the study exercise therapists 15. Undergoing physical therapy or an exercise program 16. Unstable medical or psychological conditions or unstable home or food environment 17. Cognitive deficit as defined by a Folstein Mini Mental State Exam score \< 24/30 18. Depression (defined as a score of \> 11 on the Geriatric Depression Questionnaire) 19. Out of town for \> 1 week during the 12 week study 20. Residing outside of a 15 mile radius of University of Pennsylvania Health System