Never Too Old to Get Moving: Aerobic Fitness Lowers Risk of Death, CV Events, in Elderly

May 17, 2013

San Francisco, California — The results of a large analysis show a reduction in mortality among elderly patients who maintained high levels of aerobic fitness, including benefits in individuals as old as aged 93 years.

"The point here is that it doesn't matter what age you are, you have to maintain a certain amount of fitness because the body goes into hibernation if it thinks it isn't needed anymore," senior investigator Dr Peter Kokkinos (VA Medical Center, Washington, DC) told heartwire . "We know this from broken limbs and from astronauts returning from space--if you don't use it, you're going to lose it."

If you don't use it, you're going to lose it. Dr Peter Kokkinos

Presenting the results here at the American Society of Hypertension (ASH) 2013 Scientific Sessions in San Francisco, CA, Kokkinos said that while age is associated with declines in muscle mass, strength, endurance, and aerobic fitness, older individuals respond well to exercise and exercise could play a role in preventing these age-related declines.

Given that hypertension increases in prevalence as adults age, the researchers, led by Dr Michael Doumas (VA Medical Center) examined the benefits of exercise in 2077 hypertensive men 70 years of age and older. All patients underwent routine exercise tolerance testing, and their peak workload was estimated in metabolic equivalents (METs). Of the participating men, 685 were classified as having low levels of aerobic fitness (METs ≤4.5), 786 had moderate levels of aerobic fitness (METs 4.6-6.5), and 606 had high levels of aerobic fitness (METs > 6.5).

For every 1-MET increase in exercise capacity, the risk of all-cause mortality was reduced by 8% (hazard ratio (HR) 0.92; p < 0.001). Overall, mortality was 15% lower among those with moderate levels of aerobic fitness (HR 0.85; p=0.024) and 37% lower among those with high levels of aerobic fitness (HR 0.63; p < 0.001) compared with the low-fitness group. Average follow-up in the study was nine years.

To heartwire , Kokkinos said that researchers are only now beginning to understand how the body's metabolism shuts down when it is no longer active. Computer work and nonmanual labor, which constitutes a large portion of the US workforce, means many individuals sit for long periods of time. As documented in a recent Women's Health Initiative (WHI) analysis, prolonged sitting has negative cardiometabolic effects, which are risk factors for diabetes and cardiovascular disease in their own right.

"The main message is that we need to be active," said Kokkinos. "The patients in this study were 70 to 93 years old. We don't have to do a lot to stay healthy, but we have to do something. You don't have to run a marathon--a brisk walk is all you need. As humans, we were designed to do work."

Mid-life fitness cuts HF, MI later in life

In a separate study, presented earlier this week at the American Heart Association Quality of Care and Outcomes Research 2013 Scientific Sessions, Dr Jarett Berry (University of Texas Southwestern Medical Center, Dallas) and colleagues addressed the question of mid-life fitness and its impact on nonfatal cardiovascular events. Their study was published simultaneously in Circulation: Heart Failure [1].

Using participant data from the Cooper Center Longitudinal Study and linking this with Medicare data, Berry et al found that fitness as measured by treadmill time was strongly linked to hospitalizations for heart failure and acute MI after age 65.

Compared to participants in the highest quartile for fitness at a mean age of 49, those who had been in the lowest fitness quartile face a risk of HF hospitalizations that was three times higher (14.3% vs 4.2%). As well, lower fitness was associated with a doubling of AMI risk (9.7% vs 4.5%). For every 1 unit increase in fitness as measured by metabolic equivalents (METs), and after controlling for other risk factors, heart failure hospitalization risk declined by 20% and AMI risk by 10%.

The stronger association between mid-life fitness and later HF underscores the need to improve midlife fitness levels to curb subsequent HF risk, the authors conclude.

--Shelley Wood

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