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Exercise and heart failure in the elderly

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Abstract

In this review, we will examine the physiological responses to exercise in elderly populations (age > 65 years) with and without evidence of heart failure. Aging per se in both men and women is associated with a ~40% lower maximum oxygen consumption in sedentary subjects. In trained individuals, this value is 25–32% lower. A smaller SV accounts for nearly 50% of these age-related differences, and the remainder is explained by a lower maximal HR and reduced oxygen extraction. Exercise training is also associated with an increase in the arteriovenous O2 difference in previously sedentary elderly men and women, which probably contributes to the overall beneficial effect of training in the elderly. However, during vigorous exercise (125 W), the cardiac output in the elderly is dependent upon an age-related increase in end-diastolic volume and stroke volume, which “compensates” partially for the age-related decrease in heart rate. Hence, in elderly individuals, the stroke volume during exercise depends upon diastolic filling. The changes that occur in the heart are also associated with an overall reduction in efferent sympathetic nerve activity. Despite this decline, the metaboreflex initiated by receptors in exercising muscles remains the main determinant of sympathetic activation (to maintain blood pressure) during exercise in the elderly. It is recognized that aging is associated with the development of heart failure, particularly in women in whom its prevalence increases >twofold from age 65–69 (6.6%) to age 85 years (14%). Almost half the people presenting with heart failure appear to have normal left ventricular systolic function, a phenomenon that is more common in women. Exercise training in elderly people with and without heart failure appears to have a beneficial effect in terms of enhancing the quality of life and functional capacity. Mortality benefit in the latter has not been established with certainty.

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Acknowledgments

The authors wish to thank Mr. Steve Dana, Senior Artist of the Mediaworks Group at the University of California, Davis, for preparation of the figures.

Conflict of interest

Dr. C. Tissa Kappagoda and Dr. E. A. Amsterdam have no financial relationships with any pharmaceutical or device company.

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Appendix

Appendix

Some definitions of HF Adapted from [1]

See [1] for references noted in Appendix

  • “A condition in which the heart fails to discharge its contents adequately” (Thomas Lewis, 1933)

  • “A state in which the heart fails to maintain an adequate circulation for the needs of the body despite a satisfactory filling pressure” (Paul Wood, 1950)

  • “A pathophysiological state in which an abnormality of cardiac function is responsible for the failure of the heart to pump blood at a rate commensurate with the requirements of the metabolising tissues” (E Braunwald, 1980)

  • “HF is the state of any heart disease in which, despite adequate ventricular filling, the heart’s output is decreased or in which the heart is unable to pump blood at a rate adequate for satisfying the requirements of the tissues with function parameters remaining within normal limits” (H Denolin, H Kuhn, H P Krayenbuehl, F Loogen, A Reale, 1983)

  • “A clinical syndrome caused by an abnormality of the heart and recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses” (Philip Poole-Wilson, 1985)

  • “[A] syndrome … which arises when the heart is chronically unable to maintain an appropriate blood pressure without support” (Peter Harris, 1987)

  • “A syndrome in which cardiac dysfunction is associated with reduced exercise tolerance, a high incidence of ventricular arrhythmias and shortened life expectancy” (Jay Cohn, 1988)

  • “Abnormal function of the heart causing a limitation of exercise capacity” or “ventricular dysfunction with symptoms” (anonymous and pragmatic)

  • “Symptoms of HF, objective evidence of cardiac dysfunction and response to treatment directed towards HF” (Task Force of the European Society of Cardiology, 1995)

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Kappagoda, T., Amsterdam, E.A. Exercise and heart failure in the elderly. Heart Fail Rev 17, 635–662 (2012). https://doi.org/10.1007/s10741-011-9297-4

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