Are cardiac diseases preventable in the elderly?

Aging is associated with significant changes in both cardiac and vascular structure and function that lower the threshold for clinical signs and symptoms, making older people more susceptible to cardiovascular diseases, morbidity and mortality. Understanding of age-related cardiovascular changes is necessary for effective and efficient prevention and treatment of cardiovascular disease in the elderly.

Cardiac aging is associated with progressive loss of myocytes and compensating mild hypertrophy, but also with reduced sensitivity to sympathetic stimuli that compromises myocardial contractility and pumping ability in older people. Numerous epidemiological studies were published reporting the strong association between physical activity in cardiovascular health with 30% to 40% reduction in cardiovascular mortality in active men and women of different ages.

Physiological changes in elderly

One of the most important physiological changes that occur in response to advanced aging is a decline in maximal aerobic capacity (i.e. cardiorespiratory fitness) represented by peak exercise oxygen consumption. The age-associated decline in maximal aerobic capacity is non-linear and increases progressively with each decade of life e.g. 3–6% in the third and fourth decades and > 20% per decade after age 70.

The ACSM (American College of Sports Medicine)/AHA (American Heart Association) Physical Activity Recommendations for Older Adults suggest three different options:

• Moderate intensity cardio for 30 minutes, 5 days a week;
• Vigorous cardio for 20 minutes, 3 days a week; or
• A mix of moderate and vigorous cardio, 3-5 days a week.

Setting up your cardio workout

1. Choose an activity. Pick any activity where you can work at a moderate or vigorous intensity level (or about 65% to 80% of your maximum heart rate), for example, exercises like walking and swimming are great because they can be done at both low and high intensities.
2. Choose how long to exercise. While the ACSM recommends 20-30 minutes, you may need to work up to that if you haven't exercised before. A beginner might start with 10-15 minutes of walking or cycling and build from there.
3. Choose your intensity. Start with a comfortable pace to get a feel for the exercise. Once you feel comfortable, you can push a little harder. A great way to work on endurance without having to work hard the entire workout is with interval training. Try walking fast for 1 minute and then slowing down a bit for 1-2 minutes, alternating that for 20 or so minutes.
4. Choose how often you exercise. If you're a beginner or not sure what you can handle, start with three days a week with rest days in between.
5. Assessment & preparation. Before participation in an exercise program, seniors should complete a medical history and risk factor questionnaire, to ascertain potential limitations and possible restrictions. Rikli and Jones developed the Senior Fitness Test for adults aged over 60 years. It is primarily used to evaluate physical function in healthy elderly people but is also used for people with dementia. It comprises six functional tests of strength, endurance, balance, agility and flexibility. Each test is scored separately on different scales.

Moderate exercises

A moderate level of exercise is when you can still carry on a full conversation, but you will be breathing heavier and may be sweating. Brisk walking, easy jogging, swimming and dancing are moderate-intensity aerobic activities. If you have any orthopaedic problems, you may want to use aquatic exercises or a stationary cycle to reduce the stress on your joints.

Tips to Start Walking

For older adults, walking is the most accessible exercise. You can start by:

• Walking for 10 to 15 minutes at a time.
• Focusing on your posture, and increasing your walking time by 5 minutes each week.
• After one month, you should be able to walk 30 minutes at a time.
• Once you can comfortably walk for 30 minutes, you can begin to work on improving your walking speed.
• If you are already walking for fitness, use a workout schedule to vary the intensity of your walking workouts.

Treadmill walking

Walking on the treadmill is an excellent way for seniors to stay active. Just 30 minutes a day can reduce health risks and maintain fitness, while burning calories and keeping the metabolic rate boosted. The recommended amount of cardiovascular exercise for seniors over age 65 is 30 minutes per day, five days per week. If necessary, the sessions can be broken into 3 intervals of 10 minutes. Using both forward and backward walking is an effective approach to improve postural control and gait performance in the elderly population.

Strength Training

Strength training exercises (or resistance exercises) are especially important for older adults to prevent loss of muscle mass and bone density, as well as to be able to move and function better. Lifting, pushing and pulling exercises will build muscle strength and endurance. You can use exercise machines at the gym, resistance bands, or free weights such as dumbbells, barbells, medicine balls, and kettlebells. Exercises such as calisthenics use your own body weight to provide resistance. Ideally, strength training should incorporate all muscle groups, and should be done 2 to 3 days per week.

Flexibility Exercises

Flexibility exercises such as yoga and tai chi are important to lower the risk of injuries and improve posture and balance, as well as increasing strength. Spend 10 minutes two days per week minimum to stretch your major muscle and tendon groups. Take 10 to 30 seconds per stretch, and repeat each stretch three to four times.

Avoid Inactivity over Age 65

If you have limitations that don't allow you to meet the guidelines, the most important thing is to be active in some way each day. Any amount of exercise is better than none, so getting started is the key. Happy exercising!

References

1. Physical activity and cardiovascular aging: Physiological and molecular insightshttps://doi.org/10.1016/j.exger.2017.05.016.
2. How Much Exercise Do You Need If You're Over Age 65? By Wendy Bumgardner -Updated July 09, 2019.
3. Physical Activity and Public Health in Older Adults Recommendation From the American College of Sports Medicine and the American Heart Association DOI:10.1161/CIRCULATIONAHA.107.185650.
4. Cardiovascular aging and exercise in healthy older adult Clin J Sport Med. 2008 Nov; 18(6):479-85. Doi: 10.1097/JSM.0b013e3181865f03.
5. Effectiveness of Treadmill Training on Balance Control in Elderly People: A Randomized Controlled Clinical Trial2014 Nov; 39(6): 565–570.