Could daily exercise prevent major heart disease in old age?

Could daily exercise prevent major heart disease in old age?
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Research suggests that 20 minutes of daily exercise in early old age (70-75 years old) may best prevent major heart disease, including heart failure, in late old age (80+ years old).

In the study, daily exercise was summarised as moderate to vigorous physical activity for twenty minutes. The findings reinforce that exercise is associated with a lower risk of cardiovascular disease and a longer life, irrespective of gender and ethnicity, with the benefits accruing with the effort expended. However, few studies have looked exclusively at whether exercise in later life can prevent heart disease and stroke in old age.

The findings were published in the journal Heart.

Daily exercise and heart disease

The researchers utilised data from the Progetto Veneto Anziani (ProVA), a study of 3099 older Italians (65 and above).

Initial assessments, including a detailed medical history, physical examination, scans, and a battery of blood tests, were carried out between 1995 and 1997, with two further assessments four and seven years later.

At the start of the study, women were more likely than men to have more than four coexisting conditions, with a higher prevalence of osteoarthritis, osteoporosis, and chronic kidney disease; chronic obstructive pulmonary disease (COPD) and diabetes were more common amongst the men.

Participants filled in questionnaires on their physical activity levels at each of the time points. The moderate daily exercise included walking, bowls, and fishing, whilst vigorous daily exercise was gardening, gym workouts, cycling, dancing, and swimming. Those whose daily activity added up to 20 minutes or more a day were defined as active; those who partook in less than this were defined as inactive. Men were found to be more likely to be physically active than women.

Changes in daily exercise patterns were defined as: stable-low (inactive-inactive); high-decreasing (active-inactive); low-increasing (inactive-active); and stable-high (active-active).

Other potential key background information including household income, educational attainment, number of household members, and smoking and drinking, was collected.

Diagnosis of major heart disease

The health of all the participants was tracked through linkage to hospital discharge records and death certification up to the end of December 2018. The final analysis included 2754 participants with complete data, of whom 1398 were women (60%).

During the monitoring period, 1037 new diagnoses of heart disease, heart failure, and stroke were made.

Increasing levels of daily exercise as well as maintaining an active lifestyle over time were associated with lower risks of heart disease and death in both men and women. The largest risk reduction was observed for new cases of coronary heart disease and heart failure in late old age. No significant association between daily exercise or physical activity and stroke was observed.

Most of the participants had stable active daily exercise patterns over time. Patterns of stable-high physical activity were associated with a significantly (52%) lower risk of cardiovascular disease amongst men compared with those with stable-low patterns.

“The greatest benefits of daily exercise seemed to occur at the age of 70. The risk was only marginally lower at the age of 75, and no lower at the age of 80-85, suggesting that improving physical activity earlier in old age might have the most impact,” said the researchers.

Furthermore, a J-shaped curve for exercise length was also observed, with the sharpest reduction in heart disease and heart failure associated with a period of between 20 and 40 minutes of moderate to vigorous daily exercise.

Whilst the observed associations were strongest among men, the researchers emphasised: “Women doing more physical activity had consistently lower incidence rates of almost all cardiovascular outcomes despite the fact that the risk reduction did not reach statistical significance, but when considering overall mortality, risks were significantly reduced.”

This is an observational study, and as such, can’t establish cause. The researchers acknowledge that the study relied on participant recall, that physical activity levels were subjectively assessed, and that no data were available on mid-life physical activity levels, all of which might have influenced cardiovascular risk profiles in late life.

Nevertheless, the research team concluded, “These results suggest that public health policies should be targeted at promoting or beginning a physical activity in mid-and early late life, given a probable greater effectiveness in reducing cardiovascular risks.

“At least 20 minutes of moderate to vigorous physical activity per day should be recommended to achieve the greatest cardiovascular benefits.”

Drs Enrico Fabris and Gianfranco Sinagra of the University of Trieste, Italy, explained that physical activity helps to improve arterial blood flow and may reduce its stickiness and so the formation of blood clots.

“However, the detailed mechanisms by which physical activity can reduce the future risk of cardiovascular disease remain not fully understood,” they pointed out.

“The favourable effect of physical activity may be simply explained by its capability of slowing down the atherosclerosis process through a better control of blood pressure, blood glucose level, and lipid profile.”

“The findings showed that ‘movement is medicine’ also in late life. Even a small amount of physical activity may confer beneficial effects in older people, but if undertaken early rather than late,” they concluded.

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