Reversing the Cardiac Effects of Sedentary Aging in Middle Age—A Randomized Controlled Trial

Abstract

ORIGINAL RESEARCH ARTICLEBACKGROUND: Poor fitness in middle age is a risk factor for heart failure, particularly heart failure with a preserved ejection fraction. The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness, a consequence of sedentary aging. In a prospective, parallel group, randomized controlled trial, we examined the effect of 2 years of supervised highintensity exercise training on LV stiffness. METHODS:Sixty-one (48% male) healthy, sedentary, middle-aged participants (53±5 years) were randomly assigned to either 2 years of exercise training (n=34) or attention control (control; n=27). Right heart catheterization and 3-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (Vo . 2 max) was measured to quantify changes in fitness. RESULTS: Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88±11%. Vo CONCLUSIONS:In previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness. Regular exercise training may provide protection against the future risk of heart failure with a preserved ejection fraction by preventing the increase in cardiac stiffness attributable to sedentary aging.

The impact of 2 years of high‐intensity exercise training on a model of integrated cardiovascular regulation

“…All participants in the present study were drawn from a previously published study for which a detailed description of the subject population and sample size calculation has been provided (Howden et al . ). Our previous results suggest that middle aged hearts retain some degree of plasticity and may respond to an adequate dose of training to restore youthful LV compliance (Howden et al .…”

“…Our previous results suggest that middle aged hearts retain some degree of plasticity and may respond to an adequate dose of training to restore youthful LV compliance (Howden et al . ). In brief, the present study comprised a prospective, parallel group, randomized controlled study, analysing 2 years of controlled exercise training.…”

What Do You Want From Your Echocardiogram?

“…For the reference population, the authors were careful to exclude participants with prevalent cardiovascular disease and important risk factors for DD, like obesity, but other factors, such as physical activity and fitness, were not accounted for, and these may strongly affect diastolic function and risk of HFpEF . One could make a cogent argument that the reference sample should include individuals who are both active and fit to represent the ideal of “successful” cardiac aging . Incident HF events were infrequent, and so a composite cardiovascular outcome that included myocardial infarction, stroke, and claudication was used by the authors .…”

“…Why should age‐related DD be any different? Age is typically considered to be an unmodifiable risk factor, but recent studies have shown that interventions, such as exercise training or weight loss, can reverse or at least mitigate age‐related DD. Even the cellular mechanisms of cardiac aging might one day become treatable …”

Initiating life‐long aerobic exercise 4–5 days per week before or near age 50 years: is this the ‘holy‐grail’ of preventing age‐related central artery stiffness?

“…Consistent with this idea of the optimal time for exercise‐related cardiovascular plasticity with ageing, the authors recently reported that beginning 4–5 days of aerobic exercise during middle‐age (mean age ∼53 years) for 2 years improved left ventricular compliance in previously sedentary adults (Howden et al . ), whereas this dose of exercise at least for 1 year had no effect on left ventricular compliance in seniors (Fujimoto et al . ).…”