Aerobic Training Protects Cardiac Function During Advancing Age: A Meta-Analysis of Four Decades of Controlled Studies

Abstract

Background In contrast to younger athletes, there is comparatively less literature examining cardiac structure and function in older athletes. However, a progressive accumulation of studies during the past four decades offers a body of literature worthy of systematic scrutiny. Objectives We conducted a systematic review, meta-analysis and meta-regression of controlled echocardiography studies comparing left ventricular (LV) structure and function in aerobically trained older athletes (> 45 years) with age-matched untrained controls, in addition to investigating the influence of chronological age. Methods Electronic databases were searched from inception to January 2018 before conducting a random-effects meta-analysis to calculate pooled differences in means, effect size and 95% confidence intervals (CIs). Study heterogeneity was reported using Cochran’s Q and I 2 statistic. Results Overall, 32 studies (644 athletes; 582 controls) were included. Athletes had greater LV end-diastolic diameter (3.65 mm, 95% CI 2.66–4.64), interventricular septal thickness (1.23 mm, 95% CI 0.85–1.60), posterior wall thickness (1.20 mm, 95% CI 0.83–1.56), LV mass (72 g, 95% CI 46–98), LV mass index (28.17 g·m 2 , 95% CI 19.84–36.49) and stroke volume (13.59 mL, 95% CI 7.20–19.98) (all p < 0.01). Athletes had superior global diastolic function [ratio of early ( E ) to late ( A ) mitral inflow velocity ( E / A ) 0.18, 95% CI 0.13–0.24, p < 0.01; ratio of early ( e ′) to late ( a ′) diastolic annular tissue velocity ( e ′/ a ′) 0.23, 95% CI 0.06–0.40, p = 0.01], lower A (−8.20 cm·s −1 , 95% CI −11.90 to −4.51, p < 0.01) and a ′ (−0.72 cm·s −1 , 95% CI −1.31 to −0.12, p = 0.02), and more rapid e ′ (0.96 cm·s −1 , 95% CI 0.05–1.86, p = 0.04). Meta-regression for chronological age identified that athlete–control differences, in the main, are maintained during advancing age. Conclusions Athletic older men have larger cardiac dimensions and enjoy more favourable cardiac function than healthy, non-athletic counterparts. Notably, the athlete groups maintain these effects during chronological ageing. Electronic supplementary material The online version of this article (10.1007/s40279-018-1004-3) contains supplementary material, which is available to authorized use...

Long-term athletic training does not alter age-associated reductions of left-ventricular mid-diastolic lengthening or expansion at rest

“…Trained groups demonstrated known physiological adaption to exercise training, including greater EDD, LVEDV, SV, and LVM compared with RA groups. In particular, similar differences in mean LVMi were observed in the present study (27 g m 2 ) and previously meta-analysis (28 g m 2 ) (Beaumont et al 2018 ).…”

“…Comparable resting systolic function, clearly differentiated age-associated decline in global diastolic function, that is not attenuated with chronic exercise concurs with the previous work (Molmen et al 2012 ; Carrick-Ranson et al 2012 ; Olsen et al 2015 ). In contrast to Beaumont et al ( 2018 ), O T did not demonstrate superior trans-mitral function than their age-matched untrained counterparts. In O RA , however, the ability to be relatively inactive for many years into old age and still avoid lifestyle-associated diseases known to occur in sedentary populations means that genetic factors cannot be neglected.…”

“…Comparable longitudinal strain between trained and RA cohorts supports the previous meta-analyses in young and older age (Beaumont et al 2016 , 2018 ). Compensatory increases with chronic exercise may not be necessary if reduced strain is not part of the healthy ageing process.…”

“…Whether LV strain profiles of chronic endurance exercisers differ to their non-athletic counterparts is unclear and thus, it is unknown whether chronic exercise training can attenuate age-associated differences in LV strain. Through meta-analysis, longitudinal strain was similar between age-matched older athletic and non-athletic males (Beaumont et al 2018 ), albeit only five studies were available for inclusion, which were significantly heterogeneous. Studies that have also included younger untrained cohorts, to enable age and training-related assessments within the same investigation, are also conflicting.…”

Influencing Factors of Cardiac Adaptation in Adolescent Athletes

“…However, it is well known, that TAPSE values are strongly correlated with the RV long diameter. Moreover, among several other studies we have also proved, that regular exercise training causes an increase of longitudinal diameter of RV[29][30][31][32][33]. Considering these facts, it was presumable that the correction of TAPSE on the RV longitudinal diameter (TAPSE/longitudinal diameter) will empower this parameter to separate groups.…”