Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial

Abstract

ObjectiveTo evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years).DesignRandomised controlled trial.SettingGeneral population of older adults in Trondheim, Norway.Participants1567 of 6966 individuals born between 1936 and 1942.InterventionParticipants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years.Main outcome measureAll cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT.ResultsMean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups.ConclusionThis study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT.Trial registrationClinicalTrials.gov NCT01666340.

The Feasibility of High-Intensity Interval Training in Patients with Intensive Care Unit-Acquired Weakness Syndrome Following Long-Term Invasive Ventilation

“…Third, our training protocol was arbitrary and illustrates a necessary compromise between training science to ensure maximal improvement in CRF and patient safety. Fourth, the significant increase of HR mean and HR max over time in both groups may be attributed to an increase in workload, indicating that intensity had also increased in the MCT group, a methodological problem which has also been observed in other studies [ 15 , 17 ]. Also, mean P peak did not differ between the groups, which may be due to the fact that the HIIT group was more severely impaired than the MCT group (more heart failure patients and longer periods of invasive ventilation), but may also indicate moderate rather than high-intensity interval training.…”

“…Similar to the SMARTEX heart failure study [15], in which many HIIT patients exercised below the prescribed intensity of > 90% of HR peak (51%) and approximately 80% of MCT patients tended to work harder than prescribed, our HIIT group exercised at approximately 65-70% of HR max on average if one uses the widely used formula 210mean age in the HIIT group (63.6 years). This is low considering other studies which also required mean exercise heart rate to be > 90% of HR peak [17,53]. However, it has to be noted that prescribing intensity at fixed % HR peak may lead to considerable interindividual differences due to individual heart rate performance curves [54][55][56].…”

“…HIIT seems to be as safe as other training modalities, even in high-risk patients, and compliance may even be higher due to reduced exercise time and less monotonous workouts [ 16 ]. Moreover, recent randomised trial data suggest even lower all-cause mortality in older patients performing HIIT [ 17 ].…”

Blood Volume, Hemoglobin Mass, and Peak Oxygen Uptake in Older Adults: The Generation 100 Study

“…The Generation 100 Study is a single-center, randomized, controlled phase IIb clinical trial designed to evaluate the effect of 5 years of exercise training on mortality in a population of older adults. The full study protocol (Stensvold et al, 2015 ) and a detailed description of cardiopulmonary exercise testing and report of reference data for VO 2peak and the primary study outcome in the cohort have been published (Stensvold et al, 2017 , 2020 ). Briefly, the Generation 100 Study invited all men and women residents of Trondheim, Norway, born between 1936 and 1942 to participate ( n = 6,966); a total of 1,567 participants were included between August 2012 and June 2013 and randomized 1:1 to either 5 years in an exercise-training group or to a control group encouraged to follow national recommendations for physical activity.…”

“…Immediately after the test, the participants reported the rate of perceived exertion (RPE) according to the Borg scale in a range from 6 to 20 (Borg, 1973 ). Peak heart rate (HR peak ) was measured by a heart-rate monitor (Polar RS400, Polar Electro Oy, Kempele, Finland), and HR peak was determined by adding 5 beats·min −1 to the highest recorded value during the test (Berglund et al, 2019 ; Stensvold et al, 2020 ). Peak oxygen pulse (mL·beat −1 ) was calculated as VO 2peak (mL·min −1 ) divided by HR peak (Wasserman, 2012 ).…”