1.
Measured Physical Activity and Cardiovascular Risk in Mobility
Limited Older Adults
Sonia Szawdyn
EXCM 301 – April 15th, 2015

2.
Over the past ten years, there has been extensive amount of research done, increasing our
understanding of exercise and how it effects us. Studies have shown the positive benefits of
exercising, as well as expressing what the lack of physical activity may do to our bodies. Older
adults in the U.S. are a major population where the importance of physical activity bares a huge
importance. The majority of older adults spend their lifetime being sedentary. As people age,
their skeletal muscle mass start to deteriorate especially around the age of 40 to 50. Although
deterioration of the muscles are a natural process, living a sedentary lifestyle not only quickens
the process, but increases the risk of heart problems. There are outstanding studies that support a
range of distinctive exercise training for older adults in order for them to start rebuilding muscle
mass and improve heart strength. However, older adults find it difficult to meet any exercise
targets.
Only 1 in 10 older adults aged 40 and older are getting sufficient exercise (Sparling et al.,
2014). Physical activity and health experts recently released news in the British Medical Journal,
that older adults should get 150 minutes of moderate exercise per week, keeping in mind that
these exercises should be realistic and taking into account that older adults are living sedentary
lifestyles (Sparling et al., 2014). Having older adults perform suggested amounts of physical
activity can reduce cardiovascular risk by increasing the heart rate and pumping more
oxygenated blood into the muscles. As older adults can do more of this, they are able to decrease
their blood pressure due to new blood vessels forming (Mercola, 2013). Upon review of an
article of the Journal of the American Heart Association, Fitzgerald and his colleagues looked
into lifestyle interventions and independence of 1,635 participants aged 74­84, from 8 locations

3. in the United States. The method the researchers performed was through measuring movement
with accelerometers, keeping in mind that the older adults had some physical limitations,
excluding the ability to walk up to approximately 1,312 feet (Fitzgerald et al., 2014). The
accelerometer, worn at the hip, was used to measure sedentary behavior where the participants
were able to wear it at all times. The cardiovascular (CV) risk in participants was measured using
the Framingham HCHD risk prediction model (Fitzgerald et al., 2014). The researchers were
able to predict each participants’ 10­year risk of heart attack and found that for every 20 to 30
minutes that a person is sedentary, they are increasing their risk of a heart attack by up to 1%
(Fitzgerald et al., 2014). They also found that participants that performed physical activity in the
100­499 counts per minute range involving low intensity exercise, i.e. slow walking, linked to
increased HDL cholesterol levels (Fitzgerald, 2014). The study emphasizes that an ideal score to
see full benefits of physical activity ranges around 2,000 counts per minute, however, getting
scores of around 500 is a realistic level for older adults living sedentary lifestyles and limited
mobility. The results of the testing showed that the duration of daily physical activity greatly
correlated with a decrease of CVD risk factors with a predicted 10­year HCHD risk. The
significance of this study was to change the focus of the research that investigated on a specific
type of exercise training and redirect the focus on investigating a way to reduce the amount of
time that people spend being sedentary and emphasize the cardiovascular benefits that outcome
from exercise training. The researchers concluded that they would like to expand their research
to not only focus on the duration of physical activity, but also to study the effects of intensity of
exercise and the correlation with CVD risk factors (Fitzgerald et al., 2014).

4. With more research springing, there is revealing evidence that every minute of physical
activity reduces the risk of heart attack and coronary death. Living a sedentary lifestyle can have
a huge impact on the individual and its heart strength. Reviewing another article from the
American Heart Association: Circulation, Ades and his colleagues focused primarily on
investigating older coronary patients and their correlation with exercise. Coronary patients all
have the most common type of heart disease called the coronary artery disease (CAD).
(Retrieved from web MedlinePlus, 2014). CAD restricts the blood flow to the heart muscle due
to the restriction of the arteries. Because of the narrow arteries and the limited supply of blood,
the heart is unable to get the efficient oxygenated blood it needs to pump, leading to a possible
heart attack or angina (Retrieved from web MedlinePlus, 2014). The purpose of the study was to
determine physiological adaptations to aerobic training in older coronary patients and whether
CAD is noncardiovascular in nature. The methods of the testing involved 60 older coronary
patients, all with an average age of 68 years old, that have had a myocardial infarction or
coronary bypass surgery in the past 8 weeks (Ades et al., 2014). The participants were measured
on peak aerobic capacity, cardiac output, arteriovenous oxygen difference, hyperemic calf blood
flow, and skeletal muscle fiber morphometry, oxidative enzyme activity, and capillarity (Ades,
2014). The exercise training included a 12 week, 3 hour per week program that involved the
treadmill with 25 minutes/session, bicycle with 15 minutes/session, and rowing ergometer with
10 minutes/session all while maintaining a heart rate maximum of 75% to 85% (Ades et al.,
2014). The peak aerobic exercise capacity was measured by using the Balke protocol with the
Hans­Rudolph mouthpiece. In conclusion of the 12 weeks, the researchers found that older
coronary patients improved their peak aerobic capacity after being supervised fro 3 months and

5. 12 months compared to the control subjects, however, they did not find any significant
correlation between the increase of aerobic activity and the cardiac output and blood flow,
proving to them that CAD can be noncardiovascular in nature when involved in exercise (Ades
et al., 2014).
Upon reviewing another article, the journal of The American Journal of Cardiology
revealed a study performed by Haykowsky and his colleagues that looked into older patients with
heart failure and their preserved ejection fraction (HFpEF) (Haykowsky et al., 2013). A
preserved ejection fraction has to do with the heart contracting normally but the ventricles not
being able to relax when filling with blood, causing less of a blood flow to the heart. The study
examined 38 participants, with 23 of them with HFpEF and 15 being healthy control groups
(Haykowsky et al., 2013). All participants underwent magnetic resonance imaging testing and
cardiopulmonary exercises with an electronic bicycle where they measured each of their peak
VO2 maxes (Haykowsky et al., 2013). The significance of this study was that each patient was
not only tested on VO2 max, but being measured on cross­sectional areas of the subcutaneous fat
(SCF), intramuscular fat (IMF), and the total thigh area. The thighs of patients with HFpEF had
significantly greater thigh intramuscular fat than with the healthy control group, which correlates
with the patients’ reduced peak VO2, workload, exercise time and 6­minute walk distance. Peak
blood pressure for both diastolic and systolic were similar between the two groups (Haykowsky
et al., 2013).
Continuing the discussion of research found on the the effects of exercise on participants
involved with heart complications and preserved ejection fraction, a study from the Journal of
the American College of Cardiology had Kitzman and his colleagues take a different approach

6. by looking at the dilation of the arteries in older patients with heart failure and preserved ejection
fraction (HFpEF) instead of looking at the patients with constricted blood flow to the heart.
Looking at the previous study investigated by Haykowsky, he too, along with the leading
research Kitzman and colleagues have observed that older adults experienced a reduced VO2
peak, however, exercise training increases it. The main point of the study was to see why
exercise training improves the peak VO2 for HFpEF elderly patients. Not only did the
researchers want to study the related increase of VO2 with exercise training, but also the
correlation with carotid artery stiffness and endothelial­dependent flow­mediated arterial dilation
(FMD). Kitzman and colleagues took 63 participants with HFpEF with an average of 70 years of
age. The participants were randomized to 16 weeks of exercise training with either walking and
arm or leg ergometry (Kitzman et al., 2013). The peak VO2 and the brachial artery for
measurement of FMD was found with an ischemia cuff. The carotid artery was determined with
a high­resolution ultrasound (Kitzman et al., 2013). The participants’ quality of life was
measured with a questionnaire follow up. The researchers found that after the 16 weeks of
exercise training, the only improvement was an increase in VO2 but no change in FMD or
arterial stiffness that they were already experiencing. The findings are very significant because it
opens up a door for further research on oxygen utilization of elderly participants and how that
correlates with the increase of peak VO2.
The last article was found in the American Heart Journal that had Fujimoto and
colleagues also focus on patients with HFpEF. They took 11 HFpEF patients and 13 healthy
participants. The participants had to participate in one year of an exercise training program with
patients either walking or cycling, three times per week for 25 minutes per session (Fujimoto et

7. al., 2012). Target heart rates were at 70% to 80% just below the ventilatory threshold. After 7
months, target heart rates were kept at 5 to 10 beat/minute of the maximal heart rate, added
weekly (Fujimoto et al., 2012). A 6F Swan­Ganz catheter was used to measure pulmonary
capillary wedge and the right atrial pressures. The researchers found that after a year of training
with increased intensity, the left ventricle compliance, arterial stiffness, exercise capacity and
ventricular­arterial coupling did not change compared to pre­training.
In summary, all five studies combined has provided a fundamental understanding of what
direction research is going when involving exercise training with patients that have heart
complications i.e. CAD or HFpEF. Studies show that increase peak VO2 has been shown with
exercise, but no other blood flow differences were found. This review emphasizes that further
studies should be conducted to look at oxygen uptake correlated with the heart when performing
exercise training in older adults. Also, there should be more studies that look at atrial dilation and
constriction and how it corresponds with heart function during physical activity. Overall, this
review gives the opportunity to see where we can fill the gaps in research that have been
completed.

8.
References
Ades, P., Waldmann, M., Meyer, W., Brown, K., Poehlman, E., Pendlebury, W., . . . LeWinter,
M. (2014, September 1). Skeletal Muscle and Cardiovascular Adaptations to Exercise
Conditioning in Older Coronary Patients. Retrieved January 1, 2015, from
http://circ.ahajournals.org/content/94/3/323.full
Coronary Artery Disease: MedlinePlus. (2014, September 11). Retrieved January 1, 2015, from
http://www.nlm.nih.gov/medlineplus/coronaryarterydisease.html
Fitzgerald, J., Johnson, L., Hire, D., Ambrosius, W., Anton, S., Dodson, J., . . . Buford, T. (2014,
December 23). Association of Objectively Measured Physical Activity With Cardiovascular Risk
in Mobility-limited Older Adults. Retrieved January 1, 2015, from
http://jaha.ahajournals.org/content/4/2/e001288.abstract
Fujimoto, N., Prasad, A., Hastings, J., Bhella, P., Shibata, S., Palmer, D., & Levine, B. (2010).
Cardiovascular effects of 1 year of progressive endurance exercise training in patients with heart
failure with preserved ejection fraction. ​American Heart Journal,​ ​164​(6), 869­877.
Haykowsky, M., Kouba, E., Brubaker, P., Nicklas, B., Eggebeen, J., & Kitzman, D. (2013).
Skeletal Muscle Composition and Its Relation to Exercise Intolerance in Older Patients with
Heart Failure and Preserved Ejection Fraction. ​The American Journal of Cardiology,​ 1211­1216.
Kitzman, D., Brubaker, P., Herrington, D., Morgan, T., Stewart, K., Hundley, G., . . .
Haykowsky, M. (2013). Effect of Endurance Exercise Training on Endothelial Function and
Arteral Stiffness in Older Patients with Heart Failure and Preserved Ejection Fraction: A
Randomized, Controlled, Single­Blind Trial. ​Journal of the American College of Cardiology,
62​(7).
Mercola, J. (2013, September 20). What Happens in Your Body When You Exercise? Retrieved
January 1, 2015, from
http://fitness.mercola.com/sites/fitness/archive/2013/09/20/exercise­health­benefits.aspx
Sparling, P., Howard, B., Dunstan, D., & Owen, N. (2014, December 10). Recommendations for
physical activity in older adults. Retrieved January 1, 2015, from
http://www.bmj.com/content/350/bmj.h100